The abilities of persons who have visual impairments and who also use a wheelchair, scooter, walker, or support cane can vary greatly. Any attempt to say that a specific skill will work with all consumers should be taken with great skepticism. The purpose of this book is to share techniques and strategies that have been used successfully with students in the past. This book does not suggest that any particular skill should be taught in a particular method, and acknowledges that what has worked successfully with one student has failed miserably with others.
Advances in medicine and technology have reduced the infant mortality rate while increasing the number of premature and low birth weight babies who survive. Children who are born with disabilities and adults who acquire them later benefit today from accessibility awareness, innovations, and improvements. More and more individuals who have visual impairments also use wheelchairs or other orthopedic aids. The topic of teaching Orientation and Mobility (O&M) to people with orthopedic impairments has received little attention in blindness-related literature. There are some generalized book chapters with very little information on techniques specific for visually impaired wheelchair users. Most Orientation and Mobility Specialists receive very little training during their university degree programs on how to work with wheelchair users. Most of what the instructors learn comes from trial and error or from peer consultation.
When consumers are asked how they acquired their wheelchair or support cane, they often report that it belonged to their husband, mother, or some other family member. Sometimes physicians prescribed the device, but the consumers never received training on how to use it. Other consumers report that salespersons have literally shown up at their door offering to get the device for them at no cost. Once the device is delivered, the consumer may receive brief instruction on how to perform basic operations, like turning on the electric wheelchair and how to plug it in to charge. Rarely are the consumers asked to sit in the wheelchair and try driving it with the sales representative there. None of the students with whom this instructor worked were actually given any outdoor training, unless they were later referred to physical or occupational therapy. Even then, the amount of outdoor training was very limited. If an O&M Specialist fails to consult an Occupational Therapist (OT) and a Physical Therapist (PT), aspects of the student's conditions or potential aides and appliances that may make it possible for the student to reach her full potential may be missed. Medical professionals may be limited in the amount of time they can work with the consumer. Most insurance providers do not pay for the time that O&M Specialists frequently spend with their students.
Ideally, professionals must work as a team to train individuals who are both visually impaired and need travel devices. O&M Specialists, OTs, PTs, Physiatrists, Kinesiotherapists, and the assistants within each of these professions each have a unique set of skills and resources that are vital to the success of the people with whom they work. Through exercise and techniques, a PT or OT may help reduce dependence on a wheelchair, walker, or support cane. Some students have improved to the point where they move to a less restrictive device, or to the point where they don't need any supports. Unfortunately, sometimes a person becomes more dependent on the device; try to prevent this from happening. For this reason, doctors and therapists may refuse to authorize wheelchairs for a person who can walk. The phrase "the more you use the chair, the more you will need it" can be very true. On the other hand, not having a device can severely limit one's independence. Often, when medical professionals choose not to prescribe wheelchairs for their patients, they have not taken into account the severe limitations put on independent travel when a person cannot drive or walk more than a block or two. Invite the PT and OT to attend a few lessons; it may change their view on the need for a powered aide.
People use wheelchairs for a variety of reasons, including but not limited to the following:
Wheelchair users also vary as to when they use their chairs; the consumer may use a chair full time, part time, temporarily, or intermittently.
Full time wheelchair users will enter the instructor's office in their chairs. However, even if a student enters in a wheelchair, the instructor should not assume that she uses the chair all the time. Students may utilize a wheelchair to report to training, but be able to ambulate within their homes without the chair.
Part time wheelchair users may report with or without the chair. If during the intake interview a student does not present with a chair and states that she has limited stamina or significant pain when standing or walking, the instructor should ask the student to consider the wheelchair as an option.
Temporary users are people who have some injury or other medical condition that creates the need for the chair; with good health, they should not need it at a later date.
Intermittent users are people who may not use the chair for significant lengths of time but have brief, repeated stretches of time (e.g., acute arthritis) when they need the chair.
While the potential for independent travel by visually impaired wheelchair users is great, not all consumers will choose to travel to the full extent of their potential; this is okay. Instructors must respect students' right to decide how far to pursue their travel skills. When told that they will be crossing major intersections and riding busses and trains, some consumers are frightened out of pursuing mobility training. At the opposite extreme, some consumers receive their chairs and get themselves into trouble by attempting to do too much, too fast. Family members may observe some early mistakes made by the student and discourage the student from continuing. Students and their families need to be reassured that while all travel involves risk, the student will not be put into unsafe situations. They need to understand that instruction will start slowly and only progress as far and as fast as the student's abilities allow. For some students, it works best to initially discuss the early goals and to save discussions about riding the bus or crossing major, light-controlled intersections until after they have built confidence in their ability.
Goal setting can be affected by many factors. Some students may have the potential to attain certain objectives, but the process and the amount of effort that it would take are not realistic.
Students who initially limit their goals may change their minds as training progresses. They may feel that they don't need certain skills, like riding busses or crossing large streets, but later realize they do need and want these skills.
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