Page 23 - Mobility Management, October 2017

A Hierarchy of Driving Controls
Are Some Drive Controls Easier to Use?
At first glance — and to an adult — single-switch scanning might seem quite awkward to use, while the proportional joystick might seem very intuitive to learn. But is that true?
“With little ones who have never driven a vehicle,” Norton said, “their ideas are very much limited to cause and effect: I push a button, I get a reaction. That’s how their toys are, that’s how they interact with their world. They laugh, their parents laugh — and they understand that. A single action gets a single effect. Switched control can be a very intuitive way for a very young child to learn.
“Conversely, if you have an able-bodied adult who experienced an accident and has a spinal cord injury, they’ve driven in the past. More intuitive for them is a proportional control, because
[a car’s] gas pedal is proportional, and they understand that the more I push down a gas pedal, the faster I go. So a proportional joystick, or a proportional head control or anything that is proportional is very intuitive to them.”
While switch systems may be easier for very young children to initially learn, Norton added that kids should graduate to propor- tional controls if they show that ability.
“If they can understand the cause and effect of a switch control,” he said of young children “and get the opportunity
to progress to use all four directions, and if they become fully successful at switch driving, then the introduction of a joystick gives them that much more control. They’ll still understand that pushing forward makes me go forward, and there’s a lot of things you can do as far as visual cues. If you’ve always been using a green switch, for instance, to go forward, place a green sticker
on the forward section of the joystick, so there’s still the under- standing that green means forward.”
Multiple Ways to Find Success
Children aren’t the only clients who could progress through multiple types of drive controls.
“A lot of [amyotrophic lateral sclerosis/ALS] clients, depending at what point they’re evaluated, may be standard joystick users,” Norton said. “But we know that even by the time the chair is delivered, that may not be functional for them anymore. Those are things we have to take into consideration. We may spec out the standard joystick, but we also spec out a head array or a chin control. We understand that is where they are going.
“I’ve received feedback from dealers, specifically for ALS, that funding is not prohibitive when it comes to changing drive controls. Numerous funding agencies have become more educated and understand specifically that with ALS, [changing controls] is going to be a reality. They’re going to need new funding for drive controls very quickly, before any five-year [replacement] cycle.”
The drive options available today make it easier to fine- tune controls per each client’s unique needs and preferences,
Doherty said.
“I haven’t found that one type of switch is more intuitive than
another,” he noted. “What I have found is that some individuals need to feel or hear the click of a mechanical switch versus a proximity or electronic switch. I have found that some individ- uals will press hard on an electronic switch because they don’t feel the switch depress.
“The team really needs to look at individual switches and find what matches the consumer’s needs the best. There are so many choices available today that it really comes down to consumer choice and validated success.”
Fatigue is a major factor for many of the people who utilize specialty controls — Jay Doherty
As for other factors that can impact the drive control selection process, Doherty said, “The amount of force an input requires needs to be looked at closely. Fatigue is a major factor for many of the people who utilize specialty controls. Therefore, this is a critical component that must be assessed during the evaluation process. The individual’s goals as well as their capacities and limitations are the primary consideration in choosing a specialty control input device. The one thing that teams cannot do is make any determination based on diagnosis alone. Every person’s presentation with a particular diagnosis will be different, and a thorough assessment is imperative to allow them to be as inde- pendent as possible.”
“Seating is where everything starts,” Norton said. “If someone is not properly positioned, our chances of getting them to be
a successful driver are greatly diminished. First and foremost
as you’re going through an evaluation, if they’re not properly positioned or if there is a postural issue going on — maybe they have high tone, but they’re going to the doctor to see if they can get a baclofen pump, which we know will greatly change their tone and greatly change their positioning. So that’s a stopping point, honestly, on an evaluation — we’re going to wait until the medical intervention has taken place, and then we’re going to determine how you’re going to drive.”
Despite the array of technology choices, Norton added that the client should remain at the center of the equation.
“We are always looking to match the best product to the client’s function,” he said. “There’s no one product for which we can say, ‘Okay, I’m going to make this work for this client.’ That’s looking at it backward. Look at their function, look at what they’re able to do, and decide which product is going to meet those needs or abilities.” m
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