The Preschool Blind Child Can Be a Cane User: An Article Review

American Action Fund for Blind Children and Adults
Future Reflections Fall 2019 ORIENTATION AND MOBILITY

The Preschool Blind Child Can Be a Cane User: An Article Review

by Merry-Noel Chamberlain

From the Editor: Merry-Noel Chamberlain is a teacher of the visually impaired (TVI) and orientation and mobility (O&M) instructor based in Omaha, Nebraska. Recently she earned a doctorate in education from Concordia University. Her articles have appeared frequently in Future Reflections.

While I was conducting research for my doctoral dissertation, I came across an interesting article, "The preschool blind child can be a cane user," written by R. L. Pogrund and S. J. Rosen in 1989. It was featured in the Journal of Visual Impairment & Blindness at a time when fierce debate raged among O&M instructors over the best time to introduce the cane to young blind children. Because this article is packed with timeless practical information, I compiled this review to pass its ideas along to today's parents of blind preschoolers and young children.

First of all, Pogrund and Rosen state, "A growing body of anecdotal evidence from the O&M field demonstrates that early cane instruction can produce extremely positive results for the preschool blind child" (p. 438). I find this statement to be just as strong in 2019 as it was thirty years ago. Yet, even today, many blind preschoolers are routinely led around or carried by adults. In fact, this article is bursting with indispensable quotes, and I cannot state the authors' ideas any better!

Essential Quotes Found in the Article

"The goal of O&M is to facilitate an individual's independence to the greatest degree possible" (p. 435).
"Early O&M intervention is essential" [for preschoolers] (Ferrell, 1979) "and there is much for the young blind child to learn to achieve independent, safe, efficient, and graceful movement" (p. 431).
"No thought or consideration had been given to the development or the needs of young blind children when the original O&M sequence was designed" during World War II and in the postwar years (p. 431).
"The mobility tool the blind child will most likely use his or her entire life is the cane" (p. 432).
"The cane is an extension of the arm as it probes the environment" (p. 434).
"If blind preschoolers travel only with sighted guides or by using basic skills along rote routes of travel, they will have little opportunity to explore the environment" (p. 434).
"With the use of a cane as a tool to facilitate safer movement, children will most likely be more interested in and more willing to explore their surroundings" (p. 434).
"The way young children learn about the world is through interacting with it" (Hazen, 1982; Herman, Kolker, & Shaw, 1982) (p. 434).
One "potential benefit of cane use for the severely visually-impaired child is that it serves to show sighted peers and adults that the child has a vision problem; thus, the child avoids such labels as clumsy or awkward. The label visual impairment is one the individual will live with for the rest of his or her life. The cane offers an easy explanation to others" (p. 435).

Prerequisites and the Use of Push Toys as Pre-Canes

Many instructors believe that human guide skills are a prerequisite to learning the proper use of the cane. However, Pogrund and Rosen argue that this is not true. They state that high levels "of body, environmental, and spatial concept awareness" are not prerequisites for learning to use the long white cane (p. 436). Furthermore, long-term use of a push toy hinders the transition to using the cane as a primary mobility tool. Push toys such as miniature grocery carts and hula hoops sometimes have been used to teach the bumper or probe concept, and they are great during playtime. However, they cannot be with the child all the time. Pogrund and Rosen point out that these toys protect "the child from more of the environment than is necessary" and that push toys "do not provide the child with the tactual and auditory feedback useful in identifying various textures and obstacles in the environment" (p. 432).

Safety Rules of the Cane

Thirty years ago, Pogrund and Rosen stated that preschoolers need to keep the cane tip on the ground at all times and in front of the body when walking forward. I would like to add, however, that keeping the cane tip on the ground at all times may be difficult for preschoolers. After all, they are natural wanderers, and they will want to explore with whatever tools they have on hand. Preschoolers often scribble with a crayon before they learn to print letters. In the same way, blind preschoolers will play with the cane to discover what it can do. They will over-swing the cane, lift it up in the air, or even drag it behind them. This behavior is very natural for children their age. We cannot expect three- and four-year-olds to hold the cane correctly and keep it on the ground at all times, but we can encourage them to do so . . . again and again . . . just as Pogrund and Rosen suggested thirty years ago.

Historical Debates

Needless to say, there has been an ongoing debate between traditional and non-traditional O&M instructors for many years. This article reveals that the debate was alive thirty years ago, and it still lingers today. Pogrund and Rosen leaned toward the new way of thought, as shown in the table below.

Old Way of Thought	New Way of Thought
Preschoolers need to learn pre-cane skills before being introduced to the cane. This includes: sighted guide, information gathering, protective and alignment techniques, etc.	The term pre-cane is a misnomer, and many O&M instructors feel the term needs to be changed to ‘basic skills’ in which instruction can be used with or without the cane. The term pre-cane implies that the child must master such skills prior to cane introduction. This means a child may be over the age of eight before receiving his first cane.
Preschoolers are not physically, cognitively, or socially ready before the age of eight to use a cane.	“Much of the motor passivity seen in many blind children is due to an inhibition of their normal tendencies to move rather than their lack of motivation to move” (p. 431).
Preschoolers do not have motor control or coordination to use the cane so they are not physically ready to use a cane.	“It does not take tremendous motor control to hold a cane….The cane is still acting as a bumper and a probe out in front of the child while not requiring a significant amount of motor control or muscle development” (p. 432).
Preschoolers do not need to use canes in familiar environments such as home, yard, classrooms, playgrounds, schools, etc.	Environments are dynamic. “No matter how well orientated a child is or how accurately a child uses basic skills in other environments, he or she will inevitably trip over something or bump into something unexpectedly in the ever-changing world” (p. 432).
Preschoolers will hurt other students with their canes because they are not mature enough to handle dangerous items.	“A child is not prohibited from playing with a variety of toys, which, if used improperly, could be dangerous to others (e.g., metal trucks, bats, stick toys)….Basic safety rules are essential, as are appropriate consequences if the rules are not followed…One cannot assume that a child cannot learn such rules if they are correctly taught and appropriately reinforced” (p.432).
Preschoolers will develop inappropriate cane habits which are difficult to change later.	“Do we refuse to give young children a crayon or pencil for scribbling just because they do not hold it correctly and make appropriate letter strokes? Do we refuse to give young children a spoon or fork just because they do not hold and use these eating utensils correctly?...Waiting to have any interaction with a writing tool, eating utensil…until a child has all the coordination, motor control, and/or strength to perform a skill perfectly is inappropriate and does not coincide with normal child development and normal patterns of learning” (p. 432-433)

Early Cane Travel Effects

Have you ever wondered how a preschooler's posture is affected by not using a cane? Poor postural patterns such as rounded shoulders, a backward lean of the trunk, a forward head, and lordosis, as well as poor gait patterns such as shuffling are difficult to correct when the child is older. Pogrund and Rosen discuss the long- and short-term effects of cane use on gait (p. 433):

Gait patterns are similar for both young sighted and blind children.
Typical gait for young children includes small steps, no reciprocal arm swing, out-toed position of the feet and legs (Macgowan, 1983; Miller, 1967; Rosen, 1986).
For a blind child, using a cane allows "gait patterns to mature the same way and at the same rate as they do in sighted children."
Without using a cane, the blind child may shuffle or stomp the floor with their feet as a way to decrease impact when bumping into objects.
"Motor problems and irregular gait patterns are learned behaviors, developed out of a need to try to maintain orientation and balance while moving.”

Effect of Movement

Pogrund and Rosen go on to describe the problems associated with restricted movement in young blind children and the positive effects facilitated by the early use of the cane (p. 434):

"After several unpleasant encounters with the environment, blind preschoolers soon learn that it is safer to stay in one place unless someone else moves with them, thereby offering a form of security.”
Moving through the environment without a cane does not reinforce confidence in one's ability to travel.
When the natural need for vestibular stimulation is not met, one will turn to self-stimulation such as rocking or side-to-side head movements.
"All the research available on early movement suggests that the more young blind children move, the better their muscle tone develops and their vestibular systems are stimulated" (Ayres, 1979; Palazesi, 1986).
The decreased fear of movement through cane use will motivate the child to move more in the environment.
If the preschooler is using the cane as protection when walking in the environment, the child may not feel the compelling need to develop as many inappropriate mannerisms because she or he will, in general, be more active.

Effect on Environmental Exploration and Concept Development

If the preschooler only travels with the use of a sighted guide there will be little opportunity for environmental exploration (p. 434):

With the use of a cane as a tool to facilitate safer movement, children will most likely be more interested in and more willing to explore their surroundings.
“The way young children learn about the world is through interacting with it" (Hazen, 1982; Herman, Kolker, and Shaw, 1982).
"The child must first feel safe before moving to higher cognitive levels" (Maslow, 1954).
"The passivity and lack of curiosity often exhibited by blind children may well stem from their fear of movement and the resulting lack of motivation to explore their environment" (Burlingham, 1965).
"A limited interaction with the world results in less knowledge of the environment. Such knowledge is a significant component in optimum concept development" (Hill et al, 1984).

Effect on Attitude Toward Acceptance of the Cane by Family, Child, Peers, and Professionals

For a number of reasons, it is generally easier to introduce the cane to children, their families, and their schools at a young age (p. 434):

Preschools are generally open and positive to having a child use a cane. As soon as staff members realize that the cane works as a bumper and probe to protect and warn the child, they recognize its benefits.
In general, preschoolers are not concerned about their peers' attitudes about the cane. Preschool classmates are usually more accepting than peers at the middle- and high-school levels.
After preschool, it is common to find resistance from the blind child and family members when introduction of the cane is suggested. The child and family have become accustomed to not using a cane, despite the safety concerns and the lack of efficiency and grace that result.
Some parents, children, and members of society regard the cane as a negative symbol of blindness. "Blindness cannot be denied once a cane is used" (Wier, 1988).
When the preschooler uses a cane, parents observe the child's freedom of movement and the safety the cane brings to their child. Thus, they gain a more positive attitude toward the cane.
The cane becomes an integral and natural part of the preschooler's functioning within the preschool environment and the home.
Because safety is improved, administrators, regular education teachers, and other professional staff may be more accepting of having a blind child in their school.

Effect on Self-confidence and Autonomy

Learned helplessness occurs when much of the preschooler's life is controlled by others, leading to passivity and lack of purposeful movement (p. 435):

"With the use of a cane, the young blind child has one area in which he or she does not have to be so dependent on others and thus can feel some degree of autonomy in and control of the world. It is through this feeling of control that competence, which leads to better self-esteem and self-confidence, develops" (Stotland & Canon, 1972; Hill & Ponder, 1977; Hill et al, 1984).
The more preschoolers are able to act effectively within the environment, the higher their level of self-esteem. The feeling of independence needs to develop during preschool to ensure that self-esteem will develop. The preschooler "who does not always have to go with a sighted guide and who can extend her or his travel beyond rote routes using basic skills is more autonomous and feels more self-confident." When the child moves about freely in the environment with the use of a cane, others will view him or her as being more competent and less dependent and will begin treating her or him with more respect.
Early cane use may be one very important factor in disrupting the cycle of learned helplessness.

Effect on Mobility of Low Vision Children

Like children with little or no vision, children with some usable vision can also benefit from early use of the cane (p. 435):

If the child moves with hesitancy and moves unsafely, inefficiently, or ungracefully, using a cane may allow the use of residual vision for such purposes as scanning the environment or locating visual landmarks, rather than cautiously monitoring the ground immediately in front of his or her feet.
The cane provides needed security to promote freedom of movement within the environment.

A Few Ideas for Introduction of the Cane

This article of thirty years ago is just as powerful today as it was back then. It is my hope that we all revisit this article and move forward, rather than having parents and professionals look back thirty years from today and conclude that nothing ever changed. We need to start early with our preschoolers in order to give them a fighting chance to become independent travelers. Here are some final thoughts:

Although preschoolers need the primary motor abilities to grasp the cane and to walk independently, the natural first step is to permit the child to explore freely with the cane.
The cane can be used as a bumper for protection, teaching cause and effect in the process. Shape the skill, and then provide time for the child to perfect it. "Shaping is a process of refining skills slowly over time, with reinforcement, for closer and closer approximations to the desired skills" (p. 435).
There is no need to work on everything at once. Present skills at a pace compatible to the preschooler's attention span and learning ability.
Preschoolers do not have to have expressive or receptive language to use a cane. "The use of techniques such as modeling, nonverbal communication, physical prompting, and receptive touching are effective in teaching children without these language abilities" (p. 435).
As soon as possible, integrate the cane into all daily activities (both at home and at school).
Help the preschooler to walk with the cane — even if you have to bend over to do so. Attend a NFB Cane Walk.
Have fun and be positive; children quickly pick up and mirror your attitude toward the cane.

References

Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.
Burlingham, D. (1965). “Some problems of ego development in blind children.” Psychoanalytic Study of the Child, 20, 194-208.

Ferrell, K. (1979) “Orientation and mobility for preschool children: What we have and what we need.” Journal of Visual Impairment & Blindness, 73(4), 147-150.

Hazen, N.L. (1982). “Spatial exploration and spatial knowledge: Individual and developmental differences in very young children.” Child Development, 53(3), 826-833.

Herman,J.F., Kolker, R.G., & Shaw, M.L. (1982). “Effects of motor activity on childrens intentional and incidental memory for spatial locations.” Child Development, 53(1), 239-244.

Hill, E., Rosen, S., Correa, V., & Langley, M (1984). “Preschool orientation and mobility, An expanded definition.” Education of the Visually Handicapped, 16(2), 58-72.

Macgowan, H. (1983). “The kinematic analysis of the walking gait of congenitally blind and sighted children: Ages 6-10 years.” (Doctoral dissertation, University of Minnesota 1983). Dissertation Abstracts International, 44, 703A.

Miller, J. (1967). “Vision, a component of locomotion.” Physiotherapy, 53, 326-332.

Palazesi, M.A. (1986). “The need for motor development programs for visually Impaired preschoolers.” Journal of Visual Impairment & Blindness, 80(2), 573-576.

Pogrund, R.L., Rosen, S.J. (1989). "The Preschool Blind Child Can Be a Cane User." Journal of Visual Impairment & Blindness, 431-39.

Rosen, S. (1986). “Assessment of selected spatial gait patterns of congenitally blind children.” Unpublished doctoral dissertation, Vanderbilt University, Nashville, TN.

Stotland, E. & Canon, L. (1972). Social psychology: A cognitive approach. Philadelphia: W.B. Saunders Co.
Wier, S. (1988). “Cane travel and a question of when.” Journal of Visual Impairment & Blindness, 82, 197.

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