Powered mobility intervention: understanding the position of tool use learning as part of implementing the ALP tool

The IndieTrainer system: a clinical trial protocol exploring use of a powered wheelchair training intervention for children with cerebral palsy

OBJECTIVE

The IndieTrainer system, comprised of both a mobility device and gamified training modules, was developed to aid powered wheelchair (PWC) skills acquisition in children with cerebral palsy (CP). The aims of this small-scale study are to: explore use of the IndieTrainer system to improve PWC skills in children who have CP and document parental/caregiver perceptions of, and satisfaction with, the IndieTrainer system.

METHOD

This small-scale study is an open-label single-arm clinical trial involving a three-week PWC training intervention consisting of two 60-minute training sessions per week. A single session retention trial will be held four weeks after the completion of the intervention period. All research activities will take place in-person in a laboratory-based setting located within a university. Twenty-five child-parent/caregiver dyads will participate in the study. Each child participant will be 3 to 21 years of age and have a diagnosis of CP or other similar condition. The Assessment of Learning Powered mobility use will be the primary outcome measure. Secondary outcome measures will include the Wheelchair Skills Checklist, the Canadian Occupational Performance Measure, the Customer Satisfaction Questionnaire-8, and a qualitative interview. Data analyses will involve one-way repeated measures ANOVAs followed by paired samples t-tests with Bonferroni adjustments.

IMPACT

The IndieTrainer system allows children to explore and use power mobility in their own manual wheelchair and was designed to meet the needs of power mobility learners across the continuum of learning. It is the first PWC training system to optimize learning for early learners who do not yet understand cause and effect concepts.

Effectiveness of wheeled mobility skill interventions in children and young people with cerebral palsy: A systematic review

AIM

To systematically review the effectiveness of wheeled mobility interventions in children and young people with cerebral palsy (CP).

METHOD

A systematic literature search was performed in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO, PEDro, and Web of Science using database-specific concepts such as 'child' and 'wheelchair'. Studies focusing on wheeled mobility skill interventions with participants aged 6 to 21 years with CP were included.

RESULTS

Twenty studies with 203 participants were included. The impact of wheeled mobility skill interventions was assessed on mobility skills (n = 18), activity and participation (n = 10), and quality of life (n = 3). No studies reported effects on stress, fatigue, and motivational aspects. Interventions included power wheelchair skill training (n = 12), computer-based training (n = 5), smart wheelchair training (n = 2), and manual wheelchair training (n = 1), showing positive wheeled mobility intervention effects. Study quality based on the Methodological Index for Non-Randomized Studies scale was 9 out of 16 and 14 out of 24 for non-comparative and comparative studies respectively. Risk of bias was serious-to-critical on the Risk of Bias in Non-Randomized Studies of Interventions.

INTERPRETATION

Wheeled mobility interventions showed promising beneficial effects on wheeled mobility, activity and participation, and quality of life for children and young people with CP. Future studies with structured and standardized training programmes and assessment tools are warranted to further accelerate the wheeled mobility skill acquisition process in this population.

WHAT THIS PAPER ADDS

Wheeled mobility interventions improve wheeled mobility skills in individuals with cerebral palsy. The mobility skill acquisition process benefits from structured and standardized training. Knowledge of the intervention effects on participation and quality of life is limited. Most studies had moderate quality of evidence because of methodological limitations.

Evaluating a Therapeutic Powered Mobility Camp for Children with Severe Cerebral Palsy

Background. Children and youth with severe cerebral palsy (CP) have limited independent mobility, which affects opportunities for overall development. Purpose. To examine the effectiveness of Power Fun, a therapeutic powered mobility summer camp. Methods. A quasi-experimental, repeated-measure design was used, with participants acting as their own control. Twenty-four participants with severe CP (aged 7-20 years) attended Power Fun for three weeks, five days/week. Assessments of powered mobility skills and functional mobility goals were conducted three weeks before the camp (T1), at baseline (T2), postintervention (T3), and at three-week follow-up (T4). Findings. An analysis of variance results indicated significant improvements in powered mobility skills (F(1,22) = 56.61, p < 0.001, η²_p = 0.74) and functional mobility goals (F(1,58) = 80.17, p < 0.001, η²_p = 0.74), with 70% of goals achieved postintervention. A descriptive analysis revealed three learning profiles. Implications. This study provides initial evidence supporting the effectiveness of Power Fun as an intervention promoting powered mobility for children with severe CP, across a range of abilities.

The Development and Evaluation of the Powered Mobility Function Scale (PMFS) for Children and Adolescents with Cerebral Palsy

Aims: To describe the development and evaluation of a novel task-based measure of powered mobility function: the Powered Mobility Function Scale (PMFS).Methods: PMFS was developed in Hebrew in four phases, with feedback from clinicians and clients. Psychometric properties (inter-rater, test-retest reliability, concurrent, convergent and known-groups validity) were evaluated for N = 49 children and adolescents with Cerebral Palsy (11.1 ± 4.8y) using Powered Mobility Program (PMP), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT)Results: PMFS development involved 3 versions over three years. Inter-rater reliability was κ=0.75-0.95 (video/observation). Test-retest reliability was κ=0.93-0.96. Concurrent validity (PMP) was ρ=-0.84-to-0.96. Convergent validity (PEDI-CAT) was ρ=-0.47-to-0.70. Known-groups validity (GMFCS/MACS) demonstrated medium effect sizes (r = 0.33-0.46)Conclusions: PMFS is valid and reliable for measuring powered mobility function in children and adolescents with CP. Future validation of the English version of PMFS is warranted.

Using a child's power mobility learner group to tailor power mobility interventions: a case series

PURPOSE

The purpose of this case series was to explore using a child's power mobility learner group (exploratory, operational, or functional) to tailor power mobility interventions. Materials and methods: Five cases representing 2 exploratory power mobility learners, 2 operational power mobility learners, and 1 functional power mobility learner are presented. In each case, the participant's power mobility learner group was used to tailor his/her power mobility intervention program including establishing desired outcomes/goals of power mobility use, selecting outcome measures, determining the power mobility device to be used, and identifying the specific intervention strategies to be used.

RESULTS

All participants demonstrated improvements in power mobility device use following provision of the tailored intervention. Cases involving use of the Canadian Occupational Performance Measure demonstrated clinically significant improvements in post-intervention scores.

CONCLUSIONS

These cases illustrate a means to tailor power mobility interventions that may potentially optimise learning by providing an environment and conditions that meet each child's specific needs. The short-term and long-term gains made by the children in these cases warrants a controlled study exploring the use of a child's power mobility learner group to tailor power mobility interventions.IMPLICATIONS FOR REHABILITATIONUsing a child's power mobility learner group to tailor power mobility intervention may potentially optimise learning by providing an environment and conditions that meet each child's specific needs.Children across the learning continuum represented by the 3 power mobility learner groups (exploratory, operational, and functional) may benefit from power mobility interventions.Using a child's power mobility learner group to tailor power mobility interventions may support translation research knowledge into clinical practice.

Effects of a powered mobility summer camp as perceived by school staff: a qualitative study

PURPOSE

Powered mobility has a positive effect on social skills, self-esteem and overall development of children with motor impairments, but almost all previous studies were conducted with pre-school children. The aim of this study was to explore change beyond mobility following a therapeutic powered mobility summer camp for school-aged children and adolescents with severe cerebral palsy, as perceived by school staff.

MATERIALS AND METHODS

The participants in the therapeutic camp, which ran for 3 weeks, 5 days a week, three times over the summers 2018-2019, were children ages 7-19 (median age 11) with severe cerebral palsy who needed assistance in mobility and had limited hand function. Following the intervention, 19 semi-structured audio-recorded interviews were conducted with school staff, then transcribed and thematically analyzed using an inductive qualitative descriptive design with a phenomenological theoretical framework.

RESULTS

Four overarching themes were identified: (1) "Every step you take: mastering new, sometimes unexpected, skills", (2) "Break on through to the other side: changes in behaviour", (3) "Make new friends (but keep the old): Boosting social behaviour" and (4) "I'm a believer: The journey through self-efficacy to empowerment".

CONCLUSIONS

The interviews showed the immediate positive influence of powered mobility for children who previously did not have independent mobility, following an intensive intervention. Changes in initiative, empowerment, social relationships and behaviour highlight the importance of self-generated mobility, regardless of whether independence was achieved. School-aged children with severe cerebral palsy seem to benefit from an intensive powered mobility intervention in areas other than mobility skills themselves.IMPLICATIONS FOR REHABILITATIONPowered mobility intervention seems to encourage activity and initiation among children and youth with severe CP.This research adds to the understanding of the effect powered mobility can have on social interaction and communication.Powered mobility might be a means to allow development, in addition to being an important end.

Inter-rater reliability of the assessment of learning powered mobility use, version 2.0, when applied with children and adults engaged in Driving to Learn in a powered wheelchair

INTRODUCTION

The Assessment of Learning Powered mobility use (ALP) tool including the ALP instrument and facilitating strategies, was developed for Driving to Learn. This therapeutic intervention aims to provide children and adults who have profound cognitive disabilities with opportunities to learn tool use through powered mobility practise. To allow for longer intervention periods, a partnership was developed between professionals supervising Driving to Learn and persons accompanying children or adults to their practice sessions. Accompanying persons (relatives or assistants) gradually took on shared responsibility for applying the intervention and conducting assessments with the ALP-instrument. The aim of this study was to test the inter-rater reliability of the ALP-instrument version 2.0 as applied in this novel partnership in assessment and intervention.

METHOD

A psychometric analysis compared pair-wise assessments with the ALP-instrument version 2.0, made independently by professional supervisors and accompanying persons following each Driving to Learn session. Weighted kappa statistic was used to compare the matched pair ordinal data.

RESULTS

Eight professional supervisors and 22 accompanying persons independently completed assessments with the ALP-instrument after 55 sessions with six children and five adults, who each participated in five Driving to Learn sessions. When the scores from the 55 pairs of assessments were compared, a weighted kappa value of 0.85 was obtained, indicating very good inter-rater reliability between the two rater groups.

CONCLUSION

The resulting inter-rater reliability suggests that it is reliable to implement the ALP-instrument as part of partnership in intervention between supervisors and accompanying persons. Provision of longer periods of Driving to Learn is possible when those who accompany the child or adult are able to gradually assume responsibility for practice and assessment under the supervision of a professional. This partnership approach enables children and adults with multiple and complex disabilities to practise and learn in accordance with their conditions and needs.

Feasibility Study of a Therapeutic Mobility Summer Camp for Children with Severe Cerebral Palsy: Power Fun

Aim: Powered mobility has positive effects on development of children with limited independent locomotion, but many are deprived of this opportunity due to their limitations. This study aimed to evaluate the feasibility of Power Fun, a therapeutic summer camp, for students with severe cerebral palsy (CP).Methods: Five students with CP, ages 11-15, received personally adapted powered wheelchairs and participated daily in the camp. The camp ran five days a week during three weeks and included two mobility sessions daily. Assessments were conducted three weeks prior to the camp (T1), at baseline (T2), post-intervention (T3) and six weeks follow-up (T4). Measures used were Power Mobility Program (PMP), Assessment of Learning Power mobility use (ALP), Wheelchair Outcome Measure for Young People (WhOM-YP), Goal Attainment Scaling (GAS) and Dimensions of Mastery Questionnaire (DMQ).Results: All participants finished the camp. Outcome measures showed no change between T1-T2 but improved significantly (p<.05) after the intervention (T2-T3), and gains were maintained at T4 (Wilcoxon signed-rank test). Goals improved to slightly above the expected outcome (GAS average 0.11).Conclusions: Power Fun shows good feasibility and significant improvement in mobility skills and goals of children with severe CP. Further studies are warranted.

Power mobility for children: a survey study of American and Canadian therapists' perspectives and practices

AIM

To explore the views and practices of paediatric occupational therapists and physical therapists in Canada and the USA regarding the implementation of power mobility for children with mobility limitations.

METHOD

This descriptive study utilized a web-based survey that included questions pertaining to therapists' decisions to trial and use power mobility, agreement or disagreement with statements developed from published practice considerations regarding power mobility, and the frequency of performing tasks related to power mobility prescription and training.

RESULTS

Most respondents reported that child characteristics (e.g. cognition, safety awareness) were important factors in decision-making about power mobility, whereas other child characteristics (e.g. communication abilities, age) were not as important. Family resources and home accessibility were also not considered important. The average age at which respondents considered power mobility for children was 2 years 3 months. The majority of respondents agreed with statements developed from published practice considerations and most frequently performed various power mobility tasks twice a year or less.

INTERPRETATION

Although most respondents appeared to have positive views regarding power mobility, few appeared to actively perform power mobility tasks in their practice. Resources to support therapists in the early introduction of power mobility may be beneficial.

WHAT THIS PAPER ADDS

Occupational and physical therapists positively view early introduction of power mobility for children with mobility limitations. Few therapists actively provide early power mobility experiences. Power mobility training and monitoring power mobility devices are important therapist roles.

'Power in Mobility': parent and therapist perspectives of the experiences of children learning to use powered mobility

AIM

The aim of this study was to gain insights, from the perspectives of both parents and pediatric therapists, into the experiences of children learning to use a power mobility device.

METHOD

The purposive sample included 33 participants: 14 parents of children who were learning, or had learned, to use a power mobility device and 19 pediatric occupational therapists or physical therapists. Data were gathered face-to-face via seven focus groups consisting of either parents or therapists, and eight one-on-one interviews. Data were analyzed using the constant comparative method.

RESULTS

Three main themes were identified: (1) 'Power in mobility' described how learning to use powered mobility changed more than just a child's locomotor abilities; (2) 'There is no recipe' revealed how learning to use powered mobility occurred along an individualized continuum of skills that often unfolded over time in a cyclical process; (3) 'Emotional journey' explored how learning to use powered mobility was an emotionally charged undertaking for all those involved.

INTERPRETATION

Learning to use a power mobility device is a complex process that often requires perseverance and determination on the part of the child, family, and therapist.

WHAT THIS PAPER ADDS

Powered mobility use impacts more than just a child's locomotor abilities. Learning to use a power mobility device is a highly individualized process. Learning to use powered mobility may be an emotionally charged process.

Power mobility skill progression for children and adolescents: a systematic review of measures and their clinical application

AIM

To identify and critically appraise standardized measures of power mobility skill used with children (18y or younger) with mobility limitations and explore the measures' application for 'exploratory', 'operational', and 'functional' learners.

METHOD

Five electronic databases were searched along with hand-searching for peer-reviewed articles published in English to July 2017 (updated 31st August 2017). Key terms included power(ed) mobility, power(ed) wheelchair, and database-specific terms. Studies included at least one child with a disability, and a detailed description of the measure of power mobility skill. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, abstracts, and full-text articles.

RESULTS

Of 96 titles, 24 articles met inclusion criteria, describing nine measures of power mobility skill. The Wheelchair Skills Checklist, the Powered Mobility Program (PMP), and the Power Mobility Training Tool were augmented by three adaptations of the PMP. Two additional measures were further developed to create a third, the Assessment of Learning Powered mobility use. Validity evidence related primarily to content development while reliability evidence was reported on only two measures.

INTERPRETATION

All measures are in the initial stages of development and testing. Research investigating the measures' appropriateness for different types of learners and environments is warranted.

WHAT THIS PAPER ADDS

There are four distinct measures of paediatric power mobility skill: three task-based, one process-based. Power mobility learners may be divided into three groups: exploratory, operational, and functional. Application of measures of power mobility skill differs for these three groups.