Powered mobility for young children

Occupational therapists and physiotherapists can help parents and carers choose the best powered mobility device for their child.

Cerebral Palsy Alliance offers a service to all children and adults who wish to consider using powered mobility.

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Fees will apply for therapists to provide assessment, prescription and support to learn to use powered mobility, and will depend on the provider and the number of sessions needed. Check with the provider whether fees will also apply for development of a home program, report writing or therapist travel.

Powered mobility equipment ranges in price depending on whether a modified toy car or a powered wheelchair is the appropriate choice. Powered wheelchairs range in price from AUD8,000 to AUD40,000, depending on the complexity of the equipment. Funding for the equipment may be available and this involves completing an application for funding.

Ask the therapists if you are eligible for funding to assist with fees and powered mobility equipment costs. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Adequate time is required to try out potential devices to find the right one.

The time it takes a child to learn to control a modified toy car or powered wheelchair will depend on their skills, limitations, support network and the time they have to practice.

One in three children with cerebral palsy is unable to walk or move around by themselves². Wheelchairs and other powered mobility toys can give these children the opportunity to explore their environment, and participate in social and educational activities. Research confirms young children who use powered mobility are more capable of independent movement – allowing them to have experiences that are part of typical development, they would not otherwise have^1,3,4. It helps them develop cognitive skills^3,5, confidence, communication, social skills and the ability to handle objects⁵. Importantly, this means they also need less caregiver assistance with mobility and self-care³.

Equipment

• Controllers are available to cater for children with a wide variety of physical abilities. Many children use a joystick attached to an armrest or tray to control their devices. Children who have difficulty using their hands may use a control called a switch, which is positioned to capture available body movements. For example, switches can be operated by chin, hand, foot, elbow and head movements.
• Powered mobility devices are usually programmed to go very slowly while young children are learning to use the device.
• Some children may need special seating, supports and straps to hold their body and head in a well-supported and comfortable position.
• If required, communication and environmental control systems can be used with powered mobility devices. These could include speech generating devices or the ability to switch on the television or air conditioning.

Modifications

The environment around a child is vital for successful use of powered mobility devices⁴. Alterations may be required to prepare indoor and outdoor environments at home and preschool for the mobility device. Common issues include having adequate space to turn around in, as well as ramps, wide enough doorways, and bathrooms that are accessible. In addition, the height of benches and storage areas may be altered so that a child can sit at a table or reach clothes and toys in his or her bedroom. A secure place to store and charge the battery of the device is also required.

Transport

Powered wheelchairs are large and heavy and cannot be lifted into a car. A suitable vehicle may be needed to transport the device.

Support

The child will need a network of people committed to help them master their powered mobility device and to safely explore a range of environments. Each child will need an individualised program to support them to build their skills in using the device.

Things to note

• The level of independence a child achieves using powered mobility will vary according to several factors including the child’s motivation, intellectual ability, physical environment and amount of support available.
• Young children with moderate and severe intellectual disability may experience benefits from exploring their environment using powered mobility. Specific goals for these children can be discussed with the child’s therapy team. Goals might include experiencing independent movement, building switching skills and providing opportunities for social interaction.
• The decision to use powered mobility involves understanding the needs, expectations and preferences of the child with cerebral palsy and their family, and the cost, time and resources required.
• Powered mobility is also known as motorised wheelchairs, electric wheelchairs, power drive wheelchairs and power wheelchairs, and the toys are also known as motorised cars or modified toy cars.

An occupational therapist or physiotherapist will complete a thorough assessment to better understand the child’s motor, visual, cognitive and perceptual abilities; sensory status and postural needs; as well as their environment and support network. This is to ensure that the recommended powered mobility device is suitable for the child and their home, preschool, community and playground environments. The assessment is undertaken in collaboration with the child and family, early intervention service, preschool, medical team, and therapy team.

The purpose of using an outcome measure is to determine whether this intervention achieves the child’s goals. The occupational therapist or physiotherapist, together with the child and family, will determine the most suitable measure to use. Typical outcome measures for this intervention include:

• Individually Prioritised Problem Assessment (IPPA) – measures whether a device solves the problems a person is experiencing
• Goal Attainment Scaling (GAS) – measures the extent to which a person’s goals are achieved
• Assessment of Learning Powered mobility use (ALP) - assesses where the child/adult is up to in the process of learning to use powered mobility and provides ideas to help them develop new skills as they progress⁶

We searched the medical, psychological, allied health and educational literature to find studies evaluating the outcomes of powered mobility for children under three years of age with physical disabilities.

The search aimed to find the best available evidence about whether powered mobility improves children’s ability to move around in their environment, communicate and build other developmental skills.

One good quality randomised controlled trial³ (RCT) and one case study⁷ published since this trial comprised the best available evidence to make decisions about powered mobility for young children with physical disability. The RCT included young children with severe motor impairment aged 14 months to 30 months. The study evaluated the mobility and developmental skills of a group of children who used powered wheelchairs for 12 months, compared with a group of children who did not use powered wheelchairs. The children who used the wheelchairs had better mobility and a greater ability to understand what other people were saying to them (receptive communication). Children who used powered mobility also needed less caregiver assistance with mobility and self-care.

The case study⁷ evaluated the use of a modified toy car with a 21-month old boy with spastic quadriplegic cerebral palsy. His mobility improved, as did the frequency of positive facial expressions, vocalisations and spontaneous family interaction. The study concluded that modified toy cars could be a feasible, cheaper possibility for very young children with cerebral palsy.

Overall, evidence supports the use of powered mobility for young children with physical disabilities. In addition to the studies reported here, many low level and qualitative studies have also suggested a positive impact of powered mobility on a range of outcomes^1,8. The quality of evidence is classified as low because only one RCT (and studies at lower levels) has examined the effect of powered mobility. The reasons for so little high level research may be due to the ethical concerns of withholding powered mobility from children with significant disability, the costs associated with providing powered mobility, and the difficulties finding a large enough group of young children of similar age, diagnosis, and level of physical disability.

Research evidence is just one piece of information used to make a decision about whether powered mobility for young children with cerebral palsy is the right choice. The decision will also be based on the individual abilities, needs and preferences of the child and their family. Families are encouraged to speak to an occupational therapist or physiotherapist if they are interested in discussing powered mobility.