Introduction to Orientation and Mobility

 Introduction to Orientation and Mobility:

People who have difficulty seeing are afraid to go outdoors by themselves. They sit at home because they do not know how to travel alone. They have to wait for someone to take them to the bathroom or to visit a neighbors' house. They cannot travel by themselves and must rely upon help from their family and friends.

With training, however, these people can learn to move safely around their villages. This allows them more freedom and makes them less dependent on family and friends. Children can learn to walk to school and adults can learn to walk to work or to the garden. When persons with visual impairment can travel safely in familiar surroundings, they can become more active in family and community activities
Mobility training is a term used for the combination of two skills.

1. Mobility         2. Orientation

Mobility is the ability to move efficiently in one's environment.

Mobility is the art of moving from one place to another independently, safely and gracefully.

Mobility refers to total bodily movement, which involves a change in spatial location accomplished in an upright position under one's own power. It describes all situations ranging from moving around within a single room, in a house to traveling from one own to another or even between countries.

Orientation is the use of the remaining sense to establish one's location in that environment.
The process of using the available environmental information to select and follow the correct path is called orientation.

Orientation is the science of using all other senses by a Visually Impaired person to become aware of his surroundings places and things, both movable and immovable, in relation to his own position.

Orientation and Mobility should form the basis for rehabilitation services for the Visually impaired. Rather, to put it bluntly, rehabilitation services for the visually impaired must start with Orientation and Mobility training.

IMPORTANCE OF ORIENTATION AND MOBILITY
1. Enhances Independence: As being able to travel freely is very important for the sense of independence, orientation and mobility training is an important per-requisite for the integration of a visually impaired person into the community and working life. It enables him to become more independent. It allows him more freedom and makes him less dependent on family and friends
2. Sharpens remaining senses: It sharpens his remaining senses through sensory training. It develops his coordination of movement and improves his posture. This in turn results into better acceptance of the individual in the community and by the peer group.
3. Safety of the individual: It enhances the safety of the individual and his fellow men
4. Self-image: It is essential for correcting gait and postural defects. It is not just an overcoming of practical difficulties, but it is also a step towards developing and maintaining one's own self-image
5. Leads to comprehensive rehabilitation: It is a step towards comprehensive rehabilitation, self-confidence and liberation from the solitary. It also helps in changing public attitudes towards blindness.
6. Mobility and sports: There is close inter-action between mobility and sports. Training in orientation and mobility is a prerequisite for promoting sports among the visually impaired. At the same time, participation in sports enhances understanding of the environment, enables a person to overcome fear of movement in the unknown space and improves concentration, which in turn results into better mobility.
Successful mobility training brings many advantages to the trainee. His self-confidence increases and he gets a real satisfaction from being able to move independently. His coordination, reaction and agility are developed. A well-balanced and efficient traveler is better able to obtain work and hold his job successfully.

MOBILITY AIDS
There are four mobility techniques currently available to blind.
1. The use of sighted guide
2. The use of a cane
3. The use of a guide dog
4. The use of an electronic aid

Of these, only the first two are generally used in India. The use of guide dog and the use of an electronic aid is not very practical and also are very costly affair in India.

PRE CANE SKILLS

Precane skills lessons are listed as follows:
1. Sighted guide
2. Body protection
3. Trailing
4. Systematic search procedures
5. Dealing with the sighted public
6. Familiarization

I) SIGHTED GUIDE
SALIENT FEATURES
1. It is the skill of traveling with a sighted companion
2. Training has to be imparted to the visually impaired as well as the sighted person.
3. The sighted person should know how to guide a companion in various circumstances.
4. All the members of the family of the visually impaired should know how to use the sighted guide techniques correctly.
5. A type of non-verbal communication exists between the visually impaired person and guide and the latter done not have to tell the former every time regarding the change in direction and other walking situations.

TECHNIQUE
1. ESTABLISHING CONTACT: Contact can be established either verbally or physically.

Establishing contact verbally: suggest that the person with visual impairment face the voice to establish face to face contact.

Establishing contact physically: By tapping at the back the guide contact the visually impaired's arm. The visually impaired moves his hand upward along the guide arm into a position just above the elbow.

2. GRIP:
The visually impaired grasps the guide just above the elbow with a firm but relaxed grip, with the thumb on the outside and the fingers on the inside of the elbow. The grip should be in such a way that the shoulder of the visually impaired's grip arm in directly behind the shoulder of the guides gripped arm. The visually impaired remains approximately half a step behind the guide. The visually impaired can be on the right or the left of the guide, which is most comfortable. The guide may have his gripped arm bent at the elbow or may have it hanging down by his side. However it is important that the guides gripped arm should be close to the body so that movements can be detected and the visually impaired can respond accordingly.

3. CHANGING SIDE:
The visually impaired moves behind the guide contact the arm with the free hand just above his grip. The visually impaired now releases the original grip hand trails across the guide's back to the guides opposite arm. When the opposite arm is gripped the grip on the side from where he is changing is released and brought to the opposite arm. The outside hand is released only after securing the grasp with the other hand to avoid losing contact. The proper grip and position is assumed on the other side.

4. REVERSING DIRECTION:
1. Turning around: The guide pivots around the visually impaired and assumes the opposite direction while the visually impaired does on 180 degree turn on the spot and assumes the opposite direction.

2. Inward turn or about turn: When there is no adequate room for doing turning around inwards or about turn may be done.
The guide and visually impaired stop turn towards each other face to face while maintaining the contact. Now the visually impaired grips the guide's other arm release the original grip assumes the proper position and grip. The guide and the visually impaired are now facing the opposite direction.

5. NARROW SPACE:
When passing through a narrow space the guide moves his guiding arm behind and towards the mid line of the back. The visually impaired extends his arm fully and falls back one step behind and move into a position directly behind the guide. The person with visual impairment stride is shortened to avoid stepping on the guide's heel. The guide moves his arm back to the normal position once the narrow space has been negotiated.
When passing through narrow space, the visually impaired person is one full step behind the sighted guide.

6. PASSING THROUGH DOOR WAYS:
When approaching a doorway the visually impaired should be on the correct side of the guide. The visually impaired should be always on the hinge side the door. Change of side may be indicated to keep the visually impaired on the hinge side of the door. The guide opens door with the free hand indicating whether it is a push door or pull door. Now the guide places the contact hand the handle. The visually impaired finds the handle by following the guiding with his free hand. The visually impaired opens the door fully allows the guide to pass the handle on the opposite side of door and closes the door behind him.

7. ASCENDING AND DESCENDING STAIRS:
At any change in level either up or down the guide pauses momentarily to indicate that a change in level is about to occur. The guide takes the first step. The visually impaired takes the position by keeping the toes in line with the edge of step. The visually impaired keeps himself one step behind the guide throughout the ascent or descent upon reaching the top or the bottom the guide takes an extra pace before pausing so that the visually impaired can resume the normal position.

8. SEATING
The guide place the hand of the guiding arm on the back of the chair indicating the position and the type of the chair. The visually impaired follows the guide’s hand down to the chair. Then the visually impaired moves unaided around to front trailing with his knee. At the same time he uses back of the hand to locate the edge of the table. The visually impaired adjusts chair so that he is squarely at the table. With the back of the legs squares off with the seat clears the seat and sits.

9. ROW OF SEATS:
The visually impaired may need to change side takes half a pace forward to align himself by the side of the guide away from the rows of seats. The guide side steps to lead the visually impaired along the row to his seat. The visually impaired with the back of the free hand trails the back of seats immediately in front of him. The guide stops at the appropriate seats. The visually impaired release his on the guide with the back of his legs squares off with seat clears the seat and sits.
On leaving the seats the guide usually leads passing in front of visually impaired if necessary.

10. GETTING IN AND OUT OF A CAR
The guide indicates the handle of the car by the guiding arm. The visually impaired open the door as wide as possible. The hand opening the door follows the top edge of the door. The free hand locates and gutters on the car roof. He moves closer to the car and places the inside foot in to the car. The hand on the car roof remains while the visually impaired bends to move his head beneath his hand.
Before sitting he clears the seat when properly seated he should announce his intention to close the door in order to avoid taping the hands of others. When getting out of the car the visually impaired should make sure that there are no pedestrians or obstructions outside the door.

II) BODY PROTECTION

1. UPPER BODY PROTECTION:
PURPOSE: To enable to protect the face and head.
EXECUTION: Raise upper arm with elbow slightly bent to bring the fore arm across in front of the face, palm facing outward and fingers extended so that in line with the opposite shoulder.
Keep the elbow bent about 120 degree. If the arm is bent less than that, the elbow will be in front of the forearm and will hit objects before the forearm does.
Can be used for protection from low tree branches, open doors, sharp wall curves, corners of walls, cupboards or other such obstacles, which may be vertically placed in the path.

2. LOWER BODY PROTECTION:
PURPOSE: To enable to protect from obstacles at waist level.
EXECUTION: Extend the hand downward and slightly forward diagonally across the body as low as possible. The palm is faced inwards and the fingers lightly curled inwards.
Can be used to protect against, or locate chairs, tables, cots, wash basins, kitchen platform, dressing table or other such low obstruction.

III) TRAILING

PURPOSE: To enable to walk parallel to guiding surface. To enable to locate specific objective,
EXECUTION: Position parallel to and near the object to be trailed facing the desired line of travel. Extend the arm nearer to the object downward and forward at waist level with fingers curled inwards. Establish contact with the object with the back of the fingers only light contact is maintained.
While trailing, the arm and hand should not drop too close to the body as the person may not find time to stop when there is an obstruction. He should protect his head using his other arm.

IV) SYSTEMATIC SEARCH PROCEDURES

PURPOSE: To enable to locate dropped articles.
EXECUTION: Listen to the hitting sound of the article and estimate the direction of the sound and distance. Walk towards the articles slightly under estimating its distance. Assume search position by squatting using upper body protection. Use either circular search pattern or column (airplane) search pattern.
I. CIRCULAR SEARCH PATTERN:
Place the palm of the searching hand on the ground. The palm touching the ground is the beginning point. Now move the hand round and round the beginning point in an ever-increasing circle.

2. COLUMN (Aeroplane) SEARCH PATTERN:
Place the palm of the searching hand in front. Now move the hand outward, forward, inward and so on. One can use either one hand or both hands at a time.
In the beginning, this procedure can be tried using articles on a table, then on a unobstructed floor area, and then in a room with other articles, furniture etc., and finally in a public place or pavement etc. The visually impaired person should develop a sense of direction as well as distance through sensory training any systematic practice.

V) FAMILIARIZATION:
The sighted person should walk with the visually impaired person through the area several times, using correct sighted guide techniques. While moving around, the sighted person should describe what is in the area to help the persons with visual impairment make a mental picture or map of the area.
Next, the person with visual impairment should walk through the area using a cane with the sighted person following behind. This time, the person with visual impairment should describe the area, asking questions to clarify his mental picture.
Finally the person with visual impairment should travel through the area independently. The sighted person should follow behind only to make sure the person with visual impairment has no difficulties.
Getting familiar with a new area may take a long time, depending on its complexity and the abilities of the person with visual impairment.

USING A CANE

Cane is an aid which is used primarily as an extension of the arm to help in locating obstacles along the route and provide with information about the environment.

IMPORTANCE OF A CANE
1. It is accepted as a symbol of the visually impaired.
2. It is regarded as the proven mobility aid.
3. It is inexpensive, handy and has adjustable length.
4. It plays a vital role in the education, social integration and comprehensive rehabilitation of the visually impaired.
5. The white cane techniques are simple and universal and can be applied even in a relatively unknown environment.
6. It enables them to seek a variety of jobs and expedites their economic rehabilitation
7. The collapsible white cane can be folded and put in a handbag while travelling in public transport or while at work.
8. It gives a visually impaired a new lease of life, a new dimension of independence and enables him to become fully contributing members of society.

TYPE OF CANE
Generally there are 4 types of canes that are used widely all over the world.
1. Long cane
2. Angular cane
3. Folding cane
4. Electronic cane

SELECTION OF A CANE
The length of the cane is determined by the height of the user. Generally 90 centimeters and it should reach the breastbone when held vertically. It should touch the ground about one meter in front when a person holds it.
The most popular cane is made of aluminum tubing or about 12mm outer diameter. It has a grip at the top and a nylon top at the bottom.

QUALITIES OF A GOOD CANE
1. Good conductivity
2. Durability
3. Light weight
4. Low cost
5. Strength and resilience
6. Cosmetic and elegant appearance
7. Easily availability
8. Easily repairable
9. Meeting the specific length requirements

USING THE CANE

1. HOLDING THE CANE:
The person can hold the cane in either hand. The thumb should be over the top of the cane, with the first finger extended on the side of the cane and the three remaining fingers wrapped around the underside of the cane. The cane should be held loosely. The first finger is extended along the side of the cane because in that way the cane acts as an extension of the finger. This helps the person to know where the tip of the cane is at all the time.

2. HAND POSITION:
As the person holds the cane, his elbow should be slightly bent and near the body. The hand holding the cane should always be in line with the middle of the body. This helps him to walk straight. When the cane is held to the side of the body, the person tends to veer or walk crookedly.

3. WRIST MOVEMENT:
The cane is moved from side to side by using a movement of the wrist. The arm does not move.

4. ARC:
The tip of the cane should touch the ground a little wider than the width of the person's body. This way, the cane tip touches the ground where the person is going to step and protects him from falling into ditches or tripping over objects that are in his path. The rest of the cane will protect the legs and waist. The cane tip should not swing too wide to one side.

The tip of the cane should touch the ground lightly. This will keep the tip from getting stuck as the person walks forward. The tip should not be bounced from one side to other, or the person with visual impairment may not notice a ditch or hole in the path.

5. RHYTHM:
As the cane moves to the right, the left foot steps forward. As the tip moves to the left the right footsteps forward. This way, the tip always touches the place when the next foot will stop. The person with visual impairment walks at a normal pace using this technique.

6. IDENTIFICATION OF OBJECTS:
The different objects that the cane locates will make different sounds, which the person with visual impairment will learn to identify. If the person with visual impairment wants to identify an object the cane has located, he should use his free hand and not the cane. When the cane locates an object, he slides his free hand down the cane until he locates the object. This allows the person with visual impairment to locate an object easily and quickly.

If the person with visual impairment wants to walk around an object, he should find a clear path with the cane. He should not step sideways without first checking the cane, because there may be a hole or some other object in his path.

7. SHORELINE:
Sometimes a person may want to use the cane to follow a grass line, a fence or a wall. This technique is called shore-lining, or tailing, with a cane. The person swings the cane and lightly hits the fence, but he must also swing the cane back to the other side. He should remember to keep the correct foot/cane rhythm.

Shore lining can be used to follow the side of the road and to keep from walking out into the middle. As the person walks, the tip of the cane should hit the path or road on one side of the arc and grass on the other. He should feel "road, grass, road, grass". If he feels "road, road twice in a row, he know he is walking into the road.

8. KEEPING IN STEP: The cane will help a person find the edge of a step or ditch. He should keep the cane tip at the edge and walk up to it. He then uses the cane to explore the area. If it is a step up, he can find out how high the first step is the depth and width of the step and check for obstacles. If it is a step down, he can find out how to proceed and can check that the area is clear of any obstacles. He should not just lift the cane in front of him and walk without first checking the area.

If it is a ditch, the tip of the cane is used to find the other side. After he has checked the path for obstacles, he puts the cane tip on the other side and steps to it. This way he will be sure to step far enough and not fall into the ditch.

9. DOORWAY:
Before a person with visual impairment enters a doorway, he should lightly swing the cane once from left to right to check that the area is clear of objects and that he is in the middle of the open door way.

CROSSING THE ROAD AND USING PUBLIC TRANSPORTATION

Children even as young as ten years old should be trained to cross roads and to use public transportation.

On similar roads, the person listens for vehicles and then, when it is safe, he can cross the road. As he crosses, he should use correct cane technique. He should not wave the cane in front of him because this does not protect him and could be dangerous both for him and other people.

At bigger and busier roads, the person with visual impairment may want to ask another person to help him cross. He should use correct sighted guide techniques as he crosses the road.

When you first start to train a person with visual impairment to use public transportation, select a time when it is not crowded. Teach the person to ask other passengers the number and destination of the bus, where and when to get off, and any other information that might be helpful.

When a person with visual impairment is walking along the village road and hears the sound of an approaching car, motor bike, or rickshaw, he should first stop than turn a 90 degree angle, and walk straight to the edge of the road. After the vehicle has passed the person can then safely continue on his way.

He should not just stop in the middle of the road, because, the road may not be wide enough for the vehicles to pass. The sounds of the vehicle can help the person with visual impairment with the orientation.

THE GUIDE DOG:
It is the technique of moving around, having a trained dog as a guide. This technique has not been adopted in the developing countries due to the following reasons.
*Lack of training facilities for training the guide dogs
*Very high cost of maintaining such dogs
*Crowded places and lack of traffic regulations
*Risk from stray dogs and other wild animals
*Guide dog techniques, generally, cannot be used to the exclusion of other techniques

ELECTRONICAL AIDS:
Electronic devices attached with the regular mobility canes enables the visually impaired person to detect the hazards and obstacles on his way by producing different beam sounds when touched upon.

THINGS TO REMEMBER WHILE TRAINING A VISUALLY IMPAIRED:

1. When you are teaching cane travel, you must insist that the person with visual impairment follow the six considerations such as grip, hand position, wrist, movement, arc, rhythm and staying in step.
2. Introduce cane technique slowly. Spend several sessions on correct cane technique before teaching a person with visual impairment a travel route. He should be able to use correct cane technique without having to concentrate on the six considerations before he learns to go to a specific location.
3. Do not teach a whole travel route at one time: Break it into parts. Teach and review the first part until your student can do it easily. Then add the second part and so forth. For example, when you teach someone to go from his house to the store, first teach him to go from his house to the road. When he can do that easily, then add the second part from the road to the store. If you try to teach the whole route at one time, you may confuse your visually impaired student.
4. When teaching cane technique, do not always stand behind and follow the person. Check from all sides to make sure the technique is correct. Also stand in front of the person and face him. Let him follow your voice as he walks forward.
5. Do not try to teach too much in one lesson. Too much information at one time only confuses your student. Remember also to spend time reviewing what you have previously taught.
6. Spend many days teaching the persons with visual impairment to use the long cane correctly. So be patience with them.
7. Repeat the same lesson several times until the person with visual impairment has learned it. Spend a part of each lesson reviewing what has previously been taught.
8. When the person is using the cane correctly, give him encouragement, tell him that he is doing well, and that you are pleased with his progress. This will help him feel better and become more confident.
9. Let the person with visual impairment practice using his cane, with you following three or four meters behind him. Take him to the important places in his villages, such as the school, the market place, religious and community centres. Help him become aware of what is happening around him. This will help the person to move more easily and with confidence.

USING OTHER SENSES FOR ORIENTATION

Learning to use a long cane correctly will help person with visual impairment to move safely, but will not help them to know there they are or where they are going. A visually impaired person attains independence in travel if trained in the effective and proper use of the remaining senses. Sensory stimuli termed as "clues" generally enable him to determine his position or direction in respect of the environment. Sensory training should generally be provided in the following areas. I HEARING: It plays a very important part in the orientation process.

i) Hearing:
It plays a very important part in the orientation process. Auditory clues help to compensate the hardship caused due to lack of visual perception. To gain maximum advantage, the person must use it in a number of ways.
a. Sound Discrimination: refers to selecting those sounds, which are useful for orientation. For example, in a background of a variety of noises in a farm, he may want to separate noise of a bullock cart to get an indication of pavement direction.

b. Sound localization: refers to locating the sounds in terms of its direction, distance, source and whether the sound is moving or not. Once the position of the sound is established, he may decide to move towards or away from it. For example, on locating a sound of engine of a tractor, he may move away from it for the reason of safety or move towards it for approaching the pavement.

ADVANTAGES OF SOUND DISCRIMINATION AND SOUND LOCALIZATION:
1. Identify objects from their sound.
2. Relate the sounds to their sources.
3. Discriminate between simultaneous sounds.
4. Establish direction and source, whether moving or not, of the sound.
5. Localize sounds for understanding spatial concepts.
6. Get an understanding of spaces, places, and terrain's by sound discrimination.

c. Mapping of Sound: Where ever sound is perceived in the hearing system, mind of an individual tends to create a map in the mind depending upon direction, distance, quality, variety and pitch of the sound. Individual's mind tends to recognize the source and location of the source depending upon these factors and relating the same to past experience as regard to nature of sound. A person with visual impairment person also experiences the same process. They require inputs terms of recognition of these sounds and relating the same to the source.
A visually impaired should:
Be encouraged to retrieve maps of sound generator in brain
Relate quality of sound with the source
Locates objects using this process
Experience and remember variety of sounds

d. Echo location: Refers to detecting obstacles through the noises, which are generated by an individual and reflected back from the obstacles.
Limitations
Echolocation ability deteriorates with age Echolocation is difficult in noisy conditions, when there is strong wind; and when the obstacle is very thin

POINTS TO REMEMBER WHEN TRAINING PEOPLE TO USE THEIR SENSE OF HEARING BETTER:
1. Start in a quiet place and them late move into noisier places.
2. Have the person with visual impairment stand still at first and then later identify sound while walking.
3. First use sounds that are not moving later use moving sounds.
4. Start with sounds that are continuous, later listen for sounds that are intermittent.

ii) Touch: Tactual clues are also helpful for orientation. Touch is essential for concept clarity and determination of the nature of the object.
a. Hands can be used to
1. Understand spatial quality, surface texture, resilience temperature, pliability and weight.
2. Establish the position and then identify objects.
3. Trail along any object for maintaining contact for mobility.
4. Avail information about the layout of the environment through tactile maps, models, embossed diagrams and relief maps
5. Understand the diversity of various objects.
b. Feet can be used to:
1. Understand the position of various landmarks on the pathways
2. Understand the relative position of buildings and direction and lengths of connecting roads.
3. Feel changes in surface texture, slope etc. and
4. Understand terrain and geographical condition

iii) SMELL: Smell is useful for orientation, both in the house and the outside, in the following ways
a. Particular shops, factories of establishments can be identified by odour
b. Smell from kitchen, store or dining room can be useful as a cue for direction
c. Through smell, one can establish presence of particular animals in the vicinity
d. Typical odour from sewers or open drains in the rural areas can be used as landmarks
e. Sense of smell is useful for understanding one's relative position in an agricultural dairy farm or a garden
f. To relate or associate different items from their smell.
Limitations:
a. Sense of smells may change with time and with change in circumstances
b. Difficult to differentiate smells in crowded places
c. The same smell may be coming from different directions and locations
d. Difficult to use this sense in isolation, thus to be used in combination with other senses.

iv) Temperature:
Changes of temperature on the face or body can be used to provide orientation information. The response of the body to external stimuli, termed as kinesthetic sense enables a person to avail environmental information like heat, cold rain and breeze etc.,

v) Kinesthetic Sense

The receptors in the joints, muscles and tendons give information to the brain about the physical position of the individual in the environment. This mode of information is termed as the kinesthetic sense. Through this information, a visually impaired person comes to know the type of ground or surface such as grass, road, mud etc.,
It is possible to remember and repeat particular body movements. With practice, particular muscular movements can be produced automatically in a similar situation. Getting into a bus, going up the stairs or opening the door generally involves particular muscular movement, which can be repeated time and again in a similar manner.

vi) Taste
It has limited utility for sensory training in orientation and mobility, as it does not provide any information about the relative environment. This sense, however, needs to be nurtured for its utility. It helps a visually impaired person to associate names of a particular substance with their particular taste.

ADAPTING THE MOBILITY TECHNIQUES FOR THE RURAL BLIND
a. Techniques should be easy to perform with the least possible physical strain
b. Cost of mobility appliances should be within the reach of everyone
c. Ensure maximum safety in local conditions
d. Their appearance should be in consonance with the surroundings
e. Easy to repair and maintain
f. Easily available
g. Culturally appropriate
h. User friendly

Reference:
1. Punani B, Rawal N. (1996): MANURAL - Community Based Rehabilitation, Royal Danish Embassy, P 100-105
2. Punani B, Rawal N. (2000): Visual Impairment Hand Book, Published by, Harish M. Panchal (BPA), P 77-136
3. Jachin D. Williams (1999) Paper presented at Community Based Rehabilitation - Sight Savers Project partners meeting, Vizag, Andhra Pradesh
4. Fernadez G, Koenig. C, Mani. M.N.G, Sian. T, (1999) See with the Blind, Christoffel Blindenmission
5. Kirk J. Horton, (1986) Community Based Rehabilitation of the Rural Blind - A Training Guide for the Field Workers, Helen Keller International
6. Robert C. Jackle, (1993) Mobility Skills for Blind People, Christoffel Blindenmission



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