Guest Editorial

We are a generation of orientation and mobility (O&M) professionals practicing in a new millennium. Our world and our profession are changing. We are living in a time of affluence in comparison to other countries, yet many in need throughout North America and developed countries go unserved and underserved, not least in the area of O&M. Some service areas in the United States have 100 or more certified teachers of children who are blind or visually impaired to provide services to the children (which even then may not be sufficient), while there are less than 12 O&M instructors to serve the area's entire population of blind or visually impaired individuals from birth through old age. Parents continue to report that they have never heard of O&M services, despite having a child who has been blind for 16 years. Some elderly adults wait in excess of a year for O&M services, while others pass away before ever receiving them. Often when O&M services are approved, it is only for 10 hours of O&M instruction when that amount of time is inadequate for the client's needs. We must ask why these injustices continue. What are the roadblocks prohibiting the hiring of the numbers of O&M instructors needed to provide the necessary services to those on waiting lists? Are the obstacles economic or philosophical or attributable to other factors?

O&M continues to go unrecognized as a set of crucial skills that enable independence and self-esteem. The research is clear that independent O&M is a critical factor to the education and employability of individuals who are blind, yet although O&M instruction is clearly required by IDEA, it is relegated to the status of a "related service," too often described by administrators as an optional or "Cadillac" service (Crudden & McBroom, 1999; Crudden, McBroom, Skinner, & Moore, 1998; Knowles, 1969). O&M instruction is also too often in short supply in adult services agencies. Independent mobility is a fundamental and enabling life skill, not an extravagance. Every blind or visually impaired individual, including those who are elderly or have severe multiple impairments, should have the right to the provision of quality O&M services.

Rather than expanding at a rate appropriate to the needs of the population, O&M services are threatened at every level, from the federal appropriations for personnel preparation training for O&M instruction to provision of direct services for children, adults, and older citizens. Recent developments, however, provide us with a glimpse of a future that might allow for an increase in the numbers of instructors and provide additional funding for O&M lessons. Over the past decade, alternative methods for reaching students through distance learning have been instituted by many universities. These programs offer the majority of the courses online and bring students onto campus for face-to-face classes to learn skills that are taught through hands-on experience. This approach makes personnel preparation possible for many who otherwise could not participate and thus could serve to expand the number of new practitioners.

On the service delivery front, the inclusion of services by vision rehabilitation professionals as a permanent part of Medicare may make a difference by reimbursing a specified number of lessons authorized by medical professionals. A five-year demonstration project is about to begin (see "Medicare Coverage for Orientation and Mobility Services" by Lidoff in this issue). Regardless of which agencies and sites are selected for the demonstration efforts, we must all work cooperatively and we must all be involved, as the results will frame the future. By documenting the effectiveness of O&M services and ways in which they can be efficiently delivered, the outcomes of the demonstration project have the potential to lead to systemic changes that will have an impact throughout the entire scope of service delivery. The project could lead to the eventual inclusion of O&M as part of Medicare and open up a new avenue of funding that will extend services to individuals who otherwise would not receive training, which could also create the need for additional O&M instructors and paraprofessionals to assist them in providing services.

Special issue topics

In addition to questions of personnel shortages, service funding, and reimbursement channels, the field of O&M confronts a wide array of challenges at this juncture in its development. The call for papers for this special issue on O&M suggested 15 possible topics and provided sufficient time for research to be conducted and reported. Submissions addressed four of the 15 topics, and papers on additional topics were also submitted. The majority of articles were research based. Some submissions will appear in subsequent issues of JVIB, as this special issue has only a limited number of pages.

Traffic environment

One important topic in this issue highlights how changes in traffic control and traffic flow, the shift of the population to the suburbs, the explosion of the number of cars on the road, and the proliferation of computers and satellite communications have coalesced to affect the movement of traffic in different ways and create a dramatically more complex and dynamic 21st century travel environment that O&M instruction needs to address. Several articles in this issue describe research findings related to the challenges confronting blind travelers who need to cross at roundabouts and address accessible pedestrian signals as one solution.

Canes and consumer choice

Other research articles in this issue deal with characteristics of long canes and factors influencing their selection that have been identified by consumers and that O&M instructors need to include when discussing cane options with students and clients, including materials, construction, tips, and length. These articles highlight the important issue of consumer choice. Too often, in this area as in others, consumers are not presented with options or asked about their preferences.

Personnel preparation

All the research articles in this issue have implications for the central issue of personnel preparation. Zebehazy, Zimmerman, and Fox offer the strategy of teaching observation skills through the use of videotapes of cane travel. The major disadvantage of this approach as a teaching strategy, recognized by the authors, is its lack of accessibility to O&M instructors in training who are blind. Sauerberger's Practice Report on teaching street crossings to clients who have visual as well as additional disabilities presents a pragmatic approach that fosters the problem-solving strategies at the heart of traveling in dynamic environments.

The O&M landscape today

Some trends, controversial topics, and other subjects are not addressed in this special issue of the journal. We present these briefly to encourage submissions on these topics not only to JVIB but in other public forums as well. They need to be shared and discussed openly and professionally, as they have the potential to increase knowledge and ultimately improve O&M services. They also represent the landscape against which many of the practices examined in this issue may be viewed.

A number of these issues were captured last year in a publication by the Institute on Rehabilitation Issues (IRI). The original purpose of the IRI study was to address the severe and growing shortage of O&M professionals; however, a number of critical issues quickly came to the fore, including What is a qualified O&M instructor? What are the current methods by which O&M instructors are prepared? What are the methods to be employed by blind O&M instructors? and Are there alternative methodologies? Contemporary Issues in Orientation and Mobility (Dew & Alan, 2004) described two different "camps" in O&M, referred to as the "conventional approach" and the "alternative approach" to O&M instruction. The conventional approach was defined as being based upon university preparation of instructors that was inspired by the successes of the U.S. Veterans Administration (VA) programs following World War II. The alternative approach was defined as a reaction to the VA approach and characterized as a structured discovery approach that is less prescribed and relies on experiential learning.

Discussions among the working group that developed the publication demonstrated that representatives of neither camp fully understood the philosophies, strategies, techniques, and jargon of the other camp. Both approaches have something unique to offer and have many similarities, and their differences need to be identified and examined. It became clear that each camp could learn much from the other.

Approaches to training

First and foremost among the differences between the conventional and the alternative approaches can be seen in their views of how to provide training. The conventional approach believes in a sequential model of instruction that uses a combination of guided learning, feedback and correction, and discovery learning. Within each phase of training, the instructor first provides guided learning by teaching the use of specific techniques. Practice is provided and, through feedback, the techniques are perfected. Once performing at an acceptable level, the individual is placed into more challenging environments where he or she can discover how to best use the various techniques and procedures. Within each phase of travel, the instructor starts out in close proximity to the individual and monitors the person's travel and performance. At first, the instructor is there to answer questions and provide suggestions. Later, the instructor withdraws and requires the student to solve problems more independently. When the individual experiences difficulties, the instructor is there to ask questions that the student must answer to solve the orientation problems. As the student continues to gain proficiency, the instructor withdraws further and allows the student to take complete responsibility for travel.

In contrast to this approach, the alternative method relies more heavily on structured discovery learning. It is described as a civil rights model that reflects the belief that attitudes are at the core of effective travel (Altman & Cutter, 2004). When an individual believes in his or her own ability, effective travel will follow. The professional nature of instruction is downplayed, and in its place is the belief that cane travel is a commonsense method of travel. Rather than emphasizing training in techniques, the instructor encourages the student to discover methods that will solve orientation problems. The instructor encourages learning through intrinsic discovery and emphasizes self-correction of errors. Studies on the efficacy of both approaches would provide us with data to help improve instruction (Aditya, 2004) .

O&M instructors who are blind

While both approaches believe that people who are blind can be effective instructors, this has not always been the case. Prior to the early 1990s, adherents of the conventional approach believed that some amount of sight was needed to effectively monitor the travel of students. It was assumed that vision was needed to evaluate such items as posture, gait, cane techniques, travel paths on the sidewalk and during crossings, potential collisions with obstacles, and instruction in utilization of low vision. Over the years, this view was modified, and today the conventional approach holds that instructors without vision can use alternative monitoring and other techniques to provide necessary information and assure the safety of the student. This idea still tends to remain controversial among some instructors who practice within the conventional approach; however, proponents of the alternative approach have always believed that people who are blind can be effective instructors and that monitoring can be conducted effectively by O&M instructors who are blind. They believe that instructors not only should be taught to travel by using visual occlusion but should also learn how to teach while wearing occluders. Study of nonvisual monitoring techniques is necessary to determine the most effective approaches. It is clear that practitioners of the alternative approach have more experience in preparing instructors who are blind and can offer valuable information on monitoring techniques.

Occlusion and low vision

Another area of disagreement is whether individuals with low vision should be taught to use their vision during their mobility instruction or whether they should have their vision occluded. Between the 1940s and 1970s, the conventional approach advocated for the use of visual occlusion to teach people how to make the most effective use of their remaining senses and, in some cases, to "prepare them for blindness"--particularly if the consumer had a progressive visual disorder. Instructors found, however, that after training students would quickly return to the use of vision and would not know how to use it effectively. Gradually, instructors began to introduce training in the use of vision as part of O&M instruction. They teach such skills as interpreting distorted or missing visual information, applying deductive reasoning, scanning, using optical devices, and when and how to apply those strategies generally used by those without vision. For some individuals, partial occlusion of their visual field is introduced, and for others, total visual occlusion may be used intermittently.

The alternative approach instead believes that all students must always use total visual occlusion during their instruction. They believe that this better prepares them to learn the skills of blindness and to make effective use of their other senses. Visual training, if necessary, can occur after cane training is completed. Studies comparing these approaches would add to the knowledge base for O&M instructors and would lead to research-based best practice as well as make excellent additions to the professional literature of the field.

Certification

A further disparity between the two approaches relates to the type of certification an O&M instructor earns. The conventional approach requires that the applicant has successfully completed academic, university-based courses in O&M, has demonstrated competence in teaching during an internship, and has passed a written examination covering the core competency areas in the discipline. The alternative approach does not necessarily require the applicant to have taken such academic courses but instead recognizes training provided by service agencies. Instead of a written examination, it requires an oral examination that focuses on the belief system of the instructor and includes demonstration of skills in traveling with visual occlusion.

The first comparison of these two certification approaches was recently conducted (Aditya, 2004). Although many variables were studied, the comparison did not measure the effectiveness of the approaches, so that "the data from this survey cannot be used to reach generalized conclusions on which certification or approach is better." As an exploratory study, it generated information on the reaction of consumers to sighted instructors and instructors who are blind: It appears that there are advantages to both. The question of effectiveness of approach continues to need further study.

Accessible environments

One additional difference between the two approaches relates to the need for environmental modifications that make the environment accessible to persons with visual impairment. As reported elsewhere in this issue, accessible pedestrian signals are designed to permit people with vision loss to locate and effectively cross streets with actuated signals. The conventional approach believes that people who are blind have the right to the same information that is already available to people who are sighted. Devices such as accessible pedestrian signals, electronic travel aids, and electronic orientation aids (such as Global Positioning Systems and talking signs) serve to level the playing field and thus should be available to people who are blind.

The alternative approach tends to believe that these devices are needed only in exceptional situations and would prefer for consumers to adapt to the environment, rather than adapt the environment to the consumer. Again, additional studies are needed to determine the effectiveness of environmental modifications and their impact on consumers. Consumer preference and choice needs to be a critical component of such studies.

In closing

We encourage practitioners, researchers, scientists, consumers, and administrators to continue to submit articles on topics relevant to today's practice and environmental changes. Other areas in need of study include the use of tactile warning tiles and surfaces, intersection design, paratransit systems and alternatives, quiet cars, and other environmental factors and how they might affect travelers with visual impairments. Other important issues that need to be examined are occupational therapists teaching O&M, the training and use of O&M teacher aides or paraprofessionals, and the application and effectiveness of distance education models.

O&M is a field that has grown beyond its early beginnings. At first the profession progressed by trial and error. Many practices that evolved through clinical practice became the standard. Today we need empirical studies that test our assumptions and challenge ourselves to identify what is most effective. We need to be curious, to think, conduct research, read research, and discuss similarities and differences in approaches--whether it is a single strategy or an entire philosophy. Our profession may be young, but we, the service providers, trainers, teachers, administrators, and leadership, need to guide our profession of O&M into maturity with grace, understanding, growth in knowledge, and responsiveness to consumers and the changing environments in which we live.

The editors believe that the O&M profession is long overdue for a world O&M congress where leaders, practitioners, and consumers come together to address the controversies of the day and to learn from each other. We invite the leadership of the major organizations of and for the blind to come together to sponsor such a congress.

References

Aditya, R. N. (Principal investigator). (2004, May). A comparison of two orientation and mobility certifications (A report produced through funding from RSA under grant number H133B010101-03). Washington, DC: National Institute on Disability and Rehabilitation Research.
Altman, J., & Cutter, J. (2004). Structured discovery cane travel. In D. W. Dew & G. M. Alan (Eds.), Contemporary issues in orientation and mobility (Institute on Rehabilitation Issues Monograph No. 29) (pp. 67-96). Washington, DC: George Washington University, Center for Rehabilitation Counseling Research and Education.
Crudden, A., & McBroom, L. W. (1999). Barriers to employment: A survey of employed persons who are visually impaired. Journal of Visual Impairment & Blindness, 93, 341-350.
Crudden, A., McBroom, L. W., Skinner, A. L., & Moore, J. E. (1998). Comprehensive examination of barriers to employment among persons who are blind and visually impaired. Mississippi State: Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University.
Dew, D. W., & Alan, G. M. (Eds.). (2004). Contemporary issues in orientation and mobility (Institute on Rehabilitation Issues Monograph No. 29). Washington, DC: George Washington University, Center for Rehabilitation Counseling Research and Education.
Knowles, L. (1969). Successful and unsuccessful rehabilitation of the legally blind. The New Outlook for the Blind, 63, 129-134.

Kathleen M. Huebner, Ph.D.

William Wiener, Ph.D.

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