Future Reflections Cane Travel and Independence

O&M Assessments: Erring on the Side of Positive Expectations

by Douglas C. Boone

Editor�s Note: What should a good O&M assessment look like? According to long-time cane travel instructor and consultant, Doug Boone, one of the crucial elements of a good assessment is the evaluator�s expectations and attitudes. The following piece by Doug Boone is adapted from an article entitled �Linda Gets a Cane: Parents Prevail in Due Process Hearing� in the Volume 13, Number 2, issue of Future Reflections. It is included in this special issue because it provides an excellent example of all the elements that make up a thorough O&M assessment--including that elusive element: positive expectations. Here is Doug Boone:

In the middle of April 1993, I received a phone call from Karen Mayry, President of the National Federation of the Blind of South Dakota. She informed me that a seven-year-old blind person, Linda Perez, was not receiving instruction in the use of her long white cane. Furthermore, she was not being encouraged or allowed to use her cane in the school. The wishes of Linda and her parents, as presented to the Douglas School District (which is near Rapid City) during IEP meetings were being discounted in favor of the recommendation by the regional orientation and mobility (O&M) consultant who had prescribed a precane device for Linda.

As a private consultant in the field of blindness/visually impaired issues, it has become my policy not to rely on others� perceptions of a situation. Instead, I like to evaluate each situation or human need personally and then pursue a course of action which is based upon fact. I also proceed on the assumption that it is best to err on the side of positive expectation--I always first assume that a given task or challenge can be accomplished by the person with whom I am working.

The foundation of experience and philosophy I bring to this process consists partly of my experience in the employ of three state blind rehabilitation agencies. While an employee of the state rehabilitation agencies I was often called upon to consult with educational facilities regarding the needs of blind and visually impaired adults and children in issues related to cane travel and industrial technology classes. Also vital to my foundation of knowledge is the extensive sleepshade training I received when I first entered the field, and my continued philosophical growth by way of my association with the literature and members of the National Federation of the Blind. With this background, I set about designing an appropriate evaluation of Linda Perez�s ability to function with the long white cane. Here is the text of that evaluation:

Proposal For O&M Assessment

The following is a proposal for contract services to assess the feasibility of the introduction and subsequent instruction in the use of the long white cane, as an aid to mobility, for Linda Perez, beginning on Sunday, May 9, 1993, and concluding on Monday, May 10, 1993.

The assessment will be conducted in a two-phase process: at the student�s residence on the first day and at the student�s school on the second day. The assessment schedule will help to minimize the Hawthorn effect by allowing for the development of rapport with the consultant in the secure environment of the home on the first day. This arrangement will also allow for parent observation of the process. The second day of the assessment will provide for an expansion of the assessment in a more structured environment with observation by interested instructional staff. The second day will seek to provide a review of those areas (listed below) which were assessed on the first day. The provision of two days of assessment will seek to minimize the chance that the student might have an off day and thus skew the results of the assessment. Both days of the student�s assessment will cover, to the extent possible, the following:

1. Establish rapport between the evaluator and parents and student.
2. Begin evaluation of student�s: a. expressive and receptive language skills, b. level of community/environmental awareness, c. level of social awareness.
3. Evaluation of student�s ability to collect, correctly assess, and/or use auditory, tactile, and other available environmental information.
4. Provide for the evaluation of the student�s balance under a variety of situations and conditions.
5. Evaluation of the student�s ability to grip the cane and begin manipulation of same.
6. Instruction in, and evaluation of, the ability of the student to slide or tap cane in such a manner as to provide for a clear path of movement.
7. Confirm the ability of the student to maintain, at a level consistent with that of beginning students, incorporation of the following elements in the use of the cane: a. grip, b. slide or tap, and c. acceptable width of arc.
8. A basic assessment of the student�s psychomotor skills in general.
9. An assessment of student�s maturity level and ability to maintain concentration necessary for beginning use of the cane.
10. Evaluation of the student�s ability regarding stowing the cane in an appropriate location and retrieval of the stored cane.

All of the above will serve to determine the readiness of the student to begin a course of instruction in the use of the long white cane. Of necessity the assessment will be conducted at a pace commensurate with the student�s attention and tolerance levels. To provide for these considerations, the assessment will be interspersed throughout both days of evaluation.

A written report will be sent by FAX to the school no later than the morning of May 14, 1993, and a FAX sent to the parents to a location of their choosing. This will be done in order to acquaint all interested parties with the findings of the assessment.

The summarized results of the evaluation are provided below:

O&M Evaluation Report

Locations For The Assessment: Student�s residence, Rapid City Mall, and the Douglas School Badger Clark building, Carousel building, and surrounding school environment as it relates to Linda�s instructional needs.

The evaluation began on the morning of May 9, 1993, at the residence of Linda Perez. My first efforts were directed toward establishing rapport with Linda and her parents. I asked Linda to get her cane. Linda independently found the cane, with only a verbal prompt from her parents to tell her that the cane was on the porch. Linda was receptive to becoming acquainted, and I soon asked her to show me her favorite toy. She took her cane, without prompting, and returned with a busy box. Approximately fifteen minutes later I asked Linda to put her toy back, which she did without any difficulty. I then asked her to get another toy. This time she chose a puzzle. She came back to the table and began working on the puzzle. After a short time, she asked about the location of her cane. It was at this point that I demonstrated to Linda how she could store the cane under her chair. Linda exhibited a good attention span while working on her puzzle.

Mr. and Mrs. Delker next provided me with information regarding various self-help skills which Linda is able to accomplish. While this is not directly related to the assessment of Linda�s ability to use a cane, a cursory review of her level of functioning is desirable in order to understand her behavior when using the cane. The discussion revealed an overall development in the range of a three- to four-year-old. Her parents stated that Linda has specific tasks to do in the home. A recommendation was made to encourage Linda to become involved in the selection of her own clothing since activities of this nature contribute to independent thinking and concept development. It should be noted that this portion of the assessment was for the benefit of the consultant, and was/is not intended as an official finding regarding age-appropriate development.

Evaluation Of Outside Use Of The Cane: As we prepared to leave the house for the outside evaluation, Linda prompted her parents by asking for her cane. I believe this was a significant act, demonstrating an awareness of the cane as a tool for independent mobility.

As we came down the ramp from the house, Linda found a section of plywood with the cane, then stomped on it to confirm the feedback she had received from the cane--an act not inconsistent with beginning users of the cane of any age. This demonstration of an awareness of the auditory feedback available from the cane is significant in view of the limited experience Linda has had with the cane.

Once in the yard, Linda followed her father�s voice toward the place where the bus stops. Linda continued to use her cane in a somewhat sporadic arc, mostly keeping it near to the ground but occasionally raising it. Linda displayed an ease with using the cane in either the right or left hand. This ambidextrous approach to the cane is a skill well worth fostering, as it provides for independent mobility when carrying heavier objects which can be shifted between hands to minimize fatigue. While I generally introduce this skill later in a student�s instruction, I do not view the early alternating of hands to use the cane in a negative light.

From the bus stop we proceeded to the lamb pen. Again, Linda followed her father�s voice. She used the cane surprisingly well over uneven surfaces, including tire ruts, unmown grass, mud, and loose gravel. When she arrived at the lamb pen, she was not facing the pen, but was parallel to it. Her father made note of this fact and prompted her to put the cane in front of her. She extended the cane and swung it to her left, found the fence with the cane, then turned and appropriately faced the lambs. This action represents an understanding of the value of the cane as a tool to collect information from the environment.

Next, I asked her to find the chicken house. (I had heard a chicken as Mrs. Delker was gathering the eggs.) Linda needed one additional auditory cue, then proceeded in the direction of the building. After locating the chicken house she turned and approached the feed shed which Mr. Delker had entered. After arriving at the feed shed, I showed Linda how to determine the height of a step by using her cane. The step was inordinately high, approximately fourteen inches off the ground. After several exploratory tries, Linda crawled into the shed. At all times she maintained contact with the cane or remembered where she had placed it. This behavior demonstrated Linda�s awareness of the value of the cane in enabling her to move effectively in her environment. As we returned to the house Linda continued to use her cane while following sound cue information from her parents� voices.

Evaluation At The Mall: At my request, Mrs. Delker drove Linda and me to the mall for an evaluation of cane usage in an unfamiliar location. Upon arrival at the mall, Linda unbuckled her seat belt. This was the first time she had self-initiated and independently accomplished this task.

As we entered the mall Linda immediately noticed the sound feedback available from the cane, and swung her cane with additional vigor. Initially, Linda seemed a little intimidated at the prospect of walking about using only her cane and not hanging on to her mother�s hand. This behavior was not surprising given her limited instruction in the use of the cane to date. Most people tend to experience some degree of fear and apprehension when encountering new environments.

As we walked in the mall, Mrs. Delker asked Linda to find a bench. Linda, without further information, reached out and found the bench using her cane. During this portion of the evaluation I observed multiple incidents of Linda�s swinging the cane vertically and horizontally at waist height or above. After a number of interventions by Linda�s mother failed to produce a controlled arc, I suggested to Mrs. Delker that she briefly take the cane from Linda the next time she failed to heed a verbal warning to use the cane properly. Linda once again inappropriately swung the cane. Mrs. Delker took the cane and told Linda she would have to walk the mall holding her (Mom�s) hand, not using the cane, if she were to again swing the cane improperly.

At this point I suggested that perhaps Linda was tired and we should conclude the evaluation. It is significant to note that no additional misuse of the cane occurred as we returned to the car! In my opinion, the modification of Linda�s negative behavior, which coincided with the prospect of losing the cane because of misuse, demonstrated the value she places on the cane. As we left the mall, Linda found a two-foot drop-off with the cane. She knelt down to feel the drop-off, sat down so that her feet were on the lower surface, then stood up again. We returned to the car and concluded the day�s activities.

Evaluation In The School Environment: The evaluation on the morning of May 10, 1993, was conducted at Linda�s school and included the Badger Clark building, Carousel building, and other areas used in the provision of Linda�s education plan.

I began the school portion of the evaluation by observing Linda exiting her main school bus and moving to the small bus in which she waits until a school staff member comes to escort her to the building. In going from the large to the small bus, Linda exhibited excessive vertical raising of the cane similar to what I had observed in the mall on Sunday, May 9, 1993. When leaving the bus and encountering the bus steps, Linda did not seem to know how the cane could provide information regarding the step height. Both of these observed deficits do not represent inability, but instead reflect lack of instruction and consistency of cane usage. It is worth noting that when Linda went up the steps to the second bus, she seemed to instinctively use the cane to locate the next step. Once again, she showed her appreciation for the cane by maintaining constant contact with it at all times.

After a short wait, two school staff persons came to the bus to get Linda. I introduced myself and let them know I was present for the day to observe Linda using the cane at her school. Linda then began to follow the staff to the building, located a metal grate on the sidewalk, crossed it, and proceeded into the building. She followed the staff persons down the hall, located the door to her classroom with her cane, and entered. Without asking Linda�s permission, a staff person took the cane from her and hung it up. At that point I offered to put on a pair of sleepshades and demonstrate how the cane can act as an effective tool in mobility. None of the school staff indicated a desire for me to do so.

Linda�s first class was physical education, and it was necessary to walk approximately one-and-a-half blocks outside to the track area. The staff person who was taking her to the track referred to the cane as a stick. I explained that the proper term was cane, and she apologized. I informed her that no apology was necessary as no one could expect her to know all of the terms related to blindness and visual impairment.

As we continued, I again observed the ease with which Linda switched the cane from one hand to the other. At one point, Linda walked off the sidewalk and onto playground gravel. When asked by the staff person to get back on the sidewalk, Linda located the sidewalk with her cane and, after some independent re-orientation, continued in the proper direction. At another point Linda stepped off the sidewalk onto a grass edge and seemed to be exploring and experimenting with her cane. This action of using her cane as a tool to collect information and to satisfy her curiosity is yet another indicator of her readiness to use the cane.

At one point, the staff person grabbed the cane and was teasing Linda by pulling on the cane and saying they were going to get her with it. I asked the staff person not to engage in this kind of activity because Linda, like most students, will benefit from positive reinforcement in the proper treatment of equipment; be it a baseball bat, eyeglasses, or a cane. These examples of the staff�s lack of knowledge regarding blindness are not a negative comment on the staff personnel, but rather reflects the need to empower staff through a specialized in-service training conducted by professionals and blind role models.

As we came back from physical education and were approaching the building, the staff person asked me if I wanted Linda to trail along the wall. I told her that I preferred that Linda not do this since the cane could find things for her which she would miss if she were just trailing the wall. Furthermore, by using the cane Linda would be developing transferable skills. When asked for additional information I explained that if a maintenance worker or teacher left a toolbox or some other item in the hall, trailing the wall would result in a collision. On the other hand, when using the cane correctly, items hurriedly placed in the hall could be easily detected and walked around. To the credit of the staff person, this explanation made sense to her.

Just before we entered the building Linda began to tap more heavily, again indicating her ability to use echolocation information produced by the cane. She stomped a few times, to confirm the cane information, and proceeded into the building. Once inside, her speed increased as she walked down the hall without trailing. Soon she asked the staff person if she could stop by the office and was allowed to do so. When she was in the proximity of the office, she heard sound cues coming from within. She extended her cane to her left and entered the office without contacting the door. Even the staff person commented on how well Linda was doing with the cane.

As Linda left the office, again smoothly passing through the door, she turned left to proceed to her homeroom. The staff person and I arrived at the homeroom and paused; Linda continued past the door approximately thirty feet. She stopped, without comment from either the staff person or myself, turned around, and walked back to the door. When she reached the door, she swung the cane into the opening and then she entered. The staff person acted very appropriately, allowing Linda to discover and resolve her error on her own.

Once again I extended an offer to demonstrate, under sleepshades, the full cane technique used by blind persons. I told the staff persons they had but to ask. No one asked to have the demonstration.

While waiting for Linda in her home room I heard an instructor outside the classroom repeat twice to a sighted student, �Please keep your hands off the wall; we have art work on the walls.� Encouraging trailing walls in place of using the cane does not facilitate mainstream efforts, but instead serves to enhance differences between Linda and her peers. This subtle and unnecessary allowance can have negative implications for both Linda�s self-concept and the expectations which peers have for Linda.

The next significant event, related to this assessment, occurred when it became time to go from Linda�s homeroom to her mainstream class. A staff person informed Linda that it was time to go to Carousel (her mainstream classroom). Another student in the class was looking at Linda�s cane. The staff person, while retrieving the cane from the lad, informed Linda they were running late and would have to hurry. As she finished her statement the staff person hung up the cane, took Linda�s hand, and proceeded down the hall. Approximately one quarter of the way to the mainstream classroom I heard Linda ask for her cane. The staff person told her that they were late and didn�t have time for the cane. Linda�s question reflects the value she places on her cane. The response to the question indicates the need for staff training regarding the importance of cane usage in the development of self-confidence and independence.

That failure to permit Linda to have her cane with her was a lost opportunity to reinforce her independence. Indeed, after arriving at the mainstream classroom, Linda needed to go from one location in the room to another. The staff person told her to go on over. Then, almost immediately she said, �Take my hand; there are kids on the floor.� Again, this was another example of a lost opportunity to teach Linda and her peers that blind people can do things by themselves.

Next, the class members, including Linda, were asked to go outside and get an egg carton which had been filled with dirt and planted. Linda�s assigned staff person accompanied her, helped her find a carton, and lined up with her to come back into the building. They had stopped just prior to the sidewalk while waiting for other children to move inside. When the staff person indicated to Linda that the line was moving, Linda moved forward, caught her toe on the edge of the sidewalk, and almost fell. With the cane Linda could have been in control of her own mobility and collected information relevant to her needs. She might still have stumbled, but then again, maybe not. Because she was not allowed to take her cane to the mainstream class, she did not have it available for recess or for the walk back to her homeroom.

Also, a different staff person led Linda back to homeroom by a different route. This inconsistency in going to and from various locations occurred several times and appeared to be the norm. It would be helpful for the staff to learn the value of Linda�s using the same routes during this early period of learning how to maintain orientation.

It is salient to the evaluation that Linda, when she used the cane at school, exhibited none of the negative behaviors she had displayed while at the mall on Sunday, May 9. Whatever the cause for this improved respect for using the cane, the absence of negative behavior simply means one less thing the staff at the school would need to modify.

Also noteworthy is that during the morning I observed Linda at school, with the exception of one staff person, no one else prompted her to use either the pre-cane device or the long white cane. Instead the staff consistently took Linda�s hand to accompany her to various class activities.

It is significant to note that, while staff were reluctant to expand their knowledge of the cane, I did observe a high level of commitment and concern for Linda and a good deal of coordinated effort in expanding her knowledge of geometric shapes and enhancing various concepts in general. These efforts should contribute significantly to Linda�s development of spatial awareness and the ability to generalize information when moving about with her cane.

Summary of Findings
Linda demonstrated:
1. a willingness and motivation to use the cane;
2. awareness of the value of the cane as a tool to assist her in her mobility;
3. awareness of sound feedback available from the metal cane tip and ability to use same;
4. awareness of texture variables, as they relate to orientation and mobility;
5. good echo/sound cue usage;
6. recognition that the cane can locate objects and openings through purposeful extension of the cane in the desired direction;
7. a willingness to explore her environment with the cane;
8. a firm grip on the cane for extended periods of time;
9. excellent balance in a variety of evaluation environments;
10. an increased pace when using the cane as opposed to trailing the walls; and
11. good travel orientation.

Recommendations
As a result of the evaluation, I make the following recommendations:
1. Future instruction in orientation and mobility be conducted using the long white cane.
2. The cane be used for all independent mobility as often as possible in the school and in home life.
3. Staff, parents, and peers receive in-service training in basic use of the cane by blind role model(s) and professional staff so that they will be better able to reinforce the use of the cane in and out of the school environment.
4. Establish set routes during this early phase of O&M instruction for going to and from classrooms. This will allow Linda to concentrate more on the skills associated with manipulation of the cane and less on keeping oriented.
5. Some emphasis and priority be given to cane usage until Linda develops more skills. For example, perhaps on Mondays and Wednesdays Linda might use all of her allotted time just going to and coming back from, say, physical education (or some other class). Learning independent mobility is a priority on those days. On Tuesdays and Thursdays Linda takes her cane, but may also take a staff person�s hand to quickly get to P.E. so she can participate. On these days the emphasis is on class participation. This approach is suggested as an interim solution, pending Linda�s development of speed and self-confidence in using the cane. Careful consideration should be given in a plan of this nature to assure minimum disruption of her academic curriculum.

Those were my findings but the school continued to resist the Delkers� request for Linda to receive instruction in the use of the long white cane. Indeed, the Douglas School District chose to contest the payment of my services even though it is the right of parents to seek outside evaluation in cases where the school and parents disagree.

In July of 1993 the Hearing Officer handed down his ruling and found in favor of Mr. and Mrs. Delker and ordered the Douglas School District to reimburse the Delkers� for the cost of the independent evaluation. The school district has since obtained the regular services of an O&M instructor for Linda Perez, and she is reported to be making fine progress in the use of the cane, using it not only at home, but also in school!

Doug Boone is still in the consulting and training business as D. Boone Consulting. A resident of Kalamazoon, Michigan, he consults with and trains staff for rehabilitation agencies and schools for the blind. His intense training sessions feature blindfold experiences that focus on the cane and the possibilities available to blind people when skills are developed. He can be reached at <[email protected]>.

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