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Tabletop RPG Recreation Therapy Example Scenario - Complete Visual Impairment

by Hawke Robinson published Feb 25, 2013 02:25 PM, last modified Jan 12, 2017 10:51 PM
As we continue through the course on Recreation Therapy for People with Disabilities at Eastern Washington University, we have various assignments to write up scenarios for clients with specific needs. This is one for a client with complete visual impairment due to traumatic brain injury to the occipital lobe. The client wants to participate in a non-therapy-setting leisure activity of tabletop role-playing gaming. The Recreation Therapist will need to evaluate and write up the potential challenges and modifications that may be necessary for the client to participate in this activity with as little difficulty as possible....

Originally posted Feb 25, 2013, 2:25 PM.

Using the book, Recreation Therapy Handbook of Practice, delve into one of the five areas from Activities and Participation with some detail, providing a hypothetical client and activity combination. Provide the ICF code for the Activities & Participation section, with the A&P performance qualifiers as well.

This posting overlaps with the longer RPG for TBI video presentation here:

As usual, whenever possible, I will be trying to work out the challenges related to RPG's, whether tabletop, live-action, or computer based, usually focusing initially on tabletop.

Chose to consider a completely blind client's participation in the leisure activity of tabletop role-playing gaming with other people around a table at a non-care-provider's home.


For this scenario, the client has total visual impairment (b210.4) “total blindness” due to TBI of the occipital lobe (s11993). 

Within a structured facility or at home, the client is able to perform very well overall without assistance from other people through the use of various adaptations, modifications, training, tools, and technologies (Performance: 1), but is severely challenged without these aides (Performance: 3). Of course tasks such as driving (d475.4) are not possible. 

Other than transportation to areas outside of public transit (d4702.1414), client does not generally need assistance from other people, but does have complete dependence on the assistance from visual-impairment aiding devices (braille, text-to-voice devices, walking cane, etc.).

Without these devices or aide from people, client is severely limited in many activities, including the proposed tabletop RPG (2nd qualifier: 3 – Severe). 

With the assistance of devices, client is almost able to perform all functions normally, just mild difficulty (3rd qualifier: 1). This is mostly due to client still adjusting to state of visual impairment and still developing the skills necessary, but getting closer to 0 difficulty.

Without people to assist, the client has little trouble if able to use assisting devices (4th qualifier:1), but if unable to use assisting devices, then client will have severe difficulty accomplishing the task (4th qualifier: 3).

Implementing overall ratings as per recommendation to use the higher (more difficulty performing the task) rating over the lower or average. 

So, overall coding and rating: b210.4
Total blindness due to (s11993) occipital lobe structural damage.
Performance in tabletop RPG activity rating: d9200.1313
Participation in a tabletop role-playing gaming group as a player for recreation rather than specific therapy: D920 Recreation & Leisure - d9200 Play - “Engaging in games with rules.... such as playing chess or cards...”
While RPG could also be placed under Community Life because there are many formalized RPG clubs, meetings, and conventions, the most common, and more casual form is a group of players that regularly meet, typically once per week for several hours at a participants home for a tabletop role-playing game session. This is structured play. 



The the client has complete visual impairment (4), the client will need braille versions of the rulebook(s) for the game system, and some means of keeping track of the character's statistical information, and any notes the player/client may want to keep as the adventure progresses (maybe a digital voice recorder with a headphone so the client/player can play back verbal notes to self as needed, without disturbing the rest of the group to do so).

Use of electronic dice that have an auditory ability to indicate the result of a roll. Alternatively many apps on smart phones and PC's are available that can electronically represent random dice results, then the app just needs to have a text-to-voice component for the visually impaired participant.

Failing that, the client is dependent on the other players and/or Game Master to verbally indicate the result from the client rolling the dice on the table. 

Since the rest of the game play is primarily auditory, other modifications are not necessary for complete unimpaired performance in the game.


UPDATE Feb 25, 2013, 6:21 PM

Received an email from a fellow that apparently recently also posted about RPG's and the visually impaired. He is apparently very interested in addressing this specific issue. Here is a link to his blog, please do check it out:


UPDATE: Feb 25, 2013 06:23 PM

And here are links to very approaches to dice for the visually impaired, from poor vision to complete impairment: 



UPDATE: Mar 2, 2013, 09:50 AM

RPGX says: "

We have some blind users on our site (, where users play tabletop games via "play-by-post" (PBP). This might be an excellent medium for visually impaired users. Additionally, sites like ours often have friendly communities with many members happy to help out people who are learning to play.

We've had reports that our mobile style (a simplified style, though unfortunately currently only available to paid subscribers) is very useable. A recent post: "Blind Mac user here. Just have to say, I am loving using the mobile site on my Mac. I switched my user agent under Safari to iPhone Safari with iOS 5.1, and Voiceover works beautifully. So much easier to read posts. I'd pay continuously for a CS membership for the mobile site alone." Mobile styles might be something to look for in general for this kind of text based gaming.

Further discussion with the user revealed that our character sheets are less friendly (the data titles and fields are reversed in the code, which confuses her reader and which I was able to confirm using a text only browser known as 'lynx'), but hopefully we'll be able to remedy that without breaking the visual formatting.

My main point: play-by-post (PBP) can be an excellent and accessible way to engage in tabletop gaming with an online community.

Note: Due to the nature of the medium, games tend to progress more slowly, people can game on their own schedule (there is no requirement to set aside big blocks of time for gaming), and the community members tend to be a bit older (our median age is ~27).


UPDATE: Nov 09, 2016 11:44 AM

The RPG Handbook of Practice updated to include Visual Impairment adaptations: