Recommendations for Mobility in Children with Spinal Cord Injury

Abstract

Background:Mobility is an important aspect of the rehabilitation of children with spinal cord injury (SCI), is a necessary component of life, and is critical in a child's development. Depending upon the individual's age and degree of neurological impairment, the nature of mobility may vary. Objectives: The objective of this article is to establish recommendations surrounding the selection of mobility for children with SCI. Methods: Extensive literature review and multidisciplinary peer review. Results: Types of mobility including power, manual, upright, and community are discussed, and recommendations are made based on medical necessity, neurological level, ASIA Impairment Scale score, and developmental considerations and challenges. Conclusion: Mobility is critical for proper development to occur in the pediatric population, and it may be challenging to make recommendations for mobility in children with SCI. It is essential for clinicians providing care to children with SCI to address mobility in a comprehensive and longitudinal manner across the children's environments.

Spinal cord injury in infancy: activity-based therapy impact on health, function, and quality of life in chronic injury

“…Functional goals are achieved predominantly via physical strategies compensating for weakness and/or paralysis of trunk, arm, and leg muscles, and using spared musculature above the lesion. Equipment, furthermore, provides support to achieve upright sitting (e.g., thoracolumbosacral orthosis, wheelchair, cushion, chest strap), standing (e.g., static or mobile stander), and ambulation when appropriate (e.g., knee-ankle-foot orthoses, reciprocating gait orthoses, walker) [10,11]. Recommendations for treatment intensity and duration include 2-3×/week for the first year post-SCI and 1-2×/week for the next 1-2 years [8].…”

Activity-Based Therapy: From Basic Science to Clinical Application for Recovery After Spinal Cord Injury

“…The sedentary life post-paralysis is compounded by the current approach to rehabilitation. 32–33,35–37 Furthermore, significant ‘natural recovery’ is neither expected nor reported for individuals with chronic SCI, i.e., greater than 12–18 months post-injury. 38 Children with chronic injuries are not expected to get better, and parents are often given little to no hope for recovery.…”

“…The historical and current approach to rehabilitation for children with SCI has focused on changing the environment or task to achieve support and mobility via compensation. 32–33,41 With ABT as a recovery-based intervention, the focus is on changing the child’s intrinsic neuromuscular capacity. Function also improves in the home and community in concert with the child’s own exploration of this new capacity in play and daily activities.…”

Technology-Supported Art as a "Way to Participation"

“…SCIs, such as Brianna's, result in altered abilities to participate physically in occupations of childhood, including play, school, and chores (Calhoun, Schottler, & Vogel, 2013;Smith et al, 2013). Occupations of childhood are also impacted by the new social and emotional challenges that accompany SCI (Smith et al, 2013).…”

“…Occupations of childhood are also impacted by the new social and emotional challenges that accompany SCI (Smith et al, 2013). Additionally, the challenges youth with SCI face will change throughout their lifetime based on their developmental stage and injury-related complications (Calhoun et al, 2013;Smith et al, 2013). Occupational therapy (OT) practitioners Here, she uses FES devices to complete activities, such as feeding herself, drawing, and walking.…”