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National Mobility Report: Mobility experiences and perceptions of blind and vision impaired personsFull Report

NCBI Mobility Covers.indd 2 26/06/2012 14:31

Contents Acknowledgements....................................................................................................................4

Abstract......................................................................................................................................5

Executive Summary....................................................................................................................6

Introduction............................................................................................................................6

Definition of Mobility .............................................................................................................7

International Perspectives on Mobility and Disability ...........................................................8

Context of the Study ..............................................................................................................9

Findings and Recommendations ..........................................................................................11

References ...............................................................................................................................41

Web Resources ........................................................................................................................46

Glossary of Terms ....................................................................................................................46

Chapter 1: Introduction ...........................................................................................................49

1.1 Definition of Terms ..................................................................................................50

1.2 International Perspectives on Mobility and Disability.............................................51

1.3 Context of the Study ................................................................................................52

1.4 Study Methodology..................................................................................................53

1.5 Study Sample ...........................................................................................................53

1.6 Limitations................................................................................................................54

Chapter 2: Literature Review...................................................................................................55

2.1 Introduction .............................................................................................................55

2.2 Human‐Rights Perspective.......................................................................................55

2.3 Participation and Belonging.....................................................................................57

2.4 Contributions of Psychological Theories on Understanding Motivation for Managing Change and New Learning ..................................................................................60

2.5 The Person‐Environment‐Occupational Model .......................................................63

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2.6 Impact of Visual Impairment/blindness on Mobility ...............................................65

2.7 The Influence of the Environment on Mobility .......................................................67

2.8 Rural Environment and Independent Mobility........................................................69

2.9 Signage .....................................................................................................................69

2.10 Travel and Transport ..................................................................................................69

2.11 The Social Environment ..........................................................................................70

2.12 Orientation and Mobility Training and Use of Mobility Aids...................................72

2.13 Mobility Training Strategies.....................................................................................72

2.14 Mobility Aids ............................................................................................................73

2.15 Conclusion................................................................................................................75

Chapter 3: Methodology..........................................................................................................77

3.1 Introduction .............................................................................................................77

3.2 Ethical Considerations..............................................................................................77

3.3 Informed Consent ....................................................................................................78

3.4 Development of the Interview Schedule and Process.............................................79

3.5 The Structure of the Interview.................................................................................80

3.6 Sampling...................................................................................................................81

3.7 Training of interviewers...........................................................................................82

3.8 Data Collection and Data Entry................................................................................83

3.9 Confidentiality..........................................................................................................84

Chapter 4: Results ....................................................................................................................85

Section 4.1 Description of the Study Sample (Q. 11 and 12) .........................................85

Section 4.2............................................................................................................................94

Section 4.3..........................................................................................................................109

Section 4.4 Orientation and Mobility Training (Q. 9).........................................................130

Section 4.5 Obstacles to Mobility in the Environment. (Q. 10) .........................................145

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Section 4.6 Summary..........................................................................................................148

Chapter 5: Discussion and Recommendations ......................................................................151

5.1 Introduction ...........................................................................................................151

5.2 Difficulty in using local area...................................................................................153

5.3 Younger and Older Age Groups Differ in Many Ways ...........................................156

5.4 Managing additional health and disability factors ................................................157

5.5 Reliance on a Sighted Guide for Accessing Local and Busy/Unfamiliar Areas.......158

5.6 Low Level of Expectation of Independence in Mobility ........................................159

5.7 Environmental Factors Continue to Impede Ease of Mobility...............................160

5.8 85% of Study Sample are Partially Sighted ............................................................162

5.9 High Levels of Psychological Distress Associated with Age Related Sight Loss .....163

5.10 Occupational Therapy Deemed Effective in Other Countries for Those with Sight Loss and Co‐morbidity........................................................................................................164

5.11 Sight Loss a Leading Cause of Loss of Independence Among People Over 65 (Alliance for Aging Research, 1999) ...................................................................................165

5.12 Summary ................................................................................................................165

Conclusion..............................................................................................................................167

References .............................................................................................................................168

Web Resources...................................................................................................................183

Appendix 1 .............................................................................................................................184

Appendix 2 .............................................................................................................................194

Appendix 3: Table 4...............................................................................................................196

Glossary of Terms ..................................................................................................................197

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This research was conducted by The Discipline of Occupational Therapy, Faculty of

Health Sciences, University of Dublin, Trinity College.

The report was written by Siobhán Mac Cobb, PhD, MSc. Dip. COT.

The work of Bethan Collins BSc. OT. Pg Dip Stats. is acknowledged in the

development of the research proposal, research methodology and project

management.

Orla O’Neill MA, Dip. COT and Catherine O’Connor BSc.OT contributed to the

literature review.

Paul O’Mahony, PhD, MSc. BA has provided statistical advice.

Sophie Dunga BSc.OT and Lisa Krenn BSc.OT as research assistants were involved

throughout the project.

The interviewers were Mary Dowds, BSc. OT, Claire Gleeson BSc.OT, Roisin Lynch,

BSc.OT, Denise O’Shea BSc.OT, Ruth Staunton BSc.OT, and Ciara Sullivan

BSc.OT.

Acknowledgements

The research team would like to acknowledge:

- The participants in this study for sharing their perspective and their

experiences on mobility.

- The steering committee in the sponsoring organisations NCBI and IGDB.

- The staff in both organisations for their assistance. Particular Elaine Howley in

NCBI for facilitating the researchers and providing the telephone facilities.

- The contribution of Dr.Bláithín Gallagher NCBI to the completion of the report

is acknowledged.

- Dominique Plant from The Discipline of Occupational Therapy, Trinity College

Dublin for her administrative support.

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Abstract

This study examined the mobility experiences and perceptions of an age stratified,

random sample of 564 registered blind people on the NCBI database (mean age of

younger group was 45 years, and 78.5 for older group). Mobility is a critical issue.

36% of the older age group and 25.4% of the younger group never go out in their

local area without a sighted guide. 28.8% (n=162) reported using mobility aids,

comprised of 18% (n=102) the long cane; 5.5% (n =31) the symbol cane; 5.1% (n

=29) use a guide dog. 48% (156) of the younger age group and 15% (34) of the

older age group reported having mobility training. Co-morbidity was reported by 59%

of the older group and 29.5% of the younger group. Those with poor partial sight, the

majority of whom are elderly reported most difficulty.

It is recommended that qualitative research methods be used to explore attitudes to

mobility training; that occupational therapists be employed for those with co-

morbidity; the enforcement of policy and legislation regarding access for people with

disabilities to goods, services and environment; the development of a national vision

strategy reflecting the W.H.O (2001) perspective on health outcomes in terms of

activity and participation.

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Executive Summary

Introduction

This is a national study of mobility in the lives of Irish blind and vision impaired

adults. Jointly commissioned by the NCBI (National Council for the Blind Ireland) and

the Irish Guide Dogs for the Blind (IGDB), the study examines mobility issues and

training needs of blind and vision impaired persons. Both the NCBI and the IGDB

enable people who are blind and vision impaired to overcome the complex range of

barriers that may impede their independence and participation in society, and

support individuals and their families to live life to its full potential. Currently, there

are an estimated 30,000 blind and vision impaired individuals in Ireland, and this is

projected to increase by more than 170% over the next 25 years as the population

ages (Jackson & O’Brien et al., 2008). This is one of few studies that explores the

perceptions and mobility experiences of blind and vision impaired persons with an

Irish population.

With regard to people with vision impairments, there is consensus in the literature

that mobility is an important part of everyday life, and that impairment to mobility

greatly affects the quality of life (Montarzino et al, 2007, Blasch, Weiner & Welsh

1997, Hersh & Johnson, 2008, Turner, 1998). Social integration and social networks

are associated with positive health experiences for people with disabilities (Berkman

and Glass, 2000). Reduced mobility limits the opportunities for social participation.

The majority of those with vision impairment have age related vision loss, and older

people have to cope with co-morbidity of vision loss with other age related health

challenges (Starfield, 2001).

Help seeking behaviours and adaption to disability involve a complex process, and

are usually socially learned (Mechanic, 1962; Kasl and Cobb, 1966). The culture,

social class, age and gender to which a person belongs influences expectations of

health and his/her subsequent action (Parsons, 1958; Zola, 1966) such as taking up

an offer of mobility training. Belief about one’s self efficacy is a significant factor in

the motivation to address the mobility challenges presented as a result of vision

impairment.

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Interestingly, visual acuity itself is not an accurate indicator of mobility status. Owsley

and McGwin (2007) state that measures of eye disease severity should not be used

as surrogates for the personal burden of eye disease and vision impairment, as

individuals make a personal response to and cope with their condition in wide

ranging ways.

This study reports on the perceptions and experiences of both younger and older

vision impaired Irish people, randomly selected from the NCBI national database of

people registered as blind in Ireland. The statutory definition of blindness in Ireland is

visual acuity (VA) corrected with glasses of less than 6/60 (0.1 decimal/1.0 logMAR)

in the better eye, or a field of vision limited to a widest diameter of vision subtending

an angle of not more than 20 degrees (NCBI 2008). This report presents the

personal experience of participants in order to inform responsive service planning.

More specifically, it reports on:

• the perceptions of their mobility in the home, their locality, and beyond;

• the frequency with which they move about in the various environments;

• their view on what the most significant issues are in relation to access to the

various environments;

• their use of mobility techniques and aids; and

• Their views on, and use of, mobility training.

The study also describes the demographic factors of the sample group, including

age, perceived levels of visual impairment, living locations, and settings.

Definition of Mobility

For the purpose of this study and in keeping with definitions used in literature on

vision impairment, mobility is defined as "the ability to move independently, safely

and purposefully through the environment" (Blasch, Weiner & Welsh, 1997, p.1). In

terms of independent movement and travel within one’s environment, mobility is

coupled with orientation “which involves having an awareness of space and an

understanding of the situation of the body within in it” (McAllister & Gray, 2007), or

"being aware of where you are, where you are going, and the route to get there"

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(Gargiulo, 2006, p.504). Marron and Bailey (1982) describe successful orientation

and mobility as the ability to “travel safely, comfortably, and independently” (p. 413).

The literature reports that successful orientation and mobility training involves a lot

more than the use of a guide dog and long cane. The use of problem solving

techniques, planning, best use of residual vision (Perla and O’Donnell, 2004) and

using a group training environment (Higgerty and Williams, 2005) have been

reported as successful components in developing independence in mobility.

International Perspectives on Mobility and Disability

Although a technical definition of mobility was used in this study, the impact of

restricted mobility experienced by those with vision impairment can be considered

from the perspective of limiting full participation in community and society and as a

restriction of human rights.

The human rights perspective asserts that every person, as an equal citizen, has a

right to develop and express his or her own potential. The human-rights approach

finds expression in the EU Charter of Fundamental Rights, the European disability

action plan 2003–10 and, more recently, the UN Convention on the Rights of

Persons with Disabilities 20071 (CRPD). A number of Articles of the CRPD are

especially relevant to supporting the mobility and social inclusion of blind and vision

impaired citizens. Article 9 requires states to ensure accessibility. Article 19 marks

the fundamental importance of being able to live independently and being included in

the community. Article 20 requires States to support personal mobility.

A rights based approach argues that it is the environment that disables people and

not the impairment in itself. Disability results from the interaction between persons

with impairments and the social, physical, and attitudinal barriers they meet for

example in service provision such as in education, transport, health and the built

environment. The literature reports that people with vision impairments encounter

serious issues of immobility and severe problems with transportation and access to

goods, services and other community amenities (Montarzino et al, 2007; Hersh and

Johnson, 2008; Turner, 1998). Participants in a recent study Irish study of people

1 Ireland signed this Convention in 2007.

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with vision impairment in Northern Ireland and the Republic of Ireland reported their

experience of challenges to poor access to public transport, and a perceived

absence of public awareness about vision impairment. The lack of accessible

transport created an increasing dependency on friends and family (Gallagher et al.,

2010).

Another recent change in perspective related to disability and health is reflected in

the WHO International Classification of Functioning and Disability (2001) in which

levels of activity and participation are perceived as health indicators. This

classification acknowledges that failure to tackle exclusion and marginalisation

increases the risk that disabled persons will experience ill health. In a recent study

based on this Classification of Functioning, Alma, et al., (2011) reported that in

comparison to population-based reference data, vision impaired elderly study

participants experienced restrictions in household activities (84%), socializing (53%),

paid or voluntary work (92%), and leisure activities (88%). Social isolation is a

predictor of morbidity and mortality in older people (Cruice et al., 2005).

Promoting access for disabled persons in the social and built environment is a key

health issue. The focus of this approach moves away from individual impairment to

the obligation of society delivered through health and social services to ensure

access to rights in these and other areas.

Context of the Study

In 2008, as part of their service planning process, NCBI (National Council for the

Blind in Ireland) and Irish Guide Dogs for the Blind (IGDB) commissioned the

Discipline of Occupational Therapy, Trinity College Dublin to conduct this study with

an age stratified random sample from the NCBI database. It should be noted that all

those entering the NCBI database receive an assessment. After the initial

assessment with the new service user, NCBI frontline staff offer the opportunity to

the individual to undertake mobility training where appropriate. Irish Guide Dogs also

offers mobility training with a long cane and Guide Dog. Mobility training comprises

of residual vision training and orientation techniques for those with low vision, and

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formal training in the use of the long cane for those with more severe vision loss.

Training with a guide dog is also provided where appropriate.

Study Methodology

In keeping with ethical practice to protect confidentiality, the recruitment to the study

was conducted by the NCBI. A multistage collaborative process that involved vision

impaired people, service provider staff, and a research steering committee from the

sponsoring agencies, produced an interview schedule specifically for the stated

purpose of the study. Telephone interviews were conducted over a three month

period, by trained occupational therapist interviewers with questions exploring self

reported mobility skills, mobility techniques, aids used, and the type of mobility

training received.

Information was gathered from participants in this study about how well they

considered that they manage mobility in their home, in their local area and in busy

and unfamiliar areas. Information about the percentage of the population using

special techniques, specifically the long cane and guide dogs, and differences if any

between their mobility perceptions and that of others, was sought. An important

strand in this research was to capture the participant’s involvement in mobility and

orientation training.

Study Sample

Although the majority of those on the NCBI database are aged over 65, age related

stratified random sampling was used to ensure that the views of younger people

were represented in the study results, as it was expected that their needs and

experiences of sight loss may differ from the older population. Only those on the

database who met registration criteria and were registered blind were included in the

sample selection.

The study sample comprised of 564 people from the NCBI database, 59% (n = 333)

of the sample were aged from 18 to 64 years and 41% (n =231) aged between 65 to

100 years. The mean age for the younger age group was 45 years and the mean

age for the older age group was 78.5 years. Almost 53 % of the population was

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female and 47% were male. The total number of people registered as blind on the

NCBI data base was 9758 people (NCBI, 2008)

Findings and Recommendations

Summary

This study is one of the first surveys dedicated to the exploration of the perceptions

and experiences of mobility carried out in Ireland with vision impaired adults on the

NCBI database. It describes their perceptions and experience of mobility such as

moving around their home, their local area, and busy unfamiliar areas; their

experience of vision loss and co morbidity; their use of mobility techniques and aids;

their participation in and considerations about mobility training; and the challenges

they face with regard to mobility. The results are examined by age group (older age

group mean age, 78.5; younger age group mean age, 45) and by gender.

The results of the study identified that mobility is a critical issue for participants, even

in moving around their local area. Only 46.8% of the younger age group indicated

that they had ‘no difficulty’ in moving around in their local area while 36% of the older

age group and 25.4% of the younger age group ‘never go out without a sighted

guide’.

The two age groups differ in their experience of vision impairment. Only 11 people

(4.76%) in the older age group indicate that they had ‘no useful vision’ as compared

to 76 almost 23% of the younger age group. The eye conditions experienced also

differ with the majority of those in the older age group having age related sight loss

(41% had macular degeneration, and 14% had glaucoma). Co morbidity with vision

loss and other health related issues also impacted on mobility for both age groups;

59% of the older age group and 29.5% of the younger age group reported co

morbidity.

Although the literature considers training in orientation and mobility techniques is an

essential resource for blind and vision impaired people, only 1 in 2 of the younger

age group and 3 in 20 of the older age group reported having participated in any sort

of training. However those who are the most vision impaired had the highest uptake

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of mobility training, and they reported very high satisfaction rates with this training.

The majority of respondents did not have training although it is offered to all who

register with NCBI. Participants reported that they considered the offer of training as

not relevant to their situation for various reasons, such as not needing it as they

relied on a sighted guide, and/or that their other health difficulties affected their

perceived usefulness of training. Participants were asked about their use of mobility

aids (such as long cane, guide dog, symbol cane, or ‘other’ aids related to co-

morbidity of physical disability e.g. walking frame). They were also asked about

orientation and mobility techniques used (such as of residual vision and hearing,

sighted guide, and other). Just 28.8% of the total sample (n =162) reported using

mobility aids related to vision impairment, comprised of 18% of the total sample (n =

102) using the long cane, 5.5% (n = 31) the symbol cane, and only 5.1% (n = 29)

use a guide dog. With regard to orientation and mobility techniques used to get

about the local community, almost 24% (n =79) of the younger age group use

residual vision and hearing. Almost 20% (n=66) of this younger age group report

using no technique or aid with nearly 11% (n=36) reporting their reliance on a

sighted guide as their primary technique. For the older age group, almost 35% (n

=80) use residual vision and hearing, just 12% (n=27) use a sighted guide only, 9%

(n=21) use a long cane, and 8% (n=19) use a symbol cane. Only two (0.9%) of the

older group use a guide dog. It is interesting to note that 25 in the older age group

(11%) use mobility aids related to their physical disability such as walking stick/frame

/wheelchair.

When asked “What are the things that make getting around hardest for you?” Poor

design of the built environment and of public services, such as transport, were the

most frequently reported obstacles.

The results of this study highlight the poor uptake of training as and when offered

and the associated low use of mobility aids particularly by those with co morbidity

and partial sight, the majority of whom are elderly. Further exploration using

qualitative methods would allow in depth exploration of attitudes and expectations of

improved mobility.

It is recommended that broadening the multidisciplinary approach in conjunction with

the support of the professionals in services for vision loss, that specialist

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occupational therapists be employed as in other countries (Dahlin-Ivanoff and Sonn,

2004; Eklund et al., 2004) particularly for those with co-morbidity. This would allow

for an examination of the dynamic transactional relationships between the person,

the environment, and the activity, and how this influences moving about in the

community and the provision of support and skills training to overcome the barriers in

their physical, social, and cultural environment.

In tandem with this, existing legislation and policy regarding access for people with

disabilities to goods and services and in the design of the built environment should

be enforced. A strategy of local access audits should be conducted by the national

voluntary agencies in local physical, social and community service environments as

a means of raising awareness of the needs of vision impaired people.

The results of this study are particularly important in light of the increase in our aging

population and the associated expected increase in vision impairment. A national

vision strategy is essential. This national policy should reflect the W.H.O (2001)

perspective on measuring health outcomes in terms of activity and participation.

Mobility is essential in this construct of health, for quality of life and for active

citizenship.

The findings and recommendations presented in this executive summary are a result

of an analysis of both the international literature and the results of the interviews.

1. The majority of participants experienced difficulty in using their local area.

In this study, five hundred and sixty one people with vision impairment from the

NCBI database were asked “How well do you think that you get around?” Only

19.03% (n =63) of the younger age group scored themselves in the ‘very well

category’, while 12.8% (n =39) scored themselves in the combined categories of

‘Fairly badly’ and ‘badly’. In the older age group, 12% (n=28) indicated in the ‘very

well’ category and 17.7% (n=41) in the combined categories of ‘Fairly badly’ and

‘badly’.

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Note when reading these tables that “N” = the total sample in the category and “n” = the number of respondents.

Table 1 Perceptions of Mobility N=564: n=561 Perception Under 65 Over 65

Very Well 19.03% 12.1%

Fairly well 37.58% 39%

OK 31.1% 31.2%

Fairly Badly 8.5% 10.8%

Badly 3.3% 6.9 %

Of the total sample (N), the majority of participants in both group, 55% (n =309)

reported that they experienced ‘some’ and ‘significant’ difficulty in using their local

area.

Table 2 Level of Difficulty in Local Areas N=564: n=561

Level of Difficulty Under 65 Over 65

No difficulty 155 46.8% 97 42.2%

Some Difficulty 103 31.2% 43 18.7%

Significant difficulty 73 22% 90 39.1%

Total (respondents) 331 100% 230 100%

14

Figure 1. Level of Difficulty in areasLocal. N=562: n =561

46.80%

22%

40.00%

No Difficulty Some Diffi Signif Difficulty

42.20%39.10%

50.00%

31.20%30.00%

18.70%

10.00%

20.00%

0.00%

culty icant

Under 65

Over 65

Almost 90% (n = 501) reported experiencing difficulty when using busy and

unfamiliar areas. Little difference in responses between the age groups responses

was noted

Table 3 Level of Difficulty in Busy/unfamiliar Areas

N is 564 (333 under 65 and 231 over 65), n is 561 (330 under 65 and 229 over 65)

.

Level of Difficulty Under 65 Over 65

No difficulty 36 10.9% 22 9.6%

Some Difficulty 119 36.1% 50 21.8%

Significant difficulty 175 53% 157 68.6%

Total (respondents) 330 100% 229 100%%

15

Figure 2. Level of Difficulty in Busy/unfamiliar Areas. N=564: n=559

80.00%

10.90%

36.10%

53%

9.60%

21.80%

68.60%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

No Difficulty Some Difficulty Significant Difficulty

Under 65

Over 65

Only 51% (n=288) of the total sample r d goi t in th local ar st

out less uently than this. A higher percentage of

200) went out more frequently than members of the

older cohort (38.1%, n = 88).

eporte ng ou eir eas ‘mo

days’, with the remainder going freq

the younger group (60.1%, n =

16

Table 4 Level of Difficulty in Busy/unfamiliar Areas

N is 564 (333 under 65 and 231 over 65), n is 563 (330 under 65 and 230 over 65)

Frequency Under 65 Over 65

Yes, Most days 200 60% 88 38.3%

Yes, more than once a week 30 9% 36 15.7%

Yes, most weeks 9 2.7% 7 3%

I try to avoid it 9 2.7% 14 6.1%

Never ,unless I have a sighted guide

84 25.3% 84 36.5%

Never Leaves Home 1 0.3% 1 0.4%

Total (respondents) 333 100% 230 100%

6060

70

Figure 3. Frequency of Using Local Areas. N =564: n=563

92.7 2.7

25.3

0.3

15.7

3 6.10.4

0

10

20

30

4038.3 36.5

50

Yes, most Yes, more

week

Yes, most I try to Never,

have a

Never

Home

Und

Ov

days than once a weeks avoid it unless I Leaves

sighted

e

The above results demonstrate that mobility is an issue for the study sample, with

the younger age group displaying a pattern of restriction not normally associat

those in this age group. However the results are similar to other studies reported

the literature. Research carried out by RNIB (1995) in the United Kingdom found tha

59% of respondents never went out alone due to difficulties with mobility and in

ed with

in

t

17

accessing public transport. As a consequence participants frequently considered

themselves to be isolated and excluded.

Recommendation: A pilot project with each age groups using the Person Environment Occupation Model (PEO), (Law et al, 1996) may improve mobility.

The results of this study tion in community and

society is restricted by both age groups in the study sample. It is recommended that

service providers for vision impaired people explore issues of access in ‘local areas’

for the target pilot study group. The Person Environment Occupation Model guides

examination of the dynamic transactional relationships between the person, the

environment, and the activity exploring how this influences performance of a task

such as moving about the community. It identifies the person’s ability and skills, as

well as the barriers or supports in the physical, social, and cultural environment from

the individual’s perspective. The model’s flexibility and simplicity facilitates its use in

all settings (Stewart et al, 2004). The application of this model may result in the up-

skilling of the person for mobility in their local area, the adaptation of the physical

nd social environment, and or changing the demands of the task to suit the

ple

ify

2. As expected the younger and older age groups differ in many ways.

s the NCBI database is predominantly aged over 65, and it was expected that there

ay be differences between younger and older people, the study sample was age

tratified to ensure that the perceptions of the younger people with vision loss were

corded. Participants were asked to categorize themselves into one of three

ategories; Cat. 1, “No useful vision”; Cat. 2, “Little residual vision”; and Cat. 3,

ood residual vision”. With regard to level of vision, only 11 people (4.76%) in the

ver 65 age group categorised themselves as having “No useful vision” (Cat. 1), in

show that mobility and participa

a

person’s strengths and supports.

With regard to younger people, issues affecting use of ‘unfamiliar areas’ by a sam

of this population can be explored from the PEO model in a pilot project to ident

what factors would equip the person, or what changes are required in the

environment to enhance mobility in unfamiliar areas.

A

m

s

re

c

“G

O

18

comparison to 76 (22.96%) of the younger age group who categorised themselves in

n the following Figure 4. this way. This is presented i

22.96%

4.76%5

25

Over 65

Fig Percentage of Under 65 and Over 65 Useful Vision” 1 N =87

0

10

15

20

Under 65

ure 4. in the “No

Cat.

When asked about the name of their eye condition, 560 responded. Almost 17%

responded that they “Don’t know”. Of those who did, there were differences related

to age, such as over 41% (n = 94) of the older age group indicated that their eye

condition was macular degeneration in contrast to 5.14% (n=17) in the younger

group who had a wide range of eye conditions. The following two tables present the

data on reported eye conditions related to the two age groups.

19

Table 5 Breakdown of Eye Conditions – under 65 Under 65 N = 333:n =331

Rank PrOrder

imary Eye Condition Under 65

1 Other 79 23.87%

2 Retinal Pigmentosa 48 14.5%

3 Don’t Know 43 13%

4 Glaucoma 35 10.57%

5 Optic Atrophy/Optic Neuropathy 25 7.55%

6 Cataracts 23 6.95%

7 Retinal Disease 22 6.65%

8 Albinism 21 6.34%

9 Macular Degeneration 17 5.14%

10 Traumatic Injury 16 4.83%

11 blastoma or Other Cancer Retino 2 0.6%

Total 331 100%

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Table 6 Breakdown of Eye Conditions – over 65 N = 231:n=229

Rank Primary Eye Condition ver 6 O 5

1 Macular Degeneration 94 41.05%

2 Don’t Know 252 2 .7%

3 Glaucoma 14.41% 33

4 Other 20 8.73%

5 Cataracts 4.8% 11

6 Retinal Disease 3.07 6%

6 Retinal Pigmentosa 3.06% 7

7 Traumatic Injury 2 0.87%

8 Optic Atrophy/Optic Neuropathy 1 0.44%

8 Retinoblastoma or Other Cancer 1 0.44%

8 Albinism 1 0.44%

Total 229 100%

There is also a contrasting pattern of duration of sight loss, with 34.86% (n = 114) of

e younger age group with sight loss since birth, and only 5.58 % (n = 13) in the

older age group. A further 11.9% (n=39) of the younger group have sight loss since

childhood. In contrast, 55% (n=127) of the older group (mean age of 78.5 years)

have lost their sight in the last ten years. They have had to make accommodations to

this loss in early old age, as well as managing other health, disability and age related

issues. Table 7 presents the data related to time since sight loss.

th

21

Table 7 Time since S N=564: n=556

ight Loss in Age Groups

Time Since Sight Loss Under 65 Over 65 Total Respondents

Since Birth 114 34.86% 13 5.68% 127 22.84%

Since Childhood 39 11.93% 11 4.8% 50 8.99%

For more than 20 years 50 15.29% 34 14.85% 84 15.11%

For 10 -20 years 52 15.9% 44 19.21% 96 17.27%

For 5 – 10 years 36 11.01% 61 26.64% 97 17.45%

For 2 – 5 years 23 7.03% 50 21.83% 73 13.13%

Recent onset, within last 2 years

13 3.98% 16 6.99% 29 5.22%

Total 327 100% 229 100% 556 100%

st 82% (n =186) of the older age group

Other age related differences in the numbers of participants from each group who

obility training were found. Almoreceived m

reported that they never received training. This contrasts with 47.6% (n=156) in the

younger age group. Figures 5 and 6 present this data.

Figure 5. Training Status Under 65. N=328

47%48%

2%3%

yes and I used it

offered but didnt want it

awaiting training

no

22

15% 3% 0%

82%

Figure 6. Training Status Over 65. N=228

yes and I used it

offered but didnt want it

awaiting training

no

Recommendation: Younger and older ag

bility needs of two

istinctly different groups should be explored. Taking account of the high level of co-

morbidity (see below), the differences in eye conditions, together with the variance in

rocesses for older persons

and lifestyle expectations of the younger age

ts reported that they addit ealt d disa

dity reported in the younger age group was 29.5% (n=97) and

gure 7 presents this data.

e group should be considered as having different profiles of need. Further investigation of how best to identify and to meet the mo

d

duration of sight loss, the mobility needs and training p

are different from the needs, abilities,

groups.

3. Participan had ional h h an bility factors to manage

The level of co-morbi

in the older age group was 59% (n = 135). Fi

23

29.50%

59%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

under 65 over 65

Figure 7. Level of co-morbidity. Under 65 & Over 65. N=232

This finding is in keeping with the Edinburgh study cited previously (Montarzino et

al., 2007) that reported 68% of its study sample aged over 61 years had one or more

additional disabilities.

Recommendation: A multidisciplinary perspective which includes specialist th

the individual’s lifestyle expectations,

addressing mobility needs and closer links should be established between all

ies charged with the care of vision impaired individuals who

depende or relia n a s ted guihe local and busy/unfamiliar ar

(n = 84 orted “Never” go out without

d guide even in their local area. Thirty six percent of the older age group (n =

84) reported this also. Table 8 and Figure 8 presents the data.

occupational therapy and physiotherapy inputs is recommended for those wimore complex needs related to vision impairments and co-morbidity. With regard to those with co-morbidity,

strengths, and resources should be considered in developing this personal plan for

disciplines and agenc

have complex needs.

4. There is a high level of ncy nce o igh de for accessing t eas.

In the Under 65 age group, 25.4%

a sighte

) rep that they

24

Table 8 Frequency of using Local Areas Under 65 & Over 65 N=564: n=563


Yes, Most days 200 60% 88 38.3%

Yes, more than once a week 30 9% 36 15.6%

Yes, most weeks 9 2.7% 7 3%

I try to avoid it 9 2.7% 14 6.1%

Never , Unless I have a sighted guide

84 25.3% 84 36.5%


Total 333 100% 230 100%

60

70

Figure 8. Frequency of Using Local Areas. Under 65 & Over 65. N=563

38.340

50

9

2.7 2.7

25.3

0.3

15.6

36.1

0.40

10

20

30

Yes, mo

36.5

60

st days

Yes, more than once a week

Yes, most weeks

I try to avoid it

Never, unless I have a sighted guide

Never leaves home

Under 65%

Over 65%

25

With

younge

Table 9 Frequency of using Busy/Unfamiliar Areas

umber of respondents 563 (under 85 is 333 and over 65 is 230)

regard to using busy and unfamiliar areas, this rises to 47.9% (n =159) of the

r age group who reported that they “Never” go out without a sighted guide.

Total sample in category is 564 N


Yes, Most days 30 9% 18 7.8%

Yes, more than once a week 21 6.3% 5 2.2%

Yes, most weeks 57 17.1% 17 7.4%

I try to avoid it 65 19.5% 41 17.8%

Never , Unless I have a sighted guide

159 47.8% 145 63%


Total 333 100% 230 100%

26

9 6.317.1 19.5

47.9

0.37.8

2.27.4

17.8

63

1.7010203040506070

Yes, most days

Yes, more than once a

week

Yes, most weeks

I try to avoid it

Never, unless I have a sighted

Never leaves home

F familiar Areas. N=564: n=563

igure 9. Frequency of Using Busy/Un

guide

Unde

Over

In the older age group (mean age 78.5 years), 63% (n= 146) never used a busy and

unfamiliar area without a sighted guide.

hese results highlight the dependency of this age group on others for their mobility.

These resu ith

people age their local

area. This study also reports that feelings of being unsafe were more predominant at

night and in unfamiliar locations. Alternatively familiarity with surroundings was

identified as encouraging independence.

Sugiayama and Ward Thomson (2007) in their study of 318 people over 65 years of

age in Great Britain found that supportiveness of neighbourhood environments was a

significant predictor of older people’s walking activity regardless of their age,

gender, living arrangements, education former occupation or functional status. It has

been recognised in the literature that other factors beyond task difficulty, including,

autonomy, self efficacy and a sense of control over one’s actions and affairs

influence how challenges in managing disability are addressed (Wiggins et al., 2005)

T

lts are similar to the Edinburgh study (Montarzino et al., 2007) w

d over 61 years, one third of whom did not go out alone even in

27

Recommendation: Service delivery agencies should be cognisant of the individual’s belief about their self efficacy (Bandura, 1998) and motivation factors for The problems presented by co-morbidity offer additional challenges to the person’s

self belief. Health and social service agencies should support individuals in

identifying opportunities in their local areas and in their daily life for autonomy and

independence as part of a broader understanding of mobility for community

participation.

5. Participants demonstrated a low level of expectation of independence i mobility, and had a low level of perception of the benefits of mobility

study should be interpreted in the context of the following:

. As part of the process of developing valid content for the questionnaire, staff from

e

l

The total number of participants (N=564) were asked the question “Have you ever

ad training or advice to help you move around more safely?” with the option to say

“Yes, and I used it”; “Yes, but didn’t want it; “I am awaiting training”; and “No”.

Replies were given by 556 participants. Even with these category options, only 34%

(n=190) of the respondents (n =556) reported that they received any type of training

input. Over 61% (n = 342) reported that they had not received training, and 10

(1.79%) were waiting on training, only 14 (2.51%) reported that they had refused

training. Formal training in the use of the long cane and guide dog was reported by

independent mobility.

n

training.

The results of this

1. It is a procedure employed by NCBI that a person when registering with NCBI is

offered mobility training by trained staff, when appropriate.

2NCBI and Irish Guide Dogs for the Blind as well as people with vision impairment

gave advice on the use of language they thought most suitable for asking questions

about ‘mobility training’ options. These options included training from staff in th

person’s home about use of residual sight through orientation and awareness; forma

training in the use of the long cane and guide dog; and orientation advice from family

and friends.

h

28

only 131 (23.2%) of study participants. Those who had not received training (n=342)

were asked if they had ely, of these 335

replied. Almost 90% (n=299)

comprising 88% (n=137) of the younger age group and 92% (n=162) of the older age

group.

considered training to help get around saf

reported that they would not consider training,

14%

86%

Figure 10. Consideration of Mobility TrainingUnder 65 n=159

yes (n=22)

no (n=137)

8%

Figur id ion of Mov 6

e 11. Cons erat bility TrainingO er 5 N=176

yes (n=14)

no (n=192%

62)

se

remainder gave a

When asked why would they not consider it, sixty eight percent (n=202) of the

participants considered that mobility training was not needed. The

29

variety of reasons; the most frequently reported one was that they had managed

without it and that they had support.

70%

30%

Figure 12. Reasons for not considering training. Total sample (n=335).

"I don't need it" (n=202)

other answer (n=96)

Figure 13. Reasons for not considering training. Under 65. (n=137)

29%

"Don't need", had support, managedwithout

54%

7%6%

4% not offered so didn't consider

never thought about it

not beneficial

no reason given

30

Figure 14. Reasons for not considering training Over 65. (n=162)

23% "Don't need"/ had supportNot beneficialOther mobility difficulties

9%54%8%

6% Just never considered itNo reason given

l of satisfaction with their

mobility trainin

Only 29% of the total sample reported that they use either a guide dog (n=29; 5%) a

long cane (n=102; 18%) or a symbol cane (n=31: 5.5%) for their mobility.

When comparing the reported satisfaction levels between those who used a long

cane, guide dog and a sighted guide, notable differences were found. Almost 83% (

n=24) of guide dog users scored themselves in the ‘very well’ and ‘fairly well’

categories of perception of mobility in contrast to only 30% (n=19) of those who use

sighted guide. Fifty three percent (n = 54) of long cane users scored themselves in

However, those who have had training, (this includes almost 83% (n=72) of the most

severely vision impaired participants), reported a high leve

g.

a

these ‘very well’ and ‘fairly well’ categories. The following figures and table present

these results.

31

41%

41%

10%

4% 4%

Figure 15. Perception of Mobility Dog UserGuide s. (N=29)

Very well

Fairly well

Ok

Fairly badly

Badly

6%24%

35%

22%

13%

Figure 16. Perception of Mobility Sighted Guide Users. (n=63)

Very well

Fairly well

Ok

Fairly badly

Badly

32

17%10%

3%

Long Cane Users. (n=101)

37%33%

Figure 17. Perception of Mobility

Very well

Fairly Well

OK

Fairly Badly

Badly

Table 10 Comparison of techniques with Perceptions of Mobility Number of respondents 193

Technique otal Very well Fairly well OK Fairly badly Badly T

Long cane 1 17 16.8% 37 36.6% 34 33.17% 10 9.9% 3 2.97% 10

Guide dog 12 41.4% 3 10.3% 1 3.45% 1 3.45% 29 12 41.4%

Sighteguide

63 d 4 6.35% 15 23.8% 22 34.9% 14 22.2% 8 12.7%

Total 33 64 59 25 12 193

Recommendation: A further in depth examination of this poor uptake is recommended. Factors related to the timing, the manner of the offer by NCBand psychological factors related to the new disability status of the persapplying for registration may contribute to this poor uptake. There may be adifference in perception held by the person with vision impairment and NCBI staff as to what mobility training involves, such as that it is more than the guide dog and cane. This

I on

in depth examination may best be achieved using qualitative methods with participants from both age groups.

33

6. Environmental factors continue to impede ease of mobility.

In spite of requirements for universal access in the design of public space and

buildings in Ireland, when asked about the things that make getting around hardest,

556 (98.58%) of participants commented on access issues related to the outdoor

and indoor public physical environment and the social behaviour and attitudes of

others. This is similar to the findings in previous studies including Montarzino et al.,

(200

pavem eelie bins’ and smokers behaviours

of congregating on the pavements outside pubs and restaurants, road crossings,

k

,

ds to

me of awareness of what it means to be vision

ation should be

explained. The public should be made aware that many people who are legally blind

h

7); Marston and Golledge, (1997). Participants reported problems with uneven

ents, obstacles on pavements such as ‘wh

levels of light, recognising bus numbers and difficulties with public signage. As one

participant said “I think it’s the lack of other people’s awareness, you loo

perfect...people don’t quite know what to do. The disabled sign should not be a

wheelchair… people have a problem with blind people using disabled facilities as a

result.”

Blasch et al., (1997) argue that the public can have a significant effect on the mobility

of vision impaired people by restricting access by their presence or actions or simply

by reacting in ways that may stigmatize the traveller. In Kirchner et al., (2008) study

53% of guide dog users and 46% of long cane users reported that they found the

attitudes of the public a barrier to physical activity.

Recommendation: The impact on mobility of the design of facilities and services need to be redressed specifically for a people with sight loss and co-morbidity.

The public should be made aware of the impact of vision impairment. With regar

addressing the need to improve public attitudes and behaviours, national agencies

should embark on a program

impaired, in particular providing an understanding of low vision/partial sight. The

impact of not recognising faces, bus numbers and public inform

maintain some residual vision. Ways of including and helping low vision/people wit

34

sight loss should be explained and demonstrated to the general public as part of

disability information strategy.

7. Most of the study sample (85%) are partially sighted, and their needs are different from

a

those who have vision.

nly 15% ( n= 87 ) of the study participants indicated that they had no useful vision O

(Cat. 1) and they differ from the rest of the ‘little residual vision’ (Cat. 2) group and

‘good residual vision’ group (Cat. 3) in that they tend to be younger and have had

mobility training. More of them use mobility aids in comparison to older people who

have decreasing vision and partial sight.

15%

49%

36%

Figure 18. Categories of Sight LossTotal Sample (n=562)

15% = No useful vision; Cat 1

36% = Good residual vision; Cat 3

49% = Little residual vision; Cat 2

Eighty seven percent (n=76) of those in the Cat. 1 “No useful vision” group were in

the younger age group and only 13% (n=11) were in the older age group.

Almost 83% (n=72) of these most severely vision impaired participants (Cat. 1) had

received mobility training.

35

82%

3% 2%13%

Figure 19. Cat. 1 Group - Ever had Training? (N=87)

Yes

No

Offered but didn't want it

Awaiting Training

This co e

in the other vision categories who had received training.

ntrasts with 26% (Cat. 2 group: n=71) and 23% (Cat. 3 group: n=46) of thos

26%

69%

Figure 20. Cat. 2 Group - Ever had Training? (n=271).

Yes

3% 2%

No

Offered but didn't want

Awaiting Training

36

23%

74%

Figure 21. Cat. 3 Group - Ever had Training? N =197

3%

Yes

No

Offered but didn't want

Awaiting Training

Of the 29 guide dog owners, 27 were in the younger age group.

2, 7%

Figure 22. Breakdown of Guide Dog Users N = 29

Under 65

Over 6527, 93%

Of the 102 who used a long cane, 81 were in the younger age group.

37

81, 79%

Figure 23. Breakdown of Long Cane Users N = 102

21, 21%

Under 65

Over 65

Recommendation: In light ofon others for mobility sighted (94 the nation older group ighted people can be met so as to maintain their well being and social connectedness. Support and guidance re vision impairment must take into account that 59% of this gimpac h and socialto take advice from the specialist agencies in making accommodations for the loss of vision when designing and delivering any health and social service to old p

8. al distress are associated with age related sight loss (O’Donnell, 2005; Travis et al; 2004, Horowitz, 2004; Wahl et

The literature reports that high lev

dependenc

common psychologic the one that interferes the most with

the low uptake of mobility training, and reliance , a greater focus on the needs of the partially

.7%; n=220) older age group is required. There is a specialist role foral agencies such as the NCBI and IGDB as to how the needs of this of partially s

a e group (n = 135) have additional health and disability needs that also t on mobility. As older people are entitled to and participate in healt services agencies to a greater extent than others, these agencies need

er eople.

High levels of psychologic

al, 1999).

els of distress include depression, fear,

y, and anxiety. Goodman (1989) stated that fear is one of the most

al barriers and that it is

38

mo it

residu ’s

study (2007). Pelli (1986) suggested that it was overestimation of risk rather than

degree of vision that had an im

Howev

wh a

life, an

in Ben-Zur & Debi, 2005).

Recom es should be vigilant about pos ibindivid rral to the national voluntary agencies for vision impaired people. Information about national agencies and resources for aparticucoping oss are no

In conjunction with and in s

specialist occupational t

multidisciplinary working to lessening the combined impact of vision impairment and

co morbidity (Copolillo et al., 2007). In collaboration with the person with sight loss,

stra g

used to ople

with lo a specialist

area in occupational therapy in other countri erica

(Warren, 1995), Australia and the Nether

Kingdom it is not. “Resear

general awareness of sight loss and its implications if they are to deliver effective

support to people with sight loss. Specialist training at post graduate level would be

appropriate to ensure that occupational therapists have all the necessary skills”

bil y (as cited in Griffin-Shirley et al., 2006). Feelings of safety along with age and

al vision were seen as the main restrictions on mobility in Montarzino et al.

pact on the mobility of vision impaired people.

er psychosocial factors associated with sight loss and functional disability

en ddressed, can increase functional ability, self esteem, and satisfaction with

d lower a person’s depressive symptoms (Horowitz and Reinhart, 1998. Cited

mendation: All health and social servics le sight loss and its impact on mental health in at risk groups and

uals, and make appropriate refe

m naging sight loss should be available in all health and social services, larly for elderly service users. Psychological and practical strategies for should be offered when changes in relation to irreversible sight lted.

9. Occupational therapy is deemed effective in other countries for those with sight loss and with co-morbidity.

upport of other professionals in services for vision loss,

herapists can make a particular contribution to

te ies for environmental adaptation, skill training, and activity modification are

improve independence, autonomy, and quality of life. Working with pe

w vision who have complex health needs is now considered as

es such as the United States of Am

lands. However in Ireland and the United

ch shows that occupational therapists need more than a

39

(Mc a highlighted

sight lo

Recommendation: Education of occupational therapists in Ireland should address the needs of those w vision and co- morbidit

10. Sight loss is one of ng people aged over 65 (Alliance for Aging Research, 1999).

Horowitz (2004) describes vision impairment as being one of the most commonly

overlooked and untreated conditions. The results of this Irish study show that this

study population already have additional health related needs and that most are

restricted in their mobility. With an aging population, an increase in chronic age

related sight loss and impairment is expected. This can result in significant personal,

familial and public health challenges that need to be addressed urgently (Dahlin

Ivanoff et al, 1996).

Recommendation: Addressing the needs of vision impaired people requires the involvement of families, communities and health and social service staff. Those with age related sight loss have additional health and disability issues, and a comprehensive approach to meeting their individual needs in a multidisciplinary approach is required (Eklund et al, 2004). In addition, all State and voluntary social and health services for older people should be designed and delivered to include service users with vision impairment as part of national policy and practice. The development of a National Vision Strategy is essential in advancing this holistic approach. Such a strategy would provide benefits by investing in services which would improve health and social gain, and reduce dependency on carers and family by those with low vision.

G uran, 2010). The American Occupational Therapy Association has

ss as a priority area of unmet need by occupational therapy services.

ith sight loss, particularly older people with lowy.

the leading causes of the loss of independence amo

40

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Occupational Therapy and Physical Dysfunction: Principles, Skills and

Practices. (4th ed, p. 225-282) London: Churchill Livingstone.

• Wahl, H-W., Schilling, O., Oswald, F., & Heyl, V. (1999). Psychological

Consequences of age related visual impairment: comparison with mobility-

54B (5), p304-316.

44

• Warren, M. (1995a). Including occupational therapy in low vision

rehabilitation. The American Journal of Occupational Therapy. 49 (9), 857-

860.

oms: An analysis of patients presenting

• Wiggins, R.D, Higgs, P., Hyde, M., Blane, M. (2005). Quality of life in third

age: key predictors of the Casp-19 measure. Ageing Soc. 24: 693-708.

• Zola, L. (1966). Culture and Sympt

complaints. American Sociological Review: 31: 615-630.

45

Web Resources • http://www.un.org/rights/

(Universal Declaration of Human Rights)

• http://www.un.org/disabilities/

(United Nations Convention on the Rights of Persons with Disabilities)

• http://www.who.int/icf/icftemplate.cfm

(International Classification of Function, Disability and Health (ICF).

Glossary of Terms daptation to disability refers to the person’s satisfaction with or acceptance of

his/her circumstances changed by loss of capacity to perform certain behaviours,

independence.

er

knowledge, observations or contact and

participation in events.

person to move about safely.

A

including social, family and work roles, and to be autonomous in personal

Civil rights ensure that citizens are protected from harm by other citizens of the

state, and from government itself in its policy, laws and actions.

Cohort is a demographic term for a group that share similar characteristics und

study.

Co-morbidity is either in the presence of one or more disorders (diseases) in

addition to a primary disorder, or the effects of such additional disorders.

Correlation refers to the relationship between two variables where change in one is

associated with change in the other.

Experiences are the person’s actual

Guide Dog is one specially trained to accompany and enable a vision impaired

46

Help seeking behaviours are those described in cognitive theory literature as t

stages in the process of seeking help. These stages are defining the problem;

deciding to seek help; and selecting a source of support. Individual, interpersonal

and socio-cultural factors influence decision making and action at each stage of this

complex process.

Human rights are basic rights and freedoms that all people are entitled to

regardless of their status and by virtue of being human.

Legal blindness refers to a best corrected central vision of 20/200 or worse in the

better eye, or a visual acuity of better than 20/200 but with a visual field no grea

hree

ter

l

ent. These skills including the use of

ne where necessary, and the use of

pt development, route planning, street crossing

and travelling by public transport.

o

than 20 degrees ( eg. Side vision that is so reduced that it appears as if the person is

looking through a tunnel).

Long cane is a tool for negotiating the environment as it provides feedback

regarding the pathway about two paces ahead of the user.

Mobility is defined as the ability to move independently, safely and purposefully

through the environment.

Mobility aids and techniques facilitate safe and efficient travel for a vision impaired

person. These include guide dog, low vision aids, compass, sighted guide, long

cane, laser cane, sonic guide, talking sign systems, dead reckoning system, globa

positioning systems and night vision devices.

Orientation involves having an awareness of space and an understanding of the

situation of the body within it.

Orientation and Mobility Training teaches the person independent travel skills

required to negotiate the physical environm

mobility aids such as guide dog and long ca

residual vision, sensory skills , conce

Peer education is a method of learning and guidance from equals designed t

empower learners to promote healthy lifestyles and positive changes in behaviours.

47

Peer group is a social group of individuals that are similar in age, social position or

experience.

Perceptions: The person’s interpretation and organisation of meaningful

experiences of the world.

Qualitative research examines the patterns of meaning which emerge from data

usually gathered in their natural setting. These data are often presented in the

participants own words.

Self efficacy is self appraisal of whether one can perform behaviours in a particular

context, the person’s thoughts about their capabilities in particular situations.

Symbol cane is the white cane (stick) that indicates to others that the person has

vision impairment.

Vision impairment or low vision is a severe reduction in vision that cannot be

corrected with standard glasses or contact lenses, and reduces a person’s ability to

function at certain or at all tasks.

Visual acuity is the clarity or clearness of vision. A measure of how well a person

can distinguish details and shapes of objects; also called central vision.

48

Chapter 1: Introduction

mobility in the lives of Irish blind and vision impaired

adults. Jointly commissioned by the NCBI (National Council for the Blind Ireland and

and

ge of

upport individuals and their families to live life to its full potential. Currently, there

s

rceptions and mobility experiences of

blind and vision impaired persons with an Irish population. With regard to people with

t

er,

ial participation. The majority of those with

vision impairment have age related vision loss, and elderly people have to cope with

-morbidity of vision loss with other age related health challenges (Starfield, 2001).

Help seeking behaviours and adaption to disability involve a complex process, and

are usually socially learned (Mechanic, 1962, Kasl and Cobb, 1966). The culture,

social class, age and gender to which a person belongs influences expectations of

health and his/her subsequent action (Parsons, 1958; Zola, 1966) such as taking up

an offer of mobility training. Belief about one’s self efficacy is a significant factor in

the motivation to address the challenges presented by disability.

Visual acuity itself is not an accurate indicator of mobility status. Owsley and McGwin

(2007) state that measures of eye disease severity should not be used as surrogates

This is a national study of

the Irish Guide Dogs for the Blind (IGDB), the study examines mobility issues

training needs of blind and vision impaired persons. Both the NCBI and the IGDB

enable people who are blind and vision impaired to overcome the complex ran

barriers that may impede their independence and participation in society, and

s

are an estimated 30,000 blind and vision impaired individuals in Ireland, and this i

projected to increase by more than 170% over the next 25 years as the population

ages (Jackson and O’Brien, 2008).

This is one of few studies that explores the pe

vision impairments, there is consensus in the literature that mobility is an importan

part of everyday life, and that impairment to mobility greatly affects the quality of life

(Montarzino et al, 2007, Blasch, & Welsh 1997, Hersh & Johnson, 2008, Turn

1998). Social integration and social networks are associated with positive health

experiences for people with disabilities (Berkman and Glass, 2000). Reduced

mobility limits the opportunities for soc

co

49

for the personal burden of eye disease and vision impair

personal response to and cope with their condit

ment as individuals make a

ion in wide ranging ways.

rceptions and experiences of both younger and older

blind and vision impaired Irish people, randomly selected from the NCBI national

ervice

• the p , their locality, and beyond;

• the fr u ts;

• their

various

• their e e of,

mobility training.

ng with definitions used in literature on

irment, mobility is defined as “the ability to move independently, safely

and purposefully through the environment” (Blasch, Weiner & Welsh, 1997, p.1). In

n one’s environment, mobility is

007), or

This study reports on the pe

database. It presents their personal experience in order to inform responsive s

planning. More specifically, it reports on:

erceptions of their mobility in the home

eq ency with which they move about in the various environmen

view on what the most significant issues are in relation to access to the

environments;

us of mobility techniques and aids; and their views on, and us



1.1 Definition of Terms

Mobility

For the purpose of this study and in keepi

vision impa

terms of independent movement and travel withi

coupled with orientation which involves having an awareness of space and an

understanding of the situation of the body within in it (McAllister & Gray, 2

"being aware of where you are, where you are going, and the route to get there"

(Gargiulo, 2006, p.504). Marron and Bailey (1982) describe successful orientation

and mobility as the ability to “travel safely, comfortably, and independently” (p. 413).

The literature reports that successful orientation and mobility training involves a lot

more than the use of a guide dog and long cane. The use of problem solving

techniques, planning, best use of residual vision (Perla and O’Donnell, 2004) and

50

using a group training environment (Higgerty and Williams, 2005) have been

reported as successful components in developing independence in mobility.

Blind or vision impaired

nce in any direction. Poor partial sight refers to sight between

3/60 and counting fingers; good partial sight is that measured between 3/60 and 6/60

ty

spective asserts that every

person, as an equal citizen, has a right to develop and express his or her own

s

In this study terms are used interchangeably such as vision impaired, partial sight

and loss of vision to the extent that a person meets the criteria to register as “blind”

in Ireland. This means that the person has a visual acuity of 6/60 or less in the better

eye with correction, or a visual field subtending no more than 20 degrees. Totally

blind refers to vision loss on a continuum from the inability to perceive light to a

complete loss of useful vision, i.e. inability to perceive light to inability to recognise

any shape at any dista

vision.

1.2 International Perspectives on Mobility and Disability

The impact of restricted mobility experienced by those with vision impairment can be

considered from the perspective of limiting full participation in community and socie

and as a restriction of human rights. The human rights per

potential. The human-rights approach finds expression in the EU Charter of

Fundamental Rights, the European Disability Action Plan 2003–10 and, more

recently, the UN Convention on the Rights of Persons with Disabilities 20072

(CRPD). A number of Articles of the CRPD are especially relevant to supporting the

mobility and social inclusion of blind and vision impaired citizens. Article 9 requires

states to ensure accessibility. Article 19 marks the fundamental importance of being

able to live independently and being included in the community. Article 20 requires

states to support personal mobility.

A rights based approach argues that it is the environment that disables people and

not the impairment in itself. Disability results from the interaction between person

2 Ireland signed this Convention in 2007.

51

with impairments and the social, physical, and attitudinal barriers they meet for

example, in service provision such as in education, transport, health and the built

environment. The literature reports that people with vision impairments encounter

serious issues of immobility and severe problems with transportation and acce

goods, services and other community amenities (M

ss to

ontarzino et al, 2007; Hersh and

an

n-

e, Worrall and Hickson, 2005).

cial and built environment is a key

away from individual impairment to

Johnson, 2008; Turner, 1998). Participants in a recent study with an Irish people with

vision impairment reported their experience of restricted mobility related to poor

access to public transport and a perceived absence of public awareness about vision

impairment (Gallagher, Hart, O’Brien, Stevenson and Jackson, 2010). The lack of

accessible transport created an increasing dependency on friends and family.

Another recent change in perspective related to disability and health is reflected in

the WHO International Classification of Functioning and Disability (2001) in which

levels of activity and participation are perceived as health indicators. This

classification acknowledges that failure to tackle exclusion and marginalisation

increases the risk that disabled persons will experience ill health. In a recent study

based on this Classification of Functioning, Alma, van ser Mei, Melis-Dankers, v

Tilburg, Groothoff, and Suurmeijer (2011) reported that in comparison to populatio

based reference data, vision impaired elderly study participants experienced

restrictions in household activities (84%), socializing (53%), paid or voluntary work

(92%), and leisure activities (88%). Social isolation is a predictor of morbidity and

mortality in older people (Cruic

Promoting access for disabled persons in the so

health issue. The focus of this approach moves

the obligation of society delivered through health and social services to ensure

access to rights in these and other areas.

1.3 Context of the Study

In 2008, as part of their service planning process, the NCBI (National Council for the

Blind in Ireland and Irish Guide Dogs for the Blind (IGDB) commissioned the

Discipline of Occupational Therapy, Trinity College Dublin to conduct this study with

an age stratified random sample from the NCBI database. It should be noted that all

those entering the NCBI database receive an assessment. After the initial

52

assessment with the new service user, NCBI frontline staff, offer the oppor

the individual to undertake mobility training, where appropriate. Irish Guide Dogs for

the Blind also offers mobility training with a long cane and Guide Dog. Mobility

training comprises of residual vision training and orientation techniques for

with low vision, and formal training in the use of the long cane for those with mor

severe vision loss. Training with a guide dog is also provided where appropriate.

1.4 Study Methodology

tunity to

those

e

In keeping with ethical practice to protect confidentiality, the recruitment to the study

e,

ly

was

e the participant’s involvement in mobility and orientation training.

ated

ple

the

n 65 to

was conducted by the NCBI. A multistage collaborative process that involved vision

impaired people, service provider staff, and a research steering committee from the

sponsoring agencies, produced an interview schedule specifically for the stated

purpose of the study. Telephone interviews were conducted over a three month

period, by trained occupational therapist interviewers. Information was gathered from

participants about how well they considered that they manage mobility in their hom

in their local area and in busy and unfamiliar areas. Information about the

percentage of the population using orientation and mobility techniques, specifical

the long cane and guide dogs, and differences if any between their mobility

perceptions and that of others, was sought. An important strand in this research

to captur

1.5 Study Sample

Although the majority of those on the NCBI database are aged over 65, age rel

stratified random sampling was used to ensure that the views of younger peo

were represented in the study results, as it was expected that their needs and

experience of sight loss may differ from the older population. Only those on the

database who met registration criteria and were registered blind were included in

sample selection.

The study sample comprised of 564 people from the NCBI data base, 59% (n = 333)

of the sample were aged from 18 to 64 years and 41% (n =231) aged betwee

100 years. The mean age for the younger age group was 45 years and the mean

53

age for the older age group was 78 years. Almost 53 % of the population was femal

and 47% were male.

1.6 Limitations

While it was proposed that the results of this study be of such statistical and

methodological rigor to be relevant to the NCBI population, it nevertheless has a

number of limitations. A larger sample size was planned, but due to sampling

difficulties adjustments had to be made as described in the Methodology section.

Following a literature search it was clear that no suitable interview schedule was

available, requiring that an interview schedule be specif

e

ically designed for this study.

Its development is described in the Methodology chapter. No formal measures of

oach

s

inter-rater reliability by interviewers were undertaken, and no test-retest appr

was applied outside of the piloting process.

The study is based on the participants’ self-reports and perceptions. Owsley and

McGwin (2007) state that measures of eye disease severity should not be used a

surrogates for the personal burden of eye disease and vision impairment, as

individuals make a personal response to and cope with their condition in wide

ranging ways. A formal objective assessment of visual impairment and mobility

status may produce different results.

54

Chapter 2: Literature Review

2.1 Introduction

This section summarises the key literature about mobility for blind and vision

impaired people. It covers the following areas:

• Human rights and social inclusion

• The impact of vision impairment and blindness on mobility;

• The influence of the physical and social environment on blind and

Dutch

,

d also on the online

catalogue of Trinity College Dublin. The reference lists of studies yielded further

n-Rights Perspective

vision impaired people’s mobility, and

• Factors influencing Mobility Training and Mobility Aid use.

Because of the paucity of research literature on the mobility issues facing Irish adults

who are blind or have a visual impairment, the literature search was extended to

include international publications. The majority of the studies located were from the

United States of America and the UK. One relevant Irish study was found, one

study and one study from New Zealand. The main search terms used were: “vision

impaired”, “blind” and “mobility”. The search was carried out on the AMED, CINAHL

The Cochrane Library, PsychInfo, and PubMed databases an

literature.

2.2 Huma

Historically, disabled persons have been among the most marginalised,

economically impoverished, and least visible members of society (Gannon & Nolan,

2006). Many in society viewed this social seclusion as natural, or even a necessary

outcome of the personal inabilities of disabled persons (Jolls, 2001). A human rights

perspective on disability issues challenges this prejudicial attitude. The human rights

perspective asserts that every person, as an equal citizen, has a right to develop and

express his or her own potential. The human-rights approach finds expression in the

55

EU Charter of Fundamental Rights, the European Disability Action plan 2003–10

and, more recently, the UN Convention on the Rights of Persons with Disabilities,

2007.

This practical perspective has three main elements. First, under the influence of the

social model of disability, this perspective stresses society's role in constructing

barriers that disable persons who experience impairment and its responsibility to

s

obility in the built

its

s that enhance

the ability to move around in an accessible environment. From this standpoint, the

dismantle barriers that exclude disabled persons. Social and economic condition

rather than inherent biological limitations constrain people’s abilities and create the

category of disability. This view contrasts with the ‘medical model’, which views a

person’s limitations as naturally excluding him or her from participating in

mainstream culture.

As a result of this notion, disabled persons have been systematically excluded from

resources and opportunities. For example, blind or vision impaired persons have

been denied adequate services and aids to enhance m

environment. The socially engineered environment and the attitudes reflected in

construction play a central role in creating ‘disability’ and the related exclusion from

general society. Those factors produce decisions that fix what conditions comprise

the bodily norm in society. Thus, factors external to a disabled person's limitations

are really what determine that person’s ability to function.

Secondly, it stresses that social inclusion requires civil and political rights that

equalise treatment in combination with economic, social, and cultural rights (United

Nations Convention of the Rights of Persons with Disabilities). Civil and political

rights are often called first-generation or negative rights. They include the right to be

free from discrimination based on social prejudice, the right to freedom of movement,

and the right to participate in political life. Economic, social and cultural rights are

often called second-generation or positive rights. They cover circumstances in which

rights must be tailored to meet the needs of individuals rather than applying a

standard of sameness. They also include measures or services that are designed to

make first-generation rights effective. Thus, while first generation rights recognise

the right of blind or vision impaired persons to move around, second-generation

rights make mobility possible by providing training, aids and device

56

formal removal of negative barriers and the introduction of positive measures,

programmes and services to promote the equal participation of disabled persons

the public life of their societies are essential preconditions for true equality in politi

and social life. Thus it is argued that disabled persons have a human right to

personal development within an inclusive society.

Thirdly, this perspective stresses the moral obligation of government to provide, on

the basis of individual needs, resources and services for developing human abilities

and potential (Nussbaum, 2000; Sen, 1993). Government must ensure that citizens

have the means through which to develop their full human potential as defined by

in

cal

way;

n,

y

erty

f

s

in all

nications ... and to other

rural

their capabilities. Their abilities include: the ability to live one’s life; the ability to

maintain good health, including reproductive capability; bodily integrity, including

freedom of movement and bodily sovereignty; the ability to develop one’s senses,

imagination, and cognition so as to think and express oneself in a truly human

emotions, including loving, grieving and forming relationships; practical reaso

including critical reflection and conscience; affiliation, including self-respect, empath

and consideration for others; play, including the ability to enjoy recreation; and

control over one's political environment through meaningful participation; and the

ability to control one’s material surroundings through owning and managing prop

and employment. The core imperative is to cultivate individual abilities and respect

their intrinsic moral value as human beings. These abilities require suitable external

conditions for their exercise.

2.3 Participation and Belonging

The UN Convention on the Rights of Persons with Disabilities proclaims the right o

disabled persons to participate in society. One of its eight guiding principles is: “Full

and effective participation and inclusion in society”. Article 9 of the Convention refer

to the right of disabled persons “to live independently and participate fully

aspects of life”. It requires governments to "take appropriate measures to ensure to

persons with disabilities access, on an equal basis with others, to the physical

environment, to transportation, to information and commu

facilities and services open or provided to the public, both in urban and in

areas.” It also says that these measures “shall include the identification and

57

elimination of obstacles and barriers to accessibility”. Article 19 marks the fundamental importance of being able to live independently and being included in the

community. Article 20 requires States to support personal mobility. Article 24

recognizes the right of persons with disabilities to education and requires

governments to provide "an inclusive education system at all levels ... enabling

persons with disabilities to participate effectively in a free society.” Participation

includes the everyday activities that allow a person to participate in every aspect of

society; civic, educational, economic, vocational, professional, political, com

recreational and cultural.

To participate in society a person must belong to that society. To have a fair chance

of living a flourishing life, it is important to be part of family, social and community

networks. Belonging is at the heart of any conception of human flourishing. In a just

society, everyone should have the ability

mercial,

to meet others and take part in the general

ir joining

for the

s

ejudice or barriers experiences unjustifiable limitations on

his or her ability to belong; to belong to his or her family of birth or choice, to

maintain social relationships, or to be included in the various communities open to

him or her.

culture. Anita Silvers aptly says that individuals cannot flourish without the

with other humans in some sort of collective activities (Silvers, 2003). But

existence of barriers, disabled persons, including blind and vision impaired persons,

would play an equal part in society. Belonging has two aspects. The first aspect

involves connection or personal relationships including bonds of love, friendship and

shared purpose, as well as the ability to meet, relate to and communicate with

others.

The second aspect involves social acceptance, or the concern and respect of other

that fosters inclusion in mainstream society. A person can be with and among others

with a sense of ease and with a sense that he or she has a rightful place in the

world. Belonging is central to most people’s lives. It is at the heart of disability

activism, with its emphasis on the liberty to enjoy life among family, friends,

colleagues, and its promise of inclusion, integration and participation of disabled

people in all aspects of personal and communal life (Silvers, 2000). Belonging also

occupies an important role in the activity of facing up to the challenge of living a

worthwhile life of character, identity and meaning. Thus, a person who is often

excluded through social pr

58

The research literature confirms the importance of belonging to human flourishing.

ure” of a person’s life. Belonging or social inclusion is a major

determining factor for physical and psychological health and well-being (tenBroek,

966). Social epidemiologists have produced many studies confirming the

importance of social inclusion to health and length of life (Mittlemark, 1999). The

stigmatising message of social exclusion generates in people a feeling of inferiority

as to their status in society that can adversely affect their self-esteem, health, and

ell-being. Berkman and Glass (2000) observes that the leading modern research

nds that people who are socially isolated or disconnected from others have

between two and five times the risk of dying from all causes compared to those who

aintain strong ties to friends, family and community.

on health of various relationships. The

lationships include intimate relationships, such as marriage or family, and

hips, such as friendships, neighbours, work colleagues and

members of community groups. They assess various aspects of belonging, including

ocial inclusion or integration, social connection, social networks, social support,

‘embeddedness’ (Berkman, and Glass, 2000).

lthough the studies differed about how to measure or define belonging, they show

very consistent results. Thus, in one study people who lacked social ties were two to

es

hose

.

a stroke

se

d

So strong is the need for belonging that achieving it becomes the organising

principle or “central feat

1

w

fi

m

These studies investigate the effects

re

extended relations

s

social participation, social ties and

A

three times more likely to die in a nine-year period than were their peers who had

extensive social contacts (Berkman & Syme, 1979). A six-year study of four

thousand older people showed that, when compared with more socially connected

peers, people who felt a lack of social support were nearly three and one-half tim

more likely to die, and people with impaired social roles and attachments and t

with infrequent social interaction were roughly twice as likely to die (Blazer,1982).

Strong social connections improve not only life expectancy but also quality of life

People who feel connected to others are less likely to experience depression or

other psychiatric disorders (Cohen, 2000). They recover more function after

(Glass et al., 1993).

Psychological research also recognises the basic human need to belong. Our sen

of whether and how we belong within a society informs our personal identities an

59

our conceptions of our roles and our place in the world (Baumeister & Tice 1

We respond to how we are regarded and how we are treated within a network of

interpersonal relationships. Separation, isolation, reje

990).

ction and social exclusion

commonly give rise to anxiety and stress, while social inclusion and acceptance tend

eary

1995). As social medicine shows, physical as well as psychological well-being

rtunities,

le to

rson such as

, by society to design environments for ease of

ovement by all members, and by community members to support participation and

ributions of Psychological Theories on nderstanding Motivation for Managing Change and New

ical

f

Ledwin (1951) and others developed theories of expectancy values that suggest the

to relieve such anxiety and provide a buffer against depression (Baumeister & L

correlate to belonging. It requires the inclusion, participation and acceptance of

disabled people in all aspects of modern life. Thus, policies, resources, oppo

services and devices that promote belonging and participation are indispensab

human flourishing.

Physical mobility is essential for participation and belonging to family,

neighbourhoods and communities. Any change related to age or disability that

restricts mobility such as becoming vision impaired and limiting independent mobility

can result in social exclusion. Adaptive measures are required by the pe

the learning of new mobility skills

m

inclusion. The particular role of agencies that have expertise in managing and

teaching new skills in mobility as enablers of health, wellness and social inclusion is

discussed later in this review. First however the role of the person and his belief in

his capacity to manage change in ability is discussed below.

2.4 ContULearning

In any study related to the person’s management of loss of vision, psycholog

perspectives can help explain the choice and actions that people make or do not

make. Widely accepted theories on human motivation address four common areas o

how behaviour is energised, sustained, directed and stopped (Jones, 1955).

Although environmental (physical, social, cultural) stimuli are accepted as having a

significant influence on driving the individual’s behaviour and choice, it does not

completely dictate choice of activity or response to health/ lifestyle challenges.

60

extent to which individuals engage in specific activities is related to expectations th

their actions will lead to valued outcomes. Hence the outcome such as inde

at

pendent

r satisfactory mobility outside the home has to be valued by the person as important

dent

rd a social cognitive approach to motivation that

entres on the person’s self efficacy. He proposed that people take action to produce

ce

t

e

oice

elief in

o

to achieve. Values are also influenced by others in the social environment and family

values about dependency and safety may influence expectations of indepen

mobility.

Rotter (1975) recognised that striving does not always lead to success and that

individuals’ beliefs about why their efforts result in success or not is limited by their

perception of locus of control, whether it is internal or external to the self. If a person

believes that they are capable of succeeding in a task and that the outcome is

directly related to their own effort, the person will persist. However the person with

an external locus of control is more likely to view poor performance with

uncontrollable events in the environment and is likely to disengage from the activity

or to devalue it.

Bandura (1998) has put forwa

c

an effect unless they are constrained by one or more of three factors. They may fa

environmental constraints (such as a complex route to the local shop), they may not

feel capable of achieving a goal (going shopping on their own) or that the expected

outcome may change or be interrupted (meeting a group of teenagers blocking the

entrance to the shop). Studies have documented that self efficacy belief independen

of actual ability, predicts perseverance, performance and selection of appropriat

strategies (Bandura, 1998). Thus the greatest constraint to occupational ch

(such as going to the shops) may be the belief that one is not capable of performing

new and challenging tasks. In one such study, Kurlowicz (1998) examined the

effects of perceived self efficacy and functional ability on the depressive symptoms

identified in older patient’s perceived self efficacy when in hospital for total hip

replacement. She reported that interventions that increased the person’s b

their ability to manage themselves in their new situation of recovery from the surgery

enhanced belief, improved their functional ability to manage, and that in turn this

decreased their depressive symptoms postoperatively.

61

In any population of elderly people with vision impairment, co-morbidity of visio

with other health challenges is expected (Starfield, 2001). Typically, age brings

increasing health related problems, some are chronic,

n loss

some newly acquired. It is

ng established that there is increased morbidity for those aged over 65 and

Mark in

.

e is influenced by the above, and that belief about

More recently other theoretical developments from psychology such as ‘The Health

d

lo

particularly over 75 (National Council for the Aged, 1985). Garrity, Grant and

1981 contributed to the acceptance that the presence of illness and accumulated

disability had the effect of changing self image from that of a healthy person to one

where increasingly allowances have to be made for functional limitations and loss.

Accepting functional limitations is part of the natural adaptation to aging

It has been long acknowledged that health behaviours, illness behaviours and sick

role behaviours are complex and usually socially learned (Mechanic, 1962, Kasl and

Cobb, 1966). The culture, social class, age and gender to which a person belongs,

influences the concept of health and illness held by the individual and his/her

subsequent action (Parsons, 1958; Zola, 1966). This includes help seeking

behaviours. It is expected that an individual’s response to a loss of vision and their

subsequent help seeking respons

one’s self efficacy is a significant factor in seeking to address the mobility challenges

presented by sight loss. These above theories are all the more relevant with an

aging population who have to accommodate to other functional losses as well, and to

those younger people who have co-morbidity such as multiple sclerosis or diabetes,

that is related to their sight loss.

Belief Model’ (Rosenstock, 1990), Social Cognitive Theory (Baranowski, Perry an

Parcel, 1997) and the principles of adult education and learning (Knowles, 1984)

have been applied with and by people with disabilities to change expectations, and

to support them in remediating and restoring functional ability and in improving the

experience of health and wellness. In contrast to the social model, these

psychological theories locate the individual as the change agent in adapting to

disability by challenging perceived powerlessness and building adaptive skills and

resilience in managing disability as part of an active life.

Another perspective in managing change and disability is that offered by

occupational therapy. Occupational therapy has a unique combination of theories

62

and approaches to support change in the person, in the environment and in

modifying the task and activity so that the person can participate to his/her optimum

bility. Occupational Therapy focuses on the development of skills for the enjoyment

e

the home,

an

ct competently or effectively in his/her environment (Reilly,

974, Ziviani, et. al., 2001). Involvement in purposeful activity is viewed in

.

o

tional therapists in enhancing a

erson’s participation in daily occupations is the Person-Environment-Occupation

y).

ross

person,

within

ance of

a

and participation in a satisfactory life. Occupational Therapy aims to enable th

person to engage in tasks and activities in different environments such as

community and work place. One major goal of occupational therapy is to enhance

individual’s ability to intera

1

occupational therapy as a means of enhancing the person’s competency for doing

Occupational Therapists have the skill in identifying difficulties in the task and

barriers within the environment which affect participation and can offer intervention t

develop the person’s skills in order to successfully participate in their home, work

and community environments.

2.5 The Person-Environment-Occupational Model

An example of a model of practice that guides occupa

p

(PEO) (Law, Cooper, Stewart, Letts, Rigby & Strong, 1996). This model provides a

framework for the person to engage in meaningful lifestyle through intervention on

three levels; the person, the environment and the occupation (the task or activit

Occupational performance based on the P-E-O Model is the result of the dynamic,

trans-active relationship involving the person, environment and occupation. Ac

the lifespan and in different environments, the three major components, the

the environment and the occupation, interact and combine continually to determine

the ability to do different activities, tasks and roles as part of the person’s daily life.

The extent of overlap of the circles in the diagram below supports the optimum

context for doing meaningful tasks and activities. The P-E-O Model is used as an

analytical approach by occupational therapists to assess and address factors

the person, the environment or the occupation that facilitate or hinder perform

meaningful occupations.

63

Occupational Performance

Environment Occupation

Person

Diagram 1. Person-Environment- Occupation Model. (Law, Cooper, Stewart, LeRigby & Strong, 1996)

tts,

e with

sight loss. A recent study in the United Kingdom carried out by Ward, Awang,

ights that occupational therapists need more

than a general awareness of sight loss and its implications if they are to deliver

with

dies

Occupational therapists work with people with all level of abilities and in different

contexts such as the home, residential centres, rehabilitation services and

increasingly in community and primary care areas in Ireland. However there are no

occupational therapists employed in Ireland to work specifically with peopl

Campion, Dring and Boyce (2010) highl

effective support to people with sight loss, a high percentage of which is elderly

co-morbidity. Specialist training at post graduate level was recommended.

The above sections of this review, articulates a human rights and disability stu

perspective on vision loss and mobility. It considers the person, environment and

occupation and factors affecting belongingness, social participation and general

64

health and wellness. The remainder of this chapter discusses the literature

specifically related to research with vision impaired people on the effects of sight lo

and visual impairment, mobility and mobility training.

2.6 Impact of V

ss

isual Impairment/blindness on Mobility

,

is

r

are going, and the route

to get there." (Gargiulo, 2006, p. 504). Marron and Bailey (1982) describe successful

el safely, comfortably, and

independently” (p. 413).

th,

n

eople

l (2007)

portant

, which focused on the frustrations

nd difficulties encountered because of vision impairment. It was found that two of

Mobility is defined as the ability to move oneself without coming to any harm (Stone

1997, p.10), or alternately as, "the ability to move independently, safely and

purposefully through the environment" (Blasch, Weiner & Welsh, 1997, p.1).

In terms of independent movement and travel within one’s environment, mobility

coupled with orientation “which involves having an awareness of space and an

understanding of the situation of the body within in it” (Stone, 1997, p. 10; McAlliste

& Gray, 2007), or "being aware of where you are, where you

orientation and mobility as the ability to “trav

Humans primarily rely on their vision for mobility and orientation (Geruschat & Smi

1997). According to Robson (1996), 85% of external and environmental informatio

is gained visually. Therefore, vision impairment significantly changes the way p

move around (Hersh & Johnson, 2008). Robson (1996) and Montarzino et a

considers the loss of mobility to be the greatest physical consequence of vision

impairment.

In the literature reviewed there appears to be consensus that mobility is an im

part of everyday life, and that impairment to mobility greatly affects the quality of life

of a person (Montarzino et al, 2007, Blasch, Weiner & Welsh 1997, Hersh &

Johnson, 2008, Turner, 1998). Even relatively common aged related eye conditions

cause mobility problems and were considered a factor affecting the quality of life of

people in Spaeth, Walt and Keener’s study in 2006. In 1995, the RNIB (Royal

National Institute for the Blind) conducted a telephone poll, from a random sample,

with over 500 vision impaired people in the UK

a

65

the most frustrating aspects of daily life experienced by the respondents were not

being able to get around easily, (49%) and not being independent (44%).

In a study by Laitinen et al. (2007), in which approximately 3,000 people participa

it was concluded that a slight decrease in vision acuity was associated with

limitations in mobility tasks. This study explored the Finnish population aged

years and above and focused on the independent effect of visual acuity in relation

mobility and activities of daily living (ADL’s). It was found that 82% of vision impaired

people had difficulties with at least one ADL or mobility functioning compared with

48% of those with good visual acuity. In an American study of 222 older adults

visual impairments, 32% reported difficulties with mobility (Rubin, Bandeen Roche

Prasada-Rao, & Fried, 1994). Conditions such as Glaucoma, Retinitis Pigmentosa,

Diabetic Retinopathy, age related macular degeneration,

ted,

55

to

with

,

as well as generic visual

cuity deficit and visual field loss have all been documented in terms of their

t

up

k et

ed

afe

the Netherlands in 1979 with 100

lind/partially sighted participants (Buijk, 1979). Findings noted that more men than

going out

as noted to be lower when the person had an additional disability or disabilities.

re

. They

some of the variability,

given that residual vision fails to explain much of the variation. As cited by Blasch

a

negative impact on mobility (Spaeth, Walt, & Keener, 2006; Fourie, 2007; Coyne e

al., 2004; Kuyk et al., 1997).

Implications include the loss of the ability to drive (Coyne et al., 2004), increased

falls when walking in the street (Fourie, 2007), difficulties with single steps (going

or down), and adapting to illumination changes and unfamiliar environments (Kuy

al., 1997). In a study based in Edinburgh, it was found that 64.3% of vision impair

people interviewed felt safe walking in their neighbourhood but only 49.3% felt s

walking in unfamiliar areas (Montarzino et al, 2007). A telephone questionnaire

documenting mobility was carried out in

b

women went out by themselves in unfamiliar surroundings and older blind people

went out less by themselves than younger blind people. The frequency of

w

Conversely vision impaired people with higher degrees of education and

employment were found to be more independent in their mobility (Buijk, 1979). This

is similar to suggestions by Haymes, Guest, Heyes and Johnston, (1996) that the

are implications other than residual vision which affect mobility performance

note that variables such as personality traits may account for

66

LaGrow and Peterson (1997, p.532): “Independent mobility is affected by the

interactio

and age,

n of one’s personal abilities, which is in turn affected by impairment, illness

and the environmental demands of travel.”

e

rity

t

al., 2006). Overall 67% of the Edinburgh sample

f vision impaired older adults walks out and about, two-thirds of them on their own

fferences in floor level, stairs and

glazed doors caused difficulties when getting around. Mobility within the home is

or storage of equipment such as

al, Hanson & Osipovic, 2006).

s

Feelings of safety along with age and residual vision were seen as the main

restrictions on mobility in Montarzino et al.’s study (2007). Feelings of being unsaf

were more predominant at night and in unfamiliar locations. Alternatively familia

with surroundings was identified as encouraging independence (Montarzino et al.,

2007). Pelli, as cited in Montarzino et al., (2007) suggested that it was

overestimation of risk rather than degree of vision that had an impact on the mobility

of vision impaired people. Goodman (1989) comments that fear is one of the mos

common psychological barriers and that it is the one that interferes the most with

mobility (as cited in Griffin-Shirley et

o

and one-third of them are accompanied (Montarzino et al., 2007).

It is noted that many of the studies focus on older people with vision impairments,

rather than younger people who are blind or vision impaired. The extent to which

blind and vision impaired people move around in their local areas or in unfamiliar

areas has been estimated, but varies significantly between studies.

2.7 The Influence of the Environment on Mobility

The physical and social environment impacts greatly on the mobility of blind and

vision impaired people (Blasch & Suckey, 1995). Environmental barriers in the indoor

and outdoor walking environment are noted throughout the literature. Buijk’s (1979)

respondents reported that indoor steps, sudden di

affected by narrow doorways and lack of space f

children’s toys and by oversized furniture (Perciv

When walking on the street the following obstacles were identified; uneven

pavements, puddles or poor drainage, parked cars, people swinging doors open,

street furniture, construction, narrow paths, bollards, cycle racks, litter bins, branche

67

of trees, public art and badly designed steps (Kirchner, Gerber, Smith, 2008;

Montarzino et al., 2007; Buijk, 1979).

“There is a need for the design and layout of accessible urban environments,

accessible public spaces and buildings and accessible signage to make

independent mobility much easier for blind and vision impaired people” (Hersh &

Johnson, 2008, p.169).

In Kirchner, Gerber and Smith’s (2008) study, participants were asked to r

accessibility of their local area; 94% of guide dog users and 88

ate the

% of long cane users

entified pavements as a factor affecting their mobility. Crowds were also reported

ts

ertently

The lack of suitable designated pedestrian crossings was highlighted in the RNIB

ow some people with vision impairments report needing

to travel far in order to use the nearest pedestrian crossing to access shops or

et

d

ited as

difficulties were curb ramps, islands or medians in the middle of the crossing

(Bentzen, Barlow & Franck, 2000) and lack of buzzers at traffic lights (Buijk, 1979).

Neighbourhoods with poor provision of crossing facilities were perceived as limiting

choice and interviewees’ activity levels (Montarzino et al., 2007).

id

as a difficulty by 41% of guide dog users and 45% of long cane users. Participan

reported a higher chance of banging into people who had not noticed their cane in

crowds (Montarzino et al., 2007). Environmental fa,ctors were seen to inadv

impact on both the mobility and social lives of adults with a disability who tended to

avoid areas with escalators, curbs and uneven terrains (Shumway-Cook et al., 2003

as cited in Maart, Eide, Jelsma, Leob & Toni, 2007)

report (1999). It describes h

buildings that may be directly across from their homes. Bentzen, Barlow and Franck,

(2000) conducted a study of signalised intersections in America with mobility

teachers and summarised the following difficulties for blind/vision impaired

pedestrians; knowing when to begin crossing when traffic was intermittent or right-

turning traffic masked the surge of parallel traffic; crossing straight across the stre

as traffic was intermittent and the intersection was offset; using the push-buttons as

they were too far from the crosswalk, locating the button they needed to push an

identifying for which crossing the audible signal was intended. Also c

68

One pa in a rench ed using the “Pray-and-go” technique

when aiming to cross a road (Long, Guth, Ashmead, Wall Emerson, & Ponchillia

ky

t

. Interestingly respondents with disabilities in a rural setting in

outh Africa reported less difficulty with mobility (29.5%) than their counterparts in

ided it tends to focus on

tactile and auditory information for the totally blind traveller (Van Houten, Blasch, &

Malenf more accessible is just as important

d

ey also completed

rticipant F focus group describ

2005, p.615). Vision impaired and blind participants were found to make more ris

judgements of when it was safe to cross than sighted participants. This risk

increased during peak traffic hours. In another study it was noted that few drivers

yielded to pedestrians who were waiting to cross, even for those with mobility

devices (Gerruschat & Hassan, 2005).

2.8 Rural Environment and Independent Mobility

Rural environments such as farms and country towns create another set of

challenges for the mobility of vision impaired/blind people (Boone & Boone, 1997).

This study also addresses techniques for independent mobility in these inconsisten

rural environments

S

an urban setting (41.8%) (Maart, Eide, Jelsma, Leob & Toni, 2007).

2.9 Signage

When signage for blind and vision impaired people is prov

ant, 2001). However, making visual signs

as creating auditory and tactile information. One area in which signage and

accessible information has a huge effect on the mobility of blind and vision impaire

people is travel and transport which will be examined in the next section.

2.10 Travel and Transport

Research carried out by RNIB (1995) in the United Kingdom found that 59% of

respondents never went out alone due to difficulties with mobility and in accessing

public transport. As a consequence participants frequently considered themselves to

be isolated and excluded. A study of travel and public transport conducted in

Edinburgh (Montarzino, et al., 2007) requested its 66 participants over 61 years of

age with a visual impairment to keep a travel diary for a week. Th

69

a mobility questionnaire. Of this older sample, 68% had one or more additional

ulted

rn

its

nvironment

in the social environment tended to fall under the

categories of public attitudes and the attitudes and perceptions of the blind/vision

e

re

ublic to have a less patronising attitude and 22% wanted more help from sighted

disabilities. Participants noted that the physical environment as mentioned above,

(pavements, inadequate crossing facilities) affected their decisions about use of

certain bus stops and in several cases limited their use of public transport or res

in changes of route.

It was also found that in some cases difficulty with safe transfer between different

means of transportation resulted in participants using taxis to avoid dangerous retu

journeys from bus stops (Montarzino et al., 2007). Another reasons that vision

impaired people report limited use of public transport is the difficulty accessing

information such as timetables, and the poor visibility of destination and other

information on the front of the bus (Montarzino et al., 2007). This particularly lim

access to new environments (Marston, & Golledge, 1997).

2.11 The Social E

Factors affecting mobility

impaired person. Blasch, LaGrow and Peterson (1997) argue that the public can

have a significant effect on the mobility of vision impaired people by restricting

access by their presence or actions or simply by reacting in ways that may

stigmatize the traveller. In Kirchner, Gerber and Smiths’ (2008) study, 53% of guid

dog users and 46% of long cane users reported that they found the attitudes of the

public a barrier to physical activity. However when interpreting the literature about

vision impaired people’s view on the influence of the social environment it is

important to note that the respondents are part of the environment, and that they a

influencing it also. In one such study it was found in the RNIB telephone poll (1995)

that 69% of people wanted more understanding by sighted people, 23% wanted the

p

people. However with the same research results it can be stated that 77% of the

research participants did not want the public to have a less patronising attitude, and

78% did not want more help from the public.

70

Help seeking is a complex and socially learned action. However the vision impaire

person’s feeling a

d

bout help seeking may influence his perceptions and actions in this

ocial transaction. Vision impaired participants in the study conducted by Coyne et

ce

y

ack perceived by the individual from his/her public environment (Welsh,

997). In Buijk’s study (1979) the attitudes of the blind person which included

ly

d

e to engage in long cane training, resulting in much greater

mobility. Another study reports that the participant described how when asking for

directions in an airport she receives more helpful responses if she is carrying her

cane (Ambrose-Zaken, 2005). Some participants in Higgins’ New Zealand study

reported that they felt stigmatised by the white cane and dependence on sighted

guides. Alternatively another participant felt that “A cane should be seen as an

absolutely essential part of a blind person’s life… it’s like putting clothes on as far as

I’m concerned” (Higgins, 1999, p.18).

As with any disability, it is an individual experience, and much has been written

elsewhere about the individual and the collective experience of disability.

The neighbourhood in which vision impaired and blind people live is central because

a sense of belonging reinforces a sense of safety, reduces feelings of social stigma

and affects confidence to go out (Percival, Hanson & Osipovic, 2006). Therefore

information about the frequency of interacting with one’s local area and the

perceived level of difficulty doing this is important to gather.

s

al. (2004) who had previously been independent in travel, found it demoralising

having to rely on others for transport and sometimes avoided asking for assistan

which in turn impacted on their social activities. The perception of the social

environment can impact the vision impaired person’s motivation, self-confidence,

anxiety, and attitudes (Welsh, 1997). An individual's self-efficacy can be affected b

the feedb

1

uncertainty, fear and shame were identified as problems with going out. Partial

sighted persons were found to be more ashamed of their disability and considere

their lack of vision as a source of stigma (Fourie, 2007).

In Fourie’s self-study (2007) the research participant was reluctant to use a cane

because of a perceived social stigma, however with the increasing need for mobility,

the decision was mad

71

2.12 Orientation and Mobility Training and Use of Mobility

avel is facilitated by environmental adaptations and

ed to be taught how to interpret their environment (Blasch

al

onally and physically” (Mason & McCall, 1997 as cited

McAllister, & Gray, 2007 p.842.).

other

e as

ded

bility

t evidence based practice (Virgili, Rubin, 2008). Difficulty

ccessing O&M services was noted in two of the studies (Higgins, 1999; Witte,

not

d self-confidence (Witte, 1997).

es

ability

to independently deal with novel environments (Perla & O’Donnell, 2004), involving

Aids

Even though independent tr

accessibility, people still ne

& Suckey, 1995). Orientation and Mobility (O&M) training is about more than just

getting from A to B (Perla & O’Donnell, 2002). Orientation and Mobility (O& M)

specialists teach students independent travel skills, including the use of a long cane

and residual vision, sensory skills, concept development, street crossings, route

planning and travelling by mass transportation (McGregor, Griffin-Shirley, Brown, &

Koenig, 1998). The “ability to negotiate the environment can affect the individu

psychologically, socially, emoti

in

Following O&M training four out of five blind participants considered that they could

travel independently anywhere (Griffin-Shirley et al., 2006). Participants in an

study suggested that orientation and mobility training be taught from an early ag

it helped to them to feel in control (Higgins, 1999). After rehabilitation which inclu

mobility training, clients reported higher confidence levels and rated specific mo

situations as easier than they had before rehabilitation (Kuyk, et al., 2004). O&M

instructors recommend the assessment of the usefulness of specific techniques and

more research to suppor

a

1997). Witte reported that older Americans who are blind or vision impaired are

receiving the necessary training in alternative techniques and therefore are being

denied the opportunity to lead full lives because they have not learned necessary

skills or develope

2.13 Mobility Training Strategi

Various strategies to improve mobility training are noted and evaluated throughout

the literature. They include; encouraging problem solving skills to increase the

72

families in the O&M training of their children (Perla & O’Donnell, 2002), using

group training environment for cost-effectiveness, increased learning due to sh

experiences, greater motivation and more confidence through problem solving

together (Higgerty & Williams, 2005). Peer education strategies became popular in

recent years. The method is defined as ‘instruction by or guidance from equals’

(Gould & Lomax, 1993). It is a model designed to promote healthy lifestyles and

positive attitudes and behaviours. It changes the relationship from passive

interventions to active interventions and active learn

a

ared

ing. Leadership and interaction

etween people with disabilities may have a stronger influence in raising

expectations and in giving confidence to try new challenges.

However learning new ways of managing requires a change in skill as well as a

rtant

).

bility Aids

bility aids and

chniques facilitate safe and efficient travel for a vision impaired person. A selection

of m pass,

sig ser cane,

son 97) global

positio Wolf, & Blasch, 2006) and night vision devices

(Ze e most commonly used

evices to enhance mobility appear to be the cane and guide dog.

b

change in attitude. Because mobility in the person’s own local area is so impo

for safety and confidence, the need for individual route training in complex

environments specific to the individual was also noted (Higgerty & Williams, 2005

The need for O&M instructors to adopt individualised educational programmes was

also emphasised for the instruction of students with multiple disabilities (Trief, DeLisi,

Cravello, & Yu, 2007).

2.14 Mo

According to Farmer and Smith (1997) and Bailey and Hall (1989), mo

te

obility aids are described in the literature; guide dogs, low vision aids, com

hted guides (Griffin-Shirley, Kelley, Matlock, & Page, 2006) long cane, la

ic guide, talking signs system, dead reckoning system, (Brabyn, 19

ning systems (Williams, Ray,

behazy, Zimmerman, Bowers, Luo, & Peli, 2005). Th

d

73

2.14.1 The Long Cane

The long cane is the most commonly used mobility device and is used by vision

impaired people to preview their immediate environment, to detect obstacles,

changes in the surface, and for foot placement preview (Farmer & Smith, 1997).

Acc e

blind a

used a t around. In contrast, in the study by Dahlin-Ivanoff, and

Son 3% used a

cane fo ngth,

coating

the ab into

accoun

an out

Essen nt cane traveller is self-confidence and problem

sol how

the stu 97).

When l

that co

Literat

impaire n

reason

stress obility. In a study by Whitmarsh (2005), it

wa

cane n owerment. A guide dog

was also considered to have some limitations and drawbacks such as having to care

r and control the dog and that it was not always convenient to take a dog to some

places. However, less than 10 % of non-visual travellers use a guide dog for

travelling (Hersh & Johnson, 2008). A study by Whitmarsh (2005) found that a lack of

information often inhibited people from applying for a guide dog.

ording to the RNIB survey of 1991 (Bruce et al, 1991), which studied both th

nd partially sighted registers in the UK, 22% of those registered said that they

white cane to ge

n (2004), with 85 year old vision impaired adults, it was reported that 8

r mobility. There are a range of canes from which to choose varying in le

, shaft, brand and grip. Ambrose-Zaken suggests that another type of O&M is

ility to select the correct cane one should use to get to a destination taking

t the terrain of a route, weather conditions, mobility demand and purpose of

ing (2005).

tial to being a good independe

ving skills (Hill, 1997). The emphasis, when teaching cane use should be on

dent learns and what experiences best promote this learning (Mettler, 19

learning how to use the cane, Hill described the realisation that it was “a too

uld be used to achieve true freedom” (1997, p. 23).

2.14.2 Guide Dogs

ure detailing the effects of guide dogs on the mobility of blind and vision

d people is generally quite positive. Refson et al., (1999) state that the mai

people choose a guide dog is that it is the “most effective aid at reducing the

experienced during independent m

s found that guide dog owners considered guide dogs to be better than a white

ot only as a mobility aid but also as a means of emp

fo

74

Working a guide dog certainly makes a public statement about one’s blindness. A

on

&

g

ility. A human rights view of mobility as an aspect of social inclusion

nd participation in community life has been adopted recognising the health and

re also important in how vision impairment and mobility challenges are addressed.

d

de

f

blind author describes how a guide-dog helped her to “come out” as a blind pers

(Tudor-Edwards, 2002 p.171). In his memoirs Rod Michalko describes how his

confidence grew with his guide dog getting him safely where he wanted to go. He

also explained that “Smokie” had more importantly “reintroduced me to my

blindness” (Bing et al.1988 p.53). This reveals the similar concept of getting a guide

dog as being a step in accepting a blind identity. The use of a guide dog has also

been linked to changes in social interactions with twice as many interactions

occurring when the individual was using a guide dog as opposed to a cane (Hoyt

Hudson, 1980). Many factors are taken into consideration before people are

accepted as guide dog owner candidates, including their ability to mobilise and

orientate themselves (Milligan, 1999). Training has been described as a long

process (Green, 1996) and comparable to days of five hour long driving lessons

(Tudor-Edwards, 2002).

2.15 Conclusion

The literature summarised in this review relates to the present study by outlinin

some of the issues that have been documented in relation to blind/vision impaired

people and mob

a

quality of life value of connections to family, friends, and social in the local and wider

community. Sight loss has been associated with restrictions in mobility status. This

reduced mobility can impact a person’s quality of life. Visual acuity is not an accurate

indicator of mobility status. Personal attitudes and beliefs, problem solving ability,

confidence in one’s ability to manage, and physical and social environmental factors

a

There are particular challenges in managing sight loss for older people and those

with co-morbidity. Recognising that help seeking is a complex and socially learne

behaviour may explain why less than 10 % of vision impaired travellers use a gui

dog, even though those who do consider it a very positive experience. A number o

75

studies exploring the impact of using techniques and aids used for mobility have

been reported.

The Person Environment Occupation Model is one used by occupational therapists

plication may be a way of providing intervention and support for

managing functional loss and improving activity and participation in a meaningful

The lite earch dy about the perceptions of

obility of Irish people who are blind or vision impaired (Gallagher et al., 2010)

,

ing

aids and techniques.

(Law et al. 1996) and is a possible approach to understanding the dynamic and

interactive nature of a person‘s functioning as part of their physical and social

environment. Its ap

lifestyle.

rature s revealed only one recent stu

m

There is no study reported in the literature regarding perceptions and interest in

mobility training with an Irish population. This study was carried out to explore the

perceptions of Irish people with vision impairment about their mobility in their home

local and unfamiliar areas, and their experience of and views about mobility train

76

Cha : M

committee as that of describing perceptions of mobility, frequency of

ed in previous studies, the interview

ally for this research. The membership of the

elopment and use of the interview

iew procedures, data gathering, data

pter 3 ethodology

3.1 Introduction

The research topic and the general area of interest had already been defined by the

sponsoring

getting out and about, perceived obstacles, the use of mobility aids and techniques,

interest in and training received. General demographic data was required in terms of

age and gender, living situation, and eye condition and perceived visual impairment.

Relationships between level of sight, mobility training, age and perceptions of

mobility were to be explored.

A descriptive survey using a structured telephone interview was considered as the

most appropriate method for gathering nationwide quantitative data. The quality of

data gathered in phone interviews is considered comparable to face to face

interviews (Wahl et al, 1999), even with an elderly population. As the literature

search yielded no suitable questionnaire us

schedule was developed specific

steering committee sponsoring the research comprising of service providers and

people with vision impairments was active in the development and approval of the

research methodology.

This section of the report describes the dev

schedule, the sampling method used, interv

entry, data cleaning, and data analysis. Ethical considerations taken into account are

first described.

3.2 Ethical Considerations

Ethical approval was obtained from NCBI in first instance and approval was granted

by the Ethics Committee, Faculty of Health Sciences, Trinity College, Dublin.

77

A considerable amount of effort was invested in ensuring that the process of

recruitment was ethical, and that participants were informed of their choice to

articipate or not. Those on the NCBI data base are entitled to confidentiality, and

on were

names and contact details passed onto the TCD researchers. Information gained

one call and provision of

introduced

erself, the person was asked if they had any further questions about the study, if

they were willing to participate, and if so, a time was arranged for a follow-up phone

1. to participate to sample. (NCBI researcher)

s were again asked to give verbal consent at the beginning of the phone

p

their permission was required for their details to be forwarded for possible inclusion

in the study. NCBI staff accessed the data base, conducted the sampling and made

the initial contact inviting participation in the survey. Only with permissi

was stored and treated with appropriate protection.

3.3 Informed Consent

Between one and three weeks after the initial teleph

information by NCBI, the TCD researchers telephoned those who had agreed to

have their information go forward for further contact. The researcher

h

call to collect the data. This method of four contacts was undertaken to best promote

good ethical research practice, and to ensure that participants had given informed

consent.

In summary, the contacts with potential participants were as follows:

Initial telephone invitation

2. Send Participant Information in preferred format.(NCBI researcher)

3. Telephone call to confirm consent and to arrange time for data

collection.(TCD researcher)

4. Telephone call to collect data.(TCD researcher)

Participant

interview. It was not considered to be ethical or appropriate to use printed consent

forms for people who were registered blind.

78

3.4 Development of the Interview Schedule and Process

The content and the structure of the interview schedule was developed in the pilot

n on previous studies, and

issues that typically arise for blind and vision impaired individuals in their day-

2. The literature reports that studies using focus groups can increase

two

with participants recruited by the NCBI from the

database to establish key content issues, and to develop the most appropriate

language for asking questions and recording answers. One of these took

place in Dublin, with totally blind participants, and the other in Cork, with

vision impaired participants.

3. As there was considerable interest in eliciting attitudes and experiences

related to mobility training by the sponsoring agencies, a focus group of

professionals working in the area of orientation and mobility with NCBI and

IGDB was also conducted. In this, service providers were invited to discuss

the methodology and content of the interview schedule.

4. The interview schedule was re-drafted a number of times as a result of the

pilot interviews and feedback from service providers. The length of time taken

to answer the questions was longer than anticipated, so the schedule was

shortened. The language used in the questionnaire was adapted to suit the

language of the pilot participants.

5. The first and third iterations of the interview schedules were forwarded to

NCBI and IGDB staff for comment and suggestion.

phase of this research (May – August 2008). The development of this data collection

method involved:

1. Review of the literature, to provide informatio

to-day mobility.

understanding of the problems experienced by the target group and can

increase the ecological validity of the results (Misajon et al., 2005). Hence

focus groups were held

79

3.5 The Structure of the Interview

al reports on frequency of use

with moving around the home, local and unfamiliar areas, their use of

interview format was designed to ease the person into giving their own views of their

rt of the

t it was clear that it was the person’s own views and experiences

wish without giving them suggestions.

“This reduces the chances of their giving what they perceive as socially acceptable

ey, 1997, p 99) An example of this is the first question; “How well do

o

answer into ‘Very well’, ‘Fairly well’, ’OK’ ; ‘Fairly badly’; and ‘Badly’.

The second question was ‘Can you tell me a little about your experience of sight

their description the person was then offered the categories ‘Totally

ne described their perception of their

The purpose of this question was to elicit the level of visual impairment the person

ng. The literature reports that there is poor correlation between visual

perceived visual disabilities (Lundstrom, 1994). It is also claimed that self

report may more accurately describe visual functioning and the role of impairment in

chosen by the participant could then be

ents etc.

As the interview progressed specific information requiring fixed responses were

sked such as about frequency of moving around the home, local area and busy

unfamiliar areas and the techniques used. Detailed questions about preferences and

The main focus of the survey was to capture through a telephone interview, the

individual’s perceptions of their mobility, their person

and difficulties

mobility techniques, and experience with and preference for mobility training. The

experience of mobility. Open ended questions were used in the earlier pa

interview so tha

were being sought. Open ended questions are useful in allowing respondents to

answer in any style and manner that they

answers.” (Bail

you think you get around at the moment?” The person was then given a chance to

respond in their own words. Following this the interviewer asked the person t

categorise their

loss?’ Following

blind’ (Category 1); ‘Little residual vision’ (Category 2) , ‘Good residual vision’,

(Category 3) and were asked to chose which o

level of vision.

was experienci

acuity and

a person’s daily life (Sloan et al., 2005; Massof and Rubin, 2001;

It was intended that the categories thus

used for comparison between groups such as age on various variables such as use

of mobility aids and techniques, frequency of use of different environm

a

80

use of dog, bility training were asked. More open ended

information about environmental barriers and was sought with the question “What

e study sponsors wanted to ensure that the younger age group (those

under 65) were well represented in the study, age stratification was requested.

aged over 18 years on the

NCBI data base who were registered blind. It was intended that the study results

l population on the data base and this required 703

erval of +/- 5 at the 95% confidence level.

sampling it was found that data base contact details

n that some were deceased. In addition telephone

g was not suitable for some elderly people due to cognitive impairment,

and ill h th, and their need g the support of others to take the call.

ded to live in nursing homes. It was decided to modify the sampling frame

any fur cruitment from ose living in nursin homes, and for the

viduals who were born before 1920 (those

years and older). Hence the results of this study are limited to this sample.

a guide long cane and mo

are the things that make getting around hardest for you?”

Factual personal information about age, gender, living arrangements and location,

and length of time with eye condition was gathered as part of the closure to the

interview process.

3.6 Sampling

3.6.1 The Study Population

At the time of the study sampling (June 2008) the NCBI database comprised of

9,758 individuals who met blind registration criteria and who were aged over 18

years. As th

3.6.2 Sampling frame

Initially the sampling frame consisted of all individuals

would be applicable to the genera

participants giving a confidence int

However during the process of

were inaccurate and out of date i

interviewin

hearing loss eal in

These ten

by excluding ther re th g

same reason to not recruit any other indi

aged 90

81

3.6.3 The Study Sample

ved from the database.

t (standard print, large print, audio

tape, e-mail or Braille). They were asked if they agree for their name to be passed on

stratifie oup, and 231 in the Over 65 age

group.

tailed information

bout the study so that if their clients requested more information, they would be

able to assist. Attempt was also made to publicise the study for blind and vision

impaired people.

Six qualified female occupational therapists were recruited for this study. All had

revious training in and experience of interviewing people with disabilities and in

search methods. As the study was about capturing the perceptions of the

participants it was considered important that the interviewer should ensure that

articipants were comfortable in answering the questions and that flow of the

terview should be flexible. For example if the participant began talking about their

eye condition early on in the interview, then specific questions were asked related to

A list of randomly selected numbers provided to NCBI was used to select individuals

from the database. The individual’s name, their home county, date of birth and

telephone number was retrie

Initial phone calls to the selected sample were made by researchers working for

NCBI. Potential participants were introduced to the study and were provided with

information about the study in their preferred forma

to the researchers from Trinity College Dublin.

From 1,000 contacts made to data base addresses, over a two month period, 564

agreed to have their contact details forwarded to the TCD researchers. It was

decided to conclude the recruitment process with this sample size. When age

d this resulted in 333 in the Under 65 age gr

Service providers within NCBI and IGDB were provided with de

a

3.7 Training of interviewers

p

re

p

in

82

this, rather than stopping the person giving this information until reaching the specific

end o view schedule.

aining workshops w ld prior to the study related to the use of the interview

hedule and coding . Ongoing f back from interviewers during data

llection was sought ediently w ny issues that aro

.8 Data Collection and Data Entry

ces. Most of the interviews took place

during working hours, but some also took place in the evenings. The length of time

at interviews took ranged from 15 to 30 minutes.

Hands free telephone headsets were provided for the interviewers allowing data to

be ent

A visual scan of the spreadsheet entry was carried out by the interviewer at the end

of the interview. As the full data set was compiled an independent reviewer scanned

rviewer. Missing data that could not be

the presentation of the results.

3.8.2 Data

ta was e oft cel spreadsheet and this statistical package

owed for esults describe the study sa le and ceptions

out their lty. Fr ency c ummarise

d rank or ated to use of the various e onmen se of mobility

those with mobility training.

ferential statistics such as Chi-square testing was used to establish that the

question at the f the inter

Tr ere he

sc of answers eed

co to deal exp ith a se.

3

Data collection took place between August and October 2008. The telephone

interviews were carried out in the NCBI offi

th

ered into the Microsoft Xcel spreadsheet at time of interview.

3.8.1 Data Cleaning

Comparisons were made between various categories or groups, particularly related

to the older and younger age groups and those in three categories of sight loss.

all columns and rows on the Xcel spreadsheet. Missing information and out of place

characters were checked with the inte

retrieved was noted in frequency counts in

Analysis

Da ntered into the Micros X

all analysis. The r mp their per

ab mobility and perceived level of difficu equ ounts s

an der the data rel nvir ts, u

and orientation techniques and numbers of

In

83

difference between the frequencies in the various categories or groups was

to be due to chance.

unlikely

Comments were invited in some of the questions and when given were themed and

All information from individuals was treated as confidential. This report contains

he s a whole. Where individuals are quoted, no

.

have been presented in summary tables and in quotations. Comments given by

participants are used to contextualise the themes.

3.9 Confidentiality

details of t results for the group a

identifying details are given

84

Chapter 4: Results The results are presented in the following sections:

ction 4ormation le such as age profile, gender, living circumstances,

els of sig oss, and type ye con

s side and outside the home, frequency of use

formation about mobility aids and techniques used, with an emphasis on the use of

f need for training.

Secti Obstacles to mobility and challenges in the environment outside the home.

This section of the report describes the sample size, age profile, gender and living

ituation of the research participants and their category of sight loss.

Se .1 Inf about the samp

lev ht, length of time since sight l of e dition.

Section 4.2 Perception of mobility and difficulty in

of local and unfamiliar areas.

Section 4.3 In

the long cane and guide dogs; and considerations about their use in various

environments.

Section 4.4 Orientation and Mobility training received and its perceived usefulness, obtaining

training, and perceptions o

on 4.5

Section 4.6 Summary

Section 4.1 Description of the Study Sample (Q. 11 and 12)

s

85

4.1.1 Sample size

Overall 564 participants on the NCBI data bas

1,000 database contacts made. This samp

e agreed to be interviewed from over

le was an age related stratified random

h two strata those aged 18 to 64, and those aged 65 to 100 years. There

tion, par arly a the older sample, some of who were

eceased or unwell and unable to participate in the interview.

decided that these should be eliminated from the study as it progressed. In addition

considering the numbers of deceased members being uncovered, and not wishing to

less of

questions about where they lived and whether they lived

er of respondents 535

sample wit

were some inaccuracies in the database information with incomplete or inaccurate

informa ticul with reg rd to

d

As the sampling unfolded it was becoming apparent that the telephone interview

method was unsuitable for NCBI members who resided in nursing homes. It was

cause distress to family members, it was decided to limit the upper age group to

those born after 1920. However those already recruited were included regard

their age.

Participants were asked

alone or not. Information about age and gender was provided from the database.

The following table presents summary information. (“N” = the total sample in the category and “n” = the number of respondents.)

Table 4.1 Age and Gender Total sample in category is 564 Numb

Age group Range 18 – 100 years

Under 65 333 59

Mean Age 45

Over 65 231 41

Mean Age 78.5

Breakdown of Gender (Respondents

Femal 52.9% e 283

Males 252 47.1%

86

4.1.2 Age and Gender

In the Under 65 age group, the youngest participant was18 years, the oldest was 64,

the

The age of the over-65 age group ranged between 65 and 100 years, with an

ge difference between the under and over 65’s is noteworthy. The older

group with an average age of 78.5 years and a modal age of 87 years are likely to be

differe e yo ectations. Therefore it

w iv , the results are

w for each a roup, r a ver 65

Under 65 age group

onses e tabl pre ents the coun s i

participants (5 ) live. reak n of th ties for all this age

e a dix 2.

and the average age was 45 years old. The standard deviation was 12.7 years, the

median age 46.5 and the mode is 52 years of age. In this age group 48.7% of

participants are male.

average age of 78.5 years, standard deviation from the mean of 7.2 years, the

median age is 79 and the mode age is 87 years. In the Over 65 age group 44.8% of

the participants are male, and 55.2% are female.

The mean a

nt from th unger group in lifestyle patterns and exp

was considered that the survey results should be presented as relating to the two

separate age groups, as well as for the sample as a whole.

4.1.3 Where the Participants Lived

Participants were ask in hich county they l ed and with whom

presented belo ge g the unde nd o ’s.

4.1.4

There were 331 resp , th e below s top 5 tie n which

over half the 6% A full b dow e coun

group is presented in th ppen

87

Table 4.2 Top Five Counties – Under 65 age group (N=184)

Rank County

1 Dublin 98 29.6%

2 Cork 30 9.1%

3 Donegal 21 6.34%

4 Limerick 18 5.43%

5 Tipperary 17 5.13%

It is not surprising that the county with the largest number of respondents is Dublin,

with just under 30% of the sample. There are no participants from Monaghan or

Carlow in this age group.

4.1.5 With Whom Participants Lived - Under 65 age group

whom they live. Twenty-two percent of the respondents live alone (n=73). Of the

n is ws

Table 4.3 Rank Order of Living Situations for those Living With Others – Under p

Total sample in category is 258 espondents 240

There were 331 responses indicating whether or not they lived alone, and if not, with

remaining 78% (n= 258), the breakdow as follo :

65 age grou

Number of r

Rank Living Situations

1 With Spouse and child 35% /ren 84

2 With Spouse Only 64 26.67%

3 With parents 54 5%22.

4 With friends / flatmates / lodgers 14 5.8%

5 With children 12 5%

6 With other relatives 10 4.2%

7 In a residential setting/ nursing home 2 0.8%

88

The variety in spread of living arrangements detailed above is as expected

, including 91 participants (40.2%)

ted

considering the age profile of this group with the mean age of 45 years.

4.1.6 Over 65 age group

With regard to the Over 65 age group, when asked in which county they lived, 226 of

231 in this age category responded. Almost two thirds of the participants in this

category (61.5%) live in the following five counties

residing in Dublin. A full breakdown of the counties for all this age group is presen

in appendix 2.

Table 4.4 Top Five Counties – Over 65 age group (N=226)

total sample in category is 231

Rank County

1 Dublin 91 40.2%

2 Cork 16 7%

3 6.2% Donegal 14

4 Limerick 12 5.3%

5 Kildare 6 2.7%

5 Meath 6 2.7%

4.1.7 With Whom the Participants Lived - Over 65 age group

There were 229 responses from the 231 asked whether or not they live alon

not, with whom they live. Almost 39% (85) of the respondents lived alone, with the

remaining 61.14% (144) living with someone – details are presented in the table

below.

e, and if

89

44) Table 4.5 Rank Order of Living Situations for those living with others Over 65 Age Group (N=1

Rank Living Situations

1 y 79 59.4% With Spouse Onl

2 With children 31 22.3%

3 With Spouse and child/ren 10 7.5%

4 With other relatives 9 6.8%

5 In a residential setting / nursing home 4 3.0%

6 With parents 0 0%

6 With friends / flatmates / lodgers 0 0%

*Unspecified living situations 11

Of those who lived with others, almost 60% of the sample reported living with a

spouse only. It is likely that this spouse is also elderly, and may have age related

mobilit also. support available for getting out and

about. As reported earlier, as the study progressed, people on the NCBI data base

n

4.1.8 Categories of Sight Loss and Name of Eye Condition (Q

was asked abou participant’s experience of sight loss (Q 2.) All

database of people registered as blind in

nd. Each participant w ked about their vision and responses were

to Cat 1. ‘Tot lind/no useful vision’; C ision’;

t. 3. ‘Good residual n’.

y issues This may impact on the

with addresses in nursing home were excluded. This explains the low representatio

of this group in the study.

2 and 13)

A question t the

participants were from the NCBI national

Irela as as

categorised in ally b at 2. ‘Little residual v

and Ca visio

90

Table 4. 6 Categories of Sight Loss Total Sample N=564: n = 562

Cat 1 Cat 2 Cat 3 Total

Under 65 76 22.96 144 43.5 111 33.5 331

Over 65 11 4.76 128 55.4 92 39.27 231

Total 87 15.48 272 48.4 203 36.12 562

Almost 50% of the total sample were categorised in Cat.2, with little residual vision.

ry as

majority of these were in the Under 65 age group.

ca es to this question and two non

nts. Seventy six (22.96%) reported having no useful vision or light

and f y four p ts .5%)

n (Cat.2). The that arose from these descriptions included: not being able to

ad or h tele n ing ab e c urs, sh or

; that v was a by t. If visual acuity was given, this group

d those with isual a f 3 below, but able to see more than simply

ght.

all

ting

Almost 16% of the study sample categorised themselves in the Cat.1 catego

having almost no vision, the

4.1.9 Under 65 Age Group

In the Under 65 tegory there were 331 respons

responde

perception (Cat.1). Some of these report a history of partial sight that has reduced

over a period of time.

One hundred ort articipan (43 reported that they have little residual

visio mes

see faces, re watc vision; o ly be le to se olo adows

movements ision ffected ligh

include a v cuity o /60 or

li

One hundred and eleven (33.5%) of the participants reported having good residual

vision (Cat.3). As with the participants with poor partial sight, these reported that light

conditions affect the usefulness of vision. Difficulties reported include: night

blindness; poor peripheral vision or tunnel vision; difficulty reading, particularly sm

print; difficulty seeing details or distant objects such as bus numbers and fluctua

vision.

4.1.10 Over 65 Age Group

All 231 participants responded to the question about their vision. Only 4.76 % (11) of

this older age group describe themselves as totally blind (Cat .1); 55.4% (128) as

91

having little residual vision (Cat.2), and 39.27% (92) as having good residual vi

(Cat.3).

Descriptors of poor partial sight (55.4% of the sample) included difficulty reading and

seeing details; ability to see shapes, shadows and colours; difficulty with face

recognition; deteriorating vision; limited visual field, most commonly being loss of

central vision, with some remaining peripheral vision.

Themes from within the descriptors

sion

of good partial sight include: that light affects the

usefulness of residual vision; descriptions of loss of visual field; loss of central vision;

inability either to see distances or close up objects, and difficulty recognising faces,

difficulty with seeing detail, reading and writing. Some participants reported using

visual aids.

4.1.11 Name of Eye Condition (Q. 13)

When asked about the name of their eye condition, 560 responded. The following

table presents the results.

Table 4.7 Breakdown of Eye Conditions – Total Sample N= 564; n = 560

Primary Eye Condition Under 65 (n=331) Over 65 (n=229) Total (n=560)

Don’t Know 43 12.99% 52 22.71% 95 16.96%

Macular Degeneration 17 5.14% 94 41.05% 111 19.82%

Cataracts 23 6.95% 11 4.8% 34 6.07%

Retinal Disease 22 6.65% 7 3.06% 29 5.17%

Retinal Pigmentosa 48 14.5% 7 3.06& 55 9.82%

Glaucoma 35 10.57 33 14.41 68 12.1

Optic Atrophy/ Optic Neuropathy

25 7.55 1 0.44 26 4.64

Retinoblastoma or Other Cancer

2 0.6 1 0.44 3 0.53

Traumatic Injury 16 4.83 2 0.87 18 3.21

Albinism 21 6.34 1 0.44 22 3.93

Other 79 23.87 20 8.73 99 17.68

Total 331 100 229 100 560 100

92

Forty-three (12.99%) of the Under 65 age group did not know the name of their eye

nal

disease (3.06%, 7), retinitis pigmentosa (3.6%, 7) and other conditions (8.73%, 20)

even (1 ) p ipants Un g ted t

two eye conditions, whilst 47 (20.52%) of Over 65 age group reported having at least

condi Ov ( ) of total population r h o

e eye dition.

4.1.12

a ab im sig s a n en

in the table below for both age groups.

Time since sight loss

condition. There was a wide variety of conditions reported by those who those who

did know their eye condition as lis

condition, the most common condition

degeneration (41.05%), with 94

conditions reported inc

ted above. When asked to name their eye

for the over-65 age group was macular

participants reporting that they have this. Other

lude glaucoma (14.41%; 33), cataracts (4.8%; 11), reti

Forty-s 4.2% artic of the der 65 a e group repor having a least

two eye

than on

tions.

con

erall, 94 16.78% eported aving m re

Question 14

Question 14 sked out the t e since ht los nd the informatio is pres ted

Table 4.8 – Total Sample N=565; n=556

Time Since Sight Loss Under 65 Over 65 Total (n=556) (n=327) (n=229)

Since Birth 114 34.86 13 5.68% 127 22.84%

%

Since Childhood 39 11.93

%

11 4.8 50 8.99%

For more than 20 years 50 15.29

%

34 14.85% 84 15.1%

For 10 -20 years 52 15.9% 44 19.21% 96 17.2%

For 5 – 10 years 36 11% 61 26.63% 97 17.45%

For 2 – 5 years 23 7.03% 50 21.83% 73 13.13%

Recent onset, within last 2 years

13 3.98% 16 6.99% 29 5.23%

Total 327 100% 229 100% 556 100%

93

There is a contrasting pattern of results for the younger and older age group and

si further 11.93% with sight loss since childhood. It is

eworthy that less than 6% of the older group have sight loss since birth and over

55% h e lost the i st 1 . de at the

78.5, they have lived most of their life with sight.

When comparing the data related to s and eye condition for the two age

oups numbe differ s are a rent e ca of sight s is va in the

under-65 age-group, but in the over 65s

glaucoma account for the vast majority of causes of sight loss.

The in ed that so rt ts oth ag ps it

difficult to categorise their sight loss, and few reported their visual acuity or field of

vision.

4.1.13 Co-Morbidity

Partici re also asked about having other disabilities that may affect mobility.

Ninety 9 of Under g ep havin tion ealth

issues, these including diabetes, epilepsy, arthritis, multiple sclerosis, other physical

disability (includin heelc r users ntal health is , learnin isabilities and

other enduring health problems. The conditions listed by 135 (59%) of this older age

group included diabetes, arthritis, heart problems, stroke and hearing loss,

conditions that are more prevalent in er lat e pos mp

additio al disability on overall perception of m bility sh uld be bor e in min when

id ng the p icipan erceptio of their own mobility as presented in the

next section.

Sect

.1 Overall Perceptions of Mobility (

Each of the participants in the study were asked to rate their current ability to get

around, on a scale from 1 (badly) to 5 (very well).

time since sight loss. There is a greater proportion (34.86%) of the younger group

with

not

ght loss since birth, and a

av ir sight n the la 0 years

sight los

Consi ring th ir mean age is

gr , a r of ence ppa . Th use los ried

macular degeneration, cataracts and

terviewers report that me pa icipan from b e grou found

pants we

-seven (2 .5%) the 65 age roup r orted g addi al h

g w hai ) me sues g d

an old popu ion. Th sible i act of

n o o n d

cons eri art ts p ns

ion 4.2

4.2 Q.1)

94

4.2.2 Under 65 a e grou

There were 331 responses to this question, with the breakdown described in the

figure and table 4.5 below

Table erceptions of Mobility – Under 65 age group N=333; n = 331

g p

4.9 P

Perception

Very W 63 19.03% ell

Fairly well 125 37.8%

OK 103 31.1%

Fairly Badly 28 8.5%

Badly 11 3.3%

d

’

t

lity – Over 65 age group (N=231)

Only 57% of the participants considered that they managed in the ‘fairly well’ an

‘very well’ categories. Almost 12% (n = 39) reported that they get around ‘fairly badly

and ‘badly’.


In the over 65 group, 231 people answered this question, 39% of this group repor

that they get around fairly well, and 31.2% report getting around ‘OK’ (neither well

nor badly). The results are summarised in the figure and table below.

Table 4.10 Perceptions of Mobi

Perception n %

Very Well 28 12.1%

Fairly well 90 39%

OK 72 31.2%

Fairly Badly 25 10.8%

Badly 16 6.9%

Fifty two percent (n = 118) of the older age group reported in the ‘fairly well’ and ‘very

well’ combined categories. Less than 18% indicated the ‘fairly badly’ and ‘badly’

categories.

95

A difference in mobility perceptions would be expected between such different age

groups, and also because 59% of the older group who reported additional mobility

issues. However a Pearson Product-Moment Correlation was carried out between

percep

the age groups and their perception of

otal

tion of mobility and age, (with the result of – 0144), suggesting that there

statistically significant difference between

mobility.

4.2.4 Perceptions of Mobility and Categories of Sight Loss

The relationship between categories of sight loss and perceptions of mobility is

presented in the next table.

Table 4.11 Perceptions of Mobility and Categories of Sight Loss –TSample (N=564; n=562)

How well get Category Amount of Sight around

Cat.1 t.2 Ca Cat.3

Badly 4 4.65% 18 .62% 5 6% 6 2.4

Fairly Badly 9 1 36 13 3.94 0.5% .2% 8 %

OK 25 29.1% 104 38 22.2.2% 45 %

Fairly Well 2 3 93 34 45.89 3.7% .2% 93 %

Very Well 19 22.1% 21 7.72% 52 25.6%

Total 86 1 27 10 203 10000% 2 0% %

It is interesting that 22.1% of totally blind (Cat.1) get around ‘very well’ and a further

.0001, indicating that there is a statistically significant difference

etween the category groups and their perception of mobility.

aving established that age was not a statistically significant factor in perceptions of

mobility, and that there is a difference in mobility perceptions related to sight loss

33.7% ‘fairly well’ and that less than 5% in this sight loss category get around ‘badly’.

Those with Cat.3 level of sight loss score themselves even higher than this. However

the Cat.2 group have lower scores for the ‘very well’ category with less than 8%.

However, over 72% of the Cat.2 participants were in the ‘O.K.’ and ‘fairly well’

mobility categories. The Chi-square calculation for this is 56.34 with 8 degrees of

freedom, where p = 0

b

H

96

categories, the perceptions of mobility for people in the 3 sight categories and

reported additional disabilities were comp chi-square test e

data on sight loss with additional disabiliti r those withou al

th groups, it appears th re is a e e perce f

xact natur this dif n lear. (F

isabilities: Chi-square istic is 3 8 d ees of f

ose with additional disab s, the c e st is 24

r factor that would be expected to influence perceptions of mobility is the

ht loss. It would be pected t e w were ne

ss would find mobility more difficul those ad s ss for

umber of years. However as the study data already presented above details, the

e

ave other health and disability issues that affect their mobility perceptions.

This information is presented in the following two tables. The first is a summary table

ared. A , was applied to th

es and fo t addition

disabilities. For bo at the differenc in th ptions o

overall mobility status, but the e e of ference is ot c or those

with no additional d stat 4.5 with egr reedom;

p≤0.0001. For th ilitie hi-squar atistic .52 with

8 degrees of freedom; p=0.0019.)

Anothe

length of time since sig ex hat thos ho w to

sight lo t than who h ight lo a

n

group with lower mobility tend to be in the Cat.2 sight category with poor residual

vision, 47% of these are elderly people, and many with deteriorating age related ey

conditions. So that having sight loss that continues to deteriorate over ten years may

be associated with the poorer perceptions of mobility. In addition 59% of this elderly

group h

with the percent comparisons of mobility perception and time since sight loss.

97

Table 4.12 Percent Comparison with overall perception of mobility and time since sight Loss N= 564; n=554

Mobility Perception

Sight loss

Since child-

More than 20

10 – 20

5 – 9 years

2 – 4 years

Withthe

category Since hood years years

in

last

Total

birth 2 years

Badly 7.69 0% 11.5% 34.6% 38.5% 0% 7.69% 100

% %

Fairly badly

13.2

%

7.55% 15.1% 17% 18.9% 18.9% 9.43% 100

%

OK 18.1 5.85% 17.5% 16.4% 18.7% 5.85% 100

%

17.5%

%

Fairly Well 26.3 11.3%

%

14.6% % 1 11. 4.23% 015 6.9% 7% 10

%

Very Well 32.6 13% 13% 6.3% 1 6.5 3.26%

%

1 4.1% 2% 100

%

From a total of 554 respondents only 29 w e in the cent e categ

ithin the last 2 years’.

ce

er most re tim ory of

‘w

Table 4.13 presents the information in detail showing the numbers and percents of

the various categories.( When reading the mobility perception read across the page

for percents of that category and read down the page for percents in the time sin

sight loss category.)

98

Table 4.13 Comparison of Perception of Mobility and Time Since Sight Loss N=554

Perceptiocategories

n Time Since Sight loss

birth

More than 20

5 – 9 years the last

2 years

Total

Since Since child-hood

years

10 – 20 years

2 – 4 years

Within

Very Well 30 12 3 91 n 12 15 13 6

32.6 13 3.26 100 %

across

13 16.3 14.1 6.52

3 16.6 % down 23.8 24 14.3 15.8 13.4 8.22 10.

Fairly Well

213 n 56 24 31 32 36 25 9

100 %

across

26.3 11.3 14.6 15 16.9 11.7 4.23

% down 44.4 48 36.9 33.7 37.1 34.2 31 38.4

OK n 31 10 30 30 28 32 10 171

cross

100 %

a

18.1 5.85 17.5 17.5 16.4 18.7 5.85

% down 24.6 20 35 .6 28.9 30.8 .7 31 43.8 34.5

Fairly ba 7 4 8 9 10 53 dly n 10 5

15.1 17 18.9 100 % 13.2 7.55

across

18.9 9.43

5.56 8 9. 9.47 3 13.7 9.55 % down 52 10. 17.2

Badly 3 9 0 26 n 2 0 10 2

7.69 0 11.5 34.6 38.5 0 7.69 100 %

across

99

.9 4.68 % down 1.59 0 3.57 9.47 10.3 0 6

Total 97 73 29 554 n 126 50 84 95

100 % across

22.7 9.01 15.1 17.1 17.5 13..2 5.23

100 % down

100 100 100 100 100 100 100

Chi-square = 52.98 with 24 degrees of freedom, p = 0.0030

Interestingly only 2 of the 29 participants who lost their sight within the last two

scored in the ‘badly’ category, and 34 % (10) of these were in the ‘OK’ category, w

a further 31% (9) in the ‘fairly well’ category.

years

ith

A Chi-square test has established that the difference between the percentage

frequencies in the various categories was unlikely to be due to chance. (Chi-square

of 52.98 with 24 degrees of freedom, p = 0.0030). However this does not indicate the

direction of the difference. When distributed into the mobility perception categories

this results in low numbers and low statistical power.

As highlighted above there are many factors that undermine establishing simple

linear relationships between time since loss of sight and the person’s perception of

mobility in this sample, particularly when considering the level of co-morbidity

present in both groups.

4.2.5 Living Alone and Perceptions of Mobility

A Chi-square test was used to investigate whether living alone or not is related to

perceptions of mobility. The results indicated that there is no statistically significant

difference between those living alone and not living alone and their mobility

perceptions.

4.2.6 Gender Differences and Perceptions of Mobility

When the perceptions of male and female participants were compared no significant

difference was found in the age groups. (Chi-square was 2.72 with 4 degrees of

freedom; p = 0.6048)

100

Results related to difficulties with mobility and frequency of accessing local and busy

in Moving Around the Home, Local, Busy and

articipants were asked if they have difficulty getting around their own home, their

local area and busy or unfamiliar areas. They were also asked how frequently they

reas bus a are e ith sig guide).

results provide an overall picture of the extent to which people on the NCBI

ve nd in ity, a n ed ption of

obility techniques used, certain relationships become apparent.

tion regarding difficulty and frequency of use about the total sample is

rst a then d d relation to the two age groups.

Level of Difficulty in areas – Total Sample N = 564

/unfamiliar areas will be now be described.

4.2.7 DifficultyUnfamiliar Areas (Q. 3, 4, and 5)

P

go to local a

These

and y or unf miliar as alon (i.e. w out a hted

database mo

mobility, and m

Informa

arou the commun nd whe relat to their perce

presented fi

Table 4.14

nd iscusse in

Level of Difficulty

Home (n=555)

Local (n=561)

/unfamiliar (n=559) Busy

No difficulty 469 84.5% 252 44.92% 58 10.38%

Some Difficulty 66 11.85% 146 26.02% 169 30.23%

Significant 20 3.6% 163 29.06% 332 59.39%

difficulty

Total 555 100% 561 100% 559 100%

Almost 85% of the total sample reported no difficulty in their home, 45% reported no

area, and almost 11% reported no difficulty in accessing

e

difficulty in using their local

busy or unfamiliar areas alone, indicating that most people had difficulty using their

local and other environments outside of their home. The following table presents th

information of the frequency of accessing the local and busy/unfamiliar environments

for the total sample.

101

Table 4.15 Frequency of Using Local and Busy/Unfamiliar Areas – N= 564

Frequency Local Busy/unfa(n=563)

miliar (n=564)

Yes, Most d ys 288 51.15% 48 8.51% a

Yes, more than once a w 66 11.72% 26 4.61% eek

Yes, most weeks 16 2.84% 74 13.12%

I try to avoid it 106 18.79% 23 4.09%

Never , Unl I have a ted uide

68 84% 305 54.08% ess sighg

1 29.

Never Leav 5 0.89% es Home 2 0.36%

Total 563 % 564 100% 100

This indicate o l sample access their local environment ‘most

ays’, And o er frequ ‘more ce a owever

4% either ‘ y to avoid it’ r only go wi a sighted g ide. With regard to using busy

mil areas, alm 3% try to id these areas or only go with a sighted

uide.

he results diffic d to fr

the two a groups in the following tables.

.2.8 Und g

in areas – Under 65 age group N=333

s that 51% f the tota

d ver a furth 12% as ently as than on week’. H

3 tr o th u

and unfa iar ost 7 avo

g

T related to ulty an equency of use are now presented in relation

to ge

4 er 65 age roup

Table 4.16 Level of Difficulty

Level of Difficulty Home Local (n=328) (n=331)

Busy/unfamiliar (n=330)

No difficulty 275 83.18% 155 46.8% 36% 10.9%

Some Difficulty 42 12.8% 103 31.2% 119% 36.1%

Significant difficulty

11 3.4% 73 22% 175% 53%

ting

around their own homes. The fact that over 29% of this age group reported other

Most of the Under 65 age group report having no difficulty getting around their own

home (83.8%, n =274). However, 16% report having at least ‘some difficulty’ get

102

health related problems that limit their mobility may impact on this experience of

difficulty.

With regard to moving around in their local area, more than half (53%) reported at

least ‘some’ d egard to busy or unfamiliar

en ents, 89% reporte me’ an ‘significant’ difficulty categories.

ere asked abo ency o

and unfamiliar areas with a r cate ‘unles mpanied ghted

he f wing table sents the a.

able 4.17 cy g Lo Bus Und age group =333

ifficulty was experienced. With r

vironm

Questions w

d in the ‘so

ut the frequ

d

f going out in the local area, and in busy

esponse gory for s acco by a si

guide’. T ollo pre dat

T Frequen of Usin cal and y Area– er 65 N

Frequency cal 3)

B nfamiliar (N=333)

Lo usy/u(N=33

Yes, Most d 30 9% 200 60.1% ays

Yes, more th n once a w ek 30 .1% 21 6.3% 9a e

st w ks 57 17.1% 9 2.7%Yes, mo ee

I try to avoid 65 19.5% 9 2.7% it

Never , Un ave hteduide

159 47.9% less I h a sig 84

g25.4%

Never Leave Home 1 0.3% s 1 0.3%

Over 70% (n=230) of the

without a sighted guide at least more than

under 65-age group report moving around their local area

(94) do not go out unless they have a

n lly have to. Only

busy and unfamiliar areas as frequently as ‘more than once a

rthy.

once per week. However it is noteworthy

that even in this younger age group, 28%

sighted guide and are reluctant to leave their home u less they rea

15% reported going to

week’.

It is not surprising that people have more difficulty getting around busy and unfamiliar

areas than in local areas, however in spite of the relative frequency of use of local

areas, the levels of difficulty reported in this younger age group is notewo

103


r the reported level of difficulty by the older aThe results fo ge group in moving about

in the home, local area and unfamiliar areas are presented below.

Table 4.18 Level of Difficulty in All Areas – Over 65 age group N=231

Level of Difficulty Home (n=227)

Local (n=230)

Busy/unfamiliar (n=229)

No difficulty 194 85.5% 97 42.2% 22 9.6%

Some Difficulty 24 10.6% 43 18.7% 50 21.8%

Significant difficulty

9 3.9% 90 39.1% 157 68.6%

moving about their homes, 85.5% (194) of this older age grouWith regard to p

reported having no difficulty; with regard to moving about their local areas, 58% have

t

quency of Using Local and Busy Area– Over 65 age group N=231

at least ‘some difficulty’. When using busy or unfamiliar areas over 90% reported a

least ‘some difficulty’ and 68.6% considered this difficulty to be significant. Even

when taking into consideration the age profile of this group and that 59% reported

additional health related difficulties affecting their mobility this is a noteworthy result.

The frequency of use of areas by the older age group is presented in the following

table.

Table 4.19 Fre

(n=230) (n=231) Local Busy/unfamiliar

Yes, Most days 88 38.1% 18 7.83%

Yes, more than once a week 36 15.6% 5 2.17%

Yes, most weeks 7 3% 17 7.39%

I try to avoid it 14 6.1% 41 17.8%

Never ,unless I have a sighted guide

84 36% 146 63%


104

Considering the level of difficulty in using busy and unfamiliar areas it is not

surprising that 82% of the older age group selected the ‘try to avoid it’ (17.8%)

‘only go with a sighted guide’ (63%) categories.

and

eek’. Considering the age profile and co-morbidity of other health related

sues, it is not rte g out without a sighted

guide.In order to uncover more about the frequency of use of local and unfamiliar

su lated to si s categories groups (Cat.1, Cat.2, and Cat.3)

y o were co . The following table presents the results.

that th mbers in of the ce re sma ld be n , as this

s the statistical power in making comparisons.

With regard to using local areas almost 54% reported going out at least ‘more than

once a w

is unexpected that 36% repo d never goin

areas, the re lts re ght los

and frequenc f use mpared

However

reduce

e nu some lls a ll shou oted

105

Table 4.20 Sight Categories and Frequency of Use of Busy Areas. Total Sample (N=564; n=561)

Frequency of Use

Cat.1 Cat.2 Cat.3 Total

n %

down

n % down n % n

down

Yes, most 39 44.8% 115 42.3% 132 286 65%

days

Yes, more 10 11.5%

than once a week

32 11.8% 24 11.8% 66

5 5.75% 7 2.57% 4 16 1.97% Yes, most weeks

I try to avoid it

1 1.15% 16 5.88% 6 96 23 2. %

Never Goes out unless with sighted guide

31 35.6% 100 36.8% 37 18.2% 168

Never Goes Out

1 1.15% 1 0.368% 0 0% 2

87 100% 271 100 203 100% 561

Chi-square is 39.18 with 12 degrees of freedom (p = 0.0027)

It should be noted that there are only 87 people in Cat.1 compared to 271 in Cat.2,

and 203 in the Cat.3. People with good residual vision (Cat.3) were found to go to

here is

local areas more frequently than those with no sight or poor residual vision. T

little difference in the frequency that totally blind people (Cat.1) go to either local or

busy areas when compared to those with poor residual vision (Cat.2). The following

table presents the comparison of categories of sight loss and level of difficulties

reported in using local areas.

106

Table 4.21 Sight Categories and Level of Difficulty in Local Areas – Total Sample (N=564; n=559)

Sight Levels of Category

Difficulty Signif.

To Some

None

tal

CAT.1 n 25 19 42 86

% across 29.1% 22.1% .8% 10 48 0%

% down 15.4% 13% % 15 16.7 .3%

CAT.2 n 100 76 2796 2

% across 36.8% 27.9% .3% 10 35 0%

% down 61.7% 52.1% % 48 38.1 .5%

CAT.3 n 37 50 114 201

% across 18.3% 24.8% .4% 10 56 0%

% down 22.8% 34.2% 45.2% 36%

Total n 162 145 252 559

% across 28.9% 26% 44.9% 100%

% down 100% 100% 100% 100%

Chi-square = 31.17 with six degrees of freedom; p = 0.0003

There is a statistically significant difference between the groups and their level of

difficulty. Those in Cat.2 seem to have most difficulty in local/familiar areas, with

36.5% stating they have significant difficulty mobilising. Of those who are totally blind

(Cat. 1

established that most respondents had difficulty in accessing

busy and unfamiliar areas. The data for the sight loss groups and categories of

), 29.1% report significant difficulty, of those in Cat.3, 18.3% of this group

report significant difficulty in local/familiar areas.

It has already been

107

reported difficulty were compared for the total sample. The following table presents

the results.

ies and Difficulty in Use of Busy Areas otal Sample (N=564; n=557)

Table 4.22 Sight CategorT

Sight Level oCategory

f Difficulty

Signif.

Some

Non

e

Total

CAT.1 n 48 28 9 85

% across 56.5% 32.9% .6% 0 10 1 0%

% down 14.5% 16.6% .5% 5 15 1 .2%

CAT.2 n 188 64 19 271

% across 69.4% 23.6% 7.01% 100%

% down 56.8% 37.9% 32.8% 48.5%

CAT.3 n 94 77 30 201

% across 46.5% 38.1% 14.9% 100%

% down 28.4% 45.6% 51.7% 36.1%

Total n 330 169 58 557

% across 59.2% 30.2% 10.4% 100%

% down 100% 100% 100% 100%

Chi-square = 27.92 with six degrees of freedom p = 0.0010

A statistically significant difference between the sight category groups was found.

Again it is noteworthy that those with little residual vision, the Cat.2 group seem to

have most difficulty in busy areas with 68.4% stating that they have difficulty moving

around in busy and unfamiliar areas, compared to 46.4% of those with good residual

vision (Cat.3), and 56% of the Cat.1 group, those with the least vision.

108

4.2.10 Comparison of the Level of Difficulty Experienced in the

As would be expected, those who reported having difficulty in their own home also

er overall perception r mobility. (C e statistic

8 degrees of freedom; p≤0.0001) , the level y reporte

around local areas and busy areas are both related to their overall perception of their

, that is those who report more difficulty in getting around local or busy areas

ility. ( reas hi-sq atis = 1

.0 . Bu s, C quar ic 36

mparison of the requ of use of local and unfamiliar areas with their perception of their own mobility

s re fo lated e f y w

he individual’s perception of their mobility. Those who

ore frequently move around in their local community report better overall mobility.

(Chi-square = 169.6 with 24 df; p≤0.0001). Likewise, those who move around busy

ood

d

Questions were asked about the types of orientation techniques and mobility aids

used, s

obstac

mobility aid or technique was, for each of the settings (home, local/familiar area and

busy areas). The categories of ‘techniques’ listed in the questionnaire arose out of

Home, Local and Unfamiliar Areas

reported low s of thei hi-squar = 57.34 with

d in getting. Similarly of difficult

mobility

have lower perceptions of their mob Local a , C uare st tic 77.3

with 8 degrees of freedom: p≤0 001 sy area hi-s e statist = 1 .3 with

8df: p≤0.0001).

4.2.11 Co F ency

Statistically significant difference

people use local areas, and t

we und re to th requenc with hich

m

or unfamiliar areas more frequently are more likely to rate their own mobility as g

(Chi-square = 140.4 with 24 df; p≤0.0001).

Section 4.3

4.3.1 Mobility Techniques and Aids Used (Questions 6, 7 an8)

uch as “Do you use any technique or aids to know where you are, or to avoid

les?” Participants were then asked what (if any) their primary and secondary

the focus group data, and the category “Bumping into things” was listed as a

technique and hence it is included in the category options. The responses to these

109

are described in this section. Table 4.23 is a summary table related to mobility aids

ables detail orientation and mobility

techniques and aids used by the two age groups.

Table 4.23 S echniques / Aids Used. Total Sample (N=564; n=564)

for the total sample, and the subsequent t

ummary of T

(n= 562) ondary

echn que (n= 59) TotaPrimary Technique/aid Sec

T i 2

l

Guide Dog 29 5.16 0 29 0

Long Cane 8.1 13.5 102 1 5 35 1 137

Symbol Cane

31 5.52 3 12 4.6 43

Total 162 28.83 47 18.14

Just 28.83% e m in th ey eith og lo

cane or symbol cane as their primary aid or technique. When participants were

ed if they d aid % =47 rted in g ne

l cane. or a re a

s .

4.3.2 Under 65 age group – Mobility Techniques and Aids Used

by

sponses for the use of primary

techniques, and only 150 for secondary techniques.

of th total sa ple dicated at th used er a guide d , a ng

ask used a secon ary , 18.14 (n ) repo us g the lon ca or

symbo M e details re p sented below related to the two age groups nd

techniques u ed

The table below presents the results of all the mobility aids and techniques used

participants in the Under 65 age group who were asked to list their primary and

secondary technique used. There were 331 re

110

Table 4.24 Primary and Secondary mobility techniques/aids used Under 65 age group

Technique Primary Secondary (N=150) (N=331)

N % n %

None 66 19.9% 3 2%

Bumping into things 21 6.3% 6 4%

Residual hearing and vision 79 23.9% 49 32.7%

Symbol / guide cane 12 3.6% 5 3.3%

Long cane 81 24.5% 35 23.3%

Guide dog 27 8.2% 0 0%

Sighted guide 36 10.9 49 .7% 32

Mobility aid, such as walking stick, frame 9 2.7% 3

or wheelchair 2%

A range of techniques was reported with the long cane the most frequently reported

en combining the percentage of those who

do not use any specific techniques, and those reporting

uide dog. A further 2.7% (n=9) use mobility aids

such as a walking stick or wheelchair.

The most commonly described secondary techniques, (those that are used

infrequently or as a back-up mechanism) are the use of a sighted guide, and use of

hearing or other senses reported by 32.7% (n=49) for each, followed by long cane

reported by 23.3% (n=35) as a secondary technique. It is noted that all of the

participants who have a guide dog report this as being their primary mobility aid, with

use of long cane or sighted guide as a secondary method.

primary technique used by 24.5% (n = 81) of the sample in the younger age group.

Almost equal to this was the use of other senses, such as hearing and touch by

23.9% (n=79) of this sample. However wh

reported that ordinarily they

the technique of ‘bumping into things’, this accounts for 26% (n = 87). Almost 11%

(n = 36) use a sighted guide. In terms of these more widely recognised aids /

techniques for mobility, 3.6% (n=12) use a guide or symbol cane, 24.5 %( n=81) use

a long cane, 8.2% (n=27) use a g

111

4.3.3 Under 65 age group – Primary Techniques and Aids Used

Th

and busy areas) for the Under 65 age group are listed in the following table.

Table 4.25 Primary techniques U ac U 5 ge group

e primary mobility aids used in the three different environments (home, local area

sed in E h Area– nder 6 a

Technique Home 318)

Local / Familiar (N=325)

Busy / amiliar

=324) (N= unf

(N

n % n % n %

None 178 56 43 13.2 29 9

None, but do bump into things 31 9.7 17 5.2 17 5.2

Residual vision and hearing 89 28 88 27.1 73 22.5

Symbol / guide cane 2 0.6 8 2.5 9 2.8

Long cane 9 2.8 85 26.2 72 22.2

Guide dog 1 0.3 24 7.4 19 5.9

Sighted guide 4 1.3 51 15.7 100 30.9

Mobility aid, such as walking 4 1.3 9 2.8 5 1.5 stick, frame or wheelchair

In the home environment, 56% (n=178) of the participants do not use any formal

m the table above

that people use different techniques in different areas, with more people using no

aids in in busy or unfamiliar

obility Techniques and Aids Used

he primary and secondary mobility aids used by the sample over the age of 65 are

resented below:

mobility aid / technique, in contrast in busy environments only 9% (n=29) of the

participants use no mobility aid /techniques. It appears clear fro

the home environment, and sighted guide or long cane

environments. The technique most consistently stated across the three environments

is use of different senses, such as residual vision and hearing.

4.3.4 Over 65 age group – M

T

p

112

Table 4.26 Primary and Secondary Mobility Techniques / Aids Used Over 65 age group N=231

Technique/Aid used

Pr =231 Secondary n=109

imary N

N 47 20.3% 4 7% one 3.

“Bump into things” 7 3% 4 7% 3.

R ring and vision 80 34.6% 3 .2% esidual hea 4 31

S e 19 8.2% 7ymbol / guide can 6.4%

Lo 21 9.1% 0 0% ng cane

G 2 0.9% 0 0% uide dog

Sighted guide 27 11.7% 33 30.3%

Mobility aid, such as walking stick, frame or wheelchair

28 12% 27 24.8%

Only 122 of this older age group ( n=231) reported using a technique such as use of

most

ted is the use of hearing or other senses, with

34.6% (n=80) of the sample reporting this as their primary technique. When

e thus described. Only 9% (n = 21) reported using a

symbol cane as a prim

, only 2 (0.9%) reported using a guide dog.

residual hearing and vision; symbol /guide cane; long cane; or guide dog. The

common mobility technique repor

combining the categories of ‘none’ and ‘bum

sample wer

ping into things’ 23.3% (n=54) of the

long cane, and 8.2%

(21) reported using a ary aid or technique. From a sample of

231 respondents in this older age group

113

Table 4.27 Primary techniques in each environment – Over 65 age gN=231

roup

Technique Home (n=223)

Local / Familiar

Busy /

(n=226) unfamiliar (n=219)

None 105 47.1% 29 12.8% 19 8.7%

None, but ‘bump into things’ 5 2.2% 7 3.1% 6 2.7%

Residual hearing and vision 89 39.9% 60 26.5% 41 18.7%

Symbol / guide cane 1 0.4% 19 8.4% 17 7.8%

Long cane 1.3% 15 6.6% 9 4.1% 3

Guide dog 0% 2 0.9% 2 0.9% 0

Sighted guide 5 2.2% 69 30.5% 105 47.9%

Mobility aid, such as walking stick, frame or wheelchair

15 6.7% 25 11.1% 20 9.1%

The most common techniques across the different environments are the us

hearing and other senses (26% n = 60), ‘no technique’ (particularly in the home), an

the use of a sighted guide outside the home. Over 30% of this age group use a

sighted guide for accessing the local environment, 8.4% use a symbol cane, and

only 6.

e of

d

6% use a long cane in the local environment.

alf of

s

nd techniques and reported categories of

athered from

559 of the 564 participants.

Considering the age profile, and co-morbidity it is not surprising that almost h

the Over 65 age group use a sighted guide for busy or unfamiliar areas, wherea

only 4.1% and 0.9% of these use a long cane or guide dog respectively.

4.3.5 Comparison of the Use of Mobility Techniques and Aidswith Perceptions of Mobility for the Total Sample (Q. 6 and Q1)

The data comparing use of mobility aids a

perception of mobility is presented in the following table. Data was g

114

Table 4.28 Comparison of Techniques with Perception of Mobility – Total S(N=564; n=559)

ample

Very well Fairly well OK Fairly badly Badly Total

Techniqu e

None

%

112 30 26.8% 43 38.4% 28 25% 7 6.25% 4 3.57

‘Bump in 8 32.1% 11 39.3% 4 14.3% 1 3.57% 27 to things’ 3 10.7%

Residualand vision

7 4.4% 159 hearing 21 13.2% 73 45.9% 48 30.2% 10 6.29%

Symbol/ 3.23% 31 guide cane 2 6.45% 9 29% 15 48.4% 4 12.9% 1

Long can 2.97% 101 e 17 16.8% 37 36.6% 34 33.17

%

10 9.9% 3

Guide do 12 41.4% 3 10.3 1 3.45% 1 3.45% 29 g 12 41.4%

Sighted g 8 12.7% 63 uide 4 6.35% 15 23.8% 22 34.9 14 22.2%

Walking stick/frame wheelcha

3 8.33% 14 38.9% 14 38.9 3 8.33% 2 4.56% 36

ir

Total 92 211 175 53 27 559

(Note on reading the table: Read the table percentages going down column for

comparison, e.g. 41.4% of guide dog users scored in the ‘very well’ category,

tegories. However, it should be

oted that the numbers in some of the cells are very low, and this limits the

acceptance of the statistically significant result achieved.

Almost 54% of long cane users scored themselves in the ‘very well’ and ‘fairly well’

ategories combined, and a further 33% considered that they got around ‘O.K.’ Only

30% of those who used a sighted guide reported in the ’very well’ and fairly well’

compared to 6.45% of symbol cane users.)

Chi-square for the table above is 71.52 with 28 degrees of freedom, p ≤ 0.0001,

indicating statistical significance between the ca

n

c

115

categories. However 65% of those who use ‘no technique’ reported in these

tegories. Those scoring the highest in these two combined categories combined ca

re the guide dog owners with 82%. However this relates to only 24 people in a

size of 5

3.7 Long C onsideration of

Participants were asked “Do you ever use a long cane?” Those who answered

t they did we of the lon ne in any or all of the four

areas below, and also in the “different light conditions” category.

ble 4.29. Cane is use as Primary

a

sample 59.

4. ane Use and C Use

tha re asked to indicate their use g ca

Ta When / Where the Long d Aid N=120

Under 65

Over 65

l

Tota

In my home 9 3 12 10

In local areas 86 18 88.67 104

In busy areas 73 14 87 72.5

In unfamiliar areas 77 7 84 70

In different/light conditions 19 1 20 16.67

Total Cane users (n=137) minus guide dog owners who use canes (n=17)) N = 120

The table above represents the total number of responses to each location. Some

answered in more than one ca

ong

participants tegory. Those participants who reported

using a l cane were asked for what specifically they used a long cane. The table

below presents their responses:

116

Table 4.30 What Long Cane is Used for (Total Sample minus Guide Dog =120*) Owners (N

Under 65

Over 65

Total

Finding obs 7 89.17% tacles 87 20 10

Alerting othvision impai

5 47.5% ers that I’m 52

red 57

*N=120: (Total Cane users (n=137) minus guide dog owners who use canes

(n=17))

use the cane for both of the above finding

obstacles and for alerting others of their impairment. Below are some of the

mments mad s in relation to what they specifically use a long cane

:

eel more con

“If it’s really busy then I take the cane out so that people know to get out of the way.”

ight use the cane the first time I'm in a new/ unfamiliar place, before I get to know

4.3.8 Long Cane Use by Guide Dog Owners

Sixteen of the seventeen guide dog owners who also use a cane as a secondary

elated to where they use the cane.

Some participants indicated that they

co e by participant

for

“I f fident with the cane”

“M

it”

“I'd be afraid that people would walk or bang into me, awful fear of being knocked or

tripped, if they see the white cane they give me a bit of room”

mobility aid reported on where and when they use it. The table below presents the

data r

117

Those 17 guide dog owners who stated that they use a long cane were asked for

what they used a long cane, 13 answered that it was for either finding obstacles or

alerting others of their visual impairment. The following table presents the results.

Table 4.32 Reason for use of Long Cane by Guide Dog owners. N=16; n=13

U/ 65

O/ 65

Total

n n n=13 %

Finding obstacles 11 0 11 81.25%

Alerting others re visual impairment 2 0 2 12.5%

Neither of the two participants in the Over 65 age group who use a guide dog

e. Below are some of the comments made by guide

dog owners regarding their use of the long cane.

e than 4 or 5 hours then I wouldn’t bring the

dog because it would be too stressful for her”

indicated that they used a can

“I use a cane in places that are unsuitable for guide dogs, such as night clubs or

places with music.”

“If I'm out in a place for a long time mor

Table 4.31 Where/ when Guide Dog Owners use Long Cane N=17

N=16 U/ 65 O/ 65 Total

In home 2 0 2 11.76%

In Local area 7 0 7 41.18%

Busy area 6 0 6 35.29%

Unfamiliar area 1 0 1 5.88%

Different light conditions

0 0 0 0

118

4.3.9 Consideration of Long Cane (Q. 7c)

Participants who indicated that they had never used a long cane (n =409) were

r considered using a long cane?” with the possibility of

” The table below presents the results for these.

asked “Have you eve

answering in category ‘Yes’ and ‘No’. Following this question they were asked “Why?

Table 4.33 Ever Consider Using Long Cane N=409

Yes No N

Total 74 18.09% 335 82.71% 409

By Age Group

Under 65 43 79.1% 206 20.9% 163

Over 65 31 15.3% 172 84.7% 203

Over 82% of those who didn’t use a long cane reported that they had not considered

d six partic ants fro e und 65 age- o d not

ne for mobility. Of these, 163 (79.1%) reported that they have never

onsidered using the cane, the remaining 43 (20.9%) state that they have

nsidered using the cane, whereas the remaining 172 (84.7%) state that they

have

4.3.10 Under 65 Age Group – Have Considered a Long Cane

ing a long cane, 16

ial to them, but had not taken any action to get a cane;

nine were presently involved in the training process; five had considered its use, but

g cane in the past, but for various reasons for no longer used it. Six of

ibed similar difficulties encountered during their prior

experience of the long cane, stating that:

“It wasn’t helpful at all, I didn’t like it”; another similar comment was

it. Two hundred an ip m th er group rep rte using

a long ca

c

considered its use. In the over 65 age-group, 203 participants reported not using a

long cane for mobility. Amongst these participants, 31 (15.3%) reported that they

have co

Of the 43 (20.9%) participants who reported considering us

considered it might be benefic

decided it was not beneficial. However, 14 of these 43 participants reported having

used a lon

these participants descr

119

“It didn’t work for me at all”

Three participants stated that they now use an alternative mobility aid to the cane. In

one instance a walking stick was required, whereas the other two participants

“switched” to using a guide dog, which was described as enabling to “go out more

easily and relax more” in comparison to when using the cane.

ive participan cribed their de to stop using a res

directly associated negative social reactions which they experienced.

he publi ve a bad attitude towards cane-users, whereas a guide dog is a

dly’ bol”

ver 65 age group – Have Considered a Long Cane

ade comments, 12 had

previous experience of using the cane, but stopped using it as it was not suitable to

with it”

Others ted g

sticks or other mobility aids. Others commented that it made them appear more

4.3.12 Under 65 Age Group – Have Not Considered a Long Cane

Of the 163 who reported not considering using a cane, 134 stated reasons that were

varied and are presented in the following table:

F ts des cision long cane as a ult of

“I feel t c ha

more ‘frien sym

4.3.11 O

Just over 15% of participants (N=31), in the Over 65 age group report having

considered using a long cane. Twenty respondents m

their needs and abilities:

“I tripped over it more times than it helped me so I didn’t bother

commen that their mobility had decreased, and they now used walkin

vulnerable. Four others had given long cane use consideration for the future if, and

when, their sight deteriorates. Four others dismissed the idea as they only went out

in the company of a sighted person.

120

Table 4.34 Rank Order Reasons for not considering long cane – Under 65 age group. 134 stated reasons N=163

Rank Comment n %

1 Don’t need one 94 70.15

2 Social stigma attached to use 14 10.45

3 Other mobility aid so not suitable

11 8.21

4 Never thought of it 7 5.22

5 Loss of independence 4 2.98

6 Lack of long cane training 2 1.49

6 Safety concerns 2 1.49

Total 134 100

It is noteworthy comm ts made by this er age

group relate to the perception of “not needing” to use a long cane. Over 10% of the

al stigma. Some examples of these

omments are given below:

4.3.13 Over 65 age group – Have Not Considered a Long Cane

Almost 85% (N=172) of the Over 65 age group, who do not use a cane or a guide

dog, re er ha

that over 70% of these 134 en young

comments related to a perception of soci

c

“I would be mortified if it came to that”

“I wouldn’t like to draw attention to myself. I just like to slip into the background”

port nev ving considered using a cane. The table below presents in rank

order categorised reasons offered by 155 of these respondents:

121

Table 4.35 Over 65 - Not considering long cane use (N=172) Rank order from 155 respondents

Rank Co n mment %

1 Do 79 50.97 n’t need one

2 Ot 18 11.61 her disability so not suitable

3 Al 10 6.45 ways sighted guide

4 Never knew of such a thing 9 5.81

5 Social stigma attached to use 8 5.16

5 Ma 8 5.16 nage with symbol cane

6 Never thought of it 6 3.87

6 inconvenient 6 3.87

7 Increased vulnerability 5 3.22

8 Doubtful of its use 4 2.58

9 Sign of persistent failure 2 1.29

Total 155 100

in mind the age profile (mean age 78 years) and that 59% have reported

other disability issues, many respondents in the over 65’s age category prefer going

d a

Some of the comments made by participants are presented below:

“I wouldn’t need it because I don’t go out by myself. I don’t think it would be much

use”

“My other stick works well, I can lean on it”

“I would be scared that hooligans would see me using it and take advantage”

Bearing

out with a sighted guide, it is not surprising that 50% consider that they don’t nee

long cane.

122

4.3.14 Guide Dog Use and Consideration Question 8

s about a

The Use of Guide Dogs Question 8a

Of the total sample of 564 participants, 562 answered the question, of these, only 29

he data for each age

p.

Table 4.36 Guide Dog Owners: N=29

Similar questions were asked about the use of and their consideration

guide dog.

4.3.15

reported using a guide dog. The following table presents t

grou

Under 65 27 8.2%

Over 65 0.92 %

Total 5.129 6%

Only 5.16% (n = 2 e (n=562) reported that they used a guide

og.When asked “How you find using a guide dog?” the owners were

r crossing roads and knowing where

they're going, easier to cross the road with the dog than with a cane.”

“Great because it gets you to know your routes, bad if dog gets sick as you become

Preferable over long cane:

“Very good, always loved dogs anyway, using the dog takes the tension out of

getting

back into going out, can actually go out for a walk for pleasure. I wouldn't feel that

9) of the total sampl

d

overwhelmingly positive. These participants’ comments can be categorised into the

following themes:

Independence:

“Very good for independence, they're great fo

very reliant on it; big commitment but definitely worth it.”

around, they're not perfect can make mistakes. It is a way of putting pleasure

you could go for pleasure with a cane.”

123

“It’s much easier than the cane… and much more noticeable for people and they

come and help you more often if you're in difficulty”.

arm now, would be strange to go out without

nswer to th t made you choose e a guidowing table e responses:

r

rly categorised as those

above:

Independence:

tion of independence for me - I felt the white cane made me vulnerable…it

meant that I could do things I wanted to do independently”

up getting around using a cane, using a guide dog is far, far superior in terms of

mobility.”

Essential part of life:

“It makes a difference between getting out and not getting out.”

ble 4.37 W e to use uide dog

Essential part of life:

“The dog is like an extension of my

her.”

In a e question “Wha to us e dog?” the

foll gives details of th

Ta hat made you choos a g ? N=29 Over 65 Under 65

(N=27)

Total Sample

9) (N=2) (N=2

Better Mobilit 2 100% 21 77.78% 23 79.3%y

Alert other topairment

0% 1 3.7% 3.45% visual 0 1

im

Companionship 0 0% 5 18.52% 5 17.2%

Over 79% of the responses were that choosing a guide dog was for getting bette

mobility. The comments offered by participants can be simila

“A ques

Preferable over long cane:

“I was fed

TOTAL 2 100% 27 100% 29 100%

124

4.3.16 Consideration of Guide Dogs Question 8b

Five hundred and thirty five participants who were not guide dog owners were asked

“Have you ever considered using a guide dog?” and “Why?” The table below

presents the results for the 523 participants who responded:

Table 4.38 Non- Guide dog owners Consider Guide Dog N= 535; n= 523

Yes No Used to own Total dog

Total 82 15.7% 430 82.2% 11 2.1% 523

Under 76.4% 8 2.7% 296 65 62 20.9% 226

Over 65 20 8.8% 204 89.9% 3 1.3% 227

Over 82% reported that they had not considered a guide dog, 76.4% of the Under 65

Less than 16% of those who responded repo hey had cons uide

ho had co re a guide dog their comments are presented

ble low fo der ’s age g

Under 65 age group– Considered a Guide Dog

under 21% (n=62) p ts within the Under 65 age group report

considered applyi r a e dog a fur 8 are r-g dog

wners. The reasons for considering a guide dog, and the influences on deciding

not to get a dog after consideration are presented below.

age group an almost 90% of the Over 65 age group.

rted that t idered a g

dog. Of those w nside d getting

in rank order on the ta

4.3.17

be r the un 65 roup.

Just of the articipan

having ng fo guid , and ther forme uide

o

125

Table 4.39 Rank Order Reasons for consi guide dog oup (N=62)

deringUnder 65 age grRank Comment

1 Considered but not suitable to

lifestyle/living situation

14 22.58%

2 Considered as beneficial 12 19.35%

3 Wait till sight deteriorates 11 17.74%

4 Previous dog owner but don’t

want another

8 12.9%

5 Applied and changed mind 4 6.45%

6 Applied but are unsuitable for

ng

4 6.45%

traini

6 Have made initial inquiries 6.45% 4

7 Dog-training unsuccessful 4.83 3

8 On waiting list 2 3.22

Some e

e.”

dependence and confidence in unfamiliar areas.”

4.3.18 Over 65 age group – Have Considered a Guide Dog

Almost 90% of the older age group had reported not considering a guide dog. There were

only 20 participants who reported having considered using a guide dog. Comments were

made by 17 of these participants and are ranked in the table below:

xamples of these comments are given below:

“In the future, if my sight goes totally bad I would consider getting a guide dog over a can

“I often go away for a few days at a time because of my job- it wouldn’t be good for a dog.”

“A guide dog would give me more in

126

Table 4.40 Rank Order: Would Considering Guide Dog Over 65 (N=20; n=17) Rank Comment

1 Considered but not suitabl

lifes

5 29.41% e to

tyle/living situation

2 Concerned about balance 4 53% issues 23.

3 Prev dog o do ant

another

3 17.64% ious wner but n’t w

3 Concerned they would not work

og rd enou

3 17.64%

d ha gh

4 Others deserve dog more than me 2 1.76 1 %

None of the respondents had applied for a guide dog or were planning to apply in the near

ge

Almos the under-65 group in the study have

never considered using a guide dog. The 163 comments made by these were

future. Below is an example of a comment made by a participant within the over 65’s a

group who had considered using a guide dog:

“I need support of a person’s arm for walking, would not be stable enough to walk if I was

holding a guide dog”

4.3.19 Under 65 Age Group – Have Not Considered a Guide Dog

t 77% (N=226) of the participants in

categorised and are presented in rank order on the following table.

127

Table 4.41 Rank Order Would Not Considering Guide Dog Under 65 (n=163) Rank Comment n %

1 Don’t need one 87 53.3%

2 Living situation/lifestyle not suited 18 11%

3 Dog too much responsibility 12 7%

4 Don’t like dogs 10 6%

5 Other disabilities 9 5.5%

5 Wouldn’t be able to use a do 5.5% g 9

6 Just never thought about it 8 4.9%

7 Others need a dog more than me 3 5 %

7 Prefer ing cane 3 us 5 %

The most common reason (53%

one. Other individual responses such as

) for not considering a guide dog was “not needing”

already having a pet dog, ‘a guide dog

a sighted companion, that it would reduce

and being ‘too embarrassed’ to use a dog were

ples of comm made ip ts are p ed be :

r well whe I live because there are lots of dogs in the

ried that they would be fighting”

e a effort to ter a can be expe ve as

0 Over 65 age group – Have Not Considered a Guide Dog

lmost 90% (N=204) of the Over 65 age group have never considered applying for a

guide dog. There were four non-respondents. Comments were offered by 195

never being offered’, that the person has

the person’s independence

mentioned.

Some exam ents by partic an resent low

“Don’t think it would wo

locality- I’d wor

k re

“Dogs take a lot of tim

4.3.2

nd look af nd very nsi well”

A

128

respondents. The reasons for not considering a guide dog are presented in

order in the following table.

rank

Table 4.42 Rank Order: Comments for Not Considering Guide Dog Over 65 age group N=195

Rank Comment

1 Don’t need one 114 58.46%

2 Living situation 24 12.3%

3 No able to manage a guide dog 21 10.76%

4 Have other disability, dog 13 6.66%

unsuitable

5 Can see too much to warrant a 12 6.15%

dog

6 n’t like dogs 11 5.64% Do

The mos ‘not needing’ one, with ost 59%

4) citi ade by participa

age g guide dog are pr nted be

y

“I often thought about a guide dog but I just don’t understand how he’d bring me to

the rig pub in the

t frequent comments was that of alm (n =

11 ng this. Some examples of comments m nts within the Over

65 roup who have not considered using a ese low:

“I’m in a wheelchair so I don’t know if it would be any good”

“I wouldn’t really know how to care for him”

“I feel they should be kept for people who need them most, like those who are totall

blind.”

ht places, like how does he bring me to Murphy’s pub over another

village?”

129

Section 4.4 Orientation and Mobility Training (Q. 9)

In this se re asked about orientation and mobility training received,

traini s about a

toward, and interest in mobility training uptake were also asked. It should be noted

t all research participants had an assessment of need carried out by trained staff

en the . Attitudes to a experien

bility y.

4.4.1

rticipan ing or advice to

ore safely?” The table below presents the 556 responses from the total sample.

Total

ction questions we

the ng agency, and perceived usefulness of training. Que tion ttitudes

tha

wh y were accepted to the NCBI database nd ces of

mo training are of central interest in this stud

Mobility Training Status

Pa ts were asked “Have you ever had train help you move around

m

Table 4.42 Ever Had Training or Advice to Help Move Around? (N=564; n=556)

Under 65 Over 65 (N=328) (N=228) (N=556)

Yes, I used it 156 47.56% 34 14.91% 190 34.17%

Offered but I didn’t want it

9 2.74% 7 3.07% 14 2.51%

Awaiting training 7 2.13% 1 0.44% 10 1.79%

No 156 47.6% 186 81.58% 342 61.51%

Total 328 100 228 100 556 100

From a total of 556 respondents, less than 35% (n = 190) had received training, less

an 2% were awaiting training, and 3% had rejected an offer of training. Almost 62%

(n = 342) had not received training. There was a statistically significant difference

etween the age groups. A higher percentage of the Under 65 age group had taken

p training.

he Chi-square result for this is 68.91, with 3 degrees of freedom, p≤0.0001)The

aining status for the two age groups is presented in separate tables below.

th

b

u

(T

tr

130

Table 4.44 Training Status of Under 65 age group (N=333; n=328)

Never had training 47.6% 156

Awaiting training 2.1% 7

Offered training, but did not use 2.7% 9

Had mobility trainin 47.6% 156 g

Of the Under 65 age n b and

have never had mobility training (n= 156; 2.1%) are awaiting training; 9

aining but id not use it. The results for the Over 65 age group

in the low

g Statu Over 65 ge group (n=228)

group, a equal num er have had t

47.6%); 7 (

raining (n = 156; 47.6%)

(2.7%) were offered

are presented

tr d

table be :

Table 4.45 Trainin s a

Never had training 81.6% 186

Awaiting training 0.4% 1

Offered training, but did not use 3.1% 7

Had mobility training 14.9% 34

Thus almost 82 % of the older age group reported that they had not received training for

4.4.2 Categories of Sight Loss and Training

a d on train g received and categories of sight loss. It was

ss vi re mo ely to ha ad mobi aining. T

s his and gi s details lated to sig loss and tr ning related o

pondents.

mobility.

Results were comp

expected that those

re in

with le sion a re lik ve h lity tr he

table below confirm

555 res

t ve re ht ai t

131

Table 4.46.Categories of Sight Loss and Ever Had training N=564: n =555 Have you had Cat.1 Cat.2 training No useful vision Little residual

Vision

Cat.3 Good residual vision

Yes, and I used it 72 82.76% 71 26 46 23.35% .2%

Offered, but I 3

didn’t want it 3.45% 7 2.5 6 3.05% 8%

Awaiting training 2 2.3% 6 2.2 0 0% 1%

No 11 12.65% 187 69% 145 73.6%

Total 87 100% 271 100% 197 100%

A statistically significant difference was found between the categories of sight loss

and training status. Those with greater sight

those with less sight loss (Chi-square

eful vision’ Cat.1, 72 (82.8%) have received mobility training,

al vision’ category above, only 26% (n = 71) have had training,

and of the 197 with ‘good residual vision’, 23% (n = 46) have had training.

Gender

arried out to see if there was a difference betw consid

der. Gender does not seem to be a factor as 144 females and 144

consider training whilst 17 f ales and les

consider training. (Chi-square for this calcu ion was , with

eedom (p = 0.6016). There was no statistica significa rence

etween gender and consideration of training. The next set of results relates to those

loss did have training more often than

= 119.6 with 6 degrees of freedom; p≤0.0001).

Of the 87 in the ‘No us

and 10 have never received mobility training. However it is noteworthy that of the

271 in the ‘little residu

4.4.3 Training and

Analysis was c een ering

training and gen

males stated that they would not em 18 ma

stated they would lat 1.016

two degrees of fr lly nt diffe

b

who have had training, the type of training received, and training agencies involved.

132

4.4.4 Mobility Training Received: Question 9a

The categories of responses in the interview schedule arose from the focus group

discussions held with staff and with service users from NCBI and IGDB, and inclu

categories of ‘Informal training with friend/family’; and ‘Informal training with

community resource worker’ who were NCBI staff, as well as categories to indicate

formal training with agencies in Ireland. The 19

ded

0 respondents who reported having

received training were asked about the type of training received. The following table

Table 4.47 Types of Training Received – Total sample N=190

presents the results.

Training type (Primary training)

Over 65 Under 65 Total

Informal training wifriend / family .9%

4

14.7% 18

9.47%

th

14

8

Informal training community resource

rker (NCBI) 19.2%

11

32.3% 41

21.58%

wo

30

Mobility training wiBI 43%

10

29.4%

40.53%

th

NC 67

77

Mobility training with IGDB

19

12.1%

4

8.8%

23

12.1%

Guide dog training with IGDB

16

10.3%

2

5.6%

18

9.47%

Mobility training with St. Joseph’s

5

3.2%

0

0%

5

2.7%

Mobility training wother organisation

ith 5 3.2% 3 8.8% 8 4.32%

e.g. in UK

Total 156 100 34 100 190 100

Of the 190 participants who received training, almost 41% had mobility training with

NCBI. The next most frequently availed of training was informal training with the

133

NCBI community resource worker, as 41 participants (21.6%) reported. Only 34

-one people s ad more th n one type of training in the ‘under 65’

age category. Details of this are contained in appendix 3. The following table give the

k order for the typ d e ‘under 65’ age g

4.4.5 Under 65 age group Mobility Training Rec

ble 4.48 Ranke inin eceived (prima Under 65 age group (N=156)

people in the over 65 age category reported receiving training in comparison to 156

within the under 65’s age group.

Twenty tated they h a

ran e of training receive by th roup.

eived

Ta d Mobility tra g r ry type)

Rank Type of trai ning

1 Formal Mob th NCBI 67 43% ility training wi

2 Informal training with NCBI community resource 30 19.2%

worker

3 Mobility training with IGDB 19 12.1%

4 Guide dog training with IGDB 16 10.3%

5 Informal training with friend / family 14 8.9%

6 Mobility training with St. Joseph’s 5 3.2%

6 Mobility training with other organisation 5 3.2%

Of this age group who received training, formal training with NCBI is almost twice as

frequently reported over the second ranked that of ‘informal training with the NCBI

community resource worker’. Irish Guide Dogs for the Blind are selected for both

orienta mob 22% of the sample.

% reported having had mobility

training. Of the 34 respondents (14.9%) who have had training. The following table

presents the type of training involved.

tion and ility training and guide dog training by

4.4.6 Over 65 Age Group Mobility Training Received

With regard to the older age group, less than 15

134

Table Over 65 age group (N=34)

4.49 Ranked Mobility training received (primary type)

Rank Type of training

1 Informal training with NCBI community resource 11 32.3%

worker

2 Mobility training with IGDB 10 29%

3 Formal Mobility training with NCBI 4 11.8%

4 Informa ith friend / f 11.8% l training w amily 4

5 Mobility with other organisation 3 8.8% training

6 Guide dog training with IGDB 2 5.9%

7 Mobility ing with ep train St. Jos h’s 0 0%

Informal training with the NCBI community resource worker reported by 32% is first

ed

ulness

ch

form of training are also given.

in the rank order, with Irish Guide Dogs for the Blind at 29%.

4.4.7 Perceptions of Helpfulness of Mobility Training Receiv

Participants were asked to rate their perceptions of how helpful or unhelpful the

training they received was, 187 commented on helpfulness of training out of 190 who

had training The table below gives the percentage of participants rating helpf

of the training alongside the type of training. The total numbers that have taken ea

135

Table 4.50 Mobility training: Percent Comparison between lness of tr type of training received.

otal Sample N=helpfu aining and T 190; n=187

Type of training Helpfulness

Very helpful

Fhelpf

airly ul

Neither helpful or unhelpful

fairly unhelpful

unhelpful

Very

Informal training with friend /

5.26%

10.5% 5.26%

18

family

26.3%

52.6%

Informal training with NCBI CRW

34.1%

46.3%

17.1%

2.44%

0%

41

Mobility training

with NCBI 61.5% 29.5% 6.41% 1.28% 1.28% 77

Mobility training

with IGDB 73.9% 26.1% 0% 0% 0%

23

Guide dog training with

87.5%

12.5%

0%

0%

0%

IGDB

16

Mobility training with St. Joseph’s

60%

40%

0%

0%

0%

5

Mobility training other organization

71.4%

0%

0%

28.6%

0% 7

g training is perceived to be the most helpful, with over 87% reporting this

to be ‘very helpful’, and informal training from family and friends least helpful. When

l’ categories are combined, IGDB trainees score

100% for both their types of training, and 91% of NCBI trainees scored their training

experience in these two categories also. Although only 5 reported on training by St.

Joseph’s, it too scored 100% in these combined categories. These combined

Guide do

the ‘very helpful’ and ‘fairly helpfu

136

catego by

st 80%. This level of perceived helpfulness of training is noteworthy.

Information in relation to the two age groups is presented below.

ries rated 18 participants for informal training from family and friends

reached mo

Table 4.51 Perceptions of helpfulness of Training Under 65 age group (N=156) Very helpful 92 58.9%

Fairly Helpful 46 29.5%

Neither helpful nor unhelpful 11 7.05%

Fairly Unhelpful 6 3.8%

Very unhelpful 1 0.64%

In terms of helpfulness

age group who have had training cat

of mobility training in general, 89% of those in the younger

egorised it as ‘helpful’ and ‘very helpful’. This is

a very positive rating for mobility training.

4.4.8 Over 65 age group Perceptions of Helpfulness of ity Training

his table relates to the 34 people in the older age group who have reported as

Mobil

T

having had training.

Table 4.52 Perceptions of Helpfulness of Training Over 65 age group (N=34)

Very helpful 17 50%

Fairly Helpful 14 41.2%

Neither helpful nor unhelpful 2 5.9%

Fairly Unhelpful 0 0%

Very unhelpful 1 2.9%

Over 91% of those who had received training in this age group report that it was at

ast ‘helpful’ or ‘very helpful’. le

137

4.4.10 What Made Mobility Training Possible?

eing trained, 105 answered this question. The answers give

.

ge group.

able 4.53 Rank: ade it e to Choo ning?

An open ended question “What Made Mobility Training Possible?” was asked of the

156 who reported b

some indication of the variety of triggers for training reported by the respondents

Comments were themed and ranked. The following table presents a summary of the

routes to training for the ‘under 65’ a

T What m Possibl se this TraiUnder 65 age group N=156; n=105

Rank Comment

1 Self initi .14%ated 39 37

2 NCBI/Community 32 30.47%

Resource staff

3 Took education abroad

15 14.29%

4 Social worker 8 7.61%

5 Then lived abroad 7 6.67%

6 IGBD 4 3.8%

The most frequently mentioned comment was that the person has initiated the

request him/herself with 37% (n = 39) reporting this. NCBI initiation was reported t

next most frequent source with 30.47% (n =32). The category of ‘Social Work’ may

he

refer to the NCBI staff member, as historically this was the term used for the

community resource worker. It is interesting that over 20% reported receiving their

training abroad.

With regard to the Over 65 age group, 27 of the 34 who had received training in

mobility explained how they had got involved and these are ranked in the following

table.

138

Table 4.54 Ranked Answer for What made it possible to choose this g? Over 65 age group N=34; n=27 trainin

Rank Comment

1 37.03% NCBI Community 10

Resource worker

2 Self Initiated 9 33.33%

3 Social Worker 4 14.81%

3 Other Health Professionals

4 14.81%

to

4.4.11 Mobility Training Offered but not Accepted. (Q. 9b)

ported that they declined an offer of training were asked why. In

cipants reported declining offers because considered

t they were ma such input. In the ov 5’s age

up, a total of fi ported declining various forms of mobility training,

pressed similar

4.4.12 (Q. 9c)

asked about waiting for training. There were only 8 participants waiting

r training, with the longest waiting time at 18 months. This was related to personal

Although over 66% had training recommended to them by others, it is interesting

note that at least 33% had initiated training themselves. It may be that these sought

training at a younger age.

Participants who re

the Under 65 age group, 9 parti

tha naging sufficiently well without er 6

gro ve participants re

ex reasoning as not needing it.

Waiting for Training

Question 9cfo

circumstances rather than unavailability of training.

139

4.4.13 Consideration of Mobility Training (Q. 9d)

Of the 342 who had not received training, 335 replied to a question about

considering training.

Table 4.55 Consideration of Mobility Training N=342; n=335

Under 65 (N=159)

Over 65 (N=176)

Total

Yes 22 13.8% 14 7.95% 36 10.75%

No 137 88.3% 162 92.04% 299 89.25%

Total 159 100% 176 100% 335 100%

th 88% of the

)

sked in what circumstances they would consider

training. The data is presented below regarding the small numbers of those who

4.4.14 Under 65 Age Group – Have Considered Mobility Training

bility

Almost 90% (n = 299) reported that they would not consider training, wi

younger age group and 92% of the older age group. The 36 respondents (10.75%

who answered ‘yes’ were then a

would consider training in each age group category. Following this the data

regarding those who have rejected the idea of training is elaborated.

Of those 159 participants within the Under 65 age group who have not had mo

training, 22 reported that they would consider such training. Only 12 of these stated

reasons for considering training as ranked in the table below.

140

Table 4.56 Have Considered Training Comments Under 65 N=22: n=12 Rank Comment

1 To enhance general 4

mobility 18.18%

2 Increasing independence

3 13.64%

3 If sight decreases 3 13.64%

4 With more information 2 9.09%

re training options

Total 12 54.55%

Four participants acknowledged considering different forms of mobility training in

order to enhance their general mobility when out and about. An example of one is:

According to three other participants, consideration was given to possible future

ple of this is as follows:

Two participants highlighted a lack of knowledge with regards to possible training

out there”

“I am considering using a cane and getting training for night-time mobility”

training as a means of increasing their independence and confidence when

mobilising within the physical environment. An exam

“I’ve considered mobility training to give me more confidence when I’m out, for

choosing public transport and getting places on my own.”

Consideration of training to enhance one’s ability to get around was described by

three other participants, with particular reference to their potential future sight loss, “I

will have to consider it at some point as my sight decreases”

options.

“I don’t know what’s

141

4.4.15 Over 65 age group – Have Considered Mobility

9 gave comments.

in the table below:

5 N=14: n=9

Training

Of the 187 participants (81.6%) in the over 65’s age group who have not had

training, 14 stated that they had considered mobility training, and

The most commonly reported reasons for considering such mobility training are

detailed

Table 4.56 Have Considered Training Comments Under 6Rank Comment

1 To enhance 5 35.71%

general mobility

2 Considered, but

preference for

guide dog training

2 14.29%

3 If sight decreases 2 14.29%

Total 9 64.29%

Five participants reported having considered such training as a means to improve

e cane training for when it’s dark”

r future sight loss.

ining “I would think of getting training from the Irish Guide Dogs for the

their ability to get around when mobilising outdoors,

“[I’ve considered] the whit

Two described consideration of mobility training in terms of a potential eventuality

dependent on thei

“My sight fluctuates so would consider if it dis-improved again”

Another two participants within the over 65’s age group identified their preference for

guide dog tra

guide dog training.”

142

4.4.16 Reasons for Not Considering Training

The 299 who have not considered mobility training were invited to give reasons, responses

were given by 298.

Table 4.58 Mobility Training: Total Sample Reasons for not Considering training N=298

Under 65 Over 65 Total Sample (n=137) (n=161) (n=298)

“I don’t need it” 67.79% 94 68.61% 108 67.08% 202

Other answer 43 31.39% 53 32.91% 96 32.21%

Total 137 100% 161 100% 298 100%

Almost 68% of those who answered considered that they do not need training. There

was no difference in the responses related to age group. Comments related to this

question are presented on the table below by age group.

4.4.18 Under 65’s – Have not Considered Mobility Training

Of those 156 participants within the Under 65 age group who have not had received

d

y 98

any mobility training, 137 of these reported that they had never considered getting

such training. Over half of these participants (55%) stated that they “don’t need”

mobility training, however other reasons were also given, all of which are presente

in the table below. From the 137 who said that they did not need training, onl

made further comments. The table below presents these comments in rank order.

143

Table 4.59 Comments Why Not Consider Mobility Training: Under 65 N= 98 1 “Don’t need” managed without, had support.

Had other difficulties that affected mobility 74

2 Not offered so didn’t consider 10

3 Never thought about it 8

4 Not beneficial 6

Total 98

4.4.19 Over 65’s – Have not considered Mobility Training

Amongst the 176 respondents within the over 65 age category who have not had

training, 162 (92%) report that they would not consider it. Only 74 made comments in

relation to why they had not considered such mobility training are ranked in the table

below:

Table 4.60 Comments Why Not Consider Mobility Training Over 65 N= 74

1 “Don’t need” – Had support 37

2 Not beneficial 15

3 Other mobility difficulties 12

4 Just never considered it 10

Total 74

Most of the comments were that participants considered that they didn’t need training eith

because they can manage themselves, or have support from others. Ten participants stated

that they just never considered it, and 12 had additional mobility difficulties. Three wanted to

rely on themselves and be independent.

er

144

4.20 Summary re Training

Almost 82% of the older age group never had training and 47% of the younger age

group. A greater percentage of the most vision impaired participants (Cat.1 sight

e who did not receive training considered that they did not need

it, in spite of reported difficulties and dependencies on a sighted guide.

Section 4.5 Obstacles to Mobility in the Environment. (Q. 10)

“What are the things that make getting around hardest for you?”

A more general and open ended question was asked about the ‘things that make

getting around hardest for you’

Fifteen of the Under 65 age group reported no specific problems, and 30 of the Over

65 age group stated that they had no problems as they rarely went outside their

homes unaccompanied.

A total of 556 (98.58%) participants made comments regarding access issues they

experienced, which have been themed into categories related to; the outdoor

physical environment; the indoor physical environment used by the public; and the

social environment and these are presented in the following sections of this report.

4.5.1 Outdoor Physical Environment

The factors affecting mobility outside the home in the physical environment included

obstacles on pavements (N=90) such as overhanging bushes, ‘wheelie bins’ and

cars parked on pavements, uneven or broken pavements (N=88), street furniture

(N=34), and unexpected obstacles in the familiar environment such as road works

(N=25). One such comment highlights the danger inherent in such obstacles:

category) had received training. Those who had received training considered it as

‘helpful’ or ‘very helpful’. All types of training were perceived as ‘helpful’, or ‘very

helpful’ by 100% of the trainees for IGDB and St. Joseph’s training courses.

The majority of thos

145

“Parked cars on footpaths, close to the walls, you need to go out onto the road to get

Reference was made to the negative effects of the recent increase in use of outside

reas on the pavement.

Difficulties crossing the road were described by 70 participants and arose from

changed when they don’t have any sound”

y

ey

at

gnising

and

ere

ore you get to

where you’re going”

around them”

smoking areas and eating a

various issues including: the varied height of curb-sides, the lack of audio signals at

traffic lights, as well as unexpected bicycles driving through road crossings, all of

which made mobility difficult and stressful.

“Don’t know when the lights have

Steps (N=117) especially badly lit steps or those lacking colour contrast were

mentioned specifically as being a hazard.

“There should be a lot more markings on steps on the bottom or top. I’d be very

unsure…I have a fear of falling”

Levels of light, both natural and artificial, indoors and outdoors were similarly

described as impacting mobility by 99 participants.

“I would not go out in the dark, have to be very cautious…it’s very debilitating”

“The sun shining bright- make things very difficult”

Public transport, including the lack of it, was cited as a difficulty in getting about b

68 participants. Those who lived in rural areas had to depend on others as th

could not drive themselves. Taxis were considered expensive, though useful, in th

they brought one from door to door. Using buses, getting on and off and reco

numbers was considered problematic. The lack of audio information on trains

dart services indicating stops and destinations made travelling difficult.

“The fact that public transport doesn’t necessarily leave you at the door of wh

you’re going, therefore there might be more obstacles in the way bef

“Transport is inaccessible. It’s 1.5 miles walk to the nearest bus”.

146

4.5.2 Indoor Physical Environment

According to 82 participants, indoor areas used by the public such as train stations,

out

r

on

others to get around

ay

“I have to sit in the chair … and wait for somebody to be there to help. [It’s] very

rd”

s

of others towards them when moving around outside, such as making way in crowds

or assisting with access.

think it’s the lack other people’s awareness- you look perfect…people don’t quite

ities

airports, shops and shopping centres were highlighted as difficult to navigate with

the appropriately placed, colour contrasted and well lit signage:

“Information monitors up at a height are difficult to read, especially those in the

airport”

“Signs in public places not visible enough- not at eye level and not good colou

contrast”

4.5.3 Social Environment (N=57)

Eighteen participants made comments about their dislike of having to depend

“The fact that I can’t see properly and always need someone with me…it] takes aw

my independence”. Another commented:

“It’s not good for the self esteem to be always relying on somebody”.

ha

Twenty participants reported their views on the lack of awareness and unhelpfulnes

“I

know what to do”

“The disabled sign should not be a wheelchair, it should be a ‘D’ in a circle or

something, as people often have a problem with blind people using disabled facil

as a result”

Only two participants made positive comments about a helpful public.

147

Some acknowledged that it was personal factors such as confidence that influenc

their ability in tacking the challenge of mobility outside the home, and being abl

overcome the fear of falling. An example of this is:

“It’s mostly my own anxiety- am I going to look stupid?”

However most of the comments considered that factors inherent in phy

environment as reported above that made moving about difficult.

In the following chapter, the discussion will highlight some of the key findings

ed

e to

sical

of the

and conclusions.

criteria for the NCBI

atabase and were registered blind, 59% (n = 333) of the sample were aged from 18

age for the older age group was 78.5

ues and aids;


they face with regard to mobility. The results are examined by age group (older age

group mean age, 78.5; younger age group mean age, 45) and by gender.

The results of the study identified that mobility is a critical issue for participants, even

in moving around their local area. Only 46.8% of the younger age group indicated

that they had ‘no difficulty’ in moving around in their local area while 36% of the older

age group and 25.4% of the younger age group ‘never go out without a sighted

guide’.

study, and make recommendations

Section 4.6 Summary

The study sample comprised of 564 people who met registration

d

to 64 years and 41% (n =231) aged between 65 to 100 years. The mean age for the

younger age group was 45 years and the mean

years. Almost 53 % of the population was female and 47% were male. The total

number of people registered as blind on the NCBI database was 9758 people (NCBI,

2008).

This study is one of the first surveys dedicated to the exploration of the perceptions

and experiences of mobility carried out in Ireland with vision impaired adults on the

NCBI database. It describes their perceptions and experience of mobility such as

moving around their home, their local area, and busy unfamiliar areas; their

experience of vision loss and co morbidity; their use of mobility techniq

148

The two age groups differ in their experience of vision impairment. Only 11 people

(4.76%) in the older age group indicate that they had ‘no useful vision’ as compared

to 76 almost 23% of the younger age group. The eye conditions experienced also

differ with the majority of those in the older age group having age related sight loss

(41% had macular degeneration, and 14% had glaucoma). Co morbidity with vision


59% of the older age group and 29.5% of the younger age group reported co

morbidity.

Although the literature considers training in orientation and mobility techniques is an

essential resource for blind and vision impaired people, only 1 in 2 of the younger

age group and 3 in 20 of the older age group reported having participated in any sort

f training. However those who are the most vision impaired had the highest uptake

ining.

nts

that they considered that training was not relevant to their situation for

arious reasons, such as not needing it as they relied on a sighted guide, and/or that

o asked about orientation and mobility techniques

sed (such as of residual vision and hearing, sighted guide, and other). Just 28.8%

f the total sample (n =162) reported using mobility aids related to vision impairment,

comprised of 18% of the total sample (n = 102) using the long cane, 5.5% (n = 31)

n

up,

cane, and 8% (n=19) use a symbol cane.

Only two (0.9%) of the older group use a guide dog. It is interesting to note that 25 in

the older age group (11%) use mobility aids related to their physical disability such

as walking stick/frame /wheelchair.

o

of mobility training, and they reported very high satisfaction rates with this tra

The majority of respondents did not have training. When asked why not, participa

reported

v

their other health difficulties affected their perceived usefulness of training.

Participants were asked about their use of mobility aids (such as long cane, guide

dog, symbol cane, or ‘other’ aids related to co-morbidity of physical disability e.g.

walking frame). They were als

u

o

the symbol cane, and only 5.1% (n = 29) use a guide dog. With regard to orientatio

and mobility techniques used to get about the local community, almost 24% (n =79)

of the younger age group use residual vision and hearing. Almost 20% (n=66) of this

younger age group report using no technique or aid with nearly 11% (n=36) reporting

their reliance on a sighted guide as their primary technique. For the older age gro

almost 35% (n =80) use residual vision and hearing, just under 12% (n=27) use a

sighted guide only, 9% (n=21) use a long

149

When asked “What are the things that make getting around hardest for you?” Poor

of the built environment and of public services, such as transport, were the design


The results of this study highlight the poor uptake of training as and when offered

and the associated low use of mobility aids particularly by those with co morbidity

and partial sight, the majority of whom are elderly. Further exploration using

qualitative methods would allow in depth exploration of attitudes and expectations of

improved mobility.

150

Chapter 5: Discussion and Recommendations

impairment to mobility greatly affects the quality of life (Montarzino et al,

l

ities for social participation. The impact of restricted mobility experienced by

those with vision impairment can be considered from the perspective of limiting full

particip

results

physical, and attitudinal barriers they meet for example in service provision such as

education, transport, health and the built environment. The literature reports that

ity

n

increasing dependency on friends and family. (Gallagher et al, 2010).

cGwin

s

5.1 Introduction

Currently, there are an estimated 30,000 blind and vision impaired individuals in

Ireland, and this is projected to increase by more than 170% over the next 25 years

as the population ages (Jackson & O’Brien et al, 2008). This study is one of a few

that explores the perceptions and mobility experiences of blind and vision impaired

persons with an Irish population.

There is consensus in the literature that mobility is an important part of everyday life,

and that

2007, Blasch, Weiner & Welsh 1997, Hersh & Johnson, 2008, Turner, 1998). Socia

integration and social networks are associated with positive health experiences for

people with disabilities (Berkman and Glass, 2000). Reduced mobility limits the

opportun

ation in community and society and as a restriction of human rights. Disability

from the interaction between persons with impairments and the social,

in

people with vision impairments encounter serious issues of immobility and severe

problems with transportation and access to goods, services and other commun

amenities (Montarzino et al, 2007; Hersh and Johnson, 2008; Turner, 1998).

Participants in a recent Irish study of people with vision impairment in Northern

Ireland and the Republic of Ireland reported their experience of challenges to

mobility, poor access to public transport, and a perceived absence of public

awareness about vision impairment. The lack of accessible transport created a

Visual acuity itself is not an accurate indicator of mobility status. Owsley and M

(2007) state that measures of eye disease severity should not be used as surrogate

151

for the personal burden of eye disease and vision impairment, as individuals make a

This st

vision lected and age stratified from the NCBI

ational database of people registered as blind in Ireland. The study sample

hat

s 78.5 years.

lmost 53 % of the population was female and 47% were male. The total number of

people registered as blind on the NCBI database was 9758 people (NCBI, 2008).

imal/1.0 logMAR) in the better eye, or a field of

vision limited to a widest diameter of vision subtending an angle of not more than 20

e on

er &

personal response to and cope with their condition in wide ranging ways.

udy reports on the perceptions and experiences of both younger and older

impaired Irish people, randomly se

n

comprised of 564 people, 59% (n = 333) of the sample were aged from 18 to 64

years and 41% (n =231) aged between 65 to 100 years. Age stratification was used

to ensure that the younger age group were well represented in the results, and t

the needs of both groups could be compared. The mean age for the younger age

group was 45 years and the mean age for the older age group wa

A

The statutory definition of blindness in Ireland is visual acuity (VA) corrected with

glasses of less than 6/60 (0.1 dec

degrees (NCBI 2008). This report presents the personal experience of participants in

order to inform responsive service planning. More specifically, it reports on:

• the perceptions of their mobility in the home, their locality, and beyond

• the frequency with which they move about in the various environments

• their views on what the most significant issues are in relation to access

• their use of mobility techniques and aids; and

• their views on, and use of, mobility training.



For the purpose of this study and in keeping with definitions used in literatur

vision impairment, mobility is defined as “the ability to move oneself without coming

to any harm” (Stone, 1997, p.10), or alternately as, "the ability to move

independently, safely and purposefully through the environment" (Blasch, Wein

Welsh, 1997, p.1). In terms of independent movement and travel within one’s

environment, mobility is coupled with orientation “which involves having an

152

awareness of space and an understanding of the situation of the body within i

(Stone, 1997, p. 10; McAllister & Gray, 2007), or "being aware of where you are

where y

n it”

,

ou are going, and the route to get there" (Gargiulo, 2006, p.504). Marron and

solving techniques, planning and making

ature and the results of the interviews. Recommendations

ead in the context of the findings of the entire report.

age group scored themselves in the ‘very well category’, while

he combined categories of ‘Fairly badly’ and

Bailey (1982) describe successful orientation and mobility as the ability to “travel

safely, comfortably, and independently” (p. 413). The literature reports that

successful orientation and mobility training involves a lot more than the use of a

ane, such as problem guide dog and long c

the best use of residual vision and hearing (Perla and O’Donnell, 2004).

Findings and Recommendations

The findings and recommendations presented in this chapter reflect an analysis of

the international liter

should be r

5.2 Difficulty in using local area

In this study of 564 people with vision impairment from the NCBI database were

asked “How well do you think that you get around?” with 561 replying. Only 19.03%

(n =63) of the younger

12.8% (n =39) scored themselves in t

‘badly’. In the older age group, 12% (n=28) indicated in the ‘very well’ category and

17.7% (n=41) in the combined categories of ‘Fairly badly’ and ‘badly’. Of the total

sample, the majority of participants in both groups, 55% (n =309) reported that they

experienced ‘some’ and ‘significant’ difficulty in using their local area.

153

46.80%42.20%45.00%

50.00%

Fig 5.1 Level of Difficulty in Local Areas Under 65 & Over 65

31.20%

39.10%

35.00%40.00%

22%18.70%

5.00%10.00%15.00%20.00%25.00%30.00%

0.00%

No Difficulty Some Difficulty Significant Difficulty

Under 65

Over 65

Almost 90% (n = 501) reported experiencing difficulty when using busy and

nfamiliar areas. Little difference in the responses between the age groups was

of the total sample reported going out in their local areas ‘most

ays’, with the remainder going out less frequently than this. A higher percentage of

u

noted.

Only 51% (n=288)

d

the younger group (60.1%, n = 200) went out more frequently than members of the

older cohort (38.1%, n = 88).

154

Fig. 5.2. Frequency of Using Local Areas Under 65 & Over 65

n=56360.1

6070

9.12.7 2.7 0.3

15.6

3 6.10.43

01020

Yes, mo

25.4

38.1 36

304050

stdays

Yes, morethan once

Yes, mostweeks

I try toavoid it

Never,unless I

NeverLeaves

a week have asightedguide

Home

Under 65%

Over 65%

The above results demonstrate that mobility is an issue for the study sample, with

the younger age group displaying a pattern of restriction not normally associated w

those in this age group. However the results are similar to other studies reported in

the literature. Research carried out by RNIB (1995) in the United Kingdom found t

59% of respondents never went out alone due to difficulties with mobility and in

accessing public transport. As a consequence participants frequently cons

themselves to be isolated and excluded.

5.2.1 Recommendation: A pilot project with each age group using the PersonEn

ith

hat

idered

vironment Occupation Model (PEO) (Law and Baptiste,1996) may

obility.

d

cupation Model

guides examination of the dynamic transactional relationships between the person,

such a

well as the barriers or supports in the physical, social, and cultural environment from

improve m

The results of this study show that mobility and participation in the local community

and society is restricted for both age groups in the study sample. It is recommende

that service providers for vision impaired people explore issues of access in ‘local

areas’ for the target pilot study group. The Person Environment Oc

the environment, and the activity exploring how this influences performance of a task

s moving about the community. It identifies the person’s ability and skills, as

155

the individual’s perspective. The model’s flexibility and simplicity facilitates its use in

-

ty in unfamiliar areas.

5.3 Younger and Older Age Groups Differ in Many Ways

re

orize themselves into one of three

ategories; Cat 1,”No useful vision”; Cat. 2, “Little residual vision”; and Cat. 3,“Good

, only 11 people (4.76%) in the Over 65

age group categorised themselves as having ‘no useful vision’ (Cat. 1), in

comparison to 76 (22.96%) of the younger age group who categorised themselves in

this way.

Over 41% (n = 94) of the older age group indicated that their eye condition was

macular degeneration in contrast to 5.14% (n=17) in the younger group who had a

wide range of eye conditions.

There is also a contrasting pattern of duration of sight loss, with 34.86% (n = 114) of

the younger age group with sight loss since birth, and only 5.58 % (n = 13) in the

older age group. A further 11.9% (n=39) of the younger group have sight loss since

childhood. In contrast, 55% (n=127) of the older group (mean age of 78.5 years)

o

ed

all settings (Stewart et al, 2004). The application of this model may result in the up

skilling of the person for mobility in their local area, the adaptation of the physical

and social environment, and adjusting or changing the demands of mobility by

providing supports for the person.

With regard to younger people, issues affecting use of ‘unfamiliar areas’ by a sample

of this population can be explored from the PEO model in a pilot project to identify

what factors would equip the person, or what changes are required in the

environment to enhance mobili

As the NCBI database is predominantly aged over 65, and it was expected that the

may be differences between younger and older people, the study sample was age

stratified to ensure that the perceptions of the younger people with vision loss were

recorded. Participants were asked to categ

c

residual vision”. With regard to level of vision

have lost their sight in the last ten years. They have had to make accommodations t

this loss in early old age, as well as managing other health, disability and age relat

issues.

156

Other age related differences in the numbers of participants from each group wh

received mobility training. Almost 82% (n =186) of the older age group reported that

they never received training. This contrasts with 47.6% (n=156) in the younger age

group.

o

together with the variance in duration of

and training processes for older persons are different

cited previously (Montarzino et al., 2007) that reported 68% of its

study sample aged over 61 years had one or more additional disabilities.

py and physiotherapy inputs is recommended for those with more complex needs related to vision

h

5.3.1 Recommendation: Younger and older age groups of people with vision impairment should be considered as having different profiles of need.

Further investigation to identify and to meet the mobility needs of the different groups

of people with vision impaired should be explored. Considering the high level

morbidity, the differences in eye conditions,

sight loss, the mobility needs

to the needs, abilities, and lifestyle expectations of the younger age groups.

5.4 Managing additional health and disability factors

The level of co-morbidity reported in the younger age group was 29.5% (n=97) and

in the older age group was 59% (n = 135). This finding is in keeping with the

Edinburgh study

5.4.1 Recommendation: A multidisciplinary perspective that includes specialist occupational thera

impairments and co-morbidity.

Considering the high levels of co-morbidity in both groups of people with vision

impairment, the individual’s lifestyle expectations, strengths, and resources should

be considered in developing a personal plan for addressing mobility needs and

closer links should be established between all disciplines and agencies charged wit

the care of vision impaired individuals who have complex needs.

157

5.5 Reliance on a Sighted Guide for Accessing Local andBusy/Unfamiliar Areas

In the Under 65 age group, 25.4% (n = 84) reported that they “Never” go out without

hers for their mobility. These results are similar to the Edinburgh study

(Montarzino et al., 2007) with people aged over 61 years, one third of whom did not

ing

ly

Sugiayama and Ward Thomson (2007) in their study of 318 people over 65 years of

a

age,

e n

’s

and

independence as part of a broader understanding of mobility for community

participation.

a sighted guide even in their local area. Thirty six percent of the older age group (n=

84) reported this also. With regard to using busy and unfamiliar areas, this rises to

47.9% (n =159) of the younger age group who reported that they “Never” go out in

busy and unfamiliar areas without a sighted guide. The older age group (mean age

78.5 years) 35% (n = 84) reported that they never go out in their local area without a

sighted guide and the vast majority, 63% (146) never used a busy and unfamiliar

area without a sighted guide. These results highlight the dependency of this age

group on ot

go out alone even in their local area. This study also reports that feelings of be

unsafe were more predominant at night and in unfamiliar locations. Alternative

familiarity with surroundings was identified as encouraging independence.

age in Great Britain found that supportiveness of neighbourhood environments was

significant predictor of older people’s walking activity regardless of their

gender, living arrangements, education former occupation or functional status. It has

been recognised in the literature that other factors beyond task difficulty, including,

autonomy, self efficacy and a sense of control over one’s actions and affairs

influence how challenges in managing disability are addressed (Wiggins et al.,

2005).

Recommendation: Service delivery agencies should be cognisant of thindividual’s belief about their self efficacy (Bandura, 1998) and motivatiofactors for independent mobility.

The problems presented by co-morbidity offer additional challenges to the person

self belief. Health and social service agencies should support individuals in

identifying opportunities in their local areas and in their daily life for autonomy

158

5.6 Low Level of Expectation of Independence in Mobility

The results of this study should be interpreted in the context of the following:

1. I tering with NCBI

has an as

appropriat

2. As part of the process of developing valid content for the questionnaire, staff from

s

and

he total number of participants (N=564) were asked the question “Have you ever

=299)

ported that they would not consider training, comprising 88% (n=137) of the

younger age group and 92% (n=162) of the older age group.

When asked why would they not consider it, sixty eight percent (n=202) of these

participants considered that mobility training was not needed. The remainder gave a

t is a procedure employed by NCBI that each person when regis

sessment of need and mobility training is offered by trained staff, where

e.

NCBI and Irish Guide Dogs for the Blind as well as people with vision impairment

gave advice on the use of language they thought most suitable for asking question

about ‘mobility training’ options. These options included training from staff in the

person’s home on the use of residual sight and other senses through orientation

awareness; formal training in the use of the long cane and guide dog; and orientation

advice from family and friends.

T

had training or advice to help you move around more safely?” with the option to say

“Yes, and I used it”; “Yes, but didn’t want it; “I am awaiting training”; and “No”.

Replies were given by 556 participants. Even with these category options, only 34%

(n=190) of the respondents (n =556) reported that they received any type of training

input. Over 61% (n = 342) reported that they had not received training, and 10

(1.79%) were waiting on training, only 14 (2.51%) reported that they had refused

training. Formal training in the use of the long cane and guide dog was reported by

only 131 (23.2%) of study participants.

Those who had not received training (n=342) were asked if they had considered

training to help get around safely, of these 335 replied. Eighty nine percent (n

re

159

variety of reasons, the most frequently reported one was that they had managed

without it and that they had support.

t

r

airly well’ categories.

to this

. There may be a difference in perception held by the person with vision

impairment and NCBI staff as to what mobility training involves, such as that it is

,

However, those who have had training, (this includes almost 83% (n=72) of the mos

severely vision impaired participants), reported a high level of satisfaction with thei

mobility training.

Only 29% of the total sample reported that they use either a guide dog (n=29; 5%) a

long cane (n=102; 18%) or a symbol cane (n=31: 5.5%) for their mobility.

When comparing the reported satisfaction levels between those who used a long

cane, guide dog and a sighted guide, notable differences were found. Almost 83% (

n=24) of guide dog users scored themselves in the “Very well” and “Fairly well”

categories of perception of mobility in contrast to only 30% (n=19) of those who use

a sighted guide. Fifty three percent (n = 54) of long cane users scored themselves in

these ‘very well’ and ‘f

Recommendation: The low rates of acceptance of the offer for mobilitytraining should be further explored.

A further in depth examination of this poor uptake is recommended. Factors related

to the timing, the manner of the offer by NCBI and psychological factors related to

the new disability status of the person applying for registration may contribute

poor uptake

more than the guide dog and cane. This in depth examination may best be achieved

using qualitative methods with participants from both age groups.

5.7 Environmental Factors Continue to Impede Ease of Mobility

In spite of requirements for universal access in the design of public space and

buildings in Ireland, when asked about the things that make getting around hardest

160

556 (98.58%) of participants commented on access issues related to the outdoor

and indoor public physical environment and the social behaviour and attitudes of

others. This is similar to the findings in previous studies such as (Montarzino et al.,

2007; Marston and Golledge, 1997), Participants reported problems with uneven

pavements, obstacles on pavements such as ‘wheelie bins’ and smokers behaviour

of congregating on the pavements outside pubs and restaurants, road crossings,

levels of light, recognising bus numbers and difficulties with public signage. As one

participant said “I think it’s the lack of other people’s awareness, you look

perfect...people don’t quite know what to do. The disabled sign should not be

wheelchair… people have a problem with blind people using disabled facilities as a

result.”

Blasch, et al., (1997) argue that the public can have a significant effect on the

mobility of vision impaired people by restricting access by their presence or actions

or simply by reacting in ways that may stigmatize th

s

a

e traveller. In Kirchner et al.’s

Recommendation: The impact on mobility caused by the design of facilities and services need to be redressed specifically for a people with

d co-morbidity.

n

with

d demonstrated to the general public as part of a

disability information strategy.

(2008) study, 53% of guide dog users, and 46% of long cane users reported that

they found the attitudes of the public a barrier to physical activity.

sight loss an

The public’s understanding of the impact of sight loss should be enhanced. With

regards to addressing the need to improve public attitudes and behaviours, national

agencies should embark on a programme of awareness of what it means to be visio

impaired, in particular providing an understanding of low vision/partial sight. The

impact of not recognising faces, bus numbers and public information should be

explained. The public should be made aware that many people who are legally blind

maintain some residual vision. Ways of including and helping low vision/people

sight loss should be explained an

161

5.8 85% of Study Sample are Partially Sighted

Only 15% ( n= 87 ) of the study participants indicated that they had no useful vision

(Cat. 1) and they differ from the rest of the ‘little residual vision’ (Cat. 2) group and

‘good residual vision’ group (Cat. 3) in th

at they tend to be younger and have had

mobility training. More of them use mobility aids in comparison to older people who

sion and partial sight.

Figure

have decreasing vi

5.3. Categories of Sight Loss. (n=562)

15%36%

49%

Figure 5.3. Categories of Sight Loss. (n=562)

15% = No useful vision; Cat 1

36% = Good residual vision; Cat 3

Eighty

the you

83% (n=72) of these most severely vision impaired participants (Cat. 1) had received

obility training. This contrasts with 26% (Cat. 2 group: n=71) and 23% (Cat. 3

gro : . Of the

29 guid g

cane, 8

uptake of mobility training, and reliance on h ed (94.7% ired. There is a specialist role for the

ational agencies such as the NCBI and IGDB as to how the needs of this older group of partially sighted people can be met so as to maintain their well being and social connectedness.

49% = Little residual vision; Cat 2

seven percent (n=76) of those in the Cat. 1 “No useful vision” group were in

nger age group and only 13% (n=11) were in the older age group. Almost

m

up n=46) of those in the other vision categories who had received training

e dog owners, 27 were in the younger age group. Of the 102 who used a lon

1 were in the younger age group.

Recommendation: In light of the low ot ers for mobility, a greater focus on the needs of the partially sight

; n=220) older age group is requn

162

Suppothis age group (n = 135) have additional health and disability needs that also

pact on mobility. As older people are entitled to and participate in health and soc l to take loss o g and delivering any health and social service to

lder people.

5.9 Related Sight Loss

(O’ n

The lite

depen anxiety. Goodman (1989) stated that fear is one of the most

ommon psychological barriers and that it is the one that interferes the most with

mo it ge and

residua s

study ( hat it was overestimation of risk rather than

egree of vision that had an impact on the mobility of vision impaired people.

Howev

when a

life, an itz and Reinhart, 1998. Cited

in Ben-Zur & Debi, 2005).

Recom ut possible sight loss and its impact on mental health in at risk groups and

dividuals, and make appropriate referral to the national voluntary agencies for sfor ma es, particu ice users. Psychological and practical strategies for

rt and guidance re vision impairment must take into account that 59% of

imia services agencies to a greater extent than others, these agencies need

advice from the specialist agencies in making accommodations for thef vision when designin

o

High Levels of Psychological Distress Associated withAge

Do nell, 2005; Travis et al; 2004, Horowitz, 2004; Wahl et al, 1999).

rature reports that high levels of distress include depression, fear,

dency, and

c

bil y (as cited in Griffin-Shirley et al., 2006). Feelings of safety along with a

l vision were seen as the main restrictions on mobility in Montarzino et al.’

2007). Pelli (1986) suggested t

d

er psychosocial factors associated with sight loss and functional disability

ddressed, can increase functional ability, self esteem and satisfaction with

d lower a person’s depressive symptoms (Horow

mendation: All health and social services should be vigilant abo

in vi ion impaired people. Information about national agencies and resources

naging sight loss should be available in all health and social serviclarly for elderly serv

163

co gare no

5.10

Countries for Those with Sight Loss and Co-morbidity

In c j

specia

multidi nt and

o morbidity (Copolillo et al., 2007). In collaboration with the person with sight loss,

stra g

used to of life. Working with people

ith low vision who have complex health needs is now considered as a specialist

are n

(Warre and and the United

ingdom it is not. “Research shows that occupational therapists need more than a

gen a tive

suppor

approp hat occupational therapists have all the necessary skills”

cGauran, 2010). The American Occupational Therapy Association has highlighted

sig lo

ecommendation: Education of occupational therapists in Ireland should add s ith low vision

pin should be offered when changes in relation to irreversible sight loss ted.

Occupational Therapy Deemed Effective in Other

on unction with and in support of other professionals in services for vision loss,

list occupational therapists can make a particular contribution to

sciplinary working to lessening the combined impact of vision impairme

c

te ies for environmental adaptation, skill training, and activity modification are

improve independence, autonomy, and quality

w

a i occupational therapy in other countries such as the United States of America

n, 1995), Australia and the Netherlands. However in Irel

K

er l awareness of sight loss and its implications if they are to deliver effec

t to people with sight loss. Specialist training at post graduate level would be

riate to ensure t

(M

ht ss as a priority area of unmet need by occupational therapy services.

Rre s the needs of those with sight loss, particularly older people w

and co- morbidity.

164

5.1

Horowitz (2004) describes vision impairment as being one of the most commonly

verlooked and untreated conditions. The results of this Irish study show that this

stu p

restricted i

related sight loss and impairment is expected.

familia public health challenges that need to be addressed urgently (Dahlin

Recom the in ial service staff.

hose with age related sight loss have additional health and disability issues, and a multid tate and vo ices for older people should be designed nd delivered to include service users with vision impairment as part of

nat nessenbenefi ve health and social gain, nd reduce dependency on carers and family by those with low vision

5.12

his study is one of the first surveys dedicated to the exploration of the perceptions

and xperiences of mobi

NCBI d

moving

erience of vision loss and co morbidity; their use of mobility techniques and aids;


1 Sight Loss a Leading Cause of Loss of Independence Among People Over 65 (Alliance for Aging Research, 1999)

o

dy opulation already have additional health related needs and that most are

n their mobility. With an aging population, an increase in chronic age

This can result in significant personal,

l and

Ivanoff et al, 1996).

mendation: Addressing the needs of vision impaired people requiresvolvement of families, communities and health and soc

T comprehensive approach to meeting their individual needs in a

isciplinary approach is required (Eklund et al, 2004). In addition, all Sluntary social and health serv

aio al policy and practice. The development of a National Vision Strategy is

tial in advancing this holistic approach. Such a strategy would provide ts by investing in services which would impro

a

Summary

T

e lity carried out in Ireland with vision impaired adults on the

atabase. It describes their perceptions and experience of mobility such as

around their home, their local area, and busy unfamiliar areas; their

exp

165

the a

group y gender.

ied that mobility is a critical issue for participants, even

in moving around their local area. Only

that th r

age gr r go out without a sighted

The tw impairment. Only 11 people

.76%) in the older age group indicate that they had ‘no useful vision’ as compared

to 7 a

differ w ss

1% had macular degeneration, and 14% had glaucoma). Co morbidity with vision


59% o

morbid

Althou ders training in orientation and mobility techniques is an

ssential resource for blind and vision impaired people, only 1 in 2 of the younger

age r ort

of train most vision impaired had the highest uptake

d they reported very high satisfaction rates with this training.

Partici d training as not relevant to their situation

r various reasons, such as not needing it as they relied on a sighted guide, and/or

tha .

Partici (such as long cane, guide

og, symbol cane, or ‘other’ aids related to co-morbidity of physical disability e.g.

walk

used ( 8.8%

of the total sample (n =162) reported using mobility aids related to vision impairment,

= 102) using the long cane, 5.5% (n = 31)

the symbol cane, and only 5.1% (n = 29) use

and mobility techniques used to get about th

of the younger age group use residual vision and hearing. Almost 20% (n=66) of this

y f ce with regard to mobility. The results are examined by age group (older age

mean age, 78.5; younger age group mean age, 45) and b

The results of the study identif

46.8% of the younger age group indicated

ey had ‘no difficulty’ in moving around in their local area while 36% of the olde

oup and 25.4% of the younger age group ‘neve

guide’.

o age groups differ in their experience of vision

(4

6 lmost 23% of the younger age group. The eye conditions experienced also

ith the majority of those in the older age group having age related sight lo

(4

f the older age group and 29.5% of the younger age group reported co

ity.

gh the literature consi

e

g oup and 3 in 20 of the older age group reported having participated in any s

ing. However those who are the

of mobility training, an

pants reported that they considere

fo

t their other health difficulties affected their perceived usefulness of training

pants were asked about their use of mobility aids

d

ing frame). They were also asked about orientation and mobility techniques

such as of residual vision and hearing, sighted guide, and other). Just 2

comprised of 18% of the total sample (n

a guide dog. With regard to orientation

e local community, almost 24% (n =79)

166

young d, with nearly 11% (n=36)

porting their reliance on a sighted guide as their primary technique. For the older

age r

(n=27) 19) use a

ymbol cane. Only two (0.9%) of the older group use a guide dog. It is interesting to

not h

disabil

hen asked “What are the things that make getting around hardest for you?” Poor

des n


ConThis st tions of an age stratified,

ndom sample of 564 registered blind people on the NCBI database. The results

dem group

and 25 n in

their lo of 18%

(n = 102) using the long cane; 5.5% (n = 31) the symbol cane; 5.1% (n = 29) use a

uide dog. Co-morbidity was reported by 59% of the older age group and 29.5% of

the u

elderly

It is recommended that further exploration of attitudes regarding mobility be carried

out

(Dahlin

nforcement of existing legislation regarding access for people with disabilities to

goo

strateg

rms of activity and participation. Mobility is an essential construct of health, for

qua y

er age group report using no technique or ai

re

g oup, almost 35% (n =80) use residual vision and hearing, just under 12%

use a sighted guide only, 9% (n=21) use a long cane, and 8% (n=

s

e t at 25 in the older age group (11%) use mobility aids related to their physical

ity such as walking stick/frame /wheelchair.

W

ig of the built environment and of public services, such as transport, were the

clusion udy examined the mobility experiences and percep

ra

onstrate that mobility is a critical issue, such as that 36% of the older age

.4% of the younger age group ‘never go out without a sighted guide’ eve

cal area. Just 28.8% (n =162) reported using mobility aids, comprised

g

yo nger age group. Those with poor partial sight, the majority of whom are

reported most difficulty.

using qualitative methods; that specialist occupational therapists be employed

-Ivanoff and Sonn, 2004; Eklund et al., 2004) for those with co-morbidity; the

e

ds, services and the built environment; and the development of a national vision

y reflecting the W.H.O. (2001) perspective on measuring health outcomes in

te

lit of life and for active citizenship.

167

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183

Appendix 1

Interv

The qu g options. Options will be

offered if a person struggles to answer the question, and for clarification. The

es. Numbers may

not relate to any order – they are simply to categorise answers.

ad py of this.

doing the interviews, and also

draw out a decision tree, i.e. if person answers `”no” (0) to question 6, jump straight

que on.

hink you get around at the moment?

2. yo r exp ience of sight loss?

2

sidual vision 3

Do you have any disabilities, other than sight loss that make getting around

iew Schedule

estions in bold will be asked, initially, without givin

numbers will not be read out – they are simply for coding purpos

Re the questions from a hard co

Mark out comments for yourselves, as you get used to

to stion 7 c and so

1. How well do you t

Very well 5

Fairly well 4

OK 3

Fairly badly 2

Badly 1

Can you tell me a little about u er

Totally blind 1

Little residual vision

Good re

Also add in comments in excel.

difficult?

Yes 1

184

No 0

Insert

3. Now I ask you about how you move around different areas, so we w

Do yo ifficulty moving around your own home?

es 3

ome 2

one

4. Do yo your local area or very familiar areas on your own?

Yes, m

Yes, more than once a week 4

t 2

0

d local areas alone?

on your own?

Yes, most weeks 3

comment for 1

would like to ill start with your own home.

u have any d

Y

S

N 1

u move around

ost days 5

Yes, most weeks 3

I try to avoid i

Never, unless I have a sighted guide 1

Never goes out

Do you have any difficulty moving aroun

Yes 3

Some 2

None 1

5. Do you move around unfamiliar or busy areas

Yes, most days 5

Yes, more than once a week 4

185

I try to avoid it 2

Never, unless I have a sighted guide 1

Do you have any difficulty moving around busy or unfamiliar areas on your own?

Yes 3

Some 2

None 1

6. Do you use any techniques or aids to know where you are, or avoid

1

2

8

that y our own home?

0

1

2

obstacles

No, I don’t need to 0

No I just manage, but may bump into things

Use of residual vision / hearing

Symbol / guide cane 3

Long cane 4

Guide dog 5

Sighted guide 6

Mobility aid

If so, what is the main technique ou use in y

And the main technique you use in your local area?

What is the main techniques that you use in busy areas?

None, I don’t need to in this area

None, I just manage, but may bump into things

Use of residual vision / hearing

186

Symbol / guide cane 3

4

5

6

8

ch.

as answered that they may sometimes use a long cane:

Long cane

Guide dog

Sighted guide

Mobility aid

Use same rating scale for ea

7. If person h

. When do you use a long cane?

1

In local areas 2

In busy areas 3

In unfamiliar areas 4

In different light conditions (dark / light) 5

In all situations 6

What specifically do you use it for?

Finding obstacles 1

Alerting others that I am vision impaired 2

Also insert words

b. If person has answered that they use a guide dog:

a

In my home

Do you ever use a long cane?

No 0 --- go to 7 c

In my home 1

In local areas 2

187

In busy areas 3

reas 4

In different ligh

hat specifically do y use it fo

obstacles 1

erting others that I a ion impa

Also insert words

erson has answe they have never used a long cane:

In unfamiliar a

t conditions (dark / light) 5

W ou r?

Finding

Al m vis ired 2

c. If p red that

ave you ever cons using

Yes 1

0

Why?

sert words

If person has answered that they use a guide dog:

H idered a long cane?

No

In

8. a.

How do you find using a guide dog?

Insert words

What made you choose to use a guide dog?

Better mobility 1

Alerting others that I am vision impaired 2

Companionship 2

Also insert words, particularly for 1.

b. If person has answered that they do not use a guide dog:

Have you ever considered using a guide dog?

188

I used to have one but no longer do 2

Yes 1

o 0

hy?

Insert words

e you ever h raining or advice to help you move around more afely?

and I used it 3

was offered, bu idn’t wa it

awaiting tra

0

es –

N

W

9. Hav ad ts

Yes,

It t I d nt 2

I am ining 1

No

a. If Y

What did this involve?

I don’t know 0

Friend / family, informal 1

Informal training with CRW 2

Mobility training with NCBI 3

Mobility training with IGDB 4

Guide dog training with IGDB 5

Joseph’s 6

Other 7

How helpful or unhelpful was the training?

Very helpful 5

189

Fairly helpful 4

l 3

b.

Neither helpful nor unhelpfu

Fairly unhelpful 2

Very unhelpful 1

What made it possible for you to have this training?

Insert words.

If offered but not accepted:

Why did you decide not to ha e mobility training?

Insert wo

c. If awaiting training

v

rds

What form of training are you awaiting?

Friend / family, informal 1

g with CRW 2

y training with NCBI 3

e Mobility training with IGDB 4

uide Do ining with IGDB 5

long have you been waiting for the training?

Answer in months

o –

Informal trainin

Mobilit

Long Can

G

How

g tra

d. If N

Have you ever considered having training to help you get around ?

1

No 0

safely

Yes

190

d.i If yes –

What did you consider training for?

Insert words.

What has made it difficult for you to get the training that you would like?

Insert words.

d.ii If no –

Why have you not considered mobility training?

Other answer 0

11. Do you live in:

lage 3

I don’t need it 1

Also Insert words

10. What are the things that make getting around hardest for you?

Insert words

And finally, I would like to get a few details about your situation:

A city 1

Suburban area / housing estate 2

Town or vil

In the country / rural area 4

12. Do you live alone or with other people, who?

Alone 0

With others 1

191

Codes for people participant is living with

With spouse only 1

2

r 7

Retinitis Pigmentosa 4

oma 5

7

9

Since birth 1

Since childhood 2

With spouse and child/children

With children + their family 3

With parents 4

With other relatives 5

With friends 6

Residential/nursing home/othe

13. Do you know the name of your eye condition, and if so, what is it?

Don’t know 0

Macular Degeneration 1

Cataracts 2

Retinal disease e.g. diabetic retinopathy 3

Glauc

Optic Atrophy / Optic Neuropathy 6

Retinoblastoma or other cancer

Traumatic injury 8

Albinism

Other 10

14. How long have you experienced sight loss?

192

For more than 20 years 3

For 10 – 20 years 4

For 5-10 years 5

For 2-5 years 6

Recent onset, within the last 2 years 7

What county are you from?

Date of Birth

Thank you for participating in this survey.

193

194

Appendix 2 The Table presents the information re county in which the Under 65 age group live.

Under 65 age group County (N=331)

County % County %

Antrim 0.3% Longford 0.6%

Cavan 1.51% Louth 0.6%

Carlow 0% Mayo 4.22%

Clare 3.0% Meath 3.62%

Cork 9.1% Monaghan 0%

Donegal 6.34% Offaly 2.1%

Dublin 29.6% Roscommon 1.8%

Galway 4.22% Sligo 3.3%

Kerry 4.22% Tipperary 5.13%

Kildare 2.41% Waterford 1.81%

Kilkenny 1.2% Westmeath 1.81%

Laois 2.71% Wexford 1.81%

Leitrim 0.3% Wicklow 2.71%

Limerick 5.43%

195

Over 65 age group County (N=226)

County % n County % N

Cavan 2.2 5 Longford 2.2 5

Carlow 1.7 4 Louth .9 2

Clare 3.0 7 Mayo 2.2 5

Cork 7 16 Meath 0.4 1

Donegal 6.2 14 Monaghan 0.4 1

Dublin 40.2 91 Offaly 1.3 3

Galway 2.2 5 Roscommon 2.2 5

Kerry 0.9 2 Sligo 2.6 6

Kildare 2.7 6 Tipperary 2.2 5

Kilkenny 1.3 3 Waterford 1.8 4

Laois 1.8 4 Westmeath 2.7 6

Leitrim 0.9 2 Wexford 1.8 4

Limerick 5.3 12 Wicklow 3.5 8

196

Appendix 3: Table 4 One participant claimed to have informal training with a community resource worker, four

also had mobility training with NCBI, ten had mobility training with IGDB, and six people

further claimed to have had guide dog training with IGDB as well as another type of training.

A further two participants from the Under 65 age category stated they had participated in a

third type training, which was guide dog training with IGBD in both cases. Thus, for the

aforementioned types of training, the following table provides a summary of the counts out of

total sample participating.

Types of training (Total sample) including secondary and tertiary answers)

Training type

Primary Secondary

Secondary

Tertiary

Total

% of those taking training (total sample) (N=190)

% of total sample (N=564)

Informal training with community resource worker

41 1 0 42 22.1% 7.27%

Formal Mobility training with NCBI

77 0 77 40.52% 13.65%

Mobility training with IGDB

23 10 0 23 12.1% 4.08%

Guide dog training with IGDB

16 6 2 24 12.63% 4.25%

197

Glossary of Terms Adaptation to disability refers to the person’s satisfaction with or acceptance of

his/her circumstances changed by loss of capacity to perform certain behaviours,

including social, family, and work roles, and to be autonomous in personal

independence.

Civil rights ensure that citizens are protected from harm by other citizens of the

state, and from government itself in its policy, laws, and actions.

Cohort is a demographic term for a group that share similar characteristics under

study.

Co-morbidity is either in the presence of one or more disorders (diseases) in

addition to a primary disorder, or the effects of such additional disorders.

Correlation refers to the relationship between two variables where change in one is

associated with change in the other.

Experiences are the person’s actual knowledge, observations or contact and

participation in events.

Guide Dog is one specially trained to accompany and enable a vision impaired

person to move about safely.

Help seeking behaviours are those described in cognitive theory literature as three

stages in the process of seeking help. These stages are defining the problem;

deciding to seek help; and selecting a source of support. Individual, interpersonal,

and socio-cultural factors influence decision making and action at each stage of this

complex process.

Human rights are basic rights and freedoms that all people are entitled to

regardless of their status and by virtue of being human.

Legal blindness refers to a best corrected central vision of 20/200 or worse in the

better eye, or a visual acuity of better than 20/200 but with a visual field no greater

than 20 degrees ( eg. Side vision that is so reduced that it appears as if the person is

looking through a tunnel).

198

Long cane is a tool for negotiating the environment as it provides feedback

regarding the pathway about two paces ahead of the user.

Mobility is defined as the ability to move independently, safely and purposefully

through the environment.

Mobility aids and techniques facilitate safe and efficient travel for a vision impaired

person. These include guide dog, low vision aids, compass, sighted guide, long

cane, laser cane, sonic guide, talking sign systems, dead reckoning system, global

positioning systems, and night vision devices.

Orientation involves having an awareness of space and an understanding of the

situation of the body within it.

Orientation and Mobility Training teaches the person independent travel skills

required to negotiate the physical environment. These skills including the use of

mobility aids such as guide dog and long cane where necessary, and the use of

residual vision, sensory skills , concept development, route planning, street crossing

and travelling by public transport.

Peer education is a method of learning and guidance from equals designed to

empower learners to promote healthy lifestyles and positive changes in behaviours.

Peer group is a social group of individuals that are similar in age, social position, or

experience.

Perceptions: The person’s interpretation and organisation of meaningful

experiences of the world.

Qualitative research examines the patterns of meaning which emerge from data

usually gathered in their natural setting. These data are often presented in the

participants own words.

Self efficacy is self appraisal of whether one can perform behaviours in a particular

context, the person’s thoughts about their capabilities in particular situations.

Symbol cane is the white cane (stick) that indicates to others that the person has

vision impairment.

199

Vision impairment or low vision is a severe reduction in vision that cannot be

corrected with standard glasses or contact lenses, and reduces a person’s ability to

function at certain or at all tasks.

Visual acuity is the clarity or clearness of vision. A measure of how well a person

can distinguish details and shapes of objects; also called central vision.

Contact UsIf you, or anyone you know, is experiencing significant difficulties with their eyesight please contact us.

NCBI, Whitworth Road, Drumcondra, Dublin 9Lo Call 1850 33 43 53www.ncbi.ie

Irish Guide Dogs for the Blind,National Headquarters & Training Centre, Model Farm Road, Cork. Lo Call: 1850 50 63 00www.guidedogs.ie

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