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  • Adults create safe environments that allow children to blossom.

    You know every time a child with a mobility visual impairment or blindness bumps into something or trips over something without warning that they need a way to feel safer. Babies react to the environment you create. When you provide them with the tools they need to thrive so you can include them as an active member in your daily routines, they grow and thrive because of you. Donate a safe mobility Belt Cane today. Belt Canes are a medical necessity for infants with a mobility visual impairment or blindness to walk. safetoddles.org/donate

  • Researchers AGAIN find poor skills in adults born blind with no mention of root cause: Life in a constant state of unsafe mobility

    This 2023 study compared 209 adults with a mobility visual impairment or blindness (MVI/B) with sighted adults. The authors did not give much background on the participants with a MVI/B. For example, they did not specify age at onset of the MVI/B. They surmised, "It is to be expected that this difference influences the extent to which adaptive skills are acquired" (van der Aa, Jonker, de Looff, & Didden, 2023, p. 231). Reading between the lines, we know that adults who become blind as adults retain the skills they learned growing up sighted, unless otherwise impaired. Yet, most of the individuals they studied had been located through care institutions for individuals with a visual impairment in the Netherlands. Prior research has shown that children born with a MVI/B do not become effective at adaptive skills for daily care. This is the first study that used this specific instrument the adaptive ability performance test (ADAPT) to evaluate adults with a MVI/B's skills and compare them to sighted adults. The ADAPT test van der Aa, et al., (2023) used looked at eight skill areas: 1. basic self-care, hygiene, and responsible eating (7 items); 2. household skills (6 items); 3. society skills (7 items); 4. social alignment (9 items); 5. applying school skills (8 items); 6. dealing with money, mail, and insurance (4 items); 7. daily structure and schedule (5 items); and 8. making responsible choices (16 items). Their comparison showed"...that a visual impairment results in significantly lower levels of adaptive functioning compared to sighted individuals, irrespective of an intellectual disability" (p. 229). The authors found that across the board, these 209 adults were not competent at skills their sighted counterparts did to take care of themselves, and it was unrelated to intellectual ability. Further, they found it was difficult to determine the intellect of their blind subjects. This is because, IQ scores were available for only 4% of them. Another problem was that "to substantiate a suspicion of an intellectual disability, one can look at a person’s level of completed education. However, the educational level of individuals with visual impairments is often not representative of their cognitive abilities. Individuals with visual impairments more often attend lower levels of education (Heppe et al., 2020)" (p. 226). The participants with a congenital MVI/B grew up their entire lives without safe mobility. The authors never mentioned anything about the subjects' orientation and mobility. They didn't say which mobility tool they moved about with, nor how many hours a day they spent engaged in activities on their own. It is very likely that they did not spend many hours walking solo. One question on the ADAPT is whether he/she "travels independently by public transport" (Jonker, et al., 2023). Let's be clear. Traveling independently is the deal breaker for most congenitally blind people. I need sighted people to understand, when you are unsafe moving about your whole life, you don't like to move about. When you grow up feeling unsafe and do not move about, you are unable to take care of yourself. Most congenitally blind people have spent their entire lives living in a world of unsafe mobility. That level of uncertainty about safety does real damage to people. That's why IQ doesn't matter - unsafe mobility negatively impacts children no matter how smart they are. The Blame Game In the world of research on blind people, there are no studies that suggest the danger of independently walking without any safety could be a contributing factor to their findings. Instead, most authors look to attribute the differences they find to the lack of quality of education. For example, these authors left open the question of the impact of the care hospital environment, stating "The effect of hospitalization in a positive or negative sense cannot be ruled out" (p. 230). Blame is easy and used a lot in this field. I know for a fact, when these kids were nearing high school graduation and not demonstrating the skills needed for independent college attendance, the middle school teachers were blamed for not preparing them for high school. When the children hit middle school with no skills, the middle school teachers blamed the elementary school teachers who in turn blamed the preschool teachers who blamed the early intervention providers. Of course, they all blamed the parents and somewhere along the line a teacher blamed the child with a MVI/B for not being motivated. Did no one ever wonder how can I help this blind baby feel safe enough to walk? I'm here to tell you that around the world what all children with a MVI/B have in common is they are growing up in a very different world from everybody else. They are growing up never knowing what the next step holds for them. We can see - so we don't understand. Walk a mile in a child's visual impairment and see how many seconds you last. We ask our children with a MVI/B to live their whole lives like that. I dare you to run, I dare you to walk around schools and playgrounds and forests and mazes and obstacle courses without your lower field of vision, or only a tiny pinhole of vision, or with a blindfold on. I want you to go about your daily routine inside and outside with only your arms and legs to keep you safe. No peeking for the rest of your life. You try it... I dare you. I double dare you. If you won't do it, and you shouldn't because its dangerous; then stop asking blind babies to do it. I am asking every researcher to Stop proving that congenitally blind people are unable to achieve the impossible. We got it. What a shocker, they struggle to be competent in a world that doesn't prioritize their safe mobility. We need to provide more safe mobility options. We need studies that recognize their subjects are unsafe and have been unsafe their whole lives. We need to prioritize safe mobility in the lives of people with a MVI/B. When you do walking changes for the better (Ambrose-Zaken, 2022). Children who feel safe walking, walk more and with more walking comes learning (Penrod, Burgin, Ambrose-Zaken, 2024). The child who feels safe to move, moves with ease and joy. A child who moves is an adult who can take care of his daily needs on par with his peers. References 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 Heppe, E., Cornelisz, I., & Klaveren, C. v. (2020). Visueel in Beeld. Arbeidsmarktuitkomsten van personen met een visuele beperking die Zvw ZG- zorg hebben gedeclareerd in de periode 2015 t/m 2018 [Visually in the picture. Labor market outcomes of persons with a visual impairment who have declared Zvw ZG care in the period 2015 to 2018]. Amsterdam Center for Learning Analytics, Bartiméus Fonds, Vrije Universiteit Amsterdam. Jonker, F., Looff, P., Erp, S., Nijman, H., & Didden, R. (2023). The adaptive ability performance test (ADAPT): A factor analytic study in clients with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 36(1), 3–12. https://doi.org/10.1111/jar.13044 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. van der Aa, H., Jonker, F., de Looff, P., & Didden, R. (2023). A Study Into the Relationship Between Adaptive Skills and Visual Impairment in Individuals With and Without Intellectual Disabilities. Journal of Visual Impairment & Blindness, 117(3), 224–232. https://doi.org/10.1177/0145482X231180615

  • Kids need equal access to path information: A review of 2007 Study of a program for improving motor

    Aki, Songül, Ayse and Kayihan (2007) tested motor skills of eight-year-old subjects with severe visual impairment before and after being provided with hour-long sessions of sensorimotor integration training three times a week for three months. Forty subjects with severe visual impairment (equal number of girls) were either taught at school by an experienced physiotherapist (n=20) or at home by their families. The subjects’ measured visual acuities indicated most subjects had severe visual impairment (see table 1). The authors’ purpose in providing the sensorimotor training was based on a literature review that indicated children born with severe visual impairment exhibited delayed motor skills (Adelson & Fraiberg, 1974; Celeste, 2002). For example, Celeste (2002) found children with congenital visual impairment experienced the most profound delays in mobility skills such as cruising around, walking independently, and climbing up and down stairs. Aki, et al., (2007) suggested that the reason for these motor skill delays; which also included poor balance, body coordination, and visuomotor control, was due to the children with visual impairment having had “limited experience walking stemming from poor vision” (p. 1329) (Dickinson & Leonard, 1967; Gipsman, 1982; Williams, 1983; Bouchard & Tetreault, 2000). Aki et., al. assessed the children’s motor skills before and after treatment using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) (Bruininks, 1978). To conduct the test, the researchers modified the BOTMP subtest “running speed and agility”, by measuring only running speed during a shuttle run; thereby, altering the test item by omitting the need for subjects with low vision to pick up a block off the floor at the mid-point of the shuttle run. Table two shows that the range of possible scores on the running speed and agility subtest were zero to fifteen. The two groups of subjects with low vision mean scores changed from 1.80 to 2.90 in the school training group and from 2.00 to 2.20 in the home training group. The authors interpreted the similar change in mean scores in the two groups to indicate no difference between at home and professional training. They summarized therefore that “gross motor functions, such as running speed and strength, can be improved by a home training program” (p. 1334). Yet, the subjects with visual impairment mean scores were only slightly improved, and they were also much lower than the mean scores of 120 sighted elementary school subjects also scored using the BOTMP (Duger, Bumin, Uyanik, Aki, & Kayihan, 1999). In this earlier study, subtest 1 running speed and agility, was measured by having the sighted subjects complete a timed shuttle run that included picking up a block at the turning point. The sighted subjects mean scores for girls was 4.56 and for the boys was 6.34. One might argue that, of course, sighted children running speed and agility is better than children with low vision. Yet, it is important to investigate why the difference exists. If running and agility are to be measured, why do children with low vision score so poorly, and is there anything that can be done to improve their running? Further, would sighted children have similar scores were they to experience running with impaired vision? Gazzellini, et al., (2016) compared motor skills of eleven sighted children (aged 3.5 years to 12.8 years) wearing blindfolds and twelve blind children (3.5 years to 13.2 years) none of whom had been trained in or made use of long canes. Participants were asked to complete multiple trials walking barefoot at a self-selected speed in a large room along a walkway free of obstructions. The speed and pace chosen by all subjects were atypical of normal gait patterns. All the subjects adopted similar slow, awkward protective gaits. The authors suggested the altered gaits were explained by a single mechanism “…the lack of anticipatory control” (p. 2626) and recommended “the use of a cane during walking” (p. 2626) with impaired vision. However, Aki et al., 2007 did not mention long canes as part of the testing of running speed and agility in subjects with low vision, nor were canes mentioned as part of the training program. Physical education teachers and camp counselors commonly request visually impaired learners to leave their long canes on the sidelines when participating in sport and other game activities (Furtado, Lieberman, Gutierrez, & Haegele, 2017). Therefore, it is highly likely that Aki et al., did not include using canes of any type during the testing or training activities. Aki et al’s., omission of any mention of tactile path information for the subjects with low vision not only suggests that use of long canes or rectangular adaptive mobility devices were not included in their subtest procedures, but also that the Aki’s (2007) subjects had no means to independently know and trust the safety of the path when running. Thus, one obvious reason that sighted children were able to run faster is that they had full knowledge of the path ahead of their next step and this information allowed them to run with greater confidence, speed and agility. Therefore, Aki et al., and Duger et al., (1999) conducted unequal tests because one group of subjects had full knowledge of the path during their testing (sighted group) and one group had disabled knowledge of the path during their testing (low vision group). In order to know the true running speed and agility of children who are born blind and visually impaired we need to test them on running agility after allowing them the same access to consistent path information as their sighted peers. Sighted children have consistent visual path information from the time they begin to crawl and learn to walk. Therefore, to achieve an equal playing field for children born with severe visual impairment and blindness they need to be provided with wearable canes as soon as they begin to crawl and walk. Wearable canes worn every day, all day would allow severely visually impaired and blind children to achieve similar rates of consistent tactile path information because tactile path information is an effective sensory substitute for impaired vision. Aki et al., (2007) sought to determine how to teach children with low vision to improve their motor skills, yet they did not examine the root cause of why children with low vision exhibited motor skill delays. Sensorimotor training can only truly benefit learners with low vision when it is paired with mobility tools that provide them with effective path information. Learners with severe visual impairment and blindness need essential consistent, tactile path information every step they take in order to be on an equal footing with their sighted peers. References Adelson, E, ., & Fraiberg, S., (1974). Gross motor development in infants blind from birth. Child Development, 45, 114-126. Aki, E., Songül A., Ayşe T., and Kayihan, H. (2007). Training motor skills of children with low vision. Perceptual and Motor Skills 104.3_suppl 1328-336. Bouchard, D., & Tetreault, S. (2000). The motor development of sighted children and children with moderate low vision aged 8-13. Journal of Visual Impairment and Blindness, 94, 564-573. Bruininks, R. H. (1978). Bruininks-Oseretsky Test of Motor Proficiency, examiner's manual. Circle Pines, MN: American Guidance Service. Celeste, M. (2002). A survey of motor development for infants and young children with visual impairments. Journal of Visual Impairment and Blindness, 96, 169-174. Dickinson, J., & Leonard, J., A. (1967) The role of peripheral vision in static balancing. Ergonomics, 10, 421-429. Duger, T., Bumin, G., Uyanik, M., Aki, E, Kayihan, H. (1999). The assessment of Bruininks- Oseretsky test of motor proficiency in children. Pediatric Rehabilitation, 3(3), 125-131. Furtado, O., Lieberman, L., Gutierrez, G., & Haegele, J. (2017). Sport summer camp for children and youth with visual impairment: Descriptive case study of Camp Abilities. The British Journal of Visual Impairment, 35(2), 154-164. Gazzellini, S., Lispi, M. L., Castelli, E., Trombetti, A., Carniel, S., Vasco, G., & ... Petrarca, M. (2016). The impact of vision on the dynamic characteristics of the gait: strategies in children with blindness. Experimental Brain Research, 234(9), 2619-2627. doi:10.1007/s00221-016-4666-9. Gipsman, S., C. (1982). Effect of visual condition on the use of proprioceptive cues in performing a balance task. Journal of Visual Impairment and Blindness, 85, 50-54. Williams, H., G. (1983). Perceptual and motor development. Englewood Cliffs, NJ: Prentice-Hall. #delayedmotorskills #visuallyimpaired #blind

  • Cane arc transmission: Manual or automatic

    The look of panic disappeared from the rental car agent’s face when I confirmed that, in fact, I was able to drive a car with a manual transmission, “We’re upgrading you to a Camaro” she reported, adding “no extra charge”. She was a beauty, bright orange, sweet lines and tires ready for race day at any Talladega track – but I wasn’t headed to the car races. I was on my way to the 2019 Alabama Cane Quest event at the Helen Keller School Campus, on the Alabama Institute for the Deaf and Blind campus, and yes in Talladega. The gear shift was new to me, I drive an automatic car most days, so it took a minute to figure out how to put her in reverse. I also had to work out the kinks of inexperience, several times squealing the tires in an effort to not stall the engine at the green light, again. At one time, standard transmissions, a stick shift, was all I drove; it was all anyone drove as there was no such thing as automatic transmissions. Several friends at the cane quest event admitted to me that they would not have been able to accept the “upgrade” to the Camaro, as they only knew how to drive automatic transmissions. WHAT’S THIS GOT TO DO WITH WHITE CANE DAY? Good question. The car transmission analogy can be used to help families and early intervention professionals understand how to choose among the modern day cane shape and connection designs available for kids who are severely visually impaired and blind. Thus, the standard long cane is a standard transmission because it requires knowledge and experience to use correctly. Most working age adults are taught to employ a standard long cane arc in about fifteen minutes. However, some people, especially children age five and younger, are unsafe relying on a long cane because they are unable to make the cane arc with each step (even after years of cane lessons). Cane arc is what long cane users rely upon in order to move with safety to their destinations: One step, one swipe (no prompts). When children cannot achieve cane arc with each step, then they are stalling out and they are getting hurt, because when their arc is the wrong shape and in the wrong place, it is not providing them with the path information they need for safety. Just like the transmission of a car, the cane arc is not an optional feature to a person who relies on tactile path information for safety (e.g., a person whose vision impairment makes it impossible to see obvious obstacles in the path ahead of the next step). You can usually tell who they are from their collisions with obvious obstacles, walking at a slower pace, using a maladaptive gait pattern and/or seeming reluctance to walk without a guide. Thus, it is not appropriate to require children who are blind and severely visually impaired to walk without an effective cane arc until they are finally able to correctly employ a long cane. White Cane Day began 55 years ago today to celebrate the long, white cane. Back then there was only one choice in white canes, the rod shaped cane, one might call it the Model T of white canes because it was the first cane design. Today, White Cane Day celebrates safety and equality of tactile path information in all its forms (rod and rectangle). The rectangular adaptive mobility device (AMD) in both the hand held and wearable cane design can be considered the automatic transmission of cane arc. These AMDs are the easier method of achieving long cane safety, because the user walks and the rectangle automatically provides a full cane arc check of the path ahead – no swipe necessary. The wearable cane is for children who are too little even to remember to push their rectangle. The wearable cane is for those children who are just learning to crawl or walk and, because they are blind or severely visually impaired, need tactile path information. When someone needs tactile path information to help them safely navigate their environments, they need it every day, all day everywhere they are and every time they are moving. Blind children need tactile path information in the same amount that sighted children need light to navigate their environments. The goal for most children who are born severely visually impaired and blind is to become long cane users. Children who grow up using AMDs in their younger years learn from a very young age how to rely on consistent tactile path information. They gain confidence and they do not experience gross motor skill delays. Therefore, until children who are mobility visually impaired or blind demonstrate one swipe, one step, no prompts with the long cane; they can enjoy the benefits of consistent tactile path information every step they take by using an automatic cane arc all day, every day (in between long cane lessons). It was once argued that independence came with a cost for blind babies and that cost was bruises from collisions with obvious obstacles. Today, the automatic arc in the form of rectangular AMD canes (both handheld and wearable) make the notion that blind babies should wear their bruises with pride antiquated and obsolete – good for history to remember but best left in the past.

  • Persistent “cruising” and “wide-based gait” are signs of mobility visual impairment and blindness

    It is commonly accepted that achievement of gross motor milestones varies across children. For example, the pictured milestone charts indicate “cruising”, the term used to describe when a baby steps sideways while holding on to a stable piece of furniture, can be expected by twelve months of age; yet some children may already be walking on or before their first birthdays. However, given this trajectory, the motor milestone chart suggests that children observed cruising at twelve months will likely exhibit walking with “wide-based” gaits by fifteen months. Three months later, the wide-based gait should resolve into an ability to “walk avoiding obstacles”. By two years, typically developing children are expected to demonstrate the ability to “run avoiding obstacles”. Thus milestone charts indicate that typically developing children who begin walking earlier or later will exhibit similar intervals of gross motor milestone achievement; as they continuously improve in their visual-motor coordination. Children who were born severely visually impaired or blind often do exhibit the ability to walk on time, but stop or return to cruising and walking only with assistance. Fraiberg (1977) described this phenomenon as “start-stop” pattern of motor development, where motor development milestones such as reaching, creeping, and walking began emerging and then stopped. These outcomes beg the question, whether the term “cruising” continues to be applicable for a two-year-old child who is blind and who has no way to safely transition to the next milestone of “walks avoiding obstacles”. When children who are born severely visually impaired or blind have no neuromuscular disabilities, then it is their inability to visually avoid obstacles that makes it impossible for them to achieve that eighteen-month motor milestone “walks avoiding obstacles”. Therefore, it would seem inappropriate (and unfair) to use the terminology “delayed gross motor skills” as this language suggests that these milestones are attainable given sufficient practice and encouragement to walk. It is more accurate to say, children who are blind cannot see and are therefore unable to achieve the visual motor coordination needed to attain the gross motor milestone “walks avoiding obstacles”. Thus, eighteen-month-old children who are blind and mobility visually impaired are not able to visually avoid obstacles while walking, simply because they cannot see the obstacles. It has nothing to do with their physical body and everything to do with their sensory impairment. Further, three-year-old children who are severely visually impaired or blind who have "a wide-based gait” when crossing open space are not the same as 15-month-old sighted children. The three-year-old who is blind is unable to narrow gait support without sufficient path information, whereas 15-month old sighted children have sufficient path information and they are able to narrow their gait support strategies with walking practice. Sighted fifteen-month-old children lack experience, yet through trial and error they improve their gaits through refining their visual-motor coordination. Three-year-old children with severe visual impairment and blindness exhibit gait anomalies uniquely related to their visual impairment. It is their visual impairment that causes their poor gait patterns and they have no way to improve their visual motor coordination. Therefore, it is through no fault of their own that they are in a motor milestone holding pattern. This inability to avoid obstacles can only be ameliorated through an appropriate mobility tool that provides consistent tactile path information. In other words, four-year-old children who are blind and therefore cannot “run (visually) avoiding obstacles” are not two years behind their sighted peers, they are visually impaired. They can and do run when provided with tactile path information through the pediatric belt cane. Their ability to catch up can occur when given a replacement for their faulty vision, a mobility tool that supplies them with the information they need about the path ahead. However, without accessible path information they cannot avoid obstacles while running simply because they cannot see the obstacles. Therefore, instead of labeling these children as having delayed gross motor skills, these observable indicators can help families and early intervention professionals identify these children as mobility visually impaired or blind (MVI/B). By identifying them correctly, families and professionals are able to appropriately recommend their children as needing consistent tactile path information. Consistent tactile path information can enable children who are born MVI/B to achieve the next phase of motor milestones, by providing them with independent information about obstacles before contacting them suddenly with their bodies. Mobility tools that provide them with consistent tactile path information allow them sufficient reaction distance and time needed to learn how to best interact with obstacles they encounter. Once children who are MVI/B are provided with consistent tactile path information they are able to resume proper gross motor milestone attainment. Pediatric belt canes (aka Toddler Canes) are an effective means of providing children aged five and younger with consistent tactile path information. When children who are MVI/B aged five and younger wear their canes most of the day, every day they are able to obtain the information they need about the path ahead in order to avoid harmful bodily collisions. #blindbabies #blindtoddlers #safetoddles #developmentaldelays #grossmotorskills

  • How far have we come?

    This black and white photo was published in New Outlook for the Blind in September 1967.The picture is of a preschooler boy who is blind and his teacher. The teacher is behind him smiling and she is bent over. She is holding both of his hands as he walks. His head is bent down and she is holding his hands above his shoulders. This was thirty years before orientation and mobility (O&M) was listed in the Individuals with Disabilities Education Act (IDEA) Part B (1997) as an essential support for children in preschool who are blind or visually impaired. Why is the sighted teacher being led by the blind preschool student? He can’t see where they are going. He shouldn’t be the leader because he has no tactile path information. In fact, by grasping the child by both hands, she is exposing him to further risk, because he has no way to protect his body at all. Yet, this is not an outdated preschool human guide method. A week ago, I witnessed an O&M specialist using this same ‘guiding’ technique with a blind preschool boy. Last week, the teacher had the three-year-old boy hang up his long cane at the classroom door, from there they walked like this to his chair. Her behind him, grasping both of his hands as he led the way. It was his chest that contacted the back of his chair first. Who among us wants to locate a chair we can’t see with our chests? I am concerned that in the fifty plus years since this black and white picture was published, we have not come very far in improving the safety of blind preschool children moving about inside classrooms. The boy I observed last week was being taught to use a rod-shaped cane. The O&M teacher stated that he was using the rod-shaped cane correctly for a child his age. The three-year old boy was observed walking very slowly as he held the cane tip off the ground. Although his cane tip was off the ground and behind him most of the time, his O&M instructor alternated between prompting him to re-position his cane and praising him for doing a good job. His O&M instructor told me that his learning to hold the rod-cane briefly during O&M lessons put him on the road to one day becoming a terrific cane user. She indicated that the fact that the rod-shaped cane was not yet providing him with safety was not a problem, because for his age; it was an “acceptable outcome”. Yet, once he located his chair, he sat like a lump and licked a toy, his language was non-existent as was his interest in anything beyond his tongue. A three-year-old boy who was physically able to walk, remained stationary in his chair, in his own world mouthing a plastic toy. This is not age-appropriate behavior for three-year olds. Typically developing two- to three-year-old children walk about seven hours a day; and, on average, they walk as fast as 31 steps a minute for five minutes at a time (Bjornson, Song, Zhou, Coleman, Myaing, & Robinson, 2011). Thus, instead of finding a better way for a blind three-year-old boy to independently navigate his world with safety, his O&M teacher has lowered the motor and play standards for her student. Early education professionals suggest the reason blind children remain stationary and don't play with any sophistication is they lack visual motivation. Lowry & Hatton (2002) wrote "...the motivation to move decreases in relation to the degree of vision loss" (p. 125). They suggested that the children’s blindness kept them stationary, but they have never tried to provide them with developmentally appropriate mobility tools that kept them from being exposed to sudden bodily collisions. Children born blind do learn to walk, but the stop walking- not because they can't see, but because they wish to avoid hurtful collisions. Consider: Children with correctable eye conditions are provided child-sized corrective lenses. Children with correctable hearing impairments are provided with child-sized hearing aids. Children who are paralyzed are provided with wheelchairs that fit their height and manual dexterity. Why do we look at blind three-year-old children and say, they are not motivated, even when we all watch them routinely walk into walls, fall down the stairs and trip over obstacles? Why are O&M specialists taught that nothing can be done or needs to be done to prevent harmful collisions of blind toddlers until these blind babies grow up and finally learn to swing a rod-shaped cane for safety? How far can they go? To find a solution, we must first understand the problem. The problem children who are blind have is the need for mobility tools that match their physical and cognitive abilities. Essential facts about toddlers and preschoolers: 1. Preschool children don’t run, because they are unsafe running with a long cane. 2. Preschooler’s lack the manual dexterity and cognition needed to operate a rod-cane arc for safety. 3. Preschool children who are blind don’t run, because they are unsafe running. Preschool children who are blind do run when they feel safe and they feel safe when they wear their belt canes. Thus, the reason preschool learners who are blind are idle is that they lack a developmentally appropriate mobility tool. Having no tactile path information causes blind children to be afraid to move independently. They don’t move because they don’t have enough information about the path ahead. Blind children can’t see the path, but when adults fit them with pediatric belt canes and allow them to wear their canes everywhere- they learn to feel the path ahead. When you give them consistent tactile path information – they do run, they do explore, they do move – even those who have never seen anybody else move before; because the mind wants to learn, the body wants to move, you don’t have to be sighted to have these basic human abilities. Just like the child I met last week; wearing his belt cane he began to move freely about his classroom with great interest. What a triumph - it took less than thirty minutes of wearing his belt cane for him to begin to feel safe enough to follow his natural, preschool curiosity. He began to propel himself around his classroom wearing his belt cane. He was eagerly exploring everything he encountered. His confidence was growing every time his cane contacted obstacles instead of direct body collisions. He got to decide what he wanted to touch with his hands and what he wanted to ignore. Yet, as soon as I left, his teacher, O&M specialist and the classroom aids conspired to take his belt cane away from him. His brief encounter with safe mobility ended as soon as I walked out the door. Many families and professionals are allowing their children/students who are blind to run and freely explore wearing canes. When blind children have consistent tactile path information that enables them to gain self-confidence needed to explore independently. Pediatric belt canes are a wonderfully simple solution, an innovation that makes sense for children age five and younger who will one day be long cane users. Blind children do successfully transition from belt cane to rectangular cane to rod-shaped cane. They have no difficulty in learning to employ hand-held canes as they get older, because by wearing their belt canes they learn the benefits of consistent tactile path information for locating a clear path ahead. In 2020, it's time to provide blind toddlers and preschool learners with the tools they need to develop to their potential. Pediatric belt canes are an essential first step to learning, because we all need safe mobility to learn.

  • All children need reliable path information to thrive

    In the dark, sighted people experience temporary mobility visual impairment or blindness (MVI/B). MVI/B means you cannot use your vision to avoid obstacles in the path ahead. When this is the case, you are at risk for injury. MVI/B identifies learners who must use a mobility tool for safety when walking and running. Professionals who teach orientation and mobility (O&M) skills to people who are severely visually impaired or blind are often in the same meeting as professionals who provide mobility therapy (e.g., physical therapists, occupational therapists). There are important distinctions between the mobility goals of these professionals. People with MVI/B may avoid needing a PT or OT; by using mobility tools everywhere they walk and run. Physical therapists (PT) may be called on to consult on cases of children aged five and younger who are visually impaired because they have a mobility injury or because they have difficulty achieving gross motor milestones, like walking with age appropriate pace and posture across open space. PTs and OTs do not provide mobility tools to their patients. They do not prescribe or teach white canes in any form, unless they have the additional O&M credential. O&M specialists teach learners with MVI/B how to use specific mobility tools for safe mobility. Learners with MVI/B are at risk for gross motor delays and mobility injury when they walk independently without reliable path information. Mobility tools for the blind are like light bulbs for the sighted, because mobility tools provide reliable path information enabling the user to detect obstacles in the path and avoid injury. The negative impact of MVI/B has on gross motor skills is observable, it looks the same as when sighted people walk for any length of time in the dark (slow, halting gait, defensive arm and body postures). These automatic defenses are meant to be temporary, until the lights are turned on, because while these postures are used to reduce the impact from inevitable collisions, overtime they can cause harm to the body and self-confidence. Without a mobility tool, people with MVI/B are just steps away from their next collision. Toddlers with MVI/B do not benefit from turning on lights and they are harmed by the inevitable collisions they experience because they cannot see obstacles in their path. For people who cannot turn on the lights to achieve safe mobility, the answer is O&M. There are different types of mobility tools used by people with MVI/B for safe mobility; the human guide, the dog guide, the long white cane, a rectangular cane and a wearable pediatric belt cane. With the aid of these path detectors, people with MVI/B no longer crash into obvious obstacles with their bodies, because they can find them first with their tactile warning device or avoid them altogether with their guides. Wearing their belt canes allows toddlers to achieve gross motor milestones. The term MVI/B identifies the proper course of action for adults responsible for children five and younger. Children five and younger with MVI/B need to wear their pediatric belt canes which provide them reliable, effective tactile path detection. Children five and younger are too little to use dog guides or long canes. Therefore giving them these mobility tools is the same as offering them no protection at all. A one-year old baby with MVI/B can play with a dog or long cane, but in order to walk with safe mobility they need a reliable source of path information. They need a device that will always be in front of their next step, a wearable pediatric belt cane. Pediatric belt canes are developmentally appropriate canes for little kids. Therefore, before treating the consequence of MVI/B with PT or OT, we can prevent the cause of motor injury and milestone delays by providing children five and younger with MVI/B with a way to have anticipatory control when walking. The pediatric belt cane is an effective device for very young children with MVI/B, because all children need reliable path information to thrive. Children with MVI/B need consistent tactile path information everywhere they go, every day, all day. Children with MVI/B need consistent tactile path information in the same amount as sighted children need the lights on.

  • Let the whole child participate

    By two years of age, the gross motor milestone, runs avoiding obstacles is essential to participating in games with other children. The fact that children who are blind can be physically able to run, but cannot see to avoid obstacles does not have to be the end of their fast paced games. When children born severely visually impaired or blind wear their canes most of the day, every day, they are able to achieve the gross motor milestones that rely on learning how to interact with obstacles blocking the path. Can children who are mobility visually impaired or blind (MVI/B) play on the same field, court, rink as sighted children with their mobility tools? Yes, but not without everyone accepting their mobility tools as essential to the fun. Take wheelchair basketball, the equalizer is that everybody uses a wheelchair. Therefore, if able-bodied players want to play, they must borrow a wheelchair. At onetime the thought of wheelchairs in sport was not considered feasible, now wheelchair sports are ubiquitous. Unfortunately, the same consideration does not seem to be provided to the blind sportsperson. In blind soccer, the sighted players are asked to wear blindfolds, and yet nobody is provided with a rectangular cane or long cane. All of the players are asked to play using only 18-month old gross motor skills and this results in all players risking injury from sudden, unavoidable collisions. The question should not be whether to include their mobility tools in games and sports played by people with MVI/B, but how to integrate the whole person into sport. When children are MVI/B, their long canes, rectangular canes and wearable canes complete them, by providing tactile path information. Their visual impairment robs them of essential path information, their mobility tools gives it back. Nobody would think, take the wheelchair away from the paralyzed person before starting the game of basketball, because that would rob them of their ability to move with speed and grace. The same is true for people who are MVI/B, taking away their mobility tool, robs them of their safety, speed and grace. Children who are five and younger and are MVI/B need to wear their canes all day, every day and this includes during games and sports. The sports and games can be adapted to fit the child’s needs, not the other way around. Let’s be creative and find ways to include the mobility tool into sport, not ask children who are MVI/B to give up their tools of independence in order to play with others.

  • Gross motor delays: It’s the Unexpected Collisions… duh

    Children who are blind and visually impaired can and do learn to walk, and the resulting painful consequences of colliding with unseen obstacles has been well-documented beginning in 1841 by Samuel Gridley Howe, founder of Perkins School for the Blind, who said, “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” (Howe, pg. 8). In the 1930s Dr. Thomas Cutsforth, a prominent psychologist whose classic work The Blind in School and Society wrote, “when the child (who is blind or visually impaired) 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 child and the other members of the family” (p. 21-22). In 1956, renowned educator of the visually impaired Berthold Lowenfeld recommended that “young children (who are blind or visually impaired) 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” (p. 187-188). Yet, if painful collisions are not a deterrent to children who are blind and visually impaired moving freely and independently, then why do gross motor delays resist all early intervention efforts (Adelson & Fraiberg, 1974; Brambring, 2006; Celeste, 2002; Ferrell, 2000; Fraiberg, 1977; Hatton, Bailey, Burchinal, & Ferrell, 1997; Jan et al., 1977; Norris, Spaulding, & Brodie, 1957; Pereira, 1990; Troester & Brambring, 1993; Troester, Hecker, & Brambring, 1994)? All these listed studies have reported marked developmental delays in the acquisition of gross-motor skills by children who are congenitally blind and visually impaired when compared with sighted children. The most prominent delays are in freely moving across open space, going up and down stairs and slower walking speed and defensive gait and postures. Professionals have put forth two major reasons for these gross motor skill problems: 1) parents are not following through with pushing children to move with reckless abandon and 2) the students who are severely visually impaired or blind are not motivated because they are unable to see enticing destinations. Yet, consider a third theory. Perhaps it is the collisions that result from walking with a visual impairment and without an effective mobility tool, not the visual impairment that causes these delays in gross motor skills. This is an important distinction, because while there is rarely a solution to improving one’s impaired vision, there is a solution that can eliminate harmful bodily collisions for children five and younger who are blind and visually impaired– wearable canes. For centuries, professionals have only offered two options to children born blind and severely visually impaired, learn to walk and get bruises or live a life of inaction. Since no human being likes to collide with obstacles without warning or sit around bored, Safe Toddles is offering a third option – a developmentally appropriate long cane, a cane that children who are blind and visually impaired aged five and younger can wear all day, every day. Safe Toddles created the first and only wearable cane with the purpose of reducing these painful bodily collisions with obstacles. The children who are visually impaired and wear their canes explore more and with ever increasing confidence (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson, & Bikson, 2019). For more information or to see how children five and younger who are blind and visually impaired move about wearing their canes- watch the many videos posted on our website www.safetoddles.org References Adelson, A., & Fraiberg, S. (1974). Gross motor development in blind infants. Child Development, 45, 114-126. 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 Bouchard, D., & Tetrault, S. (2000). The motor development of sighted children and children with moderate low vision aged 8-13. Journal of Visual Impairment & Blindness. 94(9). 564-573. Brambring, M. (2006) Divergent Development of Gross Motor Skills in Children Who Are Blind or Sighted Journal of Visual Impairment & Blindness, 100(10), 620-624. Celeste, M. (2002). A Survey of Motor Development for Infants and Young Children with Visual Impairments. Journal of Visual Impairment & Blindness, 96(3), 169–174. https://doi.org/10.117/0145482X0209600305 Cutsforth, T. D. (1951). The blind in school and society: A psychological study. American Foundation for the Blind: New York, pp.21-22. Ferrell, K. A., (2000). Growth and development of young children. In M. C. Holbrook & A. J. Koenig (Eds.), Foundations of education: Volume I. History and theory of teaching children and youths with visual impairments (2nd ed., pp. 111-134). New York: American Foundation for the Blind. Fraiberg, S. (1977). Insights from the blind. Comparative studies of blind and sighted infants. New York: New American Library. Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997). Development growth curves of preschool children with vision impairments. Child Development, 68, 788-806. Howe, S. G., (1841). Ninth annual report to Perkins institution and Massachusetts asylum for the blind. Boston: John H. Eastburn Printer. Jan, J. E., Freeman, R. D., & Scott, E. P. (1977). Visual impairment in children and adolescents. New York: Grune & Stratton Lowenfeld, B. (1956). Our Blind Children: Growing and Learning with Them. Springfield, IL: Charles C. Thomas. Norris, M., Spaulding, P. J., & Brodie, F. H. (1957). Blindness in children. Chicago: University of Chicago Press. Pereira, L. M. (1990). Spatial concepts and balance performance: Motor learning in blind and visually impaired children. Journal of Visual Impairment & Blindness, 84, 109-110. Troester, H., & Brambring, M. (1993). Early motor development in blind infants. Journal of Applied Developmental Psychology, 14, 83-106. Troester, H., Hecker, W., & Brambring, M. (1994). Longitudinal study of gross-motor development in blind infants and preschoolers. Early Child Development and Care, 104, 61-78. #grossmotorskills #developmentaldelays #toddlercane #blind #toddlers #visuallyimpaired #safetoddles

  • Before and after wearable cane

    Your donations to Safe Toddles allow Akira to feel safe enough to learn Akira is three years old and blind. First photo: Akira was stroller dependent. She did not walk, she was pushed. Akira in her stroller– lost in her own world, no shoes. Second photo: Akira is leaning against her teacher. In the foreground are obstacles that she has no ability to detect before she steps on them, that is why Akira feels unsafe. Third photo: Akira feels safe and confident. walking down the hallway wearing her cane. The cane warns of obstacles in the path. That is why she now feels safe, she now rejects her stroller. Fourth photo: Akira is now able to focus on learning braille, her feeling of safety and confidence translate into age-appropriate interest in learning. The wearable cane is what makes her feel safe. Wearable canes allow Akira to feel safe enough to learn. Safe Toddles provides kids like Akira with free wearable canes. Safe Toddles is a non profit, all donations are used to build and ship wearable canes. Thank you for considering a donation for Safe Toddles– wearable canes change lives.

  • Children with MVI/B who wear belt canes achieve gross motor milestones 18-months and higher

    This video is a series of short clips showing one, two and three year old children who are blind or have tunnel vision wearing their belt canes. Two, two-year-olds cried the first time they put their canes on, but learned to love the reliable tactile path information they get from their canes. These kids, now three years old, wear their canes to preschool everyday. When a child cannot see well enough to avoid obstacles, they collide with them and that hurts. When you are mobility visually impaired you have no way to anticipate the collision, you can't tense up, slow down, or veer- you just make contact with the object without warning. An eight year old sighted child who collides with something is not the same as an eight year old blind child, the sighted child can see it coming and, even if he doesn't see it, can look back and learn the location and plan course of action to prevent a next time. A blind child cannot ever see to anticipate or look back to learn anything about the collision, there is just the collision and the only way to stop it, is to stop walking alone. The belt cane prevents headlong collisions- and that allows blind babies to gain 18-month gross motor milestones and beyond. If you want to see three and four year olds running (24-month milestone) go to videos and click on Jojo's, Audrina or Jaxon's videos. In the video of these children, they are all not able to get past the 12- and 15-month gross motor milestones even though they are 15-months and older (see also attached research study N=250). The first clip is Javier. Javier is blind, 15 months at the 12-month "cruising, walks with assistance" gross motor milestone. He took his first steps ever on his own the first day he put on his belt cane- no tears. The second clip is him wearing his cane in the mall - taking lots of steps without anybody holding his hand- he is seen walking at correct developmental level "15-months -wide based gait". There is no reason for a blind child to walk without tactile path information- he will never be able to visually avoid collisions so it will always be a dangerous activity that results in gross motor delay. The next series of clips are of Charna - she is blind and was 24 months old when she started wearing her cane. We see that Charna cried the first time she wore it, but in next clip we see her able to manipulate the belt cane when in guide. We also see she get lots of feedback from the cane. Next, we see her walking in the park and refusing to hold a hand, she is looking for her father and finds him. The clip ends after we see that she stops at a break in the sidewalk, and when she hears someone walk past her, scrunching leaves, she gets the information she needs to continue walking -concept development. Then we have Matias - he was 21 months old, blind, and at the 12 month gross motor - "walks with assistance, cruising" when in solitary play he won't let go or cross open space. He too cried when introduced to the belt cane, the video shows that when the belt cane frame connects the wall, and when he gets tactile feedback from the toy touching the frame, he stops crying and starts paying attention, after that we see him walking well, and playing in the center of the room, dragging a toy around, wearing his cane. Next, I included a series of clips that demonstrate the belt cane's ability to detect/communicate drop offs-in the background of Jaxon's clip we hear his mom and O&M specialists say- when he doesn't wear his cane he always trips around the door- and with the belt cane, he doesn't trip. The final set of clips is a 33 month old boy, blind - who is on our waiting list. This 33 month old boy, won't walk on his own-and when guided his face shows a great deal of stress- he is at 10-month gross motor milestone, stands.  He won't walk, he, like all the others has a vision specialist in early education; she is recommending the belt cane. We see him working with a PT in the last two clips. The PT is pulling him, singing the same song, Javier's dad was singing to the 15 month old- twinkle star- but this child is twice the age and so far behind in his gross motor. PTs train to work with kids who are paralyzed and have motor impairments, this boy is paralyzed with fear- he doesn't need a PT he needs a belt cane. He needs consistent tactile path information about surfaces, objects and drop offs. The current pediatric belt cane does not have all the answers, but it does improve life because, blind kids need consistent, reliable tactile path information - and when they get it- they do walk independently- without prompts - and they love it. I do have a lot of data showing these wonderful changes in children - new changes- changes never before seen in children who are blind- with current instructional methods. This video shows that the belt cane is a great step forward for mobility visually impaired and blind babies.

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