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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, [email protected]
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 2
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 3
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)
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 4
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.
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 5
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 6
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 7
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 8
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 9
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.
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 10
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 11
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 12
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 13
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)
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 14
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 15
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 16
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 17
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 18
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?
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 19
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 20
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
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 21
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.
2017 SWOMA – Mobility Devices and Very Young Children – Clarke, K. 22
Figure 59 TSBVI logo