Driving to learn in a powered wheelchair: the process of learning joystick use in people with profound cognitive disabilities.
ABSTRACT The Driving to Learn project explored ways to help people with profound cognitive disabilities practice operating a joystick-operated powered wheelchair. The project used a grounded theory approach with constant comparative analysis and was carried out over 12 yr. The participants were 45 children and adults with profound cognitive disabilities. Reference groups included 17 typically developing infants and 64 participants with lesser degrees of cognitive disability. The data sources included video recordings, field notes, open interviews, and a rich mixture of literature. The findings that emerged yielded strategies for facilitating achievements, an 8-phase learning process, an assessment tool, and a grounded theory of deplateauing explaining the properties necessary for participants to exceed expected limitations and plateaus. Eight participants with profound cognitive disabilities reached goal-directed driving or higher. Participants were empowered by attaining increased control over tool use, improving their autonomy and quality of life.
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ABSTRACT: Le fauteuil roulant électrique est un outil d’autonomie de déplacement particulièrement intéressant chez le sujet âgé, souvent sous-prescrit dans cette population grandissante. Les limites de son utilisation dépendent de plusieurs facteurs liés au patient ou à son environnement. Le choix du fauteuil, l’évaluation du patient, de ses objectifs et le suivi notamment en matière de positionnement sont des moments importants de la consultation et un enjeu pour les différents intervenants médicaux ou paramédicaux.La Lettre de médecine physique et de réadaptation 28(4).
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ABSTRACT: People with profound cognitive disabilities are not expected to learn powered mobility use. The Driving to Learn project focussed on what this population could achieve from practising in a joystick-operated powered wheelchair. By means of using grounded theory methodology an eight-phase process 'growing consciousness of joystick-use' was identified. In addition, a tool for assessment of actual phase of joystick-use and facilitating strategies for each phase emerged. The aim of the present study was to evaluate inter-rater reliability of the assessment tool. The first author (LN) selected 24 video-sequences within the video data collected in the project. Each of the eight phases in the identified process were represented by three video-clips. The video-clips ranged in length between two to five minutes. LN's ratings served as criterion rating against which three independent raters' judgements were compared. The three raters were all occupational therapists, and two were experienced with the Driving to Learn method, powered wheelchair provision and the target population; and one was inexperienced. When comparing the three raters' assessments with that of LN (N = 72), the calculation gave a weighted kappa value of 0.85. All raters judged the tool as having a high degree of usability for assessing phases of joystick-use. Minimal differences were found between the experienced and inexperienced raters. CONCLUSION AND SIGNIFICANCE OF THE STUDY: The inter-rater reliability of the assessment tool was very good. The findings indicate that the tool is reliable and has clinical usability in occupational therapy practice.Australian Occupational Therapy Journal 12/2011; 58(6):447-54. · 0.72 Impact Factor