Caregivers' Perceptions of Ride-On Cars and Behavioral Changes for Young Children With Motor Delays.

PURPOSE: To investigate caregivers' perceptions of using a ride-on car (ROC) and observe behavioral changes in their children following ROC training and conventional therapy. METHODS: The study included 37 toddlers with motor delays and their caregivers, divided into an ROC training group (27 participants) and a conventional therapy group (10 participants). A binary, multiple-choice, and open-ended questionnaire was administered before and after a 3-month intervention period. RESULTS: Over 70% of caregivers had no experience using mobility devices before the intervention. Before the intervention, children's ability and age were key barriers to using mobility devices. After the intervention, caregivers in the ROC group were more inclined than those in the control group to allocate a larger budget for these devices. CONCLUSIONS: The findings highlight the importance of pediatric physical and occupational therapists working collaboratively with caregivers during such interventions and raising awareness about government subsidies and resources available for mobility devices.

Ride-On Cars With Different Postures and Motivation in Children With Disabilities: A Randomized Controlled Trial.

IMPORTANCE: A child's independent mobility, environments, and mastery motivation are critical factors during early development. OBJECTIVE: To examine the effectiveness of ride-on car (ROC) training with a standing (ROC-Stand) or a sitting posture (ROC-Sit) in enhancing children's mastery motivation and decreasing parenting stress levels. DESIGN: Randomized controlled trial (RCT) with a multiple pretest-posttest design. SETTING: Hospital-based environment in northern Taiwan. PARTICIPANTS: Thirty-nine children with disabilities ages 1 to 3 yr were randomly assigned to ROC-Stand (n = 16), ROC-Sit (n = 12), or conventional therapy (control; n = 11). All groups received 2-hr training sessions two times a week for 12 wk and then a 12-wk follow-up period that involved only regular therapy. MEASURES: Assessments included the Revised Dimensions of Mastery Questionnaire-Chinese version and the Parenting Stress Index. RESULTS: All groups showed significant changes in social persistence with adults, mastery pleasure, and general competence after the intervention. The two ROC training groups showed a significantly greater decrease in parenting stress than the control group. In addition, increased general competence of the ROC-Stand group also strongly correlated with decreased parent-child dysfunctional interaction. CONCLUSIONS AND RELEVANCE: This RCT verifies the effectiveness of ROC training and offers a novel approach to increase children's mastery motivation and decrease parenting stress. What This Article Adds: Providing a large amount of active, exploratory experiences with goal-directed, moderately challenging tasks and cooperation with caregivers may result in the greatest benefits to young children with motor disabilities.

Responsiveness and minimal clinically important difference of TNO-AZL Preschool Children Quality of Life in children with cerebral palsy.

PURPOSE: To examine the responsiveness and minimal clinically important difference (MCID) of the TNO-AZL (Netherlands Organization for Applied Scientific Research Academic Medical Centre) Preschool Children Quality of Life (TAPQOL) in children with cerebral palsy (CP). METHODS: Ninety-seven children with CP (60 males, 37 females; aged 1-6 years) and their caregivers were recruited from the rehabilitation programs of Chang Gung Memorial Hospital in Taiwan for this 6-month longitudinal follow-up study. The Functional Independence Measure for Children (WeeFIM) and TAPQOL outcomes were measured at baseline and at a 6-month follow-up. Responsiveness was examined using the standardized response mean (SRM). The distribution-based and anchor-based MCID were determined. The TAPQOL outcomes include physical functioning (PF), social functioning (SF), cognitive functioning (CF), and emotional functioning (EF) domains. RESULTS: The responsiveness of the TAPQOL for all of TAPQOL domains was marked (SRM = 1.12-1.54). The anchor-based MCIDs of TAPQOL for PF, SF, CF, EF, and total domains were 1.25, 3.28, 2.93, 2.25, and 1.73, respectively, which were similar to the distribution-based MCID values of TAPQOL, except in the PF domain. The distribution-based MCIDs of TAPQOL in various domains were 2.85-3.73 when effect size (ES) was 0.2, 7.13-9.32 when ES was 0.5, and 11.40-14.91 when ES was 0.8. CONCLUSIONS: TAPQOL is markedly responsive to detect change in children with CP. The caregivers perceived the minimally important change in HRQOL of their children at a relatively low treatment efficacy. Researchers and clinicians can utilize TAPQOL data to determine whether changes in TAPQOL scores indicate clinically meaningful effects post-treatment and at the follow-up.

Modified Ride-On Car Use by Young Children With Disabilities.

PURPOSE: The purpose of this single-subject case series study is to determine the effect of modified ride-on car use in natural environments on mobility. METHOD: Three children younger than 2 years diagnosed with various disabilities participated in this 24-week study using a modified ride-on car in their home and community. RESULTS: All 3 children demonstrated an ability to independently use the modified ride-on car and enjoyed doing so. Two of the 3 children demonstrated clinically significant gains in mobility skills as measured by the Pediatric Evaluation of Disability Inventory. CONCLUSIONS: Modified ride-on car use is an emerging powered mobility device option for children younger than 2 years. Further research is needed to demonstrate the potential long-term gains of early powered mobility access to young children with disabilities.

Ride-On Car Training for Behavioral Changes in Mobility and Socialization Among Young Children With Disabilities.

PURPOSE: To characterize behavioral changes in mobility and socialization in children with disabilities aged 1 to 3 years while they are receiving ride-on car training in the hospital environment. METHODS: Ten young children with motor disabilities received ride-on car training for 9 weeks (2 hours per session, 2 sessions per week). The driving and socialization behaviors were videotaped for 20 minutes per session (1 session per week) within the same period. RESULTS: Independent mobility, visual attention to the switch, and positive facial expressions during the training period were significantly improved. CONCLUSIONS: Ride-on car training has positive effects on behavioral changes in mobility and socialization among young children with motor disabilities. This provides clinicians a novel option for implementing early mobility training in a hospital-based environment.

Modified Ride-on Car Use by Children With Complex Medical Needs.

PURPOSE: The purpose of this report was to determine the feasibility of short-term modified ride-on car (ROC) use for exploration and enjoyment by children with complex medical needs. METHODS: A single-subject research design was used (n = 3; age, 6 months to 5 years). Children were video-recorded using their modified ROC. RESULTS: All children successfully learned how to independently drive a modified ROC. Two of the 3 children demonstrated high levels of enjoyment during use of a modified ROC. CONCLUSIONS: Modified ROC use is a feasible and enjoyable powered mobility device for children with complex medical needs.

Modified ride-on car for mobility and socialization: single-case study of an infant with Down syndrome.

PURPOSE: Before the onset of walking, children with Down syndrome experience limited mobility yet are never considered candidates for traditional powered mobility devices. The purpose of this single-case study is to quantify the feasibility and family perceptions of including modified ride-on car use as an option for increasing daily mobility, socialization, and fun for a child with Down syndrome. METHODS: A 13-month-old child, Natalie, and her family were video recorded during the 28-week study using her ride-on car in their home and community. RESULTS: Natalie demonstrated and her family reported increased movement, mobility, and socialization over the study period. CONCLUSIONS: Ride-on car use appears feasible, fun, and functional to increase daily mobility for pediatric populations working toward independent walking.

Effect of body-scaled information on reaching in children with hemiplegic cerebral palsy: a pilot study.

PURPOSE: This study examined body-scaled information that specifies the reach patterns of children with hemiplegic cerebral palsy and children with typical development. METHODS: Nine children with hemiplegic cerebral palsy (3-5 years) and 9 age-matched children with typical development participated in the study. They were required to reach and grasp 10 different pairs of cubes. Reach data were coded as either a 1-handed reach or a 2-handed reach. Dimensionless ratios were calculated by dividing the cube size by the maximal aperture between the index finger and thumb. A critical ratio was used to establish the shift from a 1-handed to an exclusive 2-handed reach. RESULTS: The critical ratio was not significantly different for either preferred or nonpreferred arms within and between groups. All children used an exclusive 2-handed reach at a similar dimensionless ratio. CONCLUSION: Our study provides evidence of the "fit" between environment (cube size) and the individual's capabilities (finger aperture) for reaching for both groups.

Modified toy cars for mobility and socialization: case report of a child with cerebral palsy.

PURPOSE: Children with cerebral palsy have limited opportunities to explore their physical and social environment. The purpose of this study was to determine the feasibility of using a "ride-on toy car" as a readily available, low-cost, fun, and functional option for children with special needs. METHODS: Brenden, a 21-month-old child, was provided a modified ride-on toy car for a 15-week study period divided up into a 1-week baseline, 12-week intervention, and 2-week postintervention. We coded mobility and socialization measures from video recordings. RESULTS: Brenden was more mobile and had more vocalizations during the 12-week intervention. CONCLUSIONS: Modified toy cars have serious potential to be a fun and functional power mobility option for children with special needs. The opportunity now exists to quantify several effects, including peer socialization, cognitive measures, and body structure/function goals involving neural, muscular, and skeletal physiology. Group study is required to formally test these findings.

A pilot randomised controlled trial of ride-on cars and postural combinations of standing and sitting for mobility and social function in toddlers with motor delays.

PURPOSE: Locomotor experiences in upright postures are essential for developing toddlers' mobility and social functions. This pilot randomised controlled trial aimed to examine the effectiveness of using a modified ride-on car (ROC) with postural combinations of standing and sitting on mobility and social function in toddlers with motor delays. MATERIALS AND METHODS: Nineteen participants aged 1-3 years with mild, moderate or severe motor delays were randomly assigned to four ROC groups. The ROC groups had different combinations of standing and sitting, namely standing for 70 min (ROC-Stand70, five participants), standing for 45 min (ROC-Stand45, four participants), standing for 25 min (ROC-Stand25, five participants) and sitting for 70 min (ROC-Sit70, five participants). All participants participated in 2-h sessions twice a week for 12 weeks. The Pediatric Evaluation of Disability Inventory, Goal Attainment Scaling and Bayley-III tests were administered before and after the intervention, and after 12 weeks of follow-up. A mixed-model analysis of variance was used to compare inter- and intra-group differences. This trial was registered at ClinicalTrials.gov (NCT03707405). RESULTS: All groups showed significantly improved mobility, social function and goal achievement at the post-test (p < .001). However, no significant changes were observed in Bayley scores. CONCLUSIONS: Combining physical and social environmental modifications with active exploration is crucial for early power mobility training in toddlers with motor delays. To enhance the robustness and generalisability of our findings, future studies should include larger sample sizes, consider variations in motor delays, and measure energy expenditure during the intervention.Implications for rehabilitationProviding active exploratory experience using ride-on cars (ROCs) with various postural combinations can improve a child's mobility.The ROC training with various postural combinations can improve social function, and the degree of improvement may depend on the severity of motor delays.Setting goals with caregivers and incorporating their roles in the training process can empower them to interact with children more frequently and actively.

Initial evaluation of an environment-based intervention for participation of autistic children: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of environment-based intervention on participation outcomes and parent efficacy in autistic children. MATERIALS AND METHODS: Twenty-one autistic children 6-10 years old and their parents were randomized to environment-based intervention (n = 11) or usual care (n = 10). The environment-based intervention targets individualized participation goals in leisure and community activities through changing environment and activity demands. The study outcomes were Canadian Occupational Performance Measure (COPM), Goal attainment scaling (GAS), and Parent Empowerment and Efficacy Measure (PEEM). Assessments included baseline, 12 weeks (post-test), and 24 weeks (follow-up). Mixed ANOVAs were used to examine within-group and between-group effects in outcome variables. RESULTS: The COPM performance and satisfaction scores and GAS T-scores increased after environment-based intervention from baseline to 12 weeks and 24 weeks (p < 0.001) but did not significantly differ from usual care. The medium to large effect sizes of COPM performance and GAS T-scores favored the environment-based intervention. For the PEEM scores, no significant differences were found. CONCLUSIONS: Environment-based intervention may support school-age autistic children to participate in self-chosen activities over time. The intervention effects on participation goals and parent efficacy, however, were inconclusive and need further research.

Environmental barriers are important attributes to participation restriction in autistic children.Interventions focusing on modifying the task and environment is viable in supporting the participation of autistic children.The environment-based intervention appears to improve the participation goals in leisure and community-based activities over time.The environment-focused strategies may include providing social support, enabling access to a sensory-friendly environment, finding inclusive programs, adapting task demands, and managing routines.

Ride-on car training using sitting and standing postures for mobility and socialization in young children with motor delays: a randomized controlled trial.

PURPOSE: To examine the effects of ride-on car (ROC) training using different postures on mobility and social function in children with motor delays in comparison with conventional therapy. MATERIALS AND METHODS: Thirty-eight children (22 males, 16 females) with motor delays were recruited and randomly assigned to three groups: ROC training while sitting (ROC-Sit, n = 15; mean age, 20.25 months; standard deviation [SD], 5.29), ROC training while standing (ROC-Stand, n = 12; mean age, 24.80 months; SD, 8.42), and conventional therapy (control, n = 11; mean age: 20.25 months, SD: 5.37). All groups underwent 2-h training sessions twice weekly over a 12-week intervention phase. The Pediatric Evaluation of Disability Inventory and Goal Attainment Scaling were performed before and after the intervention and at follow-up sessions after 12 weeks. RESULTS: Mobility and goal achievement improved significantly in all groups after the intervention (p < 0.001; p < 0.0001). However, social function improved significantly only in the ROC-Stand group (p = 0.001), which had the highest number of participants showing clinically meaningful changes in mobility and social function. CONCLUSION: Increased practice and caregivers' involvement can improve children's mobility and goal achievement. Adopting a standing posture in an ROC can enhance social function.IMPLICATIONS FOR REHABILITATIONProviding active exploratory experience through ride-on cars or practicing specific skills can improve children's mobility function.Ride-on car training in a standing posture allows children to access their distal environment visually, resulting in improved social function.Setting goals with caregivers maximizes the effects of treatment on goal achievement.

Modified ride-on toy cars for early power mobility: a technical report.

BACKGROUND AND PURPOSE: Children with significantly decreased mobility have limited opportunities to explore their physical and social environment. A variety of assistive technologies are available to increase mobility; however, no single device provides the level of functional mobility that children developing typically enjoy. The purpose of this technical report is to formally introduce a new power mobility option--the modified ride-on toy car. KEY POINTS: This report will provide (a) an overview of toy car features, (b) examples of basic electrical and mechanical modifications, and (c) a brief clinical case. CLINICAL IMPLICATIONS: With creative use and customized modifications, toy cars can function as a "general learning environment" for use in the clinic, home, and school. As such, we anticipate that these cars will become a multiuse clinical tool to address not only mobility goals but also goals involving body function and structure such as posture and movement impairments.

Modified ride-on cars and mastery motivation in young children with disabilities: Effects of environmental modifications.

BACKGROUND: Independent mobility is important for children's psychological development. Modified ride-on cars are innovative, alternative options to enhance independent mobility, socialization, and motivation in young children with disabilities. AIM: We compared the effects of combining ride-on car use and a social interaction training program on mastery motivation and home affordances with a home education program in young children with disabilities. METHODS AND PROCEDURES: Twenty-nine children with disabilities aged 1-3 years were recruited. The treatment group (n = 15) received two 2-h sessions/week for 9 weeks of ride-on car training in a hospital environment in Taiwan. The control group (n = 14) underwent similar home education programs. No treatment except regular therapy was administered during the 9-week follow-up period. Assessments included the Revised Dimensions of Mastery Questionnaire-Chinese version and the Affordance in the Home Environment for Motor Development-Toddler version-Chinese version. OUTCOMES AND RESULTS: The treatment group (compared to controls) had significantly greater improvements in object persistence during the intervention. Both groups showed significant improvements in mastery pleasure and home affordances during the intervention. CONCLUSIONS AND IMPLICATIONS: This novel study showed the potential use of modified ride-on cars to enhance mastery motivation in a hospital environment.

Perspectives on Early Power Mobility Training, Motivation, and Social Participation in Young Children with Motor Disabilities.

The efficacy of traditional training programs (e.g., neurodevelopmental therapy) in promoting independent mobility and early child development across all three International Classification of Functioning, Disability, and Health levels lacks rigorous research support. Therefore, early power mobility training needs to be considered as a feasible intervention for very young children who are unlikely to achieve independent mobility. This perspective article has three aims: (1) to provide empirical evidence of differences in early independent mobility, motivation, daily life activities, and social participation between young children with typical development and motor disabilities; (2) to discuss the contemporary concepts of and approaches to early power mobility training for young children with motor disabilities and the current need for changes to such training; and (3) to provide recommendations for early power mobility training in pediatric rehabilitation. Independent mobility is critical for social participation; therefore, power mobility can be accessible and implemented as early as possible, specifically for infants who are at risk for mobility or developmental delay. To maximize the positive effects of independent mobility on children's social participation, early power mobility training must consider their levels of functioning, the amount of exploration and contextual factors, including individual and environmental factors.

The use of modified ride-on cars to maximize mobility and improve socialization-a group design.

AIM: To examine the effects of ride-on car (ROC) training versus conventional therapy on mobility and social function in young children with disabilities in a hospital-based environment. METHODS AND PROCEDURES: Twenty young children with disabilities, aged 1-3 years, were recruited. The treatment group (n=10) received ROC training of 2h/session, 2 sessions/week for a total of 9 weeks in the hospital environment. The control group (n=10) received conventional therapy alone. Assessments included the Chinese version of the Pediatric Evaluation of Disability Inventory and the Parenting Stress Index. OUTCOMES AND RESULTS: After a 9-week intervention, the treatment group showed improvements in mobility and social function, whereas the control group showed improvements in social function alone. Four children in the treatment group had clinically meaningful changes in mobility and 3 in social function, as compared to 2 and 1, respectively, in the control group. CONCLUSIONS AND IMPLICATIONS: This is the first group study that demonstrated the potential benefits of ROC training on mobility and social function in young children with disabilities in the hospital environment. Future studies should include a larger sample size to detect any differences between ROC training and conventional therapy.