Page 14 - Mobility Management, January/February 2022

Pediatric Series
Acommon pediatric mobility precept is that operating a wheelchair requires a good grasp of cause and effect. Before kids can effectively self propel a manual wheel- chair or drive a power wheelchair, they need to fully understand that their actions cause consequences.
But is it that simple?
Lauren Rosen, PT, MPT, MSMS, ATP/SMS, Program Coordinator at the Motion Analysis Center at St. Joseph’s Children’s Hospital of Tampa, Fla., had a follow-up.
“With cause and effect, the issue is that you don’t necessarily have cause and effect before we do mobility,” she said.
So — is that precept correct? Or is it due for an update?
True Cause & Effect
It wasn’t too long ago that children usually couldn’t get a power wheelchair trial until they were preschool or kindergarten age. But over the years, pediatric mobility advocates have argued
for earlier intervention. For example, Cole Galloway, Ph.D.,
and the team behind GoBabyGo at the University of Delaware demonstrated more than a decade ago that older infants and toddlers could ably drive themselves in toy vehicles powered by batteries and switches.
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Rosen agreed that some children are presumed not to under- stand cause and effect — and are therefore excluded from wheel- chair trials — because they are too young or unable to speak or are simply uninterested in typical cause-and-effect testing.
“Especially if you’re little, maybe you had a therapist who played with a Busy Box with you, where you push the button and Elmo pops out,” Rosen said. “But some kids don’t like the Busy Box because when Elmo pops up, it scares them.
“Or I hit the button, and the blower blows bubbles in my face. I don’t like things in my face! But if I don’t have a lot of movement and I don’t have language, you might not know that bubbles in my face really annoy me.”
Rosen added that a child who genuinely doesn’t understand switch toys might actually understand a power wheelchair better.
“Because hitting a [power chair] switch with movement provides a vestibular input that you don’t get with bubbles coming into your face, sometimes the cause and effect makes more sense to my brain,” she said. “So sometimes the first two times I move the chair, I may not look like I necessarily get that I did that. Usually the first time, there’s this weird, surprised look like ‘What just happened here? Why did it do that?’ Then they hit it again, and it’s ‘Huh. Did I really do that?’ Then the ones with
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