The Experience and Use of Power Mobility by Children with Complex Non-Ambulant Cerebral Palsy: A Scoping Review

Background/Objectives: To map the literature and describe the meaning, use, and experience of power mobility for children with complex non-ambulant cerebral palsy (Gross Motor Classification System (GMFCS) levels IV–V and Manual Abilities Classification System (MACS) levels III–V). Methods: Included searches in five electronic databases, grey literature, and hand searches with no restrictions on date, study type, or language, as well as independent duplicate screening and data extraction. Outcomes and experiences were mapped to the integrated F-words Interdependence Human Activity Assistive Technology (iHAAT) framework. Results: In total, 90 studies, from randomized trials to case reports and qualitative designs, included 916 children (10 months–18 years; 432 GMFCS IV; 262 GMFCS V; 222 GMFCS IV/V), with 351 parents, therapists, or educators. Only 32 studies reported MACS levels. Power wheelchairs were used by 724 children (68 used switches rather than joysticks). Other children used modified ride-on cars, specialty pediatric devices, or platform/smart training devices. Based on 22 studies where this information was provided, alternate access/control methods were primarily used by children classified at GMFCS/MACS V, but there was considerable variability. Introduction predominantly occurred in natural settings with limited training or support. Significant and meaningful improvements in power mobility use were reported for intensive play-based, child-led, and caregiver-supported approaches; for virtual training with joystick users; and for skills-training approaches with older children who already achieved functional power wheelchair use. Conclusions: Children classified at GMFCS IV and V may benefit from power mobility experience to promote fitness, functioning, friends, family, fun, and future outcomes. Their use and experience of power mobility may be interdependent with parents, therapists, and educators, changing attitudes and perceptions of child potential.