Joe Cutter, Early Childhood O&M specialist, takes a look at issues in Orientation & Mobility, starting with an overview of O&M. Joe explained that the field developed after World War II to provide blinded veterans with a way to move about independently. The techniques that were developed were being taught to formerly sighted adults who already had well-developed concepts of space and movement. Terminology such as "arc," "in-step rhythm," and "alternating sides" made sense to them. Joe calls this standard method of teaching O&M skills a "top down" approach.
When O&M instructors began to experiment with giving canes to younger children, they found that the adult "top down" approach was not appropriate. Joe believes a better approach with children is "bottom up," an approach which takes into consideration the way children develop.
Here are some of the core ideas of the "bottom up" approach:
Just because a child is lacking eyesight, s/he is not lacking the "drive to move and the need to know." We don't see with the eye and hear with the ear; rather we see and hear with the brain! A young blind child simply needs assistance in learning how to move and in finding out what there is to know.
One of the things a child must do in order to make sense of the world is to put together, or integrate, the information s/he takes in through the senses ("sensory integration"). But a child cannot integrate information that s/he does not have! So one of the keys is making sure the child is receiving information about the world.
How does a blind child get information about the world? Largely through movement. Movement brings the child into contact with objects and people in the world. If a child is restricted in movement, s/he will be restricted in information about the world.
The goal is for the child to initiate movement him/herself. Parents and other adults in the child's life can facilitate movement by showing the child that the world is a safe place where s/he can find fun and enjoyment. First the adults bring the world to the child; then we help the child go to the world him/herself. Movement experiences in the early stages, however, must be provided in ways that the child can take in. We must feed the child from an appropriate, meaningful "menu" in order for the child to thrive and grow.
Infant Movement Experiences
Much of the literature on the development of blind babies states that they are delayed in pushing up on their arms in the prone position (on the belly) as much as six months compared to sighted babies. Is this noted delay an inevitable result of blindness?
No, says Joe Cutter. If we enrich the prone experience for the baby with parent-baby play, for example, the baby will have reason to push up, and we can begin to close the gap. For example, instead of letting a baby lie on a blanket on the floor, let the baby lie on the parent's chest The baby then gets a reward for pushing up—closer contact with mom or dad's face and voice. We can think of such interventions as alternative techniques of blindness suitable for babies.
Other important aspects of early movement are "midline" experiences. A crucial time in the development of sighted babies occurs when they discover their hands and then the rest of their bodies. When the hands come together at the center of the body (the midline), the baby begins to break out from reflexive movement and begins to make purposeful movements. This purposeful, body-discovering play leads to the ability to integrate information gained through the senses.
How can we facilitate midline experiences and, therefore, body discovery for blind babies? By "furnishing the midline space," again providing reasons for the blind baby to touch his/her hands together. On-body play—hands together, hand to foot, foot to mouth, etc.—is the way the child begins to know his/her body and how it can move. These are the components needed for eventual sitting and walking.
A third aspect parents can explore is the sound-touch relationship. Early on, sound not related to a touchable object will not have meaning to the blind baby. For a sighted baby, things to look at are things to touch, and things to touch are things to look at. How can we create an equivalent experience for the blind baby? By making sure that things to hear are things to touch and by adding a touch experience to whatever vision the child might have. Even visually directed reaching is tactually directed at first. What can facilitate sound-touch understanding and reaching? The parent's voice and body is the logical place to start.
Early Intervention Experiences
What does a blind baby need? To move in and learn about the world. A toddler with normal eyesight would be running around "visiting the world." The young blind child should have this opportunity, too. An early intervention program for a blind child should be about movement and discovery; movement should be built into the structure of the program.
A large part of the EIP day is often circle time-type activities with the desired behavior being "sitting quietly and waiting your turn" This kind of activity is often overemphasized and inappropriate for toddlers who need experience in visiting the world (and was, in fact, a program design borrowed from the preschool model meant for older children). If the needs of the child dictated the program, then sitting quietly would not be a top priority for children who need movement and exploration. Programs should be facilitating and encouraging movement. (A more meaningful and appropriate alternative to the typical circle time for a blind child might be a small circle made up of the child, the parent, and a teacher or aide.)
The Role of the Classroom Aide
The role of the aide in the classroom is another critical aspect of early programming. Joe feels classroom aides should be there to facilitate movement and independence in the child. The aide must not be a shadow hovering over the child! The aide must learn what the child can do and allow the child to do it. She should be an available but not interrupting helper. She should not be a personal bodyguard!
Use of the Cane
When should the cane be introduced? When it will facilitate and not interrupt movement, says Joe. Usually this is when the child has achieved stable walking. Some classroom teachers and even professionals in the O&M field do not as yet see the cane as a viable tool to facilitate movement in children so young. As a result of these reservations, sometimes the "sighted guide" technique is emphasized because it supposedly gives the child a quicker, more efficient way to get around. However, this quicker, more efficient movement is at the expense of the blind child's developing his/her own efficiency and speed and observing his/her own movement, all of which eventually lead to independent mobility. Of course, guided walking is also at the expense of the child's self esteem and confidence about his/her own knowledge of and ability to get around in the world. If independent mobility is the eventual goal, then the child must be allowed and encouraged to develop it.