Spinal Muscular Atrophy on Wheels, Using Power Mobility

Study Overview
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Brief Summary
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The group of children diagnosed with Spinal Muscular Atrophy (SMA) has serious restrictions on participation. SMA is a neuromuscular disease that leads to neuromusculoskeletal disorders that limit functional activities, sometimes making it impossible to sit down autonomously and to walk. Scientific evidence has highlighted the importance of implementing physiotherapy interventions in pediatrics that facilitate the integration and participation of children with reduced mobility in their natural environment through the use of different assisted mobility devices that allow the child to acquire a degree of independence and motivation according to their potential and needs. For some time, with the aim of offering independent movement opportunities for children with severe motor impairment, adapted electric cars have been used, as they are simple to use and easy for the child and family to incorporate into daily tasks within natural environments. These low-cost motorized devices can generate a very positive impact on the participation of children diagnosed with SMA type I from an early age, after training the family and/or the child himself, guaranteeing the maximum possible safety, comfort, motivation and autonomy. Due to the above, there is a need to carry out the research project defined below, to generate opportunities for the inclusion of children diagnosed with SMA type I through the use of low-cost electric cars that encourage their participation, motivation and quality of life.

Detailed Description
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OBJECTIVES To know the acceptability of an intervention with motorized mobility through electric cars for young children diagnosed with SMA type I. To check the effectiveness of the motorized mobility intervention with electric cars with respect to: (a) mobility and (b) participation of young children with SMA type I with respect to the control group of children who do not use such devices. To identify the barriers and facilitators of the child's participation in their natural environment of a motorized mobility intervention with electric cars in young children with SMA type I.

Official Title
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Community's Participation of Children With Spinal Muscular Atrophy Using Power Mobility

Conditions
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Spinal Muscular Atrophy

Intervention / Treatment
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* Device: power mobility


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of SMA type I Ages between 10 months to 5 years. No previous experience with motorized mobility. Exclusion Criteria: severe visual problems Associated disorders that do not correspond to the diagnosis of SMA type I. Families who do not agree to have training in the use of the electric car and continuous monitoring by the corresponding researcher.

Ages Eligible for Study
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Minimum Age: 10 Months
Maximum Age: 5 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 2 groups: experimental and control groups.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Power mobility<br>The study will take place in the child's natural environment for 12 weeks. | Device: power mobility<br>* Sessions of adjustment, adaptation and choice of the device for training will be carried out. Once the cars are fully adapted and conditioned to the environment and needs of the family and the child, the intervention will begin. The study will take place in the child's natural environment for 12 weeks. Three 40-minute sessions per week will be held, each session includes: 1) configuration of the environment (families will be instructed by the therapists to adapt the environment to the child's situation and their conditions for driving the car): 5 min ; 2) natural play as a warm-up activity: 5 min; and 3) mobility and social training with cars: 30 min. The 30-minute driving session will involve participants learning cause and effect concepts by driving the toy car (press the button to move and release to stop). The therapist and caregivers will use verbal cues to encourage children to drive and explore the environment. All sessions will be video and audio recorded.<br>|
| No Intervention: Non-power mobility<br>Children will perform their typical daily routine without any modification. After the study they will be invited to participate in the experimental group if positive benefits are obtained. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| QUEST (Version 2.0) Quebec User Evaluation of Satisfaction with assistive Technology | the scale includes 12 items rated on a 5-point satisfaction scale. approximately 10-15 minutes are require to complete the evaluation. | baseline and Change from basaline at week 12 | 
| YC-PEM (Young Children's Participation & Environment Measure) | to be used for children from zero to five years, explores the frequency of participation in activities. Parents will report their child's participation across home, community and childcare | baseline, Change from basaline at week 12 and Change from basaline at week 16 | 
| Pediatric Evaluation of Disability Inventory-Computer Adaptive-test (PEDI-CAT) | It is answered by the children's caregiver and has an item bank divided into two domains: (1) mobility, which includes 75 items ranging from basic motor skills (e.g., sitting without support) to more difficult motor skills (e.g., running or climbing a step ladder). Additionally, this domain includes the use of walking devices; (2) cognitive/social, which includes 60 items related to interaction (e.g., follows the gaze of another person), communication (e.g., uses gestures to ask for something), everyday cognition (e.g., recognizes his/her name), and self-management (e.g., when upset response without hitting). In these domains, the four-point scores (unable, hard, a little hard, easy) are based on different levels of difficulty. The overall score is transformed in a normative score (based on age) and a continuous score that will be used in the analyses. | baseline, Change from basaline at week 12 and Change from basaline at week 16 | 
| Photovoice | to record and present everyday realities using photography; promote dialogue and critical reflection of reality and know the strengths and weaknesses of the target audience; and reach decision makers | baseline,Change from basaline at week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Goal Attainment Scaling (GAS) | GAS is an objective method of quantifying goal attainment. Goals are scored on a Likert-type scale from -2 (representing no positive change at all from baseline/ regression), -1 (a little less change than expected), 0 (attainment of goal at the expected level), +1 (a little more change than expected), to +2 (attainment of goal at much more than the expected level) | baseline, Change from basaline at week 12 | 
| Switch Activation | Switch activation is defined as when the switch is pressed to activate the modified ride-on car and make it go, thereby moving in space from one place to another | at the end of week 4, 8, and week 12 | 
| Daily driving journal | Parents will record the date, duration (minutes) location, and activities during each driving session in a daily driving journal. | baseline, week 12 and week 16 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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home, family, natural environment, participation