A participatory approach to develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment tool

Initial validation of the powered mobility device autonomy residential screen (PoMoDARS)

BACKGROUND

The Powered Mobility Device Autonomy Residential Screen (PoMoDARS) is a new tool to enable clinicians to screen resident capacity and performance skills for powered mobility device (PMD) use in residential aged care settings. The PoMoDARS is context specific, time efficient and promotes resident autonomy and safety.

AIMS

To (i) undertake initial face and content validation of the PoMoDARS, and (ii) use the research findings to make any modifications.

METHODS

A mixed-methods study design, underpinned by Classical Test Theory. Eight clinicians completed 20 PoMoDARS screens and provided both quantitative and qualitative feedback on item importance and ease of use within a formal interview.

RESULTS

Initial face and content validity of the PoMoDARS were supported, with small modifications made to item descriptors and instructions.

CONCLUSIONS

The PoMoDARS has been developed for use in residential aged care settings to screen resident PMD use. While initial validation has been undertaken, further studies to determine the reliability of the tool and continue the validation process are required.

SIGNIFICANCE

Older adults in residential aged care facilities benefit greatly from the autonomy gained through PMD use. The PoMoDARS promotes collaboration between occupational therapists, nurses, and the wider team to support residents and safe PMD use.

Major trauma associated with mobility scooters: An analysis of the trauma audit research network

AIMS

To establish the incidence and nature of injuries seen in patients following mobility scooter incidents.

METHODS

The Trauma Audit and Research Network (TARN) database was used to collect data concerning injuries associated with mobility scooters. The data was taken from incidents that occurred between February 2014 and November 2020. The data analysed included: patient demographics, injury mechanism and patterns and associated mortality rates.

RESULTS

1,504 patients were identified of which 61.4% were male. The median age was 76.2 years (IQR 63.5-84.9). The median injury severity score (ISS) was 9 (IQR 9-17), with major trauma (ISS ≥16) being observed in 29.4% of patients. Injuries to the limb were most common, although injuries to the head were most severe. Vehicle collisions accounted for 65.4% of injuries and were most closely associated with the most severe incidents. The median length of stay in hospital was 12 days, excluding the patients who died. Overall, mortality following injury was 10.6%, but the mortality rate was 15.4% in those aged 75 years and over, and 24.2% in those sustaining severe trauma.

CONCLUSION

As the population ages, injury characteristics of those with both major and non-major trauma changes. Mobility scooter use is prevalent amongst older people, and we provided a detailed analysis of injuries sustained with their use across a national database. The length of stay and the inherent resource use, because of admission following mobility scooter trauma, is considerable. These injuries particularly affect the 'most elderly' and carry a considerable mortality burden.

International research priorities on the role of cognition in power mobility device use: In pursuit of informed clinical practices and knowledge translation

Cognition is an important factor affecting power mobility device (PMD) use. However, a gap in knowledge on the role of cognition in PMD use limits evidence of best practices for screening, assessment, and training. The overall goal of this research activity was to identify strategic research priorities to delineate the next steps in research. Following the Collaborative Prioritized Planning Process (CP3), a 1.5-day meeting was held with an interdisciplinary and international team of assistive technology users, clinicians, service providers, and researchers with expertise in PMD use and cognition. Our four-stage process included: knowledge synthesis; identification and prioritization of challenges; identification, consolidation, and prioritization of solutions; and action planning. Five of 14 challenges for research on cognition and PMD use were prioritized, and five solutions (of the 100 generated) perceived to be the most impactful were selected as the focus for the remainder of the meeting. The resulting prioritized solutions included, improving knowledge translation of existing and new evidence, profiling and addressing individualized needs, creating and evaluating training tools, development of practice guidelines, and validating and developing evaluation tools or toolkit. Preliminary action planning facilitated discussion of potential future projects, initiated new research collaborations and partnerships, and provided a foundation to build a program of research for investigating the role of cognition in PMD use.

Inter-rater reliability of the assessment of learning powered mobility use, version 2.0, when applied with children and adults engaged in Driving to Learn in a powered wheelchair

INTRODUCTION

The Assessment of Learning Powered mobility use (ALP) tool including the ALP instrument and facilitating strategies, was developed for Driving to Learn. This therapeutic intervention aims to provide children and adults who have profound cognitive disabilities with opportunities to learn tool use through powered mobility practise. To allow for longer intervention periods, a partnership was developed between professionals supervising Driving to Learn and persons accompanying children or adults to their practice sessions. Accompanying persons (relatives or assistants) gradually took on shared responsibility for applying the intervention and conducting assessments with the ALP-instrument. The aim of this study was to test the inter-rater reliability of the ALP-instrument version 2.0 as applied in this novel partnership in assessment and intervention.

METHOD

A psychometric analysis compared pair-wise assessments with the ALP-instrument version 2.0, made independently by professional supervisors and accompanying persons following each Driving to Learn session. Weighted kappa statistic was used to compare the matched pair ordinal data.

RESULTS

Eight professional supervisors and 22 accompanying persons independently completed assessments with the ALP-instrument after 55 sessions with six children and five adults, who each participated in five Driving to Learn sessions. When the scores from the 55 pairs of assessments were compared, a weighted kappa value of 0.85 was obtained, indicating very good inter-rater reliability between the two rater groups.

CONCLUSION

The resulting inter-rater reliability suggests that it is reliable to implement the ALP-instrument as part of partnership in intervention between supervisors and accompanying persons. Provision of longer periods of Driving to Learn is possible when those who accompany the child or adult are able to gradually assume responsibility for practice and assessment under the supervision of a professional. This partnership approach enables children and adults with multiple and complex disabilities to practise and learn in accordance with their conditions and needs.

ViEW: A wheelchair simulator for driving analysis

The powered wheelchair (PW) has become an essential mobility assistive technology for people with motor disabilities. A critical step involved in maximizing the end-user experience is evaluating individual functional abilities. Using powered wheelchair simulation for driving analysis offers flexibility for safely evaluating the individual's driving performance in a variable environment and situations ranging in difficulty. Additionally, it makes it possible to measure numerous variables involved in the driving process. The main objectives of this pilot study were to assess PW users' outdoor driving abilities to study how the simulator can improve outdoor driving task performance, and to define new objective criteria for evaluating the overall driving process. The study presented involved a group of 12 children and young adults diagnosed with cerebral palsy. Simulations were conducted using ViEW (Virtual Electrical Wheelchair), a 3D wheelchair simulator designed in our laboratory. A customized virtual environment was designed to immerse the user in a life-like driving experience. We used the data collected on the simulator to define driving skills indicators. The acquired skills during simulations were transferable to on-road wheelchair driving. The participants' performance indicators produced positive results. Computed performance indicators can be a valuable decision-making tool for occupational therapists.

The determinants of motorized mobility scooter driving ability after a stroke

Purpose: To investigate the determinants related to the ability to drive a motorized mobility scooter after a stroke.Method: The study was a cross-sectional study. The ability to drive a motorized mobility scooter was measured with the Power Mobility Clinical Driving Assessment. The independent variables included cognitive functions measured by the Color Trails Test and reaction time test, visual functions measured by a visual acuity test and visual field test, and motor functions measured with a dynamometer, the Box and Block Test, and the Functional Independence Measure.Results: The correlation analyses revealed that the Power Mobility Clinical Driving Assessment scores had significant correlations with reaction time (ρ = -.65, p < 0.01), binocular visual field (r = .64, p < 0.01), binocular visual acuity (r = .40, p = 0.03), and the grip strength of the unaffected hand (r = .47, p = 0.01). The multiple regression analysis indicated that reaction time, binocular visual field, and the grip strength of the unaffected hand were the most significant determinants of the ability to drive a motorized mobility scooter (R² = .76).Conclusions: The reaction time, binocular visual field, and grip strength of the unaffected hand were the most significant determinants related to the ability to drive a motorized mobility scooter after a stroke. IMPLICATIONS FOR REHABILITATIONMotorized mobility scooter driving ability for stroke patients is correlated with demographics (age, mobility scooter driving experience, time since last drive) and cognitive, visual and motor functions (reaction time, binocular visual field, visual acuity, and the grip strength of unaffected hand).Primary determinants of motorized mobility scooter driving ability for stroke patients include reaction time, binocular visual field, and grip strength of the unaffected hand.Comprehensive assessments incorporating cognitive, visual and motor functions are needed to evaluate the ability to drive a motorized mobility scooter after a stroke.

Influence of Cognitive Functioning on Powered Mobility Device Use: Protocol for a Systematic Review

Background

Power mobility devices (PMD) are critical to achieving independent mobility and social participation for many individuals who have trouble walking. Provision of PMDs is complex, with cognitive functioning expressed by clinicians as a major concern. Even if PMD use can be predicted by the level of cognitive functioning, outcome tools used to assess readiness do not consider how cognitive functioning may affect PMD use.

Objective

The specific aims of this review are to identify existing assessments used to assess cognitive functioning and PMD use, classify cognitive functions that are identified within existing assessments related to PMD use, and explore the relationships between cognitive functioning (ie, executive functions and attention) and PMD use.

Methods

A systematic review will be conducted using the electronic databases MEDLINE (Ovid), CINAHL, Embase, PsycINFO (Ovid), and Web of Science based on the concepts of PMD performance and capacity, and cognitive functioning. To be included, studies must have: a sample of PMD users (inclusive of age and diagnoses), an assessment of cognitive functioning, and an assessment of PMD capacity or performance. The International Classification of Functioning, Disability and Health will be used to classify cognitive functions. Study quality will be assessed using the Mixed Methods Appraisal Tool. Qualitative and quantitative studies will be analyzed in a complementary manner depending on their designs; a result-based convergent synthesis design will be applied.

Results

This proposed systematic review protocol has been registered in PROSPERO (CRD42019118957). It was funded by the Quebec Rehabilitation Research Network and approved on February 2019.

Conclusions

Results will inform the development of a PMD driving program that aims to enhance cognition. The results of this study will enhance understanding of the influence of cognitive functioning on PMD use and will support the clinical practice in choosing appropriate evaluative tools.

Trial Registration

PROSPERO CRD42019118957; https://www.crd.york.ac.uk/PROSPERO/display_record.php? RecordID=118957

International Registered Report Identifier (IRRID)

DERR1-10.2196/16534

Usability Evaluation of a Novel Robotic Power Wheelchair for Indoor and Outdoor Navigation

OBJECTIVE

To compare the Mobility Enhancement roBotic (MEBot) wheelchair's capabilities with commercial electric-powered wheelchairs (EPWs) by performing a systematic usability evaluation.

DESIGN

Usability in effectiveness, efficacy, and satisfaction was evaluated using quantitative measures. A semistructured interview was employed to gather feedback about the users' interaction with MEBot.

SETTING

Laboratory testing of EPW driving performance with 2 devices in a controlled setting simulating common EPW driving tasks.

PARTICIPANTS

A convenience sample of expert EPW users (N=12; 9 men, 3 women) with an average age of 54.7±10.9 years and 16.3± 8.1 years of EPW driving experience.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Powered mobility clinical driving assessment (PMCDA), Satisfaction Questionnaire, National Aeronautics and Space Administration's Task Load Index.

RESULTS

Participants were able to perform significantly higher number of tasks (P=.004), with significantly higher scores in both the adequacy-efficacy (P=.005) and the safety (P=.005) domains of the PMCDA while using MEBot over curbs and cross-slopes. However, participants reported significantly higher mental demand (P=.005) while using MEBot to navigate curbs and cross-slopes due to MEBot's complexity to perform its mobility applications which increased user's cognitive demands.

CONCLUSIONS

Overall, this usability evaluation demonstrated that MEBot is a promising EPW device to use indoors and outdoors with architectural barriers such as curbs and cross-slopes. Current design limitations were highlighted with recommendations for further improvement.

Vehicle Modification Prescription: Australian Occupational Therapy Consensus-Based Guidelines

Vehicle modifications are often essential to ensure that drivers with disabilities can drive independently and safely. Occupational therapy driver assessors and driver rehabilitation specialists routinely prescribe vehicle modifications on the basis of individualized evaluations and support by rehabilitation interventions. After a literature review and consultation with stakeholders, we identified a resource gap in information to support an evidence-based process for vehicle modification prescription. Using an action research approach, we established content validity for draft guideline items and developed consensus-based draft guidelines for vehicle modification prescription that are ready for trialing by occupational therapy driver assessors. We also propose a practice model for vehicle modification prescription that is applicable to international contexts.

A scoping review of powered wheelchair driving tasks and performance-based outcomes

Introduction: Wheelchairs and scooters promote participation and have positive effects on quality of life. However, powered wheelchairs (PW) use can be challenging and can pose safety concerns. Adequate PW assessment and training is important. There is a wide variety of tasks and PW driving assessment measures used for training and assessing PW driving ability in the literature and little consensus as to which tasks and outcomes are the most relevant. A scoping review of the literature was performed in order to characterize this extensive variety of tasks and performance-based outcomes used for training and assessing PW skills.Methods: A search of the literature was conducted in January 2017. Four databases were searched: CINAHL, Embase, PsycInfo and Medline. Articles were included if they contained at least one PW driving task.Results: 827 articles were screened and 48 articles were retained. PW driving tasks from each article were identified and categorized in terms of the environment in which they were performed: Driving in a controlled environment, ecological driving tasks, 2D virtual environment (VE) tasks, 3D VE tasks. The assessment measures formed a separate category. Subjective and objective performance-based outcomes related to PW driving were also identified and grouped into outcomes assessing speed and outcomes assessing accuracy.Conclusion: This scoping review provides an overview of tasks and performance outcomes used in the literature when training and assessing PW skills. The results of this review could guide future research when choosing appropriate tasks and performance outcomes for PW driving ability.Implications for rehabilitationThere is wide variety of tasks and performance-based outcomes for PW driving.Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.New methods to measure the interaction of speed and accuracy are needed.The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.

Comprehensive Review of the Genetics of Albinism

Introduction

It is important to understand albinism, since it is a disorder associated with visual impairment, predisposition to malignant melanomas, and social stigma. The main objective of this article is to review the genetics and biologic mechanisms of the non-syndromic albinism subtypes and to describe associated clinical manifestations. We also discuss research on its treatments.

Methods

A review of the published literature on albinism subtypes was performed, spanning basic laboratory research, published case reports, and experiences of people with albinism.

Results

Clear progress has been made in comprehending the causes of albinism; research has shed light on the complexity of the disorder and has led to the molecular classification of subtypes.

Discussion

Despite the increase in knowledge with regards to albinism, gaps still exist. It is important to continue the pursuit of unraveling the mechanism of the disorder and to monitor the frequency of the subtypes worldwide in order to aid in the development of treatments. Furthermore, disseminating knowledge of albinism is crucial for future progress.

Implications for practitioners

Albinism is a disorder characterized by hypopigmentation of the hair, skin, and eyes, with accompanying ocular abnormalities that remain relatively stable throughout life. The disorder is defined by a spectrum of pigmentation where albinism is more evident among individuals of dark complexion than their lighter-pigmented peers. Patients with albinism require protection against sun exposure and special resources to address visual impairments. When albinism patients are diagnosed and properly accommodated, they generally report a positive quality of life.

Consumer Feedback to Steer the Future of Assistive Technology Research and Development: A Pilot Study

Objective: The overall objective of this project was to identify consumers' opinions of their needs and wants related to assistive technology (AT) in a systematic and quantitative manner via a questionnaire that can be used to validate existing and establish new research priorities. Methods: This pilot study describes questionnaire development, online implementation, and revisions considered to the questionnaire in preparation for conducting a nationwide survey. Data from a sample (N = 112) are presented. The pilot study was critical to refine the questions and ensure that meaningful information was being collected. Results: It was identified that revisions were warranted to provide more structure and allow for consumers to prioritize AT research efforts. Conclusion: The questionnaire results, although positively in favor of many of the technologies presented, are inconclusive to identify generalizable research priorities, thus expansion to a nationwide population is warranted.

Step-Climbing Power Wheelchairs: A Literature Review

Background: Power wheelchairs capable of overcoming environmental barriers, such as uneven terrain, curbs, or stairs, have been under development for more than a decade. Method: We conducted a systematic review of the scientific and engineering literature to identify these devices, and we provide brief descriptions of the mechanism and method of operation for each. We also present data comparing their capabilities in terms of step climbing and standard wheelchair functions. Results: We found that all the devices presented allow for traversal of obstacles that cannot be accomplished with traditional power wheelchairs, but the slow speeds and small wheel diameters of some designs make them only moderately effective in the basic area of efficient transport over level ground and the size and configuration of some others limit maneuverability in tight spaces. Conclusion: We propose that safety and performance test methods more comprehensive than the International Organization for Standards (ISO) testing protocols be developed for measuring the capabilities of advanced wheelchairs with step-climbing and other environment-negotiating features to allow comparison of their clinical effectiveness.