Intensive Pediatric Powered Mobility Training for Very Young Children with Disabilities: a Pilot Study Jayme Mills, OTD/S, CBIS Faculty Mentor: Dr

Intensive Pediatric Powered Mobility Training for Very Young Children with Disabilities: A Pilot Study Jayme Mills, OTD/S, CBIS Faculty Mentor: Dr. Teresa Plummer PhD, OTR/L, ATP, CAPS, CEAS Expert Mentor: Claire Morress, PhD, OTR/L, ATP; In Partial Fulfillment of OTD 6680 Belmont University School of Occupational Therapy

Case Study Literature Review Mobility Training Protocol Strategies for Training Statement of the Problem Who Is Appropriate For Training? Theoretical work used framework design of training protocol: A number of strategies to employ • The benefits of independent mobility for development of Readiness cannot be solely determined by age, visual ability, cognition or during power mobility training young children are vast and well documented. Despite this, behavior. However, research has shown that: 3 were identified in the literature. there is limited research describing power mobility (PM) Trainings occurred in a structured and safe environment Developmental age, not chronological age, should be training protocols for very young children with disabilities. Many we found conducive to used to guide clinical decision-making 2 teaching power mobility skills Purpose Clinicians engaged the participants in purposeful, and Children as young at 11months have shown some during this pilot study. These • The aims of this study were: 7 engaging activities, rather than directly “teaching” power degree of powered wheelchair driving competence 5 • To describe an intensive power mobility training protocol. mobility skills strategies are listed below. • Document the immediate effects of intensive training Readiness for a PM device develops during mobility One additional strategy, sessions on a child’s ability to operate a power wheelchair. Allow the client to practice driving in a safe and motivating experience 3 responsive to child’s reaction, in • To determine how feasible and beneficial this protocol was environment in trial and error form, with minimal verbal to the parent and child. feedback6 terms of adjusting both hardware and software, to How Long Does Training Take? promote success emerged during the research. Design Literature documents a variety of times required for development of some Continual reassess and utilize clinical judgment to provide the • N-of-1, repeat measures, AB design level of competency: just right challenge to develop skills7 Strategies for Training 14 consecutive 60 mins sessions Participant 1.89 hours per day for Set-up an Engaging Involve Caregivers in Treat Participants 4 weekdays, 35-45 twice a week This figure describes the possible Dependent 238 days 8 7 20 20 14 • 29 Months & 24 Days Old mins over 12 weeks amount of assistance that a Caregiver/Experimenter Environment Training with Independence displaces joystick/switch • Female therapist might provide during the that results in power chair movement • Primary Diagnosis: Cytomegalovirus (CMV) Is There a Best Practice for Training? session, from dependent to • Secondary Diagnosis: Cerebral Palsy (CP) No, But Research Suggests: independent. Caregiver Mobility Encourage Time Couple Cause-Effect Provide Manual Independent Mobility Caregiver/Experimenter Exploration and • Classified as a Level IV on the Gross Motor Function Relationships24 Guidance24 Be Provided by a Trained Professional The child independently pushes the child's hand on Experimentation24 Classification System (GMFCS) moves the power chair the joystick/switch without cues resulting in power chair • Receives OT, PT and Speech movement (hand over Optimally in More Than One Venue hand) Prompt with Single Occur in a Structured Environment Assisted Mobility Avoid Loud Responsive to Child’s Prompted Mobility Time Words or Very Short 24 24 Expressions Reactions The child independently Caregiver/Experimenter Sentences moves the power chair in places the child's hand on Full list of references available upon request. response to verbal and/or the joystick/switch visual prompting by the resulting in the child caregiver/experimenter displacing joystick/switch causing power chair Methods Subjective Results movement Conclusion The benefits of independent mobility are well known. Training Sessions Subjective Data Data Analysis Increased Alertness & Attention Collection Participation and Self-Efficacy Unfortunately in the absence of practice guidelines, power • Baseline phase (A), • An audiotaped, • Utilizing a qualitative Caregiver described a decrease in learned-helplessness behaviors and an • Presented with increased alertness and excitability upon returning to mobility options are being underutilized as an option for very training once a week interview with the analysis strategy, increase in engagement, both with her mother and the environment. therapy program room (following PWC training). -PT young children to experience independent mobility. This case- caregiver was emerging themes from for three weeks • She attended to task better when working on letter sounds. –SLP study aimed to look at one element of PM provision, training. • Intervention phase conducted on the last the caregiver’s responses • I think that she now (has) the confidence of knowing what she • She was more alert & attended well during fine-motor activity following (B), training three day of training and and field notes were wants, and knowing that I know that’s what she wants when she training – OT Results offer some valuable clinical implication for power transcribed. coded. tells me. times per week for • Typically she would be grabbing at anything placed in front of her and mobility training including: three weeks • Field Notes from • Quantitative data will be • Typically, after school she would go straight in the car and be like attempting to rake it up and pull it toward her chest. However she • Each training session therapy team (OT, PT, entered into SPSS and/or out. Now it was like ok, I have to take her to the park, I have to remained calm, gently reached to grasp (the iPad). –SLP • Secondary benefits, such as those reported in this case-study, Excel to produce was video recorded SLP) were collected on engage, I have to do something with her. • Had increased eye-contact. -SLP should be considered during decision making. Independent for later quantitative an ongoing basis descriptive statistics and analysis throughout the project. graphical displays of the PM control is not the only goal for PM training. data at a future date. Body Functions and Structure Advances in Motor Planning • Most secondary benefits were reported after four weeks of Caregiver’s report illustrated improvements in cognition (cause-and-effect training and during the intervention phase (training 3x/wk). & decision making), vision, and gross motor skills. • She was also able to problem solve and motor plan on how to back-up the Outcome Measures chair in reverse when she did get stuck on obstacles. –PT • Clinician competence and confidence to adjust both seating • I don’t know if she really knows really what a power chair (does). • (She) used her LUE to target cell to communicate need during snack. Out of and positioning as well as programing the chair in response (But), she has her processes and (drives) then she can possibly get • Outcome, adopted from the literature, to measure 5 attempts, 4 were purposeful and controlled allowing her to accurately to the child’s actions is essential to promote success. (toy/bubbles)I think she knows now that she can move herself like target the “more” cell.- OTR Quantitative independent, assisted, and caregiver driving times. and that’s huge with her. • (She) demonstrated increased precision, independence, and control of • Allowing the child adequate response time to compensate Measure • *To be analyzed at future date. BUE. –OTR for latency can be difficult but is important. • Journal from therapy team (OT, PT, SLP) on participant’s • Clinical judgment, as with most skills demonstrated during therapy following PM Caregiver Satisfaction & Attitude Improved Gross Motor Function therapy services, is the Field Notes training. cornerstone for assessment and Satisfaction with PM training was evident in caregiver’s motivation to reassessment • Semi-structured interview with the caregiver to capture • “Demonstrated decreased scissoring gait pattern following session” -PT participate in intensive training program despite limited resources/support. • Required less assistance to prevent extension thrusting during gait training their perceptions of and motivations to participate in • Don’t count (power mobility) out because I’ve seen so many changes • Environment should be large Caregiver in her. following PWC training. -PT Interview PM training. • She was walking forward without assistance during gait training (typically enough to encourage • I would tell (other parents) that this, it kinda changed my would require ModA). -PT exploration and have limited perspective on a lot of things. distractions.