Journal of Pediatric Rehabilitation Medicine - Volume 4, issue 4
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Journal of Pediatric Rehabilitation Medicine: An Interdisciplinary Approach is an international journal designed to parallel the multi-disciplinary team approach of caring for a child with an acute or chronic disease. The issues will primarily be themed and broad in scope including, but not be limited to cerebral palsy, traumatic brain injury, spinal cord injury, spina-bifida, amputation, muscular dystrophies of all types, stroke, cancer, mental retardation, developmental delays, and others.
The aim is to include a wide range of experts who care for children with the above diagnosis. Authorship by two different disciplines is requested though not required to encourage an interdisciplinary and collaborative approach. The goal is for the reader to obtain not just the medical perspective, but also nursing, occupational, physical and speech therapy, psychology, home care, etc., in providing the most comprehensive care for children. Manuscripts will be blinded and peer reviewed with appropriate feedback. Statistical analysis will be reviewed by the biostatistician. Readers are encouraged to submit and or suggest case reviews, commentaries, editorials, original research, conference schedules, or reviews.
Abstract: Occupant restraint systems are designed based on knowledge of crash dynamics and the application of proven occupant-protection principles. For ambulatory children or children who use wheelchairs but can transfer out of their wheelchair when traveling in motor vehicles, there is a range of child safety seats that comply with federal safety standards and that therefore offer high levels of crash protection. For children who remain seated in wheelchairs for travel, the use of wheelchairs and wheelchair…tiedown and occupant restraint systems (WTORS) that comply with voluntary industry standards significantly enhances safety. Revisions to the initial versions of these standards will further improve safety for smaller children who travel seated in wheelchairs by requiring wheelchairs for children between 13 and 22 kg (18 and 50 lb) to provide a five-point, wheelchair-integrated crash-tested harness similar to that used in forward-facing child safety seats. While wheelchair and tiedown/restraint manufacturers, van modifiers, transportation personnel, clinicians, and others involved with children who use wheelchairs have clearly defined responsibilities relative to providing these children with safe transportation, parents and caregivers should be knowledgeable about best-practice in wheelchair transportation safety and should use this knowledge to advocate for the safest transportation possible.
Abstract: Questions are often raised about whether the use of postural support devices while seated in a wheelchair during travel in a motor vehicle can have potential benefits or result in harm. The benefits or harm are generally unknown as current crash-test dummies are not designed to evaluate postural supports, and there are little to no injury data for these devices in the motor-vehicle environment. Despite these limitations, guidelines and best practices can be developed for use…of postural support devices during travel in a motor vehicle using basic principles of occupant protection and knowledge about injury biomechanics. This document presents guidelines and recommendations for postural support devices used on wheelchairs that also serve as seats in motor vehicles. It addresses the basic principles of safe transportation for wheelchair-seated occupants and provides guidelines and recommendations for use of specific devices during transportation.
Keywords: Wheelchair, transportation, safety, postural support devices
Abstract: For children with Individualized Education Plans (IEPs), transportation is considered a related service and a part of their education. This paper presents an overview of the current status of wheelchair transportation for students on school buses within the United States. The review includes the school transportation environment for wheelchair-seated students, applicable regulations and voluntary standards, primary safety issues for wheelchair-seated students, and key stakeholders roles in improving wheelchair transportation safety. Future actions…to improve wheelchair transportation safety in school transportation are discussed, including the need to improve data collection, mandate payment for and use of RESNA WC19-compliant wheelchairs, improve training for bus operators and attendants, and require specialty certification for school bus operators who transport wheelchair-seated students.
Keywords: Wheelchair, transportation, safety, school bus, RESNA WC19
Abstract: This paper presents results from and provides discussion of a state-of-the-science workshop in which highly informed stakeholders in wheelchair transportation safety for students on school buses were participants. The Nominal Group Technique was used to create a process in which the main issues preventing safe transportation of wheelchair-seated students and key strategies to overcome these issues were identified and ranked. These results, along with a synthesis of group discussion and recommendations for…action, are presented along with consideration of current policies, regulations, and political realities. Critical safety shortcomings exist in this highly specialized enterprise that varies from state to state. Recommended strategies include implementing wheelchair requirements in federal transportation safety standards, creation of a clearinghouse for wheelchair transportation best practices and education, creation of national standards for training, practices, and monitoring, and increased "buy-in" to voluntary wheelchair standards by wheelchair manufacturers.
Keywords: Wheelchair, transportation, safety, standards, school bus
Abstract: Transporting children with special health care needs (CSHCN) may be complex and require a multidisciplinary approach to improve a child's comfort and safety. This review (adapted from the resource manual of the National Center for the Safe Transportation of Children with Special Health Care Needs.) will discuss the basic principles of child passenger safety for CSHCN, including types of child occupant restraints, the use of child occupant restraint devices (CRD) for selected CHSCN, and how to…locate or, if needed, develop programs to train child passenger safety technicians (CPST) to help with safe transportation of CSHCN.
Keywords: Car safety seats, child passenger safety, transportation, injury prevention, children with special health care needs, motor vehicle transportation, transportation and safety
Abstract: Commercial automotive child restraint systems (CRSs) do not accommodate all children with special healthcare needs. This study developed an alternative harness for a commercial CRS to meet the needs of children for whom a five-point harness cannot be positioned over medically involved areas and/or children whose conditions require the harness belts to be threaded through medical devices. After initial design work and a series of frontal sled-impact tests, one of two prototype designs was chosen for…fit testing on children with and without healthcare conditions. After a minor modification, additional sled-impact testing was conducted to determine compliance of the system to federal standards. The CRS with alternate harness provides good fit to children with a variety of healthcare needs and complies with all performance criteria of FMVSS 213, with the exception of peak forward head excursion using the Hybrid III 6-year-old crash-test dummy. It is expected that all performance criteria will be met using the newly-issued federal allowance to conduct CRS frontal-impact tests using an earlier version of the dummy. The new harness shows promise as a low-cost solution for achieving a safer level of transportation for children who may otherwise travel unrestrained or with a severely misused CRS harness.
Keywords: Children with special healthcare needs, child safety seats, child restraint systems, child passenger protection, omphalocele, hip spica, shoulder spica, Halo