Guide Before and With Pediatric Belt Cane

Children who are blind lack the functional vision needed to aid in their safe mobility. Two-year-old children who are blind are unable to use hand-held mobility tools to achieve consistent path information (such as white canes), however they are able to walk with a human guide (HG) to achieve orientation and mobility assistance.

HG is a term used to identify when a person who is blind holds onto another person when walking. It is recommended that the guide be positioned a half-step ahead of the person she is guiding. Guiding is a great way to increase speed and direction of travel.

It is very difficult for an uninformed guide (someone who is not a certified O&M specialist) and challenging for informed guides (O&M specialists) to provide effective mobility protection when guiding someone. That means even when guided by the best guide, two-year-old children who are blind do not experience adequate, consistent, or reliable tactile path information.

Tactile path information is essential for someone who is blind. They need cane arc safe mobility to assist them in discovering or avoiding obstacles, drop-offs, and surface changes that occur naturally within the environment. A blind toddler walking without reliable tactile path information collide with obstacles even while being guided (see photos below).

It is easier for a guide to walk correctly to a location (provide orientation), than it is for them to provide consistently safe path information (safe mobility) to a person who is blind. It is very challenging for a person acting as a HG to provide safe mobility, because people develop individual path avoidance strategies to achieve personal safe mobility and these individual strategies do not translate well to protecting two people walking together.

Sighted object avoidance strategies rely on sight and are so second nature, that it can be very difficult for sighted guides to remember that a blind person cannot visually avoid obstacles. Toddlers who are blind and encounter collisions when being guided are of great concern, because three-year-old children born blind, with no additional disabilities have been found to be eighteen months behind in gross motor skills (Ambrose-Zaken, 2021).

When children who are blind experience unavoidable collisions when being guided by an adult, it confirms to them that all walking strategies are inherently unsafe, and this fear prevents them from attaining effective guided and self-locomotion strategies. Ambrose-Zaken, Mcallister, & FallahRad (2020) suggested use of the term mobility visual impairment (MVI) to identify those children who require consistent tactile path information. They defined MVI as an inability to visually avoid obstacles. When children with MVI are being guided they may exhibit a tendency to pull away from the guide, have an uneven pace, and collide with obstacles.

Ambrose-Zaken, FallahRad, Bernstein, Emerson & Bikson (2019) proposed providing children with MVI consistent tactile path information, by having children wear pediatric belt canes (PBCs). The PBC fastens around a child’s waist, and the cane shafts magnetize to the waistband and extend to the floor, two steps ahead of the wearer. The rectangular cane frame moves with the child and provides a two-year-old child who is blind with consistent tactile path information. The purpose of this study was to measure the steps per second taken by a two-year-old boy who was blind walking with a HG before and after obtaining a PBC.

Research design A single-subject repeated measures design research study was conducted with a two-year-old male child who was blind. Baseline data were steps per second walking with a guide at home (A) and outside (B). Treatment consisted of walking with HG wearing a PBC at home (C) and outside (D).

Participant Student M. is a two year old boy with Leber’s Congenital Amaurosis (LCA). He was blind, with no light perception, and was therefore MVI because he was unable to visually navigate any environment safely. His primary mobility tool was HG. Prior to the study, Student M. had not experienced reliable tactile path information when navigating his environment.

Method Twenty-three (23) video segments of Student M. were analyzed. The video segments observed Student M. navigating within his home and outdoors with a human guide before obtaining his belt cane (n=6), and inside his home and outside walking with a HG and wearing his PBC (n=17).

Measurement: Visible steps caught on camera were counted using an iPhone counter app. A step was counted each time he moved a foot forwards or backwards, fast or slow while in contact with a guide. Within videos, a video segment was defined as total time in HG (in contact with a HG until the time when not in contact with the HG). Steps per second was the number of steps taken divided by the time in guide position during that video segment. Within the same video, a new video segment began once the child was asked to stand and/or HG contact resumed. Student M.’s steps occurring when going up or down stairs were not included in the step count or time in guide.

Data and Results Prior to obtaining a PBC, Student M. typically traveled in HG. When walking in guide, his pace consisted of many quick steps. Inside he was observed being guided to specific locations, during one video segment, as he was guided, he was videoed colliding with toys in the family room (see video Human guide poor path detector). Outside he was walking with HG for exercise and fun. In the video of the outside walk with HG he walked in circles (see Matias can’t come when called), you hear his guide ask him if he is “going in circles”.

He walked slower outside in HG, than inside in HG. Video of intervention “C”, showed Student M.’s steps per second after putting his PBC on the first time, at home. Wearing the cane inside for the first time, Student M. took very few steps in HG because during the first seven and a half minutes of the video, he was crying and appeared to resist wearing the PBC. Overtime, wearing his PBC inside he walked much slower steps per second compared to when walking with a HG without a PBC at home. When wearing the PBC outside, he walked much faster than walking outside in HG only. Outside, wearing the PBC, his steps were longer, more even, and his pace and path direction matched his guide’s pace and path direction. The length of the routes walked with the PBC were longer than those walked in HG only. The outside steps per second when wearing the PBC were about the same as steps per second walking inside with HG and no PBC.

Data chart indicated that steps per second improved in PBC condition

Discussion

The data of Student M.’s steps per second suggested that the introduction of a PBC reduced the number of steps he took when walking with a guide. When he put the PBC on the first time, his steps per second were less frequent because, although in guide position, he was crying and resisting the PBC and resisted walking. Overtime, Student M.’s walking quality improved in HG wearing his PBC.

When Student M. was outside wearing his PBC he walked a straighter path, longer strides, and a more even pace (see Matias Guided at the Zoo). The steps per second measurement demonstrated that Student M. initially resisted walking when wearing his cane when he was first introduced to it in phase “C”. However, his steps per second increased overtime when he was no longer crying or resistant to wearing his PBC. When walking HG only, his quick steps were at odds with the pace of his guide.

His walking speed with HG and wearing his PBC was more closely matched to his guide’s pace. After initially rejecting his PBC, Student M. accepted wearing his cane after eight minutes and was able to enjoy the benefits of independent path information simultaneously to achieving the advantage of walking with an adult guide. His gait and path improved, suggesting that the measure of steps per second may not be a sensitive enough measurement when examining the benefits of consistent path information for two-year-old boys who are blind.

It is important to replicate this study to see whether these findings are consistent across subjects. Student M.’s response to wearing the PBC initially was tearful and resistant, however after those first seven minutes of tears, his response to wearing the PBC improved. This suggests that the advantages of wearing the PBC should not be withheld from two-year-old children, if they cry at first attempt.

Two-year-old boys may only be upset for a few minutes after first introduction to the cane, and afterwards begin to obtain real benefit from walking with consistent accessible path information. It is important to replicate this study to learn whether other two-year-old blind toddlers who cry when first introduced to wearing PBCs, also improve their mood, gait and pace given sufficient time, experience and distractions. It is often true for very young learners, they need sufficient time before they begin to trust the tactile path information benefits they receive when wearing a PBC.

Photos of collisions with a HG with and without PBC

Lack of path information in human guide

Lack of path information leads to collision in guide

Path information means knowing exact location of drop-off

Path Information – ‘there is a bush in front of you.’

References

Ambrose-Zaken, G.V. (2021, March 25-27). Importance of Safe Mobility to Achieving Developmental Milestones: Part 1. [Conference presentation]. Virtual 2021 Rocky Mountain Early Childhood Conference. United States.

Ambrose-Zaken, G., McAllister, J., & FallahRad, M. (2020). Mobility Visual Impairment and Blindness: A New Term to Identify a Major Contributor to Developmental Delays in Children. Manuscript submitted for publication.

Ambrose-Zaken, G. V., Fallahrad, M., Bernstein, H., Wall Emerson, R.,  & Bikson, M. (2019). Wearable Cane and App System for Improving Mobility in    Toddlers/Pre-schoolers With Visual Impairment. Frontiers in Education, 1(4), 1-13.

Wearing pediatric belt canes encourages independent walking in Blind 2-year-old

Toddlers who are blind need effective mobility tools for safe mobility, because safe self-locomotion skills are essential for language development (Rosenbaum, 2005; Adolph et al., 2010; Iverson, 2010). For example, Oudgenoeg-Paz et al. (2016) suggested that exploration via self-locomotion measured at twenty months predicted later spatial language, yet children born with mobility visual impairment or blindness exhibit delays in self-locomotion due to lack of access to independently safe mobility (Ambrose-Zaken, 2021).

Children who are born blind grow up with unsafe self-locomotion and this inhibits their willingness of to freely ambulate and contributes to developmental delays (Ambrose-Zaken, 2021). The goal of independent walking is important, because walking freely is tied to language outcomes. Particularly, walking is important for building vocabulary, the most common measure of language development (Oudgenoeg-Paz et al., 2012, 2015, 2016; West et al., 2017).

Matias’ family reached out to Safe Toddles to obtain a pediatric belt cane (PBC) for him, a nineteen-month-old boy who was blind due to Leber’s Congenital Amaurosis. His family provided a video record of his self-locomotion during play activities before and after receiving the PBC. The purpose of this study was to compare the number of steps per second taken by Matias when playing indoors and outside in three conditions; without a mobility device, with a push toy and wearing his PBC.

Method

Participant Matias was a two-year-old boy who was blind with no light perception. He was typically developing and able to walk, however prior to obtaining the PBC he walked only when he was in contact with objects or people, including pushing a chair or pushing a toy. His language skills were also delayed. He repeated words and sentences out of context and he did not engage in conversation or seek out others for social interaction.

Procedures The researcher employed a single-subject repeated measures design. Sixteen videos of Matias before obtaining a PBC and nine videos of him wearing his PBC were analyzed. The videos selected were those of him playing alone inside and outside his home. Ten videos documented Matias’ typical play activities without a mobility tool (six inside and four outside). Six videos observed him when used a push toy during play time. Nine videos were taken when wearing his PBC during play activities (three inside and six outside).

Measurement Visible steps caught on camera were counted. Steps were defined as purposefully moving his foot forward or backwards, walking up or down stairs, anytime the foot moved to change his location. Steps not counted were those considered stamping in place or to adjust his balance. Steps per second was obtained by dividing the number of total steps taken during the video by the number of seconds of the video.

Matias’ steps per second with and without mobility devices

Discussion

The chart indicates that when he was playing without a mobility tool or with a push toy he took very few steps per second. When he was playing while wearing his PBC the number of steps increased over time. The more he wore his cane, the greater number of steps taken.

Matias walked many more steps per second wearing his PBC than under the condition of playing without a mobility tool and with a push toy. Therefore, two-year-old children who are blind may also benefit from wearing PBCs most of the day. This is because PBCs provide the benefits of safe mobility and consistent tactile path information. When children who are mobility visually impaired or blind wear PBCs they take independent steps with greater frequency than without a mobility tool or when encouraged to use a push toy.

Children who are blind wearing PBCs show improved self-locomotion which provides them with new learning opportunities to interact with objects, their environment, and with caregivers. When children who are blind feel safe enough to increase self-locomotion, it allows them to travel independently throughout their environments, traversing long distances to encounter objects and caregivers and builds opportunities to increase concepts and develop language and social skills.

Conclusion

Tactile path information is a known entity, since 1945 adults who are blind have benefited from using a long cane. Most physically and cognitively able adults learn to use a long cane in less than an hour. Toddlers who are blind are not able to employ a long cane for safety, after several years of instruction, many can only hold the long cane for a few steps. Children need safe mobility all day, every day.

Matias is stationary, repetitive playing while lying on his push toy

Matias is playing appropriately with a push toy while wearing his PBC

References

Adolph, K., Tamis-Lemonda, C., and Karasik, L. (2010). Cinderella indeed – a commentary on iverson’s ‘Developing language in a developing body: the relationship between motor development and language development. J. Child Lang. 37, 269–273. doi: 10.1017/S030500090999047X

Ambrose-Zaken, G.V. (2021, March 25-27). Importance of Safe Mobility to Achieving Developmental Milestones: Part 1. [Conference presentation]. Virtual 2021 Rocky Mountain Early Childhood Conference. United States.

Iverson, J. M., and Braddock, B. A. (2010). Gesture and motor skill in relation to language in children with language impairment. J. Speech Lang. Hear. Res. 54, 72–86. doi: 10.1044/1092-4388(2010/08-0197)

Oudgenoeg-Paz, O., Leseman, P. P., and Volman, M. C. (2015). Exploration as a mediator of the relation between the attainment of motor milestones and the development of spatial cognition and spatial language. Dev. Psychol. 51, 1241–1253. doi: 10.1037/a0039572

Oudgenoeg-Paz, O., Volman, M. C. J. M., and Leseman, P. P. M. (2012). Attainment of sitting and walking predicts development of productive vocabulary between ages 16 and 28 months. Infant Behav. Dev. 35, 733–736. doi: 10.1016/j.infbeh.2012.07.010

Oudgenoeg-Paz, O., Volman, M. J. M., and Leseman, P. P. M. (2016). First steps into language? Examining the specific longitudinal relations between walking, exploration and linguistic skills. Front. Psychol. 7, 1–12. doi: 10.3389/fpsyg.2016.01458

Rosenbaum, D. A. (2005). The Cinderella of psychology: the neglect of motor control in the science of mental life and behavior. Am. Psychol. 60, 308–317. doi: 10.1037/0003-066X.60.4.308

West, K. L., and Iverson, J. M. (2017). Language learning is hands-on: exploring links between infants’ object manipulation and verbal input. Cogn. Dev. 43, 190–200. doi: 10.1016/j.cogdev.2017.05.004

Effect of Pediatric Belt Cane on Number of Independent Steps taken by one-year-old girl with ONH

Co-authors: Mikel Kersey and Grace Ambrose-Zaken, Ed.D.

Children who are unable to visually detect obstacles, drop-offs, and changes in surface have a mobility visual impairment (MVI) (Ambrose-Zaken, 2021). Without consistent tactile path information, toddlers with MVI are unsafe. Some may begin walking and running, but when you can’t see where you’re going, moving about causes injury and the result is children born with MVI tend to become inactive.

Toddlers with MVI avoid walking, even when verbally prompted, preferring to be physically guided, because it’s safer. Toddlers with MVI are recognizable because when crossing open space, they walk slowly and cautiously with a wide gait and hands raised, “exhibiting a smaller stride length and more plantar foot contact” (Hallemans et al., 2011).

A person with MVI walking without an appropriate mobility tool will experience unavoidable falls and object collisions. These occurrences cause fear and a feeling of chaos the longer the duration of this- like a running through a college hazing gauntlet without end.

In a 2016 study on the impact of vision on the dynamic characteristics of gait, Gazzellini, et al., concluded that “The atypical gait of children with congenital blindness is explained by the lack of anticipatory control ”(Gazzellini, 2016). For children with MVI to have anticipatory control, they need a mobility tool that will effectively provide path information. According to Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson and Bikson (2019), children who are five years old and younger are not yet able to use a long cane effectively, because the motor and cognitive skills required to demonstrate proper long cane techniques are not yet developed.

The pediatric belt cane provides young travelers with appropriate tactile path information, allowing them to freely and safely move about their environment without requiring the advanced motor skills for manipulating a rod cane (Ambrose-Zaken, et. al., 2019). The cane frame is a lightweight rectangle that magnetically attaches to the custom made belt. The rods of the rectangle are the standard long cane length which is determined according to the height of each child. The width of the rectangle is a standard arc width (Ambrose-Zaken, et.,al, 2019). When children with MVI wear their pediatric belt canes they demonstrated greater independent mobility. Children with MVI who wore their canes began walking with longer strides, narrower gaits, and faster paces. They had better posture and appeared more balanced. Their arms and hands naturally lowered to find the belt and their once rigid, clenched muscles relaxed.

Since prior studies had studied the outcomes of preschool learners with MVI wearing pediatric belt canes, it was important to observe whether younger children might also benefit from wearing their white canes. The purpose of this single-subject study was to observe and compare the number of steps walked by a one-year-old girl with optic nerve hypoplasia (ONH) resulting in MVI with and without the intervention of a pediatric belt cane.

Method

Baseline. A single-subject repeated measures design was used. The participant was videoed for six minutes in the family room of her home by her mother at fifteen months of age without a mobility device. Intervention. At sixteen months of age, the participant was provided a pediatric belt cane. She was observed at seventeen months of age walking in the local mall for six minutes.

Measurement

The number of steps taken by the participant were counted in one-minute intervals during two, six minute videos. All steps were counted, a step was defined as anytime the child picked her foot off the ground and replaced it back onto the ground.

Results

The number of steps per minute taken by the participant is measured on the Y axis on the chart above. The X-axis displays the time in minutes. During baseline, the participant was left to play on her own in the family room. She stayed close to the furniture and a large baby toy. Although her mother called to her, she did not cross open space. The participant’s steps per minute were zero during the one, two, three, five and six minute intervals. During the 4 minute interval the she took five steps.

The one-year-old girl wore her pediatric belt cane for one month most of the day at home, when on family outings and during her O&M instruction. The intervention data was observed in two settings at an indoor mall. In the first three minutes of the video, the participant and her family were in a carpeted communal seating area. The last three minutes of the intervention video, the participate walked out of the seating area into the main lobby of the mall. The number of steps she took each minute ranged from four to ninety-three steps. In the carpeted setting, she walked 14, 4 and 14 steps in minutes one, two and three respectively. In the main lobby, she walked 55, 69 and 93 steps in minutes four, five and six respectively.

Walking zero steps

First three minutes in carpeted area

Walking to learn

Discussion

Without a mobility device in her familiar environment, the participant took five or fewer steps each minute, mostly not walking at all. It is uncommon for a child this age to refrain entirely from independently crossing open space especially in familiar settings. Sighted children age fifteen months demonstrate a curiosity about their environment, expressed in abundant levels of independent walking (Bjornson, Song, Coleman, Myuaing, & Robinson, 2013).

During the intervention phase, the participant’s steps per minute consistently increased. Data for the intervention phase of this study was collected one month after she first began wearing her pediatric belt cane. The participant was observed in the mall play area where there were many obstacles and colorful surface changes (see photo). The participant walked around a little in the play area independently standing still (not holding onto anything or anyone). Once she was in open space, her steps per minute increased exponentially. After a month of using the belt cane, the participant was walking with a narrower gait, longer stride, and developmentally appropriate posture compared to baseline videos. She appeared confident to move and explore her environment independent of her mother’s hand. She required no prompting to walk, instead her mother was engaged in teaching her the rules of staying with the group, (e.g., running away from mommy is not allowed).

Conclusion

For children with MVI to develop gross motor skills at an age-appropriate rate, it is crucial that they have the tools they need to enable them to feel safe and develop self-confidence. The pediatric belt cane provided consistent tactile path information with developmentally appropriate cane arc coverage. The cane arc was always in front of her next steps and, in that way, prevented bodily object collision. When the base of the cane detected objects, the one-year-old child wearing the cane received the information at the waist (through the belt connection). Once she began to understand that she would receive reliable information about obstacles ahead of her, she learned to interpret the information from the cane (e.g., clear or blocked path). As a result, she began to feel safe to move about familiar and unfamiliar environments. She was motivated to travel and explore freely and independently.

References

Ambrose-Zaken, G.V. (2021, March 25-27). Importance of Safe Mobility to Achieving Developmental Milestones: Part 1. [Conference presentation]. Virtual 2021 Rocky Mountain Early Childhood Conference. United States.

Ambrose-Zaken, G. V., Fallahrad, M., Bernstein, H., Wall Emerson, R.,  & Bikson, M. (2019). Wearable Cane and App System for Improving Mobility in Toddlers/Pre-schoolers With Visual Impairment. Frontiers in Education, 1(4), 1-13.

Bjornson, K. F.,Song, C. Z., Coleman, K., Myuaing, M., & Robinson, S. L., (2013). Walking Stride Rate Patterns in Children and Youth, Disability and Rehabilitation DOI: 10.3109/09638288.2013.845254.

Gazzellini, S., Lispi, M. L., Castelli, E., Trombetti, A., Carniel, S., Vasco, G., et al. (2016). The impact of vision on the dynamic characteristics of the gait: strategies in children with blindness. Experimental Brain Research, 234, 2619–2627. doi: 10.1007/s00221-016-4666-9

Hallemans, A., Ortibus, E., Truijen, S., and Meire, F. (2011). Development of independent locomotion in children with a severe visual impairment. Research in Developmental Disabilities, 32, 2069–2074. doi: 10.1016/j.ridd.2011.08.017 Safe Toddles. (2020) Safetoddles.org .

Benefits of Belt Cane for 3-year-old with Optic Nerve Hypoplasia

Children with mobility visual impairment (MVI) are unable to visually avoid obstacles. These children have difficulty achieving gross motor milestones because they lack access to consistent path information. Children with MVI can exhibit unwillingness to walk across open space independently, though they are physically able to bear weight. Instead, they seem to prefer to hold on to an object or person to walk places.

Toddlers with MVI are not able to verbally tell people that they feel unsafe walking independently, instead over time they present with a poor gait, slow pace and/or an unbalanced posture. Other observable posture concerns may include self-created taut extremities such as clenched fists.

Independent walking is essential to learning new concepts. Therefore, it is important to identify methods and tools that reduce these adverse motor behaviors. Ambrose-Zaken (2021a, b) has found that children with MVI age five and younger are unable to use rod canes correctly for safe mobility, resulting in continued unsafe travel outcomes (collisions, falls). Ambrose-Zaken (2021b) has shown that gross motor milestones and other nonverbal signs of MVI lessen and/or resolve when a child with MVI wears a pediatric belt cane most of the day, everyday.

A pediatric belt cane is a mobility tool that enables children with MVI to experience safe and reliable tactile path information. A belt cane (wearable toddler cane) is custom fitted to children with MVI who are aged five years and younger. The recommendation is that children with MVI wear their belt cane for the entirety of the day to enable free exploration and confidence in the path that lies ahead. The purpose of this single-subject study is to compare a child with MVI when walking using a rod cane to her walking wearing a pediatric belt cane.

Method
Participant: Audrina, a three-year-old with optic nerve hypoplasia, attended a preschool program in New Mexico. She had been instructed on rod cane technique by an orientation and mobility specialist since she was two years old. She had been wearing the belt cane for several hours the morning prior to the intervention of walking to the playground.

Treatment: Audrina was observed in an outdoor environment, en route to the playground with her peers. Prior to this intervention, she typically rode in a wagon to the park and back. This time she was encouraged to walk to the park. Half of the way, she walked with a rod cane and the second half of the way she wore her pediatric belt cane.

Measurement: A single-subject repeated measures design was used. The number of steps taken in 60 seconds (one minute) during ten consecutive minutes. The baseline data shown on the chart represents the number of steps Audrina took each minute while using a rod cane for five minutes. The next five minutes I counted number of steps, per minute, Audrina took wearing her belt cane (intervention data).

Results

The chart above expresses the time in minutes on the X-axis and the number of steps taken per minute by Audrina on the Y-axis. Steps were counted from 10 consecutive minutes of Audrina’s walk outdoors, five consecutive minutes walking with the rod cane and the first five minutes after switching to wearing her belt cane. The baseline performance suggests that while using a rod cane, Audrina’s steps per minute ranged from between 20-50 steps per minute. During the intervention of wearing the pediatric belt cane, Audrina’s steps per minute increased over time from 62 to 150 steps per minute. The average pace of a three-year-old is 3.1 steps per second or 186 steps a minute.

In the rod cane condition (baseline), Audrina exhibited a slow pace, stopped frequently and received frequent prompting from her teacher to use her rod cane correctly. During the pediatric belt cane intervention, Audrina’s pace steadily increased and the number of teacher prompts decreased. Audrina stopped infrequently while wearing the belt cane. When she stopped, it appeared she wanted to further investigate objects that she was able to independently locate in her environment with her cane frame. Wearing her belt cane, Audrina spoke more frequently than in the rod cane condition. Similarly, she asked questions and expressed her observations about the environment on the path to the playground.

Audrina’s long cane skills lead to unsafe mobility – she is out of step and her cane tip is checking behind her.

Audrina smiles as she picks up the pace to a run wearing her pediatric belt cane.

Discussion

Audrina’s first step after donning the belt cane began with a slight turn to free the base of the frame from an obstacle that she otherwise would have tripped over. The first minute after donning her belt cane, Audrina’s pace was faster than any of the minutes she walked with the rod cane. Audrina also eventually ran when wearing her belt cane, something she did not do with the rod cane.

In addition, she was walking to the park as part of a group. The students in her class were also visually impaired. Although her peers have visual impairments, many were not MVI. Their vision allowed them to move easily about the classroom, school and outside with age-appropriate pace, visually avoiding obstacles.

When walking outdoors with her peers, Audrina was unable to keep pace with her peer group. Therefore, she was absent during the instructional conversations about nature and social mores her teachers held with the group of students who were able to walk faster than she was. While walking with her rod cane, Audrina appeared noticeably quiet, her teachers spent most of their time prompting her to walk faster and correcting her rod cane technique.

Once Audrina arrived at the locations of interest explored by the faster walking students, her teachers did not have the same conversations about those locations with her. Instead, she was reminded to hurry up. Wearing the belt cane Audrina began to speak more. She asked more questions about her surroundings and her teachers responded to her questions with the information she requested. Her teachers appeared to relax, once they observed that she was experiencing consistently safe mobility wearing her belt cane.

Audrina appeared more confident when equipped with a safe and effortless mobility tool that provided her consistent path information. Although the difference in Audrina’s pace is apparent as well as the increase in age-appropriate conversation, we can compare the amount of steps Audrina took per minute to produce data on the benefit of the wearable cane.

It should also be considered that this change in age-appropriate conversation as well as increase in pace happened within minutes on the same day. Safe Toddles’ recommended usage guidelines for the pediatric belt cane are that children with MVI wear their pediatric belt canes the entire day, everyday. This is to ensure safe and effortless path information is always available to the child with MVI. Complete and consistent access to path information gives children with MVI security in knowing that they have the information they need for safe and confident mobility. Wearing belt canes all the time ensures that reliable path information will not be taken away causing them to return to a state of uncertainty and fear about where their next step will land.

References

Ambrose-Zaken, G.V. (2021a, March 25-27). Importance of Safe Mobility to Achieving Developmental Milestones: Part

1. [Conference presentation]. Virtual 2021 Rocky Mountain Early Childhood Conference. United States.

Ambrose-Zaken, G. (2021b). A study of Improving Independent Walking Outcomes in Children Age Five and Younger

who are Blind and Visually Impaired. Journal of Visual Impairment and Blindness (submitted 4.2021).

CVI or MVI? Exploring the path to gross motor delays

We have a new video on our YouTube channel – https://youtu.be/f5XEAXGPLCc

In thirty minutes we see how a three-year-old girl with neurological visual impairment improves in five identified areas of need: Tactile defensiveness, gross motor skills, purposeful exploration, language and cane skills.

Please comment, like and share!

Blind toddlers taught me about the cause of their gross motor delays

The world has a vaccine to alleviate the COVID-19 epidemic and we need your help more than ever in getting the solution for gross motor delays out to cure the tiniest epidemic known to mankind. It has raged for centuries in every part of the globe: Gross motor delays in blind and mobility visually impaired children due to unsafe mobility.

Congenitally blind children’s difficulty achieving developmental milestones has been described by scholars in every recorded century. In the past ten years, research studies on the concept development, physical education, language skills, and social skills of blind children continue to report that the greater the degree of congenital visual impairment, the worse the outcome. There is a direct correlation between severity of visual impairment and poorer developmental outcomes, but not for the reasons some have hypothesized. It is not because being blind makes you “unaware”. Nor does being blind make you “incapable of learning about space”.

All other things being equal, the blind child’s brain is perfectly capable of learning by doing. In fact, one might argue they have succeeded in spite of having to do it in the face of constant and extreme duress. Children who are blind or mobility visually impaired face difficulty when they attempt to explore their world independently, because when they walk without mobility tools they are unable to predict and avoid bodily collisions. Children who experience unavoidable bodily collisions are growing up under duress.

Global developmental delays result when mobility visual impairment or blindness prevents children from sustaining the 18-month motor milestone, “walks well, able to avoid collisions.” The more toddlers who are blind or mobility visually impaired attempt to move through space without mobility tools, the more collisions they sustain. Children who are blind or mobility visually impaired who achieve the 18-month gross motor milestone, have been found to regress from 15-month milestone of walking independently with a wide-based gait to the 12-month-milestone, “walks only with assistance (cruising/holding hands)”.

     The simplest explanation for this common motor skill regression is that blind children have learned that the only way they can avoid bodily collisions, is to walk only when help arrives. 

Blind and mobility visually impaired three-year-old children who are only able to walk with assistance are not able to confidently join social groups. No matter how many times a sighted person prevents a blind child from a collision; toddlers can only gain self-confident travel when they can save themselves from collisions. Blind toddlers have difficulty learning because they cannot navigate without direct bodily collisions from a very early age.

Providing children who are blind with belt canes has allowed me to learn the relationship between safety and learning. The pediatric belt cane is effective because it blocks sudden, bodily collisions, and because it provides information about the walking surface, including the location of drop-offs.

Children who are blind and wear belt canes become more social including improved language skills. Their language is filled with meaning and they engage with others, seek out others and seek out places and activities. These children are blind and become more connected to their world. To become a self-confident blind preschooler, they need to wear belt canes.

Below are a series of photos of Charna seeking out a toy she kicked under a chair. Charna has inspired new curriculum topics: For example, how to teach two-year-old girls who are blind to keep up with the family group during a walk in the park when she refuses to ride in the stroller and doesn’t want to hold anybody’s hand (Nov. 4).

Charna’s family uses voice calling (Sept 4). to help her follow them on sidewalks, at the zoo and in parks. Wearing her belt cane at home, Charna is underfoot in the kitchen (Dec. 17) and she knows how to wrangle toys that go under chairs (June 11).

In the park, Charna is confident enough to refuse help from strangers and independently seek out her dad. As soon as she hears him, she puts on a huge smile and moves directly to him with her trusty belt cane leading the way. She doesn’t want to hold dad’s hand; she just wants to walk and talk with him. Now, those are some age-appropriate social skills.

Charna and other children like her who are blind and wear belt canes have taught me that they didn’t do these things before because they felt unsafe. The belt cane allows them to feel safe. Everything you ever learned about gross motor delays in children who are blind has been written from the point of view of teh blind child who wasn’t given equal access to path information.

We have learned that with effective path information, gross motor delays are not an outcome of being blind. If you too want to prevent gross motor delays in blind toddlers, provide them with effective tactile path information. Provide them with safe mobility tool, provide them with a pediatric belt cane.

Charna finds a toy with her belt cane.

She turns towards the toy and pushes it under a chair.

She reaches down to grab it and accidentally pushes it further under the chair.

Charna is determined to get her toy, she uses her leg to locate it.

She reaches out to grab the toy with her hand.

Success! Of course, the fun was in the finding, she only plays with it for a few moments more.

Toddlers taught me all I know about belt canes

I made a lot of assumptions about how blind and mobility visually impaired toddlers would respond to belt canes. This is a list of ten assumptions that have been proven wrong since collecting videos of children wearing belt canes. The blue links take the reader to webpages containing specific example videos demonstrating the point made in that paragraph. I continue to learn about belt canes from the toddlers and preschoolers who are blind and mobility visually impaired wearing them. It won’t be long before I need to add part II of what blind and mobility visually impaired toddlers have taught us all about using belt canes.
1. Hands free – I thought hands free meant building a cane frame that never deviated from the path ahead. A major emphasis of the belt cane design was to make something that was completely hands free. The Safe Toddles’ team thought the belt cane should never drift from the path ahead. The belt cane design does stay ahead of the child on most smooth surfaces when walking alone (not holding a hand). Yet, on rougher surfaces and/or when walking in guide with an adult, the cane frame can drift off to one side, causing the need for either the child or adult to right the cane (put back into forward position).

When asked, parents were the first to allay my fears about this aspect of the belt cane. Charna’s mom and dad frequently responded by saying, “That’s not a problem for us. She doesn’t mind and Charna knows how to fix her cane.” In fact, when Charna, who was blind and two years old, wanted attention, she moved her cane around to her back, knowing her parents will say, “Charna, fix your cane.” and she did. And because they spoke, Charna now knew where her parents were located and went to them. She is so clever.

2. Push back – I worried that it would take time for children to learn to tolerate the intensity of tactile path feedback. Alilah put her first belt cane on when she was 20 months old. Right out of the box, she was filmed walking in the kitchen. We see her O&M specialist block her path with a chair. When the cane base contacted the chair legs, you see her get pushed back from the force of inertia. She remained standing. Several more times when the cane contacted something on the ground, she again withstood the impact. Once, she did fall back and she cried a little. However, mostly Alilah took it all in stride.

In her videos you can watch her gait and her pace improve. She walked much faster and further away from her parents with greater ease than she did in her “before” videos. She used her cane frame contacts to locate objects for further investigation.

3. Stairs- I thought the most important aspect of the belt cane would be that it performed like rod and rectangular canes on stairs. The first question that every O&M specialist asks about the belt cane is, “what about stairs?” We are O&M specialists, so we were the first people to ask that question. As we too want the belt cane to easily negotiate ascending and descending stairs. We have found that descending stairs, the cane works well. The method for ascending stairs wearing the belt cane has varied. However before we get too far ahead of ourselves, it is important to remember the value of knowing exactly where the stairs are. The belt cane tells the wearer exactly where the ascending and descending stairs begin. The problem that we see in children who are blind right now is that they can only guess at where the stairs begin, and can only find the stairs when their foot collides with the riser. Without consistent tactile path information, children under five have no warning before their body touches/falls down the stairs. We need to be reminded that currently, children five and younger without consistent tactile path information demonstrate highly inadequate outcomes of navigating stairs. The benefit of the belt cane is path information. I am sure that given time and opportunity, toddlers will figure out how to navigate stairs, in fact Matias has found that going up the stairs backwards is one way to go. Wyatt and Jack have both demonstrated great competence navigating the step up to wash hands at the classroom sink.

4. Free time – I thought that there was a benefit to being without a cane when you’re blind or mobility visually impaired. Many authors of early intervention articles have contended that blind children benefit walking without canes. However, there is overwhelming evidence that this is not true. When you cannot see where you are going, it is only a matter of time and distance before you collide with obstacles.

     These unavoidable obstacle collisions cause developmental delays in children who are blind or mobility visually impaired.

The more children who can’t see the path ahead walk freely, the greater number of body collisions they experience. Blind and mobility visually impaired children have no way of veering away from these collisions or slowing down to reduce the impact. Therefore, children learn that walking causes pain and that causes them to avoid walking alone. Instead, they smartly ask to hold onto a hand, touch a wall, cruise furniture, but they do not want to walk across open space on their own. It isn’t the walking with assistance that causes delays, it is walking with fear.

There is no benefit to walking in the pitch dark and there is no benefit to walking while blind without consistent tactile path information (like lights for blind kids). When children wear their belt canes, they gain confidence in themselves. They walk across open space, they let go of the wall and they let go of the hands of adults. They become hands free, because they don’t need to walk with assistance anymore. Children who are blind or mobility visually impaired walk more, better and faster wearing their belt canes. The more they wear it the greater their self-confidence.

Just remember: lights on, cane on.

5. Cane sticks – I thought that canes getting stuck under furniture would cause children to reject the belt cane. The belt cane is a set of one belt with two cane frames. The two frames were created for children in order to reduce the amount of cane sticking. The daily cane is the correct length for children who are blind and mobility visually impaired to obtain two steps of warning. The tight spaces frame is ninety percent of the length and the cane tip is turned inward to reduce catching. However, the rectangular cane frames catch on chair legs and get stuck, and this is all a part of learning. Children who are blind don’t know that canes getting stuck are a different experience from sighted people, because when you are three-years-old you think everybody is the same. Canes get stuck and that’s a fact of life, and the more you wear your cane the better you get at getting unstuck. More experience adds up to better skills. There is a difference. A child who is blind and walks and experiences direct bodily collisions, has no way to “get better” at walking with collisions, except to stop walking. A child who wears her cane all the time develops confidence. A child with confidence whose cane gets stuck, can improve in her ability to get unstuck because her confidence in herself drives her to master this problem by finding an independent solution. One thing they don’t do is ask to take off the belt cane. They just work to free themselves.

6. Catchall – I thought the cane would need to be designed to locate all the objects all the time. After two months of wearing her cane, there is a moment when Charna’s cane glides over/misses little toys on the floor, and she steps on them. Charna reaches down and investigates what she stepped on and then continues on her way. This is not the first time her cane has allowed Charna to step on something. The difference is that the number of times Charna runs into walls, cabinets, chairs and people has been reduced by ninety-five percent. Thus, the five percent of the time the cane isn’t there is within acceptable limits. We can all tolerate little accidents that occur infrequently. Next time her cane signals little bumps, she will have learned to turn away, or to step carefully. She has already learned to pick up on many of the signals her cane provides, because she is walking and learning. This is very different from children who walk without any warning, they are walking with fear. You can’t learn anything when you’re walking with fear, all you can think about is how to protect yourself. You are motivated to find safety, not to learn. The belt cane removes fear and improves learning.

7. At arm’s length- I thought that the cane frame would need to collapse so that the child could get closer to objects. One noticeable difference between the belt cane and the rod and rectangular canes is that the belt cane frame does not retract. Although Charna can achieve cane retraction because of her size, her belt slips above her waist as she moves towards a bin when wearing her tight spaces cane frame, this is not a typical outcome when wearing the belt cane.

Our search continues for a magical cane frame material that can remain strong and straight during forward propulsion and yet, when enough pressure is exerted retracts to allow the user to step closer to explore objects blocking their path. The magic part is the expectation that the material will be able to spring back to straight, strong and extended into the path when freed from the blockage. We will keep looking for that material or design feature, but in the meantime, the children have shown us that they are able to figure out multiple strategies for getting closer to objects they find. Like Matias, who when playing with a water toy one summer, put his cane frame behind him. His cane is still there, ready to be returned in front when he is ready to move again.

8. Take on/off independently – We thought it would be important for children to learn how to take their belt canes on and off themselves. At first, the first belt cane was a bungee belt, and children stepped into the belt like a pair of pants. We thought that this would be a routine that would be easily mastered by very young children. The magnet belt is a much better design. It is much less cumbersome to put on the child, as there is no need for the child to step into or out of the cane frame. The belt is closed using a mushroom head fastener that requires an adult’s strength and dexterity to pinch close and pull open.

It turns out, that some highly capable three and four-year-old boys and girls do learn how to detach their belt canes. They don't discard them, they push them. They get to decide if they want to keep them attached or detached. So, while we intended to make the canes like car seats, we made them so well that kids can take them off, and still want to use them. This is helping them with the transition to the AMD and later the rod cane.

9. Mobility instruction – I thought the child would have to be taught how to employ the belt cane. The Audrina Series, documents a three-year-old girl wearing her belt cane and compares her wearing the belt cane to when she is using her rod cane. In the video series, we see clearly that she is not able to work her rod cane to achieve one step, one swipe. No matter how much she is prompted to do so by her teachers and O&M specialist. Yet, with no instruction at all, she is moves about freely and with greater speed and self-confidence with the belt cane.

When Audrina wears her belt cane, she becomes much more of a three-year-old (meaning less compliant). She begins to discuss, some might say argue, orientation and route planning. Her language is more interesting, and she begins to run and explore and have fun. The benefit of the belt cane is that now O&M lessons can be about concept development as the cane arc is built in and the children learn to confidently explore their world. Belt cane O&M lessons are more fun because it can focus on concept development, route travel, locating fund destinations, learning the rules of the road -just more learning period about important concepts can happen when you don’t have to worry about safe mobility.

10. I didn’t know blind children would run without prompting – The first child who was mobility visually impaired to run wearing the belt cane was Jojo and he was the first child with mobility visual impairment to wear the first ever 3D printed bungee belt cane in September 2017. Since then, almost every three- and four-year-old who wears the belt cane, runs. If they are physically able to run, they run.

     Blind and mobility visually impaired children do want to run; they want to let go of the wall and they want nothing more than to feel safe and confident and to be independent.

Anybody who says the blind child prefers a sedentary lifestyle is asking that child who is blind or mobility visually impaired to walk/run without consistent tactile path information. When they have no path information, they are the smartest person in the room, as they know better than anyone else that running without path information is dangerous. Running with path information is fun (watch part five of the Audrina series).

Comparing visual and tactile path preview

What happens when a driver takes her eyes off the road? When she looks up she might jerk her head back and quickly turn the steering wheel to correct for a veer and avoid a collision. By contrast, when a driver keeps her eyes on the road she can smoothly navigate a turn so that the passenger barely notices. The advantage of vision is distant path preview allows you to make subtle path changes to avoid objects and follow the clear path.
Sudden visual path information is a lot like typical tactile path information, the jerk is physical and shocking to the system. Sighted people experience sudden visual path information much less often than belt cane users experience the push back from tactile path information. Tactile path information looks very jerky, because it is.

Blind kids can’t “keep their eyes on the road” to make smooth course corrections. Thus, walking towards a wall, the belt cane is working when it suddenly stops the blind child in her tracks. She never sees the wall coming, because she is blind.
It is important not to judge the jerkiness of tactile path preview by the standard of visual path preview. Instead, every time you see a young blind child’s cane suddenly stop them from colliding with a wall, understand that is a great outcome. It is a body collision avoided. When the cane frame takes the hit, the child gains confidence in the same way we sighted people learn to appreciate our eyes and quick reflexes.
The video I have put together shows a two year old girl who is blind. In the first scene, she is stopped from hitting the cabinet in her kitchen, she then makes a course correction and goes on to locate her mom using her words.

Next we see her stopped because a rise in the sidewalk, she uses her cane to learn that there is an iron gate blocking her way and turns to locate a clear path. Next we see her step more cautiously because her cane frame stopped her at a sidewalk rise. At the park, she finds a pole and purposefully clangs it with her cane frame on both sides, and then turns to ask her dad, “What is this?”
Finally, we see her cane stop her from hitting a sign post on the sidewalk with her body, and then she uses her cane frame to again clang the sign post, this time she reaches out with her hand to explore the sign post further.
The benefits of tactile path information is sometimes hard to understand in the eyes of those who can see, because it appears jerky and cumbersome. Yet, each time blind toddlers feel that jerk is a win for them. From the point of view of a blind toddler, tactile path preview is a kinder way to explore the world. Much better than body slamming walls, sign posts and kitchen cabinets.
Remember: Every time the cane clangs, a blind toddler is saved from a body bruise.
Pediatric belt canes are best when worn most of the day – more belt cane clangs and less body bangs encourage self-confidence, independent exploration and expansive learning.

The Pediatric Belt Cane Encourages Cane Control

I recently posted a video of a concept lesson with a blind two year old girl, Charna, on Facebook. While most of the feedback was positive emoji “likes”, “hearts” and “wow faces”; one Facebook poster expressed her concern that the belt cane is a passive tool that might prevent long cane skills from developing. The benefit of the belt cane for blind and mobility visually toddlers is that when they wear the belt cane they achieve easy access to safe mobility.

It is true, on a smooth surface the cane frame more easily remains in front of them. Since Charna is blind, she wears her cane most of the day, the terrain offers plenty of opportunities for learning cane control. Charna began wearing her cane at two years old. You can follow her progress in belt cane manipulation over fifteen months by watching her video series on our website.

At first, we see that she was barely able to manipulate her cane frame. After a month, she was able to “fix” her belt cane on her own, with prompts. Now she no longer has to be prompted to reposition her cane frame, but when she is seeking attention she has been known to push the cane frame behind her back. Then, when her parents call out “fix your cane,” she quickly moves it back in front and races to their voices.

In one video, Charna’s mom discusses her concern that when she visits friends and family Charna “bangs her cane” against their furniture. Her dad has filmed several videos documenting Charna exploring new houses and purposefully contacting their furniture with her cane frame.

A discerning eye notices that she appears to be using her cane to explore the objects, she checks how tall they are, how wide, and the sound they make. In Charna’s videos we also see how various sidewalk and playground textures challenge the position of the cane frame.

She repeatedly has to reposition her cane in front, sometimes she lets it drag longer than other times. Sometimes the cane base catches something and she is pushed off balance. On one walk she was preoccupied with a toy she was holding and her cane technique really suffered.

When she fell down, her dad picked her up and she said, “hey, my toy is gone”. And he gave her back the toy.

Charna and other belt cane wearers cane let go of their cane frames anytime they need to for balance, to carry a toy, or to explore with their hands. The purpose of the belt cane is to provide young children who are blind and mobility visually impaired with the benefit of cane arc safe mobility.

When the cane stops it prevents them from bodily collisions. When the cane frame drops down, it teaches them to stop at drop-offs. Charna also uses her cane frame to learn more about the objects near her and the surfaces upon which she is about to trod. The belt cane provides the only safe mobility option for blind babies. Safe mobility provides blind and mobility visually impaired babies with the confidence they need to thrive.

The belt cane teaches them to be cane users.

Why are belt canes free?

Raison d’etre. Pediatric belt canes dramatically improve the lives of children who are mobility visually impaired and blind (MVI/B). However, there is a great deal of ink used by theoretical and research publications in early childhood textbooks, scholarly journals, and family-directed publications; and countless training hours at universities, workshops, conferences, and in videos to promote the importance of urging blind babies to learn how to walk “freely”, meaning without holding a hand and without a mobility tool, in short, unsafely.

The need for path information is understood by sighted people, for themselves. When I cannot see, I turn on the lights, clean the windshield, or put on glasses. Somehow, through the ages, there has existed an asterisk, the suggestion that when you are blind, you benefit from the same collisions that sighted people avoid by turning on the lights.

Suggesting that blind babies are physically and emotionally different from sighted babies. They are not.

There is an adage that goes, “blind babies are the same as sighted babies because they both collide with their world, and these little collisions are mild and kids don’t seem to mind them”. Safe Toddles debunks that false comparison with logic.

Blind babies are harmed by collisions, even those considered mild, aka simple object contacts, because they cannot see it coming. Nor can they look back to evaluate the cause of the collision. They cannot learn to visually avoid collisions, brace themselves, or slow down and veer; because they cannot see them. They learn only to fear walking.

Safe Toddles pediatric belt canes are not just a mobility tool, they are an important source of information that allows children with MVI/B to learn from impacts with objects. We have seen the positive outcomes of path information in children as young as 15 months.

In order to change centuries of belief requires easy access to these canes. We give these canes away for free to accelerate the adoption of a kinder, gentler approach to child rearing and therapy practices for children born MVI/B. Collisions cause developmental delay – see below figure.

With your help we can do more.