American Action Fund for Blind Children and Adults
Future Reflections Winter 2018 TRAVEL AND MOVEMENT
by Merry-Noel Chamberlain and Denise Mackenstadt
From the Editor: Orientation and Mobility (O&M) instructors often have little training in work with children who have disabilities in addition to blindness. In their work with children in the public schools they learn from the experts themselves, their students. In this article Merry-Noel Chamberlain and Denise Mackenstadt share best practices used in public school settings by O&M instructors working with children with multiple disabilities. Both authors hold National Orientation & Mobility (NOMC) certification.
"For blind children, as for all children, the freedom to move, to be self-amused, and experience the joy of movement is fundamental to being human." —Joe Cutter (2007)
Orientation and Mobility (O&M) instructors are encountering increasing numbers of students with significant additional disabilities. These students present a variety of behavioral and physical differences, and they may have extensive individual needs for which instructors have not been prepared during their professional training (Olmstead, 2005). O&M instructors need to be open to creativity, discovery, and sometimes failure before their students can succeed. In this article we share some of our experiences in the hope that other O&M instructors may find them helpful. Many of these ideas may also be helpful to parents as they encourage their children to move and explore at home and in the community.
When a student is referred for O&M instruction, the instructor may perform an O&M evaluation. The evaluation will determine whether the student qualifies for instruction in the use of the long white cane. Usually the O&M instructor begins by examining the student's eye report from a qualified ophthalmologist. In some cases it is difficult for an ophthalmologist to do a complete eye exam because the child may be uncooperative or may lack the ability to understand verbal requests. Nevertheless, some information is better than none at all.
Next the instructor observes the student at home, in the classroom, or on the playground. Is the child stationary or active? Does he or she depend on family, friends, and/or staff members in order to move from one place to another? Observation may reveal that the child has difficulty moving from brightly lighted environments to darkened areas or has trouble with depth perception on stairs.
Based on the student's diagnosis and performance during observations, the instructor may request an audiology report. Hearing difficulties may hinder the student's success with orientation and mobility. It is wise to rule out this possibility or, if necessary, include it in the lesson planning process.
When blind students have additional disabilities such as hearing loss, autism, developmental delays, cortical visual impairment (CVI), behavior disorders, or physical impairments, the O&M instructor needs to devise some unique instructional methods. Unfortunately, some educators believe that students with severe academic delays cannot benefit from mainstream educational programs, including O&M instruction. In reality, a student with severe struggles in the classroom may be a capable cane traveler. On the other hand, a student who is successful in a mainstream educational setting may have significant challenges with spatial orientation, body awareness, or directionality. Instructors need to be aware of their own biases about students with additional disabilities.
Instructors typically follow a general checklist of O&M skills necessary for safe travel in a variety of settings. Yet lessons cannot be pulled from a curriculum or instruction manual because each student is unique and the terrain varies widely. When it comes to students with additional needs, O&M instructors draw upon their creativity, their previous experience, and the expertise of others. The O&M instructor obtains the greatest success by keeping the student involved and incorporating the student's interests. It is valuable to keep the following ideas in mind.
Self-discovery is powerful. The student is more likely to remember an action when he discovers it through experience than when he is simply told about it (Hallowell, 2011). For example, a student walks too far as he searches for the classroom door. By doing so, he finds a row of lockers with his cane. He explores farther down the hallway and finds the water fountain. At that point he hears the distinctive squeak of the classroom door. He turns toward the sound and enters the classroom. The next time he searches for the door and encounters the lockers, he is more likely to correct his mistake. For some students with additional disabilities, this process may take several tries. It may even turn into a game, with the student purposely passing the classroom to get a drink of water.
Allow the student to use the dominant hand. The dominant hand can be determined through observation and interviews with parents or teachers. It is the norm to place the cane in the student's right hand, just as it is almost automatic to place a pencil in the child's right hand. Note which hand is dominant and try placing the cane in that hand. One nonverbal student held her cane in front of her body as she walked down a hallway, but then she would switch and drag the cane behind her. An instructor noted that she did this when her cane was in her right hand and happened to swing into an open doorway. When the student was encouraged to hold her cane in her left hand, this tendency disappeared.
These points and strategies may be helpful in work with students who have additional challenges.
Wait time: Some students, such as those with cortical visual impairment (CVI), may need extra time to process their surroundings along with the instruction. This can be referred to as "wait time." Repeating the instruction may actually hinder the student from moving forward in the lesson. Each time the instruction is verbalized to the student, she may need to wind back to the beginning of her processing. The wait time between the instructor's request and the student's action needs to be extended.
Communication methods: The student's communication methods may not be self-evident. Some students communicate happy and sad feelings by emitting high- or low-pitched screams, singing slow or fast tunes, rocking back and forth, or swinging out to attack. Some students show acceptance of a person by clinging or smiling, and ignore or avoid a person to demonstrate displeasure. Such actions can speak more loudly than words. Both the student and the instructor may experience frustration while the instructor learns how the student communicates through trial and error.
The student's tolerance level: Many students are unaware of their own tolerance level or are unable to express when they have reached their maximum. Instructors need to respect the student's actions and may need to respond quickly when there is a hint of frustration. For some students, a grain of frustration can quickly turn into a sandstorm, while for others a grain is simply a grain. If a student appears to be upset at the beginning of the lesson, it may simply be carryover from the previous task. The classroom teacher may need to de-escalate the situation before the O&M lesson can begin. When frustration occurs during the O&M lesson because the student's maximum tolerance level has been reached, the instructor may need to pause the lesson so the student can take a break.
The student's behaviors: If the student intentionally drops the cane, the instructor needs to wait for him to pick it up. Sometimes the instructor may need to roll the cane closer so he knows where it is. If the instructor collects the cane and assists the student to the targeted destination via human guide, the student will expect that service every time he drops the cane. If "wait-time" is allowed, the duration of the unwanted behavior will decrease.
Be aware that dropping the cane or sitting on the floor during a lesson may be the student's way to communicate that he needs a break. Prolonged sitting on the floor may also be a behavior issue. It may be advisable to consult with the classroom teacher. A "behavior plan" may be necessary.
Reassurance and praise: Verbally reminding the student that she is not alone and that assistance is available may not always be successful, due to the student's cognitive or comprehension level. On the other hand, focusing on her success by offering a pat on the back or verbal praise using voice inflection may be quite rewarding for her. However, for some students, too much praise has the opposite effect. Overabundant praise quickly becomes meaningless. It is important to encourage the student to do as much as she can do herself, even if it means beginning with small steps.
The student's goals: Take time to be a part of the student's world. In some cases, the instructor can get to know the student's needs and motivations only through observation. If the student likes to sit in a special seat next to the CD player, he will be motivated to return to that spot. He may be frustrated when asked to walk to a location away from that spot, but he may work quickly to return to the spot he prefers. Effective lessons may begin at a location away from his favorite seat and focus on returning. Maybe the student has a special fondness for one of the cafeteria workers. The instructor might teach him the way to the cafeteria so he can turn in the classroom lunch count.
The student's preferred method of travel: Does the student tend to reach out for someone's arm as soon as she stands up? It may be that human guide technique is the only travel method she has been taught. This does not mean that she cannot benefit from O&M instruction. She may do well when she is taught the skills and expectations of independent travel.
The ultimate goal of an O&M instructor is to phase out the need for instruction as the student acquires the skills and understanding necessary for independent travel (Mettler, 1995). In order for this to happen, lessons based on the checklist must be adapted for the individual student. Instructors must have a full toolbox of individualized techniques. Time and time again, O&M instructors need to devise new plans and strategies. Here are some examples of adaptations for O&M instructors working with students with additional disabilities.
Have flexible lesson plans and allow for "teachable moments." During one lesson a student was walking on the sidewalk in front of the school. Along came a blind gentleman from the neighborhood who was using his long white cane. With guidance from the O&M instructor, the student and the gentleman had a short conversation, and the student learned that other people also use canes.
Keep the lesson successful. Even the best lesson plans may be interrupted due to unforeseen circumstances such as sudden hallway congestion, wet floors, or a fire drill. Sometimes the best lesson may be going human guide through the difficult area and then continuing to the original goal. Treat tackling unforeseen circumstances as a separate lesson.
Realize that what works in one location may not work in another. A student may be very successful in walking straight down a hallway, but may have difficulties walking straight across a pedestrian bridge. Sounds, wind, or slopes in the terrain may throw a person off.
Be sensitive to unfamiliar sounds. Since some students have difficulty with communication, they may not know how to express their fears. One student with severe cognitive delays traveled quite successfully in familiar areas. However, one day while she was traveling in the community, some construction noise appeared to make her uncomfortable. She expressed her fear by making loud noises and sitting down on the sidewalk. She would walk only when she held a staff member's arm. Once past the construction site, she was able to walk independently again.
Realize that lesson plans may need to be altered—often.
Realize that lesson plans may need to be repeated—often.
Remember that lessons and instruction techniques may need to be adjusted—often.
Allow for choices. Have a couple or more lesson goals on hand and let the student select from those choices. When a student selects the lesson goal, he often feels more in control and will perform with greater enthusiasm. Choice does not mean the student will never have to do the other lessons. It just means he does not have to do those lessons on that particular day.
Don't be afraid to abandon the lesson. Sometimes it may be best to end the lesson when unexpected problems come up. If this happens, explain to the student as well as possible why the lesson has ended. "Johnny, we need to go back to class now because it's raining very hard."
Allow the student to "scribble" with the cane. Many students don't have the dexterity to hold the cane correctly. We say that a student "scribbles" with the cane when she holds it incorrectly, as defined in the textbooks. The goal of instruction is for the student to use the cane to move about in her environment, and she may need to find her own best method. With time and gentle instruction, the student may accept encouragement to use the cane properly.
Allow the student to push the cane. Pushing the cane may not be ideal, but with time and encouragement he may begin to use it properly, especially after he has lightly bumped into a doorframe or two.
Allow the student to use the cane upside down if preferred. If she does it to get a rise out of the instructor and does not succeed, she will stop. If she likes the feel of the tactual flexibility better, she will continue. She may just be experimenting. Give her time, and she may correct herself. Remember that the student may know best. If she tends to do better when the cane is upside down, who is that hurting? She is walking independently, and isn't that the goal?
Don't wait until the student can walk before giving her a cane. Sometimes students don't realize there is anything "out there," so they have no reason to venture beyond arm's reach. A child who has not yet begun to walk can benefit from sitting and exploring her surroundings with a cane.
If the student is reluctant to hold the cane, give him something else to hold. For small children, try a push toy or paper towel roll. For older students, start with the top handle of a cane, but not the whole cane itself. The student may realize that the towel roll or cane handle finds things just beyond the reach of his hand. From here move to a wrapping paper tube or drumstick, then to the long white cane.
Allow plenty of time for the student to explore with the cane. When a student receives his first cane, he often will explore all around him, including the ceiling! Getting your first cane is like putting on your first pair of glasses. Allow students (especially those who are hearing impaired) to touch the ceiling with the cane or gently tap the walls above waist level. This is an opportunity for them to learn about their surroundings. It is fine to allow "ceiling time" at the beginning of a lesson, followed by instruction time with the cane tip on the ground. "Ceiling time" helps the student become aware of the environment, but it may put other students in harm's way. It is advisable to keep spectators at a safe distance!
Show the student other uses for the cane. The cane can be more than a walking tool. The instructor may encourage the student to use her cane to check out the height of the ceiling or the depth of a hole. The cane even can be used to measure a piece of furniture or to fish lost items from under the couch.
Be aware of weather conditions, even when working inside. Some students are very much affected by sensory changes. One student may do well on calm weather days, but he may resist completing a lesson when it is windy.
Be aware of the student's preferred environment. If a student feels comfortable only in his work station, move a necessary work item a few inches away so he has to reach for it or even take a step. Innovation is necessary when working with students who are severely affected by change.
Remember that what works for one student may not work for another. The instructor needs to find ways to motivate each particular student to move. Without motivation there is no success. One student who enjoyed going down the slide was motivated to work on her O&M skills in order to walk to the playground. Extra slide time was her reward.
Try reversing roles so that the student is the teacher and the instructor is the student. When the student provides the lesson, the instructor may learn why she is struggling in a particular area.
Remember to have fun. Students enjoy going to places of special interest. Mobility instruction provides a break in their regular routine.
Build trust with the student. If you promise something to a student, follow through.
With your guidance, allow the parent to be the teacher. When the parent has fears about letting the child use the cane, the instructor needs to teach the parent. Invite the parent to tag along on travel lessons. The parent will come to understand the basic O&M concepts, goals, techniques, and teaching methods (Castellano, 2010).
Maintain communication with the team. When you include the team, all team members can assist. Team members include parents, teachers of students with visual impairments (TVIs), occupational and physical therapists, classroom and special education teachers, and doctors. Everyone who works with or lives with the child can help, if only supplying empty paper towel tubes.
There are varying degrees of visual impairments, and there are many degrees and types of hearing impairment as well. A person may fall anywhere on the range from being hard of hearing to profoundly deaf. He may have frequency loss in the high or low range. Any level of hearing impairment can create a hindrance to the independent traveler, and it may lead to some anxiety for the instructor.
Communication with a deaf-blind student may involve signing hand-in-hand, signing within a close range or, for students with tunnel vision, signing at a distance, but bringing the signs in close to the body. A student with severe to profound hearing loss may communicate using American Sign Language (ASL). Unless the instructor knows ASL, he or she may need to work with an interpreter or intervener.
An intervener is trained to work with individuals who are deaf-blind, whereas an interpreter is trained to work with individuals who are only hearing-impaired or deaf. The intervener may provide intervention designed for a specific individual. He or she may assist the individual with access to environmental information that is otherwise unavailable or incomplete (SKI-HI, 2010). By developing a trusting relationship with the deaf-blind person, the intervener may also assist with social and emotional concerns (SKI-HI, 2010).
Unlike interpreters, interveners may not interpret word-for-word. For example, if the student is unable to understand the instruction or concept, the intervener is trained to step in and change the wording in order to convey the meaning. When working with an intervener, it is imperative for the instructor to feel that the intervener is conveying the O&M concept in its entirety.
Meet ahead of time with the interpreter/intervener to review special O&M terminology. Not all vocabulary words have established signs. The instructor needs to review the O&M terms with the intervener to create a sign to represent such terms. The instructor can teach the interpreter/intervener pre-established specialized signs such as extended grip, pencil grip, open-palm, shoreline, or walking in step.
Ask the interpreter/intervener to refrain from acting as the instructor. This can be a touchy subject. The student may be totally dependent on the intervener, and the intervener may be totally protective of the student. However, for safety reasons, it is imperative that the student not turn to the interpreter/intervener for instructional guidance outside their realm of expertise.
Establish when it is permissible for the intervener to provide information to the student outside the O&M lesson. The intervener may sign to the student "actions" or "activities" surrounding the student's environment. It isn't advisable for the intervener to disrupt the lesson to provide irrelevant and possibly confusing information.
Prepare for the use of sleepshades. Some instructors may be apprehensive to have a hearing-impaired student wear sleepshades. Sleepshade training can be successful if the instructor and student establish an agreed-upon sign that allows the student to stop the lesson and ask a question or for the instructor to provide additional instruction. Perhaps the instructor may slightly tap the student's sleepshades or give three squeezes to the student's hand. Such a sign can give the student permission to lift his shades for visual communication. The student may begin to sign or tap his own sleepshades to request permission to remove his sleepshades.
Here are some additional pointers for the instructor:
Know the escape code. If the lesson needs to be terminated immediately in the case of an event such as a fire or tornado drill, the instructor or interpreter/intervener draws an X on the student's back with a finger. Using the human guide technique she quickly leads the student. Ideally the evacuation plan can be explained and practiced ahead of time. The student can be assured that an explanation of the situation will be given once he is in a safe location.
Adjust the length of the lesson as needed. The student will need additional time to adjust to wearing sleepshades. Keep in mind that the student has depended on his remaining vision to gather information that his hearing does not provide. It is best for the instructor to begin lessons in an area that is very familiar to the student. The student will need time to gather the courage to leave his comfort zone and to trust the information a long white cane can offer.
Consider contact to be the student’s lifeline. At the beginning the student may want to maintain constant contact with the interpreter/intervener or the instructor. Contact can be maintained by holding the hand that is not grasping the cane. As the student's confidence builds, contact can be maintained by placing a hand on the student's upper arm, shoulder, or back. Later still the instructor may simply walk at a close distance and touch the student if she appears to be upset.
Allow additional time for problem solving. The student may become easily frustrated and may need an occasional break. The instructor may let the student remove the sleepshades and discuss possible problem-solving strategies. When the student is ready to return to the lesson and the sleepshades are back in place, the instructor needs to assist the student back to the spot where she became frustrated in order to continue with the lesson. In some circumstances, the lesson may need to be abandoned for the time being.
Allow time for the student to touch with the hands items found by the cane. Keep in mind that the student may not be able to determine what something is based on the sound the cane makes when tapping the object. If the cane touches a trashcan, the student may use her free hand to follow the shaft of the cane down to the object.
The student may prefer to slide rather than tap the cane across the terrain. If he is unable to use echolocation, he may gain more information about the ground or floor by sliding the tip of the cane. If the student is using a marshmallow cane tip, the instructor may consider using a metal tip instead. Metal cane tips provide more tactual information about the terrain. The tip will glide smoothly over icy areas and provide vibrations on sidewalks. It is also easier to tell the difference between carpet and tile with a metal cane tip.
When crossing a street, the student may need to depend on the instructor for the "go-ahead." The instructor monitors the crossing itself rather than the student's ability to determine parallel traffic.
Whenever possible, instruction needs to emphasize the student's other senses. Smells can indicate leather stores, restaurants, or hair salons. The feel of a breeze may suggest an alley, and a puff of heat on a cold day may suggest that the student is passing a doorway.
Instructional routes need to include tangible, unchanging landmarks. Cement posts or bus shelters, changes in sidewalk or flooring material, elevators, or stairs are clear and consistent.
Often students with physical disabilities use crutches, walkers, support canes, or wheelchairs in addition to their long white canes. These students have the potential to move independently, and they can benefit fully from O&M instruction.
Specialized wheelchairs are designed for the needs of a specific user. It is important for the instructor to be familiar with the characteristics of each wheelchair and to assess what adaptations will be appropriate for the student. Here are some suggestions for O&M instruction with students who use wheelchairs:
Use a longer cane than is typically needed. The front of the wheelchair has an extension for the user's feet. A longer cane will allow the student to detect what is in front of him when he sweeps it back and forth.
When a student is unable to move the wheelchair independently, she can still use a cane. Even though the wheelchair user is being pushed, the cane will allow her to experience environmental cues such as slopes, openings, and changes in surface or terrain.
The user of a manual wheelchair can sweep the cane to the left and right before moving forward a couple of feet. The wheelchair should move only after the user has swept the cane to clear the area in front. Students who use motorized wheelchairs need to estimate speed in proportion to their ability to sweep the cane to cover the area ahead of them. The sweep of the cane needs to be in sync with the movement of the wheelchair. The wheelchair should not move faster than the sweep of the cane in front.
Attach "curb feelers" to the wheelchair. These can be attached to the wheelchair on either side to help the student know when the chair is close to a wall or a row of lockers. Curb feelers are typically used for automobiles so drivers do not rub their tires against the curb (Wiener, 2010).
Attach a shorter children's cane to the back of the wheelchair to identify the student as someone with a visual impairment. Because not all wheelchairs are alike, it is advisable to place the cane in the best location for optimal visibility.
Attach a pocket to the wheelchair so the student can store a telescoping or folding cane. The cane needs to be within easy reach for the student to find open spaces such as doorways.
Here are some adaptations for instruction with students who use crutches:
The student needs to hold the cane loosely, using the index and middle fingers. While she walks, the cane will be extended forward in either the right or left hand as the user has his/her hands on the crutches. Between each step, the user will need to sweep the cane across the terrain to make sure the area is clear and even to step forward.
Use one of the crutches as the cane. Although this is not the most ideal method, it is successful for slow walkers and in smaller spaces. This is done by the student sweeping the crutch in front of his body the width of his shoulders then using the crutch to take a step forward.
Attach a children's long white cane to the crutch to identify the student as someone with a visual impairment.
If the student only needs one crutch, the long white cane can be used with the other hand.
Deaf-blindness is only one of many disabilities that affect a student's communication. Some students use electronic communication devices such as the DynaVox or Augmentative Alternative Communication Device. The student's educational team may provide vital communication information. In many cases it is up to the O&M instructor to unlock the student's communication around independent travel. Here are some communication pointers:
In the beginning communication may be nonexistent, due to the student's fear of strangers or unfamiliar situations. The O&M instructor may interact with the student by sitting next to her. The student may acknowledge the instructor's presence through her actions. The instructor may then imitate the student's actions and add some actions of her own. If the student imitates the instructor's actions, the odds are good that she will learn O&M.
Even the student's smallest reaction is a form of communication. The student may push or turn away from the instructor. She may frown, sit down, scream, hug, or stand very close. Through these behaviors she expresses likes, dislikes, understanding, or uncertainty. Express verbally to the student that her actions have been received and understood. "That noise tells me you don't want to hold your cane in your right hand." "I hear you screaming, and that tells me that you don't want to go outside today." Explain to the student what you expect of her, even if she isn't able to answer in words.
Sometimes asking is more successful than telling the student what to do. "Johnny, do you want to walk to the playground today?" Wait for his response.
Give choices where the student's action is the answer. "Stephanie, if you want to play in the ball pit, stand up." "Steven, take my hand if you want me to show you how to get to the water fountain."
Observe or video the student in other situations or with other staff members. Sometimes a student's behavior varies, depending on the situation or the people around him.
Greet the student as you greet others. Students may not be able to communicate expressively, but often they can receive communication without difficulty. Through tone and inflection they may be able to tell when someone is expressing praise or speaking in a derogatory manner.
Be sure that you and everyone working with the student use consistent terminology. If you have been saying, "Arc your cane from left to right," don't switch and say, "Sweep your cane from left to right."
Ask the student if it is okay for you to see him again. If he agrees, great! If not, tell him when you will be back. If you can't make it, send a note or call him directly. It seems that when a student knows the instructor is coming back, he is more willing to work at each lesson.
Be honest. "I'm sorry we need to do this today. I know you would much rather play on the computer. But this is something the school wants us to work on so you can be independent."
Explain the goal of the lesson, and ask the student if it is something he would like to do. Sometimes a student can't choose the lesson because of the Individual Education Plan (IEP) goal. "Johnny, it's nice out today, and we need to walk to the flagpole. Would you like to do that?" Rephrase the question if you think the student didn't understand. "Johnny, the sun is shining today. Shall we walk to the flagpole?" If the student cannot answer verbally, suggest an action. "Johnny, if you want to walk to the flagpole, stand up."
Individuals learn to communicate from the concrete to the abstract. At first infants know they are going to be fed when the bottle reaches their lips. Later the infant will hear her parent say we are going to feed you. Later the infant will be able to understand feeding time by hearing the preparation of the bottle with the pouring and filling sounds. Students who are nonverbal need a way to communicate needs and expectations. A student may be handed a cane to communicate it is O&M time. Later a portion of the cane will be handed to the student indicating O&M time. Later a cane tip can be handed to the student. Even more abstract would be handing a card with the cane tip attached with the name identified in Braille and large print. In the end only a verbal prompt "it is O&M time” will be used. This is taking a single act from the concrete to the abstract.
High expectations are truly individualized. The O&M instructor must always be aware of what the next step is to be taken in order to accomplish the level of independence the student needs to achieve. The instructor must never be satisfied with just what is expected of the student for today, but must focus on the achievements available for the student for his future. The O&M instructor must:
Never underestimate the student's capabilities. . . EVER! Once there was a student who didn't seem interested in walking on his own. Often he would simply sit down on the ground. Many thought that the student would not benefit from a cane because he was not walking anyway. However, when he was given a cane and some lessons, he began walking . . . everywhere!
Build upon a simple goal. Perhaps the goal for the student is simply to walk from one classroom to another. Take a look at the route. Is there more than one way to travel? Is there an opportunity to take stairs, use a different hallway, or even go outside? How about counting the doors between the classrooms? Practice walking in the middle of the hallway without shore-lining. The opportunities of the simple route are numerous.
Have high expectations, but be realistic. Adjust high expectations for students with multiple impairments: not all students have the same slope on expectations. What may be obtainable for one student may not be reachable for another. Whereas one student's goal might be to walk from one classroom to another, another student's goal may be to walk from his classroom to the lunchroom and carry his tray to the table.
For some students, success may be difficult to assess on charts because progress may be drastically slow. It is vitally important to:
Acknowledge even baby steps as successful. Take into account a student who never walks without holding on to the arm of another. The lesson may begin by sitting at a table in a familiar area and perhaps playing a game. Have a desired item nearby but just beyond reach (away from the table). Allow the student to independently take a small step to retrieve the desired item. On a later date, place a desired item a little farther away and encourage the student to walk farther and farther.
Document, document, document! Sometimes it is difficult to see the progress unless one is able to step back and look at the big picture.
Use a timer. Perhaps the student needs to travel from one classroom to another without deviating. He often becomes distracted by the noise of other children in the hallway. Measure his success by documenting the length of time it takes him to reach the classroom each day. Even the smallest improvement is a success!
When it comes to teaching O&M to students with additional disabilities, instructors are constantly learning from their students and their students' families and teachers. They also learn from their colleagues through collaboration and consultation. The O&M instructor draws upon previous experience with other students who may or may not have the same set of additional disabilities. The list above is simply a place to start. It is merely the cover of a toolbox for O&M instructors to fill as they gain experience. Each new student with multiple disabilities comes to the O&M instructor as an empty page ready, and sometimes longing, to be filled with independent travel skills.
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