Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study

Lessons learned from a pediatric powered mobility lending program

PURPOSE

To evaluate children's characteristics and impact of a powered wheelchair lending program including comparisons of diagnostic sub-groups, and validation of a predictive model of powered mobility proficiency.

METHODS AND MATERIALS

This retrospective study included 172 children who participated in the ALYN powered mobility lending program from 3/2009-7/2022. Demographics and functional levels were measured via questionnaires; driving proficiency was evaluated when the wheelchair was returned, and parents and children were interviewed following their participation in the program.

RESULTS

Two diagnostic groups were identified: cerebral palsy (CP) (n = 136, median = 9.75 yrs) and other neuromuscular diseases (NMD) (n = 30, median = 5.83 yrs). They differed significantly in the age they commenced PM training, the male/female ratio, walking ability and access mode. Fifty-seven percent of the participants with CP achieved powered mobility proficiency, a rate that was significantly lower than the 73% proficiency found for the NMD group. Four significant predictors were identified: communication, manual wheelchair operation, access mode and go-stop upon request. They predicted proficiency in approximately 80% of cases. Overall feedback from the parents and children indicated that their personal and family's quality of life improved as a result of their child's ability to use a powered wheelchair.

CONCLUSIONS

A lending program provides children with opportunities to improve mobility skills in an appropriate powered wheelchair. Children who can communicate verbally, propel a manual wheelchair, use a joystick and go-stop upon request are significantly more likely to become proficient drivers; however, many who were unable to complete these tasks also improved and even became proficient drivers.

The IndieTrainer system: a small-scale trial exploring a new approach to support powered mobility skill acquisition in children

The IndieTrainer system, consisting of a mobility device and video-based gamified training modules, was developed to assist children in attaining power wheelchair (PWC) skills. The purposes of this small-scale trial were to explore the use of the IndieTrainer system to provide PWC skills training and document parental satisfaction with the IndieTrainer system. We hypothesized that PWC skills training provided using the IndieTrainer system would result in improvements in both children's understanding of how to use a PWC and their PWC skill execution, and that parental satisfaction would be high. An open-label, single-arm trial was conduct as follows: (a) Baseline testing (T0); (b) A 3-week intervention consisting of two, 60-min-PWC skills training sessions per week; (c) Post-intervention testing (T1); and (d) A single session retention trial held 4 weeks after completion of the intervention (T2). Outcome measures included the Assessment of Learning Powered mobility use (ALP), Wheelchair Skills Checklist (WSC), Canadian Occupational Performance Measure (COPM), and Client Satisfaction Questionnaire-8 (CSQ-8). 25 child/parent dyads participated. Between T0 and T1, statistically significant differences (p-value <.0001) with large effect sizes in mean ALP and WSC scores (ALP: d = 3.14; WSC: d = 3.25) and COPM performance and satisfaction scores (Performance: d = 4.66; Satisfaction: d = 3.24) were achieved. Mean T1 total CSQ-8 score was 31.52/32. At T2, all children maintained or improved their T1 ALP and WSC scores. This study provides initial support for the usability and feasibility of the IndieTrainer system. Futhermore, larger scaled studies using more rigorous research designs are indicated.

Probability of independent walking and wheeled mobility in individuals with cerebral palsy

AIM

To estimate the probability of independent walking and wheeled mobility in individuals with cerebral palsy (CP) at home and in the community in relation to age and gross motor function.

METHOD

This was a longitudinal cohort study using data reported into the combined Swedish CP follow-up programme and national quality registry from October 2000 to October 2022. Walking, walking with aids, wheeled mobility, and assisted mobility defined independent or assisted mobility at home and in the community, based on the Functional Mobility Scale with additional data on wheelchair performance, were assessed.

RESULTS

There were 52 858 examinations reported for 6647 individuals with CP (age range 0-32 years, follow-up period 0-22 years). Most children and adults in Gross Motor Function Classification System (GMFCS) levels I or II walked without assistive devices. The probability of dependence on others for mobility in the community was high for both children and adults in GMFCS levels III to V.

INTERPRETATION

Although independent mobility is vital for participation and social inclusion, many children and adults with CP are dependent on others for mobility. We recommend clinicians, together with families and individuals with CP, explore how to increase access to independent mobility from an early age and continuously throughout the life course.

WHAT THIS PAPER ADDS

• There is a high probability of independent walking in Gross Motor Function Classification System (GMFCS) levels I to II. • Mobility options vary most at home and in the community in GMFCS level III. • Being dependent on others for mobility is likely in GMFCS levels III to V.

School-Based Therapists' Perspectives of Wheelchair Use in US Schools: A Survey Study

PURPOSE

To gather information concerning the current state of students' wheelchair (WC) use in US schools from the perspective of school-based therapists.

METHODS

This descriptive study used a Web-based survey to gather information regarding factors that facilitated or hindered student WC use at school, the frequency at which various tasks related to WC provision were performed, and factors that would facilitate students' independence with WC use.

RESULTS

A dependent manual WC was the most common type of WC mobility used at school. Various student and nonstudent factors were reported as a facilitator or a barrier to students' WC use at school.

CONCLUSIONS

Although most respondents reported working with a student who used a WC, few reported active engagement in tasks related to WC service provision. Future research exploring potential attitudinal issues influencing students' WC use at school and ways to optimally support students' independent WC use is indicated.

Family-Professional Collaboration on Modified Ride-on Car Intervention for Young Children: Two Case Reports

AIMS

The study aimed to describe the implementation of a collaborative ride-on car (ROC) intervention by applying a practice model of family-professional collaboration. The model involves specific strategies for collaboration, "visualizing a preferred future" and "scaling questions."

METHODS

The participants were two young children with mobility limitations and their mothers. The 12-week of ROC intervention involved training sessions with a therapist and home sessions. The outcomes included the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS).

RESULTS

The collaborative strategies facilitated parent engagement in goal setting, planning, and evaluation. After the intervention, the mothers' ratings of their children's performance and parent satisfaction on the COPM increased by 6 and 3 points, respectively, and the level of goal attainment exceeded expectations (+1 on GAS) in both families. Prior to the ROC intervention, both families were hesitant to use powered mobility. However, the experience of participating in the ROC intervention process broadened parents' perspectives on self-directed mobility and led them to explore options for their children to move independently.

CONCLUSIONS

The collaborative ROC intervention can be used as an intervention for early mobility and a bridging step for families reluctant to use a powered wheelchair.

RESNA position on the application of power mobility devices for pediatric users

This paper serves as an update to the previous RESNA Position on the Application of Power Wheelchairs for Pediatric Users with more current and additional scientific literature. This document contains typical clinical applications and best evidence from the literature supporting the application of power mobility (PM) for young children and to assist practitioners in decision-making and justification. It is RESNA' s position that age, limited vision or cognition, behavioral issues, and the ability to walk or propel a manual wheelchair short distances should not, in and of themselves, be used as discriminatory factors against providing PM for children. RESNA recommends early utilization of PM for children with mobility limitations as medically necessary, to promote integration and psycho-social development, reduce passive dependency, and to enhance participation, function, and independence.

Inpatient Physical Therapy After Orthopedic Lower Extremity Surgery in Children With Cerebral Palsy

PURPOSE

To characterize and examine the variability in receipt of inpatient (IP) physical therapy after lower extremity (LE) orthopedic surgery for individuals with cerebral palsy (CP) across hospital-level (region, bed size) and individual characteristics (gender, age, race/ethnicity, insurance type, technology dependency, and surgical burden).

METHODS

We retrospectively analyzed physical therapy billing data of children with CP who had LE orthopedic surgery from October 1, 2015, through September 30, 2017, from the Pediatric Health Information Services (PHIS) database.

RESULTS

Seventy-five percent of individuals received IP physical therapy during the hospital stay. Individuals from the South and West and those who were technology dependent were less likely to receive IP therapy. Those at large hospitals, aged 11 to 14 years, and with a high surgical burden were more likely to receive therapy.

CONCLUSIONS

Results provide a starting point for future research on the discrepancies of acute physical therapy services in children diagnosed with CP. (Supplemental digital content video abstract available at: http://links.lww.com/PPT/A420).

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.

Evaluation of pediatric-specific resources to support utilization of the Wheelchair Skills Training Program by the users of the resources: a descriptive qualitative study

BACKGROUND

Children's ability to engage in meaningful activities is positively influenced by their ability to move independently. Preliminary evidence in children suggests that wheelchair skills training improves wheelchair skills, which are important for independent mobility. The Wheelchair Skills Training Program is a standardized program to teach wheelchair skills. However, it is underutilized in pediatric rehabilitation settings. To increase its utilization, 3 pediatric-specific Wheelchair Skills Training Program resources related to indoor skills were developed (i.e., a storybook, four instructional posters, and a training workbook). This study aimed to describe occupational therapists' (OTs) and pediatric manual wheelchair users' (PMWUs) perceived satisfaction with the storybook, instructional posters and training workbook, and to explore their perceptions regarding the usability, relevance, and feasibility of these resources in pediatric rehabilitation settings.

METHODS

A descriptive qualitative design was used. Convenience samples of OTs and PMWUs were recruited in a rehabilitation center and affiliated schools. A focus group with OTs and semi-structured interviews with PMWUs were conducted by videoconference to obtain participants' feedback on the resource prototypes and suggestions for improvement. Data were deductively analyzed using the Framework method.

RESULTS

Eight OTs and 5 PMWUs expressed general satisfaction with the resources, describing them as usable, relevant, and feasible to integrate into wheelchair skills training with novice wheelchair users and younger children. All OTs and 3 PMWUs expressed the desire to use the resources for wheelchair skills training. Two PMWUs perceived the resources were not relevant to them because they already mastered the skills. The participants suggested minor modifications for improving the resources (e.g., more action in the story, increased precision of illustrations related to the characters' position in the wheelchair).

CONCLUSION

OTs and PMWUs were satisfied with the resources, perceiving them to be applicable for training wheelchair skills among young children and novice wheelchair users. The resources represent a concrete solution to facilitate the use of the Wheelchair Skills Training Program in pediatric rehabilitation settings. Additional resources are needed to better reach older and more experienced PMWUs (i.e., of intermediate and advanced skill levels).

The Effects of an Online-Offline Hybrid Exercise Program on the Lives of Children with Cerebral Palsy Using Wheelchairs during the COVID-19 Pandemic in Korea

Due to the ongoing COVID-19 pandemic, many online programs for social meetings, education, leisure, and physical activities have been developed and provided; however, children with cerebral palsy (CP) cannot enjoy online programs in the same way that those without disabilities can. The aim of this study was to investigate the differences in reintegration to normal living (RNL), social interaction, and quality of life among school-age children with CP after participation in a game-based online−offline hybrid group exercise program. The current study was conducted on 26 children with CP who participated in a hybrid exercise program. The RNL, social interaction, and quality of life were measured before and after the six-week program. The scores of RNL and quality of life were improved (p < 0.05) after program participation. Online or hybrid exercise programs incorporating interactive methods (i.e., competition and cooperating) could enhance RNL and quality of life of children with CP. Thus, well-designed online or hybrid exercise programs should be developed and provided for children with CP to enhance overall quality of life during the pandemic.

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions. Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16-76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing. Results: Assistive devices were used by 63% in sitting (range 5-100% GMFCS levels I-V), 42% in lying (4-92% levels I-V), and 32% in standing (2-70% levels II-V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35-100% levels I-V), sitting (81%; 50-99% levels I-V) and standing (88%; 65-100% levels I-V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting. Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.

Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury

OBJECTIVE

To understand the benefits and harms of physical activity in people who may require a wheelchair with a focus on people with multiple sclerosis (MS), cerebral palsy (CP), and spinal cord injury (SCI).

DATA SOURCES

Searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane CENTRAL, and Embase (January 2008 through November 2020).

STUDY SELECTION

Randomized controlled trials, nonrandomized trials, and cohort studies of observed physical activity (at least 10 sessions on 10 days) in participants with MS, CP, and SCI.

DATA EXTRACTION

We conducted dual data abstraction, quality assessment, and strength of evidence. Measures of physical functioning are reported individually where sufficient data exist and grouped as "function" where data are scant.

DATA SYNTHESIS

No studies provided evidence for prevention of cardiovascular conditions, development of diabetes, or obesity. Among 168 included studies, 44% enrolled participants with MS (38% CP, 18% SCI). Studies in MS found walking ability may be improved with treadmill training and multimodal exercises; function may be improved with treadmill, balance exercises, and motion gaming; balance is likely improved with balance exercises and may be improved with aquatic exercises, robot-assisted gait training (RAGT), motion gaming, and multimodal exercises; activities of daily living (ADL), female sexual function, and spasticity may be improved with aquatic therapy; sleep may be improved with aerobic exercises and aerobic fitness with multimodal exercises. In CP, balance may be improved with hippotherapy and motion gaming; function may be improved with cycling, treadmill, and hippotherapy. In SCI, ADL may be improved with RAGT.

CONCLUSIONS

Depending on population and type of exercise, physical activity was associated with improvements in walking, function, balance, depression, sleep, ADL, spasticity, female sexual function, and aerobic capacity. Few harms of physical activity were reported in studies. Future studies are needed to address evidence gaps and to confirm findings.

Mobility devices for children with physical disabilities: use, satisfaction and impact on participation

INTRODUCTION

Children with physical disabilities commonly use mobility devices. There is a lack of studies on the use and impact of mobility devices on activities and participation. Research is needed on satisfaction with the service delivery process of mobility devices.

PURPOSE

To examine the use and impact of mobility devices among children with physical disabilities and the satisfaction with the properties of their mobility devices and related services.

MATERIALS AND METHODS

A web-based survey was sent to parents of 6 - 18 years old children with physical disabilities who used mobility devices in Iceland. The use and effectiveness of mobility devices were assessed with a questionnaire designed for this study. The satisfaction was measured with Quebec user evaluation of satisfaction with assistive technology (QUEST) 2.0.

RESULTS

The survey was sent to 55 families and 36 replied. Most of the children used mobility devices in social activities. The number of participants who reported positive effects of devices on activities and participation, depended on environmental settings. There was no significant difference in participants' satisfaction between types of mobility devices. Also, there was no significant difference in participants' satisfaction with the properties of the device and the related service (for wheeled walkers p = 0.47, manual wheelchairs p = 0.08, powered wheelchairs p = 1.00).

CONCLUSIONS

The results indicate the importance of mobility devices for activities and participation and can guide healthcare workers when providing mobility devices where environmental factors across settings must be kept in mind. Stakeholders should be aware of the value of satisfaction with the devices and related services.Implications for Rehabilitation:Children with physical disabilities use mobility devices across different environmental settings and need to have more than one type of equipment.This study confirms results from earlier research that mobility devices are important for the activities and participation of children with disabilities.It is important to understand how the delivery process of devices is perceived by those who receive them. High satisfaction is an indicator of high quality of service.Environmental factors across settings must be kept in mind in the delivery process of assistive devices.

Exercise load and physical activity intensity in relation to dystonia and choreoathetosis during powered wheelchair mobility in children and youth with dyskinetic cerebral palsy

PURPOSE

To explore the relation between exercise load, physical activity intensity, and movement disorders during powered wheelchair (PW) mobility in people with severe dyskinetic cerebral palsy (DCP).

METHODS

Ten participants with DCP, 6-21 years old, users of a head/foot steering system were included. Dystonia and choreoathetosis were assessed using the Dyskinesia Impairment Mobility Scale (DIMS), heart rate (HR) was used to assess the exercise load of the tasks on the participants, and the accelerometry-based activity index (AI) to measure the physical activity intensity and energy expenditure during mobility task performance.

RESULTS

Neck- and distal arm dystonia showed significant correlations with HR (0.64 < r_s < 0.77; 0.009 < p < 0.048), whereas neck- and proximal arm choreoathetosis with AI (0.64 < r_s < 0.76, 0.011 < p < 0.044). Total-body AI was strongly correlated to the AI of the arms (0.66 < r_s < 0.90,  < 0.001 < p < 0.038), but not to the AI of the head.

CONCLUSIONS

During PW mobility tasks, dystonia is associated to exercise load and choreoathetosis to physical activity intensity and energy expenditure. Findings highlight the difficulties in measuring exercise load and activity intensity in PW users with DCP due to the involuntary hypertonic and/or hyperkinetic hallmark of the movement disorders. Nevertheless, a relaxed surrounding with minimal distractions during PW training may increase learning efficiency. Future studies with a bigger sample size are highly recommended to fully establish the relationship between the variables and to allow generalizability of results.Implications for rehabilitationDystonia is positively related to heart rate during powered mobility, which may be explained by the hypertonic hallmark of dystonia causing an increase in exercise load.Choreoathetosis is positively related to the physical activity index during powered mobility where the hyperkinetic hallmark of choreoathetosis may lead to an increase in physical activity intensity and energy expenditure.Arm overflow movements are the component which contribute the most to total-body activity index, thus, minimizing these movements may lower the overall energy expenditure during powered mobility.Mobility training in a relaxed surrounding with minimal distractions and minimized arm overflow movements may lead to a less-demanding powered wheelchair mobility experience and increased learning efficiency.

Adapting the Wheelchair Skills Program for pediatric rehabilitation: recommendations from key stakeholders

Background

Backed by over 20 years of research development, the Wheelchair Skills Program (WSP) has proven to be a safe and effective program to improving wheelchair skills for adult wheelchair users. However, evidence is lacking for the pediatric population, which may help to explain the limited use of the WSP in pediatric settings. While additional evidence specific to the pediatric population is needed, concurrent implementation of the WSP into pediatric clinical practice is equally prudent to allow those users to benefit from the years of accumulated WSP evidence. To facilitate implementation of evidence-based programs into practice, adaptation is also often required to improve the fit between the program and the local context. Therefore, the objective of this study was to understand what adaptations, if any, are required for the WSP to be implementable in a pediatric setting.

Methods

A deductive qualitative descriptive study design was used, guided by the Knowledge to Action Framework and Consolidated Framework for Implementation Research (CFIR). Occupational Therapists (OTs) from a pediatric rehabilitation center and two specialized schools in Montreal, Canada were invited to participate in a 90-min focus group. The Framework Method was followed for the data analysis.

Results

One focus group in each site (n = 3) was conducted with a total of 19 participants. From the OTs’ perspectives, our analysis revealed benefits of WSP use and various issues (e.g. some skills seem unrealistic) affecting its uptake in relation to the constructs of the CFIR Intervention Characteristics domain. The results provided guidance for the recommendations of adaptations (e.g. addition of a caregiver assistance score) to enhance implementation of the WSP in pediatric rehabilitation settings and helped to identify the need for the production of new knowledge and knowledge translation (KT) tools.

Conclusions

Implementation of the WSP with the adaptations and KT tools proposed could allow pediatric manual wheelchair users to improve their wheelchair skills.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02564-9.

Pain is frequent in children with cerebral palsy and negatively affects physical activity and participation

AIM

The aim was to identify the prevalence of long-lasting pain among children with cerebral palsy (CP) and to investigate the association between pain and participation in physical leisure activities.

METHODS

This is a cross-sectional study based on data from the National Danish Clinical Quality Database of children with CP. The study population consisted of 960 children aged 2-11 years across all Gross Motor Function Classification System (GMFCS) levels. Data were collected at children's regular clinical visits in 2016 or 2017. Information about pain and participation in physical leisure activities were obtained. The association was estimated as odds ratios (OR) and 95% confidence intervals (95% CI) by logistic regression adjusted for age and sex.

RESULTS

We included data from 817 children (59% boys) median age 6 years, 52% classified as GMFCS level I. A total of 36% reported pain, and the most frequent pain locations were hips, feet and knees. Children reporting pain had lower odds for participation in physical leisure activities (OR 0.71, 95% CI 0.53-0.96).

CONCLUSION

A large proportion of children with CP reported pain. There is an indication that long-lasting pain influences participation in physical leisure activities. Pain-relieving interventions are important to decrease pain-related suffering and facilitate participation.

Beginning power mobility: parent and therapist perspectives

PURPOSE

To explore parent and therapist experiences of early power mobility following participation in a Power Mobility Day - a 60-90 min play-based session where children with mobility limitations (<6 years of age) experienced four different early power mobility devices.

METHOD

Participants were purposefully selected from parents and therapists who took part in Power Mobility Days as part of a larger cross-sectional study. One semi-structured interview with each participant was conducted via telephone. Interviews were audio-recorded, transcribed, and analyzed using a content analysis approach.

RESULTS

Of 35 adults approached, 11 parents and 11 occupational or physical therapists completed interviews averaging 20 min (range 10-45 min), one week to three months after the session. Participants were parents or therapists of children aged 12 to 48 months of age with a variety of neuromotor diagnoses from different areas of the province. The overarching theme Empowering Children and Families to Explore was developed from themes: Earlier Experiences; A Novel Introduction; and Moving Forward.

CONCLUSION

Power Mobility Days provided a welcoming and inclusive child- and family-led introduction to power mobility. This novel approach may help change both therapists' and families' perception of child potential and perspectives on power mobility as an intervention.IMPLICATIONS FOR REHABILITATION:Exploratory sessions can provide a novel introduction to power mobility interventions.Child enjoyment has a reciprocal impact on family engagement with early power mobility.Experiential child- and family-led learning can increase awareness of power mobility options and possibilities.

Dystonia and choreoathetosis presence and severity in relation to powered wheelchair mobility performance in children and youth with dyskinetic cerebral palsy

INTRODUCTION

Power wheelchairs (PW) with head/foot steering systems are used as an alternative to joysticks in children with severe dyskinetic cerebral palsy (DCP). Mobility training programs are unstandardized to date, and insight on dystonia, choreoathetosis, and mobility performance may lead to greater independent mobility.

OBJECTIVE

To map the presence and severity of dystonia and choreoathetosis during PW mobility in DCP and their relation with mobility performance.

METHODS

Ten participants with DCP performed four PW mobility tasks using a head/foot steering system. Dystonia and choreoathetosis in the neck and arm regions were evaluated using the Dyskinesia Impairment Mobility Scale (DIMS). PW mobility performance was assessed using time-on-task and the number of errors during performance. The Wilcoxon-signed rank test and the Spearman's correlation coefficients were used to explore differences and correlations.

RESULTS

Median levels of dystonia (83.6%) were significantly higher (p < 0.01) than median levels of choreoathetosis (34.4%). Positive significant correlations were found between the Arm Proximal DIMS and the PW mobility experience (r_s=-0.92, p < 0.001), and between the Arm Distal DIMS and the number of errors (r_s = 0.66, p = 0.039) during mobility performance.

CONCLUSIONS

Dystonia is more present and severe during PW mobility than choreoathetosis. The hypertonic hallmark of dystonia may mask the hyperkinetic hallmark of choreoathetosis, resulting in lower median levels. Results may suggest that with an increase in driving experience, children with DCP adopt deliberate strategies to minimize the negative impact of arm overflow movements on mobility performance, however, future research with bigger sample size and additional outcome measures is strongly encouraged.

A Preliminary Evaluation of Energy Efficiency for Children with Cerebral Palsy for Driving A Manual Wheelchair and Walking: Use of the Total Heart Beat Index

Aims: This study aims to compare the total heart beat index (THBI) in evaluating energy efficiency between using a manual wheelchair and walking for children with cerebral palsy (CP). Methods: The energy efficiency was measured in 21 participants with CP (mean age, 13.6 ± 3.4 years) who walk or drive a manual wheelchair using a square course. THBI was calculated as total number of heart beats during the exercise period/total distance traveled. Results: Significant differences in the THBI were observed between Gross Motor Function Classification System (GMFCS) levels III and IV (p = .049, effect size = 1.60). No significant differences in THBI were observed between GMFCS levels II and III or between GMFCS levels II and IV (p > .05). Conclusions: The energy efficiency of children with CP who use a manual wheelchair in this study was equal to or better than that for walking.

Comparing children's driving abilities in physical and virtual environments

PURPOSE

To compare children's driving abilities in a physical and virtual environment and to validate the McGill Immersive Wheelchair Simulator (MiWe-C) for the use of children with disabilities.

MATERIALS AND METHODS

Participants included 30 children (17 males, 13 females; mean age 14 y 1 mo, [SD 3 y 6 mo]; range: 5-18 y) with cerebral palsy, neuromuscular disease and spinal cord injury. All children were proficient drivers with more than 3 months' experience, who had their own powered wheelchairs. Participants drove a 15-minute physical route and high-fidelity simulation of that route in a counterbalanced order. Performance of the two routes was compared using the 32 item Powered Mobility Programme (PMP). Differences between the driving modes were analyzed with the non-parametric Wilcoxon signed-rank test. Significance was set at α = 0.05.

RESULTS

The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M = 4.90, SD = 0.20; M = 4.96, SD = 0.12, respectively) with no significant difference between them (z= -1.69, p = .09). Five out of the 32 PMP tasks showed significant differences between driving modes (narrow corridors, crowded corridors, doorway, sidewalks), with higher scores for the physical driving mode.

CONCLUSIONS

Having a validated powered mobility simulator for children provides a viable option for an additional practice mode. The MiWe-C simulator is affordable and a user-friendly simulator that can be used anywhere including at home and in school. Children can be independent when practicing even if they are not yet proficient drivers since continual adult assistance is not needed.Implications for rehabilitationHaving a validated powered mobility simulator for children provides a viable option for an additional practice mode.The MiWe-C is now validated to be used with children 5-18 years with physical disabilities.The MiWe-C is one of the few options for children to practice outside of a research environment.

Development of the Dyskinesia Impairment Mobility Scale to Measure Presence and Severity of Dystonia and Choreoathetosis during Powered Mobility in Dyskinetic Cerebral Palsy

The majority of individuals with dyskinetic cerebral palsy cannot use powered mobility with a joystick, due to the lack of manual abilities by the severe presence of dystonia and choreoathetosis. Reliable measurements of these movement disorders is indispensable for good evaluation towards evidence–based insights during powered mobility. This study aimed to develop and assess the Dyskinesia Impairment Mobility Scale (DIMS), a video–based tool to measure presence and severity of dystonia and choreoathetosis during powered mobility. DIMS was measured for the neck and arms region during five mobility tasks. Interrater reliability, test–retest reliability, internal consistency and concurrent validity of the DIMS were assessed. Interrater reliability coefficients ranged between 0.68 and 0.87 for the total DIMS, and the dystonia and choreoathetosis subscales. Test–retest reliability was moderate to excellent (range 0.51–0.93) while Cronbach’s alpha was good (range 0.69–0.81) for the total scale and subscale scores. Concurrent validity showed during mobility tasks significant correlations with rest postures in the arm region, and with requested but voluntary activity in the neck region. The DIMS reliably measures the presence and severity of the movement disorders during powered mobility, increasing insights into the underlying mechanisms of independent mobility. This scale may therefore be a promising tool to evaluate mobility training.

Impacts of early powered mobility provision on disability identity: A case study

BACKGROUND/PURPOSE

Providing powered mobility technology to people with disabilities is a common rehabilitation practice. However, the relationship between powered mobility introduction and identity development, when considered in the context of lived experiences of children with disabilities and their families, is not well understood. Investigating this relationship is timely given the emergence of alternative, community-based early mobility opportunities using adapted mobility toys whose impact may contrast experiences using powered wheelchairs typically provided in rehabilitation settings.

METHOD

Using a qualitative, ethnographic case study approach, in-depth interview and field observation data were collected with 2 children and families, 1 who received a traditional powered wheelchair and the other who received an adapted mobility toy. A grounded theory approach guided the data analysis, and emerging themes were discussed until consensus was reached between Heather Feldner and families.

RESULTS

Findings revealed four themes: (1) dys/function of mobility technology; (2) daily Life, play, and participation; (3) emerging self/advocacy; and (4) complex family/industry interplay.

CONCLUSION

Similarities and differences were present within the situated experiences of each family. Experiences were foregrounded by instances of emerging identity development throughout provision processes that were influenced by caregiver perceptions of disability (positive vs. negative), aesthetics and function (medical vs. adventure), and perceived intent of the devices (an opportunity for freedom vs. prolonging need for undesired mobility equipment). These findings highlight the varied dynamics and spheres of influence this transaction may have on the developing identity of children with disabilities, which may ultimately help inform future models of provision and rehabilitation practices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trunk control and functionality in children with spastic cerebral palsy

PURPOSE

To investigate the relationship between trunk control in sitting and functionality in children with spastic cerebral palsy (CP).

METHODS

Fifty-eight children with spastic CP were included in the study. Functional abilities were evaluated with the Gross Motor Function Measurement-88 (GMFM-88) and the Pediatric Evaluation of Disability Inventory Functional Skills domain (PEDI-FSD). Trunk control in sitting was tested with the Trunk Control Measurement Scale (TCMS) and the Trunk Impairment Scale (TIS). The scores of the TCMS and TIS were compared with GMFM-88 and PEDI-FSD with Spearman correlation analysis.

RESULTS

The total score of GMFM-88 was significantly correlated with the total score of TCMS (r_ho = 0.90, p < 0.01) and TIS (r_ho = 0.78, p < 0.01). The total score of PEDI-FSD was also significantly correlated with the total score of TCMS (r_ho = 0.76, p < 0.01) and TIS (r_ho = 0.72, p < 0.01).

CONCLUSIONS

The evaluation of trunk control can provide valuable information for functional abilities of children with spastic CP.

Caregiver knowledge and preferences for gross motor function information in cerebral palsy

AIM

To determine caregiver knowledge and preferences for gross motor information and examine differences across Gross Motor Function Classification System (GMFCS) levels.

METHOD

A questionnaire was developed. Respondents reported GMFCS knowledge, preference for knowledge, and experience with GMFCS and motor curve information.

RESULTS

In total, 303 caregivers of children with cerebral palsy (CP) (GMFCS level I: 22%; GMFCS level II: 16%; GMFCS level III: 15%; GMFCS level IV: 23%; GMFCS level V: 24%) completed the questionnaire. Forty-five per cent of caregivers knew the GMFCS level at survey, and only 31% knew how their child's motor development compared with others of similar age and level. Caregiver education level was associated with knowledge (p<0.001). Most prefer discussing motor development with a therapist. Of caregivers who knew their child's GMFCS level at survey, 83% reported it would be helpful to revisit the topic over time. Compared with GMFCS level IV and V, caregivers of children in GMFCS levels I to III preferred to learn at the same time as CP diagnosis, (p=0.04) and were more likely to report having received visual aids (p=0.04). Caregivers of children in GMFCS levels IV and V found it more difficult to learn their child's level (p<0.001) versus those caring for children of GMFCS levels I to III, and reported seeing pictures with descriptions more informative (p=0.03).

INTERPRETATION

Caregivers of children with CP may not know GMFCS and motor curve information, and vary in experience and preferences for this information.

WHAT THIS PAPER ADDS

Fewer than half of caregivers of children with cerebral palsy (CP) know their child's Gross Motor Function Classification System level. Most want to know how their child's function compares to other children with CP. The majority of caregivers would like to revisit the topic over time. Caregivers want to discuss gross motor information with the therapist and doctor.

'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.

Current Status of the Utilization of Powered Wheelchair in Preschool Children with Locomotive Disability in Japan

[Purpose] This study aimed to elucidate the actual state of powered wheelchair (PWC) prescription for preschool children with disabilities in Japan, and also to determine the approximate number of preschool children with disabilities who would potentially benefit from PWC use. [Subjects and Methods] A total of 318 facilities providing rehabilitation for disabled children in Japan were enrolled in the study. A questionnaire about PWC use for preschoolers was mailed to the facilities. Each study items were analyzed employing the Fisher's exact test. [Results] Of the 318 facilities, consent to participate in this study was obtained from 108 (return rate: 34.0%). After PWC provision, many facilities reported improvement in quality of life indices for preschool children with disabilities. It was revealed that there were 6 preschool children from 2 to 6 years of age with disabilities who might acquire a means of independent locomotion through PWC provision and thereby experience improved quality of life. [Conclusion] There was no negative comment from the facilities studied about the prescription and provision of PWC for preschool children with disabilities.

Development of a wheelchair mobility skills test for children and adolescents: combining evidence with clinical expertise

Background

Wheelchair mobility skills (WMS) training is regarded by children using a manual wheelchair and their parents as an important factor to improve participation and daily physical activity. Currently, there is no outcome measure available for the evaluation of WMS in children. Several wheelchair mobility outcome measures have been developed for adults, but none of these have been validated in children. Therefore the objective of this study is to develop a WMS outcome measure for children using the current knowledge from literature in combination with the clinical expertise of health care professionals, children and their parents.

Methods

Mixed methods approach. Phase 1: Item identification of WMS items through a systematic review using the ‘COnsensus-based Standards for the selection of health Measurement Instruments’ (COSMIN) recommendations. Phase 2: Item selection and validation of relevant WMS items for children, using a focus group and interviews with children using a manual wheelchair, their parents and health care professionals. Phase 3: Feasibility of the newly developed Utrecht Pediatric Wheelchair Mobility Skills Test (UP-WMST) through pilot testing.

Results

Phase 1: Data analysis and synthesis of nine WMS related outcome measures showed there is no widely used outcome measure with levels of evidence across all measurement properties. However, four outcome measures showed some levels of evidence on reliability and validity for adults. Twenty-two WMS items with the best clinimetric properties were selected for further analysis in phase 2. Phase 2: Fifteen items were deemed as relevant for children, one item needed adaptation and six items were considered not relevant for assessing WMS in children. Phase 3: Two health care professionals administered the UP-WMST in eight children. The instructions of the UP-WMST were clear, but the scoring method of the height difference items needed adaptation. The outdoor items for rolling over soft surface and the side slope item were excluded in the final version of the UP-WMST due to logistic reasons.

Conclusions

The newly developed 15 item UP-WMST is a validated outcome measure which is easy to administer in children using a manual wheelchair. More research regarding reliability, construct validity and responsiveness is warranted before the UP-WMST can be used in practice.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-017-0809-9) contains supplementary material, which is available to authorized users.

Assistive technology needs, functional difficulties, and services utilization and coordination of children with developmental disabilities in the United States

Assistive technology (AT) enhances the ability of individuals with disabilities to be fully engaged in activities at home, at school, and within their communities-especially for children with developmental disabilities (DD) with physical, sensory, learning, and/or communication impairments. The prevalence of children with DD in the United States has risen from 12.84% in 1997 to 15.04% in 2008. Thus, it is important to monitor the status of their AT needs, functional difficulties, services utilization, and coordination. Using data from the 2009-2010 National Survey on Children with Special Health Care Needs (NS-CSHCN), we conducted bivariate and multivariate statistical analysis, which found that 90% or more of parents of both children with DD and other CSHCN reported that their child's AT needs were met for vision, hearing, mobility, communication, and durable medical equipment; furthermore, children with DD had lower odds of AT needs met for vision and hearing and increased odds for meeting AT needs in mobility and communication. Our findings outline the current AT needs of children with DD nationally. Fulfilling these needs has the potential to engender positive lifelong effects on the child's disabilities, sense of independence, self-confidence, and productivity.

Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk instability

The corticoreticular tract (CRT) is known to be involved in walking and postural control. Using diffusion tensor tractography (DTT), we investigated the relationship between the CRT and gait dysfunction, including trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed (TD) children were recruited. Fifteen patients with gait dysfunction (bilateral trunk instability) were included in the group A, and the other 15 patients with gait dysfunction (unilateral trunk instability) were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical manifestations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.

Exploring suitable participation tools for children who need or use power mobility: A modified Delphi survey

OBJECTIVES

To identify suitable tools for measuring important elements of participation for children, aged 18 months to 12 years, who need or use power mobility, and to indicate which tools should be considered for inclusion in a measurement toolkit.

METHODS

Parents, therapists and researchers with expertise in paediatric power mobility and participation (n = 70) completed an online modified Delphi survey, with consensus set a priori >80% agreement. Existing tools were matched against participation elements ranked most important for those in early childhood (18 months-5 years) and of school-age (6-12 years) by the panel.

RESULTS

Six out of 13 tools demonstrated potential, meeting at least three elements each, although none addressed all elements deemed important to measure by the panel. Only the Participation and Environment Measure for Children and Youth (PEM-CY) reached consensus for inclusion in a participation measure toolkit.

CONCLUSION

Further evaluation of these tools with this population is warranted.

Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study

Background

There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP).

Methods

A cross-sectional study based on the most recent examination of all children with CP, born 2002–2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0–11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability.

Results

In total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently.

Conclusions

The majority of children with CP, aged 0–11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.

Electrically powered indoor/outdoor chair performance for children aged 7 to 9 years

Introduction

Northern Ireland wheelchair guidelines state that wheelchair users who wish to drive their National Health Service provided powered wheelchairs outdoors must complete an electrically powered indoor/outdoor chair test. Within the same guidelines, children in Northern Ireland under the age of 10 years are not permitted to complete this assessment. Research was completed to evaluate how children under 10 years would perform in electrically powered indoor/outdoor chair training and testing under adult supervision.

Method

A case-study design was utilised with three children aged 7–9 years to evaluate if: (a) these children can complete electrically powered indoor/outdoor chair training/testing safely with adult supervision; (b) the length of time using an electric powered indoor chair correlates with performance on electrically powered indoor chair training/testing; (c) the current Northern Ireland guidelines on age restriction should be re-evaluated so that each child is assessed on an individual basis rather than age.

Findings

Paediatric powered wheelchair users aged seven to nine years can become competent electrically powered indoor/outdoor chair users with adequate training and adult supervision. Length of time (years) driving an electrically powered indoor chair may not correlate with improved electrically powered indoor/outdoor chair performance.

Conclusion

Regional Northern Ireland criteria relating to electrically powered indoor/outdoor chair provision for children should be revised in order to consider an individual needs assessment, rather than imposing an age restriction.

Evaluation of the effectiveness of robotic gait training and gait-focused physical therapy programs for children and youth with cerebral palsy: a mixed methods RCT

Background

Robot assisted gait training (RAGT) is considered to be a promising approach for improving gait-related gross motor function of children and youth with cerebral palsy. However, RAGT has yet to be empirically demonstrated to be effective. This knowledge gap is particularly salient given the strong interest in this intensive therapy, the high cost of the technology, and the requirement for specialized rehabilitation centre resources.

Methods

This is a research protocol describing a prospective, multi-centre, concurrent mixed methods study comprised of a randomized controlled trial (RCT) and an interpretive descriptive qualitative design. It is a mixed methods study designed to determine the relative effectiveness of three physical therapy treatment conditions (i.e., RAGT, a functional physical therapy program conducted over-ground (fPT), and RAGT + fPT) on gait related motor skills of ambulatory children with cerebral palsy. Children with cerebral palsy aged 5–18 years who are ambulatory (Gross Motor Function Classification System Levels II and III) will be randomly allocated to one of four treatment conditions: 1) RAGT, 2) fPT, 3) RAGT and fPT combined, or 4) a maintenance therapy only control group. The qualitative component will explicate child and parent experiences with the interventions, provide insight into the values that underlie their therapy goals, and assist with interpretation of the results of the RCT.

Discussion

n/a.

Trial Registration

NCT02391324 Registered March 12, 2015.

The child and family experience of power mobility: a qualitative synthesis

AIM

The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence fits with current theoretical concepts.

METHOD

Electronic database/hand searches were undertaken in September 2012 and updated in February 2014. The searches were restricted to qualitative studies published in English before February 2014 that included at least one child under the age of 19 with a disability and described an outcome related to the use of power mobility. Inclusion criteria were set a priori. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. McMaster qualitative review forms were used for quality appraisal.

RESULTS

Of 259 titles, 21 met inclusion criteria. From 143 codes, 15 second-order themes were developed using constant comparison and analysis. Three overarching themes emerged: power mobility experience promotes developmental change and independent mobility; power mobility enhances social relationships and engagement in meaningful life experiences; and power mobility access and use is influenced by factors in the physical, social, and attitudinal environment.

INTERPRETATION

This qualitative research provides rich and rigorous evidence supporting the benefits of power mobility for children and families. Numerous factors, which warrant careful consideration, influence power mobility access and use.

Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination

The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems.

METHOD

A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification.

RESULTS

Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors.

INTERPRETATION

CP registries and surveillance programs, including novel non-traditional ones, have significantly contributed to the understanding of how CP affects individuals, families and society. Moving forward, the global CP registry/surveillance program community should continue to strive for uniformity in CP definitions, variables collected and consistency with international initiatives like the ICF so that databases can be consolidated for research use. Adaptation to new technologies can improve access, reduce cost and facilitate information transfer between registrants, researchers and registries/surveillance programs. Finally, increased efforts in documenting variables of individuals with CP into adulthood should be made in order to expand our understanding of CP across the lifespan.

Systematic review of power mobility outcomes for infants, children and adolescents with mobility limitations

OBJECTIVE

To summarize and critically appraise the evidence related to power mobility use in children (18 years or younger) with mobility limitations.

DATA SOURCES

Searches were performed in 12 electronic databases along with hand searching for articles published in English to September 2012 and updated February 2014.

REVIEW METHODS

The search was restricted to quantitative studies including at least one child with a mobility limitation and measuring an outcome related to power mobility device use. Articles were appraised using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) criteria for group and single-subject designs. The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, abstracts and full-text articles. AACPDM quality ratings were completed for levels I-III studies.

RESULTS

Of 259 titles, 29 articles met inclusion criteria, describing 28 primary research studies. One study, rated as strong level II evidence, supported positive impact of power mobility on overall development as well as independent mobility. Another study, rated as moderate level III evidence, supported positive impact on self-initiated movement. Remaining studies, rated evidence levels IV and V, provided support for a positive impact on a broad range of outcomes from to International Classification of Functioning (ICF) components of body structure and function, activity and participation. Some studies suggest that environmental factors may be influential in successful power mobility use and skill development.

CONCLUSION

The body of evidence supporting outcomes for children using power mobility is primarily descriptive rather than experimental in nature, suggesting research in this area is in its infancy.

Practice considerations for the introduction and use of power mobility for children

AIM

The aim of the study was to support clinicians in recommending and justifying power mobility for children of different ages and abilities, and with different needs. The study comprised three distinct parts: a literature review; a Delphi consensus; and clinical practice considerations.

METHOD

A scoping review of eight electronic databases and manual searches carried out in February 2011 identified 15 themes or transferable messages among 27 articles meeting initial inclusion criteria and these formed the basis of a draft paper. Informal consensus at two international conference presentations refined and modified the paper to include 10 messages supported by 24 articles. The literature review was updated in May 2012 and a modified Delphi process sought to formalize the consensus process with an international panel of 16 expert clinicians and researchers using a priori criteria of 80% agreement.

RESULTS

Evidence from studies was classified using the American Academy of Cerebral Palsy and Developmental Medicine guidelines, with evidence from most studies being classified as either level IV or level V, apart from one study each with evidence classified as level II and level III. Expert consensus on the content and wording of nine transferable messages may raise evidence overall to level III.

INTERPRETATION

This paper suggests that power mobility may reasonably be considered as an effective and appropriate intervention for children lacking efficient, independent mobility from around 12 months of age including children who may never become competent drivers and children lacking independent mobility only in early childhood.

Recipients of electric-powered indoor/outdoor wheelchairs provided by a national health service: a cross-sectional study

OBJECTIVE

To describe the characteristics across all ages of powered wheelchair users and the assistive technology prescribed by a regional specialist wheelchair service.

DESIGN

Cross-sectional study.

SETTING

Regional wheelchair service.

PARTICIPANTS

Electric-powered indoor/outdoor wheelchair (EPIOC) users (N=544) with 262 boys and men (mean age ± SD, 41.7±20.7y; range, 8-82y) and 282 girls and women (mean age ± SD, 47.2±19.7y; range, 7-92y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Demographic, clinical/diagnostic details of EPIOC recipients, including pain, (kypho)scoliosis, and ventilators. Technical features, including specialized (adaptive) seating, tilt in space, and modified control systems. Factors were related to age groups: 1 (0-15y), 2 (16-24y), 3 (25-54y), 4 (55-74y), and 5 (≥75y).

RESULTS

Neurologic/neuromuscular conditions predominated (81%) with cerebral palsy (18.9%) and multiple sclerosis (16.4%). Conditions presenting at birth or during childhood constituted 39%. Of the participants, 99 had problematic pain, 83 had (kypho)scoliosis, and 11 used ventilators. Specialized (adaptive) seating was provided to 169 users (31%); most had cerebral palsy or muscular dystrophy. Tilt in space was used by 258 (53%) participants. Younger people were more likely to receive tilt in space than older ones. Only 92 had specialized (adaptive) seating and tilt in space (mean age ± SD, 29±17.8y; range, 8-72y). Of the participants, 52 used modified control systems.

CONCLUSIONS

The diversity of EPIOC users across age and diagnostic groups is shown. Their complex interrelations with these technical features of EPIOC prescriptions are explored. Younger users were more complex because of age-related changes. This study provides outcomes of the EPIOC prescription for this heterogeneous group of very severely disabled people.

Short-term, early intensive power mobility training: case report of an infant at risk for cerebral palsy

PURPOSE

This case report describes the feasibility of quantifying short-term, intensive power mobility training for an infant soon after a diagnosis of cerebral palsy.

KEY POINTS

An 11-month-old infant with significant mobility impairments and her parents were filmed during 14 consecutive daily training sessions. The infant moved the power chair with hand-over-hand assistance and performed open exploration of the joystick and toys. Mobility measures, coded from video, were compared across training. Frequency and combination of looking at and interacting with the joystick, percentage of time of moving independently, and average percentage of success in moving when prompted, all increased across the training.

CLINICAL IMPLICATIONS

Quantifying short-term, intensive power mobility training for infants is feasible and may have yielded positive short-term effects for this infant. The "who," "when," and "how" of early power mobility training, as well as the critical need for paradigm shifts in power mobility training, are discussed.