Study Finds Mobility Aid-Related Devices Can Be Associated With Injuries among Children and Adolescents

According to a retrospective analysis conducted by the Center for Injury
Research Policy of the Research Institute at Nationwide Children’s
Hospital, more than 63,000 children and adolescents were treated in the United
States from 1991 to 2008 for mobility aid-related injuries. According to the
study, the annual number of mobility aid-related injury cases increased 23%
during the 19-year study period. The authors of the study used data from the
National Electronic Injury Surveillance System database for children and
adolescents 19 years old or younger.

  Lara McKenzie
  Lara McKenzie

“The 23% increase was one of the more surprising findings,”
Lara McKenzie, PhD, principal investigator at the Center for Injury Research
and Policy at Nationwide Children’s Hospital, told O&P Business
. “That seemed like a pretty significant increase. Another
surprising finding was that 67% of the injuries that we found occurred when
patients were using wheelchairs.”

Crutches accounted for 25% and walkers accounted for 8% of the injuries,
according to the study.

Mobility aids such as crutches, walkers, wheelchairs help children and
adolescents remain mobile and active in most cases. Still, the study revealed
injury patterns among children and adolescents. According to the study, 60% of
mobility aid-related injuries occurred at home. The study found that children
who used crutches were more likely to sustain injuries to their arms and legs.

Age was also associated with mobility aid-related injuries, the study
revealed. Children ages 2 to 10 years who used walkers or wheelchairs were more
likely to injure their heads and sustain traumatic brain injury (TBI). These
children also had a higher likelihood of being hospitalized for these injuries,
the study found. The patient’s inability to protect themselves using their
feet or hands, may contribute to the higher likelihood of injuring their heads.
Children accounted for 42% of all cases from the study period. Patients 11 to
19 years old were more likely to strain or sprain their lower extremities.

“Trigger factors could have also caused these injuries,”
McKenzie explained. “These trigger factors would include transferring
— getting in and out of a wheelchair — stairs, ramps, curbs and rough
terrain may also have contributed to a high proportion of the cases.”

The study’s authors group the trigger factors into six categories.
The categories likely to cause injury include:

  • A specific part of the device;
  • Wet or icy surfaces;
  • Stairs or curbs;
  • Ramps;
  • Transportation and lifts; or
  • Other, including uneven terrain, entryways or exits, sports and

“I think we are seeing more and more kids use these devices and we
actually found some misuse of these devices, which could have contributed to
some of the injuries,” McKenzie said.

Misuse-related injuries accounted for 8% of all cases, according to the
study. Crutches were most commonly involved in misuse. The study’s authors
define misuse as a patient injuring themselves while playing with the device or
trying a friend’s crutches or standing on a patient’s wheelchair.

Additional research is needed to determine whether children are being
taught how to properly operate these devices, according to McKenzie.

“Unfortunately, we were not able to tell from this study’s
data whether or not the patient had received any training in how to use the
device, but it is certainly something we are curious about,” she said.
“We are wondering if a patient is provided with training when they are
prescribed the device, would that kind of education and training reduce some of
these injuries? It is possible, but we could not tell if that was the case from
this study’s data.” — by Anthony Calabro

For more information:

  • Barnard AM, Nelson NG, Xiang H, McKenzie LB. Pediatric mobility aid
    related injuries treated in US emergency departments from 1991 to 2008.
    Pediatrics. 2010; 125(6):1200-1207.


I hope that all pediatric facilities have a physical therapist available
to assess a patient when an assistive device is needed; especially when a
weight-bearing restriction is anticipated. At our hospital, the appropriate
device is selected and fit and training is provided. This ensures that the
therapist and parent are comfortable with the abilities of the child to use the
device in all environments including home and school. Age, maturity,
co-morbidities and — in an otherwise typical child — general
coordination skill levels, are also considered. A wheelchair may be the device
of choice for a busy school environment or for a younger child who does not
have the skill set for understanding how to use an assistive device.

We do the best we can to protect our patients while providing them the
mobility they need. We know that kids are unpredictable and even the child who
has used a device for a long time is a fall risk, so parent training is an
important component of treatment, including care of the equipment.

— Sandra Smith, MS, PT
Director of
rehabilitation services, Shriners Hospitals, Tampa

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