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Traditional orientation and mobility techniques and strategies often have little success with students who have multiple disabilities in addition to their visual impairment. We find ourselves working with children who may not walk or talk, children that may not even reach out and interact with their environment. The challenge is not choosing the most appropriate mobility technique, but being able to encourage any type of purposeful movement or effectively communicate with our student. Orientation and mobility, conventionally defined as a series of techniques and strategies to teach independent travel seems to have little to offer to these children, who may not be able to travel independently, at least in the immediate future. Many things that we used to take for granted, now have to be carefully planned and systematically taught.
The first step, of course,
is doing a good assessment, getting to know the student. Many children
with multiple disabilities, however, do not volunteer information, answer
questions or perform tasks upon request. Very often, these students will
work with familiar people, whom they know and trust, but not with strangers.
The new instructor may form the wrong impression that the student is not
capable of performing certain skills at all. We can work around this problem
by:
1- spending time with the
child building trust and rapport before we even begin the assessment process,
or 2- assessing the student along with somebody else with whom they already
have a trusting relationship.
Informal assessments, based primarily on observations of the child in different situations and settings, combined with interviews of family, teachers and significant others are typically the best way to go.
It is also very important to allow enough time for the child to respond, since it may take them longer to interpret our request, organize their response and produce it. If a response is produced, it may not be in the way of speech or some other communication system. We need to learn how to read gestures, slight changes in muscle tone or posture and different types of body language.
Even though the key to quality intervention is flexibility and creativity, we believe that children share some basic general needs that can guide our intervention and assist in our planning:
* THE NEED TO FEEL SAFE
Exploring the unknown can
be very frightening and threatening for many of our students. Only trust
and confidence in us and in their environment will allow them to reach
out and interact with it. It is important to begin instruction in familiar
places, paying attention to environmental factors such as lighting, level
of noise, temperature, etc.
If necessary, we can act
as a bridge between the child and objects in the environment, in such a
way that they touch through us, using our hands and body and, therefore,
do not lose their sense of security and protection.
* THE NEED TO COMMUNICATE
We often work with students
who are non-verbal or, for some reason, do not use any of the traditional
communication systems, such as sign language or augmentative communication
devices. It is in those cases that we need to work harder at discovering
in which ways the students are expressing their needs and wishes. Key people
to help identify and develop an effective communication system are those
who spend more time with the child than we do, such as the student's family
or the classroom teacher.
Daniela, for example, has
great difficulty vocalizing clearly but has good orientation and can perform
gross motor movements with her arms fairly efficiently. She uses her arms
to point in which direction (right or left) people should turn her wheelchair
on the way to the playground.
For Marcy, on the other
hand, it is easier to use facial expressions. She is severely physically
handicapped and developmentally delayed. She is non-verbal, but can clearly
communicate by smiling or remaining serious to questions that demand a
"yes" or "no" answer.
* THE NEED FOR CONTROL
Students with multiple disabilities, very often rely on others for most of their travel needs. They "miraculously" arrive where they need to be with little or no participation or understanding of the process that took place. Active involvement by answering questions and making decisions not only promotes participation and attention, but also allows them to make mistakes. Then, maybe for the first time, they can feel responsible for successfully arriving to their destination or, on the contrary, experience the consequences of getting lost. And what a functional situation to introduce basic problem-solving strategies! We may have to return to the starting point and retrace our steps, or look around for landmarks to regain orientation.
* THE NEED TO BE IN CONTACT WITH THE PHYSICAL ENVIRONMENT
Maintaining physical contact with the environment not only helps in concept-building and orientation, but it also provides a necessary sense of security. One of the basic orientation and mobility skills, trailing, can be adapted to allow children to touch their surroundings as they move about. Children with balance difficulties, for example, can trail as they walk with a modified sighted guide technique for extra support, or even from their wheelchair. Of course, they need to be close enough to walls and objects to be able to reach them with their hands or arms. If they cannot trail with their body directly, then an intermediary object can be used such as a favorite toy so that students get a feel for doors, openings, corners and other environmental features and landmarks. This strategy may work especially well with those students who are tactile defensive and refuse to use their hands for exploration.
* THE NEED FOR SOME TYPE OF INDEPENDENT MOVEMENT
Even for those who are not able to walk, there is always some type of movement they can perform independently. The floor is in general a good place to begin. Since motivation is critical to complete, or at least attempt a task, we need to find out what are the student's favorite places, things or activities so that we can incorporate them into our instruction. Some students are able to crawl or roll independently to their favorite areas in the classroom. We may need to keep distances short at the beginning and gradually reduce assistance and supervision, until independence is achieved as much as possible. They may also benefit from adapted mobility devices, such as motorized scooters to travel independently through familiar areas. Martin lies down on the board and leaves one foot and one hand in contact with the floor. Being so close to the ground provides him with a concrete sense of movement as he feels the floor beneath him or passes through different textures, such as carpet, tile, rubber mats, etc.
* THE NEED FOR CONSISTENCY AND ROUTINE
When more than one professional is involved in working with the student, in addition to the family or significant others, consistency becomes particularly important. It is necessary to get together as a team and decide on strategies to transition from one activity to another and even decide on the mobility routes we are all going to use on a daily basis. We must always talk to the students before we take them anywhere, as well as let them know exactly where they are going. Handing the student his or her cane, letting them touch the wheels of the wheelchair or stroller, putting their shoes on while we discuss with them the activities to come are some strategies that facilitate anticipation or transition to a new activity. Routines, once they are learned, become non-threatening, require less energy, and allow students to concentrate on new learning or enjoy interactions.
* THE NEED FOR MEANINGFUL MOBILITY:
When deciding on a new activity,
we should ask: is this activity meaningful to the student?, does it make
him or her more independent or in control?, is the task applicable to other
environments besides the classroom, such as the home setting or the community?,
is it appropriate for the student's age?, is it motivating and fun?
Planning meaningful activities
implies incorporating orientation and mobility into the student's daily
activities and games rather than bringing the student into a mobility class
that is taught in isolation of the rest of his or her life. If they enjoy
playing in the sandbox, for example, they can work on the skills involved
in getting there at a time when it is meaningful and functional.
In this way, an activity
that is meaningful for the child (playing in the sandbox) also becomes
functional when the student is actively involved in getting there.
As we said, there is no recipe for providing effective orientation and mobility to children with multiple disabilities. However, keeping these guidelines in mind, we can plan new and creative activities as long as the basic needs of safety, communication, control, contact with the environment, independent movement, consistency, and functionality are being carefully addressed. However, orientation and mobility is present in almost every activity, in every environment, from the moment the student gets up in the morning to the time they go to bed at night. The Orientation and Mobility instructor may not be able to accomplish much in a single 45 minute class, but there is a lot that can be done in a 45 minute meeting with the main people who are constantly in contact with the student. We have to learn to accept our limitations and, at the same time, learn to value the input and involvement of others who are in daily contact with this child. That means sharing our knowledge and experience as much as possible acting less alone and more as consultants and team members.