Developmentally Appropriate Orientation and Mobility Foundations of Developmentally Appropriate Orientation and Mobility Session 1 The Infants and Toddlers With Visual Impairments, 2004
Objectives After completing this session, participants will 1. define orientation and mobility as it applies to infants and toddlers with visual impairments. 2. describe the history of the field of orientation and mobility (O&M) and how it relates to infants and toddlers with visual impairments. Orientation & Mobility 1A
Objectives After completing this session, participants will 3. describe a developmental approach to O&M for infants and toddlers and their families, including family-centered practices, natural learning opportunities, and transdisciplinary teams. 4. describe components of early orientation and mobility. Orientation & Mobility 1B
Objectives After completing this session, participants will 5. discuss the roles of orientation and mobility specialists (OMSs) and teachers of children with visual impairments (TVIs) in facilitating sensory development and organization, cognitive development, motor development and movement, and assessment of infants and toddlers with visual impairments. Orientation & Mobility 1C
Objectives After completing this session, participants will 6. describe the relationship between attachment and mobility and strategies for promoting attachment and trust. 7. discuss the importance of and strategies for fostering independent movement and exploration in natural environments for infants and toddlers with visual impairments. Orientation & Mobility 1D
Objectives After completing this session, participants will 8. describe the importance of and strategies for providing opportunities for safe, unrestricted movement and exploration. 9. describe protective techniques for early travel and strategies to encourage their use. Orientation & Mobility 1E
Objectives After completing this session, participants will 10. describe different types of adaptive mobility devices and tools and ways to facilitate their use. Orientation & Mobility 1F
Definitions Orientation and mobility for young children are defined as follows: Orientation can be defined as knowing oneself as a separate being, where one is in space, where one wants to move in space, and how to get to that place (Anthony, 1993, p. 116). Mobility refers to motor development, including the normal integration of reflexes, acquisition of motor milestones, refinement of quality-ofmovement skills, and purposeful, self-initiated movement (Anthony et al., 2002, p.328). Orientation & Mobility 1G
History of Orientation and Mobility O&M emerged as a field and a profession in the late 1940s as rehabilitation for veterans who lost their vision during World War II. The first university preparation program for orientation and mobility specialists (OMSs) began in 1960 at Boston College. In 1962, the Vocational Rehabilitation Administration awarded grants to 22 states to fund OMSs. Joffee & Ehresman, 1997 Weiner & Sifferman, 1997 Orientation & Mobility 1H
History of O&M In the mid-1960s, the U.S. Office of Education began to sponsor university programs that prepared OMSs to work with children and youths with visual impairment. Young children did not receive O&M until the late 1980s, following the passage of PL 99-457 in 1986. Wiener & Sifferman, 1997 Orientation & Mobility 1I
History of O&M In 1997, special education laws were reorganized under the Individuals with Disabilities Act (IDEA). Part C of this act entitles infants and toddlers with disabilities to access to early intervention. In 1997, IDEA was also amended to include O&M as an early intervention service under Part C. In Part B, O&M is clearly defined as a related service for children with visual impairments ages 3 to 21 years. Orientation & Mobility 1J
History of O&M Initially, O&M techniques for adults and older children were modified for younger children. More recently, clinicians have identified early areas of development, such as object concepts, spatial relationships, body awareness, attachment, etc., that impact the development of O&M skills. This developmental perspective has helped to shape the actual definitions and program components of O&M for infants and toddlers. Orientation & Mobility 1K
Developmental O&M A developmental approach to O&M is based on the premise that the foundation for O&M skills is built during infancy and early childhood. O&M concepts and skills are developed in the child s home environment and community. OMSs need a solid understanding of early childhood development. Anthony et al., 2002 Orientation & Mobility 1L
Family-Centered Practices In order for early intervention to be as effective as possible, families must be involved. Families contribute unique information about their children s development, preferences, and needs. Developmentally appropriate and familycentered practices embrace diversity, use a transdisciplinary model of intervention, and value natural learning opportunities. Hatton, McWilliam, & Winton, 2003 Orientation & Mobility 1M
Natural Learning Opportunities Orientation and mobility intervention for young children should be embedded into the family s daily routines and activities. Family routines are valuable natural learning opportunities that promote the attainment of functional outcomes. Functional outcomes (desired goals based on family priorities) enhance children s development and improve the quality of life for children and families. Hatton et al., 2003 Orientation & Mobility 1N
Transdisciplinary Support A primary early interventionist, collaborating with other team members, provides direct support to the family. As required by Part C of IDEA (1997), the team should be comprised of individuals from various disciplines. Role release, a significant component of transdisciplinary support, is the sharing of expertise specific to the disciplines of other team members, including family members, and the undertaking of new roles while mastering specific skills. Hatton et al., 2003 Orientation & Mobility 1O
Components of Early O&M Developmental O&M programs for infants and toddlers should include the following components: sensory skill development, concept development, and motor development (including purposeful and self-initiated movement). Additional components for preschoolers include environment and community awareness and formal orientation and mobility skills. Anthony et al., 2002 Dodson-Burk & Rosen, 2002 Hill, Rosen, Correa, & Langley, 1984 Orientation & Mobility 1P
Components of Early O&M Anthony et al. (2002) recommend the following components: Orientation to expand children s body concepts, daily settings, and locations within each environment Mobility to encourage and refine independent movement (including the use of mobility devices) Purposeful Movement to reinforce children s reasons to move in different environments Environmental analysis for safety to assist the family and transdisciplinary team in analyzing natural environments, to ensure self-initiated and purposeful movement Orientation & Mobility 1Q
Sensory Development: Roles Collaborate with the family to ensure that proper medical evaluation of vision and hearing has occurred. Appropriately interpret eye care and audiological reports. Anthony, 1993 Orientation & Mobility 1R
Sensory Development: Roles Learn about all of the child s sensory abilities. Refine the child s ability over time to respond to and use sensory information based on mindful presentation of sensory information in everyday environments and daily routines. Anthony, 1993 Orientation & Mobility 1S
Sensory Development: Roles Assist the family and the early intervention team in implementing appropriate adaptations to optimize the child s sensory-based learning. Identify the types of sensory-based motivators that can be used to entice young children to move and travel effectively and efficiently. Anthony, 1993 Orientation & Mobility 1T
Cognitive Development: Roles Understand and explain the significance of cognitive development to the family and the transdisciplinary team, with particular attention to -body concept -positional concepts -cause and effect -imitation -spatial relationships -object concepts -means-end as related to motor development, movement, and orientation and mobility. Orientation & Mobility 1U
Cognitive Development: Roles Understand and explain the impact of blindness or visual impairment on early cognitive development and motor and movement development to the family and the team. Collaborate with the family and the transdisciplinary team to identify cognitive skills that will facilitate motor and movement development. Orientation & Mobility 1V
Cognitive Development: Roles Identify and introduce, with the early intervention team and family, strategies within daily routines that will facilitate cognitive development and lead to purposeful and selfinitiated movement in young children with VI. Orientation & Mobility 1W
Motor Development: Roles Collaborate with team members to develop understanding of the impact of blindness and visual impairments on motor development and movement. Suggest specific strategies to the team that will promote security, safety, and self-initiated, purposeful movement in young children. Orientation & Mobility 1X
Motor Development: Roles Collaborate with physical and occupational therapists to ensure optimal motor, sensory, and movement development through functional activities within the context of daily routines and natural learning opportunities. Orientation & Mobility 1Y
Roles in Assessment Involve the family and other members of the early intervention team in assessment. In accordance with Part C of IDEA, the assessment should involve at least two separate disciplines and include the family s priorities and concerns. Orientation & Mobility 1Z
Roles in Assessment Use a family-centered, routinesbased, and developmental approach for assessment and intervention based on knowledge about early childhood development and appropriate interpretation and application of O&M concepts and skills for infants and toddlers. Orientation & Mobility 1AA
Attachment and Mobility Secure attachment is believed to be related to the willingness of infants to venture out into the environment to explore and experience it. Infants early social-emotional responses elicit and maintain proximity and interactions with other people for protection and survival, and facilitate development in all domains. Warren & Hatton, 2003 Orientation & Mobility 1BB
Attachment and Mobility Social referencing provides children with the self-confidence to move and explore. Severe visual impairment may impede exploration and movement by making attachment more challenging, by possibly decreasing motivation to move out into the world to explore it, and by making it difficult or impossible to glance back at the caregiver (social referencing) during early exploration. Warren & Hatton, 2003 Orientation & Mobility 1CC
Promoting Independence Without the ability to visually monitor the environment, children with visual impairments may exhibit wariness. Families, caregivers, and interventionists of infants who are blind must be extraordinarily persistent in motivating their children to move out into the world. Often, families and caregivers also must overcome their own fearfulness and tendency to be overprotective. Lowry & Hatton, 2002 Orientation & Mobility 1DD
Promoting Independence Independence requires active involvement in a wide range of daily routines at home and in childcare centers (clean-up, meal times, dressing, etc.) Participation does not need to be complex it can be very simple and brief for young children. Orientation & Mobility 1EE
Promoting Independence Strategies to facilitate independence in daily routines include hands-on involvement with all materials; allowing children to help; encouraging reaching for nearby objects; orienting children to small areas of the room; and setting up play spaces with objects in predictable locations. Lowry, 2004c Orientation & Mobility 1FF
Promoting Independence Strategies to facilitate independence in daily routines include arranging furniture, equipment, and toys in stable and predictable locations; providing adult-mediated play with opportunities for self-initiation and choice making; using short miniroutes to move into and out of motivating daily routines; and receiving support from an OMS. Lowry, 2004c Orientation & Mobility 1GG
Precautions Opportunities for unrestricted movement and play, however crucial to development, present greater challenges when children are not able to visually monitor obstacles and other hazards. Simple precautions should be taken, not only to offer greater safety for children, but to provide ease of movement and to reduce stress. Lowry, 2004d Orientation & Mobility 1HH
Facilitating Ease of Movement Provide appropriate supervision while respecting children s independence. Keep furniture, equipment, and other landmarks in predictable locations. Keep travel paths clear. Use simple verbal cues to alert the child to the presence of an upcoming obstacle. Lowry, 2004d Orientation & Mobility 1II
Facilitating Ease of Movement Reposition or remove low-lying and head-high obstacles. Offer extra supervision outdoors. Add foam padding temporarily to sharp edges. When appropriate, use a modified guide technique that involves having the child hold onto the adult. Lowry, 2004d Orientation & Mobility 1JJ
O&M Mobility Techniques Hand searching represents goal-directed reaching at its best. In infancy, encouragement and opportunities to reach for toys from all postures help to prepare children for more extensive searching later on. Postural readiness and cognitive skills will determine when the infant is able to search. Orientation & Mobility 1KK
O&M Mobility Techniques Trailing involves lightly following walls or furniture to move from one point to another. It is important for verifying orientation through recognition of a known landmark, moving a short distance efficiently from one point to another, and locating a specific landmark, object, or access. Orientation & Mobility 1LL
O&M Mobility Techniques Upper body protection is used to avoid injury above the waist while walking. It is especially helpful for use in less familiar areas and with children who have just started walking. Anthony et al., 2002 Orientation & Mobility 1MM
O&M Mobility Techniques Guide technique is a method of physically guiding the child when walking together, while providing the child with a greater sense of responsibility and control. Anthony et al., 2002 Orientation & Mobility 1NN
Mobility Devices Pushcarts and other commercially available push toys may help to develop concepts that will transfer to long cane use later on, such as use of a tool to gather information about the environment, use of an intermediate object to protect, and how to plan motor correction around obstacles. Anthony et al., 2002; Clarke, 1988 Lowry & Hatton, 2002; Skellenger & Hill, 1991 Orientation & Mobility 1OO
Mobility Devices Adaptive mobility devices (AMDs) are tools with special modifications designed to meet the needs of children who cannot easily use the traditional long cane. Some of these include prescriptive single and double handles, wheels, and other auxiliary roller devices to improve ease of movement. The basic AMD is made of PVC pipe and is rectangular in shape. Anthony et al., 2002; Farmer & Smith,1997 Foy et al., 1991; Lowry & Hatton, 2002 Orientation & Mobility 1PP
Mobility Devices AMD advantages Designed to be used with two hands, offering protection with minimal cooperation and effort When well designed, is easy to use and therefore can often be introduced to younger children Many children seem to enjoy an immediate sense of protection and freedom. Offers a greater arc of protection than typical preschool cane use Lowry, 2004a Orientation & Mobility 1QQ
Mobility Devices AMD disadvantages Use of two hands not very compatible with trailing Awkward to use in crowded or narrow spaces Unsafe for use in ascending or descending steps Difficult to use over many outdoor surfaces Presents greater storage difficulty Lowry, 2004a Orientation & Mobility 1RR
Mobility Devices Long cane advantages Frees up one hand to trail, locate objects, place hand on railing, and confirm orientation Provides early experience with the actual device that will be used later More easily used safely on steps Easy to store Lowry, 2004a Orientation & Mobility 1SS
Mobility Devices Long cane disadvantages Requires more mature attention and motor skills to keep the device in front With typical preschool use, tends to leave broad areas of body unprotected More likely to tempt use as a weapon More challenging to introduce to younger and orthopedically involved children Lowry, 2004a Orientation & Mobility 1TT
Readiness for Mobility Devices The OMS, the TVI, the family, and other team members should consider several factors in determining when to introduce a device. Does the child walk with good stability and hands held at waist-level or lower? Does the child show interest in the device? Lowry, 2004b Orientation & Mobility 1UU
Readiness for Mobility Devices Is the family supportive and accepting of the device? Does the child understand cause and effect? Can the child maintain grasp of the device without assistance for a significant period of time? Lowry, 2004b Orientation & Mobility 1VV
Readiness for Mobility Devices Does the child s inability to visually detect obstacles and drop-offs indicate the need for a mobility device? Does the child spend time regularly in a setting appropriate for use of a device, i.e., settings other than the home, such as a childcare center, mall, department store, supermarket, church building, etc.? Lowry, 2004b Orientation & Mobility 1WW
Introducing AMDs or Long Canes Give the child plenty of time to explore the device. Sit down with the child and tell her that you brought a new device to help her when she walks. Tell her the name of the device (e.g., cane, AMD). Sapp, 2004 Orientation & Mobility 1XX
Introducing AMDs or Long Canes Tell her that she will get to walk with it in a little while, but first you are going to look at it while sitting down. Remind the child that she cannot swing the AMD or cane, because she might hit someone. Hand the child the AMD or cane and give the child plenty of time to explore it. Sapp, 2004 Orientation & Mobility 1YY
Introducing AMDs or Long Canes The child may choose to feel it, look at it, smell it, or even taste it. As the child is exploring the device, name the different parts. Some children may want to name their devices just as they name stuffed animals. Sapp, 2004 Orientation & Mobility 1ZZ
AMDs: First Lessons Most children will need several simple lessons to begin using the AMD. These lessons should involve a motivating goal to reach and a short, clear path to the goal. Some lessons may only last a few minutes due to the child s short attention span. Sapp, 2004 Orientation & Mobility 1AAA
AMDs: Advanced Lessons Once the child is able to use an AMD to travel a cleared path, you can begin teaching the child more advanced skills, such as obstacle detection, drop-off detection, and trailing. Sapp, 2004 Orientation & Mobility 1BBB
Parent Involvement Encourage parents to become involved in their child s AMD lessons. Encourage parents to provide children with daily opportunities to practice in appropriate environments. If parents are resistant to allowing the child to use the AMD, ask them to identify one time each week when the child can practice with the device. Sapp, 2004 Orientation & Mobility 1CCC
Long Canes: First Lesson Most children will need several lessons to practice on short, clear paths with their cane. Hard floor surfaces and mushroom or ball tips will help the cane to slide more easily than carpeting or pencil tips. During this practice, stress two issues with the child and the parent: (1) keeping the cane in front of the child, and (2) keeping the cane tip on the ground. Sapp, 2004 Orientation & Mobility 1DDD
Long Canes: Advanced Lessons Many children can begin learning more advanced cane techniques at very early ages, including obstacle detection, drop-off detection, and trailing. They might not fully master these skills until preschool or elementary school age. Sapp, 2004 Orientation & Mobility 1EEE
Parent Involvement Some children will be ready to use a cane with their families as soon as it is introduced, while other children will require several instructional sessions with an OMS before they are ready to use a cane with their parents. If a child is allowed to use a cane improperly even for a short time, it can be difficult to relearn correct cane position. Sapp, 2004 Orientation & Mobility 1FFF
Transitioning: AMD to Long Cane Some children learn to use an AMD and a long cane simultaneously with frequent opportunities to choose which one to use. Other children, especially those with additional disabilities, use an AMD for months or even years before beginning to use a cane. Some children begin instruction with a long cane with no experiences with an AMD. Sapp, 2004 Orientation & Mobility 1GGG
Transitioning: AMD to Long Cane When a child is transitioning from using an AMD to using a long cane, it is important not to assume that the child will automatically generalize skills from one device to another. Begin by introducing the cane as described earlier and then move through initial and advanced lessons. Sapp, 2004 Orientation & Mobility 1HHH