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Acquired Deafblindness

Orientation and Mobility

Orientation and mobility is a term that is used when referring to our ability to find our way or navigate our environment and being mobile with the physical ability to move about safely. Subconsciously we all use our senses of vision, hearing smell, and kinesthetic reactions to help us find our way whether it is in a familiar environment such as our home or in a new and unfamiliar environment.


Using our senses


Our vision is used more than any of our other senses to get ourselves from A to B. For example finding toilets in public places we use our vision to follow signs, although for the majority of us when we wake in the night in our own home, although it is dark, because we are familiar we are likely to find our way to the kitchen for a drink of water without needing to turn the lights on using tactile cues. We use our hearing to follow sounds, for instance, when a young child playing in the home cries out because they have hurt themselves, we can use our directional hearing to find them and assist. Our sense of smell alerts us and gives environmental cues such as the baker’s or a florist shop.

For people with low vision they may need to make use of their residual vision to interpret their environment. Depending on the type of vision loss, the conditions of the environment itself and their perception, an individual may use a combination of visual, auditory, tactile and olfactory cues to gain the necessary information when moving around in their home or externally. Information is decreased for a person who is blind and even further when a person also has hearing loss or is Deaf. For this reason it is important to keep a consistent layout within the home and or/office environment. Familiarity with their environment is vital for a person to maintain independence and find their way around safely.

 

Keep a consistent layout


A person with little or no vision can negotiate their environment if they are familiar with the layout of the room or building and placement of fittings and furniture within.  In an unfamiliar environment a person may need sighted guide support. (see also Adapting the Environment).

It is important to keep furniture in the same place.  Moving a low coffee table for example can be hazardous. A person who has built up an image in their mind of where everything is placed is likely to move about with little or no difficulty, building a route in their mind to get from A to B based on their knowledge of where furniture and other items are positioned. Once moved from its usual position the coffee table’s position in the usual route in the person’s mind becomes an obstacle and potential hazard that they could either bump into or fall over.


Control is reduced significantly when accessing the external environment with many barriers presenting challenges such as street furniture, signage, crowded shopping centres, crossing roads etc.. Department stores regularly change their layout, cars park on pavements, bicycles are chained to lamp-posts, all contributing to a changing outdoor environment.


Orientation and Mobility Training



People who acquire deafblindness or dual sensory loss may become anxious in moving around particularly in environments outside the familiarity of the home.

Orientation and Mobility Instructors can train people in building confidence using their remaining senses and learning techniques and strategies to get themselves around safely with or without a mobility aid. Training is tailored to an individual taking into account their level of vision and existing strategies they have developed.


An orientation and mobility programme can be structured from a starting point of sighted guide and indoor training, including and understanding of spatial awareness and developing a directional sense, gradually moving to upper and lower body techniques, and trailing support a person to build their confidence before developing skills in orienting and using a mobility aid, transferring skills to the outdoor environment. For other people it may not be necessary to start at this point. A guide dog is also an option for many people with a vision impairment or dual sensory loss.


To gain maximum benefit when using a mobility aid such as an ID cane or long cane learning techniques in grip, scanning, picking up changes in surfaces or drop-offs such as kerbs and stairs and negotiating safely. An O&M Instructor may also assist a person to learn routes that are regularly used that may also need to be reviewed periodically, particularly if there is a change in a person’s circumstances such as changing jobs, or transport companies changing bus routes for example. Other people may benefit from having a guide dog.



Sighted Guide



Sighted guide is another option to reduce the stress of needing to be aware of one’s space, concentrating on a route, using visual cues that may be limited to the shape of a building without the detail, listening to traffic patterns, problem solving. Independent travel is tiring.

Sighted guide support in an unfamiliar area may be a necessity for some people.


When guiding a person the basic principles applied are for the person with a vision impairment to lightly grip the guide’s arm just above the elbow, and by positioning themselves just behind the guide relying on the guide to support movement safely providing information as necessary about the environment, direction, changes in light conditions, surface changes, hazards etc.


When guiding a person with low vision and moving from bright light to darker conditions and vice versa it may be necessary to pause and allow the person’s eyes to adjust to these changes.


People will have preferences about the way they wish to be guided. Develop a partnership and work together.


Communication



It is important to keep the person informed while guiding. Communication methods for people who are Deaf or have hearing loss will vary significantly, some being verbal, visual, tactile or a combination. In these situations it is important to pause in a place that is safe and communicate information in the person’s preferred format before continuing on the journey.

    Pause or stop in a place that is safe

    Communicate what is happening (change in direction, traffic, hazard, etc.)
    Allow time for person to process information and decide what they want to do
    Proceed if safe  

For people who are hard of hearing it may be necessary to move to an area where it is quieter (where possible) to enable them to hear information being communicated.


Communication Guide



A number of countries have schemes, whether voluntary or funded, to provide human support to people who are deafblind to facilitate communication and guide them safely reducing isolation by enabling access to community services, information, leisure etc.

In Western Australia, Senses Foundation carried out a pilot project offering this support to individuals who are deafblind, and are continuing to identify funding streams to continue this vital support.  


Terms used in other countries for this type of support include Communicator Guides (UK), Support Service Providers (USA), Intervenors (Canada) and Contact Person (Denmark). There are many debates about these job titles – they are just job titles. The work that is carried out by the people who provide this type of support is the most important issue.


Making Choices



Remember that the person who has dual sensory loss or who is Deafblind may use strategies that make you feel uncomfortable and concerned for their safety when moving around.  Informed choice is important, if the person is aware of risks and has the cognitive ability they have a right to make choices.  What you deem to be unsafe may be something they have done for a long time and they have a strategy for dealing with the situation.

They may have received training by an O&M Instructor or a Guide Dog Instructor who has worked with them on a route that works for them. Explain your concerns to the person and ask if they need a review from an O&M Instructor.


Be positive and supportive.



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