Power Mobility and Safety Concerns
Power mobility can enhance participation in daily activities as well as recreation for those who are in long-term care. The devices can also pose security concerns that need to be addressed.
Instead of excluding residents who have certain diagnoses from use of power mobility that could be considered prejudicial risk management, most participants opted to adopt a teleological approach and allow all residents to try out the power mobility device.
Mobility
A power mobility device allows those with limited ability to move about their community or home and participate in daily living activities that are otherwise not accessible to them. These devices be a danger not just for the person who uses them but also to others who share their space or environment. Occupational therapists must carefully assess each client's safety needs to make the best recommendations for powered mobility.
In an exploratory study carried out by OTs at three residential care facilities of the Vancouver Coastal Health Authority, qualitative interviews were conducted with residents to determine their use of power mobility. The aim was to create a framework for client-centered power mobility prescribing. The results revealed four major themes: (1) the meaning of power mobility, (2) learning the rules of the road, (3) red flags concerning safety, and (4) solutions.
Power mobility can greatly improve the quality of life for people who have limited mobility, giving them the opportunity to participate in a range of daily living activities both at home and in the community (Brandt 2001; Evans, 2000). Participation in self-care as well as leisure and productive occupations is vital to physical and mental health for older adults, and for many people with progressive diseases power mobility can be the opportunity to keep participating in these important activities.
The majority of participants felt it was unacceptable to remove the resident's chair since it would result in a significant change in their life or trajectory and essentially prevent them from pursuing the same activities they used to do prior to the progression of their illness. This was especially relevant for those in Facility 1 who had only been in a position to use their power chair for a brief period and were now dependent on others to push them.
Another solution would be to limit the speed at which residents drive their chairs. However this could cause several issues, including privacy and the impact on the rest of the community. Ultimately, removing the chair of a resident was thought to be the most drastic and least desirable solution to security concerns.
Safety
Power mobility allows people with disabilities to move around more easily and participate in a greater range of activities and do errands. However, with greater mobility comes a greater risk for accidents. For some, these accidents could cause serious injuries to themselves or others. It is essential to consider the security of your clients prior to recommending the use of power mobility.
First consider determining if your client is able to safely use their scooter or power chair. Based on their impairment and the state of their health, this could involve a physical evaluation by a doctor or occupational therapist, or a discussion with a mobility expert to determine if a particular device is appropriate for them. In some instances the use of a vehicle lift may be necessary to allow for your client to load and unload their mobility device at home, in the community or at work.
Understanding the rules of road safety is an additional aspect of safety. This includes sharing space with other wheelchair users, pedestrians, and drivers of cars or buses. This was a theme that was mentioned by the majority of participants in the study.
For some this, it meant learning to use their wheelchairs on sidewalks, instead of driving through crowded areas or over curbs (unless specifically designed for doing so). For others this meant driving more slow in a crowded area and watching out for pedestrians.
The final and least preferred alternative was to take away a person's chair, which was viewed as a two-fold penalty that would result in losing mobility independently and preventing access to facility and community activities. This was the viewpoint of the majority of participants who had their chairs removed, including Diane and Harriet.
The participants also suggested that residents, family members, and staff be educated on the safe use of power mobility. This could include teaching the basics of driving (such as using the right side of a hallway) as well as encouraging residents to practice driving strategies when they leave and helping them understand how their actions can affect the mobility of others.
Follow-Up
A device that is powered by electricity can significantly impact a child's ability to function and take part in life. There is little research on the experience that children experience when they learn to make use of these devices. This study uses an approach that is post-previous to study the effects of six months of use with one of the four early mobility devices on a school-aged group of children who suffer from severe cerebral Palsy (CP).
We conducted interviews in qualitative format with 15 parents as well as occupational and physical therapists for children. Thematic analysis identified three main themes. The first, 'Power in mobility,' explained the ways in which powered devices changed more than just motor skills. Learning to drive electric wheel scooter can be an emotional, transformative journey for the participants.
The second theme, 'There's not a recipe book,' showed that learning to use a power mobility device was an individual process that unfolded over time in a cyclical fashion. Therapists were required to determine what was realistic based on each child's abilities and needs. During the training phase, and afterwards, therapists needed to be patient with children and parents. Parents and therapists alike described the need to help families celebrate their successes and resolve issues that arise from the process of training.
The third theme, 'Shared space was a look at the ways in which using devices that power us can affect the lives of other people and their interactions. The majority of the participants in this study believed a person must be mindful of other users when using a mobility device. This was particularly relevant when driving on public roads. Participants also mentioned that they've witnessed situations where someone else's property had been damaged by the use a power mobility device or an individual had been injured by a motorist who did not yield the right of way.
Overall, the results of this study suggest that short-term socialization and power mobility training is possible for preschoolers with CP in certain classroom settings. Future research should continue to investigate the training and outcomes for this type of intervention for children with CP. This could result in the development of more uniform training protocols for this group.