Clinical Bottom Line
“How could I apply this information?”
Children with neuromotor disabilities may be deprived of normal play opportunities1 and thus may rely on assistive devices to allow them to explore and participate in activities critical to development. This study challenges us to think about how different types of mobility devices may affect play in different settings, and lends support to the notion that using more than one mobility device may be needed to optimize participation and function across settings. This study adds to the growing support for incorporating therapy interventions into everyday activities and routines to increase dosage.2 For a child, these daily routines include self-initiated, experiential play activities in multiple environments including home, school, the community, and playgrounds. Therapists should consider using the “right device, right time, right place” approach across settings to maximize developmental and functional outcomes for young children with mobility challenges, including wheeled mobility, adapted gait devices, and out-of-the-box thinking with modified ride-on options.
“What should I be mindful about when applying this information?”
Limitations include the inability to generalize behaviors beyond the case and the context described and to infer causation regarding any change in behaviors.
The equipment described in this study required aftermarket modifications to a commercial product and may be difficult for clinicians to replicate. Clinicians performing their own modifications to ride-on toys must be mindful of safety precautions, including the assurance that all modifications are technically sound and physically safe.
A number of clinically feasible experimental methodologies could be used to replicate findings and build evidence in this area, such as studies using matched pairs, well-designed N-of-1 studies, and cross-over designs.
Melissa Tally, PT, MPT, ATP
Claire Morress, PhD, OTR/L, ATP
Cincinnati Children's Hospital and Medical Center, Perlman Center
1. Missiuna C, Pollock N. Play deprivation in children with physical disabilities: the role of the occupational therapist in preventing secondary disability. Am J Occup Ther. 1991;45:882–888.
2. Morgan C, Novak I, Badawi N. Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis. Pediatrics. 2013;132:e735–746.