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University of Edinburgh
 

A Case for Mobility

Margaret Lee
Moray House Institute 1988

Introduction

This project was embarked upon because of the growth in the numbers of children with severe visual impairment being integrated into their local mainstream schools and due to the fact that, in most cases, inadequate provision was being made to meet their correspondingly increased need for orientation and mobility skills. Although orientation and mobility have specific individual meanings, because of the interdependency of the two sets of skills, it has been decided that for the purpose of this paper, they should be treated as one curricular area.

Traditionally, 'orientation and mobility' is seen as being a highly specialised area of the curriculum involving acquisition of such skills as long cane techniques and road crossing etc. These skills were originally developed in Hines Hospital, Illinois, rehabilitate those blinded during the World War II USA, to help These skills were eventually taught to older children to prepare them for adult life. Present day thinking has broadened the interpretation, and orientation and mobility is now recognised as being part of the overall development of every child and in the yet unpublished COSPEN Report (1987) which was commissioned by the Consultative Committee for the Curriculum, orientation and mobility is identified as being specific areas of need for children with visual impairment.

Though now not always the case, in the past, all children placed in a special school specified as meeting the needs resulting from their blindness, would have had the services of a specialist in orientation and mobility and it would seem reasonable to suppose that, where required, this provision is as necessary as the teaching of braille. Strange as it may seem, those schools, which in the past were designated as being for partially sighted children, ie, 'sight-saving' schools, and which did not encourage the use of residual vision, do not appear to have had such provision. It is recognised that not all visually impaired children require braille as some are able to use sighted methods if given some additional help, and even here special provision is being made by way of expertise and resources.

The submission of this paper is that an equal amount of importance should be attached to the provision of expertise in teaching blind and visually limited children about the world they live in and to help them develop the numerous concepts required in order to cope with the environment. From observation, it would seem that there is much enthusiasm, energy and money expended on the provision of high-tech. resources but one wonders if enough is spent on providing and/or training human resources in its use and in the skills required to meet all the needs of those children with limited vision who are being integrated into mainstream

Unfortunately, no amount of hardware can help meet the needs of a child who has poorly developed orientation and mobility skills. Ideally the developmental nature of orientation and mobility requires the commitment and involvement of the class teacher as well as any available specialist. It should also be said that teachers holding qualifications in teaching children with visual impairment should certainly have the necessary skills to meet the developmental needs in this area of the work. In many cases, they may suffer from lack of confidence and will certainly need the further support of the Orientation and Mobility (O&M) specialist.

In addition, the extent of their specialist expertise is limited due to the highly skilled nature of the work when the child becomes old enough to wish to be more independent. However, they do have the skill and knowledge to back up and consolidate work done by the O&M specialist.

The main aim of undertaking this survey was to heighten the awareness of mobility needs and to look at how they may best be met. The survey falls into five main parts which look at: the incidence of visual impairment which is sufficiently severe to require specialist support; the extent of the need for mobility and orientation teaching. a very brief examination of how regional and/or divisional authorities address the meeting of specific mobility needs. a look at the perceptions and provision in other countries. submission of views of how provision may be made and delivered most efficiently and cost effectively. As already mentioned, mobility is seen as being a highly specialised area of the curriculum. However, because of the importance of this work, for its own sake, as well as for the implicit concept and sensory areas of development, it is now recognised as being the responsibility of all those who work with visually impaired children as well as being an integral part of the curriculum for the child with a visual impairment.

It should be said that spatial and environmental concepts, body awareness as well as the heightened use of hearing, touch and any usable vision etc have long been recognised as being crucial areas of the curriculum for the child with severely limited vision. In addition, it is now acknowledged that they are crucial factors affecting and being affected by the development of orientation and mobility skills. These developing skills are not seen as being the sole responsibility of any one party but of all those with responsibility for the children, ie the parent, class teacher, the support teacher or the mobility specialist and, as will be seen in the work of Tooze (1981), much team work is required. However, the role of the specialist in mobility and orientation is obviously going to be greater as the young person matures and requires an ever-increasing number and range of skills to acquire and maintain his/her age-appropriate level of independence. Further thoughts on this will be found on the chapter "Making Mobility Work".

2 Historical Background

As will be explained elsewhere, orientation and mobility techniques were developed in America during the last war in order to rehabilitate those veterans blinded during hostilities. These techniques were brought to Britain and used with adults and with older children placed in special schools for the blind. The training of instructors was the responsiblity of the National Mobility Centre situated in Birmingham. Those entering training were mainly employees of societies for the blind and the social services. However, most special schools for blind children in England and Wales sent at least one member of their staff for training and those who were teachers were not expected to undertake the teaching placement part of the Mobility Course as they were already successful and experienced teachers who would return to their own schools on completion of the course.

In investigating the incidence of those children who required support due to their visual impairment, it was decided not to cast the net too widely as this could result in making the project rather unwieldy and unworkable due to the time constraints imposed. For this reason, only those support staff known to the writer and to headteachers of special schools where there was no provision made for mobility by the education authorities were approached. The project was divided into two main parts:
Phase l. Questionnaires sent out - a. to support teachers. b. to special schools.
Phase 2. Further questionnaires sent out to those agreeing to participate in Phase 1.

It should be stressed that those taking part in this exercise were all acutely aware of the general and specific needs of those children for whom they are responsible. However, because of the number of children and young people involved, and the range and diversity of skills required, there is no way they could possibly undertake the meeting of all those needs imposed by limitations in orientation and mobility skills.

Any discrepancies in the figures may be due to some people including children who were in fact, placed in special needs settings, instead of confining their figures to those children placed in mainstream. However, every effort was made to check up on this as far as is possible. Of the Phase la., questionnaires sent out to peripatetic, resource and support teachers were all completed and returned with the exception of one which represented 14 visually impaired young people in a post-school setting. The number having O&M needs in this setting is not known, but there is at present no appropriate provision for meeting those needs.

3 Incidence of supported children with visual impairment

By far the largest number of children were in the Strathclyde region. Although Strathclyde is made up of a number of widely scattered divisions, the employment of more than one O&M specialist could be justified especially in the most densely populated divisions where there are three special schools which meet the needs of visually impaired children. There were a total of 520 children and young people (232 from Strathclyde) who were either in mainstream school or in a special needs setting where visual impairment needs are claimed to be met. With the exception of Fife, where the part-time services of a mobility officer had been introduced, no other regions in Scotland currently employed the services of an O&M specialist. In spite of the fact that a total of 91 children (59 from Strathclyde) were perceived as having pronounced mobility needs, no specialists were involved except in an unofficial capacity.

Another factor which should not be forgotten, is that those children with visual impairment and additional disabilities, who were placed in general special educational needs settings, were not included in the above figures, even when they were given support from peripatetic teachers of the visually impaired and had mobility and orientation identified as being an area of need. In this chapter,

Strathclyde region has been singled out on a number of occasions, this is because it is the biggest region in Scotland and has the largest number of children with visual impairment. However, although provision tends to vary from division to division, Strathclyde is also the largest provider. It should also be noted that there is no mention made of some regions, which are conspicuous by the fact that no specialist support teacher for children with visual impairment are known to the writer.

4 Definition of Orientation and Mobility

Having asked those who kindly agreed to complete questionnaires, most people agreed with the definitions of Orientation and Mobility given viz:
Good mobility involves the ability to move safely, efficiently and as gracefully as possible. Teaching mobility to visually impaired children, means giving each individual child the additional skills necessary for him/her to move well. The ability to find one's way in the environment by receiving and utilising the maximum amount of sensory input.

Several worthwhile comments were made to qualify and elaborate upon the exact interpretation of these two interdependent terms. It was felt that in addition to 'how the child moves' should be added the environmental aspect of familiar and unfamiliar surroundings. It was thought to be a little difficult to find a measurement or parameters for 'moving well', but the expression 'an acceptable posture and gait' is one that can be easily identified with. The difficulty of analysing unacceptable movements and positions is probably an area which requires the eye of the specialist when it comes to definition and remediation

The real emphasis should be placed on avoiding postural anomalies in the first instance, because, as maintained by Lee (1986), these postural and gait deformities, (except where there were pathological causes), in almost all instances had their origins in apprehension about the environment and the unknown obstacles lurking therein. It is an acknowledged fact that once these coping postures and gaits become firmly established, they are extremely difficult to eradicate. They feel normal to the child whose proprioception is tuned-in to accustomed messages from these positions and movements.

Many unfortunate and often unsightly coping strategies because that is often exactly what they are- are adopted by children who have severe visual limitations. These may be avoidable by the timely intervention of the O&M specialist who is able to introduce, or help the responsible adult to introduce, appropriate coping strategies and skills. Hopefully these will prevent the adoption of the weird techniques which the child is forced to develop for his own protection. In discussion of what is meant by additional skills, the phrase 'skills required in order to compensate for the loss of visual functioning' was thought to meet the need. It is inappropriate to enter into lengthy discussion of what these skills include. However, it is important to stress that much of what the visually-limited child learns in concept development and the development of enhanced sensory awareness in the classroom, at home and in social settings, can be - and indeed must be - generalised across every area of life, but most especially in the area of orientation and mobility.

Surely no-one could argue with this statement, but unfortunately, this generalising of skills does not just happen by chance but takes much patience, time and expertise to implement when teaching those mobility skills which are in themselves complex and which may in the first instance feel unnatural.

Many people held the view that it was the responsibility of the multi-disciplinary team to assess and identify the child's mobility needs. However, it might be supposed that without the services and advice of an O&M specialist, this task is not always carried out with a high degree of expertise and it interpretation of assessment. may be open to question as to the

For assessment and the identification of a child's specific mobility needs, to be successful, it requires to be continuous and linked to objectives set, worked at and re-defined where necessary. Another practice related was that the ophthalmologist, via the school medical officer, was responsible for this area of assessment.

In some instances the support teacher could not feel responsible for assessing the child's mobility needs as she did not hold any specific qualifications in visual impairment. One teacher in this position felt that in general she had so little experience in this area that she wasmore eager to 'learn than to teach'.

5 Delivery of services

It was generally agreed, particularly in the case of one special school for blind children, that all those coming into contact with the child had a part to play in meeting the child's mobility needs, although much concern was expressed over the fact that the services of an O&M specialist were not available even in these special schools where children had been 'Recorded' and where mobility had been identified as an area of special need.

Other peripatetic, support and resource teachers of the visually impaired affirmed that the responsibility for identifying and meeting the ongoing mobility needs of the children on their caseload was that no help from a specialist was available except capacity. theirs alone and in an unofficial It was thought important that specialist teachers have skills in identifying objectives. the child's needs and the ability to define appropriate They should also be able to teach, or at least reinforce, necessary skills or appropriate coping strategies both to the child and to all involved adults as well as having the ability to contextualise these skills. Those factors which have most influence on what is taught must include the age and stage appropriateness of various skills, depending on the child's individual needs, the settings and circumstances with which he and his peers would normally be expected to cope and the additional constraints placed upon him due to his limited vision.

As already stated elsewhere, the involvement of the O&M specialist is crucial, especially where the child's need for independence becomes greater. In short, to meet the mobility needs of the young visually impaired child, knowledge of child development and experience is required to identify age and stage appropriate activities, the level of independence and the environments in which the child needs to function. In only one case had a standardised assessment schedule for mobility been devised and most assessment tended to be piecemeal.

The value of observational assessment is considerable, but only when the observers knows what she is looking for, what her observations mean and how they may be used to the benefit of the child. One reason for this gap may be that the policy of integrating severely visually impaired children who have correspondingly more complex mobility needs into mainstream settings is still very much in its infancy. Another possible reason for this is probably the fact that in some areas the support teachers have not had the opportunity to qualify in the specialism of teaching children with visual impairment, being either qualified in general special educational needs or without any additional qualification at all. In this case the services and advice of the O&M specialist are even more crucial.

The one region fortunate enough to share a mobility specialist with the Society for the Blind states that he is responsible for assessing and training the children and works co-operatively with teachers and family. A group of five mobility officers kindly gave of their time to answer some questions on their involvement with school children in their region. They claimed to work with those children who were referred to them as requiring mobility training, but, with one exception, any training they undertook had to happen during holiday time or immediately after school as they were not allowed to encroach on the school day. In the main they only worked with those children of 14 years upwards who required long cane training and sometimes met them straight from school and took them to their own home area.

One officer worked with a pre-schooI child on development of spatial concepts, body awareness, shapes and route-finding as well as auditory and tactile awareness development. One specialist worked with a totally blind, 12 year old girl in mainstream setting during school hours stated that the senior social worker 'has to turn a half blind eye' to allow this to happen as it is the education authority's responsibility to ensure that the child's needs are met! All the mobility officers present liked the idea of official work with school children as this would provide continuity and allow for more team work and collaboration with parents and with school teachers.

QUESTIONS: Is the problem one of finance, in that Education Authorities are unwilling to share the cost? Do the Education Authorities fail to see the need for specialist input either by refusing to train their teachers appropriately or by refusing to enlist the services of mobility specialists from another background.? Is the service available from the Social Service Department undervalued 'not allowed to encroach on school time'?

It was hoped that this chapter would give some indication of the extent of the need for mobility input but unfortunately, due to the fact that support teachers are so hard pressed and the returns were limited, this hope has not been realised. However, it does look at areas of need which were very closely identified in the completed assessment schedules.

Out of a total of 16 responses to the initial questionnaires, nine teachers agreed to participate in the second phase of the project. In addition, in order to help develop a reasonably acceptable assessment schedule, those special schools previously mentioned were included. Having prepared the draft assessment schedule for use by those teachers who had identified children as having mobility needs, it was decided that their use of the schedule should be monitored by the writer on at least one occasion. It was hoped that this would have the added advantage of allowing time to discuss the needs of the teacher and child as well as look at the shortcomings of the schedule. Unfortunately, this proved to be more difficult than anticipated and as a result, only three teachers were visited and only 12 assessments (one from a special school) out of a possible total of 44 (excluding special school numbers) were carried out. In spit of this, it is felt that the findings are of interest and worth recording.

6 Extent of need

All the returns were assessments done on nursery and primary age children as follows:
PLACEMENT. NUMBER.
1. Mainstream nursery school: 2
2. Mainstream primary school: 4
3. Primary school unit: 4
4. Special school: 1
5. Primary school (MLD): 1
RECORD OF NEEDS l(in process)
(No5 should really be excluded for the purpose of this study).

As will be seen from the above figures, none of those children placed in mainstream primary schools numbers in this particular have Records of Needs. Obviously, the study are so ridiculously small that these findings have no significance whatsoever. However, it would be fair to say from observations that those children placed in mainstream primary schools do not generally have a Record unless provided for by a special unit within the school.

The target population of this schedule was the visually impaired child who had some usable vision and this caused us to reflect on the question of whether it was possible to have a definitive assessment which would serve all needs. Like many standardised schedules and tests, it could not meet the needs of all possible users as it stood.

What is understood by 'usable' vision, and how could it be determined? An example may be that very little light perception may be used in certain circumstances. Although much emphasis was placed on adapting or deleting inappropriate parts, were the guidelines always adequate enough to ensure that individual teachers had sufficient knowledge to judge what was appropriate individuals or inappropriate?

It was decided that all of the involved in this project probably had enough experience to make the necessary judgements. However, if the assessment items were cut down too far and only headings with some guidelines supplied, there would be some who may not have sufficient specialisation to be able to identify all the possible items appropriate to the needs of each individual child on their caseload. Conclusions were arrived at to suggest that too many items were probably better than too few and that it was easier for the non-specialist to ignore the inappropriate whilst adding any items which occurred to them, rather than to work from bare bones.

There were several significant influences on the mobility of the children assessed and though the number of the sample was very small, these factors were entirely predictable in children with visual impairments. When lighting was poor or inadequate; when there was a great deal of clutter; in crowded areas with other children rushing around; and in unfamiliar difficulty. surroundings, many of the children experienced some

It was reported that on outings one child, though always checking that the classteacher was not too far away, tended to rush on and trample on everyone's toes. Apprehension was demonstrated by those children in the hesitancy of their movements and the amount of concentration they gave to moving around.

Others displayed a number of gait and posture peculiarities in protecting themselves and one child seemed to use his elbows as sensors. In most cases, although there were areas of uncertainty, most of the children could function very well in familiar surroundings and it was thought that exposing them to more unfamiliar surroundings, provided they were age appropriate, would be a worthwhile programme for future training.

Many children were brought to school either by parents or taxi, whilst others coped with travelling independently. Again it must be stressed that age was a large deciding factor in the kind of transport arranged for the child.

Undoubtedly, the biggest single aspect of mobility to present difficulty amongst those children in the sample was that of going up and down stairs

Again, such things as familiarity, lighting which was inadequate or too bright, paintwork bearings on how the children managed. developed their own coping strategies and contrasts all had important In all cases, the children had if conditions were poor. They either held on to the bannister, trailed down the wall, went very carefully and slowly, or put two feet on each step. Some children tested each step before going down and in most cases adapted their head positions to allow them to cope in these unfavourable situations.

Discussion about methods used to answer questions included some of the following ideas: - through informal observation assessment, conducted over a prolonged, though specified period of time. This would obviously be limited to a specified number of weeks, or it would lose any real value in planning a programme. - by working through the schedule on one occasion. This has the merit of immediate feed-back, but takes a great deal of the time to the child unless the teacher already knows a large number of the answers

It goes without saying that it would be beneficial to conduct this in the least threatening manner, a game or fun situation being recommended in order to motivate the child to want to see. As stated above, teachers found it difficult to find time to complete assessment schedules and to those who made the time, much appreciation is extended

7 International perspective

On a visit to the city of Wurzburg, West Germany, on the occasion of the International Council for the Education of the Visually Handicapped's Eighth Quinquennial Conference in August 1987, the opportunity was taken to gain insight into the situations in other countries of the world. Ten participants kindly completed questionnaires and/or were prepared to discuss certain aspects of provision.

Much appreciation is extended to all the above for their willing assistance.

POLICY ON THE INTEGRATION OF VISUALLY IMPAIRED CHILDREN INTO MAINSTREAM.
In nearly every case it was claimed that the policy was of integration into mainstream of all children with visual impairment if at all possible. However, in one country, integration only took place between the ages of 15 and 25. Others qualified this statement by maintaining that placement was always decided on an individual basis, though the largest proportion of children would attend their nearest local school.

All those concerned were in agreement that provision for children with additional needs was a different matter and they almost always tended to be placed in a special school or unit for multi-handicapped children. Another cut-off point identified in one case was the degree of visual impairment. Here it was stated that where the child was not coping adequately using sighted methods, he/she would be sent for assessment with a view to possible residential placement in a school for visually handicapped children.

A very prominent educator from the United States of America held some extremely strong views and expressed his concern at some length.

As he speaks from a great depth of knowledge and understanding of the needs of the visually impaired child and the difficulties attendant with the meeting of these needs, it must be of interest to us in Scotland both as an overview as well as a warning. He maintains that there is a danger that those children who are fully integrated into mainstream schools are isolated from the skills that they need and naturally feels great concern about this situation. In backing up his statement he goes on to relate that in the USA 30 years ago these children were put in the regular classroom without any provision for specialized needs, including mobility, and the price is being paid now because not only are children not getting what they need but to change the system back when all the emphasis is in the direction of more mainstreaming is difficult to do. People accuse him of being pro-segregated schools and anti mainstream. He denies this, going on to say that he is pro the best service that a child can get in order to meet his/her needs at that particular time in his life and feels that the only way children are going to get this guarantee is always to give the option of a school for the blind.

The main thrust of his argument is that those countries that are using the USA as a model for successful integration of VI children should take another look, a closer look, because, while people make a good case for integration, the fact of the matter is that often those children are more isolated in the mainstream, and even social skills are not being learned in a very systematic way.

Those specialised needs such as mobility and living skills are totally ignored and in itinerant programmes where a totally blind child in the first grade may see an itinerant teacher two hours a week, that child is being relegated to illiteracy because he/she is never going to be a reader without at least an hour a day from the teacher who knows what she is doing. He stresses over and over again that what is appropriate for many children is not necessarily so for all. Integration in the US of America has worked for some children, but it has not worked for others and they are the ones he is concerned about. The support system is what makes integration work and it is thought that most people from USA will tell you that good programmes for visually impaired children have strong support systems to the point where if the child needs the teacher of visually impaired for half a day, every day, he would have it. If that level of support is not available, and a volunteer or an aide is put into a classroom with a totally blind or funtionally blind child, then we are saying that there are no specialised needs that require the skills of someone who understands the effects of vision loss

If this is the case, he states, then you have bought into a philosophy without understanding how to make it work in reality. The problem is that the only people who really know the profession and know the needs are the people who are experienced in working with visually impaired children, ie. teachers, mobility instructors and any psychologists who specialise. " What I find is that when I go to our capital and I talk with legislators and with administrators, often they say to me - do you mean to tell me that this is the way that people who work directly with visually impaired children and adults feel, because all we hear are the opinions of management, people who are trying to make the task managerially more simple." Interesting!

TYPES OF INTEGRATION: The range and extent of integration varied considerably from having totally blind children fully integrated into mainstream to self-contained classes for blind and/or partially sighted children within the mainstream schools. It appeared that provision depended on the density of population and the proximity to a special school. However, like Scotland, most countries professed to have a mixture of types with mainstream and unit provision, the unit being either a special one for visually impaired children or one which provided for the general special educational needs.

SPECIALIST SUPPORT AVAILABLE: In the main, specially trained peripatetic support teachers appeared to be the ones who are providing the support but there was also mention of learning difficulties specialists alone and in conjuction uith visual impairment specialists, teachers from resource centres and staff of special schools.

EXTENT OF SUPPORT: The amount of support being offered covered the whole spectrum of possibilities from almost continuous to the occasional visit from a blind institute adviser. Blind children might have as little as five hours special support or as much as 20 hours per week according to need. Some children are in situations where the support is extremely limited, taking the form of response to crisis situations by the specialist who gives advice to teachers and parents but rarely works with the child In other areas the support is limited to brailling and preparation of materials required by the child.

PROVISION OF ORIENTATION AND MOBILITY. It was agreed by all those questioned that orientation and mobility was a crucial area of work. However, one specialist who worked with partially sighted children, admitted that where she worked, it was not identified as an area of the curriculum, but provided for outwith. Others mentioned the difficulty in identifying curricular priorities and said that time for this important area was usually taken from the physical education class.

The main difficulty was, without doubt, the availability of Orientation and Mobility specialists. It was recognised that services were totally inadequate and specific examples such as the fact that little or no help was given to children who lived in rural areas. One psychologist who specialised in the field of visual impairment, stated that in her opinion, orientation and mobility was not really understood by teachers and other professionals generally, and there was an unwillingness to train and pay staff to work with children. Another factor which emerged was due to the under-valuing of O&M as a specialism and part of the solution may be to upgrade the status of the specialists or to weight training of teachers of children with visual impairment more heavily in favour of mobility.

In one state in Australia, teachers spent 200 hours of a one-year course on orientation and mobility! This seems rather excessive when there are so many other areas to cover as well as a depth of philosophy to develop. Identification and meeting of needs in orientation and mobility was to be governed by availability of specialist staff but in most cases the responsibility again rested on the peripatetic teacher of children with visual impairment or the resource teacher. However, where an O&M specialist was available, they were as involved as time would allow. The social service employees sometimes helped out in their 'spare time'. However, this was mainly with assessment especially of the child's ability to function in unfamiliar surroundings. Probably due to shortage of these orientation and mobility officers, they were not encouraged to work with children, so the input was occasional.

Training tended to start when the child entered school and very seldom before that. In a number of instances, training commenced at a transition period between primary and secondary or shortly before leaving school. Some people said that help was very limited indeed and was often only available when there was a crisis. In other cases, mobility was available only to those children in special school or who went to summer school where they would be given intensive training. Happily in a few cases, input was available when required and the frequency was governed by the need which meant that it could be weekly or even daily.

Teachers and parents were involved in the work where possible, especially with consolidating skills learned, in consultancy, in identifying a child's needs and where discussion is needed to clarify any points. However it was felt that their participation tended to be peripheral.

Approximately half of those questioned stated that O&M specialists were usually teachers who had done a post-graduate qualification, some in the form of a course run by an orientation and mobility training centre and others a masters degree but both taking about one to one and a half years to complete. The others identified these specialists as being from the social services.

Some countries were forced to send their people abroad for training which added considerably to the cost and therefore further exacerbated the problem. In a number of cases, training in orientation and mobility took the form of short courses for teachers lasting as little as one week, whereas, as already mentioned above, in one state in Australia all support and peripatetic teachers have 200 hours of O&M training during their course. Where no specialist support in O&M was available, it was generally agreed that teachers of the visually impaired, parents and advisers would do the best they could, but some children could have no mobility input at all.

Provision of O&M for children integrated into mainstream schools was considered to be inadequate in every case and some of the reasons for this severe shortfall included: too few O&M specialists, with existing staff unable to meet existing needs, particularly in rural areas and where there are additional handicaps lack of knowledge about importance of O&M by administrators lower salary than in the neighbouring states, therefore no one would apply. poor salary structure and low status influencing number and quality of candidates no full recognition of need economical factors relating to having two specialist for children class teachers are not aware of significance of O&M needs and sighted peers are too helpful. On being asked about possible solutions to this inadequate provision in this area it was clear that people felt that administrators had to be convinced about the critical nature of the work and just how important it is to the visually impaired child's development and present and future level of independence.

It would be very necessary to try to improve the image and salary structure of the O&M specialist and integrate them into teams where they would become more involved with schools, staff and children. The greater emphasis on this area of work was stressed for the training of peripatetic and support teachers, short in-service courses for both class teachers and peripatetic teachers and, last but not least, the possibility of dual competence trained specialist teachers.

The scope of the work of the O&M specialist was discussed and it was generally felt that the job entailed work with the very young child as ensuring normal development through early intervention was crucial. Teaching mobility skills, advising parents and teachers, working in concert with the visual impairment teacher and helping the child develop concepts were included as work done by the specialist in conjunction with other involved carers.

The involvement of all adults who come into contact with the child was seen as being a most important issue, but in one case the point was put forward that the classroom teachers should never be told that they have responsibility for mobility. "the classroom teacher is there to do with the visually impaired child what he/she does with every other child in the class".

However, if the teacher is interested, or believes in sensori-motor integration or gross motor development or active PE programmes this is a different matter, but obviously, he/she needs to be kept informed and aware of what is happening. Where an O&M specialist is available, he/she would obviously work closely with all concerned adults. However, in one country where all children were integrated, it was impossible to offer each child a competent specialist and in some cases the workload of peripatetic teachers was so great that it was impossible for them to work directly with each child.

Interesting comments made about two countries involving the use of the white cane were that in Bahrain, though the girls did not like to use the cane, the boys were quite happy with it, and in Sweden, many children and their parents have negative attitudes to mobility, particularly to the use of the cane, as they do not want to show that their child is blind. It should be stressed that these difficulties are not unique to any one particular country and more importantly, orientation and mobility is not synonymous with the white cane. The white cane is one aid which may be useful to some but not to others.

8 Making mobility work

A most important area of concern is not merely the employment of a mobility officer by a region or division, but also the most efficient way of employ that officer in order to ensure that each child may best be served.

Is it that the officer is the person responsible for meeting mobility needs and so works with the child on an agreed, regular basis, working as a somewhat isolated entity apart from occasional involvement of some other professional and writing reports on each child's progress?

On the other hand, should it be that his regular input is seen as being part of the child's curriculum which remains the responsibility of the school and teachers concerned, thus ensuring that all skills learned are generalised and used by the child in every appropriate situation?

If this is going to be done efficiently, some carer who works with the child, should ideally always be present during input from the mobility specialist so that all concerned may be kept informed. This situation is so important if young, severely visually impaired children are going to benefit from specialist input.

All those teachers who have completed a course for specialist teachers of visually impaired children are equipped to teach pre-cane skills and to work closely with mobility officers to ensure the generalisation of new skills. However, as mentioned elsewhere, the ideal situation would be to have all peripatetic and support teachers dual competency trained, cutting down on personnel and therefore cost

It must be said again, size of the case-load, that this should not be done by increasing the in fact, case-loads would obviously have to be reduced in order to allow these teachers to devote more time to meeting each child's individual needs. Although as much time as possible is given to orientation and mobility on the In-services course at Moray House, the work done on this course is very largely aimed at heightening the teacher's consciousness of the need and of what is involved in assessing and meeting individual needs mainly so that they may work closely with the O&M specialist. While realising the implications of what this involves regarding time and curricular priorities, it is felt that if the needs of our visually impaired children are going to be properly met, it is going to be expensive on staff.

In many areas of Scotland, mobility officers from the social services try to help meet the needs of those children who have no other specialist input. However, until recently, with a few notable exceptions, they were seldom allowed to "encroach" on the child's school day as this is the Education Authorities' responsibility, and they certainly do not work as part of a team in order to ensure that the children have a chance to consolidate new skills learned. Any consolidation must be undertaken by the parents alone as the work is usually done from home.

One scheme undertaken in Fife, involved structured input from a specialist who worked with the child and always had a nominated carer, either the teacher or an assistant, in attendance. Every lesson was followed by a careful discussion and the recording of all work covered, evaluation and planning of what should happen before the next visit. A copy of each report was either left with or sent to the specialist teacher to help her ensure that new skills were being contextualised.

The most recent expansion of this scheme was the involvement of the newly appointed mobility officer who is employed jointly by the Society for the Blind and the Education Authorities. He has been doing some mobility training with the carer in order that she might understand more fully what is required of her and of the child in her care. It is hoped that in the near future he may work from the child's home involving the parents and thus further contextualising acquired skills. He has now been involved more fully and has taken over this particular case, thus demonstrating the efficiency of provision in at least one region in Scotland.

The main work of the O&M specialist working in integrated settings where many children are scattered over a large area, is to orchestrate the teaching of the required skills and development of the necessary concepts and sensory awareness. He would do this by working as a member of various teams, assessing and identifying needs, teaching new skills, advising and endeavouring to ensure that all those working with each child has detailed information about what, when, where and how things should happen in the intervening period until his next visit.

It is of enormous value to discuss objectives fully and view them in the light of achievements and difficulties, so that all those working with the child understands what happens next. Because mobility was traditionally developed for the rehabilitation of blinded adults, there has always been a big debate about when the long cane should be introduced.

In many notable instances, the cane is introduced, not when a child is a certain age, but rather when it is obvious that the individual child would, in the view of the person responsible, benefit from its introduction. It was decided to introduce the cane to a seven year old totally blind child because she was not secure enough in the other skills she had been taught and was beginning to develop inappropriate coping strategies for her protection. As a result, she moved very slowly, sometimes used a slapping gait, was very tense and held her hands out in front of her "blind man's buff" fashion.

The introduction of the cane has not solved all her problems, but it has given her more confidence, speeded up her walking a little and is proving useful in cutting down unacceptable features in her gait. Though Orientation and Mobility Officers in Britain have not been quick to follow suit, many people in the United States of America have been introducing the cane to pre-school and very young school children.

Although no detailed information as to the success of this venture is available, one report is about an instructor who is teaching cane travel to a three year old, using a marshmallow tip and employing the technique of constant contact. His comments to justify this were that 'if you had asked me five years ago if I would ever be doing this, I would have said - no way!' He added that 'times are changing, and we have to look at mobility in a different way.

The fact is that cane travel is a sequential learning process, just like reading and we don't give a first grade child a sixth grade reading book and expect him to read it and in the same way we should not give a sixth grade child a cane and expect him to master it. We should give him the cane when he is three years old and let him play with it, let him get used to it, let it start feeling as though its an extension to his arm and whatever else we want to do, but lets start with a cane at a much younger age.

Although it must always be the most appropriate and best provision for each individual child which is kept to the forefront of our minds, the principle of integration has much in its favour. However, one fear might be that, where the policy of integration is outstripping available provision, irreparable damage is being done to the severely visually impaired child who is not having his needs met appropriately, adequately or at an early enough stage.

Although this survey has been conducted over the period of one academic session, it is appreciated the much of the data is already out of date. However if the situation has improved in any significant way, then we should all be delighted. In theory, the importance of the O&M specialist working as part of a team and not as an isolated entity is acknowledged, but in practice, if a specialist is available at all, in too many cases they work in isolation.

It has to be admitted that there are many reasons for this, time constraints and heavy case-loads, and the fact that usually the mobility specialist is not allowed to work with the child during the school day being only two of the more important ones.

9 Conclusions

It does seem a reasonable suggestion/prediction to have one person with both sets of skills in a smaller geographic area rather than two separate specialists who cover such huge areas that they sometimes spend a total of half their day travelling. Having said that, there is no point in giving a teacher dual-competency if they are also given such huge work-loads that they are totally unable to meet the needs of a large number of the children for whom they are responsible.

Finally, it must be said that some Education Authorities in Scotland are endeavouring to build up this service in a most encouraging and gratifying manner and it is to be hoped and indeed anticipated that they are leading the way for the provision of children with visual impairment integrated into our Scottish mainstream schools.

Bibliography

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COSPEN Report(Draft). Aspects of Provision For the Education of Pupils with Visual Impairment, 1986.
Lee, M, Postural Anomalies in the Blind Child. Moray House College, 1986.
O'Donnell, J, The Transition of Visually Impaired Pupils from Primary To mainstream Secondary Schools, Moray House College,1988.
Svensson, H, School Attendance at Rome. Paper, Barcelona European Conference on Integrated Education, 1986.
Thomson, G, Budge, A, Buultjens, M and Lee, M, Meeting the Special Educational Needs Of The Visually Impaired, Edinburgh University and Moray House College, 1985.
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