Biomechanical Changes Underpinning Stand-on Ride-on Power Mobility Devices for Children with Cerebral Palsy

Project Summary
Children’s participation in life activities with family and peers plays a vital role in their physical and psychosocial
development. Many children with cerebral palsy are often deprived of such interactions given limited postural control and
walking capabilities, leading to delayed development and low quality of life. Ride-on power mobility devices (PMD),
such as the go-baby-go cars, have gained much public health attention since these devices allow for the self-generated,
active control of mobility, spatial exploration, and socialization. More recently, adapted stand-on ride-on PMDs have
provided the additional support to maintaining an upright posture, expected to additionally improve children’s balance and
lower extremity strength. However, besides the limited scope of case reports and case series, literature has largely
provided qualitative outcomes after use of these devices. Still unknown are the biomechanical factors underlying
purported beneficial physical changes of using stand-on PMDs. Understanding which biomechanical factors can be altered
after PMD use, especially stand-on devices, will guide subsequent intervention work to enhance functional outcomes. For
this R03 project, we will administer an intervention with individually-adapted stand-on PMD for three months to a cohort
of children with cerebral palsy. We will recruit a small homogeneous sample (n=10) of young children (ages 4–6 years)
who have difficulty with walking and balance (Gross Motor Function Classification System level III) to gather
comprehensive pre-post biomechanical pilot data to support the subsequent R21 project. This is the first study to evaluate
biomechanical factors underlying expected changes in balance (static and dynamic) and mobility function after stand-on
PMD intervention. The completion of this study is expected to generate fundamental knowledge to guide further PMD
interventions with the goal of decreasing the lifelong burden of secondary medical conditions that emerge in this
population due to impaired balance and limited mobility. Our long-term research agenda is geared toward helping children
with impaired mobility engage in life and physical activities with family and peers to foster development and enhanced
quality of life. This goal is in alignment with the National Center for Medical Rehabilitation Research aims to develop
scientific knowledge to enhance health, independence, and quality of life of people with physical disabilities. More
specifically, our proposed work (current R03 and subsequent NIH grant applications) falls within NINDS/NICHD
Strategic Plan for Cerebral Palsy Research in which we will specifically address early interventions via active play to
improve abilities in functional activities and to minimize effects of the injury on body structure and function with the goal
of enabling increased participation in society and promoting independence.

Grant Number: 1R03HD114548-01
NIH Institute/Center: NIH
Principal Investigator: Guilherme Cesar