Power Fun: A Therapeutic Summer Camp Enabling Children With Severe Disabilities to Learn Powered Mobility (PM) Skills

Powered mobility (PM) provides opportunities for children with limited locomotion to engage in meaningful life experiences, thus promoting development, a core principle of occupational therapy. Children with severe Cerebral Palsy (CP) commonly suffer motor, visual and/or cognitive impairments, precisely those skills which predict proficiency in PM. As a result, therapists often do not provide an opportunity to learn PM, assuming they will not be independent, effectively withholding the medium that could reverse this negative loop.

Power Fun, a therapeutic PM summer camp, was designed to offer a pragmatic, theory-based solution enabling school-aged children with severe disabilities to learn PM. The protocol consists of 2 daily group sessions over 3 weeks, 5 days a week. The research questions, aimed at determining the effectiveness of the program, were: 1) Will children with severe disabilities show significant improvement in mobility skills following the summer camp group intervention? 2) Will they attain functional participation goals? 3) Will there be a change in the participants’ social interaction after the intervention?

A repeated measure, multiple base line, mixed-method study design was conducted. Inclusion criteria were children (ages 7-21) with CP who need assistance in mobility (GMFCS 4-5) and limited hand function (MACS 3-5), attend a special needs school and opt to participate, subject to parental consent. Participants (N=24) were recruited from 2 special-needs schools through intentional sampling, creating 4 groups of 6 students.

PM skills were measured using the Assessment of Learning Power mobility (ALP) and Powered Mobility Program (PMP). Functional participation goals were assessed with the Wheelchair Outcome Measure for Young People (WhOM-YP) and Goal Attainment Scaling (GAS). Qualitative data regarding the effect of PM on social behavior was collected through interviews with staff members and participants. Data was collected at 4 time points: 3 weeks prior (T1), at baseline (T2), post intervention (T3) and 3 weeks follow up (T4). Changes over time were analyzed with the General Linear model. Goals were examined by descriptive statistics and interviews using inductive qualitative descriptive design.

Results confirm that Power Fun is effective (PMP: F(1, 26) = 35.49, p<0.001, ƞ² _p=0.66; ALP: F(1, 22) = 93.74, p<0.001, ƞ² _p=0.83). There were no changes in outcome measures prior to the camp between T1-T2 (PMP: p = 1.00 (2.7); ALP p=1.00 (.048)). Significant improvements were seen post intervention between T2-T3 (PMP: p < .001 (8.1); ALP: p<.001(.195)). No significant change at T4 showing maintenance (PMP: p=1.0 (4.2); ALP p=.15(.116). Goals improved to slightly above the expected outcome (GAS average 0.2 (1.2) and significant effect over time was seen in WhOM-YP goals (F (2, 43) = 170, p<0.001, ƞ² _p=0.86). Out of the 24 participants, 23 finished the camp, and all rated the camp extremely enjoyable. Themes from interviews centered around increased initiation and self-efficacy, expression of positive emotions and more interaction.

The study confirms the validity of Power Fun as a pragmatic intervention to promote PM skills and participation for children with severe CP. Teachers and students highlight the enjoyment, increase in activity, greater interactions with staff and peers as well as a rise in self-efficacy. Occupational therapists can use Power Fun for children with severe limitations to advance independent mobility and break the negative loop. This will open opportunities for engagement in meaningful experiences that can trigger their development.

References

Kenyon, L. K., Hostnik, L., McElroy, R., Peterson, C., & Farris, J. P. (2018). Power Mobility Training Methods for Children. Pediatric Physical Therapy, 30(1), 2–8. https://doi.org/10.1097/PEP.0000000000000458

Livingstone, R., & Field, D. (2015). The child and family experience of power mobility: A qualitative synthesis. Developmental Medicine and Child Neurology, 57(4), 317–327.

Mockler, S. R. H., Mcewen, I. R., & Jones, M. A. (2017). Retrospective Analysis of Predictors of Proficient Power Mobility in Young Children with Severe Motor Impairments. ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION. https://doi.org/10.1016/j.apmr.2017.05.028

Rosen, L., Plummer, T., Sabet, A., Lange, M. L., & Livingstone, R. (2017). RESNA Position on the Application of Power Mobility Devices for Pediatric Users-Update 2017 RESNA Position on the Application of Power Mobility Devices for Pediatric Users. Arlington, VA. Retrieved from http://www.resna.org/sites/default/files/legacy/Position-Papers/RESNA Ped Power Paper 10_25_17 -BOD approval Nov2_2017.pdf