I have a student who is seven years old. We trialed the power wheelchair with the joystick. She was able to understand cause-and-effect, stop and go, and directional concepts. Following directions was inconsistent and no recognizing obstacles in attempt to avoid obstacles. She demonstrated no caution. When she crashed into something, she laughed and was unable to problem solve, even with given directions to get out of the situation. She was unable to drive from one place to another accurately. Do you have any recommendations for a power chair at this time? I am unsure of her potential to get better with a power chair. Her visual attention is poor and she is distractible.
Answer
We have a seven-year-old who understands cause-and-effect, stop and go, and directional concepts, but it sounds like following directions is not quite there yet, judgment has not developed, and that problem-solving is not there. This is exactly where I think a lot of our clients end up and do need more training to be successful with a power mobility evaluation. What I would recommend is exactly some of the things we were just talking about. I am assuming she probably has a manual chair or some type of dependent mobility base now. Put some switches on there or some colored circles, if you do not have some switches, and have her practice problem-solving. Now she laughs when she crashes, which is a very common scenario. It is very important that everyone get together ahead of time and agree that no matter how cute she is when she laughs, no one can laugh. It is a very important thing not to reinforce that behavior. It is fun to crash and she does not realize that had she been in a power chair, she could really cause some damage. It is important to bring in some behavioral things as well. Encourage appropriate problem-solving, work on those skills for a while, and when you see that she does seem to have a better sense of how to get from point A to point B, then I would go ahead and move forward with the power wheelchair evaluation. Again do not require perfection. See some potential there.
Michelle Lange, OTR/L, ABDA, ATP/SMS
Michelle Lange is an occupational therapist with over 38 years of experience and has been in private practice, Access to Independence, for over 19 years, where she currently focuses on education and consultation. 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 (1st & 2nd eds). Michelle is a RESNA Fellow and a RESNA-certified ATP and SMS. She is also a member of the Clinician Task Force.
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