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Wheelchair Mobility in Pediatrics | |
| INTRODUCTION | |
| 1 | Independent mobility is an essential issue in the development of knowledge and esteem for young children. When a child is faced with mobility limitations due to congenital birth defects, the overall emotional development can be delayed also due to the lack of ability to explore and interact with their environment (Hundert, Hopkins, 1992). The issues addressed in this report will be to cover the noted benefits of offering independent wheelchair mobility to children younger than three years of age. |
| 2 | The second aspect is to view the impact on able-bodied children when having a disabled child introduced into the educational setting. Often the main hindrance of a disabled child's independence is the good intentions of others who care take rather than allow autonomy and independent mobility and exploration of the environment (Hundert, Hopkins, 1992). |
| STUDIES AND RESULTS | |
| 3 | Most children born with congenital mobility impairments are not given their first wheelchair until at least three years of age, and most of these do not receive a chair they can propel independently until age-5 (Furumasu, 1998). |
| 4 | According to a study at Rancho Los Amigos Medical Center, independent mobility allows young children with physical disabilities to be more fully integrated into appropriate educational programs and can lead to enhanced psychosocial and cognitive development. The study involved 26 children between the ages of 18-36 months. In order to limit the chance of cognitive impairments clouding the results of the developmental outcomes, only children with pure physical impairments were selected. The impairments included spinal muscular atrophy, arthrogyposis, myotubular myopathy, spinal cord injury, and amputee (Furusumu, 1998). |
| 5 | After cognitive and motor testing was performed, the children were introduced to a power wheelchair and given basic step-by-step instructions in its use. The child demonstrated skill development in wheelchair control similar to how an able-bodied child develops. For example, the children demonstrated the ability to follow verbal commands on directing the chair forward and to swerve to miss an object before they developed the ability to stop. This demonstrates the learning of concrete cause-effect concepts more rapidly than abstract instructions. When the child was able to visually see the reason for the action (i.e.: swerve to miss a toy) they could follow the command (Furusumu, 1998). |
| 6 | A similar study was performed in England in 1991. The children were provided it more simplistic means of mobility than the US study, yet were still introduced to the chair at a very young ages, 17-24 months. Again, the children followed similar patterns of skill building as demonstrated in able-bodied children. In both studies, the children were able to learn functional use of a power wheelchair within a year, the similar time span it takes the average infant to go from crawling to toddling (Everand, 1997). |
| 7 | Of even more value is the psychological developmental issues discovered. Previous research has shown that when a child does not move around independently by the age of 9-18 months they begin showing what has been labeled "learned helplessness." Commonly able-bodied children begin independent exploration at this age and are able to learn about danger, things they can touch to experience various textures, experiencing the ability to "help" others such as in the kitchen, etc. When these experiences are denied, the child may lose motivation to explore, learn, and become emotionally and/or psychologically handicapped. This frequently leads to a worsening of the original physical disability through lack of motivation to do things for themselves, consequently requiring excessive assistance for daily living activities, and repeating the cycle of helplessness (Everand, 1999). |
| CITED EVIDENCE | |
| 8 | A news article from February 1999 demonstrates the true value of independent mobility for the child. When physical therapy was eliminated from the educational setting, many children suffered a loss of mobility based on the simple fact that without being ranged, their spasticity could not be controlled well enough to be allowed intentional/purposeful movement. This left the child unable to initiate interaction with their peers or their environment, and dependent on others for all stimulation. Michael Brown, a 10-year old who lost his services because of the decision to cut therapy in schools, became depressed and suicidal due to the toss of mobility and independence Once services were reinstated, Brown returned to his previous higher level of social interaction and educational performance. The lasting impact of the decision to remove the child's therapies may not be known for years. Brown has shown significant signs of trauma and anxiety based on the perceived potential of someone removing his mobility again at some point in the future (Humphries, 1999). |
| 9 | One question raised by psychologists in Canada was the issue of using a disabled child for fund-raising events such as the Jerry Lewis Telethon. It is noted that the children who were used for the jerry Lewis Telethon and were rewarded for their "disability" demonstrated a high dependence on assistance throughout their life, despite their level of mobility. (Dahl, 1987) |
| 10 | Independent mobility will remove the child from the stereotypical role, and potentially change their perception of being 'disabled." In doing so, the child will be interacting at younger ages with peers, and advocating for acceptance during critical years of their social development. When children grow up socializing with someone who is "different", they are less intimidated and more accepting. The social reinforcement of acceptance wilt enhance the disabled child's educational and learning opportunities, thus reinforcing self-efficacy (Dahl, 1987). |
| 11 | Contact, per se, is not the only means for solving the existing misperceptions of disability. Studies show that how a person reacts to someone with a disability is based on prior experiences in their own lives. There needs to be an environment of empowerment where the disabled person is not only provided the option of doing things for themselves and others, but also the means by which to accomplish or initiate the actions. For instance, Weinberg conducted a study to modify social stereotypes using elementary school students who attended school with mainstreamed physically disabled students. Weinberg found that the non-disabled children believed the children with disabilities to be similar to their able-bodied peers in personal, social, and cognitive areas. Early integration of children with able-bodied peers allows a perceptual change in expectations therefore fostering a higher sense of self-efficacy (Hundert, Hopkins, 1992). |
| 12 | A side note to this is that the teachers and other adults did require some instruction to alter their own beliefs so as not to interfere with the natural development of the children's relationships. Hundert and Hopkins (1992) findings showed positive changes in both teachers and children's behaviors. |
| CONCLUSION | |
| 13 | Regardless of the child's birth defect, offering independent mobility and the opportunity to explore their environment is crucial to healthy mental development. Studies demonstrate the ability to maneuver a modified power wheelchair by children as young as 14 months of age. General psychology supports the concept that exploration is part of learning and development, as well as a requirement in developing autonomy (Carter, 1999). |
| 14 | When the child is offered early mobility on an independent basis, and the freedom to interact with peers, not only does it enhance the growth and development of the disabled child, but the able-bodied peers benefit as well. Early exposure to someone who is "different" can lead to healthier comfort levels and a decreased sense of helplessness for disabled children. Self-efficacy is invaluable in a child's development. In order to achieve a sense of autonomy, the child must be allowed the choice to interact, engage, and manipulate his or her own environment. This fosters learning and a sense of positive esteem that they in fact can influence their own world. In essence, independent mobility removes the message of helplessness and replaces it with the message of empowerment (Furusumu, 1999). |
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Nominated by Dr. Eric Lewis, Psychology Instructor
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