Low Vision: Orientation and Mobility (2024)

By Galton Vasconcelos, MD; Luciene C. Fernandes, MD

Introduction

The International Classification of Functioning, Disabilities, and Health, Children and Youth Version, and Management of Low Vision in Children (World Health Organization) established that visual functioning of infants and young children can be stated in 4 main areas of daily life function:1,2

  • Orientation and mobility (O&M)
  • Communication
  • Activities of daily living (ADL)
  • Sustained near-vision tasks

The effect on these 4 main areas varies depending on the type and degree of impairment and additional impairments. The effect is also influenced by the social environment and culture the child lives in.2

Parents and relatives who live with and relate to a low-vision child might fear for the child's safety, depriving them of elementary experiences necessary for physical survival and psycho-emotional and social maturity, both of which can increase dependence, increasing the damage caused by the visual disabilities themselves.

Orientation and mobility (O&M) training can help develop the child's orientation in space as well as movement and safety in travelling.

O&M instruction is not only crucial to the multihandicapped child, but can also be very helpful to the mild or moderately vision-impaired child as well. (See Delayed Visual Development: Development of Vision and Visual Delays.)

Severely affected O&M causes further serious limits on a visually impaired child. By walking independently, a child with low vision will have more opportunities to achieve their social integration and become independent individuals.

Definition

Orientation

Orientation means an awareness of position in space.3 It refers to the ability of a child to realize his surroundings, establishing body, space, and time relations with his environment through the senses of hearing, touch, smell, and residual vision.

Mobility

Mobility means the capability of moving through the environment safely, efficiently, and independently.3 It refers to the ability of child to move and to react to various stimuli. This is often achieved through a teaching-learning process that involves the use of several features including a sighted guide, a long cane or a support cane, a protective arm, trailing, a guide dog, and an electronic aid.

There are no reliable current statistics on the use of canes or guide dogs in the United States, especially in children. However, Guiding Eyes for the Blind estimates that "there are approximately 10,000 guide dog teams currently working in the United States and about 2% of all people who are visually impaired work with guide dogs."4

O&M is usually available on an itinerant basis in the community or in a school for the blind.

O&M Training

Basic Guidelines

  • Considering its complexity, O&M training must be stepwise and geared toward helping the low-vision child eventually move and navigate independently.
  • O&M training is much more than simply teaching the technique on how to use the cane. Both the psychosocial and cognitive aspects relevant to teaching a person with disabilities must be considered, especially for them to get around with autonomy in locomotion and self-confidence.
  • An O&M training program must be geared toward the difficulties of each low-vision child individually.
  • A child who is born with low vision or who becomes visually impaired very early in life might have problems related to the development of concepts linked to position, location, direction, and distance.
  • At the minimum, each child should be given as many practical and meaningful experiences related to the context of their particular life, and this should be started in early intervention programs.
  • Evaluating basic visual functions for each child is very useful. The ophthalmologist should always try to find ways to improve contrast, color differentiation, and appropriate illumination of the environment.
  • Procedures and skills should also be transferred to the family members, who in turn will reinforce continuation of learning these skills at home. (See Delayed Visual Development: Development of Vision and Visual Delays.)

O&M Programs

O&M programs should be structured individually for each patient. Although individualized, it should be exercised in small groups, with the participation of other professionals and family.

Objective

The objective is to provide conditions for a child with visual impairment to develop their abilities to navigate and move independently.

O&M training should cover activities that allow the child to explore their maximum potential. Some technical considerations are listed below:

  • Basic movement: locomotive, manipulative
  • Perceptual skills: visual discrimination, auditory, tactile, olfactory, and coordination ability
  • Physical capacity: cardiovascular and muscular strengths, flexibility, and agility
  • Nonverbal communication: Common postural problems are tilting the head forward or downward, avoidance of extension of the arms, dragging of feet and arms, and loss of balance. The longer the duration of immobility after the diagnosis of low vision, the more pronounced difficulties might be found.

The program is divided into 2 parts: indoors and outdoors.3,5

Part 1: Indoors

  • Training in the use of residual vision and nonvisual senses
  • Interpretation of clues, establishment of benchmarks, relationship with space and time through the remaining senses
  • Skills to be developed: techniques using a sighted guide, self-protection, and long-cane techniques

Part 2: Outdoors

After achieving adequate indoor abilities, the child can move to outdoor experiences such as mobility in areas with intense pedestrian traffic, familiarization with vehicles, public transit, elevators, supermarkets, shopping malls, and other specific environments. Follow-up is essential. The mobility instructor must accompany the child to give reorientation, avoid accidents, and discuss difficulties with the patient and family.

The sooner the O&M training begins, the easier it will be for the child to build an organized self-image, body awareness, and independence in daily life.

References

  1. World Health Organization. International Classification of Functioning, Disability and Health: Children and Youth Version. ICF-CY. WHO Press.2007.
  2. World Health Organization. Program for the Prevention of Blindness: Management of low vision in children. Report of a WHO Consultation. Bangkok:1992.
  3. WHO/PBL/93.37.
  4. Faye EE. Clinical Low Vision. 2a.Ed. Boston/Toronto: Little, Brown, and Company. 1984. 415433.
  5. Guiding Eyes for the Blind. General Information. 2014.
  6. Hyvarinen L, Jacob N. What and How Does this Child See? Assessment of Visual Functioning for Development and Learning. Helsinki, Finland: Vistest Ltd. 2011.174.
Low Vision: Orientation and Mobility (2024)

FAQs

What is orientation and mobility for low vision patients? ›

Orientation and Mobility (O&M) involves training in key areas: Orientation: This helps people with blindness and low vision understand their environment—learning to use sounds, smell, texture, touch, and other sensory cues to interpret the environment, orient themselves, and mentally map their surroundings.

What are some common challenges for someone with low vision? ›

Living with low vision can be challenging and isolating, making daily activities such as reading, cooking, and navigating unfamiliar environments difficult.

How does visual impairment affect mobility? ›

VA impairment is associated with slower walking speeds 7, a greater likelihood of reporting mobility difficulty 6, and an increased risk of developing mobility disability.

What is the relationship between orientation and mobility? ›

Orientation refers to a person's ability to use their senses to know where they are positioned in their environment. Mobility refers to the person's capability and readiness to move in their environment.

What are the mobility skills for visually impaired people? ›

Essential Orientation & Mobility Skills for Those With Low Vision
  • Spatial Awareness. ...
  • Sensory Awareness. ...
  • White Cane Techniques. ...
  • Guide Dog Training. ...
  • Public Transportation. ...
  • GPS and Assistive Technology. ...
  • Crossing Streets Safely. ...
  • Indoor Navigation.
Nov 15, 2023

Which is a method of orientation and mobility that people with vision impairments use? ›

Orientation and mobility (O&M) training teaches a person with visual impairment to use mobility aids such as a white cane or guide dog and move safely through their environment. Professionals usually conduct sessions one-to-one so they can tailor training to a person's specific needs and goals.

What is considered low vision for disability? ›

You may be eligible for benefits if you have 20/200 vision in either eye that cannot be corrected, or if you have a visual field of 20 degrees or less in your better eye.

What do people with visual impairments struggle with? ›

Vision loss can affect one's quality of life (QOL), independence, and mobility and has been linked to falls, injury, and worsened status in domains spanning mental health, cognition, social function, employment, and educational attainment.

What are the characteristics of a person with low vision? ›

not be able to see objects at a distance, like on a whiteboard or blackboard. having trouble reading (or learning to read) and participating in class. not be able to focus on objects or follow them, may squint often and rub their eyes a lot, have chronic eye redness or sensitivity to light.

What is the relationship between mobility and vision? ›

The way we perceive the world through our eyes is vital for us to achieve the best possible mobility. Research has indicated that visually impaired people have slower walking speeds, poorer balance, experience more falls and report greater mobility difficulty than non-visually impaired people1.

What are the signs of mobility impairments? ›

Mobility Impairment
  • difficulty with transfers.
  • motor skill limitation.
  • muscle strength decreased.
  • range of motion limitation.
  • reluctance to attempt mobility.
  • requires assistance with ambulation.
  • shortness of breath during or after activity.
  • unable to reposition self independently.
Jan 10, 2022

Is mobility a disability or impairment? ›

A mobility impairment is a disability that affects movement ranging from gross motor skills, such as walking, to fine motor movement, involving manipulation of objects by hand. For more information, consult Glossary of Disability-Related Terms and Mobility Impairments.

What are the clues in orientation and mobility? ›

Orientation & Mobility experts define clues and landmark as, “any familiar object, sound, smell, temperature, tactile or visual clue that is easily recognised, is constant and has a discrete permanent location in the environment that is known to the traveller.” A clue can include the sounds, smells, temperature, ...

What are examples of orientation and mobility? ›

Using a cane and other devices to walk safely and efficiently. Soliciting and/or declining assistance. Finding destinations with strategies that include following directions and using landmarks and compass directions. Techniques for crossing streets, such as analyzing and identifying intersections and traffic patterns.

What are the four basic techniques in orientation and mobility? ›

It defines orientation as a blind person's awareness of their physical position and mobility as their ability to safely and independently move from place to place. It then outlines various techniques including cane technique, sighted guide techniques, self-protective techniques, and general orientation tips.

What are examples of orientation and mobility services? ›

In addition, orientation and mobility services include, as appropriate, spatial, and environmental concepts and the use of sensory information to establish, maintain or regain orientation and line of travel. An example is the use of hearing to listen at traffic intersections to learn how to safely cross a street.

What would be most useful for orientation and mobility training for visual disability? ›

Two types of canes are most commonly used: The support cane provides physical stability. A white support cane can identify you as a person who is blind or has low vision. The probing cane (more commonly called a “white cane” or a “long cane”) probes for and locates obstacles in your path of travel.

What is orientation and mobility instruction? ›

Orientation and mobility training helps a person with a visual impairment know where he or she is in space and where he or she wants to go (orientation) and how to carry out a plan to get there (mobility).

What is the concept orientation and mobility in the area of deaf blindness? ›

Orientation is knowing the layout of your body, knowing where you are in space and time, knowing where you are going, and how to get there. Mobility is the act of moving from place to place—it may be active (e.g., scooting, crawling, walking) or passive (e.g., wheelchair, stroller, being carried).

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