Page 16 - Mobility Management, September 2019

Pediatric Series
I can push myself!
By Laurie Watanabe
When teaching a new user how to optimally self propel a wheel- chair, you might talk about propulsion efficiency, getting the most distance from each stroke, and how the right mechanics can reduce the risk of repetitive strain injuries down the road.
Unless that new user is, say, a 2-year-old more interested in Peppa Pig than proper hand placement on a handrim.
Lauren Rosen, PT, MPT, MSMS, ATP/SMS, is the Program Coordinator for the Motion Analysis Center at St. Joseph’s Children’s Hospital in Tampa, Fla., where she runs a three-di- mensional Motion Analysis Lab and a pediatric and adult wheel- chair seating and positioning clinic.
Rosen assesses some very young children for seating and mobility, and due to her 20-year tenure at St. Joseph’s, she’s also seen the impact of early self propulsion as her pediatric users have grown up.
When Kids with Disabilities Grow Up
That long-term perspective isn’t something that every pediatric specialist experiences, Rosen said, and she added that to this point, research on very young self-propellers has largely been lacking. “The biggest problem honestly is all the research we have on propulsion is adult,” Rosen said. “So these were people
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who for the most part make it through most of their growing, and then had an injury and became wheelchair propellers. What we don’t have are good studies looking at shoulder remodeling in kids who propel.”
A 2005 Veterans Affairs study (see sidebar) suggested that a child’s body might better adjust to the rigors of self propulsion than an adult’s. As Rosen noted, the study “hypothesized that maybe there is some remodeling going on in the shoulders of these users who are children when they start propelling. And
so maybe they’re not as predisposed to shoulder problems.” But beyond the relative lack of research, Rosen said the industry only recently began considering pediatric self propulsion as part of a life-long continuum.
“I feel like 10 or 15 years ago, we started really realizing that kids with disabilities become adults with disabilities,” Rosen said. “We started to realize that these kids lived full lives, and
so we’ve just started looking at lifespans of these kids and what’s happening. I’ve been in the same facility for 20 years, so I’ve seen kids who are now adults. I’m seeing what they look like as adults, and I’m learning lessons from what I did when they were 4. But if you don’t see your 4-year-olds when they’re 30, you have no idea what’s happening to these kids.”
Teaching Self-Propulsion to Children Starts with Setting Up the Best Chair
MobilityMgmt.com
CHILD WITH HAT: PIXABAY/ESUDROFF