Future Reflections         Special Issue: Blind Children with Additional Disabilities

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USING THE TEACHING CANE STRATEGY WITH CHILDREN WHO ARE DEAFBLIND

by Mary Tellefson, MA, MS, TVI, COMS
Wisconsin Center for the Blind & Visually Impaired

Reprinted with Permission from DVIQ, Vol. 54, No. 3, Spring, 2009

From the Editor: This article describes an innovative strategy for encouraging young deafblind children to begin using the long white cane. The teaching cane strategy can also prove valuable for introducing the cane to other blind children, with or without additional disabilities.

The world-renowned deafblind educator, Jan van Dijk, describes the following four major developmental areas that are impacted by deafblindness (van Dijk, 1999): (1) access to sensory information; (2) communication and movement; (3) incidental learning, including concept development and mental imagery; and (4) emotional development, including sense of self, motivation, perception of safety, and isolation. The cane is a tool that addresses these areas of development by increasing the availability of sensory information to a child through auditory, tactile, kinesthetic, and vibratory feedback. Cane use promotes active movement, contact with the world, opportunities for exploration, and a sense of safety.

The teaching cane strategy, a process put forth by this author, is an approach to early cane use. It facilitates all areas of development and has valuable applications for children who are deafblind. It is a role-release approach in which an orientation and mobility specialist teaches the adults, including parents, who work most closely with a child to use a cane in the child's presence. Subsequently, once a child expresses an interest in an adult's cane and joins with the adult in handling it, the child receives his or her own cane.

The term "teaching cane," which was first introduced by pediatric orientation and mobility specialist Joe Cutter (2007), refers to the canes of both the adult and the child, since both are used to teach the child. Rather than requiring a child to demonstrate an ability to use a cane before it is introduced, the teaching cane strategy promotes early cane use as a way to facilitate the development of fine motor, cognitive and sensory skills.

The decision about whether, or when, to begin using the teaching cane approach depends on a child's spatio-temporal development and physical ability, the level of support for the process from parents or other caregivers, and the availability of an orientation and mobility specialist who is comfortable with a role-release model of service delivery. When using a role-release approach, the majority of the orientation and mobility specialist's time is spent observing and coaching parents or other important adults in a child's life. Because of their consistent relationship with the child, these adults are in a favorable teaching position.

Learning to use a cane is a process during which individual differences are acknowledged and addressed. Children as young as one year of age may be introduced to a cane using the teaching cane strategy. As a child matures, so does his or her use of the cane. The four stages of the strategy are described below. Best practice applications from the field of deafblindness can be integrated at each stage.

An ability to walk is not necessary in order to use the teaching cane strategy. The only requirement is the ability to hold the cane in a manipulative grasp. Children transported in wheelchairs or strollers can use a cane for tactile and vibratory feedback, extending reach, previewing a walking surface, and exploring.

Stage 1: Cane Exposure to Promote Awareness

The purpose of the first stage is to create conditions that encourage a child to become aware of the cane and how it is used during daily activities. This is accomplished by teaching adult role models (e.g., parents and teachers) to use the cane. As role models use the cane during everyday activities, the child may notice their movements or may notice the cane itself. The cane becomes a potential topic of conversation (Miles & Riggio, 1999).

Role of the Orientation and Mobility Specialist:

• Teach role models to use a cane appropriately, with attention to grip, the sound and rhythm of movement, and extension of reach.
• Demonstrate how to use the cane while carrying a child, pushing a child in a stroller or wheelchair, or walking hand in hand.
• Demonstrate the use of techniques to engage and positively reinforce a child's interest in the cane.
• Discuss how to take cane walks with the child and the types of walking environments that will be of auditory, tactile, and visual interest to a specific child without being overwhelming.

Stage 2: Encouraging Interest in the Cane

When a child begins to express interest in the adult's use of a cane, it is time to encourage him or her to participate in its use. The goal of Stage Two is for adult role models to learn to recognize and reinforce child behaviors that indicate interest in the cane and to apply individualized strategies that facilitate a child's understanding and participation. This should be based on a child's level of interest and motivation. At no time during this stage should the cane be forced on a child with direct instruction.

Children express interest in many different ways. The adult should observe the child for behavioral signs that indicate the child has noticed some aspect of cane use. For example, the child may reach for the cane, pause while walking, turn toward the cane, or show increased excitement or stillness when exposed to the cane. These are critical moments during which an adult should respond to the child's expressed interest.

A child may participate in cane use by hanging on to the cane while the adult moves it back and forth or makes contact with an object. If the cane is long enough, the adult can invite the child to walk in front, placing his or her hand on top of the adult's hand to hold the cane together. The vibration or sound produced when the cane contacts an object has meaning for the child if he or she is made aware of the object the cane has encountered. The child is encouraged to follow the shaft of the cane with his or her hand to the object for tactual exploration. At some point the child may show a desire to control the cane for him/herself. This suggests that the child is ready to move to Stage 3.

Role of the Orientation and Mobility Specialist:

• Celebrate and reinforce the power of mutual attention during cane use.

• Demonstrate and discuss strategies that promote the child's participation.

• Discuss the importance of multi-sensory experiences paired with communication (sign, voice, objects) to verify sensory information received through the cane.

Stage 3: Giving a Cane to the Child

Once a child's interest and coactive participation indicate readiness or a desire for a cane, it is time to help him or her experiment with it. The child can be encouraged to discover the possibilities the cane offers for learning about the environment through inspection, exploration, and play. Avoid the assumption that a child will automatically know what to do with a cane or will be able to imitate the adult role model. A child may initially reject his or her own cane. Even though the child has already been exposed to an adult's cane, his or her own cane may be perceived as a new object. Using the child's cane together (coactively) as described in Stage 2 with the adult cane, may be a necessary first step.

Because of the cane's ability to provide auditory, tactile, and vibratory feedback and facilitate physical, cognitive and social growth, a child who is willing to interact with it is learning. A child who is able to use familiar tools, such as a spoon, toothbrush or comb, may independently be able to experiment with the cane as a tool (Cutter, 2007). Opportunities for the child to use his or her cane are given during family "cane walks." In a cane walk, parents and siblings, if included, use their canes as well. Malls for indoor travel and parks or residential neighborhoods for outdoor travel are examples of environments that are interesting to explore. Conversations can be sparked by objects, sounds, textures, vibrations, and smells.

Role of the Orientation and Mobility Specialist

• Encourage continued modeling of cane use and coactive use of the cane through cane walks.
• Discuss the child's preferences and sensory limitations.
• Discuss the types of environments that are most likely to provide and promote interest and motivation for the child.
• Provide ongoing observation and support.

Stage 4: Shaping the Child's Use of the Cane

When developmentally appropriate, the child's use of the cane is shaped toward its intended use as a travel tool. Through continued modeling and direct instruction from an orientation and mobility specialist, a child's use of a cane increasingly approximates formal cane techniques in form and function.

Travel becomes oriented toward a task, activity, or destination, and the child becomes increasingly mobile under his or her own power.

Role of the Orientation and Mobility Specialist

• Periodically observe the child's functioning and provide coaching to adults to enable them to reinforce his/her specific skills.
• Check the adult's ability to identify behaviors that may indicate a child's readiness for specific techniques such as stairway travel, diagonal trailing, or touch technique.
• Explain that skills already mastered may not be accessible to a child who is mastering a new skill, especially if it includes a gross motor milestone.
• Build a relationship with the child prior to providing direct instruction.
• Participate in IEP planning and in the child's transition process from early intervention to early childhood services once a child turns three.

References

Cutter, J. (2007). Independent movement and travel in blind children, A promotion model, Charlotte, NC, Information Age Publishing.

Jensen, E. (1998). Teaching with the brain in mind, Alexandria, VA, Association for Supervision and Curriculum Development.

Miles, B., Riggio, M. (1999). Remarkable conversations, a guide to developing meaningful communication with children and young adults who are deafblind, Watertown, MA, Perkins School for the Blind.

Roman-Lantzy, C. (2008). Cortical visual impairment, an approach to assessment and intervention, New York, NY, AFB Press.

van Dijk, J. (1999). Reaching our students with Jan van Dijk, Fort Worth, TX, conference handouts, November 4.

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