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Permobil Blog / June 12, 2018

Allowing for Independent Mobility: Choosing Manual Wheelchairs Over Strollers




Last week I introduced the idea of effective early mobility. This refers to a child’s ability to independently navigate and explore his or her environment. This movement promotes growth of various sensory and motor systems and allows for meaningful participation with the environment and peers and family.



What are effective early mobility options?

As parents we often don’t want our child to be seen as “different.”  Because of this, parents seek out products that will look more “typical,” which also holds true when it comes to choosing mobility options. There are various specialty strollers on the market that look like “typical” strollers and don’t call attention to any differences. These can be effective, especially those with special seating options to provide more appropriate postural support than a typical stroller can.


It’s important to understand though, that a child can’t move independently in a stroller. Even though it may look less “medical,” it doesn’t allow for independent mobility. The main question to ask when considering a stroller is, “Does my child have the physical and cognitive ability to be independent given the appropriate mobility device?”

If the answer is YES, then there is good reason to seek out the most appropriate mobility device. In typical childhood development, independent mobility has been shown to affect self-awareness, spatial orientation, emotional attachment, fear of heights, visual/vestibular integration, and personality traits such as motivation and initiation. (2) In light of this knowledge, let’s do all we can to allow for this independent movement for children with mobility limitations!



Independent Manual Mobility

One of the options to consider for effective mobility is a manual wheelchair. To propel and maneuver a manual wheelchair efficiently, one must have the trunk and pelvic stability, arm strength, range of motion, and dexterity to propel the chair. As this option requires a certain physical and cognitive ability, a therapist can help determine a child’s readiness and suitability for this means of mobility. With this in mind, some diagnoses appropriate for manual mobility include but are not limited to: spinal cord injury, spina bifida, acquired brain injury, and cerebral palsy. There are postural support devices that can be added to provide the stability needed, such as back supports, lateral trunk supports, and pelvic belts/stabilizers. But these can add weight to the wheelchair which may over time prompt the change from a manual wheelchair to a power assist or a power wheelchair. Remember, the goal is to provide equipment that allows a child to interact with her environment, family, and peers as independently as possible!



There are common questions and misconceptions that arise when it comes to using an independent manual wheelchair. Join me next week as I address some of these and shed light on some key features of current manual mobility options.


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Glossary of Terms

Self-Awareness: An awareness of one's own personality or individuality 

Spatial Orientation: An awareness of one’s position in space

Emotional Attachment: Feeling connected to others

Visual/Vestibular Integration: The connection between vision and balance for navigating one’s environment

Initiation: The act of initiating or beginning something

Trunk Stability: The ability to maintain a position of the upper body

Range of Motion: The range that a joint is able to move

Dependent Manual Wheelchair: A wheelchair that can not be moved without assistance

Independent Manual Wheelchair: A wheelchair that can be moved independently

Visual Motor Skills: The ability to synchronize visual information with physical movement, driving a car or playing a video game of skill

Depth Perception: The visual ability to judge depth or distance

Position in Space: Knowing where your body is in space relative to surrounding objects

Socialization: The ability to interact with others

Mobility: The ability to move

Ultralight Manual Wheelchair: Made of ultra lightweight materials such as aluminum, titanium, or carbon. Usually can be configured to fit the individual user

Dictionary. (2018). Retrieved from https://www.merriam-webster.com/dictionary/self-awareness?src=search-dict-box



1. Rosen, L., Plummer, T., Sabet, A., Lange, M., & Livingstone, R. (2017). RESNA Position on the Application of Power Mobility Devices for Pediatric Users-Update 2017. Retrieved from https://www.resna.org/sites/default/files/legacy/Position-Papers/RESNA%20Ped%20Power%20Paper%2010_25_17%20-BOD%20approval%20Nov2_2017.pdf

2. Livingstone, R. (2011). Evidence for Practice: Power Mobility for School-Aged Children and Adolescents[Ebook]. Vancouver, British Columbia: Sunny Hill Health Centre for Children.

3. Milestones Checklist. (2018). Retrieved from https://pathways.org/wp-content/uploads/2015/06/MilestonesChecklist_UPDATED.pdf

Stroller and Wheelchair Icons created by https://www.flaticon.com/authors/freepik


Stacey Mullis.jpg 

Stacey Mullis, OTR/ATP
Director of Clinical Marketing

Stacey is Director of Clinical Marketing. She graduated from Western University in London, Ontario, Canada with a BA Linguistics and BSc Occupational Therapy and has practiced as an OTR for over 20 years. With experience in pediatrics, inpatient/outpatient rehabilitation, long term care, and home health, Stacey has faced the challenges first hand of providing appropriate seating in various clinical settings. This led her to pursue an apprenticeship at Care Partners Seating Clinic in Asheville, NC to advance her skills, and she obtained her ATP certification in 2012. Mullis is a member of the NCOTA, CTF, NRRTs, RESNA, and AOTA. 

Categories: Complex Rehab, Pediatrics, Manual

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