Saturday, 17 May 2014

Mobility Training

Following on from my previous post, I have also been receiving mobility training with a long cane for the past 10 months and had my final session and review on Thursday. I thought I would share the cane skills and routes I have learned over the previous 10 months and how it has made a major improvement to my confidence and day-to-day life.

I initially met Debbie Carmichael on the 6 week Living With Sight Loss enablement course, which was run by Henshaws, at my local community centre in the summer of last year. During the length of the course we had different people introduce their services and explain how they would benefit us as visually impaired people and, during one session, Debbie demonstrated the various canes and mobility aids available.

Shortly after my visit from the Salford Sensory Team, I began my mobility training with Debbie around my local area. I first tried out some of the different styles of canes and cane tips, and it quickly became apparent that I was most comfortable using the long cane with a roller tip. Debbie explained the technique that is used to identify obstacles using this particular cane and tip, which is called a walking 'in step', where the cane will go to one side as your opposite foot goes forward and then you switch between the two. So for example, if you use your right foot first you will sweep your cane to the left side, then walk forward with your left foot and sweep your cane to the right side. You repeat this using the left-to-right sweeping motion whilst walking forward. The cane will come into contact with any obstacles that are located in front or at either side of you, allowing you identify it and go around it safely.

We spent the first few sessions practicing walking 'in step' until I got the hang of it. Debbie then drove us to a quiet park to practice and I walked around the parameter using the sweeping motion of my long cane to identify when surfaces would change - such as grass, tarmac and the mosaic tiling in the middle of the park. When I was used to coming into contact with different surface areas, leaves, twigs and bits of rubbish, we then put into practice the basic skills I had learnt by walking up and down my street.

As I came to the end of the street and faced with a kerb, Debbie explained how I should hold my cane to make it more visible to passing drivers - by holding it at an upwards angle directly on the outside of the kerb. If any vehicles were to stop for me, I should pick up the sound of the engine running nearby to identify them and can then wave them onwards and wait for as much quiet as possible, before crossing. The reason behind this is that one vehicle may stop and allow you to cross, but a vehicle that is driving past on the the opposite side may not stop or know of your presence and cause an accident. It's best to wave the vehicle onwards and wait for as much silence before crossing.

After spending a few more sessions practicing how to hold the cane at a kerb and how to wave vehicles on, this flowed into the next lesson of learning how to cross a road and get back onto an upwards kerb on the opposite side. Following the decision that it is quiet enough to cross the road, a quick sweep of the cane is made to ensure nothing is in the way directly ahead when stepping off the kerb, such as parked vehicles, bits of rubbish, and so on. The road dips down first and rises upwards before levelling off in the middle and then dipping down again to meet the new street. This is useful to remember so that you know roughly where you are located in the road when crossing it. When the road dips down again, you know that an upwards kerb will be coming up ahead. This was the first time that I was able to cross a road without being guided by a family member!

We practiced crossing quiet side-roads near to where I live for another session or two until I felt confident enough to progress forward. When I felt comfortable with the basics of walking in step, identifying different surface areas, obstacles and kerbs, and self-assured enough to cross the road independently, Debbie then moved onto planning some simple routes around my area to help me get out and about and use all of the techniques I have mastered so far.

The first route that we practiced was to my local row of shops. I live on the end of quite a long street and at the opposite end, quite a distance away, resides a youth centre, a nursery, a school and a row of shops. These include a craft shop, cafe and bakery, butchers, hair salon, and small convenience store.

Implementing what I had learned in previous sessions, I was able to cross my street to the opposite side and make my way down the parallel street. With tell-tale clues such as lamp posts, grids and cracked pave stones, I am able to estimate roughly where I am on the route whilst making my way towards the destination of the row of shops. En route to the shops I pass the youth centre, butchers and hair salon and then continue to make my way down to the end of the street until I come to some tactile markings indicating a crossing for a busier road, rather than smaller side-streets which I cross earlier in the route. The street edge curves round and can be hard to indicate whether I'll be walking straight across to the next upwards kerb or out into the main road - so when I meet the tactile markings at the end of the street, I know to turn to the right and drop-and-drag my cane over the low kerb until it rises slightly and straightens off. This technique is called indenting, and is used in the knowledge that I will be crossing straight ahead rather than risking walking into the road from a curved edge.

I now had my first route planned! Debbie broke it down into small sections and we practiced it for a further 8 or so sessions until I had it perfected. The good thing about this route is that other places are situated not too far away - such as a library, post office and Co-operative store - so we would be adding more parts onto this main base route.

Following on from the route to the shops and memorising the order in which they are situated, it was then time to move forwards and add the library onto the base route. I know that I've walked past the shops as there is a small brick wall directly ahead where a house resides and a garden is surrounded by a fence made of low bricks. When my cane has made contact with the brick wall, I can then make my way around it using the inner-shore line and continue down the road. I will eventually feel a rougher surface area at the end of a very low kerb, indicating the car park to the Irlam Library. After listening to ensure no vehicles are pulling in or out of the library car park, I can then cross to the next kerb and keep walking until my cane sweeps into a large pole. This is where I turn into the library at 90° to the right hand-side and use the inner shore line of the grass verge to make my way to the steps.

The steps to the library can be distinguished by tactile markings. The tactile markings representing upcoming steps are slightly different than those found at crossings, in that they are vertical stripes rather than bumps. Shortly after locating the steps, Debbie explained the techniques of how to use the cane for identifying the next step when walking up them and coming back down. When walking up steps you should find the handrail first and move your other hand to the middle of your cane holding it upwards a few inches. Tap the step above and then tap the second step. Begin walking upwards, and swing the cane slightly so that it taps each step as you walk upwards letting you know how many more steps are up ahead. As the handrail evens off and you feel no more steps up ahead with your cane, you know that you have reached the top.

A slightly different cane technique is used when going down steps. When the handrail has been located, you move your other hand to the middle of your cane and hold it at a diagonal angle hovering above the next few steps. When you have walked down the majority of the steps the cane will hit the ground and straighten up indicating that there are no more steps to walk down. We practiced the cane techniques for going up and down steps for a session or two, before heading into the library itself and familiarising where everything is located. Audiobooks and large print books can be found at the front of the Irlam Library at the left-hand side. I practiced getting a book out from the library, though don't need to do this often as I have the Salford Mobile Library visit me every month.

Debbie and I practiced walking to the library for a few more sessions, and then built onto the route once more. In front of the library are a set of lights and a crossing which leads on to a florist and a pizza shop and further down the street resides a Tesco Express. I have never crossed the lights on my own before, so the next few sessions were focused on learning to press the switch and cross as quickly as possible while gaining confidence enough to do it without Debbie by my side.

When I felt confident enough that I'd practiced the lights to perfection, Debbie then planned the route to the Tesco Express and the easiest way for me to access it. As the main road is directly in front of the Tesco Express, the cars come in and out of the front to a car park situated on the left-hand side - so it is easiest for me to access it around the back of the car park. I can then make my way safely to the side of the shop and up the ramp into the main door. We practiced this for 3 or so sessions before then planning and adding the final part onto my route.

In my final sessions with Debbie, including Thursday's session, we walked the length of my route from my house, past the youth centre, the butchers, and the hair salon, further on to the shops, library and main road and instead turned to the right-hand side to make my way past the post office, pub and at the busy side-street next to the Co-operative. This is one of the busiest roads near to where I live, so we saved it for last.

When I have reached the tactile markings and have indented further up the road, I then have to wait for as much quiet as possible before crossing over to get to the Co-operative. This can take quite some time - so patience is a virtue! As well as cars turning in from the main road, there are also cars coming the opposite way from 3 different streets of houses and there is also a car park nearby. With so many cars coming from all different places, I need to be alert as to which direction they are driving in, whether they are stopping for me so that I can wave them on, and identifying as much quiet as possible (with the noise from the main road!) before moving across as quickly as I can. We practiced waiting and crossing and then making my way to the shop quite a few times to get the hang of it, and then moved on to the Co-operative itself - making my way inside and familiarising myself with where items are.

I now have have a base route to get to my local shops, library, post office and Co-operative and also have the skills to cross the lights to get to the florist and Tesco Express safely. I need to practice going out independently though, as this is something that I'm still quite apprehensive to do. I will have to practice the route with my mum by my side first, and then perhaps move on to having her walk behind me and increase the distance as time goes on. This will be perfect practice in between the waiting of my Guide Dog assessment.

I want to say a big thank you to Debbie Carmichael for her mobility sessions. I have learned so many cane techniques and feel a lot more confident with using my cane and not being guided as much. I have also noticed a difference in my walking speed and posture!

You can find out more about the Salford Sensory Services for visual impairment and what they offer by clicking on the bolded link.