Early use of power wheelchair for children with Duchenne muscular dystrophy: a narrative review.

PURPOSE: To review the literature on the existent evidence considering the use of power wheel chair (PWC) for children with DMD who can still walk independently. METHODS: A systematic literature search was conducted through nine databases by the three authors independently. Both quantitative and qualitative research designs were considered for inclusion. Studies were included only if the study population consisted of ambulatory children diagnosed with DMD. Data extraction was on participant characteristics, level of walking and on outcomes in term of impairment, function and participation domains (ICF, World Health Organization, 2001) in accordance to a structured diagram by the three authors independently. The methodological quality and level of evidence was graded by using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) level of evidence. RESULTS: The search yield six eligible studies out of 186 studies. All the studies were expert opinions, classified as low level of evidence (Level V). There was consensus among the experts that the main treatment goal should be physical integration of the child with his peer group in order to increase participation in daily actives, without focusing on prolonged ambulation as the primary aim. Accordingly, the six studies supported the introducing wheelchair mobility some of the time or in certain environments in children with DMD who are still independent walkers as a means of providing efficient, effective mobility. CONCLUSIONS: The current descriptive evidence advocates the introduction of PWC as an early and timely part-time mobility aid for ambulatory children with DMD in order to increase their activity and full participation in age-appropriate and meaningful activities. However, information addressing the special mobility needs of children with DMD, in particular fatigue and muscle damage is lacking and yet has to be determined. Implications for Rehabilitation The unique features of Duchenne muscular dystrophy (DMD) include progressive loss of ambulation, muscle fatigue and the potentially harmful consequences of strenuous physical activity. The current DMD treatment paradigm no longer emphasizes prolonging walking and using powered mobility as a last option. It primarily focuses on providing anticipatory, preventive care to help children function and participate in activities similar to their typically developing peers. This raises the need to review the current research on early, part-time use of powered mobility. This narrative review indicates potential benefits for early and timely part-time introduction of PWC for children with DMD who can still walk independently, to increase their activity by providing effective mobility to allow maximum participation and to promote psychosocial development. Promoting early, selective use of powered mobility while the child is still an independent walker enables the child to achieve independence, motivates him to be active while preserving energy and without reducing gross motor function. The current descriptive evidence lacks sufficient information on the special mobility needs of children with DMD, specifically when fatigue and muscle damage are considered.