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Power wheelchairs in the community: wheelchair choices of older adults

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By:

Bryan Ng

Original Article:

This is a summary of a paper published by researchers in the Department of Occupational Science and Occupational Therapy in the University of British Columbia, including ICORD researcher Dr. Ben Mortenson.

Mortenson, W. Hammell, K. Luts, A. Soles, C. Miller, W. (2015). The power of power wheelchairs: Mobility choices of community-dwelling, older adults. Scandivanian Journal of Occupational Therapy, 22(5), 1-8.

Find the original article here.

Why should people be interested in power wheelchairs?

Power wheelchairs are found to benefit a person’s health, occupation, and quality of life by improving mobility and social life, and decreasing discomfort. Despite these advantages, some people still choose to use manual wheelchairs over power wheelchairs. Currently, little is known about the factors that adult wheelchair users consider before deciding which device to use. The purpose of this project was to investigate how mobility choices are made and the challenges faced when making mobility choices.

How the study was conducted:

This study was conducted through interviews with a diverse group of 13 (age 50 or older) power mobility users, using interpretive description.

Data was collected through two interviews. During the first interview, participants were asked about their:

  • Sociodemographic information (age, sex, income)
  • Wheelchair use (i.e. “How do you use your wheelchair on a daily basis?”)
  • Customization/features of wheelchair
  • Participation in activities
  • Mobility challenges (i.e. “What difficulties do you encounter when using your chair?”)
  • Reactions to wheelchair use

In the second interview (four months later), the interviewer followed up and asked about any changes over the past four months, as well as revisiting topics that emerged in the first interview (training received, occurrence of accidents, etc.).

The data was analyzed for different patterns and prevalence of use.

Three styles of wheelchair users:

  • Reluctant: power mobility is not often used because it is not the best form of mobility
    1. Disadvantages of power mobility outweigh the benefits. Manual use has become natural while power mobility may be less capable to user.
    2. Hesitant to try power mobility.
    3. Manual wheelchair shows user is an active member of the environment.
  • Strategic: power mobility is used when it is advantageous
    1. Power mobility allows user to be more independent.
    2. Hesitation due to possibility of becoming less fit while using power mobility
    3. Physical barriers to power mobility use (e.g. customized transportation needed, inability to “wheelie” for assistance over curbs, etc.)
  • Essential: power mobility use is the best method of mobility
    1. Electrical/mechanical malfunctions are a concern.
    2. Relationship between user and wheelchair is formed – often customized for comfort and to reflect personality.
    3. Power wheelchair use is a form of independence.

Challenges to mobility choices and their potential solutions:

  • Mobility choices are rather restricted due to control from private health insurance and government funding which excludes many individuals from being able to choose their style of mobility: agencies usually only fund one primary device and/or may not provide financial resources for car modifications needed
    • Reveals a need to realign the power relationship between prescribers and users so that changes can be made to fund and provide devices.
  • Physical environmental and social (stigma/marginalization) barriers from wheelchair use may exclude users from certain fields and engagement in their jobs.
    • Need to consider how to set up public infrastructure (ramps, etc.) to reduce physical barriers to wheelchair users.
  • Limited training of power wheelchairs prevents proficiency and comfort in power wheelchair use.
    • To assist proficiency and confidence, new methods for device training and support should be considered.
    • To reduce injuries and increase comfort, power mobility add-ons such as power-assisted wheels should be considered.

What does this mean for people living with SCI?

People living with SCI face issues such as reluctance due to lack of training, lack of funding for power mobility, and the lack of public infrastructure to support mobility. This study is important because it shines light on restrictive policies and clinical issues that people may face when choosing a method of mobility.