Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use.

PURPOSE: To investigate the influence of powered wheelchair standing device (PWSD) use on changes in activity/participation in children with neurodevelopmental conditions. METHODS: A mixed methods A-B-A single-subject research design was replicated with participants. The target behavior was parental perceptions of changes in children's performance of activity/participation goals measured via the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM with children, an interview, and a 3-measure implementation survey. COPM data related to the target behavior were analyzed using the split-middle celeration line method. RESULTS: Four child-parent dyads participated in the study. All participants achieved statistically and clinically significant increases in COPM performance ratings for the 5 parent-identified activity/participation goals. CONCLUSIONS: For the participant dyads in this study, use of the PWSD appeared to positively influence parental perceptions of improvements in their child's performance of activity/participation goals.

Wheeled mobility use outcomes: a systematic review of measurement properties protocol.

INTRODUCTION: Numerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. OBJECTIVE: The objectives are two-fold: (1) to synthesize outcome measures that assess use of wheeled mobility devices, and (2) to evaluate measurement properties of the assessment tools. INCLUSION CRITERIA: The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. METHOD: The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD4202276169.

The IndieTrainer system: a small-scale trial exploring a new approach to support powered mobility skill acquisition in children.

The IndieTrainer system, consisting of a mobility device and video-based gamified training modules, was developed to assist children in attaining power wheelchair (PWC) skills. The purposes of this small-scale trial were to explore the use of the IndieTrainer system to provide PWC skills training and document parental satisfaction with the IndieTrainer system. We hypothesized that PWC skills training provided using the IndieTrainer system would result in improvements in both children's understanding of how to use a PWC and their PWC skill execution, and that parental satisfaction would be high. An open-label, single-arm trial was conduct as follows: (a) Baseline testing (T0); (b) A 3-week intervention consisting of two, 60-min-PWC skills training sessions per week; (c) Post-intervention testing (T1); and (d) A single session retention trial held 4 weeks after completion of the intervention (T2). Outcome measures included the Assessment of Learning Powered mobility use (ALP), Wheelchair Skills Checklist (WSC), Canadian Occupational Performance Measure (COPM), and Client Satisfaction Questionnaire-8 (CSQ-8). 25 child/parent dyads participated. Between T0 and T1, statistically significant differences (p-value <.0001) with large effect sizes in mean ALP and WSC scores (ALP: d = 3.14; WSC: d = 3.25) and COPM performance and satisfaction scores (Performance: d = 4.66; Satisfaction: d = 3.24) were achieved. Mean T1 total CSQ-8 score was 31.52/32. At T2, all children maintained or improved their T1 ALP and WSC scores. This study provides initial support for the usability and feasibility of the IndieTrainer system. Futhermore, larger scaled studies using more rigorous research designs are indicated.

The IndieTrainer system allows clinicians to tailor power wheelchair skills (PWC) skills training based on an individual child's specific goals and level of understanding.Selectively combining the use of progressive video-based gamified modules and real-world power mobility experiences may support children who are learning PWC skills.When provided with progressive PWC skills training, children with severe disabilities may improve their understanding of how to use a PWC and their PWC skills.

School-Based Therapists' Perspectives of Wheelchair Use in US Schools: A Survey Study.

PURPOSE: To gather information concerning the current state of students' wheelchair (WC) use in US schools from the perspective of school-based therapists. METHODS: This descriptive study used a Web-based survey to gather information regarding factors that facilitated or hindered student WC use at school, the frequency at which various tasks related to WC provision were performed, and factors that would facilitate students' independence with WC use. RESULTS: A dependent manual WC was the most common type of WC mobility used at school. Various student and nonstudent factors were reported as a facilitator or a barrier to students' WC use at school. CONCLUSIONS: Although most respondents reported working with a student who used a WC, few reported active engagement in tasks related to WC service provision. Future research exploring potential attitudinal issues influencing students' WC use at school and ways to optimally support students' independent WC use is indicated.

Caregiver perspectives on powered mobility devices and participation for children with cerebral palsy in Gross Motor Function Classification System level V.

AIM: To describe caregiver experiences, perceptions, and device preferences between a modified ride-on car (MROC) and an Explorer Mini, including perceived changes in participation, barriers, and benefits for young children with cerebral palsy (CP) classified in Gross Motor Function Classification System (GMFCS) level V. METHOD: A subset of data were analyzed from a larger multisite study. Semi-structured interviews were conducted with 10 caregivers of children with CP in GMFCS level V across a 16-week trial with two mobility devices. Each interview was audio-recorded, transcribed verbatim, and analysed using constant comparison methods. RESULTS: Seven of 10 caregivers preferred the Explorer Mini over the MROC. Four themes emerged. One related to the perceived benefits and barriers of each device (ease and convenience is essential) and three related to perceived changes in participation: (1) autonomy enacted through mobility; (2) belonging and being present; and (3) participation recognized as an area of growth. INTERPRETATION: Despite limited consideration of powered mobility for this population, caregivers of children in GMFCS level V reported similar benefits and barriers compared to children in other GMFCS levels shown in the literature. Particularly, caregivers perceived positive changes in their child's participation and recognized the ability for continued improvements in participation when using powered mobility. WHAT THIS PAPER ADDS: Children with cerebral palsy classified in Gross Motor Function Classification System level V are often excluded from powered mobility use and research. Despite this, caregivers reported positive experiences for their children. Caregivers felt that participation in powered mobility led to increased autonomy and overall sense of inclusion and belonging for their children. Most caregivers preferred the Explorer Mini over the modified ride-on car but recognized that both devices had benefits and barriers to use.

Factors clinicians consider when providing pediatric wheelchair skills training: a modified think aloud study.

PURPOSE: Children who use a manual wheelchair (WC) or a power WC may not receive adequate WC skills training. Clinicians report knowledge as a barrier to the provision of paediatric WC skills training. The purpose of this study was to explore the breadth and depth of specific factors clinicians consider when providing WC skills training for children. METHODS: Data in this modified Think Aloud study were gathered via one-on-one, Zoom-based, audio-recorded Think Aloud Sessions. Sessions consisted of participants viewing four videos, each of different children performing a different WC skill while thinking aloud (verbally expressing) about the factors they recognized, observed, and considered while watching the video. After each video, participants also responded to questions regarding the specific WC skill and the provision of WC skills training for the child in the video. Factors participants reported were independently identified by three researchers through a deductive process of directed content analysis and categorized using the International Classification of Functioning, Disability and Health (ICF) coding system. RESULTS: Twenty-eight English-speaking clinicians participated in the study. A total of 1246 distinct factors were mapped to 352 unique ICF codes spanning all four ICF Domains. The largest number of identified factors mapped to codes within the Activities and participation Domain (42.25%). CONCLUSION: Participants reported considering multiple factors across the ICF in the provision of WC skills training for children. Providing paediatric WC skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.IMPLICATIONS FOR REHABILITATIONProviding paediatric wheelchair (WC) skills training is a complex activity requiring clinicians to consider a wide range of factors that go beyond a child's motor abilities.Clinicians should consider the child's Mental Functions, Activities and Participation, and Environmental Factors when providing wheelchair skills training for children.A lack of wheelchair-specific International Classification of Functioning, Disability, and Health codes was noted. Revising these codes to better capture the diverse range of the benefits and challenges involved in learning to use and using a wheelchair would be beneficial.

Powered Mobility Device Use and Developmental Change of Young Children with Cerebral Palsy.

Mobility is a fundamental human right and is supported by the United Nations and the ON Time Mobility framework. The purpose of this study was to understand the effect of a powered mobility intervention on developmental changes of children with cerebral palsy (CP). This study was a randomized, crossover clinical trial involving 24 children (12-36 months) diagnosed with CP or with high probability of future CP diagnosis based on birth history and current developmental status. Children received the Explorer Mini and a modified ride-on car in randomized order, each for 8 weeks. The Bayley Scales of Infant and Toddler Development-4th Edition was administered at baseline, mid-study, and end-of-study. Raw change scores were used for analysis. Total minutes of use per device was categorized as low or high use for analysis based on caregiver-reported driving diaries. Explorer Mini: The high use group exhibited significantly greater positive change scores compared to the low use group on receptive communication, expressive communication, and gross motor subscales (p < 0.05). Modified ride-on car: No significant differences between low and high use groups. Regardless of device, low use was associated with no significant developmental change and high use was associated with positive developmental changes. Mobility access is critical to maximize the development of children with CP and may be augmented by using powered mobility devices. Results may have implications for the development of evidence-based guidelines on dosage for powered mobility use.

The IndieTrainer system: a clinical trial protocol exploring use of a powered wheelchair training intervention for children with cerebral palsy.

OBJECTIVE: The IndieTrainer system, comprised of both a mobility device and gamified training modules, was developed to aid powered wheelchair (PWC) skills acquisition in children with cerebral palsy (CP). The aims of this small-scale study are to: explore use of the IndieTrainer system to improve PWC skills in children who have CP and document parental/caregiver perceptions of, and satisfaction with, the IndieTrainer system. METHOD: This small-scale study is an open-label single-arm clinical trial involving a three-week PWC training intervention consisting of two 60-minute training sessions per week. A single session retention trial will be held four weeks after the completion of the intervention period. All research activities will take place in-person in a laboratory-based setting located within a university. Twenty-five child-parent/caregiver dyads will participate in the study. Each child participant will be 3 to 21 years of age and have a diagnosis of CP or other similar condition. The Assessment of Learning Powered mobility use will be the primary outcome measure. Secondary outcome measures will include the Wheelchair Skills Checklist, the Canadian Occupational Performance Measure, the Customer Satisfaction Questionnaire-8, and a qualitative interview. Data analyses will involve one-way repeated measures ANOVAs followed by paired samples t-tests with Bonferroni adjustments. IMPACT: The IndieTrainer system allows children to explore and use power mobility in their own manual wheelchair and was designed to meet the needs of power mobility learners across the continuum of learning. It is the first PWC training system to optimize learning for early learners who do not yet understand cause and effect concepts.IMPLICATIONS FOR REHABILITATIONThe IndieTrainer system is designed to meet the needs of power mobility learners across the continuum of learning.This protocol outlines a novel means of providing progressive power mobility training.The IndieTrainer was designed to expand power mobility access to children with cerebral palsy, a previously underserved population.

Using a child's power mobility learner group to tailor power mobility interventions: a case series.

PURPOSE: The purpose of this case series was to explore using a child's power mobility learner group (exploratory, operational, or functional) to tailor power mobility interventions. Materials and methods: Five cases representing 2 exploratory power mobility learners, 2 operational power mobility learners, and 1 functional power mobility learner are presented. In each case, the participant's power mobility learner group was used to tailor his/her power mobility intervention program including establishing desired outcomes/goals of power mobility use, selecting outcome measures, determining the power mobility device to be used, and identifying the specific intervention strategies to be used. RESULTS: All participants demonstrated improvements in power mobility device use following provision of the tailored intervention. Cases involving use of the Canadian Occupational Performance Measure demonstrated clinically significant improvements in post-intervention scores. CONCLUSIONS: These cases illustrate a means to tailor power mobility interventions that may potentially optimise learning by providing an environment and conditions that meet each child's specific needs. The short-term and long-term gains made by the children in these cases warrants a controlled study exploring the use of a child's power mobility learner group to tailor power mobility interventions.IMPLICATIONS FOR REHABILITATIONUsing a child's power mobility learner group to tailor power mobility intervention may potentially optimise learning by providing an environment and conditions that meet each child's specific needs.Children across the learning continuum represented by the 3 power mobility learner groups (exploratory, operational, and functional) may benefit from power mobility interventions.Using a child's power mobility learner group to tailor power mobility interventions may support translation research knowledge into clinical practice.

Motivate-to-move: development of an intervention promoting parental adherence to early power mobility programs.

PURPOSE: Parental/caregiver adherence has been identified as a barrier to implementation of early power mobility programs. Motivational interviewing (MI) may help in addressing this barrier. Two scoping reviews were conducted to gather concepts pertaining to parent-based or rehabilitation-based MI interventions and to develop a parent-based MI intervention to address parental/caregiver adherence to home-based early power mobility interventions for infants and young children. MATERIALS AND METHODS: Separate literature searches for parent-based MI and rehabilitation-based MI were conducted in PubMed, CINAHL Complete, PsycInfo, and Web of Science Core Collection. Inclusion criteria were [1]: focussed on/use of either a parent-based or a rehabilitation-based MI intervention and [2] MI interventions described in sufficient detail to be reproduced. Articles focussed on vaccinations, child abuse and neglect, mental health, or technology-based MI were excluded. Data regarding MI interventions and strategies were extracted from included articles. RESULTS: A total of 1130 unique titles were screened and 150 full-text articles were assessed for inclusion. Nineteen articles met the inclusion/exclusion criteria. Using a collaborative, consensus-based approach, a parent-based MI intervention incorporating specific MI strategies identified in the review was developed in collaboration with a psychologist. Future research exploring the application of this parent-based MI intervention is indicated. CONCLUSIONS: The parent-based MI interventions developed in this project may help to increase parental adherence to home-based early power mobility programs, thereby potentially addressing an identified barrier to implementation of early power mobility programs.IMPLICATIONS FOR REHABILITATIONTo our knowledge, this is the first study to develop MI scripts for the purpose of increasing parental/caregiver adherence to a power mobility training program for children.The MI interventions developed in this study are consistent with published suggestions to address perceived barriers to the implementation of early power mobility programs.Given the strategies of collaboration, autonomy, and empowerment embedded within the spirit of MI, parent-based MI interventions are congruous with and inclusive of the principles of family-centered care.

"Make it fun": a qualitative study exploring key aspects of power mobility interventions for children.

PURPOSE: Research suggests there are three groups of paediatric power mobility learners: exploratory, operational and functional. The purpose of this modified grounded theory study was to explore the key aspects of power mobility interventions for children in each of these paediatric power mobility learner groups. MATERIALS AND METHODS: Data were gathered through face-to-face interviews conducted in-person or via Zoom®. Three stakeholder groups were interviewed: (1) children ages 8-18 years who used a power wheelchair (PWC); (2) parents whose children (≤18 years of age) used a PWC; and (3) therapists/therapist researchers experienced in paediatric power mobility. An interview guide was created for each stakeholder group. Interviews were transcribed verbatim and an initial coding scheme was used to identify intervention activities specific to each learner group. Data for each learner group were then coded to reflect the essence of each intervention activity. Finally, patterns within the data were identified and codes were collapsed into thematic categories reflecting the key aspects of intervention for each learner group. RESULTS: A total of 29 participants (nine children, seven parents and 13 therapists) took part in the study. Key aspects of power mobility interventions for each learner group, as well as fundamental aspects of power mobility intervention applicable to all learner groups, emerged in the data. CONCLUSIONS: This study highlights both the similarities (fundamental aspects) and differences (key aspects targeting the specific needs of each learner group) of power mobility interventions for children in each of the three power mobility learner groups.Implications for RehabilitationThere are both similarities (fundamental aspects) and differences (key aspects targeting the specific needs of each learner group) in the needs of children in each of the three power mobility learner groups.Key aspects of power mobility interventions vary for children in each of the three paediatric power mobility learner groups and correspond with the learning needs of each power mobility learner group.The findings of this study will help clinicians and researchers to tailor power mobility interventions to meet the unique needs of children in each power mobility learner group.

Exploring powered wheelchair standing device use in children and adults: a longitudinal case series.

PURPOSE: The purpose of this case series was to explore the influence of powered wheelchair standing device (PWSD) use on participants': (1) activities and participation; (2) quality of life; and (3) lower extremity passive range of motion (LE PROM). CASE DESCRIPTION: Eight participants enrolled in the case series (five adults and three children). Outcome measures included: the Canadian Occupational Performance Measure (COPM), the EQ-5D-5L or the EQ-5D-Y, the Patient-Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), LE PROM measurements and PWSD use data automatically collected by each PWSD. Participants were provided with a front wheel-drive PWSD designed for both outdoor and indoor use for up to 12-months of use. OUTCOMES: Four participants completed the 12-month case series. Three participants achieved clinically significant improvements in performance on the COPM. Three of the four participants reporting issues with constipation achieved clinically significant improvements in their total PAC-QOL scores. Almost all participants demonstrated changes in some LE PROM. CONCLUSIONS: Applying the Human Activity Assistive Technology model may help to explain differences in both PWSD use and outcomes amongst the individual participants in this case series. The participants who were most successful in using the PWSD were in environments with sufficient space to use the PWSD to perform everyday activities and had higher frequencies of PWSD use. The outcomes of this case series may assist both researchers and clinicians when implementing future PWSD studies recommending PWSDs to their clients/patients. Implications for rehabilitationA wide variety of factors may influence powered wheelchair standing device (PWSD) use.PWSD use may lead to improvements in activities, participation, quality of life and lower extremity passive range of motion.The participants who were most successful in using the PWSD were in environments that permitted use of the PWSD during the performance of everyday activities.COVID-19 restrictions prohibited in-person sessions with a therapist, which could have assisted participants in better integrating the PWSD in their daily lives.

In the Driver's Seat: A Randomized, Crossover Clinical Trial Protocol Comparing Home and Community Use of the Permobil Explorer Mini and a Modified Ride-On Car by Children With Cerebral Palsy.

OBJECTIVE: The aims of this study are 2-fold: (1) to evaluate a powered mobility intervention to promote developmental, activity, and participation outcomes of young children aged 12 to 36 months who have cerebral palsy; and (2) to compare the use patterns (frequency, duration, environment) of 2 different powered mobility options. METHODS: This study is a multisite, mixed-methods, doubly counterbalanced, randomized, crossover clinical trial, where intervention A is the Permobil Explorer Mini and intervention B is a modified ride-on toy car. The study will take place in rural and urban home and community settings surrounding 3 sites (Washington, Oregon, and Michigan). There will be 24 child-caregiver dyads in the study (8 dyads per site). Primary outcome measures include the Bayley Scale of Infant and Toddler Development, the Youth and Children's Participation and Environment Measure, the Assessment for Learning Power mobility use, automated device use tracking logs, caregiver semistructured interviews, and the Acceptability, Feasibility, and Intervention Appropriateness Measures. Secondary measures include the Child Engagement in Daily Life and caregiver diaries. IMPACT: The use of powered mobility devices for young children with cerebral palsy has gained traction, with evidence that the use of powered mobility at young ages complements (rather than detracts from) other interventions focused on more traditional mobility skills such as crawling and walking. However, research is limited, and often comprised of low-level evidence. Given the clearance of the first powered mobility device for infants, the Permobil Explorer Mini, and the recent popularity of modified ride-on toy cars as an alternative for powered mobility for young children with disabilities, this study will contribute to rigorous examination of the developmental outcomes, use patterns, and caregiver perceptions of these novel devices.

Understanding the Lived Experience of Caring for a Child With Severe Cerebral Palsy: A Critical Step Toward Psychologically Informed Family-Centered Care.

OBJECTIVE: The purpose of this study was to explore the lived experience of parents who care for children with cerebral palsy who function at a Gross Motor Function Classification System Level V, their beliefs about pain and non-pain-related emotional distress, and what it means to provide care and comfort. METHODS: A phenomenological research design was used. Eleven participants were involved in this study. Pilot interviews informed the interview guide. Data were collected via participant journals and semi-structured interviews and analyzed using van Manen's framework for understanding experience. Trustworthiness criteria were met through a variety of strategies to ensure a rigorous research process. RESULTS: Four themes were revealed in this study: "life is hard, heavy with burden, worry, and love," "remarkable," "identity transformation and empowerment," and "living a life that is planned, forced with structure and without spontaneity." CONCLUSION: Caring for a child with lifelong needs is complex and requires a sensitive awareness of the contextual factors that impact daily decisions and routines. Understanding the lived experiences of parents who care for children with cerebral palsy Gross Motor Function Classification System Level V is necessary to provide psychologically informed, family-centered care. Comfort theory is presented as a framework for understanding what factors influence comfort and well-being. Understanding the complex nature of comfort for an individual can lead to greater understanding and empathy-driven care. These results will provide a foundation for future studies that aim to enhance pediatric physical therapist care through provider empathy and understanding. IMPACT: Caregiving parent experiences are impactful and play a large role in the life of children with developmental disabilities. Research exploring the lived experience of caregivers may enhance empathy-driven, psychologically informed, family-centered physical therapist care throughout the life course. LAY SUMMARY: If you are a parent who cares for a child with severe cerebral palsy, you have unique experiences that impact day-to-day activities and lifelong planning for your family and child.

Item development, internal consistency, and known-groups validity of the Self-Directed Mobility Scale.

PURPOSE: The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists' views towards self-directed mobility and their perceived ability and intentions to advocate for children's access to self-directed mobility. METHODS: Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students. RESULTS: The internal consistency was above the acceptable level of 0.70 (range = 0.72-0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples. CONCLUSIONS: The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach's alpha level is met.Implications for rehabilitationThe Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists.In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.

Relationships between Cognitive Functioning and Powered Mobility Device Use: A Scoping Review.

BACKGROUND: Powered mobility devices (PMD) promote independence, social participation, and quality of life for individuals with mobility limitations. However, some individuals would benefit from PMD, but may be precluded access. This is particularly true for those with cognitive impairments who may be perceived as unsafe and unable to use a PMD. This study explored the relationships between cognitive functioning and PMD use. The objectives were to identify cognitive functions necessary to use a PMD and describe available PMD training approaches. METHODS: A scoping review was undertaken. RESULTS: Seventeen studies were included. Four examined the predictive or correlational relationships between cognitive functioning and PMD use outcomes with intellectual functions, visual and visuospatial perception, attention, abstraction, judgement, organization and planning, problem solving, and memory identified as having a relation with PMD use outcome in at least one study. Thirteen others studied the influence of PMD provision or training on users' PMD capacity and cognitive outcomes and reported significative improvements of PMD capacities after PMD training. Six studies found improved cognitive scores after PMD training. CONCLUSIONS: Cognitive functioning is required to use a PMD. Individuals with heterogeneous cognitive impairment can improve their PMD capacities. Results contribute to advancing knowledge for PMD provision.

Outcomes of a child-based manual wheelchair skills peer training program: an exploratory case report.

PURPOSE: The purpose of this exploratory case series was to describe the outcomes for both a child-learner and a child-peer after a single manual wheelchair (MWC) skills training session involving child-based peer training techniques, followed by related home-based skills practice. MATERIALS AND METHODS: Participants were a 9-year-old with L4-L5 spina bifida (pseudonym: Amari) and a 3-year-old with T10 spina bifida (pseudonym: Mary). Pre-intervention examination included administration of the Wheelchair Skills Test Questionnaire (WST-Q), the MWC short scale within the Mobility domain of the Paediatric Evaluation of Disability - Computer Adapted Test (MWC PEDI-CAT), and the Canadian Occupational Performance Measure (COPM). The peer training session, facilitated by a physical therapy team, involved games and activities involving MWC use. When appropriate, Amari was asked to talk aloud and verbally describe the components of the skills she was performing. Each child and her mother were instructed in specific MWC skills to practice at home over a 3-week period. RESULTS: Both participants' post-intervention WST-Q capacity, confidence, and performance scores increased. Increases in parent-proxy COPM scores indicated clinically meaningful change in all identified occupational performance problems. Mary's total MWC PEDI-CAT post-intervention score increased by 11 points. Both mothers reported that the participation in the activities helped also to improve their child's self-esteem and self-image. CONCLUSIONS: Both the participants in this exploratory case appeared to demonstrate improvements in MWC skills, self-esteem, and self-image following a single child-based MWC skills peer training session and related home-based skills practice. Future research involving such peer training methods is warranted.

The Time Is Now: A FASTER Approach to Generate Research Evidence for Technology-Based Interventions in the Field of Disability and Rehabilitation.

Current approaches for generating high-quality research evidence for technology-based interventions in the field of disability and rehabilitation are inappropriate. Prevailing approaches often focus on randomized controlled trials as standard and apply clinical trial practices designed for pharmaceuticals; such approaches are unsuitable for technology-based interventions and are counterproductive to the goals of supporting people with disabilities and creating benefits for society. This communication is designed to: (1) advocate for the use of alternative approaches to generating evidence in the development and evaluation of technology-based interventions; (2) propose an alternative framework and guiding principles; and (3) stimulate action by multiple disciplines and sectors to discuss, adopt, and promote alternative approaches. Our Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER) is informed by established innovation design processes, complex intervention development, evaluation, and implementation concepts as well as our collective experiences in technology-based interventions research and clinical rehabilitation practice. FASTER is intended to be meaningful, timely, and practical for researchers, technology developers, clinicians, and others who develop these interventions and seek evidence. We incorporate research methods and designs that better align with creating technology-based interventions and evidence for integration into practice. We propose future activities to improve the generation of research evidence, enable the selection of research methods and designs, and create standards for evidence evaluation to support rigor and applicability for technology-based interventions. With this communication we aim to improve and advance technology-based intervention integration from conception to use, thus responsibly accelerating innovation to have greater positive benefit for people and society.

Stakeholder perspectives of pediatric powered wheelchair standing devices: a qualitative study.

AIM: To explore and describe the experiences and perspectives of various stakeholders regarding the use of powered wheelchair standing devices (PWSDs). METHOD: The purposive sample included: children aged 6 to 18 years who used a PWSD (n=8; diagnoses: cerebral palsy, spinal muscular atrophy, spina bifida, spinal cord injury), parents of children 18 years of age or younger who used a PWSD (n=12), rehabilitation professionals working with children who used a PWSD (n=12), and professionals working at companies manufacturing PWSDs (n=3). Data were gathered via face-to-face interviews conducted either in person or via Zoom® and analyzed using the constant comparative method. RESULTS: Three main themes emerged in the data: (1) 'Stand-on-demand' revealed how participants perceived PWSDs as allowing children to stand whenever and wherever they wanted, thereby increasing participation; (2) 'It's more than weight-bearing' uncovered participants' perceptions of psychological and physical benefits from PWSD use; and (3) 'Ecosystems influencing PWSD acquisition and use' revealed child- and non-child-related factors perceived as influencing children's procurement and use of a PWSD. INTERPRETATION: Use of a PWSD was perceived as providing a unique opportunity for children to stand whenever and wherever they desired. Findings suggest the possible transdiagnostic application of PWSDs. What this paper adds The ability to stand when desired was unique to powered wheelchair standing device (PWSD) use. Participants perceived numerous psychological and physical benefits from PWSD use. Child- and non-child-related factors influenced procurement and use of a PWSD.