Page 16 - Mobility Management, April 2019

ATP Series
Early Intervention & Spina Bifida
Power Up!
“It’s really imperative that we give kids with mobility limitations access to independent mobility at the same as their peers are starting to experience independent mobility, and that happens very young,” said Amy Morgan, PT, APT, territory sales manager for Central and Southern Ohio at Permobil. “We need to start supplementing children who can’t do that on their own to at least give them the opportunity to explore their environment and to develop their brains the same way that their peers are doing.”
This is where power mobility comes in. Morgan said that infants and young toddlers have yet to develop the musculature to self propel a manual wheelchair. “While kids can do that a little bit, maybe in a small environment, sometimes it’s really more necessary at that younger age to give them power mobility, simply because their skeleton and their muscular system aren’t developed enough to operate a manual chair,” she explained.
Introducing infants to power mobility, however, is a rela- tively new idea. In 2009, the journal Pediatric Physical Therapy published a case report entitled “Power Mobility Training for
a 7-Month-Old Infant with Spina Bifida” that explored the feasibility of implementing power training programs in infants with spina bifida as young as 7 months. Investigators found that infants could use power mobility to explore their environments in a way that could impact learning and various perceptual, cognitive and social outcomes.
If children with mobility limitations do not attain independent mobility along with their typically developing peers, they are at risk of missing critical developmental stages that could impact them in adolescence and into adulthood. For instance, Mallory said, “Many studies have shown that if a child was not given the opportunity to be mobile, and preferably independently mobile, by the age of 3, they lose the ability to learn different functions like object permanence, position in space, and they’re much less apt to interact with their environment.”
Morgan described the early developmental stages when infants and toddlers develop these skills as “the sponge phase” of the brain. “During the early years, a child’s brain is developing
like crazy, and changing, and learning and adapting to their
24-Hour Postural Management Is Key
Correct seating and positioning should not just start at an early age
— in infancy, ideally — but also be implemented often. In fact, Ross Andrews, International Business Manager and Seating Specialist with Specialized Orthotic Services (SOS) by Drive, said that postural management should be carried out throughout the day and night.
“I think 24-hour posture management is definitely key,” he said. “The book doesn’t just stop at getting a [wheel] chair, because if you break it down into numbers: I might sit in a chair between six and eight hours a day. That’s
roughly one-third of the day. If the other two-thirds of the day, I’m in a very poor position, what that chair is doing towards maintaining a good posture or corrective is just going to be undone in the other 16 hours.”
Proper positioning also includes sleep — a time when people are likely to slip into positions that are comfort- able but not necessarily beneficial from
a clinical standpoint. Andrews said, “Everyone when they sleep, they get into a preferred position. And for some of our clients, that preferred posi-
tion can be detrimental to that spinal position.”
Implementing 24-hour posture management can dramatically reduce the rate of degeneration over time. “This disability will mean eventually, if
not supported correctly, they get that severity of scoliosis that can poten- tially lead to lung collapse on one side because the scoliosis is worsening
so much,” Andrews explained. “This 24-hour posture management and early prevention with corrective seating and positioning for spina bifida clients specif- ically are potentially life-lengthening pieces of equipment.” m
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