Tabletop RPG Recreation Therapy Example Scenario - Visual Impairment

by Victoria Jesswein published 2022/10/21 17:15:29 GMT-7, last modified 2022-10-21T17:15:29-07:00
This is an excerpt from the RPG Handbook of Practice book I have been working on. This section is for clients with significant to complete visual impairment due to traumatic brain injury to the occipital lobe. It can be extrapolated for the whole range of visual impairments. 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.

This is an excerpt from Hawkes-Robinson's "RPG Handbook of Practice" useful to both professionals and layperson. It is an unofficlal extension of the book Recreation Therapy Handbook of Practice, delve into one of the five areas from Activities and Participation with some detail, providing a example client and activity combinations. Provides the World Health Organization (WHO) International Classification of Disability (ICD) and International Classification of Function (ICF) code for the Activities & Participation section, with A&P performance qualifiers as well.

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

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

Example includes a visually impaired (up to totally 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 example 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 may be significantly limited in participation level for 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. 



It is strongly recommended to use more "theater of the mind" approaches to the game play, rather than miniatures or other visually-based approaches.

Also keep in mind the player's history, and considerations for those who might have challenges similar to Aphantasia, the inability to visually imagine a scene. Use lots of adjectives for rich detailed verbal descriptiosn, and use more than just visual sense, include all of the other senses when feasible: sound, touch (temperature, humidity, smooth vs coarse, etc.), smell, taste, "sixth sense" (a gut feeling of being watched, a place that makes you feel calm, etc.).

If the client has complete visual impairment (impairment severity level 4):

  • If possible, the Game Master / Facilitator should have access to a Braille Printer. These tend to be _very_ expensive, but if have access, can print braille character sheets. Another option is electronic character sheets with screen readers on a tablet, though the technology at the time of this writing is lacking.
  • Braille dice. These can be difficult to find beyond standard d6. UPDATE 20180318: There are now some polyhedral dice assortments in braille available through the DOTS RPG Project. As of this update, you can get a set of 8 polyhedral dice for about $50. This includes 1 each of d4 d6 d8 d12 d20 and 2 d10. You can purchase the braille polyhedra dice through shapeways. Or through for about $15 here.
  • If you have access to the braille dice, you can use these to keep track of frequently changing character statistics, such as if the character normally has 8 hit points, use the 8 sided die, and like a collectible card game, have the player change the number on the die as hit points are lost or gained.
  • If you do not have the resources available for either braille or electronic devices, then although it is less ideal, the GM and/or fellow players can assist the player with the visual impairment, verbally as best as possible, so at least they are not excluded from the activity. The client will need either electronic version on a device that supports text to voice or braille versions of the rulebook(s) for the game system, 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 braille or 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. May be able to use a dice reading app for actual regular dice, in a dice tower (to be researched).
  • For those with just slight to moderate impairment, have the room more brightly lit with high-contrast or larger size dice, characters, and books without any artwork behind the text (watermarks), may be sufficient.
  • Environment should be as free of noise polution as possible since more dependence on auditory input, participants with visual impairment are not able to add visual input to differentiate some phenomes and won't be able to use typical lip-reading to differentiate some sounds (inverse of the McGurk Effect), and noisy environments (convention halls, many game store gaming areas, etc.) could severely limit their ability to follow along with the narrative.

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. The reduced autonomy without the accessible technoogies is not as self-empowering as would be ideal, but helps the player still be able to participate fully and derive the many documented benefits from participation in tabletop RPG, which is far better than exclusion.

Since the rest of RPG play is primarily auditory normally, other modifications are generally not necessary for complete unimpaired particpation 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:


UPDATE: Feb 25, 2013 06:23 PM

And here are links to various 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: 

UPDATE March 23rd, 2018 11:58 AM

Added links to two sources for braille polyhedral dice. Corrected some typos and updated language to include laypersons not just professionals.


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