A profile of orientation and mobility instruction with a student with multiple disabilities.
As for any child or young adult who has significant and complex challenges, a detailed assessment of the student's current level of functioning must be conducted. This assessment may include social, physical, intellectual, and emotional areas of development, as well as any possible concerns that might alter the acquisition and development of safe, effective, and independent travel skills. After a child's initial referral for O&M training, the O&M instructor undertakes a thorough examination of all the student's records. More information about this process is included in the assessment section of this report.
Children such as Allison who have visual impairment and multiple disabilities present unique challenges to O&M professionals. Although there is no single approach that can be applied to all the myriad and complex conditions that present themselves with children and young adults with visual impairment or blindness and multiple disabilities, several strategies and techniques, many of which are reported in the literature, seem to prove beneficial. Instructors need to consider a student's strengths, such as memory skills; learning style (for example visual, tactile, or multisensory); communication style (for example, verbal, communication device, facial expressions, or hand gestures); sensory, perceptive, and fine and gross motor abilities; stamina; and social skills, including comfort level with peers and adults. Also to be considered are the student's personal preferences (likes and dislikes), the time of day a student is most receptive to instruction (early morning or after lunch), and the effects of the medications the student may be taking. Consistency, repetition, verbal and physical prompting, hand-over-hand assistance, positive reinforcement and praise, and teamwork among all individuals who come in contact with the student, including parents, must be utilized by or encouraged by the instructor.
When teaching tasks to students with multiple disabilities, a task analysis may be needed to break down specific skills into smaller steps. The consistent and regular practice of segmented tasks has the potential to make such tasks more palatable for the student. Although making a decision to cross at an intersection is a complex learning task, eliciting a student's participation in the task to perhaps attend to traffic, note its volume and direction, are preliminary components in making that decision. With experience and successful learning outcomes, more complex tasks can be reassembled and taught to the student. These strategies may be applicable to any student who is visually and multiply impaired, regardless of ability, in any situation, but these methods arguably entail a more detailed, analytic, and time-consuming approach to the learning process.
Children with visual impairments and multiple disabilities require the same assistance in seeking help from others as all children. An important difference to remember about this population is that judgment is often inadequate and communication skills can be limited or nonexistent. People seek help in two forms: instrumental and executive. Instrumental help-seeking occurs when an individual takes responsibility when solving a problem and may ask for clues, but does not ask for the answer. Such behavior indicates a student who is motivated to obtain and grasp complex techniques. Executive help-seeking takes place when the help-seeker wants someone else to cope with the problem for him or her (Taplin et al., 2001). Executive help-seeking behaviors are often seen in children with multiple disabilities. Help-seeking behaviors should be considered when providing O&M instruction to members of this population.
As mentioned in the introduction, children with multiple disabilities, including visual impairment, require a detailed assessment of skills along with a highly structured yet flexible curriculum model and the adaptation of curriculum materials to facilitate independent travel skills, safety, concept development, cane skills when appropriate, and problem-solving skills to meet the unique and individual needs of each child. All relevant educational, social, medical, and psychological information is reviewed, including when applicable and available occupational and physical therapy reports, speech and language evaluations, and behavioral plans that would assist in providing a profile of the learner. By supplementing this information, when possible, with interviews and consultations with parents and teachers, as well as the students themselves and any support personnel, professionals may add considerably to their understanding of the student.
The O&M instructor uses the information collected to assemble and implement an evaluation of observable and demonstrated skills on the continuum of the O&M curriculum, depending on the student's age, experience, vision, and cognition, as well as any pertinent medical needs, such as a wheelchair, braces, a walker, an adaptive speech device, hearing aids, or headgear. Depending on the course of the evaluation, the instructor may decide to include more or less complex tasks than originally targeted. Some tasks may also be postponed for another time if behavioral issues interfere with the evaluative process.
INDIVIDUALIZED EDUCATION PROGRAM
The O&M section of the student's individualized education program, or IEP, is formulated based on the assessment. Goals need to be formulated specifically to meet the needs of students who tend to deviate from conventional O&M goals and timelines because of complications and disabilities in addition to visual impairment. In addition, the goals and objectives themselves may need to be qualified. For example, although the evaluation has determined that a student has insufficient judgment to negotiate a residential street crossing independently, a goal can be written for the student to actively participate in the street crossing by noting traffic flow and direction, and even providing the instructor with a verbal decision to cross. The goal can be clarified by stating that the crossing will be executed using a sighted guide in addition to the instructor.
The IEP is derived from a cross-section of educational, social, psychological, and medical disciplines. Collaboration, cooperation, and consultation among all the participants relevant to the child or young adult's educational experience are valuable. When possible, concepts can be reinforced by the classroom staff and in the sessions of related service providers (occupational therapy, physical therapy, speech and language therapy, and individual and group counseling). Hands-on exploration and concrete experiences are especially important for children with multiple disabilities, so that they may be exposed to as many opportunities as possible to acquire knowledge and skills of basic concepts (Fazzi & Petersmeyer, 2001). Repetition, redirection (if necessary), and praise are also necessary. Basic skills and concepts should be incorporated into the child's daily routine and be provided within the context of the natural environment (Fazzi & Petersmeyer, 2001). Although repetition, consistency, redirection, and contextual learning seem to reinforce learning they also, as in Allison's case, provide for opportunities to build positive self-esteem.
The second author, an orientation and mobility instructor at the Lavelle School for the Blind, selected one of the students with whom he worked in 2000 to be the focus of this report. Allison, a pleasant, energetic, and exuberant young woman, was 15 years old during the time the second author and she worked together. In April 2000, Allison and her family sought to change her placement from a "modified instructional services program for learners with visual impairment" in a public school to a small school for the blind in the northeast Bronx, where she would enter a program leading to an IEP diploma upon graduation. The transfer required administration of a battery of assessments, one of which was an O&M evaluation. According to an ophthalmological report included in the student's records, her corrected visual acuity was no light perception in her left eye and 20/200 in her right eye, because of coloboma and cataract. According to Allison's educational and functional vision evaluation, she appeared to have visual, perceptual, and visual motor deficits, as well as significantly decreased visual acuity. She also exhibited language and listening skills delays and appeared to have difficulty with auditory processing. Tests purporting to measure cognitive function, most notably the Stanford-Binet Intelligence Scale (fourth edition), reflected overall functioning to be in the "borderline range" of intelligence. The results of previous tests for verbal reasoning and short-term memory displayed consistent results and confirmed the current cognitive results. Further testing revealed Allison's ability to understand simple concepts and display basic memory skills, although it reported that her performance on formal auditory memory tasks was poor. Allison displayed a tendency to "zone out" or disengage from a task when she encountered difficulty understanding the task, and this finding was repeated across disciplines, most notably in educational and speech and hearing evaluations. Further educational testing reported that when given 18-point print on both the Spache Diagnostic Reading Test and the Key Math Test, her overall performance measured approximately in the third- to fourth-grade range.
At a meeting conducted to evaluate Allison's current level of travel performance, it became clear that she had received no formal O&M instruction and relied exclusively on residual vision in traveling. When we invited Allison' s mother to accompany her off school grounds in a quiet residential section of the city, it became even more apparent that Allison had no real experience in traveling independently. On the sidewalk she appeared to lurch and bolt ahead, committing her body almost recklessly into the space. Although she was able to visually anticipate the approach to the corner and stop appropriately, she seemed perplexed and almost agitated when answering questions put to her by her O&M instructor to analyze her ability to locate, interpret, and organize information and otherwise attend to her immediate surroundings--in this case, the crucial information essential to decide when it is safe to cross at a corner of a fairly quiet residential street without a traffic light.
Although Allison's educational evaluation stated that she appeared to have visual, perceptual, and visual motor deficits as well as significantly decreased visual acuity, some of those deficits seemed likely to be attributable to a lack of experience in traveling. Helping her to define her surroundings visually, in terms of where to look, what to look at, and in what sequence, would probably improve her visual functioning for the task of negotiating travel.
Allison was able to move independently indoors within and between school buildings and in the schoolyard with what appeared to be adequate residual vision. Her mobility and orientation were, to a significant extent, visually guided, and she was able to accomplish tasks such as alignment, location of landmarks, and orientation visually. Her gait and posture appeared appropriate, but her pace was quick--too quick, in fact, so that in unfamiliar areas outdoors she would fail to see open gates or fences in her path or detect raised concrete slabs underfoot. Occasionally, she would mistake a shadow cast by a tree on the sidewalk for a hole. Her movement simply outpaced her ability to visually discern the space into which she was committing her body.
Although Allison wore prescriptive lenses to improve her distance vision and relied almost exclusively on her vision, a cane would need to be issued along with instruction in its use. The combination of learning to use a cane and to develop visual behavior is particularly vexing for a student with multiple disabilities. The attempt to discern the environment visually persists at the beginning of the instruction process, often to the extent that cane skills become more of a hindrance to travel because such skills compete for the student's attention with visual, tactile, and motor information. The decision to use a cane effectively is often an intellectual acknowledgement on the part of a learner with low vision that his or her vision needs supplementation. With students such as Allison, who have no real experience with or instruction in traveling, that decision may prove difficult to elicit.
From the initial assessment, an IEP was developed. For Allison this included the following goals:
1. Develop visual behaviors appropriate for residential travel. Specifically, this meant that Allison would need to learn to attend to relevant visual information such as traffic at intersections; scan; locate traffic control; and identify and interpret signs.
2. Receive a folding cane and begin instruction in its use.
3. Learn to seek pedestrian assistance.
4. Become familiar with several routes in a residential area whose destination was a local grocery, where she could learn to make purchases.
ALLISON'S O&M INSTRUCTION
To achieve the O&M instruction goals in Allison's IEP, several routes were chosen in the residential area surrounding the school so that a combination of intersections both with and without a traffic light would be encountered. The final destination for each route was a grocery store, where Allison could make a purchase each week. A conscious effort was made to embed instructional tasks into a context that would be both readily comprehensible and highly motivating. Rather than having the focus of the session be a specific task requiring Allison to analyze and determine the relevance of the task, the instructional tasks became incidental in and of themselves. For example, one of the first things she learned was to stop before each intersection and look for visual information such as one-way signs and traffic lights. To do this, Allison would visually scan for poles vertically until she was able to identify a sign, usually a one-way or a walk/don't walk sign. At some point during instruction, the traffic lights' wording was replaced by the universal symbols of a red hand and a white figure walking.
Allison was issued a pocket 6x monocular telescope to assist her in visually locating poles, signs, and traffic lights. At the beginning of instruction, when standing before the intersection, Allison seemed overwhelmed by extraneous visual and auditory information and tended to disengage from the task; she needed verbal prompting to focus on an appropriate visual routine. For several months, the same drill-like routine was enforced until Allison was quite adept at locating signs and noting when the traffic light changed along a familiar route. She became so skilled at this task that she was able to locate and note traffic light changes along familiar routes without the use of the monocular device.
It should be noted that, because of Allison's tendency toward impulsivity, all crossings were executed at this stage of instruction with the assistance of a sighted guide in addition to the O&M instructor. As she became more skilled at assigned tasks, new ones were introduced. Whenever possible, complicated and detailed verbal explanations were avoided in favor of simple isolated routines with lengthy instructional practice. The instructional process can be arduous and is certainly time consuming for both student and instructor. Nevertheless, Allison seemed to enjoy sessions and her confidence grew. Each session was rewarded with an activity the student enjoyed--in this case, purchasing an item from a store. Allison soon began to organize her visual attention in purposeful pat terns by turning her head to visually check for traffic on the street parallel to the path she was traveling, then rechecking the traffic light. She learned to attend visually to turning traffic, even anticipating turning traffic on her parallel side along a familiar route.
Once introduced to the cane, she was able to cross at several intersections successfully and confidently with a traffic light along a familiar route. Her success at this task was commendable, but a real test of her decision-making capability would be her success at uncontrolled intersections. In part, the main decision of whether to cross at a traffic light is determined and validated by the traffic light itself. The decision for a student with a visual impairment to cross at an uncontrolled intersection is more complicated and requires the student to perform a visual assessment and have a unique understanding of sound and auditory perception.
Today, Allison understands her visual limitations and the need to listen at intersections without a traffic light. She also understands that sounds can be masked and that she is to seek assistance when there are noises from construction in the area. The opportunity to practice in noisy scenarios has been less than extensive.
It should be noted that the gains Allison has made have been over a 5-year period and have been approached instructionally with consistent and repetitive practice and along one of several routes. Although she continues to learn, her success appears to be specific to the routes that she has practiced over time and seems to be, in part, a function of intense familiarity with the route. Thus, her performance on one route does not necessarily confer successful and immediate transfer of skills to another, less familiar one. Like many of the students with multiple disabilities, Allison seems to learn best and make the greatest gains with consistent and lengthy practice. For Allison, success in achieving her goals came from the development of her visual motor skills, the use of the cane, and the use of her monocular telescope at street crossings.
Fazzi, D. L., & Petersmeyer, B. A. (2001). Imagining the possibilities: Creative approaches to orientation and mobility instruction for persons who are visually impaired. New York: AFB Press.
Taplin, M., Yum, J., Jegede, O., Fan, R., & Chan, M. (2001). Helping-seeking strategies used by high-achieving and low-achieving distance educating students. Journal of Distance Education, 16, 56-59.
Ellen Trief, Ed.D., associate professor, Blind and Visually Impaired and Severe/Multiple Disabilities programs, Department of Special Education, Hunter College School of Education, 695 Park Avenue, New York, NY 10021; e-mail: <etrief@ hunter.cuny.edu.> Louis De Lisi, M.A., M.S., M.S. COMS, orientation and mobility specialist, Lavelle School for the Blind, 3830 Paulding Avenue, Bronx, NY 10469; e-mail: <Nufan48@ optonline.net>. Robert Cravello, M.A., COMS, orientation and mobility specialist, Lavelle School for the Blind; e-mail: <firstname.lastname@example.org>. Zhichao Yu, M.A. COMS, orientation and mobility specialist, Lavelle School for the Blind; e-mail: <email@example.com>. Address all correspondence to Dr. Trief
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|Title Annotation:||Practice Report|
|Author:||Trief, Ellen; De Lisi, Louis; Cravello, Robert; Yu, Zhichao|
|Publication:||Journal of Visual Impairment & Blindness|
|Date:||Oct 1, 2007|
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