Question 1

Regarding the early use of mobility aids to promote children’s participation in social activities, what are the potential long-term consequences? Specifically, could this contribute to flexion patterns, contractures, or equinus gait, and might these problems worsen in young adulthood?

Early introduction of mobility aids (such as powered wheelchairs, active gait trainers, and mobile standers) is a cornerstone of contemporary pediatric physical therapy, designed to foster cognitive, social, and motor development by allowing infants and toddlers to explore their environment independently.

To address your specific clinical questions regarding biomechanical consequences:

1. Contribution to Flexion Patterns, Contractures, or Equinus Gait

The primary mobility device itself does not inherently cause flexion contractures or equinus; rather, these developments depend on underlying neuromuscular pathology (e.g., cerebral palsy, spinal muscular atrophy), passive positioning duration, and the specific biomechanical demands placed on the growing musculoskeletal system.

However, improper device configuration or unmanaged alignment can exacerbate postural patterns:

• Seated Mobility (Powered Wheelchairs): Extended sitting in a standard or poorly fitted tilt-in-space chair can reinforce prolonged hip and knee flexion, potentially contributing over time to hip flexor, hamstring, and heel cord shortening if not counterbalanced by adequate daily stretching, standing programs, or dynamic movement.
• Supported Stepping / Gait Trainers: If a gait trainer is adjusted with excessive anterior loading or insufficient postural support (such as inadequate pelvic stabilization or incorrect saddle height), it can encourage a crouched, flexed-knee posture or persistent toe-walking (equinus). Prolonged weight-bearing into equinus without a plantigrade foot position can over time increase Achilles tendon tightness.

2. Progression in Young Adulthood

Without proactive, lifelong management, musculoskeletal issues associated with severe motor impairments frequently compound during the transition into young adulthood:

• Adolescent Growth Spurts: Rapid skeletal growth during puberty often outpaces muscle length gains, frequently converting mild dynamic tightness into fixed soft-tissue contractures.
• Reduced Activity Levels: As individuals transition out of school-based services into adult day programs or higher education, overall physical activity and range-of-motion routines often decline. This reduction in daily dynamic loading and stretching accelerates muscle shortening and joint stiffness.
• Secondary Impairments: Long-standing postural patterns established in childhood—such as pelvic obliquity, asymmetrical weight-bearing, or chronic hip/knee flexion—frequently manifest in young adulthood as severe joint pain, degenerative osteoarthritis, pelvic asymmetry, and increased energy expenditure during functional mobility.

Summary / Clinical Implication

While early mobility is vital for social participation and active learning, it must be paired with longitudinal biomechanical surveillance. Mitigating long-term risks requires regular equipment reassessment, individualized 24-hour posture management programs (incorporating therapeutic standing and night-time positioning where indicated), and routine targeted stretching to counteract habitual flexion patterns before they result in fixed structural limitations.

Ginny Paleg, PT, DScPT

 

Question 2

While mobility aids offer clear benefits, they are not always accessible to families due to their cost and the need for home adaptations. How can the financial burden and the requirement to modify the home environment be addressed? especially powered mobility devices. 

Financial burden and inaccessible home environments are a huge problem – in every country world-wide. In terms of very early power mobility device use – adapting typical toys and lighter-weight devices is one approach – Go Baby Go programs are one option and have spread around the world, in Canada they are developing something called the EmPower car (https://www.apega.ca/news/2024/11/28/children-empowered-with-gift-of-new-mobility-thanks-to-partnership-between-local-non-profit-and-professional-engineers), and in Spain they just published on a low-cost device through Padrino Tecnologico (https://doi.org/10.1080/17483107.2026.2685884 ). In the UK, charity loan schemes provide the Wizzybug and Bugzi devices for young children.  For really little children there are free instructions online to adapt a typical baby seat – called the Baby Bug (https://idrpp.usu.edu/uatp/blog/2024/baby-bug-mobility-device-empowers-infants-to-move) – the link to the instructables page is in this article.

For the more toy-like devices, and for beginner power wheelchairs, I think the answer in most countries is a loan program where children can progress through different devices according to their age and the family goals and environment. Funding for home modifications – and accessible vehicles is a bigger problem – and there are no easy answers!

Question 3

Mega Power training Liesbeth van Vulpen en Baqbette Mooijekind

Liesbeth:

Kan er een voordeel zijn bij kinderen die botox hebben gekregen om megapower training te doen? Voor/ en nadelen?

Antwoord: Wij plannen vaak de botox ca 6 a 8 weken voor de start van een trainingsperiode. Dan zijn de kinderen die evt gipsredressie krijgen na de botox ook uit het gips. We zien eigenlijk geen nadelen. Bij heel lange gipsredressie periode na de BTX en veel spierzwakte in kuit en voetmusculatuur trainen we de eerste weken (2 a 4 weken) met spalk om de belasting rustiger op te bouwen en voetklachten te voorkomen.

Vraag rond kwaliteit van uitvoering: wat is het evenwicht tussen kwaliteit en kwantiteit van uitvoering?

Antwoord: We letten een beetje op de kwaliteit van het stappen bij de stapoefening (stappen met slee achter zich aan). Hier geven we verbale ques als bijv. “ver weg stappen”, “maak maar lekker veel lawaai door te stampen” Om hiermee uit te lokken dat kinderen grotere stappen maken en volledig (of meer) voetcontact maken in de standfase. Ook ritme klappen we bijv mee.

Bij de ren oefeningen laten we kwaliteit helemaal los en laten we de kinderen zelf hun meest efficiente manier vinden. Ook hier geven we wel de verbale ques als ritme en doen we goed voor bij het rennen wat we met onze armen doen bijv. Maar we sturen alleen op maximale inzet van de kinderen en snelheid.

Wat met de kracht van de heupextensoren?

Antwoord: Deze hebben we niet specifiek gemeten. Wel zijn er aanwijzingen dat ze sterker worden. Heupabductoren wel duidelijk krachtwinst en ook zien we de winst in de 30 sec kracht testen van Olaf Verschuren bijv.

Babette:

Discussie: evenwicht tussen AFO’s voor alignement en ROM maar wat doen AFO’s  met krachtontwikkeling van voet- en onderbeenspieren; kan je hier iets over zeggen?

Blijft de 13% aan toename in spiervolume op lange termijn ?

In hoeverre is de peesspierlengte onderzocht verschil tussen m. soleus en m gastrocnemius na powertraining? Gastroc is explosievere spier en soleus houdingsspier: te lange soleus: meer knieflexie en te lange soleus meer enkelflexie?