Orientation and mobility is a term usually heard when talking about services to people who are visually impaired or blind. Orientation and mobility represents a body of various skills and techniques that can help people with visual loss travel more safely and independently.
Mobility refers to the safe movement of the body in any space. As individuals with Usher syndrome experience a loss of vision, they may encounter mobility difficulties walking through indoor and outdoor areas: tripping, falling, bumping and loss of balance. There are specific skills which a mobility teacher can introduce to address and help resolve these mobility problems. To name a few, there are self-protective skills, trailing, cane skills and visual scanning techniques.
Orientation refers to the ability to understand the body's position and location relative to other points in the environment. It also refers to the ability to systematically plan routes to other destinations. Most hearing and sighted people orient themselves by relying upon visual landmarks . Most hearing blind people orient themselves primarily through the use of sound cues. Students with Usher syndrome have limited or no access to sound cues and experience increased difficulty using visual landmarks.
There are specific skills that the orientation and mobility teacher can introduce to help resolve these orientation problems. These include alternative land marking skills (using touch, smell, wind, slope and other cues), mapping skills and route planning skills, among others.
Usher syndrome students, who continually need to readjust to a progressive and deteriorating visual condition, will likely experience difficulties in the following areas:
Students with Usher syndrome usually experience a slow and progressive loss of peripheral vision, and this may be followed by a loss of central vision. As the visual loss becomes more advanced, people with Usher syndrome have increased difficulty getting around safely. Orientation and mobility services can teach students to develop and maintain a high level of safety, independence and confidence as they travel and interact in school, at home and in the community.
Many students with Usher syndrome simply stop going out into the community alone once they experience vision and travel problems. Not knowing what they can do to make travel easier, they avoid what often becomes a frightening or embarrassing experience. They depend increasingly on family and friends. A routine of dependent activity, and sometimes inactivity, develops.
This is a student who can greatly benefit from orientation and mobility instruction. Her ability to work in the future may well depend upon her continued ability to travel alone. Instruction in scanning techniques (systematic and careful use of her residual vision) and basic cane techniques will together allow her to travel through her community environment with maximum safety. A second area of instruction, expressive and receptive communication strategies to be used while traveling, would help her communicate with the public confidently and comfortably.
An orientation and mobility evaluation is an assessment of the visual, auditory and/or tactile techniques that a student uses to travel independently and safely. The evaluation should determine if there is, in fact, a need for orientation and mobility instruction and if so, in what specific skill areas. Should instruction be recommended, the student and instructor should mutually develop realistic short and long term goals. A plan of instruction would then be implemented to gradually build the skills necessary to reach those goals.
The mobility instructor should review vision reports and school records to gain an understanding of the student's particular vision loss. The instructor should then meet with the educational team to share observations and to explain the characteristics of the student's visual loss and the purpose of the evaluation.
If the student uses sign language, the instructor should also meet with the interpreter to explain the characteristics of the student's visual loss and the purpose of the evaluation, which is an assessment of visual efficiency skills, including scanning and comprehension in the classroom. If the orientation and mobility teacher is not familiar with the use of an interpreter, this is an opportunity for the interpreter to explain his or her role.
The instructor first observes the student in various natural school settings. Then, after the student and instructor have met and discussed the purpose of the evaluation, the instructor conducts the evaluation in what would be typical problem areas for a student with Usher syndrome. Indoor settings to be evaluated include stairs and stairwells, crowded areas, areas with random obstacles or poor lighting, and typical school settings such as the cafeteria, auditorium or locker rooms. The student would also be observed in outdoor settings under various sun conditions (with the student facing the sun and with the sun at the student's back), in familiar and unfamiliar areas, at street crossings and congested areas, on public transportation systems, etc. A thorough evaluation must include observation of the student in familiar as well as unfamiliar low light areas.
Every attempt should be made to conduct evaluations in home, school and community environments. It is important to include the family in the process by interviewing them and discussing the purpose of the evaluation and of orientation and mobility education. The teacher should encourage the family to learn as much as possible about Usher syndrome and should provide necessary supports and reinforcement of independence and safety recommendations.
There are several reasons for using a cane. Some students with Usher syndrome with residual vision may benefit by selectively applying specific and distinct cane techniques in different lighting, environmental, and/or fluctuating visual conditions. Some won't choose or need a cane until they are much older. The three main functions of a cane are identification, protection, and information.
A student with Usher syndrome, even one with considerable residual vision, may still benefit by using a cane, even if the cane is only for the purpose of identifying their vision loss to others. When traveling in a crowded city environment, e.g. using public transportation or crossing city streets at rush hour, the presence of a cane will greatly minimize collisions and difficulties. At street crossings, the cane is an important identifier to drivers, making it safer for students who use vision techniques alone to cross streets.
Some students' visual fields have become so restricted that, even when applying scanning techniques, they occasionally bump into obstacles. In these situations, a cane can offer a great deal of physical protection. Objects which are outside the central field of vision, such as a street pole, a curb or a knee-high sidewalk obstacle, can be safely touched and noted by the cane, thereby avoiding a collision.
When traveling in the evening, or when a student's residual vision requires regular use of a cane, the student learns specific techniques where the cane is used to gather tactile information, such as assisting in identifying landmarks, establishing position at a street corner or on a train platform.
Information about the purpose of a white cane, and the benefits it can bring with someone with Usher syndrome, should be explained to a student at the earliest opportunity. Even for those who may not yet need to use a cane, simple lessons demonstrating basic cane technique can give a student valuable information for their future safety. Some professionals in blindness education have suggested that if a student has adequate vision to travel without a cane at the time of evaluation, instruction in cane techniques should be postponed until functional vision decreases. This approach is discouraged for the following reasons:
The approach should be one of crisis prevention rather than crisis intervention. Students should be encouraged to get all the information they need in order to become active partners in the learning process. If they have the necessary information and skills, then they are likely to note before anyone else when changes happen and when they need more education. This approach is empowering and builds confidence in the student's ability to care for him or herself.
Early intervention would have made a tremendous difference in this young man's life. He was having significant problems in traveling safely, and he knew he needed training. If he had received even the most basic information about a cane and been given one, he might have carried it with him for identification during this waiting period for services, and the accidents he experienced would, in all likelihood, have been avoided.
Most students receive no services in school until vision loss has reached an extreme level. In many cases, the problems and issues of the student with Usher syndrome are not discussed or addressed at all. Often, it is not until the student graduates and begins to explore options for adult life that students come in contact with specialized services. This experience is common and often results in crises occurring rather than being prevented. If some vision services (O&M specialists, vision specialists) are provided it is often by an instructor with little or no experience in deaf-blindness. Interpreters are not always used, making it extremely difficult for rapport and trust to develop between student and teacher and impossible for adequate exchange of information or education to take place.
The inability to communicate comfortably with the hearing public is a common frustration for students with Usher syndrome. Deafness is invisible to the public, and if the student is not using a white cane, his vision impairment is also invisible. The bus drivers or store clerks with whom the student is trying to communicate have no idea that the student has a hearing or vision loss. Misunderstandings can result when the student does not obtain the information he needs.
One strategy that works well to reduce these misunderstandings is to use a simple but individualized communication book. Laminated cards are prepared in bold print at a comfortable font size and can be used with dry erase markers for a variety of community and travel needs. A tiny flashlight can also be attached to the book for use in low light situations. By laminating the cards, they can be used and then erased repeatedly, and can last under different weather conditions. In cases where visual acuity does not allow for the use of large print cards, tactile labels using a highmarker or braille can be used.
In general, mobility programs at the graduate level focus on the needs of people who are blind and hearing. They offer little or no training for people with a hearing loss who also have vision problems. The mobility instructor who receives a deaf-blind referral may be intimidated by the communication barrier and not know exactly how to proceed. This is especially true in cases of Usher syndrome, Type 1 where ASL is the primary language and profound deafness prohibits receiving instruction through voice.
Without effective and fluent communication between student and instructor, a wide range of visual abilities and skills will be overlooked. Some of these are visual efficiency skills, problem solving skills, judgment in combination with scanning skills at street crossings, and the ability of the student to follow the pace and maintain the comprehension of a classroom dialogue.
If there is inadequate or unclear communication, students may be given a false sense of security and travel unknowingly at high risk. Poor communication can result in tragic consequences.
In cases of profound deafness where ASL is also the primary language of the student, the orientation and mobility instructor should ensure that a skilled ASL interpreter, preferably certified, is present during the evaluation and any subsequent training. The strengths, weaknesses, needs and potential of a student with Usher syndrome cannot be evaluated independently by any orientation and mobility teacher or vision specialist who does not share the language of the student.
Interpreters need information regarding sign methods for students with Usher syndrome and must learn about and be comfortable with tracking and tactile signing, both of which require touch. Interpreters should also learn the techniques of sighted guide and some basic mobility skills as well.
from Ilene Miner, CSW & Joe Cioffi, M. Ed.: Usher Syndrome in the School Setting
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www.tr.wosc.osshe.edu/dblink/usher-VII.htm
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