Self-Propulsion: Tricks Are for Kids!

Kids and Self-PropulsionShe was a Paralympian whose Games nearly never happened because she didn’t know how to ride an escalator. The young woman, who’d self propelled her ultralightweight chair since early childhood, went to Lauren Rosen, PT, MPT, MSMS, ATP/SMS, program coordinator, Motion Analysis Center, St. Joseph’s Children’s Hospital of Tampa, for help. The athlete had been given an ultimatum: To compete at the 2008 Beijing Paralympic Games, she needed to learn skills — not athletic ones, but wheelchair ones — including how to get on, ride and get off of escalators. She’d need those wheelchair “tricks” to get around in China, and the U.S. team didn’t have the manpower to assist her. Learn the skills, they said, or stay home.

That episode got Rosen thinking. She’d put a number of children in ultralightweight chairs, but due to their very young ages, she knew the time wasn’t yet right to teach them to pop wheelies, ride escalators, etc. As the kids grew and matured, where did they learn these skills? Older kids and adults who sustained spinal cord injuries, for example, were taught wheelchair “survival skills” during rehab. But what about children who got their first chairs in infancy or toddlerhood? Who was teaching them?

Tom Whelan of KiMobility agrees that this is a very real need: “While they require supervision, and care needs to be taken in that respect, ultimately they need to master the same skill sets that an adult would need to be independent in their mobility.”

Tina Roesler, MSPT, ABDA, of TiLite believes that learning wheelchair skills should be an “ongoing” childhood experience.

“Many kids will learn on their own as they experience new environments,” she says. “Once their propulsion patterns mature and they are able to propel for longer periods, we should start wheelchair skills training. They need to be able to maneuver in their environments — so skills like wheelies, going up/down curbs, escalators, hills, all need to be taught. It is also important to teach them to ask for assistance when needed.”

As kids continue to grow and learn, their skills need to grow with them, Roesler adds. “A critical juncture seems to be around the teen years. Kids are maturing; they no longer have Mom and Dad around all the time, and as they grow, it gets more difficult for parents to assist with tasks like transfers. Children should be assessed for skills including the ability to propel, do pressure releases, transfers and the other skills we typically teach adults in a rehabilitation setting.”

And providers and clinicians who work with kids for the long term may be in an especially good position to help their young clients make successful transitions throughout their lives.

“Unlike some groups of individuals, we usually have better opportunity for follow-up over time [when working with children],” Roesler says. “We need to recognize when a child’s mobility needs change and determine how to address them. It is also important to get them in touch or involved with other kids and adults in chairs. It has been demonstrated that kids who participate in recreational or competitive sports activities tend to have better skills and are more confident as adults.”

Speaking of sports, the young Paralympian’s story does have a happy ending, thanks to some quality time with a convention center’s escalator system. As Rosen points out, “The ability to pop a wheelie, to get over a tree branch, etc., is life.”

This article originally appeared in the April 2014 issue of Mobility Management.

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