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Go, Baby, Go!
Why the time is Right foR a (Radical) PaRadigm shift
in PoWeRed mobility By Sam Logan, PhD, Heather Feldner, PT, MPT, PCS, Cole Galloway, PT, PhD
A
chieving independent mobility is a hallmark of early
childhood and results in an explosion of cognitive,
perceptual, and motor development.1-3 Assistive technology (AT) is frequently provided as a means to increase the
ability of children with special needs to interact with the world.
A classic definition of AT includes: “any item, piece of
equipment, or product system, whether acquired commercially
or off the shelf, modified, or customized, that is used to increase,
maintain, or improve the functional capabilities of individuals
Families are seizing the opportunity to provide the technology
and training to their children.
Everyone knows (although it is relatively rarely studied) that
children developing typically between the ages of birth and
three spend many hours per day exploring the world through
mobility.6-7 Yet the current standard of practice is for children
to receive a powered mobility device (PMD) between 3-5 years
of age.8 Why are children with mobility impairments forced to
wait until 3-5 years of age to gain a means of effective mobility?
Why are children with mobility impairments forced to wait until
3-5 years of age to gain a means of effective mobility?
with disabilities.”4 Powered mobility devices (also known as
power wheelchairs) are a common type of AT used by children
with significant mobility impairments. Traditionally, these
devices are defined as devices “powered by electricity that
provide mobility and body support for individuals with limited
ability to walk.”5 (p 806)
All of the above information is not likely to be new news
to anyone reading this article. The purpose of this article is
to tell you a few things you may not know.
1) There is a resurgence of interest in early powered
mobility for infants and young children.
2) Pediatric powered mobility (as much of pediatric AT)
continues to be smaller, more colorful hand-me-down
versions from adult rehabilitation.
3) Current AT does not fully address the basic developmental principles that modern pediatric rehabilitation
is built upon or fully address the basic mobility needs
of children and their families.
A paradigm shift is needed. Interestingly and importantly,
this shift has been generated and is being sustained and now
expanded by families fueling the change in partnership with
clinicians – not the AT industry, not academic centers of excellence, not rehabilitation engineering, not even leading hospitals.
The answer is an article in and of itself,9 but to keep that long
story short – the key factors are likely a combination of:
a)
b)
c)
d)
lack of safety
lack of a child’s perceived readiness
inability to justify a PMD
no commercially available devices specifically for children
under 2 years old (note: there are a few devices available
outside the US that fit children as young as 2-3)
To track the resurgence, let’s first take a (brief) look at the
early research. In the 1980s, Charlene Butler provided data
suggesting that PMD use provided effective mobility and
should not be a last resort or be in conflict with working on
walking goals. In her view, early PMD use should be standard
practice for any child not able to generate effective mobility
throughout the day. In multiple studies, Butler and colleagues
demonstrated the feasibility and benefits of early powered
mobility.10-12 Recent research by our lab and others continues
to demonstrate the benefits of early powered mobility for
children as young as 6 months of age.13-15
Despite the growing evidence describing the benefits of
early powered mobility, young children are still not routinely
provided PMDs until 3-5 years old. Maybe clinicians,
families, the AT industry, and third (continued on next page)
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party funding agencies are telling us something by this
reluctance to jump into a powered wheelchair for young
children. Let’s examine the characteristics of commercial
PMDs to determine if the devices themselves may be an
Characteristic
control.”10(p 472) Given that these studies were the first step in
exploring the potential benefits of powered mobility use by
infants and toddlers, the motorized wheelchair does not meet
many of our outlined characteristics of AT devices.
Definition
Adaptive . . . . . . . . . . . . Adaptation over the days to years of developmental time.This allows as few devices as possible
to be used from infancy to early childhood. Adaptations also relate to the fit (i.e. size, weight,
turning radius) of the AT to the settings within which it functions.
Flexible . . . . . . . . . . . . . Flexible use on a moment-to-moment basis allows a device to be a) suited to a child based on
their daily level of function and b) used for a variety of therapy goals. Devices that are highly
restricted to only a few uses are not flexible.
Durable . . . . . . . . . . . . . Durability is important for frequent and extensive use in a variety of settings including the
home, clinic, school, playground, other community spaces.
Low Cost. . . . . . . . . . . . A low cost to benefit ratio directly increases the accessibility of this critical AT to all families.
Aesthetic . . . . . . . . . . . Given the importance of socialization for general learning as well as emotional health,
AT should not be a social barrier but rather enhance a child’s daily interactions with peers.
Accessible . . . . . . . . . . . Given the key role that daily mobility plays in development, AT should be widely available to
all children as early as possible.
obstacle to full implementation of the new paradigm of
early powered mobility.
In the table above, we outline six developmentally-inspired
requirements of AT devices that we believe are important.
Some or all may apply to adult AT, but we love kids don’t we!
– so let the adults get their own set of requirements (ha!). We
then will briefly discuss the history of PMDs with an eye on
seeing how each lives up to these basic requirements.
1980s: adapTing power Chairs for
Young Children
In Butler’s original work, a PMD was provided to young
children with special needs.10-12 The motorized wheelchairs
used in these studies were the same used by older children
and adults with special needs. Butler states, “Only minimal
adaptations to the seating were required to enable them to
use conventional motorized wheelchairs with a joy-stick
1990-1995: The CooperCar
The CooperCar was introduced in 1992
as a low-cost approach to early powered
mobility.16 This car consisted of several
components.
a) Sears-available 6 wheeled ‘kid-car’
vehicle ($200)
b) an adaptive seat ($200)
c) various switch options ($200)
d) CooperCar conversion electronics kit ($500)
The conversion kit allowed for many options of car use,
including seven speeds, two acceleration modes, two supervisor
override modes, and a timed mode for those children who
cannot maintain contact with the switch or joystick. This
device was designed for use by children as young as 18 months
old up to those weighing 70 pounds or (continued on next page)
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so. The CooperCar fits many characteristics of a high-quality
AT device. Despite the low-cost approach (< $1000 for the
complete device), the CooperCar did not become widely used
nor did it inspire the design for other devices. Two potential
reasons for its short term popularity include parent perceptions
of car use and the lack of awareness by families that the device
was available as a do-it-yourself project.
1995-1999: go boT
During the time that the CooperCar was developed (19911995), a Stanford University
research team introduced the
GoBot. The GoBot was billed as
a more cost-effective and childfriendly mobility alternative to
traditional power chairs for
children from 12 months to 6
years of age.17 Originally known
as the Transitional Powered
Mobility Aid (TPMA), the
GoBot offered an innovative positioning frame that allowed
a child to operate the device in a seated, semi-standing, or
fully upright standing position. The frame was positioned
toward the front of the mobility base to allow the child to
more freely explore their immediate environment. GoBot
controls were modifiable and included a hand, head, or foot
operated joystick or switch control options, as well as a remote
joystick control for caregiver override. With only one safety
restraint strap, the design was intended to be restraint free.
This device offered much more flexibility in terms of positioning, drive mode, and proximity to the environment. The
cost, while significantly less than a traditional power wheelchair,
was greater than $5000, and the mobility base was similar in
bulk and weight to that of a traditional powered wheelchair.
Also, the GoBot was intended for use as a transitional device
for therapeutic or exploratory purposes. As such, the utility
of the device in a variety of environments or for longer-term
mobility needs is unclear. Interestingly, in Wright-Ott’s original
article on the GoBot, the author mentions that aside from
traditional power wheelchairs, adapted toy vehicles were
possible for transitional mobility needs. However, they mention
that these products are “noisy and cannot be used indoors.”18
Throughout the latter half of the 1990s, there does not
appear to be additional research or development of other
alternative devices such as the CooperCar or GoBot. While
developments were occurring in the commercial powered
mobility industry, such as powered standing chairs, chair-tofloor lowering devices, or stair-climbing chairs, the commercial
industry continued to focus on new technologies and adaptations for the classic powered wheelchair itself rather than
novel alternatives. Researchers also focused on the benefits of
traditional powered wheelchairs.13
2000s: The sTandard pediaTriC
power Chair
Despite advancements in technology, we
propose that the standard power chair
typically provided to children is not ideal
and does not meet many of the characteristics of a high-quality and effective AT
device. There are several characterisics of
the most common commerically available pediatric power chairs
that likely limit the frequency, duration and/or type of use in
natural environments.15, 19-20 These limitations include price (i.e.
typically >$5000 with many >$20,000), size and weight (i.e.
typically >150 lbs.), transportation requirements (i.e. van or
truck), maintenance, aesthetics, and social acceptance.8,19, 21
2005-2010: universiTY of delaware
Mobile roboTs
Our University of Delaware Infant Behavior
Lab, in collaboration with Sunil Agrawal’s
Mechanical Engineering Lab, developed a new
PMD in the form of a mobile robot.22 The
robot used in our initial studies was named
‘UD1’ and was created by modifying the
Magellan Pro iRobot®. This robot was joystickdriven, included an on-board computer that
recorded frequency and duration of joystick
The evolution of
contacts, among other features, and also had
our robota variety of sensors to provide additional
enhanced power
safety measures for driving. An improved
mobility devices.
prototype, UD2, is light-weight (20 lbs.) and
relatively inexpensive ($4,000 for initial prototype).
As the results of our research and development with UD1
were disseminated through conference presentations, symposia,
and peer-reviewed publications, it (continued on next page)
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became apparent that there existed a large demand for small,
light-weight, and affordable early powered mobility devices.
Although our robot met many characteristics of a high-quality
AT device, this robot (or a similar device) remains a research
tool and is still not commercially available for families and
clinicians to use.
2010-2015: gobabYgo! Modified
ride-on Car
The lack of access to commercially
available PMDs was increasingly
frustrating to not only our lab but
to families and clinicians across the
US who immediately could envision
the potential impact on the everyday
lives of children. It was this growing frustration plus more than
a bit of impatience that led us to consider a low-tech alternative.
For reasons that we cannot completely recall, our lab held
a meeting at the local Toys R Us to see what role, if any, small
powered toy cars (also known as ride- on cars) could play.
Maybe they would give us inspiration for new PMD designs
or at least some ideas on how to reduce the costs of our robots.
We certainly didn’t know what we were doing or that it would
lead to a federally funded research project, which we affectionately call “GOBABYGO”.
Seeing the many different sizes and types of ride-on cars,
the idea was proposed to attempt to modify these widely
available and low-cost cars. The idea was feasible and ultimately
led to trips to the local hardware store for additional components of our modification kits. In Huang & Galloway,23 we
chronicle, in the form of a technical report, some basics of
car choice and modification categories for children with
mobility impairments between 1-3 years old.
To date, we have built several dozen modified cars, conducted
multiple build-it-yourself workshops and seminars, and written
a handful of soon to-be-completed case reports and small
group studies with a variety of children who are high, mid
and low functioning, including those that are medically fragile
and on ventilators living in long term care facilities and group
homes. We disseminate all types of information on modifying
ride-on cars through an active GoBabyGo Facebook site, a
YouTube channel outlining step by step build-it-yourself
instructions and maintain as much contact with interested
families and clinicians via email and Skype as we can, given
our active research program into the feasibility and effectiveness
of these cars.
Cars and Basic Modifications: The Fisher Price Power Wheels is
the basic car used in our research. These are durable, 6 volt, small
engine toys built for daily use by infants and young children. The
electrical and mechanical modifications are relatively minimal,
involve common materials (PVC pipe, foam noodles, large and
small switches), and function to increase the child’s safety,
stability and ability to drive in sitting, standing and walking.
Common examples include replacing the typical activation
switch with a custom, low profile switch under the seat or inside
the shoe for activation in standing and walking modes.
Car Modes: We most commonly modify cars to be used while
seated, however, that is changing. Below we briefly outline where
we are headed with modified ride-on cars and expect the following
modifications to become available for families and clinicians to
learn to build by the end of the summer 2013. So, here’s to the
future! – and the future from our viewpoint is the spectrum car.
This device allows children, families and clinicians to work on
therapeutic goals (i.e. strengthening, balance, stretching) while
performing functional skills training (i.e. basic and dynamic
standing, basic and advanced walking) while the powered aspects
allow effective mobility to participate with family and friends.
Seated Car
Standing Car
Powered Walker
Modified cars activated in sitting, by standing up (note switch on the
seat and elevated steering extension) and by walking (switch hidden
under the seat). PVC tubing in standing car and powered walker strong
enough for body weight support harness (not shown).
Each child’s spectrum car has three modes that provide for
steering while sitting, standing, and/or power-assisted walking.
Our multi-switch design allows families to rapidly switch between
sit, stand and walking modes even within a session in order to
maintain a high degree of fun and just right challenge for their
infant. In each mode, a harness attached to the PVC roll cage
ensures safe driving while providing for more or less trunk and/or
body weight support in sitting, standing (continued on next page)
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and walking. Cars have an easy to reach on/off switch, and we
are close to having a radio controlled on/off switch for families.
Sitting Mode: Infants start in sitting, which requires the least
balance/strength/coordination. Activation is by a handle bar
switch or foot switch. Initially, sitting is highly supported with a
trunk harness and PVC roll bars. These are loosened as the infant
gains confidence and to challenge balance, strength and coordination in sitting.
Standing Mode: As soon as infants can take weight on their legs
and hold their trunk erect during supported standing, they will
begin to increasingly use the standing mode. Activation is by a
low profile switch hidden under the seat that is activated by
standing. That is, standing moves the car while sitting stops that
car. PVC pull bars and body weight support harness are added
to the roll cage for pull to stand practice and safety. Steering is
via elevated handle bars.
Advanced Standing Mode: Requires the standing infant to weight
shift on and off a low profile switch in their shoe to activate the
car. This wobble game prepares the infant for the alternating
weight shifts also required in the walking mode.
Walking Mode: As soon as infants can weight shift in supported
standing and activate the car during the standing mode wobble
game, they will increasingly use the walking mode. The key
difference between standing and walking mode is that feet are
in contact with the ground in walking. Activation in the walking
mode is flexible and based on what achieves the best walking
performance. Specifically, car motion can require activation of
the seat switch and shoe switch simultaneously to encourage
weight shifts or by simply activating either switch alone. Pull
bars with a body weight support harness provide for balance
and safety. Steering is via elevated handle bars.
ConClusion
Given the above experiences, we believe
that modified ride-on cars have the
potential to facilitate what Butler called
an effective mobility “paradigm shift”.9
Modified ride-on cars provide both an
Modified ride-on toy cars provide powered
mobility and therapeutic exercise for balance,
strengthening and coordination while learning
to stand (top image) and walk (bottom image).
early powered mobility device and a toy that children with
mobility impairments can use just like their peers who are
developing typically. These cars provide a means for children
with mobility impairments to look and act like their peers
and engage in similar types of play activities and socialization.
For clinicians, the adaptive and flexible aspects allow for
simultaneous progress in participation via effective mobility,
therapeutic exercise for strength, balance and coordination
while working on sitting, standing and/or walking – but
shhhhhhh don’t tell the kids and parents this! They are having
too much fun. ■
Sam Logan, PhD, is a Post-Doctoral Fellow, and Cole Galloway,
PT, PhD, is a Professor in the Department of Physical Therapy,
University of Delaware. They are members of the Infant
Behavior Lab. Their lab focuses on research and development
of training and technology to maximize the exploratory abilities
of young children and their families. This work was funded in
part by grants from the National Institutes of Health, the
National Science Foundation and the Unidel Foundation, Inc.
For more info on GoBabyGo:
• Dr. Galloway’s UD webpage:
www.udel.edu/PT/About%20Us/People/galloway.html
• Facebook: www.facebook.com/UDGoBabyGo
• YouTube: www.youtube.com/channel/UCUJvxs5iv1MDkL3WL9lN0Q?feature=mhee
Heather Feldner, PT, MPT, PCS is a pediatric physical therapist
and faculty member at the University of Illinois at Chicago,
as well as a PhD student in Disability Studies also at UIC. Her
research interests include multimodal mobility for kids with
disabilities, as well as investigating early powered mobility for
very young children using a social justice approach, especially
as it relates to self-directed participation. She is partnering
with the UD lab on several projects related to early powered
mobility experiences for children.
referenCes
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