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History of Early Intervention O&M: Part 2

Updated: 6 days ago

At the turn of the 20th century, children with MVI/B were educated at their state residential schools for the blind by well-meaning matrons and headmasters, or homeschooled. A mid-century epidemic in premature births resulting in blindness and the forward-thinking changes in US education law in the seventies created a dramatic divide between the first and second half of the 20th century for children with mobility visual impairment or blindness (MVI/B).

By the turn of the 21st century, most school-aged children with a visual impairment were taught in their home districts by university educated teachers certified in the field of blindness and visual impairment. An educator who bridged the first half of the 20th century and the second was Thomas Cutsforth, whom the 1963 New Outlook for the Blind necrology said was “the most often-quoted author in the entire field of blindness” (p. 114). 

Cutsforth was born sighted in 1893 and went blind in 1904. In his book, The Blind in School and Society he declared, “No one as yet has adequately understood how to educate the blind” (1951, p. 2).


Black and white photo of gray haired white man wearing a suit and tie.

The most impactful 20th century educational theories on the education of babies with MVI/B were based on personal experiences, not applied science.

US public schools were started in the 20th century with the mission to prepare boys with the skills to read, write and follow commands; to make them ready and able soldiers for the 'next world war'. Public schools educated the educable children and used exams and grades to rank them on a set of academic and physical achievement standards. Public schools only began attending to the individualized educational needs of its children, after the 1974 education law Educating all Handicapped Children's Act (reauthorized in 1990 as the Individuals with Disabilities Education Act) required it.

Cutsforth's first edition of his book was published just prior to the retinopathy of prematurity (ROP) epidemic, in 1933. It was a time when children with a visual impairment were held to the same educational standards, yet were educated separately from their sighted peers.

Cutsforth's education theories were based on his experiences growing up sighted. He believed sight was a necessary prerequisite for infants' physical and cognitive development. He had learned the skills he needed to succeed in school, before he went blind.

The narrative basically goes like this, sighted infants only learn to walk, talk and be social "...by watching" each other (Cutsforth, 1951, p. 5). Thus, despite of, or perhaps because of, Cutsforth's own ability to perceive the world around him without vision, he believed the developmental delays in blind infants must be because they couldn't learn how he did, visually.

Cutsforth's theory is the foundation upon which all current early intervention orientation and mobility (EI/O&M) textbooks are based today. The observable outcome that infants with MVI/B's delays are because, they are "...aware of nothing, objectively, outside the arcs described by his unsteady hands and feet (1951, p. 5)”. 

Today, every EI/O&M textbook includes a statement that blindness causes infants to be unaware of things beyond their reach as a basis for theories of why they don't walk independently. A blind child's lack of visual contact with the world does prevent them from detecting objects beyond their reach, which is unsafe for them. Yet, the converse of that statement is also true, touch is a primary learning sense for blind babies.

Instead of finding ways to capitalize on their primary learning sense of touch, they chose to accept the obvious outcome; blind children don't develop on par with sighted infants. The white cane is an example of a tool that extends the reach of the user allowing her to check the ground ahead of her next step. In 1904, there was no white cane. As a blind adolescent, Cutsforth regained his ability to travel independently through the school of hard knocks, armed only with an insider's knowledge of the sighted world.

His ability to get about without a long cane was something he was incredibly proud of, especially after long canes were invented (Koestler, 1974). Which is why he thought them unnecessary and, like many others, he worried they would result in 'soft blind kids' (Bledsoe, 1967).

Adventitious and congenital blindness are different.

Having had vision during the first 11 years of life, Cutsforth's early experiences were very different from an infant born with MVI/B. By age 11, he had learned to walk, talk, dress, read, run - everything; as a sighted child. He was able to bring all those skills and concepts into his new life as a blind child.

His feelings of loss and success were very real, yet did it make him qualified to judge the needs of infants born with MVI/B? He went from the fluid, easy and quick movements of a sighted adolescent to having to navigate the gauntlet of furniture like an unsteady toddler. He had to find ways to retain his balance to remain upright after encountering varying terrain changes and other dangers without any warning from a long cane. All the time likely fending off sighted adults well-meaning offers of help.

In 1904, going blind meant children had to learn to endure, even welcome, the bodily collisions they could no longer visually avoid. He attributed his success in life to this blunt method of adjustment, akin to a father throwing his son into the pool to teach him to swim. Those who succeeded believed it to be the best system of education, those who didn't drowned...became developmentally delayed.

Cutsforth believed the only path to independence for blind children was the one he endured, one that was trod without a guide or white cane protection. Cutsforth’s second edition of The Blind in School and Society was published six years after the invention of the long white cane, in 1951. His advice on independent walking remained unchanged from the first edition, in 1933, to the final printing in 1972. He characterized the blind child’s need to stay in physical contact with the world as a bad habit that needed to be broken.

Cutsforth's advice to parents was to withhold their helping hand when their child with MVI/B needed it most, writing:

“When the child has once learned to walk, it is well to omit any form of

manual guidance about the house and to permit the child to become

    oriented himself, even at the expense of minor injuries and emotional

    distress of both the children and the other members of the family…"

    (Cutsforth, 1951 p. 21)


Table 4. Modern interpretation of 1951 advice to parents. Advice to Parents in 1951- “…When the child has once learned to walk”, Modern Interpretation, Children with MVI/B don’t move very well, very far, or very often. 1951-“…permit the child to become oriented himself.” Modern-Actively walking is the only way to learn about the environment.; 1951-“…omit any form of manual guidance about the house...”, modern-Children with MVI/B appear to walk more freely at home.; 1951-“…even at the expense of minor injuries and emotional distress of both the children and the other members of the family...”, Modern-In 1951, long white canes were only used by blind adults., Blind babies don’t need to feel safe., The problem is the solution.

Cutsforth's advice in this influential text included the well-known thesis that it was natural for blind children to get injured when they walked independently. His contribution was to oppose providing children with MVI/B with any hand-held assistance, and later; he opposed the use of the long cane for children with MVI/B (Koestler, 1976). Although it continued to be obvious that infants with MVI/B avoided walking independently, the only possible reason Cutsforth would have us consider was the child's natural inclination to walk was being held back by a parent.

Cutsforth advocated for allowing children with MVI/B to attend their local public school. He saw the current system of residential institutions as part of the problem, and asked the reader to consider the accomplishments of "so many prominent blind men not educated in institutions, such as Gore, Pulitzer, Person, Schall, Irvine, Scapini..." (p. 203).

Each of these men became blind as teens and adults. As blind men in the early 1900s, their accomplishments in life are to be admired, but none of the men on his list were born blind. This blurring of lines of the real life differences among men who became blind as beacons of what is possible for children born blind made it all the more difficult to advocate for a more nuanced approach to educating children with MVI/B.

The 12-year-old Tommy Cutsforth felt perfectly capable of being independent and, like Blacklock, believed his parents had been too protective. Thus, the use of the term permit the child appears to have accurately defined their experiences. They wanted more permission to move about independently and were certain that is what all blind babies wanted, despite all evidence to the contrary.

The use of the word permit is intentional.

The reader should not assume that the often-repeated phrase ‘permit the child to become oriented...’ was based on published outcomes showing its success. It appears more likely to be a form of rebellion only available to adults looking back and repairing the perceived wrongs of their childhood.

'Permit the child' also fits neatly into the theory that he, Howe and Blacklock proposed, that mothers were preventing their children with MVI/B from walking freely, because they wanted to protect them. 'Permit the child to walk' is based on the assumption that the blind child's tendency to sit quietly is driven by an external force (e.g., being prevented from walking), not an internal one (e.g., self-selecting to avoid the danger of walking without visual or tactile anticipatory control).

mother guides her blind son he is ahead of her holding her hand as he stubs his bare toes on a heavy wooden toy.
Mother accidently guides her blind son into heavy wooden toy.

This narrative serves to "easily" explain the cause of children with MVI/B's developmental delay, 'it is the mother's fault' (Hatton, Ivy, & Boyer, 2013; Howe, 1841; Huffman, 1957). Howe (1841) wrote “the mother runs and fetches whatever the child requires, and pets and humors it continually. The consequence is that he is unfitted for the rough arena of the world…” (p. 6).

	The permit the child narrative places blame on external forces (e.g., the mother) for the consistent delays found in infants with MVI/B early walking attainment. 
	The child feels unsafe theory espoused by Ambrose-Zaken focuses on the internal, self-protective forces that prevent children with MVI/B from moving into danger without effective protection. 

Adults control the external forces they provide children with MVI/B. Unfortunately, the mothers' natural fear for the safety of their children with MVI/B; and their children's clear fear of walking independently did not inspire innovation in safety tools for blind babies.

By not developing tools to improve blind babies safety, the families were left with improvising external forces to improve the safe mobility of their children, like holding their hands, pushing them in strollers, and shouting verbal warnings. These external forces impact the child's internal feelings of confidence.

In the picture, on the left, the physical therapist (PT) applies the external force of her position and readiness to intercept danger on behalf of the child with cortical visual impairment (CVI). The child is wholly unaware of what her therapist is doing to keep her safe. Thus, there is no internal feeling of safety directly resulting from the adult's actions.

On the right, the same child's PT provided the external force of a Belt Cane. The touch feedback from the Belt Cane child gives clear indicators that she is protected from obstacles in her path. Her internal feelings are easily measured in her outward confidence, improved quality, and amount of walking (Ambrose-Zaken, 2022, 2023; Ambrose-Zaken, et al., 2019; Penrod, Burgin, Ambrose-Zaken, 2024).

Side by side same 3-year-old girl wearing a drool scarf, her arms are bent her hands are tucked close to her body and neck, wide base stance, her expression is stress. her PT holds her arms 16-20 in front and behind the child. She sits on a rolling stool, her gets straddle her. On right, no drool scarf, stands in sweater, jeans and new tennis shoes, wearing her Belt Cane she turns towards the camera an smiles. One arm relaxed by her side, the other hand in front.

It should be very easy to understand there is a serious problem with any educational philosophy regarding infants that recommends bruises as an instructional method. In these often repeated phrases 'the permit the child to walk' and 'allow them to sustain injury' we see blind infants being treated very differently from sighted infants.

Teachers began reporting their experiences and offering how-to guides to assist other teachers in following this advice. In these publications, the walking intervention of having no protection is again and again shown to be the basis upon all educational initiatives for children who had no insider's knowledge of the seeing world.

18th century beliefs perpetuated in the 20th century.

In the 1960s, one of the foremost educators in special education reviewed the book, “Fun Comes First for Blind Slow-Learners”. He wrote, Huffman's text "...for classroom teachers, written by a classroom teacher..." was an instructional guide that had “been awaited with eagerness by teachers from Maine to California” (Goldberg, 1958, p. 65).

Huffman's (1957) gives us an inside look at the difficulty teachers had implementing these independent walking theories in real life. She was guided by the principle that blindness restricted her students' opportunities and the “lack of these experiences was… responsible for much the emotional disturbance and asocial behavior found in the children under the writer's supervision” (p. 3).

Huffman's remedy for lack of experience was to fill her students' days with experiences of roller skating, rock climbing and other thrilling challenges.


Black and white photo of a boy just about to finish climbing a rock wall with a chain link fence in front of him. visible text reads to test his strength and courage. Playground equipment has caused accidents so often on... caption Fig. 14. Health and Safety. Climbing a rock wall.

Huffman believed the teaching of safety was “…the same for all children. The only “…difference in teaching being that emphasis was placed on sound rather than sight” (Huffman, 1957, p. 76). Huffman gave the following example of how she employed a referee's whistle to protect her pupils with MVI/B including those with physical and cognitive delays:

--------------------

“Any hazards or danger-spots in the school environment were utilized as a means of teaching objective lessons in realistic problems. Among tangible factors used to teach safety habits were: Steep steps, retaining walls with rough protruding rocks, roadways over which maintenance or delivery trucks frequently traveled; construction areas, deep and wide ditches…

For acquiring prompt group responses, a referee’s whistle was found to be convenient when used as a definite means of signaling. A long, shrill blast meant “Danger! Stand still! Listen!” The children were taught that this danger could be anything from an unexpected appearance of a car to the possibility of a child’s walking in front of a swing, stepping off in a ditch, or walking into some obstacle in his path.”

…When there was danger of an approaching car, one long shrill blast was blown, followed by the assembly signal of three short blasts repeated twice in succession. Next, I stepped to a safe place off the side of the roadway where the group collected in a compact unit until the car had passed” (pp. 76-77).

---------------------


Huffman made clear the difficulty she had supervising students who were unable to independently detect and avoid hazards. Contrary to the recommendations of Blacklock, Moyes, Howe, and Cutsforth no teacher could, in good conscience, allow her students to get hurt on her watch. Her detailed whistle types and their descriptions of communicating danger was a page long. She was on constant guard.

A side note: The problem with shouting general warnings is bind people are unable to see who the target of the warning is. When you shout “watch out”, what is the blind man supposed to do? You may have been warning your child from stepping into on coming traffic. Or you may have been warning him that he was about to step into a ditch. Sound is an inferior warning system when compared to touch (see Seatbelt safety).

Consider the problem of the "assembly signal" for a child with MVI/B - what if there is a drop-off between the child and the assembly location. Without a safety tool, the blind child still doesn't know exactly where the drop begins or how deep it is. Those are the jobs of the white cane. 

Black and white photo of the author with six pupils sitting on a bench next to her.

Huffman intended for ALL her students within earshot of the whistle blast to stop what they were doing. All had to stop so they could find out which one of them was in danger. Huffman’s whistle was her unique solution to her very real problem caused by the lack of a white cane solution for her students.


Huffman began teaching children with a visual impairment TEN YEARS after the white cane had been invented. A white cane is a tool that enables the user with MVI/B to use their touch sense to safely feel/detect “…steep steps, retaining walls with rough protruding rocks, and roadways... a ditch, or ...some obstacle in his path” two steps ahead (1957, p. 76). The next blog in this series will discuss the slow introduction of the long cane in schools.


Suffice to say, Cutsforth and Huffman were both right in their intensions, they wanted their students to be independent. They were misled from the beginning about the actual causes preventing their students with MVI/B from walking freely. Their students had not been held back by their mothers, they were simply trying to protect themselves.


The blind child is aware of things he is in contact with through his hands and feet, and it makes a difference how he learns of objects. A Belt Cane is a white cane for blind babies, it gives them a two-step safety buffer, preventing most direct body collisions and gives clear indicators of objects and drop offs. The Belt Cane extends the reach of infants with MVI/B in many meaningful ways.



6 year old walks in the school hall wearing his belt cane.
Brayden, age 6 - it took him 6 months of Belt Cane to feel safe enough to let go and walk in the middle of the hallway.

References

Ambrose-Zaken, G., (2023) Beyond Hand’s Reach: Haptic Feedback is Essential

to Toddlers with Visual Impairment Achieving Independent Walking. The

Journal of Visual Impairment & Blindness, 117(4), 278-

Ambrose-Zaken. (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.

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.

Cutsforth, T. D. (1951). The blind in school and society; a psychological study. (New

ed.). American Foundation for the Blind.

Goldberg, I. (1958). Book Review: Fun Comes. First for Blind Slow-Learners.

Journal of Visual Impairment & Blindness52(2), 65-68.

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

infants and toddlers in the United States. Journal of Visual Impairment &

Blindness, 107(5), 325–336. https://doi.org/10.1177/0145482X1310700502 

Howe, S. (1841). The Ninth Annual Report of the trustees, of the Perkins

Institution and Massachusetts Asylum for the blind 1841 from Boston:

Huffman, M. (1957). Fun comes first for blind slow-learners. With a foreword by

Samuel A. Kirk. C. C. Thomas.

Penrod, W., Burgin, X., & Ambrose-Zaken, G. (2024). Study Result: Pediatric

Belt Canes Improved Children with Mobility Visual Impairments Safety and

Independence. The Journal of Visual Impairment & Blindness, submitted for

publication.

The New Outlook for The Blind (1963). Necrology. 57(3), 113-114.

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