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

Updated: Jun 16

Justine McBride, M.S.Ed., TVI & Grace Ambrose-Zaken

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.


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).

The baseline shows a line that is relatively flat. The intervention shows a line that continues to increase upwards.
Number of steps taken each minute for ten minutes


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 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 is walking on gravel path, her rod cane is in her right hand and the cane tip is on the ground far off to her right side.
Audrina using a rod cane, not safe mobility.

Audrina is walking on a gravel path, wearing her belt cane. the base of the frame is two steps ahead and in front of her feet providing safe mobility.
Audrina's belt cane provides consistently safe mobility


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, they did not have 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. 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.

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).

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