Restrictions in heads, not carts
Today, more than a billion people in the world live with some form of disability (approximately one in seven). Between 110 million (2.2%) and 190 million (3.8%) people (aged 15 and over) have significant difficulty functioning. 
It is estimated that 65 million people worldwide could benefit from wheelchair use. However, approximately 20 million people cannot afford it.
Among wheelchairs used in highly developed parts of the world, almost 70% are manually operated, the rest are electrically operated wheelchairs and scooters.
Why at such high rates, a person moving down the street in a wheelchair can be seen very rarely? Why do we so rarely see children playing together in strollers on the playground or walking with a pet in the park?
Wheelchair is one of the most commonly used mobility aids. The wheelchair is a prerequisite for ensuring human rights and a dignified life. Properly selected, well-equipped wheelchairs can be the first step towards integration into society for many children.
A trolley is much more than just an accessory. This is a means by which the child will have the right to choose, the opportunity for self-realization and will be able to avoid being treated as an object of manipulation.
Physical therapy should not be a lifelong process!
Many children with GMFCS Level III-V cerebral palsy can study and participate in socio-cultural activities. They, like all children, want to communicate and play, although they cannot always say so. They do it in their own way as their motor experience, because the game is the basis for normal development. Therefore, it is necessary to take into account the individual characteristics of the child and really assess the level of its functionality, what it can do, not what we expect! (For this there is a special evidence base and functional scales of classifications MACS, EDACS, GMFCS, FMS…).
We need to look for strengths and develop them!
Let the child move in an adapted way, but independently! Implementing a home rehabilitation program, proper exercise, orthopedic support, positioning and properly selected aids (of which there may be several, depending on fatigue, speed, efficiency and safety of movement over different distances) are important elements for the harmonious development of the child and prevention of secondary complications.
Unfortunately, in low- and middle-income countries, most people with disabilities and parents of children with neurological status (wheelchairs) evoke negative emotions and are taboo. This is influenced by many factors, such as: low education and tolerance of the population, setting incorrect goals and predictions of treatment, architectural barriers, low choice and inaccessibility of quality equipment, information on its use and maintenance, and others.
Who can use a wheelchair as a way to move from point A to point B and not as a label?
The Rodby-Bousquet and Hägglund study describes the use of different types of carts indoors and outdoors according to different levels and forms of CPU.
This is evidence that environmental factors, parental influence, personal factors (eg choice, motivation, disability acceptance) and body functions (eg spasticity, pain and fatigue) are important for wheelchair use, both indoors and outdoors. .
Children at GMFCS level III used mostly mechanical wheelchairs for self-mobility, while electric ones were more common at GMFCS level IV.
Most children used a wheelchair for outdoor mobility rather than indoors. (GMFCS I 2%, 39% at level II and 85-90% at levels III-V).
Similarly, the number of children in need of adult care increases with GMFCS levels, and only 14% in general are able to move completely independently in a wheelchair. We have a much lower figure.
More information at the link.
Interestingly, the use of wheelchairs in children with impaired walking has less negative impact on the accuracy of movement than walking with assistive devices due to lower energy consumption, while social interaction and participation are improved.
Cognitive, psychosocial development, and child behavior, including interaction with objects, communication, and relocation, were also better in children aged 23–38 months who were provided with wheelchair access.
It is worth considering that setting the right goals in the GMF and SMART format, according to the GMFCS level, in the early stages of rehabilitation and joint cooperation of parents with a multidisciplinary team will improve independence in moving children within school, home or long distance, which will improve quality of life. daily activity and self-care skills.
It is necessary to think critically!
Should I go for a massage every day or other procedures that have no evidence in neurorehabilitation, if the child screams instead of getting at least emotional pleasure?
The effectiveness of massage to reduce spasticity or increase muscle strength is a myth. Isn’t it better to train postural control and balance in a sitting position, maintain the amplitude of movements, train muscle strength and coordination of movements of the upper shoulder girdle?
An example is children of level 4, who are promising to move independently in a wheelchair, but unfortunately, we use it.
- 95 - 99% of Spinal Bifida at the thoracic and high lumbar level, when the function of the quadriceps femoris is not preserved, use the active type trolley to move.
- 79% of Spinal Bifida at the lower lumbar level of the lesion with preserved function of the quadriceps muscle and partially preserved function of the biceps femoris in the absence of function of the middle and large gluteal muscles use a wheelchair for long distances. There is a significant difference in the function of walking at the neurological level of L3 and L4.
- People with traumatic spinal injuries, depending on the severity of the injury (ASIA) and the level of damage (C1 - Th12), will have different degrees of functionality and will need different types of wheelchairs.
- People with such nosologies as: TBI, stroke, muscular dystrophy, polio, multiple sclerosis, motor neurone disease, amputation of the lower extremities, depending on the severity of the disease should be provided with appropriate wheelchairs depending on needs.
Thus, a well-chosen wheelchair has many positive aspects:
- Mobility - an active lifestyle has physical and mental benefits for people involved in physical activity (reduced risk of cardiovascular disease, non-insulin-dependent diabetes, osteoporosis, osteoarthritis).
- Independence - no need to often rely on someone or hold hands, fear of falling. As a result, the child does not seek isolation.
- Health
- Increased self-esteem and confidence - self-esteem reduces depression and improves life satisfaction and well-being.
- Access to public life - the opportunity to move outside the house, to visit friends.
- Economic benefits - the opportunity to study and work.
It should be remembered!
There is no single type of wheelchair that meets the needs of every user. We need a wheelchair that meets their needs, their environment and is safe and high quality. It should also be borne in mind that children’s activities are different from the lives of adults and children may not always be able to say something.
It is widely believed that if a child is given a wheelchair, the child will no longer try to walk. At the same time, children are constantly growing and it is becoming increasingly difficult to carry them, and secondary complications due to the wrong position and load do their job. It is important to understand that a wheelchair usually does not prevent a child from walking. Early provision of a wheelchair with good postural support is more likely to help a child.
Any device that allows people to live their lives on their own, as they like, should be pointed out, not avoided!
We will consider the peculiarities of selection, types of carts and adaptation to environmental conditions in the next series.
Orest Kravchuk , Physical Therapist Innovo Kids
It is estimated that 65 million people worldwide could benefit from wheelchair use. However, approximately 20 million people cannot afford it.
Among wheelchairs used in highly developed parts of the world, almost 70% are manually operated, the rest are electrically operated wheelchairs and scooters.
Why at such high rates, a person moving down the street in a wheelchair can be seen very rarely? Why do we so rarely see children playing together in strollers on the playground or walking with a pet in the park?
Wheelchair is one of the most commonly used mobility aids. The wheelchair is a prerequisite for ensuring human rights and a dignified life. Properly selected, well-equipped wheelchairs can be the first step towards integration into society for many children.
A trolley is much more than just an accessory. This is a means by which the child will have the right to choose, the opportunity for self-realization and will be able to avoid being treated as an object of manipulation.
Physical therapy should not be a lifelong process!
Many children with GMFCS Level III-V cerebral palsy can study and participate in socio-cultural activities. They, like all children, want to communicate and play, although they cannot always say so. They do it in their own way as their motor experience, because the game is the basis for normal development. Therefore, it is necessary to take into account the individual characteristics of the child and really assess the level of its functionality, what it can do, not what we expect! (For this there is a special evidence base and functional scales of classifications MACS, EDACS, GMFCS, FMS…).
We need to look for strengths and develop them!
Let the child move in an adapted way, but independently! Implementing a home rehabilitation program, proper exercise, orthopedic support, positioning and properly selected aids (of which there may be several, depending on fatigue, speed, efficiency and safety of movement over different distances) are important elements for the harmonious development of the child and prevention of secondary complications.
Unfortunately, in low- and middle-income countries, most people with disabilities and parents of children with neurological status (wheelchairs) evoke negative emotions and are taboo. This is influenced by many factors, such as: low education and tolerance of the population, setting incorrect goals and predictions of treatment, architectural barriers, low choice and inaccessibility of quality equipment, information on its use and maintenance, and others.
Who can use a wheelchair as a way to move from point A to point B and not as a label?
The Rodby-Bousquet and Hägglund study describes the use of different types of carts indoors and outdoors according to different levels and forms of CPU.
This is evidence that environmental factors, parental influence, personal factors (eg choice, motivation, disability acceptance) and body functions (eg spasticity, pain and fatigue) are important for wheelchair use, both indoors and outdoors. .
Children at GMFCS level III used mostly mechanical wheelchairs for self-mobility, while electric ones were more common at GMFCS level IV.
Most children used a wheelchair for outdoor mobility rather than indoors. (GMFCS I 2%, 39% at level II and 85-90% at levels III-V).
Similarly, the number of children in need of adult care increases with GMFCS levels, and only 14% in general are able to move completely independently in a wheelchair. We have a much lower figure.
More information at the link.
Interestingly, the use of wheelchairs in children with impaired walking has less negative impact on the accuracy of movement than walking with assistive devices due to lower energy consumption, while social interaction and participation are improved.
Cognitive, psychosocial development, and child behavior, including interaction with objects, communication, and relocation, were also better in children aged 23–38 months who were provided with wheelchair access.
It is worth considering that setting the right goals in the GMF and SMART format, according to the GMFCS level, in the early stages of rehabilitation and joint cooperation of parents with a multidisciplinary team will improve independence in moving children within school, home or long distance, which will improve quality of life. daily activity and self-care skills.
It is necessary to think critically!
Should I go for a massage every day or other procedures that have no evidence in neurorehabilitation, if the child screams instead of getting at least emotional pleasure?
The effectiveness of massage to reduce spasticity or increase muscle strength is a myth. Isn’t it better to train postural control and balance in a sitting position, maintain the amplitude of movements, train muscle strength and coordination of movements of the upper shoulder girdle?
An example is children of level 4, who are promising to move independently in a wheelchair, but unfortunately, we use it.
- 95 - 99% of Spinal Bifida at the thoracic and high lumbar level, when the function of the quadriceps femoris is not preserved, use the active type trolley to move.
- 79% of Spinal Bifida at the lower lumbar level of the lesion with preserved function of the quadriceps muscle and partially preserved function of the biceps femoris in the absence of function of the middle and large gluteal muscles use a wheelchair for long distances. There is a significant difference in the function of walking at the neurological level of L3 and L4.
- People with traumatic spinal injuries, depending on the severity of the injury (ASIA) and the level of damage (C1 - Th12), will have different degrees of functionality and will need different types of wheelchairs.
- People with such nosologies as: TBI, stroke, muscular dystrophy, polio, multiple sclerosis, motor neurone disease, amputation of the lower extremities, depending on the severity of the disease should be provided with appropriate wheelchairs depending on needs.
Thus, a well-chosen wheelchair has many positive aspects:
- Mobility - an active lifestyle has physical and mental benefits for people involved in physical activity (reduced risk of cardiovascular disease, non-insulin-dependent diabetes, osteoporosis, osteoarthritis).
- Independence - no need to often rely on someone or hold hands, fear of falling. As a result, the child does not seek isolation.
- Health
- Increased self-esteem and confidence - self-esteem reduces depression and improves life satisfaction and well-being.
- Access to public life - the opportunity to move outside the house, to visit friends.
- Economic benefits - the opportunity to study and work.
It should be remembered!
There is no single type of wheelchair that meets the needs of every user. We need a wheelchair that meets their needs, their environment and is safe and high quality. It should also be borne in mind that children’s activities are different from the lives of adults and children may not always be able to say something.
It is widely believed that if a child is given a wheelchair, the child will no longer try to walk. At the same time, children are constantly growing and it is becoming increasingly difficult to carry them, and secondary complications due to the wrong position and load do their job. It is important to understand that a wheelchair usually does not prevent a child from walking. Early provision of a wheelchair with good postural support is more likely to help a child.
Any device that allows people to live their lives on their own, as they like, should be pointed out, not avoided!
We will consider the peculiarities of selection, types of carts and adaptation to environmental conditions in the next series. Orest Kravchuk , Physical Therapist Innovo Kids