Watch Your Toes!

Making toddlers safe behind the wheel

by Kathy Wechsler on July 1, 2006 - 2:56pm

QUEST Vol. 13, No. 4
Owen Norton
Owen Norton, 4, of Braintree, Mass., enjoys the freedom that comes with his Permobil Koala. Owen, who has spinal muscular atrophy, began using the chair when he was 26 months old.
The Co-Pilot
The power assist feature makes the Co-Pilot from Permobil an easy way to push your child’s chair when he or she needs a break.
The Power Assist feature of the Co-Pilot wheelchair
Attendant control joystick
Permobil also offers the PG Drives Technology attendant control joystick, which can be mounted behind your child’s wheelchair.
The Power Tiger
The Power Tiger pediatric wheelchair from Invacare offers bright colors and modern styling while providing versatile and responsive electronic controls for pinpoint accuracy. The Orbit seating system can be mounted on both a Power Tiger and a manual Orbit. Invacare has several models of pediatric power chairs, most with the capacity to “grow” with the child.
Wireless attendant control
Manufactured by Adaptive Switch Laboratories, the wireless attendant control allows you to control one or more directions of your youngster’s power wheelchair.

Most infants without disabilities learn to crawl when they reach 7 to 8 months. A few months later, they can pull themselves to their feet and toddle around by holding onto furniture. At age 1, curiosity gets the best of toddlers, and they begin to explore their environments in ways that offer more independence than ever before — by learning to walk.

For young children with neuromuscular diseases, such as spinal muscular atrophy, myotubular myopathy, nemaline myopathy and congenital muscular dystrophy, crawling and walking aren’t always possible, even though they’re as ready (cognitively) for exploration and independence as any other child.

Experts say that exploration helps a child’s mental development. Toddlers using wheelchairs need to be as mobile and inquisitive as other youngsters.

Power wheelchairs give toddlers the freedom to explore, learn and grow. The major U.S. wheelchair manufacturers that offer pediatric power wheelchairs are:

Start your engines!

Ian Kingscote, a rehabilitation technology specialist (RTS) and rehab equipment consultant with Design-Able in Bridgewater, Mass., says a child’s cognitive age is more important than chronological age when it comes to beginning to use a power wheelchair. He’s worked with children as young as 2 years old.

Whether your toddler is ready for a power wheelchair depends on many factors, including his or her maturity level and understanding of cause and effect and spatial relations. Readiness is extremely client-specific, Kingscote says.

To determine whether it’s safe for your toddler to begin using a power wheelchair, he or she should attend a specialized clinic for six to 10 weeks. During training, your child’s performance, endurance and tolerance will be monitored.

“A chair goes where it’s driven, so that’s why the children really should go to an established pediatric clinic with experienced therapists and wheelchair vendors,” said Kingscote, who’s been in the industry for 13 years. “I generally have my clinics at the Children’s Hospital in Boston ensure that if a power chair is recommended, it’s because the user has ‘passed his or her test’ and is a safe driver.”

Medicaid in most states will cover pediatric power chairs, but the order has to be accompanied by a letter of medical necessity from a therapist at the clinic. You’ll have to provide documentation that the youngster has tried specific equipment and knows how to use it safely.

Who’s in control?

Experts agree that the number-one rule of power wheelchair safety with toddlers is supervision. Of course, safety should come first in any toddler activity.

Most power wheelchairs have controls that can be programmed. Ask your RTS to adjust the chair’s speed and sensitivity, especially in the beginning. This way, when your child goes at “top” speed, the speed is only a fraction of what the chair is capable of. Your RTS can make adjustments as your child’s ability changes.

Kingscote says that wheelchair electronics sometimes can be programmed “to cut out if too much resistance is recognized by the motors — but this isn’t available on all chairs.”

You can also purchase an attendant-control feature that lets you control the speed, steering, power, or tilt and recline of your toddler’s wheelchair. With attendant controls, you can help your beginning driver avoid dangerous situations, or you can take over control of the chair when your toddler is tired of driving.

Attendant controllers can be mounted behind the wheelchair’s backrest or attached to a cable that lets you walk beside the chair. You can even get wireless remote controls.

These optional features usually can be funded by Medicaid if they’re medically justified.

Using the emergency stop switch (a.k.a. kill switch), you can shut down the power, stopping your youngster’s wheelchair in its tracks. Another option is a second joystick, which allows you to take over driving the wheelchair when your toddler runs out of energy.

“Generally, when the kid’s very young, all we do is get them to drive first. Then as they learn the system we can then get them independent in terms of turning the chair on and off, changing speed and tilting themselves back,” Kingscote says.

“We can slowly introduce more features to them as they get more competent in the chair, so that’s something that’s important to know: Don’t try and do everything straight away — drip-feed the information.”

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