Exploring change in young children’s power mobility skill following several months’ experience

Abstract

Purpose

To measure and compare progression in children’s power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories.

Methods

In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months’ experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored.

Results

Forty-six children aged 13 − 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition (n = 33; 71.74%). ALP change scores ranged from −2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size (z = 5.50, p < 0.001; r = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent (r_s = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase.

Conclusion

Positive change was demonstrated with most children (n = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities.

IMPLICATIONS FOR REHABILITATION

• Children at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methods

• The Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum.

• Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1–5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5–8).

• Access method may influence power mobility learning trajectory and training

Keywords:

• Wheelchair
• cerebral palsy
• paediatric
• outcome measures

Acknowledgements

The authors would like to acknowledge: Lori Roxborough MSc, OT/PT for her encouragement and support in development of this research project; Susan R Harris PT, PhD for her advice regarding study design and ethics application; Jane Shen MASc for setting up the database in REDCap, preparing the data for analysis, checking data output and presentation of statistical results; Boris Kuzeljevik MA for providing statistical consultation; Sunny Hill Foundation for Children for funding the devices; Sunny Hill Health Centre for Children for supporting study conduct; our colleagues on the Positioning and Mobility and Assistive Technology Teams and in the community who assisted us with supporting the loans; and we would especially like to acknowledge all the families, children and community therapists around the province for their support and participation.

Author contributions

RL initiated the idea and designed the study with consultation from DF. RL and DF conducted the study. RL completed the statistical analysis with consultation from DF. RL wrote the first draft of the manuscript. Both authors revised and refined the manuscript for publication and are in agreement with the final version. RL is the guarantor.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

A small-scale research grant from Posture & Mobility Group (UK) funded researcher time to complete the video-analysis of children’s driving skills pre-post power mobility loan.