Page 18 - Mobility Management, September 2019

Pediatric Series
I Can Push Myself!
Traditional Pediatric Concerns
Historically, Rosen added, pediatric specialists have largely focused on more immediate concerns of wheelchair seating, rather than on the longer-term impacts of self propulsion.
“I believe that most people who seat pediatrics are more worried about scoliosis and hip dislocations than they are about shoulder function into adulthood,” she said. “They’re thinking about the scoliosis you’re going to see up to that point, or the hip dislocation up to that point. Because most people who do pediat- rics don’t see adults.”
That focus on trying to prevent scoliosis or hip dislocation can cause seating teams to add components such as laterals to wheel- chairs being propelled by very small users.
“When I teach on this,” Rosen said, “I always quote the research: Lateral supports aren’t going to prevent scoliosis. There is a research article that looked at TLSOs [thoracic lumbar sacral orthoses] and found that kids with neuromuscular scoliosis can wear TLSOs 24 hours a day, only taking them off for showering or bathing, and they don’t slow the curve. So if a TLSO is not going to stop scoliosis, [laterals] are not going to stop it. If you need laterals because you can’t sit up straight to push, you get laterals. But if you don’t need them to function....”
What’s potentially wrong with adding components such as laterals to a wheelchair, even if the child doesn’t need them? Extra components can make a wheelchair heavier and harder to propel. Maybe the seating team can make an argument for extra
equipment to an older wheelchair user. But to a toddler? “They’re kids,” Rosen said. “If it’s easy to use, they’ll use it.
If it’s not, they won’t use it. When kids are little, it’s hard to convince them to use things they don’t like.”
Plus, a child who doesn’t use his wheelchair can grow up to become an adult who doesn’t use his wheelchair and therefore isn’t as active as he could be. “So [the team] is doing all this limiting of function to prevent something they can’t prevent anyway, and later we get the 300-lb. adult who has no motivation to move because they’ve never had functional mobility. Their chair has not been empowering to them because their chair was trying to prevent something we can’t prevent.”
If You Build It Right, They Will Use It
Young children are notoriously difficult to reason with, whether you’re trying to get them to try a bite of broccoli or try pushing a new wheelchair. So is getting them on board a matter of creating a wheelchair they want to use?
“I think a large part of it is ‘If you build it, they will come,’” Rosen said. “If you build that chair right, the chair from the
very first moment they are in it is empowering and gives them mobility in a way that they’ve never had it. So they do see it as an enabling device, something they want to use. Realistically, setting that chair up right, having a color the kid likes, all of that is huge, because they like everything from day one.”
So what does “building it right” mean in concrete terms? First,
Resources: When Kids Self-Propel
Centers for Disease Control (CDC) Growth Charts: Children with Special Healthcare Needs
Information on children with conditions that affect growth, including chromosomal and genetic disorders, neurological disor- ders that affect independent ambulation (such as spina bifida), low birth weight, or feeding difficulties. https://www.medicalhomeportal.org/link/5550
CDC Growth Charts: Duchenne Muscular Dystrophy
Focuses on boys aged 2 to 12 years who are still able to walk.
https://www.cdc.gov/features/musculardystrophyresearch/index.html
Journal of Rehabilitation Research & Development: Shoulder Pain in Adult- vs. Childhood Onset Wheelchair Users
Does a growing child respond better to repetitive wheelchair propulsion than an adult does? https://tinyurl.com/shoulderremodel
Pediatric Growth Charts
The Life Expectancy Project features growth charts for children with cerebral palsy; charts are provided for Gross Motor Function
Classification System (GMFCS) groups 1 through 5.
http://www.lifeexpectancy.org/articles/GrowthCharts.shtml
SMA News Today: Growth Information for Children with Spinal Muscular Atrophy
Some children with SMA experience “growth failure,” while others become obese as they lose muscle and become non-ambulatory. https://hcp.smanewstoday.com/spinal-muscular-atrophy-assess- ment-of-growth-and-growth-delay/
SCIRE’s Stroke Patterns in Wheelchair Propulsion https://tinyurl.com/strokepatterns
Podcast: Power Assist from a Proactive Perspective
Curtis Merring, OTR, MOT, Clinical Education Manager for Permobil, discusses power assist, but from
a proactive rather than a reactive perspective. Go to http:// mobilitymanagementpodcast.libsyn.com to access this and other Mobility Management podcasts. m
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