Power Mobility and Safety Concerns

Power mobility enhances participation in daily activities as well as recreation for those who are in long-term care. However, these devices can also pose safety risks that must be addressed.

Rather than exclude residents with a specific diagnosis from the use of power mobility as it could be viewed as prejudicial risk management, most participants preferred to take a teleological approach and let all residents trial a device.

Mobility

A power mobility device is a method for people who are unable to move about their community or home, and participate in activities of daily living that they might not otherwise be able to perform. These devices could cause danger not only for the person who uses them, but also to those who share their space or environment. Occupational therapists need to carefully examine each client's safety requirements to make the most appropriate recommendations for powered mobility.

In an exploratory study conducted by OTs at three residential facilities of the Vancouver Coastal Health Authority, qualitative interviews were conducted with residents to determine their use of power mobility. The objective was to develop a framework for client-centred 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: concerns about safety and (4) solutions.

Power mobility can dramatically improve the quality of life for individuals who have limited mobility, giving them the opportunity to participate in a variety of daily life activities, at home as well as in the community (Brandt 2001; Evans, 2000). Participation in self-care, productive and leisure occupations is essential to mental and physical health for older adults, and for many people with chronic illnesses power mobility is an opportunity to continue taking part in these vital activities.

Most participants found it not acceptable to remove a resident's chair, as this could cause a huge change in their life or path and prevent them from continuing with the same activities they used to do prior to their disease progression. This was especially true for those in Facility 1 who were only able use their power chairs for a short time and were now reliant on others to push them.

Another potential solution was reducing the speed at which some residents drove their chairs, however this could have raised concerns, including privacy issues and impact on other people in the community. The most drastic solution to safety concerns was to get rid of a resident's wheelchair.

Safety

Power mobility allows those with disabilities to get around more freely, participate in a wider range of activities and complete errands. With greater mobility comes a higher risk of accidents. For some, these accidents could result in serious injuries to themselves and others. This is why it is vital to consider the security of your client before suggesting that they use a power mobility.

The first step in assessing safety is to determine if your client is safe to operate their power scooter or power chair. This could involve a physical assessment by a physician or occupational therapist or a mobility specialist, depending on the nature of your client's impairment and their current health. In some instances, a vehicle lift will be required to allow for your client to load and unload their mobility device at home in the community, or at work.

Learning the rules of road safety is an additional aspect of safety. This includes sharing space with other pedestrians, other wheelchair users and drivers of cars, trucks or buses. Most participants in the study discussed this topic.

Some people learned to drive their wheelchairs along sidewalks instead of driving through the midst of crowds or on curbs (unless the wheelchair was specially designed for this purpose). Others drove more cautiously and looked out for pedestrians in a crowd.

The final and least preferred alternative was to take away the chair of a person, which was seen as two-fold punishment that would result in losing mobility independently and preventing access to facilities and community activities. Diane and Harriet among others were among the participants who had their chairs taken away.


Other ideas suggested by participants included educating residents as well as family members and staff about the safety of power mobility. This could include teaching driving basics (such as the correct side to walk on in the hallway) and encouraging residents to practice driving skills when they go outside and helping them recognize how their behavior affects the mobility of other people.

Follow-Up

A child's ability and willingness to be a part of the world can be profoundly affected by a device that can power them. There is little research on the experience that children have when learning to use these devices. This study employs the pre-post method to investigate the impact of 6 months of use with one of the four early power mobility devices on the children in school with severe cerebral palsy (CP).

We conducted interviews in qualitative format with 15 parents, as well as occupational and physical therapists for children. Thematic analysis revealed three major themes. The first theme, 'Power to move explained how the use of an electric device impacted more than just locomotor skills. Learning to drive electric wheel scooter Links to an external site. was often a transformative, emotionally charged journey for participants.

The second theme, 'There's no such thing as a cookbook,' revealed that the process of learning to use the power mobility device was an individual process that developed over time in a cyclical fashion. Therapists were required to discover what was realistic for each child's needs and abilities. During the training phase, and after, therapists had to be patient with children as well as parents. Parents and therapists alike described the need to assist families celebrate their successes and solve problems associated with the process of training.

Finally, the third theme"Shared space was a look at how the use of an electric device can influence the lives of others and how they interact. The majority of the participants in this study believed that it is important to be mindful when using a device that is powered by electricity. This is especially important when driving in public spaces. Several participants also noted that they've had to deal with situations in which someone else's property was damaged due to the use of an electric mobility device, or when a person was injured by a driver who failed to yield 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. The next research study should study the training and results for this kind of intervention in children with CP. This could lead to the development of more standard training protocols specifically for this group of children.