For mobility, culture matters

If you’ve ever had surgery, you’ll know that before you can leave, three requirements must be met: you have to eat and drink, you have to use the bathroom, and you have to move.

Mobility requirements have long been a standard of care in the adult world because of the proven benefits, but in pediatric settings, there can be more variation in how mobility is viewed. Mobility became a particular challenge during the pandemic when patients in isolation couldn’t leave their rooms and started experiencing the negative side effects of not moving, such as pneumonia, sepsis, and VTEs. And some departments have always struggled with mobility, like the ICU. While sedation and temporary immobilization are sometimes necessary, these are often not counteracted with enough mobility, and a 2021 study found that there are few complete contraindications to early mobilization and that early, graded, and individually prescribed mobilization should be part of the standard of PICU care in order to improve functional status and quality of life after discharge. So even in the most challenging settings, mobility is beneficial. 

But the real challenge is motivating that mobility, especially for children in pain or discomfort. Getting them to move takes a lot of nurse or PT time, and sometimes that time is just not available. So how can children self-motivate? To first overcome issues of pain, ask any Child Life Specialist, and they will tell you to use distraction. And distraction has a lot of evidence for clinical use. But distraction looks different for digital-native children who have grown up with electronic devices. So using gaming technology for distraction as well as motivation for mobility is a perfect fit. We’ve had a lot of success with this with our ARISE game, designed to help kids move sooner after surgery to improve recovery.

We recently talked with a Midwest hospital that has had ARISE deployed throughout the pandemic. They’ve said it’s not only Child Life, nursing, and our ambulation team using ARISE, but they also believe patients with their families are making a large contribution to these numbers by ambulating and playing on their own once they have been introduced to the AR scavenger hunt. And their numbers tell an even greater story: over the last 8 months (Jan 2023 - Aug 2023), their patients have more than 9 miles of mobility. If you consider these hallways are about 50 feet long, that’s nearly a thousand hallway walks that children were motivated to complete. This example represents several units like hematology-oncology, cardiology, complex care, and medical-surgical, where many children are recovering from surgery and generally feeling unwell. What an amazing win for these kids and this hospital!

While we are still studying all the impacts of our mobility game, we have already learned that using AR for distraction and mobility has a significant positive impact on Pediatric Quality of Life (PedsQL) scores. So a culture of mobility has a direct impact on quality of life for kids. And isn’t that the goal at the end of this? To have healthy, happy kids with a great outlook on life? 

Additional sources: 

https://publications.aap.org/pediatrics/article/147/1/e2020040261/33412/Child-Life-Services

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