Children’s Progression of Control of a Powered Mobility Device Using a Joystick

Independent mobility allows typically developing infants to acquire a broad range of skills in the cognitive, perceptual, language, emotional, and social domains. Researchers have reported that children with physical disabilities may achieve significant developmental benefits from the use of powered mobility devices (PMD), including increased interaction with the environment, self-initiated independent movement, positive affect, contact with others, spatial exploration, and communication (Livingstone & Field, 2014). To foster optimal development, therapists advocate for powered mobility as early as it is feasible for children who cannot locomote independently (Feldner, Logan, & Galloway, 2016). A recent survey of occupational and physical therapists reported that most therapists thought joystick control cin driving ould be used successfully with 14-month-old infants (Kenyon et al., 2018). However, very young children’s ability to learn to use a joystick has not been well-quantified, leaving therapists with limited information to support when the use of a joystick to control powered mobility might be appropriate.

The purpose of this research was to determine the progression of driving skills using joystick control in a robotic PMD in very young, typically developing children. A total of 10 infants who were developing typically and between the ages of 12 to 24 months were recruited. Children participated in five 20-minute sessions of mobility training over a period of no more than 3 weeks. During sessions, infants were secured safely in an infant seat mounted on top of a mobile robot. Each session included a driver training period, when infants were prompted to drive toward desired toys and other objects, and a free play period, when they were allowed to move about the space freely. We assessed driving performance from videotaped sessions using a modified version of the Power Mobility Program (Furumasu, Guerette, & Tefft, 1996); each mastered skill received one point. Data for one child was removed from the analysis, because he would not sit in the PMD. Descriptive analysis of the data was completed, using each child’s best performance, which for most children was on the final session.

The findings suggest a progression of driving skills that was significantly related to the age of the infants (r = .96). Children at 12 months demonstrated cause and effect understanding (that activating the joystick resulted in movement of the powered mobility device, but did not demonstrate the ability to direct their movement toward desired objects. At 18 months, children were also able to direct their movement toward objects of interest (forward, left, and right), and to stop spontaneously. At 24 months, infants were able to direct their movement toward objects of interest, and were able to drive around obstacles and through a doorway, although with some trial and error.

The progression of driving skills presented in this study provides preliminary evidence that may be useful to therapists considering powered mobility for this age group. Infants with mobility impairment with adequate upper extremity coordination and problem-solving abilities may be able to perform as well as infants in this study, although cognitive, perceptual, or cognitive limitations that may be present in children with motor impairment are likely to impact driving abilities significantly.

This proposal has implications for pediatric OT practice and policy as it can inform practitioners’ decision-making regarding powered mobility for very young children. This is significant because independent mobility has been proven to affect all domains of childhood development which collectively impacts children’s participation and engagement in childhood occupations.

References

Livingstone, R., & Field, D. (2014). Systematic review of power mobility outcomes for infants, children and adolescents with mobility limitations. Clinical Rehabilitation, 28(10), 954–964. https://doi.org/10.1177/0269215514531262

Feldner, H., Logan, S., & Galloway, J. (2016). Why the time is right for a radical paradigm shift in early powered mobility: the role of powered mobility technology devices, policy and stakeholders. Disability and Rehabilitation: Assistive Technology, 11(2), 89–102. https://doi.org/10.3109/17483107.2015.1079651

Kenyon, L., Jones, M., Livingstone, R., Breaux, B., Tsotsoros, J., & Williams, K. (2018). Power mobility for children: a survey study of American and Canadian therapists’ perspectives and practices. Developmental Medicine & Child Neurology, 60(10), 1018–1025. https://doi.org/10.1111/dmcn.13960

Furumasu, J, Guerette, P., & Tefft, D. (1996). The development of a powered wheelchair mobility program for young children. Technology and Disability, 5(1). doi: 10.3233/TAD-1996-5106