Question
What are some key concepts for community mobility for pediatric occupational therapy practitioners?
Answer
1. Side airbags in the front seat will hit you at the shoulder and the trunk. The middle seat is referred to as the inboard seat. The outboard seats are near the doors. Most cars do not have the side airbags. However, if available, the side curtain airbags will go off, and that is perfectly safe. The car seat will protect a child from a head injury. A side air bag will give extra protection to their head. I actually would never drive a car without side curtain airbags because they have been shown over and over again to protect passengers from head injury. There, the inboard seat is technically considered the safest seat in the vehicle for a child. That said, most parents do not put their kids there. It is harder to reach them so it is more convenient to place them in the outboard seats. The outboard seats are not dangerous, but just not as safe.
2. I would say it depends on how big and bulky it is. You know there is a difference between a leather jacket and a very fluffy down snowsuit. If it is very fluffy, I would say maybe take it off. When you do the child passenger safety training, we learn when the seat belt is pulled, it locks. That is called an emergency locking retractor. That means that when the car stops the seat, because the quick change in g-forces, that seat belt will lock and that keeps you from moving forward. This is part of the safety mechanism to keep you one with the vehicle, because remember those seatbelts are actually mounted to the frame of the vehicle. I would not use something as puffy as it will not provide as much contact and support. I would instead keep the car warmer.
3. This is definitely not for every 10 kids, as that would be cost prohibitive. It really depends on the school system. Policies get written because things happen. Once you have kids acting up or doing things they should not be doing, that often necessitates a policy change, perhaps an aide on every bus. It is really dependent on the school system. It is pretty standard just to have the one bus driver and that is it.
4. The size of the child is definitely more important, not the age. The car seat does not really know how old the child is. Fitting in the seat and the alignment with the harnesses are really the most important. There is a children's hospital in Indianapolis that has three OTs on staff. They all do child passenger safety. They manage safety seats for kids with special needs. For example, if they have a hip spica cast and cannot flex their hip, they cannot sit in a car seat. There are special seats that have a seat cut out so the hip can stay extended. You only need that until the hip heals so they have a lending library of specialty seats as they are quite expensive and you only need them for six or eight weeks. I would really encourage people to go do that training. It is some of the cheapest special ed you can get. I work in home care and community re-entry is a priority for a lot of clients. I know of one rehab facility in my city that offers the assessment and training for $250, that is pretty affordable.
5. Most folks will not pay out of pocket. This is a very loaded question. Medicare does not believe driving is medically necessary so they do not pay for driving, even if you code it as community re-entry. Therefore most private insurance and Medicaid will follow what Medicare does. It is largely out of pocket. People do pay for it because it is that important. This is something important to think about as you kids get towards driving age. You can transition them to voc rehab to get them working and be productive members of the community. If you can get driving rehab, they technically have an IEP. It is not always called an IEP, but they have essentially an IEP as part of their voc rehab. If you can get driving and community mobility as one of the goals on their voc rehab IEP, then voc rehab will pay for those services. Typically a driving eval is in the range of $300-$500 for an eval, and at least $100-$150 an hour for interventions. It is all paid for out of pocket. Voc rehab and workman's comp are good sources, but I would say particularly with your kids who are 21 and transitioning, getting them into voc rehab and having driving as one of the goals is your best bet.
6. One of the things you want to think about are projectiles. Anything, that is not strapped down, can be a projectile in the event of a crash. Any of the toys that you have hanging to occupy a kid, as long as they are secured, are okay. If you are looking at those window shades, it is best to have the cling on, so there is nothing to fall off and hit the child. This includes other things like coffee cups, purses, and cell phones that all can become a projectiles in the event of a crash.
7. It depends on the age, even if they have mastered the riding skills. They need to have good enough judgment. Additionally the Federal Government says that if they are under 10, they should not be in the street, they should be on the sidewalk. You really still need to check to make sure what your jurisdiction says is permissible in your state, your country, or whatever.
