Abstract
Currently, there is limited information available to therapists to help them in advising parents about possibilities for very early powered mobility use in infants and very young children. Presenters will discuss the results of a pilot study that examined the progression of joystick driving skills in typically developing children from ages 12 to 24 months. Possible implications of the findings from this study for evidence-based practice will be considered.
Primary Author and Speaker: Jennifer Iglthaler
Contributing Authors: Erika Dalida, Caitlin Maclang, Eunice Cho, Hekanne Simbolon, and Marielle Santiago
Many researchers and clinicians believe that providing powered mobility to infants with locomotor limitations may provide developmental benefits through self-initiated movement, environmental exploration, and interaction with others. However, existing information on the development of driving proficiency using powered mobility devices (PMDs) is limited. Two older studies investigated the use of joystick controlled PMDs in children with motor limitations, but typical cognitive development. Butler et al. (1983) studied nine children (20-39 months of age) who received PMDs for use at home. Eight became independently mobile; the youngest was 24 months of age. Furumasu et al. (1996) provided 6 PMD sessions for 24 children, aged 20-36 months. In the final session, 14 children needed hands-on assistance; the youngest of nine who required only verbal cueing was 25 months old. Mockler et al. (2017) analyzed data from 31 children (aged 14 to 30 months) with severe motor impairment who received PMDs; all but 7 used a proportional joystick. After 12 months of practice, only 14 were rated as proficient drivers; predictors included child cognition, diagnosis, and joystick control (versus alternative control). A recent survey indicated that most occupational and physical therapists thought joysticks could be used successfully with 14-month-old infants (Kenyon et al., 2018), but research from the above studies does not support this view. This presentation reports the results of a pilot study that examined the progression of joystick competence for powered mobility control among typically developing children. Ten typically developing infants (12 to 24 months of age) received five 20-minute driving experiences. We used a mobile robot controlled by a joystick, which was attached to the center front of the infant seat. Sonar sensors limited collision with objects in the environment. We measured nine driving skills using a researcher designed measurement, the Tots Joystick Driving Tool (TJDT), including infants' understanding of cause/effect, and their ability to stop, drive directionally, and navigate the environment. The total score was the sum of item scores (0 = inability, 1 = emerging skill, 2 = mastery). High interrater reliability was established from video scoring by two researchers. Driving sessions included three five-minute periods (free play, driver training, a second free play period), and finally, a trial of driving around an obstacle and through a doorway. Results indicated that 12-month-old children demonstrated cause and effect with the joystick, while 18-month-olds showed emerging directional control. By 24 months of age, children mastered directional control and were able to drive around an obstacle and through the doorway. Age was highly correlated to scores on the TJDT (r = .93). Only one child demonstrated purposeful driving in reverse. Findings provide partial support for therapists' views that children as young as 14 months can successfully use a joystick (Kenyon et al., 2018), as we found that 12-month old infants understood that moving the joystick resulted in robot movement (cause and effect), after five driving sessions. The ability to navigate in the environment with control was demonstrated only by older infants. Limitations of this study included limited driving practice. In addition, preventing collisions with the use of sonar sensors may have limited infants' learning. This study provides preliminary information to occupational therapists about when functional joystick control for PMDs may develop in typically developing children. However, they must also consider childrens' motor and cognitive abilities and reimbursement limitations when making decisions about provision of PMDs for young children.
Butler, C., Okamoto, G. A., & McKay, T. M. (1983). Powered mobility for young disabled children. Developmental Medicine & Child Neurology, 25, 472-472. https://doi.org/10.1111/j.1469- 8749.1983.tb13792.x
Furumasu, J., Guerette, P., & Tefft, D. (1996). The development of a powered wheelchair mobility program for young children. Technology and Disability, 5, 41-48. https://doi.org/10.3233/TAD-1996-5109.
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
Mockler, S. R., 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 & Rehabilitation, 98, 2034-2041. https://doi.org/10.1016/j.apmr.2017.05.028.