Page 21 - Mobility Management, October 2017

Head Array
Sip and Puff
Mini Joystick
be programming options that the team will want to consider, such as Center Dead Band (neutral zone changes), limited (short) joystick throw or tremor suppression separately or in conjunction with different mounting options. If the team feels that the indi- vidual doesn’t have the strength, range of motion, coordination, motor control, dexterity or muscle endurance to use the standard proportional joystick, then the next step is to consider alternative joystick options, which require less force to achieve full throw.”
Manufacturers offer many joystick variations, making it possible for more clients to succeed with that type of propor- tional driving control.
“If you have someone who still has functional use of their upper extremities and it’s just a matter of placement, then I would look at a very compact joystick or a mini proportional joystick,” Norton said. “If someone is banging on the joystick without a lot of fine control, then you want something more durable, like a compact joystick. However, if it’s a limitation in strength and range of motion, then we would look at a mini proportional, whether it’s one that has feedback, like the MicroGuide, or the MicroPilot, which [requires] very minimal movement.
“I mounted a mini proportional joystick off of the back cane and brought it around, and a gentleman drove with his cheek because of a very fixed C-curve deformity. That’s where his access point was. He had no functional use of his upper extrem- ities, no functional use of his feet or his head, so we mounted a mini proportional joystick off the back cane, and it came right up to his cheek. And that’s how he drove.”
Switches & Other Options
What’s next if a client cannot use any sort of joystick?
If he’s ruled out joysticks, Doherty said, “There is not a set
hierarchy; however, I tend to go through the options as follows: If the person has good upper-extremity movement but doesn’t have adequate control to utilize a proportional device optimally, then switches mounted for use of the hands may be an appropriate
Switch
option. If the individual has good gross motor movement, I try various switches laid out on a tray. Keep in mind that a wheel- chair can be controlled by five, four, three or two switches.
“If the person has good head control, I may look at a propor- tional chin control or a head array as an option. Both allow
full control of the power wheelchair and access to many of the features through just the input device itself, but the proportional device will offer infinite operation that cannot be fully achieved with any switch-operated system, even with the advances in programming ‘proportionality’ we see today.”
After that, Doherty said, “If head-controlled operation is not an option, the team may start looking at the placement of switches at one or more body parts. I recommend identifying which locations have consistent, sustainable and repeatable control. I have placed switches at any number of locations on the body. The tricky part is mounting the switch in a location where it is acces- sible throughout the day, especially when tone and/or fatigue are evident. Five, four, three or two switches are options to control driving a power wheelchair and still have total control over the other critical components necessary to use it effectively, such as power seating functions.
“If the person can drink through a straw and/or blow through a straw to create bubbles, then sip and puff may be a good option. Sip and puff can also provide full control of the features of the wheel- chair and allow independent driving as well. If the person can turn their head left and right, a sip and puff/head array combination may be the most effective and energy-efficient option for all-day use. That combination allows the person to drive forward and reverse with a sip or puff command and turn right and left with the turning of their head to activate the head array pads. This can be set up as a true combination system, where the chair can turn right/left while still moving forward to approximate proportional driving.”
The final option, Doherty said, “is single-switch scanning. This type of driving can be time intensive because the indi- vidual driving the wheelchair depends on a scanner to move directions and when.”
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