This article gives ideas and solutions that may be useful where your clients have both physical disabilities and visual impairment. Solutions for people with both disabilities include equipment and adaptations to the environment; however, training to raise confidence may also be useful.

I have considered both indoor environments (which could include homes, college accommodation and care homes). I have also considered skills for getting out and about safely.

Indoor Environments
Keep furniture laid out in the same place where possible as individuals can then learn the layout. Walkways should be kept free of any obstacles, trip hazards and uneven surfaces. Things to watch out for here include unsecured rugs, vacuum wires, rubbish bags, etc.

It may be useful to remove cupboard doors that can be left hanging open. These can create temporary obstructions, but can also be hazards if not seen. Sometimes doors can be rehang so that they open without creating so much of a hazrard.

As both disabilities can affect balance, certain equipment may be more important. Ramps and handrails may be useful. Non-slip mats can be used to give colour contrast which gives more definition in a bath or shower tray. In the kitchen, non slip trays, basket strainers and kettle tippers can increase safety in carrying.

In the home, expensive changes are often covered by a Disabled Facilities Grant.

Children with both disabilities may need encouragement to explore their surroundings; sound can be used to develop curiosity about what is around them, or games with a path to follow and items to find. This should be done equally using indoor and outdoor environments so the child is confident about being outside independently later in life.

Getting out and about: safe mobility
Ensure that lighting is sufficient, particularly around stairs. In winter keep external paths clear of leaves and ice.

Keeping active to maintain physical health is very important, and can be difficult with vision loss and physical disability.

To increase independence outside the home, it may be appropriate to have training on routes from a Rehabilitation Worker (funded through social services). If appropriate, individuals can use a white cane, but often mobility can involve confidence building and tips for safe road crossing – a white cane is not always the answer. Assessment is always recommended before using a cane.

If an individual cannot walk independently outside, they may be able to join a gym or an organised activity that suits their interest. Many towns now have a Disability Sports Worker based in the council. The NHS Healthy Steps programme also exists to enable people with disabilities and long term health problems to keep active.

Physical disability can mean that it is important to see ground level accurately and to be careful whilst walking. This can be a particular issue with sight loss in the lower half of the visual field, used for looking at the ground. Using a long cane with a roller tip will enable them to find out more information about ground level. However, other cane tips may be worth experimenting with if individuals have arm or wrist problems.

Support frames and support canes can be painted white to indicate visual impairment. Occasionally, people string a symbol cane to the front of a frame or trolley. It is difficult to use a support cane in addition to a white cane (a white cane cannot take weight).

Where physical mobility aids would normally be used for physical disability, this may not be so easy. Some sight is needed to use a wheelchair or scooter independently. A Physiotherapist or Occupational Therapist can liaise with Visual Impairment Rehabilitation Workers to advise.

Mary Parsons from Create Vision UK is a Rehabilitation Worker and can advise and train staff on the areas covered in this article. She can also train individuals, by providing short mobility sessions up to an hour. These services can be commissioned by organisations, or paid for by individuals where they have direct payments.

Please contact to find out more:info@createvisionuk.com or 01793 686449.

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