Sol M.1,2, De Groot J.F.1,3,4, Verschuren O.2,3,4, Visser-Meily A.2
1HU University of Applied Sciences Utrecht, Research Group Lifestyle and Health, Utrecht, Netherlands, 2University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, Utrecht, Netherlands, 3University Medical Center Utrecht, Wilhemina Children's Hospital, Child Development and Exercise Center, Utrecht, Netherlands, 4University Medical Center Utrecht and Rehabilitation Center De Hoogstraat, Partner of Shared Utrecht Pediatric Exercise Research Lab, Utrecht, Netherlands
Background: Children using a manual wheelchair with various disabilities, such as cerebral palsy or spina bifida, are dependent on their wheelchair for participation in daily life, community or sports settings. Participating at a similar level as their typically developing peers is more challenging due to their disability and wheelchair use. Several studies have confirmed that children with a disability have reduced levels of activity and fitness. Recently, a qualitative study in children using a wheelchair and their parents described facilitators and barriers which could influence participation in physical activity. One of the facilitators mentioned was wheelchair skills training, where children learn to become independent and confident in using their wheelchair. In adults, wheelchair skills training has proven to be beneficial towards gaining wheelchair skills and confidence. The benefit of wheelchair skills training in children remains unknown.
Purpose: The purpose of this study was to evaluate the effectiveness of wheelchair skills training in children.
Methods: Children who use a manual wheelchair were recruited via a patient organization or special needs school. All children followed four to six wheelchair skills training sessions by an experienced trainer over a period of six months. Parents were invited to attend all the training sessions and get involved with practicing the wheelchair skills. A repeated measures design was used to assess the pre-post training results on the Utrecht Pediatrics Wheelchair Mobility Skills Test (UP-WMST). The UP-WMST consists of 15 items that are measured with a time score. The ability to complete six of these items are combined to give a total ability score. In addition, patient reported outcomes from children and parents were recorded.
Results: Thirty-five children using a manual wheelchair started the wheelchair skills training program. The mean time to complete an item on the UP-WMST showed an improvement on 13 of the 15 items, with a significant improvement in six of these items. In addition, the total ability score showed a strong significant improvement. All children and parents reported an improvement in wheelchair skills and all but one child noticed an increased confidence in wheelchair use.
Conclusion(s): These preliminary findings on the UP-WMST show overall positive results of the wheelchair skills training program, where children not only improved their ability to conquer obstacles but also increased their time to complete most items. These results are endorsed by the positive findings of children and parents on the effect of the wheelchair skills training program.
Implications: Wheelchair skill mobility has the potential to become an important treatment goal for children with congenital or acquired physical disabilities who are dependent on the use of a manual wheelchair in daily life, community or sports setting. Moreover, the involvement of parents during the training program is a very important aspect. The experiences of parents to see their child independently perform wheelchair skills leads them to stimulate their child becoming independent in wheelchair mobility in daily life. Furthermore, these preliminary results show positive effects on wheelchair skills level and confidence and should therefore be implemented more widely in rehabilitation programs for children using a manual wheelchair.
Funding acknowledgements: Funded by an unconditional grant (PRO-4-03) of the Dutch Foundation Innovation Alliance (SIA-RAAK)
Topic: Disability & rehabilitation
Ethics approval: Ethical approval was given by the research board of the De Hoogstraat Rehabilitation.
All authors, affiliations and abstracts have been published as submitted.
