Riley, 13, walked purposefully down the second floor hallway in the Lower School, the constant tapping of her white cane echoing off the tile floors. She opened the door at the end and climbed down the stairs. Her right hand held the rail, pinky finger trailing along the wall, not stopping until she reached the first floor landing. For the first time she faltered, unsure of where to go next.
“We’re going through the door, Riley, to the swings,” said Ruth Weinrib, an Orientation and Mobility (O&M) intern working under the direction of Barbara Fultz at Perkins. Reaching around Riley, Weinrib rattled the door handle. Hearing the sound, Riley got back on track and opened the door.
Riley was getting the gift of time in the form of one-on-one instruction on how to physically navigate the world.
“Many of these students have multiple disabilities including cognitive impairment, so their progress can be incremental,” said Fultz, who has been at Perkins for more than 12 years. “It can take a lot of time for students to make improvements, and it’s helpful to have a team of resources at Perkins.”
Each of the 16 students Fultz works with gets two or three 30-minute sessions weekly to enhance their orientation and mobility skills. O&M teaches people with visual impairments to understand where they are in space and how to get where they’re going safely. Lessons include learning to use a white cane and follow a particular route, as well as safe ways to avoid obstacles. Initial lessons occur in the relative safety of the campus, while more advanced lessons might involve learning how to cross a busy street.
Fultz and the other instructors devise a plan for each student, guided by the goals on the child’s Individual Education Plan (IEP). As they better understand the student’s abilities and challenges, they can share these with the classroom teacher, making the teacher’s job a little easier.
“The teacher might not realize just how independent the student can be, and may be offering too much assistance,” Fultz said. Recently, Riley has been navigating so well on her own that the youngster’s teacher said she doesn’t need to provide as much assistance to Riley.
Because Fultz’s students are all so different, each one requires personalized instruction. For example, one student was born without a left thumb. Fultz worked with the Occupational Therapist to adapt a standard cane the student could use with her left hand, so she could orient herself by placing her right hand against the wall. “Every student is unique,” Fultz said.
In fact, adaptations are the norm at Perkins, because O&M instruction was originally geared to adults with typical intelligence who went blind later in life. “That’s much different from working with blind or visually impaired children who have never had typical eyesight,” Fultz noted.
Orientation and mobility evolved as a distinct therapeutic program after World War II to help teach newly blind veterans to get around safely and independently. It has since been adapted for use with congenitally blind children who often have other physical or cognitive impairments. Still, many adaptations – highly specialized techniques to teach individuals with a unique combination of disabilities – have yet to be documented.
To share these innovations, Fultz, along with several Perkins colleagues, is in the process of developing an instructional DVD. She hopes it will be useful to others in the field who work with visually impaired children.
One of the tools Fultz has developed is a pyramid chart that is a “Top Down Approach to Independent Traveling.” At the top of the chart is independent movement – for example, a student who can decide when and where to go, and how to get there. The rattling of the door handle for Riley falls about halfway down the chart, as a “sound guide” for the student. At the bottom of the chart is “hand-over-hand,” where someone physically holds hands with the student and guides him or her along.
“Riley has come a long way since I first began working with her,” Fultz said. “At first she wouldn’t even hold the cane. Now she uses what we call the constant contact cane technique.” This method has users sweeping the cane in front of them from left to right, keeping the tip in contact with the floor or walkway to detect obstacles and drop offs.
Fultz said Riley has excellent spatial memory and she has developed a nice sense of the distance between various locations on campus. She can also make her way confidently down a hallway, managing by auditory clues.
There are three ways to learn to navigate, said Fultz: by rote, route and area:
- Rote travelers need consistency to stay on track; they can travel specific routes in a familiar environment with some supervision and with some cues.
- Route travelers learn one functional route at a time, and can travel on their own with occasional assistance.
- Area travelers can plan routes and determine alternates within a larger area such as a school building or campus, or even a small business district.
During the day’s lesson, Weinrib walked in front of Riley, using her own hand to make sounds along the walls and windows to give auditory cues. She also narrated what Riley perceived through senses other than vision to benefit Riley’s language development.
Whenever Riley seemed to lose focus, Weinrib pulled out a portable schedule of activities, consisting of three tiles each with a tactile symbol, to show Riley the sequence of activities to be accomplished during the lesson. The first tile had a chain to represent a swing, the second had a textured square of rough material designating the walkway, and the third held another chain. The plan was to swing, walk, and then swing again.
“Swings are a motivator for her,” Fultz said.
Riley exited the Lower School building and traveled along a walkway, hesitating only slightly at the right turn. According to Fultz, a left turn is easier than a right turn for a person who is visually impaired.
“When turning left, in many cases the cane will hit a grass line at the end of the walk or a wall at the end of a hallway, which serve as concrete indicators for the turn one way or the other,” Fultz said. “If you’re turning right and turn too wide, you end up on the wrong side of the path and potentially in the path of other pedestrians.”
Riley finally made her way to the swing area. Although there was a straight path to the swings, Weinrib detoured the youngster to a bench first, to give her a landmark to check on the way. And then Riley was on the swing, energetically swinging in the summer breeze, getting her reward for all her hard work.
At the end of the lesson, Weinrib coached Riley as she navigated back to the Lower School building. As they walked, Fultz reflected on benefits Riley gets from O&M training at Perkins.
“The beauty of Perkins is the support and resources here,” she said. “If I have a question I can run into people in the hall, or seek out other experts. I have access to canes and other assistive devices. And I have access to a workshop full of tools and materials to adapt the standard equipment. It takes a big team to do this job, and all of them are right here.”