uir.ulster.ac.ukuir.ulster.ac.uk/34587/1/EPIOC BJOT FINAL Manuscript.d… · Web viewFinal Word...

Final Word version accepted for publication by British Journal of Occupational Therapy

TITLE

Electrically Powered Indoor/Outdoor Chair performance for children aged seven to nine

years.

ABSTRACT

Introduction: Northern Ireland Wheelchair Guidelines state that wheelchair users who

wish to drive their National Health Service (NHS) provided powered wheelchairs

outdoors must complete an electrically powered indoor/outdoor chair (EPIOC) test.

Within the same guidelines children in Northern Ireland (NI) under the age of ten are not

permitted to complete this assessment. Research was completed to evaluate how

children under ten years would perform in EPIOC training and testing under adult

supervision.

Method: A case-study design was utilised with three children aged seven to nine years

to evaluate if: these children can complete EPIOC training/testing safely with adult

supervision; length of time using an electric powered indoor chair (EPIC) correlates with

performance on EPIOC training/testing; the current NI guidelines on age restriction

should be re-evaluated so that each child is assessed on an individual basis rather than

age.

Findings: Paediatric powered wheelchair users aged seven to nine years can become

competent EPIOC users with adequate training and adult supervision. Length of time

(years) driving an EPIC may not correlate with improved EPIOC performance.

1


Conclusion: Regional NI criteria relating to EPIOC provision for children should be

revised in order to consider an individual needs assessment, rather than imposing an

age restriction.

[200 wds]

2


INTRODUCTION

Within Northern Ireland (NI), when a service user is being prescribed a powered

wheelchair clinicians are required to follow the regional wheelchair guidelines for NI

(2012). These Guidelines, which are not imposed elsewhere within the United Kingdom

(UK), have criteria which dictate both the lower age for whom an outdoor powered

wheelchair can be provided as well as the speed at which the powered wheelchair can

be driven. When the service user is provided with their first National Health Service

(NHS) powered wheelchair, it has a maximum speed of two miles-per-hour and can only

be used indoors. If the service user wishes to drive their wheelchair outdoors they then

undertake an assessment called the Electrical Powered Indoor/Outdoor Chair (EPIOC)

test. Once successfully completed they are permitted to use their NHS powered

wheelchair outdoors as well as indoors with an increased upper speed limit available of

four miles-per-hour, reflecting typical walking speed (Mohler et al. 2007). Further these

Guidelines only permit service users who are ten years of age or over to complete this

test. This imposed age criterion has no evidence supporting its foundation, and appears

to have been introduced to correlate with the age that children in NI complete their

cycling proficiency training within schools and are deemed to have acquired some level

of road safety. These criteria, unique to NI with no similar criterion presently being used

elsewhere in the World, were initially put in place as a means of reducing potential road

safety risk for the child and their caregiver.

3

Author, 03/01/-1,

This whole paragraph rewritten


Rationale

Subsequently, due to the current age restriction on driving speed, application of the

Guideline imposes several limitations on both the child under ten years, and their

family/caregiver. Specifically, where the child is reliant on a powered wheelchair for

mobility, then they are unable to independently join the family in everyday outdoor

activities, such as shopping and visiting other relatives. Furthermore, they may be

unable to partake in outdoor games and social activities with their friends, or simply to

go ‘for a walk’ up their street or to visit a neighbour.

Literature Review

Provision of powered mobility for children with mobility limitations has several benefits

including improvement in general development, (Ragonesi and Cole, 2012; Lynch et al.,

2009; Galloway et al., 2008; and Jones et al., 2003); psychosocial skills and inclusion,

participation, independence and function, (Guerette et al., 2013; Evans et al., 2007;

Tefft et al., 2011; Jones et al., 2012; Rodby-Bousquet and Hagglund, 2010).

Additionally, it can afford these children with a greater ability to socialise with their peers

and their family (Evans et al., 2007).

Tefft et al. (2011) evaluated powered wheelchair provision for twenty-three children,

aged between eighteen and seventy-two months. They found that powered wheelchair

provision can improve independence and social intervention for young children, and had

an overall positive impact upon the family, reducing the impact of caregiver stress.

Indeed, there is evidence to suggest that children with restricted mobility may have

4


passive, dependent behaviour and this can have long lasting consequences (Jones et

al., 2012). These children have been found to often fall behind in other developmental

areas because they cannot independently explore and act on their environment (Jones

et al., 2003). Further these children are at risk of participation in fewer activities (Bult et

al., 2011), and their mobility limitations are often key barriers to their participation in

everyday activities (Shikako-Thomas et al., 2008).

In the USA there are no age restrictions on children’s usage of powered wheelchairs for

outdoor mobility, with early intervention for those aged 0-3 years being federally

mandated. Each state has its own mechanism for service delivery and funding which is

similar to Canada where each province has its own fiscal criteria (Paleg et al., 2015),

and variations in provision are consequently evident within the USA. Conversely, in

Sweden there are no financial restrictions for the provision of powered wheelchairs,

however, powered wheelchairs are not routinely provided to children. Further, Rodby-

Bousquet and Hägglund (2010) reported that no child with cerebral palsy with mobility

impairments and under the age of four had independent wheeled mobility outdoors. This

may have been a result of the reluctance of parents to accept powered mobility (Rodby-

Bousquet and Hägglund, 2010), or the resistance of the therapist to prescribe to young

children (Wiart and Darrah, 2002). Moreover, in some countries children are only

afforded the opportunity to access powered mobility once they have acquired skills that

demonstrate a readiness to drive, however, as Hardy (2004) points out, these skills

often can only be attained through having opportunities to experience mobility.

Although the affirmative impact of early powered mobility on overall development is

5


recognised (Paleg et al., 2015) there continues to be variations worldwide in both

accessing and providing powered wheelchairs for young children. In N.I, children can

currently access wheelchair services from three years, with manual wheelchair

provision generally still being the first option considered, and powered wheelchairs

given to these children for indoor only use. However, similar to the rest of the UK,

should the parents wish, it is possible to obtain a powered wheelchair for indoors and

outdoors use through self-funding or through charitable organisations.

In 1991, the UK Government ratified the treaty of the United Nations Convention of the

Rights of the Child. This gives all children and young people comprehensive rights on

all matters that affect them, including the right to leisure and play, to be safe, and to rest

(Stancliffe, 2003). Within the treaty, disabled children are given additional rights to

ensure that they have special care and support so that they can lead full and

independent lives without discrimination. These rights are further enhanced through the

Disability Discrimination Act (1995); the Human Rights Act (1998); and the Special

Education Needs and Disability Act (1998, 2001). The first referring specifically to the

supply of goods and services, and includes provision of children’s equipment to promote

independence. Together the UK’s adoption of these legislative acts and policies means

that the UK is committed to the provision of services and equipment for all children in

the UK, including those with mobility challenges.

The introduction of the World Health Organisation’s (WHO) International Classification

of Function, Disability and Health – Child and Youth version (ICF-CY) (WHO, 2004)

6


identifies three levels of human functioning: (1) health condition; (2) body structure and

functions (BSF), activities and participation; and (3) environmental and personal factors.

Within this model, body structure and function (BSF) and limited independent mobility

(activity) and participation are described as the major components of health and are

influenced by environmental and personal factors (Casey et al., 2013). Children with

gross motor impairment (BSF) and limited independent mobility (activity) may have

participation restrictions unless an appropriate mobility device (environmental

intervention) is provided. Mobility devices, whether powered or manual, can provide

children with limited mobility with a means of self-initiated mobility allowing them to

independently explore their environment (Fernandes, 2006), provide them with a sense

of autonomy, the opportunity to participate in a range of activities and to pursue the

interests of their choice (Frank and De Souza, 2013).

At present children who live in Northern Ireland who have been provided with a NHS

powered wheelchair must be ten years of age before they are eligible to drive their

powered wheelchair outdoors. This criterion, which does not appear to have an

evidence base, essentially compounds young children’s limitation in accessing their

environment, as well as participation in everyday life with family and friends. Despite a

growing body of research on powered mobility exploring wheelchair training

programmes, readiness to drive or the type of powered mobility, there is a paucity of

work on whether very young children can safely drive their powered wheelchairs

outdoors. Therefore, this study was completed to evaluate how children aged four to

7


nine years who are already indoor powered wheelchair users, would perform in EPIOC

training and testing.

Aims and Objectives

The aim of this study was to evaluate the readiness of children (aged between four and

nine years), who already use a NHS powered indoor wheelchair to drive an EPIOC

under supervision of an adult caregiver.

The objectives were to explore:

If children between the ages of four and nine years can safely complete EPIOC

training/testing with adult supervision;

If exposure (time in years) to having an EPIC correlates with performance on

EPIOC training/testing;

If the Guideline should be reviewed so that each child is evaluated on an

individual basis, rather than age in regards to accessing EPIOC training/testing.

Methodology

This study used case study design. A review of existing records showed small numbers

of children in NI using powered wheelchairs. With small numbers of young children

using powered mobility case study methodology can facilitate exploration and in-depth

understanding (Crowe et al. 2011; Yin 2009) of the child’s ability to drive a powered

wheelchair outdoors, and offer the potential of analytic generalisations to be made (Yin

2009). Previous studies relating to children’s powered wheelchair have also used low

sample sizes (Lynch et al., 2009; Jones et al., 2003). Research Governance was

8


obtained from the Belfast Health and Social Care Trust Research and Development

office. Ethical approval was obtained from Ulster University and nationally from the

Office for Research Ethics Committees Northern Ireland (REC14/NI/0055). Consent

was obtained from the parent, and assent was obtained from each child. Anonymity and

confidentiality of all participants was assured throughout all phases of this study.

Sample

All children who lived in NI who had been provided with a NHS powered wheelchair,

and who were aged between four and nine years, were invited to participate in the

study. Potential participants were identified by an administrator at the Regional

Disablement Services (RDS) with access to this regional data. This administrator was

not involved in the study therefore limiting the threat of selection bias. A total of twenty-

one children were identified as being potentially eligible to participate in the study. Due

to this low number a power analysis to determine sample size was not completed. It

was anticipated that recruitment for this study would be low in line with other studies

exploring the relationship between children and powered mobility which had sample

sizes ranging from one to ten, (Ragonesi and Cole, 2012; Lynch et al., 2009; Galloway

et al., 2008; Jones et al., 2003).

The first author provided the RDS administrator with an information pack, permission

slip, copy of the EPIOC route map and the EPIOC points system to post to each of the

parents of potential participants. If the parent agreed for their child to participate in the

study they signed and returned the permission slip in the stamped-addressed-envelope.

9


They were then contacted by telephone by the first author to discuss the study further

and determine if their child met the inclusion criteria.

Inclusion Criteria

Eligible child wheelchair users had to have an NHS provided powered indoor wheelchair

for at least six months; be aged four to nine years; be able to travel to the EPIOC

test/training site with their parent; and both child and parent able to understand and

speak the English language. Parents gave informed written consent and the child gave

their assent by writing their name or ticking the relevant box on the consent form.

Exclusion Criteria:

Children were excluded if they had a medical/educational diagnosis of a severe learning

disability or cognitive disability; had any problems with eyesight (that could not be

corrected with glasses); any hearing impairment (that could not be corrected with a

hearing aid; or had a diagnosis of uncontrolled epilepsy (had to be seizure free for one

year before commencement of the study).

Participants

A total of fourteen parents returned the permission slips. Of these nine did not meet the

inclusion criteria; two children had not yet received their wheelchairs; for another the

parents were non-English speaking; and the other six children had a diagnosis of

severe learning disability.

10

Author, 03/01/-1,

Rewritten in prose

Author, 03/01/-1,

Rewritten in prose


A total of five children were eligible to participate, however due to medical reasons two

of these children withdrew before commencement of the study. The total study sample

was three children (two boys and one girl) aged seven to nine years, with diagnoses of

cerebral palsy with spastic quadriplegia (n=2) and Duchenne Muscular Dystrophy (n=1).

All three children were aged seven to nine years.

Data Collection

All training/testing was completed in the Belfast Trust on the grounds of a large regional

hospital site, the workplace of the first author. Participants were provided with two

appointments, both with their parent present; one for EPIOC training completed by the

first author; then a second appointment two weeks later to complete the EPIOC

assessment as per the current NI EPIOC assessment protocol for those aged ten and

above. In order to minimise the risk of assessor bias and potential issues with inter-rater

reliability the EPIOC assessment was completed by this second occupational therapist,

also an accredited EPIOC trainer/tester. Further, all interventions were completed using

the standardised Belfast Health and Social Care Trust route thereby reducing the threat

of measurement bias.

To date, there is no standardised outcome measure available relating to child or adult

performance in EPIOC use. Performance on EPIOC training and assessment was

captured using the EPIOC score sheet developed by Trust staff. The EPIOC is a

pass/fail test scored out of 500 points and contains twenty-five categories based on

obstacles and manoeuvres the powered wheelchair user must face along the training

11


and test route. Each category has a risk factor of low, medium or high. An optimal

score is zero, however if participants accrue 120 points they fail the assessment and

are not eligible to progress on to complete the EPIOC test as further training would be

required. It is used to determine an individual’s ability to safely and competently drive

their powered wheelchair outdoors. Additionally, parent comments regarding their

child’s performance during training/testing were recorded; along with any verbal

prompts to manage the child’s safety during driving were noted.

EPIOC Training

The participants attended the Belfast site to complete EPIOC training using their own

powered wheelchair thereby ensuring user familiarity with the wheelchair functionality

and settings. The original speed settings of the participant’s powered wheelchair were

noted and then re-programmed to a maximum speed of four miles-per-hour. EPIOC

training was then completed along the pre-determined EPIOC route, through hospital

buildings, along an outdoor footpath and crossing several traffic junctions within the

hospital grounds. An average EPIOC training session takes one to one-and-a-half

hours and once training was completed, the participant’s wheelchair speed was

returned to its original setting.

EPIOC Test

The child returned with their parent two weeks after the EPIOC training for the EPIOC

test, which lasted approximately one hour. The second assessor, blinded to their

training performance, completed the EPIOC assessment. The two week period enabled

12


determination of whether the participant had retained information from the training

session.

FINDINGS

Child number one (child #1) was male, eight years and nine months old and had a

diagnosis of cerebral palsy with spastic quadriplegia. His parents reported that he had

not achieved functional mobility prior to wheelchair use. He was issued with a NHS

powered wheelchair when he was four years of age and had been using the powered

wheelchair for independent indoor mobility for four years at the time of the study. He

used his powered wheelchair for all indoor mobility at home and at school. He was

issued with a manual wheelchair for outdoor mobility, however, he did not have

adequate upper limb function to self-propel this wheelchair, which meant that he was

reliant on others for all of his outdoor mobility.

Child #1 accrued a total of 40 points out of a potential 500 in the EPIOC training,

gaining points in not stopping and looking before crossing the road. This was because a

car driver waved him forwards, although he stopped immediately when verbally

prompted and was able to return to a safe position. Throughout the training the child

displayed an acute sense of road safety awareness and of the ‘Green Cross Code’, a

UK pedestrian road safety awareness campaign (RoSPA 2005) integrated into primary

school curriculum to promote the safety of children when using footpaths and roads in

the community. He was able to adjust the speed of his wheelchair appropriately,

13


especially reducing speed when traversing through hospital corridors. He demonstrated

an awareness of traffic and an ability to judge when it was safe to cross roads. During

completion of his EPIOC test two weeks later he accrued zero points. He had retained

all of the instructions and advice provided during the EPIOC training, passing the

EPIOC test successfully under adult supervision and with no errors.

Child number two (child #2) was aged nine years and seven months and had a

diagnosis of Duchenne Muscular Dystrophy. He walked independently until he was six

years of age and had received a NHS powered wheelchair two years prior to the

commencement of the study. His parent commented that prior to his diagnosis he was

‘climbing trees and riding a bike’ outside with friends and receiving his powered

wheelchair for mobility he has become restricted to indoor play. Child #2 did not

accrue any points out of the potential 500 during the EPIOC training and throughout the

training he too displayed an acute sense of road safety awareness and of the ‘Green

Cross Code’. He was able to adjust the speed of his wheelchair appropriately, again

reducing speed when driving along hospital wards. Similarly to child #1, he

demonstrated both an awareness of traffic around him and an ability to judge when it

was safe to cross roads. During his EPIOC test he accrued 40 points attempting to

cross the road when waved forward by a car driver. Despite this error he passed the

EPIOC assessment successfully with adult supervision. Additionally, his parent

commented that since child #2 had become wheelchair bound, being restricted to indoor

only use, he had lost friends as he was no longer able to play outdoors, and

furthermore, he showed a marked decrease in confidence.

14


The third child (child #3) was female, aged seven years and nine months. She had a

diagnosis of cerebral palsy with spastic quadriplegia and her parents reported that she

had not achieved functional mobility prior to wheelchair use. She was issued with a

NHS powered wheelchair when she was four years of age and had been using her

powered wheelchair for independent indoor mobility for three years. She used her

powered wheelchair for all indoor mobility at home and at school. She was issued with

a manual powered wheelchair for outdoor mobility, however, this child, similar to the first

did not have sufficient strength or upper limb function to self-propel her wheelchair and

so was dependent on others for outdoor mobility.

Child #3 accrued a total of 70 points out of 500 in her EPIOC training, gaining points

when travelling on the left hand side of the road to the pedestrian crossing when she

was veering too close to the kerb. She had to be prompted twice to move slightly out

from the kerb to avoid any concealed potholes/manhole covers. She also gained points

when travelling to the opposite end of the footpath, being prompted on three occasions

to increase her speed to cross the road safely. Additionally, she accrued points when

she followed a driver’s instructions waving her to cross the road. She did stop

immediately when verbally prompted and returned to a safe position. Throughout the

training she required verbal prompts to drive at an increased speed when crossing the

road. Alike the other children, she displayed a working knowledge of the Green Cross

Code and used this when deciding to cross the road.

15


In her EPIOC testing child #3 accrued 100 points. She had not retained all of the

instructions or advice provided during the EPIOC training. She, like the other two

children, required verbal prompting during the test when crossing the road and on one

occasion attempted to cross the road without looking, a potential fatal error. However,

when prompted to complete it again she performed this task successfully. This serves to

highlight the importance of having adult supervision for outdoor child powered mobility.

Towards the end of her test the participant was fatigued and her concentration was

lapsing. She completed the route safely with verbal prompting from her mother, and

despite accruing 100 points she did pass the EPIOC test.

DISCUSSION

This study sought to evaluate if children between the ages of four and nine can safely

complete EPIOC training/testing with adult supervision; if exposure (time in years) to

having an EPIC correlates with performance on EPIOC performance; and if the current

Guideline with age restriction should be amended so that each child can be evaluated

on an individual basis with regards to EPIOC training/testing.

The findings of this study suggest that with appropriate training children aged seven to

nine can become competent EPIOC drivers, however, as illustrated, this does not

remove the need for adult supervision. This adult supervision was important for the

children, as each child required verbal prompting on at least one occasion to maintain

16


their safety whilst driving their powered wheelchair outdoors. Interestingly in the Jones

et al. (2012) study parents were also required to provide supervision to assist with

safety when using powered mobility, which was appropriate to the child’s age. All three

participants in this study demonstrated a readiness, willingness and intrinsic motivation

to drive outdoors. Their parents also demonstrated the enthusiasm to supervise their

children and ensure their safety throughout the EPIOC training and testing.

All the children passed the EPIOC test and demonstrated an ability to drive their

powered wheelchair outdoors. Interestingly the error that all three children made was

that of crossing the road after being waved across by a waiting car driver. This is

deemed to be a high risk as the wheelchair user has no indication or awareness as to

other oncoming traffic. Once this error was pointed out the children were all able to

return safely to the starting footpath. Subsequently, they required adult supervision

when using the EPIOC to fully ensure their safety. This is no different from that typically

expected for any other child of commensurate age and development who are equally

acquiring road safety awareness skills.

It was hypothesised that time in years using an EPIC would have a positive correlation

with EPIOC performance with the possibility of transferable skills for outdoor driving.

However, in our small study this factor had variable impact. Child #1 had the most

experience of driving an EPIC with four years of experience and did perform better

overall. Child #2 had the least experience with two years driving, and child #3 had three

years but the latter more experienced indoor driver scored more poorly than child #2,

17


who had also been the only child to have previously walked independently. Therefore,

this suggests that there may not be an immediate transfer or acquisition of skills

between indoor and outdoor training, and that young children should be afforded both

the opportunity of exposure and practise using powered mobility with adult supervision

(Ragonesi and Cole, 2012).

The recently published international Best Practice Guidelines: Early Powered Mobility

with Children (Livingstone and Paleg, 2014) explains that children who have already

experienced independent mobility at a young age should use powered mobility in order

to maintain participation in family, school, and community life. Current NI Regional

Wheelchair Guidelines that impose an age restriction on outdoor powered mobility for

children is in contrast with these best practice guidelines. Evans et al. (2007) confirmed

the positive impact that outdoor powered wheelchair provision had on the independence

and participation for children aged 10 to 18 years. In their study many of the eighteen

children interviewed reported positive functioning following EPIOC use, including

increased independence and participation in social activities such as wheelchair

football.

Further, Scherer (1998a) in her study assessing parents’ perceptions of social

interactions with family and friends found a significant increase from pre-test to post-test

in parents’ satisfaction with their child’s ability to go where desired (p < .05) as a result

of using their powered mobility. Additionally, when using the MATCH survey to assess

the degree to which parents experience negative emotional states such as being

18


discouraged, frustrated, or angry (Scherer, 1998b) significant increases were found

between the pre-tests and post-tests. Specifically, Scherer (1998b) found the parents’

satisfaction with the child’s social and play skills (p<0.05) and the parents’ belief that the

general public accepts their child (p<0.04). Additionally, parents believed the wheelchair

had a strong positive impact, rating the wheelchair an average of 4.6 (with 5 indicating a

“very positive impact”) in terms of improving the child’s quality of life. Therefore, these

findings illustrate the importance of enabling these children with mobility limitations the

opportunity to access powered mobility for outdoor use.

In our study, there was not a strong correlation between age and EPIOC performance.

All the children passed both the practice and the test for EPIOC use. Child #2, the

oldest child, scored 0 in the practice and 40 in the test, with child #1 obtaining the

reverse of these scores. The youngest child, child # 3, accrued the most points in her

EPIOC training and test. Throughout the intervention she required verbal prompting to

concentrate on the task and this served to illustrate the importance of having adult

supervision. This is further supported by the Best Practice Guidelines (Livingstone and

Paleg, 2014) whereby it is highlighted that children’s use of powered mobility should be

commensurate with age-appropriate and developmental expectations. For example,

children with cognitive or sensory limitations may need adult supervision or assistance

in the community (as they would if able to walk) but may learn to use a powered

wheelchair to meet their independent mobility needs (Durkin et al., 2014). This perhaps

raises the issue that those who are providing supervision to their children on the use of

powered wheelchairs should also be adequately trained on the supervision of the use of

19


powered wheelchairs for outdoor use. This training should include developing traffic

awareness, where and when to cross the road (Congiu et al. 2008), avoiding potholes,

and how best to prompt the child so that the child is learning rather than merely

following instructions.

Limitations

The small sample size of this study means the results should be interpreted cautiously.

As all of the intervention was completed in the Belfast Trust area it may have inhibited

recruitment of a larger sample, as some wheelchair users and their parents may not

have been willing to drive long distances to participate. However, the findings of this

study will still be relevant to both a Northern Ireland agenda for children under ten years

who use powered mobility, and as encouragement elsewhere in the World for clinicians

and parents to afford young children opportunities to experience powered mobility. An

aim of this study was to evaluate EPIOC performance for children aged between four

and nine, however, the youngest participant was aged seven. Therefore, further

research evaluating the performance of younger children using multi-site trials to

increase participant numbers is recommended. Also, exploration of how powered

mobility can be used to enable young children to fully participate in daily activities

should be considered (Casey et al. in press) to contribute to the limited evidence base

on the effectiveness of powered mobility as an intervention.

CONCLUSIONS

20


The recruitment process highlighted that out of potentially twenty-one paediatric

powered wheelchair users (EPIC) in NI fourteen, i.e. 66% were interested in completing

a study to evaluate EPIOC performance in school aged children. This would suggest

that children and their parents view outdoor mobility as an important issue. It is vital

therefore that all children are given the chance to practise and experience driving

outdoors in order to acquire the skills to safely and competently drive a powered

wheelchair. This opportunity to participate can not and should not be based solely upon

an age criterion, which can only serve to restrict their occupational rights. Ultimately

children deserve to have their needs and occupations assessed like any other individual

and to have access to appropriate powered mobility.

[4,672 wds]

21


KEY FINDINGS

EPIC users aged seven to nine years can become competent EPIOC users with adequate

training and adult supervision.

Length of time (in years) driving an EPIC may not correlate with improved EPIOC

performance.

Criteria relating to EPIOC provision based upon age only should be reviewed.

WHAT THE STUDY HAS ADDED

Provision of children’s powered mobility for outdoor use should be considered on an

individual basis, and not be age-restricted.

ACKNOWLEDGEMENTS

The authors acknowledge the assistance given by XX who acted as a blind assessor in

this study; YY who acted as the local collaborator for the Belfast Health & Social Care

Trust; ZZ for her reviewing support; and importantly the children and their caregivers

who participated in this study.

22

Author, 03/01/-1,

Revised


REFERENCES

Bult M, Verschuren O, Jongmans M, et al. (2011) What influences participation in

leisure activities of children and youth with physical disabilities? A systematic review.

Research in Developmental Disabilities 32(5): 1521-1529.

Casey J, McKeown L, McDonald R and Martin S (in press) Wheelchairs for children under

12 with physical impairments. Cochrane Review. Cochrane Collaboration: UK.

Casey J, Paleg G and Livingstone R (2013) Facilitating child participation through power

mobility. British Journal of Occupational Therapy 76(3): 158-160.

Congiu M, Whelan M, Oxley J, Charlton J, D’Elia A and Muir C (2008) Child

pedestrians: factors associated with ability to cross roads safely and development of a

training package. Monash University Accident Research Centre. Report No. 283.

Monash Univeristy: Australia.

Department of Health (2001) The Special Needs and Disability Act. London: The

Stationary Office.

Department of Health (1998) The Human Rights Act. London: The Stationary Office.

Department of Health (1995) The Disability Discrimination Act. The Stationary Office

London.

23


Health, Social Services and Public Safety (2012) Regional eligibility criteria for the

provision of wheelchairs through the Northern Irish wheelchair service. A guide for

wheelchair users.

Evans S, Neophytou C, De Souza L, et al. (2007) Young people's experiences using

electric powered indoor-outdoor wheelchairs (EPIOCs): Potential for enhancing users'

development? Disability & Rehabilitation 29(16): 1281-1294.

Fernandes T (2006) Independent mobility for children with disabilities. International

Journal of Therapy and Rehabilitation 13(7): 329-333.

Frank AO, Neophytou C, Frank J, et al. (2010) Electric powered indoor/outdoor

wheelchairs (EPIOCs): user views of influence on family, friends and carers. Disability

and Rehabilitation: Assistive Technology 5, 327-338.

Frank AO and De Souza LH (2013) Recipients of electric-powered indoor/outdoor

wheelchair provided by a national health service: a cross sectional study. Archives of

Physical Medicine and Rehabilitation 94, 2403-2409.

Galloway JCC, Ryu J and Agrawal SK (2008) Babies driving robots: self-generated

mobility in very young infants. Intelligent Service Robotics 1(2): 123-134.

24


Guerette P, Furumasu J and Tefft D (2013) The positive effects of early powered

mobility on children's psychosocial and play skills. Assistive Technology 25(1): 39-48.

Hardy P (2004) Powered wheelchair mobility: an occupational performance evaluation

perspective. Australian Occupational Therapy Journal 51(1), 34-42.

Jones MA, McEwen IR and Hansen L (2003) Use of power mobility for a young child

with spinal muscular atrophy. Physical Therapy 83(3): 253-262.

Jones MA, McEwen IR and Neas BR (2012) Effects of power wheelchairs on the

development and function of young children with severe motor impairments. Pediatric

Physical Therapy 24(2): 131.

Livingstone R and Paleg G (2014) Practice considerations for the introduction and use

of power mobility for children. Developmental Medicine & Child Neurology 56(3): 210-

221.

Lynch A, Ryu JC, Agrawal S and Galloway JC (2009) Power mobility training for a 7-

month-old infant with spina bifida. Pediatric physical therapy: the official publication of

the Section on Pediatrics of the American Physical Therapy Association 21(4): 362-368.

McCrum-Gardner E (2008) Which is the correct statistical test to use? British Journal of

Oral and Maxillofacial Surgery 46(1): 38-41.

25


Mohler BJ, Thompson WB, Creem-Regehr SH, Pick HL and Warren WH (2007)

Visual flow influences gait transition speed and preferred walking speed.

Experimental Brain Research 181 (2): 221–228.

Paleg G, Livingstone R, Casey J and Rodby-Bousquet E (2015) Providing power and

mobility to toddlers around the world. Paper Proceedings of 31st International Seating

Symposium, 26th-28th February, Nashville, Tennessee, 97-98.

Ragonesi CB and Galloway JC (2012) Short-term, early intensive power mobility

training: case report of an infant at risk for cerebral palsy. Pediatric Physical Therapy:

the official publication of the Section on Pediatrics of the American Physical Therapy

Association 24(2): 141-148.

Rodby-Bousquet E and Hagglund G (2010) Use of manual and powered wheelchair in

children with cerebral palsy: a cross-sectional study. BMC Pediatrics, 10 59.

RoSPA. Royal Society for the Prevention of Accidents (2005) Available at:

www.rospa.com (accessed 24th November 2015).

Scherer MJ (1998a) The Matching Person & Technology (MPT) model manual. 3rd ed.

New York. The Institute for Matching Person & Technology: Webster.

26

http://www.rospa.com/


Scherer MJ (1998b) Matching Assistive Technology & Child (MATCH). A process and

series of assessments for selecting and evaluating technologies used by infants and

young children. New York: Institute for Matching Person & Technology: Webster.

Shikako-Thomas K, Majnemer A, Law M, et al. (2008) Determinants of participation in

leisure activities in children and youth with cerebral palsy: systematic review. Physical &

Occupational Therapy in Pediatrics 28(2): 155-169.

Tefft D, Guerette P and Furumasu J (2011) The impact of early powered mobility on

parental stress, negative emotions, and family social interactions. Physical &

Occupational Therapy in Pediatrics 31(1): 4-15.

Wiart L and Darragh J (2002) Changing philosophical perspectives on the management

of children with physical disabilities – their effect on the use of powered mobility.

Disability and Rehabilitation, 24 (9): 492-498.

World Health Organisation (2007) International classification of functioning disability and

health: Children and Youth Version. ICF-CY. Geneva.

World Health Organisation (2001) International classification of functioning disability and

health (ICF). 1st ed. Geneva.

27

uir.ulster.ac.ukuir.ulster.ac.uk/34587/1/EPIOC BJOT FINAL Manuscript.d… · Web viewFinal Word...

Documents

Transcript of uir.ulster.ac.ukuir.ulster.ac.uk/34587/1/EPIOC BJOT FINAL Manuscript.d… · Web viewFinal Word...