Relationships between home and community participation, social-cognitive skills, and powered mobility learning in children with SMA type I: A randomized, waiting-list controlled trial

Early powered mobility offers opportunities for autonomy and participation in children with severe motor impairments, but its impact in spinal muscular atrophy type I (SMA I) remains poorly understood. This randomized, waiting-list controlled trial investigated the effects of early powered mobility training using modified-ride-on cars on participation, social-cognitive skills, and family outcomes in infants and young children with SMA I. The final analysis included 9 children in the experimental group and 7 in the control group. The experimental group received 12 weeks of structured powered mobility training, while the control group received usual care. Participation was assessed with the Young Children's Participation and Environment Measure (YC-PEM), powered mobility learning with the Assessment of Learning Powered Mobility Use (ALP), and cognition with standardized developmental scores. Results showed small but progressive improvements in home participation in the experimental group, with effect sizes reaching the small-to-moderate range, whereas no significant changes were observed in community participation. Correlation analyses indicated moderate-to-strong associations between mobility learning and home participation at follow-up, while cognitive scores were not consistently related to participation outcomes. These findings support the feasibility and clinical relevance of integrating powered mobility in early intervention programs for SMA I to enhance participation in natural contexts.