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Powered mobility for young children

Last update: 12 Sep 2016

Powered mobility helps young children with difficulties mobilising to explore their environment
Powered mobility refers to power wheelchairs and other powered mobility devices such as modified toy cars

Who is it for?

Powered mobility may also be suitable for older children and adults, as well as young children, with cerebral palsy who have the following characteristics:
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS II, GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

See full glossary

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

See full glossary

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

See full glossary

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

See full glossary

Occupational therapists and physiotherapists can help parents and carers choose the best powered mobility device for their child.

Cerebral Palsy Alliance offers a service to all children and adults who wish to consider using powered mobility.

Find a Cerebral Palsy Alliance service

Fees will apply for therapists to provide assessment, prescription and support to learn to use powered mobility, and will depend on the provider and the number of sessions needed. Check with the provider whether fees will also apply for development of a home program, report writing or therapist travel.

Powered mobility equipment ranges in price depending on whether a modified toy car or a powered wheelchair is the appropriate choice. Powered wheelchairs range in price from AUD8,000 to AUD40,000, depending on the complexity of the equipment. Funding for the equipment may be available and this involves completing an application for funding.

Ask the therapists if you are eligible for funding to assist with fees and powered mobility equipment costs. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

Adequate time is required to try out potential devices to find the right one.

The time it takes a child to learn to control a modified toy car or powered wheelchair will depend on their skills, limitations, support network and the time they have to practice.

More about powered mobility

Powered mobility devices include wheelchairs and other motorised mobility toys that run on batteries. Very young children with physical disabilities can use powered mobility devices to move independently, explore their environment and interact with others. It is possible for children as young as 8 months to have the opportunity to explore power mobility1. Typically, a child will use a controller attached to an armrest, tray, footrest or headrest to operate their device, allowing them to move around at home, preschool and in the community.

One in three children with cerebral palsy is unable to walk or move around by themselves2. Wheelchairs and other powered mobility toys can give these children the opportunity to explore their environment, and participate in social and educational activities. Research confirms young children who use powered mobility are more capable of independent movement – allowing them to have experiences that are part of typical development, they would not otherwise have1,3,4. It helps them develop cognitive skills3,5, confidence, communication, social skills and the ability to handle objects5. Importantly, this means they also need less caregiver assistance with mobility and self-care3.

Equipment

  • Controllers are available to cater for children with a wide variety of physical abilities. Many children use a joystick attached to an armrest or tray to control their devices. Children who have difficulty using their hands may use a control called a switch, which is positioned to capture available body movements. For example, switches can be operated by chin, hand, foot, elbow and head movements.
  • Powered mobility devices are usually programmed to go very slowly while young children are learning to use the device.
  • Some children may need special seating, supports and straps to hold their body and head in a well-supported and comfortable position.
  • If required, communication and environmental control systems can be used with powered mobility devices. These could include speech generating devices or the ability to switch on the television or air conditioning.

Modifications

The environment around a child is vital for successful use of powered mobility devices4. Alterations may be required to prepare indoor and outdoor environments at home and preschool for the mobility device. Common issues include having adequate space to turn around in, as well as ramps, wide enough doorways, and bathrooms that are accessible. In addition, the height of benches and storage areas may be altered so that a child can sit at a table or reach clothes and toys in his or her bedroom. A secure place to store and charge the battery of the device is also required.

Transport

Powered wheelchairs are large and heavy and cannot be lifted into a car. A suitable vehicle may be needed to transport the device.

Support

The child will need a network of people committed to help them master their powered mobility device and to safely explore a range of environments. Each child will need an individualised program to support them to build their skills in using the device.

Things to note

  • The level of independence a child achieves using powered mobility will vary according to several factors including the child’s motivation, intellectual ability, physical environment and amount of support available.
  • Young children with moderate and severe intellectual disability may experience benefits from exploring their environment using powered mobility. Specific goals for these children can be discussed with the child’s therapy team. Goals might include experiencing independent movement, building switching skills and providing opportunities for social interaction.
  • The decision to use powered mobility involves understanding the needs, expectations and preferences of the child with cerebral palsy and their family, and the cost, time and resources required.
  • Powered mobility is also known as motorised wheelchairs, electric wheelchairs, power drive wheelchairs and power wheelchairs, and the toys are also known as motorised cars or modified toy cars.

Assessments

There are two types of assessment a child will require as part of using powered mobility.

An occupational therapist or physiotherapist will complete a thorough assessment to better understand the child’s motor, visual, cognitive and perceptual abilities; sensory status and postural needs; as well as their environment and support network. This is to ensure that the recommended powered mobility device is suitable for the child and their home, preschool, community and playground environments. The assessment is undertaken in collaboration with the child and family, early intervention service, preschool, medical team, and therapy team.

The purpose of using an outcome measure is to determine whether this intervention achieves the child’s goals. The occupational therapist or physiotherapist, together with the child and family, will determine the most suitable measure to use. Typical outcome measures for this intervention include:

  • Individually Prioritised Problem Assessment (IPPA) – measures whether a device solves the problems a person is experiencing
  • Goal Attainment Scaling (GAS) – measures the extent to which a person’s goals are achieved
  • Assessment of Learning Powered mobility use (ALP) - assesses where the child/adult is up to in the process of learning to use powered mobility and provides ideas to help them develop new skills as they progress6

Best available research evidence

We searched the medical, psychological, allied health and educational literature to find studies evaluating the outcomes of powered mobility for children under three years of age with physical disabilities.
The search aimed to find the best available evidence about whether powered mobility improves children’s ability to move around in their environment, communicate and build other developmental skills.

One good quality randomised controlled trial3 (RCT) and one case study7 published since this trial comprised the best available evidence to make decisions about powered mobility for young children with physical disability. The RCT included young children with severe motor impairment aged 14 months to 30 months. The study evaluated the mobility and developmental skills of a group of children who used powered wheelchairs for 12 months, compared with a group of children who did not use powered wheelchairs. The children who used the wheelchairs had better mobility and a greater ability to understand what other people were saying to them (receptive communication). Children who used powered mobility also needed less caregiver assistance with mobility and self-care.

The case study7 evaluated the use of a modified toy car with a 21-month old boy with spastic quadriplegic cerebral palsy. His mobility improved, as did the frequency of positive facial expressions, vocalisations and spontaneous family interaction. The study concluded that modified toy cars could be a feasible, cheaper possibility for very young children with cerebral palsy.

Overall, evidence supports the use of powered mobility for young children with physical disabilities. In addition to the studies reported here, many low level and qualitative studies have also suggested a positive impact of powered mobility on a range of outcomes1,8. The quality of evidence is classified as low because only one RCT (and studies at lower levels) has examined the effect of powered mobility. The reasons for so little high level research may be due to the ethical concerns of withholding powered mobility from children with significant disability, the costs associated with providing powered mobility, and the difficulties finding a large enough group of young children of similar age, diagnosis, and level of physical disability.

Research evidence is just one piece of information used to make a decision about whether powered mobility for young children with cerebral palsy is the right choice. The decision will also be based on the individual abilities, needs and preferences of the child and their family. Families are encouraged to speak to an occupational therapist or physiotherapist if they are interested in discussing powered mobility.

Date of literature searches: July 2016

  1. Livingstone, R. and Paleg, G. (2014). Practice considerations for the introduction and use of power mobility for children. Developmental Medicine & Child Neurology, Vol 56(3), March, pp.210-221 See abstract
  2. Novak, I. (2014). Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology. 29(8), 1141-1156.
  3. Jones, M. A., McEwen, I. R., & Neas, B. R. (2012). Effects of power wheelchairs on the development and function of young children with severe motor impairments. Pediatric Physical Therapy, 24(2), 131-140. doi: 10.1097/PEP.0b013e31824c5fdc Click on the link to pdf.
  4. 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.
  5. Nilsson, L., Eklund, M., Nyberg, P., & Thulesius, H. (2011). Driving to Learn in a powered wheelchair: Identification of the process of growing consciousness of joystick-use in people with cognitive disabilities. The American Journal of Occupational Therapy, 65(6), 652-660. See abstract
  6. Nilsson, L., & Durkin, J. (2014). Assessment of learning powered mobility use–applying grounded theory to occupational performance. Journal of Rehabilitation Research and Development, 51(6), 963-974. doi:10.1682/JRRD.2013.11.0237.
  7. Huang, H. H., Ragonesi, C. B., Stoner, T., Peffley, T., & Galloway, J. C. (2014). Modified toy cars for mobility and socialization: Case report of a child with cerebral palsy. Pediatric physical therapy, 26(1), 76-84. Click on the link to pdf
  8. Livingstone, R., & Field, D. (2014). Systematic review of power mobility outcomes for infants, children and adolescents with mobility limitations. Clinical Rehabilitation, published online 24 April 2014. DOI: 10.1177/0269215514531262. See abstract
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.