Specialty Controls for Power Wheelchairs

Canadian Clinical Blog by Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.) - Sunrise Medical

Hello all!

Recently, my colleague, Ron Claughton, Account Manager with Sunrise Medical, and I presented on specialty controls at the Canadian Seating and Mobility Conference (CSMC) in Toronto. Not only did we discuss various specialty control options, but we also demonstrated the use of specialty controls both live and through videos. Therapists and vendors were given the opportunity to drive power wheelchairs using alternate input devices. Hands on is a great way to learn, but of course, not everyone is able to attend CSMC, so I thought I would share some information on specialty controls in this month’s blog article.

Joystick Considerations

While a joystick is the most commonly used input device to operate a power wheelchair, not everyone has the physical ability to operate a wheelchair using a joystick and for these people specialty controls, or alternative input devices, are required. Just remember to ensure that it is not the programming of the power wheelchair that is limiting the person’s ability to drive a power wheelchair with a standard joystick gimble! (For more on the common adjustments that can be made to the programming of a power wheelchair, please refer to my article on Power Programming Basics). Also consider the handle on the joystick gimble. Would a ball, knob or a goal-post handle, rather than a typical stick handle, enable the person to drive a power wheelchair safely and effectively? In addition, consider the position of the joystick. Joysticks can be mounted to the right, to the left, or anywhere in between! Would a midline mount of a standard joystick enable independent power mobility? Of course, changing the orientation of the joystick from a standard orientation to a mid-line mount may require programming changes for the active orientation of the joystick.

Proportional Input Devices

A standard joystick is an example of a proportional input device. This means that the amount of deflection on the joystick gimble will correspond with a given rate of movement of the wheelchair, similar to how a gas pedal on a car works. Thus, the further the joystick is pushed out of the neutral position in any direction, the faster the wheelchair will go. Alternative joysticks, which require very little force or deflection for activation, are available. These include the MicroPilot and Touch Drive by Switch-It, Inc. and the Proportional Mini and Micro Mini Joysticks by ASL, Inc.

Non-proportional Input Devices

A switch is an example of a non-proportional drive control. This means that the switch is either “on” or “off”, similar to how a light switch works. Each switch is pre-programmed for one direction and speed. Thus, activating the switch activates the movement of the wheelchair for a set speed and direction. Other examples of non-proportional drive controls include sip and puff and head array with switch control. (A proportional head control also is available.)

Switches can be either mechanical or electronic. Mechanical switches require a depression of the switch to activate. There are numerous choices available in mechanical switches, ranging in size and amount of force required to operate the switch. In comparison, electronic switches, such as Fibre Optic Switches (Switch-It, Inc), do not require direct touch to operate. Depending upon the programming, the fibre optic switch may be activated when an object either is detected within the adjusted range or moves from the adjusted range.

Assessment and Trial

Deciding upon what is the most ideal input device for a power wheelchair user starts with the assessment of the individual. Part of that assessment will include evaluation of the access point, or the part of the body that will be used to control the wheelchair. The access point is the point on the body for which the person can move reliably in two directions. Potential access points include the head, cheek, temporal area (with caution), mouth, chin, finger, thumb, elbow, knee, foot, and toes. Whether a proportional or non-proportional input device is chosen for an individual depends on the type with which the person has the most success. Training with, and trial of, equipment is the key to ensuring proper prescription of a specialty control. What is also important is the postural stability of the individual in the wheelchair to ensure consistent access to the specialty control. A person driving a wheelchair with a specialty control must always be able to reach the input device to operate the power wheelchair.

Expandable Electronics

I have mentioned in a previous article, and I believe it bears repeating, that the use of specialty controls requires expandable electronics on the power wheelchair. If the use of specialty controls may be required for a person during the life of the power wheelchair, expandable electronics should be selected at the time of the initial wheelchair prescription to allow for the anticipated use of a specialty control. (For more information on power wheelchair electronics, please refer to my article on De-mystifying Power Wheelchairs – Selecting Electronics that can be found here.)

As therapists, we can facilitate independent mobility for individuals through thoughtful prescription of a specialty control input device. As my education counterparts at Sunrise Training and Education Programs (STEPS) in the U.S. say, Mobility is POWERful!

Resources

  1. Arva, J., Furumasu, J., Harris, M., Kermoian, R., Lange, M., McCarthy, E., Pinkerton, H., Plummer, T., Roos, J., & Rosen, L. (2009) RESNA Position on the Application of Power Wheelchairs for Pediatric Users. Assistive Technology. 21, 218-226
  2. Cook, A., Polgar, J. (2007). Cook and Hussey’s Assistive Technologies: Principles and Practice 3rd ed. Philadelphia: Mosby
  3. Cook, A., Plogar, J. (2012) Essentials for Assistive Technologies. Philadelphia: Mosby.
  4. Cooper, R. (1998). Wheelchair Selection and Configuration. New York: Demos Medical Publishing.
  5. Massengale, S., Folden, D., McConnell, P., Stratton, L., & Whitehead, V. (2005) Effect of Visual Perception, Visual Function, Cognition, and Personality on Power Wheelchair Use in Adults. Assistive Technology, 17, 108-121.

As always, please provide your comments, questions, and suggestions regarding Clinical Corner. Please email me at Sheilagh.Sherman@sunmed.com. I look forward to hearing from you!


Sheilagh Sherman BA, BHScOT, MHM, OT Reg. (Ont.) - Clinical Education Manager, Canada

Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)

Sheilagh Sherman joined Sunrise Medical Canada in 2010 as a Clinical Educator. Prior to joining Sunrise, Sheilagh gained extensive clinical experience working in a variety of settings, including neurological rehabilitation, complex continuing care, and community rehabilitation. As the Clinical Education Manager, Sheilagh is a clinical resource for therapists across Canada involved in seating and mobility. She leads workshops, seminars, and webinars on the clinical aspects of seating and mobility. In addition, Sheilagh has presented at national and international conferences on seating and mobility.

Sheilagh also has an educational background that makes her well suited to the role of Clinical Education Manager. Sheilagh earned a Bachelor of Arts degree in Political Science from the University of Toronto in 1988, which enables her to understand healthcare policy and policy changes. Sheilagh graduated with a Bachelor of Health Sciences (Occupational Therapy) degree from McMaster University in 1994. In 2012, Sheilagh earned a Certificate in Adult Education/Staff Training from Seneca College. She applies adult learning principles to the workshops she leads. Finally, she also has a Master of Health Management (MHM) degree from McMaster University after graduating in 2015. Courses that Sheilagh completed during the MHM degree, such as Knowledge Translation, Evaluating Sources of Evidence, and Quality & Safety in Healthcare, assist Sheilagh in using an evidence-based approach in her work.

In her free time, Sheilagh enjoys running, in addition to practicing yoga.


Date: 2013-05-17


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