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Power Mobility for Preschool Children

Published on: December 10, 2015
Project Number: ES0302-000
Product Line: Environmental Scans
Research Type: Devices and Systems
Issue: 55
Result type: Report

Context

Independent mobility is critical for cognitive and psychosocial development.1 There is evidence that independent mobility can stimulate psychological change,2 as well as the development of self-awareness, spatial orientation, emotional attachment, and visual vestibular integration.3-5

Power mobility devices allow children with developmental motor and cognitive disabilities to move independently. These devices include traditional powered wheelchairs (WCs), as well as commercial and customized mobility toys and mobility platforms, also referred to as ride-on or riding toys (e.g., Cooper Car, Gobot).6 These devices can be used for training, general mobility, or exploratory play. Individuals with cerebral palsy, multi-limb paralysis, severe motor impairments, and a range of other physical disabilities may benefit from power mobility.

Evidence regarding the clinical effectiveness of power mobility devices for preschool children was summarized and appraised in a CADTH Rapid Response report.7 The evidence suggested potential benefits, such as improved disability and developmental scale scores, social skills perceived by parents or caregivers, and mobility activities during play. A potential harm was reduced engagement in tasks.

Despite some concern that young children may not be ready to use advanced equipment,8 there is evidence to suggest that very young children (e.g., 24 months of age)9 can learn to operate power mobility equipment. Further, there is evidence that using power mobility at a young age does not impede independent ambulation or development of motor skills.10

It has been proposed that children with disabilities should be given the same opportunities as other children to move independently and interact with their environment.11 Despite evidence of the effectiveness and applicability of power mobility in young children, these technologies may be underutilized and supply may be limited.12 It is also unclear what approach practitioners and payers are taking in prescribing, supporting, and funding the use of power mobility in preschool children and what the resource implications of these devices are for payers and families. This Environmental Scan aims to provide information about provision, funding, prescribing, and use of power mobility, which may be useful to inform strategic planning.

Objectives

This report will summarize Canada-specific information obtained through a literature search and survey of key informants. The objectives of the Environmental Scan are to:

  1. Describe the Canadian funding practices related to power mobility for preschool children
  2. Identify the types of equipment acquired, funded, and made available by institutions to preschool children with mobility impairment
  3. Describe how health care providers in Canada are trained for the prescribing of power mobility in preschool children
  4. Describe how preschool children and their caregivers are trained and supported (e.g., initial training, follow-up, technical support and maintenance service) regarding the use of power mobility.

Methods

The findings presented in this Environmental Scan are informed by a limited literature search and responses to the Power Mobility for Preschool Children Environmental Scan Survey (Appendix 1), gathered between November 13, 2015 and December 14, 2015.

The literature search was conducted using the PubMed bibliographic database. No methodological filters were applied. The search was run on October 22, 2015 and retrieved literature related to power mobility technologies for children in a Canadian setting. Regular alerts were established to update the search until December 1, 2015. Grey literature sources (information that is not published commercially and is not found in bibliographic databases) were identified through a focused Internet search up to November 2, 2015, for information relevant to the Canadian setting, supplemented by a search of relevant sections of the CADTH Grey Matters checklist (www.cadth.ca/grey-matters).

Study selection for the database and grey literature searches followed the criteria outlined in Table 1.

Table 1 : Selection Criteria for Literature Search

Population

Preschool children (defined as age 0 to 5 years)

Subgroups of interest: age 0 to 2 years, 3 to 5 years

Setting

Publicly administered health care institutions (e.g., pediatric rehabilitation centres)

Intervention

Power mobility devices (e.g., powered wheelchairs, ride-on cars, mini cars)

Results

Types of devices available

Prescription practices

Funding programs and practices

Training and support

The main data sources for this Environmental Scan are the survey responses collected from key jurisdictional informants involved in the prescription of power mobility technology, as well as funding and patient management in the area of pediatric rehabilitation at the clinic, hospital, health authority, or ministry levels (see Appendix 1 for the survey). These informants were identified by the requester and CADTH Liaison Officers through professional and clinical networks, or referred through other respondents. Of the 25 original contacts and 17 subsequent referrals surveyed, representing all provinces and territories — with the exception of Nunavut, for which no potential respondent was identified — a total of 18 responses were received. At least one response was provided from each jurisdiction, with the exception of the Northwest Territories. Appendix 2 includes additional information on the organizations represented by the survey respondents. All respondents gave explicit written permission to use the provided information for the purpose of this report.

The survey was distributed by email. It included dichotomous (e.g., Yes/No), nominal (e.g., list of options), and open-ended questions. Quantitative dichotomous and nominal variables were summarized descriptively by jurisdiction. Open-ended qualitative responses were coded by theme and summarized narratively.

Findings

The information presented on the provision of power mobility technologies to preschool children, including prescription, funding, training, and support, is based on a limited literature search and a survey of key informants from most Canadian provinces and territories (excluding Nunavut and the Northwest Territories), gathered as of December 2015.

Funding Practices

Funding Sources and Criteria

A summary of disclosed funding sources for power mobility is presented in Table 2.

Power Wheelchairs

All participating jurisdictions declared sources of public funding managed or distributed by provincial ministries or health authorities. This funding at least partially covers the cost of power WCs for preschool children when private insurance is unavailable. All jurisdictions — excluding British Columbia, Manitoba, New Brunswick, and Quebec, which provide full funding under specific conditions — require that families participate in cost sharing of the device or find other private funding sources. The amount of this contribution likely varies by jurisdiction and may depend on a family’s income level. For First Nations children in all jurisdictions, funding for power WCs is provided through the Non-Insured Health Benefits for First Nations and Inuit (NIHB).

Some jurisdictions, such as Ontario, provide additional public funding to individuals in financial need. Some funding policies are wholly dependent on family income. For instance, Newfoundland and Labrador provides funding only to families with financial need. Nova Scotia’s funding criteria are dependent on age, as children younger than three years cannot receive public funding for power mobility devices.

Alternative Power Mobility Devices

Currently, a public funding system to support alternative power mobility devices does not appear to be in place in any jurisdiction. The cost of these devices must be covered by private sources.

Criteria for Funding

Provision of funding is generally contingent on meeting specific criteria. Common criteria include being a resident in the jurisdiction that is providing funding, confirmed disability status and relevant clinical history as assessed by a prescriber, need for power mobility devices to support activities of daily living (ADL) at present and in the future, evidence of enhancement of mobility and independence compared with other mobility options (e.g., manual WC), inability to utilize other mobility device options, demonstrable ability to operate device safely and effectively, support (e.g., from family and caregiver) in place to ensure device is properly maintained and utilized, and appropriate environment (e.g., ramps) to ensure accessibility.

Research Programs

Formal research programs linked to the process of prescribing power mobility were declared only by British Columbia and Manitoba. However, participation in research is not a requirement to be prescribed a device or receive funding.

Table 2: Funding Sources and Criteria by Jurisdiction

Province

Public Funding Source or Payera

Level of Funding Provided

Criteria for Fundingb

AB13

AB Aids to Daily Living

Client cost-share up to $500, depending on the cost of the device. Certain options on the device may be selected as an upgrade at client cost

  • Medically stable condition and appropriate clinical history
  • Capacity to operate device; may consider potential capacity for pediatric patients
  • Enhanced mobility and independence compared with the use of manual WC
  • Accessibility supports in place (e.g., ramps)
  • Means to ensure care and maintenance of device
  • Necessity to support ADL
  • Must be assessed by an authorized health care provider

BC5

BC At Home Program: The Ministry of Children and Family Development funds the Children’s Medical Equipment Recycling and Loan Service (Red Cross Loan Program)14

One basic power WC completely covered. As a result, there may be limited funding for a back-up manual WC. Manual WCs are required by most children. Alternative sources of funding (e.g., from family or through charities) must be accessed

  • Child must demonstrate ability and/or potential to properly operate device:
    • Child should be able to move WC in at least 3 directions with intention and be able to stop on cue
    • Demonstrate potential to operate the chair with age-appropriate supervision
  • Equipment is technically on loan and must be returned if being replaced
  • Prior to purchase of any new devices, loan bank must be checked for a suitable device
  • Device must be medically essential to achieve or maintain basic mobility, as determined by prescriber through assessment of link of health condition or disability that qualifies child for eligibility for the At Home Program15
  • Quote from an approved dealer must be provided with request
  • Prescriber must provide rationale for equipment and any additional components
  • Minimum 5-year period before funding for power WC replacement can be accessed

MB

Society for Manitobans with Disabilities: Wheelchair Services Program or MB Wheelchair Program, funded by MB Health, Healthy Living & Seniors16

Cost of a power WC is fully covered

 

  • Must meet same criteria as adult users:
    • Cannot propel manual WC
    • Require power WC for more than 6 hours per day for work, school, recreation, ADLs, and instrumental ADLs
    • WC-accessible housing and suitable storage
    • Ability to ensure appropriate maintenance of chair
    • Ability to safely and independently operate power WC, or have potential to learn
  • WC seating assessment must be conducted
  • All requests for pediatric chairs need to be reviewed by a therapist from the Rehabilitation Centre for Children17
  • Chair needs to be outfitted with growth features to limit number of exchanges
  • Chair must be used as primary method of mobility at home, school, and in the community

NB

NB: Department of Social Development

  • Total cost of WC cannot exceed $12,500
  • There is no cost to eligible clients for entitled WC or seating services, but equipment must be returned to the Recycling Program when it is no longer needed18,19
  • Child has permanent disability that cannot be supported by an alternative mobility device
  • Device will be used in home environment
  • Safe and secure storage available
  • Ability to operate WC safely, effectively, and independently
  • Equipment purchases will not be approved until there is confirmation that Easter Seals NB does not have any appropriate equipment in its recycling inventory

NB: Family Supports for Children with Disabilities19

Funding may be available for medical equipment through this program

  • Parent and child must be residents of NB
  • Child must be diagnosed by a health professional as having a condition limiting ADL

NL20

Government of Newfoundland and Labrador: Department of Health and Community Services, Special Assistance Program

  • Specific funding amount unclear
  • Funding provided to families who meet criteria, including those on social assistance or who qualify based on financial assessment conducted by a financial assessment officer
  • Individuals who are deemed able to contribute financially must pay their contribution before the health authority will contribute. The minimum contribution amount is unclear.21

 

Not reported

NS22

Government of NS: Department of Community Services, Disability Support Program

  • Requests for devices are referred directly to Easter Seals NS for assessment of funding eligibility23
  • If the outstanding amount (after private funding) is 25% more than the family’s annual reported income, the applicant will be considered for additional funding contingent on available funding from the Wheelchair Recycling Program special consideration budget
  • Due to number of applications and budget limitations, a maximum of $500 may be provided22
  • Co-payment to vendor is required at varying levels depending on family income and number of family members in household24
  • Child must be resident of NS
  • Funding through public programs not available
  • Must not have private health care insurance that covers power mobility devices
  • Child must be at least 3 years of age to access a new chair (only refurbished chairs are available for children younger than 3)
  • Children younger than 3 must find alternative sources of funding (e.g., community groups)

ON

ON Assistive Devices Program (Provincial)

75% of power WC and seating system

  • Child must be resident of ON
  • Have physical disability status for 6 months or longer
  • Child unable to functionally propel a manual WC
  • Child must be able to operate device safely
  • Assessment and prescription provided by a registered authorizer
  • Funding can only be accessed once every 5 years unless there is a change in size or in functional status; if so, documentation of clinical changes and a vendor quote for repair or change in size are required

ON Assistance for Children with Severe Disabilities (Provincial)

Remaining 25% not covered by the Assistive Devices Program is provided

  • Client must be receiving social assistance benefits through Assistance for Children with Severe Disabilities and meet income-based criteria

PEI

PEI: Disability Support Program25-27

  • Specific funding amount unclear
  • Applicants are required to contribute financially to all purchases that receive public funding

 

Not reported

QC28

The QC Health Program: RAMQ (Provincial)

RAMQ pays the total cost of the device that is deemed appropriate, but the device must be returned if it is no longer in use29

  • Must obtain physician approval30
  • Must be assessed by an authorized practitioner in an authorized facility prior to prescription
  • Child must meet diagnostic criteria (i.e., condition preventing functional ambulation)
  • Child must demonstrate ability to operate device

SK

SK Aids to Independent Living: Mobility and Assistive Devices (Special Needs Equipment) Program

One basic power WC provided on loan. Specialty controls considered with therapist recommendation

  • Physiatristc must authorize prescription31
  • Equipment is technically on loan and must be returned if being replaced, no longer needed, or beneficiary leaves SK or becomes ineligible for benefit
  • Children must be WC dependent and unable to propel a manual WC
  • Children must be assessed by a licensed occupational therapist and/or physical therapist
  • Children must be trained and proficient at using switches and be able to safely control the power WC in their environment

YK

YK Health and Social Services: Chronic Disease and Disability Benefits Program32,33

  • Full cost of power WC may be covered
  • Family may be required to pay the first $250 per year, up to a $500 maximum
  • Absence of federal or territorial act funding, or private or group insurance

AB = Alberta; ADL = activities of daily living; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; RAMQ = Régie de l’assurance maladie du QC; SK = Saskatchewan; YK = Yukon Territory; WC = wheelchair.
a Children with treaty status may receive funding from the National Indian Health Board. Alternative funding sources such as March of Dimes, Easter Seals, Kiwanis, Lions Clubs, and extended benefits or private funding may be available.
b Applies only to power WCs, not alternative power mobility devices. May include additional criteria or individualized assessment components.
c Physical medicine and rehabilitation physician.

Types and Procurement of Equipment

Method of Procurement

Details regarding the need for assessment prior to funding, sources of assessment equipment, and requirements for procurement of devices are presented in Table 3.

Generally, assessment, training, selection, and trialling of the device and approval of funding must be conducted before a device can be procured in all jurisdictions. One frequent issue is the limited availability or absence of appropriate loaner devices to complete this process. Vendors do not lease devices for assessment or trialling purposes in all regions. Some jurisdictions rely on loan or recycling banks as a primary source, whereas some order new devices from vendors. Devices may be delivered to the therapy centre by the vendor, or directly to the client. If jurisdictions have device-recycling banks with an appropriate device in stock, it will be made available to the client. If not, upon public funding and eligibility approval, or if private funding is available, a device may be ordered from the appropriate vendor, which will deliver it to the facility or client for assembly.

Table 3: Method of Procurement of Devices

Province

Assessment and Fitting Prior to Prescribing

Source of Assessment or Trialling Equipmenta

Funding Application Approval Required for Procurement

Third-party loan bank

Vendor lease

Public or institutional equipment loan banks

AB

Y

N

Y

Y

Y

BC

Y

Y

Y

Y

Y

MBb

Y

NR

NR

NR

NR

NB

Y

NR

Yc

NR

NR

NL

Y

NR

N

N

NR

NS

Y

NR

 

Y

NR

ON

Y

NR

Y

Y

Y

PEI

Y

NR

Y

QC

Y

NR

Y

Y

Y

SK

Y

NR

Y

Y

Y

YK

NR

NR

Y

AB = Alberta; BC = British Columbia; MB = Manitoba; N = no; NB = New Brunswick; NL = Newfoundland and Labrador; NR = not reported; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; Y = yes; YK = Yukon Territory.

a Note that this differs from the information in Table 6 regarding the sources of loaner equipment, as it refers specifically to equipment used for assessment and device fitting (prior to prescription of devices), rather than training or equipment provided for short-term use.

b Depending on the availability of a wheelchair in the loaner pool that meets the client needs, the Manitoba Wheelchair Program either loans or newly purchases a wheelchair. Application must be approved before loaning or procuring.

c Only if funding is preapproved (before assessment) or from private sources.

Types of Devices and Operation Methods

Types of Devices

A summary of types of equipment available is presented in Table 4. All jurisdictions provide pediatric power WCs, and several use alternative power mobility devices, such as ride-on toys, in clinical practice.

Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, and Ontario reported provision and use of alternative devices including mainstream power ride-on toys with and without modifications, specialized commercial early power mobility devices, and powered platform trainers that can accommodate the child’s own seat, stander, or WC (e.g., Turtle Trainer). Provision of custom-made early power mobility trainers was not declared by any respondents. Availability of specific devices appears to be inconsistent across sites within jurisdictions (e.g., may be available in independent therapy centres but not in a public health care facility), based on the variability observed by regions with multiple responses to the survey. For example, one of the five Ontario respondents reported providing alternative devices.

Furthermore, it is often unclear whether any public funding is available for these devices once their use has been suggested, and in the absence of public funding, whether there is support provided to access alternative funding sources.

Table 4: Types of Power Mobility Equipment Provided and Used Clinically

Device

AB

BC

MB

NB

NL

NS

ON

PEI

QC

SK

YK

Pediatric power wheelchairs

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Ÿ●◆

Mainstream power ride-on toys without modificationsa

 

 

Ÿ◆

 

 

 

 

 

 

 

 

Mainstream power ride-on toys with seating or support modifications

 

Ÿ●◆

Ÿ●◆

Ÿ●◆

 

Ÿ●◆

Ÿ●◆

 

 

 

 

Mainstream power ride-on toys with switch modifications

 

Ÿ●◆

Ÿ●◆

Ÿ●◆

 

Ÿ●◆

Ÿ●◆

 

 

 

 

Specialized commercial early power mobility devicesb

 

Ÿ◆

 

 

 

 

 

 

 

 

 

Powered platform trainers that can accommodate the child’s own seat, stander or wheelchairc

Ÿ◆

 

 

 

 

 

 

 

 

 

 

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; YK = Yukon Territory.
Note: Ÿ● = children younger than 3 years of age; ◆ = children 3 to 5 years of age.
a E.g., Avigo Mini Cooper.
b E.g., Cooper Car, Gobot, Enabling Devices Scooter Board.
c E.g., Turtle Trainer. In Alberta, this device is used to gauge a child’s response to power mobility and to work out potential access features. It is not regularly used.

Operation Methods

A summary of operation methods available for power mobility devices is presented in Table 5. The availability of the options presented varied by jurisdiction. Standard joysticks and different joystick handles are offered by most jurisdictions. Single or multiple switches with head, hand, or alternate access sites are offered in many jurisdictions, with the exception of Newfoundland and Labrador, and Yukon.

Table 5: Operation Methods Available for Power Mobility

Operation Methods

AB

BC

MB

NB

NL

NS

ON

PEI

QC

SK

YK

Standard joystick

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Different joystick handles

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Single switch with hand access

Ÿ●

Ÿ●

Ÿ●

Ÿ

 

 

Ÿ●

 

Ÿ●

Ÿ●

 

Multiple switches with hand access

 

Ÿ●

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

 

 

Ÿ●

 

Single switch with head access

 

Ÿ●

Ÿ●

Ÿ●

 

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Multiple switches with head access

Ÿ●a

Ÿ●

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Single switch with alternate access site

Ÿ●

Ÿ●

Ÿ●

 

 

 

Ÿ●

 

 

Ÿ●c

 

Multiple switches with alternate access site

Ÿ●

Ÿ●

Ÿ●

 

 

 

Ÿ●

 

 

Ÿ●

 

Rim head control with single switch

Ÿ●

 

 

 

 

 

Ÿ●

 

 

 

 

Other access methods

Ÿ●b

Ÿ●

 

 

 

 

 

 

 

 

 

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; YK = Yukon Territory.
a Available but not funded by the province of AB.
b Elbow; tray level proximity switches available, but not funded by the province of AB.
c Based only on response from Regina Qu’Appelle Health Region.

Equipment Loans

A summary of available loan mechanisms by jurisdiction is presented in Table 6.

Table 6: Loan Mechanisms

Mechanism

AB

BC

MB

NB

NL

NS

ON

PEI

QC

SK

YK

In-house loan bank

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Vendor loans

Ÿ●

Ÿ●

 

Ÿ●

 

 

Ÿ●

Ÿ●

 

 

 

Third-party loan banka

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

 

 

 

 

 

Ÿ●

Other mechanism

 

 

Ÿ●b

 

 

 

 

 

 

 

 

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; YK = Yukon Territory.
a E.g., The Red Cross, Easter Seals, March of Dimes.
b Government-funded province-wide loan program.

Loans are possible in all jurisdictions. The combination of in-house (e.g., therapy centre), vendor, and third-party loan banks are available in some provinces (i.e., British Columbia, New Brunswick). Some provide in-house loan banks (i.e., Quebec, Nova Scotia, Saskatchewan), rely solely on third-party loan banks (i.e., Newfoundland and Labrador, Yukon), or use a combination of in-house and vendor loans (i.e., Alberta, Ontario, PEI). Vendor loans are unavailable for pediatric patients in some jurisdictions (i.e., Manitoba, Newfoundland and Labrador, Nova Scotia, Quebec, Saskatchewan and Yukon). The reason for this inconsistency is unclear.

Some concerns raised by multiple respondents include limited in-house and third-party loan bank resources, and potentially prohibitive costs and limited time frames available for vendor loans. Many therapy centres loan only refurbished and returned equipment, which may not satisfy the individual needs of all pediatric mobility clients (e.g., appropriate size or model may not be available). Similarly, third-party loan banks often rely on used equipment and may have a limited selection, or only adult equipment. Vendor loans are generally provided on a limited basis with restricted time frames and may be cost-prohibitive, as the family may be required to take on the cost of longer-term loans.

Survey respondents from Alberta, British Columbia, Manitoba, and Saskatchewan all stated that publicly funded devices are technically “on loan” from the province, as they must be returned when no longer in use.

Provision of Follow-Up, Technical Support, and Maintenance

Details regarding how follow-up, technical support, and maintenance are provided are presented in Table 7. In general, most clinical follow-ups with the client are conducted in-house by the prescribing practitioner or care team. While some jurisdictions have seating technicians who can provide technical support and limited maintenance in-house, the majority of technical support, maintenance, and repairs are provided by the vendor and may have an associated cost. This cost may or may not be covered by public funding.

Table 7: Follow-Up, Technical Support, and Maintenance of Devices

Province

Follow-Up

Technical Support

Maintenance

Notes

In-house

Vendor

Third-party

In-house

Vendor

Third-party

In-house

Vendor

Third-party

AB

Ÿ●

 

 

Ÿ●

Ÿ●

Ÿ●

 

Ÿ●

 

  • Technical specialist on staff
  • Technical support and maintenance may be funded by AB Aids to Daily Living

BC

Ÿ●

 

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

  • In-house maintenance performed only on loaned devices, not devices that have been purchased from the vendor
  • New devices are maintained by the vendor for 2 years, after which all maintenance is done in-house
  • Maintenance may be partially funded by a third party
  • Private-pay equipment maintenance is not funded through public sources

MB

Ÿ●

 

 

Ÿ●

Ÿ●

 

 

Ÿ●

 

  • Very limited technical support in-house

NB

Ÿ●

 

 

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

 

  • Occupational therapists and seating technicians trained in industrial mechanics are on staff to provide support

NL

Ÿ●

 

 

Ÿ●

Ÿ●

 

 

Ÿ●

 

  • In-house follow-up occurs every 6 months
  • Seating technician on staff to provide support regarding seating and positioning

NS

Ÿ●

 

 

 

Ÿ●

 

 

Ÿ●

 

  • Follow-up is provided via survey and only through clinic appointments, if necessary

ON

Ÿ●

 

 

 

Ÿ●

 

 

Ÿ●

 

  • Some funding for maintenance and repairs may be provided by the Assistance for Children with Severe Disabilities Program and the Ontario Disability Support Program

PEI

Ÿ●

 

 

Ÿ●

 

 

Ÿ●

Ÿ●

 

 

QC

 

Ÿ●

 

 

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

 

  • Assistive technology service employs technicians and mechanics on-site
  • Public funding available only for maintenance by authorized facilities29,30

SK

Ÿ●

 

 

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●a

 

  • Mobility and Assistive Devices (Special Needs Equipment) Program provides technical support and maintenance for loaned equipment

YK

 

 

Ÿ●

 

 

 

 

 

Ÿ●

 

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; YK = Yukon Territory.
a Based only on response from Regina Qu’Appelle Health Region.

Training and Qualifications of Prescribers and Caregivers

A summary of the training and qualifications of power mobility prescribers in Canada is presented by jurisdiction in Table 8.

Registered occupational therapists are involved in the prescribing process for pediatric power mobility in all jurisdictions surveyed. Similarly, registered physical therapists (also referred to as physiotherapists) are involved in all areas except New Brunswick, Newfoundland and Labrador, Nova Scotia, and Quebec. Provincially mandated prescriber training is required by Alberta and Ontario, and Alberta, British Columbia, and Nova Scotia provide preceptorship or mentoring. Additional in-house, informal training is provided in Alberta, British Columbia, Nova Scotia, and Ontario. Some survey respondents from Ontario and Saskatchewan commented that physician approval is required before prescriptions can be processed. Based on survey responses across jurisdictions, Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Assistive Technology Professional Certification does not seem to be a mandatory training requirement. It is unclear whether it is available as optional or supplementary training. Other training may be offered or required on a case-by-case basis in some jurisdictions.

Table 8: Professional Qualifications and Training Required to Prescribe Power Mobility

Qualifications or Training

AB34

BC

MB35

NB

NL

NS

ON

PEI

QC

SK

YK

Occupational therapist

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Physical therapist (physiotherapist)

Ÿ●

Ÿ●

Ÿ●

 

 

 

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

Provincially mandated prescriber training

Ÿ●

 

 

 

 

 

Ÿ●

 

 

 

 

Preceptorship or mentoring

Ÿ●

Ÿ●

 

 

 

Ÿ●

 

 

 

 

 

In-house informal training, such as tutorials, guides, and workshops

Ÿ●

Ÿ●

 

 

 

Ÿ●

Ÿ●

 

 

 

 

Other

Ÿ●

 

 

 

 

 

Ÿ●

 

 

Ÿ●

 

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; YK = Yukon Territory.

Training and Support of Children

Number of Training Sessions

A summary of the number of assessment or training sessions required by each jurisdiction prior to ordering or prescribing ride-on toys and training devices and power WCs is presented in Table 7.

While some respondents gave definitive responses, several commented that the number of training and assessment sessions differs substantially on an individual basis and reported a wider range by selecting multiple options, or failing to select a specific number of sessions.

Ride-on Toys and Training Devices

There was limited reporting on the number of assessment and training sessions required prior to provision of ride-on toys and training devices. Jurisdictions (British Columbia, New Brunswick, Nova Scotia, Ontario, Quebec) that prescribe alternative power mobility may not provide assessment or training services.

It should be noted that while Quebec does have several power mobility devices available for assessment and training purposes, including the Cooper Car and Tiger Cub, public funding from the Régie de l’assurance maladie du Québec does not cover these devices. The provided training exposes children to the technology and assists them to gain power mobility skills. This process is used to determine whether a child is eligible for a power WC, not to train the child for the eventual use of an alternative device. This is similar in Alberta, where alternative power mobility devices (e.g., Gobot) seem to be used strictly for training purposes.

Power Wheelchairs

For power WCs, the number of assessments provided prior to loaning, ordering, or prescribing, or for training, varied substantially by jurisdiction, from one to two sessions to more than nine sessions.

Respondents from Manitoba reported that they do not provide training. New Brunswick respondents did not provide specific information about the number of assessment or training sessions due to high variability between individuals.

Table 9: Number of Training or Assessment Sessions Required for Provision of Power Mobility Devices

 

 

Number of Sessionsa

Age

ABb

BC

MBc

NBd

NL

NS

ON

PEI

QC

SKe

YK

Ride-On Toys and Training Devices

Assessment

Prior to Loan

< 3 y

f

1 to 2

f

f

f

1 to 2

1 to 2

f

1 to 2

f

f

3 to 5 y

f

1 to 2

f

f

f

3 to 5

1 to 2

f

1 to 2

f

f

Prior to Ordering or Prescribing

< 3 y

f

3 to 5

f

f

f

3 to 5

1 to 2

f

f

f

f

3 to 5 y

f

1 to 2

f

f

f

3 to 5

1 to 2

f

f

f

f

Training

< 3 y

f

1 to 2

f

f

f

3 to 5

3 to 5

f

10+

f

f

3 to 5 y

f

1 to 2

f

f

f

6 to 9

3 to 5

f

10+

f

f

Power Wheelchairs

Assessment

Prior to Loan

< 3 y

1 to 9

3 to 5

1 to 5

f

f

3 to 5

1 to 9

3 to 5

1 to 2

f

1 to 2

3 to 5 y

1 to 5

1 to 2

1 to 5

f

10+

3 to 5

1 to 9

1 to 2

1 to 2

f

1 to 2

Prior to Ordering or Prescribing

< 3 y

3 to 5

3 to 5

1 to 5

f

10+

3 to 5

1 to 10+

1 to 2

3 to 5

1 to 5

1 to 2

3 to 5 y

1 to 5

3 to 5

1 to 5

f

10+

3 to 5

3 to 9

1 to 2

3 to 5

1 to 5

1 to 2

Training

< 3 y

f

3 to 5

f

f

10+

3 to 5

1 to 10+

3 to 5

10+

6 to 9

f

3 to 5 y

3 to 5

3 to 5

f

f

10+

3 to 5

1 to 10+

3 to 5

10+

3 to 5

f

AB = Alberta; BC = British Columbia; MB = Manitoba; NB = New Brunswick; NL = Newfoundland and Labrador; NS = Nova Scotia; ON = Ontario; PEI = Prince Edward Island; QC = Quebec; SK = Saskatchewan; y = years old; YK = Yukon.

a If a province has a wider range recorded for number of sessions, this may be due to variation between centres for that jurisdiction, or variation within a single centre.

b In AB, very few clinicians and parents consider exploring mobility for children younger than 3 years; thus, very few preschool children have had the opportunity to explore power mobility, and data on training and assessment are unavailable.

c Training and assessment not provided through the MB wheelchair program.

d Overall response indicates that training and assessment are highly individualized processes and that the jurisdictional approach does not fall under any of the categories presented.

e Based only on the response from Regina Qu’Appelle Health Region.

f If a province did not disclose the number of sessions for any category, it is because it does not provide ride-on toys or power wheelchairs, it does not provide training or assessment, or it provided an alternative response.

Location of Training

Jurisdictions were queried regarding where training of preschool children takes place. The location of training for the responding jurisdictions is presented in Table 10.

All jurisdictions, with the exception of Yukon, provide training. Training occurs at therapy centres in all regions except Quebec, where it was declared that training occurs at preschool or daycare. Many — including Alberta, British Columbia, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Ontario — also provide training at home, although accessibility measures must be in place. Preschool- or daycare-based training occurs in all regions, with the exception of Manitoba and New Brunswick. Alberta provides training in public parks and Nova Scotia at an adult rehabilitation centre set up for WC skills training.

Some respondents highlighted accessibility of training locations and staff resource limitations as potential barriers to obtaining proper training.

Table 10: Location of Training

Location

AB

BC

MB

NB

NL

NS

ONa

PEI

QC

SKb

YK

Therapy centrec

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

Ÿ●

 

At home

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

 

 

 

At preschool or daycare

Ÿ●

Ÿ●

 

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

Ÿ●

 

In the communityd

Ÿ●

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

Ÿ●e

 

 

 

 

 

a Options available differ substantially, depending on the provider.
b Based only on response from Regina Qu’Appelle Health Region.
c Including facility grounds and hospital playgrounds.
d E.g., public parks.
e Adult rehabilitation centre with structured wheelchair skills training facility.

Provision of Group Mobility Training Sessions

The practice of providing group-training sessions is not common. Alberta reported that while it has done this in the past, it is not a current practice. Some therapy centres in Ontario and Quebec provide this option, while respondents from the remaining jurisdictions reported that they do not conduct group sessions.

Limitations

The survey findings are not intended to provide a comprehensive review of the topic, but rather present the current context and trends in Canada (with the exception of the Northwest Territories and Nunavut), based on limited perspectives. This report does not depict the full context of care; rather, the views presented may reflect the unique perspective of the respondent. For instance, views and level of insight of individuals in clinical versus government or policy positions may differ substantially. In addition, responses may reflect current practices only in the facility that provided a response, not in all facilities or organizations within a jurisdiction.

For the purpose of this Scan, powered mobility technology is defined as adapted WCs or commercial children’s mobility toys that are powered for movement by a battery.8,36 Mobile toys or equipment not within this context are therefore not considered in this report.

This Scan does not capture information about retail procurement of devices or non-public sources of funding, such as independent community-based fundraising, contributions from family members, or private donors and corporate donations.

Specifics of application procedures and prescription processes, funding, and support measures for alternative power mobility devices like ride-on toys; the content of training and assessment sessions; mechanisms of follow-up; and funding of maintenance, repairs, and replacement are not discussed in this report.

Conclusions

The objective of this Environmental Scan was to gain an understanding of the policies and practices for provision of power mobility technology to preschool children in Canada.

The responses from the survey of Canadian jurisdictions, as well as evidence identified by the limited literature search, suggest that the current context for power mobility varies substantially across jurisdictions. Disparities in funding, availability of devices, and clinical and device support were observed, while several common features across jurisdictions emerged.

Regarding types of devices, pediatric power WCs are prescribed universally, albeit at varying frequencies, by the jurisdictions that responded to this survey. Alternative power mobility devices are less frequently prescribed and may depend on the expertise and funding strategies in place at individual therapy centres. In addition, funding support models for pediatric mobility do not include alternative devices, such as ride-on toys, which rely solely on private funding sources.

To prescribe a power device, individuals must be registered occupational or physical therapists and may require further training and provincially mandated certification, as well as oversight by a physician in some regions.

To procure a device, children need to be assessed and trained. Based on the responses we received, this appears to be a highly individualized process, although some jurisdictions require a set number of sessions prior to loaning, ordering, or prescribing a device, and prior to use. Training is provided in a range of settings including in therapy centres, in schools and preschools, and in the community, and it is important for the practitioner to gauge current and prospective operating skills. Currently, few jurisdictions regularly provide group-training sessions. This may reflect the need for highly individualized training and assessment.

Vendor loans for training are not available in all jurisdictions and therapy centres, and third-party loan banks may not have access to appropriate devices for training. The reason for disparities in vendor loan policies is unclear. In these cases, assessment and training may be difficult to conduct prior to prescription and procurement. Clinical assessment informs the choice of device, which is then obtained through an order to the vendor of choice or through a recycling program, if available.

Some respondents communicated that barriers to widening the reach of power mobility for preschool children may include geographical restraints and lack of accessibility to a therapy centre, limited access to loaner devices for training and assessment purposes, lack of clinical prescribing expertise, and the cost of devices and associated therapy and maintenance.

To conclude, despite substantial interest in the provision of alternative power mobility devices for preschool children, the survey results suggest that organizational systems in place for funding and clinical practice currently focus on power WCs. Level of public funding, assessment and training practices, and support systems for power mobility vary between regions.

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Tags

disabled children, electrical equipment and supplies, mobility limitation, pediatrics, programs, wheelchairs, medical devices, Funding, Training, motorized, powered, ride-on toys