O&M for Older Adults
O&M for Older Adults
Description
Orientation and mobility (O&M) skills involve much more than crossing streets and using public transportation. For older adults, learning basic O&M skills can increase confidence and safety when moving within the home and community. They are also incorporated into performing daily tasks. How then can we do more to teach basic O&M skills to older adults and document the work being done? Join James Scott Crawford, COMS, CLVT, CATIS, as we discuss the variety of basic skills that fall under O&M which can be helpful for older adults including those with additional mobility issues.
Release date: 2024
Contact Information
James Scott Crawford
Email: scottc@affiliatedblind.org
Phone number: 337-654-9385
Video
Transcript
Jennifer Ottowitz: Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let's check out this month's webinar. Again, welcome to our presentation. Our topic today is O&M for older adults.
Jennifer Ottowitz: And as we get older, many factors, including additional mobility issues, can impact our ability to feel. Comfortable, confident, and safe whenever we're traveling in our homes and in the community. And so, I'm very excited to welcome our presenter, Scott Crawford, who is a certified orientation and mobility specialist, among other things.
Jennifer Ottowitz: And he has added experience and expertise in working with people with additional. mobility issues as well. And so, Scott, welcome. And I'd love for you to share a little bit with us about your background and experience, especially working with older adults.
Scott Crawford: Okay. So, thanks for having me. I was, it was all, it's always wonderful to hear your voice.
Scott Crawford: But I started back in 1989.
Scott Crawford: Quick survey, how many people weren't born yet? But that was at the University of Arkansas Little Rock, and so my first experience with people that weren't necessarily ambulatory came right there in my O&M program at UALR. I ended up working with a couple of young gentlemen who were in wheelchairs and became a house parent at the school for the blind there for, you know, they let you have free room and board in exchange for working with the kids.
Scott Crawford: And so that was my first real experience. From there, I moved on to the VA in Birmingham and then to the Center for the Visually Impaired in Atlanta, Georgia. And there I had the great pleasure of working with Janet Barlow, who I'm, will be forever grateful to. But she trusted me with the people who had the weird things come up, that weren't just dealing with vision impairment, but were also dealing with Head injuries or needing something else to go with that.
Scott Crawford: And really, there wasn't much training within the university program. And I got most of my experience from hands-on, either with the VA or through CVI Atlanta, and I did work for a few years for them in their older blind project. Now I'm at Affiliated Blind in Lafayette, Louisiana. So, I'm working with kids from three years old up to people who are approaching death all ages.
Scott Crawford: And in addition to the O&M part, I also coordinate our I Can Connect program, which is the deaf-blind equipment distribution program. If you haven't heard about it, you need to look it up through your state. It provides phones and computers, and braille displays and all that wonderful stuff. But I may literally bounce from a three-year-old to a 97-year-old within an hour.
Jennifer Ottowitz: Well, we are so thrilled to have someone with that range and level of experience here joining us today. Again, thank you. Now I know for me, working for OIB Tech now, I learned kind of looking at things from a national perspective, kind of comparing OIB programs across the country that in 2023, I was a little surprised that the national average, the percentage of OIB Consumers, so those are people 55 and over who experiencing vision loss and receiving services that that percentage the number of people receiving O and M training was documented at being 27%.
Jennifer Ottowitz: You know, some states higher, some states lower. And for me, just knowing as from my lived experience with vision loss, how important feeling safe and comfortable and confident and being able to move around. Your home and your community is that seemed a little low. And so, I was wondering, you know, are there more things that can be done to teach O&M skills especially to older adults and people who use, for example, walker support canes, and wheelchairs.
Jennifer Ottowitz: And then also, are there things that. We're currently doing that just are not being captured. There, you know, there are some professional, there's professional crossover in our scopes of practice. So, some vision, other vision professionals may be doing related skills. They may be teaching those and are we capturing those and the other thing that I've heard from OIB programs, staff, and administrators sometimes is that, well, older adults, they're just not interested in O&M because they're not crossing streets or taking, taking buses and O&M is so much more than that. Right? So, at this point, I'm going to turn it over to Scott, so he can share more with us about the variety of skills that can help someone.
And that includes folks with those additional mobility issues as well. And then we will have a Q&A section at the end of Scott's presentation. So, and, and you know, Kendra and I will be monitoring the chat too. If you have questions during we will either get to them right away or wait till that Q&A, so feel free. You can put things in the chat as well. Okay. I'm going to turn it over to Scott, but thank you.
Scott Crawford: All right, thanks. After you and I were having those discussions, I kind of started thinking about it and there is really a lot of overlap in between. The mobility skills, the things that the VRTs do, what your OTs do, what your PTs do.
Scott Crawford: And there's a lot of things that are necessary. And if you don't necessarily have an alignment instructor working with the student yet, the VRTs or the OTs could or should be doing. One of the simple examples we talked about was just doing a room familiarization. The, what skills do you need to do a room familiarization? Well, You need protective techniques. You need hand-trailing techniques. You might be using your cane. Some, a lot of people don't use their cane in their own home, but, but you might. So, really, it just depends on how you want to note that or record that.
Scott Crawford: Talking about the bigger part of O&M and some people not being really interested in doing that at this time. Sometimes as O&Ms we can talk about the things that we can do. And we may scare the students off by talking about things that are too big. For what their scope is for where they're living right now, go back to school, go back, think about what they, what they said in Dean Tuttle's book about self-esteem, adjusting blind if somebody's at that lower level of adjustment, and I'm talking about skills that are way past that, I may turn them off or push them off or scare them off to where they choose not to do the O&M there's a great big intersection here in Lafayette that's, you know, eight lanes and eight lanes, you know, from each side.
Scott Crawford: And really, I tell people it's the easiest street in town to cross, and nobody believes me. But when they get out and actually try it, they find out. Oh, yeah, that really was easier. Some of these other smaller streets because you have forever to get across the street. But if I walk in the door that first time and I start talking about these big goals, it may turn somebody off from doing the other things that really need to be done up to that.
Scott Crawford: Okay. So, to add something to this, just some examples for the for the room familiarizations. A lot of the older blind people that we go into work with had vision at one point in their life. So, they may be visual learners, even though they don't have vision now. So, what's a couple of things we can do to help somebody who's a visual learner, learn to learn, get this orientation.
Well, the biggest thing is tactile maps or tactile representations. And I'm not suggesting that you go in and you make these big. Permanent tactile maps of everybody's house, but there's some things you can bring along with you in the car that you can take in and make something on the fly, show it to them and then get back out.
One of the things I've used a lot in my career is just taking a file folder and thumbtack, thumbtack being poster putty. So here on this, in this file folder, I've made a little layout of a room with. Poster putty and I've marked where the table would be got little dots of poster putty for the chairs where the couch would be the TV and then maybe to two other chairs, but all that can then be just pulled right off and reshaped for the next or for the next diagram that you need to make.
One of the problems a lot of people have is, like, getting around an apartment complex, and they may not realize how the layout of the pretty. I call them the pretties, the plants, the little bulb outs in the sidewalk. So, taking my poster putty, I might be able to make the little map of how the sidewalk runs.
Jennifer Ottowitz: And Scott, while you're, while you're prepping that, the poster putty, that's available at really any real retail store, right? Walmart, Kmart, Target. Walmart, yeah. Yeah, it's just the stuff that hangs, helps hang up posters on the wall without leaving a mark. Okay, thanks.
Scott Crawford: But it'll stick to my file folder here. And it might be that there's a bulb out with the, with the sidewalk where it's curving over and then coming down and then it goes back out towards the street so I can lay out the crazy way the sidewalk goes somewhere in the design world. They say straight lines are not pretty, so they want things to curve and have gentle bends and this kind of stuff, which is, which is more difficult if you can't see it.
If it's curving real gradually, you can't tell that it's curving well, having some kind of a tactile representation can help that person anticipate. Oh, I need to go in then down and back out. And then my sidewalk is going to curve back parallel to the driveway because there's parking places here in the middle.
But anyway, for a couple of dollars in a file folder. I have a way to do a quick capital map. Another one I like to use is called an, it's just a nail board. So basically, what I have on this board is nails every two inches in a grid. And then I can take my pipe cleaners and I can wrap that around. The nails to represent the streets and this crazy little not that I have in front of me is a map of Lafayette.
It's called the hub city for a reason. None of the streets really run north, south, east, west. A lot of them curve. In fact, the street near the center where I work is university. So, as it comes down, it starts going south, then it curves a little bit, then it curves a little more, then it loops around, and it curves some more, and it comes back, and it crosses itself.
Eventually you change names. But you can literally go all the way and loop around the southeast part of town and then cross yourself coming back without ever making a turn. But the pipe cleaners can be put on one at a time, so that instead of having this big mess of streets that I have now, you might lay down one.
Okay, this is Ambassador Catholic. You can go over that a few times. When it gets to this point, it stretches off onto this street. When it gets to this point, it bends back the other way, the nail boards and pipe cleaners are a great way to just create a quick map.
Okay. And all of that's coming back around partially say that some people think of O&M, and they think they're going to have you out walking for 2 hours. Well, it may be that my person doesn't have the stamina to walk for 2 hours. They may only be able to walk for an hour or 30 minutes at a time 15 minutes.
So, what can we do in those breaks in that meantime? Well, you can sit and you can do your, your maps. Another way to do those maps is to draw it on their palm, or you could draw it on their back and just help with their orientation that way.
Jennifer Ottowitz: I think we do sometimes forget about the O part of O& M, right?
Scott Crawford: Yeah.
Jennifer Ottowitz: We focus all on the mobility part.
Scott Crawford: Yeah, and, and, honestly, how many of you all think that you have to be an O& M instructor to, to pull out something like that? You don't. In the old foundations of rehabilitation teaching books, one of the sections was orientation and movement instead of orientation and mobility.
The VRTs really do Teach part of the mobility skills and the phrase I've heard is everything up to the mailbox. And to the mailbox, if you're an apartment complex can be pretty complicated for a lot of them. It's just that. Okay, changing subjects.
Just a little talking about the where the lines drawn in between what a VRT will do and on and on. By all means, if you're not comfortable teaching something. Don't do it. If there's somebody that needs to learn to do the stairs in their home and you're not comfortable with a being able to help somebody with the stairs in their home. Don't do it. But you a lot of times that may be somebody other than an instructor.
That's as you're orienting to the house. You're having to do the stairs or getting out the front door to get to the mailbox. There may be stairs involved with that. With your. With your protective techniques doing some of the room familiarizations and stuff, you're going to use protective techniques. And the standard of course, is that somebody takes their arm, they bring it up across their body. In, in one plane, the arm they're putting up, the, the elbow should be pointed straight forward.
And then the hand extended forward and you want it extended so that there's a spring there. That's your standard upper forearm protective headband. I like to do it rotated 45 degrees to where your wrist is actually in front of your nose. That way your fingers are reaching up and protecting your forehead from that, from that cabinet door or whatever.
Or if I just dropped, dropped my fun tech and I had to bend over to get it. If I bend over, I've had a number of students come up with black eyes because they bend over and just happen to catch the doorknob, or just happen to catch a cabinet. So anytime somebody's going to bend over, they should put up that upper forearm protective technique.
I like it modified to 45 degrees. And then their hand catches that instead of their face catching that corner. Another modification I like to make with my upper forearm techniques, instead of using one hand, I like to use two. And for my kids, we call it our bumpers. Put up your bumpers. But I'm making this nice circle in front of my body with my hands kind of centered in front of my face.
And that way, nothing can get in to bump me in the head. Sometimes when people do the standard upper form technique, that hand gets off to the side a little bit, and that leaves them open to running into something with their face. So I like to use the two hand. An embarrassing story about myself. When I moved into my home, I turn off the light at night, and then I go across to turn off the, after I turn off the lights, I cross the room to go to the bedroom.
Well, first two or three nights, I hit my head right on that doorjamb. So, I said, Scott, you're a dot and gone mobility instructor. Use your techniques. So now, even in my own home, even though I have 20-something vision, I'll let my fingertips touch in front of me and then make that big circle, and then it'll protect me as I get across the room. It's just a lot of modification of the technique that you'll see in the textbooks.
A lot of times, basic cane techniques, if they're not being introduced by a VRT, they could be being reinforced by a VRT or by an OT or a PT. So that's another area where you might be able to track some O&M hours within the, within the scope of what those trainings are doing. When we get to older blind, one of the things that I used to say when I do these presentations is the, the presentation may have called for older blind and they're thinking about walkers and support kids and all that. Watch out for your ex, for your own expectations. We have to remember that everybody is an individual, and some of my older blind students are more fit, can walk farther, they tolerate the heat better, and are more open-minded than a lot of my younger students.
Just because we're doing something, we're going in to somebody who's older, don't assume that all these things are going to be here. They may. We don't want to go in with that assumption that just because somebody's older, they're not going to want to do the bigger, grander type of things. One of my students that came in, Ms. Elizabeth, came to the center, and she was not happy with me from the day she walked through the door because I was going to make her go do all these other big, grand things. And she wasn't going to do it. She was a nice Southern belle, preacher's wife. She was never getting on a city bus.
Well, guess what happened? First time she got on a city bus with me, the bus broke down. Left her stranded in the middle of Johnson Street, which is the biggest street in Lafayette. Left her stranded in the middle of the street, and the bus driver had to get down and walk her across, off the bus, to get to a, to a bench to wait for the next bus to come along.
And as much as she didn't want to do all those things, she was the one that after she graduated, she would get on the bus and take it to downtown and go listen to the music and then get on the bus and get back home and was able to travel independently, even though when I first, when she first heard that we were going to do that.
She was adamant that it would never happen, but we, we nursed it along and eventually she got, now, she had some health problems. So, she was somebody who could walk around her house just fine, but when it came to traveling any distance, if we walked one block, she'd come back in and tell everybody I made her walk a mile.
If we walked two blocks, she'd come back in and say I made her walk two miles. So, she had a little exaggeration problem, but. That's part of Cajun culture is the grandizing, the tall tales. But she was somebody who eventually graduated and was able to use her wheelchair to get to the store, which was three-tenths of a mile.
And she would ride the bus to and from the concerts in downtown. But she traveled independently to Target to get her groceries and come back home. Okay. So, let's get into that for a second. The, where there is mobility issues. There's a hierarchy of. So how much support do you really get from a long white cane?
Ideally, none. What if we modify that long white cane a little bit so that you could get a little bit of support from it. I've had a lot of people who didn't need a support cane walking down the hall, but they might need something just stepping up and down the curve. So, here's a couple of canes that I have that can be used to give you a little support. This one has a roller ball on the end of it for the tip. Okay. But at the top, I cut off part of the handle and added a crutch tip.
And then the crutch tip can be used for support as that person steps up a curb, down a curb, going up or down the stairs, where they may just need a little bit of support. Some people will get these roller, jumbo rollers, and that's from Ambutech. And the jumbo roller is kind of the shape of a donut, or a rounded over hockey puck. So, you have that nice flat surface. So, you can get some support from that just to help you up or down a curb, as long as the cane is held straight up and down.
If the cane slanted back at all, it's likely to slip out from under you. But if you can get that cane, the shaft of the cane straight up and down, it can give you a little bit of support as you go up and down. I've had some people that would just flip their cane over and just use the rubber end of the handle on the ground so that it wouldn't slip. And then when they'd start walking, they just flip it back over and take off.
Okay. So, other people may need more support than that or more consistent support. So, somebody may have to have a support team that they'll use at their side. To help them with their balance.
Okay. So, with anytime you're getting into walkers crutches, try if at all, you can to consult with your physical therapist. Because it could be that the students not using it. the proper way for what their injuries, their weaknesses say they should use it 99% of the time, your support cane goes in the hand opposite of your weak side.
So, if my right knee is weak, which in real life it is, I'm going to have my support cane in my left hand. Okay, that way I have a broader base of support. If I have it on the same side as my weaker side, I have a narrower base of support. And I want that wider base of support. Now, what would be a couple of examples that wouldn't, that wouldn't apply?
Well, it could be a hip. I have a hip that's flying out. Does it some form of weakness having the cane opposite is actually going to exacerbate that, make it worse. So, I might have the support cane on the same side to give me support to help cover up for what that weak hip isn't doing, or it could be a lateral looking into my knee that could be bad where my knees flopping out.
Well, then having the support cane there helps me keep that knee from popping out that way. So, with the support canes, I've also had some students that when they were walking, they were fine, but when they'd go to stop, they'd fall forward, so they needed something in front of them to catch them. Another lady, it was when she'd be out on the grass, and she'd start to go down a slope. Well, she couldn't keep yourself in the slope.
So, she needs some in front of her for the slope. So, for them, I took the support cane, stretched it as long as it would go, and then tighten that back up, and actually had them do two-point touch with their support cane. Now, they had very short stride lengths. So, normally when we're doing two-point touch, we do it in such a way that the tip is landing where that next foot's going to hit, and we're opposite of our cane tip.
As the cane tip goes to the left, we're stepping with the right foot, and vice versa. And ideally, that tip of the long white cane is hitting where my foot's now if I'm using the support cane for that, some of these ladies, a couple of them, their stride length was so short, even with the support cane, the cane tip was still ahead of where their foot was going to lean.
So, if somebody's taking big, long strides, that support cane in two point touch is not going to work. But if they have this smaller stride, it may be an effective way for them to use the support cane to help keep them with their balance. Now, the other criteria there would be that, normally, they have a good balance. It's just that they're having problems when they stop or when they, when they, when they hit a slope. All right, so.
Kendra Farrow: Scott, this is Kendra. Someone asked in the chat if you could show the first cane again, they couldn't quite see it.
Scott Crawford: The first one being the one with the cap on the end? The crutch tip.
Kendra Farrow: I believe so.
Scott Crawford: Okay. So, this is just a regular for linking. I cut off the top into the handle and just peeled that off. And then I stuck a crutch on top of that. So this would be for somebody who who's walking down the street normal and they don't need help. They don't need the support. But when they get to do that step up on a curb, or they start going upstairs, they need some support, they can just flip the cane over, and now I have that crutch tip that can be on the ground as I'm, as I'm walking up that curb, walking up those steps, and that's not going to slip out from under me as easily as the regular tip would, especially a ball like this, if you try to lean on that, it's not going to stay, it's going to take off, and that is the other reason some people like the jumbo roller, Because it's like a donut, so it has a flat side that you can actually take a little bit of support from, not full support, but a little bit.
Kendra Farrow: So, someone else asking about the, the crutch tip, if it can, if it needs to be over a certain type of material, like, is the material underneath, does that cause it to maybe not be as firm?
Scott Crawford: No.
Kendra Farrow: Okay.
Scott Crawford: Because it's coming down onto the aluminum shaft. Of the king.
Attendee: Okay.
Scott Crawford: So, it's got a solid end to it.
Jennifer Ottowitz: And I think this is a good time to jump in with this is a good time to jump in with some exciting news. Scott Explains much more about adding a crutch tip to a cane, as well as many other things in a new course that OIB-TAC is going to be offering. It should be available within the next couple of weeks. So, by the end of October 2024, it will be called “Walkers, Crutches, and Support Canes Oh, My! Orientation and Mobility for People with Orthopedic Conditions,” I believe, is the full title. And so, a lot more details about how to how to attach that crutch tip or, you know, considerations when you're wanting to add the crutch tip are all going to be contained in that course. And there'll be separate modules 1 on crutches.
One on support canes, one on walkers. And so, so look forward to that, not to steal some of your thunder from things you're going to be talking about next, but I thought it was a good chance to jump in because I'm sure there were a lot of questions about details related to the crutch tip. And I think that course will, will be a great help.
Kendra Farrow: So, someone's asking when that course will be up, it'll be up by the end of the month, right?
Jennifer Ottowitz: Yep. Yep, exactly.
Scott Crawford: We hope, knock on wood.
Jennifer Ottowitz: Yes, exactly. We will, we will advertise and let you know for sure.
Kendra Farrow: And someone else was asking where you got the crutch tip. Can you just buy that a medical supply? Or is it a special place you have to get it?
Scott Crawford: I bought it at Walgreens. It's just, think about how the, how wide your, the base shaft is of that cane. And then you need to find a tip that's got that size opening so that you're not having to build stuff in there, pack things in there to keep it, keep it on. You want it to be the same size, and then the rubber will stretch out just a little bit to fit over, and then hold it tight.
And I keep saying that it's a crutch tip, but it's really that particular one was the tip off of for the four-footed. Support kings for a quad king. They have a little bit smaller feet, and it was the perfect size for that. But what you're looking for is look at the diameter of your shaft, and then you want the same diameter in the opening of the. The rubber foot or tip, whatever you choose to call it. Cool beans?
Kendra Farrow: Awesome. Thank you. Someone is, I'm sorry, someone is still asking about if the cane should be aluminum or graphite. Does it, or does the whole thing need to be aluminum? Is, is there anything about the cane that we need to know?
Scott Crawford: It could be just a strong cane. I probably wouldn't do that with the fiberglass, the skinny NFB style canes. Just cause there's, they're a little bendy, they're flexy, which is one of their advantages. But that would make it not good for us to be used for, for support. But any of the folding canes, the aluminum rigid canes, even it's, it's gonna give them more than what they have without it, if that makes sense.
Okay. So, with the support team, it could be that it's on the same side as the, as the weakness, or it could be that it's opposite of the week that takes precedent in us deciding how to add environmental preview. A lot of the physical therapists are going to help somebody get to where they're sturdy.
They're not going to fall. Their techniques don't necessarily provide that environmental preview that a blind person needs of what's in front of me. Where is the drop off? Am I going to walk square into a cactus? We used to have a holly tree that I'd run into the holly tree trying to catch a ball.
You know, how do we keep ourselves out of that stuff? Well, we need the long cane for that. I don't know. Ideally. So, if they can, you want to figure out first where the support came from. And for that, that's why you need to consult, not just refer, but consult with the PT and OT because it's your PC or the doctor that's going to tell you this person needs to have it in their left hand. And then walking in step with that support came out.
Okay, or the doctor may say no, they need it in the same. Okay. So, hopefully, I can describe this good enough, but my right knee is bad. So, I'm going to have my support came to my left hand. That means I'm gonna have my long cane then in the other hand, right? The support cane takes precedence in your just when you're deciding which cane goes in which.
Now, the support cane also takes precedence with my being in step when it's opposite my right leg and that cane which is in my left hand. is going to step out at the same time and then the other foot's going to go through. Then it's going to be cane and weak leg and then good leg going through. All right.
So, that being said, I now have my support cane and my right foot going in sync. So, my long cane is in my right hand. So, if my right foot's going forward, my long cane should go to the left. As my left foot comes forward, my long cane should go to the right. So, to get that in sync with the two canes. Most of the time, I have to get the student in sync with their support cane first, even if I'm doing that through human guide or whatever. And then I can add in the long cane.
If the support cane is on the opposite side, that usually means that the two cane tips are going to come together and then go apart. Cane tips are coming together and then going apart. To describe that again, the support cane is going forward in my left hand as the long cane tip comes to the left. And as the support cane goes back, the long cane is going to the right.
So, they're spread as far apart as they could possibly be right now. Then they're going to come together and apart. Together and apart. I used to say it was like my love life. We come together, we go apart. We come together, we go apart. We come together, we go apart. Alright. Does that make sense? Jennifer, did I describe it enough that you could, that you could get that? Okay. I
Jennifer Ottowitz: think so. Yep. Everybody, everybody good? I hope. Yep.
Scott Crawford: Okay. All right. Now I'm going to swap. Let's pretend that my right leg is bad, which it is, and that I need the support cane on the same side. So, this time, as my right foot goes forward and the support cane go with it, my long cane needs to go to the left. Okay, so as I'm stepping forward with my right foot, the cane's gonna swing to the left, the long cane's gonna swing to the left, and the sport cane's gonna come forward. And so, I describe this almost like a set of windshield wipers. That they're moving at the same time, and they never really come together or go apart. They're in sync like a pair of windshield wipers. How's that work for you, Jennifer?
Jennifer Ottowitz: That makes a lot of sense.
Scott Crawford: Makes sense? Okay.
Jennifer Ottowitz: Yeah.
Scott Crawford: So, I'm just gonna do it again, just to practice. I'm gonna start, cane to my left hand, so I'm gonna start with my right foot. Canes across the long canes across my body as I step with my right foot. The long cane's gonna sweep to the left as the sport cane comes forward. As the leg and the support cane come forward, the long cane goes to the other side, and then it comes back across as the support cane and the leg go behind.
Some people can't hold that long cane and the support cane in opposite hands. Maybe they, they're hemiplegic or something. So, you can use something called a cuff. A cuff is something that you put your hands through, and then there's a slot or a tube that holds the utensil. So, a lot of people use these to hold a spoon or a knife or a fork.
And I was introduced to him by a friend who was a spastic quadriplegic. And guess what he learned to do first with his cuff? He kept a cigarette lighter, and he could light his own cigarettes. But basically, what that's doing is it's allowing the cane to be attached to your hand. That can then hold the handle of the support team.
Jennifer Ottowitz: And Scott, where would somebody get a cuff like that?
Scott Crawford: Walgreens, Amazon. If you're looking on Amazon, do a search for a utensil cup, and I prefer the ones that are either leather or something solid, not the elastic ones. With the elastic ones, the cane tends to swing away too much. Okay, so in the example right now, both things are in my right hand.
So, my right palm is on the handle of my support cane, and the long cane is just being held by the by the cuff. I'm not really grabbing it. So, to get arc out of that, I just have to do a radial ulnar twist, which means the bones in my lower arm are rotating over each other. Another way to think of it is that my palm is pointed sideways.
My palms pointed to the floor, sideways floor, or my knuckles are pointed at the ceiling. Now they're pointing to the wall to the right, ceiling wall So that twist gives me the arc of the cane. And then most of my people who need this are hemiplegic again, so they're kind of coming forward as they're stepping, they're kind of leading with one leg, the good leg, and then the weaker leg comes up beside them. But I can still clear my path with that long cane. Now, for that example, I had it in my right hand and the cane was between the handle. You can also set it up to where your fingers are going through.
And the cane is more attached to the back of your hand. It's a little more floppy that way. And you don't get as much sensation. So, I might not feel that I'm hitting something. I might have to hear that I'm feeling that cause I'm not feeling the vibrations from the cane quite as well. Okay. That being said. Does anybody have any specific questions before I jump into something else? Nope? Okay, then I'm going to keep going.
Jennifer Ottowitz: Okay, we're good.
Scott Crawford: All right. So, what I pulled out here is called an upright walker. And by an upright walker, what that means is that I have forearm supports. Instead of reaching down with my hands to hold the handles, I have the forearm supports. And what that does for me, if I don't trip over things, is when I have my arm in a truck, my hand is now free to swing my cane. So, with the upright walker, there's a trough there that my forearm sits with my hand is extended forward and it's free to just do a wrist flick back and forth to swing the cane.
Okay. So, this is something that can be bought this way. Or you can add it on what I'm holding now is basically just the forearm trough is on a longer shaft that can then be attached to the side of your Walker, and they can be bought individually, but to be honest with the cost of the upright Walker by itself with both farm troughs was less than buying two add-ons. So, it's probably cheaper for the person to just get a new Walker.
And this is the support cane that I've added the front truck to everything I've talked to or showed you about so far is something I've used with a real client. This is the 1 that I have not used with a real client, but imagine somebody has, I'm getting support from the, from the quad cane, my industry to my cane, and I can bring that forward and step into it forward and step into it.
Okay, I'm not walking smooth where everything's moving. I'm taking turns. Just check for it. I move the support cane, then I'm stepping up to it. Support cane, step up to it. Support cane, step up to it. Okay. Oh, that's weird.
Kendra Farrow: There's a question about if it didn't have the armrests, how would you hold on to it? Without the armrest.
Scott Crawford: Okay. That can be very difficult. And one of my running jokes for years has been, they answered every question that they could ask. And it really does. So, some people have enough hand strength to grab the handle of the support cane and then their fingers are long enough to hold the long cane on the inside of that. So, you can hold it all in one hand, but not everybody has that much hand strength. And that's where it comes back to maybe using a cuff. Does that answer the question?
Jennifer Ottowitz: And then, I did think I saw one more, and maybe you, maybe you did go over this, but what material was, there was a red cuff, I think that you had?
Scott Crawford: Oh, that was just duct tape.
Jennifer Ottowitz: What material?
Scott Crawford: That was literally just duct tape.
Jennifer Ottowitz: Duct tape, okay.
Scott Crawford: I made that myself.
Jennifer Ottowitz: Beautiful, thank you.
Scott Crawford: And you do the part around your palm first, that goes around your knuckles first. Just do it double sided, where you have the backs to both sides, and the sticky parts go together. And then you can add on the, the tube to hold the cane second, and then go back over that with duct tape again to hold it in. Where did it go?
Kendra Farrow: Jennifer, do you think we should go to some live questions? Yeah, if, if you're ready for that, Scott, we can, we can jump right in. I just need to allow people to unmute, so let me get there. Okay.
Jennifer Ottowitz: We know that you know, Scott could talk about this for days. There's so much to talk about that. We need to talk about it for days. So, you know, and this is something if you have a great interest, if there are related topics to this that you'd like to know more about, you know, please email us at OIB. You can email info@oibtac.org, email Kendra or myself directly. And we're happy to look at that again.
I think that the course is going to offer a lot of great information, and Scott has shared his contact information, too, which is available on the webinar page for this course. Webinar so again, OIB-TAC.org. Click on continuing education and then click on webinars and you can find his contact information there, but we'll, we'll open it up. If anybody has a specific question, they like to ask Scott, you should be able to unmute yourself. Now, if you'd like to.
Attendee: Yeah, this is Lisa. Could you just repeat that email link you just stated.
Jennifer Ottowitz: Sure. Yeah. And Kendra, if you can put it in the chat, it's OIB-TAC.org. So, OIB-TAC.org. And then you'll click on continuing education and then click on webinars.
Attendee: Okay, great. Thank you. Can we get actual credits for this?
Jennifer Ottowitz: It is available for four continuing education credits through ACVREP, as well as continuing ed credits through NBPCB.
Attendee: What was the second one?
Jennifer Ottowitz: NBPCB, the National Blindness Professional Certification Board.
Attendee: Okay.
Jennifer Ottowitz: So, great. Thank you. For anyone that has, is an NCOM, so, which is their certification.
Scott Crawford: Okay, I just put my email and phone number into the chat, if anybody wants it. I don't mind getting calls up until about 9 o'clock at night. After that, my wife asked me what Hoochie Mama's calling now. So, don't get me in trouble with her. But I usually have more time to talk in the evening or weekend.
Kendra Farrow: And, and you're in central time, face-to-face, we should clear. It’s central time zone, you're in?
Scott Crawford: Yeah. Nine o'clock. Maybe Pacific would not be an option. Yes. Yeah.
Jennifer Ottowitz: I saw in the chat something about using the walker with, without the forearm troughs and the long cage.
Scott Crawford: So, there's a bunch of different ways to do that. And right now, I just have the rollator here with me. You can do the same with the other. So, a lot of times what people do is they'll take that backrest or whatever. There's some fun of the rollator and get it out of the way. Either that or they'll run the cane in underneath it.
But if you really need support from this rollator, you got to get your palm on that handle of the rollator. Then you can bring the cane up into your, into your hand in a pencil grasp, and then just use your fingers. It's swinging it back and forth to clear it. Okay. The problem is that if people are letting go of that handle, do they still have enough support to keep them upright, keep them standing.
If they don't have enough support for that. Okay. You may need to think about going to the trough and like I said, the river went, this trough could just be mounted right onto the arm of this, this Walker to where then my arm would be here to switch. But again, that's something we're getting deep in the woods there. I highly recommend you talk to their PT consult with the PT and let the PT know what you're trying to do so that we don't do something that's going to hurt the student and leave you liable for, for, for whatever damage we might have caused. Was that enough for Julie? Did that answer?
Attendee: Yes, it was Scott. Thank you so much. Yeah. Okay. Very helpful. I have a current client that I'm totally using that on.
Scott Crawford: Okay. So, there's a lot more in that training that Jennifer was talking about, but if you email me separately, I could send you some videos of that.
Attendee (2): Great. Thank you. Yeah, I'll be in touch.
Attendee (2): Do you have some quick suggestions for a wheelchair user?
Scott Crawford: Okay, wheelchair users, buy my book.
Jennifer Ottowitz: Okay.
Scott Crawford: Okay. So, APH has done a book on that. It's $4.99, so it's not hugely expensive. It's an electronic book, so you call them, you call their customer service, and they'll send you an email that'll link you to the book.
There's, there's 192 little videos about techniques for wheelchairs. My first suggestion is always, if they have any use of their leg whatsoever, get a foot on the ground. Because once you get a foot on the ground, you can help maintain that straight line of travel. And it's O&M for wheelchair users with vision impairments, but it's in the APH catalog, or just call our customer support though.
Attendee: Can you say, can you say it again? You spoke so quickly.
Scott Crawford: I'm sorry. The name of the book is “O&M for Wheelchair Users with Vision Impairments.”
Attendee: Thank you.
Scott Crawford: And it's, it's $4.99.
Attendee: Okay. It's on the APH website?
Scott Crawford: Yeah, go through APH.
Attendee: Thank you.
Scott Crawford: So, if they cannot get it at all, get a foot on the ground, get a foot on the ground that helps you with your straight-line travel. Even if they're not propelling the chair with that foot, if they can get that foot there, they can get, they can have something to then pull up over. Otherwise, if you have both feet up in the arm, in the footrest, and you're pushing with one wheel, trying to swing the cane with the other, you're gonna go in circles. Some people are able to push the chair and alternate hands, and I'm breaking rule number one. You'd always put the brakes on first.
Alright, so you got to take the break off first. So, they might swing their cane and alternate which hand they push the chair with. So, as I'm swinging, I'm going right hand, left hand, right hand, left hand. I keep switching the cane back and forth in between those two hands. As I go. Another thing to think about is if you're backing up.
Always put the cane behind you and clear, and then you might pull back with both hands. Clear again, and go two poles. Clear again, and then go two poles. Clear again, there's, oops, there's my cabinet. I don't want to go any farther than that. Alright. Some people can actually push, reach across their body, and push, but I can't do that.
Okay. Can you still hear me?
Jennifer Ottowitz: Yes. Yeah.
Scott Crawford: Okay. Wheelchairs, when you're trying to navigate tight spaces, that's the most important thing that you can work on. So, get two chairs and then practice driving straight back and forth between those chairs. And it seems easy, but it's not as easy when you can't see what's there. It's really easy to get off just a little bit, and then you drift into one side or the other.
So, practice straight through first, then backing through second. Then you take your two chairs, and you pull up, and you turn right to go through them or turn left to go through them. Imagine you're going down a hallway and you're having to turn into a room. Practice that between the two chairs. True story, lady needed a power wheelchair all of a sudden because she had some problem with her foot.
She was going into her braille room, and she caught the door frame with the arm of her power chair, and she thought, I'll just gas it. She ended up pulling the whole door frame off the wall and pulling it into the room with her.
Jennifer Ottowitz: Oh dear.
Scott Crawford: So, I highly recommend that when you're practicing those narrow spaces. Do it between two chairs or two trash cans, something that's easy to move. So, you don't damage them, you don't damage the building, you don't damage the chair when they're getting started. But everything else ties back to that. Navigating a curb ramp is just navigating a tight space. Going through a doorway is just navigating tight space. Getting onto the lift for the bus is just navigating a tight space. It all comes back to being able to drive through those chairs. So, spend a lot of time on that.
Kendra Farrow: Can you talk about how to clear behind you? Somebody put the question in the chat.
Scott Crawford: All right. So, I just took the cane, brought my arm down by my side, and I can sweep it back there as I go back. Now, because I was, because I had my foot up in the footrest. I had to sweep, sweep, and then back up, sweep, sweep, and then back up, and not move continuously back. I'm all yours. If people have questions, otherwise, thank you for coming. Hopefully I didn't, hopefully I didn't ramble too bad.
Attendee: I have a question. Can you hear me?
Jennifer Ottowitz: Yes.
Attendee: Scott, do you, as far as all those attachments and all the things you get to adapt the cans, do you pay for all that yourself? Or are you able to get it through work? Because, you know, at the risk of sounding cheap, just, I pay a lot, I, when I'm getting things, I can't get reimbursed, really, for little, odd things, so I'm always spending of my own money, and I'm just wondering, how do you handle that? Does your company reimburse for some of these items or can you get it through any certain kind of funding? Anything like that?
Scott Crawford: Okay, so like I said, the answer to every question is it depends. The stuff that I have that I keep, of course, I buy myself. But if it's for a client, I usually try to get the client to buy it, client to get their insurance to buy it, maybe LRS for us, it's Louisiana Rehabilitation Services, but whatever it is for your state.
The Older Blind Program can buy some of this stuff. It just depends. And a lot of this stuff isn't that expensive. So, like, the cuff is 5, 6. So, usually the clients will just buy that themselves. But getting the forum support and stuff, they may go through their medical insurance or Medicaid or whatever to try and get that.
So, that referral ends up having to come from the PT to get the insurance to pay for it. But if I can consult with the PT and show the PT that this works and it's wonderful, then they'll usually go ahead and buy in and and do that.
Attendee: Okay.
Scott Crawford: And if one PT won't try another PT, we have some PTs that are, I only do this. I had one PT tell me we never do scooters. Period. Would not recommend a scooter for anybody ever. That's what the client needed. So we went to a different PT, and the PT says, Oh, yeah, that works good for her. Let's do that.
Attendee: Okay.
Jennifer Ottowitz: Thank you, Lisa. All right. Any other questions for Scott? Before we close.
Attendee (3): Hi, I have a question. This was very informative. Thank you so much. So, I have a question back on the using the mobility came for support like to go up and down curbs. So, I'm wondering, is it mainly, are you using like the folding canes or rigid canes? I'm just thinking about weight. And just what was your experience? Experience with that with your clients.
Scott Crawford: Okay. So, for this example, weight can be a good thing. Okay. I don't want to go with too lightweight of a cane because it might bend or bow or flex. I'd rather have something stronger and more rigid. And yeah, it can get heavy. The other thing is there's, I'm using the long cane as the support. It needs to be somebody who can maintain their own balance most of the time. That it's just for somebody who needs that help with a curb, needs that help with some stairs, but that otherwise just walking down the hallway is going to be able to swing their cane and not rely on it for support.
Jennifer Ottowitz: And then again, Scott, you said earlier, the fiberglass cane may be a little too bendy for a situation like that, correct?
Scott Crawford: Yeah, the long rigid fiberglass cane, it gets really thin near the bottom. Which makes it super lightweight, which is great, but it's not the best for this type of person. Did that help Lauren?
Attendee (3): Yes, it did. Thank you so much.
Jennifer Ottowitz: Great. Any other questions?
Kendra Farrow: Oh, yes, the recording will be available on the website, and I saw somebody was asking about a code. There are no continuing education credits for this webinar today. There will be for the course, though. So, if you want to come back and take the course that will be out before the end of the month or around the end of this month. There will be what four credits for that?
Jennifer Ottowitz: Yes.
Attendee: And is that course the “Walker Crutches. Oh, My?”
Jennifer Ottowitz: Correct. That's correct.
Kendra Farrow: “Canes, Walkers, and Crutches. Oh, my!”
Jennifer Ottowitz: Now, I will share that course does not cover wheelchairs because Scott's book does so again, we direct you to that book available from APH if you're interested in learning more about techniques for people who use wheelchairs.
Scott Crawford: And the other thing I should throw out there is that part of all this is in “O&M for Independence” from Nora Griffin-Shirley and.
Jennifer Ottowitz: Laura, Laura Bozeman.
Scott Crawford: Laura Bozeman. Yeah. There's a tools chapter that I wrote that has some of the support and stuff in it in the crutches. But not nearly as extensive as what. OIB is gonna be putting out.
Jennifer Ottowitz: This has been OIB-TAC's monthly webinar. Thanks for tuning in. Find recordings of our past webinars on our YouTube channel, and discover all of our many resources at OIB-TAC.org. That's OIB-TAC.org, like us on social media, and share our resources with your colleagues and friends. Until next time.
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Presenter
James Scott Crawford
James is a nationally renowned speaker and author. He is certified as an Orientation and Mobility Instructor (COMS), Certified Low Vision Therapist (CLVT), and a Certified Assistive Technology Instructional Specialist (CATIS). His Master’s Degree is from the University of Arkansas - Little Rock. He is the author of Orientation and Mobility for Wheelchair Users with Vision Impairments, an electronic book from the American Printing House for the Blind. He wrote a chapter for the textbook O&M for Independent Living, and co-authored a chapter with Dr. Sandra Rosen for the Foundations of Orientation and Mobility textbook. He has been working with people with vision impairments for over 35 years.
As an employee of the Affiliated Blind of Louisiana Training Center, in addition to teaching O&M with the Lafayette Parish Schools, providing assessments and training for Louisiana Rehabilitation Services; he currently coordinates the Louisiana portion of the National Deaf Blind Equipment Distribution Program (ICANCONNECT). AER awarded Mr. Crawford the “Orientation and Mobility Citation of Excellence for Direct Services.”