Foundations of Developmentally Appropriate Orientation and Mobility Session 1

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Foundations of Developmentally Appropriate
Orientation and MobilitySession 1
Developmentally Appropriate Orientation and
Mobility
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants
and Toddlers With Visual Impairments
FPG Child Development
Institute, 2004
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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 (OM) and how it relates
  to infants and toddlers with visual impairments.

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Objectives

• After completing this session, participants will
• describe a developmental approach to OM for
  infants and toddlers and their families,
  including family-centered practices, natural
  learning opportunities, and transdisciplinary
  teams.
• describe components of early orientation and
  mobility.

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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.

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Objectives

• After completing this session, participants will
• describe the relationship between attachment and
  mobility and strategies for promoting attachment
  and trust.
• discuss the importance of and strategies for
  fostering independent movement and exploration in
  natural environments for infants and toddlers
  with visual impairments.

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Objectives

• After completing this session, participants will
• describe the importance of and strategies for
  providing opportunities for safe,
  unrestricted movement and exploration.
• describe protective techniques for early
  travel and strategies to encourage their use.

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Objectives

• After completing this session, participants will
• 10. describe different types of adaptive mobility
  devices and tools and ways to facilitate
  their use.

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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-of-movement skills, and purposeful,
  self-initiated movement (Anthony et al., 2002,
  p.328).

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History of Orientation and Mobility

• OM 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

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History of OM

• 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 OM until the
  late 1980s, following the passage of PL 99-457
  in 1986.
• Wiener Sifferman, 1997

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History of OM

• 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 OM as
  an early intervention service under Part C. In
  Part B, OM is clearly defined as a related
  service for children with visual impairments ages
  3 to 21 years.

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History of OM

• Initially, OM 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 OM skills.
• This developmental perspective has helped to
  shape the actual definitions and program
  components of OM for infants and toddlers.

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Developmental OM

• A developmental approach to OM is based on the
  premise that the foundation for OM skills is
  built during infancy and early childhood.
• OM concepts and skills are developed in the
  childs home environment and community.
• OMSs need a solid understanding of early
  childhood development.
• Anthony et al., 2002

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Family-Centered Practices

• In order for early intervention to be as
  effective as possible, families must be involved.
  
• Families contribute unique information about
  their childrens development, preferences, and
  needs.
• Developmentally appropriate and family-centered
  practices embrace diversity, use a
  transdisciplinary model of intervention, and
  value natural learning opportunities.
• 
  Hatton, McWilliam, Winton, 2003

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Natural Learning Opportunities

• Orientation and mobility intervention for young
  children should be embedded into the familys
  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 childrens development
  and improve the quality of life for children and
  families.
• Hatton et al., 2003

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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

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Components of Early OM

• Developmental OM 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

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Components of Early OM

• Anthony et al. (2002) recommend the following
• components
• Orientationto expand childrens body concepts,
  daily settings, and locations within each
  environment
• Mobilityto encourage and refine independent
  movement (including the use of mobility devices)
• Purposeful Movementto reinforce childrens
  reasons to move in different environments
• Environmental analysis for safetyto assist the
  family and transdisciplinary team in analyzing
  natural environments, to ensure self-initiated
  and purposeful movement

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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

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Sensory Development Roles

• Learn about all of the childs sensory
  abilities.
• Refine the childs 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

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Sensory Development Roles

• Assist the family and the early intervention team
  in implementing appropriate adaptations to
  optimize the childs 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

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Cognitive Development Roles

• Understand and explain the significance
  of cognitive development to the family and
  the transdisciplinary team, with particular
  attention to
• -body concept -spatial
  relationships
• -positional concepts -object
  concepts
• -cause and effect -means-end
• -imitation
• as related to motor development, movement,
  and orientation and mobility.

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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.

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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
  self-initiated movement in young children with
  VI.

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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.

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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.

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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 familys priorities and concerns.

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Roles in Assessment

• Use a family-centered, routines- based, and
  developmental approach for assessment and
  intervention based on knowledge about early
  childhood development and appropriate
  interpretation and application of OM concepts
  and skills for infants and toddlers.

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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

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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

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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

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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 complexit can
  be very simple and brief for young children.

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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
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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

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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

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Facilitating Ease of Movement

• Provide appropriate supervision while
  respecting childrens 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

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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

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OM 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.

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OM 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.
  

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OM 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
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OM 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
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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

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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

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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

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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
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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

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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

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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

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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

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Readiness for Mobility Devices

• Does the childs 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

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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

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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

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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

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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 childs short attention span.
• Sapp, 2004

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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

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Parent Involvement

• Encourage parents to become involved in their
  childs 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

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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

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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

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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

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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

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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

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