About Orientation and Mobility
Orientation and Mobility is about knowing where you are so that you can get where you want to go and travel there safely.
O&M
specialists work with people of all ages, who are blind or
vision-impaired. We offer training in the use of mobility aids,
orientation to the environment, realistic assessment of limitations,
vision education and development of sensory awareness.
We equip
clients with the skills and concepts they need to move safely and
confidently through their environment, be it moving from the bed to the
toilet during the night, getting to school, catching a train and a bus
to get to work, going bushwalking or taking a world tour.
The Orientation and Mobility profession makes more sense if you first understand a little about vision impairment.
Vision Impairment
Vision
gives us quicker feedback about the world than our other senses (such
as hearing, touch and balance), enabling us to respond promptly to what
we see. It is vital that we seek medical advice immediately if we sense
visual changes. When all possible benefit has been gained from medical
intervention or glasses, further assistance is available through
orientation and mobility intervention. Low vision education and
training is part of any O&M program – the client learns how to use
their remaining vision to best effect, as well as becoming more skilled
in interpreting what they hear, smell and touch.
Causes of vision loss
Vision
impairment may be present at birth (congenital), or may occur later in
life from disease or accident (adventitiously). The five most common
vision impairments are cataracts, glaucoma, diabetic retinopathy,
macular degeneration and retinitis pigmentosa, but there are many more
conditions which cause vision impairment, or which have visual changes
as just one of their symptoms.
Brain damage, rather than eye
damage, can cause visual changes. The optic nerves run from the eyes
through the middle of the brain to the occipital lobe at the back of
the brain. From there, messages are sent to specific areas in the brain
which help us to make sense of what we see. Brain damage can restrict
visual fields, but the person’s ability to perceive the world may also
be affected. In addition to vision and perception, brain damage can
impinge on the person’s ability to think, feel, hear, speak, move,
balance or walk.
Vision loss does not necessarily end in
blindness. In fact, about 90% of clients referred for O&M
intervention have some useful vision. See Links if you would like to
find out more about normal vision and vision impairment.
Measuring vision
O&M
Specialists use information gained by eye specialists during clinical
vision assessment as well as making their own assessment of the
client’s functional vision.
Clinical Vision Assessment
The
optometrist, ophthalmologist or orthoptist will measure vision in terms
of visual acuity and visual fields. Other tests include contrast
sensitivity, colour perception, ocular motility and light/dark
adaptation.
Visual acuity (clarity) is measured clinically with
an eye chart, and is expressed in a fraction. 6/6 vision is considered
normal. This means that the client can see at 6 metres what a person
with normal vision can see at 6 metres. Acuities of 6/120 mean that the
vision-impaired person has to come as close as 6 metres to see what a
person with normal vision can see at 120 metres. Glasses, medication,
surgery or use of appropriate lighting may make a significant
difference for clients with loss of acuity.
Visual fields (area
seen by each eye) can be tested electronically or manually. In either
case the client keeps their eyes still, usually fixed on a point
directly ahead, and reports when they see a target moving in from the
side. Clinically, the target size can be controlled and adjusted. Areas
of occlusion (missing vision) are noted on a field chart. Normal vision
gives us approximately 180° of visual field.
Someone with tunnel
vision may have, for example, central fields of 30°. Blotchy field loss
is more difficulty to measure accurately, because the edges of each
area of occlusion need to be identified separately. O&M Specialists
tend to find that the results of a careful manual field test (eg,
Goldmann or Bjerrum) concur better with their functional vision
assessment than a computerised perimetry test. Glasses, medication and
surgery will not usually correct a visual field loss. Instead, the
client needs to learn to compensate for their visual field loss by
learning to use their residual vision to best effect. Orthoptists and
O&M Specialists can help to teach these compensatory skills.
Legal
blindness does not necessarily mean blindness. It is a clinical measure
of vision used to determine whether a vision-impaired person is
eligible for a pension. Best corrected visual acuity of less that 6/60,
or a visual field of less than 10° in the better eye or a combination
approved by a medical specialist are the criteria for legal blindness
in Australia. A person may be legally blind and unsafe to drive, yet
have excellent residual vision for safe road crossings and independent
travel on foot.
If a client is regaining their vision and wishes
to return to driving, the O&M Specialist can give an indication of
readiness for driving assessment, but the assessment itself is
conducted by an Occupational Therapist.
Functional Vision Assessment
Orientation
and Mobility Specialists are knowledgeable about vision impairment. We
deal with clients outside the clinic, usually in their familiar
surroundings. We like to have the client’s most recent clinical vision
report before commencing a program, but it is not unusual to find that
the client functions quite differently in their own environment from
what their clinical vision report would suggest. Some clients with very
low vision cope well functionally. Some clients with a lot of residual
vision, function as if blind outside the clinical setting.
Functional vision assessment may include:
- Confrontational
field test – The client fixes their eyes on the tester’s face and
reports when they see the tester's fingers coming into view.
- Print
assessment – establishing what print size, if any, the client can read
at home or out in the street (eg, phone book, newspaper, large print
texts, headlines), giving a rough idea of acuity.
- Scanning strategies for paperwork, in the home, on the footpath, and at road crossings.
- Acuity
for detecting traffic – How far away is the car before you can see it
(also considering the colour of the car and speed of approach).
- Acuity in different light – fluorescent and incandescent lighting, bright, sunny, dull or glary conditions.
- Contrast perception at home and outdoors – are there specific colours or contrasts that work best for the client?
We
find that a client’s vision may fluctuate from day to day. The time of
day, medication, blood sugar levels, fatigue, anxiety, concentration,
weather and lighting conditions all have an impact on how well the low
vision client sees at any one time. This can be frustrating for the
client, and makes it difficult for others to understand how much the
client can see.
During O&M intervention, the O&M offers
vision information to the client, and where appropriate, the client’s
family, teachers or class, to equip the client to explain to others
what they are seeing and why.
The Process of Intervention
Referrals
You
don’t need to be referred by a doctor to see an O&M Specialist.
Many clients refer themselves, and family members contact the O&M
service provider. Referrals also come from optometrists and
ophthalmologists, occupational therapists, physiotherapists, visiting
teachers, counsellors, hospitals and nursing homes, schools and
kindergartens. It is important that the vision impaired person knows
they are being referred, and why. Who are your local O&M service
providers?
Assessment
Some
agencies have a central person who conducts all initial interviews to
determine which services each client is likely to need. At other
agencies the O&M Specialist will conduct the initial assessment.
O&M
assessment involves gathering information about the client’s vision,
hearing and general health, lifestyle and mobility goals, going for a
walk with the client in their local area and doing some functional
vision assessment. This information equips the O&M Specialist to
establish some objectives with the client. The O&M and client then
work together to achieve these goals.
Training
O&M
Specialists usually work one to one with their clients. An O&M
program may be as short as one session or may continue for several
months. In one session, the O&M Specialist can provide information
to the client about their vision impairment and mobility options, but
long cane training, for example, will take much longer. Many clients
come back for subsequent training programs when their current skills
are consolidated.
Work proceeds at a pace which suits the
client, and the O&M is able to respond to incidental issues as they
arise. Sometimes an O&M Specialist will work with a small group of
clients who have similar needs. The clients learn from each other as
well as from the O&M, but this style is an adjunct to
individualised training, not a substitute for it.
There is no
generic O&M curriculum, however there are many excellent programs
and resources which address specific mobility needs (such as long cane
training). The O&M Framework gives the big picture of orientation
and mobility – the building blocks of independent travel. Each O&M
Specialist has their own style, along with a wealth of strategies and
skills, and tends to become more specialised in some areas of the
O&M Framework than in others.
Follow-up
Because
O&M focuses on independence, the O&M Specialist does not
usually aim to have ongoing contact with the client. Instead, a
training program will equip the client with a set of skills, then the
O&M Specialist leaves the client to implement these skills in the
course of their everyday life. Sometimes an O&M will arrange a
follow-up visit at a fixed time after the completion of training to
review skills. Otherwise the onus is on clients to re-refer themselves
when they are ready to learn more.
Independence
Independence
is the goal of most O&M intervention. New skills are developed with
the O&M Specialist close at hand. When the client gains confidence,
the O&M draws back a little, giving room for independent
decision-making and travel under supervision. Solo travel is only
attempted when the client and the O&M Specialist are both confident
that it will be successful, and is generally reviewed together
afterwards. Independence is considered more valuable in some cultures
than others.
Interdependence (relying on each other) works
better for some clients. If there is always someone available to assist
the vision-impaired person with safe mobility and activities of daily
living, the impact of vision loss is lessened. O&M training equips
the vision-impaired client to make choices about how they wish to move
around. This can give the client confidence, greater self-esteem, and a
sense of freedom, even when most of their travel is in the company of
others.
Safety is the greatest concern during vision-impaired
travel. Obstacles, road crossings, getting lost and wading through
crowds can all make a short trip out seem daunting. Many
vision-impaired people choose to stay at home rather than risk
independent travel. O&M training can help the vision-impaired
person find their own boundaries: to know what is safe for them to
attempt independently and when they need to ask for help.
O&M Clients
Two
clients of the same age, with the same degree of vision impairment will
function quite differently. Why? Because their upbringing, life
experiences, attitudes to change, level of support, confidence, fears,
interests and motivation are different. There is no reason why they
should be the same. This is why O&M training is tailored to suit
the needs of the individual client.
A congenitally blind client
is likely to need more frequent and more intensive O&M intervention
throughout their childhood to grasp the concepts necessary for
independent travel, which they cannot learn by observation. Yet once
they can walk, many blind children are surprisingly confident in moving
around familiar areas, even without a mobility aid. Clients who lose
vision later (adventitiously) tend to have less difficulty with spatial
concepts because their visual memory is intact. However their ability
to move confidently through their environment varies enormously.
Multiple Impairments
In
addition to vision impairment, some O&M clients also live with a
complex range of issues such as spasticity, hemiplegia, impaired
balance, hearing loss, autism, learning delays or communication
difficulties. These issues may have been present since birth, or they
may be due to disease or brain injury.
Acquired Brain Injury
ABI
can be caused by stroke, car accident, disease, hypoxia or substance
abuse and frequently results in visual changes. Neurological (or
cortico-spatial) vision impairment may involve visual field loss, but
it can also involve changes in perception. While a straightforward
field loss can be compensated for with scanning techniques (low vision
training), perceptual changes are more complex. Acquired brain injury
can impact on other functions too, such as memory, balance, insight,
stamina, thinking, planning, decision-making, understanding of spatial
information, communication and hearing. Neuro O&M Specialists have
undertaken further study into the anatomy and function of the brain and
the cognitive, emotional and perceptual changes which commonly result
from brain injury.
The O&M Specialsit may be available to
work intensively with multi-impaired clients, one to one. However, if
it takes a long time to develop rapport with the client, the O&M
may act as a consultant to the teachers, family, therapists or support
staff who know the client well and can work with them on the concepts
and skills necessary for mobility.
Early Intervention
Early
O&M intervention (birth to age 5) provides parents with support and
information about their child’s vision impairment and equips them to
work most effectively with their child. It helps to fill the conceptual
gaps in the child’s understanding of the world. It stimulates the child
to initiate movement. A fully sighted child learns about object
permanence in the first months of life by watching his parents and his
environment, then checking and re-checking his observations. The
vision-impaired child does not have this advantage. Lilli Nielson
suggests that if the child is unsure of the existence of the world
around him, he will certainly not brave moving through it.
Role of Parents
Parents
of vision-impaired children need support: people who understand what it
is to have a vision-impaired child, who will listen to the parents’
experiences and feelings, who can give some realistic idea of what the
parents’ and the child’s future may hold. A social worker,
psychologist, priest, friend, or parent of another vision-impaired
child may help in this support role.
Parents of vision-impaired
children need to be observant. This is difficult if you don’t know what
to look for, but watching and noting the child’s responses to a range
of life experiences equips parents to work effectively with therapists
and others involved. Some parents find it helpful to keep a journal
about their child, to note behaviour that needs attention or
explanation as well as to help highlight the child’s gains over a
period of time. Try doing some household tasks under blindfold to keen
your senses and make you more observant about life with less vision.
Get down onto the floor regularly to see life from the child’s
perspective.
Parents of vision-impaired children need to work
for their child. They need to research the support services available
in their area and make contact. Wherever possible, they need to explain
each new environment to the child and allow time for exploration with
hands and bare feet. They need to give the child commentary on family
dynamics, emotions and body language. They need to question and test
their own assumptions about what the child knows and understands. They
need to allow their child to take risks, make mistakes and learn from
them, and this may take more energy than being protective.
School-age Children
School-age
children (5 to 18) undertake O&M training during school hours,
after school or during the holidays. The focus and length of the
program depend on the child’s age, maturity, social needs and level of
vision impairment. Regular O&M intervention through the school
years helps to ensure that the child develops the necessary skills and
concepts for each new stage of their life.
Some children need
many intensive programs, such as long cane training, orientation skills
or concept development, while others need only one or two O&M
sessions per year, such as road safety for bike-riding, to update their
skills. O&M intervention is most effective when the O&M
Specialist works closely with parents, teachers and other therapists
involved in the child’s program, and all help to reinforce the new
O&M skills. Many O&M Specialists are finding the 6 step method
to be an effective approach with children.
Adults
A
client who discovers O&M services well after the initial onset of
their vision impairment may already have worked out strategies that
help them to cope. Consultation with an O&M Specialist may simply
confirm that these strategies are adequate and working well. On the
other hand, O&M intervention may help them to understand their
vision impairment better and explain it to their friends and family. It
may help to reassure the client’s partner of their ability to move
around independently. It may make them more aware of safety hazards,
equip them to cope with the unexpected during travel and stretch the
boundaries of what they thought was possible with a vision impairment.
Some
clients know about O&M but feel that their vision is not bad enough
yet to apply for assistance. This is particularly common among clients
with deteriorating conditions such as retinitis pigmentosa, where the
central vision is intact with good acuity, and the client can read well
and move around safely. O&M does not automatically imply long cane
training. O&M intervention can equip you to be more systematic when
moving through traffic, sharpen your listening skills and establish
safe mobility habits. These skills are quicker and easier to learn with
vision than without and can be refreshed later as the need arises. When
vision is deteriorating, early O&M referral may help to ease some
of the anxiety associated with vision loss.
When vision
impairment is new and grief is raw, O&M intervention may need to be
delayed until the client feels more ready to undertake something new.
Learning doesn’t happen unless the client is ready. On the other hand,
many of our clients come away from their last appointment with the eye
specialist having been told there is nothing more which can be done for
their vision. While this may be true medically speaking, it is not
necessarily so functionally. There are many strategies that help the
client to make the most of what vision they have. If vision loss feels
frustrating and disempowering and the client wants to do something
about it, O&M training may be just the thing. Contact your local
O&M service provider.
Orientation and Mobility Framework by Lil Deverell
It
can be difficult for an outsider to grasp what orientation and mobility
involves. Even clients who have received extensive intervention over
many years will not have needed input from all possible areas of
O&M expertise.
The O&M Framework, developed by Lil
Deverell, defines the building blocks of independent mobility from
birth and in doing so describes the breadth of the Orientation and
Mobility profession. Skills and concepts are organised into ten fields;
items are listed sequentially where appropriate.
1. Self and Sense
2. Social Interaction
3. Thinking & Problem Solving
4. Safety
5. Route travel
6. Traffic
7. Exploring
8. Locations
9. Mapping
10. Mobility aids
The Framework is not intended to function as an O&M curriculum, however it can be used as:
- A
tool for referees such as teachers, family members and health care
professionals, to identify the issues that can be addressed through
O&M intervention.
- A checklist for use during support team
meetings when developing an individual program plan for a client.
Remember, not all items in the framework are applicable to every
client. Some clients will already have attained competency with the
skills and concepts listed.
- A means of ensuring that children
receive a systematic approach to their O&M intervention through
their childhood, equipping them for future independent mobility, while
still addressing their more immediate O&M needs. Items can be
chosen from each field, each year to ensure a balanced approach.
Parents may like to use the framework to focus their efforts with their
child at home, in conjunction with O&M intervention.
- A
prompt for O&M Instructors to work with the whole client, not just
focus on one aspect of training, such as mobility aids or road safety.
- A
reminder of the concepts and skills that support the client’s current
mobility goals. When the client is struggling to learn and not
progressing, more basic concepts and skills can be checked and reviewed.
You
can copy and paste this O&M Framework and reproduce as necessary,
providing acknowledgement is given to the author, Lil Deverell.
O&M Programs
O&M Programs hone in on whatever skills are most needed at the present time while taking into consideration the client’s future mobility needs. Children’s O&M programs include more exploration and concept development. Adult programs tend to focus in on specific route travel and aid training. O&M programs may involve:
Low Vision Training
Independent Travel Skills
Concept Development
Mobility Aid Training
Consultancy
Low Vision Training
Only about 10% of our clients are blind. The rest have some degree of residual vision and even ‘light perception only’ can be useful for independent mobility. Before undertaking a low vision program, the O&M Instructor needs an accurate clinical report of the client’s visual fields, acuity, contrast perception and eye movements. Low vision clinics are one of the valuable resources offered by many O&M service providers.
When vision impairment occurs, it is easy to focus on what has been lost rather than what vision is remaining. During low vision training, the O&M Instructor works with the client on scanning strategies, posture and identification of what is seen in controlled indoor settings. Often with time and patient guidance, the client learns to make more sense of what they see. When they are ready, they use these skills while moving around indoors before trying outdoor travel. The focus of a low vision program is on the use of vision as a mobility tool. Combining residual vision with hearing, walking and where appropriate other mobility aids, takes a good deal of concentration initially, but can become second nature with practise.
After a stroke (brain injury), compensatory scanning training can help a client with visual field loss to be more aware of their deficit field. Clients who have central vision loss may benefit from eccentric viewing training – learning to use the areas of good vision closest to the occluded area. Tracking skills are helpful when trying to interpret traffic patterns.
Independent Travel Skills
By "travel" we mean walking, crawling, cycling, using public transport – in fact whatever helps us to get from point A to point B. Independent travel skills enable us to move safely, confidently and purposefully through the environment. This is undoubtedly more exhausting for the vision-impaired person than the fully sighted person. It requires concentration, attention to detail, self-awareness and extra time. Many vision-impaired travellers need O&M intervention to develop the necessary skills for the route travel they wish to undertake.
6 Step Method
Grant Brannock and Leo Golding have developed a strategy for teaching travel skills which many O&M Instructors are finding effective. The O&M client learns to use the following questions to frame any route travel they undertake. This method equips the client with a strategy they can then transfer independently into new environments.
Where am I now?
Where am I going?
How do I get there?
What are the nearby considerations?
Evaluation – how did I go?
Say the route – can I explain what I did to someone else?
Travel Goals
Here is a sample of fictitious clients who need to work on their independent travel skills:
Avoiding obstacles
Jack (73, diabetic retinopathy) likes to tinker in his shed, but he is getting bruises from bumping into doors, workbenches and tools.
Eric (67, brain injury, field loss) collides with street furniture (sandwich boards, poles, rubbish bins, awnings, phone kiosks) when he goes down to the shops.
Carol (25, patchy vision) works in the CBD and has to weave through crowds to get to and from work, and at lunchtimes.
Helen (32, low vision) walks her daughter to kindergarten in the mornings, but the council are digging up the footpath on her block.
Traffic
Frank (55, low acuities) has to wait for 20 minutes to cross a side road, because there never seems to be a quiet gap in the traffic. He needs to work on his listening skills.
Jen (43, low acuities) feels and looks unconfident at roads. She can see the cars but not the drivers who often try to wave her across the road.
Con (64, perceptual changes) can cross a quiet road safely, but at a major intersection, he can’t work out where he needs to look. There are traffic lights, islands, slip-lanes, tramlines and constant traffic as well as eye catching signs.
Sally (12, light perception only) has been using her long cane at school and when she is with mum. She is ready to learn about road crossings.
George (35, low vision) has been veering into the middle of the intersection since the pram ramps on the corner were replaced.
Orientation
Vic (82, walking frame, low acuities) has moved into a nursing home and needs to get to the dining room for his meals three times a day.
Jack (6, congenitally blind) manages OK indoors using echo location, but outdoors he keeps veering and getting lost. He needs to learn straight-line travel skills.
Ngairi (13, cerebral palsy, low acuities) has been made a message monitor in her class. She must find her way from her classroom to the school office and back independently.
Feliz (11, blind) has started playing imaginary games with blocks. She is beginning to understand the relationship between a model and reality, and is ready to learn about tactile maps.
Public transport
Harold (78, visual field loss) used to visit his wife daily in her nursing home. Since his stroke he can no longer drive. He wants to go by bus, but is has been 53 years since he caught a bus!
Kiri (16, low vision) is ready to catch the train home with her friends rather than being picked up by her mum after school.
Rural travel
Genevieve (39, long cane) lives on a bush block with an 800m gravel road to her mailbox at the front gate.
Paul (23, low vision) lives on a farm. He helps to round up sheep for the sales, but can’t see the barbed wire fences.
Ann (52, low acuities) goes camping with her extended family every summer. Since her vision worsened, she is unsure how she will cope.
Joey (12, low vision) lives in an isolated community with unsealed roads and paths.
Safety & social skills
Kev (19, long cane) wants to join his mates in town and go to pubs and night-clubs.
Sonia (28, low vision, multi impaired) has learned the way to her local shops, but she has no sense of danger. Her parents are concerned that she is likely to go off with anyone who asks her.
Maria (59, central vision loss) has decided she is not safe to go out on her own because her vision is failing, but she is feeling lonely and isolated at home.
Betty (52, night blind) goes to her bridge club on Tuesday evenings, but has difficulty managing her front steps and getting out to the taxi in the dark.
Concept Development
Concept development is usually delayed in children with vision impairment. Those who have been blind since birth have never had the opportunity to learn by observation. Even children with minimal vision loss may need to have things explained and demonstrated which others learn simply by watching.
Spatial concepts such as over, behind, left, right, circle and alongside are common in everyday speech. Children use these words in context, yet may not understand what they mean during movement. Corners, ceilings, picture rails and manholes do not necessarily exist in the child’s mind unless pointed out and explored. Environmental features such as stormwater drains, power lines, roofs, house numbers and road signs are obvious to sighted people, but need further explanation and investigation by vision impaired children to create a more complete mental picture of the world. The O&M Framework gives an idea of how concepts are built up to facilitate independent mobility.
Concept Assessment
During concept development programs, there are three criteria which indicate whether a concept has been grasped (Mark Battista, 2002):
The client can verbalise the concept. Using the same vocabulary is essential if the Instructor is to recognise when the client reaches understanding of a concept.
The client can demonstrate the concept. This enables the Instructor to see what the client understands by the words being used.
The client can abstract (transfer) the concept. This demonstrates that the concept, rather than a situation-specific instruction, has been grasped.
Age Appropriateness
While it is important to consider age-appropriateness when choosing learning experiences for a client, this approach may not ultimately be helpful if the client hasn’t yet developed the concepts and skills to support age-appropriate behaviour and goals. When a child is showing difficulty learning a particular concept, the O&M Instructor returns to familiar and known concepts, reinforcing these again before moving on to extend the child.
Concept development work is not restricted to children. Often adults who have been vision-impaired for a long time, find and fill gaps in their understanding of spatial and environmental concepts during the course of O&M training.
Mobility Aid Training
Primary mobility aids are necessary for people with very low, or no vision. A primary mobility aid gives information about the surfaces ahead or helps the client to avoid pitfalls and obstacles. Options include a mobility cane, guide dog, or receiving help from another person as a sighted guide.
Secondary mobility aids complement residual vision and help to make travel smoother by offering glare protection (hat and sunglasses), optimising visual acuity (ocular or video telescope), giving electronic warning of obstacles (mini-guide) or identifying the client as vision impaired (identification (ID) cane).
Sighted Guide Skills
The sighted guide technique is a discreet way of a vision-impaired and sighted person walking together. The vision-impaired person walks a little behind and to one side of the guide, gripping the guide’s arm just above their elbow. In this way, the vision-impaired person can let go if he or she doesn’t feel safe. The guide’s job is to navigate them both through spaces that are wide enough for two.
Canes
White canes come in 3 varieties.
The long cane takes quite a while to master, but gives the traveller feedback about the ground ahead and helps with obstacle avoidance. Every time the long cane contacts the ground, the client can feel vibrations through the shaft and grip of the cane. Practise tells the difference between grass, concrete, asphalt and dirt, stairs and curbs, trees and legs. Long cane tips may be straight, rounded, rotating or bent, depending on the surfaces to be travelled and the physical requirements of the client. Although the long cane is a signature aid of the O&M profession, it is not necessarily an appropriate aid for many of our clients.
The white ID cane is suited to people who can see well enough to avoid falling down stairs or tripping over obstacles, but who nevertheless feel safer if onlookers know they are vision-impaired. The ID cane is lightweight and is not intended for use in contact with the ground. Some clients use their ID cane at all times. Others use it only for road crossings or unfamiliar areas. It may be folded and stored away when the client is travelling in a familiar area or having a ‘good vision day’.
A support cane can help when balance is affected by the loss of vision. White is used to identify the client’s vision impairment and to maximise their visibility. If there is any question of imbalance being caused by issues other than vision loss, the O&M Instructor will usually advise a physiotherapy assessment.
Electronic Aids
Electronic aids can help to enhance residual vision (Visable Video Telescope), detect obstacles and openings (mowat sensor, mini-guide, sonic pathfinder) or give information about orientation (global positioning systems).
Wheels
Some clients are restricted in their movement because of poor health, low muscle tone, balance issues or hemiplegia in addition to their vision impairment. O&M Instructors work with clients who have electric and manual wheelchairs, walking frames and electric shopping carts. Consultation with a physiotherapist can confirm whether a client is using the most appropriate aid. Liaison with various agencies to improve wheelchair access in the community may also be part of the mobility program.
Bike safety programs help to ensure that the vision-impaired cyclist is using their residual vision to best effect and observing the road rules. An O&M Instructor can help the cyclist to work out the safest routes considering the limitations of their vision.
Public transport should not be overlooked as a mobility aid. Clients who have driven a car until recently often have limited experience using public transport and can benefit from training in the use of timetables, route maps and access options.
Guide Dogs
A guide dog is an appropriate mobility aid for a client with very low vision, who likes dogs. General O&M training usually precedes guide dog training and ensures that the client is physically fit and is travelling independently on 3-5 different routes before receiving their dog. Dogs are individually matched to the client’s needs. It takes around 4 weeks to train to use a guide dog, followed by a process of transfer and consolidation of skills in the client’s home environment. The client’s skill in handling their dog is what maintains the dog’s training, so maturity is essential to the success of the client/guide dog team.
Most Guide Dog Instructors in Australia and New Zealand are dual qualified as Orientation and Mobility Instructors. This equips them to be perceptive about the client’s vision, health and independent travel skills which inevitably affect the work of the client/guide dog team.
Consultancy
The O&M Instructor advocates for their client when appropriate. This may involve requesting that overhanging trees be cut back, white contrast strips painted on the steps of a public building, or finding a case manager or companion volunteer for the client.
Sometimes O&M Instructors are consulted about building modifications, ticketing systems, road crossing design or the placement of tactile ground surface indicators, which can maximise access for vision impaired people in schools, railway stations and shopping centres.
We offer training to community service providers such as railway staff, tour guides and flight attendants who need to deal with vision impaired people in the course of their daily work.
We conduct workshops on vision and the functional implications of vision impairment to health workers, teachers, clients’ families and the general public.
We act in an advisory role with carers of high-needs clients. If the client is unlikely to gain much independence through O&M intervention, we can still offer the carer information about vision impairment and the resources which will help them to help their client develop O&M skills.
OMAA is the Orientation and Mobility Association of Australasia. We use the term "specialists" because O&M Instructors do more than just instruct. We liaise with community groups and other professionals on behalf of our clients.
Lil Deverell