We need to know what capacity and performance are in mobility aids, particularly mobility scooters. So in this post, I will talk about performance and capacity related to this mobility aid.
Performance is what an individual is currently doing in his or her environment. In comparison, capacity refers to the maximum ability of an individual to perform his actions or tasks.
The prescription of a scooter or wheelchair includes assessing physical, cognitive, perceptual, and behavioral capacity in standardized environments such as a hospital corridor or set obstacle course, including variable settings such as home, shopping center, or workplace.
Incremental assessment has methods such as repeat testing for accurate comparison and identifying user performance in their environments. The therapist must also consider other factors such as the following:
- Impact of training and practice
- Resources needed to maintain a wheelchair or scooter.
- transport issues
- Safe and efficient and safe use of the scooter
- It requires additional equipment to be carried on the scooter, such as carry bags, mobile phones, water bottles, and large capacity urine bags.
Physical Capacity
Assessing physical capacity includes noting the medical history and physical attributes and performing a hands-on assessment. Included in the physical evaluation are the following:
- Body anthropometrics
- Cardiovascular, respiratory function, and swallowing
- Physical attributes
- Physical complications that mainly affect the function
- Diagnosis
- Medical history, treatment, and complications
- Bowel and bladder function
Decision-making capacity
In the prescription process, the therapist must respect the client’s freedom to decide. But the capacity of the client in decision-making must also be considered. If the person can make a particular decision, they may:
- Weigh the consequences of their choices
- Express themselves
- Understand the results of their choices
- Communicate the decision
- Understand the facts
- Understand the main choices
The therapist should try to help the client to make decisions and engage in the scooter prescription process. To enhance decision making:
- Minimize the effect of individual and circumstantial barriers such as, for example, by using assistive technology devices to overcome communication barriers.
- Discuss and provide accurate and prepared information to the client and others to be as informed as possible.
A person’s decision-making capacity will vary depending on the nature of the decision and circumstances. In other instances, the therapist’s ethical constraints need to override the client’s choice or preferences. Decision-making performance is context-dependent and fluctuates. The client’s capacity to contribute and make decisions about the scooter can be influenced by factors such as:
- Type of decision
- Timing
- The complexity of the decision
- Amount of information provided to the client, their understanding of the information, and how much was recalled
Behavioral and Psychosocial
According to research, psychosocial factors influence long-term mobility scooter use. These factors are as follows:
- Family and social support
- Stage of recovery
- Client engagement throughout the prescription process
- Disability adjustment
- Satisfaction and expectations of the client on the mobility scooter
Research also says the use of a mobility scooter can be empowering as it usually increases participation, activity, independence, freedom and can assist in psychosocial adjustment. However, other research also shows that social and physical barriers can hinder the client’s psychosocial adjustment to becoming a mobility scooter. There was also a study that found no significant correlation between scooter driving performance and personal traits.
Here are two consensus recommendations that have now been developed for the safe operation of a scooter or wheelchair:
- The therapist should consider consulting with suitable health professionals such as a clinical psychologist to develop a behavioral support plan for users with challenging behaviors that affect the safe use of the scooter.
- The therapist must consider the behavior, psychological status, and risk of causing harm to the person’s self or others before and during the scooter trial.
Cognition and Perception
The perpetual and cognitive of the client affects the seating and requirements not only of wheelchairs but also of scooters. Therefore, the presence of a neuropsychologist should be considered when there are concerns regarding perceptual and cognitive capacity.
The user must maintain attention or make judgments, including those concerning spatial requirements and predicting environmental changes such as walking in the near changing direction. The user must also be able to process information, attend to details, make decisions, plan, solve a problem, remember and recall, whether visual or verbal and learn from errors.
The level of perceptual and cognitive varies depending on the environment, such as the familiar home environment compared to the busy shopping center. Therefore, both client and attendant operation controls should be considered for people with limited perception and cognition variations in performance in different environments.
There is literature examining the cognitive parameters required for driving a mobility scooter. However, the researcher and conductor concluded that this research should not be considered general in scooter operation. Therefore the scooters of this study were excluded from the evidence-based related clinical questions.
The literature mentioned emphasizes that visual perceptual and cognitive skills are essential in operating a mobility scooter (seated). Unfortunately, there is only limited research and inconsistent evidence on appropriate assessment tools for perceptual and cognitive skills.
- One study found predictive figure copying of users’ functional performance on scooters.
- A study examining unilateral neglect shows that individuals make improvements in driving accuracy after minimal training.
- Inconsistent findings were reported on the correlation of scores on the “Motor Free Visual Perceptual Test” and scooters or powered wheelchair use.
- A study in people with tetraplegia concluded that people adapt to alter body dimensions in the short term. According to the authors, individuals rely on visual memory rather than on somatosensory information to judge and navigate a doorway.
Most authors of this literature recommend observational performance assessment to determine whether an individual can safely use a mobility scooter. These recommendations are as follows:
- If the user displays cognitive and/or perceptual deficits, they need to participate in graded and repeated trials of the scooter. Tests are graded based on environment, time spent on the scooter, scooter speed, and equipment features, including configurations.
- Where a user does not have the perceptual or cognitive capacity to operate a scooter in different environments independently or overextended hours, control for the attendant and the client should be considered.
- The therapist must design an initial trial of the scooter that accommodates a client’s perceptual and cognitive deficits and a safe experience for itself.
- The therapist must consider the client’s perceptual and cognitive skills before and during the scooter trial, such as attention, speed of information processing, problem-solving, level of arousal, memory, planning, decision making, and judgment.
- The user must demonstrate the safe use of the scooter in their anticipated physical and social environments before prescription of the scooter.
Sensory Requirements
The therapist needs to assess that a person who will use a mobility scooter in the community can identify obstacles and avoid collisions, judge speed, distance and react quickly.
Vision
The two essential aspects of the vision for using a scooter on the road are visual acuity and field of vision.
Visual acuity
It refers to clarity, or the ability to distinguish details with or without glasses or contact lenses. Visual acuity needs to be assessed by an optometrist. Each eye needs to be measured without corrective lenses and then retested with corrective lenses if necessary. Visual acuity needs to be better than 6/12 on the Snellen chart or anything of the sort.
Visual field
The visual field refers to the area that can be seen when the eye is directed forward, including the area outside the center of gaze or peripheral vision. It was initially screened by confrontation.
Anyone suspected of having a field or visual acuity impairment should be referred for assessment by an optometrist or ophthalmologist. The vision needs to be reviewed every five years under 55 years of age and every five years when over 55 years of age or new eye conditions.
The client needs to be trained to use compensatory techniques where the client has an identified visual field or acuity deficit. In addition, reviewed in the environment where the device will be used is needed after compensatory strategies and safety using the scooter on the road.
The client who will use the scooter without supervision and with visual field and or visual acuity impairments must be referred for assessment by an appropriate professional.
Compensatory techniques
Unilateral neglect
Visual imagery is not the only compensatory technique for unilateral neglect. But, in other research, it has been suggested that for unilateral neglect after stroke or brain injury, using a visual image analogy to teach scanning techniques helps to improve ambulation, route finding, and problem-solving.
Results from other research suggest that patients with left-sided neglect will deviate to the left side when using a scooter. The researchers concluded that the reason why the user turns to the left is that direction is task-dependent. If a person with left-sided neglect were walking, the deviation would be to the right. It needs to be considered by therapists when assessing a client’s performance.
Use of visuospatial prism adaptation
Limited research has explored the use of wedge prisms to successfully shift the visual field in unilateral neglect, resulting in successful scooter navigation. However, clinical experiences are suggesting its effects are short-term.
Using hearing
If vision is impaired, the client can use his or her hearing to detect oncoming traffic at crossings. Environmental features such as bends and hills significantly affect the client’s ability to hear vehicles to judge when to cross safely. Scooter users who use hearing to compensate for visual impairment need to check their ability to listen to vehicles and stay on the curb at each road crossing to determine whether they can hear cars well enough. Once this is defined with passing traffic, a decision can be made whether it is safe to cross.
Hearing
There is no standard or requirement for hearing when using a mobility scooter on the road. However, points that the therapist should consider are:
- If there is a recent hearing loss, the client needs to be trained to adopt compensatory techniques such as regular visual scanning, including crossing the road.
- According to research, hearing matters more as cognition declines, while cognition issues more as hearing declines. The therapist needs to be aware of this interaction for scooter users.
- If there is pre-existing impairment and recent hearing loss, then the client needs to adopt compensatory techniques, and then their capacity to use the device needs to be reviewed.
When the client experiences a change in their vision or hearing and adopts compensatory techniques, their capacity to use a scooter needs to be reviewed in the environment in which the device will be used.
The therapist should consider referral to other specialist services such as an audiologist, optometrist, mobility trainer, and ophthalmologist where a vision or hearing impairment is identified.
Upper limb capacity and risk of injury
Parts of the upper limb include the shoulder, elbow, wrist, and hand. In addition, there are additional demands are made of scooter user’s arms because they are used in the following:
Weight-bearing such as postural adjustments, transfers, and weight-relief lifts
Use of controls, for example, hand controls rather than foot controls
Majority of movements for most activities of daily living
Upper limb capacity
Strength
Greater propulsion velocity (speed) or more demanding terrain such as ramps, curbs, carpet, or slopes significantly increases shoulder joint loading. There are differences among individuals when it comes to strokes and peak kinetics.
Research also shows that peak shoulder joint loading occurs when the shoulder is extended and internally rotated. Also, according to another study, the posterior peak forces occur near the propulsion phase, and at the same time, the shoulder is maximally flexed and minimally abducted.
There is research regarding the differences between scooter users with paraplegia and tetraplegia. The level of spinal cord injury affects muscle recruitment during wheelchair or scooter propulsion. As a result, individuals with paraplegia demonstrate a more practical application of force to the hand rim in scooter propulsion than people with tetraplegia. Users with tetraplegia show significantly lower practical force application in the frontal plane and apply more significant wrist extension but less forearm pronation.
Alcohol, medications, and drug use
Anf alcohol, prescription medications, and illicit drugs can affect the user’s capacity to operate the scooter. In addition, when used in combination, they have a more significant impact on driving performance which puts users and others around at risk.
The user and attendant care worker must be informed that alcohol, prescribed medications where relevant, and illicit drugs impact their capacity to operate the scooter.
Alcohol
Any alcohol can affect the performance of the mobility scooter user. Its impact is affected by factors including the health and fitness of the person, and amount ingested, and duration of drinking, and the presence of other drugs or substances.
The scooter user needs to be aware that it is an offense to use the scooter on a road or related areas when their blood alcohol level is higher than 0.05.
The user and the attendant care worker should seek medical advice on how the medication or the change in medication impacts their capacity to operate a scooter.
Illicit drugs
Illicit drugs will impair driving performance. Therefore, the scooter should be conducted on the road if the operator is under the influence of such drugs.
Long-term need
Establishing whether scooter use is necessary for the long-term is the judgment made through clinical reasoning, including all the parameters influencing the need. All of these are related to all domains of the user’s health condition. Therefore, a checklist was formed to assist and provide guidance to the therapist during this process.
The therapist needs to consider the range of factors listed in both the long-term need checklist and goals checklist to assist in determining the need for the scooter in the long term.
Health and safety concerns
The therapist must consider the range of activities in all current and potential environments and consider the safety of the scooter user and attendant care worker.
The therapist has a professional and legal obligation to the health and safety of the clients for whom they prescribe the scooter and to their attendant care workers.
Using a scooter involves manual tasks. There are times when there is also a risk to the attendant care worker due to the scooter user’s poor compliance or challenging or unpredictable behaviors such as during transfers.
The situation will be different for each scooter user and attendant care worker. Consequently, the potential hazards and risks will be different. But, there are fundamental principles that need to be followed to manage injury risk.
- Assess the risks
- Eliminate or control the risk to reduce possible injury.
- Learn hazardous manual tasks
A hazard is any object or situation that has the potential to contribute to an injury or disorder. For example, hazardous manual tasks have any of the following characteristics.
- Application of high force such as hitting something with a hammer
- Exposure to sustained vibration such as drill for long periods
- Working with people or animals
- Carrying loads that are difficult to grasp or hold
- Carrying unstable or unbalanced loads
- Application of force or sustained movement
- Repetitive or erratic posture
Risks refer to tasks causing harm, injury, or disorder. The risk must be eliminated or controlled to avoid injury.
The client’s attitude, behavior, or cognition can also present a risk, either to themselves or their attendant care worker. This possibility needs to be considered for each client and potential difficulties identified.
The hierarchy of risk controls should be adopted. The risk controls, in order of effectiveness, are as follows:
- Use administrative controls
- Use protective equipment
- Design the task or use engineering/equipment controls
- Eliminate or substitute the task
An example is the weight of the scooter user that is dependent on transfers. Weight is a hazard. The risk of harm will be reduced if the attendant care worker uses a hoist with adequate space for maneuvering during transfers.
There must be a risk assessment conducted on the tasks performed by the scooter user or occupant and their attendant care worker concerning all aspects of scooter use.
Risks need to be eliminated, or appropriate controls need to be implemented where hazards have been identified.
Conclusion
As you can see, there are many things to consider concerning the performance and capacity of mobility scooters. However, remember that information you can find here is also applicable to wheelchair users. Though wheelchairs and mobility scooters are two different mobility aid applying safety measures and precautions from one device to another is advisable and practical.
