DME

Blog posts of '2020' 'March'

At what age can a child use the Explorer Mini?

 


Part 3 in our series about developmental milestones in early childhood focusing on mobility. 


The characteristics of the Explorer Mini take into consideration developmental milestones and the hierarchical nature of these achievements.

The 3-5-month-old child begins pre-sitting skills activating the postural support muscles. He draws on earlier achieved skills such as visual fixation, which occurs at 2 months of age, consistent with the onset of propping prone on forearms. The weight bearing that occurs in prone on forearm elicits co-contraction of the gleno-humeral (shoulder) joint muscles which provides the proprioceptive input for joint stability. This promotes upper trunk girdle activation by facilitating the thoracic extensor muscles to engage which in turn encourages head and neck extension. 

It is this co-integration of trunk extension with head extension and the visual vestibular interplay that promotes proximal stability

A young child who is able to hold his head upright, or recover head control if temporarily lost, and make postural corrections in a supported sitting position may benefit from use of the Explorer Mini to help promote further development of proximal stability. This allows the other sensory motor skills to gradually integrate. The device is designed for upper extremity weight bearing, like propping up on forearms, that would be a necessary foundation for upper body control. The Explorer Mini provides trunk, pelvis and upper body support to help an infant progress with sitting skills. The infant will be in a position to put weight through the forearms which will promote shoulder joint stability and encourage trunk extension and head control.

While the Explorer Mini is designed for 12-36 month old children, the pre-requisite motor skills are compensated for by the inherent support in the design of the sitting and trunk support surfaces (1,2,4,6). In fact, the device is designed to promote sitting by providing a wide base of support and many points of weight bearing including the feet, the pelvis and the forearms.

Proximal Support and Distal Mobility

Regarding the efficient control of the joystick, the infant with a supported seating posture begins commanding distal motor control once the support or sitting skills are initiated. In other words, one needs proximal support or control to command distal mobility. They are inextricably linked and codependent. You can see this in infants who have mastered independent sitting and are able to manipulate toys with their hands.  

Essentially, the postural activation transmits “action plans” to the motor cortex of the brain to control movement of the arms, hands and fingers (4). The multifaceted, multisensory input facilitates motor output. The sensory input mechanisms include somatosensory and proprioceptive systems, weight bearing, kinesthesia (the feeling of movement) and visual cues to align the head and the vestibular system to respond to gravity.

The Explorer Mini is designed to promote the proximal support by providing a wide base of support and many points of weight bearing, including the feet, the pelvis, and the forearms. This support and points of weight bearing promote joint stability, and in the case of the upper extremities, can allow for successful distal mobility and use of the joystick.

The Explorer Mini is designed to provide on-time mobility that supports development. As the goal is not simply getting from point A to point B, the proportional joystick and multiple weight bearing surfaces work in concert to bring about postural control and upper extremity stability required for self-initiated movement. 


1. Hadders-Algra, M., Brogren, E., & Forssberg, H. (1996). Training affects the development of postural adjustments in sitting infants. In Journal of Physiology

2. Hadders-Algra, M. (2010) Variation and variability: Key words in human motor development. Physcial Therapy (Vol. 90), Issue 12. https://doi. /10.2522/ptj.20100006

3. Rosen, L., Plummer, T., Sabet, A., Lange, M. L., & Livingstone, R. (2018). RESNA position on the application of power mobility devices for pediatric users. Assistive Technology. https://doi.org/10.1080/10400435.2017.1415575

4. Rosenblum, S., & Josman, N. (2003). The relationship between postural control and fine manual dexterity. Physical and Occupational Therapy in Pediatrics, 23,(4). 47-60.

5. Scheiman, M. (2011). Understanding and managing vision deficits: A guide for occupational therapists (3rd ed.) Thorofare, NJ:SLACK Incorporated.

6. Westcott, S., & Burtner, P. (2004). Postural control in children: Implications for pediatric practice. PT and OT in Pediatrics, 24, 5-55.

 

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS

Associate Professor in the School of Occupational Therapy at Belmont University

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS is an Associate Professor in the School of Occupational Therapy at Belmont University in Nashville, TN. She has over 40 yrs of OT experience and 20 in the area of Assistive Technology.

She is a member of the International Society of Wheelchair Providers, and the Clinicians Task Force. She is a reviewer for American Journal of OT and guest reviewer for many other journals. She has authored journal articles and textbook chapters in the area of OT and pediatric mobility and access.

Benefits of Self-Initiated Mobility in Early Childhood

 


 Part 2 in our series on early childhood developmental milestones related to mobility.  


Several therapists present courses on the benefits of early self-initiated mobility. We are among them. In this blog series, we are going to begin examining how self-initiated independent movement happens and the developmental milestones that promote independent movement. Self-initiated mobility is defined as movement that is controlled by an individual and may include:

  • Ambulation (e.g., walking, crawling),
  • Use of non-powered technology such as prosthetics, walking aids and manual wheelchairs
  • Use of powered technology such as motorized wheelchairs and battery-operated ride-on toy cars (Logan, Hospodar, Feldner, Huang, & Galloway, 2018).

Powered technology is usually considered when other means of movement have not been successful. The problem with most power mobility devices is they were not truly designed for EARLY. In fact, they are designed for “its really late-but let’s see if we can catch up” and compensate for what has been lost or never gained. Until now we have not been able to observe or examine the full benefits of early self-initiated mobility for young children with disabilities as there has not been a truly appropriate mobility device.

But we do know this, in order to learn, children need SELF-INITIATED exploration:

  • If they cannot bring objects to their mouth, their language may be delayed because the oral muscles are not adequately stimulated.
  • If they cannot bring an object from one hand to the other and manipulate it around their hand, they do not learn size, shape or texture.
  • If they do not crawl or walk or have access to EARLY mobility, they do not learn that their world is a 3-dimensional universe with walls, doors, toys, siblings or parents.
  • If they always have to wait until an adult brings them an object curiosity is not fostered.
  • Crawling (or self-initiated mobility) provides children opportunities to learn about the environment and social relationships, as well as developing their own self-awareness. (Butler, 1991).
  • If children cannot move independently, their visual skills related to spatial relations are delayed.
  • If they do not have self-initiated mobility many aspects of development are delayed.

But if we could explore the true sense of early access to self-initiated mobility, we could better understand the potential to impact development and perhaps change the growth and developmental milestones trajectory for young children with mobility impairments. 

 


 

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS

Associate Professor in the School of Occupational Therapy at Belmont University

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS is an Associate Professor in the School of Occupational Therapy at Belmont University in Nashville, TN. She has over 40 yrs of OT experience and 20 in the area of Assistive Technology.

She is a member of the International Society of Wheelchair Providers, and the Clinicians Task Force. She is a reviewer for American Journal of OT and guest reviewer for many other journals. She has authored journal articles and textbook chapters in the area of OT and pediatric mobility and access.

 

The Importance of Self-Initiated Mobility in Early Childhood

 


This is the first blog in our series on early childhood developmental milestones related to mobility. 


Young children are their own change agents. When they want something, they find a way to direct others to provide it for them. They may cry, smile, pout or grimace to cause a reaction to their action. This is a continual, increasingly complex way of making their place on earth their very own. Children learn through exploration. If a child is unable to self-direct their exploration and must rely on others to bring items to them, it is not of their choice.

Children need choice to learn to make decisions, initiate actions and learn reactions.

An infant begins exploring their environment the second they are born. They look around to find the smiling face, put their fingers in their mouth and wiggle any body part they want. If a child is unable to move, they do not find their environment and they may lose their inherent curiosity.

A quick review of development demonstrates how children come to move independently. At around two months of age they lie on their tummy, hold their head up and start to fix their eyes on objects nearby. Once they begin to sit up at 6 months, they stretch out with their hands to find objects within their reach. When successful at finding and manipulating items in reach they begin noticing items beyond their reach and because their arms are not needed to sit up, they reach beyond themselves until they fall on outstretched arms and realise “oh, if I just wiggle the right way I can get that toy.”

This is the beginning of what later becomes crawling which helps to strengthen an infant’s arms and legs to prepare for standing and eventual walking.

But what happens when a young child does not sit unsupported due to a development delay or medical condition that limits their ability?

The typical developmental sequence is altered. Their ability to change their environment, control the objects they want and forage into spaces is halted. What if we could change that? What if we could provide children with a substitute, whether it’s temporary or long term? Wouldn’t it be great if we could provide a device that offers the support a child needs to maintain their change agent status? Permobil recognises the positive impact that creating a mobility solution can have on young children.

The first two years are crucial in development.

The ability to explore the environment ushers in a cascading array of cognitive, social, emotional and spatial skills that concurrently provide tremendous opportunities for growth. Without self-initiated mobility, children are not the agent of change but rather the consequence of someone else’s decision.

Exploration made easy

At only 52lbs, the Explorer Mini is a lightweight, easy-to-transport power mobility device that empowers families and children to explore and learn in home and community environments. 

Learn more

   


  

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS

Associate Professor in the School of Occupational Therapy at Belmont University

Dr Teresa Plummer, PhD, OTR/L, ATP, CEAS, CAPS is an Associate Professor in the School of Occupational Therapy at Belmont University in Nashville, TN. She has over 40 yrs of OT experience and 20 in the area of Assistive Technology.

She is a member of the International Society of Wheelchair Providers, and the Clinicians Task Force. She is a reviewer for American Journal of OT and guest reviewer for many other journals. She has authored journal articles and textbook chapters in the area of OT and pediatric mobility and access.

 

Stacey Mullis, OTR/ATP

Director of Clinical Marketing

Stacey serves as Director of Clinical Marketing for Permobil. A practicing OTR for over 20 years, she has experience in school-based pediatrics, inpatient rehabilitation, long term care, and home health. With her interest in wheelchair seating and positioning, Stacey engaged the challenges of providing appropriate seating in various clinical settings. She now uses this experience to develop programs and resources to educate clinicians on the principles of seating and wheeled mobility.

She is passionate about equipping clinicians and through her previous role as Director of Clinical Education with Comfort Company and now with Permobil she has taught nationally and internationally to increase therapist capacity in this specialty area. 

Why Everyone Should Be Talking About the Shoulder


If you are a physio or occupational therapist working with an individual that utilising a manual or power wheelchair, you should have a better understanding of the shoulder than a sports physio. Yes, that’s right you read that sentence correctly. I want us/our client needs us to better understand the shoulder than a sports physio. Why? While that’s exactly what I will explain in today’s blog. 

Whether you are the end-user, therapist, family, dealer/supplier everyone should be thinking about the client’s shoulders. The statistics are staggering. We know that shoulder pain and dysfunction is a problem for all of us in this world, but this becomes even more significant to consider and address if the end-user relies on their upper extremities for mobility. The percentage of shoulder pain in individuals that utilise a manual wheelchair for their mobility ranges from 32% to 78% (1). It’s not just individuals who propel a manual wheelchair that we should be talking about! Even an individual utilising a power wheelchair? Yes! This is because although we like to blame propulsion for all the shoulder pain, this is just one piece. We also have to think about transfers, overhead reaching, loading/unloading a chair into the car, activities of daily living… just to name a few. This is part of the problem, but there is a whole other side to this story that we need to consider. 

What if the individual already has shoulder pain, limited range of motion, decreased strength, or muscles around the shoulder are not fully innervated? How often as a therapist do you assess your client’s shoulder? Are you assessing for pain? Do you quickly run a gross range of motion assessment and then dive further if you see any limitations? Have you at a minimum grossly tested shoulder strength? 

Yes, understanding how the equipment will affect shoulder health is crucial and this is something that I talk about extensively if you have been in one of my courses, but what about how the shoulder at its current state of health and future health will impact the client in the equipment we are selecting? We cannot determine the most appropriate equipment for a client without understanding their shoulder health and we CANNOT assess the shoulder if we do not ask questions and get hands-on. 

This is why we need to know as much or more than the sports physio. We are assessing a shoulder to perform at a high level with activities that the shoulder was not designed for. Now some of our clients may have a fully intact, strong shoulder with no reports of pain similar to an athlete or they may even be an athlete themselves, but many of our clients will have already existing shoulder impairments and pain. It is our job not only to understand what we need to complete in an assessment to determine their equipment selection such as their environment and goals, but we also need to be able to assess and understand a complex shoulder joint and how this will impact our decision. It is a big responsibility, but also one that can really show our level of education, assessment and critical thinking skills. 

So, where do we learn this information? We learned a foundation in our university, but we cannot stop there. We have to continue to further understand the shoulder and how the individual activities of each client affect their shoulders. I would suggest an orthopaedic course on the shoulder. Yes, I know. This may seem like a strange suggestion, but we and the orthopaedic based therapists have a common goal! You could even try to see if you can attend a course that is not in our specific field of study – an occupational therapy course for a physio and vis versa. Some courses allow OTs, physios, chiropractors, etc… these can be great courses to learn not only from the instructor, but also from each other. Finally -Your Clinical Educators! We are happy to help you further your knowledge and can help you to work on integrating the shoulder with the wheelchair and client to achieve the optimal outcome. Join our free webinar on the shoulder on March 24th at 2pm AEDT. If you haven’t registered yet, use the link below to register and begin your further education of the shoulder.  

Click this link to register for our webinar: 

https://attendee.gotowebinar.com/register/591256185888247052?source=Blog 

Finally, remember the why. We are asking our client’s shoulders to work hard, and we need to make sure they are able to handle the demands that we are placing on them. This might include considering a power assist add on to a manual wheelchair, a power wheelchair with ActiveHeight and ActiveReach, or creating a home exercise program to name a few. The statistics are too high. We need to help to decrease this percentage of individuals experiencing shoulder pain and the only way to do this is through education of ourselves and our clients in order to complete a proper assessment and equipment recommendation.

 

Rachel

 

 

International Wheelchair Day and Accessibility


This week’s blog celebrates International Wheelchair Day and looks into the fundamental concept of accessibility and inclusion.

March 1st 2008 was the first International Wheelchair Day, founded by Steve Wilkinson and has been celebrated on this date every year since. The day has recently gained more traction and provides an opportunity for wheelchair users, their families, friends, support workers and our industry to celebrate the positive impact a wheelchair has in their lives.

The Aims of International Wheelchair Day

To enable wheelchair users to celebrate the positive impact a wheelchair has in their lives.

To celebrate the great work of the many millions of people who provide wheelchairs, who provide      support and care for wheelchair users and who make the World a better and more accessible place    for people with mobility issues.

To acknowledge, and react constructively to, the fact that there are many tens of millions of people    in the world who need a wheelchair, but are unable to acquire one. 

Last Friday, our Permobil Asia Pacific President, Bruce Boulanger, and our Australian Customer Service Manager, Graham van Leeuwen, both experienced some of the barriers wheelchair users face by volunteering to spend the day in a wheelchair. In addition to having a firsthand experience in our TiLite manual wheelchairs, they soon discovered additional planning and task adaptations they had to make to enable them to complete everyday activities of daily living and their normal work tasks.

Luckily, both of our volunteers were very familiar with the workplace environment. They knew where the lift was located and how far the bathrooms are from their desks which makes a difference when you’re mobilising in new ways. But what happens when wheelchair users travel to new communities, new environments, and the information about steps, ramps, parking spots and bathrooms is not available?

We often take for granted our ability to move freely within our environments, yet it is this very environment that creates barriers for those experiencing mobility impairments. So for International Wheelchair Day I volunteered to participate in an Australian initiative, Wheel Easy. Wheel Easy is an online platform designed to be similar to Trip Advisor but with specific accessibility information for each landmark. 

As well as being International Wheelchair Day, yesterday was also the first day of a series of events called Mapping March for Wheel Easy. The events run in various inner-city areas of Sydney throughout the month of March with a purpose to map as many parking spots, restrooms and leisure spots as possible. Crucially, the platform includes descriptions and photos of accessibility.

Yesterday’s event started with a presentation briefing to all the volunteers. The founders, Justine and Max gave a passionate and inspiring presentation on the website and some insight into their life experiences that motivated the development of the platform. Examples of pictures and types of information that would be useful were discussed and an opportunity to ask questions to the team and the Ambassadors about the types of things to look out for.  

We then loaded the site onto our phones and went out and added cafes, parking and local venues to the website. It was really easy to add the information to each location on the site. The crowd sourcing model also enables anyone using the site to review and update information.

It is an eye-opening experience walking around a new community with a focus on accessibility. Often ramps and entrances are tucked away, accessible parking spots don’t meet everyone’s needs and just because a restaurant says it has an accessible bathroom doesn’t mean it is accessible to all types of impairments. The service uses photos which can assist users in planning what establishments they can patron. The process is also an opportunity to engage in discussion about accessibility with local businesses. 

To truly have an inclusive society we need to work towards reducing barriers. Whilst new buildings and communities are more likely to be built to universal standards or building codes that require certain access standards, older infrastructure continues to be more difficult to access and can limit inclusion.

As a wheelchair manufacturer we build and create wheelchairs to enable people with mobility impairments to live full and inclusive lives. However, even when optimal configuration and setup has been achieved the environment can still cause significant barriers. We first aim to ensure that the right fit for the end user and their environment has been met, but we also need to consider that wheelchair users participate in a variety of environments and may require multiple pieces of AT to achieve this.

The first step to breaking down environmental barriers is to create awareness. I challenge readers to create awareness, start a conversation, get involved in an initiative like Mapping March! Let’s keep working towards an inclusive society where barriers are, at the least, minimised. 

 

Tracee-lee Maginnity