Powered Mobility
OUR VIEW
Every child WANTS to move! It is engrained in our DNA from birth, regardless of motor ability. This is a fundamental building block that provides the base for many other skills such as cognitive development, visual motor skills, and social development. Children learn through exploring and moving, and we believe that all kids should have the opportunity to move independently. It should not be assumed that a child “can’t” move, when they have never been provided with an opportunity to move. We believe that all children deserve an opportunity to move, regardless of their motor capabilities.
Tips & Tricks
POSITIONING
Positioning is the number one priority when looking at how kids will access powered mobility. If a child is not positioned well, it will look as though they are “unable” , when in fact it is our error in not setting them up properly. If a child is not weight bearing through their hips, they will not have the ability to utilized controlled movements of their extremities. Even though this wheelchair is not designed for him, and he is is not given the extra supports such as a chest harness or lateral supports, you can see the immediate impact that positioning plays in his ability to hold his head up. We must look at the whole body positioning and what muscles he has to recruit to move purposefully.
SWITCH PLACEMENT
Positioning also plays a part in switch access. It seems ingrained in our brains as a therapist that we WANT our children to hit the switch with their hands. However, in order to have the skills needed to hit the switch with your hand; you need stability in your trunk so that your hands can be free, you need vision to be able to locate and see the switch, and you need shoulder stability to be able to make a graded and controlled movement in order to activate and lift off of the switch. If your child had all of those skills, you probably wouldn’t need a switch to begin with! The goal is that our kiddos will ENGAGE IN THE ACTIVITY, not that they will hit a switch! Switches without activity have no purpose or meaning, so the switch needs to be placed in a position that the child can actively participate in the activity. The moment I started looking at this subtle change, everything changed for my kiddos. For example, I frequently utilize head switches for many of my kids. As an OT, I truly WANT my kids to use their hands, but I also want them to engage in activities.
By placing the switch by their head, it eliminates the need for vision to locate the switch; and it eliminates the stability and graded muscle movements needed to access a switch with their hands. Typically, developing babies first develop head control prior to any other motor skill. Children and adults with degenerative conditions are likely to lose head control as one of the last motor skills to go. We need to put the switch in a location that the child can easily access, and not get hung up on putting a switch in a place in hopes that the child will want it enough to move.
WHEN SHOULD I INTRODUCE POWERED MOBILITY
Children learn because they move! If you think about typical development, toddlers will crawl to the kitchen cabinets and pull out the pots and pans. They learn how the pots clink together, and how to stack them on top of each other. They learn many skills because they move and explore, not because we as parents strap them in a chair and decided that pots and pans are what they should learn today.
The same principles should be applied to our special children. Typical children would be walking between 12-15 months, so if my special child is not showing signs of mobility at that time, I will introduce powered mobility. If we are working with a child with severe physical limitations, I do not want them missing out on all of the learning opportunities they need because we are waiting on their physical skills to develop. All research has proven that powered mobility does not delay children from walking! Children are not lazy; and if they have the skills to walk, they will! In addition, children want to move! Powered mobility is the easiest way to determine a switch site because every child wants to move! Not every child wants to play with the switch toy or communicate, but every child WANTS to move. It is built into our DNA and does not require being taught.
CUEING
We are teaching children how to move. We are not testing them to see if they can follow our directions. So it is incredible important to allow our children to move and explore without over cueing them. No one enjoys having a back seat driver in the car, and over-cueing our children will only increase anxiety and stress. When a child is learning how to move, it is imperative that you put language to what they are doing; “I like the way you stopped.”, “That is a great turn.”, “How are you going to get there”. Our children that have never moved before do not have the language skills to understand commands such as, “come here”, “turn around”, follow me”. In addition, when you are cueing a child to “stop”, you need them to understand that “stop” means pull you head off of the switch.
When we have taught them the word “stop” before, it would usually mean that we would stop an activity. Verbal cueing needs to be done from the very beginning to put language to what the child is doing, and allow the child to lead and explore on their terms.
SINGLE SWITCH SCANNER
A single switch scanner may be a valuable alternative access method for a child with limited motor skills Because you only need one switch site. This system would scan through the options (forward, right, left, backwards) and when she heard or saw the direction that she wanted, she can hit the switch. In this video, she is given the auditory cue as to which direction it is scanning on, and she is able to activate a switch by her foot when she hears the one she wants. This does require that the switch site is reliable and the child has good timing in order to be accurate, however, requires little physical exertion.
TWO SWITCHES WITHIN A HEAD ARRAY
A head array traditionally has three switches. The left switch turns it left, the right switch would turn right, and the back pad would make the chair go forward. However, many of the children we work with do not have the head control to be able to keep their head lifted off of the head rest. It is possible to disable the back pad so that the children have a head rest, and alternatively provide one switch (right turns her right),and the other switch (left makes her go). Many children are able to drive functionally only using two switches until a third switch site can be found.
THE POWER OF INDEPENDENT EXPLORATION
Independent mobility is the first opportunity that a child has for independent initiation of play. That is a very long way of saying that our children deserve a chance to show us what they want to do. Society makes assumptions and judgements against kids with severe physical limitations.
A child who can move independently, initiate activities, and follow directions is assumed to be cognitively more capable. Powered mobility can provide an avenue to allow our children to communicate their interests and needs, just as other children would pull you to the pantry when they wanted a snack. When we ask a typical toddler if they want to play with Cookie Monster or Elmo, and they run away to grab Buzz Lightyear, we understand that they didn’t want either of our options. When we present those same two options to our physically complicated kids, and they look away, many people then assume that the child didn’t understand and is not capable of making a choice. Our children deserve the opportunity to run away, to get into mischief, to explore their environments, and to find their own interests. Powered mobility is one of the easiest ways to find activities of interest, and allow for independence.
TACTILE SWITCHES
Movement is motivating, so I continue to utilize powered mobility even for kids with severe visual impairments. In this situation, I provided different tactile fabrics on his switches so that I could teach him that the “bumpy” switch does something different than the “slick” switch. Powered mobility also provides a way to determine WHAT kids can actually see. I can determine by watching how they access powered mobility if they can differentiate between background and foreground, how far away to they have to be to visually pay attention to objects, or if they visually see obstacles and make necessary adjustments.
PROXIMITY SWITCHES
There are multiple types of switches, and that can make a significant difference as to whether your child is successful for not.
Look for what the child can already do, and find 500 ways to maximize that movement. In this case, he was able to wiggle his toes. We used proximity switches because they require little movement, which is conducive to the small movements made by his toes. A proximity switch means that you do not need to touch or depress the switch, but you only need to get close to the switch to activate it. This is optimal for children with very small movements, and it does not create fatigue caused by having to physically push the switch down for periods of time. In addition, when you have children with extreme spasticity, switching to a proximity switch can inhibit them from utilizing the full extension patterns associated with the force required for a mechanical switch.
REQUEST A CONSULT
If you are interested and would like to see if your child is a good fit, or if you would just like to talk to one of our providers, please reach out for an online consult!