Benefits of powered standing wheelchair devices for adolescents with Duchenne muscular dystrophy in the first year of use

RESNA and CTF position on the application of supported standing devices: Current state of the literature

Supported standing devices are often used to maintain a standing position by people with difficulty or inability to ambulate or stand for a period of time. Supported standing programs are first implemented by healthcare professionals with goals to impact health and function. This paper intends to update previous position on wheelchair standing devices by the Rehabilitation Engineering and Assistive Technology Association of North America, and was written in conjunction with the Clinician Task Force. The current paper expands the previous focus on wheelchair standing devices to all types of supported standing devices. A scoping review methodology found 42 studies examining outcomes of supported standing programs in the International Classification of Functioning, Disability, and Health framework in five areas of body functions, seven areas of activities and participation, and one body structure. Patterns in outcomes related to standing device type, as dynamic, or mobile, standing devices contributed to independent daily activity performance and static standing devices impacted neuromuscular capacity. Studies support engaging consistently in supported standing from nine months of age, or as soon after onset of ambulatory disability as possible, to maximize benefits. Clinical reasoning is required to apply the information in this document to unique individual cases.

Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use

PURPOSE

To investigate the influence of powered wheelchair standing device (PWSD) use on changes in activity/participation in children with neurodevelopmental conditions.

METHODS

A mixed methods A-B-A single-subject research design was replicated with participants. The target behavior was parental perceptions of changes in children's performance of activity/participation goals measured via the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM with children, an interview, and a 3-measure implementation survey. COPM data related to the target behavior were analyzed using the split-middle celeration line method.

RESULTS

Four child-parent dyads participated in the study. All participants achieved statistically and clinically significant increases in COPM performance ratings for the 5 parent-identified activity/participation goals.

CONCLUSIONS

For the participant dyads in this study, use of the PWSD appeared to positively influence parental perceptions of improvements in their child's performance of activity/participation goals.

Exploring powered wheelchair standing device use in children and adults: a longitudinal case series

PURPOSE

The purpose of this case series was to explore the influence of powered wheelchair standing device (PWSD) use on participants': (1) activities and participation; (2) quality of life; and (3) lower extremity passive range of motion (LE PROM).

CASE DESCRIPTION

Eight participants enrolled in the case series (five adults and three children). Outcome measures included: the Canadian Occupational Performance Measure (COPM), the EQ-5D-5L or the EQ-5D-Y, the Patient-Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), LE PROM measurements and PWSD use data automatically collected by each PWSD. Participants were provided with a front wheel-drive PWSD designed for both outdoor and indoor use for up to 12-months of use.

OUTCOMES

Four participants completed the 12-month case series. Three participants achieved clinically significant improvements in performance on the COPM. Three of the four participants reporting issues with constipation achieved clinically significant improvements in their total PAC-QOL scores. Almost all participants demonstrated changes in some LE PROM.

CONCLUSIONS

Applying the Human Activity Assistive Technology model may help to explain differences in both PWSD use and outcomes amongst the individual participants in this case series. The participants who were most successful in using the PWSD were in environments with sufficient space to use the PWSD to perform everyday activities and had higher frequencies of PWSD use. The outcomes of this case series may assist both researchers and clinicians when implementing future PWSD studies recommending PWSDs to their clients/patients. Implications for rehabilitationA wide variety of factors may influence powered wheelchair standing device (PWSD) use.PWSD use may lead to improvements in activities, participation, quality of life and lower extremity passive range of motion.The participants who were most successful in using the PWSD were in environments that permitted use of the PWSD during the performance of everyday activities.COVID-19 restrictions prohibited in-person sessions with a therapist, which could have assisted participants in better integrating the PWSD in their daily lives.

Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series

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.

Use of supported standing in males with Duchenne muscular dystrophy: Individual and family perspectives

PURPOSE

This study aimed to explore stander use in individuals with Duchenne Muscular Dystrophy (DMD).

METHODS

This mixed method research study employed a survey with categorical and open-ended questions related to stander use. Categorical responses were analyzed quantitatively. Qualitative analysis of open-ended responses was linked to the International Classification of Function. Qualitative and quantitative results were merged to derive meta-inferences.

RESULTS

Of 147 respondents, 28.6% (n = 42) reported stander use. Equipment used included sit-to-stand stander (n = 27), power standing feature in a wheelchair (n = 13), and unspecified equipment (n = 2). Economic services were the most common barrier to stander obtainment. Age of loss of ambulation (LOA) and age of start of stander use were positively correlated (r = 0.61, p < 0.0001, n = 36), with 59.5% initiating stander use after LOA. Twenty-nine respondents reported standing less than the recommended dose of 60-90 minutes at least five days a week, with frequency directionally less than five days per week (p = 0.06) and time significantly less than 60-90 minutes (p = 0.002). Respondents' total dose was significantly lower than the recommended 300 minutes (p = 0.02). Lack of time and presence of contractures contributed to decreased duration of use.

CONCLUSION

This study provides a greater understanding of stander use among individuals with DMD and can assist with decision making about stander use prior to complications of disease progression to promote optimal health despite reported barriers.

Stakeholder perspectives of pediatric powered wheelchair standing devices: a qualitative study

AIM

To explore and describe the experiences and perspectives of various stakeholders regarding the use of powered wheelchair standing devices (PWSDs).

METHOD

The purposive sample included: children aged 6 to 18 years who used a PWSD (n=8; diagnoses: cerebral palsy, spinal muscular atrophy, spina bifida, spinal cord injury), parents of children 18 years of age or younger who used a PWSD (n=12), rehabilitation professionals working with children who used a PWSD (n=12), and professionals working at companies manufacturing PWSDs (n=3). Data were gathered via face-to-face interviews conducted either in person or via Zoom^® and analyzed using the constant comparative method.

RESULTS

Three main themes emerged in the data: (1) 'Stand-on-demand' revealed how participants perceived PWSDs as allowing children to stand whenever and wherever they wanted, thereby increasing participation; (2) 'It's more than weight-bearing' uncovered participants' perceptions of psychological and physical benefits from PWSD use; and (3) 'Ecosystems influencing PWSD acquisition and use' revealed child- and non-child-related factors perceived as influencing children's procurement and use of a PWSD.

INTERPRETATION

Use of a PWSD was perceived as providing a unique opportunity for children to stand whenever and wherever they desired. Findings suggest the possible transdiagnostic application of PWSDs. What this paper adds The ability to stand when desired was unique to powered wheelchair standing device (PWSD) use. Participants perceived numerous psychological and physical benefits from PWSD use. Child- and non-child-related factors influenced procurement and use of a PWSD.