Page 20 - Mobility Management, October 2017

ATP Series
A Hierarchy
of Driving
Joystick
HA
Controls
Where to Start & How to Proceed When Assessing Power Chair Options
By Laurie Watanabe
Creating a hierarchy of almost anything in the world of complex rehab technology (CRT) is tricky. Most passengers would agree that a first-class seat at the
front of the plane beats a seat in the last row, across from the lavatories. But when contemplating a wheelchair or a seating system for a CRT client, the answer is usually It depends — on factors as wide ranging as clinical presentation, prognosis, daily goals, transportation issues, medications and surgeries, etc.
Still, to maximize efficiency during an evaluation, it can help to have somewhere to start.
So when assessing driving controls for a power wheelchair user, what should be tried first? And next?
Starting with the Standard Joystick
An armrest-mounted joystick is standard equipment on a power chair. Is that where the driving control assessment should start?
Of course, it depends.
Robert Norton, director of sales, Specialty Controls, at Sunrise Medical, is well known for his work with Switch It, a driving controls specialist.
“It depends on the scenario,” he said. “Everybody is so indi- vidual, but a joystick mounted inline with the arm is the first starting point. Obviously, there are cases where a clinician or an ATP looks at [the client] and says, ‘We know that’s not going to be functional.’ But number one, a proportional control is always preferred, and number two, it’s my opinion that it’s preferable
to use the standard joystick, if at all possible. It reduces cost, it reduces pieces of equipment on the chair. If you’re using a stan- dard joystick, you don’t require extra displays, extra wires, extra mounts and the places to run things.”
Jay Doherty, OTR, ATP/SMS, director of clinical education for Quantum Rehab, said the assessment must start with the client.
“When assessing a person for the first time, the team needs to look at where the individual’s most consistent movements on their body are,” he explained. “Once the team knows where the most sustainable movements can be repeated consistently, then
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they will be able to narrow down what types of input devices can be explored, and the order in which they will explore them. If
a person has hand control, then I start with a standard propor- tional joystick and may consider an adapted handle.”
Doherty said he doesn’t always start by considering a stan- dard hand-controlled joystick, “but I do consider it, as it is an ‘included’ component of the power wheelchair and provides the greatest control over speed regulation and directional control/ steering corrections with a proportional type of device.”
Joystick Variations
While many power chair users can use a joystick, not all of them can do so with the joystick in its standard position — at the far end of the right or left armrest. No problem.
“That joystick may be mounted in more of a midline or inset position so that the user has a greater success rate of accessing the joystick, as well as the switches,” Norton said. “A lot of times, someone is just fine with the joystick, but they have a hard time reaching over the joystick to hit the mode or the profile button or the speed button. Especially with the newer joysticks that have the user buttons up on the sides of the display — that’s not always functional for someone to reach. But there are things you can do by adding switches through the ports on the bottom of the joystick to bring those to a better location for the user, while still utilizing the standard joystick.”
The possible locations for a joystick seem almost infinite.
“I’ve seen a standard joystick mounted at midline, inset from the arm,” Norton said. “I’ve seen it mounted as a foot control, or an elbow control for an amputee. There are lots of places you can mount a standard joystick to be functional.”
Doherty suggested that if a client has difficulties accessing the joystick in a standard location, “First, I think the team needs
to explore why the individual cannot use the standard propor- tional joystick in the position it is mounted. Once they under- stand the reason(s) for the lack of adequate control, they may decide that a different location is more appropriate. There may
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