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

Until now there was no mobility device for children under the age of two and there is a lack of funding for early intervention services holding children who are blind back from achieving their developmental potential. Pediatric Belt Cane Solution The pediatric belt cane addresses the problem of independent walking with safety which is critical for development. The first 1000 days of life from conception to age 2 are the most critical for brain and body development (Likhar & Patil, 2022). The last 365 of those days are the focus of this blog. By age two, toddlers’ walking should be rhythmic and relaxed with a minimum of conscience effort. Yet, infants born blind or mobility visually impaired (B/MVI) without a pediatric belt cane are not able to walk effortlessly by this important milestone. Instead, they fall behind in their motor development when they reach the stage of independent walking that depends on vision for balance, between 12 and 18 months. Sighted toddlers must rely upon their vision to let go and balance without holding on to objects or people. In the absence of vision, blind toddlers must rely on haptic feedback (touch) for balance (Ambrose-Zaken, in press; Hallemans & Aerts, 2009). ). For the first six years, blind children’s reliance on haptic feedback is their strongest, most effective means of achieving effortless, relaxed balance. For every child for whom independent walking is a goal, the most important outcome of the first 365 days after a child’s first birthday is independent, relaxed walking that requires a minimum of conscience effort. That is because effortless independent walking is the necessary building block upon which concept, language, and social skills develop (Clearfield, 2011). Toddlers who are congenitally or early onset B/MVI face several roadblocks to obtaining the tools they need to combat delays in independent walking. The first roadblock is the lack of a mobility tool for toddlers who are blind. The pediatric belt cane solved that problem. The second roadblock is the lack of funding. Follow the “LACK” of Money! One of the key reasons there is a lack of money for blind toddlers is that the Individuals with Disabilities Education Act (IDEA) Part C defines early intervention services as “voluntary” for parents. The outcome of that provision is that States, public and private companies, and agencies have little incentive to fully fund and staff early intervention services. Parents who do want to obtain services to assist them in supporting the needs of their disabled infants’ quickly find out whether they live in a good State or not. A good State engages in child find activities, has plenty of nearby agencies staffed with highly skilled professionals with specialization in blindness including O&M. These providers come to their homes, and they can also access specialized centers for additional enrichment opportunities. In Part C early intervention services there is a lack of funding and lack of choice of mobility tools offered in IDEA’s definition of orientation and mobility (O&M) instruction which reads, “teaching children as appropriate to use a long cane or a service animal to supplement visual travel skills or as a tool for safely negotiating the environment for children with no available travel vision.”(see Sec. 300.34 (c)(7)). Teachers have been attempting to teach long canes to infants, toddlers, and preschoolers who are B/MVI and have found that toddlers can no more learn to employ a long cane or service animal for safe travel as they can safely drive a car. The good news is you can request a Pediatric Belt Cane for your blind toddlers. Yes, IDEA can be used to pay for the pediatric belt cane to “supplement visual travel skills and as a tool for safely negotiating the environment.” Trying to teach toddlers to employ complex mobility tools is limiting their developmental potential. The pediatric belt cane is the best, most appropriate and proven mobility tool from 12 months through age 5 (and beyond). Instead of futile instruction in long cane skills, what could we be teaching? For infants aged 12- to 24-months who are blind or mobility visually impaired, the focus needs to be achieving effortless and independent ambulation with safety. We can substitute these complex tools with one designed specifically for toddlers. The only effective mobility tool for toddlers born blind or mobility visually impaired is the pediatric belt cane (Ambrose-Zaken, 2022, Ambrose etc, 2019). The belt cane is effective for two reasons it provides haptic feedback and safety. The belt cane does not hold a child up, it provides 12- to 15-month-old toddlers the essential haptic feedback they need to let go without visual feedback and still achieve independent balance on time. Independent balance is a prerequisite to independent ambulation. The belt cane also provides the wearer with an effective safety barrier. When children wear their cane frame, they learn to rely upon it to be in the right place at the right time. The belt cane also provides toddlers with an important introduction to long cane skills. They learn to hold onto the side of the frame, to free it to locate a clear path, to respond to the cane, for example, learning to stop when the path is blocked or when they detect a drop off. The belt cane develops a child’s ability to be independently safe as they move about freely to explore to learn concepts, language, and social skills. Supporting Research There are two published studies demonstrating the efficacy of belt canes with blind toddlers, there are no studies showing the efficacy of teaching blind toddlers or preschoolers to use the long cane for the purpose of safely negotiating their travel environment. Prior to the belt cane, teachers have done what they could to attempt the impossible with these long cane (but not service animals) as named in IDEA Parts B & C, but these tools have been proven ineffective as essential mobility tools during the first 365 days of ambulation as well as the second 365 days and the third and fourth 365 days of ambulation. Now that we have the Safe Toddles Belt Cane, the world’s only effective mobility tool for early intervention and preschools supported by research and readily available, it is time to build a coalition to rewrite Parts B & C of IDEA. For example, we need to make early intervention mandatory rather than voluntary so that States fully fund early intervention educational services. We also need to innovate and create more appropriate mobility tools and have them listed and funded through IDEA including the pediatric belt cane. It is our intention to continue innovating mobility tools that positively impact their early childhood development outcomes. Innovate. Facilitate. Legislate. References Ambrose-Zaken, G. (2022) A Study of Improving Independent Walking Outcomes in Children Aged Five and Younger who are Blind and Visually Impaired. Journal of Visual Impairment & Blindness. 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 Clearfield, M. (2011). Learning to walk changes infants’ social interactions. Infant Behavior and Development, 34(1), 15-25. Hallemans, A., & Aerts, P. (2009). Effects of visual deprivation on intra-limb coordination during walking in children and adults. Experimental brain research, 198, 95-106. Likhar, A., & Patil, M. S. (2022). Importance of Maternal Nutrition in the First 1,000 Days of Life and Its Effects on Child Development: A Narrative Review. Cureus, 14(10), e30083. https://doi.org/10.7759/cureus.30083

Click the arrow to play his video. Vinny, age 2 and blind, was at the Easter Egg Hunt recently - an unfamiliar place with loads of unfamiliar people. He loved exploring with his belt cane. Vinny's cane skills are legendary!!

Dr. Josephine DeFini was gifted in math from a very young age. Born with low vision, as the first born – she helped look after her 3 siblings. Although long white canes had been used for 5 years when she became blind, at age 11, one was never provided to her. In school, there were plenty of ways for her to learn independently -she had talking books and eventually learned braille to read independently, but the most natural independence of all- walking, she was taught a dependent solution. The only solution they could think of was for her to walk with an escort to keep her safe, which she wanted no part of. She wanted a dog guide, which was a much older mobility tool. (to listen to her podcast click button. Morris Frank got his first dog guide in 1928 – as an adult. And dog guides are still available to someone once they have graduated from high school. Jo was evaluated on the long cane before she graduated high school, but she was never provided a long cane. Independent travel tools for blind persons were once considered the domain of adults. They were invented for blind adults. It took decades to bring long canes to high schoolers (1960s). How can this be? There exists no logic to this outcome. Once it was obvious that a blind adults could be safer with a long white cane, why wasn't the next logical outcome "we need to find a way to make devices for blind toddlers and children of all ages?" Blind toddlers need our protection most of all. Why did it take 70 years from the advent of the long cane for blind adults to conceive and build a pediatric belt cane for blind toddlers? Jo grew up as an independent child -her low vision allowed her to walk on time and yet, later as an adult she became keenly aware of how unsafe her independence had been. She remembered crossing major avenues with incomplete knowledge of exactly where the cars were, before and after she became blind. Jo experienced accidents that clearly demonstrated the difference between orientation and mobility. She was oriented – no problem. But knowing where you are and where you are going is just half of the equation – the other half is mobility. Mobility with blindness or a mobility visual impairment requires a mobility tool. If she had one that day she feel down the stairs in high school, perhaps she would have avoided that accident. Or the day when the janitor left a full mop bucket next to the wall she trailed along - a messy and painful accident. She lived for 17 years without an effective mobility tool. She survived – but is that really the legacy we want for children who are born blind or mobility visually impaired? What doesn’t kill you makes you stronger? No, I don’t think so. Jo would still have been a math scholar, achieved her doctorate and gone on to be as successful as she was, even if she had been provided with mobility safety from an early age. Dangerous mobility does not make a blind person more independent. If anything it leaves a lasting negative impression on the adults in positions to protect them - looking back and recognizing clearly that those who were supposed to protect them when they were vulnerable children failed to do so. My take home message from Dr. DeFini's interview is, let’s recognize the value of mobility tools for people who are blind or mobility visually impaired- welcome them much like you already welcome wheelchairs, as essential to address a need.

In the March 19, 2008, New York Times story on Theresa (Terri) Fiorentino’s tragic death after falling onto the tracks at Croton Harmon train station, the word cane was not mentioned. Dan Brucker, a spokesman for Metro-North, the commuter railroad that serves the station, said surveillance camera images showed Ms. Fiorentino falling off the platform as the train roared through the station. She was not pushed, Mr. Brucker said, and the authorities have discarded the possibility of suicide. “It seems like this was a tragic accident,” Mr. Brucker said. Seven years before her death, Terri sat down for an interview about her life growing up with a mobility visual impairment in a podcast just uploaded today on Safe Toddles website (https://www.safetoddles.org/podcast) She was born in 1933, 12 years before the long cane was invented. She reported her vision as 5/200 at birth. She was intellectually gifted, she began college at the age of 15 and went on to obtain graduate degrees and ran a successful newsstand in the Croton Harmon New York commuter train station for 40 years. In 1964, “I was buffing wooden floors in preparation for my daughter’s first communion, and I thought I saw something on the floor… Later on, it just turned out to be a beam of sunlight… But, I reached down and I caught the corner of the buffer in my eye.” The result of this accident was that she became blind. She was twice married, had two daughters- and she and her second husband (also blind) enjoyed going to the casino for the occasional fun weekend away. During our interview she talked about her soft life. She defined that as usually having someone to take her places, she didn’t have to be independent and that is why she didn’t need instruction in independent travel skills. She discussed some of her strategies as well. For example, how she used the radio as a beacon, to orient herself at the train station, “Uh, it’s amazing… That’s what I do. I know if I walk straight toward that, I’ll walk straight into that thing, and I hear [whispers as if somebody else] see I told you she could see.” She also described her difficulty, when the radio she used as a beacon to return to her newsstand was turned off. She blamed the environment “everything is on an angle at that station”. She quipped, without the radio “I’ll end up falling off track 2”. Terri’s now prophetic remark is chilling for many reasons. First and foremost, that Terri died when she walked off the platform onto the tracks without her long cane. My guess, she was disoriented thinking she was headed back to her newsstand. Only she was on the platform and an Amtrak train was entering the track at a high speed- and she stepped off into the path of the train and died before anyone could rescue her. One problem that may seem benign to sighted people, is her misplaced pride in fooling sighted people that she was not blind because she could walk around the station without her long cane. Terry had no real choice. She was 12 before the white cane was invented. But children still grow up blind or mobility visually impaired being taught this misplaced source of pride in deceiving sighted people making them question whether they have a disability. In honor of Terri, I ask us all to stop this lesson. Let’s replace it instead with a pride in the mobility tool that is obvious but effective. Terri’s story defines the true difference between orientation and mobility. Orientation is having that beacon that tells you which way to head, mobility is using a mobility tool to make sure you have the path information needed to keep you safe from colliding with obstacles. The long cane user can locate drop offs in time to stop and avoid injury. Terri was run over by an Amtrak train, not because she was disoriented, but because she had no ability to detect the platform edge in time to stop. Walking without seeing where you are going is more dangerous without a mobility tool. It is impossible to see where you’re going when you’re blind and that is unsafe and leads to injury and sometimes even death. And this is also a part of the legacy of Terri and her wonderful life lived without benefit of a mobility tool, and without benefit of being taught to use the one long cane she occasionally carried with her to the casino. She was prouder of deceiving sighted people that she was sighted; than she ever was of her long white cane. We could all honor her by recognizing the long cane as a proud badge of honor. It enables blind or mobility visually impaired travelers to keep themselves safer as they move about. And that is what we need to do for toddlers born blind. We need to give them pride in wearing their belt canes. They too can learn to stop when they feel the drop.

Here's why 1. Visual Motivation is a myth - what blind toddlers need is a reliable mobility tool that provides haptic feedback and safety Children who are blind do not need visual motivation - but they do need haptic feedback and safety. The families and professionals who seek out a belt canes have children with different visual impairments, live in different states and countries, yet they share common concerns regarding their children's independent walking outcomes. The younger children’s developmental milestones were on target until age 11 months. By 16 months, none of the children born blind or mobility visually impaired motor milestones were on-target. The goal for these children was independent walking, but the most common walking strategy across all ages was ‘walks with assistance.’ Walking alone (without assistance) is considered by the World Health Organization as the terminal independent walking milestone, typically achieved by 18 months (de Onis, 2006). Ambrose-Zaken's (2022) study compared children with mobility visual impairment on independent walking milestones before and with pediatric belt canes. Before pediatric belt canes, the children (average age 33-months), were not walking or running. After wearing their pediatric belt canes, 32 participants achieved “walks well” milestone and five were running. 2. Bruises hurt blind toddlers - period. Samuel Gridley Howe, founder of the first residential school for the blind in the United States, is credited with saying, “parents and friends—never check the motions of the blind child; do not even remove obstacles" which he would tumble over. "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”. This was published in 1841 The Ninth Annual Report of the trustees, of the Perkins Institution and Massachusetts Asylum for the blind Families know that each of these tumbles, bruises and scrapes cause real harm. Harm on the outside and harm on the inside of the child who cannot see to avoid them. The only solution is an effective mobility tool and the pediatric belt cane is the only mobility tool that reliably protects blind toddlers as they explore independently. 3. 'Cruising' furniture after age 15 months is delayed walking Cruising is an 11 month milestone - it is not an independent form of walking - it is a dependent form of standing and balancing. Blind toddlers need haptic feedback for balance. When they continue to rely upon couches for balance they are demonstrating a need for a pediatric belt cane. This table indicates the typical milestones for independent walking achievement within the first year of life. There is no reason a blind toddler cannot achieve 24 months runs when provided a pediatric belt cane from the age of 12 to 15 months and allowed to wear it most of the day. 4 Relying on a wall for balance is another sign of motor skill delay Trailing is defined as lightly placing the back of the hand on the wall downward and forward at an approximate angle of 45 degrees in the anterior-posterior plane. The purpose of trailing is to maintain a straight line of travel and to local a specific objective. This video explores the benefits 5-year-old Brayden received the first time wearing his pediatric belt cane https://youtu.be/kei3twq-GAA 5. Independent exploring is essential to potty training, concept, language and social skill development The onset of independent mobility is the “core of system-wide changes across many developing domains”. Studies comparing sighted toddler peers have shown independent walkers demonstrated more mature social engagement than crawlers, spending three times longer interacting with their mothers. Further, placing crawlers in baby walkers provided them the same vantage point as walking, but did not result in equivalent gains. Toddlers’ milestone advancement depends on acquiring independent mobility. Providers were once concerned that wheelchairs limited the development of independent walking skills and recommended wheelchairs be a last option for children with motor impairments. “Independent mobility, in whatever form, is now often viewed as the foundation for engagement in all daily activities” and current trends are to provide wheelchairs as early as possible to children with motor impairments (Casey, McKeown, McDonald, & Martin, 2017, para. 3). 6. Gait trainers limit independence in blind preschoolers without motor impairments A child’s motivation and ability to learn are not purely visual and neither is static or dynamic balance. When toddlers born blind or mobility visually impaired motor skill delay are due purely to their blindness or mobility visual impairment (B/MVI), they do not need physical therapy tools designed for a child with a motor impairment, they need O&M tools designed for a child who is B/MVI. A child born B/MVI who has the developmental potential to ambulate, given a pediatric belt cane can achieve independent walking beyond hand’s reach. 7. Being guided limits blind toddler independent exploration Toddlers who are independently walking don't want to hold your hand, and that's because they yearn to be free to explore. Exploring is learning. Toddlers who are blind who need your hand for walking - are demonstrating to you that they need haptic feedback from a mobility tool. The only mobility tool that provides blind toddlers with reliable haptic feedback is a pediatric belt cane. 8. Blind preschoolers want to run independently Jojo on the left is running after a remote controlled toy- on the right he is standing with his back against the wall operating the same toy. The only difference in his ability to move is the pediatric belt cane. He was 4-years-old with Septo optic dysplasia, he had a pinhole of visual information which limited him in his ability to explore freely and he had never run on his own. Moments after donning his first pediatric belt cane, he ran for the first time. He needed no instruction, no outside adult prompting. He just ran with glee. 9. 3-year-olds need to explore independently 9-12 hours a day The average physical activity levels for children are well known – and independent, purposeful physical activity is essential for concept, language, and social skill development. If your blind toddler is not moving about in these amounts independently – with direction and purpose – they are falling behind developmentally. 10. Turning circles and jumping are not examples of purposeful walking or exploring Turning circles and jumping in place are signs that your blind child is restricted in his or her ability to move purposefully, independently with safety through the environment. There is a limit to the number of times a child should twirl before moving to a new location. There is a limit to how long a child should stand still holding on to something, before moving on to the next thing. Stationary, repetitive play are not signs of deep exploration & learning - the are really important indicators that signal a blind toddler/preschooler's need for you to provide them with a pediatric belt cane. For videos that demonstrate these concepts go to our YouTube channel @SafeToddles

In a recent journal of visual impairment & Blindness publication, Ambrose-Zaken's research study included the term mobility visual impairment

The Ambrose-Zaken Theory that Safe Mobility is Essential to Achieve Developmental Potential explains why "walk first, safety later" has not worked and will not work for blind toddlers. Her theory is expressed in the below triangle. The colors and words that fill this figure combine to explain why toddlers need to feel safe, independently safe, to learn and grow to their full potential. The Ambrose-Zaken model combined Maslow's Hierarchy of Needs with the nine areas of the Expanded Core Curriculum. The colors represent nature. Physiological Needs-Food, shelter and health. We begin with the earth: The solid beginnings that all creatures need. This post is about thriving, about achieving one's developmental potential. The best start for toddlers is their never having to worry about food, shelter or health. Safety Needs- stability- order, freedom from fear and Ambrose-Zaken added safe mobility Upon the well nourished earth the grass can grow - what grows from our feelings of well-being is the individual interest in independently seeking adventure and learning. Safe Mobility is such an important aspect of life - that sighted people fill their world with lights of all kinds to ensure they have a good view of what lies ahead of them. The industrial revolution was made possible because of the lightbulb. Light allowed factories to expand, and also allowed travel at night. Because no sighted person wants to walk around not being able to see to avoid collisions. Piaget called the ages 0-2 the Sensory Motor stage. By age 2 a child is expected to walk and run with the ability to deftly and expertly visually avoid obstacles. The ability to walk and run is necessary for the next stage of life- Preoperational Stage - the hallmark of that stage is developing independent play, exploration, language and social skills. Preschoolers need to have confidence in their ability to run towards and away from activities independently, at will. In one year, most toddlers transition from fully assisted walking to independently running away from the adult - with increasing skill, grace and zest for life. Current practice asks families of blind toddlers to have their children skip over the Safety Rung. They say encourage your toddlers who are blind and mobility visually impaired to walk first, and seek safety later. This advice puts blind toddlers in harm's way and this explains why they want to be held, carried, pushed in strollers and otherwise need assistance to go anywhere. Blind children walk slowly with poor posture or jump in circles instead of standing still. Blind toddlers do not quickly walk straight across the room like their peers. This is not because they are unaware, it is because they are aware of the risk this poses to them- unavoidable collisions. The plain safe mobility facts are: Turning on the lights doesn't provide blind toddlers with the same safety as it does for sighted toddlers. Holding a hand does not provide toddlers with independent safe mobility. Holding on to a couch does not provide toddlers with the ability to explore freely across open space. Holding a long cane does not provide toddlers who are blind and mobility visually impaired with consistent detection of a clear path. Independent safe mobility cannot wait for a child to get old enough to use a long cane correctly. Toddlers need safe mobility to walk freely, quickly and to run and explore WE KNOW THIS Degree of vision impairment negatively impacts a child’s development (Hatton, et. al,. 2013). According to the World Health Organization (WHO), “Young children with early onset severe visual impairment can experience delayed motor, language, emotional, social and cognitive development, with lifelong consequences” (WHO, 2019, p 1). The 15-month independent walking milestone definition is ‘inability to avoid obstacles’ (Sharma, 2011). Some have suggested that blind 15-month-old toddlers’ collisions are age-appropriate (Chamberlain, 2017). Yet, a study of 151 sighted toddlers (aged 11 to 19 months) found that after a few months they fell less and demonstrated better gait, pace, and obstacle negotiation skills in cluttered settings (Adolph, et al., 2012). A study of 330 learners with visual impairments with an average age of 3 years found that over half (52.4%) were walking only with adult assistance (a 12-month milestone), over thirty percent (33.3%) walked with slow, unsteady, wide-based gait (a 15-month milestone), and the remaining subjects had motor impairments (Ambrose-Zaken, 2021b). While attending a sports camp for the blind, visually impaired teens were given positive feedback about their athletic abilities. At the end, they were asked to rate their physical abilities and their motor skills were evaluated. The teens reported relatively high self-perceptions about their physical abilities. The group’s motor skills measured significantly below age norms (Stribling, et.al., 2021). These teenage participants had received the best of current instructional practices (see table 1). Since early childhood, they had been taught to walk and run independently in all environments without mobility tools (figure 1). For those born blind, the outcome of the current best practices that emphasize walking and running without safe independent mobility tools is a growing avoidance of independent walking and developmental delay (Ely, 2014). Figure one shows the most current practices and their shortcomings- it is clear that in 2021 - people still taught that blind toddlers need to walk first, safety later. What about the rest of the pyramid? When a child has safe mobility all day every day, the rest of life is flowers, sunshine and the sky's the limit. Wearing a pediatric belt cane is a big departure from centuries of walk first, safety later- this is NOT about wearing the belt cane during a hour of O&M instruction. This is about When the lights are on the belt cane is on. Safety First, everything else will follow. Pediatric Belt Canes Improve Safe Mobility - and safe mobility improves toddler development.

Happy New Year, Team Safe Mobility! Last year, we had five resolutions for 2021 and we achieved them all! We resolved to reduce our wait times, send out more pediatric belt canes, improve our communications and social media presence. We lost the wait! - We are now able to send out pediatric belt canes the same day we receive the order! That's because we moved our entire operation under one roof - Safe Toddles, Inc Nonprofit is now located at 1491 Route 52, Suite 44, Fishkill, NY 12524. Having everyone and all our machines in one location makes the process of taking orders, making pediatric belt canes, and shipping more efficient. We know that every day a toddler who is blind waits for a pediatric belt cane delays their progress in developing to their full potential. We met more people! We sent more pediatric belt canes than ever before in Safe Toddles history- all our numbers are up and continue to go up! We were closed for two months to move into our new Factory of Miracles- and we still bested the numbers of pediatric belt canes sent each prior year. We sent more canes out in 2021 than 2019 and 2018 combined! We learned new languages! We found new ways to talk to our members and reach out to encourage new users. Everything we know about the benefits and how to use pediatric belt canes we learned from toddlers, preschoolers and their families and professionals. We did a lot of listening and learning in 2021 and that helped us achieve this resolution. We became more social! We joined TikTok, and started a podcast. In April, thanks to TikTok sensation and pediatric belt cane user Kenedi (age 3) and her mom, we went viral! both on TikTok and Twitter. It was an amazingly humbling experience -people donated and sent messages of hope and inspiration that lifted us up and kept us moving forward. We wrote more! We now have a curriculum called Fast Forward: Early Intervention Orientation and Mobility with Pediatric Belt Canes! We have two blogs, a revamped website, YouTube Channel, and lots of thank you letters to folks who reached into their hearts and donated to provide safe mobility to these wonderful toddlers. We had a great year because of people like you, our new staff and many collaborators. We are looking towards a bright future with excitement with three new resolutions for 2022. 1. Make New Friends Our mission is to provide toddlers and preschoolers who are blind and mobility visually impaired with a solution for walking safely - a pediatric belt cane for clear path detection. To meet our mission we need to increase the number of toddlers who are blind who are using these transformative devices. Our first 2022 resolution is to spread the word about pediatric belt canes far and wide so that many more toddlers who are blind or mobility visually impaired can learn to navigate the world around them with safe independence. In 2022, we hope to triple the number of pediatric belt cane users in the world. 2. Travel More In 2022 our resolution is engage in opportunities that allow us to bring the pediatric belt cane across the United States and the rest of the world. Last year, we shipped to 39 states and 12 countries! This year we resolve to provide toddlers who are blind with pediatric belt canes in in all 50 states, and in all 7 continents! 3. Stay in touch with the people who matter! In 2022 our final resolution is to improve our outreach to professionals and families who touch the lives of toddlers and preschool learners who are blind and mobility visually impaired. We want to hear from you about what matters most to you in raising and teaching a toddler who is blind and mobility visually impaired. We know that our population is so diverse, we want to make sure you are getting the information you need from us. Don't hesitate to reach out if you're interested in being a guest on our 2022 podcast. You can listen to our past podcasts here. With your continued support, we will reach our new milestones for this new year. Sincerely, Team Safe Toddles

Fast Forward Early Intervention Orientation and Mobility Curriculum will be paired with a smart belt connected to a pediatric belt cane (wearable white cane). For more information about the early intervention orientation and mobility curriculum contact Dr. Grace Ambrose-Zaken grace@safetoddles.org Please follow the survey link to answer the questions about your interest in obtaining the Fast Forward early intervention orientation and mobility curriculum with pediatric belt cane to assist in including the pediatric belt cane into the daily routines of a child who is blind or mobility visually impaired. Please complete this survey! https://www.surveymonkey.com/r/FZKS76B Preview of the Fast Forward Curriculum - explains why static standing is improved when wearing the pediatric belt cane.

Happy Thanksgiving from President and CEO of Safe Toddles Dr. Grace Ambrose-Zaken. We’re so thankful for your continued support, and can’t wait to see what’s next! #HappyThanksgiving #SafeToddles Thank you again for your continued support. Without you, we wouldn't be here!