A Systematic Review of Infant Use of Powered Mobility

Mobility, typically within the first year of life, allows infants to effectively explore their environment, usually via crawling and walking. They begin to learn how they can interact with objects or people in their environment and surroundings. While the ability to explore the environment is of great value to the life of an infant and considered a major developmental milestone, the start of independent mobility in infants has underlying importance beyond the ability of self-locomotion. Mobility has been shown to influence development within the following areas: perception, cognition, socialization (Campos et al., 2000) spatial skills and spatial cognitive development (Yan, Thomas & Downing, 1998). Campos et al. (2000) demonstrated that locomotor experience in infants, as a “crucial agent of developmental change” (p. 151) and a point of significance for psychological transitioning, can have a range of extensive consequences on their development. In typically developing children, the initiation of mobility will aid them in their development across the array of areas aforementioned; however, infants with mobility impairments may be inhibited from having locomotor experiences, thus impacting their developmental progress. Gibson’s Theory surrounding the idea of affordances exhibits the importance of mobility (Gibson, 1988). Affordances exist within the physical environment and are qualities or properties of objects or the environment that stimulate action possibilities. To learn about the affordances in one’s environment, Gibson (1988) asserts that learning entails exploratory activities. Exploratory locomotion promotes the development of a cognitive map to help infants piece together knowledge of their surroundings. Currently, powered mobility is turned to as an option to facilitate the developmental growth in infants who have a mobility impairment. In the last 20 years, the use of powered mobility by young children has increased significantly (Wiart, Darrah, Cook, Hollis, & May, 2003). A majority of those that use powered mobility devices use a joystick as a means of control (Fehr, Langbein, & Skaar, 2000). Unfortunately for young children, the use of a joystick to control a mobility device has proven difficult (Dennis et al., 2013; Galloway, Ryu, & Agrawal, 2008). Barriers restricting the extensive use of powered mobility devices in infants include behavioral, physical and family factors (Guerette, Tefft, & Furumasu, 2005). The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) recommends early use of powered mobility for infants with a mobility impairment “to promote integration and psychosocial development, reduce passive dependency, and to enhance participation, function, and independence” (Rosen, et al., 2009, p. 219). With that being said, studies have been completed to assess infant driving. Researchers across many fields, such as occupational therapy, physical therapy, engineering, and computer science, have conducted studies with some form of powered mobility that they have either designed or that can be purchased to support infants who are mobility impaired as an aid to their development. Single subject cases and case studies such as Butler (1986), Deitz, Swinth, and White (2002), Kenyon et al. (2016), Sonday and Gretschel (2015) and an experimental study conducted by Jones, McEwen and Neas (2012) all demonstrated that the development of children with motor impairments is positively effected via the use of forms of powered mobility. Seeing that powered devices reflect positively on the lives of infants with mobility impairments, a systematic review of research of children using powered devices, in particular with a joystick, was conducted. Over the course of four months, various research studies were compiled and analyzed varying in infant ages, measures, and those including typically developing infants or not, to shape this systematic review. Research conducted thus far often compare various types or modifications of powered mobility devices to each other and analyze differences in child driving performance. However, there is a discrepancy between researchers as to how driving should be assessed and when it is feasible to give clients a power mobility device. Researchers have not collected data to specifically analyze the various capabilities and strengths toddler drivers have at various ages. Therefore, there is not sufficient research in existence that exemplifies any age appropriate driving skills when using a joystick device. The discovery after the completion of this systematic review is the need for targeted research as the larger question still remains the ability to describe the progression of infant driving skills with a joystick device