AIM
To systematically review the effectiveness of wheeled mobility interventions in children and young people with cerebral palsy (CP).


METHOD
A systematic literature search was performed in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, EBSCO, PEDro, and Web of Science using database-specific concepts such as 'child' and 'wheelchair'. Studies focusing on wheeled mobility skill interventions with participants aged 6 to 21 years with CP were included.


RESULTS
Twenty studies with 203 participants were included. The impact of wheeled mobility skill interventions was assessed on mobility skills (n = 18), activity and participation (n = 10), and quality of life (n = 3). No studies reported effects on stress, fatigue, and motivational aspects. Interventions included power wheelchair skill training (n = 12), computer-based training (n = 5), smart wheelchair training (n = 2), and manual wheelchair training (n = 1), showing positive wheeled mobility intervention effects. Study quality based on the Methodological Index for Non-Randomized Studies scale was 9 out of 16 and 14 out of 24 for non-comparative and comparative studies respectively. Risk of bias was serious-to-critical on the Risk of Bias in Non-Randomized Studies of Interventions.


INTERPRETATION
Wheeled mobility interventions showed promising beneficial effects on wheeled mobility, activity and participation, and quality of life for children and young people with CP. Future studies with structured and standardized training programmes and assessment tools are warranted to further accelerate the wheeled mobility skill acquisition process in this population.

Effectiveness of wheeled mobility skill interventions in children and young people with cerebral palsy: A systematic review.

This workshop will introduce power mobility use with infants, toddlers and preschool children and highlight the benefits and challenges of using power mobility at an early age. The presenters have been involved in publishing three recent articles on use of power mobility with children including an opinion paper, a systematic review of outcomes and a clinical practice considerations paper. Information from these publications will be shared and the evidence supporting the early introduction of power mobility and its impact on children’s development and participation will be highlighted. This will be followed by clinical examples demonstrating the use of different kinds of power mobility devices within different clinical practice settings and different countries around the world. The presenters will highlight their own experiences as well as the experiences of others and will share relevant and practical resources to assist clinicians in educating families and other therapists in the benefits of introducing power mobility with young children.

Providing power and mobility to toddlers and infants around the world

Abstract Background: Case study research is generating interest to evaluate complex interventions. However, it is not clear how this is being utilized by occupational therapists or how feasible it is to contribute to the evidence base. This scoping review explores the range and characteristics of case study research within occupational therapy and examines how it is defined, methodologies adopted and practice contexts in which it is applied. We consider the viability of case study research for contributing to our evidence base. Methods: Opinion, text and empirical studies within an occupational therapy practice context were included. A three-step extensive search following Joanna Briggs Institute methodology was conducted in June 2020 and updated in July 2021 across ten databases, websites, peer reviewed and grey literature from 2016 onwards. Study selection was completed by two independent reviewers. A data extraction table was developed and piloted and data charted to align with research questions. Data extraction was completed by one reviewer and a 10% sample cross checked by another. Results: Eighty-eight studies were included in the review consisting of (n=84) empirical case study and (n=4) non-empirical papers. Case study research has been conducted globally, with a range of populations across different settings. The majority were conducted in a community setting (57%) with populations experiencing neurodevelopmental disorder (38%), stroke (17%) and non-diagnosis specific (15%). Methodologies adopted quantitative (50%), mixed methods (26%) and qualitative designs (24%). However, identifying the methodology and ‘case’ was a challenge due to methodological inconsistencies. Conclusions: Case study research is useful when large scale inquiry is not appropriate; for cases of complexity, early intervention efficacy, theory testing or when small participant numbers are available. It appears a viable methodology to contribute to the evidence base for occupation and health as it has been used to evaluate interventions across a breadth of occupational therapy practice contexts. Viability could be enhanced through consistent conduct and reporting to allow pooling of case data. A conceptual model and description of case study research in occupational therapy is proposed to support this. Scoping review registration: Open Science Framework 10.17605/OSF.IO/PCFJ6 

Exploring the contribution of case study research to the evidence base for occupational therapy practice: a scoping review

Purpose




The purpose of this paper is to explore a large data set compiled by a UK charity loan scheme to identify trends and paint a practice-based picture of how young children use early years powered mobility (EYPM).




Design/methodology/approach




Statistical analysis was used to investigate a database of 90 children, ranging in age from 15 to 72 months who completed use of an EYPM device (the Wizzybug, or WB) between April 2011 and December 2015. Goals were set and reviewed, and thematic analysis was used to understand families’ insights into their children’s use of EYPM, using a free-text review form.




Findings




Children’s mean age when joining this free loan scheme was 39.6 months. The later the child started using a Wizzybug, the less likely they were to achieve their goals. A theme of happiness and enjoyment emerged as important for both child and family. The child’s independence translated to independence for the whole family.




Research limitations/implications




The database was operational and incomplete. Lack of a standardised outcome measure was disadvantageous.




Practical implications




Challenges of translating research knowledge into practice are highlighted, supporting the need for more rigorous and standardised outcome measures. Earlier identification of children’s readiness for EYPM is required alongside research and recognition of the holistic benefits of EYPM for all the family.




Originality/value




This research profited from a large data set of young children with long-term access to powered mobility at home.

Trends, goals and outcomes for children and families using early powered mobility in a charitable loan scheme

Background One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown. Objective The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years. Review methods The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources. Data sources A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index™ (SSCI; Clarivate Analytics), Conference Proceedings Citation Index – Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index – Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019. Results In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or ≥ 5 years. However, strong support was found that powered mobility interventions have a positive impact on children’s movement and mobility, and moderate support was found for the impact on children’s participation, play and social interactions and on the safety outcome of accidents and pain. ‘Fit’ between the child, the equipment and the environment was found to be important, as were the outcomes related to a child’s independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is ‘movement for movement’s sake’ and the latter destination-focused mobility. Powered mobility should be focused on ‘movement for movement’s sake’ in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends £1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure. Limitations The original research question could not be answered because there was a lack of appropriately powered published research. Conclusions Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on ‘movement for movement’s sake’. Future work Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility. Study registration This study is registered as PROSPERO CRD42018096449. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.

pdf/powered-mobility-interventions-for-very-young-children-with-47hl694264.pdf

Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis

IntroductionNorthern Ireland wheelchair guidelines state that wheelchair users who wish to drive their National Health Service provided powered wheelchairs outdoors must complete an electrically powered indoor/outdoor chair test. Within the same guidelines, children in Northern Ireland under the age of 10 years are not permitted to complete this assessment. Research was completed to evaluate how children under 10 years would perform in electrically powered indoor/outdoor chair training and testing under adult supervision.MethodA case-study design was utilised with three children aged 7–9 years to evaluate if: (a) these children can complete electrically powered indoor/outdoor chair training/testing safely with adult supervision; (b) the length of time using an electric powered indoor chair correlates with performance on electrically powered indoor chair training/testing; (c) the current Northern Ireland guidelines on age restriction should be re-evaluated so that each child is assessed on an individual ba...

Electrically powered indoor/outdoor chair performance for children aged 7 to 9 years

Lung Single-Cell Transcriptomic Analysis During the Development of Pulmonary Arterial Hypertension in the Rat SU5416-Chronic Hypoxia Model

Identification by Single-Cell Transcriptomic Analysis of a Novel Endothelial Stem Cell Population Mediating Lung Microvascular Regeneration by an Apelin-Dependent Mechanism

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Electrically powered indoor/outdoor chair performance for children aged 7 to 9 years

Lung Single-Cell Transcriptomic Analysis During the Development of Pulmonary Arterial Hypertension in the Rat SU5416-Chronic Hypoxia Model

Identification by Single-Cell Transcriptomic Analysis of a Novel Endothelial Stem Cell Population Mediating Lung Microvascular Regeneration by an Apelin-Dependent Mechanism