Principles for providing Orientation and Mobility to People with Visual Impairment and Multiple Disabilities
Dona Sauerburger, Eileen Siffermann, and Dr. Sandra Rosen
Providing orientation and mobility (O&M) services to people who have disabilities in addition to visual impairment presents an exciting challenge. It is especially rewarding when it enables students to achieve a meaningful life which they and their families might not have thought possible.
The O&M specialist may feel overwhelmed when beginning to work with these students because he or she may be unfamiliar with factors such as assessment techniques which will lead to appropriate strategies and equipment needed to achieve success and a great level of independence. Through the authors' experiences working with people with multiple disabilities, they have learned basic principles for success, which are explained in this practice report. These principles are as follows:
Understand that multiple disabilities have more impact than the simple addition of each disability.
Have high expectations for success.
Be functional in the assessment and instruction.
Be creative and flexible, and design the program for the individual.
Encourage participation in the community, even if it cannot be done independently.
Find resources and information related to each of the disabilities.
Work with a team or in consultation with others who have expertise in the additional disabilities.
Multiple disabilities have more impact than the simple addition of each disability
Each combination of disabilities presents a unique situation, with challenges that add up to more than the challenges of each disability added together. People who have disabilities other than vision impairment normally use adapted techniques that rely on their vision to function, and many of the strategies and adaptive devices that people with vision impairments use to travel safely and communicate with the public require normal hearing, cognitive functioning, and mobility. Many of these adaptive strategies are not feasible for blind people who also cannot hear well, cannot understand the strategy or process the information, or cannot move safely and maintain their balance.
So when vision loss and other disabilities are added together, the impact on people's options and their ability to function are not added together, but rather they are multiplied.
Have high expectations for success
When expectations are high, students can be inspired and motivated to achieve their best. Therefore keep an open mind and let your students teach you about how much they can achieve, and encourage them to reach their potential for independent travel. Be aware that in spite of the seemingly insurmountable challenges that multiple disabilities can present to people with vision impairment, they can achieve high levels of independent travel, often beyond the level at which people thought they were capable.
For example, people who are completely blind and have moderate cognitive disabilities are using buses and travelling to and from their homes and their work places or centres every day by themselves. People who are completely blind and have severe cognitive disabilities are travelling independently inside their home and workplace. People who are completely blind and profoundly deaf or using a wheelchair or mobility aid travel around the world by themselves.
Be functional in the assessment and instruction
Students with multiple disabilities should be assessed within the activity and environment in which they naturally travel. In many cases, instruction should be done at the times and places that the student would normally travel. For example, assessment of the risk of deaf-blind students to cross streets should be done at the times of day that the student will be travelling there.
When working with students with a cognitive as well as a visual disability, the assessment should note when mobility tasks are critical to the student's daily/weekly schedule. During this process the O&M specialist should make several direct observations of the student within the normal environments of school/work, residence, and the community, such as when the students ride from their residence to school/work, and at their regularly scheduled lunch time. As part of this assessment it is also very important to obtain information on the student's visual function, hearing function, psychological function and medical status. The O&M specialist might request additional assessments from the audiologist, the occupational therapist and the physiotherapist.
The assessment is then shared with the student and the person(s) who made the referral. The O&M specialist sets forth areas and circumstances in which O&M skills could be taught including any mobility devices which might be used. The team prioritises the areas of instruction and identifies specific skills to be worked on by the O&M specialist. For example, it might be very important to the classroom teacher that the student learns to leave the classroom and, with only distance supervision, travel independently to the school cafeteria.
The O&M specialist then develops an instructional plan to address the identified O&M skill. The instruction on that skill will be scheduled at the time the activity occurs during the day.
Be creative and flexible, and design the program for the individual
Standard "recipe" strategies and solutions that are successful for most people who have a vision impairment may not work for those with additional disabilities, but there are ways to get around most challenges. Be creative and willing to try new strategies and ideas developed for the individual student with multiple disabilities.
For example, for students who use aids to walk or move, there are specialised techniques to use a long cane together with the aid, and even techniques in which the aid can replace the long cane when necessary. Deaf-blind students who cannot get information from hearing may prefer to slide their cane rather than use touch technique, and may prefer to follow a building or grass line rather than walking along the middle of a sidewalk as we normally teach blind students. In this way they can be taught to maintain their alignment and orientation while travelling. O&M programs for people who are deaf-blind must also include a systematic program to teach them to communicate with the public, using techniques that are appropriate for the individual student.
Encourage participation in the community, even if it cannot be done independently
All people have the right to acquire skills which allow them to function, at least in part, in a wide variety of environments and activities in their community. Experience in the community should not be denied to any people because they are unable to perform certain activities without assistance. For example the student might learn to develop a shopping list and accompany someone to the grocery store to select the items; attend a sports /exercise club after learning how to get around the building independently; participate in a work program sorting silverware at a cafeteria; sorting clothing at a thrift shore; stacking paper or crushing cans at a recycling center. Even though students may be able to only partially complete the tasks required to do these activities independently, they can still participate, getting assistance when appropriate.
Find resources and information related to each of the disabilities
None of us can be experts in all things, nor can it be expected that we know all that is necessary to work with all students. Thus we need to know where to get help and resources.
We should become familiar with professionals and agencies which serve people with other disabilities, as well as sources of devices and equipment used by people with other disabilities. For example, physiotherapists are great sources of information about gross motor function and use of aids such as wheelchairs, canes, and walkers, and occupational therapists can help with fine motor issues and adapted techniques to perform daily living skills.
A wealth of information about various disabilities is also available in literature, as well as information about serving people who have vision impairment and additional disabilities. The most notable of these is The Foundations of O&M, Second Edition by AFB Press, and the third edition is planned to be even more extensive and useful.
Work with a team or in consultation with others who have expertise in the additional disabilities
The benefits of working with others can start with administrators. All students have the greatest opportunity for success when the O&M instructor works together with program administrators. When those who are responsible for funding and managing the program understand the students' needs for O&M as well as the need of O&M specialists for training and resources to serve special populations, they are better able to support and facilitate the O&M program. Further, when O&M instructors work with and understand the program administrators, they are better able to utilise or promote resources to enhance the O&M instruction.
When providing O&M to students with multiple disabilities it is considered best practice for the O&M specialist to consult, or work together as a team, with others. This is because students with multiple disabilities have needs that are beyond the job description or body of knowledge that is normally expected of O&M specialists. It is unethical and often ineffective or even detrimental to provide services outside of our area of expertise. Working or consulting with others makes the best use of resources, and provides support when consultants or team members suggest strategies and help brainstorm solutions.
Sometimes all that is needed is consultation, where the O&M specialist asks others for information or ideas to meet the complex O&M needs of the student, after which the O&M specialist provides the instruction, consulting again only if needed. At other times, the O&M specialist works with others as a team during the entire O&M program. The team members assess needs and develop goals together, share expertise and ideas throughout the instructional program, and take equal responsibility for monitoring the progress of the student and reinforcing skills.
Usually, however, the best model for providing O&M to any particular student with multiple disabilities is somewhere in between the two extremes of consulting and team work. Some of the program development and instruction is done as a team, and some of it done by the O&M specialist alone, with consultation as needed.
Which professionals are chosen to serve as consultants or team members to provide O&M service to students with multiple disabilities will depend on the characteristics of the student; what support or knowledge the O&M specialist needs in order to be able to serve that student appropriately; and what resources and personnel are available in that culture/community to students with those disabilities. These consultants and team members typically include physiotherapists; occupational therapists; professionals who serve people with cognitive or hearing disabilities such as special education teachers or communication specialists; travel instructors and job coaches for people with cognitive, physical, or other disabilities; city planners and engineers. Often, people who should be consulted or part of the team because they know about the student's special needs are the family or staff who live and work with the student and who provide the student with emotional support. Of course, the most important person to consult and be a member of the team is the student.
Usually, the professionals and personnel who are consulted or are part of the team know little or nothing about blindness and what people can achieve without vision. Thus it is important that O&M specialists:
share with the others their expertise about O&M strategies and adaptations for people who have a vision impairment;
learn from the others information and ideas about strategies in their area of expertise; and
work together with the others to develop solutions and strategies for the student to get around safely and efficiently.
Conclusion
No two O&M students are the same, and this is especially true of students with additional disabilities. For these students, O&M takes on new and fascinating challenges. Using the above principles, including seeking out information and working collaboratively with others, can go a long way to making a seemingly impossible task become both fun and successful. We wish you and your students the joy that can come from overcoming challenges and being successful and effective.
Return to IMC's paper "Orientation and Mobility for Visually Impaired Persons with Multiple Disabilities Including Deaf-Blindness"
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