Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Power Fun, a therapeutic powered mobility summer camp, provides a pragmatic solution to promote mobility for children with severe cerebral palsy. This session presents the Power Fun protocol and the results of a repeated-measures mixed-methods validation study (N = 24). These showed significant improvement in powered mobility skills, attainment of most functional goals, and social change after participation, making it an evidence-based intervention for children with severe disabilities.
Primary Author and Speaker: Lori Rosenberg
Additional Authors and Speakers: Yafit Gilboa
Contributing Authors: Adina Maeir
PURPOSE: Powered mobility (PM) provides opportunities for children with limited locomotion to engage in meaningful life experiences, thus promoting development, a core principle of occupational therapy. Children with severe cerebral palsy (CP) commonly have impairments in skills that predict proficiency in PM, therefore many therapists do not provide them with the opportunity to learn PM, assuming they will not succeed. This, effectively, withholds the medium that could reverse this negative loop. Power Fun is a therapeutic summer camp designed to offer a pragmatic, theory-based solution enabling school-aged children with severe CP to learn PM. The protocol consists of 2 daily group sessions over 3 weeks/5 days a week. The research questions were: 1) Will children with severe CP show significant improvement in mobility skills following the summer camp intervention? 2) Will they attain functional participation goals? 3) Will there be any change in the participants' social interaction after the intervention?
DESIGN: A repeated measure, multiple base line, mixed-method quasi-experimental study design was conducted. Inclusion criteria were children (ages 7-21) with CP who need assistance in mobility (GMFCS 4-5) and limited hand function (MACS 3-5), attend a special needs school and opt to participate, subject to parental consent. Participants (N = 24) were recruited from 2 special-needs schools through intentional sampling, creating four groups of 6 campers.
METHOD: PM skills were measured using the Assessment of Learning Power mobility (ALP) and Powered Mobility Program (PMP). Functional participation goals were assessed with the Wheelchair Outcome Measure for Young People (WhOM-YP) and Goal Attainment Scaling (GAS). Qualitative data regarding the effect of PM on social behavior was collected through interviews with staff members and participants. Data was collected at 4 time points: 3 weeks prior to the camp (T1), at baseline (T2), post intervention (T3) and 3 weeks follow up (T4). Changes over time were analyzed with the General Linear model. Goals were examined by descriptive statistics and interviews using inductive qualitative descriptive method.
RESULTS: Out of the 24 participants, 23 finished the camp, and all rated the camp extremely enjoyable. Results confirm that Power Fun is effective in improving PM skills (PMP: F(1, 26) = 35.49, p < 0.001, ηp
2 = 0.66; ALP: F(1, 22) = 93.74, p < 0.001, ηp
2 = 0.83). There were no changes T1-T2, prior to the camp (PMP: p = 1.00 (2.7); ALP p = 1.00 (.048)). Significant improvements were seen post intervention T2-T3 (PMP: p < .001 (8.1); ALP: p < .001(.195)). No significant change at T4 showed maintenance (PMP: p = 1.00 (4.2); ALP p = .15(.116). Goals (n = 48; 2 goals per person) were reached (GAS average 0.2 (1.2) or slightly above the expected outcome) and a significant effect over time was seen in WhOM-YP goals (F (2, 43) = 170, p < 0.001, ηp
2 = 0.86). Staff interviews (n = 19) identified 4 overarching themes: (1) ‘Every step you take: mastering new, sometimes unexpected, skills' (2) ‘Break on through to the other side: changes in behavior' (3) ‘Make new friends (but keep the old): Boosting social behavior' (4) ‘I'm a believer: The journey through self-efficacy to empowerment'.
CONCLUSION: The study confirms the validity of Power Fun as a pragmatic intervention to promote PM skills and participation for children with severe CP. Teachers highlight enjoyment, increase in activity, greater interactions with staff and peers as well as a rise in self-efficacy. Occupational therapists can use Power Fun protocol for children with severe limitations to advance independent mobility and break the negative loop. This will open opportunities for engagement in meaningful experiences that can trigger development.
References
Rosenberg, L., Maeir, A., & Gilboa, Y. (2019). Feasibility Study of a Therapeutic Mobility Summer Camp for Children with Severe Cerebral Palsy: Power Fun. Physical and Occupational Therapy in Pediatrics, 0(0), 1–15. https://doi.org/10.1080/01942638.2019.1695699
Kenyon, L. K., Hostnik, L., McElroy, R., Peterson, C., & Farris, J. P. (2018). Power Mobility Training Methods for Children. Pediatric Physical Therapy, 30(1), 2–8. https://doi.org/10.1097/PEP.0000000000000458
Livingstone, R., & Field, D. (2015). The child and family experience of power mobility: A qualitative synthesis. Developmental Medicine and Child Neurology, 57(4), 317–327. https://doi.org/10.1111/dmcn.12633
Rosen, L., Plummer, T., Sabet, A., Lange, M. L., & Livingstone, R. (2017). RESNA Position on the Application of Power Mobility Devices for Pediatric Users-Update 2017 RESNA Position on the Application of Power Mobility Devices for Pediatric Users. Arlington, VA. Retrieved from http://www.resna.org/sites/default/files/legacy/Position-Papers/RESNA Ped Power Paper 10_25_17 -BOD approval Nov2_2017.pdf
