Short-term, Early Intensive Power Mobility Training

Ragonesi, Christina B.; Galloway, James C.

doi:10.1097/pep.0b013e31824c764b

Cited by 37 publications

(34 citation statements)

References 31 publications

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“…All included studies that reported on learning outcomes described positive results, with one study also noting negative results ( Table 12). 72 Therefore, there was no scope for assessing the efficacy of specific approaches to supporting children to use powered mobility.…”

Section: Learning To Drive the Powered Mobility Equipmentmentioning

confidence: 99%

Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis

Bray

Kolehmainen

McAnuff

et al. 2020

Health Technol Assess

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Background One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown. Objective The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years. Review methods The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources. Data sources A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index™ (SSCI; Clarivate Analytics), Conference Proceedings Citation Index – Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index – Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019. Results In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or ≥ 5 years. However, strong support was found that powered mobility interventions have a positive impact on children’s movement and mobility, and moderate support was found for the impact on children’s participation, play and social interactions and on the safety outcome of accidents and pain. ‘Fit’ between the child, the equipment and the environment was found to be important, as were the outcomes related to a child’s independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is ‘movement for movement’s sake’ and the latter destination-focused mobility. Powered mobility should be focused on ‘movement for movement’s sake’ in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends £1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure. Limitations The original research question could not be answered because there was a lack of appropriately powered published research. Conclusions Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on ‘movement for movement’s sake’. Future work Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility. Study registration This study is registered as PROSPERO CRD42018096449. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.

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Section: Learning To Drive the Powered Mobility Equipmentmentioning

confidence: 99%

Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis

Bray

Kolehmainen

McAnuff

et al. 2020

Health Technol Assess

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“…With the increased independent mobility using PMDs, young children with motor disabilities can engage with their various environments more than before, and begin noticing social norms ( Bottos et al, 2003 ; Ragonesi et al, 2010 ). Ragonesi and Galloway (2012) suggested that the experience of social interaction obtained by using PMDs might help young children with disabilities perceive people’s responses to their actions and attend to their own actions, thereby changing their social behaviors. Some studies have provided evidence of improvements in play and social skills for young children with motor disabilities after using the PMDs ( Livingstone and Field, 2014 ; Logan et al, 2016 ; Huang et al, 2017 ).…”

Section: Current Approaches To Increase Independent Mobility In Earlymentioning

confidence: 99%

“…Some studies have provided evidence of improvements in play and social skills for young children with motor disabilities after using the PMDs ( Livingstone and Field, 2014 ; Logan et al, 2016 ; Huang et al, 2017 ). However, most research used behavioral observations or unstandardized measurements of parents’ survey to assess children’s social interactions ( Deitz et al, 2002 ; Home et al, 2003 ; Ragonesi et al, 2010 , 2011 ; Ragonesi and Galloway, 2012 ). Moreover, no studies examined the effects of PMDs use on motivation.…”

Section: Current Approaches To Increase Independent Mobility In Earlymentioning

confidence: 99%

Perspectives on Early Power Mobility Training, Motivation, and Social Participation in Young Children with Motor Disabilities

Huang

2018

Front. Psychol.

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The efficacy of traditional training programs (e.g., neurodevelopmental therapy) in promoting independent mobility and early child development across all three International Classification of Functioning, Disability, and Health levels lacks rigorous research support. Therefore, early power mobility training needs to be considered as a feasible intervention for very young children who are unlikely to achieve independent mobility. This perspective article has three aims: (1) to provide empirical evidence of differences in early independent mobility, motivation, daily life activities, and social participation between young children with typical development and motor disabilities; (2) to discuss the contemporary concepts of and approaches to early power mobility training for young children with motor disabilities and the current need for changes to such training; and (3) to provide recommendations for early power mobility training in pediatric rehabilitation. Independent mobility is critical for social participation; therefore, power mobility can be accessible and implemented as early as possible, specifically for infants who are at risk for mobility or developmental delay. To maximize the positive effects of independent mobility on children’s social participation, early power mobility training must consider their levels of functioning, the amount of exploration and contextual factors, including individual and environmental factors.

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“…Power mobility may facilitate independent exploration and participation in everyday activities from a young age . These early exploratory behaviors have a positive impact on overall and psychological development, and recent research suggests that children can begin using power mobility devices in infancy . However, power wheelchairs are not commonly prescribed for children below 3 years of age .…”

mentioning

confidence: 99%

“…6 These early exploratory behaviors have a positive impact on overall and psychological development, 7,8 and recent research suggests that children can begin using power mobility devices in infancy. 9,10 However, power wheelchairs are not commonly prescribed for children below 3 years of age. [11][12][13] Assistive devices, such as power wheelchairs, may be seen as enablers of function or as a stigma.…”

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confidence: 99%

The child and family experience of power mobility: a qualitative synthesis

Livingstone

Field

2014

Develop Med Child Neuro

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AIM The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence fits with current theoretical concepts.METHOD Electronic database/hand searches were undertaken in September 2012 and updated in February 2014. The searches were restricted to qualitative studies published in English before February 2014 that included at least one child under the age of 19 with a disability and described an outcome related to the use of power mobility. Inclusion criteria were set a priori. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. McMaster qualitative review forms were used for quality appraisal. RESULTSOf 259 titles, 21 met inclusion criteria. From 143 codes, 15 second-order themes were developed using constant comparison and analysis. Three overarching themes emerged: power mobility experience promotes developmental change and independent mobility; power mobility enhances social relationships and engagement in meaningful life experiences; and power mobility access and use is influenced by factors in the physical, social, and attitudinal environment.INTERPRETATION This qualitative research provides rich and rigorous evidence supporting the benefits of power mobility for children and families. Numerous factors, which warrant careful consideration, influence power mobility access and use.Power mobility devices, such as powered wheelchairs and ride-on toys, provide efficient, autonomous mobility for children with mobility limitations. [1][2][3][4][5] Power mobility may facilitate independent exploration and participation in everyday activities from a young age. 6 These early exploratory behaviors have a positive impact on overall and psychological development, 7,8 and recent research suggests that children can begin using power mobility devices in infancy.9,10 However, power wheelchairs are not commonly prescribed for children below 3 years of age.11-13 Assistive devices, such as power wheelchairs, may be seen as enablers of function or as a stigma.14 For parents, the psychological and social impact is significant, 15,16 with both positive and negative experiences of power mobility reported. [17][18][19][20][21] In keeping with family-centered care, it is essential that clinicians and researchers set meaningful goals collaboratively, in line with child and family priorities. [22][23][24] A recent systematic review of power mobility outcomes for children 5 identified, but did not include, a significant number of qualitative studies relating to the child's and family's perspective, and it was recognized that a separate, more appropriate, analysis was warranted. Three previous systematic reviews on children's use of assistive technologies [25][26][27] included only two qualitative studies on power mobility use. 18,28 Within the wheeled mobility literature, several models attempt to interpret the many factors that influence power mobility use; however, the validity of these mode...

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Short-term, Early Intensive Power Mobility Training

Cited by 37 publications

References 31 publications

Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis

Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis

Perspectives on Early Power Mobility Training, Motivation, and Social Participation in Young Children with Motor Disabilities

The child and family experience of power mobility: a qualitative synthesis

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