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Five Requirements of Mobility Devices For People who are Mobility Visually Impaired and Blind

Children born blind and mobility visually impaired need safe mobility to thrive. Mobility visually impaired (MVI) is a term used to describe someone whose visual impairment impedes their ability to visually avoid obstacles when walking or running.

Videos of 19, one-year-old children who are MVI and blind (MVI/B) aged 14 to 23 months, showed each child was being taught to walk absent any mobility tools. This is to say that before belt cane, the one-year-old toddlers who were MVI/B were standing or walking in their videos, their vision impairment was such that they lacked the ability to visually avoid obstacles, and none of them were protected by a mobility tool.

Videos of two-year-old children (n=21) with MVI/B, three-year-old children (n=33), four-year-old children (N=12), and five to 10-year-old children (n=12), were mostly walking without mobility tools. However, there were an assortment of videos that demonstrated these children employing various mobility tools unsuccessfully. The devices included long, white canes, adapted mobility devices, hooples, hula hoops, various PVC crafted cubes, reverse walkers, heavy wooden chairs, rolling carts, and strollers.

The purpose of this article is to demonstrate that the concerns raised by the confirmation that 97 children aged one to ten years who were MVI/B lacked effective mobility tools for the purpose of moving about independently. This will be demonstrated by listing and describing the five requirements of an effective mobility tool for someone who is MVI/B.

When provided an effective mobility tool, children who are MVI/B are motivated to independently move about, explore, run and demonstrate self-confidence.

This article identifies five requirements to judge whether the mobility device is the correct one for someone who is MVI/B. The five requirements that need to be met by the user who is employing the mobility tool. When employing the mobility tool, the user needs independent, consistent, reliable path information:

1. Independent: used without assistance from another person.

2. Consistent: the device can be used most of the day, every day.

3. Reliable: device locates most of the obstacles in the path

4. Path: device detects obstacles in the forward horizontal path width of the user

5. Information: The device checks the area upon which the next step will be trod with sufficient reaction time.

When considering a mobility tool for a toddler consider that independent does not mean that toddlers with MVI/B will be responsible for locating or maintaining the device. Instead, toddlers with MVI/B will need adults to still be responsible for ensuring that the device they have is provided to them. By nature, toddlers depend on adults to provide them with the tools they need for safety.

Instead, independent means, once the device is in place, toddlers will need little assistance from the adult to maintain its position or functioning. While there is no such thing as perfect functioning in devices operated by toddlers, the more their mobility device operates independently with them, the greater ease they will have to explore and learn. Any device that tethers them to an adult reduces their creativity and independence. However, as toddlers they will still require adult supervision.

Consistent means the device is able to be used most of the day, every day- as often as the light switch is turned on for a sighted child, the child with MVI/B needs the same, consistent access to path information.

An easy and important way for sighted people to understand toddlers with MVI/B need for consistent mobility tool access is that for all intents and purposes toddlers with MVI/B are walking in the dark whenever they are without their independent mobility device. This explains why they trip over obstacles, crash into people and objects and are more likely to fall down the stairs when they are walking absent a mobility tool.

Reliable means the mobility tool will be in the right place at the right time to detect the obstacles in the path they are walking on most every time they are walking or running. They need to be able to trust the sensory information from the tool is relevant to their safety. When the mobility tool says stop, that is because there is an obstacle one inch tall or taller blocking the path. When the mobility tool dips down ahead of them, that is reliably because there is a down step. When the mobility tool changes vibration feedback, that means it has detected a change in surface that might challenge their balance.

A reliable mobility tool teaches children with MVI/B to trust themselves.

Path of travel is the width of the person; it is also importantly the surface upon which both feet will trod. The mobility tool checks the surface ahead of both feet because both feet need a stable, clear path. The mobility tool checks the width of the body because the hips or shoulders may be wider than the width of the base of support created by the two feet. The more efficient walker has a narrow base, the feet swing near each other. The younger walker, 15-months of age, for example, notably exhibits a less efficient, wide-based gait. However, the wide-gait, with experience with effective, consistent path information narrows. Therefore, the mobility tool checks the surface ahead of the feet and the width of the body to make sure forward motion is through a path wide enough for the child.

Information the most important purpose of a mobility device is communicating information that is otherwise not available to children who are MVI/B because their visual sense is compromised. Consider that lack of moving about is not due to lack of visual motivation and instead a response to negative stimuli of unexpected and unavoidable contacts with objects and others. These unavoidable contacts occur when they lack important information about how close or far away, they are from people and things.

We all appreciate having the information about obstacles before our body contacts them. We also appreciate being able to decide whether we will explore objects further with our hands or ignore them.

Nobody likes to be unexpectedly poked.

Table 1 lists a few of the devices that have been tried with toddlers and preschool learners with MVI/B and their mobility device requirement score.

One point for each basic requirement provided by the mobility device: For the device to be selected, it must score a five. Less than five means it is missing essential safety requirements and should not be provided to the child for the purpose of daily travel needs.

three year old boy walks on packed gravel wearing belt cane, one hand on either grip. Smiles.
Pediatric Belt Cane User

Only one device scored a 5 for toddlers and preschoolers

Pediatric belt cane offers toddlers and preschool learners all five requirements. The adult does need to put the belt cane on the child. Depending on the age and ability of the child, the adult may need to adjust the position of the cane frame for the child when it becomes off center. However, mostly the pediatric belt cane is a tool that toddlers and preschool learners with MVI/B can independently achieve consistent, reliable, path information.

The remaining devices scored less than 5 for toddlers and preschool learners

Regular white cane- to provide consistent reliable path information must be swung back and forth, one step, one swipe. This is not something children under five are able to do. Therefore, while it may be provided during instructional time, in between those lessons, the pediatric belt cane is needed by children aged five and younger.

Three year old holds white cane behind him.
Long cane is left behind by 3-year-old

Adaptive Mobility Device – whether in the shape of a “rectangle”, “capital I” or “push broom”, toddlers with MVI/B have difficulty maintaining a grip on the device and keeping it in position. The fact that the device can be dropped means that it is unable to be consistent or reliable. When it is positioned correctly by the child, it provides path information. Preschool learners may have better success with rectangular adapted mobility devices, but this requires adults to be diligent about their use in all circumstances.

Three year old girl pushes AMD rectangle made of PVC
AMD is in front of 3-year-old girl, for now.

Hoople – this device is hand-held, and it has a tear-drop shape. Because it it is hand-held, it cannot be consistent and reliable for toddlers. For preschool learners, it’s shape provides only a narrow contact with the surface, it doesn’t provide full path coverage, the tear-drop shape compromises the information it provides, especially when held off to one side.

three year old girl holds on to top of tear shaped (oversized tennis racket-looks like) and her teacher holds it too- to help position.
Hooples only provide one point of ground contact.

Push toys maybe independently employed, but are also easy for a toddler to lose interest in and let go of. The can be very difficult to steer and poor posture may be needed to move them.

three year old bent forward pushing a push toy.
Push toys are made for fun, not safe mobility

Strollers, wooden chairs and rolling carts are temporary contraptions that have no independent outcomes for a toddler with MVI/B.

Each time you employ any type of mobility tool ask yourself what independence means for toddlers with MVI/B. Independence means once the adult has provided it, the child can independently move about with minimal adult support.

What about hula hoops and reverse walkers? Consider recent videos showing children with MVI/B inside the hula hoop being led about by an adult. No part of the hula hoop is touching the ground. Therefore, hula hoops score a zero – as they are providing no independent, reliable, consistent, path, or information.

three year old boy in middle of multi-colored circle, his arms on either side, a teacher outside the circle walks backwards pulling him forwards.
Hula hoops used this way are not mobility tools.

Reverse Walkers Children with MVI/B who are not motor impaired, are provided reverse walkers for balance. The videos we see show some independence with them, but the open front indicates they do not provide the information needed for the child’s feet.

The rank of this reverse walkers is not as important as it isn’t a mobility tool for someone who is MVI/B, instead in these instances the reverse walker is supplied by professionals outside of the field of orientation and mobility in response to the consequence of toddlers with MVI/B growing up without mobility tools that meet the five requirements and the result is that they are unable to maintain balance and develop an ineffective gait and slow pace when walking because they cannot see where they are going.

three year old girl walks holding onto a reverse walker and wearing a belt cane.
Reverse walkers and pediatric belt canes work together

If you can't see where you're going, you risk injury. That is why we need to find better mobility tools to meet the complex, diverse needs of children born MVI/B. Pediatric belt canes are an important advancement in a field that is thirsty for innovation.

Consider the needs of older adults who are blind and people who are blind who also use wheelchairs- they need to better solutions than they have now. We seek better tools to meet these needs.

In order to find answers, you must first ask questions.

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