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"Here Comes That Wall!"

Amy Morgan, PT, ATP, on Allowing Children to Interact in Three Dimensions

It's a bit of an irony, but becoming proficient at a new skill usually requires some degree of failure during the learning process. We swing and miss the baseball, then adjust the arc of the bat on our next try. We lean too far to the left, topple off the bicycle, then try leaning a little less the next time.

There's a learning curve to successfully operating a power chair, and when the student is a very young child, it's understandable that parents and therapists get nervous during the learning process. Children need to be safe, of course. But Amy Morgan, PT, ATP, pediatric & standing specialist at Permobil, points out that there are ways to balance safety with exploration, so very young children can maximize the independence that their power mobility devices can offer.

Morgan says that understanding cause and effect has been a traditional pre-requisite for children being assessed for power mobility, but she says, "A lot of times, we don't see the cause-and-effect skill develop until we give them the opportunity to use the chair."

Rather than requiring the child to have full cause-and-effect understanding before allowing him to try a power chair, Morgan suggests the thinking should be, "Sit in the power chair to develop your cause-and-effect skills."

The second question Morgan asks about the child, she says, is "Can they stop -meaning physically, can they let go of the switch or let go of the joystick? But also, if I say stop, can they do that?"

Morgan cautions against expecting children to perfectly obey orders, however.

"I don't like to evaluate children on following my commands, because quite honestly, when they get that independence, they aren't going to want to listen to what I'm saying," she points out. "They're going to want to explore. So we have to know the difference between behavior and safety and how those interact, because I think a lot of kids are labeled as unsafe because they're just challenging their new-found independence.

"We have to expect that type of 'behavior' to happen and not label that as 'They're unsafe.'"

To teach kids when to stop, Morgan says she helps them out "by saying, 'Here comes that wall, you're getting close to the wall,' and giving them leading clues to see if that entices them to stop the chair. But all kids should be given the opportunity to interact with the three-dimensional world - meaning, bumping into walls."

Until they have the ability to interact with the three-dimensional world, Morgan says, these children who are just acquiring independent mobility don't understand three dimensions.

"So they don't understand that the wall is hard, and they have to avoid that. Everything to this point has probably gotten out of the kid's way. They've never had to understand 'Oh, I have to stop.' We have to remember that with these kids and see their reaction when they do interact with the world."

To make the learning process safer, Morgan says, she "lowers the power or the torque settings of the wheelchair, so when they do bump into that wall, it's not going to continue to drive through or up the wall. It's just going to stop there."

But she says it's important to allow kids "to feel the jolt of three dimensions, so they understand what it is."

In the long run, allowing a new power chair operator to fail safely at the start can lead to eventual success.

"The biggest mistake I see therapists make when they're doing trials or training with kids in power is they'll hit that stop switch right before they get to the wall," Morgan says. "And then (the kids) still don't get the concept of three dimensions. They only know 'Somebody is going to stop me if I get into a situation I shouldn't.' And so they never learn to stop themselves, to problem solve and see in the environment the obstacles that are out there.

"We are allowing safe interactions with the world so they can begin to learn what obstacles are and how to avoid those obstacles."

This story is an exclusive online bonus to the pediatric mobility story "What Drives Them?", which appeared in the April 2011 issue of Mobility Management.

This article originally appeared in the April 2011 issue of Mobility Management.

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