Clinically Speaking

Annie & Me: The Importance of Early Mobility Intervention

When I met 3-year-old Annie Linden, my first thought was, “Wow this little girl has a lot of energy!” She reminded me of my niece, who was the same age at the time, and I was always chasing after her in my power chair, trying to keep up.

Yet, what made 3-year-old Annie unique was that she was in her own wheelchair — an ultralight manual with complex rehab seating to address her kyphosis — and she propelled it as intuitively as my 3-yearold niece darting about.

“When Annie was 2, we knew she could benefit from a manual chair,” recalls her mom, Holly. “She was at the age where toddlers walk, and through the really advanced use of her arms, we knew she’d do well in a manual chair.”

Annie was very fortunate because while many therapists today understand the importance of early intervention of complex rehab technology, many insurers still question it at times, wondering if the child is ready. But Annie received a manual chair that another child outgrew.

“It was an unbelievable gift,” shares Holly. “The little boy had spina bifida just like Annie, and the seating and all fit her perfectly. We had to show her the concept of pushing, but after that, she was off and going!”

What’s seen through Annie, now 5 and active in kindergarten, is that a child’s introduction to mobility technology should be based on his or her physical and cognitive skills, not a preconceived notion of a fixed “right age.” As Annie illustrates so well, if a child with a disability is ready at 2 — a logical age of mobility progression for most ambulatory children — then a manual or power wheelchair is often appropriate. Put simply, intervention should occur when a toddler or child demonstrates a deliberate desire to move, and thereby can be assessed and fitted with appropriate mobility technology.

A Personal, Historical Perspective

As a lifelong complex rehab power chair user myself, I wasn’t as fortunate as Annie. In the early 1970s, not only were power chairs a new technology, but all saw them as too dangerous for young children. For me, having severe cerebral palsy, unable to propel a manual wheelchair, the world was one of isolation and confinement. I was passive, with vague body awareness. However, thanks to an insightful therapist, I, at age 5, tried a power chair for the first time, and went from a world of confinement to one of liberation at the touch of a button.

Interestingly, although we’re discussing this subject 37 years after I began using a power chair, some still wonder today if 2, 3, 4 or 5 years old is too young to place a child in a power chair.

Lund University in Sweden published a 2010 study of 562 children with cerebral palsy, from the age of 3 and up, who used manual vs. power chairs. Of those using manual wheelchairs, 86 percent required adult assistance. Yet here’s what’s fascinating: Of those using power chairs, exactly the same amount, 86 percent, required no adult assistance — that is, children with cerebral palsy using power chairs were remarkably independent. What this study shows is the clearly positive impacts that mobility has on a child’s independence — one that I learned first-hand.

The Importance of Autonomy

It’s said that autonomy is the Holy Grail of early childhood development. For those with disabilities, this is no different. The ability to develop independence builds self-esteem. We’ve all seen the face of a 3-year-old light up as he or she says, “Look at what I did, Mommy!”

Mobility is, of course, synonymous with autonomy, and it’s arguably the most vital aspect of the early intervention in applying manual or power chairs. When I was 3, I lived in a very small world, where unless I was carried or pushed in my manual wheelchair, I couldn’t move. I had no control over my own being. Think for a moment how that had to affect my sense of self — that is, I had no autonomy and thereby extremely low selfesteem. I couldn’t even go get a ball from across the room. My autonomy — the vital developmental aspects of self-esteem and worth — was stunted, putting my future emotional health and age-appropriate stages of growth at risk. What’s more, autonomy is formed through physical exploration serving as an intellectual stimulus. Three-year-olds learn by seeking and touching, so the ability to give a child with a disability the right mobility technology is the ultimate developmental tool toward functionality, cognitive development, visual perception, emotional development and social interaction.

The Learning Curve

Many wonder whether children under the age of 5 have the cognitive ability to learn to use a manual or power chair.

Although each child is an individual, the statistics are telling. It takes the average 2-year-old 1,000 hours to go from standing with assistance to independently walking. Yet, a 1984 study showed children between 20 and 37 months of age learned to drive a power chair proficiently in just 16 days. This shows that as long as physical and cognitive abilities are present, children exhibit a remarkably fast learning curve toward mobility technology.

Now, what’s vital to recognize is that just because a toddler can use a mobility device, parental supervision doesn’t stop. To the contrary, all children need adequate supervision with their newfound mobility. Just as supervision and safety devices like “baby gates” are used for ambulatory toddlers, they are prerequisites for children using mobility devices as well. There’s no more danger in a child using an appropriate mobility device than one who’s ambulatory. However, there’s no less danger, either. Although children’s mobility needs differ, attentive parenting doesn’t change.

How to Approach Early Intervention

First, it’s important to recognize that mobility technology is only part of therapeutic early intervention. Although a wheelchair may be absolutely needed, other therapies, such as gait training and ambulation, may still apply. Therefore, a wheelchair should be seen as a part of the early intervention process, not the whole.

Secondly, no one technology should be assumed, but assessed. In the case of power chairs, tools like the Pediatric Powered Wheelchair Screening Test (PPWST), by Los Amigos Research and Mobility is, of course, synonymous with autonomy Education Institute, is a great assessment and screening protocol. Such processes used by therapists and seating clinics are invaluable to finding the right technology per child.

Kids Just Being Kids

Beyond clinical practices and theory, early intervention is ultimately about one goal: allowing children to be children, regardless of disability. Through the right mobility technology, at an early age for those children who have the properly assessed abilities, we know that early intervention fosters emotional, cognitive and social growth. This creates not just a child’s mobility, but his or her health and happiness.

As for Annie, while her wheelchair serves her well, she’s expanded her mobility in ways many might not assume. On the weekends, in a custom wetsuit, she sees her wheelchair from afar as she lies belly down on a surfboard, catching waves off of the San Diego coast. It’s astounding where the right mobility at the right age can lead a child’s spirit.

This article originally appeared in the November 2013 issue of Mobility Management.

About the Author

Mark E. Smith is the General Manager for Pride Mobility Products Corp., and can be reached at 800-800-8586, or via email at

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