Figure 1, SWOMA 2017 Logo showing a stick figure women with a cane, stick figure man with a dog guide, a compass with braille letters N, S, E, W, and Conference title of "Exploring Changing Times"

SWOMA ConferenceOctober 20-21, 2017Houston, TX

Mobility Devices and Very Young Children

Presented by Kay Clarke, Ph.D., COMSWorthington, Ohioklclarke630@gmail.com

Slide 1, MOBILITY DEVICES AND VERY YOUNG CHILDREN:Clues to Making Informed Decisions

Figure 1 A toddler pushes a toy cart as he walks.

Kay L. Clarke, Ph.D. – COMS

Slide 2, Where Does our Field Stand on Devices? Shift in thinking over past 3 decades

Not “IF” but “what”, “when”, and “how”

Cane vs. Alternative Mobility Devices

Anecdotal evidence

Questions remain

Figure 2 Images of a walking and popping toy, a hula hoop, long, white cane, and an adaptive mobility device

2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 1

Slide 3, Devices in Perspective

Figure 3 Image for disability with four boxes showing wheel chair, sign lanuage, travler with long cane, and cognitive

Devices are not a panacea

o ”No amount of equipment can encourage growth for which inner readiness is not mature” (Breckenridge & Murphy, 1963)

o Emphasis on devices alone does not facilitate purposeful travel

Devices are a single element in a highly complex network of skill areas which enable a child to master the environment

Slide 4, Traditional O&M Components

Figure 4 Child holding an adult's finger.

Body imagery

Sensory skills

Spatial skills / mapping

Self concept / esteem

Environmental exploration

Concept development

Self-protection

Human guide

Basic skills

Mobility devices

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Slide 5, Mobility Devices for Very Young ChildrenMobility Device = a mobility instrument that can be used as a developmental support, a bumper, and a probe for travel purposes

Figure 5 A folding white cane

Slide 6, Types of Devices for Very Young Children(Adapted from: Clarke, 1988)TRANSPORT / SEATING

(carrier; swing; bouncy seat; stroller; travel chair)

Figure 6 Series of images from left to right: Images showing devices: a carrier, swing, bouncy seat, stroller, and travel chair

Slide 7, Types of Devices for Very Young ChildrenUPRIGHT - SUSPENDED(baby jump seats; body harnesses with track; hopsa dress)

Figure 7 Series of images from left to right: harness with track, baby jump seat, HOPSA Dress

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Slide 8, Types of Devices for Very Young ChildrenCREEPING / CRAWLING - WITH SUPPORT

(blankets; scooter boards; support bench; prone crawlers)

Figure 8 Series of images from top left clockwise: blanket, scooter board, support bench, prone crawler.

Slide 9, Types of Devices for Very Young ChildrenWALKING – WITH SUPPORT

(walkers; hula hoop; cruising surfaces; push toys; body harnesses; transition objects)

Slide 10, Types of Devices for Very Young ChildrenSELF-GUIDED RIDE IN / ON(riding push toys; pedaled vehicles; wheelchairs; powered mobility)

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Figure 9 Series of images, top row right to left: child on walker, hula hoop, playpen, body harness and bottom row left to right push toy, transition object and stroller.

Figure 10 Series of images from left to right tricycle, powered mobility device, wheelchair, riding toy.

Slide 11, Types of Devices for Very Young ChildrenWALKING – WITHOUT SUPPORT

(hula hoop; push toys; adapted mobility devices; long cane)

Figure 11 Images from top left clockwise: hula hoops, popcorn push toy, adapted mobility device, long cane.

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Slide 12, Bicycle Analogy

Figure 12 Series of images in progression: infant in child seat on back of parent’s bike, toddler on three wheeled toy with feet able to easily touch ground, child on tricycle, child on two-wheel bike that is foot propelled, boy on bicycle with training wheels, and finishing with a girl riding a bicycle unaided.

Slide 13, Early O&M Components

Figure 13 Infant reaching for brightly colored toy

Object / person permanence

Cause-effect

Choice-making / requesting

Reaching / movement

Purposeful, self-initiated actions

Problem-solving

Social interactions

Attachment / secure base

Social referencing

Self-control

Object interactions / play

Tool use

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Slide 14, Tools for Very Young Children

Figure 14 Toddler wearing a bib and using a child’s utensil with a palmar grasp, enjoys eating from a bowl

Tool = an object that is used as an extension of the body for a specified purpose

*Gradual process: Blossoms at 18 months to 2 years developmental age

Slide 15, Types of ToolsDeveloped & refined from ~ 8 months onReaching & connecting (step stool; leash; rope)

Eating (utensils; cups)

Figure 16 Photo of a young child with a huge smile eating cake and ice cream with a fork

Musical /rhythm (maracas; drum; xylophone)

Figure 17 Image of maracas

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Figure 15 Images of child's step stool and puppy on a leash

Slide 16, Types of Tools Play (toy tools; pounding benches; string toys)

Figure 18 Child’s toy hammer and pegs to hammer

Self care (toothbrushes; hairbrushes)

Figure 19 Young girl smiling while brushing her teeth

Language (words / sounds as tools)

Figure 20 Baby and Mother staring at each other intently as though communicating

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Slide 17, Types of ToolsCooking (pots & pans; cooking utensils)

Figure 21 Two young children sitting on floor banging on metal pots and bowls with a whisk and a spatula

Cleaning (sponges; dusters)

Figure 22 Bucket filled with cleaning supplies next to sponges and a spray bottle

Gardening (child-sized rakes; shovels; trowels)

Figure 23 Toy rake and toy shovel

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Slide 18, Types of ToolsArts & crafts (paint brushes; glue sticks; scissors)

Figure 24 Paint brushes with large, easy to hold handles

Construction (blocks; scrap materials)

Figure 25 Young boy stacking letter blocks

Scribbling & writing (print / braille)

Figure 26 Two images on the left child scribbling and on the right child pressing keys on a Perkins Brailler.

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Slide 19, Types of Tools Technology (tablets; computers; cell phones)

Figure 27 Toddler holding a tablet.

Vision (binoculars; magnifiers)

Figure 28 Two images, on the left a child holding binoculars and to the right, a child examining a leaf with a magnifying glass.

Slide 20, A Mobility Device as a Tool Functional device use is a complex form of tool use

Necessitates effectively manipulating the device while navigating through an ever-changing environment

With limited or no visual feedback

Figure 29 Image of a stick figure walking with a white cane

Slide 21, Clues to Making Decisions

Figure 30 Cartoon image of an inspector holding an oversized magnifying glass to his eye

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Slide 22What are early experiences and skills that may prepare a very young child for effective device use?

Figure 31 Cartoon figure scratching its head with a question mark thought above its head

Slide 23, Tool Use Progression(Schwartz & Reilly, 1981)

Hands - Hands-on exploration

Figure 32 Infant feeding himself with his hand; his face and hand both covered with food

Short, light tools “Transition tool”

Figure 33 Toddler using a child-sized toothbrush

Longer, heavier tools Mobility device

Figure 34 Very young girl walking with a supportive walking toy

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Slide 24, Ability to Use Tools Hands

Figure 35 Child’s hand using a tool to spread paint on paper

Thinking

Figure 36 Graphic of a human head with interlocking gears inside

Spatial Understanding

Figure 37 Child’s hand placing a cube into a shape sorting toy

Experience

Figure 38 Family with two young children sitting down having a meal together

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Slide 25, Learning to Use Tools: Hands

Figure 39 Small child’s hand

Hands as first “tools” (Schwartz & Reilly, 1981)

Simple grasp and release

Bang hand-held objects (Kahrs, Jung, & Lockman, 2012)

“Hands-on” exploration of objects

Modify grasp necessary for manipulating various tools (Connolly & Elliot, 1972)

Self-directed use [moving to] external goal (McCarty, Clifton, & Collard, 2001)

Coordinate manual skills & other behaviors occurring simultaneously (e.g., objects carried while walking -- not dropped) (Cratty, 1986)

Slide 26, Learning to Use Tools: Thinking

Figure 40 Cartoon silhouette of child’s head that is filled with bubbles of numbers, letters, music, art, science, etc.

Means-ends relationships (Castle, 1985)

Combining objects in play (Bruner, 1972)

Problem-solving (Claxton, McCarty, & Keen, 2009)

Symbolic thinking (Bates, 1979)

Think about 2 things at once in relation to each other (Newson & Newson, 1979)

Understand tool function - “I cannot identify the thing as a tool if I do not know what it is for…” (Polyanyi, 1958)

Manipulate tool [moving to] Know what tool has contacted (Polyanyi, 1958)

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Slide 27, Learning to Use Tools: Space

Figure 41 Young child having a bath in the kitchen sink places its hand on the window sill to balance as it peers into the world outside.

“Space is a puzzlement for young children. Even an older toddler, who has just seen his ball roll under a table, is likely to chase after the ball, retrieve it by ducking under that table and then, forgetting that the space above his head is bounded by the table surface, stand up suddenly and hit his head.” (Honig, 1981 – p. 8)

“Controlling an object may not be as much of a problem as spatial accuracy.” (Keogh & Sugden, 1985)

Localize limbs in space for reaching/grasping

o Accuracy by ~ 12 months for sighted children (Keogh & Sugden, 1985)

Readjust perception of location in space when hand is holding a tool

o More difficult when limb is moved while holding an object (Keogh & Sugden, 1985)

Implications of limited visual input

Slide 28, Learning to Use Tools: Experience Many and varied experiences with objects (explore, play with, use) (Vandenberg, 1978)

Integrate knowledge of objects w/ knowledge of body (Schwartz & Reilly, 1981)

Pressure-free “trying out” period in a variety of contexts (Bruner, 1972)

Master sub-skills before using tool functionally (Strelow & Warren, 1985)

Opportunities and expectations (Keogh & Sugden, 1985)

Role of observing others (Deak, et al, 2014)

Familiarity and practice

Focus on tool [moving to] Focus on task (Vandenberg, 1978)

Figure 42 Mother and Baby sitting on floor together playing with kitchen tools

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Slide 29, Components for Using a Tool(Schwartz & Reilly, 1981)

Grasp tool with 1 or 2 hands

Localize working edge in space where it will have effect

Manipulate working edge to carry out task

Release tool to end activity

Figure 43 Baby sitting up and playing xylophone with wood mallet

Slide 30, Tool Skill Development Grasp & Release

“Calibration” – hand in space

“Recalibration” – hand + tool in space

Focus on tool in hand [moving to] Focus on working edge

Skilled manipulation of tool’s working edge

Figure 44 Toddler using a plastic hammer to crush things in a zip-lock baggie

Slide 31What factors can we use to determine the optimal time to introduce a mobility device for travel purposes?

Figure 45 Cartoon figure scratching its head with a question mark thought above its head

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Slide 32, Introducing Device Individual differences (Warren, 1994)

Hand, thinking, & spatial skills

Short, light tool use experiences (Schwartz & Reilly, 1981)

“Walking age” and stability

Amount of direct physical exploration

Complexity of travel environment(s)

Experience, understanding, & familiarity with device

Family comfort level & support

Figure 46 Series of children in a progressing from sitting to forward crawl, to quick crawl, to squat, and on to early walking

Slide 33Can there be costs as well as benefits to early introduction of a device?

Figure 47 Cartoon figure scratching its head with a question mark thought above its head

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Slide 34, Potential “Costs” Task demand overload Barrier between child and environment: Implications for

orientation

Safety concerns

Impact on motor development

Inhibition of child’s travel

“Looks” good…but effective?

Figure 48 Photograph of a woman walking with a young child; the child is holding onto the woman’s hand with one hand and holding a long white cane in the other

Slide 35Additional Thoughts…

Figure 49 Cartoon lightbulb indicating an idea

Slide 36, Movement or Navigation?(Pasthas, 1976)

Movement = mechanics of locomotion with no endpoint (“wandering”)

Navigation = goal-directed locomotion

QUESTION: Is this young child simply moving, or moving with purpose, when traveling with and/or without a device?

Figure 50 Cartoon lightbulb indicating an idea

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Slide 37, Moving Through or Interacting With the Environment?

Figure 51 Cartoon lightbulb indicating an idea

Moving Through = getting from place to place

Interacting With = physically interacting with and learning about the environment along the way

QUESTION: How can we be sure that this young device user has sufficient opportunities for direct interaction with the environment as he travels from place to place?

Slide 38, Device as Intermediary or Barrier?

Figure 52 Cartoon lightbulb indicating an idea

Intermediary = acts as a mediator / link between child and environment

Barrier = serves as a barricade that separates child from her physical and/or social environment

QUESTION: How can we minimize the barrier effects of this child’s device and maximize the intermediary aspects?

Slide 39, Device Manipulation or Functional Use?

Figure 53 Cartoon lightbulb indicating an idea

Manipulation = mechanics of physically moving a device

Use = implies that device is serving its intended functions

(developmental support; bumper; probe)

QUESTIONS: Is the device fulfilling its intended functions for this child? If not, are there other device options or ways to continue to improve the use of the current device so it is more functional?

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Slide 40What are important considerations when selecting the best device option for a very young child?

Figure 53 Cartoon figure scratching its head with a question mark thought above its head

Slide 41, Selecting a DeviceChild’s overall development (not age)

Child’s strengths

“Try out” period (options)

Pros and cons of device thoroughly assessed for child

Suited to child’s environment(s) / travel needs

Safety and effectiveness of use (keep records)

Family support / adult monitoring

Figure 55 Cartoon image of a checklist being checked off

Slide 42What are effective practices for teaching a very young child to use a device?

Figure 54 Cartoon figure scratching its head with a question mark thought above its head

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Slide 43, Principles for Instruction Determine a good child-device match

“Getting to know my device” period

Safety rules (emphasis on what TO do)

Experimentation phase (free flowing)

Guidance in effective use - strategies for young children

Opportunities to contact obstacles / environmental features

Parent/staff input & involvement

Figure 55 Toddler holding a long cane and learning to use it while walking; she is being closely followed by an adult walking with a teaching cane.

Figure 56 A young boy walking with an adaptive mobility device while an adult watches closely nearby

Slide 44Additional Questions or Comments?

Figure 57 Cartoon figure scratching its head with a question mark thought above its head

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SWOMA SponsorsRegion 4 Education Service Center (ESC), Houston

Figure 58 Region 4 ESC logo.

Texas School for the Blind & Visually Impaired

Outreach Programs

Figure 60 IDEAs that Work logo and OSEP disclaimer.

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Figure 59 TSBVI logo