Domain 7 Module: Mobility Skills (29 test questions) Flashcards
Where should an instructor be positioned during stair travel?
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
Where should an instructor be positioned during escalator travel?
Same positioning as stair travel
– movement of the body in space
• Relevance: 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.
Kinesiology
– awareness of body position in space
Proprioception
– how strong and flexible gross motor muscles are
Muscle tone
: 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 over sensitive 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.
Predictability
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.
Sequencing
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.
Active movement:
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)
quality of movement:
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.
Timing of movement
It is important to integrate new sensorimotor skills into students’ everyday lives.
Integration of movement:
What impact does vision loss have on the sensorimotor functions?
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.
used to maintain a static position, such as sitting or standing.
Static Balance:
used during movement, such as walking or running.
Dynamic balance
For what purpose would a learner use the upper-hand-and-forearm techniques?
- 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
For what purpose would a learner use the lower-hand-and-forearm techniques?
- 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
Give examples of when a learner would use protective techniques during their daily travels.
- 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
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
• Direction taking
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 whie using protective techniques
Includes Squaring off and parallel Alignment
Trailing
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
squaring off
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
Parallel alignment
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
Why it’s important
- Safely travel through narrow passageways
When can you use it?
- Congested hallways
- Doorways
- Alleys
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
NARROW PASSAGEWAYS
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
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)
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
REVERSING DIRECTIONS
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
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
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
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
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
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
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
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
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
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.
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.
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.
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.
