Separate and Unequal Independent Walking Standards for Blind Toddlers

Since 1841, when the Perkins School for the Blind first opened its doors to blind children, educators have recognized their many needs — but none began by asking the most basic question: How can we make their movement safe?

For nearly two centuries, blind children have been expected to walk, explore, and learn without tools designed to protect them from collisions. The consequences of that omission persist today.

Fear of the Unseen

Hatton, Bailey, Burchinal, and Ferrell (1997) summarized decades of research documenting that children with a mobility visual impairment or blindness (MVI/B) — and their families — share a natural fear of walking into the unseen (Brown & Bour, 1986; Jan et al., 1975; Sonksen et al., 1984).

Educators have long interpreted that fear as a developmental obstacle, often advising parents not to restrict movement for safety reasons. The prevailing belief remains that blind toddlers must first learn to walk independently — without a cane — before being “ready” to use one.

Say that aloud: a blind person must walk without a cane before being taught to walk safely with one. It defies reason.

In every other context, we lead with safety. Construction workers wear helmets. Cyclists wear helmets. But for blind toddlers — safety comes later. Why?

The Onset of Walking: An Epigenetic Event

For sighted infants, walking is an epigenetic event — meaning its significance goes far beyond the physical act of moving upright. When babies begin walking, their world expands. They engage more with their environment, stimulating language, cognition, and social-emotional growth (He, Walle, & Campos, 2015).

Within six months of their first steps, most sighted toddlers walk with longer strides, better balance, and adult-like coordination (Vieira et al., 2019). This rapid progression occurs because walking itself fuels development — toddlers learn by moving.

But for toddlers with an MVI/B, this transformation rarely happens.

Photo from Video showing the B6OMSI Score before and after Introduction of the Belt Cane

When Walking Isn’t Safe

Children born with an MVI/B do learn to walk — but their progress often stalls. Six months, one year, even three years after first steps, many remain at the same early walking stage (Ambrose-Zaken, 2022, 2023). Their walking does not mature, because movement itself is unsafe.

Without tactile feedback about the path ahead, each step carries risk. The child’s fear of collisions — and the parent’s fear of injury — lead to less movement, fewer opportunities, and slower global development.

This is not a matter of motivation; it’s a matter of safety.

How We Measure “Independent Walking”

The Birth to 6 Orientation and Mobility Skills Inventory (B6OMSI) is currently the only validated tool for assessing O&M skills in young children who are blind (Baguhn, 2021). It measures how much verbal or physical prompting a child needs to perform six walking sub-skills — from “a. Takes steps with support” to “f. Able to walk with a cane or other object" (see Table 1).

That last item, f, is the only mention of a cane in the entire inventory.

In practice, this means that professionals assess blind toddlers’ walking skills based on how well they can walk without tactile path information. Sighted children, meanwhile, are assessed with adequate lighting and visual awareness of the floor beneath them.

Why, then, are toddlers with an MVI/B tested on unseen surfaces — with no protective feedback — when safety is a prerequisite for learning?

Photo from Video showing the B6OMSI Score before and after Introduction of the Belt Cane

Six Months vs. Six Years

For sighted toddlers, the expected timeline from first steps to confident walking is roughly six months. For blind toddlers, the B6OMSI allows six years to achieve similar benchmarks.

If a sighted 18-month-old were no better at walking than they were at 12 months, clinicians would immediately seek intervention. Yet blind toddlers are given years — not months — to reach the same level, because the test itself is devoid of safety measures.

In other words, the system expects less because it builds for less.

Separate and Unequal Standards

This disparity is not new. It traces back to 19th-century assumptions that blindness inevitably limits development. Researchers like Howe (1841), Fraiberg (1977), Ferrell (1990), Bigelow (1992), and Hatton et al. (1997) all documented that blind children walk less, are less active, and experience more delays than their sighted peers.

Their conclusion? The problem was the absence of vision — not the absence of safety.

Hatton et al. (1997) even proposed that blind children follow “alternative developmental pathways” rather than be compared to sighted children. This well-intentioned recommendation created separate and unequal walking standards — assessments that accept limited movement in blind children as "on target" for a blind child, instead of recognizing the cause is entirely preventable: use an easy mobility tool to improve their mobility safety.

What the Data Have Always Shown

Across studies, the findings have been consistent:

• Blind toddlers fail to reach walking milestones on time.

• They move less than sighted peers.

• They and their parents experience understandable fear of injury.

And yet, instead of designing mobility tools that address safety, professionals have normalized risk and consequent delays.

The B6OMSI, for instance, measures how many steps a blind child will take onto an unseen surface. Only the final milestone — “f. Walks with a cane or other object” — acknowledges tactile protection. That means instruction and assessment both reinforce the expectation that blind children will demonstrate this metric without the safety of a mobility tool.

A Better Standard: Safety First

When sighted children are tested, no one turns off the lights. When blind children are tested, no one should take away their canes.

Toddlers with an MVI/B deserve the same developmental expectations — and the same safety accommodations — as any other child.

The Belt Cane provides a two-step tactile safety buffer that allows blind toddlers to explore freely, to experience walking as an epigenetic event, and to engage with their world confidently. In clinical studies (Ambrose-Zaken, 2022, 2023), every child who used a Belt Cane demonstrated measurable improvement in independent walking.

The difference was not age, cognition, or motivation. It was consistent access to their strongest sense, the sense of touch for balance, protection from and information about the path ahead.

Photo from Video showing the B6OMSI Score before and after Introduction of the Belt Cane

Conclusion: Equal Standards Begin with Equal Safety

We must stop asking blind toddlers to walk into the unseen and then blaming blindness for their developmental delays. The standard itself is the problem.

When we provide safety first, blind children learn to walk, run, play, and explore just like any other child. The Belt Cane restores equality by ensuring that the first steps of every child — sighted or blind — lead toward independence, not fear.

It’s time to retire “separate and unequal” walking standards and embrace a simple truth: Blind toddlers can meet their motor milestones— when they feel safe to walk.

Table 1

The Birth to 6 Orientation and Mobility Skills Inventory Motor Skill Items and Rating Scale

5.       Standing Skills
	a. Stands with support (hands held or trunk support)
	b. Stands up to 30 seconds after being placed in balanced standing
	c. Stands independently
	d. Transitions in and out of standing
6.       Walking Skills
	a. Takes steps with support (one or two hands held)
	b. Takes 5 independent steps
	c. Takes 10 independent steps indoors
	d. Takes 10 independent steps outdoors
	e. Walks independently on various surfaces indoors and outdoors
	f. Able to walk with a cane or other object
7.     Hurried Walk/Running Skills
	a. Takes 10 hurried steps indoors
	b. Takes 10 hurried steps outdoors
	c. Runs 20 feet indoors
	d. Runs 20 feet outdoors
	e. Runs with guide holding hands or prop/rope
	f. Runs independently on various surfaces indoors and outdoors
8.     Quality of Independent Walking
	a. Stride (demonstrates appropriate stride length)
	b. Arm Swing (demonstrates arm swing when walking)
	c. Stance (demonstrates appropriate stance phase)
	d. Walks with balanced heel to toe foot strike
	e. Aligns head, shoulders, hips, and feet when walking
	f. Balance (demonstrates balance when walking on typical indoor surfaces)
	g. Balance (demonstrates balance when walking on typical more varied outdoor surfaces)
	h. Demonstrates walking speed appropriate for conditions

Note. Interviewer asks child representative to choose one of the 5 scores below.

RATING SCALE

0=Student not capable of demonstrating skill or does not need skill. (Zeros do not count against score.)

1=Student does not yet demonstrate skill but may/will need to learn skill.

2=Student only demonstrates skill with verbal and/or physical prompting.

3=Student sometimes (3 of 5 trials) demonstrates skill without verbal and/or physical prompting. 

4=Student often (4 of 5 trials) demonstrates skill without verbal and/or physical prompting.

5=Student consistently (5 of 5 trials) demonstrates skill without verbal and/or physical prompting.

Video transcript:

Using the B6OMSI criteria we evaluate children with mobility visual impairment or blindness before and after they are introduced to a Pediatric Belt Cane. Score of a is with support, b is takes 5 independent steps, c is 10 independent steps inside, d is 10 independent steps outside, e. is Walks independently.

Blind due to brain trauma, non-verbal at 19 months- scores a 0 on the B6, with the Belt Cane he takes 10 independent steps inside, the score of c .

Age 2, blind born, she walks with assistance or score of a, with Belt Cane she scores “e”  Walks independently on various surfaces indoors and outdoors with a Belt Cane.

Age 3, CVI,   takes 10 or more independent steps inside, the score of “c”

            Now she scores “e”  Walks independently on various surfaces indoors and outdoors with a Belt Cane.

Walking with the Belt Cane her therapists purposely put a giant garbage can in her way, the Belt Cane bumps into it and she stops and then turns to find a clear path.  Without the Belt Cane her therapist stays nearby with her hands protectively held on either side of her as she walks.

Age 6, CVI, takes 10 or more independent steps inside, the score of “c” you can see she returns to sitting after a series of steps she was verbally and physically prompted to take. With the Belt Cane at least she is safe as she walks independently in the mall with her family.

References

• Adolph, K. E., Cole, W. G., Komati, M., Garciaguirre, J. S., Badaly, D., Lingeman, J. M., & Sotsky, R. B. (2012). How do you learn to walk? Thousands of steps and dozens of falls per day. Psychological Science, 23(11), 1387-1394. doi:10.1177/0956797612446346. 

• Ambrose-Zaken, G. (2023). Beyond Hand’s Reach: Haptic Feedback Is Essential to Toddlers with Visual Impairments Achieving Independent Walking. 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

• Baguhn, S. (2021). Early Intervention Orientation and Mobility: A Delphi Study of the Content of the Birth to 6 Orientation and Mobility Skills Inventory (B6OMSI). Journal of Visual Impairment & Blindness, 115(5), 361–371. https://doi.org/10.1177/0145482X211047626

• Biringen, Z., Emde, R. N., Campos, J. J., & Appelbaum, M. I. (1995). Affective reorganization in the infant, the mother, and the dyad: The role of upright locomotion and its timing. Child Development, 66, 499–514.

• Hatton, D., Ivy, S., & Boyer, C. (2013). Severe visual impairments in infants and toddlers in the United States. Journal of Visual Impairment & Blindness, 107, 325–336.

• He, M., Walle, E. A., & Campos, J. J. (2015). A Cross-National Investigation of the Relationship Between Infant Walking and Language Development. Infancy, 20(3), 283–305. https://doi.org/10.1111/infa.12071

• Tabb, C. (2024). Live Binder.

• The New Mexico School for the Blind (Accessed November 24, 2023). NMSBVI Orientation & Mobility Inventory. https://www.nmsbvi.net/235010_2

• Vieira, A. P. B., Carvalho, R. P., Barela, A. M. F., & Barela, J. A. (2019). Infants’ Age and Walking Experience Shapes Perception-Action Coupling When Crossing Obstacles. Perceptual and Motor Skills, 126(2), 185–201. https://doi.org/10.1177/0031512518820791