Evaluating a Therapeutic Powered Mobility Camp for Children with Severe Cerebral Palsy

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.

Novel rehabilitation technologies in pediatric rehabilitation: knowledge towards translation

Purpose: Knowledge translation (KT) refers to the process of applying the most promising research outcomes into practice to ensure that new discoveries and innovations improve healthcare accessibility, effectiveness, and accountability. The objective of this perspective paper is to discuss and illustrate via examples how the KT process can be implemented in an era of rapid advancement in rehabilitation technologies that have the potential to significantly impact pediatric healthcare.

Methods: Using Graham et al.'s (2006) Knowledge-to-Action cycle, which includes the knowledge creation funnel and the action cycle, we illustrate its application in implementing novel technologies into clinical practice and informing healthcare policy changes. We explore three successful applications of technology research: powered mobility, head support systems, and telerehabilitation. Additionally, we examine less clinically mature technologies such as brain-computer interfaces and robotic assistive devices, which are hindered by cost, robustness, and ease-of-use issues.

Conclusions: The paper concludes by discussing how technology acceptance and usage in clinical settings are influenced by various barriers and facilitators at different stakeholder levels, including clients, families, clinicians, management, researchers, developers, and society. Recommendations include focusing on early and ongoing design partnerships, transitioning from research to real-life implementation, and identifying optimal timing for clinical adoption of new technologies.

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.

Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS)

PURPOSE

To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS).

MATERIALS AND METHODS

A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains.

RESULTS

Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes.

CONCLUSIONS

Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.

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.

Development of a new tool: progression of paediatric powered mobility- 3PM

PURPOSE

To develop a tool to assess the progression of powered mobility skills for children and determine its psychometric properties.

METHOD

A three-phase, the mixed-method design included: I) conceptualisation based on international specialists' input through a focus group or interview to generate initial items; II) tool development using a two-round Delphi survey and III) evaluation of psychometric properties from eight video recordings of children. The Progression of Paediatric Powered Mobility (3PM) was validated via Intraclass correlation coefficients (ICC) calculated from conventionally powered mobility assessments: the Powered Mobility Program, the Assessment of Learning Powered Mobility tool, and the Powered Mobility Proficiency test.

RESULTS

Content derived from 20 clinical experts led to the development of the first version consisting of 19 demographic and 61 driving skill items. Following two Delphi rounds, the final tool included 14 demographic and 41 driving skill items. Internal consistency was excellent (Cronbach alpha = 0.96) as was the inter-rater reliability (ICC = 0.96, 95% confidence interval = 0.95-0.96). Pearson correlation coefficients between the 3PM and other PM assessments demonstrated good convergent validity.

CONCLUSION

The 3PM, created through international collaboration with experts in PM, has excellent psychometric values as a valid measure that can be used reliably to assess children's powered mobility skills.Implications for rehabilitationThe 3PM reflects the three stages of powered mobility development: exploratory, operational, and functional stages.Input from clinical experts in PM mobility contributed to the identification of the key driving skills important to include in the 3PM.A reliable and valid tool can facilitate assessment and tailored intervention in paediatric powered mobility.

Effectiveness of wheeled mobility skill interventions in children and young people with cerebral palsy: A systematic review

AIM

To systematically review the effectiveness of wheeled mobility interventions in children and young people with cerebral palsy (CP).

METHOD

A systematic literature search was performed in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO, PEDro, and Web of Science using database-specific concepts such as 'child' and 'wheelchair'. Studies focusing on wheeled mobility skill interventions with participants aged 6 to 21 years with CP were included.

RESULTS

Twenty studies with 203 participants were included. The impact of wheeled mobility skill interventions was assessed on mobility skills (n = 18), activity and participation (n = 10), and quality of life (n = 3). No studies reported effects on stress, fatigue, and motivational aspects. Interventions included power wheelchair skill training (n = 12), computer-based training (n = 5), smart wheelchair training (n = 2), and manual wheelchair training (n = 1), showing positive wheeled mobility intervention effects. Study quality based on the Methodological Index for Non-Randomized Studies scale was 9 out of 16 and 14 out of 24 for non-comparative and comparative studies respectively. Risk of bias was serious-to-critical on the Risk of Bias in Non-Randomized Studies of Interventions.

INTERPRETATION

Wheeled mobility interventions showed promising beneficial effects on wheeled mobility, activity and participation, and quality of life for children and young people with CP. Future studies with structured and standardized training programmes and assessment tools are warranted to further accelerate the wheeled mobility skill acquisition process in this population.

WHAT THIS PAPER ADDS

Wheeled mobility interventions improve wheeled mobility skills in individuals with cerebral palsy. The mobility skill acquisition process benefits from structured and standardized training. Knowledge of the intervention effects on participation and quality of life is limited. Most studies had moderate quality of evidence because of methodological limitations.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice

METHOD

Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP).

RESULTS

All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only.

CONCLUSIONS

This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

Towards functional improvement of motor disorders associated with cerebral palsy

Cerebral palsy is a lifelong neurodevelopmental condition arising from non-progressive disorders occurring in the fetal or infant brain. Cerebral palsy has long been categorised into discrete motor types based on the predominance of spasticity, dyskinesia, or ataxia. However, these motor disorders, muscle weakness, hypotonia, and impaired selective movements should also be discriminated across the range of presentations and along the lifespan. Although cerebral palsy is permanent, function changes across the lifespan, indicating the importance of interventions to improve outcomes in motor disorders associated with the condition. Mounting evidence exists for the inclusion of several interventions, including active surveillance, adapted physical activity, and nutrition, to prevent secondary and tertiary complications. Avenues for future research include the development of evidence-based recommendations, low-cost and high-quality alternatives to existing therapies to ensure universal access, standardised cerebral palsy registers to harmonise epidemiological and clinical information, improved adult screening and check-up programmes to facilitate positive lived experiences, and phase 3 trials for new interventions.