The Art and Science of Teaching Orientation and Mobility 2013 Edition made Screen Readable for Blind and Visually Impaired Persons by Professor T K Bansal.

Although the diagonal long cane technique has its limitations, it still offers more protection than self-protection techniques. The cane acts as a bumper for the body and a buffer between the body and obstacles in the environment. Because the cane also identifies its user as having a visual impairment, people who are traveling in hallways or other areas while lessons are being conducted may tend to move out of the student’s way, which can be helpful or detrimental, depending on the goals of the lessons.

The student first learns to hold the cane while in the various human guide positions, as described earlier. The specialist determines whether the student will then be introduced to all the diagonal cane grasps outlined in this chapter or to just one or two of them. Her decision will be determined, in part, by such considerations as her knowledge of the student's ability to grasp with his fingers; any physical impairments in his hands, arms, and shoulders; and the student’s ability to use previously learned motor skills. Thus, if the student had difficulty rotating his wrist and shoulder as he learned to trail with his arm, the specialist may decide not to teach him to use the index finger grasp, which places a good deal of stress on the wrist, elbow, and shoulder. If it is necessary for the student to use the index finger grasp, the specialist can modify the technique to meet the physical requirements of her student.

5.6.1 Assessing Readiness for Cane Skills: Lesson Sequencing and Pacing

Out of necessity, some students (such as those who live in rural areas and need to travel a dirt path to get to their mailboxes) may have to be taught how to use a cane early in their O&M program. Not only will they need to learn the two-point-touch long cane technique (see Chapter 6) before they learn the diagonal cane procedure, but they may need to learn it outdoors before they master it indoors, as is usually suggested. If a student is learning cane skills in the sequence suggested in this text, he should be ready for cane skills upon demonstrating smooth and efficient self-protection procedures as he hand trails along walls and walks into open spaces and as he becomes familiar with rooms in a building. Some specialists prefer to teach the room-familiarization procedure as a culminating experience after learning self-protection techniques and before they teach the cane techniques because the cane often gets in the way of objects in the room and can thus become a burden.

5.6.2 Adaptive Mobility Devices for Children and People Who Are Elderly

As children with visual impairments grow and move about their immediate environments, specialists must decide when to introduce the use of canes. Preschoolers can be introduced to the notion of using a cane as a bumper and protector by learning to use an adaptive mobility device (Smith & Penrod, 2010). These devices are typically fashioned out of plastic conduits or pipes to form a T-shape, with the shaft placed on the ground so the child pushes it in front of him. Other devices form a rectangle of plastic pipes with a roller placed over the base for ease of movement. In recent years, these devices have been fashioned out of aluminum and some roll-on wheels. After the children learn to use these devices, and as their developmental levels allow, they may be ready to maneuver a long cane that is specially cut for their height. Some specialists have taught children as young as three years old to use a cane.

Adaptive mobility devices have also proven useful to elderly adults who need a device for limited travel within their immediate home environments and who do not wish or need a full O&M program. These devices mustn’t be used for balance or support, however, as they are not made to support weight and could collapse under the student.

5.6.3 Long-Cane Users Who Have Low Vision

Individuals with low vision who may not always be using long canes for mobility may still need to use them for identification when they cross streets or use public transportation, and they may need to rely on them in dimly lighted areas or when encountering glare. Identification (ID) canes look like long canes but are very thin and flimsy and should only be used by travelers with low vision when crossing streets or entering and exiting buses, for example. They are meant to alert others that the person is a traveler with low vision. They are not needed by the traveler to detect objects or drop-offs. They are merely used to identify the individual as someone who has limited vision in situations that merit such identification.

As mentioned in Chapter 2, some specialists prefer to blindfold students with low vision to teach them how to rely on canes. Others, however, believe that blindfolding does not simulate poor or challenging lighting conditions and that the only true way to simulate lighting conditions is to teach their students at night or in nighttime conditions. Although the prognosis for some students with these and other conditions may be poor, that is, it is likely that they will lose more or all of their remaining vision someday, one cannot, in general, truly prepare them for the eventual loss of vision by blindfolding them and teaching the skills as if the students were blind. Once the blindfold is removed, students will revert to using whatever remaining vision they may have. Therefore, specialists are encouraged to work with the usable vision of these students, and, if it fluctuates or decreases permanently, make adaptations or modifications in instruction based on their students' current visual statuses.

That said, however, low vision simulators, especially those that block out the inferior visual field, are excellent tools to use when teaching cane skills because the students cannot look down at their canes while walking but they can look forward to using their vision. Low vision simulators are goggle-like devices that closely mimic certain low vision conditions like hyperopia, hemianopsia, macular degeneration, retinitis pigmentosa, and cataracts.

5.6.4 Reluctant Long Cane Users

Some students may be technically ready to learn to use a cane but may not be ready emotionally. They may believe that there is a stigma attached to using a cane, especially if they have not yet adequately dealt with the loss of their vision. Some believe they can travel without a cane because they are doing just fine” round their Homes or schools.

As specialists work with these students and get to know them as individuals, the rapport they develop should lead to trust between them. In subsequent lessons, the specialists may broach the subject of using a cane and what it can do for the students. Some students may relent and agree to learn to use the cane while not being committed psychologically to it. In some such instances, specialists may note that these students do not use their canes between lessons, forget to bring their canes to lessons, or have many excuses for not using them during lessons. Specialists need to be patient with these students and encourage them over time. Offering lots of praise, developing meaningful experiences, relating the use of the cane to future situations important to the students, and peer pressure are all ways to encourage reluctant students to use canes.

5.6.5 Long Cane Manipulations with the Diagonal Cane Technique

As a student travel using the diagonal cane technique, the cane tip and shaft will occasionally stick into hallway furniture and open doorways. The student must then extract the cane from these obstacles without damaging it and while protecting himself. To extract the cane, the student gently removes the tip or shaft from the object while maintaining his line of direction and keeps the cane in front of him when he reassumes the correct positioning.

For example, as the student trails in a hallway along a wall on his left side and makes cane contact with the side of a bench against the wall, he turns 90 degrees away from the wall and trails along the side of the bench until his cane locates one of the front legs. He extracts the cane tip from underneath the bench. He then turns back 90 degrees, so the bench is still on his left side, and trails its front until he locates the opposite side with the cane tip, extracts the tip, turns 90 degrees toward the wall, and trails the side until he locates the wall with the cane. He extracts the tip from the rear leg and then turns 90 degrees to the right and continues trailing the wall in the desired direction. In this example, the student keeps the proper diagonal cane position throughout the many turns while he extracts the tip from underneath the bench before each turn. In this manner, he learns always to maintain the correct position and, hence, he always has adequate protection.

5.6.6 Long Cane Clues

As the student maneuvers the cane through the environment, he learns to identify objects by touching them with the cane. When using the index finger grasp, he begins to figuratively extend his fingertip out farther into the environment through the cane shaft to the cane tip itself. The shaft and tip seem to become extensions of his hand and fingers. Later, he will learn to auditorily extend farther out into the environment and will rely less upon objects he contacts with his cane. For the present, he learns to identify objects without touching them with his hands. At first, he stops to explore an object with the cane, but as he gains skill, he learns to do so while in motion by observing where the cane contacted the object, the sound the object made as it was contacted by the cane, and the approximate dimensions of the object by noting where along the shaft he felt the opposing force of the object as the cane maneuvered along its surfaces.

5.6.7 Correction of Veering While Using the Diagonal Cane Techniques

As the student walks out using the diagonal cane technique, he adjusts his line of direction as he contacts objects in his path. For example, if he veers into the wall while walking into open spaces, he learns to turn slightly away from the wall and continue walking. After a few paces, he will be in the center of the hall, where he turns again slightly toward the wall he contacted, which should realign him to face directly down the corridor.

The specialist shows the student how to correct his veering by standing behind him and gently putting some hand or finger pressure against the closer shoulder to the wall (by touching that shoulder with one, two, or three fingers) just as he makes cane contact with the wall. Using those same fingers, she then gently redirects the student slightly away from the wall by gently putting more pressure on that shoulder, and when they reach the middle of the hallway, she gently realigns him to face the proper direction by using the same procedure but concentrating on the opposite shoulder. The specialist continues this procedure whenever she observes the student veering into the wall until the student executes it on his own.

Generally, students tend to turn away too far from the wall after encountering it, which only causes them to contact the opposite wall after a few paces. This “pinballing” effect that is, the experience of bouncing from wall to wall can be both disconcerting and disorienting to the student and should be eliminated as quickly as possible (see Sidebar 5.2).

SIDEBAR 5.2

Case Study: Correction of Veering While Using the Diagonal Cane Techniques

Jason is a 10-year-old student receiving O&M instruction in the use of the diagonal cane technique. Jason has no useful vision and has been blind all of his life. His O&M specialist has noticed that when he concentrates on his cane technique, he has a tendency to “pinball” down the hallway, or veer from wall to wall. She decides to try gently guiding him as he walks along the hall. At first, she provides human guide skills while having Jason demonstrate the index finger method of using the diagonal cane technique. As they walk together, she has Jason walking in a straight line. Then she asks Jason to let go of her arm and walk independently down the rest of the hallway.

As Jason walks along, she anticipates his tendency to veer so she steps behind him. As soon as he starts to veer, she gently touches the shoulder closer to the direction toward which he begins to turn and exerts a slight pressure. As she feels him move away from her fingers, she places her other hand next to his opposite shoulder in anticipation of his overcorrecting and turning too far away from his intended line of straight travel. Should he overcorrect, she would apply the same amount of pressure to that shoulder as she had just applied to the other one.

In that manner, the two walk down the hall together. As Jason begins to learn to make subtle corrections, he not only learns to adjust his gait pattern but also learns what it feels like kinaesthetically to walk in a straight line. Through observation of Jason's movements and his ceasing to bump into her fingers, the O&M specialist can assess that Jason is learning how to walk in a straight line.

End of the sidebar.

(a) Tactile Defensiveness

O&M specialists need to forewarn students who do not wish to be touched or are tactilely defensive before they lightly touch the student's shoulders, or they should describe in detail what needs to be done. Specialists may have to develop activities to lessen the tactile defensiveness of these students and can work closely with other professionals involved in the educational or rehabilitation process to help students overcome these difficulties.

(b) Avoiding Sidestepping

The student needs to take care not to sidestep away from the wall or step to his side one or two steps when correcting a veer because doing so will not alter his direction. Rather, sidestepping inevitably causes the student to make contact with the same wall a few paces farther along the route.

Should the student be veering to the left wall, as an example, he would be facing somewhat toward it. If he should try to correct his positioning by sidestepping, all he has accomplished is moving himself over to his right. This does not change the fact that he is still facing toward the left wall. He will simply be heading once again to the left wall once he begins walking. Sidestepping can also injure the student because he has stepped into an area not covered by the cane where there may be, for example, an object, a descending stairway, or a street curb.

If the student wishes to check his relative location in the hallway, he can do so by sweeping the cane along the floor in a 90-degree arc from his midline to the side of his cane hand and then placing the cane into his other hand and repeating the procedure on the other side. It is important for the student not to cross his midline when sweeping to explore the ground surface because he may inadvertently turn his body to do so, which could then change his direction and alignment an especially critical problem when standing at the intersection of two hallways, two sidewalks, or even two streets.

5.6.8 Detecting Openings with the Diagonal Cane Technique

When trailing the wall line using the diagonal cane technique, the student will encounter open doorways and intersecting halls. To cross these openings, he uses the same squaring off or aligning procedures described in Chapter 4. The student needs to be careful not to stick the cane into the open space unless he can determine that no pedestrians are attempting to cross his path. Once he is certain that the path is clear, he assumes the cane position and crosses the opening accordingly. The student should use the upper hand and forearm technique while crossing to discover any objects that the cane does not detect.

5.6.9 Utilizing Route Patterns to Meld the Diagonal Cane Skills with Orientation Skills

As the student gains familiarity with the diagonal cane technique, he walks various routes in the hallways while maintaining his orientation and proper cane manipulations. He uses the same route patterns and sequencing that were described in earlier chapters. The specialist stands or walks farther away from the student as he travels along the route and provides feedback only when the cane skill is done incorrectly.

By the end of the mini-unit, feedback from the specialist should be at a minimum during the routes because too much feedback can lead to the student’s dependence on the specialist. At this point, the student should begin to determine at the end of each route whether he used the skills properly. One way to encourage this self-determination of skills acquisition is to talk with the student at the end of a route or lesson and ask him to critique his skills. Such questions as,
how did it go?
How do you think you did?
Did you veer?
How do you know if you veered?
How did you correct yourself once you knew you were veering?

This kind of debriefing should be built into all lessons as it is an efficient way to summarize learned skills, but it also allows the student to ask questions and may lead to a better understanding of how and what the student is thinking.

By the end of this unit, the student has gained enough self-confidence to begin to explore unfamiliar environments. He does so first indoors and then outdoors, and he begins the process by learning to use the two-point-touch cane technique, which is described in detail in the next chapter. Although the skills that have been described thus far in this book are sometimes taught by the certified rehabilitation therapist or the vision teacher or paraeducator, the remaining chapters in this text describe advanced techniques and skills that should be taught solely by the O&M specialist.