1.png

PEDIATRIC BELT 
CANES

BUILDING SELF-CONFIDENCE,
ONE STEP AT A TIME

The PBC consists of a rectangular frame that connects to a belt with magnets. The base of the cane slides along the floor with approximately one inch clearance in between the two cane tips. The cane frame remains forward of the wearer during ambulation with minimal need for a user to employ corrective hand control on most surfaces (see Figure). The design ensures that adults were responsible for the device being used, without having to constantly be in contact with the child or the PBC.

Pediatric belt canes are an effective developmentally appropriate mobility tool because the belt makes it possible for toddlers and preschoolers who are BVI to easily maintain consistent placement of the protective mobility frame which allows them to independently detect obstacles in the path ahead. The pediatric belt cane is an effective barrier able to reduce unwanted, unavoidable direct bodily contacts.

pbc-diagram_5EBfkow5.jpg

Donning the Pediatric Belt cane.

1

The belt is fastened about the hips so that it fits snugly and comfortably

2

Choose the correct frame for location. 

  • The daily frame is the correct cane length for the learner’s height and should be used during most activities and in most locations. Also, the cane tips on the daily frame are reinforced by steel plates which allows them to glide over most surfaces. 

  • The tight-spaces frame is 90% of the length of the daily frame, allowing closer inspection of forward objects and the cane tips are positioned to reduce catching on furniture. The tight-spaces frame is intended for indoor home environments.

3

Attach the cane frame. The belt cane frame is positioned to allow the magnets to securely click into their respective connectors on either side of the belt.

with belt cane_LI.jpg
Screen Shot 2021-11-02 at 2.24.09 PM.png

Doffing the pediatric belt cane 

1

Press one corner of the magnet pod located on the belt to release the frame. Once one side is free, the other easily pulls away.

2

To unfasten the belt, peal the top end edge away from the bottom piece.

Pro Tips

  1. Limit wearing belt without frame

  2. Introduce wearing the belt cane as a unit. You might have the student hold the frame with two hands and push in front to demonstrate the purpose of the cane frame to the student and assist in the transition to clicking the frame magnets onto the belt- saying "the cane will protect you and you don't have to hold it all the time”. The more your student wears the belt cane as a unit the better the acceptance. 

  3. As students grow, they will need a larger size belt cane until they are able to transition to hand-held mobility tools. Older students can learn to disconnect the frame to begin pushing it as a rectangular cane. The most important outcome is that they use a safe mobility tool every day, most of the day.

Belt:

The belt works best when it is snug. The size is correct when the ends close only half-way. The fastener has an extraordinarily strong grip and takes a strong pinch to close securely.

Two cane frames:

The longer frame design is the daily frame. It is the correct length for your student’s height and recommended to be used the most. If there are any drop-offs (curbs, stairs) the daily frame gives the most warning. The daily frame tips’ metal glides move across most surfaces. The shorter, tight spaces cane, frame is designed for use in living rooms with furniture with legs. This shorter frame does not have metal glide material on the tips and the angle of the frame is less forgiving, that’s why it is recommended for use in small, cramped spaces. For example, in a large indoor mall, the daily frame is recommended.

3d7325_32d323b750dd4fc3b909750ab37f8109~mv2.jpg

Does my student have to hold on to the frame?


If it is within your student’s developmental potential your student will eventually reach down and begin to control the frame, however this does not have to happen right away. Independent control of the cane frame can be encouraged. A student who is not yet able to independently right the frame or get it unstuck will need adult assistance and instruction.




What lessons does student need to learn how to wear the belt cane most of the day?


Allow student to stand still, twist, sway and bang the cane. Help student learn to regain balance, get unstuck, backup, locate a clear path, contact, and investigate objects with the cane frame, keep the tips on the floor. During O&M lessons: ask student to walk to a destination for a specific purpose – (e.g., to engage in an activity, once there). Avoid simply asking student to “walk”, instead say, “let’s go to the toy room and find your ball so we can play bounce ball.” Goal: student to independently sit down and stand up from the floor, at a table.

There are videos on safetoddles.org/belt-cane-how-to that show various ways young students learned to stand up wearing their belt canes and other skills.





CHARGE SYNDROME PILOT STUDY: INITIAL RESULTS 

az theory title.jpg
A-Z Safe Mobility Achieve Developmental Potential.png

Ambrose-Zaken’s theory “Safe Mobility is Essential to Achieve Developmental Potential” helps us to understand the psychological reasons unavoidable collisions cause children who are blind and mobility visually impaired harm. When toddlers who are blind and mobility visually impaired are not provided safe mobility, any independent walking achievement predictably regresses to the 12-month walks with assistance or crawling, the 11-month milestone cruising or 10-month milestone stands, that is they stop all walking activity (Ambrose-Zaken, 2021).

Children who are blind or mobility visually impaired who have been encouraged to walk independently, have experienced unavoidable collisions, because unavoidable collisions are the only dependable consequence of independent walking when blind or mobility visually impaired. Ambrose-Zaken’s theory is that children who are blind and mobility visually impaired walk very slowly or request to walk with assistance because they have become afraid of walking independently.

Ambrose-Zaken’s theory combined Maslow’s Hierarchy of Needs with the Expanded Core Curriculum’s “nine areas of instruction children with visual impairments (both those who are blind and those with low vision), including those with additional impairments, need to be successful in school, the community, and the workplace” (Sapp & Hatlen, 2010, p. 338) to demonstrate that safe mobility, the ability to independently detect collisions before they impact the body, is essential to achieving one’s developmental potential.

The first rung of Maslow’s hierarchy is Physiological Needs. Physiological needs were defined as biological requirements for human survival, e.g., reliable access to food, shelter and good health.

None of the expanded core curriculum areas are included in that rung. A child who lacks food, shelter and good health can learn, but if nothing changes to improve access to these necessities they are not going to develop to their full potential. If these needs are not satisfied the human body cannot function optimally. Maslow considered physiological needs the most important as all the other needs become secondary until these needs are met. Children’s learning cannot be as robust when much of their energy and mental focus is diverted to solving these more pressing concerns.

 

The next rung is Safety Needs defined as stability, order, freedom from fear including safe mobility. Once an individual’s physiological needs are satisfied, the needs for security and safety become salient. People want to experience order, predictability and control in their lives. These needs can be met external supports derived from family and societal structures.

 

Toddlers who are blind and mobility visually impaired lack the visual ability to gain control over their independent movement essential to improving their internal feeling of safety. This lack of control that results in living in a constantly unsafe state driven by an inability to independently improve their safety (e.g., reduce accidents and injury while moving freely) is detrimental to toddlers who are blind and mobility visually impaired independent walking progress, which prevents their age-appropriate exploration of the environment.

 

In the expanded core curriculum (ECC) “orientation and mobility” were listed together as one of the nine areas of instruction. We see these as two areas. The first area is safe mobility and is listed in the safety rung, the term “orientation” has been replaced with the terminology “independent travel skills” and located within the Love and Belonging rung. Early independent walking is awkward, unbalanced. The toddler can harness this skill into purposeful, intentional, directed way finding only through daily practice.

 

Increasingly safe independent walking is fundamental to learning. The onset of independent walking triggers immediate, significant acceleration in language growth; a pattern that is stable and is evidenced across cultures. Infants’ walking experience significantly predicts both receptive and expressive language growth with walking infants having significantly larger vocabularies than their age‐matched peers who are not yet walking. The ability to walk affords new opportunities and experiences that bolster infants’ language development.

Children who are blind and mobility visually impaired need access to safe independent mobility most of the day in order to obtain similar amount of walking practice as their sighted peers. The areas of the expanded core curriculum that are included on this rung are self-determination, compensatory functional, and sensory efficiency. Children who feel safe enough to independently explore develop self-confidence. Children who possess self-confident independence can acquire self-determination. The practice of independently moving about also develops their sensory efficiency.

The importance of safe mobility to toddlers who are blind and mobility visually impaired is equal to that of a sighted child or adult. All toddlers need adults to protect them. Adults turn on the light switch for sighted toddlers, otherwise they would be left in the dark as they cannot reach the switch. Toddler who are blind or mobility visually impaired need adults to ensure their safety by providing them with effective tools. Toddlers who are blind and mobility visually impaired cannot secure effective mobility tools for themselves. They also cannot make sure their belt canes are fastened to them. Toddlers are not responsible enough to oversee their safety.

Once adults have secured safe mobility and made room for all the changes that a pediatric belt cane brings to the environment- children born blind and mobility visually impaired will be able to feel safe when independently mobile, a feeling needed to reach their developmental potential.

Each rung on this pyramid relies on the lower rungs. Children who know only collisions, cannot benefit fully from the next rung entitled Love and Belonging nor can they seek it out. After physiological and safety needs have been fulfilled, the third level of human needs is social and involves feelings of belongingness. 

 

Belonging and Love refers to a human emotional need for interpersonal relationships, affiliating, connectedness, and being part of a group. Two belonging and love needs which are at risk in children who are blind and mobility visually impaired are trust and acceptance. It is inherently unsafe to walk and run if you cannot see where you are going. The trust of children who are blind and mobility visually impaired is challenged each time they are encouraged by another to move about freely into harm’s way.

A child who is blind and mobility visually impaired without pediatric belt canes who knows only unavoidable collisions resulting from their desire to walk independently may build a protective shell, wall themselves off from the pain caused by independent exploration and the failure of those around them to protect them. Children who are blind and mobility visually impaired may develop a protective shell from experiencing a world that seems bent on harming them and the knowledge that they can do nothing to avoid the harm except to stay in one place, which results in developing self-stimming activities, echolalia and tactile defensiveness.

Toddlers equipped with the pediatric belt cane can achieve “independent travel skills”. The ability to be oriented when walking safely is the basis for development of complex travel skills, navigating home environments, neighborhoods, indoor shopping and greeting every environment with confidence.

Preschool learners who are blind and mobility visually impaired and are eager to walk independently can learn how to stay with the family, the rules of store etiquette, movie theaters, playgrounds. A child who is blind and mobility visually impaired who is happy in the knowledge that the cane frame will prevent most bodily collisions, eagerly runs into the world to discover and begin to acquire independent travel skills, recreational and leisure skills and social interaction skills through experience and direct instruction.

Consider the contrast of achieving the next rung Esteem.  Esteem needs are the fourth level in Maslow’s hierarchy and include self-worth, accomplishment, and respect. Maslow classified esteem needs into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the desire for reputation or respect from others (e.g., status, prestige).

Compare the esteem of children who are blind and mobility visually impaired growing up knowing every step for them is uncertain. Yet their siblings (including younger children), parents, teachers, can move and avoid colliding with obstacles. From the very beginning of understanding children who are blind know only that they are unable to be like others in this important respect but can’t understand the abstraction that they are not all the same sensory-wise.

Self-actualization needs are the highest level in Maslow's hierarchy, and refer to the realization of a person's potential, self-fulfillment, seeking personal growth and peak experiences. Maslow (1943) describes this level as the desire to accomplish everything that one can, to become the most that one can be.

Some children who are blind indeed do grow up and graduate high school despite these difficulties. The question to ask of any child who is blind or mobility visually impaired who achieves success, despite of these tremendous odds, is what they could have achieved given a life of predictable, reliable, independent safe mobility during their sensorimotor period of development.

There are many children who are blind and mobility visually impaired with developmental delays, how many of them could have, if not held back by unsafe mobility, been on par with their development? How much did a constant risk of unavoidable bodily collisions exacerbate or even cause additional disabilities?

What is the true price of developmental delay? What is the price of fear of independent walking?

We can celebrate those blind children who can make it despite a lifetime of unavoidable collisions, but it is the development of self-worth, through self-reliance and self-confidence that enables us to consider career, living independently and adopting assistive technology. Consider the unemployment rate of adults with visual impairments has remained consistently above 70 percent. One major reason is orientation and mobility concerns. How many of the academically successful high school students who are blind are afraid to independently travel? The key is not to celebrate the few notable children who may succeed despite hardship, but instead to provide children with nurturing environments so that they can thrive.

Toddler’s who are blind and mobility visually impaired experience with unavoidable collisions causes them to fear natural inclination to run and explore. Children who are blind and mobility visually impaired who grow up without an independent means of safe mobility are at greater risk. Resilience among children and adults may account for those who “beat the odds” but given the reality of the need to see where you’re going- either visually or tactually- it is common sense to solve for safe mobility as early as possible, rather than risk the outcomes of developmental delay, and poor employment that befall so many children who are congenitally blind and mobility visually impaired.

Instead of celebrating those children who “beat the odds” we would do better to help all blind toddlers achieve their true potential by providing them the tools they need to develop on par with their peers.

If you are willing to turn on the light switch for a sighted toddler, then perhaps you would be willing to secure a pediatric belt cane for a blind toddler.

Publications

Ambrose-Zaken, G., 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, 01.

Ambrose-Zaken, G.V. (2020). 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, under review.

Ambrose-Zaken, G.V. (2020). Teaching O&M to Learners with Cognitive 
     Impairments and Vision Loss. In W. Wiener, B. Blasch, R. Wall-Emerson (Eds.), 
     Foundations of Orientation and Mobility (4th Ed., Vol. 2. Chpt 19). Louisville, KY: 
     APH.