Toddler Cane’ Can Help Prevent Speech and Motor Skill Developmental Delay Stemming From Childhood Blindness
Professors’ Invention Another Example of ‘Genuinely Life-Changing Research’ Being Done by CUNY Faculty, Says Chancellor Milliken

March 30, 2018

Professors from two colleges at The City University of New York have developed a wearable cane that allows blind and severely vision-impaired toddlers to walk safely long before they develop the cognitive skills and manual dexterity needed to use a traditional handheld white cane. The wearable “toddler cane” fastens around the waist, positioning two attached white shafts joined with a U-shaped bumper on the ground two steps ahead, providing the child with continuous next-step warning.

The cane may do more than help toddlers avoid falling over objects and walking into walls and trees. Research has found that childhood blindness also can lead to delays in speech, motor function and the ability to play and socialize. Ongoing research by the professors indicates that better connecting vision-impaired toddlers with their world through the wearable toddler cane may well reduce or avoid those complications.

“Vision-impaired toddlers want to run and explore the world just like sighted kids, but they trip over unseen objects, fall and walk into walls,” explains toddler cane inventor Grace Ambrose-Zaken, who coordinates Hunter College’s master’s in rehabilitation teaching and orientation and mobility (O&M) programs. “Those who can’t move around independently without hurting themselves tend to avoid moving. They don’t play by themselves, but lay on the floor and twirl around because they are prisoners in their space and moving is fraught with danger.”

“This simple, yet extraordinary device is yet another example of the genuinely life-changing research going on at CUNY,” says Chancellor James B. Milliken. “I could not be prouder of our faculty and more pleased for the children and families who will benefit from this wonderful invention.”

One stunning effect of the cane that is readily apparent in video footage that Ambrose shot is that youngsters suddenly walk – indeed, run – straight ahead.

All that happens instinctively and in a snap, says Brooklyn parent Karen Dunlap, who in her work life sources and sells tea. “My daughter’s O&M specialist shared a video of Grace demonstrating a very early prototype and I contacted her immediately.” Léa has a little-known condition, cortical visual impairment, from a stroke after birth, which primarily impacts her safe mobility, “I just had to have one for Léa and “from the first time she wore the toddler cane, there were dramatic differences in her being able to walk upright. Before, Léa’s head was always down and she couldn’t walk straight,” Dunlap says. “But when she wore her cane, she walked upright and straight.”

Ambrose explains: “Vision-impaired toddlers slow down and walk sideways because their bodies are telling their brains to protect them and keep them upright no matter what comes. But after they put on the toddler cane, they naturally associate the tactile warning it provides with the information they need to walk faster. The body deals with the cognitive request for more speed by demanding that they walk upright and straight, which is the most efficient way to get through space.”

For Dunlap, the instant change in posture was convincing evidence that Léa’s tilted stance was vision-related. It also showed that the physical therapists who had sought to remedy her stance with restrictive garments and a wheeled gait trainer (designed for people who can’t walk independently) were the ones headed in the wrong direction. The toddler cane, Dunlap says, “helped the physical therapists understand her vision deficit.”

Before age 5, the typical child with visual impairment cannot understand how to use a traditional cane, which Ambrose calls “a small point of tactile information that works very well when you position it correctly and sweep it back and forth each time you take a step.”

Younger children – especially 2-year-olds who are bursting with energy and the desire to explore and grasp things – need something else, particularly because they don’t yet command enough language to give and receive complex information, e.g., “There’s a flight of stairs ahead of you.” But with the wearable toddler cane, Ambrose says, “They’ll get the warning that something’s ahead, and they’ll be the masters of their universe.”

The basic idea for the wearable toddler cane came in 2014, when Ambrose was commuting to Hunter on the subway. “I was trying to figure out what we could do to improve toddlers access to safe mobility, and it hit me,” Ambrose recalls. “They have to wear it like a Southern belle hoop skirt.” She made prototypes in her garage and submitted her idea to the CUNY Institutional Review Board (IRB), which protects the rights and welfare of human research subjects, in order that she might begin testing them.

When City College biomedical engineering professor Marom Bikson learned about Ambrose’s work, he volunteered to help her perfect the design, produce prototypes and ramp up for manufacturing. Bikson remembers, “as a father of two toddlers, I saw the absolute necessity for this device, so I offered to help make it.” At City College’s Grove School of Engineering, Bikson manages a program that develops medical devices; his special focus is treating neurological and psychiatric disorders, like depression and development delays.

Since then, the project won a grant from the U.S. Department of Education for Phase 1 testing, allowing the team to conduct prototype development trials using state-of-the-art, rapid-prototyping facilities, including 3-D printers, in fabricating the toddler canes, which are currently custom-made to fit each child.

“We thought we’d have to train children how to use this, but they get it immediately,” Bikson says. “The toddlers start to run for the first time in their lives, and, when you take it off them, they’re crying in protest. These kids have been scared and held back, and they’ve been waiting for it.”

Ambrose and Bikson have found that the wearable toddler cane may well minimize or help avoid developmental, emotional, and social delays – findings they continue to document with the families using the device. “Subjects who wore the toddler cane walked further without prompting and spoke more words, more frequently compared to the long-cane condition,” they wrote (2017). “When wearing the toddler cane, the subjects spoke spontaneously about destination, locating and traveling to people, objects and places. The learners’ posture, gait and pace were visibly better. In addition, subjects were more animated and engaged in preschool antics, for example spontaneously starting games of chase and tag and defying authority.”

Collaborating with Sahar Ghaheri, Safe Toddlers’ creative director of app design, the professors also are developing an app to help families and professionals teach vision-impaired children to safely navigate the world, while also logging usage data that the cane automatically reports.

Dunlap is enthusiastic about the app: “If you’re not visually impaired, you really don’t know how to coach your kid on how to find your house or do a task in a house that has stairs. The app gives pointers to parents on how to walk on your street, things to pay attention to and how to give audio cues, like ‘Let’s go wash our hands in the sink.’ These develop scanning and mapping skills that visually impaired kids have to learn that come naturally to sighted people.”

The CUNY professors now seek additional government and foundation funding for Phase 2 development, including reducing the cost of manufacturing the custom-fit wearable toddler canes. There also will be further clinical trials to collect more data on the benefits of the toddler cane, not simply on mobility but also on general measures of well-being and development. Through support from CUNY foundations and the U.S. Department of Education, canes are provided cost free to users participating in the clinical trials.

Meanwhile, word about their work has spread across the United States and internationally, including to Australia, Canada, France, Israel, Mexico, New Zealand, Panama, Poland, South Africa and the United Kingdom. “We’re looking for regional partners, such as charities, to support the costs of canes for kids. If they can sponsor custom-fit toddler canes for a local school for the blind, or even for one child, it would mean the world to those children,” Bikson says. “We believe that every vision-impaired toddler deserves a wearable white cane, so our goal is simple: building and delivering the best cane for every kid in need.”

The City University of New York is the nation’s leading urban public university. Founded in 1847, CUNY counts 13 Nobel Prize and 23 MacArthur (“Genius”) grant winners among its alumni. CUNY students, alumni and faculty have garnered scores of other prestigious honors over the years in recognition of historic contributions to the advancement of the sciences, business, the arts and myriad other fields. The University comprises 24 institutions: 11 senior colleges, seven community colleges, William E. Macaulay Honors College at CUNY, CUNY Graduate Center, CUNY Graduate School of Journalism, CUNY School of Law, CUNY School of Professional Studies and CUNY Graduate School of Public Health and Health Policy. The University serves more than 272,000 degree-seeking students. CUNY offers online baccalaureate and master’s degrees through the School of Professional Studies.