Heather A. Feldner

Why the time is right for a radical paradigm shift in early powered mobility: The role of powered mobility technology devices, policy and stakeholders

Abstract This article explores the changing landscape of early pediatric powered mobility. We specifically focus on key indicators that suggest pediatric powered mobility technology (PMT) practice for very young children is poised for a radical paradigm shift. This shift will challenge the current purview of PMT design and function, how it is obtained, and its introduction to children and their families. We propose that this positive, yet radical shift is essential in achieving a standard of practice in which PMT provides for early exploration and participation for children with disabilities at an age concomitant with their non-disabled peers, and within socially inclusive environments. To sustain this new standard, we must acknowledge the significant disconnect that currently exists between clinical research supporting the use of PMT with very young children, and barriers to widespread device access, effective user-driven design and positive social perception of PMT. In this article, we discuss three areas that are particularly important for both shift and sustained change: the history and current availability of novel and conventional PMT devices, pediatric PMT policies and the role of children and families as primary stakeholders in PMT practices. Within each area, we suggest barriers, facilitators and future directions. Implications for Rehabilitation The time is right for reframing how powered mobility technology for very young children is conceived, designed, and implemented. In order for multiple innovative devices to survive in the powered mobility industry, it is important to continue to show the benefits of early powered mobility use for both traditional and non-traditional users, and also enact and enforce policy that promotes sustainable access and financial support for powered mobility technology. The experiences of children and families and the realities of everyday use of powered mobility technology must be brought to the forefront of a movement toward user-centered design. Advocacy efforts undertaken in partnership with families, clinicians, researchers, and disability communities are essential in recognizing mobility, and access to early powered mobility technology, as a human right.

Modified Ride-on Car Use by Children With Complex Medical Needs.

Purpose: The purpose of this report was to determine the feasibility of short-term modified ride-on car (ROC) use for exploration and enjoyment by children with complex medical needs. Methods: A single-subject research design was used (n = 3; age, 6 months to 5 years). Children were video-recorded using their modified ROC. Results: All children successfully learned how to independently drive a modified ROC. Two of the 3 children demonstrated high levels of enjoyment during use of a modified ROC. Conclusions: Modified ROC use is a feasible and enjoyable powered mobility device for children with complex medical needs.

Modified Ride-On Car Use by Young Children With Disabilities

Purpose: The purpose of this single-subject case series study is to determine the effect of modified ride-on car use in natural environments on mobility. Method: Three children younger than 2 years diagnosed with various disabilities participated in this 24-week study using a modified ride-on car in their home and community. Results: All 3 children demonstrated an ability to independently use the modified ride-on car and enjoyed doing so. Two of the 3 children demonstrated clinically significant gains in mobility skills as measured by the Pediatric Evaluation of Disability Inventory. Conclusions: Modified ride-on car use is an emerging powered mobility device option for children younger than 2 years. Further research is needed to demonstrate the potential long-term gains of early powered mobility access to young children with disabilities.

Power-Up: Exploration and Play in a Novel Modified Ride-On Car for Standing.

Purpose: The purpose of this study was to compare the physical activity and play behaviors of preschoolers without disabilities and 1 preschooler with physical disability. Methods: Participants were 42 preschoolers without disabilities and 1 preschooler with physical disability (Child A). Child A used either crutches or a modified ride-on car while in the gymnasium and playground. Results: In the gymnasium, Child A engaged in less solitary play and more parallel play while using the modified ride-on car compared with crutches. On the playground, Child A engaged in more sitting and less running while using crutches compared with preschoolers without disabilities. On the playground, Child A engaged in more peer interaction and less teacher interaction when using the modified ride-on car compared with crutches. Conclusions: For children with disabilities who may use assistive devices, clinicians, families, and teachers are encouraged to embrace a “right device, right time, right place” approach.

Toy-Based Technologies for Children with Disabilities Simultaneously Supporting Self-Directed Mobility, Participation, and Function: A Tech Report

Go Baby Go is a community-based outreach, research, and clinical treatment program that works with families, clinicians, service providers and industry to provide pediatric equipment to children with disabilities for movement, mobility and socialization. The purpose of the current technical report is to describe two innovative and novel extensions of the initial modified ride-on car technology that encourages self-directed mobility, participation and function for young children with disabilities. The current report provides a description of the ‘sit-to-stand’ and ‘throw-baby-throw’ ride-on car technologies: (1) Sit-to-stand modified ride-on car technology: Commercially available, battery-operated, ride-on cars are adapted by installing a large, easy-to-press activation switch that is placed on the steering wheel. The switch has a large surface area and turns on at the slightest touch allowing easier activation for children with disabilities. Common materials such as PVC pipe, swimming kickboards and fun noodles, and Velcro are used to build a custom seating system that provides optimum support for each child. There are no commercially available powered wheelchairs for children with disabilities from birth to three years old. An innovative sit-to-stand version of modified ride-on car will be presented and requires a child to stand up in order to activate the switch to encourage the physical skills of pulling from sit-to-stand, weight bearing, and balance; (2) Throw-baby-throw technology: Children with disabilities that experience limited upper-extremity function are not able to throw an object. The throw-baby-throw technology includes modification of a commercially available, toy-based ball pitching’ machine that projects foam balls to. We modified the toy so that it is switch activated and attached to a modified ride-on car. Our modified throwing device allows children with disabilities to engage in the fundamental motor skill of throwing. Both technologies presented in this technical report embrace the holistic view of the International Classification of Functioning, Disability, and Health framework by placing equal emphasis on the body structure and function, activity, and participation domains. Both technologies specifically target the advancement of physical skills while simultaneously providing opportunities to engage in experiences associated with activity and participation.

Why We Move: Social Mobility Behaviors of Non-Disabled and Disabled Children across Childcare Contexts.

Background Social mobility is defined as the co-occurrence of self-directed locomotion and direct peer interaction. Social mobility is a product of dynamic child–environment interactions and thus likely to vary across contexts (e.g., classroom, gymnasium, and playground). Purpose The purpose of this present study was to examine differences in children’s social mobility: (1) across contexts by age and (2) between non-disabled and disabled children. Method Participants (n = 55 non-disabled and three disabled children; Mage = 3.1 years, SD = 1.4) were video recorded within a university-based early learning center. Children were recorded for 20 min in each context: classroom, gymnasium, and playground. A 15-s momentary time sampling method was used to code social mobility, the simultaneous occurrence of self-directed locomotion, and direct peer interaction. This variable was calculated as percent time within each context. Results A planned Friedman’s rank ANOVA (n = 55), stratified by age, indicated that older children (3–5 years old) differed across contexts in their social mobility [χ2(2) ~ 7.3–10.5, p < 0.025], whereas younger children (1–2 years old) were similar across contexts. Social mobility was significantly lower in the classroom compared with the playground and gymnasium (with no difference between the latter contexts) for older children. Visual analysis confirmed that disabled children (n = 3) engaged in substantially less time in social mobility (average 0–1%), compared with non-disabled, age-similar peers (2–3 years old average 1–12%) across all contexts. Conclusion A substantial gap exists between non-disabled and disabled children for social mobility. There is an increase in magnitude and variability of social mobility around age three that suggests the gap between non-disabled and disabled children will continue to widen.

Mobility in pictures: a participatory photovoice narrative study exploring powered mobility provision for children and families

Abstract Aim: Rehabilitation professionals are increasingly recognizing mobility as a basic human right and endorsing the efficacy of early powered mobility for children with mobility impairments to foster independence, promote socialization with peers and facilitate participation in family and community life. However, the relationship between mobility and technology provision, when considered in the context of lived experiences of children with mobility impairments and their families, is complex and understudied. Perceptions of these experiences from children’s own points of view are especially limited, as is the use of participatory research methods in describing these experiences. The purpose of this study was to empower children and families as co-researchers, investigating their experiences and perspectives of powered mobility provision processes and early use of their mobility technology in their own words and images. Methods: Two families in a major Midwest metropolitan area- one who was receiving a powered wheelchair and one who was receiving a modified powered ride-on toy car- participated as co-researchers from 2015–2016, documenting their experiences with a research camera and narrating their photos to describe meaningful or important aspects of their respective powered mobility provision processes and early use of their devices. Results: Four themes emerged: (1) Dys/Function of Mobility Technology; (2) Daily Life, Play and Participation; (3) Emerging Self/Advocacy and (4) Complex Family/Industry Interplay. Conclusions: These themes and experiences may inform further innovation in powered mobility practices, generate new hypotheses about the role of technology in shaping disability identity and demonstrate the feasibility and impact of using participatory methods more broadly in rehabilitation research. Implications for Rehabilitation Participatory methods may be a useful and underutilized research tool in describing the impact of powered mobility provision processes on child and family experiences of technology and disability. Empowering children and families as co-researchers is important to move the field of powered mobility technology forward in creating innovative, accessible and socially welcoming devices and processes. It is important to capture the similarities and differences in child and family perceptions and experiences within different models of powered mobility provision, such as traditional powered wheelchair prescription and crowdsourced ride-on toy car modification. Powered mobility provision processes and the perceptions and experiences of children and families move beyond business or medical transactions and may help shape disability identity and pride. A disability studies framework may be useful in analyzing the complexities of technology provision and the nuanced interplay between bodies and technology.

“Look, your muscles are firing!”: A Qualitative Study of Clinician Perspectives on the Use of Surface Electromyography in Neurorehabilitation

OBJECTIVE To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives. DESIGN A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features. SETTING The study was conducted at hospital systems in a large metropolitan area. PARTICIPANTS Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes. RESULTS Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems. CONCLUSIONS Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention.