John V. Rider PhD, MS, OTR/L MSCS & Kaila Patton, OTD-S
Powered mobility can improve the quality-of-life for people with mobility impairments by promoting independence in daily activities, community participation, and social engagement. Powered mobility devices, such as power scooters and wheelchairs, can offer independence to many people who would not otherwise be able to do so. Some individuals may be overlooked in PMD evaluations because of cognitive impairments.
Evidence suggests that cognitive functioning is one of the top concerns when evaluating someone for a PMD. Evidence suggests that cognitive function is a major concern when evaluating someone to determine if they have a PMD. 1,2 Although cognition is a major concern for therapists it is subjective clinical judgement that is used to determine if an individual has the cognitive functions necessary to use a PMD independently and safely. 1
Cognitive skills for driving a PMD
Driving a PMD is a difficult task. Multiple cognitive outcomes have been associated or predictive of PMD use. Cognitive abilities such as intellectual functions, visual-spatial perceptions, attention, abstractions, judgment, planning and organization, problem-solving and memory are all related to the ability to use a powered mobility device for functional mobility.
The research is unsure of the level of cognition required for safe PMD use. The current PMD driving assessments, as shown below, are primarily focused on motor skills and performance based outcomes, rather than cognitive abilities. It is important to assess the client’s motor skills and performance outcomes, which includes powered mobility trials. However, due to the uncertainty regarding necessary cognitive skills, some individuals are prevented from powered mobility evaluations or trials early in the rehabilitation process.
Power Mobility Driving Assessment Tools are Available Online
- The Power Mobility Indoor Driving Assessment is a PIDA.
- The Power Mobility Community Driving Assessment
- The WheelCon
- The Wheelchair Skills Test
- The Power Mobility Road Test
- The Functional Evaluation Rating Scale
- The Powered Mobility Device Assessment Training Tools (PoMoDATT).
Initial Cognitive Screening
Imagine you are working with a client who has suffered a cerebrovascular injury (CVA) in an outpatient or inpatient rehabilitation setting. You think that the client could benefit from a PMD. You are concerned about the client’s cognitive impairments, and whether or not they can safely use a PMD. Consider performing a simple screening of the client’s cognitive abilities before dismissing power mobility.
For PMD, clients must understand and demonstrate cause-and-effect, stop-and go concepts, directional concept, judgment, problem solving, following directions, motivation, and motivation. Consider assessing these functions within the context of therapeutic exercises throughout your treatment session. You can test directional concepts by asking a client to describe their home or clinic. By following safety precautions, and by working through self-care activities, you can demonstrate judgment and problem-solving. Simple discussions on how their life will be different with powered mobility, and their level of interest will help to understand motivation.
If you do not feel comfortable performing a PMD assessment, refer the client to a clinician who is qualified. The data gathered from the cognitive screening can be given to the wheelchair assessment team, the referring physician and the assistive technology professional to further document the need for PMD.
If you’re still concerned about your cognitive abilities, try a mock trial using a manual wheelchair. This is an accessible and safe way to screen cognitive abilities in relation to PMD usage. The therapist can push the wheelchair from behind and the client can control it using a mock joystick. If the goal is to assess cognitive abilities, then the client can also indicate actions verbally. (e.g. stop, go, left, right or backward). Or with hand signals. The therapist can simulate the client using the PMD to assess their cognitive abilities in a controlled and safe manner (e.g., navigating the wheelchair around obstacles or to another room to retrieve an item).
Standardized Cognitive Assessment
Standardized cognitive assessments can help to better understand the cognitive abilities of clients. They can be used in conjunction with observations of functional performance and a mock PMD test using a manual wheelchair. There are several cognitive assessment tools available for people with cognitive impairments or neurological injuries. They have been recommended in the literature.
The Cognitive Assessment for Stroke Patient (CASP) for example is a standard test that assesses cognitive functions such as attention, memory and language abilities. It was designed for individuals who have suffered a CVA, and can be used in conjunction with observations of functional performance. The Repeatable Battery for the Assessment of Neuropsychological Status is another tool that is commonly used to assess cognition in people with neurological injuries. The RBANS is an assessment tool that measures different aspects of cognitive abilities, such as memory, attention, visuospatial ability, and language. The RBANS is validated for use by individuals with a variety of neurological injuries including stroke, traumatic head injury, and dementia.
Montreal Cognitive Assessment is another tool that is commonly used. The MoCA is an easy and quick cognitive assessment tool. It evaluates different aspects of cognition including attention, memory and visuospatial abilities. The MoCA has been widely used in clinical practices and validated to be used with individuals with neurological injury. The assessment can only be administered by those who have received MoCA certification and training. The Trail Making Test (TMT), in addition to the MoCA has been widely used for PMD assessment. The TMT is a 2-part assessment that can be administered in approximately 5 minutes. Each part requires a different skill, such as visuoperceptual ability, sequencing, working memories, and task-switching. Clients must connect numbers in part A, and both numbers and letter in part B, as quickly as they can while maintaining accuracy.
These assessments can be used as a tool to determine if an individual is capable of safely operating a PMD. If an individual has difficulty with executive function, they may struggle with sequential tasks such as maneuvering a wheelchair in a crowded space. If a person has difficulty paying attention, they might have trouble focusing on the surroundings when operating a wheelchair, which could lead to a collision. The results can be used in therapy to target and correct specific cognitive skills to increase a client’s ability operate a powered mobility tool safely and independently.
It is important to consider cognitive abilities. If a client has sufficient cognitive abilities to safely operate a PMD, there are many alternative access controls which allow individuals with all physical abilities to use a PMD. ).
This article emphasizes the importance of assessing cognition abilities for safe and independent use. When evaluating a person for a PMD, cognitive functioning is the top concern. It is also often the main reason that healthcare clinicians choose not to continue with further PMD evaluations. The research does not establish a benchmark for the minimum cognitive functions required. However, occupational therapists may use a combination screening tools, standardized tests, simulated tasks and observation of occupational performance in order to assess functional cognition. This will help them initiate the proper process for PMD assessment. In order to ensure independence in daily activities, it is important that clients have functional mobility. Therapists can address the cognitive functions needed for PMD usage through a remediation method.
John V. Rider is an Associate Professor in the School of Occupational Therapy at Touro University Nevada. He has worked as an occupational therapist for many years in various settings, such as primary care, home health, and outpatient. He currently runs a wheel chair clinic and performs complex rehab technology assessments for clients with neurological involvement.
Kaila Patterson, BS OTD-S is a doctoral student in occupational therapy at Touro University Nevada. She is interested in improving independence and functional cognition through power mobility devices.
Caption: A manual wheelchair can be used to test a person’s cognitive ability to determine if they are able to use a powered mobility aid. Photo: John V. Rider
- Maywald A., Stanley M. Prescription of mobility scooters in Australia. Occupational Therapists’ Narratives. Australian Occupational Therapy Journal. 2015;62(2), 86-92.
- Mortenson, W., Clarke, L., and Best, K. Prescribers’ experiences with powered mobility prescribing among older adults. The American Journal of Occupational Therapy. 2013; 67(1), 100-107.
- Pellichero A., Kenyon K., Best K., Lamontagne, Lavoie, Sorita E., Routhier, F. Relationships among cognitive functioning and powered-mobility device use: An scoping review. International Journal of Environmental Research and Public Health. 2021;18(23), 12469.
Original Blog: https://rehabpub.com/mobility/power-wheelchairs/assessing-cognitive-abilities-for-power-mobility-use/?utm_term=RM%20Rehab%20Today%20Nov%202023&utm_campaign_type=newsletter&utm_hsid=415264501&utm_medium=email&_hsmi=282189046&_hsenc=p2ANqtz-8i0eyFQyKbhaTKOugRI3aFxNhXoSO4QQ9b42ny20ChdAOI7nE9GEqAHmCyHD_ii8hlV3SMBoCn9Fs6-C5-i6bf-1zgKg&utm_source=newsletter