O&M: A Pediatric Perspective
by Joe Cutter

Historically, orientation and mobility has been taught from adult to adult with particular emphasis on cane travel as the beginning of instruction. This tradition can be referred to as a "top-down*" approach, adults already having the concepts and learning new motor schemes to match their comprehension.

With a pediatric perspective, however, the approach will be "bottom-up."* First the child learns purposeful movement, and out of the relied-upon motor schemes will come the concepts. During these early years, the blind child will come to know and move in his/her environment with a greater or lesser degree of competency. The orientation and mobility specialist can have a significant positive impact on the blind child's development.

The 0&M specialist working with young blind children will function as a "mobility architect," analyzing related needs of the child, working with the parents, school (early intervention, preschool, kindergarten) and designing strategies that will assist in preparing the child for present and future independent travel. The 0&M specialist's role may fluctuate between consultant, demonstrator, and ongoing instructor. Of particular importance will be providing parents with clear, accurate information and helping them to "read" their child's signals. This attunement between parent and child will be the foundation for getting to know and be in the world. The O&M specialist will evaluate what is available to the child and assist the parents and school in helping the child "take it all in."

In partnership with parents, the O&M specialist will explore strate-gies, activities, and tools to facilitate purposeful thought and pur-poseful movement. By being more aware of the "menu," we will feed blind children experiences (adaptive techniques, etc.) that will make sense to them. In this way, the more natural course and intent of maturation may unfold over time. In this way, for example, cane travel will not be viewed as an isolated set of skills, but as part of a process: a continuation of learning manipulative skills. The spoon, then, becomes the precursor to the cane. Tools used to manage "space" and get tasks done (spoons, scoops, shovels, brooms, etc.) will be respected in this "bottom-up" approach. The alternative techniques of blindness will be thought out and applied from infancy to adulthood. The 0&M specialist will be cautious not to prematurely insist upon "proper" techniques, as this may interrupt the young child's need to explore, figure it out, and develop his/her own useful self-taught solutions.

I believe that as human beings, blind children have a sense of order, a sense of organizing their experiences, and the ability to improve upon the experiences AS ALL CHILDREN DO! I believe in the interconnectiveness of the sensory systems, that vision is only one system and that blind children have a multitude of systems available to them (touch, auditory, vestibular, proprioceptive, smell, taste, the drive to move, the need to know, the ability to self-amuse, etc.). We must invite the blind child to make the world their home; to move safely, confidently, and effectively, and to demonstrate the kind of strength, wisdom, and poise that is within them.

* "Top-down" and "bottom-up" as introduced by Dr. Lorraine McCune in her Infant Studies courses at Rutgers University.

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