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Practice considerations for the introduction and use of power mobility for children
Roslyn Livingstone1, Ginny Paleg
1Sunny Hill Health Centre for Children, Vancouver, BC, Canada.
Insights
Power mobility devices can be recommended for children with mobility impairments starting around 12 months of age. This intervention supports independent mobility for children with diverse needs and abilities.
Area of Science:
- Pediatric rehabilitation
- Assistive technology
- Developmental pediatrics
Background:
- Clinicians require guidance for recommending power mobility for children.
- Power mobility aims to enhance independence and participation for young users.
- Diverse pediatric populations present unique challenges for mobility solutions.
Framework:
- A comprehensive approach integrating literature review, Delphi consensus, and clinical practice.
- Scoping review identified 15 themes, refined to 10 transferable messages from 27 articles.
- Modified Delphi process with 16 experts achieved 80% agreement on key messages.
Implementation:
- Evidence levels ranged from Level II to V, with consensus potentially elevating overall evidence to Level III.
- Focus on practical application and justification for power mobility interventions.
- Consideration of varying child abilities, ages, and specific mobility needs.
Implications:
- Power mobility is a viable intervention for children from 12 months lacking independent mobility.
- Supports children who may not become proficient drivers or only have early childhood mobility limitations.
- Facilitates early intervention and improved long-term outcomes for pediatric mobility.
Aim:
The aim of the study was to support clinicians in recommending and justifying power mobility for children of different ages and abilities, and with different needs. The study comprised three distinct parts: a literature review; a Delphi consensus; and clinical practice considerations.
Method:
A scoping review of eight electronic databases and manual searches carried out in February 2011 identified 15 themes or transferable messages among 27 articles meeting initial inclusion criteria and these formed the basis of a draft paper. Informal consensus at two international conference presentations refined and modified the paper to include 10 messages supported by 24 articles. The literature review was updated in May 2012 and a modified Delphi process sought to formalize the consensus process with an international panel of 16 expert clinicians and researchers using a priori criteria of 80% agreement.
Results:
Evidence from studies was classified using the American Academy of Cerebral Palsy and Developmental Medicine guidelines, with evidence from most studies being classified as either level IV or level V, apart from one study each with evidence classified as level II and level III. Expert consensus on the content and wording of nine transferable messages may raise evidence overall to level III.
Interpretation:
This paper suggests that power mobility may reasonably be considered as an effective and appropriate intervention for children lacking efficient, independent mobility from around 12 months of age including children who may never become competent drivers and children lacking independent mobility only in early childhood.
