Why Wait?Why Wait?The Role of the COMSThe Role of the COMS

Orientation and MobilityOrientation and Mobility

IN EARLY INTERVENTIONMarjie Wood, M.Ed., COMS,TVIBellevue, WA7-19-2012

History of O&MHistory of O&M

Late 1940’s -began after WWII to aid blinded veterans1960- 1st O&M University Program Started1970’s- O&M for 3-21 year olds in public schools

The late 1970’s O&M instruction included infants and toddlers in the public schools

First time as a related service, IDEA 1997

Since the early 90’s, O&M instruction for children from birth through 22 years of age has been provided on an itinerant basis in Texas public schools.

History of O&M (cont.)History of O&M (cont.)

What is Orientation and Mobility?What is Orientation and Mobility?

Orientation and mobility services means, “services provided to blind or visually impaired students by

qualified personnel to enable those students to attainsystematic orientation to and safe movement within their environments in school, home, and community; and includes teaching students the following as appropriate:

Spatial and environmental concepts and use of information received by the senses

Federal Law - IDEA B 1997Federal Law - IDEA B 1997

(such as sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel (for example, using sound at a traffic light to cross the street); • To use the long cane, as appropriate, to supplement visual travel skills or as a tool for safely negotiating the environment for students with no available travel vision; • To understand and use remaining vision and distance low vision aids, as appropriate; and • Other concepts, techniques, and tools as determined appropriate.” [34 CFR 300.24(b)(6)]

IDEA – Part B (cont.)IDEA – Part B (cont.)

) (17) Vision services mean— (i) Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities that affect early childhood development; (ii) Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and (iii) Communication skills training, orientation and mobility training for all environments, visual training, and additional training necessary to activate visual motor abilities.

IDEA Part C 9-28-2011IDEA Part C 9-28-2011

303.13(c)(5) Qualified personnel. The following are the types of qualified personnel who provide early intervention services under this part: (1) Audiologists. (2) Family therapists. (3) Nurses. (4) Occupational therapists. (5) Orientation and mobility specialists. (6) Pediatricians and other physicians for diagnostic and evaluation purposes. (7) Physical therapists. (8) Psychologists. (9) Registered dieticians. (10) Social workers. (11) Special educators, including teachers of children with hearing impairments (including deafness) and teachers of children with visual impairments (including blindness). (12) Speech and language pathologists. (13) Vision specialists, including Ophthalmologists and optometrists http://www.gpo.gov/fdsys/pkg/FR-2011-09-28/pdf/2011-22783.pdf

IDEA Part C (cont.)IDEA Part C (cont.)

“ For the very young child, mobility refers to general gross motor development, including the normal integration of reflexes, acquisition of motor milestones, refinement of quality-of-movement skills, and purposeful, self-initiated

movement” ( Pogrund and Fazzi, Eds., 2002, p.328).

1. Where am I? Body in space (O)

2. Where am I going? Body in space(O), spatial understanding(O) and safety in movement ( O & M)

3. How will I get there? Spatial understanding (O & M)

OOrientation and rientation and MMobilityobility

Orientation-◦Where Am I?1) vestibular2) proprioception3) visual4) auditory5) tactile/ haptic sense6) olfactory

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

1. Vestibular- A. Composed of 3 structures in the inner ear which register 1. the speed, force, and direction of movement, 2. the effect of gravity on the body, and 3. head and body position. B. Assists in the regulation of muscle tone, coordination, balance, and equilibrium C. Fully functional at birth and the first sensory system to mature D. “ Visual impairments affect how the vestibular system develops, how vestibular input is

registered and used which can lead to low postural tone, delayed balance reactions, and delayed motor

development” (Anthony, Brown, Lowry and Hatton, 1994, p. 157)

2. Proprioception- A. The receptors located in the tendons, muscles, and joints. B. Provides information regarding the orientation of the body in space and the

relation of body parts to each other. C. Plays a role in balance, postural tone development, posture and haptic

perception( ability to tactually identify objects). D. Provides information about the body when it is static, e.g. lying, sitting, or

standing. E. Provides the only means to identify and precisely coordinate movement for

those who are blind

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

3. Vision-◦ A. One of the 2 distance senses

◦ B. The first 2 years of life are particularly influenced by children’s visual environment(Anthony, Brown, Lowry, and Hatton, 2004).

◦C. “Without vision, learning motor skills through imitation is extremely difficult. They cannot learn by watching and have to be introduced to most fine and gross motor tasks. Even then, children with visual impairments sometimes exhibit different ways of moving or a different quality of movement” (Pogrund and Fazzi, Eds., 2002).

◦D. “Children with visual impairments do not have the opportunity of incidental learning. They do not have the benefit of vision as a unifying sense to assist in learning the meaning sounds, the functions of objects, and help in organizing their world” (Pogrund and Fazzi, Eds. 2002).

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

4. Auditory-◦ A. The other distance sense

B. 3 levels of hearing 1. primitive- breathing, swallowing, chewing and familiar background sounds 2. signal warning- monitoring the environment- in conjunction with vision 3. spoken communication(speech)-develops naturally due to the child’s ability to hear; “a great deal of listening does

and indeed must occur (14-16 months) before verbal output can occur” (Flexer, 1999, p.16)C. “ A mild hearing loss ( associated with frequent ear infections) can affect a child’s language development during the first years of life” (Anthony, Brown, Lowry, and Hutton, 2001, p. 142).

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

5. Tactile- A. Refers to stimulation reaching the central nervous system from receptors in the skin B. Most mature sense at birth and first to emerge in utero C. Activates most of the newborn reflexes (rooting reflex) D. Children with visual disabilities must use their hands to gain information about the world. E. Six types of sensory information detected through touch: deep touch, light touch,

vibration, pain, temperature control and two-point touch ( ability to identify how many points of contact an object has on skin, e.g. braille cells)

F. Haptic sense- the ability to recognize an object by touch

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

Movement◦“Many factors such as neural maturation, the environment, biomechanics, kinesiology, perception, learning, and goal-directed behavior influence movement” (Alexander, Boehme, & Cupps, 1993; Bly, 1994; Shumway-Cook @ Woolacott, 2001: Ulrich, 1997).

◦“Movement facilitates early development. Young children’s movement not only affects motor development, but also plays a major role in the development of cognition, social-emotional relationships, and communication” (Anthony, Brown, Lowry and Hatton,1994, p. 351).

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

The COMS’ role is to: Encourage early purposeful and self-initiated movement in children who are

visually impaired and continue as children move through and explore increasingly complex environments (Pogrund and Fazzi, Eds., 2002).

The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

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Video of 2 year old transitioning from floor to couch

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The Role of the COMS in the Early Intervention TeamThe Role of the COMS in the Early Intervention Team

The COMS’ role is to:◦Encourage early purposeful and self-initiated movement ;

TVI COMS

Vision Team Roles in Early Intervention Vision Team Roles in Early Intervention

Provides hand under hand instruction in play, activities of daily living, and pre-literacy activities.

“Brings the world to the child”

Helps structure the home environment for beginning orientation and safety,

provides instruction to encourage safe and purposeful movement.- training for all environments, visual training, and additional training necessary to activatevisual motor abilities- IDEA PART C

“Brings the child to the world”

The VI Team in Early InterventionThe VI Team in Early Intervention

Child

O&M VI

TVIOT

COMS

The Interrelationship of the TVI, COMS, and OTThe Interrelationship of the TVI, COMS, and OT

TVIOT

PTCOMS

The Interrelationship of the Early Intervention (EI) Service Providers The Interrelationship of the Early Intervention (EI) Service Providers (Large circle rep. the EIS and SLP)(Large circle rep. the EIS and SLP)

Early Identification and Intervention is Crucial Early Identification and Intervention is Crucial

Children who are visually impaired and their families need specialized instruction and educational guidance from professionals who have expertise in addressing their disability-specific needs. (Pogrund, R.L. & Fazzi,D.L. Eds. 2002).

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Current Students Who Current Students Who Have Received Early Have Received Early Intervention ServicesIntervention Services

photo goes here

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Video of 4 year old learning to jump rope

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Video of student playing on equipment in gym

This is a video of a child who has a cortical visual impairment and other multiple disabilities. You will see examples of 2 different O&M routines which encourage body awareness and purposeful movement.

VideoVideo

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Video of Motor Music Routineand

Swinging Routine

Alexander, R., Boehme, R., & Cupps, B. (1993). Normal development of functional motor skills: The first year of life. Tucson, AZ: Therapy Skill Builders.

Anthony, T., Brown, C., Lowry, S., and Hatton, D. (1994). Developmentally Appropriate Orientation and Mobility (pp.127-157, 351). University of North Carolina at Chapel Hill, NC: FPG Child Development Institute.

Blye, S. (1994). Multivariate data mappings. In G. Kramer (Ed.), Proceedings of the International conference on Auditory Display 1992. Auditory display: Sonification, audification, and auditory interfaces. Reading, MA: Addison-Wesley

ResourcesResources

Flexer, C. (1999). Facilitating hearing and listening in young children (2nd ed.) San Diego, CA: Singular Publishing Group.

Shumway-Cook, A., @woollacott, M.H. (2001). Motor Control (2nd. ed.). Baltimore: Lippincott, Williams & Wilkins

Ulrich, B.D. (1997). Dynamic systems theory and skill development in infants and children. In K.J. Connolly & H. Forssberg (Eds.), Neurophysiology and neuropsychology of motor development ( pp. 319-345). Cambridge, U.K.: Cambridge University Press.

Pogrund, R.L., & Fazzi, D.,Eds.(2002). Early Focus: Working with Young Children Who Are Blind or Visually Impaired and Their Families, 2nd Ed. New York: American Printing House for the Blind

ResourcesResources