Mobility. What does that mean? Getting from point A to point B to perform a task of some type. Mobility is not exercise. Adults are very goal-oriented in their mobility. For infants and children, self-initiated mobility is Mobility. What does that mean? Getting from point A to point B to perform a task of some type. Mobility is not exercise. Adults are very goal-oriented in their mobility. For infants and children, self-initiated mobility is the way they learn — it allows development of perceptual motor skills, social skills, and cognitive skills. Children with mobility limitations need the same type of experiences; self-initiated, efficient mobility — to be able to participate in
what they need to do and why they choose to do it.
In the late 1970’s/early 80’s the first small research studies and papers about why early and efficient mobility was important to facilitate in children who were not going to be ambulatory, or who were inefficiently ambulatory, were introduced. Charlene Butler, an educator from Seattle, and Karin Paulsson, a psychologist at the Karolinska Institute in Stockholm, were among the first authors. The evidence was overwhelming, but it’s really just common sense. One needs to move in order to understand the environment and the relationship to it. How would you know how to navigate through a doorway to a sidewalk if you’ve never tried? How do you understand what is right and wrong, if you have never had the chance to do something wrong and then be corrected? How do you understand the give and take involved with others if you cannot interact easily with others?
Lisa Thornton, a pediatric physiatrist, gave a TedTalk in 2015 in which she spoke about children she had seen throughout her career. She referenced a study in which children with disabilities and typically developing children were questioned about how satisfied with life they were, and that they scored equally. However, one factor that did lead to dissatisfaction amongst the children with disabilities was a lack of autonomy in being able to participate in decisions and being able to do things for themselves.
There are still roadblocks to efficient mobility for children. These include a fear that they will “get lazy,” not develop, or have the desire to develop gross motor skills. A “wait and see” mentality can waste valuable developmental time. Consider the statement, “the tyranny of OR and the beauty of AND.” What does it mean? It means that the method should suit the activity — there is never one method for every activity we engage in. It’s acceptable to walk for some activities, and to use a wheeled device for others. We don’t wear dress shoes to run, it would be very uncomfortable, and we would not be able to complete our run. We tailor the method and equipment we use for getting from point A to point B based upon the activity, and the fact that once we reach our destination we would like to be able to have the energy to participate in the reason we went there in the first place.
Programs such as Go Baby Go, initiated by Cole Galloway at the University of Delaware after years of clinical investigation on very early mobility for children, have brought nationwide awareness to the importance of facilitating movement, in this case, through adapted ride on toys. Sam Logan from the Oregon State University continues to hold national Go Baby Go workshops that involve the child and family, their therapist and Assistive
Moving to learn is a concept that needs to be kept in the forefront when evaluating young children.
Youtube videos of Lisa Thornton, MD (TED Talk) and Cole Galloway, PhD (TEDMED Talk)
www.health.oregonstate.edu/gobabygo (Go Baby Go at Oregon State)
http://sites.udel.edu/gobabygo/ Go Baby Go and programs at University of Delaware)
www.Resna.org position paper on Pediatric Powered Mobility which provides a summary of research as well as citations for more information. A new updated version will be posted soon.
Select articles used for this Nu Digest
Butler, C. Augmentative mobility: why do it? PMR Clin NA. Vol 2, no 4. 11/1991
Hays RM. Childhood motor impairments: clinical overview and scope of the problem. In: KM Jaffe, ed. Childhood Powered Mobility: Developmental, Technical and Clinical Perspectives. Seattle, Washington: RESNA; 1987: 1–10. 18
Livingstone, R and Paleg, G. Practice considerations for the introduction and use of power mobility for children. Developmental Medicine & Child Neurology 2014, 56: 210–222.
Livingstone, R and Field, D Systematic review of power mobility outcomes for infants, children and adolescents with mobility limitations. Clinical Rehabilitation 2014, Vol. 28(10) 954 –964.
Paulsson, K and Christoffersen, M. Psycho-social Aspects on Technical aids- how does independent mobility affect the psychological and intellectual development of children with physical disabilities? Early Intervention: Theory and Practice. April 7, 2015 (retrieved online)