The Value of Providing Early Mobility to Infants with Motor Impairments: For Patients, Families, and Physical Therapists

Background:

My passion for working with children was established long before entering UNC’s DPT program. After exploring the many ways I could combine this passion with my interest in human movement, I felt drawn to becoming a pediatric physical therapist. Throughout the DPT curriculum, I have learned the many ways in which physical therapy can impact a child’s immediate life; however, I have also learned how this impact can extend far into the child’s adolescent and adult life as well. The opportunity to make a tremendous difference in a child’s life is so special, and has remained my motivation throughout my education.

During a lecture given by pediatric physical therapist Cathy Howes, I was introduced to the concept of early mobility. She mentioned how researchers are using modified toy ride-on cars to achieve early mobility for children with motor impairments, and ultimately promote areas of development such as cognition. I was intrigued by this notion, as this was the very essence that has driven my passion for pediatrics. For my critically appraised topic in the EBP-II course, I elected to develop a deeper understanding of the importance of early mobility as well as the emerging evidence behind modified ride-on cars.

 

Overview/Purpose:

Research has demonstrated that early mobility allows children to explore and learn from their environments, contributing to cognitive development and even language and social skills.¹ For children with motor impairments, early mobility is often limited or delayed, resulting in delayed acquisition of cognitive, language, and social skills.¹ Assistive devices have been developed in order to improve independent mobility for these children; however, these devices are often not commercially or financially available for children younger than 2 years old, leaving children with mobility impairments at a disadvantage for developing critical skills during these formative years.²

Programs such as GoBabyGo! have produced modified toy ride-on cars for young children with motor impairments in order to bridge this gap.³ While the research surrounding these cars is relatively limited, results have demonstrated improvements in independent mobility, language, and socialization. The most important piece remains independent mobility, which acts as a springboard for other critical components of development.

 

Statement of Need:

Throughout personal research as well as research performed during the EBP-II course, it became evident that modified ride-on cars are primarily being used in larger PT practices associated with academic institutions. Additionally, I learned that while these cars are low-cost compared to powered wheelchairs, third-party payers will not provide reimbursement for their use. For my Capstone Project, I wanted to create resources that would make modified ride-on cars a more familiar and feasible intervention option for all pediatric PT practices. Cathy Howes and fellow pediatric physical therapist Mae Thomas, who both have a wealth of clinical experience, agreed to serve as committee members and mentors through the development of these resources.

 

Products:

Three products were produced as part of this Capstone Project. First, I created a written literature review of the available evidence pertaining to early mobility. This evidence included: 1) early mobility for children developing typically, 2) early mobility for children with motor impairments, 3) early mobility via pediatric assistive devices, and 4) early mobility via modified ride-on cars. This information, as well as information regarding seeking and requesting funding for modified ride-on cars, was integrated into a PowerPoint Presentation (pdf version linked). This presentation is designed to serve as a clinical resource for pediatric physical therapists who are considering and requesting funding for patients who may benefit from modified ride-on cars. Finally, a parent-friendly handout was created in order to introduce families and/or caregivers to modified ride-on cars. This handout describes the benefits of early mobility for all children, how modified ride-on cars can help achieve these benefits, and important factors to consider before bringing a car home.

 

Evaluation:

Throughout the process of creating my literature review, PowerPoint presentation, and family handout, I utilized feedback from my committee members to improve each of my products. Additionally, my PowerPoint presentation will be delivered as an inservice to pediatric therapists working in an outpatient setting during my final clinical experience. In order to supplement the inservice, my written literature review and parent handout will also be made available to the therapists. I have created two digital surveys for inservice attendees to complete. The first survey will be sent to attendees prior to the inservice, and will assess pre-existing knowledge of presentation objectives. The second survey will be sent following the inservice, and will assess whether the presentation helped improve knowledge of content. The second survey also includes questions related to presentation delivery. This survey system will help determine whether presentation objectives were met, as I will be able to compare pre- and post-presentation responses. However, it will also give me feedback directly related to my presentation skills. This will allow me to maximize the clinical relevance of my products, and to better my personal presentation skills.

 

Self-Reflection:

Through this project, I have been able to expand my personal knowledge of early mobility and its benefits. As a result, I feel better prepared to serve not only children and families considering use of modified ride-on cars, but also all children with motor impairments. Additionally, I have gained greater exposure to the application of early mobility and use of modified ride-on cars in clinical practice. This has occurred through frequent feedback and input from project advisors, as well as conversations with pediatric therapists and researchers who are spearheading programs such as GoBabyGo! By connecting with these established clinicians, I have developed an appreciation for the mentorship, encouragement, and forward thinking that exists within the pediatric physical therapy profession.

In developing my parent handout, I have experienced the important need for considering family factors when choosing interventions for a child. Ultimately, if a patient’s family is not in agreement with the use of a modified ride-on car, or if other barriers exist in the family’s home, the process of obtaining and funding a car is of no use. Finally, I have become more familiar with seeking and requesting funding for pediatric assistive equipment, which can seem a daunting task to a novice clinician.

Overall, I am proud of my products, but I feel equally grateful for the personal learning, growth, and relationships that have occurred throughout this process. I am also thankful to have developed a deeper appreciation for the pediatric PT profession through my project. Modified toy ride-on cars represent what so many pediatric PT interventions can achieve: lifelong improvements in impairments, participation, and ultimately quality of life. It is my hope that the resources developed through my project will serve to make these cars a more familiar and feasible option for physical therapists, patients, and families.

 

Acknowledgements:

I would like to thank my committee advisor Debbie Thorpe, PT, PhD, and committee members Cathy Howes, PT, DPT, MS, PCS and Mae Thomas, PT, DPT, PCS for all of the time and effort they have devoted to my Capstone materials. Their expertise provided valuable insight into every aspect of this project, and I cannot thank them enough for being willing to share this with me. Thank you also for serving as professional role models to me throughout the DPT program. I would also like to thank Stacey Dusing, PT, PhD, Kate Smotrys, PT, DPT, and Sam Logan, PhD, for sharing the work they are performing in their respective GoBabyGo! programs. Their pursuit of knowledge and absolute willingness to share this knowledge is inspiring. Finally, a thank you is in order to my husband. Thank you for chasing this and every one of my dreams with me.

 

References:

1. Lobo MA, Harbourne RT, Dusing SC, McCoy SW. Grounding early intervention: physical therapy cannot just be about motor skills anymore. Phys Ther. 2013 Jan;93(1):94-103. doi:10.2522/ptj.20120158.
2. Logan SW, Feldner HA, Galloway JC, Huang HH. Modified ride-on car use by children with complex medical needs. Pediatr Phys Ther. 2016;28(1):100-107. doi:10.1097/PEP.0000000000000210.
3. University of Delaware. GoBabyGo! University of Delaware. https://sites.udel.edu/gobabygo/. Published 2019. Accessed March 28, 2019.

Image Source: https://www.wvxu.org/post/go-baby-go-cars-give-tots-mobility-issues-new-moves#stream/0