The origin story of the field of orientation and mobility (O&M) is about the heroes of WWII who returned home blind, were handed Lions Club canes, and told they were ready to return to civilian life. The Lions Club cane was too short to check the walking surface ahead of the next step. They were taught to wave the Lions Club canes when standing at the curb to let drivers know they wanted to cross the street. "When the blind person crosses a street let him extend it so that everyone can see and be aware of his blindness" (Martin & Kleinfelder, 2008, p. 33). The presumption was these brave, blind WWII veterans now had everything they needed to get about town independently. Russell described what it was like to walk without a white cane in his autobiography To Catch an Angel: Adventures in the World I Cannot See. Born sighted, he lost his vision at age five. The first time he left the protective walls of the New York Institute for the Blind by himself was in 1936. He did not even have a short Lions Club cane when he turned twelve and his parents signed the permission slip... “With trembling hands, I took my first slip from the principal's office to my housemother and made a dash for the gate. I had nowhere to go; but to stand outside the fence was enough...Fortunately, there was another boy in the same predicament. Together we mustered the courage to explore the wilderness of the Bronx. Stumbling over curbs and running into lampposts, we finally covered the seven blocks to the business section of White Plains Road. After banging into nine hundred baby carriages, asking countless questions, and receiving much help, we made our way to the dime store..." (1962, p. 62). The young men who had helped to defeat Hitler and Hirohito rejected this precarious strategy of getting about town that Bledsoe later dubbed "the stumble and crash method" (2010, p. 583). The blinded vets in their twenties were not as gullible as 12-year-old blind boys. They refused to walk independently with tools and techniques that did not adequately protect them. A blind adult invented the long cane for blind adults. US army Sergeant Richard Hoover is regarded as the father of the long cane. Hoover credited William Hanks Levy's with the discovery. Levy was blind and had made his living by establishing handicraft industries and workshops for the British blind. Towards the end of his life, in 1872, he published his treatise on blindness (Koestler, 1976). Levy used a long stick when he walked and described the length, shape, and his system for using it specifically for safety. He described how he used his stick to systematically check the ground"...about six to nine inches from the feet, the ground will always be examined before being actually trodden (p. 70). He called it a "stick" but, please do not picture a branch off a tree. Levy's stick was a well-crafted, elongated walking stick that was repurposed for checking ahead of him. It had a handle "somewhat like a hook, and sufficiently large to be grasped firmly, so that it may not easily be knocked out of the hand"...and "...suited to the height of the individual, but it should be longer than what would be used..." as a support cane. and "...it should always have a good ferrule..." (a ferrule is a metal cap or band placed on a wooden pole to prevent splitting) (Levy, 1872, p. 70). Hoover famously altered Levy's cane arc technique, or the instruction that makes up the “M” or Mobility part of the new field orientation & mobility (O&M). Levy had described "waving the stick alternately from right to left to correspond with the movements of the feet”. He explained that he used his long stick to check ahead of his leading foot (Levy, 1872, p. 70). Hoover recommended tapping the long cane so that it checks the ground ahead of the trailing foot. His goal was to provide two steps of reaction time. In 1977, Bledsoe explained to John Chester on his radio show “Dialogue Today” that long cane "...use has to be taught and carefully taught in conditions and situations in which blind travelers go. One of the first things we discovered is that no one picks up a cane and touches in front of the trailing foot naturally. In fact, it takes hours and hours of training to get blind people to do it that way. It seems to be the opposite of conditioned reflex." Curiously, when Hoover (sighted), Bledsoe (sighted) and Williams (adult on-set blind), devised the “O” or the Orientation part of the O&M training program; they did not make any changes. Levy believed that the most important ability is for a blind man to be able to cope if he did not have a guide "...if he were to be left alone at any moment he would be master of his own actions, and be enabled to direct his steps through the world, gives to him such confidence and comforting self-reliance which no other possession could afford" (1872, p. 69). This description of the confidence a blind man gains by walking alone without a guide was given prior to his discussion of his stick. The history of early intervention O&M has shown that most believed that people with a MVI/B would be better off, once they were able to walk alone. Everyone knew the danger of not being able to see where you are going, yet they believed that injury was a necessary consequence of independence for blind people. I call it the walk first, safety last paradigm that has plagued the field of early intervention O&M since its inception. The purpose of this blog is to demonstrate the lineage of this paradigm, how it made its way into current practice, and why it needs to be replaced with Safety First, everything else after safety. Walk first, safety last has always been a bad idea. And so it happened, that even though it was the blind vet's objections to walking unprotected that created the long cane, their instructors insisted they prove they could walk without it, first (Miyagawa, 1999). Blinded veterans were taught orientation skills inside the Valley Forge medical center with only pre-cane skills to protect them, first, before they learned the long cane. Levy's 1872 recommendation for walking with a long stick to probe the ground ahead for safety, ignored for 73 years, is now the defacto mobility tool for everybody. If others had begun using Levy's long stick as early as 1872, perhaps it could have led to innovative designs for protecting all blind people. As it was, walk first, safety last remained the only method for teaching blind people to walk independently. This may explain why, in 1945, there was no recognition whatsoever that if blind WWII heroes were afraid to walk without protection, then so too must infants with a MVI/B be afraid. Safe Mobility and Age of Onset. Most would have us believe that infants born with a MVI/B and adults who acquire a MVI/B have very different outcomes from the same disability due to the age of onset. Adults who became blind as adults demonstrate the same outward visible motor affectations as children with a congenital MVI/B do when they are asked to walk exclusively by the grope, stumble, and crash method. Consider the story told by Dorothy Eustis, founder of the first US guide dog school The Seeing Eye, of a blind WWI veteran before and after he took the harness of his guide dog. "He was about forty-five years old and stockily built. She guessed he had once had a good deal of exercise, perhaps as a farmer, but since his blindness, his muscles had turned to fat. When he moved, he shuffled uncertainly with hesitant groping gestures of his hands and feet. He seemed timid, lost, helpless, and very, very blind...when the big farmer straightened up from buckling on his dog's harness.... his head was erect. His shoulders were thrown back. He gave his dog the command forward and strode out confidently" (Putnam, 1963, pp. 25-26). The guide dog and the long cane demonstrated that blind travel could be safe and efficient. These were the first tools that could replace two functions of vision necessary for independent walking: obstacle preview and balance. Yet, the leading profile of a 'mobility tool user' was someone who was smart, physically able, with an adult-onset MVI/B. Up until recently, no infant born with a MVI/B has known the feeling of reliable safety from obstacles all day long. We cannot know and will only learn what blind infants are capable of once we ensure they feel safe all day, every day. We will learn what blind infants are capable of once we ensure they feel safe all day, every day. The development of mobility tools by adults for adults fit neatly into the "must walk first" paradigm. All the people who used them were able to walk and talk already. Graduate students who learned to travel with the white cane fit the same profile, they were all physically and cognitively capable people. University programs preparing teachers of learners with a visual impairment (TVIs) and O&M specialists imported the cane training curriculum directly from the originators of O&M. The walk first, safety last paradigm was adopted without question into the curriculum for preparing teachers of children with a MVI/B. Starting in 1945, adults were provided long canes and gained the confidence only attainable through independent safety. At the same time, parents continued to watch their infants fail to navigate through their world safely and seeming to lose more confidence with each passing year. The problem with external motivation is it doesn't work on infants. One major difference between adults and children under five is that it is harder to get children to ignore their basic instincts and walk into danger, than adults. The young, blinded vets of WWII were able to patiently wait and endure their difficult training protocols because they were externally motivated. They could only receive their additional blind benefit pay if they completed the mandatory program (Koestler, 1976). Infants have an internal sense of self-preservation. Since the beginning of time, they have successfully thwarted all attempts by adults to make them walk without safety. Infants with a MVI/B's inability to walk independently only served to make adults work harder to achieve this unattainable goal. This safety-last instructional sequence remained throughout the century. Any further innovation of white cane safety tools for the diverse group of humans with MVI/B would have to wait. Including white canes in the advice for educating children with a MVI/B. The introduction of the US Army's long cane instruction crashed civilian life as an uninvited party guest. In the 1950s, the loudest opposition to white canes came from residential school staff, who found fault with the method for training the instructors, “The sighted individual who is blindfolded can approach problems of the newly blinded adult in a way he cannot approach problems of the congenitally blind” (Bledsoe, 1952, p. 3). Which, of course, is true. Instructor training methods were only part of the resistance to long canes (Bledsoe, 1952; Hoover, 1960). There was great professional concern that providing a safety tool and systematic instruction to children with a MVI/B would do more harm than good. As it was truly believed that blind babies needed to walk first, despite the injuries (See prior blogs). Warren Bledsoe was born and raised on the campus of Maryland School for the Blind (MSB), because his father was superintendent. Bledsoe was the co-inventor of the long-cane technique, after which he, Hoover, who had been a PE teacher at MSB before the war, and many others spent considerable time trying to get long cane use accepted into civilian life. Bledsoe explained, “…this battle began in a world in which one of the most complimentary things his friends could say about a blind person was, "He goes all over the place without a cane." To this it was often added by some cynic, "With the help of 120 million people." I know in any case that a great premium was put on the natural appearance which was attributed to blind people who managed to go about without canes” (Bledsoe, 1952, p. 2). During these early exchanges on whether to teach long cane use, what never appeared in the discourse was any imperative to improve safety through white cane designs for infants, people in wheelchairs, on crutches, with cognitive limitations and those with no functional use of their hands. People who were on the move, but unable to see where they were going and needed safety, too. The field instead presented the long cane as the one and only mobility tool for people who did not want or were too young to use a guide dog. Anyone who could not use the long cane continued to be taught 'pre-cane' skills until they were ready to use the long cane or never. Most children with a congenital MVI/B are unable to use the long cane for safety, no matter what age it is introduced to them (Ambrose-Zaken, 2023; 2022). Pre-Cane Hand Skills. The US army formalized the natural response of using one's hands for protection and information and called them pre-cane skills. Done the army way, pre-cane skills resemble a soldier marching in a military parade. The problem with pre-cane skills is they are unable to guard against hazards beyond hand's reach, like drop-offs. Pre-Cane Listening skills. The US Army had an interest in finding other technologies and strategies beyond the 'long white stick' for use by its blind veterans. One example included investigating and testing the limits of human hearing. As part of their final stage before discharge, and their increased benefit pay, blinded WWII vets were told to leave their long canes behind at Valley Forge before being shipped out to Avon Old Farms. There, the men were taught to use facial vision to navigate. Facial vision is a term that encompasses the hearing ability to detect both audible and inaudible sound waves as they bounce off objects. The farm had low ceilings and many oddly shaped stairs and passageways. This made navigating without a long cane extremely stressful. Most reports from the blind vets confirmed that facial vision did not work well enough to feel safe walking without the long cane. They simply put up with it to receive their pay bump at the end of the program and this crazy scheme was the last obstacle in their way (Koestler, 1976; Miyagawa, 1999). Various teachers in public schools attempted to teach children with a MVI/B to use their facial vision and said they found improved outcomes for their subjects (Manley, 1962; Hunter, 1962). As described by Hetherington in 1955, “Much of the success of a student’s ability to master foot travel is dependent somewhat upon his ability to perceive objects in time to avoid them... It is our belief that the sooner a child can become aware of this ability and develop it, the more confident he becomes. The elementary students taking travel are given obstacle perception exercises and training...” (P. 15). To be clear, the "obstacle perception exercises" being advocated for here were listening skills. While listening is an educable skill, nobody's hearing can detect the exact location of the edge of a coffee table or drop-off. To do that, you either need sight or a white cane. Children and adults with a MVI/B, who are also hearing capable, can develop more skillful listening abilities. It is just a lot easier to detect obstacles with a white cane. People with a MVI/B who have highly trained listening skills, like Daniel Kish, a blind man who has made a career teaching object perception and echolocation, use long canes (pictured). Long canes intentionally excluded from the classroom. In the 1960s, teachers of learners with a visual impairment (TVIs) were employed by school districts and most O&M specialists were employed by vision rehabilitation agencies. Most TVIs in schools were women who were doing everything they could to follow the prescribed standard of education, 'walk first'. Most O&M specialists were men who jealously guarded their new profession. O&M specialists were taught that students had to possess certain pre-requisite knowledge and skills before they could learn long cane skills. TVIs were responsible for students developing travel concepts and pre-cane skills. TVIs understood that the long cane was not in their job description. All TVI university programs intentionally omitted the use of the long cane during their blindfold lab classes. Lord and Blaha (1968) wrote, “The presentation of the skills was done by placing the teacher under a blindfold, the actual use of the cane was not involved. The acquisition of cane techniques is universally seen as the function of the fully trained specialists, and this role was clearly defined for the participating teachers” (p. 21). From the start of the 1960s, the accepted division of labor between TVIs and O&M specialists was TVIs would continue to teach everything but the long cane at school and O&M specialists would teach long cane and outdoor travel skills, when the child was ready. O&M instructors in the 1960s began to use the long cane as a carrot, a reward that children with a MVI/B could earn by learning to walk without it (Lord and Blaha, 1968; Gronemeyer, 1969; Weiner, 1980). For example, Gronemeyer (1969) concluded the difficulty in teaching an adolescent blind boy is he “needs to be more physically active before he can have a cane” (p. 41). Waiting for the long cane. The long cane is a deceptively difficulty tool to use correctly for safety. It is important to understand the mechanics of long cane safety. The user must be able to interpret and respond to sensory information transmitted through the half-inch diameter cane tip. To ensure the best safety outcome, the user must rhythmically swing the cane tip back and forth with each step to check the ground for danger. Used correctly, the user is two steps from a decision. He must be able to interpret the tactile information in time to stop, investigate further, and decide what to do next. Used any other way, the long cane is not a safety tool. Infants do not possess the intellect, patience, or motor skills to maintain the cane tip position, rhythmical movement or respond to long cane feedback. In the 1960s, attempts to teach high school students to use the long cane were frustrating to the O&M instructors for many reasons, not the least of which was the difficulty students had in learning the precision the proper techniques demanded, finding that "some were careless in the application of the skills, which resulted in unsafe and inconsistent performances (Miyagawa, 1999, p. 193). The degree of difficulty in using the long cane further ensured the walk first, safety last paradigm for infants with a MVI/B. The need to qualify for long cane instruction may have brought even greater pressure to bear on parents of infants with a MVI/B to get their children walking and talking on time so they could finally be safe. For example, Lowenfeld (sighted), a highly acclaimed educator of blind children, instructed parents that their children with a MVI/B… “…must learn to walk without help of any kind in familiar territory. What is familiar territory expands as they grow older, until they learn to venture out into places that are new to them. When the time comes to do this, they should learn to use the cane. Usually this is found practical only after a youngster is fourteen years of age, more often older than that” (Lowenfeld, P. 187-188). Table 5. Modern interpretation of 1961 advice to parents. Lowenfeld’s recommendation rests on his correct assessment that the long cane was too challenging for infants to learn to use correctly for safe mobility. Yet, he firmly believed that infants with a MVI/B could be motivated to work against their own self-interest and learn to walk independently without safety. He understood that children who remained stationary, as children with a MVI/B did, were also delayed in reading comprehension. He was aware that TVI lessons did not include the long cane. He taught TVIs to include independent walking into their teaching activities because, "Reading will come more easily to a child who can relate the words he reads to realities he has experi­enced. It is the responsibility of his teacher to see that he continues to enjoy many experiences and has opportunities to learn what is going on in the real world around him, first in the school, its grounds, and then the world outside (1956, p. 126). The unattainable prerequisite skill. Lowenfeld, like so many before him, truly believed children with a MVI/B needed to wait until they had the prerequisite skill of walking independently before getting a white cane. The prerequisite skill of unsafe independent walking is unattainable for most children with a MVI/B. The ability to walk into danger should not be the necessary bar to achieve before infants are provided with tools that allow them to safely walk independently and learn to read. Lowenfeld's use of the term “permit” again promoting the theory that blind infants would walk if adults allowed them to. The newly minted curriculum for teaching independent travel was based on working with blind adults which led teachers to the misguided conclusion that children with a MVI/B, like recently blinded adults, were pining away for safety. These children had no concept of what safety meant; they had always just run into walls without warning. Doesn't everybody? An early 1950s pilot project brought three of the originators of O&M, Stanley Suterko, John Malamazian and Larry Blaha to teach a group of high school students with a MVI/B. It was very difficult for them to understand why some high school children could master the long cane and some could not. Those children who could learn O&M skills were seen as cooperative, those who couldn't were faulted for not trying hard enough, not wanting it enough. They reported, "In spite of those who encountered problems, other youngsters showed both the ability and desire for extending their skills and quickly learned to travel independently from their home to a variety of locations" (Miyagawa, 1999, p. 193). There was no understanding of the life these high school children had led until then. Every child who failed to pass the prerequisite test or master the long cane was faulted for lacking an interest in learning to be independent. No one took into consideration the fact that these children had been left to fend for themselves for 16 years without safety. How could they even conceive of the idea that there was a safe way to get about. Those children who actually received these specialized services were the lucky ones. In describing the results of her experimental life skills program at the Illinois braille and sight saving school for developmentally-delayed visually-impaired children, O'Meara admitted that "Each year a greater number of these children have come to the school seeking admission. Unfortunately, the deprivation which they have suffered in the area of experiential and sensory stimulation during infancy and early childhood has made it very difficult, even at times impossible, for them to benefit from regular educational programs provided for blind and/or partially seeing children" (O'Meara, 1966, p.18). Imagine the strain that must build up when you must travel without safety. In the 1960s, educators began to ask in earnest, “At what age should mobility training start?" Miller's answer "I would risk saying, emphatically, ‘in the cradle!” (1964, p. 307). Miller was among the first graduates with a master's degree in O&M. After having learned to travel blindfolded with her long white cane, it was plain to her that children with a MVI/B needed the protection of white canes too, but how? Infants with a MVI/B could not use a long cane; toddlers did not have the language to learn long cane skills, preschoolers appeared to reject holding the long cane, and most school-aged children were unreachable, quiet, solitary, stationary people, worn down by a life of unsafe expectations and demands to walk into danger to prove their worthiness for safety. The same year Miller (1964) was reporting the detrimental motor outcomes she found in the student population she served, Royster (1964) detailed his instructional map for teaching a child with a MVI/B from birth using the walk first, safety last approach. Royster explained: "In the infant stage the primary emphasis must be concentrated in more than usual amounts of emotional warmth in physical care. As the child becomes a tod­dler, he ...needs to be taught free and independent ex­ploration techniques to orient himself, ...and acquire motor skills of balance and coordination. During the preschool years, ...teach imagery stimulation and spatial orientation of objects in the environment. At school age, ... activities of running, jumping, swinging, bal­let dancing, climbing, and pounding should be a regularly scheduled part of the school cur­riculum.... Provided a continuous sequence of orienta­tion opportunities and activities, the adolescent is ready to learn mobility and travel from a peripatologist" (p. 42). In 1964, Miller observed: “The problem presented itself to me as soon as I entered a school for the blind. Why, if blindness was their only defect, did these children present such a picture of physical abnormality, with poor posture, awkward gait…I asked Dr. Hoover*, What could be the cause of this? “…He looked sad and said, “Nothing, I guess, but tension. Imagine the strain that must build up when you have to travel like that (without safety)” (Miller, 1964, p. 305). * R.E. Hoover, originator of the Hoover cane technique. At the time of her publication in 1968, Moor reported that, “one-tenth of the population of individuals with a visual impairment were under twenty years of age” and 25% were infants and toddlers who were not receiving educational services. Moor also painted a bleak picture of the children with a MVI/B entering her school at the end of the 1960s. She described the children with a MVI/B as “frequently indifferent to the school experience, and at first may physically withdraw by curling up on the floor or even on a bookshelf” (p. 9). Moor’s choice of the word ‘indifferent’ seems out of context with her description of children with a MVI/B physically withdrawing. A blind child hiding inside a bookshelf seems more like a cry for help, than indifference. Early school standards favored the able bodied, visual child. The practice of preparing TVIs to walk without long canes created in them a certainty that walking without a white cane was a 'best practice' for their students with a MVI/B. It was simply expected that blind children would roam the hallways untethered and unprotected. The children who succeeded in achieving these standards were those who could walk independently. The more sight you had the better you could walk. This is not to ignore the those children with a MVI/B who were able to walk and learn to use the long cane as teenagers. Most children with MVI/B were crushed by the expectation of walking into danger every day had to be in special classes to address the consequences of daily, unsafe mobility. For example, New York City schools used students' mobility as an entry criterion to resource room programs. The 1965-66 Curriculum Bulletin: Educating Visually Handicapped Pupils: Board of Education – City of New York, stated: “1: Resource Program for Visually Limited Children: The resource program for visually limited children serves those pupils…whose mobility is sufficient for regular class placement…” and “2. Resource Program for the Blind serves those students who…possess sufficient mobility with which to participate in the regular school curriculum” (p. 1). 1966 COMSTAC Report Twenty years after the introduction of long cane “most of the work with systematic orientation and travel training programs had only been done with blind adults” (Koestler, 1966, p. 231). Yet, when the leading experts in the field of blind travel gathered in 1961 to create O&M standards, they believed that there had “…been enough experience to confirm the validity of using the basic cane program standards for children as well” (p. 231). The most anticipated publication in the field of O&M of its day, The COMSTAC report, detailed the standards for teaching O&M to children born with a MVI/B as: “It is often said that preparation for orientation and travel should begin at birth. In a blind child’s earliest years, the emphasis is on orientation; as he grows, he needs more and more systematic travel teaching. Just as much care should go into good teaching and experience in orientation in the early years as should go into systematic travel teaching later… “ (Koestler, 1966, p. 231) Table 6. Modern interpretation of 1966 advice to parents. Koestler, the editor of the COMSTC report, was a highly respected author in the field of blindness and visual impairment. She wrote "The Unseen Minority: A Social History of Blindness in the United States" (Koestler, 1976). As the editor, she was responsible to ensure the result accurately reported the tone, intention, and current thinking of the leaders of each specialty area serving learners with a visual impairment or blindness. The COMSTAC report once again described the familiar instructional sequence for teaching infants with a MVI/B as walk first, safety last. Landmark O&M study exposed flaws in current theory of early O&M methods. At the close of the 1960s, Lord and Blaha reported their findings from the first of its kind O&M demonstration project. Three O&M instructors evaluated and taught fifty-one adolescents with a MVI/B aged thirteen to twenty-one to use the long cane. Their evaluations found the “blind adolescents have limited travel …in relation to normal youths of similar age. Their social life is very limited... Their travel often is confined to a high school campus and home...” (1968, p. 78). The report recommended the adolescents' “Orientation skills and knowledge need to be developed further, primarily because blind children lack experiences with their environment. They have a great need for orientation materials that can be classified as educative rather than rehabilitative” (p. 11). Their O&M instructors reported that long cane instruction had “enhanced their physical and mental development” (p. 11). They also reported that, like Blacklock did in 1797, the 1968 “Students tend to blame parents for their limited travel experiences” (p.  12). These fifty-one adolescents were the physical and cognitive demonstration of unsafe walking since infancy. Lord & Blaha’s conclusion was ‘parents needed to try even harder to give their infants with a MVI/B more opportunities to walk independently BEFORE they became teenagers’. Their recommendation, “It therefore appears that active programs of recreation, travel, etc. should be instituted to generate normal travel needs. Orientation and mobility training would then become an important service to a youth in relation to these needs.” (Lord & Blaha, 1968, p. 74). Blaha had died suddenly of a heart attack in March of 1968. Lord was tasked with finishing their report. Throughout the report we see the suggestion that children with a MVI/B did not travel because they were uninterested in going places outside their familiar routines. This narrative appears to blame children for the outcomes of the decisions made by adults since they were infants. Lord's thesis demonstrates the utter inability for sighted people who keep flashlights, extra batteries, candles, and matches at the ready for when the power goes out, to understand the safety problem for blind children. How could they never once consider how impossible a task they had given infants with a MVI/B to grow up and learn with only their two feet in contact with the world. Summary Beginning in the 1960s, it became well documented that toddlers with a MVI/B didn’t explore even when their legs worked fine, didn’t speak even though they understood, and didn’t seek out their peers even though they loved being engaged socially. Lord and Blaha's 1968 findings had exposed the antiquated 19th century experiment of “treating blind children the same as sighted peers” as an epic failure, yet the connection of delayed walking skills and unsafe mobility remained elusive to these early educators. Afterall, 160 plus years of certainty that infants with a MVI/B must first learn to walk, was difficult to dispute and was left unquestioned. Instead, research throughout the 20th century consistently described preschool children with a MVI/B, as demonstrating devastating developmental delays that began very early and recommended additional external motivators be applied. Although throughout the 1970s there were multiple studies that revealed these instructional mandates were not successful with children with a MVI/B, the fault was assigned to the children and to their families. Any innovation in mobility tools would have to wait for the 1997 reauthorization of the Individuals with Disabilities Education Act (IDEA) that included Part C, early intervention. The next blog will discuss the early intervention in the 1970s before and after the authorization of P.L. 94-142 Education of All Children Education Act. 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- 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 Bledsoe, C.W. (2010). Originators of orientation and mobility training. In W. Wiener, R. Welsh, & B. Blasch, (Eds). Foundations of Orientation and Mobility: Volume II Instructional Strategies and Practical Applications (3rd Ed) (pp.434- 485). AFB Press. Bledsoe, C.W. (1952). Resistance. C. Warren Bledsoe Manuscript Collection, AER O&M Division C. Warren Bledsoe Archives, museum of the American Printing House for the Blind, Louisville, KY. Chester, John, (1977). “Dialogue Today” C. 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The COMSTAC Report: Standards for Strengthened Services. Commission on Standards and Accreditation of Services for the Blind, New York, NY. ED025068 Koestler, F. A. (1976). The Unseen Minority: A Social History of Blindness in the United States. New York: David McKay Co. Lord, F. E. and Blaha, L. E. (1968). Demonstration of Home and Community Support Needed to Facilitate Mobility Instruction for Blind Youth. Final Report. California State Coll., Los Angeles. Special Education Center. Spons Agency Rehabilitation Services Administration (DHEW), Washington, D.C. Lowenfeld, B. (1956). Our Blind Children, Springfield, Ill. Charles C Thomas. Levy, W. H. (1872). On the Blind Walking Alone, and of Guides” (pp. 68-76) in (W. H. Levy) Blindness and the Blind: A Treatise on the Science of Typhlology. London : Chapman and Hall https://archive.org/details/blindnessblindor00levyiala/page/n5/mode/2up Manley, J. (1962). Orientation and foot travel for the blind child. The Education of the Blind, October. Martin, P., & Kleinfelder, R. (2008). Lions Clubs in the 21st Century. Authorhouse. Miyagawa, S. (1999). Journey to Excellence: Development of the Military and VA Blind Rehabilitation Programs in the 20th Century. Galde Press, Inc. Miller, J. (1964). Mobility training for blind children: Possible effects of an organized mobility program on the growth and development of a blind child. The New Outlook for the Blind, 58(10), 305-307. Moor, P. M. (1968). No time to lose: A symposium. American Foundation for the Blind, New York. O’Meara, M. (1966). An experimental program at the Illinois braille and sight saving school for developmentally-delayed visually-impaired children. The International Journal for the Education of the Blind. XVI(1), 18-20. Putnam, P. (1963). The triumph of the Seeing Eye. Harper & Row. Royster, P. M. (1964). Peripatology and the development of the blind child. The New Outlook for the Blind, 58, 136-138. Russell, R. (1962). To Catch an Angel: Adventures in the World I Cannot See. Vanguard Press. Weiner, W. (1980). Orientation and mobility come of age. 1979-80 AAWB Annual Blindness. American Association of Workers for the Blind, Inc. Washington, D.C. 118-148.

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). 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) 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). 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). 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. 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. 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. 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- 291. https://doi.org/10.1177/0145482X231188728. 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. https://doi.org/10.1177/0145482X221121824 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 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 & Blindness, 52(2), 65-68. https://doi.org/10.1177/0145482X5805200208 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: Eastburn https://play.google.com/books/reader?id=0JoyAQAAMAAJ&hl=en&pg=GBS.PA36 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.

Infants, toddlers, and preschoolers have very different walking abilities. The infant cannot walk. The toddler unsafely and unsteadily walks 3 to 6 hours a day meeting incremental milestones. The preschooler safely walks independently 6 to 8 hours a day in most environments (Adolph, et al., 2012). Parents and professionals express difficulty providing their children with mobility visual impairment or blindness (MVI/B) under the age of six with a safe and effective way to participate independently in their 6 to 8 hours of recommended daily physical activity. Parents find the challenges of helping their toddlers with MVI/B to use long canes correctly and consistently prevents them from participating safely in most activities (Ambrose-Zaken, 2023, 2022). The Pediatric Belt Cane is a 2-step safety buffer. It has a singular and very important job - to detect obstacles in the path ahead. The rest is up to you. If you want to teach your toddler with MVI/B to achieve preschool-level independence just remember that, like in the dictionary, mobility comes before orientation. First, make your child feel safe moving, then teach them to go places. When children are safely moving independently, they learn more freely, easily, and happily. Toddlers safe mobility is in the hands of their adults. Safe Toddles provides parents with a white cane solution for keeping their children with MVI/B safe. Contact us at info@safetoddles.org for more information 845-244-6600. 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. 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- 291. https://doi.org/10.1177/0145482X231188728. 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. https://doi.org/10.1177/0145482X221121824

"The blind man who governs his steps by feeling, in defect of eyes, receives advertisement of things through a staff." — Digby (1622) With the mass of those who are blind, there is little choice; they must either walk alone or sit still; and as health of body, tranquility and vigor of mind, and the attainment of the means of subsistence largely depend upon the power of moving at will ... One of the greatest aids to him who would walk by himself is a stick ; this should be light and not elastic, in order that correct impressions may be transmitted from the objects with which it comes in contact…” (Levy, 1872, p. 69). Adults who became blind as adults, seemed to have always understood the value of using a tool for safe mobility. From earliest recorded history, newly blinded adults have restored their safety using a stick, staff, human or animal guide. The same cannot be said of adults overseeing the development of infants with mobility visual impairment or blindness (MVI/B). Parents have always had great difficulty teaching their infants born with MVI/B to walk. Many have invested time and energy trying to follow the developmental sequence first described in 1797 by two scholars who were blind themselves. The instructional sequence still in place today in early intervention for learners with a visual impairment states: First, 1) teach the child to WALK, after they are walking, then 2) teach the child to ORIENT, and once they are moving about well; THEN, FINALLY you can 3) teach the child to use a tool for SAFETY. In the 21st century, research has documented a consistent 30 percent of learners with a visual impairment who are not able to develop within that recommended sequence. Their visual function is more aptly described as MVI/B. Researchers have observed that blind toddlers don't walk unless holding a hand (Ambrose-Zaken, 2023, 2022). The opposite of this observation is also true. Blind babies can and do walk when they hold a hand, touch a wall, a table, a couch…, anything will do in a pinch. People with MVI/B need more tactile contact with their world, than sighted children. They use hand holding to travel more efficiently. When you understand how smart this behavior is, then you can understand why a white cane solution, like a Belt Cane, works so well in achieving walking and daily physical activity goals. Belt Canes provide these infants with more points of contact and safety. (Ambrose-Zaken, 2023, Penrod, Burgin, Ambrose-Zaken, 2024). This is the first in a series of articles that takes the reader on a journey back in time to the origin story of the developmental sequence still in use today. First published in 1797, parents of infants with MVI/B have followed it faithfully, with limited success, for the past 220 years. The history of early intervention for infants with MVI/B is important to understand. This series will make the case that it is the lack of proper safety caused by blindness that creates the deficits parents and professionals struggle with daily. The good news, there is a way to improve their safety. The revised developmental sequence is 1) Provide safe mobility to the infant with MVI/B; and then 2) Play, explore, laugh, and learn together. The Pediatric Belt Cane allows infants with MVI/B to remain in contact with the structures of the world around them and it protects them as they move through the world. But first, we must begin at the beginning on the isle of Scotland in the late 1700s. 18th Century Drs. Blacklock and Moyes, both blind, authored an article entitled "Blind” for the Encyclopedia Britannica: Third Edition. They recommended to parents that it would be better that the child with MVI/B “should lose a little blood, or even break a bone than be perpetually confined in the same place, debilitated in his frame and depressed in his mind” (Levy, 1872, p. 76). Dr. Blacklock, blind at age 6 months due to smallpox, was an “eminent philosopher, divine, and poet” (Levy, 1872, p.76). According to Levy (also blind), Blacklock blamed his parents for his physical weakness and timidity of nature, because they did not allow him to walk anywhere without a guide. One could argue Dr. Blacklock seems to have fared well in life. Exhibit 1) he’s a Doctor of Philosophy, and b) he was tapped to write for the Encyclopedia Britannica –  …on any scale those are points in the plus column for development. Yet, Blacklock's beliefs found their way into his and Moyes' 1797 Encyclopedia Britannica article in the cruelest way imaginable. They advocated for parents to ignore their children and instead to listen to them. If they had listened to their children they might have heard the reason they were not letting go and walking, they felt unsafe and their blindness makes it necessary to increase the amount of tactile contact they have with the world. Blacklock and Moyes’ encyclopedia article firmly established the 'walk first, safety later' developmental sequence in early intervention for infants with MVI/B. All subsequent early intervention educational texts have recommended this sequence of development to parents and professionals supporting the needs of infants with MVI/B. The incredibly cruel and wrong-headed method repeated through the centuries exposed blind children to direct bodily injury 'for their own good'. Blacklock and Moyes’ 1797 Thesis That They Delivered to The Future Is True. The modern interpretation of Blacklock and Moyes advice solidifies two truths, one, that walking is the most important outcome of infant development. Two, it is dangerous for blind infants to walk unaided. Yet, Blacklock & Moyes’ solution contained no quest for finding a way to accomplish the first by improving the second. Instead, the belief that the child with MVI/B must endure bruises to be truly independent was now written in stone, or, at least, in a highly respected reference book. The piano was invented in the 1700s, and in the 1800s students at residential schools for the blind were taught to play professionally or to be piano tuners. In the 1700s, Ben Franklin invented bi-focal eyeglasses for people whose vision could be corrected with lenses. Yet, in the 1700s, learned men who were blind could not even conceive of the idea of making a safety device to protect blind babies when they walked. 19th Century As founding superintendent of Perkins School for the Blind, Samuel Gridley Howe oversaw every aspect of his pupils' education. The influence Blacklock and Moyes' had on the curriculum taught at the first US school for the blind was obvious in Howe's Ninth Annual Report to the school's Trustees. Howe wrote, “Do not too much regard bumps upon the forehead, rough scratches, or bloody noses; even these may have their good influences. At the worst, they affect only the bark, and do not injure the system like the rust of inaction”(1841, p.8). Howe’s advice to parents was to consider any resulting 'bumps, scratches and bloody noses' that befell their children with MVI/B as proof of their success as parents. The real problem was that nobody believed the blind babies. These learned men were convinced that the evidence before them, that infants with MVI/B did not walk any distance unless in contact with someone, was the result of ignorance on the part of the infants. Ignorance, they believed, that could be overcome with rigorous educational standards, which began with achievement of independent walking. Everyone recognized the potential of the infant with MVI/B to learn, and those could also physically walk. Everyone understood the fear preschoolers with MVI/B demonstrated when walking independently was a natural fear to have. The advice to parents focused on how important it was for blind infants to walk independently and believed the child's fear could be overcome through an adult's shear force of will. These texts did not attempt to interpret the infants with MVI/B persistence on being in contact with their world, instead they made walking without a guide as the highest form of independence for all age groups. Yet, at the most basic level, an infant's contact is an act of self-preservation, because holding on to a parent is a more efficient and safer way to walk. Children with MVI/B appeared to prefer to remain connected to objects even when standing still (Ambrose-Zaken, 2022, 2023; Penrod, et al., 2024). Yet, adults insisted children with MVI/B would only, could only be made strong and whole by enduring the gauntlet of making their way through the furniture inside home, across the uneven terrain of the yard, and among the hustle and bustle of the community completely exposed and unprotected. The 1800s was a time of great expansion in ideas, abilities, and technical solutions for people great and small. Inventions in the 1800s included the typewriter, a device immensely important to students of residential schools for the blind to independently write print. The telephone, steam engine, electricity, and the light bulb were all invented in the 1800s, just no device for keeping blind babies safe. A Modern Idea at the Turn of the Century, Just Say 'There Is No Problem'. The 19th century development of residential schools was dominated by men who had high educational and physical standards for their students with MVI/B beginning with strict admissions requirements; the children had to demonstrate "intellectual promise" (Koestler, 1976, p. 403). Their students were expected to ride bicycles, roller skate, play football and other ball games, and run track. All to prove that blind kids can do anything sighted kids can do. Most founders of schools for the blind did not train to be educators. In the 19th century, many schools for the blind were begun with one or two children. In Vienna, Johann Wilhelm Klein (1804) took in a blind lad, Jakob Braun, into his home with the purpose of educating him. His success led him to seek public funds to start a school for the blind which became the Imperial Royal Institute for the Education of the Blind. Klein published his theories which included advocating for children with MVI/B to attend the same school as their peers. The start of the Oak Hill School in Connecticut also began with a series of well-meant abductions. Emily Wells Foster, took blind immigrant children from the darkened halls of “a rundown tenement” to begin her school: “Foster made her way to the tenement and, while groping along the darkened walls, she found the object of her search, literally tripping over the child as he sat motionless and silent on the dank floor. He was three years old and …feeble, deformed and unpromising…his life was absolutely devoid of interest or occupation” (Palm, 1993, p. 9). One notable exception, Overbrook in Pennsylvania began with a study of practices in France begun by Valentin Hauy, the sighted founder of the Royal institution of Blind Children. Hauy's focus was to teach students with MVI/B manual work skills that would enable them to earn a living. He may be best known for teaching blind children to read raised letters. Early educators of children with MVI/B also had access to the publications of Howe, Klein, and Francis Campbell. Howe and Klein were both sighted, Campbell, who founded the Royal Normal College and Academy of Music for the Blind, was sighted until age 6. Campbell, like Howe & Klein, was a learned, respected, and well-traveled man. Among these superintendents of residential schools for the blind, there was no mystery that blindness was the cause of their students' fear of walking. The problem was the solution. These superintendents of schools for the blind were, "...convinced that only through exercise could they overcome the natural fear of injury which locked so many blind people into sedentary existences" (1976, p. 403). They admitted into their schools only children who had demonstrated "sufficient intelligence to educate...". From these children they understood their fear of walking was "natural". Yet, instead of finding a way to protect them as they walked, they pushed them to face those natural fears completely unprotected (Koestler, 1976, p. 404). The common sentiment that united the advice to parents was that blind children would get hurt, and this would increase their tolerance for the pain resulting from the naturally occurring, unavoidable collisions from being blind. By the end of the 19th century, the world of providers of educational services for blind babies had been convinced there had to be a way to teach children with MVI/B to overcome their resistance to walking independently. Unfortunately, it was doomed to fail because it relied on developing in these children a supernatural ability to navigate without any protection whatsoever. An impossible goal. The 19th century ended with the widespread distribution of a letter entitled, “To the Parents of Blind Children”. It was first distributed to families at the private Institute for the Blind in Austria in 1893. It was so popular, the Massachusetts Commission for the Blind sent it out to its families in 1898; and in 1907 the journal Outlook for the Blind published the letter in its entirety. The authors advised parents to… “1. Treat the blind child exactly as if it were a seeing child, and try as early as possible to make it put its body and mind into action... Teach the child to walk at the age when seeing children learn” and “2. Do not allow the child to sit long in one place alone and unoccupied, but encourage it to go about in the room, in the house, in the yard, and, when older, even about the town” (p. 44). Once again, the problem was framed as the solution. The new twist on the old problem was amplified further in this article. The first sentence uses the phrase "do not allow the child to sit". This phrase squarely places the blame on the child. The authors are saying, the child with MVI/B is getting away with the bad behavior of sitting too long. This speaks perhaps to the frustration felt by well-meaning and hard working teachers at schools for the blind witnessing what Howe reported, “Most of our pupils are over fourteen years old when they enter, and they have generally the quiet and staid demeanor, and the sedentary habits of adults (p. 5). The adults were interpreting the children's reluctance to freely walk and run as an ignorance on the part of the children, rather than recognizing it as a natural human reaction to unsafe conditions. There are only arguments to be made in favor of the the next two points in the popular letter which provided expectations and goals for development that are age and outcome based. It is the final sentence that confounds logic in our modern understanding. "Treat the child exactly as if it were a seeing child..." How can it be right that adults should not consider the degree of visual impairment when making safety and education decisions for infants? This advice has continued to be heralded as the highest standard a blind child could achieve; to be treated no different from a sighted child. This meant, blind children should roller skate, ride bikes, and be encouraged to do sport and other games that rely on eye/hand coordination. The obvious difficulty being, that this leads to feelings of unworthiness. How can a blind child truly compete in games of eye/hand coordination and why should they? 20th Century The 1900s was a time of revolutionary inventions. Inventions in the early 1900s included the radio and phonograph, devices used to teach, entertain, and inform graduates of residential schools for the blind. The telephone, steam engine, electricity, the light bulb, computers, cell phones, long canes and rocket ships to the moon were all invented in the 1900s…just no device for keeping blind babies safe. The next blogs in this series will delve into more detail about the early 20th century, before and after the white cane makes its way into the advice provided to parents. Every time you feel pressured to encourage your blind baby to walk into danger - remember - Safe Toddles has research to prove that blood, bruises and broken bones do not result in better blind baby outcomes. Your blind baby doesn't walk because he can't see where he is going and he doesn't feel safe. The people who wrote the advice to act as if your child could see did not base their conclusions on any scientific rationale, nor did they study the outcomes of their hypothesis. Maybe they just didn't know it was wrong? What else could explain such barbaric treatment of our most precious resource-our beautiful blind babies. References Levy, W. H. (1872). On the Blind Walking Alone, and of Guides” (pp. 68-77) in (W. H. Levy) Blindness and the Blind: A Treatise on the Science of Typhlology. London : Chapman and Hall https://archive.org/details/blindnessblindor00levyiala/page/n5/mode/2up Howe, S. (1841). The Ninth Annual Report of the trustees, of the Perkins Institution and Massachusetts Asylum for the blind 1841 from Boston: Eastburn https://play.google.com/books/reader?id=0JoyAQAAMAAJ&hl=en&pg=GBS.PA36 Koestler, F. A. (1976). The Unseen Minority: A Social History of Blindness in the United States. New York: David McKay Co. Massachusetts Commission for the Blind. (1907). To the Parents of Blind Children Leaflet Number I (1898). In Outlook for the Blind July.

Since 1841 when Perkins began accepting the first blind children into the first school for the blind, educators met the children at the door seeing a great many needs before them. Yet, not one believed that they should first find a way to make the children safer as they moved about their new school and beyond. Hatton, Bailey, Burchinal & Ferrell (1997) review of literature on developmental delays in blind toddlers, reported that children with mobility visual impairment or blindness (MVI/B) and their families expressed a natural fear of walking into the unseen (Brown & Bour, 1986; Jan, Robinson, Scott, & Kinnis, 1975; Sonksen, Levitt, & Kitzinger, 1984).” This fear has typically been expressed as an obstacle to blind toddlers walking well. One that many educators felt could be overcome if parents did not let their fear cause them to ‘restrict their blind child’s movements for safety reasons’ (Hatton, et.al., 1997). Despite the many obvious downsides of toddlers with MVI/B being encouraged to walk without a two-step safety buffer, current opinion believes blind toddlers’ must demonstrate the ability to walk independently without a cane, before they can be taught to use a cane. If you say that sentence out loud three times fast perhaps you might hear how absurd it sounds. Blind people are unsafe when they walk without a white cane. In every construction yard grown men post the sign ‘safety first’ and wear proper safety equipment. How can it be safety first for everybody but blind babies? THE ONSET OF WALKING In sighted infants, the ‘onset of walking’ is an epigenetic event. Epigenetic means it is not the emergence of the skill “can walk” that is of great importance, it is the world of opportunities now available to the ambulatory child.  Epigenetic event means, children are using their ability to independently walk to engage in activities that build their related systems like language and social skills. Research has found that the later the age of onset of walking, the later the epigenetic effect of walking (He, Walle, & Campos, 2015). Onset of walking means toddlers have taken their first few steps and now seem to never stop walking. Six months after the first steps, the toddler gait has narrowed, they take longer steps, and they demonstrate adult-like stability and coordination (Vieira, Carvalho, Barela, & Barela, 2019). Overtime, children walk better because they engage in recommended daily physical activity through both spontaneous and organized activities (Adolph et al., 2012; Vieira, et al., 2019). Blind Toddlers Can Walk. For children born with mobility visual impairment or blindness (MVI/B), the onset of walking does not appear to result in an epigenetic event. Children with MVI/B have been shown to remain at the “can walk independently” description for many years (Ambrose-Zaken, 2022, 2023). Six months after toddlers with MVI/B take their first steps, their subsequent walking experience does not result in the maturing walking abilities described above. Instead, the amount of solo walking logged in children born with MVI/B appears to remain stagnant during the first three to five years of life (Ambrose-Zaken, 2022, 2023). The Blind Standard of Walking The Birth to 6 Orientation and Mobility Skills Inventory (B6OMSI) is the only orientation and mobility (O&M) instrument for the assessment of toddlers with MVI/B that has had its validity examined through research. Baguhn (2021) reported an agreement score above 90% on her Delphi Study of the B6OMSI. An expert panel in the field of blindness and visual impairment reviewed the inventory items and affirmed that computation of a student’s B6OMSI test score would result in a meaningful snapshot of that student’s functioning. The clinician using the B6OMSI is instructed to rate how much verbal and physical prompting an adult provides the child to achieve the six Walking Skills (a-f) independently. Providing a physical prompt would be like touching the child’s back with a gentle nudge to get the child started. A child who needs physical support like holding a hand would be scored as demonstrating the first B6OMSI Walking Skills sub-skill “(a) takes steps with support (one or two hands held)”. To score “b. Takes 5 Independent steps”, the child must walk those steps unaided, except for verbal and physical prompting. Table 1 provides the B6OMSI Motor Skill Items and Rating Scale Items. The final sub-skill in each numbered Motor Skill category is highlighted in yellow. In Walking Skills, the final sub-skill is “f. Able to walk with a cane or other object”. Walking Skills item “f.” is the only mention of a cane in that section or in any of the Motor Skill items or Rating Scale items. In other words, the expert panel consisting of O&M professionals, early intervention teachers and professors all agreed that testing toddlers with visual impairment’s ability to walk independently without a two-step safety buffer is an important test of current functioning, regardless of the severity of the child’s visual impairment. Yet, given that sighted children are made safe with adequate lighting when their walking abilities are tested so that they can see the surface on which they will take their next step, I question why toddlers with MVI/B are asked to step onto unchecked, unseen surfaces, with no direct white cane tactile protection? Separate and Unequal Walking Standards for Blind Babies Six Months not Six Years for Walking Skill Development. The most glaring difference in the walking standards for sighted toddlers and blind toddlers is the expected amount of time to achieve independent mobility. The six-year age range given for blind children’s achievement of the walking skills listed in the B6OMSI is well beyond the 6-months timetable anticipated for sighted toddlers (see Table 1). Most would agree that if a child took his first steps at 12 months and is no further along in walking skills at 18 months, he needs medical or therapeutic intervention. Why are infants with MVI/B given six years to achieve the motor skills listed in the B6OMSI? Could it be because the B6OMSI standard is extremely difficulty to achieve? The B6OMSI gives infants with MVI/B six years to learn how to walk into any environment without a 2-step safety buffer. Blind toddlers with the developmental potential to walk should be measured using the same walking skill measurements (e.g., gait, pace, posture, activity time, and number of falls) as sighted toddlers. All blind toddlers should be tested under the same safety conditions as sighted toddlers. They don’t turn the lights off when sighted toddlers’ walking skills are measured. They shouldn’t ask blind toddlers to walk without a 2-step safety buffer. Why are the safety standards for independent walking separate and unequal? Instead of trying to reduce fear and improve children with MVI/B’s safety to ensure their onset of walking is an epigenetic event, the field of blindness has created separate and unequal walking scales for blind babies as they continue to insist they are better off walking into the unseen, just as it has always been. These field-created assessments are rooted in over a century of evidence from highly qualified practitioners that have seen year after year, decade after decade the undisputed facts. Everyone knows that toddlers with MVI/B: 1.       Cannot walk well by 18 months. 2.       Do not walk as much as they need to for learning, at age 3 years. And we have always known toddlers with MVI/B are … Delayed in motor milestones and have qualitative differences in locomotion documented by numerous researchers (Brown & Bour, 1986; Ferrell et al, 1990; Fraiberg, 1977; Hatton, Bailey, Burchinal & Ferrell, 1997; Norris, Spaulding, & Brodie, 1957; Traster & Brambring, 1993). Less active than sighted children documented by numerous researchers (Bigelow, 1992; Fraiberg, 1977; Preisler, 1991, 1993; Traster & Brambring, 1993), Due to fear of movement and parental fear of harm documented by numerous researchers (Brown & Bour, 1986; Jan, Robinson, Scott, & Kinnis, 1975; Sonksen, Levitt, & Kitzinger, 1984).” So, we all agree, the worse a child’s visual impairment, the worse their onset of walking outcomes. Yet, Howe (1841), Fraiberg, (1977), Ferrell (1990), Bigelow (1992, 1993), Hatton, et. al., (1997) Rogers & Puchalski (1988); Troster & Brambring (1993) and everyone before and since have concluded the reason blind toddlers do not achieve their recommended daily physical activity is they can’t see so they have no external motivation to move. Hatton et al., (1997) concluded that children with MVI/B “inability to imitate motor actions” (i.e., see), …probably accounted for” why the children with MVI/B got older and continued to fall behind their sighted peers in development or as they wrote, “the increased divergence of the trajectories of children with visual function of 20/800 or worse over time” (p. 802). THIS IS WHERE THE SEPARATE AND UNEQUAL WALKING STANDARDS BEGAN. Hatton et al., (1997) and others proposed separate standards and assessment criteria for children with MVI/B who, because of their visual impairment, had the greatest difficulties learning to walk on time. They felt that children with MVI/B should not be held to the same standards as other children. “Future research should explore these alternative developmental pathways, … and identify strategies by which parents and professionals can promote successful adaptation, recommended by Warren (1994), rather than trying to alleviate perceived delays that result from comparisons to sighted children or to other visually impaired children (p. 803). Instead of separate standards, stop asking blind toddlers to do the impossible and risk injury. The B6OMSI Measures how many steps children with MVI/B will take onto an unseen surface. Except for the final milestone “f. Able to walk with a cane or other object”, the B6OMSI Walking Skill sub-skills a-e evaluate how many steps a blind child will take onto an unseen surface. A surface he cannot ever see unless provided with a white cane. This is a problem because these assessments are used to drive instruction (Olson, 2003, as cited in Tabb, 2024). These assessments misunderstand the absolute necessity of safety for blind toddlers to thrive. The video created in demonstration of this blog can be viewed by clicking on any of the embedded photos from the video. The video shows children aged 19 to 79months before and after they could safely walk independently. The goal is to help parents keep their toddlers with MVI/B safe as they explore to learn. Each of the children in the video improved their ability to independently walk only after they were provided the safety of the Belt Cane. Stop asking parents to patiently wait for their blind toddlers to start walking before they can provide their children with the safety of the white cane. Let's all get behind encouraging blind baby safety first. It's about time. Table 1 The Birth to 6 Orientation and Mobility Skills Inventory Motor Skill Items and Rating Scale Note. Interviewer asks child representative to choose one of the 5 scores below. 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

Safe Toddles trusts parents’ instincts! Parents instinctively want to protect their blind babies while also encouraging them to walk confidently without holding their hand. For toddlers born blind, safe independence is now possible. Thanks to the Safe Toddles Pediatric Belt Cane, blind toddlers now have a safety tool that allows them to be independently mobile and safe as they explore to learn. Braylen was born with CHARGE syndrome and is blind, deaf, and balanced challenged. He was 3.5 years old and not yet walking on his own. MISSION ACCEPTED get Braylen walking independently. MISSION ACCOMPLISHED. After 2 months, Braylen walked independently and safely without holding anyone's hand. Braylen's video shows how his therapists achieved their mission. Watch Video MISSION POSSIBLE: Help blind toddlers walk safely every day and everywhere independent of a guide’s arm by wearing their pediatric belt canes. This Year End Fundraising Campaign is called Mission Possible (To Donate just click sentence or go to www.safetoddles.org/donatetoday). Will you be a champion and support Safe Toddles’ efforts to improve children with disabilities’ lives? Your donation will put a Safe Toddles’ Belt Cane on a toddler who is blind and provide the wrap around services they need to learn to safely explore independently. Please help every family in need achieve their mission of safe independence for their blind baby. Donate to Safe Toddles so toddlers who are blind can be free to let go and explore with safety! Here’s how your donation will make a difference in the life of toddlers who are blind: A monthly donation of $25 would ensure that as a child grows, they are provided a new belt cane set annually. To safely walk independently A one-time donation of $100 provides a the wrap around services a blind baby needs to thrive wearing their belt canes. A one-time donation of $250 provides a replacement belt and frames when children outgrow their starter belt canes. A one-time donation of $300 provides a fully funded Complete Belt Cane Set with all wrap around services to a blind baby in need. Larger donations can provide Safe Toddles’ Belt Canes to even more toddlers in need. Your generous gift of any amount will forever contribute to enriching the life of a toddler who is blind. Your gift helps them start traveling safely down the path of life. The Belt Cane is the only mobility tool that addresses the diversity, equity, inclusion, and accessibility needs of blind toddlers. Children with blindness or mobility visual impairment, including those with cortical visual impairment from 10 months to 11 years have shown their eagerness to walk on their own once their families provide them with the power of independent safety. Watch this video to see the highlights of many of the children who have benefited by wearing belt canes. We are proud of the work we have done so far; our belt cane has already made the lives of 1000s of toddlers who are blind safer to explore. But there is so much more work to do. Safe Toddles’ staff work tirelessly to reach every toddler whose life would forever be changed for the better if only the Safe Toddles’ Belt Cane was available to them. Thousands of toddlers remain unserved and unsafe. We are working tirelessly to increase our ability to reach parents. EVERY PARENT NEEDS TO KNOW that a real safety solution exists for their blind babies. It is our goal to provide the Safe Toddles’ Belt Cane and wrap around supports to every toddler who is blind in the world. Wearing the belt cane allows blind toddlers to feel safe as they reach their independent walking potential. Independent walking essential to early childhood development, that's why we need to make sure blind toddlers get belt canes whether their parents can afford to purchase them or not! Help us help blind children like Braylen to safely walk independently just as his sighted friends do by making your donation today. Safe Toddles is a 501(c)(3) organization, your donation is tax deductible. Most of our funding comes from supporters like you. Your life-changing gift today will help put the world’s only proven blind toddler mobility device in the hands of blind toddlers so they can travel safely and play like other children their age. Watching Braylen's video will show you the impact your gift can have on the life of blind toddlers. You can see more videos of Braylen and other belt cane users on all our social media platforms @SafeToddles. Thank you for your support of Safe Toddles Nonprofit!! We exist to make sure all families of blind toddlers benefit from this one and only white cane safety solution for their blind toddlers. Thank you and Happy New Year! We have a lot to look forward to! Roxann Roxann Mayros, Chair, Safe Toddles Board

Netflix's New Series “All the Light We Cannot See” Shines A Light on the History of un-Safe Mobility for Blind Children The Netflix TV Show anachronistic use of the long cane during WWII is a more progressive stance on blind children’s safety than was actual historical fact. The character Marie Laure at age 6 and 16 years uses white canes in the TV series. Yet, there is no proof that six-year-old children used Lions Club canes in 1932 and the long white cane did not exist in 1944. If the blind girls did have a white cane or a staff, it was not for safe mobility (probing the next step for safety) it was for identification or balance support. Historical records show blind children are not the reason either the short or long white cane was invented. Blind children’s access to white cane safety began long AFTER Lyndon B. Johnson signed the first Presidential Proclamation for White Cane Safety Day, in 1964. Blind children’s access to white cane safety began long AFTER Lyndon B. Johnson signed the first Presidential Proclamation for White Cane Safety Day, in 1964. As proof, Ambrose-Zaken’s YouTube video includes footage showing 1966 state-of-the-art orientation and mobility (O&M) instruction of blind children. Footage shows teaching blind school-aged children skills for walking independently without white canes.  “From Here to There” was written, directed and narrated by Phil Hatlen, then principal of the California School for the Blind (1962 to 1966). Hatlen released the film in 1966. White canes were invented for adults. In 1930s the Lions Club cane was invented for Elmer Thomason, a blind businessman in Peoria Illinois, and in 1932 shipped around the world to blind high school students and adults. Thomason used a long staff before Bonham gave him the short, white Lions Club cane to use instead. The long, ornate staff likely helped Thomason to keep his balance as he made his way independently through downtown Peoria. According to history of Lions Club published in 2008 , Bonham had been in the audience of Helen Keller and Anne Sullivan in Sandusky, Ohio. It was a trip Bonham could not wait to take because he was president-elect and he wanted to learn everything he could about his leadership role in the Lions Club and, of course, meet Helen Keller. Keller and Sullivan did not want to leave sunny California for a Lions Club convention in Ohio, but did. In the audience, Bonham heard their well-honed pitch, asking leaders in the field of blindness to find ways to help blind people to help themselves. On one of Bonham's subsequent trip to his Lions Club headquarters, he passed Thomason's newspaper stand outside the Peoria Courthouse with renewed interest. This time, as he observed Thomason needing assistance to get across the street, and he wondered... How could he aid Thomason in getting across the street independently? Bonham hypothesized, if Thomason's long wooden staff was replaced with white cane, he might not need help to cross the street. Bonham hypothesized, if Thomason's long wooden staff was replaced with white cane, he might not need help to cross the street. Changing Thomason's staff for a short white cane didn't change driver behavior. Bonham next tried having Thomason wave the short white stick at drivers. When waving the "all-white" stick didn't work, Bonham added red to the bottom. Red and white, the colors of the stop sign. This time he claimed victory. The red and white short Lions Club cane was sent worldwide with usage instructions. For use when seeking to cross a street independently: hold the Lions Club cane in the air Wave it Once the cars have stopped, cross the street keep waving the cane. News came back rather swiftly from all parts of the world, that waving the Lions Club cane did not get drivers to stop. Undeterred, the Lions Club advocated for each state to adopt the White Cane law. In short, the law stipulated that drivers must recognize the white cane held aloft and waving as a signal that the pedestrian is blind and needed them to stop so they could cross. Once all 50 states passed these laws, President Johnson signed the first presidential proclamation of White Cane Safety Day in 1964. Lions Club Short White Canes Were not designed to make the blind person have independent safe mobility. It was only for holding aloft (off the ground). The cane tip off the ground endangers a blind person's safety, not to mention must have been a mystery to sighted drivers. Were not created to solve the safe mobility problem faced by toddlers born blind. Were not effective at communicating to drivers to stop. The Lions Club Cane was created for adults because, the theory goes, only blind adults would be expected to travel independently and would need to alert drivers that they could not see, by themselves. In fact, no matter the circumstance blind babies need safe mobility, too. US Army Long White Canes Were designed in 1945 specifically to improve safe mobility of recently blind WWII veterans. Were not created to solve the safe mobility problem faced by toddlers born blind. Are difficult to use correctly for safety, when used 100% correctly are 60% effective (Kim & Wall Emerson, 2014). Safe Toddles Pediatric Belt Canes In 2014, the idea to wear the white cane specifically to improve safe mobility of congenitally blind toddlers was conceived. In 2016, garage prototype passed the toddler test. In 2017, we showed proof of concept with 3D printed model in New Mexico Preschool for the Blind. In 2018, we began shipping belt cane to blind toddlers. In 2019, we became a non-profit, published research study improved outcomes from belt cane usage, and began producing our multi-media curriculum. In 2020, we maintained operations through COVID. In 2021, we moved into our Fishkill Headquarters, began growing our Board of Directors and nonprofit presence. In 2022, published research study in JVIB, which defined mobility visual impairment and showed improved outcomes from belt cane usage. Safe Toddles Belt Canes were invented for toddlers born blind and provide them easy safety. Everything we do is based on research with real blind kids in their real environments. It has been shown repeatedly that safe mobility is essential to blind toddlers achieving developmental milestones on time. Safe Mobility is Essential to Blind Toddlers Achieving Developmental Milestones Bill Penrod of Northern Illinois University (NIU) Orientation and Mobility Program just completed his study of 50 children (60% boys) with blindness or mobility visual impairment aged 11 to 56 months old (Mean age=29.04, SD=11.41) before and after being introduced to the belt cane. He looked at the reasons given for obtaining a belt cane. They indicated that the children’s visual impairment made it unsafe for them to move about. Adults were seeking an effective tool that blind or mobility visually impaired children could easily use to walk as safely and as independently as possible. They were seeking an effective tool that their children could easily use to walk as safely and as independently as possible. NIU documented the blind children's demonstration of specific motor skills on video. The video coders logged the number of seconds the children spent demonstrating the eight specific motor skills during the pre- and final- video footage. The eight motor skills logged by the video coders in order of passive to active independence were Laying Down Sitting Crawling Standing with Assistance Walking with Assistance Standing Solo Walking Solo Solo Running/Hurried Walking Before Belt Cane The children walked independently about 10% of the time. They spent sixty percent their time sitting quietly, standing with assistance and walking with assistance. In 3 hours of pre-video footage 8 blind children used mobility tools for a combined total of 8 minutes. After Introduction to the Belt Cane In final-belt video footage, the children wore the belt cane 100% of the time. The children walked and ran solo 60% of the time. Safely standing, walking and running solo is the start of everything important in childhood development. Safe Independent Mobility is supposed to happen by age 2. These blind or mobility visually impaired children began the belt cane study at age 2 and a half. They were idle and needed assistance to walk. Blind children wearing the belt cane learned to safely stand, walk, and run solo. There is nothing a child cannot learn using their ability to safely walk independently! References Kim D.S., Wall Emerson R. (2014). Effect of Cane Technique on Obstacle Detection with the Long Cane. J Vis Impair Blind. Jul;108:335-340. PMID: 25505352. Kleinfelder, R. Mart, P. (2008). LIONS CLUBS in the 21st CENTURY, AuthorHouse.

Dear Friend, Braylen can't see, can’t hear, and has trouble with his balance. At home, he did not walk. He sat. When Braylen's physical therapist found the Safe Toddles' Belt Cane website, she was ready to try something new. The video of Braylen is set to the Mission: Impossible Theme. Because they worried that Braylen may never achieve his mission to safely walk independently. So many children born blind before Braylen never became fully independent. For them, achieving independent walking was an Impossible Mission. For Braylen, it was Mission Possible! The difference for Braylen was the pediatric belt cane. Braylen had been working on independent walking since he was 1-year-old. At age 3 ½ he was no closer to his goal of independence, until he was introduced to the belt cane. His therapist began with him using the belt cane in the therapy room, and she worked very closely with him to develop his belt cane balance, safety skills, and confidence over several weeks. See Video: https://www.youtube.com/watch?v=YG8NZF4xc0o Families submit applications for Safe Toddles’ belt canes for their children knowing that without them, their blind toddlers will continue to struggle to walk independently on time and with safety. Since we started providing belt canes at a reduced rate, we’ve received hundreds of applications from families reaching out for this helping hand. And unfortunately, there’s been more families than we can currently help. (Click paragraph below or go to www.safetoddles.org/donatetoday) That’s why during this year’s Mission Possible drive, we’re asking folks like you to donate to help more families waiting for this kind of support. Make your donation this week to help kids waiting for their first Safe Toddles Belt Cane and other essential support services. Safe Toddles invented the Belt Cane, the only mobility tool for toddlers who are blind! The impact of its development has been on par with the invention of the wheelchair because of its medical necessity to safe independence. The Safe Toddles Belt Cane provides life-changing outcomes of independent and safe mobility, a joy of exploring, and enhancing early childhood development for toddlers who are blind. I am Dr. Grace Ambrose-Zaken, a certified orientation and mobility specialist and President/CEO of Safe Toddles, Inc. I saw the difficulty blind children like Braylen were having and decided to do something about it. I invented the Safe Toddles’ Belt Cane and brought it to market. This belt cane has already changed the lives of many toddlers who are blind. But there is so much more work to do. Team Safe Toddles works tirelessly to reach every toddler whose life would forever be changed for the better if only the Safe Toddles’ Belt Cane was available to them. Thousands of toddlers remain unserved while we increase our ability to meet this unmet need. It is my goal to provide the Safe Toddles’ Belt Cane and necessary supports to ensure every toddler who is blind can walk independently and safely, and enhance their early childhood development, similarly to their sighted peers. Will you be a champion for blind toddler safety and support Safe Toddles’ efforts to improve children with disabilities’ lives? Your donation will put a Safe Toddles’ Belt Cane on a toddler who is blind and change their life forever! Please Let’s Get Up and Go together. Donate to Safe Toddles so toddlers who are blind can Get Up and Go! Here’s how your donation will make a difference in the life of toddlers who are blind: A monthly donation of $19 would ensure each year a child is provided a complete belt cane set. A one-time donation of $50 subsidizes the cost of Belt Cane materials A one-time donation of $100 provides a complete set of cane rods A one-time donation of $200 is the cost of a complete Belt Cane Larger donations can provide Safe Toddles’ belt canes to even more toddlers in need. Your generous gift of any amount will forever contribute to enriching the life of a toddler who is blind– your gift will literally help them start traveling safely down the path of life! The Pediatric Belt Cane changed the life of Braylen, his therapists, and his family. Braylen’s journey was shared on social media for others to find this medically necessary device for all blind toddlers. Braylen started wearing his belt cane at age 3 1/2, he took his first independent steps 4 weeks later. Braylen continues to improve in strength and ability. In the video we watch him snake his way through the classroom maze all on his own (video link https://www.youtube.com/watch?v=YG8NZF4xc0o). Help us help blind children like Braylen to walk safely just as their sighted friends do by making your donation today. Safe Toddles is a 501(c)(3) organization, your donation is tax deductible. Most of our funding comes from supporters like you. Your life-changing gift today will help put the world’s only proven blind toddler mobility device in the hands of blind toddlers so they can travel safely and actively like children their age. Watching our videos will show you the impact your gift will have on the life of blind toddlers. Go to @SafeToddles on any social media channel to see more videos of Braylen and many other children using their Safe Toddles’ Belt Canes too! And thank you for helping make a difference in the lives of blind toddlers! Sincerely, Grace Dr. Grace Ambrose-Zaken, President/CEO Safe Toddles

Executive Summary Results of The Northern Illinois University 2-Year Pediatric Belt Cane Study Photo: (left) 3-year-old boy with mobility visual impairment walks with safety assistance from his teacher (right) same child walks with safety assistance from his belt cane. Dr. William Penrod, Orientation and Mobility Professor at Northern Illinois University (NIU) led a 2-year study to evaluate 50 blind children under the age of 5 before and after being introduced to wearing a pediatric belt cane. This research project was funded by a grant from the Lavelle Fund for the Blind. This Executive Summary reports the major findings of the study. Fifty children (60% boys) with blindness or mobility visual impairment with an average age of 2 1/2 years participated in the study. The children resided in 22 states in the United States and 7 countries. They were blind (52%), mobility visually impaired (44%), or dual sensory impaired (4%). Mobility visual impairment was defined as having impaired vision such that they cannot visually avoid obstacles (Ambrose-Zaken, 2022). Most of the children were described as requiring adult assistance when standing and walking. Walking with assistance is a 12-month motor milestone. Yet, 98% of participants were above the age of 12 months. The children had no physical impairment that explained their delayed walking. Key Findings Before belt cane, the children were inactive. They spent 65% of their time sitting or standing still while holding on to someone or something. They walked solo (without any help) only 13.8% of the time. Only 16% of the children were observed using any form of mobility tool and their average mobility tool usage time was 62 seconds. When wearing the belt cane, the children were active. They spent 60% of their time solo walking and running and 18% solo standing. The belt cane significantly improved independent motor skills of blind or mobility visually impaired children under the age of 5. The children changed from passive, quiet, idle babies, to engaged, active little kids. Figure 1 Percent of Time Engaged in Specific Motor Skills Pre-and Final-Belt Cane Video (n=50) Families and teachers cited a major problem was their children could not use their mobility tools (e.g., long canes) without full adult assistance. NIU found after the parents put the belt cane on the child, the children required little to no adult assistance to use the belt cane. This contributed their ability to be safe independent walkers. This is the only mobility tool that allows them to be fully independent. Providing blind toddlers with easy access to safe mobility made a significant difference in the amount and quality of their independent walking. Achieving independent, effortless walking is directly correlated to toddler gains in receptive and expressive language skills and the ability to engage socially with family and peers (He, Walle, & Campos, 2015; Oudgenoeg‐Paz et al., 2016). Conclusion NIU’s findings are consistent with previously published research on the motor skill delays, limited mobility tool usage in young learners with blindness and visual impairments, and the positive outcomes associated with belt cane use (Ambrose-Zaken, et al., 2024, 2023, 2022, 2019; Warren, 1994, Penrod, et al., 2023). Belt cane studies show children born blind or mobility visually impaired were safer and they consistently improved their independent walking when they wore their belt canes. Safe Mobility is Essential to Blind Toddler Development. The photo below is of a 3-year-old boy who is mobility visually impaired. The two pictures demonstrate two methods of providing him safety information when walking. On the left, the adult provides safety information by clasping the child’s shoulders from behind and steering him towards the clear path. On the right, the child’s belt cane prevents him from walking into the obstacle. He can simply move his cane frame to locate the clear path. One method is passive, the other is active and engaged. The belt cane design makes safe independent mobility easy for blind toddlers. Blind toddlers provided with an easy-to-use mobility tool demonstrated improved activity levels, safety, and independence. The belt cane enables blind toddlers to safely move about on their own and gain confidence in their ability to keep themselves safe. No other mobility tool has shown similar, positive outcomes for blind children. 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- 291. https://doi.org/10.1177/0145482X231188728. 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. https://doi.org/10.1177/0145482X221121824 Ambrose-Zaken, G. & Anderson, D. (2024). Teaching Orientation and Mobility to Learners who are Blind or Visually Impaired and have Cognitive Impairments. in Foundations of Orientation and Mobility, Fourth Edition: Volume II, Instructional Strategies and Practical Applications Chapter 19 (in press). 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 He, M., Walle, E. A., & Campos, J. J. (2015). A cross-national investigation of the relationship between infant walking and language development. Infancy, 20, 283—305. https://doi.org/10.1111/infa.12071 Oudgenoeg-Paz, O., Volman, M. J. M., & Leseman, P. P. M. (2016). First steps into language? Examining the specific longitudinal relations between walking, exploration and linguistic skills. Frontiers of Psychology, 7, 1—12. https://doi.org/10.3389/fpsyg.2016.01458 Penrod, W., Burgin, X., & Ambrose-Zaken, G. (2023). Study Result: Pediatric Belt Canes Improved Children with Mobility Visual Impairments Safety and Independence. The Journal of Visual Impairment & Blindness, submitted for publication.

Safe Toddles trusts parents’ instincts! Parents instinctively want to protect their blind babies while also encouraging them to walk confidently without holding their hand. For toddlers born blind, safe independence is now possible. Thanks to the Safe Toddles Pediatric Belt Cane, blind toddlers now have a safety tool that allows them to be independently mobile and safe as they explo re to learn. Braylen was born with CHARGE syndrome and is blind, deaf, and balanced challenged. He was 3.5 years old and not yet walking on his own. MISSION ACCEPTED get Braylen walking independently. MISSION ACCOMPLISHED. After 2 months, Braylen walked independently and safely without holding anyone's hand. Braylen's video shows how his therapists achieved their mission. Watch Video MISSION POSSIBLE: Help blind toddlers walk safely every day and everywhere independent of a guide’s arm by wearing their pediatric belt canes. This Year End Fundraising Campaign is called Mission Possible (To Donate just click sentence or go to www.safetoddles.org/donatetoday). Will you be a champion and support Safe Toddles’ efforts to improve children with disabilities’ lives? Your donation will put a Safe Toddles’ Belt Cane on a toddler who is blind and give them the safety they need to explore to learn. Please help every parent achieve their mission of safe independence for their blind baby. Donate to Safe Toddles so toddlers who are blind can be free to let go and explore with safety! Here’s how your donation will make a difference in the life of toddlers who are blind: A monthly donation of $19 would ensure that as a child grows, they are provided a new belt cane set annually to safely walk independently. A one-time donation of $95 is the cost of a Standard Graphite Cane Frame. A one-time donation of $125 is the cost of a Custom Belt. A one-time donation of $300 is the cost of a Complete Belt Cane Set to get a blind toddler started on the road to safely walking independently. Larger donations can provide Safe Toddles’ Belt Canes to even more toddlers in need. Your generous gift of any amount will forever contribute to enriching the life of a toddler who is blind. Your gift helps them start traveling safely down the path of life. The Belt Cane is the only mobility tool that addresses the diversity, equity, inclusion, and accessibility needs of blind toddlers. Children with blindness or mobility visual impairment including those with cortical visual impairment from 10 months to 11 years have shown their eagerness to walk on their own once their families provide them with the power of independent safety. Watch this video to see the highlights of many of the children who have benefited by wearing belt canes. We are proud of the work we have done so far; our belt cane has already made the lives of 1000s of toddlers who are blind safer to explore. But there is so much more work to do. Safe Toddles’ staff work tirelessly to reach every toddler whose life would forever be changed for the better if only the Safe Toddles’ Belt Cane was available to them. Thousands of toddlers remain unserved and unsafe. We are working tirelessly to increase our ability to reach parents. EVERY PARENT NEEDS TO KNOW that a real safety solution exists for their blind babies. It is our goal to provide the Safe Toddles’ Belt Cane and educational supports to ensure every toddler who is blind can walk independently and safely, and enhance their early childhood development, similarly to their sighted peers, whether their parents can afford to purchase it or not! Help us help blind children like Braylen to walk with independent safely just as his sighted friends do by making your donation today. Safe Toddles is a 501(c)(3) organization, your donation is tax deductible. Most of our funding comes from supporters like you. Your life-changing gift today will help put the world’s only proven blind toddler mobility device in the hands of blind toddlers so they can travel safely and play like other children their age. Watching Braylen's video will show you the impact your gift will have on the life of blind toddlers. You can see more videos of Braylen and other belt cane users on all our social media platforms @SafeToddles. Thank you for your support of Safe Toddles Nonprofit. We exist to make sure all parents of blind toddlers benefit from our white cane safety solution.

Mission Accomplished! Blinded veterans invented white cane safety. After WWII ended, the young soldiers who returned home blind yearned to be free to walk independently anywhere at any time in their neighborhoods. At that time, the only way they could be safe was to hold on to their mother’s arm. For these single young men in their 20s, that needed to change... and fast! They knew instinctually that there had to be a better way to be blind and be safe walking independently. The US Army trusted their veteran's instincts. They used army surplus: white paint, aluminum tubing, golf grips and chair glides to invent the first ever long white cane. The US Army’s invention of the long white cane proved blind people could safely walk anywhere, independent of their mother’s arm. Safe Toddles trusts parents’ instincts! Parents instinctively want to protect their blind babies while also encouraging them to walk confidently without holding their hand. For toddlers born blind, safe independence is now possible. Thanks to the Safe Toddles Pediatric Belt Cane, blind toddlers now have a safety tool that allows them to be independently mobile and safe as they explore to learn. Braylen was born with CHARGE syndrome and is blind, deaf, and balanced challenged. He was 3.5 years old and not yet walking on his own. MISSION ACCEPTED get Braylen walking independently. MISSION ACCOMPLISHED. After 2 months, Braylen walked independently and safely without holding anyone's hand. Braylen's video shows how his therapists achieved their mission. Watch Video MISSION POSSIBLE: Help blind toddlers walk safely every day and everywhere independent of a guide’s arm by wearing their pediatric belt canes. This Year End Fundraising Campaign is called Mission Possible (To Donate just click sentence or go to www.safetoddles.org/donatetoday). Will you be a champion and support Safe Toddles’ efforts to improve children with disabilities’ lives? Your donation will put a Safe Toddles’ Belt Cane on a toddler who is blind and give them the safety they need to explore to learn. Please help every parent achieve their mission of safe independence for their blind baby. Donate to Safe Toddles so toddlers who are blind can be free to let go and explore with safety! Here’s how your donation will make a difference in the life of toddlers who are blind: A monthly donation of $19 would ensure that as a child grows, they are provided a new belt cane set annually. A one-time donation of $95 is the cost of a Standard Graphite Cane Frame. A one-time donation of $125 is the cost of a Custom Belt. A one-time donation of $300 is the cost of a Complete Belt Cane Set. Larger donations can provide Safe Toddles’ Belt Canes to even more toddlers in need. Your generous gift of any amount will forever contribute to enriching the life of a toddler who is blind. Your gift helps them start traveling safely down the path of life. The Belt Cane is the only mobility tool that addresses the diversity, equity, inclusion, and accessibility needs of blind toddlers. Children with blindness or mobility visual impairment including those with cortical visual impairment from 10 months to 11 years have shown their eagerness to walk on their own once their families provide them with the power of independent safety. Watch this video to see the highlights of many of the children who have benefited by wearing belt canes. We are proud of the work we have done so far; our belt cane has already made the lives of 1000s of toddlers who are blind safer to explore. But there is so much more work to do. Safe Toddles’ staff work tirelessly to reach every toddler whose life would forever be changed for the better if only the Safe Toddles’ Belt Cane was available to them. Thousands of toddlers remain unserved and unsafe. We are working tirelessly to increase our ability to reach parents. EVERY PARENT NEEDS TO KNOW that a real safety solution exists for their blind babies. It is our goal to provide the Safe Toddles’ Belt Cane and educational supports to ensure every toddler who is blind can walk independently and safely, and enhance their early childhood development, similarly to their sighted peers, whether their parents can afford to purchase it or not! Help us help blind children like Braylen to walk with independent safely just as his sighted friends do by making your donation today. Safe Toddles is a 501(c)(3) organization, your donation is tax deductible. Most of our funding comes from supporters like you. Your life-changing gift today will help put the world’s only proven blind toddler mobility device in the hands of blind toddlers so they can travel safely and play like other children their age. Watching Braylen's video will show you the impact your gift will have on the life of blind toddlers. You can see more videos of Braylen and other belt cane users on all our social media platforms @SafeToddles. Thank you for your support of Safe Toddles Nonprofit. We exist to make sure all parents of blind toddlers benefit from our white cane safety solution.

What are Long Canes, Rectangular Canes, and Pediatric Belt Canes? For people with blindness or mobility visual impairment walking is a high-risk mobility challenge when compared to their sighted peers. When used correctly, a mobility device evens the playing field, by reducing the risk of walking without vision. When the person keeps the cane tips touching the floor, two steps in front of themselves, they get the time they need to react and improved balance. The three commercially made mobility tools come with distinctive white and red shafts, and black grips. The choice of which mobility device to use depends on the person’s physical and cognitive abilities to use the it correctly for safety. Types of Mobility Devices for Young Children Pediatric Belt Canes (age 11 months to 5 years) Rectangular Canes (age 3 years and up) Long Canes (age 5 years and up) Adapted Canes Pediatric Belt Canes Pediatric belt canes are a toddler’s first cane. Belt canes consist of a lightweight, small rectangular frame connected with magnets to a custom belt. Belt canes have two plastic tips with stainless-steel wheeled glides that slide easily over most surfaces. The belt cane currently comes with two frames and one belt. The longer frame is the standard length for most travel. The shorter frame is for inside small spaces with furniture and no drop-offs. The belt cane is the easiest mobility device to use. The child wears the belt cane which keeps the frame positioned correctly in front and in contact with the ground. The belt cane design makes it easier for young children to learn to keep the cane frame positioned in front of themselves for maximum safety. Rectangular Cane (aka Alternative Mobility Devices or AMDs) Rectangular canes are made of four lightweight canes shafts that are connected to form a rectangle. They have rubber grips on each side and there are three different cane tip choices available. Rectangular canes are more difficult than the belt cane because it requires people to have good use of their hands to be able to hold on and push it. Rectangular canes are easier than the long cane because they only need to push the rectangular cane forward, not swing it back and forth each time they take a step. Ambutech sells three different tip designs. The center grip is to hold when going upstairs. The person holds the rectangular frame in front and one step ahead, so that the frame leads the way upstairs. Long Canes and Modified Long Canes Long canes for children are sometimes called Kiddie canes. Kiddie canes are simply a shorter adult-length long cane. Long canes are lightweight, have many types of tips and grips to choose from based on personal preference. The long cane is the most difficult mobility device to use correctly. For the long cane to be an effective safety device, a person needs to have good use of at least one hand, and be able to consistently create the safety arc by moving the cane tip back and forth in front of each foot, each time they take a step. Types of Modified Long Canes Push broom tip Tandem bar The push broom and tandem bar are attachments to the long cane to aid the user in making the protective safety arc. The push broom tip makes it so that the bottom of the long cane now resembles the bottom of the rectangular cane, for an easy, complete safety arc. People can use one or two hands to push the long cane with the push-broom tip forward in front of themselves. The tandem bar connects the student’s cane to the instructor’s cane. The instructor uses the tandem bar to sweep the student’s long cane back and forth to create the safety arc as they walk. How Can Parents and Teachers Decide What Device (if Any) to Use? Does My Child Need a Mobility Device? Children with blindness or mobility visual impairment require a mobility device for independent safety when they walk and run. Children who can learn to use their vision to avoid obstacles do not need a mobility device for safety. People with mobility visual impairment may only need to use their mobility device under certain lighting conditions. What Device to Use? Belt cane. Toddlers who are blind or mobility visually impaired need to begin wearing their belt canes by age 11 months. This allows them to safely transition from standing, cruising, and taking steps while holding an adult’s hand, and finally to walking solo. Young children wearing the belt cane most of the day enables them to learn more quickly to react to the cane’s safety arc leading the way. Rectangular cane. Children who outgrow the belt cane can continue to be safe walking when pushing the rectangular cane ahead of themselves. For safe independence, the child needs to push the rectangle in front of themselves everywhere they go. Older children who are struggling with the long cane may find the rectangular cane easier to use for safety. Long cane. To be an effective safety device, the long cane requires people to use precise motor skills. It is best for young children to wait to begin learning the long cane until they have the motor and cognitive ability to learn the safety arc technique correctly in an hour. Providing the blind children the long cane too young leads to poor cane skills. Poor long cane skills makes children less safe when walking. Determining the Right Cane The determination about whether a student should use a pediatric belt cane, rectangular cane, or long cane, should be made by a qualified O&M instructor. The O&M instructor will work closely with families and school personnel, including a student’s physical therapist if applicable. Some families are hesitant about having their child use any mobility device. They may feel that the device will call unwanted attention to their child, may be in the way during family outings, or may be too complicated for their child to learn to use. Other families may embrace a mobility device because they believe it helps the public understand that their child is blind or mobility visually impaired, allows their child greater independence, and prepares the child for future travel either alone or with less support. Why Do Children with Blindness or Mobility Visual Impairment Need Mobility Devices? The most obvious answer IS the right answer, mobility devices level the playing field. Children who are blind or mobility visually impaired need mobility devices because they can’t see where they’re going. The safety arc created by the different mobility devices enables the child to see the path ahead through touch feedback. When the safety arc is in front of them, they have the information they need to learn how to make decisions about where to go next. For example, when there is a wall blocking the path, the safety arc alerts the person two steps ahead. People with blindness or mobility visual impairment learn to use those two steps of warning to think about where to go next. Orientation and mobility (O&M) teachers are an essential part of the instructional team of your child acquiring the ability to use their mobility device most of the day. Use of pediatric belt canes with toddlers has been associated with the emergence of free movement and exploration, quick and sure gait patterns, efficient muscle use, good posture, muscle strength, and coordination. Young children with blindness or mobility visual impairment with the aid of effective mobility devices can independently and safely explore their environment to gather information about obstacles and other details such as drop-offs and changes in texture of the under-footing along the travel path. They learn to use the information about their surroundings conveyed by the devices to stay oriented and to avoid possible injury. For children with blindness or mobility visual impairment to be masterful mobility device users, they must consistently use their mobility devices throughout their entire day. Whether your child is using a belt cane, rectangular cane, or long cane at home, it is vital to have them continue to use it at school, arrange to write “must use mobility device everywhere for safety in school, on field trips and when outside” on your child’s Individualized Family Service Plan or Individualized Education Plan. What are “Pre-Canes” and “Alternative Mobility Devices”? Teachers and parents may still hear the terms alternative mobility device and pre-cane device used interchangeably. These are outdated terms, used before the belt cane and rectangular canes were invented and used regularly. In the 1980s it was obvious that children struggled to employ the long cane for safe independence. In those days, O&M specialists made homemade devices that were called alternative mobility devices (AMD) or pre-canes. Many O&M specialists continue to innovate by creating unique mobility devices for their unique students. Let's hope their attempts to expand the number of mobility device options to meet the needs of their students is successful so we can increase the diversity of mobility devices available to us all! The AMD was the first alternative to the long cane and children found it to be much easier to use before they learned the long cane. However, the term pre-cane is a misnomer because it implies preparation for long cane use. Young children with blindness or mobility visual impairment need easy to use mobility devices to move about most of the day in safety. Rectangular canes, belted or hand-held, are often the mobility device that can best meet the present needs of young children who may or may not go on to use a long cane. The most important outcome is the child’s independent safety as they move as freely as possible. How Can Pediatric Belt Canes, Rectangular Canes, and Long Canes, Be Obtained? The nonprofit, Safe Toddles, is currently the only supplier of Pediatric belt canes. Rectangular canes, long canes and their modifications come in many different lengths and are available through commercial suppliers. Use those search terms to locate your nearest supplier.