Wednesday, November 21, 2012

How Do You ... Get Around?

This is the third installment in my series of posts called "How do you ...?" designed to answer some questions I frequently get about living as someone with a visual impairment. The first two posts in this series covered how people with visual impairments use computers and how people with visual impairments read. Future posts will include how people with visual impairments manage diabetes, how people with visual impairments accomplish everyday things around the house like cooking and cleaning, and (newly added thanks to a reader suggestion!) how people with visual impairments participate in exercise and sports. If you have any ideas or questions that I can cover in future posts, please comment!

Getting around a busy urban environment. For people who are losing vision, getting around is probably the most scary aspect of the process. For people who have low vision, using a white cane is probably one of the most psychologically-ridden decisions they can make. And for people who aren't blind or visually impaired, getting around is probably the aspect of daily living most shrouded in myths and misconceptions. Do people develop super acute hearing as they lose their vision? Do they count their steps to get from Point A to Point B? Should I (as someone who is sighted) help when I see someone with a white cane standing at a street corner? Do guide dogs automatically lead their handler where they need to go?

In this post, I will answer all of the above, and give you some insight into how people navigate indoors and out with little or no vision.

First off, no one who is blind or visually impaired is handed a white cane and told to go out on the streets and hope for the best. Just as someone with a spinal cord injury will get rehabilitation services, someone who is visually impaired has access to a plethora of rehabilitation services. The exact system varies by country, and there are ongoing controversies about how services should be funded and delivered (right now, in Canada at least, all vision rehabilitation services rely on non-profit organizations, which is far from ideal). One of the specialists encountered will be an orientation and mobility (O&M) instructor. An O&M instructor will teach someone the skills needed to know where they are and stay oriented in the environment (orientation) as well as the skills necessary, and the use of any necessary tools such as a white cane or monocular, to navigate safely through that environment to get from Point A to Point B (mobility).

(I will note here that I am not an O&M instructor. If you happen to be reading this as someone who is blind or visually impaired, please seek the services of an O&M instructor to learn how to travel safely. Do not take this post for any kind of professional advice!)

So, without further ado, I'll get on to how some of this stuff actually works.

First off: orientation. Right off the batt I'll tell you that people who are blind and visually impaired do not have any kind of enhanced hearing, smell, taste, or touch. People with visual impairments use these senses more, and so we gain more practice in paying attention to them, but that's it. Anyone could learn to feel braille dots or hear the flow of traffic on the street if they practiced enough, most people just don't have the need or interest to do so.

The built environment is so visual that many people think it must be impossible to navigate non-visually. In keeping oriented, people with visual impairments use many non-visual cues. Rather than visual landmarks, people with visual impairments rely on sound, tactile, olfactory, and kinesthetic landmarks and cues. Sound cues are easy to pick up—the sounds of traffic letting you know you are approaching a cross street, the sound of squealing brakes letting you know the bus has just pulled up to the stop you've been waiting at, the sound of a fountain letting you know you have reached the front doors to your office building. Tactile cues and landmarks can be found with the tip of a cane or with a hand or foot. A technique called "trailing" involves running the back of a hand along a wall or other surface to locate an object such as a water fountain or display case.

An O&M instructor will teach different "cane techniques" for use in different situations. The standard "two point touch" is what you see when someone is walking down a street rhythmically tapping their cane back and forth in cadence with their steps. Other techniques allow the cane user to get more information about the texture of the surface they are walking on, or to scan to the left and right of the path they are walking on to look for intersecting paths or other landmarks such as fences or signposts. When walking up or down stairs, the cane is held in a specific position so that the user will know a step or two ahead of time when they are about to reach the top or bottom of the staircase. These are all various types of tactile cues and landmarks.

Olfactory cues are something everyone notices when they are good—the smell of bread from a bakery, the smell of popcorn at a movie theatre—but most people don't notice much on a daily basis. The next time you talk a walk down a city street with stores, take note of all the smells! A clothing store and shoe store and hardware store all smell very different. Smells may not be the most-used sense in O&M, but it can definitely provide some useful information a bout where you are and when you may have reached a landmark or destination.

Kinesthetic landmarks include things involving movement, like going up or down a ramp or sensing that a street is curving slightly to left. When I was first learning to take the bus to school as a preteen, my cue that the bus was coming to my stop was that it came up the crest of a hill and levelled off right before it stopped. (I didn't realize until I was in my late 20s that people who are sighted can actually read street signs to tell where to get off the bus. I fiured most of them used landmarks like me, except smaller visual ones, to tell when to get off, and didn't realize that they could actually know their exact location at any given time.)

Of course, most people with visual impairments do have some degree of residual vision, and therefore in addition to everything listed above can use their vision in staying oriented in the environment and navigating from place to place. This vision may be anything from the ability to tell where in a room a window is to being able to see crosswalk lines to being able to see traffic signals to being able to read street signs with low vision devices. For those who have enough vision, magnification devices such as monoculars (basically small telescopes) are available that allow viewing things like street signs, traffic signals, and bus numbers from a distance.

Speaking of residual vision, the white cane is often one of the biggest hurdles for people with vision loss. Picking up a cane feels (at first) like accepting defeat, relenting to a disability, admitting that you are blind, and shouting to the world that you are (at least perceived as) vulnerable. It is a HUGE psychological hurdle, perhaps even the biggest hurdle in the adjustment process. Many people with low vision do something called "passing" where they pretend to see much more than they actually can. They walk down the street carefully watching the movements of people ahead of them to figure out when a curb or flight of stairs is coming. They pretend they forgot their glasses when handed a sheet of printed paper they can't read. They nod and say thank you when someone gives them directions, even though they have no idea where "the yellow sign over there" might be. Often, they accept that they may look foolish or oblivious, because (to them) that is preferable to looking blind.

In reality, the cane should be seen by society as a symbol of independence. A cane signifies confidence, strength, independence, and freedom. People do not need to be totally blind before they will benefit from a cane. For those of us with low vision, a cane identifies steps and curbs, helps in situations where lighting is not ideal (which happens a lot), and communicates easily to others that we can't see well. There may be misconceptions we have to deal with, but it's better to deal with them and educate people than to hide and pretend we're something that we're not.

The process of O&M is so complex that it's nearly impossible to explain in a blog entry. Developing good O&M skills may take months or years, and the skills needed differ a bit by each individual depending on where they want to travel, their confidence level, and their level of residual vision. Simulation activities can give a better idea of what it's like to travel with a visual impairment, but these are used with caution because they tend to invoke a reaction of fear ("Wow, I cant believe how scary that was!") which is not the point. Of course, travelling with impaired vision may be scary at first, but it wears off over time. I am no more scared going out and crossing the four-lane, advance green (in Canada, this means a left turning lane), very busy intersection in front of my apartment building than anyone else would be. I just rely on slightly different information to tell when it's safe to cross; like the sound fo parallel traffic moving, the audible pedestrian signal sounding, the sound of cars in my path stopping, and whether other people are walking (although I never rely on another person walking as a sign that the light is in my favour).

So, you ask, what about guide dogs? Rather than learning all this stuff about different senses and white cane techniques, why not just get a guide dog and let them do all the hard work.

Well, the short answer is because guide dogs don't work that way.

A guide dog takes commands from their handler and then guides them around obstacles. The commands aren't broad ones, like "Take me to Starbucks." Instead, they consist of "forward," "left," and "right," among some other school-specific commands. Some handlers teach their dogs to find certain things like elevators and empty chairs. But beyond that, a handler still has to know where they are in the environment and has to know how to give their dog detailed directions to where they want to go. Where the dog helps is avoiding obstacles (instead of contacting them with a cane and having to negotiate around them), as well as avoiding overhead obstacles which a cane can't detect. A dog will also stop at curbs, stairs, and other changes in elevation. A dog doesn't help with crossing a street—the handler has to listen to traffic and give a "forward" command when it's safe to go. A dog is trained, however, to block a handler's path if they misjudge and attempt to step out into moving traffic (ditto if the handler should ignore the dog stopping and attempt to step off a flight of stairs, or step in front of a moving train, and so on).

A person goes about getting a guide dog by applying to a guide dog school and, if accepted, going away to live for a month on a campus where they will be paired and trained with a dog. The dog, by the way, already has the training by the time they meet their handler; they are raised by volunteer puppy raisers and are returned to the school for formal training when they are still fairly young. The month-long training at the school is for the handler's benefit, so that they can learn the commands and how to work with and care for their dog. Some schools also do home training. Although training a guide dog is expensive (thousands of dollars), there is usually only a minimal or no cost to the trainee. Most guide dog schools run entirely on donations.

Guide dog schools make a point of emphasizing that a dog is not a substitute for good O&M skills and good cane technique. In order to be accepted into guide dog training, a person who is visually impaired needs to already have solid white cane and travel skills. Schools interview applicants and make them run through a test route with a cane and with a mock dog (where the interviewer is at the other end of the harness) before they are accepted into training.

The decision between cane and canine is sometimes a heated debate among the blindness community. In the end, both methods have their pros and cons. A cane is low maintenance, doesn't get sick, and doesn't incur any cost. A dog requires daily care, financial resources, and a guide dog handler is often never left alone in public (as someone who used a guide dog for several years, I can attest to this!). For some people, getting a guide dog is a life-changing and life-enhancing decision. For others, a cane works just fine (in case you're curious, I myself do not plan on getting another dog in the foreseeable future). Interestingly, while most of the general public may think the majority of people with visual impairments (and particularly those who are totally blind) have guide dogs, the actual proportion of legally blind people who are guide dog handlers is well under 5%.

Hopefully this entry has given you some glimpses into how people with low vision or blindness navigate through the world. In case you are wondering about some ways in which you can help (or hinder) a traveller who is visually impaired, here are some quick tips:
  • Feel free to ask if someone with a white cane or guide dog needs help, but be prepared to back off if they politely decline.
  • Never grab someone's arm in an attempt to guide them, especially without asking them if they need help first.
  • If someone does request assistance, ask if they would like to take your arm (many people will have enough vision to simply follow you).
  • A guide dog is a working dog, distracting them is like someone distracting you while you're driving.
  • Never talk to or pet a guide dog while it is working, and especially never touch its harness in any way.
  • If you are a driver, never blare your horn at someone with a visual impairment; it's startling and confusing since they likely have no idea what the honking is all about, and they may be standing at a corner not crossing simply because they are trying to figure out what type of intersection they are at by listening for the flow of traffic
  • If giving directions, give specific directions (either cardinal or left/right) rather than using terms like "over there" or pointing, which have no meaning if you can't see
On a last note, you might have noticed a conspicuous lack of technology in this post. Unlike using a computer and reading and writing, orientation and mobility still relies on relatively old-fashioned tools of white cane, guide dog, and optical low vision aids. However, devices such as GPS units designed specifically for those with visual impairments (the Trekker Breeze being one example), electronic travel aids that warn of overhead obstacles, iPhone and other applications that are accessible to screen readers, and electronic aids built into the environment (such as audible pedestrian signals and talking signs) are all technologies that can help. Some of these, like GPS, are becoming relatively established, while others, such as indoor navigational aids (a challenge as GPS doesn't cover indoor environments) are still emerging. Regardless, navigating with a visual impairment will likely always remain relatively low-tech.

No comments:

Post a Comment