Page 19 - Mobility Management, January/February 2020

technology clients, what works for one person or even most people isn’t the best answer for everyone.
As Education Coordinator for Adaptive Switch Laboratories (ASL), Byron Guisbert is well versed not just in alternative driving controls, but in making them work optimally for each power chair user.
“Everyone is different,” Guisbert said. “Somewhere, sometime,
the ‘standard’ joystick position just happened to be at the end of an armrest in almost exactly the same position on every manufacturer’s [power chair]. I agree that there are individuals who could benefit from having it placed elsewhere, but that could be inches left or right.
“For me, where the joystick is positioned is dependent on what joystick, how much stability someone needs for their upper extremities, how their hand needs to be positioned, where their visual field is capable. What function are they using to move the joystick — shoulder, arm, hand, fingers, etc.?”
Guisbert pointed out that mounting power chair controls in a midline location requires those controls to swing away to allow for transferring in and out of the chair. Some swing-away mounts “swing away when you don’t want them to swing away,” he said. And those mounts need to be able to return those power controls to the exact same spot every time. It’s not just a matter of a power chair user being finicky: It’s a matter of having learned how to
use those controls exactly where they were. Having controls in a different location, even one just slightly different, could make it difficult or impossible for the power chair user to function.
“The one thing they don’t like is change,” Guisbert said of complex rehab power chair users.
Finding Each User’s Functional Sweet Spot
Guisbert noted that power chair consumers with complex seating needs develop unique ways to use their power chair controls.
“The standard method became mounting [controls] on
an armrest, but they were standard for spinal cord injuries,” Guisbert said of how joysticks originally came to be located. “And if they had shoulder movement, that was awesome, because they laid their hand on the armrest and they drove.
“But for me, it’s always a question of who am I working with? Am
I working with someone who’s using the shoulder, the entire chest
to use the joystick? Some people are even rotating their trunk. You might find somebody using a hand-over-hand [method], where they’re using both hands to utilize a joystick and actually rocking the joystick itself. Are they rocking it by using the weight of their hands?”
Flowers agreed: Every power chair user is different.
“It extends beyond just the operation of the chair, and that’s what to me has always been intriguing about driving in a position
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