A guide to O&M program planning for the CVI student. CVI and O&M: Part 4

Essentials for O&M instruction, concept development, accommodations 

Following a comprehensive, CVI-specific assessment, the IEP team — including the parents — reviews the results to determine whether the student requires orientation and mobility (O&M) services. If so, an O&M specialist will write and implement a program for the Individualized Family Service Plan (IFSP) or Individualized Education Plan (IEP). In her extensive experiences as a TVI, COMS, CATIS, and Program Manager at Northeast Resource Center for Vision Education, Allie Futty says, “I have yet to meet a kid with CVI who doesn’t need some level of O&M support.”

No matter their visual abilities, mobility challenges, or coexisting disabilities, “all students with a visual impairment — whether ocular, brain-based, or both — would benefit from O&M instruction,” says Valery Kircher, TVI, COMS, and Education Coordinator for the Virginia Department for the Blind. 

The goals and accommodations must be based on the results of the CVI and O&M assessments, reflecting the individual’s CVI visual behaviors, their impact on the student’s ability to orient and move through space, and how the materials and lessons will be designed for their specific needs.

Learn more about why O&M instruction is essential for students with CVI and why an understanding of the CVI visual behaviors is critical for program planning in this series.

• Why O&M is essential for students with CVI: Part 1 
• How does O&M address CVI visual behaviors: Part 2 
• How do you center CVI in O&M assessments? Part 3

When carefully planned, consistent, and individualized to address the whole child, an O&M program can offer a student agency and a challenge worthy of building their self-concept.  

Futty offers an example from her experience with a deafblind preschool student.

“He had almost no connection with the world outside of what was going on in his own body. Other than playing a tickle game with his dad, he was completely turned inward, just experiencing his version of the world. 

“He was just getting pushed around the school in his wheelchair with no idea where he was going, or what was happening, but his physical therapist wanted power mobility for him. She got some local high school students to build a Hot Wheels car with a big red ‘go’ button. At first, the adults steered it, so he just had to learn to press go. 

“There was something about having control over his mobility that increased his orientation to space. He started to recognize patterns, for example, he liked to stop in front of certain classrooms because he liked something going on inside. We also taught him how to recognize a stop sign so we could get him to the end of the hallway and hold the stop sign in front of him to wait for other kids.” 

This rich example reminds us that students with CVI will have a range of mobility needs. They may require a wheelchair, gait trainer, or white cane. They may move independently or with the help of an adult.

Regardless, “the goals of O&M are the same for children in wheelchairs: to have a better understanding of the environment and have the ability to move through it as independently and safely as possible,” says Susan Abu-Jaber, TVI, COMS, in an Expert Q&A on CVI and O&M.

“I’ve always thought that orientation and mobility starts with the hands, with wanting to reach out and know what’s out there,” Abu-Jaber adds. “So for a child in a wheelchair, it may be that their tray table or desktop in front of them is where their mobility lessons start.”

Because many students with CVI have multiple complex needs, O&M instruction requires collaboration with other disciplines, like physical therapy, speech pathology, and occupational therapy. 

Emily Price, CVI-certified COMS at Perkins School for the Blind, is accustomed to working closely with fellow team members to tailor O&M instruction. 

“I have a student right now who just had a decrease in her vision and she was up to the point where she was using a gait belt. She got to the point where she was walking independently, but her change in vision impacted her independence and confidence while moving. So I’m working with the PT to introduce a cane to her. And the PT is working on the piece of slowly going back and letting go of the gait belt, allowing me to instruct on cane use in concert with the PT.”

Concept development

The O&M assessment reveals the student’s grasp of concepts like body awareness and spatial perception. In turn, O&M goals should be written based on present levels of performance (PLOPs or PLEPs) that show up during assessment. 

Rebecca Hommer, TVI and O&M specialist at Connections Beyond Sight and Sound in Maryland, says O&M instruction for students with CVI must be intentional, systematic, and meaningful. She recommends beginning with routine-based, concrete, familiar, and consistent activities. As the student develops their skill sets, the instructor can shift to experience-based, sequential activities, which are more complex. (Expert Q&A: CVI and O&M)

Depending on the individual’s abilities, lessons may cover:

• Body awareness
• Positional or spatial perception
• Shapes and colors
• Numbers
• Visual recognition of objects and environmental features
• Interpreting visual information
• Physical maps
• Mental mapping
• Navigating new environments by making connections with known environments
• Temporal concepts

A few ideas for activities that build concept development, courtesy of Hommer (Expert Q&A: CVI and O&M):

• Body awareness: Engage with songs and rhymes, sensory activities, and functional activities, like washing hands.
• Positional or spatial perception: Play Simon Says, Mother May I; use an object/symbol schedule to represent activities and locations in the school and at home. 
• Shapes and colors: Place shapes on a lightbox.
• Numbers: Work on 1:1 correspondence with sorting trays.
• Objects and environmental features: Learn to recognize and find objects, cues, symbols, features, and landmarks. An example of a cue could be red reflective tape on a school bus door, to indicate where the student should board. More on landmarks later in this article.
• Interpreting visual information: Identify salient features and describe landmarks and locations. Play “find them all,” locating items along a route, or “one of these things is not like the other,” categorizing and comparing items.
• Maps: Explore objects or photos, intentionally selected to be meaningful to the student Match objects or photos to the correct room, plan routes, or sequence the landmarks on a map.
• Temporal concepts: Discuss whether it will take longer to get from the front door to the classroom or the cafeteria, for example.

No matter what they are working on, we want students to generalize the skills they learn in one situation to many others. 

In a Paths to Literacy video on environmental adaptations for CVI, Dr. Christine Roman-Lantzy explains, “You want the individual to be more than living in the moment. You want them to think about the system they use to do it. So that hopefully that system can be transferred to new settings and new places where the skills can be generalized.” 

Developing visual schemes

Many of the concepts covered during O&M instruction apply to both students with ocular visual impairments and CVI. However, the student with CVI is constantly working to develop stable visual schemes. 

“Visual schemes for O&M can be defined as sets of static information that can be assessed and sorted by visual feature (such as shape, color, or texture) to allow for classification of an object, person, or place. This process can help a student develop, store, and retrieve stored information about a place or event,” write Alisha Waugh and Roman-Lantzy. (CVI: Advanced Principles, 2019)

Waugh and Roman-Lantzy reiterate that the point of these systems is for the student to generalize them. 

“In students with CVI, the lack of diverse visual experiences may result in visual schemes that can be rigid and inflexible. O&M instruction needs to facilitate appropriate generalization of concepts to allow more flexible thinking so that salient features are used as guidelines to aid in recognizing and identifying unfamiliar items, but not as hard and fast rules that do not allow any variation.” (CVI: Advanced Principles, 2019)

Landmarks

Jennifer Siff, COMS, explains that dorsal stream dysfunction is why people with CVI tend to rely on memorization, making it “really important that, as O&Ms, we’re discussing environmental features. Identifying those landmarks, identifying those cues and clues, so that we make sure they’re not just memorizing how to get to that specific item in the store, and they are learning the layout of the store.”

Price says that her students identify landmarks by many sensory features, visual, auditory, and tactile alike.

“We’ve used water fountains as a sound landmark, listening to that as you pass by. In our building, we have this wooden plaque and it has all of the alphabet in sign language on it, each letter with a different bright color. So that can be a visual landmark. And it’s also raised so you can feel it. Even if they’re using hand trailing with a cane or without, it’s natural to feel that along the way, which serves as a great landmark.”

Maps 

Depending on the student’s ability to access different forms, the instructor can use a three-dimensional (object) or two-dimensional (photos/symbols) map, either on a tablet with backlighting or with something like the Wheatley Picture Maker, to build cognition and understanding of where they are in space. Maps also provide an opportunity to talk about time-distance relationships and to engage in route planning.

Price says, “I have one student who uses Tactile Town from APH. It has little buildings and you can add roads and there’s a little piece that looks like a body of water, which can represent the pond on Perkins campus. He loves to build a map of the campus and add all of the buildings. Then we go around and he can tell you where each building is. It’s a great way to work on mental mapping.”

Hommer suggests another activity as a precursor to using maps to build wayfinding skills. “You could play games and teach those early route skills by having three shapes, a square, a triangle, and a circle, and then you place them along the hallway. First, we’re going to find the square, and you find the square. Then we’re going to find the triangle… So now we’re setting up those sequential steps and… an early mapping system.” (Expert Q&A: CVI and O&M)

Accommodations

Students with CVI require numerous accommodations to support their learning in the classroom and community. O&M instructors control external factors to the best of their abilities to open up learning opportunities.

“Both internal and external sensory complexity, we know can affect visual functioning,” says Siff. “Internal factors like hunger, pain, anxiety, or excitement can all impact visual functioning, just like movement or lighting can.

“We’re never going to make a grocery store fully CVI-friendly, it’s just not the way they work. We have to work with the world and the settings that we’re given. We know that visual novelty, complexity, movement, light, etc., are all pitfalls for CVI learners. And we have limited ability to tailor that environment to our needs during O&M instruction and travel.”

Though we can’t redesign the world we live in to perfect CVI standards, certain accommodations make a huge difference for the student. While accommodations are student-specific based on unique needs, here are a few examples.

• Use of non-visual sensory channels to support navigation and need for visual breaks – What are the student’s preferred sensory channels? How do they use tactile, auditory, or olfactory cues to understand where they are in space and move through an environment? How do they use compensatory skills to support perception and understanding? How often do they need a break? What are the signs of visual fatigue, so we know when to take a break? Can the break occur naturally along the travel route?
• Color – “The use of a vibrant, [bold] color, can be very helpful,” Roman-Lantzy explains in this Paths to Literacy video. “I do recommend that when you’re placing a color cue somewhere in the environment, that you do it based on the salient feature of that environmental location. So the edge of a door, or highlighting where an exit sign is, or a corner where a person needs to turn to get to a particular destination.” Word of caution: Use color intentionally. Too many colors can confuse.
• Scheduling – Travel at off-times and add complexity little by little. Providing extra time to pack up and transfer to the next class can also be helpful because it allows the student to travel the hallway when it is less busy.

“Visual fatigue is a significant hurdle for people with CVI,” Siff reminds us. “So scheduling lessons for early in the day or week can decrease the chance of encountering visual fatigue. For community outings, you want to schedule classes during off-peak hours if at all possible.”

Materials, equipment, assistive technology: Consider all the tools a student will need to successfully participate in school and, more specifically, O&M lessons. A few ideas that just scratch the surface:

• Hat with a brim
• Sunglasses
• Visual occluders
• Binoculars
• Bone conduction headphones (for walking GPS without blocking ambient noise)
• Assistive technology and apps for navigation, identifying currency, scanning for optical character recognition, speech-to-text
• Mobility aids like a white cane or pre-cane
• Technology like AACs, computers, tablets
• Maps in the appropriate format, e.g., tactile, 3D, acoustic, Wheatley, online, etc.

• Instructional approach – Provide clear directions, opportunities for experiential learning, descriptive narration of activities and environment, previewing materials before a lesson, and engaging in plenty of repetition. Provide adequate processing time to compensate for delays in visual processing. 

• Environmental supports – Preferential seating, permission to move around the room, extra desk space, personal cubby or locker, black partition to simplify, previewing spaces through photos, videos, or pre-visits to a space. Be conscious of the impact of light coming through a window and spotlighting the floor, which may cause anxiety for the student crossing over it.

• Social interactions — Encourage others to say the student’s name and identify themselves when beginning a conversation.

CVI visual behaviors and compensatory skills

Each of the student’s CVI visual behaviors and preferred compensatory strategies can impact O&M skill acquisition and development. The IFSP or IEP should reflect that.

It is worthwhile to go through each CVI visual behavior to understand how it affects the student’s perspective and ability to participate. Learn more about the CVI visual behaviors as they pertain to O&M.

Ocular conditions and CVI

Many students with CVI have co-existing ocular conditions to take into account.

“Here we have to consider the fact that not only is the visual information being compromised by the CVIs affecting the brain, the initial visual information coming from the eyes might be missing, or partial, or incomplete, etc.,” says Siff. “It’s important to differentiate the root cause of certain visual behaviors in case they show up or don’t show up in other settings.” 

She gives the example of a roller skating rink. Someone with CVI may be able to tolerate a roller skating rink because the people move in the same direction at a relatively consistent speed. Yet, the organic, messy movement of shoppers in a mall might be disorienting. This can confuse people who don’t understand CVI. (O&M Through the CVI Lens)

Compensatory skills

Many with CVI have strategies and workarounds for so much in their daily lives, and many use non-visual skills to support recognition and understanding, access the educational curriculum, and navigate the world. Compensatory skills use strengths to overcome areas of challenge and are often developed naturally. Individuals with CVI use their sensory channels and cognitive processes to figure out the world around them. Their experiences directly impact how these skills are shaped and used. Some CVI compensatory skills include context, auditory cues, verbal cues, tactile cues/exploration, and color coding. It’s important to understand how a student with CVI uses their compensatory skills and to implement O&M instruction and tools that best match the student’s needs.

For some with CVI, using more than one sensory channel at a time can be difficult. CVI Scotland explains that while children with CVI rely on compensatory skills, “CVI is different. For some with CVI, they can see things, but what they see may not always be very useful, or may be confusing or even overwhelming. It can also be difficult to deal with two things at once for the child with CVI, so relying on spoken instructions or the surrounding sounds may not help, nor may a cane, [at first]… Let the child explore and learn about their surroundings, building up step by step may prove more effective.” (Sharing & Developing Our Understanding of CVI: A Guide for Parents)

Learn more about CVI and compensatory strategies.

How family can support O&M day-to-day

Price says to “let your child explore. They can practice navigating in different environments. And then this encourages them to be curious about what is in the environment. If they become disoriented or they find something unexpected, it’s all part of the learning opportunity.” 

Futty encourages parents to do some task analysis, breaking down regular routines or outings into simple steps, and then working with the child on one step at a time.

Take the grocery store, for instance. “What are the 50 steps involved with that?” Futty asks. “Start including your child in one or two. Can you talk about the way that you drive to the store? And can they understand that? And then once you’re there, walk two steps behind them to see if they can get to the front door.” 

For safety reasons, “You want to be right there to grab them, but there’s no reason that you can’t test those things.” If the child can’t do the things you thought they could, Futty says please don’t panic or overreact. “Parents worry, ‘They’re so unsafe, I need to clamp down even harder.’” 

Instead, think of all these steps as learning opportunities that build on each other. 

“You’re working on problem-solving,” says Price. “How do they move around different obstacles? Can they take multiple routes to get somewhere, even going outside to the backyard? And then the parent is nearby to assist or intervene if it’s needed. But overall, your child’s deciding where they want to go and what they want to do.”

“Just approach the outings in tiny digestible pieces,“ Futty says. “Because if you try and do too much at once you’re setting yourself up and your kid up for failure which is just going to turn you both off from trying new things.”

More resources

O&M instruction, based on an understanding of the CVI visual behaviors and comprehensive assessment, is essential for students with CVI. From concept development to accommodations to compensatory skills, an O&M education for students with CVI requires consistent, intentional school programming and family support to achieve the greatest levels of independence.

There’s much more to understand about CVI and O&M. This is the fourth article in our series on CVI and O&M linked below.

• Why O&M is essential for students with CVI: Part 1
• How does O&M address CVI visual behaviors? CVI and O&M: Part 2
• How do you center CVI in O&M assessments? Strategies for CVI and O&M: Part 3

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How does O&M address CVI visual behaviors? CVI and O&M: Part 2

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How do you center CVI in O&M assessments? Strategies for CVI and O&M: Part 3

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Why O&M is essential for students with CVI: Part 1

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