Pediatric Powered Mobility and Young Children:
A Program of Research
Jan Furumasu, BSPT, Donita Tefft, MA, CCC-SP, Paula Guerette, PhD
Independent mobility is important in the development of a number of cognitive and psychosocial skills, including spatial relations, verbal skills, and social interactions with peers. For a young child with a mobility impairment, the opportunity for early powered mobility may enhance the development of certain skills that may otherwise develop more slowly or not at all. This instructional session will highlight a program of research that has been conducted at our center in the area of early powered mobility.
Our initial project was designed to develop a cognitive assessment battery that could be used with children with disabilities, to develop a powered mobility skills list and objective scoring scale, and to determine the cognitive predictors of young children’s success in a powered wheelchair. During this 5-year project, we developed a Piagetian-based cognitive assessment battery that could be used for children in the 18-36 month age range that did not penalize the child for motoric limitations.1 The assessment battery included items evaluating five cognitive domains – cause/effect, object permanence, problem-solving, spatial relations and symbolic play. We also developed a powered mobility program (PMP) that included 34 items evaluating basic/exploratory mobility skills, and functional mobility skills in structured and unstructured environments. The items in the PMP are scored on a 0 to 5 scale which provides objective criteria relating to the amount of hands-on assistance and verbal cueing provided.2 A total of 26 children with orthopedic disabilities (18-36 months) were run through wheelchair tasks and cognitive assessment, and these scores were related via regression analyses. The result was a screening assessment battery that included 16 items assessing problem solving (PS) and spatial relations (SR) skills.3
During phase II, we validated the assessment battery at 8 centers (see note 1 below). We added evaluations of the child’s coping skills and level of symbolic representation to determine if these would increase the predictive power of the assessment battery. We evaluated the applicability of battery in children with orthopedic disabilities only (n = 24) and in a population of children with cerebral palsy (i.e., those with possible developmental delays; n = 26). Finally, we evaluated modifications to the assessment battery that would allow yes/no and eye gaze responses for children with limited-or-no functional extremities. Results of stepwise regression analyses indicated that SR and PS remained highly predictive of wheelchair driving skills for children in both groups who used a joystick as an input device (R2 = .62, p<.005), but not for children who used switches. The coping inventory and symbolic representation did not add any additional predictive power. Finally, the assessment battery can be modified to accept yes/no responses.
Currently, we have begun a 5-year project to develop and validate a model for the provision of powered mobility to young children. In addition, we will collect pre/post data on young children who receive powered wheelchairs in order to evaluate the impact of powered mobility on factors such as language, social and play skills, the impact of the wheelchair on the family, etc.
Prior to developing and evaluating a new model of provision of powered mobility, we wanted to determine the existing practices/models that are being used across the country. We have recently completed a national survey to determine existing practices/models used to evaluate a young child for powered mobility, and to obtain baseline data regarding the efficacy of these models. Approximately 130 surveys were received from clinicians and Rehabilitation Technology Specialists who provide early powered mobility. These data are currently under analysis, with some results being presented at the RESNA conference in June, 2002. In addition, we are beginning a prospective study at three centers (see Note 2) evaluating a new service delivery model, and will collect preliminary outcome data regarding the impact of powered mobility on various psychosocial and cognitive factors. The service delivery model includes the use of our cognitive assessment battery as a preliminary screening device, the use of an objective wheelchair scoring method, and the recommendation of developmental activities targeting specific skills for children who are not recommended powered mobility. A total of 70 children (including children with orthopedic disabilities and children with cerebral palsy) who operate the powered wheelchair using a joystick will be evaluated using the model. Thirty-five children who receive a powered wheelchair will be followed for pre/post testing. In addition, up to 20 children who operate a powered wheelchair using switches will also be followed for pre/post testing, although they will not be evaluated using the model.
It is hoped that this model can assist clinicians in areas that do not have access to powered wheelchairs during testing (or do not have access to ‘loaner’ chairs for extended practice periods), that standardized scoring will help with the justification process to physicians and third party payers, that the recommendation of developmental activities targeting specific skills will facilitate development of skills prerequisite for driving, and that the outcome measures will help to document some of the benefits of early powered mobility.
References
Note 1: Our thanks to the following participating centers:
Note 2: Centers participating in our current prospective study:
|
Notes: |