The Effects of Combining Modified ride-on Cars With Bimanual Training on Enhancing Mobility, Socialization, Motor Function and Participation in Toddlers With Disabilities

Spontaneous self-initiated actions have consequences, and experiencing these is very educational. Independent mobility is believed to be essential for perceptual-motor and social skill development. Self-produced locomotion is an organizer of psychological changes in children with typical development, especially developmental changes in perceptions, social understanding, spatial cognitive, and emotions. In addition, through active manual exploration, children can detect the object and individual's information that relates size, orientation, shape, substance to their perceptual and movement capabilities and interpersonal relationships. Children require exploratory behaviors to gather relevant information for a task. They can learn the relationship between the object-surface and movements through increased independent mobility and manual exploration. There is convincing evidence that the use of powered mobility for children with disabilities has positive impacts on their overall development and increases their exploration. Studies are focusing on reducing the limitations in the areas of social, cognitive, perceptual, and functional development that were induced by lack of independent mobility in early ages. Limited evidence also demonstrated that early powered mobility training had positive impacts on the family participation, including decreasing parents' level of stress and increasing their satisfaction with their child's sleep patterns, ability to move out, and ability to interact and socialize with the family.

Pediatric rehabilitation, through training and assertive technology (AT), seeks to provide children with disabilities with the same level of mobility, exploration, socialization and participation for children with typical development (TD). Proponents of powered vehicles for very young children present strong reasons for introducing powered mobility to children at a time in their developmental pattern that coincides as closely as possible to when they would have begun independent mobility as a child with TD. Research has suggested that there is no negative influence on motor development or self-care abilities. In addition, children with disabilities may be more motivated to participate in therapy and may demonstrate increased head, trunk and arm-hand control for exploration in the surrounding environment. However, up to date, the lack of rigorous studies and limited evidence of the increased independent mobility and early child development across all three International Classification of Functioning, Disability and Health (ICF) levels, still signify the needs of considering early power mobility as a feasible intervention in the clinical settings for very young children who have not yet achieved a means of independent mobility and are unlikely to achieve it.

There are many basic barriers to achieving this high standard and no single AT or combination of AT can currently provide the level of mobility and exploration that children, families and therapists desire. Currently, the most critical barrier to including power mobility in EI programs is the lack of readily available power chairs for children younger than 2-3 years of age, the period when mobility is rapidly developing for children with typical development. Certain characteristics of the most common commercial pediatric power wheelchairs limit their use in the home and community spaces such as playgrounds. These limitations include price (e.g., typically >$5000), size and weight (e.g., typically >150 lbs), transportation requirements (e.g., van or truck), maintenance and aesthetics and social acceptance. Experimental power mobility devices (PMD) have the potential to address some of these limitations such as size, weight and infant use. Unfortunately these are likely years from commercial availability. Moreover, power wheelchairs have historically been designed to address a limited set of goals related to mobility with minimal consideration of socialization. Investigators believe there is a need for readily available mobility options for immediate use by very young children and their families that address some of the above limitations while expanding the role of PMD past simply mobility and into socialization.

There are four strengths of using ride-on toy cars for mobility. First, the cost is comparable or less than most mobility devices. Second, most are relatively lightweight, small and easily transported in contrast to power chairs. Third, the child-friendly, colorful toy designs are more acceptable to adults and children and likely seen as simply a toy. This may be an important aspect for clinicians wanting to start early power mobility training with families hesitant to discuss powered chair options. Fourth, because toy cars are simple electromagnetically devices, they can be modified quickly and easily to match the child's current and/or future abilities and goals. The use of modified ride-on toy cars may provide a readily available, convenient and fun way for families, therapists and early educators to help young children improve their mobility starting within the first years of life.

From our initial pilot results, it indicated that this early powered mobility training through the use of modified toy cars might enhance cognition, language, mobility, and socialization in toddlers with mobility impairments. However, the fine and gross motor remained at a similar level before and after 9-week intervention. These initial findings suggest a number of important points: 1) early power mobility training may increase exploratory behaviors and benefit independent mobility, cognitive and social development; 2) the improvements of children's development and caregiver's involvement in the training may decrease family stress level and increase family participation; 3) simple early power mobility training may not be enough to improve motor function. Better postural control coupled with reaching and grasping ability allows infants to independently explore objects in new ways for sustained periods through mouthing and touching. The seat adjustments (e.g., a seat belt er, a hip strap) of ride-on toy cars may provide sufficient postural stability for the child with disabilities, however, the impaired reaching and grasping ability may decrease the opportunities of doing manual exploration for both hands. Most daily activities are functional tasks and may require two hands doing different actions. The development of increased functional independence requires use of both hands in cooperation. Gordon et al. had asked caregivers to identify goals for the intervention, and measured the progress using goal-attainment scale (GAS). Nearly 85% of the goals were bimanual. Principles of motor learning (practice specificity) suggest the most functional way to balance the cortical activity and improve bi-manual control would be to practice bi-manual activities directly.