Domain 7 Module: Mobility Skills (29 test questions)

Question 1

Where should an instructor be positioned during stair travel?

Answer 1

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 beow when descending

Question 2

Where should an instructor be positioned during escalator travel?

Answer 2

Same positioning as stair travel

Question 3

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.

Answer 3

Kinesiology

Question 4

awareness of body position in space

Relevance: 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)

Answer 4

Proprioception

Question 5

how strong and flexible gross motor muscles are

Relevance: 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.)

Answer 5

Muscle tone

Question 6

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.

Answer 6

Predictability

Question 7

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.

Answer 7

Sequencing

Question 8

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.

Answer 8

active movement

Question 9

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)

Answer 9

quality of movement

Question 10

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.

Answer 10

timing of movement

Question 11

it is important to integrate new sensorimotor skills into students’ everyday lives.

Answer 11

Integration of movement

Question 12

What impact does vision loss have on the sensorimotor functions?

Answer 12

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.

Question 13

List and define the two types of balance.

Answer 13

Static Balance: used to maintain a static position, such as sitting or standing.
Dynamic balance: used during movement, such as walking or running.

Question 14

For what purpose would a learner use the upper-hand-and-forearm techniques?

Answer 14

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

Question 15

For what purpose would a learner use the lower-hand-and-forearm techniques?

Answer 15

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

Question 16

Give examples of when a learner would use protective techniques during their daily travels.

Answer 16

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

Question 17

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
Helps maintain orientation
Arm closest to trailing surface extended forward and down with the wrist at waist height
Allows for reaction time
Reduces chance of contacting protruding objects
Palm slightly cupped, fingers and thumb relaxed and close together and the fingers pointing downward
Reduces changes of jamming fingers
Aligns body along the wall
move forward with the side of the pinky finger maintaining light contact with surface
reduces chances of scrapes or injury
allows learner to more easily move around objects
Trail surface until a line of travel is established or a landmark or destination is located

Answer 17

Trailing

Question 18

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

Answer 18

direction taking

Question 19

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

Answer 19

Squaring off

Question 20

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
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
This will help reduce veering

Answer 20

Parallel alignment

Question 21

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
Provides maximum informational feedback
Allows guide freedom of movement
Maintains constant contact
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
Optimal environmental feedback
Reduces risk of breaking contact
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
Minimizes body width
Reduces possibility of bumping into objects
Provides maximum safety
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
Minimizes combined body width
Ensures perpendicular approach
Reduces possibility of contacting objects
Allows for reaction time and interpretation of cues
Be aware of: following too closely (decreases reaction time), too far behind (may get inappropriate feedback)

Answer 21

BASIC HUMAN GUIDE

Question 22

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
Nonverbal indication
Student extends arm
Maximum safe distance
Avoid stepping on heels
POSITION: directly behind guide
reduces combined body width
Be aware of: posture changes due to new and insecure students
Maintain consistent walking pace

Answer 22

Narrow Passageways

Question 23

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:
Grab guide arm with free hand and release original hand grip
Contact with free hand assures continual contact
Turn 90* toward opposite arm
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:
Grip guide arm with free hand above guide hand
Secure continuous contact
Extend both arms
Prevents student from stepping on heels
Be aware of: arms extending partially
Release original grip and trail hand across guide’s back
Trailing helps locate opposite arm
Grip opposite arm
Helps with security and stability
Do not release free hand grip before transfer is complete

Answer 23

Transferring sides

Question 24

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
The only way the student will know
Student releases grip and turns toward guide 180*
Establishes consistent pattern
Maintains orientation
Looks more natural
Uses minimum amount of space
Reestablish contact

Answer 24

REVERSING DIRECTIONS

Question 25

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 To reduce space and avoid injury Grasps opposite arm with free hand “partial switch” allows free to the door to grab it an assist in walking through it With free hand, use upper body protective technique protects from door swinging and hitting student will help locate the door/push bar provides greater contact area Be aware of: arm placement Once door is grabbed, push/pull 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 Protects from injury will help locate the door/push bar provides greater contact area Be aware of: arm placement Once door is grabbed, student pushes/pulls long enough for team to get through Emphasizes teamwork

Answer 25

Doors

Question 26

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 To make sure guide reaches stairs before student Helps maintain orientation and alignment Student aligns next to guide Guide takes first step and student follows at guide’s pace – one step behind Increases safety Indicates if stairs are ascending or descending Even pace and distance ensure accurate feedback and safety Makes it easier to judge depth and height of stairs Pauses / slight pull forward at the landing Eliminates step counting

Answer 26

Stairs

Question 27

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 Hand can be used, too, but this is more natural After facing the seat, hand and forearm in front of face For protection when clearing the seat Bend at the waist and contact seat with arm Looks natural when going to clear the seat Establishes reference point Lightly sweep the seat with the back of fingers: horizontal/vertical or circles Indicates the size and shape of seat Determines seat’s back Checks for content on the seat 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 Ensures proper position before moving Move through the row using side-steps using hands to trail the backs of the seats in front Maintains alignment Not noticeable Reduces possibility of contact with seated people When arrive at seat, release grip and square off against the seat using the back of legs Grip release allows for freedom of movement Squaring off ensures proper alignment Clear seat while sitting down 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 Maintains alignment Not noticeable Reduces possibility of contact with seated people Indicate when the aisle is reached

Answer 27

Seating

Question 28

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 Loosens grip from guide Tells that grabbing is inappropriate Keep feet stationary Helps balance, alignment, direction Grasp guide’s wrist with free hand while verbalizing intentions Wrist is easiest place to grasp Communicates intention and educates the public politely Pull wrist forward until contact is broken 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 Informs guide ad anybody observing of appropriate procedures To refuse aid: release grip and politely say “no thank you”

Answer 28

ACCEPTING/REFUSING AID

Question 29

Describe the responsibilities of the learner when using a human guide.

Answer 29

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

Question 30

When guiding small children, how would you modify the human guide technique?

Answer 30

The child would either hold onto the guide’s wrist or pinky finger

Question 31

What are some advantages to using human guide technique?

Answer 31

Safely orient to environment Environmental preview from guide’s movement Allows student to focus on task at hand Encourages safety

Question 32

What are some disadvantages to using human guide technique?

Answer 32

Not independent Can lead to dependence If you don’t know the person, it’s hard to develop trust

Question 33

What are some advantages to using a long cane?

Answer 33

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

Question 34

What are some disadvantages to using a long cane?

Answer 34

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.

Question 35

What are some advantages to using a dog guide?

Answer 35

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.

Question 36

What are some disadvantages to using a dog guide?

Answer 36

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.

Question 37

What are some advantages to using ETAs?

Answer 37

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

Question 38

What are some disadvantages to using ETAs?

Answer 38

Student can pay too much attention/become over dependent on it Student doesn’t pay attention to any other sensory information Tiring to learn

Question 39

What is meant by “residual vision”?

Answer 39

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

Question 40

What are environmental factors which the O&M specialist should consider which impact the use of “residual vision” during O&M instructions?

Answer 40

Sunny days (glare) Overcast days Glare from snow Shadows

Question 41

Functional Low Vision Mobility Problems

Answer 41

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

Question 42

What are some advantages to using AMDs?

Answer 42

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

Question 43

What are some disadvantages to using AMDs?

Answer 43

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

Question 44

What are some qualities that a learner would need to be considered for receiving a dog guide?

Answer 44

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

Question 45

What are some qualities that a learner would need to be considered for receiving an adapted mobility device?

Answer 45

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

Question 46

What are some qualities that a learner would need to be considered for receiving a long cane?

Answer 46

Age/maturity Cognitive ability Posture/gait Muscle tone Level of independence

Question 47

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 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 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 More relaxed and comfortable Tip will move more easily Works well in congested areas ARM/FOREARM: slightly extended, grip hand 12 inches in front of hip Extends cane and provides advanced information and reaction times Should absorb impact o contact with objects SHOULDER: does not shift forward Avoids veering or diversion from path HAND: waist high 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 More comfortable for extended use ELBOW: slightly bent; cane shaft angled diagonally across body Bend in elbow allows diagonal position of cane to be maintained 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 Provides constant information about lower obstacles/travel surfaces Reduces potential for tip sticking Provides maximum advanced preview/good diagonal line Acts as a bumper Does not provide information about drop offs be aware of: cane tip drift –over/under extension of cane

Answer 47

Diagonal Cane Technique

Question 48

Verifies location, establishes straight line of travel, locate desired destination or landmark Process Face desired line of travel Align parallel and close to surface Physical contact with wall is not recommended Use diagonal cane technique in hand opposite of surface to be trailed Cane should be across and in front of body Cane tip lightly contacts point where floor and wall meet, 2 ½ feet in front of body Light touch keeps tip moving forward and free to adjust to small changes Keeping tip 1 in off ground can help detect doorways Move forward while maintaining cane position

Answer 48

Trailing with Diagonal Cane

Question 49

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 Supports firm grasp Provides maximum tactile information to the hand Especially effective in congested areas INDEX FINGER: extended down along the flat side of grip Provides good tactile information Good cane control THUMB: around the grip, rest of fingers around the bottom of grip Balance, stability, and control Cane centered in midline of body, arm forward but not locked Easier to create and maintain an arc length 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 Helps move the cane in an arc in a consistent manner Cane tip contacting point just beyond widest point of body Provides info on the path to be travelled When moving forward, cane tip lifts slightly off ground No more than 1 in – information can be missed Cane tip and heel of opposite foot contact the ground at the same time In step, in rhythm Provides continuous coverage Clears travel path in advance If you walk out of step, tap cane twice on one side to regain the in-step position Eliminates need to stop flow of travel Congested areas Narrow arc, slow pace, choke up on cane, flex elbow to bring cane closer Limits unnecessary contact with other people’s feet Trailing Walk parallel to and near surface to be trailed Tap cane tip to opposite side of surface and swing arc back to touch surface Low, flat arc, returning cane tip to beyond opposite shoulder Repeat until no longer needed

Answer 49

Two-Point Touch

Question 50

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 Maintains rhythm and step Provides greater reaction time for what is being looked for Slow down as soon as in close proximity to desired objective 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 Gathers additional surface information when needed (looking for a dropoff)

Answer 50

Touch and Slide

Question 51

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 Firm grasp provides maximum tactile information Typically dominant hand Pencil grasp can also be used Index finger extended downward along flat side of grip Provides tactile information Controls cane Thumb around grip Balance, stability, control Cane is centered to midline, arm extended forward but not locked Easier to create and maintain arc that provides coverage on both sides Facilitates straight line of travel Forward arm extension acts as a buffer and minimizes impact Wrist flexed, extended, and hyper extended Moves cane in an arc from side to side Walking forward, pressure is put on cane tip to keep it on the ground 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 Continuous coverage Clears travel path ahead of next step trailing with the touch techniques

Answer 51

Constant Contact

Question 52

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 When can you use it For short distances Not as a default When there is a detectable change in surface texture Grass/gravel Process Align parallel and near surface to be followed/trailed 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 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 Ensures constant contact Use low, flat arc, returning cane tip to slightly beyond opposite shoulder until objective completed Provides optimum coverage Makes tip less likely to bounce and makes it easier to bring back across to the trailed surface

Answer 52

Touch Trailing (Shorelining)

Question 53

Enables following of a raised surface and detection of a desired location on a level higher than current walking surface 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 Helps stay in-step 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 Slide it up over surface

Answer 53

Three-point Touch

Question 54

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 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 Dragging needs a bit more pressure 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 Provides optimum coverage Makes it less likely the tip will bounce on contact Makes it easier to drag back to trailed surface

Answer 54

Touch and Drag (Shorelining)

Question 55

Anchor cane tip against base of first stair Reference point Rotate hand until cane is vertical against base of stairs 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 Confirms and corrects body perpendicular to stairs Gauges width of stairs Transfer cane to left hand when handrail is desired 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 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 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 Helps retain control over cane placement Maintain consistent distance between body and cane tip Prevents catching tip or overstepping 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 Provides natural transition Resume constant contact

Answer 55

Ascending stairs

Question 56

Anchor the cane tip against edge of stair 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 Reference point for stair edge Lower cane to tread of first step, slide it forward to edge 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) Not necessary to contact each riser Helps ensure cane does not protrude or tip gets stuck Cane tip reaches landing with advanced notice Begin descent, lean slightly backward, extend arm enough to keep cane tip hovering just blow step edge Provides balance When contacting the landing, anticipate last step and prepare for forward travel by clearing landing before taking last step Tip will reach landing before body Clearing landing is important – will inform if another set of stairs or obstacles are present Resume constant contact

Answer 56

Descending Stairs

Question 57

Maneuver around obstacles without losing line of direction Process Cane tip anchored against object To anchor: slight pressure applied to cane to keep it stationary against surface Serves as reference point Stand still until location is determined Stop and determine intended next steps – explore or move around Pausing allows processing time before a decision is made 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 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

Answer 57

Detecting and Moving Around Obstacles (Diagonal)

Question 58

What are the components used to analyze intersections?

Answer 58

Shape of intersection Traffic controls Flow of traffic Visit location at different times of day to note any patterns

Question 59

These are the following tasks for street crossing.

Answer 59

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

Question 60

For analyzing an intersection, you need to do the following:

Answer 60

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

Question 61

What are some common risks when crossing an intersection?

Answer 61

Bicycle traffic permissive lanes not enough time to cross drivers running red lights distracted driving/ignoring white cane blind spot of driver

Question 62

How can the O&M specialist prepare the learner to make informed decisions?

Answer 62

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

Question 63

Describe the following traffic control systems of the intersection or crossing:

Answer 63

2-way stop: 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, 4-way stop: 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. T-shaped intersection with 1-way stop on stem : 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 traffic light controls: 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 simple phase traffic light: run on a predetermined, or fixed, semi-actuated, or fully actuated cycle. 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.. 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

Question 64

Where within the environment is the most frequent placement of yield signs?

Answer 64

Channelized right turn lanes roundabouts

Question 65

Describe what defines a Situation of Uncertainty.

Answer 65

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.

Question 66

What strategies should the O&M specialist use to teach crossings in Situation of Uncertainty?

Answer 66

Getting assistance to cross, Cross somewhere else, Getting a ride, Delivery of items instead of going out, Requesting intersection alterations Assess risk to cross: Take students to a street that is suitable for this training, then determine their crossing time for traffic from the left and from the right. Help students develop an intuitive understanding of their crossing time for each half of the street by visualizing themselves walking across and estimating when they would complete their crossing, until they are reliably accurate (details here). Now, have the students apply this intuitive understanding to the current crossing and compare the warning times of approaching vehicles with the crossing time: Ask student to wait until it is quiet/(s/he sees nothing coming) and then tell you when s/he first thinks s/he hears/(sees) something the MIGHT be a vehicle coming. Start the timer when s/he detects a vehicle, and stop it when the vehicle arrives. Do not report the result to the student yet, but record it on the TMAD Checklist. Ask the student if s/he thinks the warning time (detection-to-arrival time) for that vehicle was longer or shorter than the crossing time. Make sure the student is basing this judgement on an intuitive understanding of crossing time, rather than counting seconds. After the student guesses, report the time that was measured with the stopwatch, and let the student know if s/he was correct or not. REPEAT these four steps, using a stopwatch to provide feedback, until your student becomes reliably accurate at comparing warning times with crossing time. If the student keeps making mistakes and misjudging whether the warning time of a vehicle is longer than the crossing time, review his or her intuitive understanding of crossing time again, then resume comparing warning times of approaching vehicles to crossing time until s/he becomes reliably accurate. ASSESS SITUATION: After listening to/(watching) enough vehicles to observe the range of warning times for vehicles approaching from the right and from the left in that situation, discuss with the student whether it is a Situation of Uncertainty or a Situation of Confidence (the back of the TMAD Checklist has a flowchart to help guide this discussion). Finally, in each Situation of Uncertainty, use the Risk Analysis Checklist to have the student: Assess the risk, Decide if the risk is acceptable, and Consider alternatives. 

 REPEAT! Take the students to a variety of crossing situations and ask them to independently assess whether it is a Situation of Uncertainty or not, based on their observation of the traffic and their estimate of the width of the street (using their intuitive understanding). 

Then the instructor uses the TMAD with a stopwatch to analyze the situation and give feedback as to whether the student was correct. If it is a Situation of Uncertainty, the student analyzes the risk, decides if the risk is acceptable and if not, considers and implements alternatives. 

Continue this practice until the students become skilled and accurate with their assessments of the situations, including at least one Situation of Uncertainty and one Situation of Confidence. You can use the CHECKLIST: Teaching Students to Recognize Situations of Uncertainty to record students' assessment of each crossing situation.

Question 67

What is the technique for crossing at an uncontrolled crossing using visual strategies?

Answer 67

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

Question 68

What is the technique for crossing at an uncontrolled crossing using auditory strategies?

Answer 68

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.

Question 69

What is the technique for crossing at a stop sign controlled crossing using visual strategies?

Answer 69

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

Question 70

What is the technique for crossing at a stop sign controlled crossing using auditory strategies?

Answer 70

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

Question 71

What is the technique for crossing at a signalized crossing using visual strategies?

Answer 71

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.

Question 72

What is the technique for crossing at a signalized crossing using auditory strategies?

Answer 72

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.

Question 73

Explain the use of the pedestrian button in the timing of street crossing

Answer 73

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.

Question 74

What strategies should be used when teaching a learner to use APS?

Answer 74

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.

Question 75

Identify and describe a tactile method of alignment at street crossings.

Answer 75

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

Question 76

dentify and describe an auditory method of alignment at street crossings.

Answer 76

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

Question 77

Where should an instructor be positioned while on the corner before the learner initiates the crossing?

Answer 77

Behind the student and opposite of parallel traffic as to not mask their hearing

Question 78

Where should an instructor be positioned after the learner initiates the crossing, during the crossing?

Answer 78

Behind the student and toward the oncoming perpendicular traffic

Question 79

What is the basic procedure for bus travel?

Answer 79

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 techique

Question 80

How can a learner obtain route information when planning a trip using public transit?

Answer 80

Audible maps online Calling the bus terminal Text updates and information Asking for assistance at the bus stop

Question 81

What is paratransit and how does a learner become eligible to use the paratransit system.

Answer 81

It is door-to-destination transportation on a call-in basis for a minimal fee; Eligible via proof of disability

Question 82

What cane techniques should be used in snow?

Answer 82

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

Question 83

What cane techniques should be used in rain?

Answer 83

Vary between constant contact or 2-point touch, depending upon sensitivity to tactile information Use cane to determine puddle depth and width

Question 84

How would excessive heat conditions impact the learner’s ability to travel?

Answer 84

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.

Question 85

What strategies could be used to improve the ability to travel in excessive heat conditions?

Answer 85

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

Question 86

What characterizes a rural environment?

Answer 86

Inconsistent pavement, unlighted intersections, travel vast open spaces with few auditory or tactile clues, unique smells & environmental sounds; few consistent traffic sounds

Question 87

What procedure and cane techniques should be used when traveling in areas without sidewalks?

Answer 87

Shorelining Indenting at intersections Touch and drag Constant contact

Question 88

What procedure and cane techniques should be used when making a street crossing without sidewalks?

Answer 88

Shorelining, touch and drag to stay on shoreline and know when an intersection is approaching Indenting the curb to ensure street crossing Constant contact

Question 89

Identify specific strategies used when traveling in a supermarket.

Answer 89

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

Question 90

Identify specific strategies used when traveling around a gas station.

Answer 90

touch-drag to shoreline, maintain traffic flow observation; return to parallel surge to find sidewalk

Question 91

Describe strategies used to recover from getting disoriented in shopping mall parking lots.

Answer 91

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.