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Wheelchair Safety with Integrity: Enhancing Mobility through Solidarity

In a world where the power of perception often shapes our understanding of others as well as ourselves, it’s crucial to embark on an exploration of wheelchair safety in solidarity with promoting inclusive mobility that values integrity and wellness beyond physical needs. Debunking prevailing social myths surrounding the capabilities of individual mobility device users, we hope to illuminate a path to break free from the biases that might negatively impact individuals’ self-perception and driving potential.

Emphasizing the functional strengths of individual mobility devices users, we will delve into how various factors – education, interaction, and societal attitudes – can profoundly influence the safe use of mobility devices, whether for the better or worse. In doing so, we hope to shift the focus away from individuals’ diagnoses and/or functional limitations to pay more attention to their current capabilities.

In our previous blogs, we explored surprising technological factors such as seating, programming and configurations, and drive controls: 3 Reasons for Accidents with Wheelchairs that Might Surprise You (Technological Factors) as well as key environmental barriers from accessibility, weather to traffic: Safeguarding Wheelchair Users: Unveiling 3 Key Environmental Barriers that Impact the Safe Use of Wheelchairs that all contributed to the safety of wheelchairs. With this third blog breaking down the significance of education, interaction, and societal attitudes, we invite everyone to perceive the safe use of mobility devices as an opportunity for assistance rather than a problem demanding solutions.

1. Mobility Education and Experience

1.1 Mobility Training Communication

It is essential to shift the conversation surrounding the training for individuals with disabilities from a focus solely on what they cannot do to a recognition and emphasis on what they still can, as this perspective encourages a more positively balanced view on their mobility potential, especially with proper use of mobility devices and adaptive technology. To elaborate, when individuals are learning about overall functionality of their bodies which is essential to their safety with mobility devices, they should be asked questions such as “which body part(s) do you find you use the most and are most helpful?” rather than only questions like “which part of your body do you struggle with the most in your everyday life and routine when you try to use mobility devices?”.

These two seemingly similar questions actually carry contrasting implications. One question emphasizes heavily on the individuals’ needs for the solutions proposed based on their reported limitations. This passive focus, in another word, implies that the individuals must depend on factors outside of their control to make their decisions for them. The other question, on the contrary, leaves the decision-making power within the hands of the individuals by simply highlighting all the functional capabilities they still have, allowing them to understand and recognize the available solutions in a much more dignified manner. The latter one is often more difficult to achieve because it requires not just telling, but also educating the individuals more in depth about their circumstances in order to arrive at the right decisions on their own.

1.2 Self Awareness and Training for Mobility

To build the self awareness needed to fully take control of one’s safety as well as realize one’s mobility potential in the long run, one should familiarize oneself with the diverse spectrum of functional abilities that impact one’s mobility:

Cognitive Ability

Cognitive ability is the way we think. It is all about our ability to focus, memorize, multi-task, and make decisions. It impacts our attention and interpretation of the world around us. If an individual has impacted cognitive ability, it is likely they will need more training and repetition of tasks involving their mobility device in their home and outdoor settings, to ensure they have the ability to safely make decisions about when to go faster, slower, change direction, and/or stop their wheelchair. Additionally, if decision-making is impacted due to cognitive impairment, it is best to steer clear of doing multiple tasks at once while driving the mobility device, as the individual might not be able to focus their attention on safety if they are distracted.

Fine Motor Ability

Fine motor ability is the way we move and use our fingers, hands, feet, and toes to complete tasks. Individuals with impacted fine motor skills may need more therapeutic intervention to maintain or enhance their level of functioning to better use their fingers and hands. In this case, training in alternative drive controls such as sip-n-puff, chin/tongue switch, and head array would be helpful – anything that can be used in place of a joystick that requires finger and hand movement. 

Gross Motor Ability

Gross motor ability is the way we move and use our head, neck, shoulders, arms, trunk, hip, and legs to complete tasks and navigate the world around us. Individuals with impacted gross motor skills may be receiving ongoing rehabilitation to maintain or enhance their current functioning and might be able to move their body to a certain degree while using their mobility device.

Visual Ability

Visual ability is the way we see the world around us. It is how clearly we see, how far we can see, how much depth we can recognize, what colors we see, and what textures we can recognize. Spatial ability is how we use all of this information to help us navigate in relation to our environment. Together, these are termed visual-spatial ability. Therapeutic interventions involving eye movements, hand-eye-coordination, and depth perception can help with rehabilitation. Training on adaptive technology and assistive devices that may help to “see” the world around them, past the point of their real visual field, could help in operating mobility devices safely. 

1.3 Experience with Mobility Devices

More time spent using a mobility device provides more experiential learning opportunities for individuals to become more aware of their bodies in relation to their surroundings, leading to safer use of mobility devices. Overtime, more experienced individuals learn to understand how to navigate various terrains in various weather conditions. They learn what areas in their homes are harder to navigate and which public spaces are accessible to mobility devices. They also have a better idea of how they can balance, go faster, go slower, or stop entirely while navigating known terrains ( the environment blog in this safety series discusses this in more detail). All in all, individuals who have more experience with their mobility devices can better advocate for improvements that will make their community more accessible and inclusive.

Individuals can learn to use their assistive devices and adaptive devices better, through use of these alongside their mobility device. Additionally, their ability to solve problems and later, build confidence in mobility device use increases as well. For example, the individual is not only aware of their own strengths, but the features of their assistive and adaptive technology, and the combination of both helps the individuals learn to be a safer mobility device user. Our technology blog in this safety series explores this further. Overall, their quality of life and self efficacy increase through experience of terrain and learning of technology.

Solution:

It is important to provide training on cognition, fine motor skills, gross motor skills, and visual-spatial skills to clinicians, vendors, families, and anyone else who works with individuals who use mobility devices. This knowledge can help stakeholders understand the goals and strengths of individuals who use mobility devices, so recommendations and opportunities can be made to fit well with these individuals. They can also learn more about the strengths-based approach and person- and family-centered care. This would help view needs as goals and view functioning as strengths. Experience working with mobility devices over time will assist with understanding accessibility more as well.

2. Societal Attitude

It is important to understand what societal attitudes, perceptions, and acceptance is when it comes to mobility devices and individuals who use them.  Although accessibility and disability may seem like universal concepts, the level of acceptance society displays varies.

Can societal attitudes of independence have an impact on how society views users of mobility devices and ultimately, how users of mobility devices view themselves? Can cultures where independence is highly valued view disability as more devastating perhaps, when compared to cultures where interdependence is supported?  Is it possible that individuals who use mobility devices from independence-valuing cultures view themselves as being more in need of accessibility than individuals who use mobility devices from interdependence-valuing cultures?

A journal article published in the Scandinavian Journal of Occupational Therapy suggests that societal attitudes of disability impact whether individuals who use power mobility devices either feel included or excluded in society. The issue is not just societal attitudes, it runs deeper.  The way society feels about individuals who use mobility devices can impact the way that individuals who use mobility devices view themselves. 

We have to be mindful to make sure that our attitudes of disability, mobility devices, and accessibility are equitable and fair so we can create a more inclusive society for everyone. Explicitly, negative bias may look like individuals saying insensitive things about disabilities. Implicitly, this bias may play out in the way that spaces are designed, policies are created, and health related evidence-based practices are researched. Some individuals may not be familiar with the challenges faced by wheelchair users and may lack awareness or understanding of their needs. This can result in barriers that make it harder for wheelchair users to move around comfortably and safely.  

Solution:

Providing more advocacy related campaigns, social media posts, and education can help people understand whether society is being inclusive of individuals who use mobility devices  or if there is more work that needs to be done to enhance accessibility of society by changing attitudes towards disability and accessibility.

3. Interaction

Individuals using a mobility device have either used these as a child or they come into contact with using a mobility device in their adult life. Skills like navigation, learning a skill, using our senses, identifying problems, and using creativity to solve these problems develop not just through our training in mobility devices and the experience we have with mobility devices. Rather, it goes beyond that – the training and experience works through the element of interaction. Interaction is when the individual can make changes to their mobility device, environment, and/or themselves in response to their experience with the mobility device and associated technology, their own goals and strengths, and their environment.

For example, when an individual uses their mobility device and their adaptive devices and technology in their daily routine, they may realize they need to alter their mobility device (such as adjust their seating), their routine (perhaps to low-traffic times), the devices and technology on the mobility device (perhaps adding backup cameras or blind spot sensors), and/or their own training (perhaps needing more information or training on certain aspects).  Check out our blog on The Prevention of Wheelchair Collisions to understand more about the value of experience, training, and your role in how to use mobility devices safely.

Solution:

The three blogs in the safety series highlight the importance of the technological, environmental, and personal aspects of safe mobility. We must understand the individual and their needs not in isolation, but view the goals and strengths of the individual in relation to their current mobility device, environment, training, experience, technology, and support available through relevant stakeholders (such as clinicians, vendors, and family). 

In summary, the goal of this entire blog series was to shed light on the factors beyond the individual’s diagnosis and functioning, and to increase opportunities for independent mobility. The purpose of this blog series therefore, is to take the strengths-based approach to improving quality of life. Just as one must not just speak of health in the presence of illness,  one must not speak of accessibility only in the presence of disability, otherwise we will only work to make this society more accessible if and when there is a disability. 

References

Mortenson, W. B., Miller, W. C., & Hardy, T. (2009). Ready to roll? Wheelchair use in residential care. . Disability Health Research network: UBC Okanagan. http://www.dhrn.ca/page.php?pageID=181

Widehammar, C., Lidström Holmqvist, K., Pettersson, I., & Hermansson, L. N. (2020). Attitudes is the most important environmental factor for use of powered mobility devices – users’ perspectives. Scandinavian journal of occupational therapy, 27(4), 298–308. https://doi.org/10.1080/11038128.2019.1573918