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Meaningful O&M for Students with Visual Impairments and Additional Disabilities

Stephanie Herlich, MA, TSVI, OMS

Shelby Zimmerman, MA, TSVI, COMS

CAOMS Conference - December 2024

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Handout

Meaningful O&M for Students with Visual Impairments and Additional Disabilities (Google Doc)

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CSB Assessment Center Team

Stephanie Herlich, MA – Teacher of Students with Visual Impairments, Orientation and Mobility Specialist, Assessment Center Coordinator
Shelby Zimmerman, MA, COMS – Teacher of Students with Visual Impairments, Orientation and Mobility Specialist
Rebecka Henry, MS, CCC-SLP – Speech Language Pathologist
May Nguyen, MS, LEP, NCSP, ACUE – Licensed Educational Psychologist�

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Workshop Outline

Background Information
Profiles and Impact to Orientation and Mobility (O&M)
Assessment
Instruction
Case Study

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Background Information

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Proprioception: What our body is doing at any point in time

Orientation

Use of an individual’s remaining senses to determine their location in an environment

Mobility

Use of an individual’s remaining senses to determine their location in an environment

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��65% of school-age students who are visually impaired have visual and multiple impairments.�� (Dote-Kwan, Chen, & Hughes, 2001; Hatton, 2001)��

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IDEA (Sec. 300.34 [c] [7]):

O&M is a related service

(ii) Including

(A) Spatial and environmental concepts

(B) Use of a long cane or a service animal

(C) use of remaining vision and distance low vision

aids

(D) Other concepts, techniques, and tools.

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AB-947 (California Legislative Information)

SECTION 1. (a) (1): Essential for VI students to receive instruction in the expanded core curriculum (ECC).

SECTION 2. (c) Services may be provided before or after school hours.

SECTION 3. (a) (2) Evaluations shall occur in familiar and unfamiliar environments, in varying lighting conditions, and in the home, school, and community, as appropriate.

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California Education Code 56353 & 56354

ECC “may” be beneficial and defines 9 areas of the ECC
Services provided before or after school hours
LEA includes charter schools
Services provided by certified O&M specialist
Conducted in home, school, and community and include familiar and unfamiliar environments
LEA must provide transportation if a specialist is prohibited from using a personal vehicle

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Who Qualifies for O&M

“When it is established that their visual impairment interferes with their ability to develop environmental, spatial, or body concepts and to travel safely, efficiently, and independently in the home, school, or community environment.”

Foundations of Orientation and Mobility, Volume 1

Wiener, Welsh, & Blasch, 2010

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Profiles & Impact to O&M

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Characteristics of Learning Disabilities

Distinguishing and localizing sounds
Behavior deficits
Basic concept difficulties
Easily disoriented
Problem-solving difficulties
Memory deficits
Weak expressive & receptive language skills
Low frustration level
Easily distracted
Disorganized
Reading difficulties

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Characteristics of Intellectual Disability

Concept development
Limited attention span
Memory deficits
Inability to use abstract thinking
Inability to generalize skills across environments
Communication deficits
Poor balance, posture, flexibility, and eye-hand and eye-foot coordination
Difficulty with basic self-care needs
Social deficits

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Characteristics of Autism Spectrum Disorders

Sensory sensitivity
Lack of impulse control
Difficulty with transitions
Social deficits

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Characteristics of Cortical Visual Impairment

Color preference
Need for movement
Visual latency
Visual field preferences
Difficulties with visual complexity

Array
Target/object
Multisensory
Human faces

Need for light
Difficulty with distance viewing
Atypical visual reflexes
Difficulty with visual novelty
Difficulty with visually guided reach

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Visual Behaviors – CVI Protocol

Visual Attention
Visual Recognition
Impact of Clutter/Crowding/Spacing
Visual Field Abilities
Impact of Color
Form Accessibility
Visual Guidance –Upper Limbs
Visual Guidance – Lower Limbs

Access to People
Impact of Light
Response Interval
Impact of Motion
Sensory Integration
Visual Curiosity
Appearance of the Eyes
Movement of the Eyes

Stephanie

16 Visual Behaviors that are all interconnected and overlap. I highly encourage you to visit the CVI Protocol informational webpages linked in your handout. These are similar to the 10 Range characteristics but have some distinct differences.

Visual Attention: This is an assessment of your child’s ability to look and sustain gaze for recognition. For example, your child might focus on only one small area while unable to process or understand other items. We consider her ability to maintain gaze in cluttered and un-adapted environments, as well as her ability to maintain gaze while ill or tired.

Visual Recognition: This is an assessment of your child’s abilities to visually recognize known items or known classes of items. Your child might immediately recognize her favorite toy or cup but might not recognize a similar, unfamiliar toy or cup.

Impact of Clutter/Crowding/Spacing: This is an assessment of the number of objects your child can tolerate in a display. Sometimes spacing items out improves kids’ visual attention and visual recognition. Your child might have trouble with visual clutter — when too many things are in an environment, they might blend together. Or she might be able to identify items in a predictable line presentation but not when items are scattered on a table, because it’s too visually complex.

Visual Field Abilities: This is an assessment of visual field awareness and abilities to recognize materials in all fields. Your child might not respond to items in a particular visual field or she might pay more attention to one side, with a visual deficit in another. Visual fields assessed include their left and right peripheral fields, upper visual field, and lower visual field.

Impact of Color: This is an assessment of how your child reacts to different colors and black and white, how she uses color for visual attention and object recognition, and how she uses it as an overall strategy function. Many kids with CVI are reported to notice one color more than others. We try to see how color helps her understand the world.

Form Accessibility: This is an assessment of the “accessible form.” How well the student can distinguish 2-D and 3-D objects, photos, black and white or line drawings. Think about a common figure, like Donald Duck: Even though it’s a cartoon, we know it’s a duck. A child with CVI might have trouble making that recognition. Your child might see three-dimensional items but have trouble with photos, for example. Or she might see color but struggle with black and white or line drawings.

Visual Guidance of the Upper Limbs: This is an assessment of reaching while maintaining visual attention, reaching accuracy, and looking while exploring an object. Your child might hold something in her hands but can’t look at it simultaneously, or she might gaze off into the distance while playing with an object. Or she might over- or underestimate her reach or reach tentatively.

Visual Guidance of the Lower Limbs: This is an assessment of her ability to step accurately or to place her foot accurately, such as into a shoe or stepping up onto a curb or stool.

Access to People: Your child might have difficulty looking at faces and difficulty with facial recognition. Some kids have trouble interpreting facial expressions. For example, you might smile, and she won’t smile back or look into your eyes. Many parents describe their child looking “through” them or past them.

Impact of Light: This is an assessment of the distraction of light, need for light, light sensitivity, attraction to light, and need for backlighting. Your child might be so impacted by light that it’s just a visual target; other kids benefit from lighted objects for improved visual attention or recognition.

Response Interval: This is an assessment of her degree of delay in visual attention and delay in visual recognition. Your child might take a long time to look at an object and a long time to understand what she’s seeing.

Impact of Motion: This is an assessment of her need for motion to gain visual attention; the distraction of environmental motion; the inability to follow fast-moving items; impaired perception of motion (difficulties understanding the speed, distance or direction of motion of objects); and a phenomenon called blindsight (the ability to avoid objects while moving, without awareness of the obstacle). Your child might need an object to move to know it’s there. Or she might have trouble assessing distance and speed, such as a ball or car coming toward them.

Sensory Integration and Impact on Vision: This is an assessment of the impact of competing sensory input on her vision use. Your child might not be able to listen or feel vibration while busy looking.

Visual Curiosity : Think about going to the grocery store. A child is constantly learning about shapes and objects as she watches mom or dad load up the conveyor belt from her perch in the carriage. A child with CVI might not absorb those incidental life lessons due to their visual impairment. As such, this is an assessment of the accessibility of “incidental learning” for distance materials and events with and without compensatory supports and for all visual fields.

Appearance of the Eyes: This is an assessment of alignment and eye preference. We assess whether both of your child’s eyes are working together. Are their eyes pointed straight when looking at something or does one eye turn in while the other turns out? Does your child favor or use one eye over the other? Does she alternate? This information is often validated by clinical optometry or ophthalmology examinations.

Movement of the Eyes: This is an assessment of ocular (eye-related) motor skills. We look at the way both of your child’s eyes move in different directions: horizontally, vertically, and diagonally. We analyze the child’s shifting of their gaze from one place to another, and how she responds to a moving target.

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Characteristics of Traumatic Brain Injury�(Ambrose-Zaken, Calhoon, & Keim, 2010, p. 631)

LEFT BRAIN (right side)

Logic
Words
Parts & specifics
Analysis
Sequential thinking

RIGHT BRAIN (left side)

Emotions
Pictures
Parts & whole
Synthesis (putting together)
Simultaneous & holistic thinking

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Regions of the Brain and What They Do (Arizona State University)�

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Regions of the brain and their function

Frontal Lobe – motor control, planning, concentration and problem solving, speech, and smell
Parietal Lobe – touch and pressure, tase, body awareness
Occipital Lobe – vision
Cerebellum – coordination

Reading uses 3 regions – temporal, occipital, and parietal

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Assessment

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Assessment Process

Review of medical records
Interviews
Observation, observation, observation
Test

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Review of Records

Medical history
Current medications
Limitations
Review of previous assessments
Review of education services

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Interviews

What motivates your child?
What are preferred activities?
What does your child do well?
What would you like to see your child do?
What else would you like me to know about your child?

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Observation, observation, observation�(Pogrund, R. L. & Griffin-Shirley, N., 2018, p. 235)

Integration of reflexes
Orienting response
Anticipation
Habituation
Muscle tone and motor planning
Biobehavioral state
Response to sensory information
Sensory preferences

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What's in Your Assessment Toolbox (Google Doc)

"The most important thing when giving an assessment is to know if the student understands what is being asked of them. If the student does not understand the directions, then the outcome has no meaning."

Accessible Tests Resource Center (APH)

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Comprehensive O&M Assessments

Teaching Age-Appropriate Purposeful Skills (TAPS), 3rd edition Assessment and Ongoing Evaluation (TSBVI)

For students ages 3 to 21
Interview questions for the student, parent/�guardian, and educators
Assessment areas and environments: home/living,�campus, residential, commercial and public �transportation, ambulatory devices
Digital supplements (TSBVI)

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O&M - Concept Development

Hill Performance Test of Selected Positional Concepts (Stoelting)

Spatial/positional concepts (ex. front, back, left, right)

Relationships of body parts
Moving body parts in relation to one another
Moving the body in relationship to objects
Object-to-object relationship

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O&M - Early Learners

Texas 2 STEPS Curriculum and Evaluation Set (TSBVI) - ages 0-5
Inventory of Purposeful Movement Behaviors (PDF) - (Anthony, 2004) ages 0-6
O&M Assessment: Early Years of Birth through Three (PDF) (Anthony, 2004)

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More O&M Early Learners

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O&M – Cortical Visual Impairment (CVI)

CVI Screening Tools (TeachCVI)
CVI Parent/Caregiver Interview (Christine Roman-Lantzy)
CVI Range Templates (Christine Roman-Lantzy)
CVI Progress Chart (Christine Roman-Lantzy)
CViConnect Pro
CVI Protocol (Perkins)

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Determining Service Delivery

(TSBVI)

VISSIT

(MDE-LIO)

Michigan O&M Severity Rating Scales

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Instruction

“Movement is life. It is in all we do on a daily basis…for children, movement is also the natural learning medium. It is the means by which they explore the environment, learn how it functions, and interact with it.”

(Rosen, 1997, p. 170).

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O&M and the ECC

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Expanded Core Curriculum

Orientation and Mobility

Independent Living Skills
Career Development
Technology
Social Skills
Sensory Efficiency
Compensatory
Recreation and Leisure
Self Determination

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Concept Development/Orientation

Positional concepts: top/bottom, up/down, in/out, inside/outside, near, in front, across, short/long, high/low, around
Time concepts: first, then, next, before
Quantity: another, more, full vs empty, small vs large, missing, all, both
Qualitative: same/different, good/bad
Body parts

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Mobility

Campus routes and level of supervision
Establish a safety word
Functional skills
Community exposure
Thematic units

*Dignity of Risk*

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Active Learning

“Learning takes place through movement” (Nielsen, L., 1992)

Equipment from Active Learning Space (ALS)

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Adaptive Mobility Devices (AMDs)

Bridge the gap between basic skills and traditional cane travel
Promotes concept development, problem-solving, and self-confidence
Safer travel, optimal gait pattern, and good posture

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Ambulatory Aids (Wheelchairs, scooters, walkers, crutches, orthopedic canes)

Foundations of Orientation and Mobility, 4th Edition (APH Press) contains O&M techniques for ambulatory aids.
Orientation and Mobility for Wheelchair Users with VIsual Impairment or Blindness (APH Press)

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Calendars & Routines

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Brain Gym (YouTube) – Movement Based Learning

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Technology

Experience books -Create books of O&M lessons and experiences.

Pictello
My Story

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Instructional Tips

Use preferred objects
Consider the environment
Slow down
Don’t interrupt
Scaffold skills and task analysis
Flexibility
Include IEP team members

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Case Study

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Meet Berry

8 years old

Loves balloons, bubbles, being silly, music, & her siblings.

Lives with her parent and 4 siblings.

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Berry’s Vision & More

Cortical Visual Impairment (CVI) – phase 1
Cerebral Palsy
Absent Corpus Callosum Autosomal Deletion Syndrome
Hydrocephalus
Epilepsy (tonic/clonic, atonic, and myoclonic. High seizure activity.

Home Hospital Instruction (HHI)

Seizures

Letter sounds emerging

Rolls on a floor mat

Sits with back support

Can hold an item.

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Interventions

IEP TEAM: Classroom teacher, SLP, AAC Specialist, OT, PT, O&M, & TVI.
Team collaboration: monthly virtual meetings, use of Google Classroom for parent to refer to or reinforce skills (works well for parent), check-in with parent to see what is working well.
Use of Berry’s preferred items and activities: siblings, balloons, and songs.

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Berry & O&M - Beginning

Preschool:

Consult only
Focus on Orientation
Use of tactile cues
Parent training on descriptive language and body-to-self concepts

4 years old:

Minimal eye gaze, no tracking/scanning.
Short periods of focus
Minimal purposeful movement

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What happened at 5/6 years old

Kinder/1^st Grade

Direct service weekly
Used TAPS Body Movements (PDF)
Team collaboration
Sample Lesson (Google Doc)

5/6 Years Old

Increased eye gaze, latency more obvious
Longer periods of focus
Purposeful movement difficult

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What happened at 7/8 years old

2^nd Grade

Expand Body Movement Routines (Google Slides)
Lots of repetition
Spring 2023: Berry able to isolate body part and reach for it.

7/8 Years Old

Longer eye gaze
Continued Latency
Longer periods of regulation
Increased purposeful movement

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Berry and O&M – Video #1

Berry beginning to develop purposeful movement.

Video: Berry Hearts (YouTube)

Video: Berry is sitting in her chair with her tray. Her mother is recording the video and cannot be seen. Berry is wearing a blue shirt and earrings, her dark hair pulled back, and the black chair harness. She has a G-tube in her left nostril.

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Berry and O&M – Video #2

After one month, Berry demonstrates

more purposeful movement

Video: Berry Shamrocks (YouTube)

Video: Berry is sitting in her chair with her black chair harness. She is wearing a colorful sleeveless shirt, her dark hair is pulled back, and she has a G-tube in her left nostril. She is smiling. The shamrock is white paper cut out with green ink.

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Testimonial from parent

“I am incredibly grateful to O&M therapy. It has been a life changer for Berry and our family. She has been able to discover so many things about her body, movement, and space.”

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What's happening in your district/county?

Are you qualifying/not qualifying these students?
How are these students being served?
Who is providing services?
Do your administrators support qualifying these students?

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Key Ideas

Routine
Wait Time
Charting
Repetition
Teamwork

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Additional Resources