Hybrid approaches to allied health services for children and young people: a scoping review.

BACKGROUND: Hybrid models that integrate both in-person and remote health services are increasingly recognized as a promising approach. Nevertheless, research that defines and characterizes these models in children and young people is scarce and essential for establishing guidelines for implementation of hybrid allied health services. This scoping review evaluates four key aspects of hybrid allied health services in children and young people: 1. definitions, 2. service characteristics, 3. outcome measures, and 4. results of hybrid allied health services. METHODS: Six databases were searched: Medline (Ovid), Embase, CINHAL, Psycinfo, Cochrane CENTRAL, and Web of Science. Of the 9,868 studies potentially meeting the inclusion criteria, 49 studies focused on children and young people. Following full-text review, n = 21 studies were included. RESULTS: Terminology used for hybrid allied health services varied across studies which targeted diverse clinical populations and varied in study design, type and frequency of remote and in-person treatments. Over 75% of cases used custom-written software, limiting scalability. All interventions started in-person, possibly to establish a therapeutic alliance and solve technological issues. Most hybrid allied health services (67%) were in mental health, while only a minority involved physical, occupational or speech therapy. The most common outcomes were feasibility and satisfaction, but tools used to measure them were inconsistent. Although 57% of studies demonstrated effectiveness of hybrid allied health services, none measured cost-effectiveness. DISCUSSION: Despite the potential of hybrid allied health services for children and young people, the literature remains at a preliminary stage. Standardization of definitions and outcome measures, and clearer reporting of service characteristics and results would likely promote consolidation of hybrid allied health services in children and young people into clinical practice.

Home Videos for Remote Assessment in Children with Disabilities: A Scoping Review.

Background: Analysis of parent-provided home videos is a mode of technology that can facilitate a telehealth assessment, allowing observation of function in the child's natural home environment. This scoping review investigated areas of use of home videos for functional assessment by health professionals with a pediatric population with disabilities. Methods: Four databases were searched for articles in which parent-provided home videos were employed by health professionals for functional assessment in children with disabilities. Articles published from 2013 to 2023 were included in the review if they met the inclusion criteria, and the data were extracted into an Excel file. Results: After screening 3,019 articles, 30 articles were included in the data extraction. The majority of studies utilized home videos for diagnosis of autism, followed by assessment of motor development in infants. Studies found that using home videos for assessment is feasible and empowers parents. The validity and reliability of various home video platforms were demonstrated. Conclusions: Analysis of home videos can aid in making a timely diagnosis for prompt intervention, and can be used to assess various body functions, interchangeable with a live clinic assessment. It is important to provide parents with clear instructions when using this method. Future studies are necessary to determine whether parent-provided home videos can be utilized by a multidisciplinary team to assess diverse factors, including activity, participation, and the environment, in a variety of populations of children with disabilities, thus extending services beyond the physical borders of the clinic.

Predictive model of proficiency in powered mobility of children and young adults with motor impairments.

AIM: To identify variables that can predict proficiency in powered mobility use for children in young adults. METHOD: Participants included 80 children and young adults (42 males, 38 females; mean age 10y 2mo, [SD 5y 1mo]; range: 2-22y) with cerebral palsy, neuromuscular disease, and spinal cord injury who participated in the ALYN Hospital Powered Mobility Lending Program from 2009 to 2016. Data were collected and compared before and after participation in the program and powered mobility levels were determined by the Israeli Ministry of Health (MOH) Powered Mobility Proficiency Test. Multivariate logistic regression analysis followed by a bootstrapping procedure that was based on 1000 samples were used to determine if the variables were predictive of success on the Israeli MOH Powered Mobility Proficiency Test. RESULTS: Significant variables for predicting success were identified: manual wheelchair propulsion, go-stop voluntarily upon request, and using a joystick. The model was able to correctly identify 80% of the children. INTERPRETATION: Children and young adults with the ability to go-stop upon request, propel a manual wheelchair short distances, and use a joystick to activate the powered wheelchair had a higher chance of becoming proficient. In countries where wheelchair proficiency is a requirement for powered wheelchair procurement, these findings may support policy changes, as they did in Israel. WHAT THIS PAPER ADDS: Using powered wheelchairs offers children earlier and more natural practice to determine driving proficiency. Manual wheelchair propulsion, go-stop voluntarily upon request, and using a joystick were predictors of powered mobility proficiency. More than 80% of children use a joystick with their hand to activate a powered wheelchair.

MODELO PREDICTIVO DE LA COMPETENCIA EN MOVILIDAD MOTORIZADA DE NIÑOS Y ADULTOS JÓVENES CON DEFICIENCIAS MOTORAS: OBJETIVO: Identificar variables que puedan predecir la capacidad de uso de la movilidad motorizada para niños en adultos jóvenes. MÉTODO: Fueron incluidos 80 niños y adultos jóvenes (42 varones, 38 mujeres; edad media 10a 2m, [SD 5a 1m]; rango: 2-22a) con parálisis cerebral, enfermedad neuromuscular y lesión de la médula espinal que participaron en el Programa de Movilidad Motorizada del ALYN Hospital del 2009 a 2016. Los datos se recopilaron y compararon antes y después de la participación en el programa y los niveles de movilidad impulsados ​​se determinaron mediante la Prueba de competencia de movilidad impulsada por el Ministerio de Salud de Israel. Se utilizó el análisis de regresión logística multivariable seguido de un procedimiento de arranque que se basó en 1000 muestras para determinar si las variables eran predictivas de éxito en la Prueba de Competencia de Movilidad Movida por MOH de Israel. RESULTADOS: Se identificaron variables significativas para predecir el éxito: propulsión manual en silla de ruedas, posibilidad de arranque y freno a la orden, y uso de un joystick. El modelo fue capaz de identificar correctamente al 80% de los niños. INTERPRETACIÓN: Los niños y adultos jóvenes que tienen la capacidad de detenerse cuando se lo requiere, que pueden impulsar una silla de ruedas manual a corta distancia y que pueden usar un joystick para activar la silla de ruedas motorizada tienen una mayor probabilidad de convertirse en expertos. En los países donde el dominio de las sillas de ruedas es un requisito para la adquisición de sillas de ruedas motorizadas, estos hallazgos pueden respaldar cambios en las políticas, como lo hicieron en Israel.

MODELO PREDITIVO DE PROFICIÊNCIA NA MOBILIDADE MOTORIZADA DE CRIANÇAS E ADULTOS COM DEFICIÊNCIAS MOTORAS: OBJETIVO: Identificar variáveis que podem predizer proficiência no uso da mobilidade motorizada para crianças e adultos jovens. MÉTODO: Os participantes incluíram 80 crianças e jovens adultos (42 do sexo masculino, 38 do sexo feminino; média de idade 10a 2m, [DP 5a 1m]; variação: 2-22a) com paralisia cerebral, doença neuromuscular, e lesão da medula espinhal que participaram do Programa de Mobilidade Motorizada do Hospital ALYN de 2009 a 2016. Os dados foram coletados e comparados antes e após a participação no programa, e os níveis de mobilidade motorizada foram determinados pelo Teste de Proficiência em Mobilidade Motorizada do Ministério da Saúde (MS) Israelense. Análise de regressão logística multivariada seguida por procedimento e bootstrapping baseado em 1.000 amostras foi usada para determiner se as variáveis eram preditivas do sucesso no Teste de Proficiência em Mobilidade Motorizada do MS Israelense. RESULTADOS: Variáveis significativas na predição de sucesso foram identificadas: propulsão da cadeira manual, capacidade de iniciar e parar voluntariamente quando solicitado, e uso de controle do tipo joystick. O modelo foi capaz de identificar corretamente 80% das crianças. INTERPRETAÇÃO: Crianças e adultos jovens com a capacidade de iniciar e parar quando solicitados, de impulsionar uma cadeira de rodas manual por distâncias curtas, e usar um joystick para ativar a cadeira de rodas tiveram maior chance de se tornar proficientes. Em países em que a proficiência na cadeira é um requisite para solicitar a cadeira de rodas motorizada, estes achados podem dar suporte a mudanças nas políticas empregadas, como ocorreu em Israel.

Lessons learned from a pediatric powered mobility lending program.

PURPOSE: To evaluate children's characteristics and impact of a powered wheelchair lending program including comparisons of diagnostic sub-groups, and validation of a predictive model of powered mobility proficiency. METHODS AND MATERIALS: This retrospective study included 172 children who participated in the ALYN powered mobility lending program from 3/2009-7/2022. Demographics and functional levels were measured via questionnaires; driving proficiency was evaluated when the wheelchair was returned, and parents and children were interviewed following their participation in the program. RESULTS: Two diagnostic groups were identified: cerebral palsy (CP) (n = 136, median = 9.75 yrs) and other neuromuscular diseases (NMD) (n = 30, median = 5.83 yrs). They differed significantly in the age they commenced PM training, the male/female ratio, walking ability and access mode. Fifty-seven percent of the participants with CP achieved powered mobility proficiency, a rate that was significantly lower than the 73% proficiency found for the NMD group. Four significant predictors were identified: communication, manual wheelchair operation, access mode and go-stop upon request. They predicted proficiency in approximately 80% of cases. Overall feedback from the parents and children indicated that their personal and family's quality of life improved as a result of their child's ability to use a powered wheelchair. CONCLUSIONS: A lending program provides children with opportunities to improve mobility skills in an appropriate powered wheelchair. Children who can communicate verbally, propel a manual wheelchair, use a joystick and go-stop upon request are significantly more likely to become proficient drivers; however, many who were unable to complete these tasks also improved and even became proficient drivers.

Children who are able to engage in verbal communication, propel a manual wheelchair for short distances, use a joystick and go-stop upon request are significantly likely to become a proficient powered wheelchair drivers.Children with cerebral palsy who have greater physical challenges (e.g., cannot walk at all or propel a manual wheelchair) can reach powered mobility proficiency following practice with a powered wheelchair borrowed from a lending program, although at a lower rate than those with other neuromuscular diseases; additional training strategies should be developed to increase the percent success for children with cerebral palsy.A multivariate logistic regression was able to correctly predict whether a child will become proficient driver in 80% of case.Training with a powered wheelchair from the lending program enabled parents to observe their children's independent mobility in their home environment; they reported improvement in the family's quality of life.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice.

METHOD: Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP). RESULTS: All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only. CONCLUSIONS: This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

Development of a new tool: progression of paediatric powered mobility- 3PM.

PURPOSE: To develop a tool to assess the progression of powered mobility skills for children and determine its psychometric properties. METHOD: A three-phase, the mixed-method design included: I) conceptualisation based on international specialists' input through a focus group or interview to generate initial items; II) tool development using a two-round Delphi survey and III) evaluation of psychometric properties from eight video recordings of children. The Progression of Paediatric Powered Mobility (3PM) was validated via Intraclass correlation coefficients (ICC) calculated from conventionally powered mobility assessments: the Powered Mobility Program, the Assessment of Learning Powered Mobility tool, and the Powered Mobility Proficiency test. RESULTS: Content derived from 20 clinical experts led to the development of the first version consisting of 19 demographic and 61 driving skill items. Following two Delphi rounds, the final tool included 14 demographic and 41 driving skill items. Internal consistency was excellent (Cronbach alpha = 0.96) as was the inter-rater reliability (ICC = 0.96, 95% confidence interval = 0.95-0.96). Pearson correlation coefficients between the 3PM and other PM assessments demonstrated good convergent validity. CONCLUSION: The 3PM, created through international collaboration with experts in PM, has excellent psychometric values as a valid measure that can be used reliably to assess children's powered mobility skills.Implications for rehabilitationThe 3PM reflects the three stages of powered mobility development: exploratory, operational, and functional stages.Input from clinical experts in PM mobility contributed to the identification of the key driving skills important to include in the 3PM.A reliable and valid tool can facilitate assessment and tailored intervention in paediatric powered mobility.

Reliability and validity of pediatric powered mobility outcome measures.

PURPOSE: To determine the intra-rater and inter-rater reliability of the Powered Mobility Program (PMP) and the Israel Ministry of Health Powered Mobility Proficiency Test (PM-PT); to test inter-rater reliability of the Assessment of Learning Powered Mobility (ALP) tool; to determine the convergent validity of these measures for children with physical disabilities. MATERIALS AND METHODS: Participants included 30 children (mean 10 years, 6 months [SD 3 years, 7 months]; range: 6-18 years) with cerebral palsy and other neuromuscular disorders. Participants were non-proficient powered wheelchair drivers. Two blinded raters assessed the driving ability by viewing videos of the participants twice as they drove a pre-designed route at ALYN Hospital, Israel. They were assessed via the PMP, ALP and PM-PT outcome measures. Intra-class correlation coefficients (ICC2,1) were used to test intra-rater and inter-rater reliability and Spearman correlation coefficients were used to assess convergent validity. RESULTS: The PMP intra-rater reliability revealed ICCs2,1 of coefficients were 0.97/0.98 for both raters. For the PM-PT the ICC2,1 was 0.89/0.96 for both raters. The PMP inter-rater reliability ICC2,1 was 0.94/0.87 for the two tests, for the PM-PT the ICC2,1 was 0.91/0.87 for the two tests and for the ALP the ICC2,1 was 0.83. The convergent validity between the PMP and the PM-PT was rs=0.96, between the PMP and ALP was rs=0.89 and between the PM-PT and ALP was rs=0.87. CONCLUSIONS: The PMP and PM-PT intra and interrater reliability were good to excellent, the ALP inter-rater reliability was good and the convergent validity between all three measures was good to excellent.Implications for rehabilitationThere is evidence of validity and reliability for three tests of powered wheelchair proficiency (PMP, PM-PT and ALP).Children using powered mobility, aged 6-18 years, now have outcome measures with empirical evidence that was previously lacking.When time for assessment is limited, the shorter PM-PT can be used instead of the more comprehensive PMP.

Adaptive control of a wheelchair mounted robotic arm with neuromorphically integrated velocity readings and online-learning.

Wheelchair-mounted robotic arms support people with upper extremity disabilities with various activities of daily living (ADL). However, the associated cost and the power consumption of responsive and adaptive assistive robotic arms contribute to the fact that such systems are in limited use. Neuromorphic spiking neural networks can be used for a real-time machine learning-driven control of robots, providing an energy efficient framework for adaptive control. In this work, we demonstrate a neuromorphic adaptive control of a wheelchair-mounted robotic arm deployed on Intel's Loihi chip. Our algorithm design uses neuromorphically represented and integrated velocity readings to derive the arm's current state. The proposed controller provides the robotic arm with adaptive signals, guiding its motion while accounting for kinematic changes in real-time. We pilot-tested the device with an able-bodied participant to evaluate its accuracy while performing ADL-related trajectories. We further demonstrated the capacity of the controller to compensate for unexpected inertia-generating payloads using online learning. Videotaped recordings of ADL tasks performed by the robot were viewed by caregivers; data summarizing their feedback on the user experience and the potential benefit of the system is reported.

Lessons Learned during a Naturalistic Study of Online Treatment for Pediatric Rehabilitation.

The COVID-19 pandemic forced many health care providers to modify their service model by adopting telehealth and tele-rehabilitation with minimal time to plan for its execution. ALYN-Pediatric Rehabilitation Hospital in Jerusalem, Israel, responded with alacrity by providing a broad range of rehabilitation services to young people via online therapy during the first 5 months of the pandemic. The objectives of this naturalistic study were: (1) to monitor usage and user experience of online rehabilitation provided to young people receiving out-patient sessions of physical therapy, occupational therapy, speech and language therapy and psychology and (2) to consider the advantages and disadvantages of retaining this model of online treatment in full or in part post-COVID-19. The online rehabilitation treatment program was provided to 147 young people, aged 3 months to 20 years (mean 8.5 y; SD 5.3), and monitored and evaluated via data from the medical records as well as interviews, questionnaires and focus groups. The results use descriptive and inferential statistics to analyze data on the types and frequencies of therapy provided to 147 young people. Over a five month-period, 2392 therapy sessions were provided, 61 therapists from four disciplines were involved and 56.4% of the young people received two or more types of therapies via online rehabilitation. A repeated measures ANOVA showed significant differences over time per therapy. Feedback and recommendations about the process from therapists, parents and young people were collected during two focus groups of the professional staff (n = 12), parents and young people (parents n = 5, young people n = 3). Tele-rehabilitation services were perceived to be beneficial and effective by the great majority of young people, their parents and the healthcare professionals. The results are discussed within the context of conventional therapy as well as in comparison to reports of other online services for similar populations. We conclude that a hybrid approach in which in-person therapy sessions are coordinated with synchronous, online sessions, will provide a best-case fit for young people with chronic disabilities.

Comparing children's driving abilities in physical and virtual environments.

PURPOSE: To compare children's driving abilities in a physical and virtual environment and to validate the McGill Immersive Wheelchair Simulator (MiWe-C) for the use of children with disabilities. MATERIALS AND METHODS: Participants included 30 children (17 males, 13 females; mean age 14 y 1 mo, [SD 3 y 6 mo]; range: 5-18 y) with cerebral palsy, neuromuscular disease and spinal cord injury. All children were proficient drivers with more than 3 months' experience, who had their own powered wheelchairs. Participants drove a 15-minute physical route and high-fidelity simulation of that route in a counterbalanced order. Performance of the two routes was compared using the 32 item Powered Mobility Programme (PMP). Differences between the driving modes were analyzed with the non-parametric Wilcoxon signed-rank test. Significance was set at α = 0.05. RESULTS: The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M = 4.90, SD = 0.20; M = 4.96, SD = 0.12, respectively) with no significant difference between them (z= -1.69, p = .09). Five out of the 32 PMP tasks showed significant differences between driving modes (narrow corridors, crowded corridors, doorway, sidewalks), with higher scores for the physical driving mode. CONCLUSIONS: Having a validated powered mobility simulator for children provides a viable option for an additional practice mode. The MiWe-C simulator is affordable and a user-friendly simulator that can be used anywhere including at home and in school. Children can be independent when practicing even if they are not yet proficient drivers since continual adult assistance is not needed.Implications for rehabilitationHaving a validated powered mobility simulator for children provides a viable option for an additional practice mode.The MiWe-C is now validated to be used with children 5-18 years with physical disabilities.The MiWe-C is one of the few options for children to practice outside of a research environment.