Livingstone Roslyn W, Field Debra A
Sunny Hill Health Centre, Vancouver, Canada.
Disabil Rehabil Assist Technol. 2023 Apr;18(3):285-294. doi: 10.1080/17483107.2020.1847207. Epub 2020 Nov 27.
To measure and compare progression in children's power mobility skill among process and task-based measures following a loan of one of four early power mobility devices. Additionally, to explore different power mobility learner groups and skill development trajectories.
In this pre-post study, children were purposefully sampled and power mobility skill was measured from video taken pre-post several months' experience (mean 192.40; SD 42.79 days) using the Assessment of Learning Powered mobility use (ALP) and two task-based measures. Associations among power mobility skill measures were examined. Child and environmental factors influencing ALP phase at loan-end were explored.
Forty-six children aged 13 - 68 months (mean 40.40; SD 15.60) participated, with cerebral palsy being the most common condition ( = 33; 71.74%). ALP change scores ranged from -2 to +4 ALP phases (median 1.0). Wilcoxon signed rank test was significant for pre-post differences with a large effect size ( = 5.50, < 0.001; = 0.57). End-of-loan Spearman correlations between ALP and two task-based paediatric measures were excellent ( = 0.92). Kruskal-Wallis test revealed significant effect of device, access method, diagnostic group and communication abilities on loan-end ALP phase.
Positive change was demonstrated with most children ( = 39; 84.78%) changing at least one ALP phase during the study. Positive change was seen with children at all phases of tool-use, using all devices and access methods. Process and task-based measures were highly correlated, but differed in application for different learner groups. Different trajectories of skill development may be associated with different child profiles and access abilities.IMPLICATIONS FOR REHABILITATIONChildren at all phases of tool-use can demonstrate positive change in power mobility skill using different devices and switch as well as joystick access methodsThe Assessment of Learning Powered mobility use (ALP) is useful for assessing tool-use and learning process skills for young children across the power mobility skill continuum.Task-based measures may also be helpful for guiding training and recording progress; The Power Mobility Training Tool (PMTT) is most useful for children exploring cause-effect and direction (ALP Phases 1-5), while the Power Mobility Program (PMP) is most useful for functional learners and those progressing from exploring direction to functional use (ALP Phases 5-8).Access method may influence power mobility learning trajectory and training.
在借用四种早期动力移动设备之一后，测量并比较基于过程和任务的测量方法中儿童动力移动技能的进展情况。此外，探索不同的动力移动学习者群体和技能发展轨迹。
在这项前后对照研究中，我们有目的地选取了一些儿童，并通过使用学习动力移动使用评估（ALP）和两种基于任务的测量方法，从儿童在几个月体验前后（平均192.40天；标准差42.79天）拍摄的视频中测量其动力移动技能。我们研究了动力移动技能测量方法之间的关联。探讨了在借用期末影响ALP阶段的儿童和环境因素。
46名年龄在13至68个月（平均40.40；标准差15.60）的儿童参与了研究，其中脑瘫是最常见的病症（n = 33；71.74%）。ALP变化分数范围为 -2至 +4个ALP阶段（中位数为1.0）。Wilcoxon符号秩检验显示前后差异具有统计学意义，效应量较大（z = 5.50，p < 0.001；r = 0.57）。借用期末，ALP与两种基于任务的儿科测量方法之间的Spearman相关性非常好（r = 0.92）。Kruskal-Wallis检验显示设备、接入方法、诊断组和沟通能力对借用期末的ALP阶段有显著影响。
大多数儿童（n = 39；84.78%）在研究期间至少改变了一个ALP阶段，显示出积极的变化。在工具使用的各个阶段，使用所有设备和接入方法的儿童都出现了积极的变化。基于过程和任务的测量方法高度相关，但在不同学习者群体中的应用有所不同。不同的技能发展轨迹可能与不同的儿童特征和接入能力相关。
对康复的启示
处于工具使用各阶段的儿童，使用不同设备以及开关和操纵杆接入方法，都能在动力移动技能方面表现出积极变化。
学习动力移动使用评估（ALP）有助于评估幼儿在动力移动技能连续体中的工具使用和学习过程技能。
基于任务的测量方法也可能有助于指导训练和记录进展；动力移动训练工具（PMTT）对探索因果关系和方向的儿童（ALP阶段1 - 5）最有用，而动力移动计划（PMP）对功能性学习者以及从探索方向过渡到功能性使用的儿童（ALP阶段5 - 8）最有用。
接入方法可能会影响动力移动学习轨迹和训练。
