Addressing orientation, mobility & educational needs of students with deaf-

blindness

Introduction
It is a skill that is related to using the remaining senses to establish position in,
and in relation to significant objects in the environment. Generally we use
vision and hearing together to gain the information about the surrounding and
based on this information, we understand the details of our environments.
Orientation is, „Knowing where you are and being able to plan how to go to
where you want to be. In the absence of vision and hearing, one has to
depend upon the remaining senses to be able to move around freely. The
sense of touch, smell and taste can all be used to help in recognizing the
position in relation to the obstacles and landmark around, in the environment.
“Mobility is defined as action of travelling, going from one place to another,
safely and freely.” To be mobile, a person should be able to gather and use
sufficient information from the environment to avoid hazards and to reach the
destination safely.

What skills are taught through orientation and mobility?

When planning an O & M program for children, the focus of training may
include:
Sensory awareness: gaining information about the world through hearing,
smell, touch and movement.

Spatial concepts: realizing that objects exist even if not heard or felt, and
understanding the relationships that exist between objects in the environment.
Searching skills: locating items or places efficiently.

Independent movements: Such as crawling, rolling, walking and so on.

Sighted guide: using another person to aid in travel.

Protective techniques: specific skills which provide added protection in

unfamiliar areas.

Cane skills: use of various cane techniques to clear one‟s path or to locate
objects along the way.
Why is Orientation mobility training important for children with deaf blindness?
Process of gathering, recognizing and interpreting sensory information helps
in meaningful and useful concepts development. When a child cannot access
his world efficiently through his vision and/or hearing, he needs to learn to use
his other senses more effectively.

Orientation and Mobility (O&M) instruction provides students who are

deafblind with a set of foundational skills to use residual visual, auditory and
other sensory information to understand his or her environment. O&M
instruction provides opportunities and skills that can broaden the student‟s
awareness of the environment, resulting in increased motivation,
independence and safety.

O&M instruction for individuals who are deafblind is designed to teach them to
move as independently and as purposefully as they are able. For some
children who are deafblind, it is reasonable and desirable to expect that they
will move about independently in both indoor and outdoor environments. This
independence may mean using a white cane to cross streets successfully and
learning to use public transport. For others, O&M instruction will provide the
skills necessary to allow independent movement within the classroom or
within the home. At a more basic level, and for children with limited motor
capabilities, increased independence will mean that they have better
developed residual senses and can more fully understand and interpret
information from their environments. They may come to understand where an
object is located and where the object is in relation to their own bodies. They
will have the ability to move with purpose, perhaps to extend an arm or roll to
obtain that object.

While outcomes and expectations may be different for the student who is
deafblind, the instruction is similar to that for a child with only visual
impairment or blindness. The most important adaptations are those related to
communication. The O&M instructor will need to ensure that instructions are
given to the student in his or her primary language. This may require the
support from the teacher and the development of touch cues or object cues.
Certain accommodations that enable the student to interact with the public
also need to be developed, such as using communication cards for students
who want to travel using the public transport, go to the market, restaurant or
any other place in the community.

For some children, the lack of auditory and visual input may have severely
limited opportunities to learn about his/her environment and to develop the
language to talk about it. O&M instruction must often be augmented by hands-
on learning to make up for the child‟s lack of prior experience. Language
instruction is an integral part of any O&M training experience.

Program development and implementation

Communication: Developing ways to communicate presents the most
significant challenge for children who are deafblind. Communication issues
must be addressed in every aspect of instruction. For example, planning for
instruction in areas such as concept development must take into account that
although the child may be able to perceive the shape of the dining room within
the school, he or she may need to be taught the specific language
(“rectangle”) to enable the child to understand.
Children who are deafblind use a variety of communication methods including
tactile sign language, speech, gestures, Finger spelling, augmentative
devices, pictures, Flash cards, objects, body movements, behaviour and facial
expressions. Instruction strategies must incorporate the Child‟s primary
communication methods.

Motor development includes both gross and fine motor skills and focuses on
developing and/or enhancing a student‟s motor abilities. These skills involve
Large muscle movements such as walking or running, as well as the finer
skills associated with hand and wrist movements.

Concept development is closely linked to general Cognitive development. It

involves the understanding of sizes, shapes, and functions of objects, as well
as spatial and positional relationships. It includes the Awareness and
knowledge of one‟s own and another‟s body, an understanding of the body
parts, of their movement capabilities, and of body part relationships.

Concept development also incorporates an understanding of and knowledge

about the environment.

Sensory development optimizes a student‟s ability to utilize the senses of

residual sight and hearing, as well as the tactile, olfactory, and kinesthetic
senses. Most students who are deafblind have residual hearing and/or sight,
and instruction can be provided to help them learn to use this sensory
information to understand and interpret information they are gathering through
their senses. It is important to teach the child to interpret sensory information,
assisting him or her to use this information for purposeful movement.

Mobility skills incorporate those O&M techniques that promote movement

through the environment with safety and ease. These skills include walking
with another person (guided travel), self-protection skills, and cane travel. For
young children, these mobility skills will include early purposeful movements
such as crawling and walking.

Sense of Touch
In the absence of vision a person can orient himself by his sense of touch.
Touch is essential for concept formation. It is very important for the child with
deaf blindness to get used to various sensations. Tactual skills include
experiences with wide variety of shapes, sizes and textures.
Children with deaf blindness need to learn to use their hands and feet to
explore the environment. Hands can be used to understand spatial
relationship, about texture, temperature and weight. Hands can be used to
trail along any object for mobility. Through hands, one can understand the
diversity of objects. Feet can be used to understand position, various
landmarks on pathways, and feel changes in surface texture, slope and so on
as he moves about in the environment. Changes in temperature on face/body
can provide orientation information. The touch has its limitation because large
objects and environments and distant objects in general are beyond tactile
exploration.

Sense of Smell
Smell is useful for orientation both indoor and outdoor. Although there has
been little research in the area of olfactory awareness, it is an important sense
in relation to orientation and mobility. Information gained through the sense of
smell may be very beneficial in obtaining feedback regarding the immediate
environment. Many physical locations can be easily identified through smell;
such as a vegetable market, petrol pump, fish market.

Smell can be useful as a clue for directions - Smell from kitchen, fish market
or flower shop. Typical odour from a particular place can be used as landmark
which also helps in orientation and mobility.

Sense of Sight
When a child with deafblindness is very young, it is often difficult to
adequately assess child‟s vision. Therefore, it is important to work with the
child to develop whatever abilities child has in this area. To find out what you
know now about the child‟s vision. Observe for,

 What he/she is able to see?

 From how far child can see.
 How does he/she use his sight to get around the house or outside?
 What other ways could the child learn to use his / her vision while
moving about?

Following are some suggestion for visual stimulation

 Pair several sensory cues when working with the child.
 Choose toys which have differing textures, colours, and if possible toys
that produce a sound.
 Present objects to the child from varying positions, such as in front of
him/her, from above, below or from either (left/right) side. Observe if the
child responds to visual stimuli equally regardless of its positions.
 Encourage actions paired with use of vision. If it appears that the child is
able to see an object, such as a ball, when holding the object within his or
her reach, encourage to reach for it.
 Communicate to the child about what is around him/her, both indoors and
outdoors.
 It is important to name, sign and then to describe objects and their
functions if he/she can understand this additional information.
 Exploration is an important ingredient in helping the child to understand
his/her world. If the child is able to sign, have him/her tell what he/she
sees.
 Ask the child to identify an object which is within child‟s reach, later
gradually expand this area to include objects in the room, the house, and
ultimately outdoors.
 A child who has begun independent movement should be encouraged to
use his/her remaining vision.

The Importance of concept development

Developing an accurate body image
It is essential that the child develops an awareness of self, independent of
others or his or her environment. Although this occurs naturally for sighted
and hearing infants and toddler, it may not be so easy for a child with deaf
blindness.

Assist the child in forming an accurate body image or body awareness,

through many activities or games. Bathing time is an excellent opportunity to
begin working on naming body parts; for example, stroke the child, name a
specific body part and, if appropriate, pair it with movement (for example say,
“wash your hand” and then move his hand.

When dressing the child, describe what is happening and what he will do to
assist. (“Time to put on your shirt... Here it comes... over your head... Push
your head through.... Oh, there‟s your head! Now bend your arm and push it
through... Good! Where is your other arm? Push it through.... Oh look! Your
shirt is on”). Through a wide variety of games and activities, assist the child in
building a realistic body image. He will come to understand that he has a
body, has size and weight, takes up space, grows and changes and has
different parts that do different things. This is followed by the realization that
everyone has a body like himself

Awareness of body parts: The child needs to know that he has different body
parts, each having different name and he should be able to associate
movement and functions with parts of body. Children with deaf blindness do
not get opportunities to learn by watching movement of other people and so it
is necessary to teach children, different movements by manipulating
physically. Awareness of movements will enable a child to explore his
environment in many ways.

Spatial relationship: Once the child develops awareness of his own body, he
needs to learn to use his body as a reference point to orient himself in space.
For example, a Child standing near the kitchen may turn and go towards door
where the Mother is standing. In the next stage, it is important to be able to
generalize his understanding of concepts related to him. He needs to
understand spatial relationship by relating an object or a person to him. For
instance - Dog is in front of me, doll is on my lap. For children with deaf
blindness, these concepts are much more difficult to understand and need to
be taught.

Development of Motor Skills: Development of Motor skills helps a person to

move around. It is a basis for mobility skills. Once a child learns to maintain
balance, all balance activities need to be taught in sequential steps so that he
is prepared to avoid hazards in the path.

A Child with deaf blindness does not learn by observation and so they need to
be trained on proper posture and gait. Drooped head position or clumsy gait
affects the way the child walks. One has to use physical prompt to train the
child for correct posture and gait.

Communication: It is also necessary to have means of communication so that

the child understands. A child with deaf blindness may need nonverbal mode
of communication such as Physical prompt, Modeling or Sign language. Some
children may need objects, pictures, drawing, flash cards, symbols, Braille
cards as communication system.

What are the Special Orientation and Mobility Techniques?

Once a child with deaf blindness learns to walk independently, there are a
number of O&M techniques that can be taught to the child. This includes

 Protective techniques
 Trailing techniques
 Sighted guide techniques
 Cane techniques

Protective Techniques
Even in the familiar surroundings, there are many hazards and obstacles and
they may hurt a person. Protective techniques help a person to be safe. One
uses it when he is unsure and does not want to walk into unsafe situations,
such as open table drawer, closed door and so on. There are two protective
techniques
a) Upper arm techniques:
Arm is raised to shoulder height. Forearm is held across in front of face. Hand
is turned so that palm faces away from person.

This technique protects the upper body around the chest and head. It can be
used for protecting from open door, sharp wall curves, cupboards, hanging
objects, tree branches and so on.

b) Lower arm techniques:

Arm is fully extended and moved to the middle of the body. Palm faces the
body. Arm is held in front of the body.

This technique protects the lower part of the body near waist level. Can be
used to protect against or to locate chairs, table, cot, wash basin, kitchen
platform or other small obstacles. In these techniques hands are used like a
bumper. It helps in learning if there is any obstacle in the immediate
environment.

This technique requires a lot of coordination. Many children with deafblind

have problem with coordination. So the trainer needs to think of adapted
positions keeping in mind child‟s abilities.

Trailing Techniques
Trailing can be used to locate an object or destination
Back of the hand should be used to trail wall or other similar furniture or
object. Extend arm that is closer to the wall or object. Walk by trailing fingers
along the surface towards destination.

Trailing provides tactual information and enables to detect landmark or to find

doorways. Children with deaf blindness may demonstrate variation in trailing
techniques including modification in arm and hand positioning depending on
his age and development of motor skills.

Sighted Guide Technique

The visually impaired person typically holds guide‟s arm just above the elbow
and maintains a position one half step behind the guide. Interprets the guide‟s
body movements such as turns, steps up, and steps down as they travel from
one place to another.

If the traveller is a child, modified grasps at lower level such as at the wrists or
extended finger of guide may be used depending on the child‟s height and
that of the guide. At initial stages, the child may need help to initiate and
maintain the grasp.

Cane Techniques
A cane can be introduced to a child if he/she can hold cane, can maintain
balance and can walk.

Selection of cane: To differentiate a person with deaf blindness from one who
is visually impaired, look at their canes. The cane of the deafblind person is
red and white whereas the cane of a visually impaired person is white.

The length of cane should be determined by the height of the user. It should
reach breastbone when held vertically.
a. Holding the cane
 Hold cane in dominant hand.
 Thumb should be on the front of the top with forefinger fully extended.
 Second finger should be relaxed.
 Elbow slightly is bent near the body.
 Cane should always be in line with middle of the body and in front of
the traveller.

b. Using the cane: wrist movements: the cane is moved from side to side by
flexion and extension of wrist with tip touching the ground in each
movement. The arm should not move.

c. Qualities of cane:
 Durable
 Low weight
 Strong and resilient
 Easily available
 Easily repairable

The aim of training children with deaf blindness in orientation and mobility is to
create positive experiences of movements, increased interest in and ability for
exploring the environments and independent mobility. Training in orientation
and mobility has emphasis on movement and exploration that assist the child
to be independent which is the ultimate goal of education.