Abstract
BackgroundThere is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP).MethodsA cross-sectional study based on the most recent examination of all children with CP, born 2002–2013, reported into the Swedish cerebral palsy registry (CPUP), from January 2012 to June 2014. There were 2328 children (58 % boys, 42 % girls), aged 0–11 years, at all levels of gross motor function and hand function. Hazard ratios adjusted for age and sex were used to calculate the risk for not being able to self-propel based on Gross Motor Function Classification System (GMFCS) levels, upper extremity range of motion and hand function including Manual Ability Classification System (MACS), House functional classification system, Thumb-in-palm deformity, Zancolli (spasticity of wrist/finger flexors) and bimanual ability.ResultsIn total 858 children used wheelchairs outdoors (692 manual, 20 power, 146 both). Only 10 % of the 838 children self-propelled manual wheelchairs, while 90 % were pushed. In contrast 75 % of the 166 children who used power mobility outdoors were independent. Poor hand function was the greatest risk factor for being unable to self-propel a manual wheelchair, while classification as GMFCS V or MACS IV-V were the greatest risk factors for not being able to use a power wheelchair independently.ConclusionsThe majority of children with CP, aged 0–11 years did not self-propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.
Highlights
There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities
Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels are shown in Table 1 along with the percentages and numbers using manual and power wheelchairs
Outdoors power wheelchairs were operated independently by 75 % of the 166 children while 25 % needed assistance, in some cases related to severe visual, cognitive or motor impairments. These results provide support for previous studies, showing that power wheelchairs provide independent mobility while manual wheelchairs only facilitate care [21]
Summary
There is a lack of understanding of the factors that influence independent mobility and participation in meaningful activities. The purpose of this study was to analyse physical factors influencing independent use of manual and power wheelchairs in a total population of children with cerebral palsy (CP). There is a relationship between independent mobility, overall development and participation for children with disabilities [1]. Infants and toddlers with motor impairments, and/or intellectual impairment, benefit from independent mobility experience to enhance overall development [2], while older children and adolescents. The Gross Motor Function Classification System (GMFCS) [4, 5] classifies children with cerebral palsy (CP) according to their level of gross motor function and, in particular, method of locomotion. Even within GMFCS levels, there is considerable variability in the mobility methods that children use across settings as personal and contextual factors influence level of independence [9]
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