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To seek a Solution, First You Must Identify the Problem

Just this week I was once again asked by orientation and mobility Facebook group members, to once again prove the thesis that children who are mobility visually impaired or blind (MVI/B) need better mobility tool options (e.g., wearable belt canes) mobility visual impairment is the inability to visually avoid obstacles.

"Show us your data" was the request. We do have a published research study (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson and Bikson, 2019). We have another research study that was recently submitted for publication (Ambrose, McAllister & FallahRad, submitted 2019). We continue to collect and analyze data from hundreds of children with MVI/B.

In this blog post, I will share some of our data on gross motor delays that support our thesis: blind toddlers need developmentally appropriate mobility tools. But, first- let’s look at prior research that has identified the problem we’re attempting to solve with wearable belt canes. As the adage goes, 'identifying the problem is half the battle."

One year old girl, MVI due to optic nerve hypoplasia, walks without a mobility tool

There is over a century of research that has identified global developmental delays in children born with MVI/B, which have continued to be documented in children despite access to early education (EE) therapies (Celeste, 2002; Hatton, Bailey, Burchinal, & Ferrell, 1997; Hatton, Ivy and Boyer, 2013).

The research on motor skill delays alone is extensive (Brambring, 2006; Celano, Hartmann, Dubois, Drews-Botsch, 2015; Celeste, 2002; Gazzellini, et. al., 2016; Hallemans, Ortibus, Truijen, Meire, 2011; Hatton, et. al., 2013; Wyver and Livesey, 2003; Tsai, Meng, Wu, Jang, & Su, 2013).

Children aged five years and younger with MVI/B are less likely to achieve motor

milestones on time (Bakke, Cavalcante, Oliveira, Sarinho, & Cattuzzo, 2019). Wyver and Livesey concluded that “findings are generally consistent despite the studies being conducted in a wide range of settings, in a variety of countries … there is strong evidence of an adverse impact of visual disability on motor development” (2003, p. 25).

A review of the bulleted list of common gross motor milestone definitions at five ages (Sharma, 2011); finds that toddlers’ eighteen-month-motor milestones included the expectation that they will have developed their visual/motor coordination enough to walk and avoid obstacles independently.

By twenty-four months of age, children were expected to be able to run and avoid obstacles, independently (not holding hands or couches) (Sharma, 2011).

  • Nine months -- crawling, standing

  • Twelve months – cruising, walks with assistance

  • Fifteen months -- Walks alone feet wide, hands up, often falls, bumps into furniture

  • Eighteen months -- walks well with arms down, runs carefully but cannot avoid obstacles

  • Twenty-four months -- runs avoiding obstacles.

Children with MVI/B are said to demonstrate gross motor milestone delays (Brambring, 2006). However, gross motor milestone evaluations rely on the visual motor skill of ‘obstacle avoidance’. By definition, MVI/B makes it difficult (to impossible) to develop visual/motor coordination needed to avoid obstacles when walking and running (Pigeon, Li, Moreau, Pradel, and Marin-Lamellet, 2019).

Children five and younger with MVI/B may appear to have motor impairments, but another explanation might be that their MVI/B limits their ability to achieve motor milestones that depend upon visual/motor coordination. The solution for learners whose MVI/B prevents them from avoiding obstacles is to equip them with a mobility tool that provides them with consistent tactile path information.

People whose MVI/B robs them of path information benefit from mobility tools that detect obstacles. Obstacle detection is the first step needed to develop motor planning strategies used to interact effectively with obstacles, such as obstacle avoidance.

The wearable belt cane is a new, developmentally appropriate mobility tool for toddlers with MVI/B, when worn, the rectangular shape of the cane offers a reliable cane arc and enables very young children with MVI/B to experience consistent tactile path information.

Toddlers with MVI/B receive the benefit of consistent tactile path preview because the base of the cane frame maintains contact with the floor, two steps ahead of their intended paths. Toddlers with MVI/B cannot forget their belt canes because the top of the frame is connected by magnets to a belt that is worn about their waists (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson, & Bikson, 2019).

Same one year old girl with ONH, walks erect, hands rest on cane frame

On the intake form to obtain wearable belt canes, adults provided motor skill statements on 234 children five months to 180 months old (mean age 42.6 months). There were ten (.04%) children who were age five to fifteen months old, yet 92.8% of all reported children demonstrated motor skills of ten-month old babies, ‘stands’ to fifteen-month old toddlers ‘wide based gait, bumps into furniture.’

Seven of the ten children age fifteen months and younger demonstrated motor skills considered on-target for their age. Three children aged fifteen months were reported at twelve-month-motor milestones (cruising). The children aged eighteen months and older who were not motorically impaired, were reported as walking, collides with obstacles (15-month milestone) and cruising/walking with assistance (12-month milestones).

Regardless of age, no children with MVI/B were reported at the twenty-four-month motor milestone ‘runs avoiding obstacles.’ Most children with MVI/B appeared to be clustered at the skills representative of the fifteen-month motor milestones and younger. Therefore, the diverse sample of children with MVI/B were similar in their inability to demonstrate eighteen-month motor milestones and above.

Families and professionals sought wearable belt canes for children with MVI/B who were different ages, had different MVI/B etiologies, lived in different states and countries, but whose motor skills were similar. Children with MVI/B motor skills appeared to plateau at the fifteen-month milestone, walks alone, bumps into furniture.

Adults were actively encouraging the children with MVI/B to walk independently, yet they did not. Many were also reported to be learning to hold long canes and push toys. Yet, these children with MVI/B were also reported to have sedentary play habits and global developmental delays.

Families and professionals have identified the problem, toddlers with MVI/B are not able to achieve past the fifteen-month gross motor milestone. The wearable belt cane is the first developmentally appropriate mobility tool for toddlers with MVI/B. The number of children with MVI/B wearing belt canes who were able to walk and run across open space independently can be observed on our website videos.

The belt cane must be worn because toddlers are not only not responsible for their safety during any other life activity, they are also not cognitively and physically able to employ hand-held mobility tools correctly for safety. Further, in the hands of a toddler, hand-held mobility tools are easily cast aside or entirely forgotten. The reason adults gave for requesting wearable belt canes was that their children with MVI/B were afraid to move and the current mobility tools had not solved that problem.

Wearable belt canes solve the problem of obstacle detection and allow toddlers to learn how to avoid obstacles and continue their gross motor development.

For proof in the form of family-shared videos, please navigate to our website and see for yourself www.safetoddles.org. Toddlers with MVI/B don’t run because they prefer to be sedentary, they don’t run because they are the smartest people in the room.

Once they have reliable tactile path information- they do run, they do cross open space, they gain confidence, expand their language and concepts- they enjoy and learn from the information that belt canes provide.

References

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, 4. doi.org/10.3389/feduc.2019.00044

Ambrose, G. V., McAllister, J. & FallahRad, M (submitted 2019). Would A New Term

Improve Gross Motor Outcomes? A Study of Children with Visual Impairment and

Blindness, Journal of Visual Impairment & Blindness.

Bakke, H. A., Cavalcante, W. A., Oliveira, I. S. de, Sarinho, S. W., & Cattuzzo, M. T. (2019).

Assessment of Motor Skills in Children with Visual Impairment: A Systematic and

Integrative Review. Clinical Medicine Insights: Pediatrics. https://doi.org/10.1177

/1179556519838287.

Brambring, M. (2006). Divergent Development of Gross Motor Skills in Children Who Are

Blind or Sighted. Journal of Visual Impairment & Blindness, 100(10), 620-634.

Celano, M., Hartmann, E.E., Dubois, L.G., Drews-Botsch, C. (2015). Motor skills of children

with unilateral visual impairment in the infant aphakia treatment study.

Developmental Medicine & Child Neurology, 154-159. doi: 10.1111/dmcn.12832.

Celeste, M. (2002). A survey of motor development for infants and young children with

visual impairments. Journal of Visual Impairment & Blindness, 96(3), 169-174.

Ferrell, K. A., Shaw, A. R., & Deitz, S. J. (1998). Project PRISM: A longitudinal study of

developmental patterns of children who are visually impaired(unpublished

manuscript). Retrieved from http://www.unco.edu/ncssd/research/PRISM

/default.html

Gazzellini, S., Lispi, M.L.,·Castelli, E.,· Trombetti, A., Carniel1, S., Vasco1, G., Napolitano,

A.,· Petrarca, M. (2016). The impact of vision on the dynamic characteristics of the

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

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

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Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997). Developmental growth

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Hatton, D.D., Ivy, S.E, Boyer, C. (2013). Severe visual impairments in infants and toddlers

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Pigeon, C., Li, T., Moreau, F., Pradel, G., & Marin-Lamellet, C. (2019). Cognitive load of

walking in people who are blind: Subjective and objective measures for assessment.

Gait & Posture, 67, 43–49. https://doi-org.proxy.wexler.hunter.cuny.edu/10.1016

/j.gaitpost.2018.09.018

Sharma, A. (2011). Developmental examination: birth to 5 years. Archives of Disease in

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Tsai, L.-T., Meng, L.-F., Wu, W.-C., Jang, Y., & Su, Y.-C. (2013). Effects of visual rehabilitation

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