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Powered wheelchair skills training for older adults with cognitive impairment : using shared control to facilitate independence Smith, Emma Maria

Abstract

Powered wheelchairs (PWCs) promote participation and well-being for individuals with limited mobility. However, many individuals who would benefit from a PWC do not have access to one. This is particularly true for older adults with cognitive limitations who are perceived as being unable to learn or require additional training to become safe and effective drivers. Novel training approaches which address the needs of this population, while maintaining safety in the training environment, are necessary. Purpose: To generate knowledge through end-user input to develop a wheelchair skills training program for older adults with cognitive impairment, using an errorless learning approach, and evaluate the feasibility of implementing this program in a randomized controlled trial for individuals living in residential care. Methods: To address the purpose, we conducted three studies: A North American survey of PWC skills training providers; qualitative interviews; a think-aloud task analysis; and a mixed-methods feasibility 2x2 factorial randomized controlled trial. Results: Evidence-based PWC skills training programs are rarely used in current practice. The most commonly used training techniques are trial-and-error methods using verbal and visual cues, with safety maintained through proximity to the wheelchair. Clinicians experience tensions in providing client-centred practice in resource limited environments and maintaining safety during training while meeting the learner’s needs. There is a perception shared control technology may enable safe training opportunities and reduce training related anxiety and stress, however, clinicians require training and practice with new technologies to ensure competence. The majority of the skills and abilities used when driving a PWC are mental functions, while knowledge of the self, environment, wheelchair, and activity or task are used during driving. An errorless intervention for PWC skills training, facilitated by shared control, is safe and effective for training new wheelchair users with cognitive impairment. Participants felt safe and benefitted from the use of shared control. Conclusion: Although many clinicians are hesitant to train individuals with cognitive impairments, learning is possible within this population. Shared control can facilitate errorless training strategies. Future research should incorporate alternative trial designs, integration into clinical practice, and wheelchair-related outcome measures validated for use with older adults with cognitive impairment.

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Attribution-NonCommercial-NoDerivatives 4.0 International

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