Active mobility, active participation: a systematic review of modified ride-on car use by children with disabilities

The development of gait and mobility: Form and function in infant locomotion

The development of locomotion can be described by its form (i.e., gait) and its function (i.e., mobility). Both aspects of locomotion improve with experience. Traditional treatises on infant locomotion focus on form by describing an orderly progression of postural and locomotor milestones en route to characteristic patterns of crawling and walking gait. We provide a traditional treatment of gait by describing developmental antecedents of and improvements in characteristic gait patterns, but we highlight important misconceptions inherent in the notion of "milestones". Most critically, we argue that the prevailing focus on gait and milestones fails to capture the true essence of locomotion-functional mobility to engage with the world. Thus, we also describe the development of mobility, including the use of mobility aids for support and propulsion. We illustrate how infants find individual solutions for mobility and how the ability to move cascades into other domains of development. Finally, we show how an integration of gait and mobility provides insights into the psychological processes that make locomotion functional. This article is categorized under: Psychology > Motor Skill and Performance Psychology > Development and Aging.

A pilot randomised controlled trial of ride-on cars and postural combinations of standing and sitting for mobility and social function in toddlers with motor delays

PURPOSE

Locomotor experiences in upright postures are essential for developing toddlers' mobility and social functions. This pilot randomised controlled trial aimed to examine the effectiveness of using a modified ride-on car (ROC) with postural combinations of standing and sitting on mobility and social function in toddlers with motor delays.

MATERIALS AND METHODS

Nineteen participants aged 1-3 years with mild, moderate or severe motor delays were randomly assigned to four ROC groups. The ROC groups had different combinations of standing and sitting, namely standing for 70 min (ROC-Stand70, five participants), standing for 45 min (ROC-Stand45, four participants), standing for 25 min (ROC-Stand25, five participants) and sitting for 70 min (ROC-Sit70, five participants). All participants participated in 2-h sessions twice a week for 12 weeks. The Pediatric Evaluation of Disability Inventory, Goal Attainment Scaling and Bayley-III tests were administered before and after the intervention, and after 12 weeks of follow-up. A mixed-model analysis of variance was used to compare inter- and intra-group differences. This trial was registered at ClinicalTrials.gov (NCT03707405).

RESULTS

All groups showed significantly improved mobility, social function and goal achievement at the post-test (p < .001). However, no significant changes were observed in Bayley scores.

CONCLUSIONS

Combining physical and social environmental modifications with active exploration is crucial for early power mobility training in toddlers with motor delays. To enhance the robustness and generalisability of our findings, future studies should include larger sample sizes, consider variations in motor delays, and measure energy expenditure during the intervention.Implications for rehabilitationProviding active exploratory experience using ride-on cars (ROCs) with various postural combinations can improve a child's mobility.The ROC training with various postural combinations can improve social function, and the degree of improvement may depend on the severity of motor delays.Setting goals with caregivers and incorporating their roles in the training process can empower them to interact with children more frequently and actively.

Assistive technology to facilitate children's play: a scoping review

PURPOSE

Play is a fundamental human right and one of the most important occupations in children's lives. Fewer opportunities exist for children with physical disabilities (CWPD) to play. This study aimed to conduct a scoping review of published peer-reviewed literature on using AT to enable "play-for-the-sake-of-play" by CWPD.

METHOD

The review was conducted using a widely accepted scoping review methodology. Literature searches were conducted from January 2000 to March 2022 using MEDLINE, Central, CINAHL, ERIC, Scopus, and EMBASE. Pairs of reviewers used an online systematic review system to manage title, abstract, and full-text screening. Excel was used for data extraction and charting. Data was charted based on type of AT, play types according to LUDI definitions, and level of evidence.

RESULTS

The search yielded 5250 papers after the removal of duplicates. Title and abstract screening identified 58 studies for full-text screening. The final sample included 31 papers. Seven types of AT were identified in studies: power mobility, virtual reality, robots, adaptations for upper limb differences, switch-adapted games, augmentative and alternative communication devices, and mobility aids. Twenty-three papers addressed cognitive play, seven addressed social play, and one addressed both cognitive and social play. Most studies used case study, descriptive, or repeated measures designs.

CONCLUSION

There is limited evidence regarding the use of AT to support play-for-the-sake-of-play in CWPD. Given the importance of play, further research using rigorous methodologies and the development of assistive technology dedicated to promoting play-for-the-sake-of-play is warranted.

Caregivers' Perceptions of Ride-On Cars and Behavioral Changes for Young Children With Motor Delays

PURPOSE

To investigate caregivers' perceptions of using a ride-on car (ROC) and observe behavioral changes in their children following ROC training and conventional therapy.

METHODS

The study included 37 toddlers with motor delays and their caregivers, divided into an ROC training group (27 participants) and a conventional therapy group (10 participants). A binary, multiple-choice, and open-ended questionnaire was administered before and after a 3-month intervention period.

RESULTS

Over 70% of caregivers had no experience using mobility devices before the intervention. Before the intervention, children's ability and age were key barriers to using mobility devices. After the intervention, caregivers in the ROC group were more inclined than those in the control group to allocate a larger budget for these devices.

CONCLUSIONS

The findings highlight the importance of pediatric physical and occupational therapists working collaboratively with caregivers during such interventions and raising awareness about government subsidies and resources available for mobility devices.

Ready, Set, Move! Tracking Children's Modified Ride-On Car Use With a Custom Data Logger

PURPOSE

To create and implement a next-generation, custom data logger to automatically track modified ride-on car (MROC) use in home and community settings, establish feasibility of long-term remote collection of community MROC use data, describe trends of MROC use, and explore parent perception of the MROC.

METHODS

In this descriptive study, a custom data logger was constructed and integrated into MROCs using an Arduino Pro-Mini microprocessor to capture real-time use data remotely.

RESULTS

It is feasible to automatically track MROC use in home and community settings. On average, MROC use trends appear consistent with caregiver reports and show higher initial use with steadily decreasing frequency over time, and varying bout duration and play session length, despite favorable caregiver perceptions of the cars.

CONCLUSIONS

Remote tracking of MROC use may decrease burden on busy families and provide clinicians with valuable technology use data.

Off to the park: a geospatial investigation of adapted ride-on car usage

PURPOSE

Adapted ride-on cars (ROC) are an affordable, power mobility training tool for young children with disabilities. Previous qualitative research has identified environmental factors, such as weather and adequate drive space, as barriers to families' adoption of their ROC. However, we do not currently know the relationship between the built environment and ROC usage.

MATERIALS AND METHODS

In our current study, we quantified the driving patterns of 14 children (2.5 ± 1.45 years old, 8 male: 6 female) using ROCs outside and inside of their homes over the course of a year using a custom datalogger and geospatial data. To measure environmental accessibility, we used the AccessScore from Project Sidewalk, an open-source accessibility mapping initiative, and the Walk Score, a measure of neighborhood pedestrian-friendliness.

RESULTS

The number of play sessions with the ROC ranged from 1 to 76; 4 participants used it less than 10 times and 4 participants used it more than 50 times. Our findings indicate that more play sessions took place indoors, within the participants' homes. However, when the ROC was used outside the home, children engaged in longer play sessions, actively drove for a larger portion of the session, and covered greater distances. Most children tended to drive their ROCs in close proximity to their homes, with an average maximum distance from home of 181 meters. Most notably, we found that children drove more in pedestrian-friendly neighborhoods and when in proximity to accessible paths.

CONCLUSIONS

The accessibility of the built environment is paramount when providing any form of mobility device to a child. Providing an accessible place for a child to move, play, and explore is critical in helping a child and family adopt the mobility device into their daily life.

Early Introduction of Power Mobility Devices for Children with Fukuyama Congenital Muscular Dystrophy and Its Psychological Impact on Caregivers: A Case Report

Recently, motorized mobility devices (or power mobility devices (PMDs)) have been introduced for infants and toddlers who lack the means for self-mobility. Previous reports have primarily focused on PMDs for individuals with cerebral palsy. Few have explored PMDs for individuals with neuromuscular diseases who have intellectual disabilities. This report presents a case study of the early introduction of a PMD for an infant with Fukuyama congenital muscular dystrophy and presents the results of an interview with the father regarding psychological aspects and the child's manipulative abilities. The PMD was introduced at the age of 1 year and 10 months, and the changes during the 19 months after the introduction were evaluated six times, using the Assessment of Learning Powered mobility use tool (ALP). A semi-structured interview with the father was conducted 19 months after the introduction. The ALP evaluation and the interview were conducted by one physical therapist and two physical therapy students, and the results were shared with the hospital's physical therapist and nurses at the nursing facility. This report provides a basis for expanding the scope of PMD use and for considering the family's involvement, especially for the child.

Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study

Our research aims to evaluate the utility of joystick-operated ride-on-toys (ROTs) as therapeutic adjuncts to improve upper extremity (UE) function in children with hemiplegic cerebral palsy (HCP). This study assessed changes in affected UE use and function following a three-week ROT navigation training incorporated into an existing constraint-induced movement therapy (CIMT) camp in 11 children (3-14 years old) with HCP. We report changes in scores on the standardized Shriners Hospital Upper Extremity Evaluation (SHUEE) from pretest-to-posttest and changes from early-to-late sessions in percent time spent by the affected arm in: (a) "moderate-to-vigorous activity", "light activity" and "no activity" bouts based on accelerometer data and (b) "independent", "assisted", and "no activity" bouts based on video data. We also explored relationships between standardized measures and training-specific measures of affected UE activity. We found small-to-medium improvements in the SHUEE scores. Between 90 and 100% of children also showed medium-to-large improvements in affected UE activity from early-to-late sessions using accelerometers and small improvements via video-based assessments. Exploratory analyses suggested trends for relationships between pretest-posttest and training-specific objective and subjective measures of arm use and function. Our pilot data suggest that single joystick-operated ROTs may serve as motivating, child-friendly tools that can augment conventional therapies such as CIMT to boost treatment dosing, promote affected UE movement practice during real-world navigation tasks, and ultimately improve functional outcomes in children with HCP.

Powered Mobility Device Use and Developmental Change of Young Children with Cerebral Palsy

Mobility is a fundamental human right and is supported by the United Nations and the ON Time Mobility framework. The purpose of this study was to understand the effect of a powered mobility intervention on developmental changes of children with cerebral palsy (CP). This study was a randomized, crossover clinical trial involving 24 children (12-36 months) diagnosed with CP or with high probability of future CP diagnosis based on birth history and current developmental status. Children received the Explorer Mini and a modified ride-on car in randomized order, each for 8 weeks. The Bayley Scales of Infant and Toddler Development-4th Edition was administered at baseline, mid-study, and end-of-study. Raw change scores were used for analysis. Total minutes of use per device was categorized as low or high use for analysis based on caregiver-reported driving diaries. Explorer Mini: The high use group exhibited significantly greater positive change scores compared to the low use group on receptive communication, expressive communication, and gross motor subscales (p < 0.05). Modified ride-on car: No significant differences between low and high use groups. Regardless of device, low use was associated with no significant developmental change and high use was associated with positive developmental changes. Mobility access is critical to maximize the development of children with CP and may be augmented by using powered mobility devices. Results may have implications for the development of evidence-based guidelines on dosage for powered mobility use.

Feasibility of Using Joystick-Operated Ride-on-Toys to Promote Upper Extremity Function in Children With Cerebral Palsy: A Pilot Study

PURPOSE

To evaluate the feasibility of implementation, acceptance, and perceived efficacy of a joystick-operated ride-on-toy intervention to promote upper extremity (UE) function in 3- to 14-year-old children with hemiplegic cerebral palsy.

METHODS

Exit questionnaires were collected from children, caregivers, and clinicians/camp staff following a 3-week ride-on-toy training program incorporated within a summer camp for children with hemiplegic cerebral palsy. Training encouraged children to use their affected UE to maneuver the ride-on-toy. Questionnaires included Likert scale and open-ended questions to assess enjoyment, acceptance, feasibility, and perceived efficacy of the training.

RESULTS

All stakeholder groups indicated that the training was enjoyable. Clinicians/staff and caregivers indicated that the training increased children's motivation to use their affected UE and reported perceived improvements in UE movement control and function following training.

CONCLUSIONS

Our promising preliminary findings call for future research to systematically assess the efficacy of ride-on-toys to promote UE control and function in children with hemiplegic cerebral palsy.Supplemental Digital Content 1 video abstract, available at: http://links.lww.com/PPT/A404.