Parents of a child being assessed for a power chair often have to work through conflicting feelings. They want what’s best for their baby, but may cling to the hope that their child will walk one day. They may be intimidated by the size and weight of a power chair and worry about their child’s safety.
ATPs and clinicians, therefore, are faced not only with teaching a very young child to operate a power chair, but also with educating her parents. Some tips from clinicians who’ve worked with young children:
Emphasize the power of independent mobility. Sharon Pratt, PT, says, “I believe in taking away some of the fears that parents have with regard to the idea that ‘If my child uses a power chair, this is disabling and maybe they will therefore not walk’ — which of course is what every parent wishes for their child — and instead emphasizing the powerful message that motor skills do not decrease when children use power mobility. Share the studies that show better use of motor skills, increased motivation in therapy, and improved cognitive development.”
Reassure parents that the team and child can work on both power mobility and walking. “We need to let parents know that just because we are working with a child and power mobility doesn’t mean he or she has to give up on ambulation and standing activities,” says Jay Doherty, OTR, ATP/SMS. “Many children need both.”
Explain the definition of independent, functional mobility. Maggie Love, OTR, says, “It is important to talk to the parents about the difference between therapeutic ambulation/exercise and functional mobility. Just because a child may be able to ambulate short distances with a walker or manual mobility device does not mean that it is functional. It should be relatively effortless for a child to move in their environment. Children with disabilities, just like their peers, need cardiovascular exercise. Exercise, by definition, is tiring: We ourselves make the distinction between exercise and mobility.” She suggests painting that picture for parents: “Can you imagine if you jogged everywhere? How tired would you be? How much would you be able to concentrate on work/school?”
Address their safety concerns. A child learning to use a power chair will bump into things — accidentally, and maybe even on purpose — as part of the exploration process. Remind Mom and Dad that typically developing children are no different. “When a child begins walking, he or she may walk into something in a room, not paying attention — that’s part of learning about moving in their environment,” Doherty says. “Children in wheelchairs need the same opportunities.”
Love adds, “Of course, safety measures such as a remote stop switch and an attendant control should always be considered for children in the midst of power mobility training.”
And when those wheels inevitably meet that solid object (again!), Love suggests the kind of encouragement parents would give if the child were learning to walk.
“When considering verbal directives,” she says, “provide positive feedback: ’You found the table!’ versus ‘You crashed!’ And try and suggest things (‘Lift your hand off ’) — rather than issuing commands (“Stop!”) (Jones et al., 2003).”