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Field DA, Borisoff J, Chan FHN, Livingstone RW, Miller WC. Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series. Disabil Rehabil Assist Technol 2024; 19:454-464. [PMID: 35943726 DOI: 10.1080/17483107.2022.2096933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/27/2022] [Indexed: 10/15/2022]
Abstract
Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life. PURPOSE to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life. MATERIALS AND METHODS An interrupted time series of purposefully sampled children aged 5-18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery. RESULTS Six children aged 7-18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed. CONCLUSION PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. IMPLICATIONS FOR REHABILITATIONFor children with mobility limitations, PWSDs may promote participation in daily life and increased mobility.Data logger technology provides valuable information about children's PWSD use and how this varies over time.Benefits and challenges exist with implementing PWSD and data logger technologies.When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers.
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Affiliation(s)
- Debra A Field
- Clinical Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia (UBC); Occupational Therapist, Sunny Hill Health Centre for Children, Vancouver, Canada
| | - Jaimie Borisoff
- International Collaboration on Repair Discoveries (ICORD) and Principal Investigator Adjunct Faculty, Department of Occupational Science & Occupational Therapy, UBC; 'Director, MAKE+ and the Rehabilitation Engineering Design Laboratory, British Columbia Institute of Technology, Vancouver, Canada
| | - Franco H N Chan
- Rehabilitation Research Engineer, ICORD, UBC, Vancouver, Canada
| | - Roslyn W Livingstone
- Clinical Assistant Professor, Department of Occupational Science and Occupational Therapy; and Investigator, British Columbia Children's Hospital Research Institute, UBC; former Occupational Therapist, Sunny Hill Health Centre for Children, Vancouver, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, UBC, Principal Investigator, Rehabilitation Research Program, GF Strong Rehabilitation Centre and ICORD, UBC, Vancouver, Canada
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Huang HH, Chu YW, Chan AT, Chen CL. 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. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38180348 DOI: 10.1080/17483107.2023.2299712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
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.
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Affiliation(s)
- Hsiang-Han Huang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Wen Chu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy, Hung Da Wei Rehabilitation Clinic, Taichung, Taiwan
| | - Ai-Tzu Chan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan
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Dabiri Golchin M, Ripat J, Verdonck M. Assistive technology to facilitate children's play: a scoping review. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38166593 DOI: 10.1080/17483107.2023.2298825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
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.
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Affiliation(s)
- Minoo Dabiri Golchin
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Michèle Verdonck
- Department of Occupational Therapy, School of Health, University of the Sunshine Coast, Sippy Downs, Australia
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Hospodar CM, Feldner HA, Logan SW. Active mobility, active participation: a systematic review of modified ride-on car use by children with disabilities. Disabil Rehabil Assist Technol 2023; 18:974-988. [PMID: 34435924 PMCID: PMC9328769 DOI: 10.1080/17483107.2021.1963330] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Modified ride-on cars (MROC) are a low-cost option to provide self-directed mobility to children with mobility limitations, in lieu of or as a precursor to other powered mobility devices. OBJECTIVES We appraised evidence to (1) describe and categorize MROC study characteristics, (2) synthesize existing knowledge of children's use of MROCs and (3) frame outcomes within the International Classification of Functioning, Disability and Health (ICF) framework. METHODS Articles were identified through four electronic databases: Medline, CINAHL, PsycNET, and Web of Science. We included all published, peer-reviewed studies involving MROC use. Relevant data were extracted, and articles were appraised using the American Academy of Cerebral Palsy and Developmental Medicine criteria for group and single-subject designs. RESULTS 23 studies met inclusion criteria of 204 titles identified from 1980 to 2021. Study designs included case studies, case series, group designs, and qualitative research, but only three studies were rated evidence level III or higher. Children with a range of disabilities used MROCs across multiple settings, including the home, hospital, and community, though use and adherence varied widely. Positive impacts were reported on a range of outcomes related to the ICF framework, with an emphasis on activity and participation. CONCLUSIONS MROC studies have primarily addressed activity and participation, with most studies suggesting increased functional mobility and social interactions due to MROC use. More robust research designs with larger samples are needed in order to develop evidence-based strategies for MROC use.IMPLICATIONS FOR REHABILITATIONPhysical and occupational therapists may consider using MROCs as a therapeutic tool or accessible play opportunity as part of a multi-modal approach to increase children's mobility, family engagement, and participation in community life.Personal (e.g., child's enjoyment) and environmental factors (e.g., caregiver attitudes and stress) must be considered when developing plans of MROC use.
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Affiliation(s)
- C. M. Hospodar
- Department of Psychology, New York University, New York, NY, USA
| | - H. A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - S. W. Logan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Logan SW, Sloane BM, Kenyon LK, Feldner HA. Powered Mobility Device Use and Developmental Change of Young Children with Cerebral Palsy. Behav Sci (Basel) 2023; 13:bs13050399. [PMID: 37232636 DOI: 10.3390/bs13050399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
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.
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Affiliation(s)
- Samuel W Logan
- College of Health, Oregon State University, Corvallis, OR 97331, USA
| | - Bethany M Sloane
- College of Health, Oregon State University, Corvallis, OR 97331, USA
| | - Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI 49504, USA
| | - Heather A Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
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Huang HH, Hsieh YH, Chang CH, Tsai WY, Huang CK, Chen CL. Ride-on car training using sitting and standing postures for mobility and socialization in young children with motor delays: a randomized controlled trial. Disabil Rehabil 2022; 45:1453-1460. [PMID: 35417316 DOI: 10.1080/09638288.2022.2063418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine the effects of ride-on car (ROC) training using different postures on mobility and social function in children with motor delays in comparison with conventional therapy. MATERIALS AND METHODS Thirty-eight children (22 males, 16 females) with motor delays were recruited and randomly assigned to three groups: ROC training while sitting (ROC-Sit, n = 15; mean age, 20.25 months; standard deviation [SD], 5.29), ROC training while standing (ROC-Stand, n = 12; mean age, 24.80 months; SD, 8.42), and conventional therapy (control, n = 11; mean age: 20.25 months, SD: 5.37). All groups underwent 2-h training sessions twice weekly over a 12-week intervention phase. The Pediatric Evaluation of Disability Inventory and Goal Attainment Scaling were performed before and after the intervention and at follow-up sessions after 12 weeks. RESULTS Mobility and goal achievement improved significantly in all groups after the intervention (p < 0.001; p < 0.0001). However, social function improved significantly only in the ROC-Stand group (p = 0.001), which had the highest number of participants showing clinically meaningful changes in mobility and social function. CONCLUSION Increased practice and caregivers' involvement can improve children's mobility and goal achievement. Adopting a standing posture in an ROC can enhance social function.IMPLICATIONS FOR REHABILITATIONProviding active exploratory experience through ride-on cars or practicing specific skills can improve children's mobility function.Ride-on car training in a standing posture allows children to access their distal environment visually, resulting in improved social function.Setting goals with caregivers maximizes the effects of treatment on goal achievement.
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Affiliation(s)
- Hsiang-Han Huang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,bDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Hsin Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Ching-Hao Chang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chen Yang Clinic, New Taipei City, Taiwan
| | - Wan-Ying Tsai
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Shi Yuan Poly Clinic, Taoyuan, Taiwan
| | - Ching-Kai Huang
- bDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Ling Chen
- bDepartment of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Huang HH, Chang CH, Tsai WY, Chu YW, Lin MC, Chen CL. Ride-On Cars With Different Postures and Motivation in Children With Disabilities: A Randomized Controlled Trial. Am J Occup Ther 2022; 76:23265. [DOI: 10.5014/ajot.2022.047035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: A child’s independent mobility, environments, and mastery motivation are critical factors during early development.
Objective: To examine the effectiveness of ride-on car (ROC) training with a standing (ROC–Stand) or a sitting posture (ROC–Sit) in enhancing children’s mastery motivation and decreasing parenting stress levels.
Design: Randomized controlled trial (RCT) with a multiple pretest–posttest design.
Setting: Hospital-based environment in northern Taiwan.
Participants: Thirty-nine children with disabilities ages 1 to 3 yr were randomly assigned to ROC–Stand (n = 16), ROC–Sit (n = 12), or conventional therapy (control; n = 11). All groups received 2-hr training sessions two times a week for 12 wk and then a 12-wk follow-up period that involved only regular therapy.
Measures: Assessments included the Revised Dimensions of Mastery Questionnaire–Chinese version and the Parenting Stress Index.
Results: All groups showed significant changes in social persistence with adults, mastery pleasure, and general competence after the intervention. The two ROC training groups showed a significantly greater decrease in parenting stress than the control group. In addition, increased general competence of the ROC–Stand group also strongly correlated with decreased parent–child dysfunctional interaction.
Conclusions and Relevance: This RCT verifies the effectiveness of ROC training and offers a novel approach to increase children’s mastery motivation and decrease parenting stress.
What This Article Adds: Providing a large amount of active, exploratory experiences with goal-directed, moderately challenging tasks and cooperation with caregivers may result in the greatest benefits to young children with motor disabilities.
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Affiliation(s)
- Hsiang-Han Huang
- Hsiang-Han Huang, ScD, OTR, is Associate Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan, and Associate Research Fellow, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan;
| | - Ching-Hao Chang
- Ching-Hao Chang, MS, OTR, is Occupational Therapist, Chen Yang Clinic, Shulin, New Taipei City, Taiwan, and Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ying Tsai
- Wan-Ying Tsai, BS, OTR, is Occupational Therapist, Shi Yuan Poly Clinic, Longtan, Taoyuan, Taiwan, and Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Chu
- Yu-Wen Chu, MS, OTR, is Occupational Therapist, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Min-Ching Lin
- Min-Ching Lin, MS, OTR, is Occupational Therapist, Department of Rehabilitation, Division of Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Chia-Ling Chen MD, PhD, is Attending Physician, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, and Professor, Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Bray N, Kolehmainen N, McAnuff J, Tanner L, Tuersley L, Beyer F, Grayston A, Wilson D, Edwards RT, Noyes J, Craig D. Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis. Health Technol Assess 2021; 24:1-194. [PMID: 33078704 DOI: 10.3310/hta24500] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown. OBJECTIVE The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years. REVIEW METHODS The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources. DATA SOURCES A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index™ (SSCI; Clarivate Analytics), Conference Proceedings Citation Index - Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index - Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019. RESULTS In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or ≥ 5 years. However, strong support was found that powered mobility interventions have a positive impact on children's movement and mobility, and moderate support was found for the impact on children's participation, play and social interactions and on the safety outcome of accidents and pain. 'Fit' between the child, the equipment and the environment was found to be important, as were the outcomes related to a child's independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is 'movement for movement's sake' and the latter destination-focused mobility. Powered mobility should be focused on 'movement for movement's sake' in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends £1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure. LIMITATIONS The original research question could not be answered because there was a lack of appropriately powered published research. CONCLUSIONS Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on 'movement for movement's sake'. FUTURE WORK Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility. STUDY REGISTRATION This study is registered as PROSPERO CRD42018096449. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nathan Bray
- School of Health Sciences, Bangor University, Bangor, UK.,Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer McAnuff
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lorna Tuersley
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Aimee Grayston
- Children's Services, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Dor Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rhiannon Tudor Edwards
- School of Health Sciences, Bangor University, Bangor, UK.,Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Plummer T, Logan SW, Morress C. Explorer Mini: Infants' Initial Experience with a Novel Pediatric Powered Mobility Device. Phys Occup Ther Pediatr 2021; 41:192-208. [PMID: 33019827 DOI: 10.1080/01942638.2020.1819935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The purpose of this study is to describe the driving experience and emotional responses of young children who experience mobility limitations during initial use of the Explorer Mini, a new pediatric powered mobility device. METHODS The current study utilized a descriptive, cross-sectional, and mixed- method approach. Thirty-three young children between 6 and 36 months of age who experience mobility limitations participated in this study and were provided up to two, 15-minute driving sessions with the Explorer Mini. Researchers completed an observation form that included field notes (qualitative data) and answers to yes/no questions to generate percentages of observed behaviors (quantitative data) regarding young children's driving experience and emotional responses while using the Explorer Mini. RESULTS Thematic analysis from field notes (i.e., qualitative data) revealed two inter-related themes: 1) I can move, 2) I think I like it- don't I? Ninety four percent (i.e., quantitative data) of young children were able to move the Explorer Mini to explore their environment. CONCLUSIONS Young children demonstrated self-initiated mobility with a powered mobility device using the midline joystick. The results support the notion that infants 6-36 months can effectively use the Explorer Mini. The device received Food and Drug Administration 510k clearance in February 2020.
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Affiliation(s)
- Teresa Plummer
- School of Occupational Therapy, Belmont University, Nashville, Tennessee, USA
| | - Samuel W Logan
- Kinesiology, Oregon State University, Corvallis, Oregon, USA
| | - Claire Morress
- Perlman Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Longo E, De Campos AC, Spinola Barreto A, de Lima Nascimento Coutinho DL, Leite Galvão Coelho M, Corsi C, Souza Monteiro K, Logan SW. Go Zika Go: A Feasibility Protocol of a Modified Ride-on Car Intervention for Children with Congenital Zika Syndrome in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186875. [PMID: 32967070 PMCID: PMC7558945 DOI: 10.3390/ijerph17186875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
Children with congenital Zika syndrome (CZS) present severe motor disability and can benefit from early powered mobility. The Go Zika Go project uses modified ride-on toy cars, which may advance the body functions, activities, and participation of children. This paper describes the study protocol aiming to assess the feasibility of a modified ride-on car intervention for children with CZS in Brazil. A mixed-methods design with a multiple 1-week baseline, 3-month intervention, and 1-month follow-up will be implemented. Modified ride-on car training sessions will be conducted three times a week at the participants’ home or in the clinic. The primary outcome will be a narrative description of study feasibility (photovoice method, focus groups, parent feasibility questionnaire and assessment of learning powered mobility). Secondary outcomes will be switch activation, driving sessions journal, social-cognitive interactions, mobility (pediatric evaluation of disability inventory computer adaptive test), goal attainment scaling (GAS), and participation (young children’s participation and environment measure). Go Zika Go is expected to be viable and to improve function, activity, and participation of children with CZS, providing a low-cost, evidence-based rehabilitation option that will be relevant to early child development in a global perspective.
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Affiliation(s)
- Egmar Longo
- Postgraduate Program in Rehabilitation Sciences and Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil;
- Correspondence: ; Tel.: +55-8432912411
| | - Ana Carolina De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos 13565-905, Brazil; (A.C.D.C.); (C.C.)
| | - Amanda Spinola Barreto
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil; (A.S.B.); (D.L.d.L.N.C.)
| | - Dinara Laiana de Lima Nascimento Coutinho
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil; (A.S.B.); (D.L.d.L.N.C.)
| | - Monique Leite Galvão Coelho
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil;
| | - Carolina Corsi
- Department of Physical Therapy, Federal University of São Carlos, São Carlos 13565-905, Brazil; (A.C.D.C.); (C.C.)
| | - Karolinne Souza Monteiro
- Postgraduate Program in Rehabilitation Sciences and Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil;
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte—Faculty of Health Sciences of Trairi (UFRN-FACISA), Santa Cruz 59200-000, Brazil; (A.S.B.); (D.L.d.L.N.C.)
| | - Samuel Wood Logan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA;
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Abstract
PURPOSE The purpose of the study is to examine how perceived barriers change before and after a 3-month period of modified ride-on car use. METHODS This study used a qualitative content analysis of perceived barriers. Fourteen caregivers (13 mothers; 1 grandmother) responded to a single-question, free-response survey before and after a 3-month period of modified ride-on car use. RESULTS A total of 11 and 20 perceived barriers were reported before and after the 3-month period. Environmental barriers were the most frequently reported before and after the 3-month period. CONCLUSIONS Pediatric physical therapists need to be aware of the potential perceived barriers that families may experience in regard to young children with disabilities using modified ride-on cars and determine strategies to support families on an individual basis.
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Exploring the Unmet Need for Technology to Promote Motor Ability in Children Younger Than 5 Years of Age: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100051. [PMID: 33543078 PMCID: PMC7853335 DOI: 10.1016/j.arrct.2020.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To (1) identify types of technology that promote motor ability in children younger than 5 years of age, (2) report on the type of support these devices provide, and (3) evaluate their potential for use in the community (outside of the laboratory or clinic). Data Sources A literature search of PubMed was conducted in February 2019 using specific terms, including child, rehabilitation, movement, and instrumentation. Study Selection The search yielded 451 peer-reviewed articles, which were screened by multiple reviewers. Articles that described the use of devices for the purpose of motor rehabilitation and/or assistance (regardless of device type or body part targeted) in the age range of 0-5 years were eligible for inclusion. Data Extraction In conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, final stage data extraction consisted of full text readings where each article was reviewed twice by 3 independent reviewers. Data Synthesis About half of the devices available (46%) for children younger than 5 years of age are orthotics and corrective casting devices. There are more facilitative (ie, power mobility devices) than inhibitive (ie, casting) technologies being used. Approximately 60% of the devices are designed for use by a single body part. Walking is the most common motor skill addressed. Although most of the devices were used to some degree outside of the laboratory or clinic, most of the devices available are considered investigative and are not available for commercial purchase. Conclusions Many types of pediatric devices to assist movement exist, but the current scope of employed devices is limited. There is a need for developing technology that allows for, if not supports, high-dosage, early, and variable motor practice that can take place in community settings.
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Perceived Barriers of Modified Ride-On Car Use of Young Children With Disabilities: A Content Analysis. Pediatr Phys Ther 2020; 32:129-135. [PMID: 32150029 PMCID: PMC7546953 DOI: 10.1097/pep.0000000000000690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Modified ride-on cars have emerged as an early powered mobility option for young children with disabilities. The purpose of this study was to identify, extract, and synthesize perceived barriers of modified ride-on car use reported in previous studies. METHODS This study was descriptive using a qualitative content analysis of previously published studies identified from a systematic literature search. RESULTS Categories of perceived barriers were identified: device, environmental, child-related perceived barriers regarding health, tolerance, and abilities, and caregiver-related perceived barriers regarding physical requirements, time, and motivation. Device and environmental perceived barriers were the most reported. CONCLUSIONS Pediatric physical therapists play a critical role in working with families to promote their self-efficacy for using the modified ride-on car and their capacity for overcoming the inherent difficulties associated with use. Most of the reported perceived barriers are modifiable, at least to some degree, with likely effects on modified ride-on car use.
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Hospodar CM, Sabet A, Logan SW, Catena MA, Galloway JC. Exploratory analysis of a developmentally progressive modified ride-on car intervention for young children with Down syndrome. Disabil Rehabil Assist Technol 2020; 16:749-757. [PMID: 31939311 DOI: 10.1080/17483107.2019.1710773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children with Down syndrome (DS) may have limited opportunities to engage in self-directed mobility and play due to motor delays. A recent modified ride-on car innovation is the sit-to-stand (STS) model, which incorporates functional standing and walking training with the experience of powered mobility. AIMS This study aimed to: (1) describe total dosage and daily usage of three modified ride-on car modes (seated, standing, and power-push) by young children with DS; (2) examine the ability of young children with DS to independently activate the modified ride-on car in seated and standing modes; (3) describe the age of onset of selected motor milestones of the sample in comparison to DS norms. MATERIALS AND METHODS Eight young children with DS (8.6 ± 2.0 months) used three modes of the modified ride-on car over a 9-month intervention. RESULTS All eight children independently activated the modified ride-on car in seated and standing modes. Most motor milestones were achieved earlier in this sample than expected for DS norms, including the onset of independent walking. CONCLUSIONS AND IMPLICATIONS The developmentally progressive nature of the intervention and high dosage may have been instrumental in encouraging the onset of independent activation and earlier motor milestones.IMPLICATIONS FOR REHABILITATIONYoung children with Down syndrome were able to achieve independent activation in seated and standing modified ride-on cars.Developmentally progressive modified ride-on car interventions may facilitate motor skill development, but future work utilizing a randomized control group is needed to examine the potential motor developmental benefits of the STS model and power-push mode.The developmentally progressive nature of the intervention may have been instrumental in encouraging the onset of independent switch activation in both seated and standing modes, as well as the high dosage and adherence rates compared to previous studies.
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Affiliation(s)
- Christina M Hospodar
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Andrina Sabet
- College of Health Sciences, Cleveland State University, Cleveland, OH, USA
| | - Samuel W Logan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Michele A Catena
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - James C Galloway
- Department of Physical Therapy and Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA
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Logan SW, Hospodar CM, Bogart KR, Catena MA, Feldner HA, Fitzgerald J, Schaffer S, Sloane B, Phelps B, Phelps J, Smart WD. Real World Tracking of Modified Ride-On Car Usage in Young Children With Disabilities. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2019; 7:336-353. [PMID: 33015208 PMCID: PMC7529107 DOI: 10.1123/jmld.2019-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Go Baby Go is a community program that provides modified ride-on cars to young children with disabilities. AIMS (1) To describe the real world modified ride-on car usage of young children with disabilities; (2) To compare subjectively reported modified ride-on car usage recorded by parents with objectively reported usage based on electronic tracking data. METHODS 14 young children (1-3 years old) with disabilities used a modified ride-on car for three months. RESULTS On average, parent-reported activity log data indicated that children used the modified ride-on car for 17.8 minutes per session (SD = 9.9) and 195.1 total minutes (SD = 234.8) over three months. Objective tracking data indicated 16.5 minutes per session (SD = 8.6) and 171.4 total minutes (SD = 206.1) over three months. No significant difference of modified ride-on car usage was found between parent-reported activity log data and objective tracking; yet, the mean absolute difference between tracking methods was 96 minutes (SD = 8.6) and suggests over- or under-reporting of families. Children used the modified ride-on car more in the first half compared to the second half of the three-month period (p < .05). CONCLUSIONS This study may inform future research studies and local chapters of the Go Baby Go community program.
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Pritchard-Wiart L, Bragg E, Thompson-Hodgetts S. The Young Movers Project: A Case Series Describing Modified Toy Car Use as an Early Movement Option for Young Children With Mobility Limitations. Phys Occup Ther Pediatr 2019; 39:598-613. [PMID: 31144554 DOI: 10.1080/01942638.2019.1585403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Modified toy cars for have gained popularity as a tool for early exposure to power mobility. Aims: to (1) determine modifications required, (2) describe frequency of home and community use, (3) describe assistance and encouragement provided, child's motivation and enjoyment of the car, and (4) explore therapist and parent experiences with the cars. Methods: This mixed-methods case series included children aged 13-58 months (n = 5) with cerebral palsy (n = 4) and arthrogryposis and hypotonia (n = 1). Four children received cars and follow-up visits from therapists in their homes. Quantitative data were collected using a family driving record. Qualitative interviews were conducted with parents (n = 5) and therapists (n = 2). The data management strategy described by Knafl (1988) facilitated qualitative data analysis. Results: One child could not be adequately supported; she did not receive a car. Driving frequency ranged from 1.3 to 2.9 days per week, 12-63 min in duration. Qualitative analysis resulted in four themes: (1) A gentle introduction to power mobility, (2) It's more than just mobility, (3) You just need to try it, and (4) Cars are simple tools. Conclusions: Modified toy cars are feasible for early exposure to power mobility with young children with physical disabilities who do not require extensive seating modifications.
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Affiliation(s)
- Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Elaine Bragg
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sandra Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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James D, Pfaff J, Jeffries LM. Modified Ride-on Cars as Early Mobility for Children with Mobility Limitations: A Scoping Review. Phys Occup Ther Pediatr 2019; 39:525-542. [PMID: 30592238 DOI: 10.1080/01942638.2018.1547808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: This study aims to systematically examine and map current available evidence describing the benefits of modified ride-on car use for young children with mobility limitations and identify potential applications to occupational and physical therapy practice while illuminating gaps in knowledge to be explored in future research. Methods: An electronic database search, manual search of bibliographies, contact with existing networks and organizations were used to identify all relevant literature. Studies addressing modified ride-on toy use by children ≤6 years old with identified mobility delays were included. Data were extracted and analyzed independently by the investigators using a standardized process. Results: Thirteen case studies and one case controlled study involving children ≤6 years old with a variety of diagnoses were included in the review. Studies were at the activities and participation levels and focused on mobility, interpersonal interactions and relationships, communication, and Community, Social, and Civic Life. Conclusion: Findings support the use of modified ride-on cars as a form of early mobility to encourage the development of social-emotional and mobility skills in young children with mobility limitations. Future research with valid, reliable outcome measures that address changes in developmental levels across domains is indicated.
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Affiliation(s)
- Dawn James
- a Physical Therapy, West Coast University.,b Rehabilitation Sciences, OUHSC , Oklahoma City , USA
| | - Jacklin Pfaff
- b Rehabilitation Sciences, OUHSC , Oklahoma City , USA.,c TES Therapy , South Pasadena, California , USA
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Abstract
PURPOSE The purpose of this study was to determine the feasibility of infants with Down syndrome to use a modified ride-on car with seated and standing modes. METHODS Participants included 4 infants with Down syndrome. Families were asked to provide at least 8 minutes of modified ride-on car driving per day, at least 5 times per week throughout the 9-month intervention. RESULTS AND CONCLUSIONS Families demonstrated a variety of adherence rates to the intervention. Infants demonstrated independent activation of the modified ride-on car in seated and standing modes and enjoyed driving. The modified ride-on car intervention was feasible and warrants further testing to address barriers that influence adherence to the intervention.
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Lundy M, Rodriguez A, Aceros J. Engineering, Physical Therapy and the Community: A Service Learning Course. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1640-1643. [PMID: 30440708 DOI: 10.1109/embc.2018.8512654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The School of Engineering and the Physical Therapy program at the University of North Florida developed a novel, community-based course where undergraduate engineering students are partnered with physical therapy students. In this course students participate in hands-on, team-based design projects focused on low-tech and high-tech rehabilitation technology for children with disabilities. The impact of this interprofessional education experience on the students has been evaluated using the Public Service Motivation Scale for three years and its impact on the students is presented.
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Abstract
PURPOSE The purpose of this single-subject case series study is to determine the effect of modified ride-on car use in natural environments on mobility. METHOD Three children younger than 2 years diagnosed with various disabilities participated in this 24-week study using a modified ride-on car in their home and community. RESULTS All 3 children demonstrated an ability to independently use the modified ride-on car and enjoyed doing so. Two of the 3 children demonstrated clinically significant gains in mobility skills as measured by the Pediatric Evaluation of Disability Inventory. CONCLUSIONS Modified ride-on car use is an emerging powered mobility device option for children younger than 2 years. Further research is needed to demonstrate the potential long-term gains of early powered mobility access to young children with disabilities.
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Logan SW, Feldner HA, Bogart KR, Goodwin B, Ross SM, Catena MA, Whitesell AA, Zefton ZJ, Smart WD, Galloway JC. Toy-Based Technologies for Children with Disabilities Simultaneously Supporting Self-Directed Mobility, Participation, and Function: A Tech Report. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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