Domain 7 Module: Mobility Skills (29 test questions) Flashcards
1
Q
Where should an instructor be positioned during stair travel?
A
Slightly below and to the side of the learner to fully view the technique and to prevent support in case of a misstep.
Directly behind when ascending, two to three steps below when descending
2
Q
Where should an instructor be positioned during escalator travel?
A
Same positioning as stair travel
3
Q
movement of the body in space
A
Kinesiology
4
Q
awareness of body position in space
A
Proprioception
5
Q
how strong and flexible gross motor muscles are
A
Muscle tone
6
Q
movement provides much of the environmental characteristics that is usually provided through vision. Movement gives meaning to words and provides information regarding size, shape, location, texture and others. Early learners will benefit from movement activities focusing on movement across the midline, trunk rotation, isolated movement of small body parts, upper body strength, full extension of joints, and increasing stamina. Will enable an O&M instructor to understand the movement of their students and the lack of certain movements. Also with VI babies and young children this movement is critical because they lack motivation to lift their heads, and reach around themselves. This lack of movement has long life repercussions.
A
Kinesiology
7
Q
facilitating proprioceptive awareness will help travelers (especially children) perform specific motions, and to improve coordination throughout the body 2 things O&M can do to improve are resistance activities (tug of war, pushing, swimming) and joint compression (crawling, jumping, hopping)
A
Proprioception
8
Q
Low muscle tone is responsible for many of the posture, gait, and coordination difficulties children with vision loss experience. As an O&M instructor, you should encourage independent movement in all forms to develop stronger muscles. For older adults, muscle tone can be developed by introducing more challenging physical activities that include resistance training (tug of war, weight bearing activities, etc.)
A
Muscle tone
9
Q
vision serves as an important function of preparing one for changes in sensory and motor input. If a child is not expecting something to happen because they cannot see it coming, they might be oversensitive and startled quickly. Hands on demonstrations and letting the child know exactly what is happening, step-by-step is an important strategy to prepare students without eliciting a protective response. In the environment, if somebody cannot see, they may hesitate to move freely due to fear of the unknown. Knowing this, parents and facilitators should prepare safe environments for children and adults to explore, including visual, tactile, and auditory clues for safety and mental organization of the space. Making sure floors and stairs are free of clutter, good lighting, and providing contrast to corners and drop offs will help children and adults navigate through their environment.
A
Predictability
10
Q
The optimal performance of sensorimotor skills relies not only on the previously development of lower level skills, but also the adequate development of fundamental sensorimotor elements – sensory awareness, muscle tone, and coordination. When choosing and designing sensorimotor activities, it is important to consider what functional skills the student needs and which prerequisite abilities they must have, and to choose activities that facilitate normal muscle tone, sensory development, reflexes, and equilibrium as appropriate.
A
Sequencing
11
Q
Purposeful, self-initiated movement is essential for developing motor skills. Through movement, muscle tone, proprioceptive awareness, and coordination are developed. Only through active interaction with the environment can people learn how to function within it.
A
active movement
12
Q
Because the acquisition of higher-level motor skills relies heavily on the development of lower-level skills and abilities, it is important to weigh in and mediate need against long-term benefit of emphasizing quality of movement. Focusing on prerequisite skills (proprioceptive, muscle tone, and balance) will facilitate better quality of movement goals (walking)
A
quality of movement
13
Q
specific skills are learned best during critical periods when the appropriate sensory and motor inputs are coming together. If these critical periods are missed, some skills may never be learned, or if they are learned out of sequence, higher-level skills may rest on faulty foundations. Is it important to encourage the sequential development of sensorimotor skills are normal developmental ages.
A
timing of movement
14
Q
it is important to integrate new sensorimotor skills into students’ everyday lives.
A
Integration of movement
15
Q
What impact does vision loss have on the sensorimotor functions?
A
Because of the major role that vision plays in sensorimotor development in children, some aspects of development may often be delated in clients with vision loss. Due to the degree of interaction among visual, vestibular, and reflex sensory inputs in the central nervous system, when one of those systems is slow to develop, usually one of both of the others can demonstrate delay. Many children who are congenitally blind have hypotonia, or low muscle tone and demonstrate motor skill delays and postural and movement problems. Coordination difficulties are related to poor sensorimotor integration of reflexes. Self-initiated exploration and movement are decreased in students with vision impairment. This lack of physical activity delays the later acquisition of motor skills and can impact cognitive and perceptual development.
As people age, they may experience a decrease in proprioceptive function, which can alter a person’s gait pattern and balance. This will lead to an increased chance of falling.
16
Q
used to maintain a static position, such as sitting or standing.
A
Static Balance
17
Q
used during movement, such as walking or running.
A
Dynamic balance
18
Q
For what purpose would a learner use the upper-hand-and-forearm techniques?
A
- Allows for efficient and independent travel
- Offers protection when you don’t have a cane
- Assists in locating objects that cannot be detected with a cane
- Helps locate landmarks on wall
- Detects and protects from objects that may be encountered by the upper part of the body
- Used for: travelling through doors with guide, detecting vertical obstacles at head and chest level (coatrack), most effective when using cane
19
Q
For what purpose would a learner use the lower-hand-and-forearm techniques?
A
- Detects and protects from objects at waist level – not effective for below waist level
- Used for: locating chairs, doorknobs, objects below waist level
- Should be used in familiar environments without drop-offs, surface level changes, or known obstacles that may be present and can cause injury
20
Q
Give examples of when a learner would use protective techniques during their daily travels.
A
- Upper: travelling through doors with guide, detecting vertical obstacles at head and chest level (coatrack), low hanging branches
- Lower: locating chairs, doorknobs, objects below waist level
21
Q
Why it’s important
- Establish a straight line of travel which will avoid potential hazards
-
When is it used?
- when you need to travel a straight line
- when you need to locate a landmark
Process
- Position yourself parallel to the surface to be trailed in your desired line of travel
o Helps maintain orientation
- Arm closest to trailing surface extended forward and down with the wrist at waist height
o Allows for reaction time
o Reduces chance of contacting protruding objects
- Palm slightly cupped, fingers and thumb relaxed and close together and the fingers pointing downward
o Reduces changes of jamming fingers
o Aligns body along the wall
- move forward with the side of the pinky finger maintaining light contact with surface
o reduces chances of scrapes or injury
o allows learner to more easily move around objects
- Trail surface until a line of travel is established or a landmark or destination is located
A
Trailing
22
Q
Why it’s important
- Enables a learner to use a perpendicular surface to establish straight line of travel for crossing a hallway or other open space.
When is it used?
- When you don’t have a cane
- Familiar environments
- Street crossing
- With or without long cane or while using protective techniques
Includes Squaring off and parallel Alignment
A
Direction taking
23
Q
Why it’s important
- Establish a straight line of travel which will avoid potential hazards
- Helps in search patterns
- Establishes object to object relationships
When is it used?
- When you don’t have a cane
- Familiar environments
- Street crossing
Process
- Put two or more body parts against object; align back, shoulders, or heels against a straight surface or object
o Ensures alignment
- Project line of travel in a straight line from midline, perpendicular from object your back is to and walk forward using a protective technique or a cane
o Will tactually/conceptually provide a straight-line movement
A
squaring off
24
Q
Why it’s important
- enable learner to use a parallel surface to establish a straight line of travel
- Establishes object to object relationships
When is it used?
- When you don’t have a cane
- Familiar environments
- Room Familiarization
- crossing through open space
Process
- Use one arm or shoulder to position parallel to a straight surface or object
o Makes sure you’re aligned before moving forward
- Project a straight line of travel from midline into open space and walk forward using either protective techniques or a cane
o This will help reduce veering
A
Parallel alignment
25
Why it’s important
- Learn how to work as a team to travel safely
- Learn how to take an active role in travel
- Basic fundamentals of travelling independently
- Be able to teach an inexperienced guide
- Maintains orientation
- Self-Advocacy
- Can learn about an environment without fear of bumping into things
When can you use it?
- Familiar environments
- Unfamiliar environments
- Crowded
- When you don’t have a cane
- Varying conditions
Process
- POSITION: Guide contacts student’s arm and student moves his hand up to place it just above guide’s elbow
o Provides maximum informational feedback
o Allows guide freedom of movement
o Maintains constant contact
o Allows guide to observe
- HAND: thumb is on the inside of the guide’s arm with the fingers wrapped to grasp the other side – not too tight, not too loose
o Optimal environmental feedback
o Reduces risk of breaking contact
o Allows student to brace himself if guide trips/slips
- ARM: upper arm is parallel to side of body and forms an angle of 90* with lower arm
o Minimizes body width
o Reduces possibility of bumping into objects
o Provides maximum safety
o Be aware of: swinging out on turns, arm drifting, lag behind due to insecurity
- SHOULDER: grip shoulder is directly behind guide’s gripped shoulder, and student remains one half step behind guide at all times
o Minimizes combined body width
o Ensures perpendicular approach
o Reduces possibility of contacting objects
o Allows for reaction time and interpretation of cues
o Be aware of: following too closely (decreases reaction time), too far behind (may get inappropriate feedback)
BASIC HUMAN GUIDE
26
Why it’s important
- Safely travel through narrow passageways
When can you use it?
- Congested hallways
- Doorways
- Alleys
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Process
- Guide moves arm behind him toward small of back
o Nonverbal indication
- Student extends arm
o Maximum safe distance
o Avoid stepping on heels
- POSITION: directly behind guide
o reduces combined body width
- Be aware of: posture changes due to new and insecure students
- Maintain consistent walking pace
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NARROW PASSAGEWAYS
27
Why it’s important
- There might be some situations where you need to switch the side you will be guided on
- Will allow comfort in negotiating various situations
When can you use it?
- When you prefer one side over the other
- Social reasons (cultural norms/expectant behaviors)
- When there’s a handrail on one side of stairs
- When arm is tired
- Holding packages
Process
- Verbal indication to transfer sides
- Method 1:
o Grab guide arm with free hand and release original hand grip
Contact with free hand assures continual contact
o Turn 90* toward opposite arm
o HAND: Back of hand trails across guide’s back and grab opposite arm
Back of hand provides greater surface contact
Avoids catching on clothing and hair
- Method 2:
o Grip guide arm with free hand above guide hand
Secure continuous contact
o Extend both arms
Prevents student from stepping on heels
Be aware of: arms extending partially
o Release original grip and trail hand across guide’s back
Trailing helps locate opposite arm
o Grip opposite arm
Helps with security and stability
o Do not release free hand grip before transfer is complete
TRANSFERRING SIDES
28
Why it’s important
- In some situations, turning around quickly may be necessary
When can you use it?
- In crowded areas (hallways, auditoriums, public gatherings)
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Process
- Verbal indication to start the process
o The only way the student will know
- Student releases grip and turns toward guide 180*
o Establishes consistent pattern
o Maintains orientation
o Looks more natural
o Uses minimum amount of space
- Reestablish contact
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REVERSING DIRECTIONS
29
Why it’s important
- Allows safe travel through doors of any kind
- Must be able to work as a team and assist guide to get through safely (active participation)
When can you use it?
- Through doors that push/pull to the left/right
- Doors to hallways and public building – pull open
- Doors to homes and individual openings – push open
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Doors on opposite side of learner
- Guide pushes/pulls door
- Student moves behind guide
o To reduce space and avoid injury
- Grasps opposite arm with free hand
o “partial switch”
o allows free to the door to grab it an assist in walking through it
- With free hand, use upper body protective technique
o protects from door swinging and hitting student
o will help locate the door/push bar
o provides greater contact area
o Be aware of: arm placement
- Once door is grabbed, push/pull
o assists guide in travelling through
```
```
Doors on same side as learner
- Guide pushes/pulls door
- With free hand, student assumes the upper body protective technique
o Protects from injury
o will help locate the door/push bar
o provides greater contact area
o Be aware of: arm placement
- Once door is grabbed, student pushes/pulls long enough for team to get through
o Emphasizes teamwork
```
Doors
30
Why it’s important
- To be able to safely get up the stairs
When can you use it?
- Ascending stairs
- Descending stairs
- Curbs
Process
- Guide approaches steps and pauses at edge of first step
o To make sure guide reaches stairs before student
o Helps maintain orientation and alignment
- Student aligns next to guide
- Guide takes first step and student follows at guide’s pace – one step behind
o Increases safety
o Indicates if stairs are ascending or descending
o Even pace and distance ensure accurate feedback and safety
o Makes it easier to judge depth and height of stairs
- Pauses / slight pull forward at the landing
o Eliminates step counting
Stairs
31
Why it’s important
- Gives independence to locate, examine, and seat yourself
When can you use it?
- Anywhere that has seating: houses, restaurants, auditoriums, stadiums, concert halls
General seating
- Guide brings student to end of seat and tells them where it is located
- Student releases grip on guide and makes contact with seat using his foot
o Hand can be used, too, but this is more natural
- After facing the seat, hand and forearm in front of face
o For protection when clearing the seat
- Bend at the waist and contact seat with arm
o Looks natural when going to clear the seat
o Establishes reference point
- Lightly sweep the seat with the back of fingers: horizontal/vertical or circles
o Indicates the size and shape of seat
o Determines seat’s back
o Checks for content on the seat
o Fingers in this position less likely to disturb objects on seat
- When rising, grab guides arm as standing up
Auditorium Seating
- Guide pauses at appropriate row
- Align alongside of guide
o Ensures proper position before moving
- Move through the row using side-steps using hands to trail the backs of the seats in front
o Maintains alignment
o Not noticeable
o Reduces possibility of contact with seated people
- When arrive at seat, release grip and square off against the seat using the back of legs
o Grip release allows for freedom of movement
o Squaring off ensures proper alignment
- Clear seat while sitting down
o check for objects in a discrete manner
- Slide arm up guide’s arm while rising and place in appropriate grip
- Side-step out toward the aisle using hand to trail back of seats until aisle is reached
o Maintains alignment
o Not noticeable
o Reduces possibility of contact with seated people
o Indicate when the aisle is reached
SEATING
32
Why it’s important
- Good opportunity to provide independence
- Enables you to take control of a situation and make decisions based on your preferences
When can you use it?
- When somebody offers to help and it’s unwanted
- When somebody grabs, and starts to push/pull
Process
- Relax grabbed arm and move it toward opposite shoulder
o Loosens grip from guide
o Tells that grabbing is inappropriate
- Keep feet stationary
o Helps balance, alignment, direction
- Grasp guide’s wrist with free hand while verbalizing intentions
o Wrist is easiest place to grasp
o Communicates intention and educates the public politely
- Pull wrist forward until contact is broken
o This will put the guide’s arm into the right position to grp appropriately, should you want to accept aid
- To accept aid: assume proper grip
o Informs guide ad anybody observing of appropriate procedures
- To refuse aid: release grip and politely say “no thank you”
ACCEPTING/REFUSING AID
33
Describe the responsibilities of the learner when using a human guide.
Hold hands in the appropriate position
Stay half a step behind the guide
Vocalize what you like/don’t like in terms of information
Accurate communication (verbal & nonverbal), use sensory information for mental mapping & orientation
34
When guiding small children, how would you modify the human guide technique?
The child would either hold onto the guide’s wrist or pinky finger
35
What are some advantages to using human guide technique?
Safely orient to environment
Environmental preview from guide’s movement
Allows student to focus on task at hand
Encourages safety
36
What are some disadvantages to using human guide technique?
Not independent
Can lead to dependence
If you don’t know the person, it’s hard to develop trust
37
What are some advantages to using a long cane?
Environmental preview through cane feedback
Detect drop offs/obstacles in path
Can be used in familiar and unfamiliar environments
Identification
Help supplement functional vision
Allow one hand to trail, locate objectives, place hand on railing, and confirm orientation
Are easier to use safely on steps
Are easier to store (e.g., they can be folded and worn in a holster while eating, playing)
Provide early experience with the actual device that will be introduced later
A cane is easily replaceable and affordable. With a cost between free to $40, you can have a spare on hand in case of emergencies.
Canes give you tactile information about your environment. You can stop and smell the flowers when you know exactly where the flower box planter is on the sidewalk.
You can learn your environment faster and more thoroughly. The tactile information you gain from the cane finding fixed landmarks helps you understand the terrain you are exploring and provides concrete objects to ensure your orientation is correct.
38
What are some disadvantages to using a long cane?
Require more mature attention and motor skills to keep the device in front
Leave broad areas of the body unprotected
Do not initially achieve consistent arc coverage
Are more challenging to introduce to younger and orthopedically involved children
Increased interference from the public wanting to assist – kindhearted people always want to help by grabbing your arm, cane or clothing but sometimes their help isn’t helpful. (Hint: Always ask first!)
Cane travel can be more cumbersome and not as fluid. A cane gets stuck in cracks and you get a poke in the stomach – ouch!
Weather negatively impacts cane travelers. A six-inch or more snowfall with a cane can really wreak havoc getting around, as it is difficult to tap or sweep the cane and some landmarks may not be available to check your orientation.
39
What are some advantages to using a dog guide?
Faster and more graceful travel in general—with a dog you breeze by people and obstacles without much change in pace or direction.
A guide dog can be a bridge to the general public opening opportunities for conversation and making new connections. Personally I have made many new friends talking “dogs” with my fellow commuters and folks who are interested in learning about guide dogs.
Guide dogs can be a deterrent to potential personal attacks. While guide dogs are not trained to attack, a thief may think twice before trying to take your purse, wallet or smart phone.
40
What are some disadvantages to using a dog guide?
Time and responsibility of daily care for a guide dog – feeding, watering, relieving, grooming and playtime are all a part of a guide dog handler’s day.
Two- to three-week commitment to train with a new guide dog – it may be nice to get away from it all and have your meals prepared and your room cleaned, but it is still time away from work, family and other responsibilities.
Expenses incurred with a guide dog – big dogs eat lots and vet bills are not inexpensive.
Dog attacks are increasing and can ruin a dog’s confidence and ability to work. With the increase in pet-friendly hotels and apartments, therapy dogs, emotional support dogs and the like; we are running into more and more dogs in our daily travels. Dog encounters can be a dangerous situation with one serious act of aggression ending a dog’s working life.
Dog hair on clothing and in home – lots of grooming and a lint brush and tips for getting dog hair off fabric surfaces is a must.
41
What are some advantages to using ETAs?
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Provides extensive preview of the environment that would not be available when solely using a cane
Can be hands free
Signals can be audible, tactile, haptic
Some can detect obstacles
Some have GPS features
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42
What are some disadvantages to using ETAs?
Student can pay too much attention/become over dependent on it
Student doesn’t pay attention to any other sensory information
Tiring to learn
43
What is meant by “residual vision”?
usable vision in an individual with congenital or acquired visual impairment. For example, an individual with impaired vision in the peripheral visual field due to glaucoma may still have residual vision in the central visual field
44
What are environmental factors which the O&M specialist should consider which impact the use of “residual vision” during O&M instructions?
Sunny days (glare)
Overcast days
Glare from snow
Shadows
45
Detecting changes in terrain
Detecting changes in depth
Avoiding unwanted contact
Negotiating street crossings
Having insufficient auditory and tactile information
Light adaptation from outdoors to indoors and vice versa
Dim and night lighting
Frequent changes in lighting while moving through the environment
Functional Low Vision Mobility Problems
46
What are some advantages to using AMDs?
Can be used with two hands, offering protection with minimal cooperation and effort
Are easy to use and can often be introduced to younger children when well designed
Offer an immediate sense of protection and freedom to some children
Offer a greater arc of protection than long canes
Can be custom made to meet the needs of clients
47
What are some disadvantages to using AMDs?
Are not very compatible with trailing when using two hand
Are awkward when used in crowded or narrow spaces
Are unsafe for use in descending or ascending steps
Can be difficult to use over many outdoor surfaces
Can be difficult to store
Can be a barrier to environmental exploration
48
What are some qualities that a learner would need to be considered for receiving a dog guide?
Degree of vision loss – too much residual vision is not good because there’s a chance that the student will disregard what the dog is teaching
Home visit
Activity level – ability to take the dog out multiple times a day
Age
Health- not allergic
Physical condition – able to take care of dog
Hearing
Orientation skills – good orientation skills and cane techniques are a must
If they work
Out of home obligations
Responsibility
49
What are some qualities that a learner would need to be considered for receiving an adapted mobility device?
Age – young children might be better starting with this because of lack of ability to hold cane, older individuals may need to compensate for lack of movement, people with physical disabilities may not be able to sweep the cane
Ability to grasp
Posture/gait
Cognitive level
50
What are some qualities that a learner would need to be considered for receiving a long cane?
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Age/maturity
Cognitive ability
Posture/gait
Muscle tone
Level of independence
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51
Why it’s important
- Travel independently in a familiar indoor environment
- Gather sensory information
- Lower body protection
- No drop off detection
- Only detects objects on one side
When can you use it?
- Familiar environments only with no drop-offs
Process
- Index finger grasp: index finger extended along flat part of grip, thumb up, fingers wrapped around; cane rests comfortably in palm of hand
o Can be used for multiple cane techniques
- Thumb Grasp: thumb on flat edge, fingers flexed around; upper arm/forearm extended, grip hand 10-12 in from body; same side shoulder does not shift forward to cause veering; forearm/wrist rotated inward, back of palm facing upward
o Firm control of cane while walking in open spaces, allows pressure to keep tip in front
- Pencil Grasp: cane grip rests between middle and index finger, thumb applying light pressure, wrist relaxed, back of hand facing away from body
o More relaxed and comfortable
o Tip will move more easily
o Works well in congested areas
- ARM/FOREARM: slightly extended, grip hand 12 inches in front of hip
o Extends cane and provides advanced information and reaction times
o Should absorb impact o contact with objects
- SHOULDER: does not shift forward
o Avoids veering or diversion from path
- HAND: waist high
o Once cane is held diagonally, will provide contact with objects at waist level or lower
- FOREARM/WRIST: rotated together, back of hand facing up, palm of hand facing the ground
o More comfortable for extended use
- ELBOW: slightly bent; cane shaft angled diagonally across body
o Bend in elbow allows diagonal position of cane to be maintained
o Provides about objects at waist level or lower located directly in path
- Cane tip lightly rests on ground and across body – 1-2 in beyond width of opposite shoulder, 2 ½ feet in front
o Provides constant information about lower obstacles/travel surfaces
o Reduces potential for tip sticking
o Provides maximum advanced preview/good diagonal line
o Acts as a bumper
o Does not provide information about drop offs
o be aware of: cane tip drift –over/under extension of cane
Diagonal Cane Technique
52
Why it’s important
- Travel independently in indoor and outdoor environments
- Gather sensory information
- Lower body protection
- Drop off detection
When can you use it?
- Indoors, outdoors
Process
- HAND: in position of handshake – back of hand facing side, cane resting in middle of palm
o Supports firm grasp
o Provides maximum tactile information to the hand
o Especially effective in congested areas
- INDEX FINGER: extended down along the flat side of grip
o Provides good tactile information
o Good cane control
- THUMB: around the grip, rest of fingers around the bottom of grip
o Balance, stability, and control
- Cane centered in midline of body, arm forward but not locked
o Easier to create and maintain an arc length
o Forward extension provides a buffer, minimizing impact of being pushed into the stomach
- WRIST: flexed, extended out, hyperextended to move the cane in an arc from side to side
o Helps move the cane in an arc in a consistent manner
- Cane tip contacting point just beyond widest point of body
o Provides info on the path to be travelled
- When moving forward, cane tip lifts slightly off ground
o No more than 1 in – information can be missed
- Cane tip and heel of opposite foot contact the ground at the same time
o In step, in rhythm
o Provides continuous coverage
o Clears travel path in advance
- If you walk out of step, tap cane twice on one side to regain the in-step position
o Eliminates need to stop flow of travel
- Congested areas
o Narrow arc, slow pace, choke up on cane, flex elbow to bring cane closer
Limits unnecessary contact with other people’s feet
- Trailing
o Walk parallel to and near surface to be trailed
o Tap cane tip to opposite side of surface and swing arc back to touch surface
o Low, flat arc, returning cane tip to beyond opposite shoulder
o Repeat until no longer needed
Two-Point Touch
53
- Enables detection of surface changes (texture, expansion joints in sidewalks, blended curbs, subtle drop-offs)
When can you use it
- Probe beneath leaves or show to contact sidewalk
Process
- Slow pace to accommodate additional slide of tip
o Maintains rhythm and step
o Provides greater reaction time for what is being looked for
- Slow down as soon as in close proximity to desired objective
o Will allow you to quickly free cane from obstruction
- Narrow the arc width – cane tip touches point in front of the instep of each foot
- At the point of contact with the ground, slide the cane tip forward to a point slightly beyond opposite shoulder
o Gathers additional surface information when needed
(looking for a dropoff)
Touch and Slide
54
- Travel independently
- Gather sensor information
- Lower body protection
- Detects drop-offs (more reliable than two point touch)
- Can be used in a variety of indoor and outdoor environments
Process
- Hand in handshake position, cane resting in middle of palm
o Firm grasp provides maximum tactile information
o Typically dominant hand
o Pencil grasp can also be used
- Index finger extended downward along flat side of grip
o Provides tactile information
o Controls cane
- Thumb around grip
o Balance, stability, control
- Cane is centered to midline, arm extended forward but not locked
o Easier to create and maintain arc that provides coverage on both sides
o Facilitates straight line of travel
o Forward arm extension acts as a buffer and minimizes impact
- Wrist flexed, extended, and hyper extended
o Moves cane in an arc from side to side
- Walking forward, pressure is put on cane tip to keep it on the ground
o Pressure may be needed to maintain constant contact
- Moving forward in step and in rhythm, cane tip and heel of opposite foot reach end of arc simultaneously
o Continuous coverage
o Clears travel path ahead of next step
trailing with the touch techniques
Constant Contact
55
- Maintain line of travel parallel to wall or surface
- Locate a landmark along a wall/surface
- Locate opening or intersecting sidewalk
- Touch trailing in outdoor environments, following a line between a sidewalk and the grass
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When can you use it
- For short distances
- Not as a default
- When there is a detectable change in surface texture
o Grass/gravel
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Process
- Align parallel and near surface to be followed/trailed
o Helps maintain contact while using consistent arc on both sides
- Slow pace, use same hand position, height, rhythm, and in step used for two-point touch
o Slowing pace allows maintained rhythm and step
- Create full arc by tapping cane tip to the opposite side and then back to base of trailed surface
o Ensures constant contact
- Use low, flat arc, returning cane tip to slightly beyond opposite shoulder until objective completed
o Provides optimum coverage
o Makes tip less likely to bounce and makes it easier to bring back across to the trailed surface
Touch Trailing (Shorelining)
56
- Enables following of a raised surface and detection of a desired location on a level higher than current walking surface
o Curbs
When is it used
- Locate the intersecting sidewalk when recovering from a wrong street crossing
Process
- on the lower surface, align parallel to the vertical surface
- Slow pace so that three taps fit into the two-step stride sequence
o Helps stay in-step
o Reduces chance of overstepping
- Maintain hand-centered position
- Move cane tip from just beyond shoulder of opposite side, over to the vertical surface
- Bring cane tip up and over vertical surface to contact level above
o Slide it up over surface
Three-point Touch
57
- Maintain desired line of travel
- Locate landmark, opening, or change along surface or slightly different elevation
When can you use it
- Curbs, grass lines, expansion joints, retaining walls and fences, train platforms
Process
- Align parallel and near surface to be followed
o Maintain constant contact and straight line of travel
- Slow pace, tap cane tip to opposite side of surface, and drag it to surface to be trailed
o Dragging needs a bit more pressure
o Provides more surface information and exact location of surface being followed
- Maintain same rhythm and step
- Use low, flat arc, returning cane tip to just beyond opposite shoulder, repeat until no longer needed
o Provides optimum coverage
o Makes it less likely the tip will bounce on contact
o Makes it easier to drag back to trailed surface
Touch and Drag (Shorelining)
58
- Anchor cane tip against base of first stair
o Reference point
- Rotate hand until cane is vertical against base of stairs
o Allows for straight line of travel to base of stairs
- Lower grip on shaft, move cane right midline and then left midline, position near handwail
o Confirms and corrects body perpendicular to stairs
o Gauges width of stairs
o Transfer cane to left hand when handrail is desired
o Lower grip makes it easier to move cane to clear stairs
- Lift cane until the tip moves over top edge of step and pushes it forward so that the tip rests against next riser
o Provides info about height and depth of stairs
- With arm extended, lift cane slightly so that tip rests on riser of second step, 1-2 inches below edge
o Tip will contact each subsequent riser when ascending
- Keep arm extended and begin ascent, leaning slightly forward, keeping enough pressure on cane to keep it moving 1-2 steps ahead
o Helps retain control over cane placement
o Maintain consistent distance between body and cane tip
o Prevents catching tip or overstepping
o Ensures cane will provide timely information when arrive at landing
- When the tip o longer contacts riser, prepare for landing by cleating landing before taking last step
o Provides natural transition
- Resume constant contact
Ascending stairs
59
- Anchor the cane tip against edge of stair
o Informs about location of top step/edge
- Rotate hand so that cane is vertical
- Move cane to locate desired side of stairs, transferring cane to free hand if using handrail is desired
o Reference point for stair edge
- Lower cane to tread of first step, slide it forward to edge
o Provides information about depth and width of step
- Lift cane until tip moves over top edge, extend it downward in diagonal cane technique position to hover slightly below the next step (without contacting riser)
o Not necessary to contact each riser
o Helps ensure cane does not protrude or tip gets stuck
o Cane tip reaches landing with advanced notice
- Begin descent, lean slightly backward, extend arm enough to keep cane tip hovering just blow step edge
o Provides balance
- When contacting the landing, anticipate last step and prepare for forward travel by clearing landing before taking last step
o Tip will reach landing before body
o Clearing landing is important – will inform if another set of stairs or obstacles are present
- Resume constant contact
Descending Stairs
60
- Maneuver around obstacles without losing line of direction
Process
- Cane tip anchored against object
o To anchor: slight pressure applied to cane to keep it stationary against surface
o Serves as reference point
o Stand still until location is determined
- Stop and determine intended next steps – explore or move around
o Pausing allows processing time before a decision is made
o Not pausing may result in unnecessary movement and loss of orientation
- To explore object – rotate hand to make cane vertical, walk forward, press cane up against object to determine height, then move horizontal to determine width, use upper body protection if needed
o Switching to pencil grasp may make it easier
- To move around object – note object’s location, selects and clears a space to the left or right, reestablish desired line of travel
Detecting and Moving Around Obstacles (Diagonal)
61
What are the components used to analyze intersections?
Shape of intersection
Traffic controls
Flow of traffic
Visit location at different times of day to note any patterns
62
Detect the street/truncated domes
Locate crosswalk
Analyze intersection shape, control, traffic flow
Align to traffic using a physical cue or ears to realign
Asses the crossing and determine when it is safe to cross, taking into consideration traffic controls
Initiate crossing and maintaining a straight line
Recovering from a veer
These are the following tasks for street crossing.
63
Observe movement of traffic through the intersection
Identify near-lane parallel traffic, determine vehicle travel paths, estimate # of lanes
Identify far-lane parallel traffic, determine vehicle travel paths, estimate # of lames
Identify near-lane perpendicular traffic, determine vehicle travel paths, estimate # of lanes
Identify far lane perpendicular traffic, determine vehicle travel paths, estimate # of lanes
Synthesize information to determine the shape of the intersection
Explore features present at the corner to determine any obstacles that may impact the visibility, mask auditory information, or impact decision of crossing
Observe vehicle movements to determine traffic pattern, sequence of traffic, and type of vehicle controls, pedestrian controls, and actuations present
Listen for pedestrian activity
Determine pattern of traffic flow of near lane parallel
Determine pattern of traffic flow of far lane parallel
Determine pattern of traffic flow of near land perpendicular
Determine pattern of traffic flow of far lane perpendicular
Examine corner to determine if there is a stop sign or traffic light
Determine appropriate time to cross based on the control present
For analyzing an intersection
64
What are some common risks when crossing an intersection?
```
Bicycle traffic
permissive lanes
not enough time to cross
drivers running red lights
distracted driving/ignoring white cane
blind spot of driver
```
65
How can the O&M specialist prepare the learner to make informed decisions?
teaching them effective street-crossing strategies and become reliably skillful;
discuss risks and possible consequences involved in each situation & how to reduce risks as much as possible.
Teach alternatives when cost is not acceptable
66
two streets meet at an intersection but only vehicles on one street must stop
At a stop sign on the parallel street; the learner gets into the ready position and listens for traffic to come to a complete stop. As a vehicle surges forward & learner determines by listening that it isn't turning, initiate travel using traffic as a buffer. If on perpendicular street. learner listens for traffic to complete stop, starts crossing immediately once determines there is no parallel traffic,
2-way stop
67
two streets meet at an intersection where both streets have stop signs and all vehicles must stop
Learner in ready position listens for surge of parallel vehicle after determining it isn't turning. Then starts crossing while listens to perpendicular vehicle to ensure they are not moving.
4-way stop
68
one street ending at the intersection of another. The street that is ending is the street that has the stop sign
Learner listens for perpendicular traffic and travels with parallel left surge
T-shaped intersection with 1-way stop on stem
69
one street ending at the intersection of another. The street that is ending is the secondary street. The primary street will have a longer green light than the secondary street and may have an actuated light, only turning green to cross the primary street when a button is pushed
Learner listens for perpendicular traffic and travels with parallel left surge
T-shaped intersection with traffic light controls
70
The amount of time of the light cycle may change depending on the time of day
•Learner detects parallel surge and travels with it as a buffer..
simple phase traffic light: run on a predetermined, or fixed, semi-actuated, or fully actuated cycle
71
complex phase traffic light with left turn arrows: Multi lanes, opposite parallel traffic turning on the wrong side of the road. Separate lane for left turning traffic
• Using parallel traffic is usually not possible
complex phase traffic light with left turn arrows:
72
Where within the environment is the most frequent placement of yield signs?
Channelized right turn lanes
| roundabouts
73
Describe what defines a Situation of Uncertainty.
Situations at uncontrolled crossings where you do not have enough warning about approaching vehicles to know whether or not it's clear to cross, even when it's as quiet as it can be in that situation.
74
What strategies should the O&M specialist use to teach crossings in Situation of Uncertainty?
```
Getting assistance to cross,
Cross somewhere else,
Getting a ride,
Delivery of items instead of going out,
Requesting intersection alterations
Assess risk to cross
```
75
What is the technique for crossing at an uncontrolled crossing using visual strategies?
Watch for all clear
Determine if gaps in traffic are long enough
Scan slowly left to right
Cross with pedestrians
People with less than 5 degrees of central vision need to scan slowly to not miss even large objects, approaching cars 2 car lengths away.
need to learn to hold their gaze.
Determine your time needed to cross with safety margins included
76
What is the technique for crossing at an uncontrolled crossing using auditory strategies?
Recognize possible masking sound;
Count how long it takes for the car to get to you after you furst hear it to determine speed
Use 4-direction sound recognition,
Use above strategies of crossing with pedestrians or large enough gaps.
77
What is the technique for crossing at a stop sign controlled crossing using visual strategies?
Scan each lane of traffic to determine traffic movement
If there are regular periods where there is an “all quiet”, student can cross in those quiet periods
If there is no “all quiet” – student can look to see if there are cars in the near parallel lane
Student can cross with near parallel traffic acting as a shield car, if the car is going fast enough to know it is not turning in their path
78
What is the technique for crossing at a stop sign controlled crossing using auditory strategies?
Align with parallel traffic using hearing
Listen to each lane of the intersection to determine movement of cars
If there is an “all quiet” – no sound of cars, student can determine to cross then
If there are no “all quiet” scenarios, student can listen to the car in the near parallel lane to determine if it is going fast enough to act as a shield car
79
What is the technique for crossing at a signalized crossing using visual strategies?
Look for marked crosswalks and observe the angle
Look for traffic lights
Count lanes of traffic by counting dividing lines
Visually track other pedestrians
Scan the corner to see if there are any obstructions of view
Analyize each lane by systematically scanning and tracking cars as they drive by
Look to see if there is a pedestrian signal
Analyze to see if you can see the “Walk” signal
If you can see it, and you have determined its safe to cross, cross when the walk signal is on
Look for the surge of near parallel traffic, if there is a clear surge, and there is no right hand turn, cross with the cars travellng straight
Accurate information about the functioning of traffic signals and push-button pedestrian signals and crossing with near parallel traffic.
While crossing, understand traffic movements, discuss lane-by-lane analysis for potential cars that may be hidden.
Can use waiting perpendicular cars as an alignment tool.
Pay attention to right-turning cars that may not be planning on stopping.
Use alternatives at intersections where acceptable risk cannot be determined.
80
What is the technique for crossing at a signalized crossing using auditory strategies?
Determine lane of near parallel traffic
Counterclockwise: listen for the surge of near parallel traffic moving in the same direction you are crossing. Note the other traffic movement just before the surge. Noting whether there is a clear surge of traffic evident. If there is a clear surge and there are no cars turning, cross with the surge
Clockwise: listen to the surge of traffic in the near parallel lanen, note other traffic movements and whether a clear surge is evident.
If there is an APS and the student can see it, make sure the walk signal coincides with the parallel surge. If it does, cross with caution, it if does not, continue to analyze the intersection
Accurate information about the functioning of traffic signals and push-button pedestrian signals and crossing with near parallel traffic.
While crossing, understand traffic movements, discuss lane-by-lane analysis for potential cars that may be hidden.
Can use waiting perpendicular cars as an alignment tool.
Pay attention to right-turning cars that may not be planning on stopping.
Use alternatives at intersections where acceptable risk cannot be determined.
If there is an audible pedestrian signal, make sure it aligns with the parallel surge.
81
Explain the use of the pedestrian button in the timing of street crossing
Pedestrian signals are used to provide information to pedestrians about when they are supposed to begin crossing an intersection and when enough time has been provided in the signal cycle for the “typical pedestrian” to cross.
82
What strategies should be used when teaching a learner to use APS?
Pushing the button longer may give you more information
Pushing the button may give you more time to cross.
Emphasize that the signal states only that it is on, not that it is safe to cross.
Use as a supplementary aid to visual/auditory information.
Approach intersection & stop @ curb/ramp.
Check for alignment of crossing via traffic.
Determine starting location for crossing & id tactile cues to realign after pushing button.
Listen & evaluate intersection.
Leave the curb & search for push button in an organized manner then explore device & function.
Listen to aps & traffic for a full cycle to correlate information.
Push button at beginning of perpendicular surge, realign & prepare to cross.
When the indicator is made, confirm perpendicular traffic has stopped & listen for surge of near parallel sure.
Cross street using typical technique while listening for turning cars.
83
Identify and describe a tactile method of alignment at street crossings.
With touch and drag, locate the curb cut/truncated domes
When you find the curb, anchor your cane and walk up to it
Look for the curb to the left or right with cane to determine perpendicular curb edge
Align at 90* to the perpendicular curb edge
84
Identify and describe an auditory method of alignment at street crossings.
Listen to the sound of cars traveling parallel and perpendicular to you
Make sure that the parallel cars pass at exactly 3:00 and 9:00 and the perpendicular cars pass at exactly 12:00
85
Where should an instructor be positioned while on the corner before the learner initiates the crossing?
Behind the student and opposite of parallel traffic as to not mask their hearing
86
Where should an instructor be positioned after the learner initiates the crossing, during the crossing?
Behind the student and toward the oncoming perpendicular traffic
87
What is the basic procedure for bus travel?
Locating the bus stop
• Determine likely place for the bus stop in relation to the intersection
• Travel to that corner
• Position yourself one to two steps back from the curb
• Face the street
• Hold cane in diagonal position
Boarding the bus
• Determine arrival position of the bus using auditory or visual cues
• Localize the sound of the door and walk toward the bus
• When reaching the steps, verify with bus driver that this is the appropriate bus
• Ascend stairs using stair technique and hold on to railing
• Ask driver to inform when the stop is reached, if the seat behind the driver is vacant (or where the nearest vacant seat is), and to provide info on transfers
• Locate a seat and sit down
• If you need to travel down the aisle, used the congested area technique
Getting off the bus
• Upon being informed or recognizing stop, grasp vertical pile and localize the location of the door
• Constant contact and congested area cane technique to walk toward the door
• Before exiting, ask driver for information regarding the position of the big in relation to the intersection
• Descending stair technique
88
How can a learner obtain route information when planning a trip using public transit?
Audible maps online
Calling the bus terminal
Text updates and information
Asking for assistance at the bus stop
89
What is paratransit and how does a learner become eligible to use the paratransit system.
It is door-to-destination transportation on a call-in basis for a minimal fee; Eligible via proof of disability
90
What cane techniques should be used in snow?
```
Constant contact
Heavier touch, higher arc in medium snow
Light touch for heavy snow
Reverse arc in powder snow
Allow movement of the arm
Vary width of the arc
Experiment with different techniques
Trail top of snow bank to locate landmarks
```
91
What cane techniques should be used in rain?
Vary between constant contact or 2-point touch, depending upon sensitivity to tactile information
Use cane to determine puddle depth and width
92
How would excessive heat conditions impact the learner’s ability to travel?
```
Heat related illnesses
Sunburn
Heat rash
Heat stress
Heat cramps
Hear exhaustion
Heat stroke
Decreased focus on environment;
Medical conditions can exasperate symptoms;
Dehydrated or low sugar/sodium,
Wet cane grips lessen accuracy.
```
93
What strategies could be used to improve the ability to travel in excessive heat conditions?
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Determine if student is able to safely participate in lessons
Avoid times where sun is the strongest (10am – 4:pm)
Wear light clothing
Wear light colors
Wear a hat
Sunglasses
Sunscreen
Increase water intake
Avoid alcohol or soda
Be aware of signs of dehydration
Allow a flexible working schedule in the early morning or during evening hours
Rest in shady areas
Practice indoors when possible
```
94
What characterizes a rural environment?
Inconsistent pavement,
unlighted intersections,
travel vast open spaces with few auditory or tactile clues, unique smells & environmental sounds;
few consistent traffic sounds
95
What procedure and cane techniques should be used when traveling in areas without sidewalks?
Shorelining
Indenting at intersections
Touch and drag
Constant contact
96
What procedure and cane techniques should be used when making a street crossing without sidewalks?
Shorelining, touch and drag to stay on shoreline and know when an intersection is approaching
Indenting the curb to ensure street crossing
Constant contact
97
Identify specific strategies used when traveling in a supermarket.
```
Retract cane from typical placement,
constant contact,
self-protective techniques
make a list ahead of time
locate customer service
ask for assistance when needed
orient using human guide first
```
98
Identify specific strategies used when traveling around a gas station.
touch-drag to shoreline,
maintain traffic flow observation;
return to parallel surge to find sidewalk
99
Describe strategies used to recover from getting disoriented in shopping mall parking lots.
Listen for traffic in parking lot and bordering streets;
walk toward traffic sounds and establish parallel until a sidewalk is found.
As parked cars are detected, the angle is explored with 2-point touch technique until square-off;
use self-protect technique to avoid mirrors/objects.
