Power Mobility and Safety Concerns
Power mobility can enhance participation in daily activities as well as recreational pursuits for individuals in long term care. However, these devices can also pose safety risks that need to be addressed.
Rather than exclude residents who have certain diagnoses from use of power mobility that could be considered risk management prejudicial, most participants opted to adopt an approach based on teleology and let all residents test a device.
Mobility
A power mobility device allows people who are unable to move around their homes or communities and engage in daily activities that might otherwise be impossible for them. However, these devices may also pose a risk for the person using them and also to other people who are in their space. Occupational therapists must carefully assess each client's safety needs to provide the most appropriate recommendations regarding powered mobility.
In scooter green power (von Zweck 1999), OTs from three residential care facilities of the Vancouver Coastal Health Authority conducted qualitative interviews with residents about their power mobility use. The objective was to establish an environment that allowed for a client-centered power movement prescription. The results revealed four major themes: (1) power mobility meaning, (2) learning road rules, (3) red flags security concerns, and (4) solutions.
Power mobility can significantly increase quality of life for individuals with limited mobility by allowing them to participate in a range of daily living activities, both at home and in the community (Brandt, 2001; Evans, 2000). Participation in self-care, productive and leisure occupations is crucial for physical and mental health of older adults, and for those who are suffering from progressive illnesses power mobility can be a way to continue participating in these vital activities.
It was considered unacceptable by the participants to remove a resident's wheelchair because it would alter their life's narrative and direction, and prevent them from engaging in the same things that they did before their disease progressed. This was particularly relevant to those in Facility 1 who were able to maintain their chairs for short durations and were dependent on others to help them move around the facility.
Another solution would be to slow down the speed at which residents drive their chairs. However it could create various issues like privacy and the impact on the rest of the community. In the end, removing a resident's chair was considered the most drastic and least preferred solution to security concerns.
Safety
Power mobility lets people move more easily. They can also participate in a wider range of activities and complete around on their own. However, with greater freedom of movement comes a greater risk for accidents. These accidents can cause serious injuries for a few. It is essential to think about the security of your clients prior to recommending power mobility.
The first step in determining safety is to determine whether your client is safe to operate their power scooter or power chair. Based on the nature of their disability and the state of their health, this could involve a physical assessment by an occupational or physician therapist, or a discussion with a mobility expert to determine if a specific device is appropriate for them. In some instances, your client will need a lift for their vehicle to be able to load and unload the mobility device at home, workplace or community.
Another aspect of safety is to learn the rules of the road. This includes sharing space with other pedestrians, wheelchair users, and bus drivers. The majority of participants in the study have mentioned this issue.
For some this, it meant learning to use their wheelchairs on sidewalks instead of driving through areas that were crowded or over curbs (unless specifically designed to do such). For others, it meant driving more slowly in a busy environment and keeping an eye out for people walking.
The final and least popular option that was to take away the wheelchair of a person was seen as a double-punishment that would result in the loss of mobility and hindering them from participating in community and facility activities. This was the viewpoint of most participants who were able to remove their chairs, including Diane and Harriet.
Participants also suggested that residents, family members, and staff be informed about the proper use of power mobility. This could involve teaching the basics of driving (such as using the correct side of the hallway) as well as encouraging residents to practice driving strategies while out, and helping them to understand how their behavior affects the mobility of others.
Follow-Up
A device that is powered by electricity can have a profound impact on a child's ability to function and be a part of life. There isn't much research on the experience that children go through when they first learn to make use of these devices. This study employs the pre-post method to investigate the effects of six months' experience using one of four early power mobility devices on a group of school-aged children with severe cerebral palsy (CP).
We conducted interviews in qualitative format with 15 parents as well as occupational and physical therapists who work with children. Thematic analysis revealed three main themes. The first, 'Power in Mobility explained the ways in which a powered device changed more than just locomotor abilities. Learning to drive a mobility device was often an emotional and transformative journey for the participants.
The second theme, 'There isn't a recipe book,' showed that the process of learning how to use a power mobility device was an individualized process that unfolded over time in a cyclical manner. Therapists were required to discover what was appropriate for each child's needs and abilities. In the initial phase of training and after, therapists had to be patient with children as well as parents. Therapists and parents alike spoke of the need to help families celebrate their achievements and address issues related to the process of training.
Finally, the third theme, 'Shared space', explored how the use of an electric device can have an impact on the lives of others and how they interact. The majority of those who participated in this study believed one should always show consideration for other users when using a mobility device. This was especially true when driving in public areas. A few participants also mentioned that they've encountered situations in which someone else's property was damaged by the use of an electric mobility device, or in which an individual was injured due to a driver who not yielded the right-of-way.
Overall, the findings of this study suggest that short-term power mobility and socialization training is possible for preschoolers with CP in certain classroom environments. The next research study should examine the effectiveness of training and outcomes for this kind of intervention for children with CP. This could eventually lead to more standardized training protocols for children with CP.