Date Presented 4/17/2015
This study investigated early power mobility using adapted ride-on-toys in toddlers with disabilities. Improvements were seen in cognitive, social, and self-care domains on standardized measures. Early power mobility using adapted ride-on-toys may yield positive changes in key areas of development.
SIGNIFICANCE: Early mobility and exploration is important for a toddler’s participation in daily occupations. Early mobility limitations can have devastating consequences for children with neuromuscular disorders, with many children falling behind more mobile peers in socialization and learning. A recent systematic review of toddler power mobility outcomes suggests that the introduction of early power can have a significant positive impact on children born with neuromuscular disorders. Unfortunately, despite the potential positive influence on development, studies suggest that power mobility is rarely introduced in children aged less than 3 yr due to several barriers, including cost to purchase early power devices.
INNOVATION: The use of low-cost, commercially available ride-on-toys as alternatives to more expensive early power mobility devices is innovative. These commercially available ride-on-toys are significantly less expensive (approximately $250) than many power wheelchairs (up to $20,000) and are easily modifiable to fit the child’s individual developmental needs.
In addition, the use of low-cost ride-on-toys allows children to reserve energy for other important functional activities, such as play and daily self-care tasks.
APPROACH: The specific aim was to investigate the effects of early power mobility for a child born with a rare neuromuscular disorder. Our hypothesis was that early power mobility will improve the cognitive, language, and motor skills of children aged less than 2 yr who were born with significant mobility impairments.
METHOD: A case series design with a pretest, posttest, and 2-mo follow-up was implemented. Fourteen individualized intervention sessions with an adaptive ride-on-toy were used. The setting took place in a pediatric research laboratory. Three male participants aged 18 to 24 mo participated in the study. All participants had significant mobility impairment due to Pierre Robin sequence, myotonic dystrophy, and spinal muscular atrophy (Type II). Measures included pre- and posttests as well as a 2-mo follow-up with the Bayley Test of Infant and Toddler Development—Third Edition (Bayley–III), the Pediatric Evaluation of Disability Inventory (PEDI), and the Quality of Upper Extremity Skills Test (QUEST). Sessions were video-taped and recorded for later viewing for specific behaviors, such as independent versus assisted mobility. The results of the pretest, posttest, and follow-up test were examined for changes in standard scores and domain classifications (average vs. below average). Video recordings were viewed and scored by investigators (interrater and intrarater reliability intraclass correlation coefficient values ≥ .87).
RESULTS: Improvements were seen in cognitive and language domains of the Bayley–III for all participants (below average to average, borderline to average) and were maintained at follow-up testing. All participants showed improvements in social and self-care domains of the PEDI that were maintained at follow-up. No significant changes were seen in QUEST results.
CONCLUSION: This study is the first to use standardized assessments to measure changes in the cognitive, language, social, and motor domains following participation in a manualized intervention using an adapted ride-on-toy. These results support previous descriptive studies that found that children aged less than 2 yr can successfully learn to independently operate power mobility devices and that short-term improvements may be seen. Because this study involves only 3 subjects, it may be difficult to generalize the results to children with different diagnoses.
