Self-Confidence Levels in Sequential Learning Versus Structured Discovery Cane Travel, Post-Orientation and Mobility Instruction: A Comparison Study

By Dr. Merry-Noel Chamberlain

Merry-Noel Chamberlain is a teacher of blind students and an Orientation & Mobility instructor in Nebraska. She has a Bachelor of Science in Elementary Education, a Master of Science in Educational Psychology, a Master of Science in Special Education, Visual Impairments, and a Doctorate in Transformational Leadership. Merry-Noel holds NOMC certification and is the parent of a blind child. She has worked in the field of blindness for over 30 years.

Abstract

Sequential Learning (SL), the medical model of Orientation and Mobility (O&M), was designed for blinded World War II veterans in the 1940s. This preeminent curriculum monopolized the O&M profession, creating a paradigm paralysis, until Structured Discovery Cane Travel (SDCT) made its official debut in 1997. The conceptual framework for this study is William Glasser's Choice Theory, in which ideas or systems of belief direct or oversee behavior, and this principle holds true for both O&M professionals and consumers (individuals who are blind or visually impaired). This comparison study answers the research question: Which curriculum offers consumers the highest level of self-confidence post-instruction? Data was collected through a quantitative study of 40 participants (20 SL, 20 SDCT), who voluntarily responded to an electronic survey. Because of their increased frequency and distances traveled and their decreased need for additional training, study results reveal SDCT consumers’ self-confidence was higher than SL consumers by 32%. In addition, this study discovers that when guide instruction commences prior to introduction of the long white cane (as in the SL curriculum), self-confidence is hindered and leads consumers toward the Custodial Paradigm. However, when instruction of the long white cane and problem-solving is paramount (as in the SDCT curriculum), the foundation for ongoing successful O&M post-instruction is likely, whereby consumers are led toward the Independence Paradigm.

Keywords

Orientation & Mobility, Structured Discovery Cane Travel, sequential learning, NOMC, COMS

Introduction

The Sequential Learning (SL) curriculum of Orientation and Mobility (O&M) has monopolized rehabilitation for individuals who are blind or visually impaired since it was designed to assist blinded World War II veterans in the 1940s (Joffee & Rikhye, 1997), that is, until Structured Discovery Cane Travel (SDCT) made its official debut in 1997 (Aditya, 2004). The SL curriculum is clearly outlined in The Long Cane (Veterans Administration, 1952a, 1952b),in which instruction was medically oriented with doctors considered the authorities (Bailey & Head, 1997; Baldwin, 2016). The basic assumption was that “blind people were fully capable of independent movement—all they needed was some training and a few basic tools…the long cane that probes space as the blind person moves about,” which led to the cane becoming “the focal point for the creation of an entire profession” (Baldwin, 2016, p. 42). Foot travel (Veterans Administration, 1952a, 1952b), known today as O&M, is one of several rehabilitation training services available to consumers (i.e., individuals with visual impairments) in the United States. However, the SL O&M curriculum “never had a philosophical basis upon which to found an entire discipline” (Baldwin, 2016, p. 42), nor was opportunity given to “blind individuals who were experts in nonvisual skills” to offer their input (Cutter, 2007, p. xxiii). Furthermore, the SL curriculum was created with a sighted bias for veterans with mature cognition and visual memory comprehension (Pogrund & Rosen, 1989), and without protocols or content consideration for the congenitally blind because it is quite evident that “none of the veterans who lost their vision during the war were born blind” (Cutter, 2007, p. 8). Thus, the SL curriculum evolved through a health-recovery medical model, without any philosophical basis to prove its efficiency or rehabilitation knowledge of how to use cane techniques (Bailey & Head, 1997; Baldwin, 2016; Koestler, 2004; Welsh, 2005a), for sighted military trained soldiers prior to becoming adventitiously visually impaired (Geruschat & De l’Aune, 1989).

The SL O&M training skills were performance-based focused on environments with increasingly complex conditions and “this sequence of skill development has been proven to be highly effective for the majority of adventitiously blind adults” (Pogrund & Rosen, 1989, p. 431). Chief Williams and Richard Hoover, the SL curriculum developers, believed that complicated techniques in O&M needed to be presented in step-by-step components with enough time between lessons so patients could absorb the new information and master self-confidence in those techniques (Miyagawa, 1999; Welsh, 2005a, 2005b; Williams, 1967). Furthermore, Chief Williams believed that the instructors needed to be former servicemembers with manly interests because the patients were mostly men (Pogrund & Nora Griffin-Shirley, 2018; Welsh, 2005b; Williams, 1967), which resulted in the development of techniques for males that created limitations for females, who have different physical characteristics. Those instructional techniques are still prevalent today within the SL curriculum.

In 1997, Louisiana Tech collaborated with Louisiana Center for the Blind to develop the SDCT educational psychology program that draws its principles from a cognitive learning theory approach (Aditya, 2004; Bell & Mino, 2011; Dodds et al., 1983; Schroeder, 1997). Consumers who receive SDCT training are instructed to master simple cane techniques, then their lesson quickly shifts to problem-solving opportunities, which is essentially a mental processing skill that is vital for independent mobility (Dodds, 1988; Mino, 2011; Perla & O’Donnell, 2004). It is through this cognitive growth method that consumers learn to develop self-confidence in their independent travel in a way that is meaningful to them (Tigges, 2004). Therefore, consumers’ self-confidence mirrors their psychological aspects of independent and safe travel.

The SDCT curriculum was adopted by and for blind people because of concerns from the blind community when the Veterans Administration (VA) was developing its training program (Baldwin, 2016; Ferguson, 2007). Discovery Learning (DL) is a teaching strategy where material learned is uncovered while solving problems or completing tasks (Fazzi & Barlow, 2017). In O&M, DL is action-based through transformational knowledge (Mezirow, 1991) by way of teachable moments and hands-on experiences. Teachable moments are educational opportunities to engage in real-life learning during new and unexpected encounters to ensure a stronger personal impact for the consumer that will help stimulate long-lasting concepts or memory of the learning experience (Hansen, 1998). Dr. Kenneth Jernigan (Direction of Iowa Department for the Blind from 1958-1978) infused the discovery philosophy into its training program. Jernigan, who was a successful blind cane traveler, states, “Our approach is fundamentally based upon the belief that techniques used by sighted teachers and the alternative techniques which we use are equally effective and that ours are in no way inferior” (Morais et al., 1997, p. 2). The DL philosophy significantly and positively impacted rehabilitation and became internationally noticed (Aditya, 2004; Bell & Mino, 2011). Alan Dodds (1984), a British O&M instructor, coined the term “Structured Discovery” when he described his cognitive problem-solving mobility experience with an agency-trained blind O&M instructor. Dodds (1984) stated that rather than receiving sighted information second hand, he was permitted to make mistakes and actively explore the environment to determine solutions without any external assistance. Through research, it was discovered that structured discovery and discovery learning has been combined into Structured Discovery Cane Travel (SDCT).

Currently, there are two official O&M curricula in the United States: SL delivered through Certified O&M Specialists (COMS) and SDCT delivered through National O&M Certified (NOMC) trained instructors. Both curricula have adopted various O&M instructional techniques developed through the VA (Sauerburger, 2007), which are evident within university training programs across the country. O&M lessons include the following: independently traveling in and to unfamiliar destinations, environmental familiarization, assessing intersections (i.e., traffic patterns, intersection geometry, one or two lanes of traffic), problem-solving techniques, drop-offs (a technique developed by Chief Williams after being accidently dropped off at an incorrect address in 1950; Sauerburger, 2007; Williams, 1967), and mental mapping skills. Mental mapping is a perceptual and cognitive process of obtaining and storing information to build a model of the environment (Dodds, 1988). DL closely resembles the VA’s O&M program, and these features were considered appropriate for the sequential learning approach to O&M “because it served a very homogenous group of people—all the clients were suddenly, completely, and permanently blinded” (Sauerburger, 2007, para. 2).  Therefore, all but one university O&M training programs teach the sequential learning O&M techniques “including the use of functional vision to enhance travel, which does not emphasize discovery learning” (Pogrund, & Griffin-Shirley, 2018, p. 25), even though activities focused on DL can reinforce the development of higher self-confidence while perfecting skills through transformational knowledge.

Keep in mind that “any curriculum always reflects the values [and philosophies] of those who created it” (Wiles, 2009, p. 14). Curriculum developers use research to help define goals and some of the valued learning outcomes, which affect curriculum design include: (a) self-esteem, (b) capability for continuous learning, (c) being a responsible member of society, (d) use of accumulated knowledge to understand the world, and (e) coping with change (Wiles, 2009, pp. 15-16). Most importantly, the curriculum needs to be honest, open, and understood (Wiles, 2009), while outcomes need to be consistent with the curriculum goals (Vaughan, 1993). Due to regional differences, evidence-based practices, and university preparations, there are a variety of cane techniques and philosophies among O&M professionals (Fazzi & Barlow, 2017). Since SDCT has only been available since 1997, “the ultimate test of any new method is clearly the extent to which it gains acceptance among a group of people, but there are many routes towards ultimate acceptance and rejection” (Leonard, 1968, p. 3). Even though research which compares O&M performance can impact and enhance the delivery of O&M instruction (Lumadi et al., 2012) between the two curricula, such research has been scarce (Zijlstra et al., 2012) or nonexistent (Fazzi & Barlow, 2017).

Sighted (i.e., human) guide instruction compared to when the long white cane is introduced to consumers accounts for the significant fundamental difference between the two curricula. “Traditional sequences introduce the use of the long cane after working on guide techniques and upper- and lower-body protective techniques,” as seen in the SL approach (COMS Handbook, 2018; Fazzi & Barlow, 2017, p. 95; Orr & Rogers, 2001). On the other hand, nontraditional O&M training begins with the use of the long white cane to “teach independent travel as soon as possible with the technique that will be used most often,” as seen in the SDCT approach (Aditya, 2004; Fazzi & Barlow, 2017, p. 95). Just as in A Class Divided (Peters, 1985), the first lesson establishes the philosophical foundation that directs the mindset henceforth. O&M instructors at Hines were told their employment would be a custodial position (Miyagawa, 1999). Therefore, this study is necessary to determine if a guide is introduced to consumers at the very beginning of instruction (as seen in the SL curricula) hinders the development of self-confidence, which subsequently leads them to the Custodial Paradigm. Or if the cane is introduced first (as seen in the SDCT curricula), consumers are encouraged to use problem-solving skills which leads to mastering transformational knowledge and higher self-confidence whereby they enter the Independence Paradigm. High self-confidence enhances independent action and motivation (Bénabou & Tirole, 2002; Williams et al., 2013; Williams, 1967) and such independent action displays perceived abilities and self-confidence (Schreiber & Moss, 2002).

Many individuals are unaware of O&M services (Casten et al., 2005), whereby O&M is the necessary foundational skill, which forms the basis of future independence and autonomy (Castellano, 2010) to be active and live self-sufficient lifestyles (Geruschat & De l’Aune, 1989). Today, one of the most critical aspects of human abilities is to have the necessary skills to maneuver within one’s home and community. Limitations of this essential life necessity can negatively impact one’s vocational and social opportunities, as well as one’s adjustment to blindness (Long, 1990). This is contrary to “earlier centuries, when not only blind people but the great majority of others seldom ventured far from their native soil” (Koestler, 1976, p. 303). The industrial revolution created opportunities of economic betterment with the growth of social mobility and “for blind people to be members of the larger society, freedom of movement has become a must” (Koestler, 1976, p. 303). Therefore, the goal of O&M is to enable consumers to “enter any environment, familiar or unfamiliar, and to function safely, efficiently, gracefully, and independently” (Hill & Ponder, 1976, p. 1). Furthermore, movement is necessary to stimulate curiosity and, more importantly, create connections to arouse interactions with others (Castellano, 2005). When that happens, consumers experience “the most important of human abilities” (Long, 1990, p. 90), which is the ability to travel whenever and however they decide (Maurer et al., 2007).

What Is Orientation and Mobility?

Since the beginning of human history, blind individuals have used a stick or type of cane for independent travel (Bryant, 2009; First Steps, n.d.; Foundation Fighting Blindness, n.d.; Kim & Wall Emerson, 2012; Roberts, 2009; Sauerburger & Bourquin, 2010; Williams, 1967) to essentially extract and process environmental information (Dodds, 1988). That is, consumers are “fully capable of independent movement with a long cane that probes space as the blind person moves about” (Baldwin, 2016, p. 42), whereby the task of the consumer “is to maintain contact with the horizontal surface, while avoiding contact with the vertical ones” (Dodds, 1993, p. 50). Today, we know O&M as the skill of using the long white cane for terrain interpretation, locating, and negotiating around obstacles, along with performing elevation changes in a safe and efficient manner (Sauerburger & Bourquin, 2010). However, for centuries prior to the 1960s, O&M instruction or curriculum was unknown (Williams, 1967); “there were no formal methods; each person figured out a practice that worked for their own needs” (First Steps, n.d.).

For example, Lieutenant Holman (1786-1857), a self-taught navigator, used a walking stick with a metal tip (to prevent the wood from splitting) and this tool was considered “standard strolling equipment for gentlemen of the day” (Roberts, 2009, pp. 75-76). The metallic clicking sounds from the tip of his walking stick offered a quick burst of noise (i.e., echolocation), which Holman used for detection of walls and streets (Roberts, 2009). The metal cane tip provides “echo-ranging cues and force-impact information” about ground textures (Pogrund & Griffin-Shirley, 2018, p. 178) as well as provides information about the surrounding environment. Virtual environments are now available through technology; however, consumers need hands-on O&M strategies to achieve and apply practical cognitive mapping skills with strong attention to auditory feedback (Guerreiro et al., 2017; Lahav et al., 2015). Therefore, sensory acknowledgment skills must be learned first-hand because “tap, tap, tap…is the sound of independence” (Winter, 2015, para. 1).

As far back as the 1870s, William Levy, a blind teacher of blind students, expressed the advantages of mobility skills for consumers (Williams, 1967). Levy “laid out theories for cane use and design,” which are like those used today and the importance to everybody “of acquiring the power of walking the streets without a guide can scarcely be exaggerated” (First Steps, n.d.; Koestler, 1976, p. 302). Later, in 1910, an American educator, Dr. Edward Allen, extolled the overall German training techniques for consumers (Williams, 1967). It was the Lions Club International who adopted and promoted the white cane as a national program in the 1930s, due to its visibility to motorists (Foundation Fighting Blindness, n.d.).

Orientation has two interrelated metaphorical senses; the first focuses on where one is in location relative to the world (positioning and awareness) and the second is the knowledge awareness, which dictates a direction leading to desired destinations (Sarid, 2012). Mobility is the ability to facilitate movement (Jacobson, 1993) by any means, such as crawling, scooting, or perhaps moving with the aid of a wheelchair or crutches. Simply put, orientation is knowledge of where one is within space, while mobility is efficiently and safely maneuvering from one location to another (Pogrund & Griffin-Shirley, 2018). The teaching of such concepts, techniques, and skills to consumers to independently travel efficiently, gracefully, and safely in a myriad of locations and situations is the profession of O&M (Aditya, 2004; Cutter, 2007; Jacobson, 1993).

A vital component of O&M is for instruction to take place within natural environments (Kaiser et al., 2018) because that offers consumers the ideal settings to develop problem-solving skills, develop functional O&M techniques, and promote skill generalization. When instruction is conducted within natural environments, knowledge is considered transformational, whereby consumers can utilize their gained knowledge after instruction has been completed (Mezirow, 1991). It is essential to prepare consumers to travel at various times of the day and in different weather conditions because authentic travel situations “cannot be adequately replicated in contrived or controlled settings” (Kaiser et. al., 2018, p. 5) or via on-line, simulated activities. Here is an example from a consumer who wrote this to his former SDCT instructor:

You taught me to simply pay attention to what’s going on around me…I now usually “sense” the item’s being there as I pass by…Now it all seems so natural…Thanks to your efforts, I’m unafraid to venture out on my own now, even when traveling in a new city. You gave me the understanding and courage to simply “get the job done,” no matter the supposed obstacles. You taught me—undeniably—that I can be dropped off anywhere, not even knowing exactly where, and still find the location where I need to go (Gravel, 2006, pp. 23-25).

Therefore, the practice of O&M ensures that consumers are provided opportunities to achieve maximum independence (Ballemans et al., 2011; Leonard, 1968) through self-dependent mobility (Malik et al., 2018; Williams, 1967), by using the long white cane as (a) a symbol of independence (Channel 3000 / News 3 Now, 2014; Omvig, 2005), (b) a cherished and positive tool for autonomy (Vaughan, 1993), (c) a probe to navigate and identify the environment (Foundation Fighting Blindness, n.d.), and (d) identification that the user’s vision is impaired (Ballemans et al., 2011; Kaiser et al., 2018). The O&M instructor recommends an appropriate cane length for consumers, “while accounting for factors such as height, gait, walking speed, proprioceptive and tactile sensitivity, travel environments and personal preferences” (Kaiser et al., 2018, p. 11).

As consumers fine-tune physical techniques of O&M, instructors introduce more challenging and complex tasks at or just above the consumers’ skill level (Chamberlain, 2013), whereby the curriculum needs to be individualized according to consumers’ needs (Jacobson, 2013; Welsh, 2005b). Even though the VA developed an individualized sequence of instruction because veterans had multiple disabilities (i.e., amputations of arms or lower limbs and/or severe hearing impairments) (Welsh, 2005b), they followed a SL curriculum. Above all, O&M instructors need to help consumers develop a positive attitude about independent travel, including the acceptance of using the cane, and this positivity must emerge from within the individuals (Chamberlain, 2013; Dodds et al., 1983).

One need not have vision to learn O&M. Rather, “learning is informed by and is integrated” via “movement through space, requiring a greater degree of multi-tasking than if the learner remains static” (Deverell, 2011, p. 69). Spatial orientation is necessary because it is vital for the brain to have a system to keep track of where the body is, and that option is through touch (Kaiser et al., 2018; Payne, 2002). Therefore, many consumers use the long, white cane as their mobility tool (Tuttle, 1984), since one of its many qualities is that it provides tactile information about the terrain. Canes with metal tips provide information to consumers about the environment through echolocation, which “is the use of reflected sound to explore and more efficiently move and travel in the world” (Cutter, 2007, p. 5). For example, consumers may use echolocation to obtain awareness of physical objects, such as houses or mailboxes along the travel path (Chamberlain, 2013; Roberts, 2009), because metal cane tips offer consumers distance sense through sound, while knowledge of near space is offered through touch (Cutter, 2007).  Although some professionals underestimate consumers’ abilities to retrieve sensory information (Vaughan, 1993), others believe not obtaining this skill leaves consumers environmentally illiterate (Baldwin, 2016).

When instruction of the long white cane with a metal tip and problem-solving is paramount, the foundation for ongoing successful O&M post-instruction is likely, whereby consumers are led toward the Independence Paradigm. One of the primary O&M goals is to “address environmental barriers and teach individuals alternative techniques for navigating various environments to increase their skills and confidence” (Kaiser et al., 2018, p. 3). Successful problem-solving involves both external and internal factors, including the consumer’s conceptual knowledge, ability to manage stress, and skill level (Dodds et al., 1983; Perla & O’Donnell, 2004). Problem-solving is one of the most important mental processes for human beings to engage in, and consumers must make use of alternative forms of information when vision is unreliable to solve problems that they encounter when traveling (Mino, 2011). Highly skilled consumers depend heavily on auditory and tactile information and when that happens, there are no limits to how far they may travel (Maurer, 2011). In addition, consumers who are successful problem solvers are capable of handling unpredictable situations, and it is not necessary for them to depend on guides or seek additional instruction whenever faced with new predicaments (Perla & O’Donnell, 2004).

Consumers with low self-confidence are more inclined to be involved in accidents compared to those with higher levels of self-confidence (Aditya, 2004). However, when problem-solving opportunities are paramount and embedded in all instructional encounters, consumers increase their self-confidence and self-efficacy, whereby their travel is not hindered. For example, in 2017 the British Broadcasting Company News reported Tony Giles, who is blind, has traveled to over 120 countries independently and states that he travels by himself because:

…if I travel with someone, particularly someone sighted, they would be doing all the work, they would be doing all the guiding, and I wouldn’t get to touch as many things, and find as many things, as I do by myself (British Broadcasting Company News, 2017).

Despite the shortage of O&M instructors (Pogrund & Griffin-Shirley, 2018), the profession of O&M is growing beyond only serving consumers to also instructing functional mobility skills to individuals with vision and cognitive disabilities (Blasch & Gallimore, 2013; Pogrund & Griffin-Shirley 2018). This current issue of instructing O&M to those “who have disabilities but do not have a visual impairment” (Pogrund & Griffin-Shirley, 2018, p. 24) is sparking new controversy among O&M professionals. While some individuals with intellectual disabilities have developed self-taught O&M skills for community travel, one-to-one travel instruction is necessary for others (Blasch & Gallimore, 2013). Since O&M instructors have developed specialized expertise in teaching problem-solving techniques in mobility, it is recommended that O&M instructors can assist individuals with cognitive disabilities as well, because these individuals need to have opportunities to recognize problem-solving encounters to determine solutions (Blasch & Gallimore, 2013).

O&M professionals understand the synthesis of skills whereby consumers need to have opportunities to link skills smoothly; therefore, instruction must focus on “the whole of the independent travel being greater than the sum of its parts” (Blasch & Gallimore, 2013, p. 23). Holistic goals can only be successful when instruction is devoted to the development of O&M skills and, according to Blasch and Gallimore (2013), the expanded future will require “O&M training for all people with disabilities who have mobility needs” (p. 30). Considering individuals with intellectual mobility disabilities are not visually impaired, the implications of this study support warranting revision of the O&M curriculum with the following benefits: (a) organizational cost efficiency, (b) increase in O&M referrals, (c) reevaluation of the social and education policy, and (d) revision of the O&M curriculum (Bénabou & Tirole, 2002).

What Is Sighted Guide?

Whereas canes are tools used to seek obstacles to aid in orientation, guides are used to avoid obstacles (Long & Giudice, 2010; Williams et al., 2013). Over the years professionals have changed the O&M lexicon so that human guide has replaced sighted guide, although the latter is still the norm found in reference materials, storybooks, and training manuals (Crow & Herlich, 2012; Fazzi & Barlow, 2017; Flaherty et al., 1997; Foundation Fighting Blindness, n.d.; Halpern-Gold et al., 1988; Hill & Ponder, 1976;  LaGrow & Weessies, 1994; Pogrund & Griffin-Shirley, 2018; Pogrund et al., 1995; Salus University, n.d.; Scholl, 1986; Schwartz, 1987; Thomas, 1980; Vrabel, 2015; Wainapel, 1989; White, 1991). Some professionals believe a guide must have sight (American Foundation for the Blind, 2018a; Cincinnati Association for the Blind and Visually Impaired, 2016), while others contend that any competent consumer (i.e., someone with better mapping capabilities, problem-solving, and travel skills) may serve as a guide regardless of visual acuity (Chamberlain, 2015). Keep in mind, anyone can serve as a guide such as family members, classmates, friends, companions, etc.  (American Foundation for the Blind, 2018b; Kaiser et al., 2018; Vaughan & Omvig, 2005). For this study, the term sighted guide(s) was used because in the SL approach, guides are usually sighted (Cutter, 2007).

SL instructors stress the goal of O&M is to make the consumer as indistinguishable as possible (Dodds, 1988), therefore sighted guide techniques are over emphasized. However, using a guide is a simple accommodation where the leader walks about a step ahead of the consumer, who holds the guide’s arm approximately an inch above the bent elbow (Cincinnati Association for the Blind and Visually Impaired, 2016). The guide may direct the follower efficiently by merely moving the elbow (Cincinnati Association for the Blind and Visually Impaired, 2016). It is important for the guide not to grab the arm of the consumer; instead, let the consumer be the instructor (Vaughan, 1993). Both need to walk at a pace that is comfortable, whereby the guide is not pulling or dragging the consumer, and the consumer is not pushing the guide (Flaherty et al., 1997). Experienced consumers are capable of teaching novice guides, and, with a minimal amount of practice, the guide can become an expert at the skill (Foundation Fighting Blindness, n.d.). It is such an elementary skill that children are guides in the Mexican city of San Pedro Yolex, where there is a high incidence of consumers and where having children as guides is considered mutually beneficial (Vaughan & Omvig, 2005).

University professors teaching SL to future O&M instructors spend countless hours on guide instruction, which is a method that merely can take less than 7 minutes to learn (Saltzman, 1978) or review (American Foundation for the Blind, 2018b). The SL curriculum begins with consumers following the physical movements of a guide by holding on to the guide’s elbow, a technique which creates a trusting relationship and strong rapport between the consumer and instructor (Jacobson, 1993). Thereafter, since trust can lead to action (Usoro et al., 2007), guide instruction remains the focus of the lessons until both the consumer and the instructor are convinced that the skill has been mastered (Bailey & Head, 1997; Jacobson, 1993). In SL, traveling with a guide is considered the primary method used by consumers to obtain assistance from the public (Jacobson, 1993), that is, a person who walks ahead of the consumer to pay attention to environmental occurrences (Welsh, 2005b) to protect the consumer from physical encounters with environmental objects within the travel path.

Thereafter, SL O&M instructors preview prospective travel routes to evaluate supports or hindrances, “such as signage, sound, texture, and organization; and safety features and hazards” (Kaiser et al., 2018, p. 6). They plan destinations (i.e., fixed-routes) for consumers to walk to and provide virtually step-by-step accounts as to what they will encounter along their route (Crudden, 2015). Instructors employ strategies to satisfy their basic needs, and these ideas or systems of belief govern their behavior (Glasser, 1998) or plans for their clients. Fixed-routes further embeds the Custodial Paradigm in which “the sighted would determine for the blind what places were good for them to go” (Ferguson, 2001, p. 170), rather than focusing on natural environments, which are real-world settings where consumers work, live, play, interact, learn and travel (Kaiser et al., 2018). SL consumers must memorize routes, causing a decrease in performance due to the negative relationship between stress effects and short-term memory (O’Donnell, 1988). Fixed routes “will never be accomplished or experienced in exactly the same way,” nor will two consumers with the same visual acuity perform identically (Deverell, 2011, p. 67; Dodds et al., 1983). This leads to the defining factors between accomplished and poor travelers which include their level of self-confidence, their ability to handle anxiety (Alan Beggs, 1992), and their memory abilities. Many SL consumers struggle due to lack of mental mapping skills to enable route retention (Guerreiro et al., 2017).

Consumers can become dependent on others when only traveling with a guide and often consider their O&M instructor as their personal guide (Welsh & Blasch, 1980), even though instructors provide opportunities to build independence, so they do not become overly dependent on others (Kaiser et al., 2018). Since the 1960s, guides have been a quandary for consumers; that is, knowing when to obtain assistance and when to detach oneself from guide dependency when no longer required (Leonard, 1968). This practice referred to as learned dependency (Omvig, 2002) or learned helplessness, can be best described in the following example: A woman who regained her vision after receiving an ocular treatment was asked by her doctor to walk down the hall. She replied that she was not used to walking without a guide because she had not walked any other way for years (Ferguson, 2001). Clearly, this demonstrates extreme dependency when the sole mode of travel is with guides (Tuttle, 1984), as well as how guide travel removes one’s independence (Ferguson, 2001; Pogrund & Griffin-Shirley, 2018).

Navigation can influence consumers’ decisions regarding using guides such as: (1) the situation, (2) the consumers’ personality, (3) necessity, (4) convenience, or (5) in new or unfamiliar indoor locations until familiarity of the area is gained (Cincinnati Association for the Blind and Visually Impaired, 2016; LaGrow & Weessies, 1994; Vaughan & Omvig, 2005; Williams, 1967). Novice consumers with rudimentary travel skills use guides more often than those with advanced O&M expertise (LaGrow & Weessies, 1994), also some consumers only begin traveling with guides as their vision decreases (Shimizu, 2009).  Some consumers absolutely refuse to use guides with the philosophy that it is essential that they be and are capable of independent travel (Vaughan & Omvig, 2005). The latter believe independence is not attainable when a person is continuously guided from one location to another (Castellano, 2005), for being guided is equivalent to being a passive passenger in any form of moving vehicle. Bickford, a consumer and O&M instructor, states, “A personal guide may range from necessary to helpful to bothersome. As hard as it sometimes is to find help when you need it, sometimes it is harder to get rid of help when you don’t want it anymore” (Bickford, 1993, p. 72). Professionals have deliberated as to which technique is better for consumers—to travel with or without a guide (Blasch et al., 1997; Soong et al., 2000). Results of a performance study found no significant differences as to which produced better mobility performance (Soong et al., 2000). Furthermore, participants of that study did not express any bias towards either technique, although they demonstrated quicker walking speeds when traveling independently (Soong et al., 2000).

Background of the Problem

Glasser’s Choice Theory is the conceptual framework for the problem whereby the direction of people’s lives is determined by how and why people make choices (Glasser, 1998). Having opportunities to make choices supports one’s internal control psychology. That is, when people are able to make their own decisions, they are in control of their own direction rather than being told what to do or subject to external factors. Since the 1990s, consumer choice has been an essential component of Vocational Rehabilitation (VR) services (Kosciulek, 2004), for when there is active involvement in decision making, an increase in training effectiveness is likely (Coulter et al., 1999). Consumers who are not given informed choice conclude their feelings and actions are controlled by others (Glasser, 1998) causing individuals to make risky decisions regarding their future independent movement (Cutter, 2007; Storey, 2005). Keep in mind, Glasser “states that, for all practical purposes, we choose everything we do” (Glasser, 1998, p. 3). However, instructors “often have differing priorities within the rehabilitation process…expressing divergent views regarding the most important components” (Wolf-Branigin et al., 2000, p. 21), leading to decisions without consulting consumers (Kelley, 2004; Wehmeyer, 2004). That is, consumers encounter professionals who determine what is right for the instructor and what the instructor believes is right for the consumer, thereby “following a destructive tradition that has dominated” (Glasser, 1998, p. 4) and monopolized VR for decades. This may be because management controls policy and procedures and has “the potential to influence service delivery and outcomes (Steinman et al., 2013). This leaves consumers uninformed of the availability or extent of services and they may end up pigeonholed (O’Day, 1999), even though individuals who receive VR services with decision-making experience have better outcomes than those with less control (Hibbard & Peters, 2003; Steinman et al., 2013). Remember that Choice Theory is paramount in the SDCT curriculum, because it permits and encourages consumers to make independent choices while accounting for their own mobility. While in the SL curriculum, sighted guide is paramount from the beginning of instruction which restricts or hinders consumers from making independent mobility choices.

The steady, exponential increase of older individuals with visual impairments is considered the most significant factor in the growing demand and abundant need for O&M instruction (Orr & Rogers, 2001). However, since its conception, studies measuring O&M curricula have resulted in unanswered questions about best practices regarding the most effective method of training for consumers (Long, 1990) and assessment of independent functioning (O’Donnell, 1988). Studies conducted between blind consumers and blindfolded sighted individuals determined that the latter “did not develop the sensory and motor skills of their visually impaired counterparts” (Soong et al., 2001, para. 41). This investigation supported a self-confidence curriculum comparison of the consumers’ post-O&M training because consumers need opportunities to speak for and represent themselves.

There are no known studies that focus on when to introduce guide technique versus the long white cane (Geruschat & De l’Aune, 1989). Research regarding measurement that precisely evaluated the feasibility, effectiveness, or efficacy of one O&M approach over another to determine which curriculum of instruction yielded the highest level of self-confidence among consumers leading to the best practice curriculum has been scarce, unestablished, or concluded with mixed results (Baldwin, 2016; Ballemans et al, 2011; Fazzi & Barlow, 2017; Kim et al., 2016; Kuyk et al., 2004; Zijlstra et al., 2012). It is imperative that curriculum evaluation be conducted on outcomes “to ensure results consistent with the goals of rehabilitation” (Vaughan, 1993, p. 213). Since SDCT has now been available for over 20 years, it is necessary to conduct sound research that compares O&M performance among consumers; this research could positively impact O&M services.

The SL medical model of O&M has monopolized the profession without being challenged since the 1940s (Bailey & Head, 1997; Baldwin, 2016). Other professions, such as occupational therapy, use a discipline foundation which is philosophically and clinically supported (Baldwin, 2016). Yet, the SL O&M discipline evolved without a philosophical basis to prove its effectiveness and without a rehabilitation curriculum based on how to use cane techniques to maximum advantage (Baldwin, 2016; Koestler, 2004). Since the SL curriculum was focused on health recovery and surgery (Welsh, 2005a), a design limitation was created because the primary participants were sighted military-trained soldiers prior to becoming adventitiously blind (Geruschat & De l’Aune, 1989). Any prior visual experiences help consumers understand O&M concepts, as well as environmental features, whereas for those with congenital blindness need a plethora of hands-on experiences (Kaiser et al., 2018) to comprehend environments.

Within the O&M professionals, as with learning theorists, there has been ongoing debates as to which is better between the two curricula: the guided approach/sighted paradigm (SL), or the discovery approach/cognitive learning theory (SDCT; Aditya, 2004; Baldwin, 2016; Blasch et al., 1997; Cutter, 2007; Fazzi & Barlow, 2017; Mettler, 1995; Omvig, 2002; Pogrund & Griffin-Shirley, 2018). Even though detailed descriptions of O&M training programs within literature are scarce (Ballemans et al., 2011), training goals of both approaches include facilitation of safe and independent travel within the community via optimal use of individual abilities to maintain previous or new activities (Zijlstra et al., 2009). However, the two curricula have distinctly different paradigms (Aditya, 2004): sighted versus blind instructors (Baldwin, 2016; First Steps, n.d.), visual versus cognitive (Mettler, 1995), allocentric versus egocentric (Baldwin, 2016), traditional/conventional/SL versus nontraditional/SDCT (Aditya, 2004; Blasch et al., 1997; Cutter, 2007; Fazzi & Barlow, 2017; Pogrund & Griffin-Shirley, 2018), and Custodial Paradigm versus Independence Paradigm.

Although the above paradigms are ongoing, the purpose of this study focused on the two O&M curricula, while keeping in mind that “curricula do not always represent promising practices in a field” (Wall Emerson & Corn, 2006, para. 27). The SL curriculum has historically focused on recipe-driven, time-based hierarchy sequences of technical and cognitive skills resulting in limited success, which demonstrates that this profession is not teaching the whole human being (Baldwin, 2016; Joffee & Rikhye, 1997). That is, the SL O&M curriculum focuses on a top-down approach, which means “out of concept comes the experience;” while the SDCT curriculum focuses on the bottom-up approach, which is “driven by sensory and motor experience,” so that “out of the experience comes the concept” (Cutter, 2007, pp. 11-12). Even though the O&M syllabus includes various techniques, a curriculum review was necessary (Malik et al., 2018).

This study addresses the pivotal timing of guide instruction versus cane instruction, and its effects on how often and how far consumers ventured independently post-instruction. When priority is placed on guide instruction, it does “more to delay the process of independent movement and travel than to facilitate it” (Cutter, 2007, p. xxiii). Since people’s actions represent their beliefs (Schreiber & Moss, 2002), then the measurement of consumers’ independent travel post-training may coincide with the belief of their O&M abilities and skills, thus representing their self-confidence levels. Keep in mind, consumers who do not have skills to move efficiently and safely or become easily disoriented cannot be independent travelers (Pogrund & Griffin-Shirley, 2018).

O&M instructors create lessons which, based on their own education, follow either assumption (a) specific skills are sequenced such that each needs to be mastered before another skill is introduced (Bailey & Head, 1997; Baldwin, 2016; Blasch et al., 1997), as in SL, or (b) skills are transferrable such that they may be learned in one location and used in another (Bailey & Head, 1997), as in SDCT. Although the SL curriculum was designed by sighted people for blinded World War II veterans (Mettler, 1995; Miyagawa, 1999), it was the belief of Chief Williams (1967), a blinded veteran, that techniques established in the past by blind individuals could help future veterans be successful (Welsh, 2005b). Because patients (i.e., blinded veterans; Miyagawa, 1999) were formerly sighted with preconceived experiences, concepts, and skills necessary to travel safely, they already understood distance, traffic flow, intersections, public transportation, and sidewalk navigation; they essentially were learning how to do the same tasks without sight (Castellano, 2010).

Since the O&M SL curriculum is renowed, many consider it superior, which has caused an O&M paradigm paralysis, whereby professionals who prefer the SL method have developed ongoing strategies to resist meaningful action, “preferring the comfort of the familiar” (DuFour et al., 2006, p. 4). Thus, many of the SL professionals remain paralyzed within routine without any desire to create turbulence (Smith & Rigby, 2015). These professionals are reluctant to move forward due to their “inability or refusal to see beyond current ways of thinking” or “beyond the present situation,” in which focus is placed on what is “supposed to work instead of what really works” (Smith & Rigby, 2015, p. XIV; see also Koestler, 1976; Kosciulek, 2004). Furthermore, “it is one thing to know that a certain method can be shown to achieve specified results by a group of people—it is quite another to find acceptance for a new method” (Leonard, 1968, p. 3). When something “has been with us so long that it is considered common sense, and we use it without thinking” or without reliable data to prove otherwise, it is similar to being unknowingly coerced (Glasser, 1998, p. 6). Thus, because of its longevity, SL O&M professionals do not question the validity of the SL curriculum which, keep in mind, supports the Custodial Paradigm.

“As in the fable of Blind Men and the Elephant, no two of us perceive it the same way” (Glasser, 1998, p. 44), and this is the same for O&M professionals, since many consider their curriculum of instruction superior to the other. When there is a difference in curriculum favoring one over another, professionals attending conferences are often unwilling to discuss controversial issues—particularly with consumers (Vaughan, 1993). Furthermore, ophthalmologists’ or physicians’ attitudes regarding blindness can vary across the nation and influence patients positively or negatively, as some have commented that rehabilitation is no concern of theirs (Vaughan, 1993).

American society does not always place equal expectations on consumers; therefore “it would not be unusual for a blind individual to grow up with a sense of inadequacy and lack of self-confidence” (Aditya, 2004, p. 70) and neither does society always “see the role of a person who was blind as an independent one” (Pogrund & Griffin-Shirley, 2018, p. 4). Informed choice is the challenge that is necessary to respect consumers’ dignity, so they are not faced in a Catch-22 position, where the options presented are not truly accurate (Storey, 2005). However, research is currently inadequate regarding exploration of the underlying concerns that consumers have regarding choices in mobility options (Ball & Nicolle, 2015). Yet, giving consumers the opportunity to make informed choices places them on equal status as the givers within the Independence Paradigm. In contrast, withholding information or not providing consumers with informed choices places them beneath the givers within the Custodial Paradigm.

Custodial Paradigm

Orientors (the term used for O&M instructors by the VA) were told their job would be a custodial position (Miyagawa, 1999). Perhaps it is because during the early Christian and Judaic periods came the birth of compassion and pity for individuals who were blind (Ferguson, 2001; Koestler, 2004; Tuttle & Tuttle, 1996), whereby sighted people considered blind people as not being capable contributors of society and therefore felt a responsibility to care for those less fortunate (Tuttle & Tuttle, 1996). Unwittingly, many VR programs have embraced this negative view of consumers, and this misconception has migrated to the consumers themselves (Omvig, 2002). Furthermore, literature often portrays a demeaning or negative attitude towards blindness by depicting consumers as helpless, unhappy, and objects of pity (Blasch et al., 1997). For example, “It was my first week in Jodi’s class. She knew who I was, but I hadn’t talked to her yet. I thought she might be a little weird because she couldn’t see” (Schwartz, 1987, p. 2).

Stigmatized consumers may elicit predictable atypical reactions from the public (or even the instructor), which may have a negative impact on the consumer and therefore negatively affect their O&M performance (Blasch et al., 1997). They do not want to be considered a burden, as seen by others; instead, consumers consider themselves as contributors to society (Kelley, 2004). All too often, however, consumers and others “only see the disability, not the person” (Kelley, 2004, p. 8) and this perception establishes low expectations of consumer capabilities (Ferguson, 2007). Thus, it is vitally important that instructors establish positive attitudes regarding consumers’ capabilities (Morais et al., 1997) because the way consumers feel about themselves strongly influences their performance (Tuttle & Tuttle, 1996), both positively and negatively.

Self-Confidence

Self-confidence, self-esteem, and self-determination are all considered forms of  consumers’ sense of competence, adequacy, value, worth, and self-satisfaction in successfully meeting life’s demands (Tuttle & Tuttle, 1996). Furthermore, self-confidence can be defined as the degree to which individuals feel assured and capable of their behaviors and decisions (Bearden et al., 2001). Measurement of self-confidence can be easily observed by comparison of novice automobile drivers (i.e., consumers who overly depend on guides) to expert drivers (i.e., consumers who travel independently) in that novice travelers tend to be slower with spasmodic movements, while experts maneuver smoothly and methodically. Such dependency can be cemented via the first lesson in SL, where there may be a reinforcement of minimal expectations of consumers (LaGrow & Weessies, 1994), which lowers self-confidence. Thus, those consumers are faced with dynamic forces which cripple their sense of self-competence and self-worth, leaving them especially vulnerable (Tuttle & Tuttle, 1996) with lower self-confidence. Transitioning from guide dependency to independent travel with a cane can be difficult for some consumers, especially when self-confidence is low.

On the other hand, in SDCT rehabilitation agencies, deeply rooted within every aspect of rehabilitation training for consumers, is the Structured Discovery curriculum (Tigges, 2004). Directly after basic introduction on how to use the cane, consumers receive instruction supporting their development of transformational knowledge through environmental exploration, information gathering, internal processing, and problem-solving (Tigges, 2004). When encountering problem-solving opportunities, consumers are encouraged to depend on their own ingenuity, instead of relying on their instructor for reassurance and/or guidance (Tigges, 2004). It is believed that through this curriculum, knowledge is increased and retainable, ensuring longevity, and consumers’ self-confidence in independent travel is better developed (Tigges, 2004).

Keep in mind that self-confidence can merely be defined as the degree to which consumers feel assured and capable of their behaviors and decisions (Bearden et al., 2001). Campus travel skills mostly involve guide techniques, while community travel involves higher cognitive abilities and independent skills (Cmar, 2015), and movement involves spatial intelligence, which can easily be noticed in proficient consumers, who sometimes have “greater accuracy, confidence, and skill than sighted people” (Lazear, 1999, p. 65). Thus, evaluating consumers’ independent travel habits post-instruction may coincide with self-beliefs of perceived O&M abilities and skills. Whereby higher self-confidence enhances action and motivation, while eliminating self-handicapping habits (Bénabou & Tirole, 2002). Although the physical components of O&M performance have been used to evaluate self-confidence through the documentation of walking speed and gait (Geruschat & Turano, 2002), this data differs considerably when consumers’ preferences are noted post-instruction. Furthermore, since consumers’ actions represent personal beliefs (Schreiber & Moss, 2002), self-confidence can be defined and measured as the extent to which consumers feel capable and assured (Bearden et al., 2001) and this can be determined through the measurement of frequency and distance independently traveled post-instruction.

Significant Differences Between SL and SDCT Curricula

The first noteworthy significant difference between the SL and the SDCT curricula involves cane characteristics (i.e., length and features) and the second is when guide instruction is introduced to newly blinded consumers. Two other differences include who holds locus of control during instruction and the use of sleep-shades for both the instructors and their consumers. In the SL curriculum, Lieutenant Hoover, who received his experience working at the Maryland School for the Blind, was the instigator in using a cane as the preliminary adjustment travel tool for mobility (Baldwin, 2016; Koestler, 2004). Following Hoover’s guidance, the cane introduced to consumers has a length reaching to the sternum (Aditya, 2004; Koestler, 2004). Keep in mind that the cane’s function is to preview the terrain prior to the consumer encountering the environment. The SL textbook technique of holding the short cane at arm’s length causes consumers to walk bent over with the arm extended out to increase the distance between the body and potential objects (Bryant, 2009). This position is unnatural and uncomfortable, causing the arm to become quickly tired and lackadaisical, whereby many SL consumers misuse their canes post-training (Dodds, 1984, 1988). Consumers receiving SDCT O&M training obtain a cane that is about as tall as the consumer’s mouth or somewhere between the chin and the nose (Aditya, 2004), which follows Chief William’s example (Miyagawa, 1999). This longer cane is “infinitely more comfortable” because instead of holding the cane at arm’s length, the cane is “held about two inches in front of the stomach, with the elbow bent” (Dodds, 1984, p. 7). Longer canes alert consumers of environmental hazards quicker than shorter canes because they contact the surface sooner (Rodgers & Wall Emerson, 2005), providing more reaction time when encountering unexpected objects, such as physical drop-offs (i.e., curbs or stairs). The bottom of the cane in SL includes a variety of tips, which can be exchanged for various types of terrain, while the SDCT cane tip is metal to offer active, consistent, echolocation for the user by producing a specific, reliable signal-sound designed and enhanced to reflect off objects (Johnson, 2012). Keep in mind that blind individuals have used metal tips on the bottom of canes to assist in echolocation since the 1800s (Roberts, 2009).

Although cane characteristics are noteworthy differences, they are not significant enough to be a pivotal factor in this study. Instead, it is the second substantial difference, which involves the critical timing of the introduction to guide techniques compared to when the cane is introduced, that is the basis of this study. Beginning with The Long Cane (Veterans Administration, 1952a, 1952b), sighted guide technique continues to be listed as the first travel option before introduction to the cane in SL O&M textbooks, university programs, pamphlets, training manuals, and storybooks (Crow & Herlich, 2012; Fazzi & Barlow, 2017; Flaherty et al., 1997; Foundation Fighting Blindness, n.d.; Halpern-Gold et. al., 1988; Hill & Ponder, 1976; LaGrow & Weessies, 1994; Pogrund & Griffin-Shirley, 2018; Pogrund et al., 1995; Salus University, n.d.; Scholl, 1986; Schwartz, 1987; Wainapel, 1989; White, 1991). Joe Cutter, who was trained in SL before shifting to the SDCT curriculum of instruction, states that his university training began with and then placed overemphasis on the guide technique with “pages and pages demonstrating the technique in the textbook curriculum and hours and hours in the practicum experience” (Cutter, 2001, para. 9). Cutter adds that the guide technique is merely an unnecessary readiness curriculum that only serves the professional, who, in his opinion, has not perfected O&M skills or the teaching of them (Cutter, 2001). When traveling with a guide, the primary lesson consumers learn is merely how to mimic another person’s physical movements, rather than developing their own (Cutter, 2001). Yet, training a guide is relatively easy (Pogrund & Griffin-Shirley, 2018), and verbal communication can be supplemented if the guide’s body movement is insufficient in the identification of terrain (e.g., step-up or step-down), directional, or pace changes (Tuttle, 1984). Finally, instructing consumers in guide techniques is more of a curriculum filler activity versus time spent on learning independent cane travel skills, which Cutter states is the real skills of blindness (Cutter, 2001).

The focus of the first several lessons in the SL university curriculum is on guide technique, prior to learning the long white cane (COMS Handbook, 2018; Salus University, n.d.). By focusing on guide techniques at the beginning of instruction, newly blinded consumers subconsciously learn that safe travel may only be obtained when there is a guide available (Chamberlain, 2013), which can hinder the development of self-confidence in independent travel. On the other hand, the first lesson in the SDCT curriculum focuses on the physical components of holding and using the long white cane. During this first lesson, instructors help consumers build self-confidence by encouraging them to identify different sounds the metal cane tip makes when tapped against environmental objects (i.e., wall, trash cans, or doors; Chamberlain, 2013). SDCT consumers are shown human guide as an alternative method of travel during teachable moments, such as sticking together in crowded areas. Teachable moments offer opportunities for promoting personal interests, skill building, and critical reflection with self-assessment (Hansen, 1998) leading consumers toward the Independence Paradigm.

Since it is vital for the brain to have a system to keep track of where the body is within space (Payne, 2002), the SDCT curriculum commences with cane techniques. After the tool is introduced, orientation begins by traveling to consumers’ desired locations, during which instructors assist consumers while developing cognitive problem-solving and mental-mapping skills along the way. Such problem-solving opportunities were available to veterans in the 1940s when their instructors attempted first to confuse them, then drop them off with the objective of figuring things out on their own (Welsh, 2005b). Cognitive processes (i.e., attention, auditory, and memory) are often relied upon by consumers during rehabilitation training (Iskow, 2010). Therefore, consumers’ ability to access their own cognitive map while traveling serves as a higher mental spatial ability than to memorize a sequence of associated actions or landmarks and this ability is fundamental for successful mobility (Long & Giudice, 2010) during and post-training.

Who holds locus of control is a fundamental difference between the two curricula. Locus of control is

…closely linked to the learned hopelessness concept. Locus of control is simply another way of saying that the client perceives that he is in a position to have some effect on the world or not. It basically addresses the issue of how much power the client perceives himself to have over his circumstances. A person with a low locus of control will believe that events simply happen to him, and he is powerless to change their course. A person with a high locus of control will believe that he can largely determine what happens around him (Dodds, 1988, p. 49).

SL instructors assume locus of control for the consumers’ safety until instructors can determine that consumers are able to assume shared responsibility (Aditya, 2004). On the other hand, SDCT consumers maintain locus of control directly after receiving cane instruction (their first lesson), and henceforth the satisfaction remains with the consumer through their own successes (Mettler, 1995).

Finally, sleep-shade instruction is a significant difference for both the consumers and instructors. Occluders are any type of blindfold, bandana, sleep-shade, or contraption used to restrict or block visual input, and minimal experience with them leads to misconceptions as to the true capabilities of consumers (Kappan, 1994). Future SL O&M instructors spend minimal and sporadic time in sleep-shade training compared to SDCT O&M instructors, who spend extensive hours in occlusion training (Aditya, 2004), which models the VA, where new O&M instructors spent substantial hours in sleep-shade training in the 1940s (Miyagawa, 1999). This supports that full occlusion during training builds confidence and perfects nonvisual skills (Pogrund & Griffin-Shirley, 2018), while minimal experience in occluded disability awareness activities has the potential to create false impressions and safety concerns (Kappan, 1994), and this limited experience leads to misconceptions as to the true capabilities of consumers. The lack of occlusion skills by any O&M instructor displays an absence of the instructor’s self-confidence in their travel abilities, as well as lowered confidence within their consumers’ capabilities, which further instills the Custodial Paradigm.

Research Design, Intended Population, and Limitations

This is a comparison study conducted by way of a Likert scale type survey of two consumer groups: (a) those who received O&M instruction via the SL curriculum with COMS instructors and (b) those who received O&M instruction via the SDCT curriculum with NOMC instructors. Both the Likert scale and paired sample t-tests were used in Aditya’s (2004) study to compare the two O&M certifications; therefore, those same methods were used in this comparative study of the two O&M curricula. The intended population for this study included consumers from throughout the United States who (a) were blind or visually impaired (self-reported), (b) completed *formal O&M training in or after 1999 (* = formal training consisted of instruction received in a state or private rehabilitation training center designed for individuals with visual impairments), (c) did not receive any formal O&M training prior to attending a private or state rehabilitation training center, (d) were between the ages of 20 and 70, (e) did not use a long white cane for mobility prior to the age of 20, (f) were not current or former O&M instructors, and (g) were not guide dog users. Participants who had severe disabilities (e.g., hearing, mental or physical impairments) that may hinder independent travel were excluded from the survey, whereas individuals with minor disabilities who traveled independently were encouraged to take the survey.

It was anticipated that locating participants who received instruction via the SDCT curriculum equal to those who received instruction via the SL curriculum would be a limitation, considering the overwhelming number of instructors and rehabilitation agencies who have been using the SL curriculum since the 1940s and because SDCT has only been in existence since 1997. Having the survey only being administered electronically was also considered to be a possible limitation for participants who did not have access to a computer, skills to access the internet (Crudden et al., 2017), and/or access to live readers. Also, because of the ongoing debates within the professional field of O&M instructors (Aditya, 2004; Baldwin, 2016; Blasch et al., 1997; Cutter, 2007; Fazzi & Barlow, 2017; Mettler, 1995; Omvig, 2002; Pogrund & Griffin-Shirley, 2018), proponents from the conventional approach might air adverse reactions regarding this study, as seen in Aditya’s (2004) study. None of the possible limitations listed above were of any significant consequence. Rather, when there were suddenly more SL participants than SDCT, additional outreach was necessary to enable an equal number of SDCT consumers compared to SL consumers and once the number of SDCT participants matched SL, survey collection terminated.

Study Results

This study was conducted to determine which O&M curriculum yields the highest level of self-confidence to offer consumers clear, researched-based choices. Just as in “A Class Divided” (Peters, 1985), those in authority can influence consumers’ perception of self, beginning with the initial lesson, which establishes the philosophical foundation that directs consumers throughout their remaining lessons and beyond. By participating in a study that compared the distance and frequency consumers independently travel post-O&M training, the consumers had the opportunity to demonstrate that their level of self-confidence dictated the best O&M curriculum. In addition, this study questioned the SL curriculum, which places guide instruction before introduction to the long white cane and considers sighted guide a prerequisite to cane instruction, even though guide skills are not prerequisites to learning cane travel (Fazzi & Barlow, 2017; Pogrund & Rosen, 1989). Rather, many O&M professionals  “support the earliest possible introduction of the long cane” for purposeful movement (Fazzi & Barlow, 2017, p. xvii).

This study consisted of 40 consumers who responded to the survey; 20 SL participants who received training from a COMS, and 20 SDCT participants who received training from a NOMC. Of the participants, 75% said they were uninformed of the two available O&M certification options at the beginning of their training. Sighted instructors accounted for 90% of the SL COMS, while the extreme opposite was noted with 80% of the SDCT NOMC instructors identified as blind or legally blind. Twenty-five percent of the SL participants considered sighted guide instruction as their first formal lesson, while 100% of SDCT participants stated the long white cane was the focus of their first formal lesson. Fifteen percent of the SL participants stated they always use sighted guide when traveling outside their home environment post-instruction, compared to 0% (zero) of the SDCT participants. Data confirmed consumers are not given informed choice, whereby only 25% were informed there were two O&M certifications available to consumers.

Since consumers’ feelings towards their cane is a psychological connection which helps direct independent travel, participants were asked if they considered their cane as a symbol of independence. Of the SL participants, 75% considered the cane a symbol of independence, compared to 100% of the SDCT participants. In addition, 90% of the SL participants considered the cane as a mobility tool, compared to 100% of the SDCT participants. Two SL participants said they did not like their canes and refused to use them. Negative opinions can lead consumers to “struggle in some social situations, such as when they need to ask for assistance” (Kaiser et al., 2018, p. 15).

Self-confidence was defined and measured (through frequency and distance traveled) to the extent of which consumers felt capable and assured (Bearden et al., 2001). Consumers’ post-training activity was used to calculate self-confidence, whereby participants could answer with one of three options (never, sometimes, always). In addition, traveling to visit relatives/friends, frequency scores, and the need for future O&M instruction were evaluated to help determine which curriculum offered higher self-confidence post-instruction. Keep in mind that evaluating consumers’ need for future O&M instruction was used as a method to evaluate O&M self-confidence since, according to Perla and O’Donnell (2004), consumers who are successful problem solvers are capable of handling unpredictable situations, and it is not necessary for them to seek additional O&M instruction or to depend on others whenever faced with new predicaments. This study investigated transformational effectiveness and confirmed that dependency on a guide for O&M lowers self-confidence and self-abilities.

Therefore, having a curriculum which fosters transformational learning decreases the need for additional O&M training when new travel situations or obstacles arise. Calculations for this study evaluated consumers’ self-reporting of: (1) how often they traveled outside their city limits, (2) if they traveled independently to visit friends/relatives, (3) their frequency of traveling independent, and (4) their need for no additional O&M training. Results of this study reveals SDCT participants average higher self-confidence in their independent travel by 32% over SL participants. Table 1 offers additional information about the study participants, while Table 2 displays self-confidence level calculations of the study participants.

Detailed Analysis

Based on the data collected, an analysis of the two types of O&M curricula was conducted to determine if there was a relationship between two levels of independent variables—consumers who received the SL O&M curriculum with a COMS instructor and consumers who received the SDCT O&M curriculum with a NOMC instructor. The correlation coefficient, r = 19, computed revealed a statistically small difference between the two curricula of O&M instruction, t(2.7) = .004, p = η2 = .22, η2= .2. The strength of the relationship between the two methods used, as assessed by η2, was small with the participants accounting for 22% of the variance. There was a 95% confidence interval for the differences in means range from 8.04 to 36.05. Based on the participants’ responses, SDCT scores (M = 149.35, SD 14.4) were higher than SL scores (M = 127.3, SD 26.35).

Conclusion

The purpose of this Likert-type survey study was to determine which curriculum of instruction (SL or SDCT) offers consumers higher self-confidence. According to Long (1990), research that compares O&M performance which differs on variables can impact the delivery of O&M services. Therefore, it is for the better good of blind consumers to receive the O&M curriculum that provides them with the highest level of self-confidence skills for them to become successful contributing members of society. This comparison study (a) explored if relationships of when sighted guide (SL curricula) or long white cane (SDCT curricula) instruction is presented to consumers could predict self-confidence levels and (b) if this relationship could be exposed via evaluating the distance and frequency consumers travel independently from their homebase post-instruction (see Table 2).

Basic techniques of cane instruction are the foundation of O&M and, as such, are transferable to more advanced phases of travel (Blaha, 1967) and the levels of this transformation between the SL and SDCT curriculum were revealed through the participants in this study. Higher self-confidence enhances action and motivation (Bénabou & Tirole, 2002; Cmar, 2015). Since actions mirror one’s self-confidence (Schreiber & Moss, 2002), this study revealed SDCT participants have higher self-confidence than SL participants by 32%. Although O&M studies on consumers’ training are scarce (Zijlstra et al., 2012), this data differs considerably because it removed any possible physical disabilities, which could emphasize walking speed or gait. Also, the cane type, length, or the consumer’s visual acuity was not of any significance for this study. Rather, it focused on independent travel within the consumers’ environment post-instruction, which supported Long (1990), who states research needs to be conducted within the consumers’ natural environments. The development of cognitive mapping abilities while traveling is a higher mental spatial ability than memorizing a sequence of associated actions or landmarks (Long & Giudice, 2010). This ability is fundamental for successful cane travel (Long & Giudice, 2010), as was evident in the results of this study. Consumers who learn problem-solving skills in the SDCT curriculum become environmentally literate, while those who depend on guides tend to focus on their guide’s movements, whereby omitting their environmental cues which leads them to becoming environmentally illiterate.  Consumers who are overly dependent on guides do not travel as far or as often as those who have higher self-confidence in their independent travel skills and abilities. Such dependency may have been cemented via the first lesson in SL, where there may be a reinforcement of minimal expectations of consumers (LaGrow & Weessies, 1994), which lowered their self-esteem and directed them toward the Custodial Paradigm. Thereafter, the dependency of a guide remains with the consumer post-instruction, as shown in this research.

Instruction of the long white cane needs to be introduced to consumers prior to guide instruction in order to achieve the highest self-confidence level of independent mobility.  Consumers who received the SDCT curriculum were more capable of building effective travel strategies, which transferred post-O&M training to novel environments, whereby they solved a myriad of travel woes associated with independent travel. These results mirrored veterans who were self-motivated during off-training hours to independently travel to local establishments (Miyagawa, 1999), an example of the Independence Paradigm.

One of the SDCT participants commented, “I’ve been waiting for someone to ask these questions!!!” By giving consumers opportunities to voice their contributions towards a research-based O&M curriculum, this study cements the instructional locus of control back to the consumers. This implication supports the possibility that “if research can make the facts known, then the blind will be in a better position to make up their own minds” (Dodds, Carter & Howarth, 1983, p. 441), leading to informed choice regarding their O&M options. The conceptual framework for this study is Glasser's (1998) Choice Theory, whereby ideas or systems of belief direct or oversee behavior, and this principle holds true for both consumers and O&M professionals. Furthermore, it benefits all taxpayers because rehabilitation agencies that use the SDCT approach do so with less governmental funds than SL (Institute on Disability, 2015, 2017).

Since results revealed that the SDCT curriculum yields higher self-confidence than the SL curriculum by 32%, perhaps this finding will be used to overcome the O&M paradigm paralysis of the Custodial Paradigm through action towards acceptance of the Independence Paradigm. After all, O&M instructors engage in lifelong learning and “continue to be a driving force in shaping the future of the O&M profession” (Fazzi & Barlow, 2017, p. xvi) because “education is the key component and driver of emancipation and transformation” (Lumadi et al., 2012, p. 302). Ideas or systems of belief direct or oversee behavior (Glasser, 1998) and this principle holds true for both consumers and O&M professionals since their combined beliefs affect the quality world of current and future consumers. Because of this study, “open-mindedness, flexibility, patience, and courage” (Jacobs, 2010, p. 211) are necessary to change the mental models of how professionals instruct and assess O&M. The first step to curriculum modification is to alter perceptions and the second is to be willing to form new routines while abandoning the old (Jacobs, 2010). Plus, it is necessary for a shared vision of the essential skills that consumers need to be successful. Furthermore, it is necessary for the requirement of “professional preparation curricula to continue to evolve to meet the needs of an even greater variety of students” because of the ever-changing population of individuals needing O&M instruction (Pogrund & Griffin-Shirley, 2018, p. 290).

Instructors need to accept that those who have been trained and certified in the rival approach may not all think alike, and they can benefit from accepting the knowledge of the other curriculum with respect to the consumers who can become easily obscured behind the profession (Aditya, 2004). The bottom line is that it is not the instructor’s certification or if the instructor is blind or sighted that determines how well consumers are served; instead, it is the curriculum that holds the key (Aditya, 2004). Keep in mind, this study is not an attempt to conclude that blind instructors are superior to sighted ones, although one SDCT participant commented, “The blind role models helped me to build my confidence and skills to be independent.”

For consumers, empowerment is critical to ensure success, so that they receive O&M through holistic person-centered training leading to their development, goals, and priorities (Wolf-Branigin et al., 2000). Furthermore, Choice Theory “states that, for all practical purposes, we choose everything we do” (Glasser, 1998, p. 3) and this holds true for independent mobility among consumers who received the SDCT curriculum because they were permitted and encouraged to make choices, while accounting for their own mobility. Since consumers’ actions represent their beliefs (Schreiber & Moss, 2002), then the measurement of their independent travel post-training coincides with their O&M abilities and skills, thus representing their self-confidence levels. Therefore, for the betterment of future consumers, it is the O&M professional’s duty to step forward and accept the results of this study for it was the consumers who revealed that the SDCT curriculum offers the highest level of self-confidence paving their way toward the Independence Paradigm.

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Table 1
Additional Information of the Study Participants

Curriculum Received	Sequential Learning			Structured Discovery Cane Travel
Number of Participants	20 (13 Females/7 Males)			20 (12 Females/8 Males)
Participants	▪ 25 Caucasian/White ▪ 7 Native Hawaiian ▪ 5 Asian ▪ 2 Hispanic ▪1 Black/African American ▪ 0 veterans ▪ 23 blind ▪ 17 legally blind
States Represented	▪ Arkansas ▪ California  ▪ Colorado  ▪ Florida  ▪ Georgia  ▪ Hawaii ▪ Idaho ▪ Indiana  ▪ Louisiana  ▪ Mississippi  ▪ Missouri ▪ Montana  ▪ Nebraska  ▪ Nevada  ▪ New Jersey  ▪ New York ▪ 3 Unreported
Sighted Instructors (n = 22)	18 (90%)			4 (20%)
Sleep shade Comparison	13 (72%) Did not offer to wear sleep-shades during instruction		5 (28%) Offered to wear sleep-shades during instruction	4 (31%) Did not offer to wear sleep-shades during instruction		9 (69%) Offered to wear sleep-shades during instruction
Blind or Legally Blind Instructors (n = 18)	2 (10%)			16 (80%) (Note: Some legally blind instructors are also counted above.)
Consumer Organizations Represented	50%	National Federation of the Blind		90%	National Federation of the Blind
	30%	American Council of the Blind
	20% - Belonged to both NFB and ACB 10% - Unreported

Table 2
Self-Confidence Level Calculations

		SL	SDCT
Travel Outside City Limits (TOCL):	Never	15%	------
	Sometimes	55%	25%
	*Always	30%	75%
Travel independently to visit friends/relatives		50%	95%
Frequency Score		75%	90%
Self-reported NO need for future O&M training		50%	70%
Average score (* = score used for calculation)		51%	83%
Difference			+32%

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