Let’s Get Moving and Find Some FUNdamentals!!!

Authors: Amy Fletcher, Certified Orientation and Mobility Specialist, Teacher of Students with Visual Impairments, and a Developmental Vision Specialist at the New Mexico School for the Blind and Visually Impaired Birth to Three Program and Rita Garcia, Certified Orientation and Mobility Specialist and a Developmental Vision Specialist at the New Mexico School for the Blind and Visually Impaired Birth to Three Program

New Mexico School for the Blind and Visually Impaired Birth to Three Program Overview

New Mexico School for the Blind and Visually Impaired (NMSBVI) established the Birth to Three Program in August 2000. In 2007, NMSBVI began offering orientation and mobility (O&M) services to children from birth to three years old, initially with only two O&M specialists traveling across the state to complete evaluations and provide ongoing O&M services. Since then, O&M services have significantly expanded and now include ten O&M specialists who provide services throughout the entire state.

New Mexico is considered an at-risk state, offering specialized services to children who show a need due to medical risk or vision delays. Many of the children who are referred to the program have not yet been diagnosed with a visual impairment. When a child qualifies for services, they receive support from a Developmental Vision Specialist (DVS) and O&M specialist. The DVS can assist families by sending a referral to the local eye specialist and attending the eye appointment to support and guide the families through this process. The level of intervention provided to families varies based on the individual needs of each family. 

Importance of Early O&M in Birth to Three

Learning to use a toddler cane

Why Introduce O&M At a Young Age?  

Starting orientation and mobility services at a young age is crucial for children who are blind or visually impaired. These children often have reduced access to incidental learning, making structured and repeated learning experiences essential. In the NMSBVI Birth to Three Program, O&M specialists explain what O&M services are and how they can be implemented at home and in the community. 

Playing the piano at a children’s museum

How to Introduce O&M?

Families are educated and coached on how to modify their environments to make them more accessible for their child. It is important to emphasize making play and movement enjoyable and meaningful. If children do not have a specific purpose for moving towards an object or location, they may lack motivation to explore their surroundings. Movement varies for each child; some may roll, crawl, or walk. Each child’s unique way of moving must be embraced before teaching them how to reach objects or desired locations safely and independently. 

What is Early O&M?

Early O&M focuses on promoting independence and safety for each child. This is achieved by introducing concepts such as body and spatial awareness and location concepts, to encourage purposeful movement and active learning at home and in the community. Following each child’s lead and making these experiences FUN is key to encouraging them to move with intention across a variety of settings.

Using a toddler cane to navigate thick grass at the park!

Expanded Core Curriculum and the Coaching Model

When collaborating with families, it’s important to adopt an approach that prioritizes family-centered practice and coaching. Discussions with caregivers are intentional, collaborative, and supportive. Caregivers are encouraged to actively engage in home and community visits, as these experiences provide valuable opportunities for both the caregiver and child to practice routines together. Such participation deepens the team’s understanding of the child’s needs and learning style. 

The NMSBVI Birth to Three staff is dedicated to initiating instruction in the Expanded Core Curriculum (ECC) as early as possible, empowering caregivers to understand how they can support their child’s learning and school readiness. We firmly believe that children learn most effectively within their daily routines and natural environments. Our objective is to integrate the ECC into the child’s everyday life using familiar objects, toys, and people. 

Early O&M instruction encompasses a significant part of the ECC because it focuses beyond just physical movement and helps with developing conceptual understanding. The ECC skills taught will evolve as the child grows to ensure continued progress in their independent life skills. Caregivers are educated on the importance of advocating for their child’s needs as they develop.  

Setting up the Child’s Environment  

Setting up a child’s environment is essential for making it accessible, which helps the child be successful and motivated to move. Active learning is a key concept in creating this environment at home. The O&M specialist can help establish defined play spaces that are meaningful for both the family and the child. These defined play areas, equipped with meaningful objects placed in predictable positions, can enhance the child’s understanding of their surroundings and promote independence. 

The toys and objects in these defined play spaces should be engaging and motivating. Each play space is customized for every child, varying in each home based on the child’s needs, the size of the family home, and the resources available to the family. For instance, one mother from our community designed a mobile play space, using a wagon called the “Wonderfold”, because her family traveled so frequently. She wanted her daughter to participate in these trips while having a designated area for her daughter to move and learn.

Example of a defined “Wonderfold” play space

When creating spaces for children, it’s important to involve families and consider each child’s needs to establish a meaningful and motivating environment. Defined play spaces can be utilized across a variety of activities in different locations. For example, highchair trays and cribs can act as defined spaces that encourage reaching. Initially, the size of the area should be narrowly defined and gradually increased as needed. Heavy furniture, walls, or cabinets should border at least two sides of these spaces. 

To create an enriching learning environment, it is vital that the toys and objects in these play areas are engaging for the child. Keeping these items in consistent locations not only enhances the child’s experience but also fosters a sense of security. By customizing these spaces, the child is empowered to explore and interact independently and safely. Incorporating custom-made play stands into the designated play area encourages reaching and grasping in various positions, such as sitting, side-lying, or standing. This variety is essential for a child’s development, allowing them to learn and discover from different perspectives.

Introducing the Exploratory Cane and the 5 W’s

Using an exploratory cane to locate bubble wrap

What is An Exploratory Cane?  

The exploratory cane is a 12-14″ white cane. This short, white cane offers all of the same characteristics that a regular-sized white cane provides. The exploratory cane is made up of an aluminum shaft, golf grip, a marshmallow tip, elastic band and reflective red tape. The cane is light enough for a child to sit and hold onto the device, but at the same time it provides just enough weight to make it difficult for the child to lift it up more than a few inches off the ground.

A new cane!

Who Receives An Exploratory Cane? 

The exploratory cane is provided to a child with a visual impairment who has limited functional vision. The O&M specialist will provide these short canes to children who are likely going to benefit from the use of a white cane in the future. The earlier the cane is introduced to the child, the more time they have to become familiar with all of the features, textures and added benefits while they are in the sitting phase of motor development. 

Some children may not find the exploratory cane as interesting in the beginning, so it helps to get creative. Pre-cane items can include wooden or plastic cooking utensils. When providing a young child with these alternatives, they are still practicing the basic concept of holding onto and making contact with objects in their environment.

Playing a drum

When to Introduce the Exploratory Cane? 

The exploratory cane is introduced to a child as early as possible, before they master the milestone of cruising or walking. Ideally, the child is learning how to sit with minimal support or is emerging into independent sitting. The typical age for introducing these short canes can range from six months up to three years old while the child is with the NMSBVI Birth to Three Program. 

Why is the Exploratory Cane Introduced?  

The purpose of introducing the exploratory cane is to promote an interaction with objects around the child. This new tool can encourage the child to learn about different sounds when banging it against objects and surfaces. The child has a tool to transfer between hands as well as practice holding onto with both hands. The child will be encouraged to roll the cane tip across a variety of surfaces and learn about vibrations and other informative features and textures. 

Where to Introduce the Exploratory Cane?  

The exploratory cane is introduced to the caregiver and child in their natural environment. Initially, the child uses the cane in their home setting, but it can also be introduced in the daycare or community setting. Caregivers are encouraged to use it a few times each day, when the child is alert and active. Setting up an environment or defined play space for the child to explore and play with the cane is ideal. Providing the cane while the child is seated in different locations, such as the high chair, can also be beneficial.

Exploring the grip of a new exploratory cane

When O&M services begin, the family is provided with handouts as well as discussions about the possibility of a white cane in the child’s future. It is important to start these conversations about the “white cane” at such a young age because it provides the caregiver with more time to process what their child may need to be independent. When introducing the exploratory cane to the caregiver, the O&M specialist will explain how it is an extension of the child’s body. Here’s an example script of what that conversation may look like in order to help a caregiver understand the importance of using this tool.

The exploratory cane is a great tool to introduce when you’re ready for your child to start moving out into space. I know you’re ready for your child to start building those orientation skills, so they can begin to know where they are within their environment. At the same time, they are building an awareness of what the white cane feels like, sounds like, and the information it can offer. For a child with a visual impairment, their ability to visually search for an object they want can be difficult, which can impact their motivation to move. The cane allows your child to know there are things beyond their reach, which will hopefully motivate him to want to move out to find those items. The cane can help increase the child’s motivation to tap on and make contact with the floor surfaces, furniture, and other household objects. This activity can help the child build concepts as well as strengthen their hand, fingers and wrist muscles. In the beginning, you can place their favorite toy in front of them to make contact with and then eventually start moving those items out, away from their body. Challenging the child to extend further out in space and reach out with their exploratory cane can help them develop a better understanding of a larger environment. There’s something beyond their body that they have the choice to move towards if they so choose.

Let’s Get Moving! Bring on the AMD, Adult Teaching Cane and Toddler Cane

Learning to use an AMD

Adaptive Mobility Device (AMD)

The adaptive mobility device (AMD) is made from PVC and serves as an excellent pre-cane option. Designed specifically to facilitate a child’s transition to using a cane, each AMD is uniquely tailored to meet the child’s individual needs. Educating parents about the AMD is essential before the O&M specialist leaves it with the child at home. Close supervision during its use is crucial, and families must understand that AMDs are not intended to provide support or balance. To optimize the benefits of the AMD, consulting with the child’s physical therapist (PT) and occupational therapist (OT) is vital to ensuring they receive the best support. An AMD empowers children to navigate environments safely and purposefully, enabling them to find and identify objects. Acting as a bumper, the AMD contacts obstacles before the child does, helping to slow their movements and allowing them to process the information in their surroundings effectively. By incorporating an AMD into their routine, children gain the independence and confidence they need while moving about. Collaborating with the child’s O&M specialist is essential for determining the most appropriate type of AMD, ensuring the child can thrive as they explore the world around them. Caregivers enjoy getting to customize the AMD with the child’s favorite colors, wrapping it with duct tape or tennis grip wrap.

A young student uses an AMD to locate a tactile/auditory marker in his home.

Adult Teaching Cane

An adult teaching cane is provided to the family when the child with a visual impairment begins to show an interest in walking. These canes are to encourage the child to start taking steps with the caregiver assisting and guiding. The O&M coaches the caregiver on how to handle the cane and support their child as they take steps and move about. The child is shown how to place one hand to hold onto the adult teaching cane, while the other hand is holding onto the caregiver’s hand. The adult teaching cane provides the child with the information about the route as they navigate the environment together. The adult teaching canes provided to the caregiver vary from family to family. Some families need different lengths, cane tips and/or folding options.

An adult uses a teaching cane to walk with a young child at a park.

The caregiver can challenge the child as they become more confident and comfortable by releasing the child’s hand, having them walk while holding onto the adult teaching cane only. The O&M can provide strategies for the caregiver to work on as they practice walking while using the adult teaching cane. The child can be shown how to make right/left turns as the caregiver labels and gives directionality information. Words such as slow down, stop and go can be practiced so the child can feel these actions in real time with the caregiver guiding them through these movements. FUN games, such as Red Light, Green Light! can be played to help with communication, strength, balance, stamina, and basic cane skills. Caregiver-toddler games are the earliest social interactions that encourage language and communication development.

The child and adult continue walking by the park with the adult teaching cane.

Toddler Cane

The toddler cane is introduced after the child has graduated from using the adult teaching cane. Once the child is independently traveling about with their own toddler cane, the O&M specialist will need to provide more direct support to the child’s family as a whole. Coaching the whole family on basic O&M skills is essential as they are with the child more than the O&M specialist. The toddler cane provides the child with opportunities to explore different surfaces and obstacles within their path. The goal is helping the child learn to be successful when planning a route with the O&M and caregiver providing guidance. Instruction begins in the home setting before moving further out to practice routes outside of the home. This may include walking from the child’s front door to the mailbox or to the caregiver’s vehicle. Afterwards, families are encouraged to go out into the community: the park, the local mall, grocery store, library, zoo, museum, and other community settings. During these stages of learning, the O&M specialist can teach the family and child about proper hand grip, how to ascend/descend stairs, use upper/lower protective techniques, trail walls, detect drop offs, as well as many other beneficial cane skills. The goal of the O&M specialist is to provide the family with the highest level of support and instruction in the first three years, in hopes that the child will reach their full potential with their travel abilities.

I can carry a cane, a chicken nugget and a race car!

A young child uses a toddler cane to detect a drop off.

When meeting with families out in the community, there will most likely be a time when the child’s cane is misplaced or left behind at home. O&M specialists can get creative with the caregiver and use an alternative, when needed for the visit. These alternatives may include a push toy or similar item that acts as a cane. The O&M specialist is encouraged to let the child take the lead to safely move with a purpose. When provided the opportunity to explore, the child gets to build upon and develop their problem-solving skills.

A fun alternative (candy) cane!

O&M Outings in the Community

Providing O&M services in the community is just as crucial as offering experiences in a child’s natural environment. The O&M specialist needs to observe how a child interacts and explores in various settings—indoors, outdoors, busy environments, and unfamiliar locations. Children quickly learn to map their surroundings, and by introducing them to new or unfamiliar environments, the O&M specialist can gather valuable information about the child’s travel skills. This information can help plan and develop strategies for families, preparing the child for a smooth transition into school.

Walking on a new surface

A young student uses a toddler cane to walk through a department store.

Community visits can include local shopping centers such as malls, grocery stores, libraries, parks, new school settings, museums, zoos, and many more! These outings are planned with family input in mind, ensuring their preferences are considered regarding where their child would like to explore.

Fun at the park!

Outings provide an excellent opportunity to teach crucial O&M concepts—such as labeling objects, following directions, practicing routes, localizing sounds, using a cane in unfamiliar environments, and enhancing the child’s use of vision in new contexts. These community experiences offer both families and children the opportunity to engage in environments that may not be part of their daily lives, broadening their experiences.

Oh, Christmas Tree!

Moreover, we focus on teaching vital transition skills, including traffic awareness and recognizing environmental sounds. These outings demonstrate how families can consistently reinforce these skills while navigating their communities. O&M specialists can empower families, but it is the parents who make the true impact. By equipping them with the right tools and strategies, they can foster the child’s independence and confidence in the world around them! 

An O&M specialist helps a student descend the steps at the school stadium.

Conclusion

Begin implementing the FUNdamentals of Orientation and Mobility services for children who are blind or visually impaired starting today! It’s never too early to provide these essential services. At NMSBVI, we firmly believe that every child deserves access to O&M. By introducing O&M at an early age, we give children a significant advantage as they prepare for school. Establishing confidence in their mobility is one of the greatest challenges these young individuals face. By offering support during this crucial time, we can help them acquire vital skills for their future. The primary aim of early O&M is to empower these children to become independent and safe travelers, equipping them with the necessary tools to thrive as successful adults.

Playing at the park

First day of school!