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?
- Power-mobility Indoor driving assessment (PIDA) = (Dawson, Kaiserman, Chan, & Gleason, 2006)
- 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.
- 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
- Driving to Learn (Nilsson, Eklund, Nyberg, & Thulesius, 2011).
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.
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.
- 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.
Part 1: the 5 things you should know about Smart Wheelchair technology!
Part 2: The Current State of Wheelchair Training and Assessment
Part 3: Challenges and Solutions in Wheelchair Training and Assessment.
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.