The Orientation and Mobility Specialist Your Advocate for Greater Independence

1. -- The Orientation and Mobility Specialist Your Advocate for Greater Independence JoAnne Chalom, COMS, Ed.S.

2. A Jumping Off Point Participants will • Understand how orientation and mobility fits into clients’ overall rehabilitation • Understand how to differentiate between client preferences and family preferences • Understand the role of a Certified Orientation and Mobility Specialist (COMS), specifically an itinerant one who supports older adults in their homes Hadley School for the Blind

3. What is Orientation & Mobility? • Orientation and Mobility (O&M) is a profession specific to blindness and low vision that teaches safe, efficient, and effective travel skills to people of all ages. Hadley School for the Blind

4. What is Orientation & Mobility? • Orientation refers to the ability to know where you are and where you want to go, whether you're moving from one room to another or walking downtown for a shopping trip. Hadley School for the Blind

5. What is Orientation & Mobility? • Mobility refers to the ability to move safely, efficiently, and effectively from one place to another, such as being able to walk without tripping or falling, cross streets, and use public transportation. Hadley School for the Blind

6. What is Orientation & Mobility? • Examples of O&M: • Executing a route from one room to another • Traveling around a residential neighborhood • Upper and lower body protective techniques • Cane techniques • Using landmarks and clues Hadley School for the Blind

7. The Role of the COMS and Older Adults in their home • What are the client’s specific goals? • What would they like to be able to do that they are unable to do Hadley School for the Blind

8. The Role of the COMS and Older Adults in their home • What are the client’s specific goals? • What would they like to do that they are unable to do • travel in a residential area • find their way around a grocery store • walk around the neighborhood • walk to the mail box Hadley School for the Blind

9. How does it fit into their overall rehabilitation? • It can increase independence • It can increase the ability to be more in control of daily decisions • It can help the client regain some degree of independence Hadley School for the Blind

10. How does it fit into their overall rehabilitation? • Executing routes within the home • Walking from the living room to the bedroom • Walking to the mail box • Walking around the block Hadley School for the Blind

11. How does it fit into their overall rehabilitation? • Locating the bus stop in an over 55 community • Using the community bus to locations within the residential development Hadley School for the Blind

12. Reaching Out for Help • Losing independence vs. maintaining independence • Reversing roles • Presenting the idea that using a long cane is just another tool in the tool box might be more acceptable Hadley School for the Blind

13. Reaching Out for Help • A client once told me that I should think of her like a young child • “I’ll do it myself!” Hadley School for the Blind

14. Reaching Out for Help • Accepting the idea that you need help can be difficult • Matriarchs of the family • Prideful • Denial Hadley School for the Blind

15. Reaching Out for Help • The internal argument of needing help vs. I’m fine • I’m clumsy vs. tripping on objects not seen • Walking into walls or having poor depth of perception Hadley School for the Blind

16. Obtaining Services • What documents or information should they have ready to apply for O&M services? • Current eye medical report • Other documents requested by state division of blind services Hadley School for the Blind

17. Clients preferences vs. family preferences • Client preferences for greater independence • Family member’s concern for their safety • If family members are present and being supportive they can be very helpful !! Hadley School for the Blind

18. Clients preferences vs. family preferences • Helpful • Reinforce concepts being presented • Providing time to practice skills learned • Translating sessions for clients whose native language is not English Hadley School for the Blind

19. Clients preferences vs. family preferences • Family members not being supportive • “He’s not blind so he really doesn’t need a cane” • “We take him everywhere he doesn’t need to use a cane.” Hadley School for the Blind

20. Clients preferences vs. family preferences • Clients need to know how to use a long cane and implement the techniques needed to use it effectively • Clients can still have ‘some vision’ or low vision and still use some tools in the toolbox • O&M is for the client’s safety and their degree of comfort Hadley School for the Blind

21. What to expect on the first visit • Family members are welcome to join in on first or subsequent visits. Be prepared to share • What challenges are you experiencing getting around the home? • Becoming disoriented • Walking into objects or walls • Locating rooms Hadley School for the Blind

22. What to expect on the first visit • What challenges are you experiencing around a residential area? • Drop offs • Becoming disoriented • Crossing streets with stop signs Hadley School for the Blind

23. What to expect on the first visit • Family members are welcome to join in on first or subsequent visits • Set aside enough time to have a conversation Hadley School for the Blind

24. What to expect on the first visit • Turning off the TV or other noise makers • Other impairments or challenges (be forthcoming) • Other illnesses • Limited mobility • Limited time for instruction • Too many doctor’s appointments or caretaker responsibilities Hadley School for the Blind

25. What to expect on the first visit • If the appointment is for one hour be present for that one hour • Think about this as an opportunity to regain some of your independence Hadley School for the Blind

26. What to expect on the first visit What challenges are you experiencing getting around the home? • Becoming disoriented when trying to locate rooms • Walking into objects or walls • What challenges are you experiencing around a residential area? • Drop offs • Crossing streets with stop signs Hadley School for the Blind

27. What to expect on the first visit • Try to prioritize O&M the same way you would other events that are important to you. Hadley School for the Blind

28. The More the Merrier ?? • It is up the client if he/she would like another individual present • Some family members invite themselves and can be very assertive • Other family members may try to control the discussion Hadley School for the Blind

29. The More the Merrier ?? • Client goals should be their wishes that are addressed • Family members can express their concerns • It’s ultimately up to the client to decide what skills they would like to learn Hadley School for the Blind

30. Making the most of a COMS visit • Explain concepts in terms that the client can understand • Explain the difference between a long cane and walking stick Hadley School for the Blind

31. Making the most of a COMS visit • What you cannot do….. • Organize their closet • Take them to the convenience store for cigarettes • Be their healthcare aide • Determine their need for low vision devices, CCTV, magnifiers Hadley School for the Blind

32. Making the most of a COMS visit • If concerns are brought up that are beyond the scope and practice of a COMS • Information can be forwarded to other team members • Examples can include needing low vision devices or low vision exams Hadley School for the Blind

33. Factors leading to success • Willingness to learn • Willingness to practice skills learned • A serious commitment of time • Understand that a long cane is a tool that is only as useful as the person who is using it effectively Hadley School for the Blind

34. Unrealistic Expectations • Unrealistic Expectations • Expecting other pedestrians or drivers to automatically yield and cross streets without understanding the culture of drivers in the area. • Be aware of White Cane laws and the fact that drivers may not be aware of the law Hadley School for the Blind

35. Words of Wisdom • As an invited guest in a client’s home and a professional • Be honest if it is your observation that the client is making choices that could be harmful • Request that a family member or healthcare aide join them during instruction if medical issues are present (diabetes, cognitive, balance issues) • Crossing a street without the knowledge of strategies or techniques Hadley School for the Blind

36. Some things to consider? • Questions? • Comments Hadley School for the Blind

37. Thank you for your time! Merci ! ขอขอบคุณ mèsi gracias Hadley School for the Blind

38. Contact Information JoAnne Chalom, COMS, Ed.S. jchalom@infocusmobility.com Hadley School for the Blind

39. Key Resources • Vision Aware: An Introduction to Orientation and Mobility Skills • http://www.visionaware.org/info/everyday-living/essential-skills/an-introduction-to-orientation-and-mobility-skills/123 Hadley School for the Blind