Today, if kids cannot motor around on their own two feet, there are a lot of options to help PTs aid mobility, some that make "motoring" literal rather than figurative. The diversity in assistive products and therapeutic tools mirrors the diversity in patients. At Kids Abilities Pediatric Therapy in Shoreview, Minn, patient diagnoses cover a wide range of conditions, from physical to neurological. Goals differ for each, but mobility is the ultimate goal for all.

"One thing we strongly feel is that kids do need to be mobile. That is always one of our goals," says Jenny Sargent, PT, co-owner of Kids Abilities. "For some kids, they are so physically involved that independent mobility is not an option, and with them, we look at good positioning programs," adds Carol Gilligan, PT, fellow co-owner.

Equipment plays an important role in helping to achieve these goals, but only with proper fit and use. To reinforce therapeutic goals, Kids Abilities works to cultivate a team for each child. The practice itself includes occupational and speech therapy in addition to physical therapy. The therapists, in turn, work closely with patients’ families and schools to maximize therapeutic benefit.

"We have one patient—a 10-year-old boy—diagnosed with spastic cerebral palsy. We provide both physical therapy and occupational therapy. Our therapists have a close relationship with his school PTs, and his family is great, following the home program. Because of the close-knit communication and shared goals, in the past year he has moved from using a wheelchair at school to ambulating in school with a walker. He is also able to write his name legibly and can ride a bike at home," Gilligan says.

GROWING INTO GOALS

The young boy is representative of a large group of children in the practice’s care. "Children progress a lot faster when the home, school, and medical community work together," Sargent says, noting that poor communication can impede progress.

"We look at each child individually and see what level he or she is at. Then, we set high goals," Gilligan says. Kids Abilities’ patients have been diagnosed with a wide range of conditions; a number are even undiagnosed, waiting for a decision or labeled with developmental delay.

"Generally, we provide an evaluation of each patient. We evaluate their equipment needs, if necessary. We communicate the therapy goals to the school staff and other caregivers to make sure there is carryover of the goals. We establish home programs. And we try to educate the families about other community programs that can be an adjunct to therapy," Gilligan summarizes.

The therapist aims to get most children upright and weight-bearing in whichever way the children can achieve that goal. Movement to maintain range of motion is also important, particularly for diagnoses such as cerebral palsy and traumatic brain injury. "It’s extremely important to get them upright and offer a variety of positions so they are not just sitting," Gilligan says.

"That is always one of our goals, along with a need to be mobile throughout the day. They can’t sit in a wheelchair for

8 hours without any alternate positioning or movement opportunities. So we incorporate walkers, bikes, and gait trainers to get the kids up and moving," Sargent says.

WITH A LITTLE HELP

The equipment matches the child’s ability. To work on sitting balance and equilibrium, the two therapists may use therapy balls and bolsters. For more advanced children, options include trampolines, swings, balance beams, and boards. To get children standing, Gilligan uses EasyStand standers from Altimate Medical Inc, Morton, Minn. "With one lever, the child can pump themselves up to standing," Gilligan says.

If the patient can use a walker, the therapist will incorporate it. These can include postural control walkers (or reverse walkers) as well as Lofstrand, or forearm, crutches. Gilligan uses the line of Walk Easy crutches from Walk Easy Inc, Delray Beach, Fla.

At home, Gilligan will recommend adapted bicycles, suggesting the Freedom Concepts Inc, Winnipeg, Manitoba, Canada, devices.

"And then, of course, we use a lot of wheelchairs," Gilligan says. Patients may have manual or power. With power chairs, Gilligan believes that midwheel drive gives children much more mobility. She recommends the Quantum line of midwheel power chairs from Pride Mobility Products Corp, Exeter, Pa.

Sargent notes that the power wheelchairs, much like other equipment such as walkers and crutches, are becoming more child-oriented, with lighter weights, streamlined designs, and color options. "The products change as the technology advances, and they are more kid-friendly rather than merely adopting an adult look for a child," Sargent says.

Though she would hate to have to do without any of the above equipment, atop her wish list sits a gait trainer. Unfortunately, the cost of gait trainers can run high, and Kids Abilities has not yet allocated funds to cover the expense. In the meantime, the therapists use the EasyStand gliders, which accommodate a variety of body types and positions.

Pediatric Impediments

Equipment economics can be a challenge for the patient as much as the therapist, if not more so. "The primary challenge is paying for equipment. If we can have the child try out the equipment, using it in the clinic and at home and school, and show improvement, we can then justify its use in a letter to payors highlighting how well the child did or how it enabled her to change function," Gilligan says.

Sargent notes that buyer relationships are key to enabling this path. "It helps to have a close relationship with vendor sales representatives so that we are able to get our hands on the equipment and have the kids try it," Sargent says.

GROWING OLDER

Figure 1. The Walk Easy line of forearm crutches features both pediatric full cuff and half cuff.

Additional functions are good, too. Sargent notes there is already a chair that is designed to travel up and down stairs. "In the future, we’d like to see this equipment become more affordable and accessible within the community," she says.

Future options may include a wider range of positioning and greater speeds, as well as more chairs that allow the patient to stand. Gilligan expects the advances will provide more opportunities for children to control their environment and to improve their lives and the lives of their family members.

Sargent expects the same advances to be seen in orthotics, with lighter weights and more streamlined designs. And she is excited to see where electric stimulation leads. Research has shown mixed results regarding electrical stimulation of pediatric patients. The studies that lack statistically significant improvements report seeming visual improvements; others show positive impact.

A study by researchers in the United Kingdom concluded that neuromuscular electrical stimulation and/or threshold electrical stimulation (TES) "may be useful as an adjunct to therapy in ambulatory children with diplegia who find resistive strengthening programs difficult."¹ Another study "concluded that TES may be beneficial in children with spastic CP who have undergone a selective posterior rhizotomy procedure more than one year previously."

As researchers discover which patients will benefit from this treatment, PTs will continue to use the equipment available to help improve the mobility of their pediatric patients. But should the future find that electrical stimulation does help, it could give motoring a whole new meaning.

Renee DiIulio is a contributing writer for  Physical Therapy Products. For more information, contact .

References

1. Kerr C, McDowell B, Cosgrove A, Walsh D, Bradbury I, McDonough S. Electrical stimulation in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2006;48:868.
2. Steinbok P, Reiner A, Kestle JR. Therapeutic electrical stimulation following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: a randomized clinical trial. Dev Med Child Neurol. 1997;39:515-520.