Mobility - The Research
Mobility is a big deal; it is how we accomplish the tasks that we need to do. Research clearly indicates that early independent mobility increases cognitive skills, psychosocial skills, vision and visual perceptual skills. Some of our clients may come to their mobility later on. I would love to see more of my clients when they are very young, but just because our client is older when we are looking at mobility does not mean they cannot still benefit from that activity. There is research to back this up. What is that research? The RESNA position paper on pediatric mobility includes a comprehensive listing of research. It is getting a little dated now and actually there is a group of us working on updating this, even as we speak, to include much more recent research. Since this paper came out, probably most the research that has come out is indicating that augmented mobility experiences, even for very young children, even for children who may not be independent in that power chair, but by just having experiences in a power chair can really have key developmental benefits. Sometimes this is being used not so much to provide mobility as it is to build those developmental skills. That is how critical this is. You can find this position paper on the RESNA website. If you cannot find it there, you can find it on my website at www.atilange.com under Resources. Keep an eye out because in the next year there will be an updated version of this as well.
Resistance to Power Mobility
Sometimes clients may not want to look at power mobility. Usually resistance falls into three different categories, either concerns about motor development, concerns that that child can get mobile in some other way if we just wait a little bit longer, or concerns about funding.
Barrier #1: Concerns regarding motor development with use of power mobility
Many times I have been in a mobility evaluation where someone on that team says if this child gets a power chair they will never walk or they will never use their other mobility equipment. Concern is present even if it is a manual wheelchair or a gait trainer. Another concern is that they might get lazy. I was in a session just this last week at a conference where one of the participants said that team members had said the client will gain weight if they get a power wheelchair. That is along the same line of concern. Fortunately, research, and some of this research is in that RESNA position paper, has shown that children who use a power chair are actually more likely to attempt any other form of mobility; that the child will not become lazy. Let's say that a child has never been able to move themselves independently before. If they see a toy that is out of reach, they may not even try to get it because they know that they cannot. If that child has had some mobility experiences where they were able to independently grab that toy, then when they are down on the floor and that toy is just out of reach, they might make even more of an effort to go get it. They know now that they have gotten it before. It spurs more motor development, not the opposite concern.
Barrier #2: Lengthening therapy and/or trying alternative methods
There may be someone on the team that says hold on, if I can just work with this person a little longer, I know I can get them walking or I know I can get them propelling that manual chair or using that gait trainer. It is important that we remember as clinicians that a power chair does not mean that we failed in therapy. It is just another tool in our tool box. What is our goal? Our goal is for clients to be as independent and functional in their mobility as possible. We want that mobility to be efficient for them. Efficient means does not take a lot of time, does not take a lot of effort. If we are working with a client who truly does not have independent functional mobility, we have a whole array of options to help us get that person mobile. It does not mean we stop therapy as soon as we provide something like a power wheelchair. A power wheelchair may be the only way of providing independent mobility that to that client at that time.
