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

Dicesare v. Comm Social Security

USDC for the District of New Jerse

Brenda Dismuke v. Comm Social Security

USDC for the District of New Jerse

A Moment in Human Development: Legal Protection, Ethical Standards and Social Policy on the Selective Non-Treatment of Handicapped Neonates

Selective non-treatment decisions involving severely handicapped neonates have recently come under renewed judicial and legislative scrutiny. In this article, the author examines the legal, ethical and social considerations attendant to the non-treatment decision. In Part II he discusses the predominant ethical viewpoints relating to this issue and proposes a new moral standard based on personal interests. Part III presents a survey of the jurisprudence relating to selective non-treatment decisions. Parts IV and V of this article provide a critical examination of the recently enacted Child Abuse Amendments of 1984, a federal legislative initiative designed to regulate treatment decisions relating to handicapped infants. The author suggests that the ethical standards and treatment criteria proposed in this article may prove useful to courts seeking to balance the handicapped neonate\u27s constitutional right to privacy with the requirements of the new federal law

Russell Hess, III v. Commissioner Social Security

USDC for the Eastern District of Pennsylvani

Changes in the EEG Spectrum of a Child with Severe Disabilities in Response to Power Mobility Training

Literature suggests that self-generated locomotion in infancy and early childhood enhances the development of various cognitive processes such as spatial awareness, social interaction, language development and differential attentiveness. Thus, having access to a power mobility device may play a crucial role for the overall development, mental health, and quality of life of children with multiple, severe disabilities who have limited motor control. This study investigates the feasibility of using electroencephalography (EEG) as an objective measure to detect changes in brain activity in a child due to power mobility training. EEG data was collected with a modified wireless neuroheadset using a single-subject A-B-A-B design consisting of two baseline phases (A) and two intervention phases (B). One trial consisted of three different activities during baseline phase; resting condition at the beginning (Resting 1) and at the end (Resting 2) of the trial, interaction with adults, and passive mobility. The intervention phase included a forth activity, the use of power mobility, while power mobility training was performed on another day within the same week of data collection. The EEG spectrum between 2.0 and 12.0 Hz was analyzed for Resting 1 and Resting 2 condition in each phase. We found significant increase of theta power and decrease in alpha power during all three phases following the first baseline. In respect of previous findings, these observations may be related to an increase in alertness and/or anticipation. Analysis of the percentage change from Resting 1 to Resting 2 condition revealed decrease in theta and increasing alpha power during the first intervention phase, which could be associated with increasing cognitive capacity immediately after the use of power mobility. Overall, no significant difference between baseline phase and intervention phase was observed. Thus, whether the observed changes may have been influenced or enhanced by power mobility training remains unclear and warrants further investigation

2016 Author Recognition Bibliography

https://scholarworks.gvsu.edu/authorrecognition/1010/thumbnail.jp

Planning for a Medical Surge Incident: Is Rehabilitation the Missing Link?

This study explores planning considerations for patients needing rehabilitative care in the event of mass casualty incidents, in particular, patient surge. While planning for a patient surge usually considers prehospital and hospital care, the final step for many disaster patients, rehabilitation is often overlooked. Rehabilitative care begins in the hospital, before discharge, with the consultation of a physician specialist. By including early physiatrist care there are documented decreases in hospital length of stay, fewer medical complications and better functional outcomes. Based on past disaster studies, the variables of Simple Triage and Rapid Treatment (START), Injury Severity Score (ISS), and hospital discharge were chosen as benchmarks. The quantitative study research questions are: Can START classifications predict whether a patient will need to be admitted into a rehabilitation facility after a disaster? Can ISS scores predict which patients will need to be admitted into a rehabilitative facility after a disaster? A secondary disaster dataset was constructed from the 2011 National Trauma Data Bank (NTDB) dataset for patients injured during a disaster. Analysis of this empirical data provided evidence that the selected variables did predict rehabilitation admission, and thus can be used in pre-disaster and operational medical planning. Qualitative methods were used to investigate how rehabilitation considerations might be incorporated in surge planning. A Haddon matrix for surge planning provided the conceptual framework and aided in the development of interview questions. Six themes were analyzed based on the interview question responses: barriers to planning; multiple surges; planning for v resources; planning to prevent injuries; optimal time to look for rehabilitation beds; and, additional recommendations. The insights of subject matter experts revealed many new strategies to improve surge planning and patient outcomes. This study concludes that a reconceptualization of surge planning to include three phases of field, hospital, and rehabilitation is a needed improvement to medical disaster planning

The Impact of Family Income and Primary Caregiver Education Level on the Usage of Modified Ride-On Cars Among Children with Disabilities

Modified ride-on cars are used by young children with disabilities for self-directed mobility. Purpose: The purpose of this study is to (1) determine the association between modified ride-on car driving time, family income, and primary caregiver education level; and (2) compare modified ride-on car driving time, family income, and primary caregiver education level between High Use and Low Use groups in the study. Method: The amount of time fourteen children with disabilities utilized modified ride-on cars during a three-month study period was recorded and analyzed according to family income and primary caregiver education level. Results: Driving time and family income, as well as family income and primary caregiver education level were correlated but driving time and primary caregiver education level were not. Between the High Use and Low Use groups, driving time was significantly different, but no significant differences were demonstrated in family income or between primary caregiver education level. Conclusion: A child’s access to and usage of modified ride-on cars is impacted by intersectional factors beyond their disability. Effective rehabilitation interventions should consider factors such as family income and parental education level when working to address the physical or cognitive development of children with disabilities. Key words: modified ride-on car, family income, primary caregiver education level, driving tim

Changes in Neural Network Connectivity of Normal Young Adults in Response to Power Wheelchair Trainer using EEG Coherence

The ability to move and explore their surrounding environment plays a critical role in the development of cognitive function in children, especially during early childhood. The lack of independent and autonomous mobility is, therefore, a clear disadvantage for the overall development of children with multiple, severe disabilities. Limited number of studies have been conducted on the impact of power mobility device on this specific population. Previous exploratory and pilot studies showed promising results regarding quantifiable and consistent changes in the electroencephalogram (EEG) of children with multiple, severe disabilities when provided with power mobility training. This study aimed to further extend our understanding of the cognitive impact of power mobility training on a different population: healthy young adults aged 18 to 24 – a well-studied neurotypical control population. The study used Magnitude-Square Coherence (MSC) derived from the electroencephalogram (EEG) recorded at resting-yet-awake state before and after power mobility training to investigate changes in the functional connectivity in the brain of seven healthy young adults in the 18-to-24-year-old age range. Neural processes invoked between different functional lobes in the brain in: delta (1-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), beta (14-30 Hz), and gamma (31-100 Hz) in response to power mobility training were examined and analyzed. Statistical analyses were then performed on the change, or difference in EEG coherence between the 5-minute rest with eyes closed before and after power mobility training. Results from both the paired t-test and the Wilcoxson-signed rank test with an alpha level of 0.05 (p≤0.05) on the change in EEG coherence after mobility training showed an overall decrease in EEG coherence between the parietal and temporal regions on healthy young adults after using the Trainer in all five frequency bands. Reduced interregional EEG coherence was found in the centro-parietal region for both the delta and beta frequency. Lower EEG coherence was also noted between the frontal and temporal regions in alpha frequency. These findings help edify that power mobility training is responsible for objectively quantifiable changes in neural network connectivity that may be correlated with improvement in subjective measures of cognitive gains on children with multiple, severe disabilities