Supporting the Emotional Adjustment to Blindness from the Beginning of Cane Travel Instruction

By Justin M. H. Salisbury, MA, NOMC, NCRTB, NCUEB

Justin Mark Hideaki Salisbury is an Orientation and Mobility Therapist for the State of Hawai‘i, Department of Human Services, Division of Vocational Rehabilitation, Services for the Blind Branch (Ho`opono), Adjustment Section, located in Honolulu, Hawai‘i.

Abstract

An emotional adjustment to blindness is the keystone to the blindness rehabilitation process. An instructor has the ability to support or detract from that adjustment from the very beginning of training, and, at some training centers, the cane travel instructor is the first instructor to work with the student. This article discusses the ways in which the cane travel instructor can support or detract from that emotional adjustment, thus setting the pace and leaving a first impression for the entire training process. It discusses parts of cane travel instruction but does not provide a comprehensive manual on how to teach. Pre-cane skills, including trailing, squaring off, sighted guide, protective techniques, and the use of pre-canes themselves, are discussed. Everything that an instructor does will impact a student’s emotional adjustment to blindness.

Keywords

Blindness, Structured Discovery, cane travel, orientation and mobility, pre-cane skills

Introduction

Riccobono (2010, 2017) explained that it is harmful when blindness rehabilitation practices are biased toward the use of vision over the use of nonvisual techniques. It comes from a vacuum of misinformation about blindness which every well-intended person is fed by society, which Jernigan (1984) described as part of a circle of sophistry. Contemporary leaders in the blindness rehabilitation field understand this vision-centered approach to be counterproductive. Hill (1997a; 1997b) explains that instructors who operate under this approach tend to overprotect blind students and emphasize the teaching of pre-cane skills prior to cane skills, even though cane travel is best taught in a simple and common-sense manner. Blind students can generally handle going right into the cane skills without the distraction and complication of pre-cane skills. Blind people who embrace nonvisual techniques, such as cane travel, are generally more successful (Aditya, 2004; Bell & Mino, 2015; Schroeder, 1996). According to Maurer, Bell, Woods, and Allen (2006), cane travel refers to a skill set which a blind person uses to navigate the world. A student should be given a cane at the beginning of cane travel instruction (Altman & Cutter, 2004). Schroeder (1986) asserted that pre-cane skills should not be taught to a blind consumer prior to cane travel instruction. It is important not to contradict the message of empowerment and also the message of the importance of using one's cane at the beginning of the process of teaching the person how to use a cane. In other words, there is little productive value, if any at all, in teaching a student an alternative to using his or her cane and subsequently giving them a cane. A cane is the primary or default travel tool, not a backup that the student should use only when necessary. Witte (1997) explained that most people view the white cane as a symbol of all the unfortunate misconceptions about blindness, leading many blind people to try to hide the cane or walk without it as long as possible. Teaching pre-cane skills first leads the student to try to depend first on the pre-cane skills and second on the cane skills and also sends the message that cane travel is unnecessarily complicated, thus requiring the exclusive intervention of specially-trained professionals in order to experience any benefit (Schroeder, 1986). From this point forward, following the example set by Morais et al. (1997), a generic student will be given singular male pronouns, and the instructor will be given singular female pronouns, as appropriate, with the exception of specific student examples, which will use code names for confidentiality.

Ideally, students will be willing to agree to wearing sleepshades. If the student is attending a residential Structured Discovery program, he is already required to wear sleepshades (Altman, 2012; Bell & Mino, 2015; Dodds, 1984; Olson, 1982; Omvig, 2002; Salisbury, 2017b, 2018; Tigges, 2004). Rather than simply telling the student that he needs to wear sleepshades and expecting him to do it, the instructor can also explain the reasons why the sleepshades are used. As Jernigan (2005) explains, a person can properly be considered blind when he has to devise enough alternative techniques to function efficiently that his pattern of daily living is substantially altered. Thus, if the student is to learn how to function efficiently, he must devise nonvisual alternative techniques. Sleepshades help a student to focus on nonvisual stimuli to enhance perceptual learning. Eventually, nonvisual skills are practiced to the point of automaticity so that the student’s attention is freed up to focus on higher levels of problem-solving, which gradually become even more automated themselves (Maurer, 2011). As students advance, they shift from only having role models to also serving as role models for the students who are at earlier stages in training than they are. Students build a stronger sense of self-efficacy as they continue to conquer more challenging tasks, have good role models, learn how to manage stress, and receive positive feedback from instructors and peers (Bandura, 1977, 1997; Mettler, 1995/2008, 1997; Tigges, 2004). It is good for the instructor to monitor nonvisually even if she is sighted to demonstrate belief in the efficacy of nonvisual techniques but also to help the student to understand how the instructor is monitoring him to inform his own self-monitoring and to feel completely comfortable and confident with the idea of a blind person monitoring someone else’s cane travel. This also helps the student to really believe that a blind person can monitor his cane travel as an instructor (Bell & Mino, 2011; Dodds, 1984, 1985), which helps him feel comfortable with his instructor, whether blind or sighted and under sleepshades, and with the concepts of the capability of blind people.

At one Structured Discovery training center, the student’s first day begins with a brief meeting with the director to go over the program rules and expectations, which typically lasts no more than 30 minutes, and then the student works with a cane travel instructor on basic travel skills. The justification often given is that, the first step in attending the classes at the training center is to be able to navigate the training center to get from class to class. The instructor will typically use her discretion in response to competing priorities in order to decide how long to teach the new student. Some students come in with a decent foundation in cane travel and need very little formal instruction, if any at all, to be able to navigate the center from class to class. Others will have never held a cane before. All students learn at different rates, and all students fatigue at a certain point (Mino, 2011). The instructor’s role is to bring the student to a point where he can move freely and safely through space, without eating up his entire training day, and hopefully without completely exhausting his physical energy or emotional reserves. Cane travel instruction will, of course, resume at the next regular cane travel class time, if not sooner. Morais et al. (1997) explained that, though it is normal for students to fear for their safety while using sleepshades, a few hours of experiencing predictable success begins to alleviate that fear. Prolonged instruction, over time, is vital in helping students experience more successes and come to understand more than just the initial struggle of being blind with no skills (Silverman, 2015; Silverman, Gwinn, & Van Boven, 2015). Soong, Lovie-Kitchin, and Brown (2001) found that short-term orientation and mobility training without sleepshades produced no significant lasting skill improvement, which foils long-term sleepshade training under the Structured Discovery model.

Pre-Cane Skills

Some common pre-cane skills include trailing, squaring off, sighted guide, and protective techniques. If students come to Structured Discovery Cane Travel after having already been taught to use these pre-cane skills, frequently, the instructor must un-teach these skills. In other words, the instructor must break the student of the bad habits which were previously taught so that they do not undermine emotional adjustment or task performance. Furthermore, since one of the major objectives of training is teaching a blind person to blend into a broader society dominated by sighted people (Omvig, 2002, 2009; Salisbury, 2018), the use of pre-cane skills contradicts that objective by making the blind person stand out. Such behaviors are socially isolating. Teaching pre-cane skills first makes them the default means of travel and relegates cane skills to a second-class status. A potential logical consequence of this ideology is that those people who use those nonvisual techniques are then relegated to second-class status, which can be damaging to the equality of the blind. Since instructors are supposed to be helping students develop feelings of first-class status, they can improve their effectiveness at this task by emphasizing the use of cane skills.

At the physiological level, these pre-cane techniques often lead a person to focus on their own movements or on objects or people close to them rather than focusing further away from themselves, like a typical human would do. McNevin, Shea, and Wulf (2003) investigated the learning advantages associated with an external focus of attention. One critical factor underlying this learning advantage is the distance between the action and its effect. When instructed to focus on the body (feet) or proximal effects, the regulation of control processes involved in maintaining balance are constrained, resulting in performance and learning decrements. Increasing the distance of the effect from the movement producing it appears to allow performance to be mediated by automatic control processes that results in enhanced learning. The way this applies to cane travel is that the traveler is better off focusing on a destination that is further away from his body rather than focusing on his own movements or near objects.

Pre-cane techniques emphasize the memorization of specific patterns of movement through specified environments. This can potentially communicate and reinforce the notion that blind people should not be expected to travel independently beyond familiar routes and environments, and even those familiar environments must be professionally selected by the cane travel instructor to ensure the traveler’s success and safety. These subtle and perhaps inadvertent messages can produce a feeling in the student that he must not take risks and venture into new situations without the care and supervision of a qualified professional to monitor his safety and direct his movements. Feelings of greater freedom and individual agency are possible, and the instructor must do her best to cultivate those feelings in her student.

Trailing.

Anderson (1965, p. 35) defined trailing as "The act of using the back of the fingers to follow lightly over a straight surface (e.g. wall, lockers, desks, tables, etc.) for one of the following reasons: a. to determine one's place in space; b. to locate specific objectives; c. to get a parallel line of travel." Students who are taught trailing are likely to struggle with walking straight. If they get into a rhythm of delegating the decision-making about where straight actually is to an inanimate object, then they learn to trust that inanimate object more than they trust themselves. They are externalizing their locus of control, but part of the goal of adjustment to blindness training is exactly the opposite: internalizing locus of control. Also, a person who is trailing will have his or her attention focused only as far as the point of contact with the object that he or she is trailing. A traveler needs to be able to focus his or her attention more broadly so as not to miss out on other environmental information.

Sometimes, students will be taught to trail by an education or rehabilitation professional, who can be assumed to be well-meaning despite being uninformed about the consequences. It is also possible that an adult who becomes blind later in life devises the trailing technique as a matter of survival. Such a situation illustrates the importance of receiving proper adjustment to blindness training as soon as possible after becoming blind.

For example, one student, Diane, who became blind at about age 60, lived alone and had no family for thousands of miles. She had to figure out some way to continue surviving after abruptly becoming blind. She found a way to survive, and some of the means she used for traveling were trailing or using sighted guide. When she would try to walk along sidewalks, she would occasionally drift toward the edge of the sidewalk, no matter how wide it was, and stay close to the grass line or whatever bordered the sidewalk. This gave her a security blanket and helped her believe that she could walk straight because of the grass line. She would occasionally encounter curvatures in the landscaping, where the grass line would curve, perhaps up a driveway, and she would follow it without noticing herself turning. This demonstrates that she would be getting her direction from the grass line rather than her own internal compass. In other words, she was not making a conscious decision about where she wanted to walk other than the relative positioning to wherever the edge of the sidewalk went.

When Diane would exit her apartment building and walk through the ground floor parking garage, she would quickly walk toward the outer wall of the parking garage, which paralleled the main road but blocked its sound completely, and then trail the wall all the way to whichever opening she planned to use as an exit. She would have to walk through about eight parking spaces in either direction to get to the outer doorway, some of which would occasionally contain parked vehicles. If she encountered one, she would stop, turn away from the wall, and trail all three edges of that vehicle until she returned to the wall on the other side. Then, she would return to trailing the wall until either the next parked vehicle or the doorway finally appeared. This pattern of walking is extremely inefficient and presents safety concerns. Drivers expect pedestrians to be in certain normal places, but this technique leads a person to walk in places which are not normal. If blind travelers walk in this pattern, their attention is taken away from what their canes are doing and leaves them vulnerable to obstacles, such as drop-offs or mirrors on the parked cars.

There was a pedestrian doorway that would appear before each driving entrance, thus closer to the door from the lobby through which residents were likely to enter the parking garage. It measured about 5 feet wide and had a gated door. Diane would intend to go into that walkway first rather than walk through the lane where the vehicles would drive, but she would often get to it, watch her cane get sucked into it, hear the loud traffic on the six-lane main road outside, feel the wind whipping through the doorway, and still decide that she had not found the doorway yet. She would often continue following in the direction that she had been trailing even after the wall had disappeared. Again, she was not making a conscious decision about where she was going and not paying attention to environmental cues. She also was in such a habit of being wrong at what she was doing that she had learned to second-guess herself, thus leading her to assume that she was wrong and that she must not have found what she wanted.

When Diane began crossing streets, she had immense difficulty getting her alignment because she wanted to do it based on something stationary that she could touch or follow. Instead of using traffic sounds to get her alignment, she would begin by trying to align to the direction that the curb ramp pointed her. Then, she would insist that the sounds were in the right place to justify the alignment she had produced based on the direction of the curb ramp. As she learned that this alignment pointed her out toward the center of the intersection, she began attempting to start with that alignment but gradually turn as she was crossing so that she would travel a curved path, making the parabolic shape of a rainbow or an elbow macaroni noodle. This method is much less precise and less safe. Drivers expect pedestrians to be moving in a straight pattern across the street and will behave according to that expectation. Since the shortest distance between two points is a straight line, the shortest distance to be traveled through the street would also be a straight line, and the extended distance created by the curved route would keep the pedestrian in the street longer than necessary. Aiming a curved path is generally more difficult than aiming a straight path. Since this same student was not getting her alignment based on parallel traffic at a basic four-way lighted intersection, when the parallel traffic flow would disappear, she could not follow that wall of traffic and needed to cling to something else. To help her finish a crossing, her instructor pointed out that the perpendicular traffic, which was parked next to the crosswalk as the vehicles waited for the stoplight, could serve as another tool for alignment. After that crossing, she attempted to cling to this method of alignment, aiming herself toward where she thought there would be parked perpendicular traffic. She would then occasionally end up behind the front row of cars at that intersection and become disoriented. Regardless, she was still not crossing straight and did not trust herself to make a decision about where her destination would be. Her focus was always too close to her body, and she was still trying to trail the front bumpers of the cars parked at the intersection. Trailing limited her skill development, which is part of the emotional adjustment, but it also kept her from trusting herself. These two problems can work symbiotically to hinder the progress of a student.

Trailing versus Shorelining.

The shorelining and trailing techniques are quite different but can be confused by the untrained observer. The use of a cane does not automatically transform trailing into shorelining; it is possible to trail using a cane instead of one’s fingers. The term shorelining comes from the idea of monitoring where a shoreline is. Historically, in the absence of formal navigational equipment, if a fisherman wanted to remain close to the shoreline while out fishing for the day, he could simply stay close enough to shore that he could still see it. This same idea is a part of cane travel. A traveler can simply remain close enough to a shoreline that he or she knows where that shoreline still is, which generally involves touching that shoreline during each cane arc or hearing its echo. Shorelining is often used when walking along the edge of a street or parking lot so as not to drift out into the middle of the street or parking lot accidentally. If a traveler is walking along the edge of a street, he or she can touch the edge of that street at some point in the cane arc. If the edge of that street is a curb, it is likely that the edge of the street will be touched at the relevant end of the cane arc. Such a technique is common in places where there is no sidewalk or an obstructed sidewalk. If the edge of the street is defined by a grass line, the same is likely true. If the edge of the street is defined by a seam, it is likely that the traveler will have switched into a constant contact technique to monitor where that seam is as they continue along the edge of that street. In any case, the traveler is still maintaining his or her own direction rather than delegating that decision to the person who built the road. Blind people need to understand that they have the right to have their own itineraries as they travel (Salisbury, 2017a, 2018; tenBroek, 1966) and not depend only on the built environment to dictate that for them. Since trailing is a matter of getting one’s direction from the built environment, like following a trail, the blind traveler is surrendering his or her own ability to chart his or her own course. Instead of empowering this person to feel in control of his or her own life, an important part of the emotional adjustment to blindness (Jernigan, 1993; Omvig, 2002), trailing is doing the opposite.

Squaring off.

Squaring off is defined as "the act of aligning and positioning one's body in relation to an object, for the purpose of getting a line of direction and establishing a definite position in the environment" (Anderson, 1965, p. 35). Squaring off is often applied by putting one's back flat against a wall (Cratty & Sams, 1968) and then walking away from that wall. Other straight-edged objects, such as couches or tables, are occasionally used for this purpose. A student taught to use this technique is forced to focus his attention backwards instead of focusing forward on his destination. It specifically disorients a student. Some travelers attempt to use this technique to get their alignment for street crossings by squaring off from the curb. First, the curbs are not designed for this purpose, so, though it may work once, it is not as dependable as other techniques devised by blind people over the centuries. Some curbs are rounded off at corners to serve multiple crossing directions, and some do not angle exactly the same way that a crosswalk may angle. Second, it carries all the same problems mentioned above associated with squaring off.

Sighted guide or human guide.

Anderson (1965) described a following technique involving a blind person lightly grasping a sighted guide's elbow while taking a walk. Over time, this technique has colloquially become known as “sighted guide” or, less commonly, “human guide,” (Jernigan, 1993). If sighted guide is taught at the beginning of cane travel instruction, it introduces an alternative to using the cane before teaching the student how to use the cane and will thus be a disincentive for the student to practice using his new cane skills. Teaching sighted guide can give the impression that the instructor thinks that the student is incapable of figuring out how to hold onto someone and follow them. A student will naturally do this on his own if he thinks he needs it, and it does not need to be encouraged by the instructor. In fact, during training, students are generally told not to use sighted guide to make them focus on exploring ways to use cane skills. Also, teaching sighted guide communicates that the instructor believes that there exist some environments where the student may be better off depending on someone else than traveling on his own. One of the main differences between the two terms is the reason that someone uses a sighted guide or human guide. If the person believes that a sighted person is inherently more competent as a traveler and thus initiates the guide process, then the fact that the guide is sighted is relevant and may then be included in its name. If this assumption is not being made, then the blindness status of the guide is irrelevant, so human guide would be more appropriate. The instructor should be encouraging the student to practice his cane skills outside of class time, even when not wearing sleepshades (Altman, 2012). Even if a blind person is walking sighted guide, he should still be using his cane at the same time (Morais et. al, 1997). Additionally, Altman and Cutter (2004) explain that teaching sighted guide reinforces dependency on the instructor, which contradicts the emotional adjustment to blindness. Since part of a student’s emotional adjustment to blindness is coming to feel in his heart that he can be the driver in his own life rather than the passenger, everything the instructor does should support that adjustment. Teaching sighted guide at the beginning of cane travel instruction relegates the student to the role of a passenger, which undermines the adjustment to blindness from the very beginning.

Protective techniques.

Martinez (1998, p. 2) defined protective techniques as “specific skills which provide added protection in unfamiliar areas.” Protective techniques often involve walking with the hands outstretched, one in front of the face and one in front of the genitalia. Some variations may exist, but this pattern of walking is often accompanied by foot shuffling or some other highly defensive way of walking. Such behaviors are unusual to the general public and precipitate misunderstanding and social isolation. Altman and Cutter (2004) explain that proponents of the Structured Discovery model believe that teaching cane travel is inseparable from addressing the misperceptions and low expectations of and for blind people which exist in society and understand themselves to be a part of the movement toward full integration and equality, so they do not teach protective arm techniques. These techniques also are not safe because they fail to detect many obstacles that a cane can detect, potentially leading a blind person to trip, stumble, and fall. A person in such a circumstance struggles immensely to develop confidence in his travel ability. Since these consequences of using protective techniques undermine the adjustment to blindness, it is helpful to avoid teaching them.

Pre-cane devices.

A pre-cane is generally a device that exists to teach students a type of familiarity with moving through space and using a mobility device. They are most commonly used with children but can sometimes be used with adults. There are infinitely many variations of pre-canes. In fact, applicants for orientation and mobility jobs in the primary school system are often asked what kinds of pre-canes they make. Pre-canes can cause problems for students of any age. Any student who is planning to use a long white cane can simply begin cane travel instruction by using long white canes. Pre-canes can inadvertently depict cane travel as an unnecessarily complex discipline. This idea is sophistry; in other words, it is clever and plausible but false and misleading (Jernigan, 1984). Students who use pre-canes can fall into the trap of thinking that their instructors are rare experts in the engineering, manufacturing, and instrumentation of these highly scientific biomedical engineering masterpieces, which can give them the feeling that they will not be able to manage their own cane travel equipment. Since cane travel is more of a common-sense skill set, it can be harmful to a student to think that cane travel is much more complicated than it actually is. If a discipline is deemed to be so complicated that only the unusually talented person can master it, then the performance expectations for the average student will naturally not include full mastery. Lower expectations yield lower outcomes, so it undermines the learning of cane travel and the overall adjustment to blindness. Blind people need to understand that it is their innate human capacity that is the source of their independence, not the fancy technology (Riccobono, 2017). Furthermore, students must understand that they will not be constantly in need of the services of a cane travel instructor for the rest of their lives to help them with their cane travel needs. A well-adjusted blind person can manage his own affairs after training without the intervention of a cane travel instructor.

Introducing the Cane

Asking the student for his height, the instructor can approximate the cane length to be about six inches below his overall height. Canes in this range can then be given to the student, and the student can be asked to determine where on his body the cane reaches while standing up. This is an early opportunity for the student to learn to take initiative and monitor his cane in relation to his body. If the instructor takes care of all measurements without involving the student, she is failing to capitalize on this opportunity to help the student take ownership of the training process from the very beginning. The cane should measure somewhere around the student’s nose or eyes, but this is only an approximation for what really matters. Bickford (1993) wrote that the cane “needs to reach a good two steps in front of where [the student is] stepping” (p. 11). This gives the traveler enough advance notice of obstacles in order to react accordingly. Over time, as a student learns to walk faster, a longer cane may become appropriate (Hill, 1997a). Once the student has a proper cane, the instructor should encourage the student to investigate his new cane for a minute, just noticing the different parts of it. When the student notices the lanyard, if the cane has one, the instructor can point out that the lanyard has no function during the travel process itself but exists as a relic of past cane designs and is now used to hang up the cane when not in use or to decorate it in a unique way for identification. Some inventors have devised canes which involve complex technology; however, since cane travel should be simple, students must understand that the capacity lies in them rather than in the technology (Riccobono, 2017). Witte (1997) explains that the student may not want a cane because of the negative misperceptions about blindness that the cane may symbolize, so the instructor may have to reframe the cane as a symbol of independence and help him adjust to identifying with it overall.

Teaching Basic Cane Technique

First, it is important to explain two different methods of instruction used to show a student a new concept. “Hand-over-hand” is one method versus “hand-under-hand.” Since a blind student, especially while wearing sleepshades, cannot watch visually what the instructor is demonstrating, he can monitor through tactile methods. If an instructor wants to demonstrate a hand technique so that a student can watch what she is doing, she can use hand-under-hand instruction. In other words, the instructor’s hand is under the student’s hand, so that the student is watching the instructor’s hand motions. Hand-over-hand instruction means that the instructor’s hand is placed over the student’s hand, so that the instructor is physically manipulating the student’s hand. Hand-over-hand is often used for students who are newer or less experienced in the area of instruction, thus the instructor is giving more direct guidance, versus hand-under-hand. If a student struggles too much with learning the most basic concepts, it can lead him to think that cane travel is unnecessarily difficult, so it is important not to make the student feel overwhelmed; thus, hand-over-hand keeps the lesson more structured and keeps the student’s mind and emotions from wandering. On the other hand, if a student is easily able to learn from hand-under-hand techniques and feels more in control of his own movement because he is moving his hands on his own, hand-under-hand can help him to feel more empowered. An instructor will choose which method based on which one she believes is most efficient, recognizing that the emotional adjustment to blindness is an outcome of equal or superior importance to the mastery of techniques (Jernigan, 1993; Omvig, 2002; Salisbury, 2017b).

Similarly, there is a spectrum between guided learning and discovery learning. Any instance of Structured Discovery instruction will involve some guided learning and some discovery learning. Even in the very beginning, when a student is being shown hand-over-hand how to do something, that student is still having some small level of perceptual learning experience which cannot be directly taught. On the other end, there is no true discovery learning in Structured Discovery because the instructor is still providing some guidance by giving an assignment. The true discovery learning is what happens before and after Structured Discovery training.

Open-palm grip.

With a brand-new student, it is common to begin working with the student in a quiet area out of the way of mainstream foot traffic, such as a hallway. It is ideal to be in a long hallway with plenty of room to walk. The instructor can begin with teaching the open-palm technique. The instructor can use hand-over-hand to show the student exactly how to hold his fingers or the instructor can use hand-under-hand to ask the student to look at what she is showing and then touch his hand to verify. If the student doesn’t get it right immediately, it may be most efficient to switch into hand-over-hand to correct the technique. If the instructor allows the student to feel too disoriented, it can set the student on a feeling that cane travel is confusing. Though this class and the broader rehabilitation process are about teaching the student to have full control over his life, it may be necessary for the instructor to take control during the initial cane travel lesson, or at least this part of it, so that the student can learn the simplest of concepts as easily as possible to move forward. If the student has had some instruction in these techniques previously, he can reasonably be asked to simply demonstrate many of these skills, and the instructor may choose to move on to the next one or make adjustments in technique as needed.

The open-palm grip is a matter of grasping the cane with the thumb and forefinger and moving it by opening and closing the last three fingers while the palm is facing up. This allows the cane to move freely over the palm. When introducing it to the student, it can be useful to use the analogy that he needs to hold his hand open flat, a few inches in front of his belly button, like he is about to receive some money. This is a nice tie to employment, which is the basis upon which vocational rehabilitation is founded (Witte, 1997). It can help the student’s adjustment to know that his instructor genuinely expects that he will be gainfully employed in the future and use an example that subtly illustrates it. Then, the student needs to hold the cane between his thumb and forefinger a few inches in front of his belly button. This is a good opportunity to allow the student to self-monitor by telling the instructor where this position is. The instructor need not find the student’s belly button; if she did, this would be an invasion of space and privacy, certainly not the way to treat an adult. It is important that the instructor treat the student with respect and in age-appropriate ways to help convey the notion that the instructor considers the student to be a first-class member of society (Salisbury, 2018). Morais et al. (1997) explained the importance of close instructor attention to detail with technique so that sloppy habits are not formed and confidence is built by constant reinforcement. The instructor can have the student begin arcing the cane back and forth simply by opening and closing his hand; no wrist motion should be happening. If the instructor notices that the student’s wrist is moving, she can have him hold his dominant wrist with his non-dominant wrist to help stabilize it and focus the motion on the parts of the hand that should be moving. At the beginning, the instructor is focused on the act of arcing the cane by opening and closing the hand in this position. When the instructor sticks her finger between the base of the student’s thumb and the handle of the cane, his motion should pinch her finger each time he closes his hand. Once this technique is understood, the instructor can leave the student to practice it for about five minutes.

As the instructor returns to the student, she will verify that he is moving his hand properly. Next, she will work on his arc width and then arc height. One way to measure the arc width and balance is by standing behind the student and listening to notice if the arc is balanced from side to side and if it has an appropriate width (Morais et. al, 1997). The cane arc should cover each shoulder with a little bit of extra room, perhaps about two inches on either side, so that the student is clearing an area that is sufficiently wide enough for his body to pass through it. One way that the student can be involved in this process is by asking him to determine whether the cane arc is balanced and is covering that width. The instructor can stand in front of the student, as well, and face straight at him. She can listen for the sound of the balance of the cane arc from this position, as well, or, if she is sighted, she has the option to determine this visually. The student also must have a sufficiently low cane arc. To measure this, the instructor can kneel on the floor in front of the student and place her hand flat on the ground in the middle of his cane arc. If his cane brushes across the knuckles of his instructor without dragging along the ground the whole way and without breaking rhythm, then his arc is sufficiently low. Once this has been explained, the student can again self-monitor to figure out how to adapt his arc to meet expectations.

Once the student has had time to practice each part of the cane arc, it is time to begin walking, likely up and down a hallway. At first, the student is simply walking up and down the hallway to see how well he really is covering his body and to get the feel of moving through space. If he realizes that he is bumping his shoulder along a wall, he can tap a little wider on that side. It is an opportunity for the student to realize that he can use his own common sense to self-monitor and self-regulate. After the instructor determines that the student is comfortably moving up and down the hallway with a sufficient cane arc, the instructor can introduce walking in step. Walking in step means alternating the cane taps so that they are always in front of the trailing foot (Morais et. al, 1997). Some instructors have thought of this as kicking the cane because the cane is always on the opposite side from the leading foot and moves at the same time as each new foot moves forward to take the lead. At any given time, the student should be touching the ground with one point or three points because his cane will move in synchrony with his feet. At first, it is common for the student’s cane technique to deteriorate as he focuses on the skill of walking in step. With practice, however, and before he moves on from this skill, all parts of his cane technique should be in rhythm. The instructor will likely give the student some time to practice this skill on his own and come back after five to ten minutes to check on his progress. The instructor can ask the student to freeze on command, then ask him which foot is in front, which side the cane is on, and if he is in step. If he is in step, he can be praised. If he is not, he can be asked to correct it, and then praised. As the student continues, he can again be asked to freeze until he seems to be getting it right sufficiently often. At that point, the instructor can ask him without stopping him, “Are you in step?” in order to get the answer. If he is, he is on track; if not, he should correct himself. This process requires the student to monitor himself, subtly teaching him that he is capable of self-monitoring, which will make it possible for him to function without the help of an instructor in the future. This message is at least as important as the cane technique itself.

Next, the student can learn how to tap-slide. This is very simple but is best illustrated on a surface that is somewhat porous rather than perfectly smooth to exacerbate the sound difference between a basic tap and a tap-slide. The student will simply leave his cane on the ground for a split-second longer so that it will slide on the ends of his arc. He does not need to move the cane any differently; it is purely leaving the cane on the ground a little bit longer so that the forward momentum causes the tip to slide. A porous concrete surface works well for this. Putting the student in this setting makes it not only easier for the instructor to monitor the technique nonvisually, but also the student to self-monitor using the same means that the instructor can use. The instructor can role model the technique for the student and describe it as described above, and the student can be asked to demonstrate this technique. It will be obvious to the instructor and student from the sound of the cane technique if it is being performed correctly. This is another opportunity for the student to realize that he can self-monitor and self-regulate through nonvisual means once he is aware that this is the goal. The instructor can also go hand-over-hand, if the student is not understanding, to grab the student's hand or cane and hold his cane on the ground for a second so that he feels the difference. This can give the student some clearer direction on how to perform the technique so that he can spend more time feeling good about performing it and less time feeling confused.

Pencil grip.

Next, the instructor can teach the student how to hold the cane in pencil grip. While introducing this new grip, the instructor can tell the student that this new grip is good for tight spaces or scanning their environment at close-range. Pencil grip is good for waiting in lines, navigating crowds, or walking off-road, such as at the beach or hiking.

In order to harness some of the student’s existing knowledge, the instructor can start by asking the student if he knows how to hold a pencil or throw a dart. Some instructors exclusively use the pencil analogy, but many people, blind or sighted, have different variations on how they hold a pencil. There are fewer, if any, variations on how to hold a dart when throwing it in a serious manner, so the alignment of these two examples may help the student to conceptualize the grip on their own. If the student has an idea and tries it, then the instructor can check their grip by touch. If there is an issue, the instructor may choose to go hand-under-hand to role model this technique for the student and ask him to try again. Otherwise, she may just use hand-over-hand to move his fingers into the proper position. If the student has no idea how to either hold a pencil or throw a dart, which happens occasionally, especially with people who were blind from birth and sheltered their entire lives, the instructor may wish to go hand-over-hand from the beginning to help bring more order to the process. With this situation, like many others, it is a simple judgment call for the instructor and would be difficult and meaningless to organize in a decision tree. Once the student understands how to hold the cane in pencil grip, the instructor can tell him to arc it in the same arc he was using earlier with the open-palm technique. Once he masters that, the student can practice walking, still in-step, in that same hallway. He is likely to have built some confidence in that space, which will allow him to focus on the technique itself.

Implications for Practitioners and Families

It is important to consider the emotional adjustment to blindness in every step of the blindness rehabilitation process because it is the keystone of the process. This article does not provide a comprehensive manual on how to teach Structured Discovery Cane Travel but instead highlights how certain parts of the model support the emotional adjustment to blindness from the very beginning of instruction. This article has laid out a generic set of best practices, which instructors will individualize as appropriate to best support emotional adjustment. Instructors can teach students to self-monitor, even from the very beginning of cane travel instruction. Instructors can help students learn to trust nonvisual techniques, for themselves and for others, by using nonvisual monitoring techniques with the student, even if visual monitoring techniques are available (Altman & Cutter, 2004). When a blind instructor uses nonvisual monitoring techniques, it communicates to the student that blind people have ways of functioning effectively. When a sighted instructor uses nonvisual monitoring techniques, it communicates to the student that the instructor trusts the efficacy of these nonvisual techniques and does not consider visual monitoring techniques to be inherently superior. Structured Discovery Cane Travel emphasizes a more internal locus of control and a more external locus of attention; since pre-cane techniques support the opposite, they undermine cane travel instruction and the adjustment to blindness process. Families should seek services from practitioners who emphasize an emotional adjustment to blindness based on confidence, self-efficacy, and first-class status, who feel comfortable with blindness at the instinctual level.

Implications for Future Research

Future literature could document more of the strategies used to teach adults versus children. Teaching children often requires more playful creativity to work with shorter attention spans and less developed ways of looking at the world. Children may only have a frame of reference based on a theme from a nursery rhyme or television show rather than real-life experiences. Senior citizens will have their own need trends, as well. For any group of students, it will always be impossible to come up with an exhaustive list of techniques used to build confidence and facilitate the emotional adjustment to blindness, but the sharing of ideas for how to do this can add to the toolbox of every instructor or other related rehabilitation or education professional.

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