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Foundations of Developmentally Appropriate Orientation and Mobility Session 1

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Title: Foundations of Developmentally Appropriate Orientation and Mobility Session 1


1
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
2
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.

1A
3
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.

1B
4
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.

1C
5
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.

1D
6
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.

1E
7
Objectives
  • After completing this session, participants will
  • 10. describe different types of adaptive mobility
    devices and tools and ways to facilitate
    their use.

1F
8
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).

1G
9
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

1H
10
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

1I
11
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.

1J
12
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.

1K
13
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

1L
14
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

1M
15
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

1N
16
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

1O
17
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

1P
18
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

1Q
19
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

1R
20
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

1S
21
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

1T
22
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.

1U
23
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.

1V
24
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.

1W
25
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.

1X
26
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.

1Y
27
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.

1Z
28
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.

1AA
29
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

1BB
30
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

1CC
31
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

1DD
32
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.

1EE
33
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
1FF
34
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

1GG
35
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

1HH
36
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

1II
37
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

1JJ
38
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.

1KK
39
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.

1LL
40
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
1MM
41
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
1NN
42
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

1OO
43
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

1PP
44
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

1QQ
45
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
1RR
46
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

1SS
47
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

1TT
48
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

1UU
49
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

1VV
50
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

1WW
51
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

1XX
52
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

1YY
53
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

1ZZ
54
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

1AAA
55
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

1BBB
56
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

1CCC
57
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

1DDD
58
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

1EEE
59
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

1FFF
60
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

1GGG
61
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

1HHH
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