Intern 8.2

Well, thankfully CH was somewhat back to her normal self today.  She had on closed-toed shoes but didn't bring her cane ("But how can we do mobility when it's raining out?"  Well, let me show you....)  We got a fair amount of work done so I think it was a good lesson.

I spent most of the day at a low vision evaluation with one of Steve's students or helping with an all-day training for new DBS employees.  For the low vision eval, it was interesting just watching and seeing what the student's vision was like.  She didn't need much in the way of correction, but definitely has significant field losses.  

She ended up with three different prescriptions (near, intermediate, and distance).  The student decided to get bifocals for the near and distance, even though the doctor was somewhat concerned about her already small visual fields being cut off by the bifocals (something I was wondering about too).  Either way, I can't imagine having to tote around three pairs of glasses, plus sunglasses.  

I was curious about her contrast vision, which seemed mostly normal.  One part that I really wanted to see was trying out the different sunglasses/filters.  The weather was not cooperating with us though, so the student will have to pick some when she goes back.  

I also talked to the student when the doctor was out of the room and threw out some other ideas of what she might want to try (what about an electronic magnifier?).  Steve and I had also talked about a monocular, which the student tried.  She couldn't see anything through it, even with some practice, so this was definitely a dud.  But you don't know unless you try, right?  

Intern 8

Had a strange lesson today with CH.  She has low vision is learning how to use a cane.  

Thursdays at the center are "Professional Development" days so the students are expected to dress up.  Last Thursday my student came to class wearing dressy open-toed sandals (students have to wear closed-toe shoes during mobility lessons), which I didn't realize until halfway through the lesson.  I decided to let it pass for the day but told CH that next time I would have to send her back to her room to change shoes.  

So before CH's class with me today, I saw her on campus wearing closed-toe shoes.  Oh good!  I thought to myself.  Well, bizarrely enough, CH showed up to my class after lunch and announced that she was wearing flip-flops, before I even noticed.  So of course I asked her to go back to her room to change shoes.  She just sat there.  Me: Ok, we'll practice your cane skills in the dorm hallway anyways, so let's go back to your room so you can change shoes.  Finally she moves.

Back in the dorm, CH heads into her room but turns and tells me, "I'm not changing my shoes or coming back out of my room once I go in."  Huh?  Really?  I have to babysit you through this?  This girl was quiet when she first came to the center, but less than a week ago she had been bubbly and chatty with me.  

I'm thinking something must be going on her in personal life.  So I followed CH, sat down, and asked her what's going on.  What I really wanted to know was, is this something to do with mobility?  The cane?  The center?  Or something else entirely?  Or maybe even me?  She wouldn't talk (something she had no problem with last week!) but finally I convinced her to get up, change her shoes, and we headed out to practice her cane skills.  

To be honest, I think part of the problem is that her vision is so good that she doesn't see the point of learning to use the cane.  The cane is really for her to use at night, but she doesn't want to do blindfold training.  I'm planning on her receiving night mobility instruction but I've been told it might not be an option by the time she's done working with me, due to the time change and sunset. 

Either way, I hope tomorrow goes more smoothly.

Intern 7.2

Talked to Steve about the concerns I mentioned in the last post.  He didn't really have an answer for me, but I at least feel more confident about where I'm going with the student I was agonizing over.

My newest student is learning how to use a cane so today I showed her how to stay in step.  This is my first time teaching someone cane techniques from scratch, so I'm anxious to do it right and keep my student from developing any bad habits.  So far seems to be going well.

Steve was out today so I took on one of his students who also happens to have Usher Syndrome.  She has a low vision evaluation next week (I'm going with her to the appointment), so I took the opportunity to talk with her about that.  I shared that I was a fellow Usher so we also talked about hearing aids, life with RP, driving,  how to cross streets when you can't hear the traffic that well, etc.  It will be interesting to see how Steve addresses street crossings with this student.

Another one of my students happens to have a hearing loss on her right side but she is in denial about it.  I brought it up in her progress report today, and she asked me to remove that information because she doesn't want anyone to know about it.  She had a hearing aid when she was younger but she didn't like wearing it.  I talked to her about my own hearing loss and how hearing aids have helped me, in the hopes that it would sway this student's thinking.  She was pretty adamant though and doesn't want to have another hearing test or anything to do with hearing aids.  My concern is that she can't hear traffic very well on her right side, so I really have to get her to understand to pay attention to that side.  

Yesterday I taught two of my students  how to travel on the stairs using a cane.  Both were very nervous about it, but we took our time and by the end I could tell they were feeling more confident.  They both had the technique down pretty well too.  Hooray!

Last night I went to Walmart with the dorm group and worked with my student who is a good cane traveler.  I haven't been able to go on this Walmart trip for several weeks (it's every Wednesday), so I was glad to be able to go last night.  This student likes having a lot of information about his surroundings and is good at developing mental maps.  I told him about the cardinal directions of the store, where the different sections of the store were, what the different textures on the floor meant, and how the main pathways were laid out in the store.  

While this student is pretty smart, he definitely needs to work on self-advocacy and giving appropriate directions/guidance to whomever is assisting him.  I'll just say that shopping with him was interesting: "what exactly are you looking for?  Do you want the toothbrush with the rubbery things on the side, soft bristles, medium?  Does your face wash come in a blue bottle?  No, multivitamins aren't one brand." Oy vey.

Several weeks ago, this student told me that if someone came up to him and grabbed his arm to "help him", he'd just go along for the ride because that's the nice thing to do.  So of course I taught him the Hines Break and threatened some kind of retaliation if I saw him "going along for the ride" again.  Ok, not really, but I think he got the point.

Intern 7

Bit of an interesting week so far.  A trainer from the Seeing Eye was at the center today, and several of my students are possibly interested in getting guide dogs.  The trainer did juno walks with three of my students, which was interesting for both them and me.  I got a refresher on what the commands are and when to use them, and different things to consider when thinking about getting a dog (do you need tactile feedback?  are you willing to give up some control?).  I was surprised at how well my students did and enjoyed seeing how differently they reacted to the opportunity.

This Friday I have progress reports to submit/meetings for two of my students.  The email alerting me to these meetings prompted me to look at the progress report template the center has for mobility.  These two students have been making progress, and I felt like we were working at a good pace.  After looking at the report template though, I realized that there are several areas that I probably need to be doing more.  Now I'm questioning whether I'm moving these students along fast enough.

The source of my anxiety might not make sense, so let me explain.  When we get new students, we do an assessment on them and develop a plan and goals.  With that plan, we say how many hours the student will need to meet his or her goals.  This number is expected to change, which is part of the purpose of monthly progress reports/meetings.  I know how many hours my students theoretically have "left" to meet their goals, and some are obviously going to need way more time or not as much.

So far, I've been operating on the assumption that my students will be able to meet their goals, regardless of how much time it takes (within reason, of course).  Maybe they won't be experts, but they'll at least have a firm foundation of skills to transfer to their home communities.  However, I'm starting to get the impression that if a student is here too long, the decision-makers start getting antsy and want the student to finish and make room for a new student.  Of course there are a limited number of dorms, but the biggest problem is that there is a limited number of students that the mobility instructors can have.

Now I'm starting to see that some of my students are unlikely to reach the goals they have in an "acceptable" amount of time.  Although I might be able to teach these students some basics, it's unlikely it'll be enough for these students to get around independently when they're back home.  Especially considering that one of my students never goes past her mailbox by herself back home.  Will this change?  I'm somewhat doubtful, which is frustrating.

Intern 6

Another week of teaching has passed!  Wow.  The recurring theme this week was street crossings.  Funny, because that's one reason that I wanted to work with adults for my internship.  My reasoning was that street crossings are one of the hardest things to teach, so I wanted as much practice in that as possible.  And who would be working on these the most?  Probably adults at a rehab center more than children in elementary school.

Which leads to the very in-depth experiences that I had with street crossings in the past week or so.  Many of the intersections here in Daytona are actuated, and it's obvious that they are.  For example, at several intersections, the light on the major street will stay green until a car shows up on the minor street.  Or, the light will not be nearly long enough for a person to cross if they don't press the button/have a button to push.

As I said previously, I feel more and more than I need to teach my students the problem solving skills to be able to assess any crossing that they come to.  I've already told one student that I won't always be there with her, so she needs to be able to confidently make the decision whether or not to cross.

Actuated signals don't seem quite as challenging to teach with my low vision student who can see the pedestrian signal (of course I still want her to pay attention to the traffic).  As for my students who are blind, I think it will be a whole 'nother ball of wax.  My more confident traveler has no problem crossing when it is quiet, but I'm not sure my other two students will be as decisive.  Either way, it is going to take a lot of patience on my part.

The student I have who was struggling with staying in step is still not there, but she is in step more often than she was before.  She also knows how to effectively correct her step as she is walking.  Now the problem is veering.  She tends to turn her head as she crosses a driveway, so she veers in that direction.  This will definitely take more practice.

For one of my lessons with a student who is blind, we recreated a nearby intersection using Tactile Town (with the lane stripes and everything).  It was a last minute thing (it was cold out and had just started raining), but it worked out really well.  The student gained a much better understanding of different parts of the intersection, and she also learned how to identify the corners by their cardinal directions (NW, SW, etc).  She understood where to place the cars (to my surprise) and we talked about when to cross (with the near parallel traffic).  With this experience in mind, I think the Wheatley Picture Maker will be my new best friend on mobility lessons.

+

Intern 5.2

Am done teaching for the week and didn't have too many challenging lessons to teach.  I've been reviewing the basics of cane techniques and sighted guide with my more experienced traveler.  Next week we're going to start doing street crossings. 

Am still in the assessment phase with my newest student.  I've put her in a lot of different environments and so far she hasn't had any difficulty during the day.  She reports having worse vision at night, but I wish there was a way that I could see for myself.  Either way, I'm planning on teaching her cane skills during the day so that she can transfer them to the nighttime.  We can also have her take nighttime mobility lessons.

I'm still working on staying in step with SL, but it hasn't been as much of a focus.  She had been working on a longer route and was having difficulty reversing it.  She finally got it, so I had her go on the route and come back to my office by herself.  She did it without any problems!  The biggest thing she needs to work on is being aware of all of her senses and her landmarks.

I've been working on street crossings with TM, which is something she's anxious about.  We started by crossing driveways and then moved into a quiet residential area with stop signs.  Yesterday I took her to a small lighted intersection.  However, it was a challenging intersection because it was semi-actuated.  So rather than having her wait for the all quiet or crossing with the parallel traffic (which was very unpredictable), I had her use the pedestrian buttons. 

I'm not sure if this was the best way to do it, but I didn't want to put the student in an unsafe situation.  I mentioned this previously- the center has a policy of teaching street crossings in a clockwise motion.  The problem is that this student has a significant hearing loss in her right ear.  At least two or three times she has missed the turning traffic over her right shoulder.  So is this really safe for her?  I suppose I need to work with her more on scanning with her eyes.  At any rate, small, simple, and straightforward intersections seem difficult to come by here.  Or maybe they're not common anywhere anymore?

My last student missed a lot of class this week and she was out most of the first week that I had her, so I've only worked with her a handful of times.  She is working on crossing driveways and is very anxious about it.  She also has a difficult time remembering routes and using mental maps.  It's frustrating to me when she misses so much class because I can tell that there is a backslide in her skills.  Also, she is a very slow walker so it limits how far we can go in one lesson.  Hopefully she'll build up her stamina over time.

Intern Part 5.1

What week is this?  Losing track of  how long I've been here and definitely getting into a groove.  Have done a little of everything as far as reports/paperwork goes so pretty comfortable there.  Have a new student this week who has low vision and is very different from my other new student.  She doesn't use a cane and has limited mobility training.  She seems to get around ok at the center but only goes out with her grandparents when she's back home (has never crossed a street independently).  Quiet young lady, a little unsure of herself and probably nervous about being on her own.  Working on establishing a good rapport with her so she'll trust me and be more relaxed.

Doing a "refresher" lesson on cane techniques with my experienced traveler tomorrow.  Brushing up on all that info myself so I can confidently share it (eek!).  Another student has been working on the same route for almost a week now.  She has no problem getting to her destination but reversing the route is a different story.  Trying to get her to focus on her landmarks and what's around her but multitasking is not her strong suit.  My student with the wild and crazy cane arc is still one of my pet peeves.  Broke out my own cane tonight so I could come up with ways to get her cane arc lower and under control.  Tempted to walk on campus tomorrow with my cane and blindfold.  Think I might have some techniques to try with the student too.

One of my supervisor's students has a severe hearing loss, and given my own experience with hearing aids/audiograms/etc, he has asked me to interpret this student's audiogram.  I knew the basics, but it was very interesting delving into the nitty gritty and seeing how the student's mobility skills might be affected.  I went to the instructional plan meeting last Friday, and the student's hearing loss was the main topic of discussion.  I found myself nodding along with most of the statements (sound localization is tricky, why is my hearing aid whistling? how am I going to cross streets?)  My question was, can we make sure a program is placed on her new hearing aids that does NOT mask background noise?  And wouldn't an FM transmitter be helpful for my supervisor to have to teach this student during mobility lessons?  Oh the possibilities.

Oh, and Steve has informed me that he's not going to give me the answer when I have mobility (non-procedure/center rules) questions anymore.  Instead, he's going to question me and help me find the answer on my own.  We'll see how that goes!