A Study of Improving
Independent Walking Outcomes in Children Who Are Blind or Have Low Vision
Aged 5 Years and Younger

Grace Ambrose-Zaken, Ed.D., COMS

Summary of article published in the Journal of Visual Impairment & Blindness:

This study examined independent walking in thirty-five children with blindness or mobility visual impairments (B/MVIs) aged fourteen to sixty-nine months. Before obtaining a belt cane, they had limited to no ability to walk independently with safety. Wearing the pediatric belt cane (PBC) provided them with consistent, haptic tactile feedback and safety from colliding with objects in the environment.


Methods:

Thirty-five participants with B/MVIs’ independent walking milestones were analyzed using pre- and post-video recordings provided weekly one month before and the three months after obtaining the PBC. The PBC consisted of a rectangular frame that connects to a custom-made belt with magnets. The PBC provided no weight support. While none of the participants had motor impairments, 80 percent of them were receiving physical therapy services prior to obtaining a PBC. Fifty-four percent were receiving orientation and mobility services, and half were equipped with hand-held mobility tools (e.g., long canes). 
 

Results: Visual impairment
   Twelve participants had optic nerve hypoplasia septo optic dysplasia (35.3%), eleven had cortical visual impairment (29.4%). Three participants had retinopathy of prematurity. Two participants each presented with Norrie’s disease, microphthalmia with retina coloboma, Leber Congenital Amaurosis and traumatic brain injury. The cause of one participant’s congenital blindness was listed as unknown. Seventeen of the participants were blind (NLP) and eighteen were visually impaired, they responded to visual stimuli but the result of the severity of their visual impairment meant they were unable to visually avoid collisions, or MVI. 

mean age and walking skills (Ambrose 2022). four lines top left dashed with black dots show mean (x) age in months before (from left) Stand (x-21) cruises (x=21.5), walks with assistance (x=35.4), walking wide gait (x=35), top long dashed line with four dots is mean (x) age in months with PBC walks with assistance (x=34), walking wide gait (x=30), walks well (x=39), runs (x=36), lower dotted line shows number of participants at milestone before stands (n=3), cruises (n=4), walks with assistance (n=18), walking wide gait (n=10), walks well (n=0), runs (n=0), fourth line solid with dots at stands (n=0), cruises (n=0), walks with assistance (n=2), walking wide gait (n=10), walks well (n=18), runs (n=5).

Independent Walking Ability 

The adults reported that children had the physical ability to walk and many continued to walk with assistance. Those who were reported as walking independently, were described as walking caused them to collide with obstacles (unsafe). Adults indicated that either the participants currently walked independently but could not avoid obstacles or no longer walked independently. For example, a teacher reported her 23-month student with cortical visual impairment (CVI), “M. often does not look down, is not able to see or maneuver around obstacles in her path and falls frequently. She has trouble with depth perception and does not see steps or uneven pavement until she's already tripping on it.” A parent reported, the 38-month-old child with CVI,” He is ambulatory, but not safe due to profound visual deficits that cause him to collide with objects”. A physical therapist indicated a 42-month-old child with no light perception due to Anophthalmia, was “no longer walking, gross motor delays partially due to lack of environmental preview.”

PBC cane skills and motor outcomes

There was a significant difference in independent walking. Participants who were not walking independently before began walking independently wearing their PBCs. The participants wearing PBCs all demonstrated improved: static standing, ability to recover balance after the PBC stopped them from advancing towards stationary objects, ability to stand up and sit down on the floor, ability to manipulate the cane frame to locate a clear path once the PBC was blocked from moving forward, and overall ability to respond to various surface changes, object contacts, and level changes. The children who were scored as “walking well” wearing the PBC demonstrated a consistent ability to independently cross open space, at will, and were exploring and seeking out others.