Engagement is the active involvement in experiences which allows for development. For children with severe mobility impairments however, challenges arise in accessing experience which can lead to learned helplessness. Due to these challenges powered mobility has been suggested as a mechanism for the provision of self-initiated access to experiences. However, powered mobility is out of reach of the majority of children with disabilities in South Africa hence a non-powered alternative has been sought. This study sought to determine the effect of non-powered, self-initiated mobility on the engagement of young children, with severe mobility impairment, in play. A multiple probe design across participants was used. Four participants, aged 2 years 10 months to 6 years 9 months with severe mobility impairment (Gross Motor Function Classification Scale (GMFCS) level V) underwent a minimum of 5 baseline sessions, followed by 8 intervention sessions. Engagement was measured during each session using the Individual Child Engagement Record –Revised (ICER-R). The data was analysed using visual graphic and statistical analysis. All participants demonstrated an improvement in engagement in play with the introduction of non-powered, self-initiated mobility. A reciprocal deterioration in non-engagement was also recorded. A decrease in engagement in play at the start of intervention was attributed to the focus of engagement being on mobility skills as the device was introduced but this reverted as the participants spent more time on the mobility device. Functional abilities were identified as having a greater role in engagement than age. The introduction of non-powered, self-initiated mobility correlated with the improvement of engagement of young children with severe motor impairment. Non-powered, self-initiated mobility is a viable, cost effective mechanism for mobility at a young age. / Thesis (PhD)--University of Pretoria, 2015. / Centre for Augmentative and Alternative Communication (CAAC) / PhD / Unrestricted

While the active dynamic stability of automobiles has increased over the past 17 years there have been very few similar advances made with electrically powered wheelchairs. This lack of improvement has led to a long standing acceptance of less-than-optimal stability and control of these wheelchairs. Accidents due to loss of stability are well documented. Hence, the healthcare industry has made several efforts for improved control of electric powered wheelchairs (EPWs) to provide enhanced comfort, safety and manoeuvrability at a lower cost. In response, an area of stability control was identified that could benefit from a feedback control system using solid state sensors. To design an effective closed–loop feedback controller with optimal performance to overcome instabilities, an accurate model of wheelchair dynamics needed to be created. Such a model can be employed to test various controllers quickly and repeatedly, without the difficulties of physically setting a wheelchair up for each test. This task was one central goal of this research. A wireless test-bed of a front wheel drive (FWD) wheelchair was also developed to validate a dynamic wheelchair model. It integrates sensors, a data control system, an embedded controller, and the motorised mechanical system. The wireless communication ensures the integrity of sensor data collected and control signals sent. The test-bed developed not only facilitates the development of feedback controllers of motorised wheelchairs, but the collected data can also be used to confirm theories of causes of dynamic instabilities. The prototype test-bed performed the required tasks to satisfaction as defined by the sponsor. Data collected from live tests in which the test-bed followed set patterns, was processed and analysed. The patterns were designed to induce instability. The analysis revealed that an occupied wheelchair is more stable than an unoccupied wheelchair, disproving an initial instability theory proposed in this research. However, a proximal theory explaining over-steer is confirmed. Two models of the FWD test-bed were created. First, a dynamic model inherited from prior research, based on equations of motion was tested and enhanced based on measured data. However, even with alterations to correct parameter values and variables in the equations, a complete model validation was not possible. Second, a kinematic model was created with a factor to compensate for dynamics not normally accounted in kinematic models. The kinematic model was partially validated versus the measured data. Although, still highly accurate, there is room for improvement in this model. Both models contained a sub-system drive motor model, to account for input forces to the FWD wheelchair system model, which is fully validated.

Introduktion: Elrullstolen anses idag vara en viktig terapeutisk insats som optimalt introduceras i ett tidigt skede. Elrullstolen ger ett barn möjlighet att ta sig från punkt A till punkt B, men kan även bidra till att uppnå milstolpar i barnets utveckling samt öka dess delaktighetsgrad. I Sverige tillhandahålls dessa hjälpmedel genom förskrivningsprocessen, där målet är att öka brukarens upplevda livskvalité. Flera olika professioner kan ingå i denna process som ett team där bland annat fysioterapeuten ofta ingår. Syfte: Syftet med denna uppsats var att belysa fysioterapeuters erfarenheter och upplevelser av sin roll i förskrivningsprocessen av elrullstolar till barn.  Metod: Metoden för uppsatsen var kvalitativ innehållsanalys. Totalt har fem fysioterapeuter som arbetar på habiliteringsverksamhet eller hjälpmedelscentral i Västerbotten och Hälsinglands län intervjuats. Data insamlades genom semistrukturerade intervjuer med frågor som berörde fysioterapeutens arbete med förskrivningsprocessen.  Resultat: Alla informanter var tydliga med att de inte var förskrivningsansvariga. De såg dock sin kompetens som värdefull och upplevde att de som fysioterapeuter fyller en viktig funktion i förskrivningsprocessen, i synnerhet vad gällde sittbedömningar. Informanterna såg en tidigt initierad förskrivning som positivt för barnet. För att detta ska bli möjligt ansågs ett välfungerande teamarbete samt en förtroendefull relation till barnets familj och nätverk som viktiga faktorer. Dessa personer blir även viktiga för att stödja barnet i att köra på ett säkert och effektivt sätt. Analysen av materialet resulterade i temat “Fysioterapeuten arbetar för att skapa självständig förflyttning hos barnet och ser detta som en grundläggande rättighet” samt fem stycken kategorier med 10 underkategorier. Kategorierna var “Fysioterapeuten har en viktig roll och bidrar med unik kunskap, fysioterapeuten har sitt fokus på barnets fysiska behov och förmåga att ta eget ansvar, Fysioterapeuten ser personer i barnets närhet som en viktig del i teamet, Barnet får en chans att vara som andra, Skapa allians med föräldrar krävs för tidig initiering. Konklusion: Fysioterapeuten bidrar med unik kunskap och har en självklar roll i förskrivningsprocessen. Att våga ta plats i processen har i denna studie kopplats till erfarenhetslängd. Det kan därför finnas anledning att inom fysioterapeutprogrammet tydligare lyfta vikten av att våga ta plats.