Once again, orientation and mobility Facebook group members asked for proof … “Show us your data” was the request. Prove that children who are mobility visually impaired or blind (MVI/B) need better mobility tool options (e.g., wearable belt canes).
Which is tough to hear because I thought it was obvious. There are two pictures of the same girl in this blog post, on the Safe Toddles website are her videos that demonstrate the difference wearing a pediatric belt cane made for Alilah.
Before the belt cane – she didn’t walk unless prompted, urged and cajoled by her parents and O&M specialist. When she walked it was with an unsteady, unbalanced gait and she was very quiet. The second photo is Alilah in the mall- her videos confirm. She walks away from her mother, her mother has to find ways to stop her from running away from her. She has to teach her the rules every child must learn about stranger danger- because she will now wonder off. She is also much more talkative.
That’s important developmentally- blind children need to wander off and their parents need to teach them the rules of staying near. Independent walking is the fast track to achieving developmental milestones.
Alilah no longer not fits the poor motor outcomes found in so many research studies that describe children like her – those born mobility visually impaired and blind (MVI/B). She has optic nerve hypoplasia, and a small window of vision.
There is more than a century of research that has identified global developmental delays in children born with MVI/B who grow up with early education, but without access to consistent tactile path information from an effective mobility tools (Celeste, 2002; Hatton, Bailey, Burchinal, & Ferrell, 1997; Hatton, Ivy and Boyer, 2013).
The research on motor skill delays found in children like Alilah (before belt cane) is extensive (Brambring, 2006; Celano, Hartmann, Dubois, Drews-Botsch, 2015; Celeste, 2002; Gazzellini, et. al., 2016; Hallemans, Ortibus, Truijen, Meire, 2011; Hatton, et. al., 2013; Wyver and Livesey, 2003; Tsai, Meng, Wu, Jang, & Su, 2013).
Children born with MVI/B who do not wear belt canes are less likely to achieve motor milestones on time (Bakke, Cavalcante, Oliveira, Sarinho, & Cattuzzo, 2019). Wyver and Livesey concluded that “findings are generally consistent despite the studies being conducted in a wide range of settings, in a variety of countries … there is strong evidence of an adverse impact of visual disability on motor development” (2003, p. 25).
A review of the bulleted list of common gross motor milestone definitions at five ages (Sharma, 2011); finds that toddlers’ eighteen-month-motor milestones included the expectation that they will have developed their visual/motor coordination enough to walk and avoid obstacles independently. By twenty-four months of age, children were expected to be able to run and avoid obstacles, independently (Sharma, 2011).
- Nine months — crawling, standing
- Twelve months – cruising, walks with assistance
- Fifteen months — Walks alone feet wide, hands up, often falls, bumps into furniture
- Eighteen months — walks well with arms down, runs carefully but cannot avoid obstacles
- Twenty-four months — runs avoiding obstacles.
Children with MVI/B who grow up without wearing pediatric belt canes demonstrate gross motor milestone delays (Brambring, 2006). The cause of these gross motor milestone delays is their inability to develop visual motor skills needed for ‘obstacle avoidance’ and their lack of tactile information to learn tactile/motor skills for obstacle avoidance (Pigeon, Li, Moreau, Pradel, and Marin-Lamellet, 2019).
People whose MVI/B robs them of visual path information benefit from mobility tools that provide tactile path information. Obstacle detection is the first step needed to develop motor planning strategies used to interact effectively with obstacles, such as obstacle avoidance.
The pediatric belt cane is a developmentally appropriate mobility tool toddlers with MVI/B wear. The rectangular shape of the cane offers a reliable cane arc and enables very young children with MVI/B to experience consistent and reliable tactile path information.
The cane frame maintains contact with the floor, two steps ahead of the child. Toddlers with MVI/B cannot forget their belt canes because the top of the frame is connected by magnets to a belt that is worn about their waists (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson, & Bikson, 2019).
Families and professionals who order pediatric belt canes for children with MVI/B do so because the children with MVI/B in their care were experiencing unavoidable collisions and the older they became the less they walked independently. By age three, they simply avoided all independent walking.
Adults were actively encouraging the children with MVI/B to continue walking independently, yet they no longer would- they were not interested in colliding with furniture, walls, and tripping over toys without warning. Before requesting belt canes, the adults tried getting these children to hold long canes and push toys. Yet, these children with MVI/B were reported to simply not be able to swing the cane most didn’t even hold the cane for very long.
Families and professionals identified the problem, toddlers with MVI/B were not able to walk safely because they could not see well enough to avoid obstacles. They needed to wear a pediatric belt cane a developmentally appropriate white cane for toddlers with MVI/B.
Toddlers need belt canes because they are unable to keep themselves safe using hand-held white canes. In the hands of a toddler, long canes are easily cast aside or entirely forgotten.
Adults are getting pediatric belt canes for children with MVI/B because these children are afraid to move. It is almost too late! We should be providing these children with effective wearable canes BEFORE they grow afraid and insecure about walking independently.
Wearable belt canes solve the problem of obstacle detection and allow toddlers to gain self-confidence. Proof in the form of family-shared videos is on our website www.safetoddles.org. In our articles, Ambrose-Zaken, G. V., FallahRad, M., Bernstein, H., Wall Emerson, R., & Bikson, M. (2019) and Ambrose, G. V., McAllister, J. & FallahRad, M (2020).
Toddlers with MVI/B want to run. Once they have reliable tactile path information- they do run, they do cross open space, they gain confidence, expand their language and concepts- they enjoy and learn from the information that wearing pediatric belt canes provide them.
References
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, 4. doi.org/10.3389/feduc.2019.00044
Ambrose, G. V., McAllister, J. & FallahRad, M (2020). Would A New Term Improve Gross Motor Outcomes? A Study of Children with Visual Impairment and Blindness, Journal of Visual Impairment & Blindness.
Bakke, H. A., Cavalcante, W. A., Oliveira, I. S. de, Sarinho, S. W., & Cattuzzo, M. T. (2019). Assessment of Motor Skills in Children with Visual Impairment: A Systematic and Integrative Review. Clinical Medicine Insights: Pediatrics. https://doi.org/10.1177/1179556519838287.
Brambring, M. (2006). Divergent Development of Gross Motor Skills in Children Who Are Blind or Sighted. Journal of Visual Impairment & Blindness, 100(10), 620-634.
Celano, M., Hartmann, E.E., Dubois, L.G., Drews-Botsch, C. (2015). Motor skills of children with unilateral visual impairment in the infant aphakia treatment study. Developmental Medicine & Child Neurology, 154-159. doi: 10.1111/dmcn.12832.
Celeste, M. (2002). A survey of motor development for infants and young children with visual impairments. Journal of Visual Impairment & Blindness, 96(3), 169-174.
Ferrell, K. A., Shaw, A. R., & Deitz, S. J. (1998). Project PRISM: A longitudinal study of developmental patterns of children who are visually impaired(unpublished manuscript). Retrieved from http://www.unco.edu/ncssd/research/PRISM/default.html
Gazzellini, S., Lispi, M.L.,·Castelli, E.,· Trombetti, A., Carniel1, S., Vasco1, G., Napolitano, A.,· Petrarca, M. (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., Meire, F. (2011). Development of independent locomotion in children with a severe visual impairment. Research in Developmental Disabilities, 32, 2069–2074.
Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997). Developmental growth curves of preschool children with visual impairments. Child Development, 68, 788–806.
Hatton, D.D., Ivy, S.E, Boyer, C. (2013). Severe visual impairments in infants and toddlers in the United States. Journal of Visual Impairment & Blindness, 107(5): 325-336.
Pigeon, C., Li, T., Moreau, F., Pradel, G., & Marin-Lamellet, C. (2019). Cognitive load of walking in people who are blind: Subjective and objective measures for assessment. Gait & Posture, 67, 43–49. https://doi-org.proxy.wexler.hunter.cuny.edu/10.1016/j.gaitpost.2018.09.018
Sharma, A. (2011). Developmental examination: birth to 5 years. Archives of Disease in Childhood – Education and Practice. doi: 10.1136/adc.2009.175901
Tsai, L.-T., Meng, L.-F., Wu, W.-C., Jang, Y., & Su, Y.-C. (2013). Effects of visual rehabilitation on a child with severe visual impairment. American Journal of Occupational Therapy, 67, 437–447. http://dx.doi.org/10.5014/ajot.2013.007054
Wyver, S. R., & Livesey, D. J. (2003). Kinaesthetic sensitivity and motor skills of school- aged children with a congenital visual impairment. British Journal of Visual Impairment, 21(1), 25–31. https://doi.org/10.1177/026461960302100106
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