Why Wait?
The Role of the COMS
Orientation and Mobility
IN EARLY INTERVENTION
Marjie Wood, M.Ed., COMS,TVI
Bellevue, WA
7-19-2012
History of O&M
 Late
1940’s -began after WWII to aid blinded veterans
st
 1960- 1 O&M University Program Started
 1970’s- O&M for 3-21 year olds in public schools
History of O&M (cont.)

The late 1970’s O&M instruction included infants and toddlers in the
public schools

First time as a related service, IDEA 1997

Since the early 90’s, O&M instruction for children from birth through 22
years of age has been provided on an itinerant basis in Texas public
schools.
What is Orientation and Mobility?
Federal Law - IDEA B 1997
 Orientation
and mobility services means, “services provided to blind or
visually impaired students by
 qualified personnel to enable those students to attain
 systematic orientation to and safe movement within their environments in
school, home, and community; and includes teaching students the
following as appropriate:
 Spatial and environmental concepts and use of information received by
the senses
IDEA – Part B (cont.)









(such as sound, temperature and vibrations) to establish, maintain, or regain
orientation and line of travel (for example, using sound at a traffic light to cross
the street);
• To use the long cane, as appropriate, to supplement visual travel skills or as a tool
for safely negotiating the environment for students with no available travel vision;
• To understand and use remaining vision and distance low vision aids, as
appropriate; and
• Other concepts, techniques, and tools as determined appropriate.” [34 CFR
300.24(b)(6)]
IDEA Part C 9-28-2011
) (17) Vision services mean—
 (i) Evaluation and assessment of
 visual functioning, including the
 diagnosis and appraisal of specific
 visual disorders, delays, and abilities
 that affect early childhood development;
 (ii) Referral for medical or other
 professional services necessary for the
 habilitation or rehabilitation of visual
 functioning disorders, or both; and
 (iii) Communication skills training,
 orientation and mobility training for all
 environments, visual training, and
 additional training necessary to activate
 visual motor abilities.

IDEA Part C (cont.)























303.13(c)(5) Qualified personnel. The following are the types of qualified personnel who provide early intervention services under this part:
(1) Audiologists.
(2) Family therapists.
(3) Nurses.
(4) Occupational therapists.
(5) Orientation and mobility
specialists.
(6) Pediatricians and other physicians
for diagnostic and evaluation purposes.
(7) Physical therapists.
(8) Psychologists.
(9) Registered dieticians.
(10) Social workers.
(11) Special educators, including
teachers of children with hearing
impairments (including deafness) and
teachers of children with visual
impairments (including blindness).
(12) Speech and language
pathologists.
(13) Vision specialists, including
Ophthalmologists and optometrists
http://www.gpo.gov/fdsys/pkg/FR-2011-09-28/pdf/2011-22783.pdf
Orientation and Mobility
“
For the very young child, mobility refers to general gross motor development, including the normal
integration of reflexes, acquisition of motor milestones, refinement of quality-of-movement skills, and
purposeful, self-initiated
 movement” ( Pogrund and Fazzi, Eds., 2002, p.328).

1. Where am I?
 Body in space (O)

2. Where am I going?
 Body in space(O), spatial understanding(O) and safety in movement ( O & M)

3. How will I get there?
 Spatial understanding (O & M)
The Role of the COMS in the Early Intervention Team
 Orientation-
◦Where Am I?
 1) vestibular
 2) proprioception
 3) visual
 4) auditory
 5) tactile/ haptic sense
 6) olfactory
The Role of the COMS in the Early Intervention Team


1. Vestibular-
A. Composed of 3 structures in the inner ear which register

1. the speed, force, and direction of movement,

2. the effect of gravity on the body, and

3. head and body position.

B. Assists in the regulation of muscle tone, coordination, balance, and equilibrium

C. Fully functional at birth and the first sensory system to mature

D. “ Visual impairments affect how the vestibular system develops, how vestibular input is registered and
used

which can lead to low postural tone, delayed balance reactions, and delayed motor development”
(Anthony, Brown, Lowry and Hatton, 1994, p. 157)
The Role of the COMS in the Early Intervention Team

2. Proprioception-

A. The receptors located in the tendons, muscles, and joints.
B. Provides information regarding the orientation of the body in space and the relation of body
parts to each other.
C. Plays a role in balance, postural tone development, posture and haptic perception( ability to
tactually identify
objects).
D. Provides information about the body when it is static, e.g. lying, sitting, or standing.
E. Provides the only means to identify and precisely coordinate movement for those who are blind





The Role of the COMS in the Early Intervention Team
 3.
Vision-
◦ A. One of the 2 distance senses
◦ B. The first 2 years of life are particularly influenced by children’s visual environment(Anthony, Brown, Lowry, and Hatton,
2004).
◦ C. “Without vision, learning motor skills through imitation is extremely difficult. They cannot learn by watching and have to be
introduced to most fine and gross motor tasks. Even then, children with visual impairments sometimes exhibit different ways of
moving or a different quality of movement” (Pogrund and Fazzi, Eds., 2002).
◦ D. “Children with visual impairments do not have the opportunity of incidental learning. They do not have the benefit of vision
as a unifying sense to assist in learning the meaning sounds, the functions of objects, and help in organizing their world”
(Pogrund and Fazzi, Eds. 2002).
The Role of the COMS in the Early Intervention Team
 4.
Auditory-
◦ A. The other distance sense

B. 3 levels of hearing
 1. primitive- breathing, swallowing, chewing and familiar background sounds
 2. signal warning- monitoring the environment- in conjunction with vision
 3. spoken communication(speech)-develops naturally due to the child’s ability to hear; “a great deal of listening does and indeed must
occur
 (14-16 months) before verbal output can occur” (Flexer, 1999, p.16)
 C. “ A mild hearing loss ( associated with frequent ear infections) can affect a child’s language development
during the first years of life” (Anthony, Brown, Lowry, and Hutton, 2001, p. 142).

The Role of the COMS in the Early Intervention Team

5. Tactile-

A. Refers to stimulation reaching the central nervous system from receptors in the skin
B. Most mature sense at birth and first to emerge in utero
C. Activates most of the newborn reflexes (rooting reflex)
D. Children with visual disabilities must use their hands to gain information about the world.
E. Six types of sensory information detected through touch: deep touch, light touch, vibration, pain,
temperature control and two-point touch ( ability to identify how many points of contact an object has on skin,
e.g. braille cells)
F. Haptic sense- the ability to recognize an object by touch





The Role of the COMS in the Early Intervention Team
 Movement
◦ “Many factors such as neural maturation, the environment, biomechanics, kinesiology, perception,
learning, and goal-directed behavior influence movement” (Alexander, Boehme, & Cupps, 1993;
Bly, 1994; Shumway-Cook @ Woolacott, 2001: Ulrich, 1997).
◦ “Movement facilitates early development. Young children’s movement not only affects motor
development, but also plays a major role in the development of cognition, social-emotional
relationships, and communication” (Anthony, Brown, Lowry and Hatton,1994, p. 351).
The Role of the COMS in the Early Intervention Team



The COMS’ role is to:
Encourage early purposeful and self-initiated movement in children who are visually impaired
and continue as children move through and explore increasingly complex environments (Pogrund
and Fazzi, Eds., 2002).
Video of 2 year old transitioning from floor
to couch
18
The Role of the COMS in the Early Intervention Team
COMS’ role is to:
◦ Encourage early purposeful and self-initiated movement ;
 The
19
Vision Team Roles in Early Intervention

TVI

COMS
Provides hand under hand instruction in play, activities of daily living, and pre-literacy Helps structure the home environment for beginning orientation and safety, provides
activities.
instruction to encourage safe and purposeful movement.
“Brings the world to the child”
- training for all environments, visual training, and additional training necessary to activate
visual motor abilities- IDEA PART C
“Brings the child to the world”
The VI Team in Early Intervention


Child
O&M
VI
The Interrelationship of the TVI, COMS, and OT
TVI
COMS
OT
The Interrelationship of the Early Intervention (EI) Service Providers
(Large circle rep. the EIS and SLP)
TVI
COMS
OT
PT
Early Identification and Intervention is Crucial

Children who are visually impaired and their families need specialized instruction and educational guidance from
professionals who have expertise in addressing their disability-specific needs. (Pogrund, R.L. & Fazzi,D.L. Eds.
2002).
Current Students Who Have
Received Early Intervention
Services
photo goes here
25
Video of 4 year old learning to jump rope
26
Video of student playing on equipment in gym
27
Video
 This
is a video of a child who has a cortical visual impairment and other
multiple disabilities. You will see examples of 2 different O&M routines
which encourage body awareness and purposeful movement.
Video of Motor Music Routine
and
Swinging Routine
29
Resources

Alexander, R., Boehme, R., & Cupps, B. (1993). Normal development of functional motor skills: The first year of
life. Tucson, AZ: Therapy Skill Builders.


Anthony, T., Brown, C., Lowry, S., and Hatton, D. (1994). Developmentally Appropriate Orientation and
Mobility (pp.127-157, 351). University of North Carolina at Chapel Hill, NC: FPG Child Development Institute.

Blye, S. (1994). Multivariate data mappings. In G. Kramer (Ed.), Proceedings of the International conference on
Auditory Display 1992. Auditory display: Sonification, audification, and auditory interfaces. Reading, MA:
Addison-Wesley
Resources
Flexer, C. (1999). Facilitating hearing and listening in young children
 (2nd ed.) San Diego, CA: Singular Publishing Group.


Shumway-Cook, A., @woollacott, M.H. (2001). Motor Control (2nd. ed.). Baltimore: Lippincott, Williams & Wilkins

Ulrich, B.D. (1997). Dynamic systems theory and skill development in infants and children. In K.J. Connolly & H.
Forssberg (Eds.), Neurophysiology and neuropsychology of motor development ( pp. 319-345). Cambridge,
U.K.: Cambridge University Press.

Pogrund, R.L., & Fazzi, D.,Eds.(2002). Early Focus: Working with Young Children Who Are Blind or Visually
Impaired and Their Families, 2nd Ed. New York: American Printing House for the Blind