Rolstoelvaardigheidstraining bij kinderen en jongeren met ernstige cerebrale parese

This PhD is part of the paediatric neuro-rehabilitation research line at the Department of Rehabilitation Sciences, Campus Bruges, within the Neurorehabilitation Technology Lab. Central to this PhD is the development of suitable measurement instruments and training programs for wheelchair skills, with a strong emphasis on their applicability for digital implementation and validation in collaboration with therapists, carers, and other clinical experts. Cerebral palsy (CP) is the most common cause of childhood-onset disability, and for approximately one third of affected individuals, independent mobility is only possible with a power wheelchair. Yet, only about 38% of children with severe CP (GMFCS levels III-V) achieve independent driving, often due to limited training opportunities and insufficiently structured interventions. This doctoral research aimed to improve personal mobility and promote the greatest possible independence in children and young people with severe CP (6-21 years old) by advancing the evidence base for power mobility training, outcome measurement, and digital therapeutic solutions. The thesis comprised four studies. Study 1 systematically reviewed existing wheeled mobility training interventions for children and young people with severe CP. Although most interventions reported positive effects on wheelchair skills, the evidence quality was moderate, and theoretical frameworks were often lacking. The review highlighted the need for more rigorous, theory-driven research and robust outcome measures. Study 2 explored the psychometric properties of the Wheelchair Skills Test (WST) and Wheelchair Skills Test-Questionnaire (WST-Q) caregiver proxy. The exploratory study demonstrated that the WST has good inter- and intra-rater reliability, while the WST-Q showed good concurrent validity but limited responsiveness, suggesting it is suitable for assessing skill levels but not intervention effects. Study 3 investigated the effects of a four-week Wheelchair Skills Training Program (WSTP). Participants showed significant improvements in power mobility capacity and mobility-related participation, confirming the feasibility and therapeutic potential of structured, task-based training approaches. Study 4 described the development and initial usability testing of a computer-based, individualized power wheelchair skills training prototype. Expert feedback and preliminary clinical testing supported its therapeutic relevance and suitability for further development. Together, these studies contribute to a deeper understanding of effective power mobility training for children and young people with severe CP. They emphasize the value of structured, evidence-based, and individually tailored interventions, and demonstrate how technological innovations can support more efficient, engaging, and accessible therapy delivery.