ADAPT Project: Perception and expectations of families regarding motorized mobility - a qualitative study

Proyecto ADAPT: Percepción y expectativas de las familias en relación con la movilidad motorizada -un estudio cualitativo

ABSTRACT

Motorized toy cars are viable devices for the exposure of children with disabilities to self-directed mobility as an option of lower cost and greater accessibility when compared to adapted locomotion equipment. This study aimed to know the perception and expectations of families of the ADAPT Project regarding motorized mobility. Nine mothers of the children enrolled in the ADAPT Project who agreed to participate in this qualitative study responded to a semi-structured qualitative interview by video call. The interviews were recorded and transcribed in full and were coded via content analysis. As a result, most children were diagnosed with cerebral palsy and had mean age of 2.7 years (SD:1.24). Most mothers were unaware of negative points related to the use of motorized cars for mobility. When asked about the positive points related to the early use of motorized mobility, three major themes arose from the interviews: development, inclusion, and autonomy and independence. Family expectations and perceptions about the use of motorized mobility within the scope of the ADAPT Project are legitimate and feasible according to the literature. The use of a motorized and individually adapted toy car can contribute to the development, inclusion, and autonomy and independence of these children.

Keywords:
Early Mobility; Motorized Mobility; Atypical Children; Family Perception; Motorized Toy Car

RESUMO

Carros de brinquedo motorizados são dispositivos viáveis para a exposição precoce de crianças com deficiência à mobilidade autodirigida, como uma opção de menor custo e maior acessibilidade quando comparados a equipamentos de locomoção adaptados. O objetivo deste estudo qualitativo foi conhecer a percepção e expectativas das famílias do Projeto ADAPT em relação à mobilidade motorizada. Participaram nove mães de crianças inscritas no Projeto ADAPT, que aceitaram responder a uma entrevista qualitativa semiestruturada realizada por videochamada. As entrevistas foram gravadas e transcritas integralmente, e codificadas por meio de análise de conteúdo. Como resultados, a maioria das crianças tinham paralisia cerebral, com idade média de 2,7 anos (DP:1,24). Grande parte das mães respondeu que desconhecia pontos negativos ligados ao uso do carrinho motorizado como opção para mobilidade. Quando questionadas sobre os pontos positivos relacionados ao uso precoce da mobilidade motorizada, três grandes temas surgiram das entrevistas: desenvolvimento, inclusão, e autonomia e independência. As expectativas e percepções familiares sobre o uso da mobilidade motorizada no âmbito do Projeto ADAPT são legítimas e factíveis de acordo com a literatura. O uso do carro de brinquedo motorizado e adaptado individualmente pode contribuir para desenvolvimento, inclusão e autonomia e independência dessas crianças.

Descritores:
Mobilidade Precoce; Mobilidade Motorizada; Crianças Atípicas; Percepção Familiar; Carro de Brinquedo Motorizado

RESUMEN

Los coches de juguete motorizados son dispositivos viables para la exposición temprana de los niños con discapacidades a la movilidad autoguiada como una opción más económica y accesible en comparación con los equipos de movilidad adaptados. El objetivo de este estudio cualitativo fue conocer la percepción y las expectativas de las familias acerca del Proyecto ADAPT en relación con la movilidad motorizada. Participaron nueve madres de niños inscritos en el Proyecto ADAPT quienes accedieron a responder una entrevista cualitativa semiestructurada realizada por videollamada. Se grabaron las entrevistas, se las transcribieron en su totalidad y se las codificaron mediante el análisis de contenido. Los resultados revelaron que la mayoría de los niños tenían parálisis cerebral, con una edad media de 2,7 años (DE:1,24). La mayoría de las madres respondieron que desconocían los puntos negativos relacionados con el uso de coches motorizados como opción de movilidad. Cuando se les preguntó sobre los aspectos positivos relacionados con el uso temprano de la movilidad motorizada, surgieron tres temas principales de las entrevistas: desarrollo, inclusión y autonomía e independencia. Las expectativas y percepciones familiares sobre el uso de la movilidad motorizada en el Proyecto ADAPT son legítimas y factibles según la literatura. El uso de coches de juguete motorizados y adaptados individualmente puede contribuir al desarrollo, a la inclusión, a la autonomía y a la independencia de estos niños.

Palabras clave:
Movilidad Temprana; Movilidad Motorizada; Niños Atípicos; Percepción Familiar; Coche de Juguete Motorizado

INTRODUCTION

At the moment a baby is born, it is expected that its development will occur naturally and uneventfully, as it happens with most children. When receiving a diagnosis of disability, whether at childbirth or later, perspectives are shaken, as well as the plans parents idealized¹. Consequently, parents are faced with an unexpected and unwanted condition that deviates from the norms known to them².

Children with motor disabilities, especially those with more severe impairment usually involving deficits in head and trunk control, need parents or caregivers’ help as well as adapted equipment for their locomotion from an early age³. This group of children tends to endure restricted participation⁴, as well as lower levels of motivation, curiosity, and initiative in environmental exploration than expected⁵. In this sense, the exploratory experience limited by immobility can lead the child to a deficit, in which they have no control over their needs, becoming dependent on third parties, since there is no initiative to conduct their own will, intentions, and the exploration of the environment by themselves⁵.

Independent and effective locomotion, whether via an assistive or adaptive device/technology, plays an essential role in the development of the individual^6,5. When this experience does not occur, the child becomes susceptible to developmental delay, when compared to peers with typical development⁶. Therefore, the literature encourages early training for independent mobility for children who, in the developmental phase, have not yet reached the expected mobility milestones and/or do not have a prognosis to reach them⁵.

Studies reveal that children with disabilities who have limitations in independent mobility can benefit from assistive technologies aimed at self-directed mobility, which favor greater participation and functioning with other people and the environment^4,5,7. A study found that independent locomotion was positive for the development of spatial awareness, memory, communication, visual perception, socio-emotional skills, cognitive development and motor skills⁴. This practice can be conducted by playing, considering its instrumental value, learning and repairing developmental delays^8,9.

In the context of playing, motorized toy cars are viable devices for the early exposure of children with limited locomotion to mobility, since they are commonly available and cheap, when compared to adapted locomotion equipment (as motorized wheelchairs)⁷. Its use has been encouraged as a stimulus to independent early locomotion for children with disabilities^7,10. However, poor families may still have difficult accessing this equipment⁴.

The adaptations of motorized toy cars occur mainly using low-cost materials, such as swimming noodles, swimming boards, foam blocks, polyvinyl chloride (PVC) tubes⁷, plus padding and strapping⁴. The individual customization of each car enables the advancement of the child’s development, since they have a greater possibility of engaging in playful and socialization activities concomitantly with the therapeutic exercise⁴. In this way, these devices can be used to achieve goals, expand the child’s participation and encourage the development of bodily structures and functions, compensating for the delays resulting from the absence of self-directed mobility⁵.

Most atypical parents report gait as one of the main acquisition expectations for their children, as it is considered a very important motor milestone, associated with the child’s independence. The possibility of self-directed mobility has been pointed out as one of the greatest desires of families regarding motor development^11,12, and many attach great importance to achieving independence and autonomy, regardless of the levels of severity of the disability or developmental delays, maintaining positive expectations for the future¹³.

Family expectations are related to beliefs about the child that arose even before birth and/or diagnosis of disability, and are entrusted to procedures, therapists, and interventions, and may play an important role in the acquired outcomes¹³. Family members wish the child to fit better into the parameters considered “normal,” thus being perceived as an “almost normal” child¹³.

Since the family remains positive in relation to disability, a more favorable gaze to self-directed mobility is observed⁶ and a relationship of optimism regarding early motorized mobility is inferred. In an ideal scenario, the family should be involved, providing information about the child and their preferences, as well as their perceptions about the use of the equipment⁵. Frequent access to adapted toy cars, in line with the early use of motorized mobility, are achievements desired by the family².

Child rehabilitation professionals and families have shown increasing interest in adapted toy cars due to their benefits. The ADAPT Outreach Project is an action conducted via a partnership between the Faculty of Physical Therapy and the Faculty of Engineering of the Universidade Federal de Juiz de Fora (UFJF). The project aims to provide children and adolescents with disabilities with the opportunity to experience motorized mobility early and at a reduced cost. This occurs by adapting and developing children’s toy cars-originally non-motorized equipment-to assist in the mobility of children¹⁴ (Figure 1).

Figure 1
Participants of the ADAPT Project.

In this sense, family behavior can modify the outcomes achieved via early motorized mobility¹⁵. By understanding the family’s expectations on the use of this device, professionals involved can be prepared to teach and guide parents and caregivers about the use of the adapted toy car^5,8,2, always seeking to explore the maximum potential of the benefited child. In view of these assumptions, this study aims to know the perception and expectations of the families participating in the ADAPT Project of UFJF regarding motorized mobility.

METHODOLOGY

This qualitative and cross-sectional study was conducted in the outreach project of the Universidade Federal de Juiz de Fora, entitled ADAPT Project-promoting mobility for children and adolescents with disabilities. In interface with the research, it has the active participation of students from the Faculties of Physical Therapy, Engineering, Arts, and Design in all stages of the development of the toy car, from its motorization and adaptation to the home monitoring of the use. Upon expression of interest via the project’s social networks, the child is initially evaluated by the physical therapy team for later adaptation of the toy car to their specificities. Then, the equipment is delivered and checked out monthly for possible repairs to the car and establishment of learning goals for the child. This study was conducted in the city of Juiz de For a, Minas Gerais State, from April 2022 to January 2023, and the interviews were conducted between September and December 2022. All parents electronically signed the informed consent form.

The families contacted for the study (n=15) were those enrolled in the ADAPT Project who had not yet been contemplated with the motorized toy car or who were in the process of adapting this equipment for use. The children should be aged nine months to six years old and not have had contact with motorized mobility previously. Participants who did not respond to contact via telephone or social networks (n=5) or who did not have an agenda available for the interview (n=1) were excluded (n=6).

The parents or guardians of the children participating in the study (n=9) were remotely interviewed (semi-structured interview with a script), containing the following questions: “What motivated you to learn more about the ADAPT Project?”; “What reason made you want motorized mobility for your child?”; “Where and when do you intend to use the toy car?”; “What positive changes do you believe motorized mobility will bring to your child?”; “What negative changes do you believe motorized mobility will bring to your child?”; “What are your expectations with this form of mobility for your child?”; “Before the project, how was your child’s mobility done?”; “Before the project, had you ever thought about motorized mobility options?” From these questions, data were collected on the expectations of this form of mobility for their children. The interviews were conducted at the time of best convenience for the participating families, recorded with consent and transcribed in full in a Word document after the end of the application.

Subsequently, two researchers, at different times, performed the content analysis of all the interviews, comprising three stages: pre-analysis, exploration of the material and treatment of the results, and categorization according to the recurrence of the statements to interpret the contents collected¹⁶, followed by the pairing of both.

The participants were described according to their sociodemographic and environmental characteristics, as well as the characteristics of their children enrolled for participation in the ADAPT Project. No participant was identified by name, and their identity was replaced by a fictitious identification for the purposes of scientific dissemination.

RESULTS AND DISCUSSION

This study had the participation of nine mothers of children with disabilities, of whom six (66.7%) lived in Juiz de Fora (MG) - headquarters of the ADAPT Project; one in Timóteo (MG); one in Brasília (DF); and one in Três Rios (RJ). The mean duration of each interview was 15.04 minutes.

As for the children, 55.6% were male and the remaining (44,4%) were female. Among them, the diagnoses were cerebral palsy (n=5; 55.6%), hydrocephalus (n=2; 22.2%), congenital malformation of limbs (n=1), and inborn error of metabolism (n=1). Mean age was 2.7 years old (SD=1.24). (Table 1)

Table 1
Data concerning the characteristics of the participants (n=403).

MOTHER	INTERVIEW LENGTH (min)	RELATIONSHIP OF THE PARTICIPANT	DIAGNOSIS OF THE CHILD	INDEPENDENT MOBILITY	SEX OF THE CHILD	AGE OF CHILD (years old)	CITY - STATE
1	17.01	Mother	PC	GMFCS-V	F	1.8	Juiz de Fora (MG)
2	12.42	Mother	Hydrocephalus	Does not wander	F	2.7	Juiz de Fora (MG)
3	8.31	Mother	PC	GMFCS-V	M	2.1	Juiz de Fora (MG)
4	19.51	Mother	Congenital malformation of limbs	Does not wander	M	4.7	Timóteo (MG)
5	24.16	Mother	PC	GMFCS-V	M	2.5	Brasília (DF)
6	11.57	Mother	PC	GMFCS-V	M	4.3	Juiz de Fora (MG)
7	14.32	Mother	Hydrocephalus	Does not wander	F	3.8	Três Rios (RJ)
8	13.21	Mother	PC	GMFCS-V	M	1.6	Juiz de Fora (MG)
9	11.31	Mother	Inborn error of metabolism	Does not wander	F	1.2	Juiz de Fora (MG)

• Caption: CP = Cerebral Palsy; GMFCS V = Gross Motor Function Classification System Level V: children dependent on wheelchairs, with limited independent locomotion; F = female; M = male; MG = Minas Gerais; RJ = Rio de Janeiro; DF = Distrito Federal

By content analysis, most participants (n=7) learned about the UFJF project via physical therapy professionals who accompany or have accompanied their children, and a smaller portion of mothers (n=2) became aware of it via the internet and social media. All (n=9) reported that their child’s mobility is performed by means of the lap and the baby stroller. Moreover, two mothers stated that their children demonstrate mobility on the ground (by dragging). Four mothers expressed availability of four or more days a week for the future use of the stroller by their children, while the others reported that they would use the equipment in three or more places, such as home, streets and parks. Only two mothers reported having thought or discussed with their families about the use of motorized mobility (both referring to the motorized wheelchair) for their children before they learned about the ADAPT Project.

When asked about the negative points that motorized mobility could bring to their children, six mothers reported not believing in the possibility of negative points. Nevertheless, two mentioned a possible increase in demand and parental overload, and one mother reported the difficulty related to the learning process and understanding the operation of the motorized adapted toy car.

In the interpretation of the interviews, three major thematic categories emerged from the content analyzed: development, inclusion and independence and autonomy (Table 2).

Table 2
Table of thematic categorization of the content of the interviews

MOTHER	DEVELOPMENT	INCLUSION	INDEPENDENCE AND AUTONOMY
1	“The child who has their own independence discovers everything around them. So, like, I don’t want my daughter to be still in the same place, just with her little hand like this [back and forth], just swinging her legs. I want her to feel that there are several things around her for her to touch, for her to see, for her to smell. She must understand that she must get there, that it won’t come to her. She needs to get to them.”	-	-
2	-	“I liked it a lot because I found this world of special children very difficult, ‘hard’ to find anything for special children. So, when I saw it, I fell in love and said: ‘I’m going to enroll my daughter’.”	-
3	-	-	That’s what I call autonomy, right? A little bit of not being too dependent on me, because he is very dependent, he doesn’t know how to ask, so I know that, if I’m not there and he learns to do the movement [activating the car], he’ll want to do it, because he’s very smart. He’ll want to do it himself.”
4	-	-	“He is very independent. Do you know those motorized cars at the mall? He loves it, he drives and thinks he’s the one driving. So, like, we’ve already seen that it’s something he likes, it is something that gets his attention, I know he’ll like it a lot. Our expectation is that it will work out and he will succeed on his own, he learns everything very quickly, he picks things up very quickly. He doesn’t like us to help him, so it’s already a positive point. Sometimes he gets nervous and says, ‘oh mom, I can’t do it’, and I say ‘no, you can. Nice and easy. Let’s go slowly, but it will work out,’ then he insists until he succeeds. So, I have a very high expectation that it will work out, because it is the best choice for our son in this phase he is living.”
5	-	“It’s this, that he can participate further in the games, that he can be with his brother, other children, other children in the building. Here in Brasília the buildings are all open, they have no fence. We don’t have a condominium here, with a building, a fence, with a fence... It’s all open, so you end up knowing the whole block, it’s separated by blocks, right?! And then you know the whole block. When he goes down with the kids, he watches and get very upset, right?! You could perceive that, now that he is two years and five months old he started to understand a little bit more, he was upset, right?! And it still is. We go to the mall, in those toy cars. I think those electric cars are absurd, you know?! That one which is fever now, that every child wants? That there is a parent who stays on the remote control and the child is driving around the mall? They haven’t adapted it, they don’t have it. And then he is like ‘I want it, I want a toy car...’, and we can’t put him in the car. How do you explain this to him, two years old? It’s so hard. So, we wanted to include him more in the activities, you know?! In the games...”	-
6	“[I believe it will help] In terms of posture, trunk, and body control, to sit alone and help with the hips as well.”“[I liked] especially because of his phase, usually at this age, the child is developing, and because the toy car moves around, this will help a lot in his development.”	“So, I found it very interesting. We only see this toy car for children without disabilities, only they use it, and we think about that, we think our children will never be able to use it, so that motivated me. It’s a electric car that we don’t find for sale, just like we see the wheelchair, right?! But we can’t find a toy car like this, so, you see, that’s what motivated me.”	-
7	-	“I think it’s interaction, right? There will be more interaction with her on the social side, being able to socialize more in life, because we get very stuck. Like I said, [I stay] with her a lot on my lap… I think it will give more mobility, it will make her more sociable, right? There will be more contact with the children, because she is always on my lap and the children sometimes think she is a little baby and are afraid to come to play. I think that in the toy car alone the children will be more sociable to her... And I think it also makes people more friendly [to overcome prejudice].”	-
8	-	-	“For their independence and to help development as a whole.”
9	“Today my daughter is already one year old, so, she [physical therapist] decided it would be better to my daughter to have new experiences, you know? Even to further develop her motor skills, which is very impaired. Then she ended up introducing me and talking a little more about the project, which ended up arousing my interest.”	-	-

Development

The current literature provides ample knowledge on the relationship between early experiences and development during early childhood, as well as about the absence of adequate development to trigger delays^3,8,9 in the expected milestones for each age group. Developing involves the continuous and progressive acquisition of skills to perform more complex functions, considering, in addition to functional capabilities, opportunities for participation and the impact of social and environmental factors, according to the International Classification of Functioning, Disability and Health (ICF)¹⁷. In this sense, the acquisition of independent mobility is of paramount importance, since it is strongly related to cognitive development^18,19, engine^11,20, visual⁶, as well as, possibly, vocal development¹⁹, among others. In this category, the word “development” was described in 20 responses during the analysis of the interviews, being mentioned at least once by seven mothers. The main expectation of the family observed in this study was that the development of children who use motorized mobility at an early age is possible, which is in line with scientific results.

Personalized modifications, according to the specific needs of each child, allow the learning of how the stroller works-started with the help of the family through help verbal and/or manual to make the car move-enable the acquisition of skills in the most diverse areas of development¹¹, including gaining strength, balance and coordination, as well as increased participation and independence⁴. Hospodar et al.¹⁰, in a systematic review, demonstrated that the use of motorized toy cars can promote gains in all domains of the ICF, especially in the domains of activity and participation, positively impacting the quality of life of these children.

Inclusion

The concept of social inclusion, according to the ICF, is based on the idea of full and equal participation of all individuals in society, regardless of their health conditions or disability¹⁷. Mentioned by six participating mothers, in 13 responses, it is also observed the perception and expectation of inclusion of children with disabilities using motorized mobility, with the potential to maximize participation and social engagement, as well as minimize delays generated by irregularity in community experience and learned helplessness²¹.

Understanding that social function may be compromised in individuals with global developmental disabilities²², studies reveal the use of motorized mobility as an efficient strategy to mitigate limitations and motivate the interaction of children who do not have independent mobility. Huang et al.²⁰, when examining the effects of training in motorized toy cars using different postures in children with motor delays, compared to conventional therapy, demonstrated significant improvements in mobility and social function in these children. Gaining motor skills triggers opportunities for interaction¹⁹ and can contribute to school involvement, leisure activities in non-usual environments, communication and socializing with other children and adults^11,18,23.

Independence and autonomy

In addition to the domains of development and inclusion, another aspect widely reported by the family members was that of the independence and autonomy of the children, not only in their current phases, but also in relation to the future. According to the ICF, autonomy is the ability to make decisions and control one’s own life, while independence involves performing activities without external help, both of which can be achieved with the use of assistive devices, such as motorized mobility¹⁷. The domain of independence was mentioned in 13 answers and was addressed by five participating mothers. Like the others, it is shown to be a legitimate expectation, since efficient motorized mobility allows its driver to increase the opportunities to act and move freely through the environment, learning about the consequences of their actions through exploration²⁰. Barchus et al.¹⁹ observed, through semi-structured interviews with parents of children who used motorized toy cars, that, among the topics addressed, “mobility is a path to autonomy” was highlighted, suggesting positive benefits in the socio-emotional domain of these children. In this way, the child begins to better understand his functionality and participation in the environment²⁴, as well as their emotional expressions and desires¹⁹, factors that, when associated and optimized, can result in improved quality of life for these children²⁴.

The main limitation of this study was the small number of participants, in addition to the fact that the interviews were not conducted in a face-to-face format, which could enrich the collection of information, given the absence of observation of the interviewee’s body language. However, it is believed that this could not change the legitimacy of this study, since giving voice to the mothers participating in the project brought knowledge about the family view of the use of early motorized mobility, achieving the proposed objectives and contributing to humanizing and optimizing the work conducted by the project.

Future research must be directed to investigating the achievement of expectations after the use of motorized mobility, as well as to a more detailed description of the benefits of independent mobility in the child’s developmental stages. Moreover, the demand of parents and family members in the use of motorized toy cars should be considered in future studies.

CONCLUSION

According to the results of this study, it is concluded that the families participating in the ADAPT Project of the Federal University of Juiz de Fora have positive perceptions and expectations related to the inclusion, development, autonomy and independence of children with the use of motorized mobility. The desire and changes expected by the participants with the use of the motorized toy car are linked to greater social inclusion and the reduction of inequalities when compared to typical and atypical child development, the search for a maximum potential for motor and cognitive development, as well as functional independence during childhood and adulthood.

ACKNOWLEDGEMENTS

To the Foundation for Research Support of the State of Minas Gerais (Fapemig) and to all the children and families participating in the ADAPT Project of the Universidade Federal de Juiz de Fora (UFJF).

DATA AVAILABILITY STATEMENT

The entire dataset supporting the results of this study is available within the article.

REFERENCES

• ¹ Pamplona EA, Neves RDF, Araújo AM, Guedes De Brito GE, Soares Forte FD, et al. Perspectiva dos pais sobre a reabilitação fisioterapêutica de crianças com deficiência múltipla. Acta Fisiatr. 2019;26(4):220-9. doi: 10.11606/issn.2317-0190.v26i4a167642
  » https://doi.org/10.11606/issn.2317-0190.v26i4a167642
• ² Schaffer S. Exploration of caregiver disability orientation and attitudes towards self-directed mobility on modified ride-on car usage of children with disabilities. 2019. [trabalho de conclusão de curso]. [Oregon]: Oregon State University Honors College; 2019. 38 p.
• ³ Silva DR. Bebês com deficiência física e parentalidade: implicações para o desenvolvimento infantil. São Paulo: Blucher; 2022 [citado 29 nov. 2024] Available from: https://storage.blucher.com.br/book/pdf_preview/9786555064360-amostra.pdf
  » https://storage.blucher.com.br/book/pdf_preview/9786555064360-amostra.pdf
• ⁴ Feldner HA, Logan SW, Kenyon LK. In the driver's seat: a randomized, crossover clinical trial protocol comparing home and community use of the Permobil Explorer Mini and a modified ride-on car by children with cerebral palsy. Phys Ther. 2023;102(7):pzac062. doi: 10.1093/ptj/pzac062
  » https://doi.org/10.1093/ptj/pzac062
• ⁵ Huang H-H. Perspectives on early power mobility training, motivation, and social participation in young children with motor disabilities. Front Psychol. 2018;8:2330. doi: 10.3389/fpsyg.2017.02330
  » https://doi.org/10.3389/fpsyg.2017.02330
• ⁶ Logan SW, Bogart KR, Ross SM, Woekel E. Mobility is a fundamental human right: factors predicting attitudes toward self-directed mobility. Disabil Health J. 2018;11(4):562-7. doi: 10.1016/j.dhjo.2018.06.001
  » https://doi.org/10.1016/j.dhjo.2018.06.001
• ⁷ Feldner HA, Logan SW, Otieno S, Fragomeni A, Kono C, et al. Short-term powered mobility intervention is associated with improvements in development and participation for young children with cerebral palsy: a randomized clinical trial. Phys Ther. 2024;105(1):pzae152. doi: 10.1093/ptj/pzae152
  » https://doi.org/10.1093/ptj/pzae152
• ⁸ Freire JAK. Relação entre brincadeiras ao ar livre e desenvolvimento motor infantil. Rev SL Educ. 2024;6(5):205-12.
• ⁹ Delvalle EC, Mesquita LESH, Oliveira MADS, Amorim PAB, Machado TR. Desenvolvimento motor na educação infantil através da ludicidade. Rease. 2021;7(6):1265-77. doi: 10.51891/rease.v7i6.1507
  » https://doi.org/10.51891/rease.v7i6.1507
• ¹⁰ Hospodar CM, Feldner HA, Logan SW. Active mobility, active participation: a systematic review of modified ride-on car use by children with disabilities. Disabil Rehabil Assist Technol. 2023;18(6):974-88. doi: 10.1080/17483107.2021.1963330
  » https://doi.org/10.1080/17483107.2021.1963330
• ¹¹ Felix JB. Go zika go: estudo da viabilidade de carros de brinquedo motorizados modificados para a mobilidade de crianças com Síndrome Congênita do Zika (SCZ). 2023. [dissertação]. [Natal]: Universidade Federal do Rio Grande do Norte; 2023 [citado 29 nov. 2024]. 93 p. Available from: https://repositorio.ufrn.br/handle/123456789/54508
  » https://repositorio.ufrn.br/handle/123456789/54508
• ¹² Barreto, AS. Experiências de crianças com Síndrome Congênita do Zika durante a utilização da mobilidade motorizada: um estudo qualitativo usando o método Photovoice. 2023. [dissertação]. [Natal]: Universidade Federal do Rio Grande do Norte; 2023. 44 p. Available from: https://repositorio.ufrn.br/handle/123456789/55043
  » https://repositorio.ufrn.br/handle/123456789/55043
• ¹³ Oliveira PS, Lamy ZC, Guimarães CNM, Ferreira RHSB, Okoro RDS, et al. Sentimentos, reações e expectativas de mães de crianças nascidas com microcefalia pelo vírus zika. Cad Saúde Colet. 2023;31(4):e31040210. doi: 10.1590/1414-462x202331040210
  » https://doi.org/10.1590/1414-462x202331040210
• ¹⁴ Notícias UFJF [Internet]. Juiz de Fora: UFJF. Projeto promove mobilidade para crianças com deficiência; 16 ago. 2021 [citado 2 nov. 2024]. Available from: https://www2.ufjf.br/noticias/2021/08/16/projeto-promove-mobilidade-para-criancas-com-deficiencia/
  » https://www2.ufjf.br/noticias/2021/08/16/projeto-promove-mobilidade-para-criancas-com-deficiencia/
• ¹⁵ Portugal LCL, Alves RDCS, Fernandes Junior O, Sanchez TA, Mocaiber I, et al. Interactions between emotion and action in the brain. Neuroimage. 2020;214:116728. doi: 10.1016/j.neuroimage.2020.116728
  » https://doi.org/10.1016/j.neuroimage.2020.116728
• ¹⁶ Julio E, Santos K, Morais S, Faria Neto A. Estruturação de aplicação da análise de conteúdo. Rev Cienc Exatas. 2017;23(2):19-29.
• ¹⁷ Ministério da Saúde (Brasil). CIF - Classificação Internacional de Funcionalidade, Incapacidade e Saúde. São Paulo: EdUSP; 2003.
• ¹⁸ Fong A, Gemperli A, de Vries W. Association between the availability of mobility assistive products and participation outcomes in individuals with spinal cord injury in Switzerland. Top Spinal Cord Rehabil. 2023;29(4):96-107. doi: 10.46292/sci22-00030
  » https://doi.org/10.46292/sci22-00030
• ¹⁹ Barchus R, Barroero C, Schnare W, Dean SM, Feldner HA. "Kind of empowered": perceptions of socio-emotional development in children driving ride-on cars. Rehabil Psychol. 2023;68(2):155-63. doi: 10.1037/rep0000482
  » https://doi.org/10.1037/rep0000482
• ²⁰ Huang HH, Hsieh YH, Chang CH, Tsai WY, Huang CK, et al. Ride-on car training using sitting and standing postures for mobility and socialization in young children with motor delays: a randomized controlled trial. Disabil Rehabil. 2023;45(9):1453-60. doi: 10.1080/09638288.2022.2063418
  » https://doi.org/10.1080/09638288.2022.2063418
• ²¹ Feldner H, Plummer T, Hendry A. A guideline for introducing powered mobility to infants and toddlers [Internet]. Permobil; 2022 [cited 2024 Nov 29]. Available from: https://www.permobil.com/en-nz/clinical-research/a-guideline-for-introducing-powered-mobility-to-infants-and-toddlers
  » https://www.permobil.com/en-nz/clinical-research/a-guideline-for-introducing-powered-mobility-to-infants-and-toddlers
• ²² Dalsin C, Haubert B, Renner JS, Schemes C. O design da cadeira de rodas infantil e o processo de exclusão/inclusão social: uma revisão integrativa da literatura. Multitemas. 2019;59-80. doi: 10.20435/multi.v24i56.1969
  » https://doi.org/10.20435/multi.v24i56.1969
• ²³ Livingstone R, Field D, Sanderson C, Pineau N, Zwicker JG. Beginning power mobility: parent and therapist perspectives. Disabil Rehabil. 2022;44(12):2832-41. doi: 10.1080/09638288.2020.1842916
  » https://doi.org/10.1080/09638288.2020.1842916
• ²⁴ Spoor JKH, Rooda OHJE, Kik C, van Meeteren J, Westendorp T, et al. Newborns with myelomeningocele: their health-related quality of life and daily functioning 10 years later. J Neurosurg Pediatr. 2023;31(1):3-7. doi: 10.3171/2022.8.PEDS22162
  » https://doi.org/10.3171/2022.8.PEDS22162

• 1
  Study conducted as a final thesis for the School of Physical Therapy at the Universidade Federal de Juiz de Fora (UFJF) - Juiz de Fora (MG), Brasil.
• 2
  Paper featured at the 2nd International Congress on Cerebral Palsy, Campinas (SP), April 29-May 1, 2023.
• Financing source:
  Fundação de Amparo à Pesquisa do Estado de Minas Gerais (Fapemig) - Process no.: CDS-APQ-03664-22
• 5
  Approved by the Research Ethics Committee of UFJF (CAAE: 59915322.8.0000.5147).

Edited by

• Responsible editor:
  Sônia LP Pacheco de Toledo

Publication Dates

• Publication in this collection
  26 June 2026
• Date of issue
  2026

History

• Received
  01 Feb 2024
• Accepted
  14 May 2025