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File created April 10, 2010. This is not the final version of record. The following article was published in the Journal of Visual Impairment & Blindness, April 2010 • Volume 104 • Number 4, (Print edition pages 203-214). The final version of record can be found at http://www.jvib.org.

JVIB - April, 2010

Teaching the Use of a Long Cane Step by Step:
Suggestions for Progressive, Methodical Instruction
Dona Sauerburger and Eugene Bourquin

Abstract: A fundamental part of the orientation and mobility curriculum is the acquisition and retention of skills in using a long cane automatically and proficiently to detect and negotiate obstacles and drop-offs. Using practitioners' experiences and the principles of learning theory, instructors can monitor students' advancement and adapt teaching strategies to optimize the results.

One of the important skills of orientation and mobility (O&M) instruction is the use of the long cane for anticipating what is ahead of the user and negotiating obstacles and changes in surface elevation (such as steps and curbs). However, use of the cane will not ensure the safety of students unless they reach a sufficient level of proficiency in the skills of moving the cane correctly without having to concentrate, being able to notice unexpected obstacles and steps even when distracted, and knowing how to negotiate obstacles and steps safely.

For example, a man who learned how to use a cane fell off a curb because he was not able to move the cane correctly when distracted. A woman who could move the cane well even when distracted fell off a transit platform because she did not notice when the cane went over the edge. An intern at a nursing home who was proficient with the cane had not learned how to negotiate obstacles, so she knocked over a patient because she sidestepped to get around a medicine cart she had contacted with her cane. These people all needed further instruction and practice before their ability to use the cane to notice and negotiate hazards was proficient enough to provide for their safety. This article presents ideas and information that may help facilitate instruction in and practice with using a cane, drawn from extended observations in professional practice and the results of research from physical therapy, neuroscience, and psychology.

Appropriate practice and instruction

According to Ackerman (2007, p. 238), "Although practice is the primary determinant of individual differences in skilled performance of tasks with significant motor requirements, the sheer amount of practice provides only a moderate amount of explanatory power." Practice can be made more efficient with careful consideration of the principles of learning.

Students go through a series of stages as they learn any skill, and instruction should vary according to the stage of learning. For example, the beginning stages of learning require the student to concentrate on the task, whereas advanced students can perform the task with little or no effort (psychologists call this "autonomous performance"; Ackerman, 2007, p. 236). According to Adi-Japha, Karni, Parnes, Loewenschuss, and Vakil (2008, p. 1544), improvements in performance "are related to transitions between two types of processing modes: an initial, controlled, more effortful mode and eventually a more automatic mode."

In 1911, mathematician Whitehead noted:

Likewise, it is an advantage to students with visual impairments to reach a level of proficiency where they do not have to "think" about their canes or the details of the techniques they are using but, rather, perform in a manner that is independent of cognitive control. Some aspects of successful travel, such as learning to use landmarks in the environment for traveling routes, require conscious cognitive effort (Martinsen, Tellevik, Elmerskog, & Storlilokken, 2007); we suggest that effective use of a cane need not be one of these components that require such cognitive effort.

Retention of skills is the goal of practice, as described by Maas et al. (2008, p. 278): "The distinction between performance during acquisition (practice) and retention or transfer implies that learning, a permanent change in the capability of skilled movement, must be measured by retention and/or transfer tests. Retention refers to performance levels after the completion of practice." For cane skills, which are motor related, the student will follow through the acquisition and retention stages; note, however, that learning how to negotiate obstacles can be done at any time, even when the student is in the beginning stages of learning to use a cane.

The retention of skills depends on temporal factors, including the human sleep cycle. Studies have shown that after practicing a task and undergoing another practice session "between 10 minutes and 6 hours later, without intervening sleep, the memory undergoes the first, stabilization phase of consolidation, making it resistant to interference from a competing memory" (Walker, Brakefield, Hobson, & Stickgold, 2003, p. 618). However, even though spacing practice sessions apart can help consolidate the skill memory, it does not necessarily improve speed or accuracy for performance. In experiments published in 2003, Walker et al. reported that "following practice of a specific motor sequence, delayed performance improvements only occur across a night of sleep [emphasis added], while waking periods of 4, 8 or even 12 hours offer no such performance enhancements" (p. 617). An awareness of timing and scheduling for practice can be used in each stage of cane mastery.

The practice of cane techniques can also be maximized with appropriate feedback from the instructor. Studies have consistently shown that too much feedback can impede learning. Sullivan, Kantak, and Burtner (2008) found that when participants received feedback on their performance only 62% of the time, beginning with frequent input and fading to less input, they performed motor skills more consistently and accurately when tested later, as opposed to those who always received feedback. The authors hypothesized that "educed feedback practice conditions … increase information-processing demands during practice that are advantageous to the relatively permanent effects associated with motor learning observed in a delayed retention test" (p. 721). Jacobson and Bradley (1997) also suggested that after providing continuous reinforcement in the beginning of instruction, providing less frequent praise later will encourage a student to continue to engage in high levels of effort. Instructors should monitor and consider the amount and timing of the correction and input they provide as students pass through the stages of acquiring cane skills.

Stages of learning

It may be helpful to understand what expectations and teaching strategies could be appropriate as students move through the various phases of acquiring cane skills. We propose, on the basis of the results of empirical studies (Walker et al., 2003; Sullivan et al., 2008), the following model of how students pass through stages of learning to use a cane:

Stage 1: Beginner--acquiring manual performance skills. The student is learning how to move the cane and requires feedback and correction.

Stage 2: Concentration--maintaining independent movement. The student can maintain the correct cane technique without correction but only with concentration.

Stage 3: Consolidation--performance without concentration. The student can maintain the correct cane technique without conscious concentration; movement of the cane has become natural for the student and is done correctly even when the student is distracted. However, the student may not notice when the cane drops over an edge that was not expected.

Stage 4: Proficiency--noticing and using information provided by the cane. The student moves the cane correctly without having to concentrate and notices when the cane contacts any unexpected edges or obstacles even when the ground seems flat. At this stage, the cane provides the student with a reliable warning of hazards in all situations (see Box 1).

BOX 1: Obstacles that a cane may not detect

Students should be aware that the cane cannot always protect them from

Stage 1

Stage 2

Stage 3

Stage 4

Level of attention required to notice information provided by a cane
Ability to use proprioceptive information from the cane
Ability to override misleading visual information
Negotiating obstacles
Negotiating stairs with impaired vision

Discussion and conclusions

Instructors can enhance the effectiveness of learning to use a long cane. By using practices that ensure that students advance successfully through the stages of acquiring skills, including addressing the tasks of negotiating obstacles and stairs, O&M specialists ensure that the cane delivers the information needed for safe travel and that travelers can interpret and use the input from their canes. Being aware of current hypotheses related to memory and motor tasks, instructors can improve the long-term performance of cane travelers.

Strategies for providing instruction in the use of the cane are effective only for those who are motivated to learn to notice and use nonvisual information for everyday situations, including situations in which their vision is compromised because of lighting conditions. These strategies are not as likely to help those who are not motivated, such as those whose vision provides sufficient information in all conditions or who are in training only to prepare for future vision loss.

References

Ackerman, P. L. (2007). New developments in understanding skilled performance. Current Directions in Psychological Science, 16, 235-239.

Adi-Japha, E., Karni, A., Parnes, A., Loewenschuss, I., & Vakil, E. (2008). A shift in task routines during the learning of a motor skill: Group-averaged data may mask critical phases in the individuals' acquisition of skilled performance. Journal of Experimental Psychology: Learning, Memory, and Cognition, 34, 1544-1551.

Diekelmann, S., & Born, J. (2007). One memory, two ways to consolidate? Nature Neuroscience, 10, 1085-1086.

Hill, E., & Ponder, P. (1976). Orientation and mobility techniques: A guide for the practitioner. New York: American Foundation for the Blind.

Jacobson, W. H. (1993). The art and science of teaching orientation and mobility to persons with visual impairments. New York: American Foundation for the Blind.

Jacobson, W. H., & Bradley, R. H. (1997). Learning theory and teaching methodologies. In B. B. Blasch, W. R. Wiener, & R. L. Welsh (Eds.), Foundations of orientation and mobility (2nd ed., pp. 359-382). New York: AFB Press.

Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17, 277-298.

Martinsen, H., Tellevik, J. M., Elmerskog, B., & Storlilokken, M. (2007). Mental effort in mobility route learning. Journal of Visual Impairment & Blindness, 101, 327-338.

Rodgers, M. D., & Emerson, R. W. (2005). Human factor analysis of long cane design: Weight and length. Journal of Visual Impairment & Blindness, 99, 622-632.

Santos, A. A., Bertato, F. T., Montebelo, M. I. L., & Guirro, E. C. O. (2008). Effect of proprioceptive training among diabetic women. Revista Brasileira de Fisioterapia, 12(3), 183-187.

Schilling, M. A., Marangoni, A., Vidal, P., & Rajan, M. (2000, August). Learning by doing something else: The impact of task variation on organizational learning curves. Paper presented at the annual meeting of the Academy of Management, Toronto, Ontario, Canada.

Sullivan, K. J., Kantak, S. S., & Burtner, P. A. (2008). Motor learning in children: Feedback effects on skill acquisition. Physical Therapy, 88, 720-732.

Walker, M. P., Brakefield, T., Hobson, J. A., & Stickgold, R. (2003). Dissociable stages of human memory consolidation and reconsolidation. Nature, 425(6958), 616-620.

Whitehead, A. N. (1911). An introduction to mathematics. New York: Henry Holt.

Dona Sauerburger, M.A., COMS, orientation and mobility specialist, 1606 Huntcliff Way, Gambrills, MD 21054; e-mail: <dona@sauerburger.org>.
Eugene Bourquin, DHA, CLVT, COMS, senior instructor, Helen Keller National Center for Deaf-Blind Youths and Adults; mailing address: 315 8th Avenue, 10E, New York, NY 10001; e-mail: <oandmhk@msn.com>.

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