A seamless approach to transitioning cane skills from the diagonal to the two-point touch technique.
Article Type: Report
Subject: Medical education (Methods)
Ophthalmology (Study and teaching)
Author: Penrod, William M.
Pub Date: 04/01/2012
Publication: Name: Journal of Visual Impairment & Blindness Publisher: American Foundation for the Blind Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 American Foundation for the Blind ISSN: 0145-482X
Issue: Date: April, 2012 Source Volume: 106 Source Issue: 4
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 287867028
Full Text: The profession of orientation and mobility (O&M) is replete with literature describing specific cane techniques (Hill & Ponder, 1976; Jacobson, 1993; LaGrow & Long, 2011; LaGrow & Weesies, 1994), strategies for teaching O&M to specific populations and age groups (Dodson-Burk & Hill, 1989; Fazzi & Naimy, 2010; Griffin-Shirley & Welsh, 2010; Skellinger & Sapp, 2010; Welsh, 2010), rationales, and appropriate settings (Hill & Ponder, 1976; Jacobson, 1993; LaGrow & Weesies, 1994; LaGrow & Long, 2011). These strategies and techniques are also addressed in many university preparation programs.

All the foregoing authorities have done an excellent job of using task analysis to describe specific cane techniques, and some have even offered suggested sequences for introducing skills and presented teaching strategies. However, there is an apparent paucity of information on specific activities that are necessary to "connect the dots" for practitioners that make sense to students and that provide a nearly seamless transition from what has been learned previously to what needs to be learned. Such information may be provided by practitioners who have determined from their experience what works best with students who are blind.

A case in point is the two-point touch technique (Hill & Ponder, 1976; Jacobson, 1993; Knott, 2002; LaGrow & Long, 2011; LaGrow & Weesies, 1994). All agree that there are essentially seven components to this primary mobility skill for travel in familiar and unfamiliar environments. These components are: the position of the cane (at the midline), the index finger down the flat side of the grip, wrist action (flexion, extension, and hyperextension), the height of the arc (no more than 1.5 inches off the surface at the apex of the arc), the width of the arc (approximately 1 inch beyond the widest parts of the student's body), rhythm (the cane taps the surface each time either of the student's heels touches the surface), and staying in step (the cane taps on the opposite side of the foot touching the surface). Note that Pogrund et al. (2000) identified nine components for the same skill by separating the arm position and the hand position and adding an additional component "in-step correction" (that is, skipping or tapping the cane twice on the same side to get back in step, while Knott (2002) identified only six steps. However, differences between these techniques are descriptive rather than substantive.

I have frequently observed that if the skill set known as the two-point touch technique is taught as a whole, both the student and the instructor are often frustrated. Such attempts are characterized by constant verbal corrections--for example, "arc left, arc right, get in step, arc right, cane at the midline, not enough coverage on your right, your arc is too high, you're out of step," ad nauseam!

As a solution, when using this strategy, the instructor is advised to introduce the components one step at a time, starting with the diagonal technique. It should be emphasized that the following is just one strategy, not the only strategy, for teaching the two-point touch technique, and, as a professional, the instructor has every right to make modifications that he or she deems appropriate for the individual student who is blind.

The diagonal technique is usually the first independent cane technique that is taught to students. Succinctly, it serves the purpose of being a bumper that is far more effective than the lower hand and forearm protective technique, and can be used to trail vertical surfaces for alignment and to locate doors and intersecting hallways. In addition, this technique is extremely easy to teach, easy to learn, and infinitely functional for familiar indoor environments where there is no danger of drop-offs or stairs, and may used to make the transition easily and seamlessly to the two-point touch technique.

STEPS IN THE TECHNIQUE

Step 1

Have the student position the cane diagonally across his or her body with the cane tip on the floor. Ensure that the student's thumb is in a proximal position (close to the body) and that the cane is pushed forward with the thumb until both the grip and the cane tip are no more than an inch or so beyond the widest parts of the student's body. Although the student may elevate the cane tip an inch above the surface, that step is not needed in most circumstances. The instructor must initially position the student's body in the desired positions.

Step 2

Have the student follow the instructor's voice or, even better, an audible and distinguishable sound source, such as keys being jingled. Only two verbal corrections are usually needed: "cane tip is too high" and "increase your coverage on the right [or the left]." The instructor should be cognizant of stairs and drop-offs that may be in his or her path, since if the instructor unknowingly backs off a flight of stairs or drop-off while watching a student, he or she may be severely injured.

Step 3

Position the student on the right side of the hallway with the cane in a diagonal position and the cane tip against the wall, and ask the student to trail the wall until the student finds the intersecting hallway. Repeat the process as many times as needed and then have the student locate doors. Encourage the student to use the upper hand and forearm protective technique when in proximity to protruding and overhanging objects along the wall. Repeat this step until the student has mastered it. In this and all subsequent steps, mastery is determined according to when automaticity is achieved. Guth, Riser, and Ashmead (2010, p. 17) defined automaticity as "the amount of attention required to perform a motor skill-the less attention that is required the more automatic that behavior is said to be." In other words, the student should practice the skill until he or she performs it to the standard without conscious thought.

Step 4

Give the student an anticipatory set. That is, explain that as good as the diagonal technique is, it will not reliably detect drop-offs or stairs and should be used only in familiar indoor places. To travel in unfamiliar places where there may be stairs or drop-offs, the student should use the two-point touch technique or its well-established variation, the constant contact two-point touch technique, which provides additional protection because the cane tip never leaves the surface being traveled. Give the student an incentive to use this technique; for example, taking attendance sheets to the office is usually a prized responsibility for many elementary school-aged students.

Step 5

Place the student in the middle of an open hallway as in the diagonal technique. Ask the student to position his or her finger down the flat side of the cane and to follow the sound source as he or she did with the diagonal technique. Since the thumb is still in a proximal position, doing so will take only a few minutes. The student's palm is pronated. This step introduces the student to the grip.

Step 6

From the diagonal technique position, have the student lightly tap the cane tip on the surface each time either foot touches the floor as he or she follows the instructor down the hallway. This step introduces the student to rhythm.

Step 7

From the diagonal technique position, have the student lightly tap the cane only when the appropriate foot touches the surface. For example, if the student is right-handed, the cane will tap only when his or her right heel touches the surface as the student follows the instructor's sound source. This step introduces the student to being in step.

Step 8

From the diagonal technique position, have the student center the cane from the midline and extend the cane tip directly forward. The student's palm is positioned medially. Ask the student to tap the cane lightly as he or she walks toward the instructor's sound source. The only correction that is usually needed is "too high" or "too low." This step introduces the student to the notion that the cane is positioned at the midline and reinforces rhythm.

Step 9

From the modified diagonal technique with the cane centered and extended forward at the midline, ask the student to kick the cane out of the way every time he or she takes a step. Some instructors may want to start from the traditional diagonal technique position with the cane positioned in front of the left foot if the student is right-handed.

This step introduces wrist action (flexion, extension, and hyperextension) and reinforces rhythm and being in step. Usual corrections are to kick the cane to the left side using the right foot and to kick the cane to the right side using the left foot. Do not worry about the width of the arc at this time. My experience has shown that the arc will naturally narrow as the student's walking speed increases and automaticity occurs. There will be plenty of time for refinement in subsequent lessons.

Step 10

After the student has progressed to the point that the movements are natural and fluid, introduce additional corrections for refinement: "arc right, arc left, too much right, too much left, and arc too high." Doing so will refine the width of the arc while reinforcing the height of the arc and being in step. Continue these corrections until the student has achieved automaticity.

Once the student has mastered the two-point touch technique, the instructor can use the same method to teach more advanced skills. In fact, using a constant contact modification of the two-point touch technique actually removes the subtask "height of the arc." Touch trailing may be taught by introducing just one more subtask: contacting the wall that the student wants to trail with the cane tip. Touch trailing, touch and drag, and touch and slide may all be taught by introducing one or two more subtasks to the previously learned techniques. Although the three-point touch technique requires more attention, it can also be mastered one subtask at a time. Simply start with touch trailing and have the student extend the arc over and past the curb (a new subtask) and step and pause (a new subtask); by doing so, the instructor has provided the student with a seamless transition from touch trailing to the three-point touch technique.

CONCLUSION

This is not the only method one can use to teach the two-point touch technique to students who are blind, but it is a way that I have found to be effective for many students. Although with some students, it is not reasonable to expect that perfect mastery will occur, the instructor should determine if further effort is warranted on the basis of both the characteristics and the travel needs of a particular student. I advise instructors not to move on to a subsequent subtask until the student has practiced the preceding one to the point that it is not going to get any better. Remember, practice does not make perfect; only perfect practice makes perfect!

This method is based on three practical premises:

1. On the basis of sound and logical task analyses, introduce each subtask until the student has achieved mastery, as evidenced by the student's automaticity.

2. Introduce one subtask at a time and reinforce it with as few verbal corrections as possible. Positive reinforcement is effective during this learning experience because the proper application increases the probability not only that the behavior will recur, but that it will improve.

Over the years, I have taught many students using this method. I believe that with many students, this method provides a time-efficient and effective transition to the mastery of cane skills.

REFERENCES

Dodson-Burk, B., & Hill, E. (1989). An orientation and mobility primer for families and young children. New York: American Foundation for the Blind.

Fazzi, D., & Naimy, B. (2010). Teaching orientation and mobility to school-age children.

In W. Wiener, R. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. 2, pp. 208-262). New York: AFB.

Griffin-Shirley, N., & Welsh, R. (2010). Teaching orientation and mobility to older adults. In W. Wiener, R. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. 2, pp. 286-311). New York: AFB Press.

Guth, D., Riser, J., & Ashmead, D. (2010). Perceiving to move and moving to perceive: Control of locomotion by students with vision loss. In W. Wiener, R. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. 1, pp. 3-44). New York: AFB Press.

Hill, E. W., & Ponder, P. (1976). Orientation and mobility techniques: A guide for the practitioner. New York: American Foundation for the Blind.

Jacobson, W. H. (1993). The art and science of teaching orientation and mobility to persons with visual impairments. New York: AFB Press.

Knott, N. (2002). Teaching orientation and mobility in the schools: An instructors' companion. New York: AFB Press.

LaGrow, S. J., & Long, R. (2011). Orientation and mobility: Techniques for independence (2nd ed.). Alexandria, VA: Association for the Education and Rehabilitation of the Blind and Visually Impaired.

LaGrow, S. J., & Weesies, M. J. (1994). Orientation and mobility: Techniques for independence. Palmerson North, New Zealand: Dunmore Press.

Pogrund, R., Healy, G., Jones, K., Levack, N., Martin-Curry, S., Martinez. C., Marz, J., Robertson-Smith, B., & Vrba, A. (2000). Teaching age-appropriate purposeful skills: An O&M curriculum for students with visual impairments. Austin: Texas School for the Blind and Visually Impaired.

Skellenger, A., & Sapp, W. (2010). Teaching orientation and mobility for the early childhood years. In W. Wiener, R. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. 2, pp. 163-207). New York: AFB Press.

Welsh, R. (2010). Teaching orientation and mobility to adults. In W. Wiener, R. Welsh, & B. B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. 2, pp. 263-285). New York: AFB Press.

William M. Penrod, Ed.D., assistant professor, Department of Special and Early Education, Northern Illinois University, 232 A, Graham Hall, DeKalb, IL 60115-2828; e-mail: .
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