Power Mobility and Safety Concerns
Power mobility can enhance participation in daily activities and activities for people in long term care. The devices can also create security concerns that need to be addressed.
Instead of excluding residents who have certain diagnoses from use of power mobility as it could be viewed as prejudicial risk management, most participants chose to take a teleological approach and allow all residents to try out a device.
Mobility
A power mobility device enables people with limited ability to move around their home or community and take part in daily activities that would otherwise be impossible for them. These devices be a danger not just for the person who uses them, but also to other people who are in their environment. Occupational therapists must carefully assess the safety requirements of each client before making recommendations regarding powered mobility.
In an exploratory study (von Zweck, 1999), OTs from three residential care facilities within the Vancouver Coastal Health Authority conducted qualitative interviews with residents regarding their power mobility use. The objective was to develop a framework for client-centred power mobility prescribing. The results revealed four major themes: (1) power mobility meaning, (2) learning road rules, (3) red flags - safety concerns, and (4) solutions.
Power mobility can dramatically improve the quality of life for people who are mobility-challenged by permitting them to take part in a range of daily living activities at home as well as in the community (Brandt, 2001; Evans, 2000). Self-care, productive and leisure activities are essential to the physical and mental well-being of the elderly. For many who suffer from advanced illnesses, power mobility allows them to take part in these vital activities.
The participants felt it was inconvenient to remove a resident's wheelchair because it would alter their life story and trajectory, and prevent them from doing the same activities that they were doing before their condition worsened. This was especially relevant to those in the Facility 1, who had been capable of maintaining their power chairs for brief periods of time, but were forced to rely on other residents to move them around the facility.
Another solution would be to reduce the speed that residents drive their chairs. However this could cause various issues like 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 safety concerns.
Safety
Power mobility allows those with disabilities to move more freely, participate in a wider variety of activities, and even run around. With greater mobility comes a higher chance of accidents. For some, these incidents could result in serious injuries to themselves or others. It is essential to think about the safety of your clients before recommending power mobility.
The first step in determining safety is to determine if your client is able to safely operate their power wheelchair or scooter. This may include an assessment of physical health by a doctor or occupational therapist or a mobility specialist, depending on the nature of your client's impairment and their current health. In some cases your client may require an automobile lift to be capable of loading and unloading the mobility device at their home, community or workplace.
Knowing the rules of road safety is another aspect of safety. This includes sharing space, with other pedestrians, wheelchair users, and bus drivers. This is a topic that was mentioned by a majority of participants in the study.
For some, this meant learning to use their wheelchairs on sidewalks, instead of driving through crowded areas or over curbs (unless specifically designed to do this). For others it meant driving slowly in a busy environment and watching out for people walking.
The final and least preferred alternative was to take away the chair of a person, which was viewed as a double punishment: losing independent mobility and preventing access to facility and community activities. Diane and Harriet among others were among the participants who had their chairs removed.
Other ideas suggested by the participants included educating other residents as well as family members and staff on the proper operation of power mobility. This could include teaching the basics of driving (such as which side to walk on in a hallway) and encouraging residents to practice driving techniques while outside and assisting them to be aware of how their actions affect other people's mobility.
Follow-Up
A power mobility device can have a profound impact on the child's ability to function and take part in life. There isn't much research on the experiences children go through when they first learn to utilize these devices. This study uses a post-previous design to examine the effects of six months of use with one of the four early mobility devices on a group of school-aged children of children who suffer from severe cerebral palsy (CP).
We conducted interviews in qualitative format with 15 parents, along with occupational and physical therapists who work with children. Thematic analysis revealed three main themes. The first, 'Power and mobility explained how the use of powered devices changed more than just motor skills. Learning to drive a power mobility device was often an emotional, transformative journey for participants.
The second theme, 'There isn't a recipe book,' showed that learning to use a power mobility device was a bespoke process that evolved over time in a cycle. Therapists were charged with determining the most appropriate solution for the individual child's needs and abilities. Through the training and post-training phases, therapists were also required to have patience with parents and children. Therapists and parents alike spoke of the need to assist families celebrate their achievements and address issues related to the training process.
The third theme, "Shared space", looked at how the use of an electric device can affect other people's lives and interactions. The majority of participants in this study believed a person should always show consideration for other users when using a mobility device. This is especially important when driving in public spaces. Participants also said that they had seen situations in which property belonging to someone else had been damaged by the use a power mobility device or a person had been injured by a motorist who did not yield the right of way.
Overall, the results of this study suggest that short-term power mobility and socialization training is feasible for preschoolers with CP in certain classroom settings. Future research should continue to investigate the effects of training and results of this type of intervention with young children with CP. This could eventually lead to more standard training protocols for children with CP.