Power Mobility and Safety Concerns
Power mobility allows people in long-term care to participate in their everyday activities and leisure activities. However, the devices can also pose safety risks that need to be addressed.
Instead of excluding residents with a specific diagnosis from the power mobility option that could be considered risk management that is prejudicial, the majority of participants preferred to take the teleological approach and let all residents trial the device.
Mobility
A power mobility device allows those with limited ability to move about their community or home and take part in daily activities that are otherwise unavailable to them. However, these devices may also pose a risk to the person using them and other people who are in their space. Occupational therapists must carefully assess each client's safety needs to make the best 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 assess their power mobility use. The objective was to establish a framework that would allow for client-centred power movement prescribing. The results revealed four main themes: (1) the meaning of power mobility, (2) learning the rules of the road, (3) red flags concern about safety and (4) solutions.
Power mobility can greatly improve the quality of life for individuals who have limited mobility, giving them the opportunity to participate in a variety of everyday living activities, both at home and in the community (Brandt, 2001; Evans, 2000). Participation in self-care, productive and leisure occupations is crucial to mental and physical health of older adults, and for many people with progressive diseases, power mobility offers an opportunity to continue taking part in these vital activities.
The participants felt it was inconvenient to remove a resident's wheelchair, as this would disrupt their life's story and progression and stop them from doing the same activities that they did before their disease progressed. This was especially true for those in the facility 1, who had been capable of maintaining their chairs for short periods of time and were forced to rely on others to move them around the facility.
Another possible solution is to limit the speed at which residents drove their chairs, but this could have raised issues, such as a lack of privacy and impact on other people in the community. In the end, taking away the chair of a resident was thought to be the most drastic and least preferred solution to safety concerns.
Safety
Power mobility lets people move more freely. They are also able to participate in a broader range of activities and complete errands. However, with increased freedom of movement comes a greater risk for accidents. These incidents can result in serious injuries for certain. It is crucial to think about the safety of your clients prior to suggesting power mobility.
First, determine if your client is able to safely operate their power chair or scooter. Depending on the severity of their impairment and the state of their health, this could involve a physical evaluation by a physician or occupational therapist, and a discussion with a mobility expert to determine if a particular device is suitable for them. In certain situations your client may require a lift for their vehicle to be capable of loading and unloading the mobility device at their home, community or workplace.
Knowing the rules of road safety is an additional aspect of safety. This includes sharing space with other wheelchair users, pedestrians and drivers of buses or cars. This topic was mentioned by the majority of participants in the study.
For some it required learning to use their wheelchairs on sidewalks instead of driving through areas that were crowded or over curbs (unless specifically designed for doing such). Others drove slower and paid attention to pedestrians in a crowd.
The last and least popular alternative was to take away the chair of a person. This was seen as two-fold punishment loss of mobility independent and preventing access to facilities and community activities. This was the view of the majority of those who were able to remove their chairs and included Diane and Harriet.
Other solutions that were suggested by participants included educating other residents staff, family members and other residents on the proper operation of power mobility. This could include teaching the fundamentals of driving (such as using the right side of a hallway), encouraging residents to practice driving skills when they go out and helping them understand how their behavior can influence the mobility of others.
Follow-Up
A power mobility device can significantly impact the ability of a child to function and take part in life. Yet little research has been done on the experiences of children who learn to use this equipment. This study employs a post-previous design to examine the effects of 6 months of using one of the four early mobility devices on a school-aged group 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 identified three major themes. The first theme, 'Power for Mobility explained how the use of a powered device affected more than just the child's motor skills. The process of learning to operate a powered mobility device is often an emotional and transformative one.
The second theme 'There's no recipe book' showed that learning how to utilize an equipment for mobility was a process that took place in a continuous manner over time. Therapists were required to determine what was realistic based on each child's abilities and requirements. Through the training and post-training phases, therapists were also expected to be patient with children and parents. Many parents and therapists mentioned a need to help families celebrate successes and problem-solve challenges associated with the training process.
The third theme, "Shared space", looked at how the use of a power device can impact the lives of others. The majority of participants in this study felt that people should always show consideration for others when using their power mobility device. This is particularly true when driving in public areas. Many participants also reported that they've encountered instances where another's property was damaged due to the use of an electric mobility device, or when a person was injured by a driver who had failed to yield right-of-way.
The results of this study show that power mobility and socialization training for preschoolers with CP can be carried out in specific classroom settings. Future research should be focused on the effects of training and results of this type of intervention for children with CP. This will hopefully result in the development of more standard training protocols for this group.