Early Orientation and Mobility: Birth to Three

Transcript: 

Hello and welcome to Perkins eLearning to go, this is Valerie.  On today’s podcast we will be listening to an audio version of one of our webinars.  That webinar title is Early Orientation and Mobility birth to three.  Ironically, it is about early orientation and mobility from the ages birth to three.  It will be covering such mobility skills as hand use,  crawling, standing and walking.  This webinar was presented by Susan Abu Jaber who is an orientation and mobility specialist and She has worked with students with visual impairments, deaf-blindness and other challenges for over 31 years.  Please note this was a live environment, at the time, and we missed approximately 1 minute of the webinar being recorded.  You are missing the first minute, which were introductions to Susan Abu Jaber.  We hope you enjoy this webinar

--when a visual-- when a child has a visual impairment, and possibly other conditions as well. Step back from those traditional expectations of the time, and possibly the sequence, of developmental milestones, and support your child in their particular process. When I was working on this webinar and had no idea who was going to be attending, I chose to say you were a child, realizing that some people would be teachers, and some parents. So I'm speaking to everybody, of course.

As Robin said, I've worked with students from birth to 22 with visual impairment and other challenges. In people's homes, public school settings, and here on campus at Perkins School for the Blind. I've also worked with the Perkins International department. And taught a range of topics on early childhood development and visual impairment, as well as consulted at preschools and schools, particularly in Indonesia.

More personally, I'm the middle child of five, who were born in 7 and 1/2 years. My next younger sibling, my brother, was and is diagnosed with a variety of different conditions. It was my job growing up to work with him. While he is not visually impaired, I learned a lot early on about working with children with special needs, and the potential impact of a child with special needs on a family system. Now that he is an older adult, I have a different perspective on how supports and early years can lead to best outcomes for adult individuals with special needs.

Which leads us to today's topic, early orientation and mobility. Orientation and mobility is one part of the specialized approach to helping a child with limited vision, develop a systematic understanding of the world. We use our visual system to gather most of the information we take in. Vision allows us to quickly perceive both what's at a distance, as well as what's at near. It helps us make sense of what we hear. It helps us determine where we want to go.

Early development of O&M skills can start right after birth, and are shaped by the infant's closest people. I would like to add, while we are focusing on O&M in this webinar, all areas of development are interconnected and overlap. I'd like you to have a child in mind during this webinar. Hopefully you will find some of the ideas presented here helpful, and working on their ongoing development.

Imagine you are going someplace for the first time. How long is it going to take? If you're driving, will there be street names on the signs, on the turns? And will there be parking once you get there? If you're going by train, will it be on time? Will you be able to get a seat? How do you get on and off?

Now imagine that this is an old and familiar route for you. You barely have to think about it. Working with children with visual impairments is kind of like that. How do we take them from that early, unfamiliar experience to one in which they have understanding, confidence, and skill? We want the child to be able to manage unpredictable environments. And the way to get there is to start with extremely predictable environments.

Things that I'd like you to keep in mind. What kinds of environments best support development? What kinds of materials and toys will encourage curiosity, interaction, and learning? What are some of the approaches that people around a child can use to support social interaction, cognitive development, and an understanding of the world around them?

Having a new baby is a time of magic, wonder, and stress. Having a new baby with a visual impairment, and possibly other challenges, can be more so. And can be a walk down a lonely road. For a first time parent, all those concerns about how to parent can be amplified. There can be tremendous grief. These things are important to acknowledge because it is also the start of early bonding and communication, and the baby's beginning understanding of the world around them.

Working with an early intervention team can help with this process in many ways. By providing services to the child and the family, and helping parents connect with each other. Ideally, the team will include a developmental specialist, physical, occupational, and speech therapists, as well as a teacher of the visually impaired. And an orientation and mobility teacher. It can be challenging to find these last two, particularly teachers with experience with young children. Look for online resources in groups for help if you are in a more rural area.

O&M is just one piece of the picture. There are overlaps between disciplines, and professionals will come from different perspectives based on their areas of expertise. While at times this might be confusing, overall, it can be very helpful and works best if the team works collaboratively. The role of the O&M specialist is to facilitate gross motor development, general sensory awareness, and cognitive development.

When a child has a visual impairment, many things have to be taught intentionally. Vision organizes experience. For example, the child won't watch other people eating with a fork or a spoon, they will have to be taught what these utensils are and how to use them. They won't watch people walking through doorways countless times, disappearing and reappearing. There isn't the ability to observe, and then imitate, and practice.

Developmental assessments are incredibly helpful in understanding what your child's current skills are, and how and where to go next. Generally, they cover cognitive, motor, language, social, and self-help, or compensatory skills. Functional vision and hearing assessments look at how children use their available vision and hearing in their real environments.

Sometimes it can be hard to translate a medical, vision, or hearing report, into real life daily activities. Functional vision and hearing assessments do just that. Assessments provide a roadmap. If you are using an assessment developed for children with sight, make sure specific items are not vision-based.

It's important to identify areas of strength, as well as areas of challenge. You can work from those areas of strength to help a child develop skills in areas of greater challenge. For example, if your child is very curious about the world and wants to reach out and explore, but has motor challenges. How can you position them in a supportive way that best allows them to reach out and explore?

It's important to break skill development into as small parts as necessary so your child experiences success. It is much easier to build upon successes than to try and bring a child back from repeated experiences of failure. For example, if you want your child to sit independently, you don't just plunk them down and expect them to sit, right? You hold them on your lap with lots of support. Then as time goes by and they develop greater muscle control, then maybe you hold them at their hips so they have to do more of the muscle work to maintain sitting upright. Then maybe you have them sit on the floor with supports around them. Only when they can do that, do you take away those supports and have them sit independently.

Orientation is about understanding where one is in space. With the infant and young child, orientation refers to early concept development. Specifically about body image, spatial awareness, and environmental concepts. It also means learning to understand predictable routines and space, and how familiar spaces fit together.

Mobility is all about the motor act of moving through space. For the infant and young child, this means general gross motor development, integration of reflexes, motor milestone acquisition, redefining quality of movement, self-initiated movement, walking, and beginning to use specific tools and techniques for safe and efficient travel.

Another way to think about O&M, is the different developmental areas that impact eventual independent travel. Sensory development includes vision, hearing and touch, smell and taste, as well as proprioception. Proprioception is the understanding of the relative positions of the parts of one's body, and where one is in space.

Close your eyes for a moment and hold your arm up. Now, I want you to bend your arm. I'd like you to move your arm to the side. Move it in front of you. Now, as my husband reminded me when I was practicing this with him, you can open your eyes. Your proprioceptive understanding both help you be able to do this, as well as know where in space your arm was.

Development proprioception, in part, happens in all those weight-bearing positions children go through in the early years of life. Concept development is a huge area, but starts with developing meanings for specific people, objects, environments, and events that the child experiences daily. Concept development requires the ability to remember. It organizes reality, the structure in which learning and experience is contained.

If you think about how a sighted baby and young child learn, they observe and then imitate the people around them. When vision is compromised, you have to think in terms of all the things you need to bring to the child, and teach intentionally. This is most easily done through many repetitive opportunities to have concrete experiences with real things. The activities need to be meaningful.

For example, think about spoon use. When you're getting ready to feed your child, give them a second spoon that is exactly the same as the one you will be using. Let them hold and explore it. Use the same consistent spoon with them so it becomes familiar. You can then also work on a greater understanding of spoons in general. For example, take a tray, or a bowl, or a play frame with different types of spoons for the child to explore, play with, compare and contrast.

Concepts are best learned through consistent routines. I'm not suggesting you think, well, now it's time to teach reaching. I'm suggesting you look at the child's daily activities and think, OK, where in the daily routines can I teach reaching? It might be, say, while they're playing with toys or sitting in their high chair and eating.

It's important to remember that an orientation and mobility teacher is not a physical therapist or an occupational therapist. Working with both PTs and OTs can help with facilitating more typical early movement and motor patterns. Particularly if your child has additional motor challenges. This gets back to that idea of collaboration.

A lot happens in these early years. One thing to keep in mind, static positions, such as sitting, are generally achieved more easily than ones with movement components, such as crawling. When a baby has a visual impairment, they will often quiet in response to hearing something. Sometimes the adults around them interpret this as a rejection. It's not. The child is trying to engage. They are just doing it differently.

Pre-cueing is a consistent way to intentionally let the child know who you are and that you are going to touch them, so that they don't have a startle response. Consider what kind of touch the child likes, gentle or firm. Are there parts of their body they particularly like to be touched? What do I mean by consistency and routines? Well, think about it. You have lots of them. Brushing your teeth, making your breakfast, getting ready for bed. I bet you probably do these things in a pretty consistent way.

One routine might be bath time. Bring the child into the bathroom so they can hear the water running. Give them a dry wash cloth or sponge, then give it to them wet. Then undress them and put them in the water. Narrate what's happening with simple words or a song. The more consistent approach everyone uses with a baby and young child, the easier it is for them to start making sense of what can seem like random experiences.

You are helping them start to create that internal construct, that organizational system, without the organizing structure of vision. If you think about it, vision is the one long-distance sense. Without it, you're getting pieces of information that don't necessarily make sense or have any context. So remember environment, objects, toys, materials, and people. This is all about how you can create a structure around the child, to best allow them to learn and start to interact with the world around themselves independently. That independence is absolutely necessary for movement.

So why are we talking about hand skills? Well, reaching and exploration is first done with the hands. We want to change the dynamic from everything coming into the child, to them reaching out. Incidental interactions with objects, and people, and pets, leads to intentional interactions, to curiosity, and cognitive development.

Hands are tremendously sensitive. There are a huge number of nerve endings in your fingertips. Early interactions with a child's hands can lead to them learning to pull away or pull back. Or they can lead to them reaching out. If a child isn't reaching out with their hands, it makes it much more difficult to learn to walk.

While I will be talking about hands, I'd like to note, for some children, using their feet will be easier. Some children also explore with their mouths. Remember, think broadly. How can you bring the world to the child? How can you enhance early exploration and develop curiosity about what's out there, rather than fear?

There's an assessment of hand skills that is part of a larger set of assessments called PAIVI: Parent Assessment of Infants with Visual Impairments. It's available from APH, American Printing House for the Blind, and is in the resource section at the end of today's webinar. It looks at how a child uses their hands to manipulate objects, complete functional activities, and problem solve. Determining the child's current level of ability, and then presenting challenges that are just a small step beyond that ability. Well, as I said earlier, help them experience success rather than frustration, and support their developing curiosity. This is something an OT can help you with as well

How best to help a child use their hands and start moving more independently? When you are working with a child with limited independent movement, you will be doing a lot of positioning, and physically moving them yourself. Remember, pre-cueing. You want to minimize any startle responses as much as possible.

Very young children, and children with motor challenges, often end up lying down a lot. If you look at this slide, one thing all these babies has in common, is that they are lying down. Gravity is not their friend. It will be harder for the two on their backs to use their hands together to explore, than for the little guy in the right corner. Who just by being positioned on his side, now has his hands in much greater proximity to each other.

There's an old article called "The In-Arms phase," by Jean Liedloff. It discusses the benefits of carrying your child. Things like vestibular input, development of writing reflexes, and bonding. There's a link to it at the end of the talk in the resource section. And remember, PTs can help a lot with positioning.

Next, I'd like to discuss tummy time. This is another not so favorite activity for a lot of kids. You're lying there with your face smushed into the floor. Why? You have to give the child a reason to work on lifting their head up. Whether it is a favorite sound, a light-up or a vibration toy, or a favorite person, or song.

Remember we talked about proprioceptive development? Strengthening the shoulder girdle, and neck and torso, are hugely important to walking. So now we're going to do a standing activity. And I want you all to stand up because I don't want to be doing this here all by myself in this little room.

So here you are. You're standing up. When kids have low tone, what they tend to do is lock their joints to maintain an upright position. So what I'd like you to do is pretend you're an early walker. Spread your feet apart, nice, wide stance, turn your toes out.

Now I want you to lock your joints, lock those knees, lock those hips, and lock your shoulders. I don't know about you, but for me, this position, my feet feel really far away. The floor feels really far away. I'm stationary, but the idea of trying to take a step is going to be really a lot harder than if your body is relaxed. And you have that muscle tone that you need.

So you see, muscle development throughout the whole body helps with ease of movement. Activities that are also helpful with the development of muscles, are both swimming and therapeutic horseback riding. Again, in the resources section, there's a short video reference called Leo Learns by Doing, which follows a little guy as he goes through those early motor development stages.

Couple more thoughts about positioning. You want to work on one skill at a time. For example, if you are working on a motor skill, do not expect the child to work on a visual skill at the same time. It's likely just going to be too hard. You can use vision as a distraction, depending on your child's visual condition. What they need for toy presentation will vary.

For a child that has an acuity loss, the issue won't necessarily be how many toys there are, or perhaps the contrast between the objects and the background. For a child with cortical visual impairment, visual clutter will be a real issue, so you might present only one toy at a time. For a child with a field loss, you will need to make sure toys are within their visual field.

An environment can be as small as your lap. Again, this is a time for you to step back and observe and analyze. What are the child's daily environments? And how can you arrange and modify them to best support their increasing understanding of space, and how to move through it. You want to simplify and organize.

In this picture, the child is sitting in a box. He's getting a nice, up close and personal experience of what walls are. What corners are, and what those early ideas about components of rooms are. He's also getting some nice support in a seated position. So take a moment and look around your space. And if you're a professional, just think about some of the spaces that you're working in.

How cluttered is it? Are there consistent places for things? How noisy is it? I know this is a tall order, but as much as possible, you want to keep things very organized, and the placement of things like furniture, consistent. This will make it easier for the child when they start moving more independently.

Here are some more pictures of small spaces. How complex are the environments the child is in? Think about the auditory as well as the visual surroundings. Again, you're going to want to simplify. So environments are both the actual surrounding environment and the things in it. Put yourself in the child's position. Think about what is right near and what is farther away.

So what just happened there? That was me making the environment a little more complex, auditorily Probably got more difficult for you to hear what I was saying. So I'll go back and say that again. But again, remember, how noisy an environment is can have a huge impact on a child's ability to learn and move in that environment.

So environments are both the actual surrounding environment and the things in it. Put yourself in the child's position. Think about what is right nearby and what is farther away. Think about lighting. Where are they in position relative to windows, relative to overhead lights? What kind of light is there?

Now, some of you may be saying, this is utterly impossible. I have two other children, and a dog, and it's chaos all the time. Just like I suggested for your child, work on these ideas in small amounts, in ways that you can be successful. It's important for you to experience success as well.

There's a particular approach I'd like to talk about, Lilli Nielsen's active learning approach. Want to make sure I'm in the right slide here. There we go. Lilli was a woman from Denmark who grew up with, I believe, five brothers who were blind. She developed an approach that focuses on bringing materials to the child, and letting them interact with them in ways that encouraged curiosity, movement, and spatial understanding.

So one really important piece of equipment is called The Little Room. Now, these are knockoff Little Rooms, in this picture here. You can see, if you look at the two bottom pictures, that there are lots of toys and objects hanging down there on elastic. So if the child bumps into them, they will have an immediate response. The toys and objects should have the qualities of texture, weight, temperature, sound reflection, or light.

What I see happen, is the child bumps into one thing and gets curious about it and starts exploring it. In the process of movement, they bump into another object and start checking that one out as well. They start feeling out how the two objects relate to each other. That spreads throughout the space.

They are on a thing called a Resonance Board. A Resonance Board is a thin piece of plywood on about an inch lip. What that does is it increases the sound that's happening in the space, leading to the child both moving more and vocalizing more.

These are just some pictures of more environments. The adapted chairs pictured here are made at the assisted device workshop here at Perkins. It's run by Molly Campbell, who's an OT. Again, there is contact information for her in the resource section. I've also included information on adaptive designs and Alex Truesdell. She's based in New York.

Expand your definition of what a toy is. As I was saying, think about texture, weight, temperature, auditory, visual, and vibrational components. Use functional objects, such as metal measuring spoons and cups. You want the child to be able to compare and contrast qualities.

Remember how close or far away the material should be to support independent reaching. What kinds of toys and textures does the child like? Not all children like soft textures. If your child has CVI, or if they have an acuity loss, again, their material needs will likely be different.

In this slide, there's a few different. The top pictures, just things on a tray. Bottom right is things hanging in a small space that a child could be lying down on their side and playing with. On the left is a play frame made out of PVC, that piping that plumbers use. This one is set up so that a child in a wheelchair can be wheeled right underneath it.

So remember the idea of routines and consistent environments. Associating a specific item with a specific place, helps with that early understanding of space. You want to think about real versus miniaturized objects. If you want a child to understand, say, a horse, and you give them a plastic horse, are there any qualities of that plastic horse that relate to the qualities of a real horse? Rather than give a miniaturized object, think about the pieces of information that will give more real learning to the child.

So for example, you might have a recording of sounds that horses make. You might have a piece of material that feels like horse hair. You might go to a farm and interact with real animals. Those real, warm, big, moving things.

This little guy featured here is on a piece of pig board. It's another Lilli Nielsen idea. And so he can sit but he's not yet able to move beyond a stationary sit position. What I've done, is I've attached, again, using elastic, different toys and objects to this board.

So if he turns around at all, or he bumps things with his feet, he finds something. What he's found here, he's found a bowl and he's checking it out. And then the bowl will, because of that elastic and getting loose in his hand, it springs away. And he's got his right foot against a colander, and he's turning to check out that colander. This is just another idea of a way to bring materials to a child by modifying their environment.

When you're thinking about people, big thing, people often create transitions. Transitions tend to be times that are more chaotic. So you want to, again, create a consistent routine. When you're reaching out to a child, when you're entering a space, when you're leaving a space. Maybe you have a particular object that identifies you, or a particular song. And again, you want to pre-cue them. Let them know before you start touching them or moving them.

So there's a thing called hand-over-hand and a thing called hand-under-hand. The picture on the left, the teacher is using hand-over-hand. She's directing the movement of the child's hand. She has her hand on the back of his hand, and she's bringing the attention to the back of his hand. And she's moving his hand. He does not have independent movement here.

The teacher on the right has her hand under the child's forearm. You can also have your hands under their hand. In this position, the child has a choice. They can decide, no, I'm not interested in this activity, and pull their hand away. The difference is, in this situation, the attention for the child is on the palm of the hand. They have independent ability to interact.

This is really important because sometimes hand-over-hand leads to children pulling their hand away. It's really not a very comfortable sensation to have somebody grab your hand and move it around. And if this happens repeatedly, they may tend to pull their hand away as an immediate response, and then get labeled tactically defensive.

Another person I'd like to talk about is Jan van Dijk, from the Netherlands. He developed another approach for working with children with deafblindness and other conditions. His approach is all about communication and that interactions are conversations. How you interact with your child gives them different messages.

Co-Active movement is all about developing understanding of turn taking. So for example, if I'm singing, [SINGING] trot trot to Boston, trot trot to Maine, and bouncing the child on my lap, I'll stop and I'll wait and let the child give me some indication. It might be just a widening of the eyes it might be the slightest movement of the body. It might actually be a movement. It might be a sound that tells me, oh, you want more. Now I will continue on with the song. We're having a conversation. We are in partnership with each other.

So now I'm going to do something that they always tell you not to do when you're giving a webinar. I'm going to stop. I'm going to pause. OK, how long was that? That was actually 10 seconds. So when I'm talking about pausing, I mean you might be pausing for a minute.

Some kids, it takes that long or longer for them to organize themselves to be able to respond. And if you jump in too fast, they don't have the opportunity for that independent response. So remember, sit on your hands, cross your arms, put your arms behind you, put your hands in your pockets and wait. Be aware of scents for kids with seizure disorders. Perfumes, strong smells, can actually set off seizures.

So think about music, songs, and movement. Use clear language with short sentences. Hi, Jane, it's Susie. Verbal labeling also includes spatial relationships. Hands up, hands down. It's in front of you rather than over here. Organize things. If your child has movement, let them help you organize things. Get them involved right away.

So now take a moment. What have you heard so far? And is there anything that you think you can apply to, either your child, or a child you work with? What's one environmental modification, one materials modification, and one people-related modification you might be able to try?

Now we're going to move into larger environments. When you think about space, and understanding predictable routines and space, we want to think about how familiar spaces fit together. You want to make those spaces safe. You want to perhaps put tactile markers on the wall at the beginning of a route, say, near the child's bedroom and at the end of the room. Maybe where they are entering the kitchen, so that they can start understanding that these two rooms relate to each other.

You want to put bumpers on the edges of coffee tables. You want to perhaps put a tablecloth with an overhang on the table, so that if they have some vision, they can see where the edge of that table is better. We want to help them understand. If they've got difficulty with depth perception, when they're moving from one floor covering to another, if it looks like a depth change to the child, that it's all flat.

Landmarks and clues. A landmark is something that's basically always there. A clue is something that's there some of the time. So for example, a refrigerator would be a landmark and a chair would be a clue. Echolocation. Echolocation is using reflective sound to have an understanding of where you are in space. And you can start actually working on this very early. All you need is a bowl.

So what you want to do is put the bowl near the child's ear, but not touching it, and then move it away. Don't say anything. You don't have to tell them you're doing this. Put the bowl near the ear and then move it away. Eventually-- this of course works for children who have hearing, not for children with hearing loss-- they'll realize something's out there. And they'll start reaching to figure out what's going on, what's out there.

They're hearing the reflected sound. For children who can learn to use echolocation, they can locate open doors in walls. They can know when they've come to the end of a building outside. One little guy I used to work with could walk down the middle of the hall, walk around people having a conversation, and continue down the middle of a hall. So it's a really great skill if a child can learn to use it.

You want to introduce concepts and language even before you expect a child to understand them. So I might say, it's on your left with a touch cue. You want to use specific, clear language. It's in front of you, rather than over here. If you're giving a child the sound cue, come on over here, Sally, it's over here. You want to use an intermittent sound cue, not a constant sound cue.

You want to step back. And this can be really hard to do. Kids get bumps and bangs, and of course you don't want them to. Sometimes it happens. So that's why you make the environment as safe as you can. But you really do need to step back so that they start having those independent experiences.

For a child to develop an understanding of space, it's pretty crucial for them to have opportunities to move through it independently. This helps develop those early mapping skills. When you're talking about routes, as a mobility teacher, we refer to routes as I, L, U, and Z routes. I know it doesn't really make sense, since if you're blind, you can't see letters. But an I-route is a straight route, from point A to point B. An L-route has one turn. A U-route has two turns in the same direction. And a Z-route has two turns in opposite directions.

So you can tell your child it's a straight route. Oh, you just have one turn. You're going to be making a right turn. A route, no matter how short, has a beginning, middle, and end. Even if it's from one end of the couch to the other.

Have toys or a person the child likes waiting for them when they get there. Praise them. If a child is in a wheelchair, be creative. How can you help them understand they are moving through space? It may be-- and they may need some kind of propping or positioning to do this-- that you have them positioned so that they can feel the wall going by as they're rolling along.

"I"ness is about understanding that you are separate from the space around you, and that you can act upon things in the space. Remember The Little Room, and that it supports early understanding of spatial relationships? We want to expand on that. And again, those hand skills come into play here. Exploring, comparing, rotating, throwing, dropping, pushing, and pulling.

If you think of how a child develops an understanding of, say, a cup, they look at it, they hold it, they rotate it so they can observe it from multiple, different angles to develop the knowledge of cupness That's what kids need to have the opportunity to do.

When kids are learning how to organize, and be organized on their own, it's really important you give them opportunities to do just that. How do they know where their toys are? They can help you put them in the basket. How do you deal with space and objects in the space? Well, it's really important that children have the opportunity to be involved in routines, from the beginning to the end.

So for example, if you hand a child their bottle or their cup, in space, how are they going to know that there's that part of the routine that involves picking it up and putting it down? They're just going to drop it because they haven't learned, oh, there's a solid surface down here. And I can pick my cup or my bottle up from that surface. So make sure that you give them entire routines, not part of routines.

Be careful that you're not being the good fairy. Don't think, oh, I'm going to help them. That's just a little too far away. I'm going to move it closer. Well, maybe they actually knew where it was when it was a little too far away, but now you've moved it and they don't know where it is. So again, put hands in your pockets, pause, see what happens.

I've got a couple of slides here about safety concepts I'm going to skip. You can look at them later. I'd like to get into some actual mobility skills.

This is actually the little guy who used echolocation to walk down the middle of a hall and around those people. He's using an early trailing technique, walking into his preschool on the right here. His hand is following the railing. Trailing, you're either following along a wall, or some other surface to your side, so that you know where you are in space. It helps you locate where walls end, where doors are, where there are corners.

On the picture on the right, he's using an upper protective technique. Now, typically it takes a long time for kids to get to this point. You want to start with them getting their hands in front of them and together. Maybe they're going to be carrying something like a basket with a handle or a ball. And then eventually you'll have them putting their hands together. I usually call them bumper cars. And then they start learning to separate, and putting one hand up and one hand down.

Now think again about all that muscle development and how important that is for things like trailing, as well as upper and lower protective technique. For the mobility teachers out there, I actually teach a child to use their right hand for training, so that they can hold their cane in their left hand if they're in a situation where they want to be able to trail and use their cane at the same time.

Let's see here. Sighted guide. Picture on the left is a more traditional sighted guide. The person being guided holds above the elbow. Their hand is in a sort of c-shaped cup. The picture on the right is for a child, a smaller child. This child's holding the person's wrist. One thing I like to do is have them hold my hand near the pinky side of my hand. That way, they're, again, independent. They can take their hand away if they want to, but if they trip, I can grab and keep them from falling.

Different types of mobility devices. Before you get to a cane, you can use push toys and pre-canes. The top two pictures here are push toys. They move in one plane, front and back, and you can weight them to slow them down. The lower left picture is a pre-cane, and the curved pieces at the bottom stay on the ground. And the bar at the top is what the child holds onto.

Picture at the right. It's kind of hard to see, but the pre-cane is modified so that the teacher standing up has a handle. So if the child has some tactile sensitivity, they can let go and the cane doesn't fall, it just bumps gently against their tummy.

The little guy on the left here is using his pre-cane. And one of the nice things about a pre-cane, is it allows the child to have two hands-- so the strength of two arms-- and to move in a symmetrical fashion, as opposed to with their body torqued. So he's got those two hands in front of him, and he's got a nice safety coverage. He doesn't have to think about it.

On the picture on the right, he's just getting his new cane. And as you can see, he doesn't have the arm strength to hold it with one hand yet. And he hasn't learned that you hold your cane in one hand and at a diagonal across your body. So pre-cane really does give you some nice, early coverage in a way that a cane can't.

Sometimes when kids are first learning to use a tool, such as a white cane, they experiment with it. They don't use it exactly the way they're supposed to. And personally, as long as they keep the tip of the cane on the ground, I let them explore because it's curiosity and movement. Some of my colleagues are more strict about that than I am. But this is one of those personality things. You can decide what makes the most sense to you.

So remember those roots that you've been working on. Those little itty-bitty roots. They get larger and longer, and they include inside and outside components. So remember simplicity. You want to keep breaking them down into manageable pieces that the child can learn.

Give them tactile clues and landmarks along the way, so that they know where they are in space. Some kids do better with backward chaining. Learning that very last part of the route, and then working back towards the beginning of the route. It all depends on the kiddo and the situation. Obstacle courses are a fun way to work on understanding depth perception if your child has difficulty with depth, as well as early tool use.

Stairs. For a child who has some usable vision, I like to put a contrast color mat at the bottom of the stairs. Solid color. And I also like to put a stop hand or a stop sign. Something red at the top of the stairs to remind them to pause before they go down the stairs.

I will put about an inch and 1/2 wide contrast-colored tape on the edges of the stairs, the top, and the riser. With the littler kids, I will take each stair. Eventually you want to move towards just taping the top stair and the bottom stair. And remember, when they're getting to the bottom, to tell them that there it's flat, all clear, or they're finished.

Remember that transitions tend to be noisier times. How can you make them environmentally easier for the child to be successful? And attend when they're transitioning from one activity to another. What kind of pre-cue do you need to give them to the activity?

There's a resource at the very end called calendar systems. It's a book by Robbie Blaha. That's a very useful book. Another thing, is maybe you leave a few minutes earlier before everybody else, so it's quieter when they're transitioning. And again, you want to use those visual and tactual markers. And you want to make sure that things are as easy as possible for them. So for example, their cubby might be the one that's at the end of the row of cubbies, so it's easiest to find.

Remember, you're the observer. You're the detective. You want to work towards success in small, manageable increments. Pre-cue. Simplify and organize. Use consistent routines throughout the day, and encourage independence. Thank you.