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  • Mikel Kersey, M.S.Ed., TVI

Effect of Pediatric Belt Cane on Number of Independent Steps taken by one-year-old girl with ONH

Updated: May 16

Children who are unable to visually detect obstacles, drop-offs, and changes in surface have a mobility visual impairment (MVI) (Ambrose-Zaken, McAllister, & FallahRad, submitted for publication). Many individuals with MVI do not begin learning to use a mobility device until they are eligible to receive special education services through the school system between three to five years of age. However, children begin learning to walk around age nine to twelve months. Without consistent tactile path information, toddlers with MVI are unsafe moving about and tend to remain inactive. As a result, they demonstrate delays in gross motor development.

Toddlers with MVI tend to remain sedentary unless verbally prompted or physically guided. When crossing open space, they walk slowly and cautiously with a wide gait and hands raised, “exhibiting a smaller stride length and more plantar foot contact” (Hallemans et al., 2011). Without an appropriate mobility tool, they frequently experience falls as well as object collisions. These occurrences cause fear and further delay motor development.

In a 2016 study on the impact of vision on the dynamic characteristics of gait, Gazzellini, et al., concluded that “The atypical gait of children with congenital blindness is explained by the lack of anticipatory control ”(Gazzellini, 2016). For children to have anticipatory control, they need a mobility tool that will effectively provide path information.

According to Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson and Bikson (2019), children who are five years old and younger are not yet able to use a long cane effectively, because the motor and cognitive skills required to demonstrate proper long cane techniques are not yet developed.

The pediatric belt cane provides young travelers with appropriate tactile path information, allowing them to freely and safely move about their environment without requiring the advanced motor skills for manipulating a rod cane (Ambrose-Zaken, et. al., 2019). The cane frame is a lightweight rectangle that magnetically attaches to the custom made belt. The rods of the rectangle are the standard long cane length which is determined according to the height of each child. The width of the rectangle is a standard arc width (Ambrose-Zaken, et.,al, 2019).

Ambrose-Zaken, et al., (2019) found that wearing the belt cane promoted safe and independent mobility and positively impacted preschool learners’ gross motor skills. Children with MVI who wore their canes began walking with longer strides, narrower gaits, and faster paces. They had better posture and appeared more balanced. Their arms and hands naturally lowered to find the belt and their once rigid, clenched muscles relaxed. The purpose of this single-subject study was to observe and compare the number of steps walked by a one-year-old girl with optic nerve hypoplasia (ONH) resulting in MVI with and without the intervention of a pediatric belt cane.


Method

Baseline. The participant was videoed for six minutes in the family room of her home by her mother at fifteen months of age without a mobility device.

Intervention. At sixteen months of age, the participant was provided a pediatric belt cane. She was observed at seventeen months of age walking in the local mall for six minutes.

Measurement

The number of steps taken by the participant were counted in one-minute intervals during two, six minute videos. All steps were counted, a step was defined as anytime the child picked her foot off the ground and replaced it back onto the ground.

Results

The number of steps per minute taken by the participant is measured on the Y axis on the chart above. The X-axis displays the time in minutes. During baseline, the participant was left to play on her own in the family room. She stayed close to the furniture and a large baby toy. Although her mother called to her, she did not cross open space. The participant’s steps per minute ranged from zero to five steps per minute.

During the intervention phase, a second observation was completed after wearing her belt cane regularly for two months. In the first three minutes of the video, the participant and her family were in a carpeted communal seating area. The last three minutes of the intervention video, the participate walked out of the seating area into the main lobby of the mall. The number of steps she took each minute ranged from four to ninety-three steps.

Still cruising at 15 months inhibits language development
Sitting and mouthing toys inhibits concept development
Wearing her cane at the mall, 17 months
Walking allows concept, language and social skill development

Discussion

Without a mobility device in her familiar environment, the participant took five or fewer steps each minute, mostly not walking at all. In other baseline videos not used in the data analyses, the participant was videoed walking and attempting to walk without the belt cane (https://www.safetoddles.org/alilah). In those videos, she needed almost constant prompting to walk and walked very few steps per minute. When she walked her gait was unsteady, wide-based, with a short stride length, and her arms were held in high-guard position. While these gait attributes may be typical for children aged 15 months, it is uncommon for a child this age to refrain entirely from independently crossing open space especially in familiar settings. Sighted children age fifteen months demonstrate a curiosity about their environment, expressed in abundant levels of independent walking (Bjornson, Song, Coleman, Myuaing, & Robinson, 2013).

During the intervention phase, the participant’s steps per minute consistently increased. The participant was sixteen months old when she was first introduced to the belt cane. Data for the intervention phase of this study was collected a month after she first wore the cane. The participant was observed in the mall play area where there were many obstacles and colorful surface changes (see photo). The participant walked around a little in the play area independently standing still (not holding onto anything or anyone). Once she was in open space, her steps per minute increased exponentially.

After a month of using the belt cane, the participant was walking with a narrower gait, longer stride, and developmentally appropriate posture compared to baseline videos. She appeared confident to move and explore her environment independent of her mother's hand. She required no prompting to walk, instead her mother was engaged in teaching her the rules of staying with the group, (i.e., running away from mommy is not allowed).


Conclusion

For children with MVI to develop gross motor skills at an age-appropriate rate, it is crucial that they have the tools they need to enable them to feel safe and develop self-confidence. The pediatric belt cane provided consistent tactile path information with developmentally appropriate cane arc coverage. The cane arc was always in front of her next steps and, in that way, prevented bodily object collision.

When the base of the cane detected objects, the one-year-old child wearing the cane received the information at the waist (through the belt connection). Once she began to understand that she would receive reliable information about obstacles ahead of her, she learned to interpret the information from the cane (e.g., clear or blocked path). As a result, she began to feel safe to move about familiar and unfamiliar environments. She was motivated to travel and explore freely and independently.

References

Ambrose-Zaken, G., McAllister, J., & FallahRad, M. (Submitted to JVIB). Mobility Visual

Impairment and Blindness: A New Term to Identify a Major Contributor to

Developmental Delays in Children.

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, 1(4), 1-13.

Bjornson, K. F., Song, C. Z., Coleman, K., Myuaing, M., & Robinson, S. L., (2013). Walking Stride

Rate Patterns in Children and Youth, Disability and Rehabilitation DOI:

10.3109/09638288.2013.845254.

Gazzellini, S., Lispi, M. L., Castelli, E., Trombetti, A., Carniel, S., Vasco, G., et al. (2016). The

impact of vision on the dynamic characteristics of the gait: strategies in children with

blindness. Experimental Brain Research, 234, 2619–2627. doi:

10.1007/s00221-016-4666-9

Hallemans, A., Ortibus, E., Truijen, S., and Meire, F. (2011). Development of independent

locomotion in children with a severe visual impairment. Research in Developmental

Disabilities, 32, 2069–2074. doi: 10.1016/j.ridd.2011.08.017 Safe Toddles. (2020) Safetoddles.org .

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