Lesson 6: Human Guide

Introduction

In lesson five, environmental orientation techniques used to move safely in the home and /or office were introduced. In this lesson, travel outside the home will be addressed. One way for an individual who is visually impaired to travel independently is to use a long cane. Instruction for using this mobility device is taught by an orientation and mobility (O&M) specialist. The second mode of independent travel used by some individuals is a dog guide. However, before either of those mobility modes are taught, people often learn to get around in unfamiliar environments using the human guide technique. Sometimes this technique might also be referred to as sighted guide. Although a guide is usually sighted, the term human guide is preferred since a visually impaired individual can also provide it.

Lesson Goals

Travel safely and confidently using the Basic Human Guide Technique.

Navigate safely through narrow passages such as open and closed doors assisted by a human guide.

Open and close vehicle doors independently when traveling with a human guide.

Seat yourself in restaurants, medical offices, etc., with human guide assistance.

Walk safely up and down curbs and stairs assisted by a human guide.

Speak up and instruct those who wish to guide you in the proper technique.

Basic Human Guide Technique

Perhaps you've been guided by well-meaning people who push or pull you, grab you by both arms, and attempt to seat you in a chair, or open a door and want you to lead the way into a dimly lit area where you've never been before. Traveling with a human guide familiar with the technique will eliminate these scenarios and give you a greater sense of safety and confidence. These guiding techniques can be taught to family, friends, or anyone who might serve as a guide in familiar or unfamiliar places.

In the beginning, visually impaired individuals may find practicing with one trusted friend or family member helps them establish what works best. Each person is unique in their preferences and needs, so some adjustments to the standard technique may need to be made. Once safe and comfortable practices have been identified, the individual may find it helpful to ask others to guide them using these strategies. Note that some individuals may not need this type of assistance in all circumstances. It may be that some individuals only need this assistance at night or in dimly lit areas. Individuals who understand their functional difficulties will benefit most when explaining these difficulties to others and solicit assistance for those challenging situations. Remember the toolbox. Each tool may not need to be used every day, but adding this tool to the toolbox allows the user to be more prepared to face a wider variety of situations.

All guiding techniques start from a natural walking position. The individual being guided should bend their arm at a 90-degree angle, grasp the guide's arm just above their elbow, keep their thumb on the outside of the guide's arm, and their shoulder just behind the guide's shoulder. The guide can choose if they prefer to keep their arm hanging straight next to their body or bent at the elbow. The guide's arm must be held in a natural position close to their body so changes in walking pace and direction can be detected and when to step up or down. This configuration puts the guide a half-step ahead, enabling the individual to be guided to sense any changes in the guide's pace or terrain, like stepping up, down, or gradually sloping.

An easy way to connect with a guide's elbow is for the guide to touch the back of the individual's hand. The individual can trail up the guide's arm to above the elbow.

Once the guide's elbow is grasped, like holding a soda can, the individual can infer the guide's height. A guide's height is important primarily if the person being guided is taller than the guide. When this is the case, it will be necessary for the individual to ask the guide to let them know if they need to bend over to avoid an overhanging obstacle. It can also help ask a guide to give a verbal cue before they start to walk. If the guide is substantially shorter, for instance, if the guide is a child, an alternative is to place the hand on the guide's shoulder.

Individuals who have difficulty balancing or walking at a steady pace may want to use a modified technique for more support. This can be done by placing the individual's arm through the guide's bent arm and grip the guide's forearm. If more support is needed, lace your fingers together. The support from the guide's arm can stabilize and assist in balance. If necessary, a guide can further support with the other hand. The above method should only be used when the guide is strong and steady on their feet. Otherwise, the individual being guided could cause the guide to fall, leading to possible injury for both the individual and the guide.

Individuals who experience unsteadiness when they walk or who have any balance issues may find it helpful to use a support cane or a walker instead of hoping a human guide will support them if they lose their balance.

Communication

Communication is vital for safety and smooth transitions while using a human guide. It's essential for the individual being guided to share information with the guide, such as preference on which side to be on or their walking speed. If, for example, a person has difficulty hearing in their left ear, they may want to walk on the guide's left side to put their good ear in the best position for hearing verbal cues from the guide. Perhaps, an individual may need more support on their left side to feel safer walking on the guide's right side. It can also be helpful to let the guide know what verbal cues are preferred and how much information is desired about the environment. Note that some individuals who provide human guide may also have preferences, and their needs should be accommodated. It is important to find the best arrangement for both individuals.

If a guide needs to walk away briefly, it can be beneficial to locate a comfortable location for the individual being guided to wait. Everyone has their preferences, so identifying if a chair or bench or if leaning against a wall or counter is preferable. Waiting in an open area without a landmark for reference can be problematic for individuals with limited vision. A guide should inform the visually impaired person they are leaving or returning using verbal communication to prevent misunderstandings.

Narrow Passages

The basic methods are used when walking in spaces wide enough to accommodate both people easily. However, there will be times when a narrower environment will force a change in positions. This frequently happens when walking through a restaurant or store. Using the human guide technique, the guide can inform the individual being guided by a narrow passage by both verbal cues and changing their arm position. When indicating a narrow passage, the guide should place their guiding arm behind them with their lower arm in the small of their back. This gives the person being guided the cue to walk directly behind the guide, indicating the individual being guided should slide their hand to the guide's wrist and extend their arm more to avoid stepping on the guide's heels.

A modified version is to slide the hand down to the wrist and hold the guide's wrist with both hands. Some people prefer to step behind the guide and place their hand on the guide's shoulder if they need to walk behind them for an extended period, such as an airplane aisle. Depending on the environment, the guide and the person being guided may find different, more comfortable positions. As long as the position is safe and the person is directly behind the guide, it's up to individual preference. After traversing the narrow space, the guide returns their arm to the normal position signaling the person to change back to walking beside them. Note that holding hands with the guide is not as safe as holding the arm or shoulder. The guide's movements, stepping up or down, are more discernable since the arm's upper part will move with the guide. The hand is further from the body, and the elbow or wrist can bend in positions that obscure these positional cues.

Closed Doors

When approaching a closed door, there may need to be adjustments to the guiding position. First, the guide should verbally identify if the door opens towards or away from the line of travel and on which side of the travelers it will open. For example, the door is opening toward us on the left. This information will dictate the appropriate position. The individual being guided should be on the hinged side of the door. When approaching the door, if the person is on the handle side of the door, the guide should pause and let the visually impaired person step behind them and switch to the other side.

When walking through doors that open away, the guide pushes the door open, and the person being guided reaches out with their free hand to hold the door open as they pass through. If the door opens towards the pair, the guide opens the door, and the visually impaired person reaches up with their free arm bent so the edge of the door will connect with their forearm. They can then grab the edge of the door and hold it open as they pass through, closing it behind them if necessary. Visualizing these scenarios and practicing can help navigate smoothly.

Car Doors

It is common for people to want to be courteous and open a car door for a visually impaired individual. However, it is easier and safer for them to do it themselves. If a human guide or other helpful person opens the door, there is no way to know where the door is, how far it is open, or where the sharp top corner is located. The safest and most effective way to handle this scenario is for a guide to place their hand on the car door handle and then allow the person to use their arm as a guide and trail it down to grasp the door handle themselves. Then the person takes a small step back as they open the door to prevent getting hit with the edge. It may be a good idea to use the upper protective technique with the free hand in an unfamiliar car to avoid injury. Once situated in the car, the person can reach out and pull their door closed.

Seating

Communication is crucial for smooth transitions from standing to sitting. The guide can describe the scene, giving brief but essential information. How high is the chair? Does it have arms or wheels? Does it swivel? Is the chair under a table? In a restaurant, are there one or two chairs on each side of the table? Are the tables close together, and are people sitting nearby? When approaching the chair from behind it, the guide should place their hand on the chair's back. The visually impaired person switches from the guiding position to trail down to the back of the chair. Then they can pull the chair out for themselves. If the person doesn't have the strength to pull out the chair, the guide can pull out the chair with their free hand before the person trails to find the chair's back. Whether or not the chair is pulled out should be communicated verbally to avoid problems.

When transitioning into a booth, the guide places their hand on a corner of the table so the person can slide their hand from the arm to the table. The location and shape of the corner of the table will inform which side of the booth. The other hand can slide along the booth's seat as a guide to assist in getting seated.

Seating in medical facilities may be different, especially when the waiting room is full. Frequently, the chairs are arranged in back-to-back rows with several chairs in each row. If three or four consecutive chairs are available, the guide can lead directly to one of the center chairs. Taking small steps, find the chair's front edge by making contact with the front of the legs. Then turn and sit down. If balance is a problem, the individual should continue to hold onto the guide's arm until they are fully seated. When only single chairs are available, the guide should lead up to a chair with the side of the person's body perpendicular to the chair. This allows the guide to assist with seating without standing directly in front of the person seated in the adjacent chair. Again, good communication makes a difference in how well this works.

In every setting, the guide should communicate if a magazine, cat, or something else is lying in the seat. Just in case, it's best for the individual who is visually impaired to sweep the seat with one hand while using the upper protective technique with the other before sitting.

Curbs and Stairs

The first step when being guided up or down curbs and stairs is brief but effective communication. When encountering a curb, the guide should indicate if the step is up or down, low or high, and what is after the curb, such as grass, street, or sidewalk. Will there be an incline or decline afterward? All of this information can be provided in one brief sentence while approaching the curb. For example, we are approaching a curb, stepping up onto a sidewalk. Then the guide pauses before stepping up or down to give the person time to prepare. The guide always steps up or down first because it provides tactile information about how high the step is before they follow. When going up and down curbs and stairs, it's important to pause at the top and bottom every time before moving forward.

Providing information about stairs is equally helpful. Are they ascending or descending? Is there a handrail? Do the steps have contrasting textured edges that allow people with low vision to see and people with no vision to feel through their shoes? Are there only a few steps, or is it a long flight of stairs? The guide should lead to the handrail, which may mean that switching sides is necessary before approaching. The guide should pause while the handrail is located and then take the first step. They should always be one step ahead and pause at the end to give time to adjust. Some people may find it more comfortable to walk down the stairs without holding on to their guide. This is fine as long as there are no concerns about balance and the individual stays in contact with the handrail.

Safety Tips

The techniques provided in this lesson are considered the safest and most effective ways of being guided by another person. Using a human guide gives an individual with a visual impairment a sense of control. If they feel uncomfortable, all they need to do is let go of the guide. When the individual being guided lets go of the guide, the guide will usually stop, listen to feedback, and implement suggestions to improve the guided individual's experience.

Educating others on how they can help puts them at ease since it gives them a practical way to assist. Many family or friends want to help, but they don't want to embarrass the individual, and they are uncertain as to how to broach the topic of how to help.

Individuals who are visually impaired may find it helpful to have a strategy for dealing with people who approach and offer unwanted or incorrect assistance. One way to handle these situations is to speak up and explain the correct way to help. For example, when someone takes the individual's arm and starts pushing or pulling them, they might stop and plant their feet and ask to take their arm. If humor can be inserted, it may relax the situation. A comment such as, "If you hold my arm, that makes me the guide and that could get dangerous," might help communicate the point.

Summary

This lesson has introduced techniques for getting around safely and confidently by using a human guide's assistance. These methods provide safe navigation strategies through doorways, up and down steps, and finding and sitting in a chair. Individuals who use a human guide can walk with dignity and confidence. Practicing to determine when and how these strategies can be used will add another tool to your toolbox to cope with and adjust to living with a visual impairment.

Suggested Activities

Try the following activities to get comfortable with the techniques in this lesson:

Teach the human guide techniques to a close friend or family member.

Practice using these techniques in your home where you are comfortable.

Try the human guide techniques in a location outside your home without crowds or significant noise to gain confidence.

Ask others who have a vision impairment to share their strategies for dealing with individuals who offer unwanted or incorrect assistance.