Date Presented 04/05/19
Primary Author and Speaker: Mary Hill
Additional Authors and Speakers: Ben Salatin
INTRODUCTION: “Robert” (name changed to protect personal information) is a Veteran who survived an ASIA C, C4 spinal cord injury (SCI) in Spring, 2018. After lengthy physical rehabilitation with Occupational Therapy (OT), Physical Therapy (PT) and Speech Language Pathology (SLP) in hopes of restoring Robert’s body function, Robert did not experience recovery of functional motion below his level of injury. Robert was evaluated for a power wheelchair (PWC) with alternative drive controls. The course of training for Robert in his PWC was made more complicated because he experiences hallucinations and differences in thinking reflated to schizophrenia, a BMI of 35 deeply entrenched denial of his health condition.
PURPOSE: The primary objective of this case study is to discuss the numerous objective measures used, training strategies applied and assistive technology options considered and trialed to promote improved mobility for Robert. Robert signed a release of information and photo release which is on file at the New Mexico Veterans Administration Spinal Cord Injury Unit in Albuquerque, NM. He said “It is important to help people learn.”
METHODS: This single subject case study will relate information from over forty skilled occupational therapy treatment sessions along with numerous interventions completed by an interdisciplinary team that includes PT, SLP, clinical rehabilitation engineering, nursing, social work and medical staff members. The ways in which objective measures including The Montreal Cognitive Assessment (MoCA), the Canadian Occupational Performance Measure (COPM), the Wheelchair Skills Test 4.1 (WST 4.1) and the Power-Mobility Indoor Driving Assessment (PIDA) will be discussed. Roberts complex environmental, cognitive, psychosocial and physical needs will be examined through the lenses of both the Occupational Therapy Practice Framework (AOTA, 2014) and the Human Activity Assistive Technology Model (Giebrecht, 2013). Because the anticipated discharge location for Robert is a skilled nursing facility with transition to full time nursing care, measures taken by OT and Rehab Engineering to make the alternative controls “Rocky Mountain Proof” will be discussed with hands-on opportunities for poster session participants.
RESULTS: Robert completed more than 40 training sessions and improved markedly in the use of his alternative drive controls. He was independent after self-directed set-up of the controls to manage his mobility in open hallways, but continued to need assistance through use of an attendant control in cramped spaces, such as a crowded hospital room. Robert completed his therapy at the New Mexico Veterans Administration Health Care System and returned to his home state. His treatment team in New Mexico provided detailed pass-down of information to improve continuity to the team that will continue to provide him with care.
CONCLUSION AND IMPACT: Alternative drive controls provide opportunities for improved independence in mobility using power wheelchairs (Dolan & Henderson, 2017). Evidence based guidelines suggest that numerous, short training sessions benefit people who demonstrate difficulty in adapting to the cognitive needs related to driving a power wheelchair (EnableNSW 2011). For Robert, the training sessions resulted in increased independence, but objective measures demonstrated that he had not yet achieved modified independence with his alternative drive controls.
References
EnableNSW and Lifetime Care & Support Authority, Summary of the guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury. EnableNSW and LTCSA Editor, 2011, Sydney.
Dolan, M. J., & Henderson, G. I. (2017) Control devices for electrically powered wheelchairs: prevalence, defining characteristics and user perspectives, Disability and Rehabilitation: Assistive Technology, 12:6, 618-624, DOI: 10.1080/17483107.2016.1201154
Giesbrecht, E. (2013). Application of the Human Activity Assistive Technology model for occupational therapy research. Australian Occupational Therapy Journal, 60(4), 230–240. https://doi-org.libproxy.unm.edu/10.1111/1440-1630.12054
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1– S48. http://dx.doi.org/10.5014/ajot.2014.682006
