Powered mobility for people with cognitive disabilities Lisbeth Nilsson, ESS presymposium workshop in Dublin on the 7 th of November 2011 Lisbeth Nilsson, PhD, Reg. Occupational Therapist and specialist in the field of paediatrics and community care. Associated researcher, Division of occupational therapy and gerontology, Department of health sciences, Lund University, Sweden E-mail: lisbeth.nilsson@kiruna.se or lisbeth.nilsson@med.lu.se Homepage: www.lisbethnilsson.se Postal address: Box 158, S-960 33 MURJEK, Sweden Cell phone +46 70 5838596 Introduction Cognitive disabilities – causes and definitions Powered mobility – safety, technology, learning tool use Cognitive disabilities may have congenital origin or be acquired through illness or trauma. The cognitive dysfunction may be of different degrees and can be found in people of different ages. Due to the diversity in origin cognitive disabilities may occur in a wide variety of combinations. Additional disabilities are more common when the cognitive disabilities are of severe or profound degree. Physical limitations, impaired sight, hearing, speech or limitations of other ways to communicate are typical additional disabilities. People with cognitive disabilities often have limited opportunities to be active and participate in societal activities. They may have difficulties to physically perform or to cognitively understand how to execute and accomplish an activity. Their social interactions with other people are dependent not only on their own ability to express their needs and wishes but also on other’s ability to recognize and interpret their sometimes vague or different expressions. When communication between people is deficient or not working the prerequisites for trust and mutual interaction is limited or non-existing. Mutual interaction is influenced by the partakers’ earlier encounters and knowledge. It is of great importance whether their earlier experiences have been positive or negative and what attitudes they take up to each other. A person with cognitive disabilities may behave in a rejecting manner due to insecurity and fright in new and unfamiliar situations. Care-givers or professionals working with people with cognitive disabilities may regard many activities as impossible to involve their care-takers in without commencing practical tests. Their choices of activities are often based on visual impressions and an intellectual sorting of possible possibilities, especially if their choices concern people with profound or severe cognitive disabilities. The research project Driving to Learn Short about method, participants, practice, outcomes, findings The Driving to Learn project started in 1993 and the implementation of the Driving to Learn™ method is in progress. The incitement that initiated the project was an extraordinary experience from clinical practice. A 13-year-old boy with profound cognitive disabilities, after a period of six years of practice in a powered wheelchair, developed the ability to steer goal-directed in the restricted area of his Special school environment. In clinical practice people with profound cognitive disabilities typically are excluded from practice in powered wheelchair, as they are not expected to develop tool use skill. Thus, in the Driving to Learn project people with profound cognitive disabilities were provided with opportunities to practice in joystick-operated powered wheelchairs. The project had a classical grounded theory approach and 109 participants, in different ages and with different degrees of cognitive disabilities, were engaged in powered wheelchair practice over a period of 12 years. The participants were included accumulatively and the length of their practice periods varied between one month and around six years. The practice sessions took place at paediatric clinics, pre-schools, special schools, day centres for adults, health care centres or in the participant’s home. The practice was facilitated by the project leader and rehabilitation staff together with people that the participants were acquainted with (parents, assistants, caregivers). Infants with typical development making tests in a joystick-operated powered wheelchair In 1997, 17 non-disabled infants aged between 3 and 12 months were engaged in the project. The aim with engaging the infants was to make comparisons between the process of growing consciousness of joystick-use in infants with typical development and the participants with cognitive disabilities.