Caregiver perspectives on powered mobility devices and participation for children with cerebral palsy in Gross Motor Function Classification System level V

Families' experiences and perspectives on the early use of powered mobility in children with spinal muscular atrophy type I in the natural context

PURPOSE

To describe the experiences of parents who used powered mobility in children with Spinal Muscular Atrophy, SMA type I,at an early age in the natural context like a family-centered program, using inductive qualitative content analysis.

MATERIALS AND METHODS

This qualitative study was embedded within a single-blinded randomized waiting list controlled clinical trial, which involved 16 children with SMA type I. This study specifically explores the experiences of the 9 parents whose children participated in the intervention group and completed the training. The training lasted 12 weeks, 3 weekly sessions of half an hour each in a motorized mobility car. Subsequently, there were 4 weeks of free use, based on the child and family's interest. The therapist evaluated the learning of powered mobility using the ALP assessment. Parent Interviews were conducted using an interview guide.

RESULTS

The results revealed that parents' learning was supported by powered mobility coaching, leading to acquired knowledge, skills, and competence. Several themes emerged for consideration in early age power mobility applications: motivation, playing, the importance of a family-centered program to enhance adherence to training and family satisfaction and to share decision making.

CONCLUSION

The study concludes that early powered mobility for children with SMA type I should educate, empower, and monitor families to increase the interaction and goal achievement and considering barriers in the child's context is essential for accessible mobility.

Quantifying toddler exploration in different postures with powered mobility

Access to powered mobility can support play and development for toddlers with disabilities. Using powered mobility in a standing posture has been theorized to support development of muscle coordination, balance, head and trunk stability, and transition to ambulation. The purpose of this study was to quantify and characterize joystick control, bodyweight support, and muscle activity while using the Permobil Explorer Mini in seated and supported standing postures. Nine children with mobility disabilities participated in four visits where they completed two, 15-20 minute play sessions, one in each posture, with a break between. We found that all toddlers engaged with the joystick in both postures, with individual differences in favored directions and control patterns. Participants had similar loading through their feet in both postures, but had slightly higher muscle activity in standing, especially while driving. These results demonstrate that young children with disabilities quickly engage with joystick-based powered mobility in seated and standing postures, with important individual differences that can inform future design of devices and interventions to support play and development.

The effects of family directed power mobility on self-care, mobility, and social function in very young children with severe multiple developmental impairments

Introduction

Children with impaired mobility often experience negative impact on overall development leading to depression, social isolation, and perceived lower quality of life.

Objective

Our study explored the effects of Power Mobility Devices (PMD), in the form of modified ride-on toy cars with two distinct activation/steering technologies, on functional independent and social function in young children with severe multiple developmental impairments.

Methodology

Twelve children (age range 12-54 months) with neuromuscular, musculoskeletal, and genetic diagnoses, and metabolic progressive diseases participated. Significant cognitive, visual, or communication impairment was not exclusionary. Two types of activation and steering modifications (proportional control joystick and line follower technologies) were provided. Paired samples t-test contrasted pre-post functional capabilities after three months of PMD use in both Pediatric Evaluation of Disability Inventory scales of Functional Skills and Caregiver Assistance, each with the subscales self-care, mobility, and social/cognitive.

Findings

Improvements were observed in all three subscales for Functional Skills (significant 9.8% increase in self-care, 21.4% in mobility, and 17.5% social/cognitive) and Caregiver Assistance (significant 35.4% increase in self-care).

Conclusion

These quantitative results support findings of previous studies analyzing qualitative data, suggesting that early power mobility interventions provide positive improvements in the quality of life of children with severe developmental disabilities.

Quantifying joystick interactions and movement patterns of toddlers with disabilities using powered mobility with an instrumented Explorer Mini

Powered mobility technology can be a powerful tool to facilitate self-initiated exploration and play for toddlers with motor disabilities. The joystick-controlled Permobil Explorer Mini is currently the only commercially available powered mobility device for children ages 1-3 years in the United States. However, many open questions persist regarding how joystick-based mobility technologies should be designed to optimally suit the developmental needs of toddlers. The purpose of this study was to quantify how toddlers with motor disabilities use the Explorer Mini during free exploration and play. For this work, we developed a custom-instrumented Explorer Mini with embedded sensors to measure joystick interactions and wheel rotations. Nine children with motor disabilities (ages 12-36 months) participated in 12 in-lab visits, and during each visit they engaged in two 15-20 minute play sessions. For each session, we calculated several quantitative outcome metrics, including the time spent using the joystick, distance traveled, and the number, duration, and complexity of joystick interactions. Every participant independently interacted with the joystick and moved the Explorer Mini during every session. Over 12 visits, participants significantly increased their distance traveled and the time spent with the joystick active. Surprisingly, we found that only 48% of joystick interactions resulted in device movement, which has important implications for learning. These results can serve as a benchmark for caregivers and clinicians to understand early device use patterns. Furthermore, this knowledge can be used to inform the design of new powered mobility technologies for toddlers with disabilities or support the refinement of existing devices.

Wheelchair skills training improves power mobility and participation in young people with cerebral palsy

AIM

To explore the effect of a 4-week structured power wheelchair skills training programme (WSTP) intervention on mobility skills and participation in children and young people (CYP) with cerebral palsy (CP).

METHOD

This was a one-group, repeated-measures study; baseline, intervention, and retention phases, each lasting 4 weeks, were used. Twelve participants (three females, nine males) with a mean age of 15 years 11 months (SD = 3 years 6 months) classified in Gross Motor Function Classification System levels IV and V participated in the study. To be included in the study, individuals had to be aged 6 to 21 years and currently using a power wheelchair. Participants received 12 WSTP training sessions of 45 minutes, 3 times per week. Power mobility skills were assessed using the Wheelchair Skills Test (WST) before baseline, before the intervention, after the intervention, and at the follow-up; mobility-related participation was assessed with the Canadian Occupational Performance Measure (COPM). Generalized mixed models with Bonferroni correction were used to assess the differences between the assessment points (p < 0.05).

RESULTS

Statistical analysis showed a 10.4% (12.5) increase in WST total scores (p < 0.001) after the intervention compared to before the intervention, and a 1-point (0.9) increase in the COPM performance subdomain (p = 0.002).

INTERPRETATION

Power mobility skills and mobility-related participation improved after a 4-week WSTP intervention in CYP with CP. Thus, task-based power mobility skills training based on the WSTP, and in line with individualized needs and capabilities, taking place in a natural environment, should be recommended. Power mobility skills training needs to be structured and individualized; the training interventions must consider the individual, the task, and the environment.

Experiences of children with congenital Zika syndrome while using motorized mobility: a qualitative study using the photovoice method

AIM

The congenital Zika Syndrome (CZS) often leads to severe motor impairment in affected children, making independent walking unlikely. Early introduction of motorized mobility through ride-on cars has been recommended for young children with severe motor impairment, enabling independent movement in various environments. This study aims to explore mothers' perceptions of their children's experiences while using ride-on cars at home and in the community, focusing on children with CZS.

METHODS

This is a qualitative and descriptive study design using the Photovoice method. Four mothers of children with CZS, participating in the 'Go Zika Go' intervention project, were included. The research involved the following six steps: 1) Presentation of guide questions and Photovoice training; 2) Participants capturing photos; 3) Individual interviews to contextualize the photos; 4) Transcription and data analysis using thematic analysis principles; 5) Validation of analyses by mothers; and 6) Exhibition of photos to the community.

RESULTS

The mothers and researchers selected the 21 most relevant photographs, which revealed five main themes related to the use of motorized ride-on cars: 1) Experiences of participation; 2) Independence in mobility; 3) Characteristics of mobility devices; 4) Family support; and 5) Accessibility of the environment.

CONCLUSION

The narratives provided by participants, along with photographs depicting the daily lives of children with CZS, shed light on aspects of functionality, autonomy, and participation. The use of these devices contributes to overall equity, breaking down social and cultural barriers and enabling children with disabilities to be seen as equals by their peers.

Powered mobility in low- and middle-income countries: Caregivers' perspective from Bangladesh

This commentary is on the original article by Sloane et al. on pages 333–343 of this issue.

Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools

Children with developmental central hypotonia have reduced muscle tone secondary to non-progressive damage to the brain or brainstem. Children may have transient delays, mild or global functional impairments, and the lack of a clear understanding of this diagnosis makes evaluating appropriate interventions challenging. This overview aimed to systematically describe the best available evidence for tools to identify and evaluate children with developmental central hypotonia aged 2 months to 6 years. A systematic review of systematic reviews or syntheses was conducted with electronic searches in PubMed, Medline, CINAHL, Scopus, Cochrane Database of Systematic Reviews, Google Scholar, and PEDro and supplemented with hand-searching. Methodological quality and risk-of-bias were evaluated, and included reviews and tools were compared and contrasted. Three systematic reviews, an evidence-based clinical assessment algorithm, three measurement protocols, and two additional measurement tools were identified. For children aged 2 months to 2 years, the Hammersmith Infant Neurological Examination has the strongest measurement properties and contains a subset of items that may be useful for quantifying the severity of hypotonia. For children aged 2-6 years, a clinical algorithm and individual tools provide guidance. Further research is required to develop and validate all evaluative tools for children with developmental central hypotonia.