Long canes / Adaptive Mobility Devices
Joani Levy (Myers), O&M Specialist
Collaborative use ensures acquisition of concepts and skills required to become a safe, efficient, independent traveler.
There should be no controversy between the use of the standard long cane and an adaptive mobility device (AMD), because each mobility device has its unique positive and negative qualities. Both should be viewed as tools for achieving the skills necessary to become a knowledgeable, safe, efficient long cane traveler. It must be understood, however, that individuals with certain physical challengers may be unable to use the standard long cane effectively, and thus their primary mobility tool would be an AMD.
When a child who has severe visual impairment becomes ambulatory, both an AMD and long cane should be introduced, because both devices provide unique qualities that facilitate the development of environmental awareness, proprioception, and kinesthesia. The AMD facilitates body-width protection, which enables the child to move safely while detecting objects, stairs, and curbs. This protection cannot be provided by the long cane without sophisticated fine or gross motor movement which the child at this stage of development does not yet have. The long cane's size, weight, and design, however, facilitates the acquisition of auditory knowledge that an AMD cannot.
It is not reasonable nor in the child's best interest to think that care givers will monitor the child's movements at all times. Care givers must be highly selective to determine which environments and situations the child should be utilizing which mobility device (or in some cases no device at all). In this way, the child's awareness of the environment expands at a greater rate while promoting the safety of the child and others.
Throughout the period that the child uses an AMD, regardless of age, attempts should be made to integrate the standard long cane. Frequent exposure is necessary because it is difficult to determine exactly when the child has developed the maturity, cognition, fine and gross motor skills, proprioception and kinesthesia that are required before the cane can be used effectively as a primary as a primary mobility device.
EXAMPLES OF USING AMDs:
"Sandy" is a 2-year-old child who has light perception only. She has average intelligence and no additional disabilities. Sandy constantly wanted to move around, particularly toward light sources. She had a limited understanding of the potential dangers imposed within various environments and would move with no protective techniques, using atypical gait patterns. A standard long cane was demonstrated to her but she used it haphazardly, providing her little protection and endangering other children in her preschool class. One-to-one supervision was not available on a regular basis in the school situation to help alleviate the situation.
Sandy was then presented with a basic T-shaped AMD which, like the long cane, has one shaft, but has a T-bar as the tip. This device enabled her to implement the same opportunities at home and school to practice pushing it ahead of her body to maneuver hallways, ramps, stairs, sidewalks and curbs, using her other hand to trail or explore as desired. Her pace increased, movements became more coordinated, and in general she demonstrated more self-assurance.
During the same period of time that Sandy used the T-cane, she practiced using the long cane and was given opportunities to move with the cane while closely supervised. After Sandy had matured (at about age 5), the long cane became her primary travel device.
"Sam" is a nine-year-old child who is totally blind and who has mild cognitive delays. After a few years of receiving cane instruction by another O&M specialist, Sam was still unable to maintain body-width protection while using two-point touch or constant-contact cane technique. Because he held the cane diagonally to his right with his right hand, he never received any information about obstacles directly ahead of his body.
Sam was given a Side Drop-off Tee Cane that I designed last year which is shaped like Sandy's T-cane with two differences: 1) the T-tip was modified such that it wold detect parallel drop-offs and 2) the grip has a short elbow bar extending to the left, which Sam periodically touched with his other hand to check the midline position of the device. Using this device Sam was able to travel safely, efficiently, and independently whenever he desired and, like Sandy, was able to use his free hand to trail and explore. Periodic checks using a long cane were done to assess his ability to maintain proper arm position for body-width protection. Ultimately Sam was able to use a standard long cane as his mobility device.
"Jennifer" is an 8-year-old child who is totally blind, with average cognitive functioning. She has a shortened left heel cord, and muscle tone like that of cerebral palsy affecting her left side and part of her right. Jennifer had also been receiving instruction in the long cane by another O&M specialist for several years but she also was unable to move the cane in a consistent body-width lateral motion, and consistently veered to her left. She had many fears when traveling independently, particularly of contacting descending stairs.
After several more months of training with the long cane as well as frequent intervention by the occupational therapist, a Side Drop-Off T-cane with a T-grip was presented to Jennifer. With practice, this AMD enabled her to maintain body-width protection, a straight line of travel, and the confidence to move independently, even near descending staircases.
Currently, Jennifer uses both the AMD and the standard long cane. She uses the AMD on routes she hasn't yet mastered because her cane technique becomes ineffective when she has difficulties with orientation; using the AMD enables her to concentrate on the environmental landmarks and clues, rather than on cane techniques. She uses the long cane, however quite effectively on short, familiar routes.
Jennifer at all times determines which device she is comfortable using The focus of her O&M program is improving her skills with orientation and with the long cane. It is difficult to predict, however, whether she will eventually use a long cane, an AMD, or both devices depending on the travel situation.