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Kids need equal access to path information: A review of 2007 Study of a program for improving motor

Aki, Songül, Ayse and Kayihan (2007) tested motor skills of eight-year-old subjects with severe visual impairment before and after being provided with hour-long sessions of sensorimotor integration training three times a week for three months. Forty subjects with severe visual impairment (equal number of girls) were either taught at school by an experienced physiotherapist (n=20) or at home by their families. The subjects’ measured visual acuities indicated most subjects had severe visual impairment (see table 1).

Table 1 Visual acuity of children according to snellen chart: 40/200 15%, 20/200 25%, 10/200 35%, 2/200 20%, 1/200 10% light perception

The authors’ purpose in providing the sensorimotor training was based on a literature review that indicated children born with severe visual impairment exhibited delayed motor skills (Adelson & Fraiberg, 1974; Celeste, 2002). For example, Celeste (2002) found children with congenital visual impairment experienced the most profound delays in mobility skills such as cruising around, walking independently, and climbing up and down stairs. Aki, et al., (2007) suggested that the reason for these motor skill delays; which also included poor balance, body coordination, and visuomotor control, was due to the children with visual impairment having had “limited experience walking stemming from poor vision” (p. 1329) (Dickinson & Leonard, 1967; Gipsman, 1982; Williams, 1983; Bouchard & Tetreault, 2000).

Aki et., al. assessed the children’s motor skills before and after treatment using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) (Bruininks, 1978). To conduct the test, the researchers modified the BOTMP subtest “running speed and agility”, by measuring only running speed during a shuttle run; thereby, altering the test item by omitting the need for subjects with low vision to pick up a block off the floor at the mid-point of the shuttle run.

Table two shows that the range of possible scores on the running speed and agility subtest were zero to fifteen. The two groups of subjects with low vision mean scores changed from 1.80 to 2.90 in the school training group and from 2.00 to 2.20 in the home training group.

Table 2 pre- and post training results of training and home training groups on bruininks-motor proficiency test subscales: running speed and agility possible range 0-15 M 1.80, SD 2.56 post training M 2.90, SD 2.33; home training pre training M 2.00, SD 2.10; posttraining M 2.20, SD 2.06

The authors interpreted the similar change in mean scores in the two groups to indicate no difference between at home and professional training. They summarized therefore that “gross motor functions, such as running speed and strength, can be improved by a home training program” (p. 1334).

Yet, the subjects with visual impairment mean scores were only slightly improved, and they were also much lower than the mean scores of 120 sighted elementary school subjects also scored using the BOTMP (Duger, Bumin, Uyanik, Aki, & Kayihan, 1999). In this earlier study, subtest 1 running speed and agility, was measured by having the sighted subjects complete a timed shuttle run that included picking up a block at the turning point. The sighted subjects mean scores for girls was 4.56 and for the boys was 6.34.

Table 3 Levene's t-test subtest 1 Girls X 4.56, SD 2.11, Boys X 6.34, SD 2.42

One might argue that, of course, sighted children running speed and agility is better than children with low vision. Yet, it is important to investigate why the difference exists. If running and agility are to be measured, why do children with low vision score so poorly, and is there anything that can be done to improve their running? Further, would sighted children have similar scores were they to experience running with impaired vision?

Gazzellini, et al., (2016) compared motor skills of eleven sighted children (aged 3.5 years to 12.8 years) wearing blindfolds and twelve blind children (3.5 years to 13.2 years) none of whom had been trained in or made use of long canes. Participants were asked to complete multiple trials walking barefoot at a self-selected speed in a large room along a walkway free of obstructions.

The speed and pace chosen by all subjects were atypical of normal gait patterns. All the subjects adopted similar slow, awkward protective gaits. The authors suggested the altered gaits were explained by a single mechanism “…the lack of anticipatory control” (p. 2626) and recommended “the use of a cane during walking” (p. 2626) with impaired vision. However, Aki et al., 2007 did not mention long canes as part of the testing of running speed and agility in subjects with low vision, nor were canes mentioned as part of the training program.

Physical education teachers and camp counselors commonly request visually impaired learners to leave their long canes on the sidelines when participating in sport and other game activities (Furtado, Lieberman, Gutierrez, & Haegele, 2017). Therefore, it is highly likely that Aki et al., did not include using canes of any type during the testing or training activities. Aki et al’s., omission of any mention of tactile path information for the subjects with low vision not only suggests that use of long canes or rectangular adaptive mobility devices were not included in their subtest procedures, but also that the Aki’s (2007) subjects had no means to independently know and trust the safety of the path when running.

Thus, one obvious reason that sighted children were able to run faster is that they had full knowledge of the path ahead of their next step and this information allowed them to run with greater confidence, speed and agility. Therefore, Aki et al., and Duger et al., (1999) conducted unequal tests because one group of subjects had full knowledge of the path during their testing (sighted group) and one group had disabled knowledge of the path during their testing (low vision group).

In order to know the true running speed and agility of children who are born blind and visually impaired we need to test them on running agility after allowing them the same access to consistent path information as their sighted peers. Sighted children have consistent visual path information from the time they begin to crawl and learn to walk.

Therefore, to achieve an equal playing field for children born with severe visual impairment and blindness they need to be provided with wearable canes as soon as they begin to crawl and walk. Wearable canes worn every day, all day would allow severely visually impaired and blind children to achieve similar rates of consistent tactile path information because tactile path information is an effective sensory substitute for impaired vision.

Aki et al., (2007) sought to determine how to teach children with low vision to improve their motor skills, yet they did not examine the root cause of why children with low vision exhibited motor skill delays. Sensorimotor training can only truly benefit learners with low vision when it is paired with mobility tools that provide them with effective path information.

Learners with severe visual impairment and blindness need essential consistent, tactile path information every step they take in order to be on an equal footing with their sighted peers.


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