Power Mobility and Safety Concerns
Power mobility enhances participation in daily activities as well as recreational pursuits for individuals who are in long-term care. However, the devices could also cause safety issues that need to be addressed.
Instead of excluding residents with certain diagnoses from the power mobility option that could be considered prejudicial risk management, most participants chose to take the teleological approach and let everyone test the device.
Mobility
A power mobility device provides a method for people who are unable to move about their home or community, and also to take part in activities of daily living that they would not be able to do. However, these devices could also pose a risk to the person using them as well as other individuals who are in their space. Occupational therapists must be aware of 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 about their use of power mobility. The aim was to develop an environment that allowed for a client-centered power movement prescription. The findings revealed four main 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 greatly improve the quality of life for individuals who have limited mobility, allowing them 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 as well as leisure and productive occupations is crucial to mental and physical health for older adults, and for those who are suffering from progressive illnesses power mobility is the opportunity to keep participating in these vital activities.
The majority of participants felt it was unacceptable to take away a resident's chair, as it would result in a significant interruption to their life or trajectory and essentially prevent them from continuing to engage in the same activities they had been doing before the progression of their illness. This was particularly true for those in Facility 1 who had been allowed to use their power chairs for a short time and were now dependent on others to push them.
Another potential solution was reducing the speed at which some residents drove their chairs, however this raised a number of concerns, including a lack of privacy and the impact on other residents in the community. In the end, removing the chair of a resident was deemed the most drastic and least desirable solution to safety concerns.
Safety
Power mobility lets people move more freely. They can also take part in a greater variety of activities and complete around on their own. With the increased mobility comes an increased chance of accidents. For some, these accidents could result in serious injuries to themselves and others. It is important to consider the security of your clients prior to suggesting power mobility.
First check whether your client is able to safely operate their scooter or power chair. Based on the nature of their disability and current health, this may involve a physical evaluation by a physician or occupational therapist, and an interview with a mobility specialist to determine if a specific device is suitable for them. In green power mobility of a vehicle lift may be required to allow for your client to load and unload their mobility device at home, in the community or at work.
Another aspect of safety is to learn the rules of the road. This includes sharing space with pedestrians, other wheelchair users, and drivers of trucks, cars or buses. Most participants in the study mentioned this theme.
For some, this meant learning to drive their wheelchairs on sidewalks instead of driving through crowded areas or over curbs (unless specifically designed to do so). Others drove slower and looked out for pedestrians in a crowd.
The final and least preferred option was to remove a person's chair, which was seen as two-fold punishment: losing independent mobility and preventing access to facilities and community activities. see page was the opinion of the majority of participants who were able to remove their chairs and included Diane and Harriet.
Other solutions that were suggested by participants included educating residents, family members and staff about the safety of power mobility. This could include teaching the basics of driving (such as which side to walk on in a hallway) as well as encouraging residents to practice driving skills while outside, and helping them recognize how their behavior affects the mobility of others.
Follow-Up
A device that is powered by electricity can significantly impact the child's ability to function and be a part of life. Yet there isn't much research about the experience of children learning to use this device. This study employs an approach that is pre-post to study the impact of six months of experience with one of the four early power mobility devices on a group of school-aged children with severe cerebral palsy (CP).
We conducted qualitative interviews with 15 parents as well as occupational and physical therapists for children. Thematic analysis revealed three major themes. The first, 'Power and mobility explained how the use of a powered device changed more than just a child's motor skills. Learning to drive a power mobility device can be an emotional and transformative journey for participants.
The second theme 'There's no cookbook' revealed that learning how to make use of a mobility device was a process that took place in a cyclical manner over time. Therapists were charged with determining what was realistic for each child's needs and abilities. In the initial phase of training and following, therapists were required to be patient with children and parents. Many parents and therapists mentioned a need to help families celebrate their successes and work through problems that arise from the process of training.
Finally, the third theme, 'Shared space was a look at the ways in which using a power device could have an impact on other people's lives and interactions. The majority of those who participated in this study believed a person should always show consideration for others when using their power mobility device. This was particularly relevant when driving on public roads. Many participants also reported that they had encountered situations in which someone else's property was damaged by the use of an electric mobility device, or when a person was injured due to a driver who not yielded right-of-way.
Overall, the results of this study suggest that short-term socialization and power mobility training appears feasible for preschoolers with CP in certain classroom environments. Future research should continue to explore the effects of training and results of this type of intervention for young children with CP. This could lead to more standardized training protocols for children with CP.