Abstract
This chapter provides an overview of studies using technology-based approaches to promote ambulation in participants with intellectual disabilities and motor delays (i.e., children with Down syndrome) or with multiple disabilities (i.e., combinations of intellectual and neuromotor disabilities or of intellectual, neuromotor, and sensory disabilities). The most popular technology-based approach consists of the use of treadmills. A second technology-based approach combines the use of walker devices with microswitches. The microswitches allow the monitoring of the person’s stepping responses and the automatic delivery of brief periods of preferred stimulation contingent on those responses. A third technology-based approach, representing an early attempt to develop technological support for ambulation, consists of the use of a mobile robot. This chapter provides an overview of the different approaches by summarizing the studies using them, their procedural conditions, their differences in emphasis and aims, and their outcomes. This chapter also provides (a) a discussion of the results obtained with the different approaches and their implications in terms of applicability, practicality, and suitability of the approaches within education (rehabilitation) contexts and (b) a brief presentation of some relevant issues for future research in the area.
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References
Accivatti, C., Harro, C. C., & Bothner, K. E. (2006). The effect of body weight supported treadmill training on gait function in children with cerebral palsy. Pediatric Physical Therapy, 18, 82–83.
Angulo-Barroso, R., Burghardt, A. R., Lloyd, M., & Ulrich, D. A. (2008a). Physical activity in infants with Down syndrome receiving a treadmill intervention. Infant Behavior & Development, 31, 255–269.
Angulo-Barroso, R. M., Wu, J., & Ulrich, D. A. (2008b). Long-term effect of different treadmill interventions on gait development in new walkers with Down syndrome. Gait & Posture, 27, 231–238.
Anttila, H., Autti-Rämö, I., Suoranta, J., Mäkelä, M., & Malmivaara, A. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics, 8, 14.
Bar-Haim, S., Harries, N., Belokopytov, M., Frank, A., Copeliovitch, L., Kaplanski, J., & Lahat, E. (2006). A comparison of efficacy of Adeli suit and neurodevelopmental treatments in children with cerebral palsy. Developmental Medicine and Child Neurology, 48, 325–330.
Beard, L. M., Harro, C., & Bothner, K. E. (2005). The effect of body weight support treadmill training on gait function in cerebral palsy: Two case studies. Pediatric Physical Therapy, 17, 72.
Begnoche, D., & Pitetti, K. H. (2007). Effects of traditional treatment and partial body weight treadmill training on the motor skills of children with spastic cerebral palsy: A pilot study. Pediatric Physical Therapy, 19, 11–19.
Begnoche, D., Sanders, E., & Pitetti, K. H. (2005). Effect of an intensive physical therapy program with partial body weight treadmill training on a 2 year-old child with spastic quadriplegic cerebral palsy. Pediatric Physical Therapy, 17, 73.
Blundell, S. W., Shepherd, R. B., Dean, C. M., Adams, R. D., & Cahill, B. M. (2003). Functional strength training in cerebral palsy: A pilot study of a group circuit training class for children aged 4–8 years. Clinical Rehabilitation, 17, 48–57.
Bobath, K. (1980). A neurophysiological basis for the treatment of cerebral palsy (Clinics in developmental medicine, Vol. 75). London: Spastic International Medical Publications.
Bobath, K., & Bobath, B. (1984). The neurodevelopmental treatment. In D. Scutton (Ed.), Management of the motor disorders of children with cerebral palsy (Clinics in developmental medicine, Vol. 90, pp. 6–18). London: Spastic International Medical Publications.
Bodkin, A. W., Baxter, R. S., & Heriza, C. B. (2003). Treadmill training for an infant born preterm with a grade III intraventricular hemorrhage. Physical Therapy, 83, 1107–1118.
Borg, J., Larson, S., & Ostegren, P. O. (2011). The right to assistive technology: For whom, for what, and by whom? Disability and Society, 26, 151–167.
Borggraefe, I., Meyer-Heim, A., Kumar, A., Schaefer, J. S., Berweck, S., & Heinen, F. (2008). Improved gait parameters after robotic-assisted locomotor treadmill therapy in a 6-year-old child with cerebral palsy. Movement Disorders, 23, 280–283.
Brown, R. I., Schalock, R. L., & Brown, I. (2009). Quality of life: Its application to persons with intellectual disabilities and their families – Introduction and overview. Journal of Policy and Practice in Intellectual Disabilities, 6, 2–6.
Callahan, K., Henson, R., & Cowan, A. K. (2008). Social validation of evidence-based practices in autism by parents, teachers, and administrators. Journal of Autism and Developmental Disorders, 38, 678–692.
Cernak, K., Stevens, V., Price, R., & Shumway-Cook, A. (2008). Locomotor training using body-weight support on a treadmill in conjunction with ongoing physical therapy in a child with severe cerebellar ataxia. Physical Therapy, 88, 88–97.
Cherng, R.-J., Liu, C.-F., Lau, T.-W., & Hong, R.-B. (2007). Effect of treadmill training with body weight support on gait and gross motor function in children with spastic cerebral palsy. American Journal of Physical Medicine & Rehabilitation, 86, 548–555.
Chia, L. C., Guelfi, K. J., & Licari, M. K. (2010). A comparison of the oxygen cost of locomotion in children with and without developmental coordination disorder. Developmental Medicine and Child Neurology, 52, 251–255.
Cirignano, S. M., Du, L., & Morgan, K. T. (2010). Promoting youth physical activity in the classroom through a comprehensive walking program. Family and Consumer Sciences Research Journal, 39, 161–172.
Claxton, K., Paulden, M., Gravelle, H., Brower, W., & Culyer, A. J. (2011). Discounting and decision making in the economic evaluation of health-care technologies. Health Economics, 20, 2–15.
Damiano, D. L., & DeJong, S. L. (2009). A systematic review of the effectiveness of treadmill training and body weight support in pediatric rehabilitation. Journal of Neurologic Physical Therapy, 33, 27–44.
Dannemiller, L., Heriza, P., Burtner, P., & Gutierrez, T. (2005). Partial weight bearing treadmill training in the home with young children with cerebral palsy: A study of feasibility and motor outcomes. Pediatric Physical Therapy, 17, 77–78.
Day, J. A., Fox, E. J., Lowe, J., Swales, H. B., & Behrman, A. L. (2004). Locomotor training with partial body weight support on a treadmill in a nonambulatory child with spastic tetraplegic cerebral palsy: A case report. Pediatric Physical Therapy, 16, 106–113.
DeJong, S. L., Stuberg, W. A., & Spady, K. L. (2005). Conditioning effects of partial body weight support treadmill training in children with cerebral palsy. Pediatric Physical Therapy, 17, 78.
Deutsch, J. E. (2009). Virtual reality and gaming systems to improve walking and mobility for musculoskeletal and neuromuscular conditions. Studies in Health Technology and Informatics, 145, 84–93.
Dillon, C. M., & Carr, J. E. (2007). Assessing indices of happiness and unhappiness in individuals with developmental disabilities: A review. Behavioral Interventions, 22, 229–244.
Dodd, K. J., & Foley, S. (2007). Partial body-weight-supported treadmill training can improve walking in children with cerebral palsy: A clinical controlled trial. Developmental Medicine and Child Neurology, 49, 101–105.
Green, C. (2010). Considering the value associated with innovation in health technology appraisal decisions (deliberations): A nice thing to do? Applied Health Economics and Health Policy, 8, 1–5.
Green, C. W., & Reid, D. H. (1999a). A behavioral approach to identifying sources of happiness and unhappiness among individuals with profound multiple disabilities. Behavior Modification, 23, 280–293.
Green, C. W., & Reid, D. H. (1999b). Reducing indices of unhappiness among individuals with profound multiple disabilities during therapeutic exercise routines. Journal of Applied Behavior Analysis, 32, 137–147.
Green, C. W., Reid, D. H., Rollyson, J. H., & Passante, S. C. (2005). An enriched teaching program for reducing resistance and indices of unhappiness among individuals with profound multiple disabilities. Journal of Applied Behavior Analysis, 38, 221–233.
Hamed, N. S., & Abd-elwahab, M. S. (2011). Pedometer-based gait training in children with spastic hemiparetic cerebral palsy: A randomized controlled study. Clinical Rehabilitation, 25, 157–165.
Hayakawa, K., & Kobayashi, K. (2011). Physical and motor skill training for children with intellectual disabilities. Perceptual and Motor Skills, 112, 573–580.
Horton, S. V., & Taylor, D. C. (1989). The use of behavior therapy and physical therapy to promote independent ambulation in a preschooler with mental retardation and cerebral palsy. Research in Developmental Disabilities, 10, 363–375.
Hubbard Winkler, S. L., Vogel, B., Hoenig, H., Cowper Ripley, D. C., Wu, S., Fitzgerald, S. G., Mann, W. C., & Reker, D. M. (2010). Cost, utilization, and policy of provision of assistive technology devices to veterans poststroke by Medicare and VA. Medical Care, 48, 558–562.
Katz-Leurer, M., Rotem, H., Keren, O., & Meyer, S. (2010). The immediate effect of treadmill walking on step variability in boys with a history of severe traumatic brain injury and typically developed controls. Developmental Neurorehabilitation, 13, 170–174.
Kazdin, A. E. (2001). Behavior modification in applied settings (6th ed.). New York: Wadsworth.
Ketelaar, M., Vermeer, A., Hart, H., Van Petegem-van Beek, E., & Helders, P. J. M. (2001). Effects of a functional therapy program on motor abilities of children with cerebral palsy. Physical Therapy, 81, 1534–1545.
Kollen, B. J., Lennon, S., Lyons, B., Wheatly-Smith, L., Scheper, M., Buurke, J. H., Halfens, J., Geurts, A. C. H., & Kwakkel, G. (2009). The effectiveness of the Bobath concept in stroke rehabilitation: What is the evidence? Stroke, 40, e89–e97.
Lalli, J. S., Mauk, J. E., Goh, H., & Merlino, J. (1994). Successful behavioral intervention to treat children who are reluctant to ambulate. Developmental Medicine and Child Neurology, 36, 625–629.
Lancioni, G. E., Bellini, D., Oliva, D., Guzzini, F., & Pirani, P. (1989). A robot for guiding multihandicapped blind persons to carry out familiar daily activities. Journal of the Multihandicapped Person, 2, 271–282.
Lancioni, G. E., Bellini, D., & Oliva, D. (1993a). A robot to provide multihandicapped blind persons with physical guidance and activity choices. Journal of Developmental and Physical Disabilities, 5, 337–348.
Lancioni, G. E., Bellini, D., & Oliva, D. (1993b). Building choice opportunities within a robot-assisted occupational program: A case study. Behavioral Residential Treatment, 8, 219–226.
Lancioni, G. E., Gigante, A., O’Reilly, M. F., & Oliva, D. (2000a). Evaluating mild physical exercise with two persons with profound multiple disabilities. Journal of Visual Impairment and Blindness, 94, 461–465.
Lancioni, G. E., Gigante, A., O’Reilly, M. F., Oliva, D., & Montironi, L. (2000b). Indoor travel and simple tasks as physical exercise for people with profound multiple disabilities. Perceptual and Motor Skills, 91, 211–216.
Lancioni, G. E., Oliva, D., & Signorino, M. (1994). Promoting ambulation and object manipulation in persons with multiple handicaps through the use of a robot. Perceptual and Motor Skills, 79, 843–848.
Lancioni, G. E., Oliva, D., & O’Reilly, M. F. (1997). Ambulation, object manipulation, and multiple disabilities: Extending the applicability of a robot. Journal of Visual Impairment & Blindness, 91, 53–60.
Lancioni, G. E., O’Reilly, M. F., & Basili, G. (2001). An overview of technological resources used in rehabilitation research with people with severe/profound and multiple disabilities. Disability and Rehabilitation, 23, 501–508.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Oliva, D., Scalini, L., & Groeneweg, J. (2004). Improving assisted ambulation in a man with multiple disabilities through the use of a microswitch cluster. Behavioural and Cognitive Psychotherapy, 32, 245–249.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Campodonico, F., Oliva, D., & Vigo, C. M. (2005a). Promoting walker-assisted step responses by an adolescent with multiple disabilities through automatically delivered stimulation. Journal of Visual Impairment and Blindness, 99, 109–113.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Campodonico, F., Piazzolla, G., Scalini, L., & Oliva, D. (2005b). Impact of favorite stimuli automatically delivered on step responses of persons with multiple disabilities during their use of walker devices. Research in Developmental Disabilities, 26, 71–76.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Oliva, D., & Basili, G. (2005c). An overview of research on increasing indices of happiness of people with severe/profound intellectual and multiple disabilities. Disability and Rehabilitation, 27, 83–93.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Groeneweg, J., Bosco, A., Tota, A., Smaldone, A., Stasolla, F., Manfredi, F., Baccani, S., & Pidala, S. (2006). A social validation assessment of microswitch-based programs for persons with multiple disabilities employing teacher trainees and parents as raters. Journal of Developmental and Physical Disabilities, 18, 383–391.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Piazzolla, G., Pidala, S., Smaldone, A., & Manfredi, F. (2007a). Automatically delivered stimulation for walker-assisted step responses: Measuring its effects in persons with multiple disabilities. Journal of Developmental and Physical Disabilities, 19, 1–13.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Scalini, L., Castagnaro, F., & Di Bari, M. (2007b). Promoting foot-leg movements in children with multiple disabilities through the use of support devices and technology for regulating contingent stimulation. Cognitive Processing, 8, 279–283.
Lancioni, G. E., De Pace, C., Singh, N. N., O’Reilly, M. F., Sigafoos, J., & Didden, R. (2008). Promoting step responses of children with multiple disabilities through a walker device and microswitches with contingent stimuli. Perceptual and Motor Skills, 107, 114–118.
Lancioni, G. E., O’Reilly, M. F., Singh, N. N., Sigafoos, J., Campodonico, F., & Oliva, D. (2009a). A wheelchair user with visual and intellectual disabilities managing simple orientation technology for indoor travel. Journal of Visual Impairment and Blindness, 103, 308–313.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Didden, R., Manfredi, F., Putignano, P., Stasolla, F., & Basili, G. (2009b). Fostering locomotor behavior of children with developmental disabilities: An overview of studies using treadmills and walkers with microswitches. Research in Developmental Disabilities, 30, 308–322.
Lancioni, G. E., Singh, N. N., O’Reilly, M. F., Sigafoos, J., Oliva, D., Smaldone, A., La Martire, M. L., Stasolla, F., Castagnaro, F., & Groeneweg, J. (2010). Promoting ambulation responses among children with multiple disabilities through walkers and microswitches with contingent stimuli. Research in Developmental Disabilities, 31, 811–816.
Lee, L.-L., Watson, M. C., Mulvaney, C. A., Tsai, C.-C., & Lo, S.-F. (2010). The effect of walking intervention on blood pressure control: A systematic review. International Journal of Nursing Studies, 47, 1545–1561.
Liso, D. R. (2010). The effects of choice making on toy engagement in nonambulatory and partially ambulatory preschool students. Topics in Early Childhood Special Education, 30, 91–101.
Lloyd, M., Burghardt, A., Ulrich, D. A., & Angulo-Barroso, R. (2010). Physical activity and walking onset in infants with Down syndrome. Adapted Physical Activity Quarterly, 27, 1–16.
Looper, J., & Ulrich, D. A. (2010). Effect of treadmill training and supramalleolar orthosis use on motor skill development in infants with Down syndrome: A randomized clinical trial. Physical Therapy, 90, 382–390.
Lotan, M., Isakov, E., Kessel, S., & Merrick, J. (2004a). Physical fitness and functional ability of children with intellectual disability: Effects of short-term daily treadmill intervention. The Scientific World, 4, 449–457.
Lotan, M., Isakov, E., & Merrick, J. (2004b). Improving functional skills and physical fitness in children with Rett syndrome. Journal of Intellectual Disability Research, 48, 730–735.
Maher, C. A., Evans, K. A., Sprod, J. A., & Bostok, S. M. (2011). Factors influencing postural management for children with cerebral palsy in the special school setting. Disability and Rehabilitation, 33, 146–158.
Miltenberger, R. G. (2004). Behavior modification: Principles and procedures (3rd ed.). New York: Wadsworth.
Nolan, K. J., Savalia, K. K., Yarossi, M., & Elovic, E. P. (2010). Evaluation of a dynamic ankle foot orthosis in hemiplegic gait: A case report. NeuroRehabilitation, 27, 343–350.
Palisano, R. J., Tieman, B. L., Walter, S. D., Bartlett, D. J., Rosembaum, P. L., Russell, D., & Hanna, S. E. (2003). Effect of environmental setting on mobility methods of children with cerebral palsy. Developmental Medicine and Child Neurology, 45, 113–120.
Provost, B., Dieruf, K., Burtner, P. A., Phillips, J. P., Bernitsky-Beddingfield, A., Sullivan, K. J., Bowen, C. A., & Toser, L. (2007). Endurance and gait in children with cerebral palsy after intensive body weight-supported treadmill training. Pediatric Physical Therapy, 19, 2–10.
Richards, S. B., Taylor, R. L., Ramasamy, R., & Richards, R. Y. (1999). Single subject research: Applications in educational and clinical settings. New York: Wadsworth.
Russell, D., Rosenbaum, P., Avery, L., & Lane, M. (2002). The gross motor function measure (GMFM-66 & GMFM-88) user’s manual (Clinics in developmental medicine, Vol. 159). London: Mac Keith Press.
Samuelsson, K., & Wressle, E. (2008). User satisfaction with mobility assistive devices: An important element in the rehabilitation process. Disability and Rehabilitation, 30, 551–558.
Sanders, E., Begnoche, D., & Pitetti, K. H. (2005). Effect of an intensive physical therapy program with partial body weight treadmill training on a 9 year-old child with spastic diplegic cerebral palsy. Pediatric Physical Therapy, 17, 82.
Schindl, M. R., Forstner, C., Kern, H., & Hesse, S. (2000). Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy. Archives of Physical Medicine and Rehabilitation, 81, 301–306.
Schmidt, H., Werner, C., Bernhardt, R., Hesse, S., & Krüger, J. (2007). Gait rehabilitation machines based on programmable footplates. Journal of Neuroengineering and Rehabilitation, 4, 2.
Simard-Tremblay, E., Shevell, M., & Dagenais, L. (2010). Determinants of ambulation in children with spastic quadriplegic cerebral palsy: A population-based study. Journal of Child Neurology, 25, 669–673.
Storey, K. (1996). Social validation issues in social skills assessment. International Journal of Disability, Development and Education, 43, 167–174.
Strawbridge, L. A., Drnach, M., Sisson, L. A., & Van Hasselt, V. B. (1989). Behavioral therapy combined with physical therapy to promote walker use by a child with multiple handicaps. Education and Training in Mental Retardation, 24, 239–247.
Tieman, B., Palisano, R. J., Gracely, E. J., Rosenbaum, P., Chiarello, L. A., & O’Neil, M. (2004). Changes in mobility of children with cerebral palsy over time and across environmental settings. Physical & Occupational Therapy in Pediatrics, 24, 109–128.
Tsorlakis, N., Evaggelinou, C., Grouios, G., & Tsorbatzoudis, C. (2004). Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Developmental Medicine and Child Neurology, 46, 740–745.
Ulrich, D. A., Ulrich, B. D., Angulo-Kinzler, R. M., & Yun, J. (2001). Treadmill training of infants with Down syndrome: Evidence-based developmental outcomes. Pediatrics, 108, e84.
Ulrich, D. A., Lloyd, M. C., Tiernan, C. W., Looper, J. E., & Angulo-Barroso, R. M. (2008). Effects of intensity of treadmill training on developmental outcomes and stepping in infants with Down syndrome: A randomized trial. Physical Therapy, 88, 114–122.
Van Gestel, L., Molenaers, G., Huenaerts, C., Seyler, J., & Desloovere, K. (2008). Effect of dynamic orthoses on gait: A retrospective control study in children with hemiplegia. Developmental Medicine and Child Neurology, 50, 63–67.
Vashdi, E., Hutzler, Y., & Roth, D. (2008). Compliance of children with moderate or severe intellectual disability to treadmill walking: A pilot study. Journal of Intellectual Disability Research, 52, 371–379.
Whittingham, K., Fahey, M., Rawicki, B., & Boyd, R. (2010). The relationship between motor abilities and early social development in a preschool cohort of children with cerebral palsy. Research in Developmental Disabilities, 31, 1346–1351.
Willoughby, K. L., Dodd, K. J., Shields, N., & Foley, S. (2010). Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91, 333–339.
Wu, J., Looper, J., Ulrich, B. D., Ulrich, D. A., & Angulo-Barroso, R. M. (2007). Exploring effects of different treadmill interventions on walking onset and gait patterns in infants with Down syndrome. Developmental Medicine and Child Neurology, 49, 839–845.
Wu, J., Ulrich, D. A., Looper, J., Tiernan, C. W., & Angulo-Barroso, R. M. (2008). Strategy adoption and locomotor adjustment in obstacle clearance of newly walking toddlers with Down syndrome after different treadmill interventions. Experimental Brain Research, 186, 261–272.
Zwicker, J. G., & Mayson, T. A. (2010). Effectiveness of treadmill training in children with motor impairments: An overview of systematic reviews. Pediatric Physical Therapy, 22, 361–377.
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Lancioni, G.E., Sigafoos, J., O’Reilly, M.F., Singh, N.N. (2013). Technology-Based Approaches for Promoting Ambulation. In: Assistive Technology. Autism and Child Psychopathology Series. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4229-5_6
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