Children who are unable to visually detect obstacles, drop-offs, and changes in surface have a mobility visual impairment (MVI) (Ambrose-Zaken, 2021). Without consistent tactile path information, toddlers with MVI are unsafe. Some may begin walking and running, but when you can't see where you're going, moving about causes injury and the result is children born with MVI tend to become inactive.
Toddlers with MVI avoid walking, even when verbally prompted, preferring to be physically guided, because it's safer. Toddlers with MVI are recognizable because when crossing open space, they walk slowly and cautiously with a wide gait and hands raised, “exhibiting a smaller stride length and more plantar foot contact” (Hallemans et al., 2011).
A person with MVI walking without an appropriate mobility tool will experience unavoidable falls and object collisions. These occurrences cause fear and a feeling of chaos the longer the duration of this- like a running through a college hazing gauntlet without end.
In a 2016 study on the impact of vision on the dynamic characteristics of gait, Gazzellini, et al., concluded that “The atypical gait of children with congenital blindness is explained by the lack of anticipatory control ”(Gazzellini, 2016). For children with MVI to have anticipatory control, they need a mobility tool that will effectively provide path information. According to Ambrose-Zaken, FallahRad, Bernstein, Wall Emerson and Bikson (2019), children who are five years old and younger are not yet able to use a long cane effectively, because the motor and cognitive skills required to demonstrate proper long cane techniques are not yet developed.
The pediatric belt cane provides young travelers with appropriate tactile path information, allowing them to freely and safely move about their environment without requiring the advanced motor skills for manipulating a rod cane (Ambrose-Zaken, et. al., 2019). The cane frame is a lightweight rectangle that magnetically attaches to the custom made belt. The rods of the rectangle are the standard long cane length which is determined according to the height of each child. The width of the rectangle is a standard arc width (Ambrose-Zaken, et.,al, 2019). When children with MVI wear their pediatric belt canes they demonstrated greater independent mobility. Children with MVI who wore their canes began walking with longer strides, narrower gaits, and faster paces. They had better posture and appeared more balanced. Their arms and hands naturally lowered to find the belt and their once rigid, clenched muscles relaxed.
Since prior studies had studied the outcomes of preschool learners with MVI wearing pediatric belt canes, it was important to observe whether younger children might also benefit from wearing their white canes. The purpose of this single-subject study was to observe and compare the number of steps walked by a one-year-old girl with optic nerve hypoplasia (ONH) resulting in MVI with and without the intervention of a pediatric belt cane.
Method Baseline. A single-subject repeated measures design was used. The participant was videoed for six minutes in the family room of her home by her mother at fifteen months of age without a mobility device. Intervention. At sixteen months of age, the participant was provided a pediatric belt cane. She was observed at seventeen months of age walking in the local mall for six minutes.
Measurement
The number of steps taken by the participant were counted in one-minute intervals during two, six minute videos. All steps were counted, a step was defined as anytime the child picked her foot off the ground and replaced it back onto the ground.
Results
The number of steps per minute taken by the participant is measured on the Y axis on the chart above. The X-axis displays the time in minutes. During baseline, the participant was left to play on her own in the family room. She stayed close to the furniture and a large baby toy. Although her mother called to her, she did not cross open space. The participant’s steps per minute were zero during the one, two, three, five and six minute intervals. During the 4 minute interval the she took five steps.
The one-year-old girl wore her pediatric belt cane for one month most of the day at home, when on family outings and during her O&M instruction. The intervention data was observed in two settings at an indoor mall. In the first three minutes of the video, the participant and her family were in a carpeted communal seating area. The last three minutes of the intervention video, the participate walked out of the seating area into the main lobby of the mall. The number of steps she took each minute ranged from four to ninety-three steps. In the carpeted setting, she walked 14, 4 and 14 steps in minutes one, two and three respectively. In the main lobby, she walked 55, 69 and 93 steps in minutes four, five and six respectively.
Discussion
Without a mobility device in her familiar environment, the participant took five or fewer steps each minute, mostly not walking at all. It is uncommon for a child this age to refrain entirely from independently crossing open space especially in familiar settings. Sighted children age fifteen months demonstrate a curiosity about their environment, expressed in abundant levels of independent walking (Bjornson, Song, Coleman, Myuaing, & Robinson, 2013).
During the intervention phase, the participant’s steps per minute consistently increased. Data for the intervention phase of this study was collected one month after she first began wearing her pediatric belt cane. The participant was observed in the mall play area where there were many obstacles and colorful surface changes (see photo). The participant walked around a little in the play area independently standing still (not holding onto anything or anyone). Once she was in open space, her steps per minute increased exponentially. After a month of using the belt cane, the participant was walking with a narrower gait, longer stride, and developmentally appropriate posture compared to baseline videos. She appeared confident to move and explore her environment independent of her mother's hand. She required no prompting to walk, instead her mother was engaged in teaching her the rules of staying with the group, (e.g., running away from mommy is not allowed).
Conclusion
For children with MVI to develop gross motor skills at an age-appropriate rate, it is crucial that they have the tools they need to enable them to feel safe and develop self-confidence. The pediatric belt cane provided consistent tactile path information with developmentally appropriate cane arc coverage. The cane arc was always in front of her next steps and, in that way, prevented bodily object collision. When the base of the cane detected objects, the one-year-old child wearing the cane received the information at the waist (through the belt connection). Once she began to understand that she would receive reliable information about obstacles ahead of her, she learned to interpret the information from the cane (e.g., clear or blocked path). As a result, she began to feel safe to move about familiar and unfamiliar environments. She was motivated to travel and explore freely and independently.
References
Ambrose-Zaken, G.V. (2021, March 25-27). Importance of Safe Mobility to Achieving Developmental Milestones: Part 1. [Conference presentation]. Virtual 2021 Rocky Mountain Early Childhood Conference. United States.
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, 1(4), 1-13.
Bjornson, K. F.,Song, C. Z., Coleman, K., Myuaing, M., & Robinson, S. L., (2013). Walking Stride Rate Patterns in Children and Youth, Disability and Rehabilitation DOI: 10.3109/09638288.2013.845254.
Gazzellini, S., Lispi, M. L., Castelli, E., Trombetti, A., Carniel, S., Vasco, G., et al. (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., and Meire, F. (2011). Development of independent locomotion in children with a severe visual impairment. Research in Developmental Disabilities, 32, 2069–2074. doi: 10.1016/j.ridd.2011.08.017 Safe Toddles. (2020) Safetoddles.org .