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Power Wheelchair Assessment: Determining and Developing Readiness

Power Wheelchair Assessment: Determining and Developing Readiness
Michelle Lange, OTR/L, ABDA, ATP/SMS
February 10, 2015
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Mobility - The Research

Mobility is a big deal; it is how we accomplish the tasks that we need to do.  Research clearly indicates that early independent mobility increases cognitive skills, psychosocial skills, vision and visual perceptual skills.  Some of our clients may come to their mobility later on.  I would love to see more of my clients when they are very young, but just because our client is older when we are looking at mobility does not mean they cannot still benefit from that activity.  There is research to back this up.  What is that research?  The RESNA position paper on pediatric mobility includes a comprehensive listing of research.  It is getting a little dated now and actually there is a group of us working on updating this, even as we speak, to include much more recent research.  Since this paper came out, probably most the research that has come out is indicating that augmented mobility experiences, even for very young children, even for children who may not be independent in that power chair, but by just having experiences in a power chair can really have key developmental benefits.  Sometimes this is being used not so much to provide mobility as it is to build those developmental skills.  That is how critical this is.  You can find this position paper on the RESNA website.  If you cannot find it there, you can find it on my website at  www.atilange.com under Resources.  Keep an eye out because in the next year there will be an updated version of this as well.

Resistance to Power Mobility

Sometimes clients may not want to look at power mobility.  Usually resistance falls into three different categories, either concerns about motor development, concerns that that child can get mobile in some other way if we just wait a little bit longer, or concerns about funding. 

Barrier #1: Concerns regarding motor development with use of power mobility

Many times I have been in a mobility evaluation where someone on that team says if this child gets a power chair they will never walk or they will never use their other mobility equipment. Concern is present even if it is a manual wheelchair or a gait trainer. Another concern is that they might get lazy.  I was in a session just this last week at a conference where one of the participants said that team members had said the client will gain weight if they get a power wheelchair.  That is along the same line of concern.  Fortunately, research, and some of this research is in that RESNA position paper, has shown that children who use a power chair are actually more likely to attempt any other form of mobility; that the child will not become lazy.  Let's say that a child has never been able to move themselves independently before.  If they see a toy that is out of reach, they may not even try to get it because they know that they cannot.  If that child has had some mobility experiences where they were able to independently grab that toy, then when they are down on the floor and that toy is just out of reach, they might make even more of an effort to go get it.  They know now that they have gotten it before.  It spurs more motor development, not the opposite concern.

Barrier #2: Lengthening therapy and/or trying alternative methods

There may be someone on the team that says hold on, if I can just work with this person a little longer, I know I can get them walking or I know I can get them propelling that manual chair or using that gait trainer.  It is important that we remember as clinicians that a power chair does not mean that we failed in therapy.  It is just another tool in our tool box.  What is our goal?  Our goal is for clients to be as independent and functional in their mobility as possible.  We want that mobility to be efficient for them.  Efficient means does not take a lot of time, does not take a lot of effort.  If we are working with a client who truly does not have independent functional mobility, we have a whole array of options to help us get that person mobile.  It does not mean we stop therapy as soon as we provide something like a power wheelchair.  A power wheelchair may be the only way of providing independent mobility that to that client at that time.


michelle lange

Michelle Lange, OTR/L, ABDA, ATP/SMS

Michelle Lange is an occupational therapist with over 35 years of experience and has been in private practice, Access to Independence, for over 15 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the co-editor of Seating and Wheeled Mobility: a clinical resource guide. She is the former NRRTS Continuing Education Curriculum Coordinator and Clinical Editor of NRRTS Directions magazine. Michelle is a RESNA Fellow and member of the Clinician Task Force. Michelle is a RESNA-certified ATP and SMS.



Related Courses

Wheelchair Seating For The Pediatric Population
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Video
Course: #5907Level: Advanced2 Hours
Pediatric seating and mobility equipment are not simply smaller than equipment designed for adults. This course will present the importance of pediatric positioning, clinical considerations, how to determine if a child is positioned adequately, as well as alternative positioning. A detailed case study will pull all the information together in a practical way.

AAC: Early Intervention and Transition
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS, Jill Tullman, MS, CCC-SLP
Video
Course: #5226Level: Advanced3 Hours
Master skills to implement in your practice immediately with continued Master Class. This three-hour master class addresses the complex needs of children with multiple disabilities in the early intervention setting, including successful transition to school. A multi-disciplinary approach to augmentative-alternative communication (AAC) and interventions are addressed and case studies are included.

Pediatric Power Wheelchair Assessment And Training
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Live WebinarTue, Apr 16, 2024 at 12:00 pm EDT
Course: #6317Level: Advanced3 Hours
Pediatric power wheelchair assessment, including determining and developing cognitive and motor readiness, team evaluation, and mobility training as a part of the school day, will be comprehensively addressed in this course. Assessment, skill development, and skill training are critical to achieve functional and independent use of power mobility.

Secondary Supports: It’s All In The Angles!
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Video
Course: #6111Level: Intermediate1 Hour
Wheelchair seating systems often include secondary supports including pelvic belts, anterior trunk supports, and ankle straps. This course will explore secondary supports and appropriate clinical applications, as well as what to do when secondary supports are required, and team members have restraint concerns. Case studies will be included.

Continued Conversations, The CE Podcast: The Top Ten Mistakes Clinicians Make During Seating and Mobility Evaluations
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Audio
Course: #4610Level: Introductory1 Hour
This podcast will be a conversation about common mistakes made during wheelchair seating and mobility evaluations. The discussion will give you new ideas to improve the evaluation process!

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