Power Mobility and Safety Concerns
Power mobility allows people in long-term care to participate in their routine activities and leisure pursuits. These devices also raise security concerns that need to be addressed.
The majority of participants choose to adopt a teleological perspective and give all residents the opportunity to test a device, rather than restrict residents with certain diagnosis that could be viewed as a risk management decision that is prejudicial.
Mobility
A power mobility device provides a method for people with limited mobility to move around in their home or community, and also to take part in activities of daily living that they might not otherwise be able to do. However, these devices could also be a danger to the person using them, and other people who are in their space. Occupational therapists need to carefully examine each client's safety requirements to make the most appropriate suggestions regarding powered mobility.
In an exploratory study (von Zweck, 1999), OTs from three residential care facilities in Vancouver Coastal Health Authority conducted qualitative interviews with residents about their power mobility use. The goal was to develop a framework for client-centered power mobility prescribing. electric power scooters revealed four major themes: (1) the meaning of power mobility, (2) learning the rules of the road, (3) red flags: concerns about safety and (4) solutions.
Power mobility can significantly increase quality of life for people who have limited mobility, permitting them to take part in a variety of daily living activities both at home and in the community (Brandt 2001; Evans, 2000). Self-care, productive and leisure activities are essential to the mental and physical health of older adults. For many who suffer from chronic illnesses, power mobility offers a way to participate in these important activities.
It was considered unacceptable by the participants to remove a wheelchair from a resident's home because it would alter their life story and trajectory, and prevent them from doing the same activities that they did before their disease worsened. This was particularly true for those in the Facility 1 who were only allowed to use their power chairs for a short period of time and were now dependent on others to push them.
Another option is to slow down the speed at which some residents drive their chairs. However, this could raise several issues, including privacy and the impact on the rest of the community. Ultimately, removing a resident's chair was considered the most drastic and least desired solution to security concerns.
Safety
Power mobility lets people move around more freely. They are also able to participate in a broader range of activities, and run errands. With greater mobility comes a higher chance of accidents. These accidents can cause serious injuries for some. It is crucial to think about the security of your clients prior to suggesting the use of power mobility.
First check if your client is able to safely use their scooter or power chair. This could involve a physical assessment by a doctor, occupational therapist or mobility specialist, depending on the nature of your client's disability as well as their current health. In some cases, a vehicle lift will be necessary to allow for your client to unload and load their mobility device at home in the community, or at work.
Another aspect of safety is learning the rules of the road. This includes sharing space with other wheelchair users, pedestrians, and bus drivers. Most participants in the study discussed this topic.
Some people learnt to drive their wheelchairs on sidewalks instead of driving in busy areas or on curbs (unless the wheelchair was designed for this purpose). Others drove more cautiously and kept an eye out for pedestrians in a crowded environment.
The last and least preferred option that was to take away the wheelchair of a person, was viewed as a double whammy as it would mean losing mobility, and also preventing them from participating in activities with the community or at facilities. Diane and Harriet among others were among the participants who had their chairs taken away.
Other solutions that were suggested by participants included educating other residents, family members and staff on the safe operation of power mobility. This could include teaching the basics of driving (such as using the correct side of a hallway) as well as encouraging residents to practice driving skills when they leave and helping them to understand how their behavior can influence the mobility of others.
Follow-Up
A child's ability and willingness to participate in life can be greatly affected by a device for power mobility. However, very little research has been conducted on the experience of children learning to use this device. This study employs a pre-post design to examine the effects of six months of use with one of four early power mobility devices on a group of school-aged children with severe cerebral palsy (CP).
Qualitative interviews were conducted with 15 parents and pediatric occupational and physical therapists. Thematic analysis revealed three key themes. The first theme, 'Power for Mobility explained how using a powered device affected more than just the child's locomotor skills. The experience of learning how to drive a powered mobility device is often an emotional and transformative experience.
The second theme, 'There's not a recipe book,' showed that the process of learning to utilize the power mobility device was a bespoke process that developed over time in a cycle. Therapists were required to decide what was appropriate in light of the child's capabilities and requirements. In the initial phase of training and afterwards, therapists needed to be patient with children and parents. A number of parents and therapists emphasized the need to assist families celebrate their successes and work through problems that arise from the training process.
The third theme, "Shared space", examined how the use of the power device can affect the lives of others. The majority of participants in this study believed a person must always be considerate of other users when using a mobility device. This was especially applicable when driving on public roads. Several participants also noted that they had encountered situations where someone else's property was damaged due to the use of an electric mobility device, or when a person was injured due to a driver who failed to yield the right-of-way.
The results of this study show that socialization and power mobility training for preschoolers with CP can be conducted in a variety of classroom settings. Future research should be focused on the training and outcomes of this kind of intervention for children with CP. This will hopefully lead to the development of more standardized training protocols specifically for this group of children.