Functions of the Cane
and the Bottom-Up Approach to O&M for Children
Independent Movement and Travel in Blind Children: A Promotion Model
A Volume in Critical Concerns in Blindness
by Joseph Cutter
Introduction and Review
by Barbara Cheadle, Editor, Future Reflections
President, National Organization of Parents of Blind Children
Independent Movement and Travel in Blind Children: A Promotion
A Volume in Critical Concerns in Blindness
by Joseph Cutter
Includes bibliographical references
Copyright 2007 IAP--Information Age Publishing, Inc.
ISBN 13: 978-1-59311-603-3 (paperback)
ISBN 978-1-59311-604-0 (hardcover)
331 pages, large print font, black and white photos.
and paperback editions are available for purchase from IAP at <www.infoagepub.com>
(search by author, Cutter). Paperback copies are also available from the NFB
Independence Market: <IndependenceMarket@nfb.org>, fax (410) 685-2340,
phone (410) 659-9314, extension 2216.
Joe Cutter has finally done it. He’s written a book with answers
to the questions that parents have been asking ever since the NFB revolutionized
orientation and mobility (O&M) for blind kids by being the first to produce
and promote kid-size canes for toddlers on up. For years, parents have been
asking: When is a child ready for a cane? What kind of cane should she use?
How long should the cane be? What if my child has additional disabilities? Our
traditionally trained O&M instructor is using techniques and strategies
that don’t work with our three-year-old; is she just too young or is there a
different approach that will work?
The last question is key to understanding the unique breakthrough
that Cutter’s book represents. This is more than a book about cane techniques
and teaching strategies (although there is enough of that to satisfy the most
detail-oriented parent or instructor), it is a guide that lays out a whole new
way to think about and approach the facilitating of normal--yes, normal--movement
and independence in young blind children.
That’s what has made it so hard to select a segment to reprint
from the book. If we only print the practical tips and strategies, then the
reader will not fully understand the vital conceptual underpinnings; and if
we only print segments about principles and philosophy, then we lose the practical-minded
who are looking for specifics. So, as editor, I determined that to do this properly,
it required printing a segment from two different sections of the book. Going
in reverse order, the first segment is reprinted from chapter 4, “Cane Travel
for the Blind Child--From the Bottom Up.” This is a very practical discussion
of the specific functions, uses, and characteristics of the cane, with special
attention to its functionality and adaptations for the very young child. Last
is a segment reprinted from chapter 1, “The Promotion Model.” This segment is
a short explanation of the philosophy behind the practices that are described
in the book, with specific attention to the bottom-up concept that
Joe Cutter has pioneered in the development of the Promotion Model.
Having said all this, it still does not do justice to the importance
of this book. Since movement is essential to all aspects of development and
growth for every blind and visually impaired child, the value and scope of this
book goes far beyond questions related to the use of the white cane. In fact,
I can say--without hesitation--that if the parents, caregivers, or instructors
of blind/visually impaired children between the developmental ages of birth
to kindergarten could only have one book or one resource to consult--this is
the one they must have.
With permission of IAP--Information Age Publishing, here are
pages 149-160 as reprinted from Independent Movement and Travel in Blind
Children: A Promotion Model:
Functions of the Cane
The cane is a handheld tool used for independent movement and
travel. It performs many functions. Under the blind child’s direction, it can
inform, explore, inspect, detect, protect, and most of all, facilitate getting
to know and moving in the world.
To illustrate, the cane is more than a windshield wiper
on the world. It is the steering wheel that can be manipulated to where
the traveler wants to go and gives direction for whenever the traveler wants
to circumvent an obstacle. It is the headlights giving preview of what’s
ahead. It is the bumper protecting from unexpected encounters. It is
the antennae receiving resonance information about the sound space
world. It is the tires, adjusting to the terrain and providing a smoother
safe ride. Like the car, the cane is as effective as the driver who must obey
the laws of the road. The cane gets children where they want to go.
Below is a list of the basic functions of the cane.
- Tool Usage: In the progression of tool
usage, the cane is used intelligently by the child to reach off his/her body
and touch the world. It is a handheld tool. With practice, the cane increases
the safety, confidence, effectiveness, and efficiency of the child moving
about in the world.
- Protector, Detector, and Previewer: The
cane conducts information through its shaft into the blind child’s hand. This
is often referred to as feedback. The child, as a traveler, then
uses this information to decide how and where to go and what to do to get
there. Like vision, the cane tells the child what is ahead, detects what is
to be avoided or approached, and gives general preview, not only of where
the traveler will be stepping next but also echolocation information of objects
- Tool for Action and Sensory Integration:
The cane is a tool for active movement. It gathers information. Sensory integration
is what children do with sensory information. The cane facilitates sensory
integration, as it is a handheld tool used by the upper body that connects
to the ground, and this connection affects the movements of the lower body.
Occupational and physical therapists who work with blind children can be given
guidance to incorporate the cane into their therapy activities. When this
is done therapists find that the use of the cane facilitates sensory integration
of information. This occurs because the cane conducts information to the child’s
hand that travels up the arm into the child’s brain.
The cane decreases the need for self-stimulation by increasing
the active movement of the blind child in a purposeful and satisfying way.
Therapists agree that the less the child needs to think about the movement,
the more automatically it will be done. I can think of no other tool that
affords such facilitation of the goal of automatic movement with a handheld
tool than the cane.
- Tool for Normalizing Posture and Gait: Use
of the long cane assists with the child’s development of normal gait patterns
and posture. The research on movement in blind children typically reported
a wide-based stance, abnormal gait patterns, poor posture, and constriction
of the body when moving. These abnormalities were thought to be due to blindness.
We now know otherwise: they were due to lack of opportunity to use the cane.
The lack of opportunity for the blind child to use the appropriate tool at
the appropriate developmental time caused the abnormalities in posture and
gait to occur. With the long cane the child can stand relaxed and erect, develop
typical gait patterns, and move faster and more confidently.
- Tool for Play: Initially,
the cane is used and enjoyed by blind children in their play. The child has
fun with it, poking it in snow and bushes or exploring a playground. The child
taps it on different surfaces for the fun of hearing echoes. In an amusing,
fun way the cane introduces the child to the world beyond the fingertips.
Use of the cane stimulates the creative and imaginative nature of the child.
- Low Vision Aid: The cane can be used by
partially sighted children to look where their eyes cannot see; for example,
the cane looks down or to the side so they can look up. It touches
the world for children, offering the possibility that they may want to visually
view what it touched. The use of the cane as a low vision aid was covered
more extensively in chapter 3 in the section titled “Succeeding with Partial
- Tool for Confidence and Self-Esteem: O&M
is a confidence-based skill and the early use of the cane introduces the blind
child to experiences that increase self-confidence. When introduced early
in life, the cane affirms who the blind child is and what must be done to
be independent. The child develops confidence earlier in the what and
how of independent travel. Such confidence integrates into the personality
of the child.
- Tool for Freedom of Movement: The cane
affords the opportunities for freedom of movement and joy of movement that
is every child’s right. With it children decide where and when to go, and
how fast or how slow. The cane facilitates awareness of the child’s movement
and this increases attention span while moving and traveling in the environment.
- Tool for Cognitive Development: The cane
is a tool that provides opportunities for children to use intelligence in
thinking about self-directed movement, making decisions, developing good judgment,
and learning to problem-solve. Through self-monitoring the child directs the
movement of the cane to satisfy curiosity and understand the requirements
of safe and effective travel. Driven by cognitive interests, the cane is a
tool to learn about the environment. Its use facilitates the formation of
basic concepts about the environment and prepares the child for learning more
advanced O&M concepts and skills.
- Puts the Blind Child at an Advantage When Traveling:
The use of the cane has so many functions that it places the child
at a real advantage in learning about the world and in moving and traveling
in it. Through everyday experiences with the cane, blind children learn through
their own orientation and mobility to view themselves as independent travelers.
To not get an early start on cane travel for the blind child is to place the
child at a disadvantage and all of the aforementioned “functions of the cane”
are not a possibility; instead limitations will be developed by the passive
movement that following someone’s lead engenders. The child’s cognitive development,
freedom of movement, and confidence to travel independently is also at risk
of not developing. Make sure the blind child in your care is given all the
Characteristics of the Cane
The characteristics of the cane can affect the safety, effectiveness,
and efficiency of the traveler. As travelers, blind children and blind adults
have the same requirements for the characteristics of the cane. These main characteristics
that need to be considered when choosing a cane are: composition, weight, length,
grip, tip, flexibility of the shaft, resonance affordability, and one piece
As blind children mature and develop appropriate posture, balance,
hand-functioning, height, and size, they will use a proportionately larger cane.
Over the years, I have experimented with a variety of types of canes, grips,
and tips. I have found that the straight, hollow, flexible, lightweight, metal-tipped
canes, such as those available through the National Federation of the Blind,
possess the most advantages for the blind traveler. These canes start at about
24 inches and, as their length increases, the overall proportions of the cane
are scaled larger. The design of the cane is not altered. This creates
a seamless continuity for the child and makes it unnecessary to adapt to a different
type of cane.
The characteristics of the long cane can either afford the traveler
advantages in use of this handheld tool or not. Below is a list with a brief
explanation of the characteristics that have the most significant effect on
the independent movement and travel of blind children.
- Composition: Canes can be made of metal,
fiberglass, carbon fiber, and wood. What is important for blind children is
that the material used is lightweight and flexible and is a superior conductor
of resonance and tactile information. I have found the materials that facilitate
the child’s travel most to be fiberglass and carbon fiber.
- Weight: Remembering that a cane is a handheld
tool, the lighter cane has an advantage over a heavier cane because children
can more easily manipulate the use of it with the hand. A cane that is too
heavy will compromise hand-functioning. The lighter cane approach to travel
places children at an advantage.
With a heavier cane the blind child usually drags it behind
or keeps it to the side. This leaves the child vulnerable in front, as the
cane is not always clearing ahead. Canes that are too heavy will reduce the
control that the child has to manipulate the cane at the wrist, hand, and
fingers. Easy manipulation of the cane will be reduced. The heavier canes
restrict the possibility of a longer cane for younger blind children who need
the extra length to compensate for lack of extension of the arm and walking
in-step as older blind children and blind adults can do.
- Length of Cane: A lightweight cane introduces
the possibility for a longer cane to be introduced to the child. The O&M
specialist must take into account the fact that the blind child will not extend
the arm forward and not be able to walk in-step. These are developmentally
advanced skills beyond the capability of the young child. Therefore, a child-centered
measurement would be around the mouth-to-nose area. This gives the child more
time to react to an object when contacted.
The conventional approach of sternum/breastbone area as a marker
for length is based on the adult skill of walking in-step, adult reaction-time
capability, and other adult-based factors. When working with the bottom-up
approach, it is understood that the child will not have these same capabilities.
Therefore, this rationale for conventional measurement of length of the cane
- Grip of the Cane: It is important that blind
children be able to place their child-sized hands comfortably around the shaft
of the cane. An adult-sized cane that is cut down may be the correct length
for the child, but the grip circumference is often too big. Consequently the
child cannot grip the cane properly. In addition, some types of child-sized
canes on the market have a sponge or rubber type material around the shaft
with a section notched out for the pointer finger. In my work with blind babies
and cane use, they would often try to bite this material. This, of course,
was not safe, as the material is not meant to be chewed and digested.
A cylinder-shaped cane grip makes it easier for the child to
“grasp and go,” whether the child is right- or left-handed. A grip that has
one flat side is obtrusive to the child’s natural inclination to hold the
cane. In addition, the flat surface is for isolating the index finger, which
the younger blind child is not usually ready to do. Also, isolating the index
finger is a conventional O&M grip protocol, which is not necessary to
hold and use the cane proficiently, as there are alternative grip positions.
These are discussed later in this chapter.
- Tip of the Cane: The best type of tip for
the cane is a metal tip. The tips of the NFB-type canes are metal surrounded
by rubber and have a certain amount of flexibility. This way, the blind child
can get the crisp, clear information from the metal tip cane and is less likely
to get stuck in cracks in the sidewalk, as the child gains experience in handling
the various types of terrain. The cane can come with many different types
of tips. For example, the marshmallow (rolling and non-rolling), mushroom,
and teardrop tips (made of plastic/plastic-type materials) were developed
because it was assumed that gliding over uneven surfaces more easily would
be a good thing for blind children.
My experience has been the opposite, however. By easily gliding
or rolling over the ground, these tips reduce the texture information and
details of the ground surface. From the bottom-up, blind children need to
understand about cracks in the sidewalk, uneven terrain, and the more subtle
texture differences in ground surfaces. They need to easily identify where
the sidewalk, grass, and driveway differentiate. A cane tip that subdues this
information is not affording clear information. In addition, these types of
tips distort the resonance (sound feedback) that the cane should afford the
- Flexibility of the Cane Shaft: It is important
for the composition of the cane to have flexibility as it contacts the environment.
Fiberglass canes have a certain amount of give and take and can bend and go
back to their original shape. Metal canes are easily bent and once bent they
do not regain their original shape. Metal folding canes are the most frequently
dispensed canes in O&M instruction even though they easily lose their
shape and become deformed at the joint-fit.
In addition, there is the added factor of getting hurt. When
moving with the cane, blind children are learning about speed, confronting
an object, and reaction time with the cane. Earlier on in learning to use
the cane, children can hit an object and continue forward. This results in
the cane being pushed into their stomach or groin area. A more flexible cane
results in less of a push and a more user-friendly understanding of contacting
the object world.
- Resonance and Tactile Feedback Potential of the Cane:
The importance of the resonance capability of the cane cannot be
overstated. The blind child will learn to use resonance for information and
orientation, as in echolocation. The importance of tactile feedback is also
essential. It gives very useful information about ground surfaces and assists
in identifying what type of surface is ahead. Therefore, hollow, one-piece
canes made of fiberglass are superior conductors of resonance and tactile
information. In contrast, folding canes have elastic running down the shaft
that distorts and dampens resonance and tactile information, thereby providing
much less information to the child.
- One Piece Hollow Design: A cane made of
a one piece, hollow construction facilitates vibration and tactile information,
as well as resonance for echolocation use, in a superior way that folding
canes do not. For the first-time traveler it is best to use a one-piece, hollow-design
cane. In addition to facilitating these aforementioned characteristics, such
a cane affords the opportunity for the child to learn how to store the cane
in the classroom, cafeteria, and the car. When children are given a folding
cane, they do not have an opportunity to learn to store a one-piece cane.
- Folding and Telescopic Canes: Folding
canes should never be used as the blind child’s first cane. Folding canes
embody many negative characteristics for blind children. Here are some reasons
1. The elastic running down the shaft of a folding cane dampens and distorts
2. Folding canes add weight and this will reduce the increased length of the
cane that the child can handle without compromising hand functioning.
3. Folding canes increase dependence because many young blind children in
early intervention and pre-school cannot fold or unfold their cane; they must
rely on someone else to do it for them. This does not facilitate independence.
4. Folding canes convey negative messages about the cane. What message do
we send blind children when we ask them to fold their cane? Is the cane in
the way? Should it not be seen? It is subtle negative messages about the cane
that result in blind children developing poor self-esteem and negative thoughts
about the use the cane.
5. Telescoping canes have the advantage of having a hollow center and no elastic
running down the staff to distort resonance, but they don’t offer the stability
of the one-piece cane. These canes tend to telescope in when they hit an object.
Young blind children may not be ready to react quickly enough should this
happen and it could bring them in harm’s way.
Eventually, a telescoping or folding cane might be an option
as a back-up cane, or when the child has developed efficient reaction time and
a light touch with using the cane. However, in the early movement of blind children,
adults must promote what is known to be best to facilitate independent movement
and travel, and which affords a rich and valuable experience in using the cane.
When these characteristics of the cane are considered carefully,
we are more likely to choose a cane that places the blind child at an advantage.
The bottom line is this: any cane is better than no cane. However, if we are
to promote the independent movement and travel of blind children, we should
consider the characteristics outlined above. We should be placing blind children
at an advantage by using what we know has worked successfully when learning
to use the cane.
When these characteristics are considered and built into a cane,
this becomes the cane of choice for the blind child. There are blind adults
who use this cane of choice every day and blind children should have the opportunity
to use it too. The Resources chapter gives contact information for purchasing
this cane through the National Federation of the Blind.
Ideas for Adapting the Cane for the Child
To better meet the needs of the child, it may be necessary to adapt the cane.
The cane may need to be adapted for various reasons--hand and finger functioning,
keeping the tip oriented down, and differences in the child’s developmental
level to grip and use the cane. Below are some ways to adapt the cane.
- For some children “building up” a cane grip is needed for
better hand-functioning. Usually these blind children are working with an
occupational therapist. The therapist can assist in finding a grip for the
cane that will be more functional. The adaptation might be similar to what
is used by the child to hold eating utensils. Consider using a sponge taped
down with duct tape and a bicycle grip slipped over the shaft of the cane.
- For the child who has not yet learned to keep the cane down,
weight can be added. For example, tape a fish weight at the end of the cane,
just above the tip. This will not distort the resonance as much as the large
plastic tips discussed previously. For some children who need a heavier downward
orientation, a three to six inch piece of metal plumbing pipe may be added,
depending on how high the child is lifting the cane off the ground when walking.
Put the cane tip end through the hollow pipe, taking the cane tip off first
and then putting the cane tip back on and taping down the pipe.
- Velcro and therapy putty can be used to attach the cane
to the child’s desk vertically if placing it underneath the desk or table
is not an option. Velcro can also be used as a marker for where to hold the
cane for going up stairs or the shorten-position for navigating through crowded
areas, as discussed later in this chapter.
- Some children like the feeling of an edge at the end of
the cane that they can feel in the palm of their hand. A rubber band twisted
around the grip end can provide such an edging or a piece of Velcro taped
to the end.
- Some children prefer a different feeling on the grip, perhaps
a material that is softer. Taping over a thin sponge can create such a cushioned
These modifications can be removed as the child develops more
advanced hand-functioning and control over inadvertently lifting the cane, or
when personal preferences for griping the cane change.
[The following segment is reprinted from chapter one, pages
10-12, of Independent Movement and Travel in Blind Children--A Promotion
Model, with permission of IAP--Information Age Publishing.]
The Building Blocks of the Promotion Model
Below are the building blocks of the Promotion Model. First,
the philosophy, which is its essence and spirit. Second, the principles, which
are the foundational truths that support the model. Third, the developmental
perspectives, which are the fundamental beliefs to fuel and guide the model.
Fourth, the strategies, which put the philosophy, principles, and developmental
perspectives into a plan for action. And fifth, the practices and techniques,
which facilitate and put the strategies into action in the everyday learning
and development of life skills for the independent movement and travel of blind
Philosophically, we must acknowledge that child development
is built on gain and not loss. The adult-centered approach of conventional O&M
gives significant consideration to the loss of vision that adults experience
later in life. When looking at child development, however, the Promotion Model
recognizes that loss of vision does not factor significantly in the developmental
gains that children make every day. Children born blind or who lose vision in
the first years of life do not experience the type of loss associated with adults
who lose vision. These children have not acquired years of developing visual
skills nor do they possess a visual orientation to the world that has a long-standing
integration into their personality.
For blind children, success is not measured by how much vision
they have, but rather is built on how many skills are developed for independent
movement and travel. With one skill built upon another, the goal of development
is mastery over the environment to move and travel safely, confidently, and
In the Promotion Model, the child leads the way, and if we are
willing to learn from the child, many possibilities emerge. As an O&M professional
service provider, I have connected with parents of blind children, incorporated
them into my service delivery plan, and learned much from their experiences
with their blind children. I have partnered with the organized blind that have
provided me with positive, skilled blind role models for independent movement
and travel. The building blocks of the Promotion Model have been developed from
years of such learning from blind children, their parents, and skilled blind
adults (the organized blind). Together, they form the fabric of the “nature
and nurture” of independent movement and travel. Together, they present a formidable,
alternative program of O&M to promote the independent movement and travel
of blind children.
The child is not born with concepts of the world. The baby is
born with sensory systems, like “fingers of the brain,” that gather information.
With sensory and motor experiences the child matures over time and gives purposeful
thought to what is experienced. One way to describe this process is bottom-up,
which means that out of the experience comes the concept. If the experiences
we give blind children are developmentally sound they will experience independent
movement and travel age/stage appropriately. Blind children will develop the
concept or self-perception of themselves as travelers.
Historically, conventional O&M was developed as an adult-centered
approach. Its protocols were developed from an adult point of view for adult
learners. For instance, the adult was given the concept of a new skill and the
skill demonstrated for him/her. Then the newly blinded adult would perform the
skill. This can be described as a top-down approach, which means that
out of the concept comes the experience. This is a very different approach than
bottom-up, which is the perspective of the Promotion Model.
Bottom-up is driven by the sensory and motor experiences of
the child, and top-down driven by the cognitive concepts directing the movements
of the adult. For example, when blind children under three years of age are
learning to use the cane, they will need to be amused, explore, and have fun
with their cane. Their movements will be more exaggerated and less refined.
On the other hand, these are not the behaviors or the goal of the adult learning
cane travel for the first time; adults will be ready to perform at a different
cognitive level of understanding.
When promoting independent movement and travel in blind children
we need to approach skill acquisition from the bottom-up, making sure our intervention
and practice is suited to the developmental ability of the child. Imposing a
top-down approach at a developmentally inappropriate level will meet with frustration
and disappointment for both the child and the teacher. As a result, the conventional
O&M instructor often assesses that the child is not ready for O&M instruction
or ready for using a cane. In the latter case a pre-cane device is often used.
Within the Promotion Model, however, the blind child is ready for instruction,
just not from the top-down but rather from the bottom-up.