This series of 5 presentations focus on assessment tools that can support the work of orientation and mobility specialists.

Session 1: The Orientation and Mobility (O&M) Inventory

Presented by Ron Later

The Orientation & Mobility (O&M) Inventory is a computer based compendium of the skills that comprise Orientation & Mobility. It is a tool with which O&Ms can measure student progress, plan lessons, record progress, and dispatch paperwork common to special education and progress reports. It aspires to be both thorough and quick/easy to use. Since the creation of the Inventory (built for students from the age of 6 through adults) in 2011, it has been followed by the (M)Inventory for students with multiple impairments, the Birth-6 Inventory (skill items drafted by other O&Ms from the New Mexico School for the Blind and Visually Impaired working with small children) for students under the age of 6, and – most recently – the (W)Inventory, a tool designed (in collaboration with Scott Crawford and Joe MacDonell) for students who are using wheelchairs. Each of the Inventory versions have the following in common:

• The Inventory has both breadth and depth while being quick and easy to use.

• The Inventory isn’t pass/fail and uses a rating system for each skill in each area of each domain.

• The Inventory can show regression in skills that have deteriorated over an extended break.

• The Inventory shows progress across the continuum of O&M skills instead of only showing progress with discrete skills.

• Goals drawn from the Inventory can be discrete, cover a skill area, an entire domain or all O&M skills while being quantifiable.

• The Inventory allows data to be drawn from skill areas, domains or all O&M skills.

• The Inventory allows progress to be tracked over 12 assessment periods. The periods could be 12 individual lessons (for contractors working with a client on particular skills or domains), weeks (for hopelessly obsessive O&Ms), grading periods (quarterly for most school districts or every 6 weeks for Texans), or annually.

• The Inventory lives online so it can be easily forwarded to an O&M who is receiving your student.

• The Inventory isn’t a static tool. It is designed to adapt to meet the needs of the O&Ms who use it. (The B-6 Inventory is the exception as changes have to go through Western Michigan University.)

• The Inventory makes it possible to show the progress the O&M’s students have made as a whole.

• The Inventory is free. Each version of the Inventory can be downloaded from the www.nmsbvi.org website along with free supporting materials.

Learning Outcomes

Attendees will learn how the Inventory works and how it can help them deliver services to a wide range of learners. The mechanics of using the Inventory transfer intuitively from one version to another. In addition, attendees will learn how to use the report/paperwork features of the standard Inventory and (W)Inventory – the (M)Inventory will gain that function when it finally receives a badly needed overhaul – to assist in easing their paperwork burden which will free up more time to work with students/clients.

Session 2: The VROOM and OMO assessment tools

Presented by Dr Lil Deverell

A person’s clinical visual status doesn’t predict their functional capability or what they need to learn in O&M. Rather, functional O&M assessment is the foundation of good person-centred practice. The O&M specialist interviews the client and any other relevant stakeholders, but we don’t take the client’s word for it. We also observe the client at home, at school or work and in their local neighbourhood, doing the things that matter to them. We ask questions, listen to multiple opinions and make comparisons. We see the client’s capability and limitations, and explore what the client hopes for. Then we identify goals, do a reality check, and make a plan of action together.

There are many checklists, interview schedules and assessment tools that detail what to consider in a comprehensive O&M assessment. These tools are especially helpful when focusing on a particular O&M population such as children, CVI, RP, etc. They teach us what to look for, how to structure our assessment and categorise our observations. But comprehensive assessment tools can also be unwieldy in their detail, and reporting the outcomes of a functional O&M assessment can be wordy and time-consuming.

Yet it is difficult to measure a person’s capability, the outcomes of a tailored O&M program, or compare clients when they are so different to each other.

Instead of getting bogged down in the detail, the VROOM and OMO tools measure what is universal about any functional O&M assessment, reducing wordy observations to numbers. Then in our functional assessment report, an O&M specialist can illustrate the client’s comparable VROOM and OMO scores with just enough words to capture the details which make this client unique.

The OMO tool measures Orientation and Mobility Outcomes in a co-rated score out of 50, in the context of ordinary O&M assessment. The VROOM tool measures Vision-Related Outcomes in O&M, also producing a score out of 50 in the same context. Co rating means that everyone’s opinion matters, and we come to a decision together about which number on each scale best describes what the client can do. Importantly, the VROOM and OMO tools can be used with anyone of any age or capability, anywhere in the world, not just O&M clients. This means we can practice using the tools on ourselves, our family and friends before trying them with clients. We don’t have to think about diagnoses or disability categories before we start. We let the rating scales tell the story, and the results can be surprising.

The VROOM and OMO tools are not intended to standardise how we conduct a functional O&M assessment – in person-centred practice it is important to follow the client’s lead. But these tools do standardise the reporting practices of O&M specialists to reduce the word-porridge and create comparable measures. They provide a clear, sequenced language to account for functional vision and O&M that shows how the client can improve, and they help us communicate the mysteries of low vison, blindness and O&M to others.

Learning outcomes

By the end of this webinar, participants will be able to:

1. Explain four different elements of everyday environments that affect the complexity of an O&M challenge.
2. Identify 5 characteristics of functional assessment that make it different to clinical assessment.
3. Use the VROOM and OMO tools to co-rate their own and others’ O&M and functional vision.

Session 3: 3D Block Constructions test of spatial cognition

Presented by Ian Stuart and Dr Lil Deverell

Mental mapping is the hidden work of O&M. Spatial cognition enables people to know where they are in space then maintain orientation during mobility. But what if the client is struggling to learn orientation to a new place?

In fact, some clients find it very difficult to make sense of basic lines and angles, shapes, directions and distances or to build these features into a stable mental map. This might be due to a congenital condition such as cerebral palsy, or acquired brain injury such as a stroke, or for no apparent reason. Whatever the cause, O&M specialists need to recognise the problem, bypass the blame-game, assess the client’s spatial cognition, then work out how best to work with the client.

Dr Ian Stuart, a Melbourne-based neuropsychologist became interested in the spatial cognition of congenitally blind children in the 1980s. He completed a PhD, creating two assessment tools that are always used without vision: the Tactile 3D Block Constructions Test and the Stuart Tactile Maps Test. This non-visual approach to the assessment of spatial perception and spatial memory is an important equaliser, because the visuo-spatial tasks typically used to assess spatial cognition are inaccessible to blind people.

The Tactile 3D Block Construction Test and the Stuart Tactile Maps Test are both undertaken under blindfold, so they remove the confounding variable of vision. Both tests can be used with people who have full vision, low vision, or no vision.

In Session 3 we focus on the 3D Block Constructions test, which investigates right parietal brain function - whether a person can make sense of spatial relationships in real time, without relying on spatial memory or mental mapping. The client uses two hands to explore a fixed model of blocks, and then uses the equivalent loose blocks to replicate the fixed model, moving freely between the two models to compare. There are four levels of complexity with these fixed block models. The assessment shows the strategies a client attempts, and whether or not these strategies are effective to make sense of 3D spatial relationships. The test has an obvious relevance to exploring and making sense of spatial relationships in the built environment.

Since this test is not commercially available, we explore ways of using commercial wooden blocks or Duplo to investigate the same concepts and sequences as the 3D Block Constructions test. We also discuss how to interpret results. A poor performance on this task suggests the client has a fragmented sense of space, and is likely to find orientation difficult in lived environments, especially with little or no vision. Intact spatial perception is a prerequisite for learning a new spatial map of a travel environment, and the ability to learn a mental map is assessed with the Stuart Tactile Maps test.

Learning Outcomes

By the end of this webinar, participants will be able to:

1. Identify 5 characteristics of spatial dysfunction that become evident in O&M.
2. Explain the role of the right parietal lobe in spatial orientation.
3. Demonstrate how to use 3D blocks to test a client’s spatial awareness.

Session 4: Stuart Tactile Maps test of mental mapping

Presented by Ian Stuart and Dr Lil Deverell

Assessing spatial cognition is a multi-stage process that can be undertaken by an O&M Specialist, but it is important to have findings confirmed by other professionals and stakeholders in the client’s life. The 3D Block Constructions test and the Stuart Tactile Maps test are used to assess different aspects of spatial cognition. The 3D Block Constructions Test assesses a person’s spatial perception in real time, a function of the right parietal lobe. This is important first step because we cannot map and remember what doesn’t make sense to us in the first place.

In Session 4, we focus on Stuart Tactile Maps (STM) test. This controlled, standardised test assesses whether a person can remember a sequence of lines and turns, measures how much repetition is needed to achieve this learning, and to what level of complexity. There are three raised line maps in the STM assessment kit. The client’s hand is guided along the raised line on the simplest map three times, then the client is asked to draw the pattern, either on paper with a pencil, or with a finger on the table-top. The client is allowed 3 lots of 3 exposures to each map, and the test is scored out of 9.

Spatial perception is a right parietal function, but spatial memory is a function of the hippocampus, which glues together spatial features and relationships into a stable map that becomes useful for later reference in O&M. We explore some of the neural processes that make mental mapping effective, how to recognise spatial fragmentation, and what navigation strategies we have in O&M that don’t depend on mental mapping, and so might be effective if spatial dysfunction is evident.

The Stuart Tactile Maps test is commercially available. It takes only 5-15 minutes to administer, and is an excellent predictor of a person’s dynamic orientation skills. We discuss how to interpret results, and the implications for O&M programs and activities of daily living.

If a client shows any difficulty with orientation to new places, regardless of level of vision, then the Stuart Tactile Maps test can save hours of frustration and futile attempts to teach orientation strategies to a person who cannot learn mental maps. This energy can be better spent learning non-spatial strategies to navigate the environment.

These two tests have been used with congenitally blind children as young as five, adults who have ultra-low vision from retinal problems, and many sighted O&M specialists (under blindfold). The results are surprising. There are five year olds and adults blinded by acquired brain injury who understand complex spatial relationships and are brilliant mental mappers. Conversely, there are fully sighted O&M specialists who drive to their clients’ homes, but struggle with these tests of spatial cognition, and who have much to teach us about non-spatial methods for navigation.

Learning Outcomes

By the end of this webinar, participants will be able to:

1. Explain the different functions of the right parietal lobe and the right hippocampus in spatial orientation.
2. Identify three situations when working with clients, where assessing with the Stuart Tactile Maps would be appropriate.
3. Identify five strategies for navigation that don’t depend on mental mapping.

Session 5: An O&M Toolkit

Presented by Dr Bronwyn Scott

This session will review principles of assessment in early childhood. When working with this age group, O&M specialists need to use a range of professional and clinical assessment tools to identify children’s strengths and design programs that best support each child’s learning and development. This session will review early childhood specific assessment tools, including eco-maps and routines-based assessments, and discuss how these can be linked to specific O&M assessments such as the O&M Inventory and the Texas 2-STEPS.

Learning Outcomes

At the end of this session, participants will be able to:

• Understand how the principles of early childhood best practice inform the assessment process.
• Identify assessment tools suitable for use with children aged 0 – 8 years.
• Describe how outcomes from tools such as eco maps and routine based assessments can inform O&M assessment and program design.

This series will contribute 5 PD hours towards COMS re-certification with ACVREP as it addresses the Core Domains of the OMAA O&M Framework.