Mobility training for the older blind: a common sense approach.
People over 65 make up from 60 to 70 percent of the blind and severely visually impaired population. This age group is also the fastest growing group. This population needs and can benefit from sound rehabilitation training. Such programs for blind persons of any age are built on the premise that most tasks that need to be accomplished in any walk of life do not require vision. A blind person can participate fully in the community if he or she learns the appropriate alternative techniques of blindness. The validity of this approach has been demonstrated repeatedly as the number of successful blind people who have participated in these programs increases.
Advanced age alone does not negate an individual's ability to learn. In society at large, many senior citizens participate in elder hostels, pursue second careers, or become involved in volunteer work--all of which require the ability to learn. Like their sighted peers, older individuals who are blind can also learn and can benefit from the training of a good rehabilitation program, as evidenced by the competencies developed by those who have already received such training.
The need of the older blind for training in alternative techniques is not being met. The rehabilitation literature has discussed this problem over the past 30 years. However, no solution has been agreed upon. As a result, a large number of older blind people in many locales are simply not getting a "fair shake." Two major barriers preventing this are:
* the federal laws and regulations pertaining to rehabilitation, and
* the amelioration of the condition of the blind on one hand, and an artificial shortage of professional workers in some fields of rehabilitation on the other.
Federal Laws and Regulations
Historically, older blind persons have experienced difficulty in securing training services when such individuals are not pursuing employment. Rehabilitation agencies serving blind people typically administer rehabilitation programs that focus on employment. Some separate state agencies for the blind have offered older blind persons a wide range of services, such as a library, access to aids and devices useful to the blind, radio-reading programs, and perhaps some effort at employment through a home industries program. But these services, valuable as they are, have generally been thought of as more ameliorative than rehabilitative. In addition, there has often been some "bootlegging" of home teaching services, including mobility training, to persons like the older blind whose vocational goal was probably ephemeral. Even then, such home teaching in many states did not include mobility training because of the policy of some agencies to hire only mobility teachers with master's degrees in orientation and mobility (O&M). Because the number of instructors possessing such credentials was small, these states were unable to hire enough mobility instructors to meet the needs of blind people, including those who were older.
In 1978, the Federal Government made some effort to serve the older blind population. Federal funding for what came to be known as "Centers for Independent Living" enables some agencies serving the blind to formalize separate programs for blind people, including the elderly, who are not pursuing vocational goals. Independent living centers initiated by state agencies for the blind take different forms. In some places, individuals come to a central location to receive instruction in a wide range of blindness techniques. In others, the centers send out itinerant teachers to work with blind persons in their communities. In still other instances, agencies contract with others for the provision of rehabilitation services to the older blind. In any case, the development and continuing existence of these centers represents a national recognition of the needs of older blind people and a commitment to meet those needs.
Not all of these centers can offer mobility training, however. Those programs tied to the requirement that only O&M practitioners with a master's degree can provide such training find themselves limited by a shortage of qualified staff. Consequently, the elderly blind get the "leftovers" of such training--if they are lucky enough to get anything at all. Agencies that did not require graduate level training in mobility of its staff did not experience this problem.
There was an additional and unexpected benefit to locating an independent living program within a separate state agency for the blind. Common public attitudes and misconceptions about blindness, when adopted by newly blinded people themselves, can be devastating. Many such persons, at any age, have a tendency to "sell themselves short." Training in the more open-ended approach of independent living can help such persons overcome their lack of self-confidence. Many of these students, including the older blind, have eventually found themselves wanting to expand their goals beyond independent living and were able to easily transfer to the vocational rehabilitation program available in the same agency.
Both the initial concept of independent living centers and the categorical funding of rehabilitation training for the older blind within separate state agencies for the blind were largely beneficial. Unfortunately, changes detrimental to the provision of these services came with the passage of the 1992 Amendments to the Rehabilitation Act. Prior to 1993, all three funding streams in Title VII could provide categorical funding for blind individuals. The State Independent Living Services formula grant (formerly Part A, now Part B) provides funds directly to all state agencies, general and blind. These funds continue as before and can support a broad series of innovative programs, including programs either directly operated by state agencies serving blind people or through a subgrant or contract from these agencies. As before, states determine the priority for expenditure of these funds. A large change occurred in the Centers for Independent Living Program (formerly Part B, now Part C). Before 1993, centers were able to serve single disability groups such as the blind; however, after 1993 centers must be nonprofit organizations that serve individuals with all significant disabilities. The Independent Living Service for Older Individuals who are Blind Program (formerly Part C, now Chapter 2) continues as before to provide services to older blind people. The Chapter 2 program is the major source of federal funds available to provide independent living services to older blind people. There are now grants in every state and territory except the Commonwealth of Northern Marianas.
This change has had a drastic effect on the rehabilitation services, particularly mobility services, that have been provided to older blind people. With the shortage of qualified mobility instructors--even those without advanced degrees in O&M--most private, cross-disability independent living centers could not find a sufficient number of qualified staff to serve their consumers.
The problems of blindness are complex, requiring those who work with blind people to have comprehensive knowledge and understanding unique to the field. Any teacher of the blind must approach the task from two directions: teach the skills--including mobility--necessary to deal with the problems resulting from the physical loss of eyesight and, more important, deal with the public misconceptions about blindness that prevent blind persons from developing the self-confidence necessary to live independently. Training in the alternative techniques of blindness and achieving this attitudinal shift takes time, particularly for older blind individuals. Given a shortage of funds and the agency's need to meet "production goals," blind people, especially those who are older, are less likely than people with other disabilities to receive adequate services under this system. It is ironic that blindness, which is generally thought to be among the worst of all disabilities, is expected, under this system, to be dealt with like all other disabilities. It is even more ironic that, in the past, this argument had been successfully used to maintain separate programs for blind people.
The second major barrier to the delivery of services to older blind individuals--an artificial shortage of trained rehabilitation specialists, particularly mobility instructors--has already been alluded to. There would not be much point in discussing curriculum and methodology in teaching mobility to older blind persons if there are no teachers available. The issue of who is qualified to teach mobility has been debated since World War II, when the long white cane came into use. Soon after the efficacy of the Veterans Administration (VA) mobility program was recognized and state and private agencies began to emulate it during the 1950's, a strong movement arose to systematize this field and to give it specialized professional status by requiring master's degrees in orientation and mobility.
This movement occurred not without some strong opposition. Discussions have been ongoing about what kind of certification should be required of mobility teachers, about whether blind persons can or should be allowed to teach mobility, about such methodology as one-on-one instruction, and about whether paraprofessionals should be allowed to assist in the instruction process. There has also been a growing awareness that the emphasis being placed on graduate level education with its resultant certification and methodology has resulted in a severe shortage of mobility training for many blind people, especially the older blind.
The National Council of State Agencies for the Blind (NCSAB) has been extensively involved in trying to resolve what appears to be a standoff in this controversy. In 1983, 41 directors of state agencies serving the blind participated in an NCSAB survey dealing with this issue. There was some disagreement on the question of whether both rehabilitation and O&M teachers should receive training on the graduate level. Thirty-one directors thought rehabilitation teachers could also teach mobility, while nine disagreed. Ten respondents required their mobility teachers to have master's degrees in orientation and mobility, but 25 did not.
Since the early 1980's, a debate on this issue has taken place continuously between the NCSAB and the Association for the Education and Rehabilitation of the Blind and Visually Impaired (AER), which strongly maintains that graduate level training and certification are necessary. The NCSAB, on the other hand, suggests alternative approaches, such as reducing the requirements for graduate level training and providing short-term training for rehabilitation teachers of the blind which would enable them to add the teaching of mobility to their repertoires. The NCSAB approach has been proven to be successful in those agencies that have developed comprehensive mobility training programs that do not require graduate level preparation, that recognize that blind persons can teach mobility, and that, consequently, allow for their rehabilitation teachers, independent living teachers, and vocational rehabilitation counselors to provide mobility training as just one of a variety of skills available. This approach has meant that older blind people, whether in rural or urban areas or in residential centers, are receiving from these agencies mobility training on the same basis as blind people of any other age group. With the success of this approach and the increasing needs of a growing older blind population, the allegiance to requirements that are unnecessary must be reconsidered.
Common sense and creativity are the keys to teaching mobility to older individuals who are blind. The instructor must first be aware of two caveats, though. When teaching this skill to anyone who is blind, the teacher is often tempted to categorize that person and then to predetermine the type of training that will be offered based on such characteristics as age, physical condition, and mental capacity. In the past, specialized approaches have been developed for groups like children, the elderly, the diabetic, the traumatic brain injured, and the hearing impaired. But the experienced practitioner soon comes to understand that each person, both regardless and because of his unique combination of characteristics, does not fit into any of these specialized categories. There are blind persons in their seventies who are as independently mobile as anyone can be, and there are young persons who have great problems in mobility because of loss of balance, hearing, or tactile deficiencies. Therefore, the instructor must not look to specialized programs for the solutions to any given individual's problems in developing independent mobility skills but should be observant and creative in dealing with the factors that will impact on how well a particular individual may develop those skills. The incidence of additional disabling conditions within the older blind population is generally greater than among other groups, but this factor should only stimulate the teacher's ingenuity more and not cause that teacher to look for a special mobility program for this group.
The second caveat for the teacher to bear in mind is that much of the skill of independent mobility for blind persons of any age is self-taught. If the student is to teach him-/herself, the teacher must then serve as an observer, a suggester, and a motivator, giving the student the necessary leeway to explore and experiment on his or her own so that the student can reach the highest skill level possible. A student who is not allowed to do so will be tempted to restrict him-/herself unnecessarily when no longer under the watchful eye of his/her instructor.
This discussion is focused on the long cane method of mobility instruction. Both the use of the guide dog and the use of electronic devices are very specialized areas that would require separate treatment. Mobility instructors must familiarize themselves, however, with these areas so that they can provide their students with meaningful information about them. This is particularly true of electronic mobility aids, an area where there are likely to be more technological advances. As such developments occur, more blind people will become interested in receiving training with such devices and mobility instructors must be in a position to provide or to help them find this training.
Many types of long canes are available. The teacher needs to point out the advantages and disadvantages of each, mindful that the student may try out several before finding a favorite. The teacher must keep in mind, though, that a white cane may be the last thing a newly blinded person of any age wants. To most people the white cane symbolizes all the unfortunate misconceptions many hold about blindness, which is why many blind persons try to hide the cane or get along without it as long as possible. This situation can be especially true for a newly blinded older person, who may be resistant to learning new skills and whose negative notions about blindness are deep seated. As encouragement, the teacher may have to point out that the cane is not just a useful tool but also a positive symbol of the fact that a blind person can be independent and mobile in an efficient and safe manner. If the teacher helps the student adjust to having a cane, that student will be more likely to use it properly and with self-confidence.
As the older person who is blind adjusts to owning and using a cane, the mobility teacher may find it necessary to make more modifications for his training than for a younger blind person. Some older blind individuals live at home, while others are residents of nursing homes. Some may have no orthopedic problems, while others may be using a walker, a support cane, or a wheelchair. Various approaches have been developed for dealing with these situations. Some older blind people, for example, use a lightweight long cane in conjunction with crutches or walkers or support canes. Some wheelchair users have found electronic mobility devices to be helpful.
Common sense and creativity are also helpful in choosing an optimal location for mobility training for the older blind. The mobility teacher usually works with an individual in his place of residence. Some agencies, however, have successfully modified this approach. One such modification is to have several older blind individuals attend a minitraining center each day for a week or two. Located in a central geographical area and staffed by one or two rehabilitation teachers, this approach makes a maximum use of staff, allows for the teaching of several skills, including mobility, and provides the opportunity for blind persons to share experiences and notions about blindness with each other. A second modification uses a residential training center for the blind to allow a larger group of older blind persons to live for a time in an atmosphere most conducive to dealing with the problems of blindness and to take advantage of all of the available instructional facilities. A third approach involves using peers as resources to help newly blinded older persons learn the skills and self-confidence necessary for living independently.
In working with older blind individuals, the mobility instructor is likely to encounter many problems that have already been solved by others. Discussing those problems with other mobility teachers can be helpful. Valuable information can also be found in many publications. The Journal of Visual Impairment and Blindness has published many articles on mobility issues. The American Foundation for the Blind has also published numbers of books and articles written by practitioners in the field. Organizations of the blind, including the National Federation of the Blind and the American Council of the Blind, can also be very useful resources.
The best advice, though, that can be given to a mobility instructor who works with older persons who are blind is this: If you know and understand the skill and have the ability to teach--do it. Too many older blind persons are still being denied the opportunity to lead full lives because they do not have the opportunity to learn the necessary skills and develop self-confidence.
Mr. Witte, formerly Program Administrator of the Orientation and Adjustment Center, State of Iowa Department for the Blind, is now retired.
RELATED ARTICLE: Library of Congress to Explore Educational Reading Services for Print Handicapped Students
Provision of educational reading services to people with print disabilities, including elementary, secondary, and college-level students, will be the focus of a major study announced by the National Library Service for the Blind and Physically Handicapped (NLS), Library of Congress.
The study, estimated to take 1 year to complete, will examine the current constellation of agencies and individuals who provide these students with materials in alternative formats. It will search for mechanisms through which the skills of NLS and its network of cooperating libraries might be utilized to serve eligible students.
According to the October 27, 1997, issue of Newsweek magazine, "In an astonishing estimate, some researchers now say that as many as 20 percent of schoolchildren may have a neurological deficit, ranging from mild to severe, that makes it hard for them to read and write." Using the 20 percent estimate, more than 13 million of the projected 67 million students in the United States could be eligible for Library of Congress services.
In announcing this study of both the informational and educational reading needs of this segment of the population, Frank Kurt Cylke, director of NLS, said, "The largest single organization now serving this group provides materials to only about 39,000 individuals. While other groups and many individuals also provide materials to thousands more, there may be a need for central coordination of their efforts.
"NLS with its cooperative network of 140 lending libraries throughout the United States has matured in its 66 years of existence to a level of sophistication where together we believe we can extend our national program to cover educational needs of the eligible population," Cylke said. "In addition, the Library of Congress is currently embarked on the development of a national digital talking-book technical standard through the National Information Standards Organization. We will ensure that this standard will meet future scholastic and academic needs as well."
The NLS network functions as the largest and frequently sole source of public library materials and services for the population who cannot readily use the print materials of local libraries. The NLS network annually circulates more than 23 million books and magazines in Braille and recorded formats to a readership in excess of 776,000 eligible U.S. adults and children. The great majority of the network of cooperating libraries operate within state library systems that are committed to serving the informational, educational, and recreational needs of individual readers.
"NLS embraces the vision `That All May Read' and participates in the Library of Congress's commitment to lifelong reading. As NLS steps into the next millennium, it is our obligation to review and improve services to all the populations we serve," Cylke said.
Suggestions and comments are welcome. They may be addressed to the survey project coordinator, Michael M. Moodie, Research and Development Officer, NLS, Library of Congress, Washington, DC 20542. Mr. Moodie may also be reached by telephone at (202) 707-5108 or by facsimile at (202) 707-0712. His E-mail address is: firstname.lastname@example.org