Orientation and Mobility for Young Children With Visual Impairments

Young children with visual impairments learn from a variety of professionals, including a teacher of the visually impaired (TVI) and an orientation and mobility (O&M) specialist.  This Q&A is about O&M services.  Skellenger and Sapp (2010) provided valuable information for this Q&A.

What is orientation and mobility?

Definition

According to Orientation and Mobility, orientation and mobility (O&M) is a lifelong process beginning in the first few months of life. 

• Orientation is knowing the layout of your body, where you are in space and time, where you are going, and how to get there. 
• Mobility is the act of moving from place to place

Expanded Core Curriculum

All children with disabilities learn the general education curriculum, but children with visual impairments also learn the Expanded Core Curriculum (ECC).  Learn more about the ECC in CVI & The Expanded Core Curriculum: Early Childhood Specifics and Understanding the Expanded Core Curriculum. Sighted children learn many skills by observing and imitating others.  Children with visual impairments learn using other methods. There are nine parts of the ECC:

1. Compensatory skills – skills (like Braille) needed for academic learning
2. Orientation and mobility – skills for moving independently and safely
3. Social interaction – skills like playing and sharing
4. Independent living skills – skills like eating, bathing, and household chores
5. Recreation and leisure – skills for enjoying fitness and free time  
6. Career education – skills for getting and keeping a job* 
7. Assistive technology – skills for using tools such as screen readers
8. Sensory efficiency – skills for using the senses of hearing, touch, smell, and taste
9. Self-determination – skills for knowing and stating wants and needs

*Not all components of the ECC apply to very young children.

Many children receive O&M services from their local early intervention or special education team. Some children attend a special program or school, such as the one provided by the Illinois School for the Visually Impaired.

Exploration

Infants and toddlers are in the sensory-motor stage, which means they are exploring their environment with their senses.  For children with visual impairments, adults need to set up safe sensory exploration opportunities. 

The tutorial, Orientation and Mobility: Birth to Three, provides many helpful suggestions. A baby’s play area should be small, organized and consistent; have boundaries that the baby understands; and offer choices of different sensory experiences.  For example, a small blanket may be enclosed by a couch on one side and sturdy pillows or pool noodles on the other sides.  Toys are placed in the corners of the blanket, each offering different sensory experiences.  One corner might have a soft washcloth while the other has a hard rattle.  One corner might have crinkly paper while the other has a fluffy stuffed animal.  The baby can have different sensory experiences by reaching for the different toys. 

Babies need consistency in their environment and routines. This helps them feel secure and willing to engage. Caregivers can announce themselves with the same words and phrases every time.  “It’s mama.”  They can use a consistent song or phrase before touching the baby. They can provide object cues to let the baby know what is next.  For example, place a damp washcloth on the baby’s leg before bathtime.

Caregivers can find creative ways to include babies in daily routines in ways that emphasize senses other than sight. For example, a baby can feel a soft, warm basket of laundry when clothes come out of the dryer. Babies can explore new foods using their senses of touch, smell, taste, and even hearing as foods make different sounds when they are placed on a tray or eaten.

Muscle development

Babies need to develop muscles. Large muscles develop before small muscles, so babies should have experiences that encourage them to roll towards sounds and objects and lift their head during tummy time.  Muscles develop from top to bottom, so babies will use their head to turn toward a sound or smell before they use their body to roll, crawl, or walk toward something.

Exploration

Preschool children benefit from sensory exploration, in more advanced ways.  For example, they may explore utensils at mealtimes. They can feel for the shoes they need to leave the house or listen for the doorbell. Preschoolers begin to explore techniques like cruising along a couch while holding on to it or trailing their arm along the wall while they walk. 

Getting from Place to Place

According to Orientation and Mobility for Preschoolers, preschoolers with visual impairments can start to learn routes. Children can learn routes between important locations, such as from their bedroom to the kitchen at home, or from the classroom to the playground at school. 

Explained in Orientation and Mobility for Babies and Toddlers: A Parent’s Guide, adults can help children prepare for routes by using directional terms.  Here are some examples:

• Right from left – “I’m touching your right hand.”
• Front from back – “The couch is in front of us.”
• Top from bottom: – “The ball you want is in the top bin.”

Landmarks and clues are tactile markers that help define routes. 

• Landmarks are consistent – for example, the flooring changes from carpet to tile at the kitchen doorway
• Clues are sometimes available – for example, backpacks are placed near the kitchen doorway on school days

Routine and repetition help children learn routes. For example, a child walks from their bedroom to the kitchen each day for breakfast.  It is helpful when the end of route is motivating, leading to a preferred meal or favorite toy.  

Routes should start simple.  Parents can describe routes using these terms:

• I – straight (“This route doesn’t have any turns”)
• L – one turn (“This route has only one turn”)
• U – two turns in same direction (“This route has two turns, but they will both be in the same direction”)
• Z – two turns in opposition direction (“We have two different types of turns for this route.”)

As children learn routes, they will become more independent. They may begin with a high level of support such as full physical assistance like holding an adult’s hand as they walk. Eventually the child will travel the route with a few verbal cues or on their own.

Instruction

O&M specialists will provide instruction and feedback to preschool students.  For example, they may observe the child’s gait (walk/stride) and help correct alignment or posture issues. This will help the child travel in a straight line.

During transitions at school, O&M specialists may have the child leave a few minutes early, offering more time and less commotion.  Strategies like placing a child’s cubby or locker at the end of a row, making it easier to find, are helpful.

In addition to materials that provide sensory experiences, infants can use items that extend their reach and allow them to touch objects away from their body. Items like a long handled wooden spoon are helpful for infants.  Toddlers can use pool noodles and paper towel rolls to extend their reach.

As children begin to walk, they can use push toys that have cylinder handles.  Toy shopping carts, push toys, and pretend lawn mowers support walking and act as a “bumper”, so the child does not run into walls or objects with their body.

In classrooms, teachers can create a path on the floor using waffle blocks. Waffle blocks are flat, square blocks that can be attached to one another, forming a path that is several inches wide and slightly higher than the floor.  Bumpy or rough tape may be another option for creating a path. The child can walk on the path and learn concepts such as “along”, “across”, “side”, and “shoreline”.

For safety, classrooms for children with visual impairments should have wide walking paths and be free of clutter.  For example, toys should be off the ground and chairs should be pushed into tables when not in use.

The article Mobility Devices for Young Children describes several options for special equipment, along with age ranges:

• Pediatric Belt Cane (11 months to 5 years) – a belt is attached to a rectangular frame with two plastic tips ending in wheeled glides.
• Rectangular Cane (3 years and up) – four lightweight shafts are connected to form a rectangle. They have rubber grips on each side.
• Long Canes (5 years and up) – similar to long canes used by adults but adjusted to a child’s size.  They may be adapted, with a push broom or bar at the tip.

Long canes

Some professionals believe that children should be exposed to a traditional long cane as soon as possible, as a baby. Even if they cannot use it correctly, early exposure will help children see it as a necessary tool in their life. Other professionals recommend the gradual progression of equipment described above. Tools are selected based on the child’s developmental level, with several options used before the long cane.  Educators should consider the child’s strengths and other disabilities when selecting equipment. Decisions should be based on the child’s IFSP or IEP, and the O&M should guide the decision making of the team.

The American Federation of the Blind believes that no blind person should be without a white cane, regardless of their ability to pay for it. Visit the Free White Cane Program website to learn more about getting a free white cane.

Educators can explore the  American Printing House for the Blind Connect Center. They empower people toward independence and success by providing free information and resources to assist children, parents, job seekers, and adults who are blind or low vision.