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To examine the effects of ride-on car (ROC) training using different postures on mobility and social function in children with motor delays in comparison with conventional therapy.Thirty-eight children (22 males, 16 females) with motor delays were recruited and randomly assigned to three groups: ROC training while sitting (ROC-Sit,Mobility and goal achievement improved significantly in all groups after the intervention (Increased practice and caregivers' involvement can improve children's mobility and goal achievement. Adopting a standing posture in an ROC can enhance social function.IMPLICATIONS FOR REHABILITATIONProviding active exploratory experience through ride-on cars or practicing specific skills can improve children's mobility function.Ride-on car training in a standing posture allows children to access their distal environment visually, resulting in improved social function.Setting goals with caregivers maximizes the effects of treatment on goal achievement.

Importance: A child’s independent mobility, environments, and mastery motivation are critical factors during early development. Objective: To examine the effectiveness of ride-on car (ROC) training with a standing (ROC–Stand) or a sitting posture (ROC–Sit) in enhancing children’s mastery motivation and decreasing parenting stress levels. Design: Randomized controlled trial (RCT) with a multiple pretest–posttest design. Setting: Hospital-based environment in northern Taiwan. Participants: Thirty-nine children with disabilities ages 1 to 3 yr were randomly assigned to ROC–Stand (n = 16), ROC–Sit (n = 12), or conventional therapy (control; n = 11). All groups received 2-hr training sessions two times a week for 12 wk and then a 12-wk follow-up period that involved only regular therapy. Measures: Assessments included the Revised Dimensions of Mastery Questionnaire–Chinese version and the Parenting Stress Index. Results: All groups showed significant changes in social persistence with adults, mastery pleasure, and general competence after the intervention. The two ROC training groups showed a significantly greater decrease in parenting stress than the control group. In addition, increased general competence of the ROC–Stand group also strongly correlated with decreased parent–child dysfunctional interaction. Conclusions and Relevance: This RCT verifies the effectiveness of ROC training and offers a novel approach to increase children’s mastery motivation and decrease parenting stress. What This Article Adds: Providing a large amount of active, exploratory experiences with goal-directed, moderately challenging tasks and cooperation with caregivers may result in the greatest benefits to young children with motor disabilities.

To examine the responsiveness and minimal clinically important difference (MCID) of the TNO-AZL (Netherlands Organization for Applied Scientific Research Academic Medical Centre) Preschool Children Quality of Life (TAPQOL) in children with cerebral palsy (CP). Ninety-seven children with CP (60 males, 37 females; aged 1–6 years) and their caregivers were recruited from the rehabilitation programs of Chang Gung Memorial Hospital in Taiwan for this 6-month longitudinal follow-up study. The Functional Independence Measure for Children (WeeFIM) and TAPQOL outcomes were measured at baseline and at a 6-month follow-up. Responsiveness was examined using the standardized response mean (SRM). The distribution-based and anchor-based MCID were determined. The TAPQOL outcomes include physical functioning (PF), social functioning (SF), cognitive functioning (CF), and emotional functioning (EF) domains. The responsiveness of the TAPQOL for all of TAPQOL domains was marked (SRM = 1.12–1.54). The anchor-based MCIDs of TAPQOL for PF, SF, CF, EF, and total domains were 1.25, 3.28, 2.93, 2.25, and 1.73, respectively, which were similar to the distribution-based MCID values of TAPQOL, except in the PF domain. The distribution-based MCIDs of TAPQOL in various domains were 2.85–3.73 when effect size (ES) was 0.2, 7.13–9.32 when ES was 0.5, and 11.40–14.91 when ES was 0.8. TAPQOL is markedly responsive to detect change in children with CP. The caregivers perceived the minimally important change in HRQOL of their children at a relatively low treatment efficacy. Researchers and clinicians can utilize TAPQOL data to determine whether changes in TAPQOL scores indicate clinically meaningful effects post-treatment and at the follow-up.

Purpose The purpose of this single-subject case series study is to determine the effect of modified ride-on car use in natural environments on mobility. Method Three children younger than 2 years diagnosed with various disabilities participated in this 24-week study using a modified ride-on car in their home and community. Results All 3 children demonstrated an ability to independently use the modified ride-on car and enjoyed doing so. Two of the 3 children demonstrated clinically significant gains in mobility skills as measured by the Pediatric Evaluation of Disability Inventory. Conclusions Modified ride-on car use is an emerging powered mobility device option for children younger than 2 years. Further research is needed to demonstrate the potential long-term gains of early powered mobility access to young children with disabilities.

Purpose To characterize behavioral changes in mobility and socialization in children with disabilities aged 1 to 3 years while they are receiving ride-on car training in the hospital environment. Methods Ten young children with motor disabilities received ride-on car training for 9 weeks (2 hours per session, 2 sessions per week). The driving and socialization behaviors were videotaped for 20 minutes per session (1 session per week) within the same period. Results Independent mobility, visual attention to the switch, and positive facial expressions during the training period were significantly improved. Conclusions Ride-on car training has positive effects on behavioral changes in mobility and socialization among young children with motor disabilities. This provides clinicians a novel option for implementing early mobility training in a hospital-based environment.

The purpose of this report was to determine the feasibility of short-term modified ride-on car (ROC) use for exploration and enjoyment by children with complex medical needs.A single-subject research design was used (n = 3; age, 6 months to 5 years). Children were video-recorded using their modified ROC.All children successfully learned how to independently drive a modified ROC. Two of the 3 children demonstrated high levels of enjoyment during use of a modified ROC.Modified ROC use is a feasible and enjoyable powered mobility device for children with complex medical needs.

Before the onset of walking, children with Down syndrome experience limited mobility yet are never considered candidates for traditional powered mobility devices. The purpose of this single-case study is to quantify the feasibility and family perceptions of including modified ride-on car use as an option for increasing daily mobility, socialization, and fun for a child with Down syndrome.A 13-month-old child, Natalie, and her family were video recorded during the 28-week study using her ride-on car in their home and community.Natalie demonstrated and her family reported increased movement, mobility, and socialization over the study period.Ride-on car use appears feasible, fun, and functional to increase daily mobility for pediatric populations working toward independent walking.

Aim To examine the effects of ride-on car (ROC) training versus conventional therapy on mobility and social function in young children with disabilities in a hospital-based environment. Methods and procedures Twenty young children with disabilities, aged 1–3 years, were recruited. The treatment group (n = 10) received ROC training of 2 h/session, 2 sessions/week for a total of 9 weeks in the hospital environment. The control group (n = 10) received conventional therapy alone. Assessments included the Chinese version of the Pediatric Evaluation of Disability Inventory and the Parenting Stress Index. Outcomes and results After a 9-week intervention, the treatment group showed improvements in mobility and social function, whereas the control group showed improvements in social function alone. Four children in the treatment group had clinically meaningful changes in mobility and 3 in social function, as compared to 2 and 1, respectively, in the control group. Conclusions and implications This is the first group study that demonstrated the potential benefits of ROC training on mobility and social function in young children with disabilities in the hospital environment. Future studies should include a larger sample size to detect any differences between ROC training and conventional therapy.

BackgroundConstraint-induced movement therapy (CIMT) is a potentially effective intervention for children with hemiplegic cerebral palsy (CP).PurposeThe objectives of this systematic review are: (1) to investigate whether CIMT is supported with valid research of its effectiveness and (2) to identify key characteristics of the child and intervention protocol associated with the effects of CIMT.Data Sources and Study SelectionA search of MEDLINE (1966 through March 2009), Entrez PubMed (1966 through March 2009), EMBASE (1980 through March 2009), CINAHL (1982 through March 2009), PsychINFO (1887 through March 2009), and Web of Science (1900 through March 2009) produced 23 relevant studies.Data Extraction and SynthesisThe 2 objectives of the review were addressed by: (1) scoring the validity and level of evidence for each study and calculating evidence-based statistics, if possible, and (2) recording and summarizing the inclusion and exclusion criteria, type and duration of constraint, intervention and study durations, and outcomes based on the International Classification of Functioning, Disability and Health (ICF).LimitationsOnly studies published in journals and in English were included in the systematic review.ConclusionsStudies varied widely in type and rigor of design; subject, constraint, and intervention characteristics; and ICF level for outcome measures. One outcome measure at the body functions and structure level and 4 outcome measures at the activity level had large and significant treatment effects (d≥.80), and these findings were from the most rigorous studies. Evidence from more-rigorous studies demonstrated an increased frequency of use of the upper extremity following CIMT for children with hemiplegic CP. The critical threshold for intensity that constitutes an adequate dose cannot be determined from the available research. Further research should include a priori power calculations, more-rigorous designs and comparisons of different components of CIMT in relation to specific children, and measures of potential impacts on the developing brain.

This study examined body-scaled information that specifies the reach patterns of children with hemiplegic cerebral palsy and children with typical development.Nine children with hemiplegic cerebral palsy (3-5 years) and 9 age-matched children with typical development participated in the study. They were required to reach and grasp 10 different pairs of cubes. Reach data were coded as either a 1-handed reach or a 2-handed reach. Dimensionless ratios were calculated by dividing the cube size by the maximal aperture between the index finger and thumb. A critical ratio was used to establish the shift from a 1-handed to an exclusive 2-handed reach.The critical ratio was not significantly different for either preferred or nonpreferred arms within and between groups. All children used an exclusive 2-handed reach at a similar dimensionless ratio.Our study provides evidence of the "fit" between environment (cube size) and the individual's capabilities (finger aperture) for reaching for both groups.

Children with cerebral palsy have limited opportunities to explore their physical and social environment. The purpose of this study was to determine the feasibility of using a "ride-on toy car" as a readily available, low-cost, fun, and functional option for children with special needs.Brenden, a 21-month-old child, was provided a modified ride-on toy car for a 15-week study period divided up into a 1-week baseline, 12-week intervention, and 2-week postintervention. We coded mobility and socialization measures from video recordings.Brenden was more mobile and had more vocalizations during the 12-week intervention.Modified toy cars have serious potential to be a fun and functional power mobility option for children with special needs. The opportunity now exists to quantify several effects, including peer socialization, cognitive measures, and body structure/function goals involving neural, muscular, and skeletal physiology. Group study is required to formally test these findings.

Background Environmental and task modifications are powerful methods used to affect action in rehabilitation and are frequently used by therapists. Objective The purpose of this study was to examine and quantify the relationship between hand size (person characteristics) and object size (environmental characteristics) and the effect of this relationship on the emergent reaching patterns for children and adults with typical development. Design This was a cross-sectional prospective study. Methods Seventeen children and 20 adults participated and were required to reach and grasp 10 pairs of cubes of different sizes. The dimensionless ratios were calculated by dividing the cube size by the aperture between index finger and thumb to quantify emergent reach and grasp patterns. A critical ratio was used to establish the shift from a 1-handed to an exclusive 2-handed reach pattern. Results The results demonstrated no significant difference in the mean critical ratios between the 2 groups. However, a 2-handed reach was used more frequently than a 1-handed reach at a significantly smaller ratio for children in comparison with adults. Limitations The relational metrics between the cube and hand are only one contribution to the emergent reaching and grasping patterns. Conclusions Children had more variability of reaching patterns than adults. A personal constraint, such as experience, and a task constraint of accuracy may account for the variability. The results encourage further research on body-scaled information for individuals with different personal constraints (eg, children with cerebral palsy) and the impact of body-scaled information on emergent actions.

We investigated the association of infants' sleep and awake positioning with motor milestone acquisition as measured by the Alberta Infant Motor Scale (AIMS). Participants were 30 very-low-birthweight (VLBW) infants with preterm white matter disease (PTWMD; 21 males, nine females; mean birthweight [BW] 1,129 g [SD 338]; mean gestational age [GA] 28 wks [SD 2.44]); 21 VLBW infants without preterm WMD (PT; 13 males, eight females; mean BW 1,107 g [SD 370]; mean GA 28.05 wks [SD 2.21]); and 17 term infants (Term; seven males, 10 females; mean BW 3,565 g [SD 382]; mean GA 40 wks [SD 1.31]). Testing occurred at 1, 5, and 9 months of age (corrected for prematurity). Preferred positions during sleeping, playing, and feeding were obtained through parent interview. These positions and group were the independent variables. Prone sleeping was significantly and positively associated with motor development at all ages (1 mo: p=0.005; 5 mo: p=0.011; 9 mo: p=0.040). At 5 months, prone sleeping and playing were significantly and positively associated with AIMS scores (prone sleeping, p=0.016; prone playing, p=0.047). However, group was negatively associated with preterm white matter disease, with the PTWMD group having significantly lower AIMS scores than the Term group (p=0.029). At 9 months, sitting playing and group membership were significantly associated with AIMS scores (sitting playing, p=0.005; group, p=0.012). Prone positioning should be encouraged for awake time, particularly for infants with preterm white matter disease.