Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study

Abstract

Background: Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. Methods: A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. Results: Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents’ perception of their children’s wheelchair skills. Conclusions: A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.

Wheelchair Dance: Exploring a Novel Approach to Enhance Wheelchair Skills, Belongingness and Inclusion among Children with Mobility Limitations

“…The team chose to conduct an intensive dance camp because several studies suggest that intensive rehabilitative approaches (with intense repetitions) are associated with improved neuroplasticity and global motor function over the long term [18,39,40]. Even though the most optimal duration and frequency remain unknown for young people, some research suggests that condensed training may not be the most suitable option to promote skills development in this population and that, consequently, frequent and shorter training sessions distributed over a longer period of time appear preferable [12,15,17]. In particular, for advanced skills that have had no improvement in WST results (e.g., perform a stationary wheelie) along with the complexity of the dance activity integrating wheelchair skills, to allow more time for rest between training sessions and consolidation or to vary contexts in which wheelchair skills are practiced could be beneficial to improve dance camp [15,17].…”

“…Even though the most optimal duration and frequency remain unknown for young people, some research suggests that condensed training may not be the most suitable option to promote skills development in this population and that, consequently, frequent and shorter training sessions distributed over a longer period of time appear preferable [12,15,17]. In particular, for advanced skills that have had no improvement in WST results (e.g., perform a stationary wheelie) along with the complexity of the dance activity integrating wheelchair skills, to allow more time for rest between training sessions and consolidation or to vary contexts in which wheelchair skills are practiced could be beneficial to improve dance camp [15,17]. Further studies would be needed to determine whether intensive therapy is more effective than conventional therapy when interventions are distributed over a longer period of time [41].…”

“…YDs explained how seeing other people in wheelchair executing movement showed them new possibilities with their wheelchair and increased their confidence in trying them out. In fact, peer-training can increase physical activity participation of children with and without disabilities, increase peer interaction, improve confidence in one's ability to learn new skills and generate behavior changes (e.g., increase wheelchair mobility) [17,49]. A peer trainer may also be considered more credible than other professionals, as they have lived experiences using their wheelchair [50].…”

“…Numerous studies have demonstrated the effectiveness of the WSTP for improving wheelchair skills and confidence in adults, as well as satisfaction with participation in meaningful activities that require the use of a wheelchair [13]. However, the influence of the WSTP on manual wheelchair mobility in young people has only been explored in four studies with small samples ranging from one to eight participants [14][15][16][17]. Moreover, the program is underutilized in pediatric rehabilitation settings, thus limiting young people's opportunities to develop the manual wheelchair skills needed to participate in artistic and leisure-time physical activities [10].…”

Community mobility and participation assessment of manual wheelchair users: a review of current techniques and challenges

“…A further example for the effectiveness and importance of communitybased rehabilitation comes from a 2019 study by Madsen et al (2020) They reviewed nine articles on outdoor and communitybased rehabilitation programs and reached the conclusion that the programs "seemed to empower participation opportunities and social inclusion of people with disabilities" (Madsen et al, 2020). Additional support comes from a 2022 pilot study that assessed 8 wheelchair participants and found that "a community-based peerled approach to wheelchair skills training seems promising for improving wheelchair outcomes" (Ouellet et al, 2022).…”