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Pediatric Belt Cane Education Plan (IFSP/IEP) Justification

Information to assist the child's education team in determining when Pediatric Belt Cane is medically necessary for a child.

father walks backwards watching his 3-year-old son walking independently wearing his belt cane.

Clinical Visual Impairment indicative of an MVI/B   

Blindness and mobility visual impairment (MVI/B) are the two most severe categories of vision impairment because they cause children to be unable to consistently and correctly visually avoid collisions.


MVI/B means they cannot see well enough to protect themselves. For example, a child with an MVI/B cannot see a drop-off in time to stop themselves from falling off.

 

These handouts describe the clinical definitions of MVI/B and the MVI challenges to moving about independently. Moving about means an ever changing visual environment. For example, you move from a well-lit house to bright sun, or darkened sky. 

 

Each of these MVI conditions cause independent movement to be much less predictable for children even under adult supervision.

Three Reasons to Recommend a Belt Cane

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Describes the expected walking milestones in children with an MVI/B by age. If MVI walking is not progressing, need an assistive technology device for daily activities (see citations).

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Describes the expected daily physical activity in children with an MVI/B by age. If they are not active, they need an assistive technology device during their daily activities (see citations). 

Sensorimotor Development and walking

Sensorimotor combines sensory perception with motor actions for effective lifelong learning of physical activities.

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​​Blind infants and children with a mobility visual impairment (MVI) have impaired vision. An MVI disrupts visual perception, sending incomplete images, and makes relying on visual balance, protection, and information less efficient.  

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Children with an MVI/B can fill the visual void with touch feedback. Constant touch feedback of the surface ahead helps with balance, protection and information.

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The primary goal of the first two years of development is independent movement. These hand outs include first and second year walking milestones to aid in determining the child's current walking delay. MVI/B sample walking goals when protected by an assistive technology device.

Mother sits on the floor smiling at her toddler girl who is standing independently wearing her belt cane.
Justification
Fituma Yadasa kneels in front of a crowd of children at the Ethiopian middle school six of whom are wearing belt canes.

Recommended Daily Physical Activity

Young children aged 1–4 years need physical activity for proper cognitive and motor skill development.

 

Children with impaired vision have difficulty with achieving their recommended daily physical activity when they rely upon cruising, hand holding, or strollers to get about. 


After the age of 12 months, Children's independent physical activity is expected to more than double; from 3 hours of physical activity daily to 7 ½ hours a day by 24-months-old. 

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Research suggests that children who lack independent means to move about risk delays to their concept, language ,and social skill development (see citations).

mother holds up a toddler toy and a toddler girl is reaching and playing iwth the toy plastic piano while wearing her belt cane.

Belt Cane Citations

Research Studies and Textbook Chapters

Foundations of O&M textbook Chapters on Pediatric Belt Canes

 

Ambrose-Zaken, G.V., Anderson, D. (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.

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Penrod, W., Smith, D., Tikkun, S. (2020). Adaptive Technology for O&M. In W. Wiener, B. Blasch, R. Wall-Emerson (Eds.), Foundations of Orientation and Mobility (4th Ed., Vol. 1. Chpt 8). Louisville, KY: APH.

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Riddering, A. (2020). Kinesiology and Sensorimotor Functioning in O&M. In W. Wiener, B. Blasch, R. Wall-Emerson (Eds.), Foundations of Orientation and Mobility (4th Ed., Vol. 1. Chpt 5). Louisville, KY: APH.

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Riddering, A. (2020). Sensorimotor Facilitation in O&M. In W. Wiener, B. Blasch, R. Wall-Emerson (Eds.), Foundations of Orientation and Mobility (4th Ed., Vol. 2. Chpt 5). Louisville, KY: APH.

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Sapp, W., Anthony, T.  (2020). Providing O&M Foundations for Pre-School Children. In W. Wiener, B. Blasch, R. Wall-Emerson (Eds.), Foundations of Orientation and Mobility (4th Ed., Vol. 2. Chpt 7). Louisville, KY: APH.

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Journal Articles
Chong, P., Enzenauer, R., Ambrose-Zaken, G., (2025). Improved Gait in Children with Cerebral Visual Impairment when wearing a Pediatric Belt Cane. Pediatrics. (June 17)


Ambrose-Zaken, G., Bakshi, I., Chong, P., and Enzenauer R. W. (2024). Comparison of Blind Children’s Gait Pre/Post Introduction of a Wearable Assistive Safety Device. Acta Ophthalmologica, (Oxford, England) 103(S284).

https://doi.org/10.1111/aos.17186


Ambrose-Zaken, G., Chong, P. Enzenauer, R., (2024). Comparative video gait analysis of assistance for children with cerebral visual impairment (CVI). Investigative Ophthalmology & Visual Science, 65(7):2579. https://iovs.arvojournals.org/article.aspx?articleid=2794668 


Penrod, W., Burgin, X., Jerrard, C., & Ambrose-Zaken, G. (rejected 2025). Babyproofing blind walking: A study the physical activity outcomes before and after introducing the pediatric belt cane. The Journal of Visual Impairment & Blindness, rejected for publication 1/8/25. (click to read)


Ambrose-Zaken, G. (2023). Beyond Hand’s Reach: Haptic Feedback is Essential to Toddlers with Visual Impairment Achieving Independent Walking. The Journal of Visual Impairment & Blindness, 117(4), 278-291. https://doi.org/10.1177/0145482X231188728.


Ambrose-Zaken, G. (2022). A study of improving independent walking outcomes in children who are blind or have low vision aged 5 years and younger. Journal of Visual Impairment & Blindness, 116(4), 533–545. https://doi.org/10.1177/0145482X221121824  
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. https://doi.org/10.3389/feduc.2019.00044  
 

mother holds her one-year-old from behind, she is kneeling and he is standing with her help from behind while wearing his belt cane.

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