Powered mobility - Derbyshire Healthcare NHS Foundation Trust

Powered mobility - Derbyshire Healthcare NHS Foundation Trust
Community Paediatric Occupational Therapy and Physiotherapy Service
Powered mobility
Pre-mobility Training for the Young Child
Stop and Go
Your child needs to understand the concept of stop and go and have the ability to stop on
command.
• When you are taking him out in his pushchair play “stop and go” games, when you are about
to stop say so and when you are about to go say “Go”. Tell him why you are stopping, ie “to
let the lady walk past otherwise we would run her over” and why you are going to move again
“there’s nothing coming to that could run into us, it’s safe to go.”
• When driving in the car talk about stopping at the red lights and going on the green lights,
stopping for pedestrians, other traffic etc and going when the way is clear.
• Switch operated toys or cars can also help build up the concept of stopping and starting.
Directional concepts
• Your child may be too young to understand left and right but will need to learn how to make a
wheelchair move in a particular direction.
• Work on basic directions by standing with your child and pointing out where things are, get
your child to point to objects in the room (use left right in front behind if you wish or else over
there will do). This is an exaggerated version of the pointing he / she will do with the joystick
to get somewhere.
• When you are out with your child in the buggy verbalise your turns ie here is the corner were
going to turn left etc. Do the same when in the car.
• In the home and out in the local environment ask your child which way you have to go to get
to a certain place ie where’s the kitchen, which way is the shops, which way do we turn to get
to grannies house. Don’t expect your child to reply with right or left. A point in the correct
direction and the words that way will suffice.
• Buy your child a joystick controlled car to play with, once he / she has got used to the
controls see if the car can be steered through a small obstacle course ie: drive around teddy
and park next to the toy garage.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
• If you have a computer buy a joystick to replace the mouse and some of the basic joystick
games for practice of directional concepts (ask your therapist for names of companies who
produce this type of material).
Judgement
Judgement of dangers is very important. For example your child needs to know what to do if
someone steps into their path, if they come across a kerb, step or bumpy ground and if there
are things in the way. If your child is under 5 years old they may still be at the stage most
toddlers go through of charging towards the thing they want oblivious of what is in their way. In a
wheelchair this can be very dangerous to them and to others.
When pushing your child in their buggy talk them through what you are doing ie:
•
•
•
“There are a lot of people here, so I am going slow so I don’t hit them”,
“ I stopped pushing you then because someone walked in front of us”,
“I’m going to turn around, but I have to look behind when I reverse so that I don’t hit
anyone.”
You can also do the same when driving the car or when you are operating your child’s joystick
toy.
• Bedtime stories about children with wheelchairs can help your child learn some of the rules
and concepts. Unfortunately there are no commercially available books related to wheelchair
training but there are story books about children who are wheelchair users, you can use your
imagination to change the story a bit. (see www.scope.org.uk for books)
J Nicholson. Senior Occupational Therapist.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
Community Paediatric Occupational Therapy and Physiotherapy Service
Powered mobility
Introducing the use of a Wheelchair to the Nursery / School Environment
Using a powered chair at nursery or school can give a child freedom of movement otherwise
denied them. The child can make independent choices about where to go in the classroom and
play alongside their friends in the playground. Pre-school powered chairs such as the Whizzy
bug have been designed with nursery safety in mind others may not have been.
Understandably, some teachers are going to worry about having a powered wheelchair user in
their class. Below are some ideas for ensuring things run smoothly when your little one takes
his/her powered chair to school.
Preparation.
• To prepare your child for the day when he / she will take their wheelchair to school, they will
need to do some pre-mobility training. Ideas are listed on a separate sheet.
• When you have a date for your child to attend nursery /school. alert the school to the fact that
your child will be in a motorised wheelchair and that although they can drive it well, initial
supervision will be required while they get used to their new surroundings.
• School staff may be anxious about having a “driver” in the class. To alleviate some of their
worries, arrange to take your child for a visit at the end of the school day or at lunch time so
the teachers can see how your child manages in their wheelchair.
• Also, ask if the teachers / helpers can do some awareness work with the other children, so
that when your child gets to school, other children do not try to take over the controls or use
the chair. The other children will also need to learn to watch out for the wheelchair. For safety
reasons, they must also learn that they should not fiddle with any part of the wheelchair. Your
Occupational Therapist may be able to help with the awareness work.
• The biggest danger will be when your child is reversing, and when there are other children on
the floor below eye level. There may need to be a distinct barrier between the floor play area
and other areas of the classroom.
• The school should do a risk assessment to ensure that your child will be able to drive his/her
wheelchair around school safely. This may mean making a few changes to the classroom to
enable better wheelchair access and establishing what level of supervision is required for
your little driver.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
To avoid accidents.
• Do not introduce the use of the wheelchair to nursery / school until you are sure your child
has a good awareness of the other children and understand the need to avoid hitting them
with the chair. Generally, if your child can manoeuvre around people and things at home,
he/she is likely to be okay. However, the movement of others in a nursery / school is more a
bit more unpredictable. Talk to your child about these issues.
• Do not introduce the use of the wheelchair to nursery / school unless your child has the ability
to manoeuvre the chair within tight spaces. If he/she is managing at home with just the
occasional bump into furniture, they should be okay.
• If adult supervision is not available, consider whether your child and / or the other children will
be safe.
• Do not allow your child to use the chair without an adult’s close supervision until you and
school are satisfied that they understand the basic rules for driving in a busy environment,
including safety of others. The supervising adult will need to be close enough to switch off the
chair or grab the joystick in the event of potential crashes etc.
• Keep the wheelchair on its slowest setting whilst in the classroom. It is better not to let it
exceed walking pace until your child is fully proficient with its use and has learnt
consideration for others.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
Community Paediatric Occupational Therapy and Physiotherapy Service
Powered mobility
Powered Wheelchair Use in the Home
When your child gets his first wheelchair there may be the potential for accidents to
occur. These need to be minimised with temporary precautions.
Wheelchairs tend to drag lightweight furniture along with them, or to knock the furniture
over with the potential of hurting the child or breaking the furniture.
Temporary Changes in the House
• Small coffee tables are best moved from the centre of a room to the edges.
• Ensure there are no valuable ornaments on cupboard shelves which could be knocked off.
• Be careful with positioning of the TV and video, are they in a place where they can be run
into? You may need to temporarily move them to a safer place until your child has gained
good control of the chair and a good awareness of the dangers of running into things.
• Your sofa may get banged into, to protect the fabric until your child has learnt to manoeuvre
cover the base of the sofa with a sheet or blanket, tuck it under the sofa legs to prevent the
sheet getting caught in the wheelchair wheels.
• Walls are at risk of being marked by foot plates or the edges of the wheelchair. Temporary
protection can be arranged by fixing bubble wrap to the lower sections of the wall/door with
masking tape so that the chair marks that and not the wall or woodwork.
• Legs of tables and chairs can also be protected by taping foam or bubble wrap around them.
• Be careful around fire areas, it is often better to have a fire guard.
• Radiators may also be vulnerable to knocking and if possible it may be better to have some
furniture placed in front of them.
• Indoor steps such as single steps between rooms may not be noticed. Keep doors shut or
make a barrier until you are sure your child understands that they cannot drive down a step.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
In the Garden
•
Consult your wheelchair manual to ensure that the wheelchair can cope with uneven
ground.
•
Some wheelchairs will get stuck or loose balance just driving off the edge of a lawn onto
a flower bed.
•
Supervise your child around the garden initially until you are sure they are safe. Make no
go areas clear to them i.e. the flower beds.
•
Make sure gates are locked if your child is playing unsupervised.
•
If you have steps in the garden make sure to keep your child away from them. Block
them off if possible whilst they are out there.
•
If you have raised ramps / paths do not let your child use the ramp without your hand on
their driving hand if there is any risk at all of them toppling off the edge if they don’t steer
correctly. Get a fence or rails fitted either side of such ramps. (Be aware of the
positioning of rails. Horizontal rails are usually fitted to accommodate adults and children
can often drive under them or into them at head height. The shock of the collision can
mean that in some cases the child continues to push the joystick and does not stop in
time. This may result in the chair tipping or the child choking if the rails is at throat level.)
Child’s Behaviour
• Make your child aware of the dangers of hitting things, both to him, other people and to the
object itself.
• Do not laugh when your child bumps into something whether it is accidentally or not, they
have to learn quickly that it is not a good thing to do.
• Praise your child for good driving when he manages to avoid all the obstacles around him.
Find him a treat or reward of some sort for good driving to emphasise its importance.
• If your child insists on bumping into things make it clear that you will remove him from the
chair or turn it off for a period of time.
J Nicholson. Senior Occupational Therapist.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
Community Paediatric Occupational Therapy and Physiotherapy Service
Powered mobility
Tips for Developing Powered Wheelchair Driving Skills in Young Children
Some children take to their wheelchair like a duck to water. Others take time to learn how to use
it and need encouragement.
Older children learning to use a wheelchair can be encouraged to develop skills with games
and obstacle courses. It is often harder to get a pre-school child to do these things and different
strategies have to be used within the home.
Spinning
If your child has not had much experience of wheelchair driving, don’t worry if they spend all
their time going round in circles. It’s fun! When they get fed up, they usually start exploring other
directions.
Moving away from spinning to purposeful driving
You can start to get your child out of spin mode if you manipulate the situation / environment a
little bit. TV can be a big incentive. Put your child in their chair facing away from the TV and turn
the TV onto a programme or DVD that they really like and want to watch. Then turn their
wheelchair on / re-engage the wheels and encourage them to turn to see the TV. They may
miss by turning too far, but they usually work it out pretty quickly. If you stay around and give too
much prompting, beware! They may just expect you to re-position them and get frustrated if you
don’t. Sometimes it’s better to distance yourself, hide round the door or turn a deaf ear and busy
yourself doing something else within the room.
Playing “peek a boo” is also a good way to get the child to turn around. Particularly as it is a
game they will be familiar with. Hide behind their chair and call their name i.e. “Joe where are
you?”
Once they are able to turn to the thing they want, they may spontaneously drive towards it. Start
putting your child in the wheelchair some distance from the TV or toy they want. You may find
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
that it is you that they want, so encourage them to come to you. If you have an adjacent room
from which you and your child can still see each other call them to come and join you.
If your child has older brothers or sisters they can be a great incentive as your child will want to
follow them. They often have the time to encourage the wheelchair driver that you yourself may
not have. It is often something that interests older children and they can be very patient and
inventive when it comes to encouraging their younger brother / sister.
Some children may have difficulties getting out of spin mode and you may have to help them
out. Place your hand on theirs to drive but talk them through what you are doing i.e. ”push the
stick forwards”, “pull the stick backwards”. Next time, prompt them to move the stick as you say
“push forward” or “push to daddy” etc. With your hand, you can block any attempts to move the
joystick in the wrong direction.
If your child has problems with their hand or arm muscles, and is continuing to have difficulties
with control of the joystick, contact their therapist as the joystick may not be in the best position.
Stopping
Some children find this difficult. Just like any “toddler” they see what they want and don’t always
notice obstacles. They may stop only when they have run into something and can go no further
without changing direction.
Play games pretending to be a train that has to stop at the station. Turn certain areas of the
garden or room in to stations give good visual reference points i.e. “the patio table is the station
house! stop there!.”
Make some traffic lights and encourage them to stop when they see red and go on green.
Some children may need you to play the games with them hand on hand together to get the
idea.
Remember:
• Make your child aware of the dangers of hitting things, both to him, other people and to
objects.
• Do not laugh when your child bumps into something whether it is accidentally or not, they
have to learn quickly that it is not a good thing to do.
• Praise your child for good driving when he manages to stop when he should. Find him a treat
or reward of some sort for good driving to emphasise its importance.
• If your child insists on bumping into things, make it clear that you will remove him from the
chair.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
J Nicholson. Senior Occupational Therapist.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
Community Paediatric Occupational Therapy and Physiotherapy Service
Powered mobility
Frequently Asked Questions about Powered Wheelchairs and their Use
How old does my child have to be to drive a powered wheelchair?
Children as young as 2 years have been able to drive quite competently within a few months of
getting their wheelchair. If your child has learning difficulties, sensory problems or difficulties
with hand control, it may not be appropriate to introduce a powered chair at such a young age.
Ask the advice of your child’s Occupational Therapist if you are unsure.
How much freedom can I give my child in his wheelchair?
It is important to remember that whilst your child has freedom to move in their powered chair
that there have to be limitations on that freedom to ensure their own safety especially when the
child is young. For example, you would not walk down the road without holding your toddlers
hand to stop them running into the road ,getting lost etc and so you must take control of the
joystick on pavements near busy roads etc.
Will using a powered wheelchair stop my child wanting to walk?
No. Quite often once a child gets a powered chair you will see an improvement in the quality of
their walking because they can relax in the chair and then when it is time to get out and walk
they are rejuvenated. It is important to realise that powered chairs do not have to be used all the
time. They may only be needed in the playground to give your child a rest and enable him/her to
rush around with their friends.
Sometimes it seems as though children with wheelchairs begin to walk less or not at all, but this
is often because the powered chair has been introduced at a time when the child was struggling
to maintain his walking skills anyway. Some children cannot fight the negative effects of growth
and gravity on their limbs as they age and despite all efforts find walking harder and less
satisfying. These children usually complain about having to walk and begin to opt for their
wheelchair more and more. Denying them the wheelchair will not help to keep them on their
feet, allowing the wheelchair at key times may ensure that they can continue to walk around the
home at least.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
When is the right time to get my child a powered chair?
If your child is struggling to walk long distances.
If your child can’t keep up with his friends in the playground.
If your child is unable to explore your house or garden because of their mobility difficulties.
If your child is unable to use a self propelling wheelchair efficiently.
If your walking child is tired all the time.
If your child is unable to walk at all when all his peers can.
Where can I get a powered wheelchair for my child?
Powered wheelchairs can be obtained through a variety of sources. You can self fund, get one
from the NHS or apply for one through a children’s charity. These items are expensive and even
the cheapest are usually over £2000. If your child passes their assessment the NHS will provide
a chair which is only for indoor use. After using the indoor chair for 6 months they would then be
eligible for a chair which can be used indoors and outdoors. There is often a waiting list for
these chairs. Unfortunately, many children often want an outdoor chair so they can play in the
garden, the nursery / school playground, the park etc with their friends and brothers and sisters.
There are lots of children’s charities that look favourably on requests for wheelchairs, some may
be in a position to fund the whole cost, others will offer a contribution.
Indoor / outdoor chairs are often supplied by charities. If a charity pays the full cost of a chair
you may be responsible for its maintenance, this can be costly (batteries can cost £80+ and
tyres are a similar price). If you are on a low income charities such as Whizz Kidz will help you
maintain the chairs they have provided. There are many wheelchairs to choose from and it is
best to try these before making a decision. Some charities will send a therapist to assess your
child’s needs and help you find the best wheelchair to suit your child’s lifestyle. Your local
therapist will be able to offer advice also.
How do I know my child will be able to drive a powered wheelchair?
There are a few different sorts of wheelchairs available at the Ronnie MacKeith centre for
training purposes. We also have a special powered base which can be driven by a variety of
joysticks and switches so we can work out what would be easiest for your child.
If your child is a bit nervous about going in a powered chair we will use an adult chair to start
with. So he/she can sit on your knee and you can both experiment with driving.
What if my child can’t control a joystick?
It may be that your child just needs a different sort of joystick. Sometimes if a child is not fully
supported in his chair, his hand skills can be affected, better seating can often help. There are
also many other alternatives to the joystick such as directional switches which can be operated
by different parts of the body i.e. head, mouth, knees. Or, hand operated switches of different
shapes and sizes.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
My child who can walk indoors with a frame only needs something for playing on
outside. He has a special bike but gets tired after a while. We have tried battery cars but
he can’t control the foot pedal and needs a bit of trunk support. Do you know of anything
we can get him?
It is highly likely that your child will be able to manage the battery toy with a few adaptations to
the seat and a conversion to hand controls. Contact your OT or Physio who will be able to refer
you to a charity called REMAP who specialise in adapting equipment for disabled adults and
children. They have done a number of these conversions over the years.
What sort of powered chairs are there?
Some chairs will be designed for indoors only. The batteries need charging more often on these,
speeds may be lower and you cannot use them safely on rough ground. The seat tends to be
fixed height and on most the features are limited with the exception of a few chairs.
There is a whole variety of chairs which can be used for indoors and outdoors. The smallest one
available grows with the child and will fit an infant of around 18 months old to 5 years.
Some chairs have recline and / or tilt facilities which are good if your child gets tired and needs
to change position. Special postural supports can be provided for most chair seats.
A few chairs have a high-low facility enabling the child to reach worktops in the kitchen or the
coffee table. A few manufacturers also produce seats which will go all the way down to the floor
so the user can sit at ground level, legs out in front of them for floor play, picnics etc. These
chairs have a larger wheelbase than other powered chairs so if they are to be used indoors you
need to ensure that there is enough space in the home and the nursery / school.
Several wheelchairs can be driven from a standing position. There are two main types. One is
available for the very young child and this has an interchangeable standing frame and seat. The
most common sort is a sit to stand wheelchair whereby at the push of a button the seat converts
into a standing frame lifting the child gradually into a standing position. Unfortunately these are
only available for children of 8 years and over (or the height of an average 8 year old).
It is important for you to be aware that not all these types of powered wheelchair are available
through the NHS Wheelchair Service. It may be that highly specialist chairs will require private
or charitable funds.
Do I need a wheelchair accessible vehicle for my child’s powered chair?
Powered wheelchairs are extremely heavy. Small children who are going to use chairs such as
the Whizzy Bug do not necessarily require an adapted vehicle or ramps as the chair can be
taken apart and loaded into the car piece by piece.
Other chairs are unlikely to fit into car boots easily and before you obtain the wheelchair you
need to consider whether you will need to transport the wheelchair to other places. If you need
a bigger car to do this then we recommend you consult with your therapist and with an
independent organisation such as Driveability regarding suitable vehicles. If your child receives
mobility allowance you will be eligible for the Motability scheme and they will fund an
assessment through Driveability prior to leasing you a suitable adapted family car.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
You may also have a people carrier or similar vehicle which has got space for a wheelchair - in
which case you may be able to manage with ramps. There are a few things to consider when
purchasing ramps for example if they are too steep, there is a risk that the wheelchair will tip up.
Again, driveability therapists will be able to advise on the best sort.
Because of their weight, wheelchairs can be a risk to passengers in the event of a crash or
sudden stop, it is important that any wheelchair being transported in a car is secured to the car
with appropriate restraints fitted by a garage. Your wheelchair supplier should be able to provide
details of appropriate restraints and where to get them.
Useful Contacts:
www.motability.co.uk
www.ricability.co.uk
www.wheelchairchildren.org.uk
For details of local and national mobility roadshows, ask your therapist for details.
Derby NHS Paediatric Therapy Team 2008
Powered Mobility Advice
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