Cane users the world over will tell you, it isn’t “if” the butt of the long cane stabs you in the belly- it’s “when” it happens… What happens is, the cane tip catches on an unexpected sidewalk crack and stops. Cane users who fail to notice and keep walking forward, feel the end of their canes bury into them with a force magnified by the speed of their travel. Yet, the consequence of a cane handle belly punch is not enough of a reason to forgo the use of a rod cane, because tactile path information is essential to individuals who are mobility visually impaired or blind. The absence of the rod cane means the absence of tactile path information, and that is so dangerous as to prevent all inclinations of walking freely. People who are blind and mobility visually impaired obtain three path previews using canes that allow them to safely navigate while walking and running. The three previews. Tactile path information of the cane is broken down into three essential previews. These three previews are how the white cane user benefits from tactile path information. The three previews are; elevation, surface and object. Elevation preview is, most importantly, about locating the exact edge of a drop-off. Knowing the exact location of a drop-off edge is essential to stopping in time so as to not fall down the stairs. The cane user learns to stop when the cane tip falls off the edge. The cane user detects the drop-off when the cane tip becomes silent, no vibration from flooring friction and no sound. The cane user stops because the absence of friction paired with gravity lowering the cane tip is learned to be recognized as a very alarming warning that means drop off. Surface preview is when the cane tip detects the texture of the flooring. For a cane user with low vision, it can be challenging sometimes to know whether the change in color indicates a shadow or a puddle. It is very important for cane users to know whether they are about to step on a rough or smooth surface. The long cane extends out towards the surface and, with a quick brush of the cane tip, all is revealed. The cane user uses the tactile feedback about surface texture to continue forward, change direction or stop. Object preview is just as it sounds, the cane tip locates whether there are fixed or free objects in the path ahead. When the cane tip and cane shaft contacts objects, the cane user gets information about the material, weight and size of the object. The cane user benefits by letting the cane lead the way, to be the first point of contact with all objects. The job of the long cane is to touch obstacles (elevation, surface, objects) and provide the cane user with two or more steps of time to react accordingly. Currently there are two forms of cane attachments; hand-held and wearable. Hand-held canes come in two forms; the rod-shaped cane and the rectangular-shaped cane also known as an assistive mobility device (AMD). In hand-held devices, tactile path information is transmitted through the cane tip by way of the cane shaft to the hand. The cane grip is held with the four fingers (thumb, middle, ring and pinkie) grasped around the cane’s grip as the index finger extends down along the side of the cane grip. When held correctly, the cane shaft is said to extend the reach of index finger to touch the ground. Cane arc. Most people identify the sound of cane tapping as a blind person using a rod cane. The tapping technique is called “the touch technique”. The touch technique is not solely about the sound it produces; it is also about the syncopated movement of the cane (one step/one tap). Rod cane users are taught to tap the cane tip in front of the trailing foot, or “walking in step”. Rod cane users walking in step are systematically swinging the cane in front of their next step in order to check the path ahead. Cane users who are walking in step create an arc shape with the cane tip by moving the tip back and forth in syncopation with their pace. Walking in step with a rod cane enables the cane user to check the path ahead in time to react to information from the three previews. Walking in step can also be done without lifting the cane tip off the ground. That cane technique is called “constant contact” and is recognized by how the cane user sweeps the cane on the ground back and forth (one step, one swipe) without lifting it off the ground. The cane user still makes the arc with the cane tip, because this motion is necessary to check the step ahead before they trod upon it. Most adults can learn to tap and swing a cane in-step in less than thirty minutes. Therefore, anyone who is not able to learn to walk in-step with a rod-shaped cane in fifteen to thirty minutes would benefit from a rectangular cane. The rectangular cane has a built in cane arc. When using a rectangular cane, the cane user holds both sides of the rectangular cane in the same way as they hold a rod-shaped cane. The cane grip is held with the four fingers (thumb, middle, ring and pinkie) grasped around the cane’s grips as their index fingers extend down along each cane shaft. The rectangular shape of the cane means the user simply pushes the cane in front and has full cane arc of path information. The rectangular cane is the easiest way for people to learn the value of tactile path information. Children who grow up severely visually impaired and adults who have motor or intellectual disabilities benefit from rectangular canes because of their simplicity and immediate effectiveness. Rectangular canes have built in cane arc. Adults with intellectual disabilities can quickly learn to freely walk by pushing a rectangular cane in front of them. Once an adult understands how the rectangular cane arc helps them, they might be able to learn how to make the cane arc with a rod-shaped cane. Wearable canes, the pediatric belt cane also known as the toddler cane. In order for children born mobility visually impaired or blind to grow up with safe mobility they need to wear their tactile path information during their formative years (age zero to five). Children age five and younger are unable to use a rod cane, and those younger than three cannot benefit even from a rectangular cane. Pediatric belt canes have only been available to children aged five and younger since September 2017. These new canes have also been dubbed “safety belt canes” by their young users. The wearable cane has a rectangular cane shape attached to a belt. The tactile path information is transmitted through the cane tip by way of the cane shaft to the belt. The children often begin to touch the cane shaft, and if they are physically able to use their hands, they soon learn how to grasp and manipulate the cane shafts of the belt cane. Safe Toddles’ pediatric belt cane is the first and only cane designed for children aged five and younger. Children who are age five and younger and mobility visually impaired or blind need consistent tactile path information as often as sighted children need the lights turned on when they walk. Push toys, rectangular canes and rod canes are not effective for them, because babies are too little to be responsible for their own safety. Babies, toddlers and preschool learners need access to devices that keep them safe as they learn how to move about and explore their world. Only an adult can turn on the light switch for a sighted toddler and only an adult can put a belt cane on a toddler who is mobility visually impaired or blind. Blind babies, toddlers and preschool learners need to wear their canes every day, all day. The more we get the message out about the benefits of wearable canes, the more blind children we can save from having to learn how to walk without the benefit of essential tactile path information. Anyone can donate a cane to the children on our waiting list. Please take a moment to donate a cane today. Thank you for your help! #blind #canes #visuallyimpaired #tactilepathinformation

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

Once upon a time before COVID-19, my husband Benny and I rode our bicycles through New York City as part of an organized bike ride named the Five Boroughs, because the 54-mile route takes riders through all five NYC boroughs (Manhattan, The Bronx, Queens, Brooklyn and Staten Island). One of the many sights includes crossing the Third Ave bridge – it is a spectacularly fun ride. Yesterday, Benny and I drove through four NYC boroughs and Long Island with even greater excitement and satisfaction. We were working in service of children who need pediatric belt canes for safe mobility. We would do anything to achieve Safe Toddles' mission, to provide an effective system of safe mobility for babies who are blind and mobility visually impaired learning to walk, including the job of couriers. Such is the new reality of COVID-19. The way we built belt canes pre-pandemic – was much simpler- all the manufacturing and shipping was housed under one roof in Shames Engineering Professor Marom Bikson’s Lab on the third floor of the Center for Design and Innovation on the City University of New York campus. There, he and Mohamad FallahRad led a small army of engineering students who enlisted to make pediatric belt canes. Now the campus is quiet, but our workers have been reactivated in making canes at home. The purpose of this blog is to detail one new step in the pediatric belt cane making process - schlepping parts from one house to another. These photos will share Benny and my recent journey to move around cane parts to prepare for their eventual assembly into pediatric belt canes (aka toddler canes). After we left our home in sleepy Dutchess County New York (70 plus miles from NYC), our first events included city traffic and the Manhattan skyline seen from the Robert F. Kennedy bridge. In Queens, Julianna provided us with two bags of 3D parts she printed. One bag was for Osagie and one bag for Mohamad. The parts Julianna printed need to be cleaned up and readied for assembly. After that, we made our way to Brooklyn to bring Osagie his bag and pick up the parts he also prepared for Mohamad. Osagie cleans up the newly printed 3D parts and assembles them into pieces that Mohamad will use to make the finished belt canes. He also cuts and partly assembles the belts. We then made our way to Long Island. There we dropped off all of these parts and collect our bonus- we got to meet Melody, Mohamad and Shadi’s almost one-month old daughter. The next time we visit them; we’ll be picking up fully assembled canes. Mohamad assembles and glues them together according to the sizes that have been requested by families and professionals. Benny and I are responsible for boxing and shipping the completed canes. We are learning everyday. One lesson we learned recently was a very tough lesson to learn because instead of getting the free pediatric belt cane to Reeti to begin walking with safety, her box was returned due to our mistake. We learned several important lessons from our mistake: 1) you must get a custom's form completed even when shipping a free belt cane via Free Matter, 2) the USPS will provide tracking numbers for Free Matter mail, and 3) we need to use a lot more tape! Reeti's belt cane is going to be repacked and shipped back to her on Monday! We have recently received just over 1500 dollars donated to our cause by good Samaritans. Every donated dollar goes to making belt canes. Everyone at Safe Toddles thanks you for your help, your patience and your belief in the innate abilities of toddlers who are blind and mobility visually impaired. When you give children who are blind an arm to hold on to you keep them dependent. When you teach them them to wear their belt canes you unleash their learning potential.

For far too long, families with children who are blind and mobility visually impaired (unable to visually avoid collisions) have been asked to accept any development as a positive sign, rather than to be alarmed by lack of age-appropriate developmental gains. This is evidenced in the descriptions that families and professionals provided to Safe Toddles when seeking pediatric belt canes. Developmental milestones are observations of the stages of ability that children progress through. One of the most important developmental milestones is walking, ambulatory children should walk freely by 18 months and run freely by 24 months. Walking age is important because independent walking sparks rapid growth in concept and language development. Children’s development improves dramatically once they begin moving around their space independently. In children who are born blind and mobility visually impaired, the poor walking outcomes due to unavoidable collisions is so alarmingly common that professional observations of these children suggest that falling is a normal developmental milestone for two- and three-year-old blind children. For example, the description of Fred, a 25-month-old boy with visual cortex and optic nerve damage. His orientation and mobility (O&M) specialist wrote that, “Fred can walk very well... He does stumble and fall when his body detects obstacles in his path.” Stumbling and falling over obstacles is not developmentally correct for his age. By age 24 months, Fred should be running and avoiding obstacles. The fact that he cannot walk and avoid obstacles is because he is mobility visually impaired, yes. BUT the fact that we know the root cause of his collisions, should make finding a solution that much easier. Since 1945, we have known how to prevent blind people from stumbling and falling over obstacles, provide them with a device to detect those obstacles. Adults who are blind learn to use a rod-shaped long cane. They swing it back and forth with each step. Fred’s inability to detect obstacles before stumbling over them is a huge problem that requires an immediate solution. Fred is only two-years-old. He is too little to use a hand-held long cane. He is too little to be responsible for his safety. The O&M professional also reported Fred’s learning ability. “Fred is a smart boy for his age. He comprehends all that is said to him and will demonstrate an understanding of what is requested of him. His language is coming along as well.” Fred knows what is happening and he is able to express himself. So, when his O&M specialist said: “When [Fred is] left alone he does get upset and will cry until he hears a familiar voice. He seems to be scared when left alone.” We need to see that Fred understands that he unable to avoid colliding with unseen objects. He is consciously choosing to move only with assistance because he understands that this is his best option for safe mobility. Even though he is only two, we should listen to him. His O&M specialist did listen and she reached out to Safe Toddles for a free pediatric belt cane. The pediatric belt cane is a lightweight rectangular frame that connects to a belt. When children as young as twelve months of age who are blind wear it, they can detect clear and blocked paths. This is essential information that is unavailable to Fred without this cane. When asked, why she was requesting a belt cane for him, her answer was: “I want Fred to learn to be independent as he is learning to travel within different environments. I want him to feel safe and secure in all environments as well. Having and utilizing a [pediatric belt] cane will provide tactile feedback about the routes Fred will encounter. The [belt] cane will help build confidence with gaining tactile feedback which will help with his gross motor, concepts, language and social skills. The [belt] cane will open a whole new world for Fred while exploring his world.” Blind children are children and they hurt the same as sighted children when they collide with objects. They can also be measured with the same developmental milestone charts used with sighted children. A blind child can't let go and run without effective safe mobility, so not providing him with a pediatric belt cane is holding him back developmentally. Once Fred received his cane, he began to grow with self-confidence. He began to explore and seek out adventures. His language, concepts and his play caught up to his developmental potential. When children who are blind or mobility visually impaired are age 18 months and older and they are still only walking with assistance, this must be understood as an important indicator that they are seeking safe mobility. Pediatric belt canes are the solution to self-confident safe mobility for children whose vision impairment results in stumbles and falls over unseen obstacles. Belt canes are essential equipment to children who are blind and mobility visually impaired. When you see a toddler or preschool child who can’t see well enough to avoid collisions (has unsafe mobility), you can recommend an effective safe mobility solution – the pediatric belt cane. The sooner they begin wearing it the better.

I was riding on the subway on Monday, November 3, 2014 mulling over the needs of children with visual impairment and blindness. The early education teachers needed the children to have concrete experiences in order to develop concepts. The preschool teachers needed them to be more social, for example walk over to a friend and start a conversation. The physical education teacher needed them to enjoy the benefits of running. What did all these needs have in common? Safe, self-confident mobility Toddlers who are blind and mobility visually impaired have one thing in common, the inability to achieve safe, self-confident mobility because they cannot see well enough to avoid sudden collisions. Therefore, they need a cane in order to develop gross motor, concept, language and social skill goals. I thought, if only there was a long cane that was compatible with their abilities. What would a developmentally appropriate long cane look like? How could we make a long cane that babies didn’t have to be responsible for and would give them the information and safety they needed to achieve their developmental milestone potential? My first thought was a hoop skirt that touched the ground 360 degrees. Yet, truly what they needed was information specifically about the path of their next step. That was when we began the search for a design that would allow toddlers to have all the features of a white cane, but in toddler form. On March 16, 2016, we succeeded in making a belt cane using a circle skirt. The skirt was the mechanism that connected the child to the carbon fiber cane frame. The rectangular, polygonal cane frame complete with rolling tips, employs an elastic webbing to stay in the forward path position when worn by an energetic three-year-old boy named Logan and his older sister Lily. Lily has optic nerve hypoplasia. Her mom, Nicole, allowed her and Logan to wear all the designs I crafted. Nicole also gave me generous feedback about the many designs, and, in exchange for all of these gifts, I offered in return my only asset. I provided her daughter Lily with extracurricular O&M sessions. The Safe Toddles team grew on September 16, 2016 to include the resources and support of the genius medical device engineer, Shames and Cattell Professor of Engineering, Marom Bikson. At his lab at the Center of Discovery and Innovation on the City College of New York campus, he asked engineer Mohamad FallahRad and a robust team of student engineers to join the effort. Marom and Mohamad translated the original homemade design into a sleek 3-D bungee belt cane that could withstand the force of an entire class of New Mexico preschoolers. However, our first successful test was with Jojo, a four-year-old with optic nerve hypoplasia, on September 5, 2017. Since that sunny day in September, our little group of hard working, committed folks at Safe Toddles have produced and shipped over a thousand canes. We have shipped them to almost every state in the United States and to fifteen countries. We post videos of the changes that children who are blind and mobility visually impaired make when provided with belt canes to wear most of the day, every day. Having consistent tactile path information enables children who are blind and mobility visually impaired to develop the self-confidence they need to develop motor, concept, language and social skills. Safe Toddles Quarantined We wish we could continue to make the belt canes right now, but we are complying with the order to maintain social distance by staying home. Until we can get back to work, perhaps it would be useful to describe how I made a belt cane at home. Perhaps others can recreate and improve upon the belt cane design. If you have any questions or would be willing to share your belt cane creations- please do contact us at info@safetoddles.org or by Facebook and Twitter @SafeToddles How-to make a homemade belt cane The homemade belt cane consists of an elastic waistband circle skirt and a lightweight frame with rolling ball cane tips. Step 1: Create the cane frame 1. the outer belt was crafted by creating a top square with plastic tubing. The entire cane shaft is held together with taut elastic cord. Carbon fiber rods (cane shafts) are strategically placed within the plastic tubing to provide structure and support. 2. Connect the two cane shafts to the top square using plastic tubing, elastic cord and strong tape. 3. The rolling ball tips were attached to the elastic cord. The elastic cord was thread through the entire inside of the cane frame structure. The end of the cane tip was pulled into the end of the plastic tubing. Below is a picture of the elastic cord connected to the cane tip before and after it was pulled to fit snugly into the plastic tubing. 4. Next, the top square frame is outfitted with elastic webbing Front webbing. The right and left sides of the top square are controlled by elastic webbing. The front square webbing was created by sewing two capital "T" shapes using two elastic bands. Each end (3 ends) of this shape contains a loop that will be fitted tightly to the top square and the shaft. One loop is attached to the front of the top square and a second loop is attached to the right side of the top square. The third loop is attached to the right cane shaft. The same configuration is completed for the left side. Rear webbing. The rear elastic webbing is all one piece. It looks like a capital "H". The middle line of the "H" is two inches longer than the sides of the "H". There are six loop ends. One right side loop is positioned on the back of the top square, and one is positioned on the right rear side of the top square, with the third loop connected to the right rear of the cane shaft at the same point as the front elastic loop. The same configuration is completed for the left rear side. Next make the elastic-banded circle skirt 1. Measure, cut and sew a circle skirt with an elastic band. I followed the YouTube video How to make a Circle Skirt - for any age + any size posted by MADE everyday. Click on the link to watch her easy to follow instructions on sewing a circle skirt with an elastic waistband. 2. Attach the circle skirt tightly to the outside of the frame, careful that the waist band is at the center of the frame. The measurements are based on the size of the child. The waistband should fit snugly and the cane tips should reach at least two steps ahead. When next to the child, the top of the cane shaft would reach to the child's arm pit. If you have any questions- please let us know!! Happy crafting!

Raison d’etre. Pediatric belt canes dramatically improve the lives of children who are mobility visually impaired or blind (MVI/B). However, there is a great deal of ink used by theoretical and research publications in early childhood textbooks, scholarly journals, and family-directed publications; and countless training hours at universities, workshops, conferences, and in videos to promote the importance of urging blind babies to learn how to walk “freely”, meaning without holding a hand and without a mobility tool, in short, unsafely. The need for path information is understood by sighted people, for themselves. When I cannot see, I turn on the lights, clean the windshield, or put on glasses. Somehow, through the ages, there has existed an asterisk, the suggestion that when you are blind, you benefit from the same collisions that sighted people avoid by turning on the lights. Suggesting that blind babies are physically and emotionally different from sighted babies. They are not. There is an adage that goes, "blind babies are the same as sighted babies because they both collide with their world, and these little collisions are mild and kids don't seem to mind them". Safe Toddles debunks that false comparison with logic. Blind babies are harmed by collisions, even those considered mild, aka simple object contacts, because they cannot see it coming. Nor can they look back to evaluate the cause of the collision. They cannot learn to visually avoid collisions, brace themselves, or slow down and veer; because they cannot see them. They learn only to fear walking. Safe Toddles pediatric belt canes are not just a mobility tool, they are an important source of information that allows children with MVI/B to learn from impacts with objects. We have seen the positive outcomes of path information in children as young as 15 months. In order to change centuries of belief requires easy access to these canes. We must give these canes away for free to accelerate the adoption of a kinder, gentler approach to child rearing and therapy practices for children born MVI/B. Collisions cause developmental delay – see below figure. With your help we can do more.

Just this week I was once again asked by orientation and mobility Facebook group members, to once again prove the thesis that children who are mobility visually impaired or blind (MVI/B) need better mobility tool options (e.g., wearable belt canes) mobility visual impairment is the inability to visually avoid obstacles. "Show us your data" was the request. We do have a published research study (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson and Bikson, 2019). We have another research study that was recently submitted for publication (Ambrose, McAllister & FallahRad, submitted 2019). We continue to collect and analyze data from hundreds of children with MVI/B. In this blog post, I will share some of our data on gross motor delays that support our thesis: blind toddlers need developmentally appropriate mobility tools. But, first- let’s look at prior research that has identified the problem we’re attempting to solve with wearable belt canes. As the adage goes, 'identifying the problem is half the battle." There is over a century of research that has identified global developmental delays in children born with MVI/B, which have continued to be documented in children despite access to early education (EE) therapies (Celeste, 2002; Hatton, Bailey, Burchinal, & Ferrell, 1997; Hatton, Ivy and Boyer, 2013). The research on motor skill delays alone is extensive (Brambring, 2006; Celano, Hartmann, Dubois, Drews-Botsch, 2015; Celeste, 2002; Gazzellini, et. al., 2016; Hallemans, Ortibus, Truijen, Meire, 2011; Hatton, et. al., 2013; Wyver and Livesey, 2003; Tsai, Meng, Wu, Jang, & Su, 2013). Children aged five years and younger with MVI/B are less likely to achieve motor milestones on time (Bakke, Cavalcante, Oliveira, Sarinho, & Cattuzzo, 2019). Wyver and Livesey concluded that “findings are generally consistent despite the studies being conducted in a wide range of settings, in a variety of countries … there is strong evidence of an adverse impact of visual disability on motor development” (2003, p. 25). A review of the bulleted list of common gross motor milestone definitions at five ages (Sharma, 2011); finds that toddlers’ eighteen-month-motor milestones included the expectation that they will have developed their visual/motor coordination enough to walk and avoid obstacles independently. By twenty-four months of age, children were expected to be able to run and avoid obstacles, independently (not holding hands or couches) (Sharma, 2011). Nine months -- crawling, standing Twelve months – cruising, walks with assistance Fifteen months -- Walks alone feet wide, hands up, often falls, bumps into furniture Eighteen months -- walks well with arms down, runs carefully but cannot avoid obstacles Twenty-four months -- runs avoiding obstacles. Children with MVI/B are said to demonstrate gross motor milestone delays (Brambring, 2006). However, gross motor milestone evaluations rely on the visual motor skill of ‘obstacle avoidance’. By definition, MVI/B makes it difficult (to impossible) to develop visual/motor coordination needed to avoid obstacles when walking and running (Pigeon, Li, Moreau, Pradel, and Marin-Lamellet, 2019). Children five and younger with MVI/B may appear to have motor impairments, but another explanation might be that their MVI/B limits their ability to achieve motor milestones that depend upon visual/motor coordination. The solution for learners whose MVI/B prevents them from avoiding obstacles is to equip them with a mobility tool that provides them with consistent tactile path information. People whose MVI/B robs them of path information benefit from mobility tools that detect obstacles. Obstacle detection is the first step needed to develop motor planning strategies used to interact effectively with obstacles, such as obstacle avoidance. The wearable belt cane is a new, developmentally appropriate mobility tool for toddlers with MVI/B, when worn, the rectangular shape of the cane offers a reliable cane arc and enables very young children with MVI/B to experience consistent tactile path information. Toddlers with MVI/B receive the benefit of consistent tactile path preview because the base of the cane frame maintains contact with the floor, two steps ahead of their intended paths. Toddlers with MVI/B cannot forget their belt canes because the top of the frame is connected by magnets to a belt that is worn about their waists (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson, & Bikson, 2019). On the intake form to obtain wearable belt canes, adults provided motor skill statements on 234 children five months to 180 months old (mean age 42.6 months). There were ten (.04%) children who were age five to fifteen months old, yet 92.8% of all reported children demonstrated motor skills of ten-month old babies, ‘stands’ to fifteen-month old toddlers ‘wide based gait, bumps into furniture.’ Seven of the ten children age fifteen months and younger demonstrated motor skills considered on-target for their age. Three children aged fifteen months were reported at twelve-month-motor milestones (cruising). The children aged eighteen months and older who were not motorically impaired, were reported as walking, collides with obstacles (15-month milestone) and cruising/walking with assistance (12-month milestones). Regardless of age, no children with MVI/B were reported at the twenty-four-month motor milestone ‘runs avoiding obstacles.’ Most children with MVI/B appeared to be clustered at the skills representative of the fifteen-month motor milestones and younger. Therefore, the diverse sample of children with MVI/B were similar in their inability to demonstrate eighteen-month motor milestones and above. Families and professionals sought wearable belt canes for children with MVI/B who were different ages, had different MVI/B etiologies, lived in different states and countries, but whose motor skills were similar. Children with MVI/B motor skills appeared to plateau at the fifteen-month milestone, walks alone, bumps into furniture. Adults were actively encouraging the children with MVI/B to walk independently, yet they did not. Many were also reported to be learning to hold long canes and push toys. Yet, these children with MVI/B were also reported to have sedentary play habits and global developmental delays. Families and professionals have identified the problem, toddlers with MVI/B are not able to achieve past the fifteen-month gross motor milestone. The wearable belt cane is the first developmentally appropriate mobility tool for toddlers with MVI/B. The number of children with MVI/B wearing belt canes who were able to walk and run across open space independently can be observed on our website videos. The belt cane must be worn because toddlers are not only not responsible for their safety during any other life activity, they are also not cognitively and physically able to employ hand-held mobility tools correctly for safety. Further, in the hands of a toddler, hand-held mobility tools are easily cast aside or entirely forgotten. The reason adults gave for requesting wearable belt canes was that their children with MVI/B were afraid to move and the current mobility tools had not solved that problem. Wearable belt canes solve the problem of obstacle detection and allow toddlers to learn how to avoid obstacles and continue their gross motor development. For proof in the form of family-shared videos, please navigate to our website and see for yourself www.safetoddles.org. Toddlers with MVI/B don’t run because they prefer to be sedentary, they don’t run because they are the smartest people in the room. Once they have reliable tactile path information- they do run, they do cross open space, they gain confidence, expand their language and concepts- they enjoy and learn from the information that belt canes provide. References Ambrose-Zaken, G. V., FallahRad, M., Bernstein, H., Wall Emerson, R., & Bikson, M. (2019). Wearable Cane and App System for Improving Mobility in Toddlers/Pre-schoolers With Visual Impairment. Frontiers in Education, 4. doi.org/10.3389/feduc.2019.00044 Ambrose, G. V., McAllister, J. & FallahRad, M (submitted 2019). Would A New Term Improve Gross Motor Outcomes? A Study of Children with Visual Impairment and Blindness, Journal of Visual Impairment & Blindness. Bakke, H. A., Cavalcante, W. A., Oliveira, I. S. de, Sarinho, S. W., & Cattuzzo, M. T. (2019). Assessment of Motor Skills in Children with Visual Impairment: A Systematic and Integrative Review. Clinical Medicine Insights: Pediatrics. https://doi.org/10.1177 /1179556519838287. Brambring, M. (2006). Divergent Development of Gross Motor Skills in Children Who Are Blind or Sighted. Journal of Visual Impairment & Blindness, 100(10), 620-634. Celano, M., Hartmann, E.E., Dubois, L.G., Drews-Botsch, C. (2015). Motor skills of children with unilateral visual impairment in the infant aphakia treatment study. Developmental Medicine & Child Neurology, 154-159. doi: 10.1111/dmcn.12832. Celeste, M. (2002). A survey of motor development for infants and young children with visual impairments. Journal of Visual Impairment & Blindness, 96(3), 169-174. Ferrell, K. A., Shaw, A. R., & Deitz, S. J. (1998). Project PRISM: A longitudinal study of developmental patterns of children who are visually impaired(unpublished manuscript). Retrieved from http://www.unco.edu/ncssd/research/PRISM /default.html Gazzellini, S., Lispi, M.L.,·Castelli, E.,· Trombetti, A., Carniel1, S., Vasco1, G., Napolitano, A.,· Petrarca, M. (2016). The impact of vision on the dynamic characteristics of the gait: Strategies in children with blindness. Experimental Brain Research, 234, 2619–2627. DOI 10.1007/s00221-016-4666-9 Hallemans, A., Ortibus, E., Truijen, S., Meire, F. (2011). Development of independent locomotion in children with a severe visual impairment. Research in Developmental Disabilities, 32, 2069–2074. Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997). Developmental growth curves of preschool children with visual impairments. Child Development, 68, 788–806. 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. Pigeon, C., Li, T., Moreau, F., Pradel, G., & Marin-Lamellet, C. (2019). Cognitive load of walking in people who are blind: Subjective and objective measures for assessment. Gait & Posture, 67, 43–49. https://doi-org.proxy.wexler.hunter.cuny.edu/10.1016 /j.gaitpost.2018.09.018 Sharma, A. (2011). Developmental examination: birth to 5 years. Archives of Disease in Childhood - Education and Practice. doi: 10.1136/adc.2009.175901 Tsai, L.-T., Meng, L.-F., Wu, W.-C., Jang, Y., & Su, Y.-C. (2013). Effects of visual rehabilitation on a child with severe visual impairment. American Journal of Occupational Therapy, 67, 437–447. http://dx.doi.org/10.5014/ajot.2013.007054 Wyver, S. R., & Livesey, D. J. (2003). Kinaesthetic sensitivity and motor skills of school- aged children with a congenital visual impairment. British Journal of Visual Impairment, 21(1), 25–31. https://doi.org/10.1177/026461960302100106

We put together this video to show how much care and attention is paid to each wearable cane being packed for shipping. We have shipped canes to 45 states and 14 countries. Safe Toddles is a non profit. Families never receive a bill from Safe Toddles for their children's canes or shipping. Wearable canes are for mobility visually impaired and blind children age five and younger. These children are afraid to walk because they cannot see the path ahead. Wearable canes allow them to develop confidence in their ability to walk, run, explore and learn. Thousands of children are diagnosed severely visually impaired or blind each year and they all need wearable canes to thrive. Safe Toddles relies on funding from people like you to continue our life saving mission - go to www.safetoddles.org/SafeMobility to donate a cane today.

Since 2012, the first Tuesday after Thanksgiving had become Giving Tuesday. This year Giving Tuesday will be December 3, 2019. Facebook is offering to match up to 7 million dollars in donations made to non-profits on Giving Tuesday. Safe Toddles needs your help to participate in Giving Tuesday so we can achieve our mission of providing specially designed canes for very young blind children. Safe Toddles uses all donations to provide free first wearable canes and to continue to provide new wearable canes as a child grows. Safe Toddles is asking the families and friends of our non-profit to support us on Giving Tuesday (create a fundraiser for Safe Toddles on Facebook - it's in the how to help list below). You can help Safe Toddles help young blind kids. HOW TO HELP You can either: 1. Follow the link- Facebook.com/fundraisers/SafeToddles/ and donate to an existing Safe Toddles fundraiser 2. Follow the link Facebook.com/fundraisers/SafeToddles/ and create your own fundraiser for Safe Toddles Step 1 Click on Create a Fundraiser Step 2 Use drop down boxes to select your name, Safe Toddles, amount and date specifics. Step 3 Use this page to tell your story or chose to use the text already provided Step 4 Use the photo provided to click edit to select another, click create. Step 5 encourage your friends and family to participate.

In 1964, President Lyndon Johnson signed the first proclamation declaring White Cane Safety Day in recognition of the passage of the federal White Cane Law. Every October 15, the United States (US) president signs a White Cane Safety Day proclamation. Over the past 55 years, the meaning of White Cane Safety Day has evolved from the commemoration of the new law, to the broader observance of the white cane as a symbol of independence for people who are blind and visually impaired. In 2011, President Barack Obama added the name Blind Americans Equality Day to the White Cane Safety Day proclamation. The advantage of the long white cane is that when used properly it provides the user with consistent tactile path information. Yet, consistent tactile path information is more important than any one type of mobility tool. For example, guides dogs were the first independent mobility tool, introduced in 1923 and they are still used today, by blind adults. Children are not mature enough to employ guide dogs, that’s why it is very rare that a high school student would have a guide dog before graduation. In 1932, the Lions Club disseminated a short, white cane with the express purpose of helping blind adults get the attention of drivers when they wanted to cross streets. In 1945, it was the blinded veterans who demanded and got better mobility tools. The US Army made the white canes longer, lighter and more durable. The long white cane began to be introduced to high school students in the 1960s. By 1997, education law entitled the Individuals with Disabilities Education Act (parts A, B and C) listed and defined orientation and mobility (O&M) services for students birth to 22 years of age with visual impairment and blindness. Orientation and mobility are the specialized skills and techniques for teaching travel with a visual impairment (including teaching the use of the long cane). Yet, there was still no effective solution for consistent tactile path information for children five and younger born severely visually impaired and blind. Skellenger and Sapp (2010) wrote that “a major overriding role of O&M specialists working with learners in the early childhood years will be the facilitation of the child’s typically innate enjoyment of exploration, which is so often thwarted by absent or impaired vision” (p. 168). The authors stated the role of the practitioner was to continue with enrichment activities until such time as these students with visual impairment demonstrated “higher developmental skills that indicate readiness to begin long-cane instruction” (p. 190) and lack of competence with the long cane was considered probable through age five. In the same O&M Foundations textbook, Rosen stated that children born severely visually impaired or blind were typically 3-6 months behind in gross motor skill development, and reasons for delays included "…apprehensions about moving in space without vision." The concern, Rosen explained, was that gross motor skills, "the ability to move about and explore is essential to global development and forms the foundation for cognitive development." Children age five and younger do not benefit from long canes, because the long cane is only useful when used correctly (one step, one swipe, no prompts). Yet it is hard to follow the logic that suggests that ‘because blind toddlers are unable to physically and cognitively use the long cane correctly to achieve consistent tactile path information, that they don’t need consistent tactile path information. Therefore, it is only when they are able to use the long cane correctly, that they need consistent tactile path information.’ This is not logical, because everybody needs path information to move about safely, especially children aged five and younger. The expert advice of the O&M Foundations textbook is that children who are congenitally visually impaired and blind should be taught to explore their environment with damaged or no path information, despite their reluctance to move about free of an adult’s hand and that moving freely with impaired vision caused developmental delays. Yet, in 2019 children born blind and visually impaired are asked to navigate their first five years without access to consistent tactile path information and it is causing them harm. That is why Safe Toddles has declared October to be Equal Access to Path Information Month. We need a full month of awareness on behalf of children born severely visually impaired and blind, because path information is not optional hence the light bulb and specialized mobility tools. Children born severely visually impaired and blind who are age five and younger demonstrate their need for mobility tools through their poor motor skills such as developing a slow, halting gait, delay in walking free of an adult’s hand, and bruises from colliding with unseen obstacles. In fact, Wyver and Livesey (2003) review of motor skill research on children with visual impairment concluded, “…findings are generally consistent despite the studies being conducted in a wide range of settings, in a variety of countries and with children with varying degrees of visual disability... there is strong evidence of an adverse impact of visual impairment on motor development” (p. 25). Bakke, Cavalcante, De Oliveira, Sarinho, and Cattuzzo (2019) reviewed 1113 articles on motor skills with visual impairment. They stated that, “… motor development in children with visual impairment is expected to be different from that in typically developing peers” (p. 1). The studies focused on changing the environment and/or offering adapted physical therapy training to address the motor skill impact on this population. Yet, none of the research reviewed sought to investigate whether these motor skill deficits could be avoided. Instead, researchers overwhelmingly agreed that severe visual impairment and blindness resulted in motor skill delays. The delays were due to a lack of anticipatory preview of the environment and the consensus has been that for children five and younger who are severely visually impaired and blind nothing can prevent these “inevitable motor skill delays”. Yet, although blind adults have successfully thrived using tactile path information (the long white cane) for almost 80 years, none of the 1113 studies investigated the use of mobility tools for providing path information to congenitally blind learners aged five and younger. Why have researchers failed to hypothesize or propose a method to apply what is understood to be the benefits of white canes for blind adults in order to propose a developmentally appropriate mobility tool for blind babies, toddlers and preschool learners? It is true, children five and younger with severe visual impairment and blindness are unable to employ rod-shaped canes or any mobility tool that is employed by hand, but it is also true that they need consistent tactile path information for effective, safe ambulation. The provision of consistent, tactile path information would prevent these motor skill delays. Safe Toddles says celebrate equal access to path information month by learning more about wearable canes because wearable canes provide learners five and younger with path information in an easy to interpret tactile form (Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson, & Bikson, 2019). Children five and younger who are blind and visually impaired benefit from wearing their canes every day all day, because they need path information and wearable canes provide them with tactile path information in a developmentally appropriate mobility tool. We celebrate October as Equal Access to Path Information month because we are committed to improving families and professionals’ understanding of the urgency of supplying appropriate mobility tools to children age five and younger who are born severely visually impaired and blind and we have the tool that helps them -a wearable cane (see photo). References Ambrose-Zaken, G. V., FallahRad, M., Bernstein, H., Wall Emerson, R., & Bikson, M. (2019). Wearable Cane and App System for Improving Mobility in Toddlers/Pre-schoolers With Visual Impairment. Frontiers in Education, 4. doi.org/10.3389/feduc.2019.00044 Bakke, H., Cavalcante, W., De Oliveira, I., Sarinho, S., & Cattuzzo, M. (2019). Assessment of Motor Skills in Children With Visual Impairment: A Systematic and Integrative Review. Clinical Medicine Insights. Pediatrics, 13, 1179556519838287. Skellenger, A. C., & Sapp, W. K. (2010). Teaching orientation and mobility for the early childhood years. In W. R. Wiener, R. L. Welsh, & B. Blasch (Eds.), Foundations of orientation and mobility (3rd ed., Vol. II, pp. 163-207). New York: American Foundation for the Blind. Wyver, S. R., & Livesey, D. J. (2003). Kinaesthetic sensitivity and motor skills of school-aged children with a congenital visual impairment. British Journal of Visual Impairment, 21(1), 25–31. https://doi.org/10.1177/026461960302100106

New York Dr. Max Gomez will run the story of the toddler cane tonight - around 5:45PM on CBS New York and the link of the story will be posted on his blog. I will post it as well. Stay tuned!!

This extended-length video provides an in-depth take on safe mobility and the wearable white cane.