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EM-POWERING CHILDREN FOR MOVEMENT EXPLORATION AND SUCCESS: A CASE SERIES andDianne Cherry Forum: Best Practices in Pediatric Clinical Education

Department

Physical Therapy

College

College of Health Professions

Date Range

2013-2014

Disciplines

Medicine and Health Sciences

Abstract

Background & Purpose: Children with severe motor, cognitive, and communication deficits are limited in their ability to use self-initiated movement to explore and learn from the world around them. These children are often dismissed as candidates for power wheelchairs and are denied access to power mobility. Our Power Wheelchair Trainer (Trainer) provides an opportunity for these children to safely explore power mobility. This case series describes the use of the Trainer to provide these children with the opportunity to explore their environment and improve prerequisite skills for power mobility. Case Description: The Trainer is a motorized platform that allows a manual wheelchair to be temporarily converted to a power wheelchair, thereby permitting children to practice using power mobility while positioned in their own seating system. The control panel on the Trainer interfaces with both a traditional joystick and switches that adapt the power access system to meet the needs of each child. Three children with cerebral palsy at Gross Motor Function Classification System levels IV or V participated in this case series. Examination procedures included the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD), the Power Mobility Screen, the Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and assessment of power access options using switches or a joystick. Individualized interventions focused on operating the Trainer were designed based on the needs of each child and included structured repetition of mobility tasks in the Trainer as well as opportunities for self-directed mobility exploration. Intervention frequency and duration were determined based on the setting (school versus outpatient) and ranged from 30-60 minutes, 2-3 times per week over a period of up to 12 weeks. Outcomes: In each case, beginning intervention sessions were characterized by accidental switch or joystick activation. As each child became more familiar with the Trainer, independent purposeful activation of the Trainer increased and movement exploration in the Trainer emerged. Increases in purposeful stops and obstacle avoidance were observed in each case. All cases demonstrated improvements on the Power Mobility Screen and 2 had improvements on the CPCHILD. Parents of all 3 children reported incidental benefits such as increased contentment and increased engagement. The one child who was able to communicate often remarked that he enjoyed driving and that it was awesometo be able to move by himself. Discussion: When provided with consistent, repetitive practice in the Trainer, the children participating in this case series demonstrated improvements in active exploration of their environment while simultaneously improving their prerequisite skills for power mobility. Future research objectives include the development of child-centered instructional methods and valid assessment instruments to optimize use of the Trainer in promoting self-directed mobility for this unique population.

Conference Name

Combined Sections Meeting of the American Physical Theerapy Association

Conference Location

Las Vegas, NV

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