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Current State of Wheelchair Training and Assessment (Part 2)

04/26/2018

The Smart Wheelchairs in Assessment and Training (SWAT) State of the Field workshop was an initiative to gather various stakeholders in power wheelchair training and assessment and create a comprehensive review of the current state of the discipline. The participants involved a balance of both clinical and technical experts on wheelchair training and assessment and the outcomes of the workshop are published in an AGEWELL report. The 3-part Braze Mobility SWAT Blog Series will discuss some key outcomes of this workshop.

As discussed in the previous blog post, power wheelchairs provide diverse benefits to their users. However, they also pose a risk to both the user and those around them if not properly paired with the user’s abilities. It is therefore important for therapists to thoroughly assess the abilities of their client, and train them on the safe use of a power wheelchair (PWC).

What do therapists measure in a PWC Assessment?

Assessments will include an interview with the user to determine their mobility goals and needs. Following this, the assessment will typically include several trials of PWCs, in order to assess various PWC skills. In addition, an evaluation of physical, cognitive and perceptual functional status of the user will be performed. Additional relevant information includes the client’s support network, main method of transportation, age, personality, and details about the environment the PWC will be used. All of this information is used to determine which PWC, if any, is the most appropriate for the client. In addition, this information can be used by clinicians to determine appropriate modifications or technologies that can help the user to succeed in operating a PWC safely. For example, for users who have difficulty with backing up or navigating in tight spaces, the Braze Sentina is a new technology that attaches to any wheelchair and provides auditory, visual and/or vibration feedback to the user about hazards in the environment. To find out more about Braze mobility products, click here!

What are the challenges in power wheelchair assessment?

In the SWAT workshop, it was determined that there is an overall lack of well-established tools to guide therapists in training and assessment that demonstrate both scientific rigour and clinical utility. In a recent survey of power wheelchair training and assessment professionals, most reported using non-standardized mobility skills assessments. Given the diverse and unique needs of clients, standardization of assessments may be ineffective, and unjustly limit access to PWCs. However, the push for evidence based practices encourages the integration of standardized, evidence-based PWC assessments.

What are the assessment tools currently used in power wheelchair assessments?

  1. Power-mobility Indoor driving assessment (PIDA) = (Dawson, Kaiserman, Chan, & Gleason, 2006)
  2. Power Mobility Community Driving Assessment (PCDA) (Letts, Dawson, & Kaiserman, 1998)

Both of these tools are clinically useful, and provide therapists with a guideline to assess skills both within the community and indoors. These checklists draw attention to certain areas of power wheelchair use, and are intended to act as an indication of areas requiring further training, device modification, or environmental interventions.

  1. The Wheelchair Skills Program (Dalhousie University, 2007)

This program includes the Wheelchair Skills Test (WST), a questionnaire (WST-Q) and the Wheelchair Skills Training Program (WSTP). The program can be used to both assess and train users, and have undergone several tests to ensure reliability, validity and clinical utility

  1. Driving to Learn (Nilsson, Eklund, Nyberg, & Thulesius, 2011).

This approach uses a training PWC and tool to understand the incremental learning process, and appropriate strategies to facilitate a user’s continued learning. This tool is designed for individuals with profound cognitive disabilities. It has demonstrated very good inter-rater reliability, and is a reliable tool for clinical use.

  1. The Pediatric Powered Wheelchair Screening Test (PPWST)  (Furumasu, Guerette, Tefft, 2004)

This tool is designed to help therapists assess a child’s readiness to drive a PWC. Only cognitive skills are evaluated using this tool.

  1. The Obstacle Course Assessment of Wheelchair User Performance  (Routhier, Vincent, Desrosiers, Nadeau, & Guerette, 2004)

This tool is used to assess the more difficult wheelchair skills . Both the content and construct validity has been established, however clinical usefulness is less clear.

  1. The Power Mobility Skills Test  (Rico, 2014)

This tool provides standardization and consistency in assessment of individuals for PWC use. It has been used extensively in California, where it is now mandatory in evaluation of PWC readiness. More research is needed to establish the clinical utility, reliability and validity outside of the California Children’s Services agencies.

Read more!

Download our FREE E-Book on Smart Wheelchair Technology!

Part 1: The 5 things you should know about Smart Wheelchair technology!

Part 3: Challenges and Solutions in Wheelchair Training and Assessment.

References:

Dalhousie University. Wheelchair Skills Program (WSP), Version 4.1 2007. Available from: www.wheelchairskillsprogram.ca. Last accessed 23 July 2014.

Dawson, D., Kaiserman-Goldenstein, E., Chan, R., & Gleason, J. (2006). Power-Mobility Indoor driving assessment manual.

Letts, L., Dawson, D., & Kaiserman-Goldenstein, E. (1998). Development of the power-mobility community driving assessment. Canadian Journal of Rehabilitation, 11, 123-129.

Nilsson, L., Eklund, M., & Nyberg, P. (2011). Driving to Learn in a powered wheelchair: Interrater reliability of a tool for assessment of joystick-use. Australian occupational therapy journal, 58(6), 447-454.

Rico, L. (2014, May 29). Powered Mobility Devices (PMD). Retrieved July 22, 2014, from http://www.dhcs.ca.gov/services/ccs/Documents/ccsnl090514.pdf

Routhier, F., Vincent, C., Desrosiers, J., Nadeau, S., & Guerette, C. (2004). Development of an obstacle course assessment of wheelchair user performance (OCAWUP): a content validity study. Technology and Disability, 16(1), 19-31.

Viswanathan, P., Wang, R., Sutcliffe, A., Kenyon, L., Foley, G., Miller, W., Bell, J., Kirby, L., Simpson, R., Mihailidis, A., Adams, M., Archambault, P., Black, R., Blain, J., Bresler, M., Cotarla, S., Demiris, Y., Giesbrecht, E., Gardner, P., Gryfe, P., Hall, K., Mandel, C., McGilton, K., Michaud, F., Mitchell, I., Mortenson, B., Nilsson, L., Pineau, J., Smith, E., Zambalde, E., Zondervan, D., Routhier, F. & Carlson, T. (2018). “Smart Wheelchair in Assessment and Training (SWAT): State of the Field” AGEWELL.

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5 Things You Need to Know About Smart Wheelchairs! (Part 1)

04/17/2018

The Smart Wheelchairs in Assessment and Training (SWAT) State of the Field workshop was an initiative to gather various stakeholders in power wheelchair training and assessment and create a comprehensive review of the current state of the discipline. The participants involved a balance of both clinical and technical experts on wheelchair training and assessment and the outcomes of the workshop are published in an AGEWELL report. The next 3 blogs will discuss some key outcomes of this workshop.

The top 5 things you should know about smart wheelchair technology!

  1. What is a “smart wheelchair”?

A smart wheelchair is a power wheelchair (PWC) that collects information on driver behavior and interaction with their environment. This is done through the use of sensors and/or cameras positioned to provide feedback on a driver’s ability to control the device and navigate their environment safely. The information can be relayed directly to the user to modify behavior, such as through an auditory, sensory or visual feedback system. The data can also be tracked and used to provide therapists with valuable insight on the user’s driving habits. This can be used to assess the safety of the user and those around them, as well as areas to focus on during future training sessions and ways to modify the environment.

  1. Why is this important?

Access to PWC technology can increase a clients independence, improve their ability to navigate their environment and is considered to be a human right by advocacy groups such as UsersFirst. Access to mobility devices is closely tied to an increase in confidence level, self-efficacy and self-reported desire to use technology. Mobility devices can also reduce the social stigma related to disability, by increasing independence of a person with mobility impairment. Through the use of information collected by smart wheelchairs, therapists are able to more thoroughly assess a client’s ability to safely operate a PWC, and could increase access for users who might otherwise be denied access due to safety concerns.

  1. What can smart wheelchairs do for therapists?

A smart wheelchair can supplement a clinician’s decision making. Although there is no substitute for clinician experience and judgment, smart wheelchair feedback can provide valuable insights into how a client interacts with their PWC on a daily basis. They can provide insight into a client’s potential to learn, and whether training sessions will increase their ability to operate a PWC independently. They also provide insight into specific areas to focus on during future training sessions. They can create objective measures of performance (such as number of collisions experienced) and provide ongoing monitoring of clients, even when training sessions end.

  1. What are the main barriers preventing client access to PWC technology?

The primary concern of most therapists in prescribing a PWC is the safety of both the client, and the people the client interacts with. Exclusion from PWC use is more likely to occur in users who show symptoms of inattention, delayed reaction time, poor judgment and decreased visuospatial awareness. For clients who require extensive training to safely use PWC technology, a limitation in the amount of training available due to therapist time constraints acts as a barrier to access. In addition, the high cost of PWC equipment, along with funding constraints can limit client access. There is additionally a limitation in commercially available technology to accommodate client needs for smart wheelchair technology.

  1. What smart wheelchair technology is commercially available?

Braze Mobility develops devices that can turn any wheelchair into a smart wheelchair. The Braze Sentina and Hydra are blind spot sensors that can be easily installed on any wheelchair, and provide auditory, visual and/or vibration feedback increasing the user’s spatial awareness and ability to maneuver tight spaces.  Braze CEO and co-organizer of the SWAT initiative Dr. Pooja Viswanathan developed these devices using the outcomes of the SWAT report to guide user-focused design. To learn more, click here!

Read More!

Download our FREE E-Book on Smart Wheelchair Technology!

Part 2: The Current State of Wheelchair Training and Assessment

Part 3: Challenges and Solutions in Wheelchair Training and Assessment.

 Reference:

Viswanathan, P., Wang, R., Sutcliffe, A., Kenyon, L., Foley, G., Miller, W., Bell, J., Kirby, L., Simpson, R., Mihailidis, A., Adams, M., Archambault, P., Black, R., Blain, J., Bresler, M., Cotarla, S., Demiris, Y., Giesbrecht, E., Gardner, P., Gryfe, P., Hall, K., Mandel, C., McGilton, K., Michaud, F., Mitchell, I., Mortenson, B., Nilsson, L., Pineau, J., Smith, E., Zambalde, E., Zondervan, D., Routhier, F. & Carlson, T. (2018). “Smart Wheelchair in Assessment and Training (SWAT): State of the Field” AGEWELL.

Read More