Australian Occupational Therapy Journal (2013) 60, 454–457
doi: 10.1111/1440-1630.12095
Viewpoint
Competent use of a motorised mobility scooter – assessment, training and ongoing monitoring: A vital role for occupational therapy practice Kathryn Townsend and Alana Watson Occupational Therapy Department, Austin Health, Heidelberg Repatriation Hospital, Heidelberg Heights, Victoria, Australia
KEY WORDS assessment, competency, motorised mobility devices, training.
Introduction The use of motorised mobility devices, such as scooters and electric wheelchairs, has grown in popularity as older Australians strive to maintain active and independent lifestyles (Berndt, 2002; Cassell & Clapperton, 2006). Maintaining active community mobility is essential for social inclusion and is associated with many positive health indicators such as, improved quality of life and self esteem (Edwards & McCluskey, 2010; Sutton & Hill, 2010). Motorised mobility scooters (MMS) are a valuable way to achieve this goal (Buck, 2003; Cassell & Clapperton). The authors believe that the use of MMS will continue to grow as the population ages and government policies focus on supporting older people to remain living at home. There are as many as ‘231,000 [MMS] users Australia wide’, approximately half of these individuals are aged over 60 years (Australian Competition & Consumer Commission et al., 2012, p. 3). For some, MMS are an alternative to other means of transport when an individual ceases driving a car, while for others; they are viewed as a ‘replacement of legs’ that enables greater mobility (Australian Competition & Consumer Commission et al.). Chronic illness, use of medication and changing physical and cognitive abilities can affect an individual’s ability to use a MMS safely, just as they can impact on driving or public transport use. Kathryn Townsend BOccTher, GradCertHealthSciences; Occupational Therapist. Alana Watson BOccTher; Occupational Therapist. Correspondence: Kathryn Townsend, Austin Health, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Vic. 3081, Australia. Email: kathryn.townsend@ austin.org.au Accepted for publication 7 October 2013. © 2013 Occupational Therapy Australia
Is MMS use safe? There is an ‘emerging concern of injury to older persons related to their increasing use of … [MMS]’ (Cassell & Clapperton, 2006, p. 1). At least six Australian MMS users die each year and there are as many as 700 injuries (Gibson, Ozanne-Smith, Clapperton, Kitching & Cassell, 2011). Capturing accurate hospital statistical data about MMS-related injuries is difficult so these figures may be higher (Cassell & Clapperton; Gibson et al.). It must be acknowledged that the number of injuries and fatalities associated with MMS use reflects only a small percentage of all MMS users Australia-wide. Despite this relatively small number of incidents, the authors believe that a proactive approach is warranted so that individuals are equipped with the skills required for safe MMS use. Reported causes of MMS-related injuries include engineering problems (mechanical or electronic), environmental issues (for example, inclines and footpath use), user knowledge or skill deficiencies and system problems (for example, inadequate training) (Australian Competition & Consumer Commission et al., 2012; Cassell & Clapperton, 2006). The authors believe that many of these incidents could be prevented through education, comprehensive assessment and training. Unfortunately the media often ignores the benefits of MMS use, instead presenting a negative image which focuses on the injuries and fatalities. This causes some to suggest that MMS use should be limited or prohibited (Australian Competition & Consumer Commission, 2010).
Purchase, prescription, licensing and registration responsibilities In Australia, ‘there are currently no legislative requirements…for [MMS] driver competency assessment’ (Nitz, 2008, p. 276). Under the Australian road rules, an individual using a MMS is classified as a pedestrian and must obey the relevant road rules (Berndt, 2002; On your scooter, 2006). A MMS should only be used by an individual who has difficulty walking, however, the maximum ‘driving’ speed of a MMS is 10 km/h (On
455
COMPETENT USE OF A MOTORISED MOBILITY SCOOTER
your scooter, 2006). This speed resembles a ‘running’ pace. The authors believe that this speed is too fast. Instead, a ‘walking’ pace should be maintained to allow the user adequate reaction time to respond appropriately to unexpected situations (for example, cars reversing from driveways). This needs to be reinforced through education and assessment. ‘Little can prevent a person from purchasing a [MMS]’ from a retailer without any formal assessment from a health professional (Berndt, 2002, p. 334). While a basic training session may be provided by equipment retailers, the content and quality of this varies (Australian Competition & Consumer Commission et al., 2012; Edwards & McCluskey, 2010). Have you ever noticed that advertisements for equipment suppliers often promote MMS? Some companies even offer an ‘obligation free seven day home trial’ with a ‘30 day money back guarantee’. This emphasis on selling a product fails to recognise the importance of whether an individual has the skills to use it appropriately. A survey of 515 MMS users identified that only 25% had training or tuition with the key training providers being occupational therapists or suppliers (Australian Competition & Consumer Commission et al., 2012). Queensland is the only state where MMS registration is required. Registration is free, and it also includes compulsory third party insurance. Although a licence is not required to use a MMS in Queensland, all devices must be registered (On your scooter, 2006). In addition, a doctor must verify that a MMS is required due to severe mobility impairment. A safety inspection must occur as part of this process (On your scooter). This system has many advantages. Providing medical clearance for a MMS user suggests that there are no medical, cognitive or behavioural issues which could impact upon safe use. Inherent in the clearance report is the need for ongoing monitoring of medical conditions and medications that could compromise MMS use. In the absence of ‘fitness-to-drive’ criteria for MMS use, medical clearance is an important first step for all potential users. It ensures that individuals who genuinely need to use a MMS are medically appropriate candidates. Referrals to occupational therapists for a MMS driving assessment may also occur as a result. Interestingly, in other states, while medical input is not required when a MMS is purchased, all state government and Department of Veterans’ Affairs funding applications require medical clearance before an assessment occurs. This acknowledges that an individual is medically appropriate for MMS use. While medical clearance and MMS registration are important, they do not guarantee safe MMS use because education is not provided and driver skill is not assessed. A Victorian Injury and Surveillance Unit report (2006) recommended expanding ‘assessment and training so
that all potential… [MMS] users are assessed by a trained therapist and undergo competency based training’ (Cassell & Clapperton, 2006, p. 11). Similarly, the Australian Competition & Consumer Commission advocated for assessment and training, in their publication, ‘Help cut mobility scooter accidents’ (2010), however, it failed to identify the type and nature of the training. Arguably, comprehensive assessment and training could assist in overcoming many of the factors reported to cause injury to MMS users (Nitz, 2008). To date, concerns about MMS use have been voiced, but little action has resulted. Occupational therapists have a key role in supporting community participation and mobility. Their unique knowledge base in physical, psychological, visual perceptual and cognitive assessment means that there is an ‘increased demand on [occupational therapists] to determine driving skill competence’ (Letts, Dawson & Kaiserman-Goldenstein, 1998; p. 123). The authors believe that comprehensive assessment and training in MMS use is vital and should be conducted by an occupational therapist.
Complexity of skills required for MMS use Like driving a car, competent MMS use demands many pre-requisite skills. These skills include coordination, strength, balance, endurance, visual acuity and visual fields, depth perception, reaction time, memory, concentration, insight, divided attention and judgement (Nitz, 2008). ‘Adaptability to new situations’ is another vital skill which facilitates the generalisation of basic skills to more complex environments (Buck, 2003, p. 26). Assessment in a variety of situations where the MMS will be used is required because different skills are required depending on the environment. To ensure comprehensive MMS assessment, observation of a client’s perceptual, cognitive and driving skills over time and across a variety of environments is advisable, rather than relying on a single assessment. While occupational therapists are often sought ‘to determine driving competence or to identify driving skills [requiring further training] to attain competence’, occupational therapists vary in knowledge and experience in MMS assessment and training (Letts et al., 1998, p. 123). Consensus about the type of skills required for safe MMS use is lacking and as a result, assessment and training in MMS use occurs on an ‘ad hoc’ basis. While a general list of skills provides a useful guide for therapists, lack of descriptive criteria to guide assessments results in subjective observations (Buck, 2003; Nitz, 2008). Specific skill descriptions, for example, drive forwards or backwards in a straight line are more helpful as these skills can be more accurately observed. © 2013 Occupational Therapy Australia
456 Lack of guidelines for MMS user assessment and training makes it difficult to determine user competence. There are few reliable and valid assessment tools available to assist this process (Berndt, 2002; Letts et al.,1998; Mortenson et al., 2005). It is beyond the scope of this article to detail the features of available assessment tools. The authors believe that minimum skills required for safe MMS use need to be identified. Thorough assessment of community MMS use needs ‘to assess the fit between the driver, the [MMS] device, and the larger environment… this fit can be optimised through skill training, device modification, environmental modification and advocacy to increase community accessibility’ (Letts et al., 1998, p. 124). Education is an important component. It should be provided by an occupational therapist with an understanding of the intrinsic relationship between the person, environment and their MMS. Occupational therapists should ensure that the individual has attained basic driver knowledge, including relevant road rules and education regarding MMS use before driving skills are assessed. Comprehensive training is imperative. It is ‘a primary factor contributing to the safety of [MMS]’ users (Gibson et al., 2011, p. 5). As the client’s knowledge develops, education has a more practical approach. This should be graded according to the individual’s needs and learning style. Topics should include: ● Basic MMS ‘road rules’ ● Impact of medical conditions, medications, vision and hearing on MMS use ● Responsibilities of MMS users ● Maximising visibility ● Planning a safe route of travel ● Crossing roads ● Sharing footpaths ● MMS Maintenance ● Indoor use/shopping centre use ● Insurance and road side assistance ● ‘The Re-charge scheme’ or similar ● Use of public transport ● Use of maxi taxis The authors’ experience suggests that this information needs reinforcement over time to ensure comprehension and consolidation of knowledge. Often an equipment representative will provide a ‘one-off’ scooter education session. It can be assumed that their focus is on the features of a MMS and achieving a sale, rather than the unique characteristics of the user and how they interact with their environment.
Multidisciplinary approach As discussed, driving a MMS is a complex task requiring perception, good judgement and quick responses in a rapidly changing environment. The impairment of physical and/or cognitive skills can affect the ability to safely use a MMS (Nitz, 2008); therefore, the authors © 2013 Occupational Therapy Australia
K. TOWNSEND AND A. WATSON
believe that, monitoring of MMS users’ driving skills over time is imperative. This monitoring requires a multidisciplinary approach. General practitioners should monitor changes in medical conditions or medications which could impact upon competent MMS use. Occupational therapists need to educate general practitioners about their important role. As a result, a referral to occupational therapy for a MMS use review may be warranted to assess competency over time and to refine skills. Holistic MMS assessment and training also requires physiotherapy input. It is important for MMS users to maintain functional strength and balance and to continue walking where possible. In some cases, MMS use may be contraindicated after consultation with a physiotherapist. To be effective, MMS assessment must be a collaborative approach.
How do occupational therapists currently manage MMS assessment and training? MMS assessment and training is rarely considered an urgent priority for community occupational therapists as they are time consuming and may be difficult to justify ahead of other priorities. The timeframes for funding approval can also be a deterrent, tempting occupational therapists to refer self-funding clients directly to suppliers. Awareness of the importance of MMS assessment and training has resulted in a number of new initiatives, including: ● An Assessment and Training clinic based at a public hospital. Referrals are accepted for individuals wishing to explore MMS use. Assessment and training involves a combination of centre-based and homebased sessions with an occupational therapist ● Practical group sessions facilitated by an occupational therapist and multiple MMS equipment suppliers ● Community-based education groups for existing users to reinforce strategies and to encourage safe MMS use
Future practice considerations The complexity of the issues related to MMS use requires a coordinated, collaborative approach between health professionals, consumers and government agencies. The authors believe that legislation needs to be uniform across Australia. It should address registration and licensing requirements, assessment and training needs as well as ongoing monitoring of competency. Clear, consistent legislation could provide clarity and ownership of the issue of MMS use (Berndt, 2002; Gibson et al.,
COMPETENT USE OF A MOTORISED MOBILITY SCOOTER
2011). A greater understanding of the potential causes and types of MMS accidents and fatalities is required as it may further support the need for legislation change. Mortenson et al. (2005) suggest that assessing ‘safety is a contentious and troubling issue for occupational therapists primarily because no gold standard exists to determine when driving becomes unsafe’ (p. 143). There is a compelling need for a universal set of prescribed skills and assessment tools for MMS prescription. A documented minimum skill standard for MMS use would assist occupational therapists’ clinical reasoning during MMS assessment and training. Ultimately, the authors believe that a standardised MMS assessment tool should be developed. Occupational therapists have a key role to promote and provide thorough, client-centred MMS assessment and training so that individuals can competently use a MMS. Ongoing monitoring is needed to ensure that skills and competence are maintained. While the issues are complex, great opportunity exists to advocate for change in practice that will benefit current and future MMS users.
References Australian Competition & Consumer Commission (2010). Help cut mobility scooter accidents (ACCC Publication No. 42105). Canberra, ACT: Australian Competition & Consumer Commission. Retrieved 17 January, 2013, from http://www.accc.gov.au/content/index.phtml/itemId/ 945577 Australian Competition & Consumer Commission, NRMA Motoring & Services, CHOICE, EnableNSW & Flinders University (2012). Mobility scooter usage and safety survey report. Canberra, ACT: Australian Competition &
457 Consumer Commission. Retrieved 17 January, 2013, from www.productsafety.gov.au Berndt, A. (2002). Scooters as a safe alternative for cars? In Transport SA, Australia (Eds.), Road safety research, policing and education conference. Held in Adelaide, South Australia, 2002 (pp. 334–342). Adelaide, Australia: Transport SA. Buck, S. (2003). Prescribing independence: For some clients, scooters are the perfect fit. Rehab Management, 16 (10), 26– 29. Cassell, E. & Clapperton, A. (2006) Consumer product-related injury (2): Injury related to the use of motorised mobility scooters. Victorian Injury Surveillance Unit. Hazard No. 62 p. 1-11. Edwards, K. & McCluskey, A. (2010). A survey of adult power wheelchair and scooter users. Disability & Rehabilitation: Assistive Technology, 5 (6), 411–419. Gibson, K., Ozanne-Smith, J., Clapperton, A., Kitching, F. & Cassell, E. (2011). Targeted study of injury data involving motorised mobility scooters. Retrieved January 17, 2013 from www.accc.gov.au Letts, L., Dawson, D. & Kaiserman-Goldenstein, E. (1998). Development of the Power-mobility community driving assessment. Canadian Journal of Rehabilitation, 11 (7), 123– 129. Mortenson, W., Miller, W., Boily, J., Steele, B., Odell, L., Crawford, M. et al. (2005). Perceptions of power mobility use and safety within residential facilities. Canadian Journal of Occupational Therapy, 72 (3), 142–152. Nitz, J. (2008). Evidence from a cohort of able bodied adults to support the need for driver training for motorized scooters before community participation. Patient Education & Counselling, 70, 276–280. On your scooter (2006). Retrieved 14 January, 2013, from www.choice.com.au Sutton, L. & Hill, K. (2010). Transport and getting around later in life. Resources in Later Life Research, 1–11.
© 2013 Occupational Therapy Australia
doi: 10.1111/1440-1630.12095
Viewpoint
Competent use of a motorised mobility scooter – assessment, training and ongoing monitoring: A vital role for occupational therapy practice Kathryn Townsend and Alana Watson Occupational Therapy Department, Austin Health, Heidelberg Repatriation Hospital, Heidelberg Heights, Victoria, Australia
KEY WORDS assessment, competency, motorised mobility devices, training.
Introduction The use of motorised mobility devices, such as scooters and electric wheelchairs, has grown in popularity as older Australians strive to maintain active and independent lifestyles (Berndt, 2002; Cassell & Clapperton, 2006). Maintaining active community mobility is essential for social inclusion and is associated with many positive health indicators such as, improved quality of life and self esteem (Edwards & McCluskey, 2010; Sutton & Hill, 2010). Motorised mobility scooters (MMS) are a valuable way to achieve this goal (Buck, 2003; Cassell & Clapperton). The authors believe that the use of MMS will continue to grow as the population ages and government policies focus on supporting older people to remain living at home. There are as many as ‘231,000 [MMS] users Australia wide’, approximately half of these individuals are aged over 60 years (Australian Competition & Consumer Commission et al., 2012, p. 3). For some, MMS are an alternative to other means of transport when an individual ceases driving a car, while for others; they are viewed as a ‘replacement of legs’ that enables greater mobility (Australian Competition & Consumer Commission et al.). Chronic illness, use of medication and changing physical and cognitive abilities can affect an individual’s ability to use a MMS safely, just as they can impact on driving or public transport use. Kathryn Townsend BOccTher, GradCertHealthSciences; Occupational Therapist. Alana Watson BOccTher; Occupational Therapist. Correspondence: Kathryn Townsend, Austin Health, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Vic. 3081, Australia. Email: kathryn.townsend@ austin.org.au Accepted for publication 7 October 2013. © 2013 Occupational Therapy Australia
Is MMS use safe? There is an ‘emerging concern of injury to older persons related to their increasing use of … [MMS]’ (Cassell & Clapperton, 2006, p. 1). At least six Australian MMS users die each year and there are as many as 700 injuries (Gibson, Ozanne-Smith, Clapperton, Kitching & Cassell, 2011). Capturing accurate hospital statistical data about MMS-related injuries is difficult so these figures may be higher (Cassell & Clapperton; Gibson et al.). It must be acknowledged that the number of injuries and fatalities associated with MMS use reflects only a small percentage of all MMS users Australia-wide. Despite this relatively small number of incidents, the authors believe that a proactive approach is warranted so that individuals are equipped with the skills required for safe MMS use. Reported causes of MMS-related injuries include engineering problems (mechanical or electronic), environmental issues (for example, inclines and footpath use), user knowledge or skill deficiencies and system problems (for example, inadequate training) (Australian Competition & Consumer Commission et al., 2012; Cassell & Clapperton, 2006). The authors believe that many of these incidents could be prevented through education, comprehensive assessment and training. Unfortunately the media often ignores the benefits of MMS use, instead presenting a negative image which focuses on the injuries and fatalities. This causes some to suggest that MMS use should be limited or prohibited (Australian Competition & Consumer Commission, 2010).
Purchase, prescription, licensing and registration responsibilities In Australia, ‘there are currently no legislative requirements…for [MMS] driver competency assessment’ (Nitz, 2008, p. 276). Under the Australian road rules, an individual using a MMS is classified as a pedestrian and must obey the relevant road rules (Berndt, 2002; On your scooter, 2006). A MMS should only be used by an individual who has difficulty walking, however, the maximum ‘driving’ speed of a MMS is 10 km/h (On
455
COMPETENT USE OF A MOTORISED MOBILITY SCOOTER
your scooter, 2006). This speed resembles a ‘running’ pace. The authors believe that this speed is too fast. Instead, a ‘walking’ pace should be maintained to allow the user adequate reaction time to respond appropriately to unexpected situations (for example, cars reversing from driveways). This needs to be reinforced through education and assessment. ‘Little can prevent a person from purchasing a [MMS]’ from a retailer without any formal assessment from a health professional (Berndt, 2002, p. 334). While a basic training session may be provided by equipment retailers, the content and quality of this varies (Australian Competition & Consumer Commission et al., 2012; Edwards & McCluskey, 2010). Have you ever noticed that advertisements for equipment suppliers often promote MMS? Some companies even offer an ‘obligation free seven day home trial’ with a ‘30 day money back guarantee’. This emphasis on selling a product fails to recognise the importance of whether an individual has the skills to use it appropriately. A survey of 515 MMS users identified that only 25% had training or tuition with the key training providers being occupational therapists or suppliers (Australian Competition & Consumer Commission et al., 2012). Queensland is the only state where MMS registration is required. Registration is free, and it also includes compulsory third party insurance. Although a licence is not required to use a MMS in Queensland, all devices must be registered (On your scooter, 2006). In addition, a doctor must verify that a MMS is required due to severe mobility impairment. A safety inspection must occur as part of this process (On your scooter). This system has many advantages. Providing medical clearance for a MMS user suggests that there are no medical, cognitive or behavioural issues which could impact upon safe use. Inherent in the clearance report is the need for ongoing monitoring of medical conditions and medications that could compromise MMS use. In the absence of ‘fitness-to-drive’ criteria for MMS use, medical clearance is an important first step for all potential users. It ensures that individuals who genuinely need to use a MMS are medically appropriate candidates. Referrals to occupational therapists for a MMS driving assessment may also occur as a result. Interestingly, in other states, while medical input is not required when a MMS is purchased, all state government and Department of Veterans’ Affairs funding applications require medical clearance before an assessment occurs. This acknowledges that an individual is medically appropriate for MMS use. While medical clearance and MMS registration are important, they do not guarantee safe MMS use because education is not provided and driver skill is not assessed. A Victorian Injury and Surveillance Unit report (2006) recommended expanding ‘assessment and training so
that all potential… [MMS] users are assessed by a trained therapist and undergo competency based training’ (Cassell & Clapperton, 2006, p. 11). Similarly, the Australian Competition & Consumer Commission advocated for assessment and training, in their publication, ‘Help cut mobility scooter accidents’ (2010), however, it failed to identify the type and nature of the training. Arguably, comprehensive assessment and training could assist in overcoming many of the factors reported to cause injury to MMS users (Nitz, 2008). To date, concerns about MMS use have been voiced, but little action has resulted. Occupational therapists have a key role in supporting community participation and mobility. Their unique knowledge base in physical, psychological, visual perceptual and cognitive assessment means that there is an ‘increased demand on [occupational therapists] to determine driving skill competence’ (Letts, Dawson & Kaiserman-Goldenstein, 1998; p. 123). The authors believe that comprehensive assessment and training in MMS use is vital and should be conducted by an occupational therapist.
Complexity of skills required for MMS use Like driving a car, competent MMS use demands many pre-requisite skills. These skills include coordination, strength, balance, endurance, visual acuity and visual fields, depth perception, reaction time, memory, concentration, insight, divided attention and judgement (Nitz, 2008). ‘Adaptability to new situations’ is another vital skill which facilitates the generalisation of basic skills to more complex environments (Buck, 2003, p. 26). Assessment in a variety of situations where the MMS will be used is required because different skills are required depending on the environment. To ensure comprehensive MMS assessment, observation of a client’s perceptual, cognitive and driving skills over time and across a variety of environments is advisable, rather than relying on a single assessment. While occupational therapists are often sought ‘to determine driving competence or to identify driving skills [requiring further training] to attain competence’, occupational therapists vary in knowledge and experience in MMS assessment and training (Letts et al., 1998, p. 123). Consensus about the type of skills required for safe MMS use is lacking and as a result, assessment and training in MMS use occurs on an ‘ad hoc’ basis. While a general list of skills provides a useful guide for therapists, lack of descriptive criteria to guide assessments results in subjective observations (Buck, 2003; Nitz, 2008). Specific skill descriptions, for example, drive forwards or backwards in a straight line are more helpful as these skills can be more accurately observed. © 2013 Occupational Therapy Australia
456 Lack of guidelines for MMS user assessment and training makes it difficult to determine user competence. There are few reliable and valid assessment tools available to assist this process (Berndt, 2002; Letts et al.,1998; Mortenson et al., 2005). It is beyond the scope of this article to detail the features of available assessment tools. The authors believe that minimum skills required for safe MMS use need to be identified. Thorough assessment of community MMS use needs ‘to assess the fit between the driver, the [MMS] device, and the larger environment… this fit can be optimised through skill training, device modification, environmental modification and advocacy to increase community accessibility’ (Letts et al., 1998, p. 124). Education is an important component. It should be provided by an occupational therapist with an understanding of the intrinsic relationship between the person, environment and their MMS. Occupational therapists should ensure that the individual has attained basic driver knowledge, including relevant road rules and education regarding MMS use before driving skills are assessed. Comprehensive training is imperative. It is ‘a primary factor contributing to the safety of [MMS]’ users (Gibson et al., 2011, p. 5). As the client’s knowledge develops, education has a more practical approach. This should be graded according to the individual’s needs and learning style. Topics should include: ● Basic MMS ‘road rules’ ● Impact of medical conditions, medications, vision and hearing on MMS use ● Responsibilities of MMS users ● Maximising visibility ● Planning a safe route of travel ● Crossing roads ● Sharing footpaths ● MMS Maintenance ● Indoor use/shopping centre use ● Insurance and road side assistance ● ‘The Re-charge scheme’ or similar ● Use of public transport ● Use of maxi taxis The authors’ experience suggests that this information needs reinforcement over time to ensure comprehension and consolidation of knowledge. Often an equipment representative will provide a ‘one-off’ scooter education session. It can be assumed that their focus is on the features of a MMS and achieving a sale, rather than the unique characteristics of the user and how they interact with their environment.
Multidisciplinary approach As discussed, driving a MMS is a complex task requiring perception, good judgement and quick responses in a rapidly changing environment. The impairment of physical and/or cognitive skills can affect the ability to safely use a MMS (Nitz, 2008); therefore, the authors © 2013 Occupational Therapy Australia
K. TOWNSEND AND A. WATSON
believe that, monitoring of MMS users’ driving skills over time is imperative. This monitoring requires a multidisciplinary approach. General practitioners should monitor changes in medical conditions or medications which could impact upon competent MMS use. Occupational therapists need to educate general practitioners about their important role. As a result, a referral to occupational therapy for a MMS use review may be warranted to assess competency over time and to refine skills. Holistic MMS assessment and training also requires physiotherapy input. It is important for MMS users to maintain functional strength and balance and to continue walking where possible. In some cases, MMS use may be contraindicated after consultation with a physiotherapist. To be effective, MMS assessment must be a collaborative approach.
How do occupational therapists currently manage MMS assessment and training? MMS assessment and training is rarely considered an urgent priority for community occupational therapists as they are time consuming and may be difficult to justify ahead of other priorities. The timeframes for funding approval can also be a deterrent, tempting occupational therapists to refer self-funding clients directly to suppliers. Awareness of the importance of MMS assessment and training has resulted in a number of new initiatives, including: ● An Assessment and Training clinic based at a public hospital. Referrals are accepted for individuals wishing to explore MMS use. Assessment and training involves a combination of centre-based and homebased sessions with an occupational therapist ● Practical group sessions facilitated by an occupational therapist and multiple MMS equipment suppliers ● Community-based education groups for existing users to reinforce strategies and to encourage safe MMS use
Future practice considerations The complexity of the issues related to MMS use requires a coordinated, collaborative approach between health professionals, consumers and government agencies. The authors believe that legislation needs to be uniform across Australia. It should address registration and licensing requirements, assessment and training needs as well as ongoing monitoring of competency. Clear, consistent legislation could provide clarity and ownership of the issue of MMS use (Berndt, 2002; Gibson et al.,
COMPETENT USE OF A MOTORISED MOBILITY SCOOTER
2011). A greater understanding of the potential causes and types of MMS accidents and fatalities is required as it may further support the need for legislation change. Mortenson et al. (2005) suggest that assessing ‘safety is a contentious and troubling issue for occupational therapists primarily because no gold standard exists to determine when driving becomes unsafe’ (p. 143). There is a compelling need for a universal set of prescribed skills and assessment tools for MMS prescription. A documented minimum skill standard for MMS use would assist occupational therapists’ clinical reasoning during MMS assessment and training. Ultimately, the authors believe that a standardised MMS assessment tool should be developed. Occupational therapists have a key role to promote and provide thorough, client-centred MMS assessment and training so that individuals can competently use a MMS. Ongoing monitoring is needed to ensure that skills and competence are maintained. While the issues are complex, great opportunity exists to advocate for change in practice that will benefit current and future MMS users.
References Australian Competition & Consumer Commission (2010). Help cut mobility scooter accidents (ACCC Publication No. 42105). Canberra, ACT: Australian Competition & Consumer Commission. Retrieved 17 January, 2013, from http://www.accc.gov.au/content/index.phtml/itemId/ 945577 Australian Competition & Consumer Commission, NRMA Motoring & Services, CHOICE, EnableNSW & Flinders University (2012). Mobility scooter usage and safety survey report. Canberra, ACT: Australian Competition &
457 Consumer Commission. Retrieved 17 January, 2013, from www.productsafety.gov.au Berndt, A. (2002). Scooters as a safe alternative for cars? In Transport SA, Australia (Eds.), Road safety research, policing and education conference. Held in Adelaide, South Australia, 2002 (pp. 334–342). Adelaide, Australia: Transport SA. Buck, S. (2003). Prescribing independence: For some clients, scooters are the perfect fit. Rehab Management, 16 (10), 26– 29. Cassell, E. & Clapperton, A. (2006) Consumer product-related injury (2): Injury related to the use of motorised mobility scooters. Victorian Injury Surveillance Unit. Hazard No. 62 p. 1-11. Edwards, K. & McCluskey, A. (2010). A survey of adult power wheelchair and scooter users. Disability & Rehabilitation: Assistive Technology, 5 (6), 411–419. Gibson, K., Ozanne-Smith, J., Clapperton, A., Kitching, F. & Cassell, E. (2011). Targeted study of injury data involving motorised mobility scooters. Retrieved January 17, 2013 from www.accc.gov.au Letts, L., Dawson, D. & Kaiserman-Goldenstein, E. (1998). Development of the Power-mobility community driving assessment. Canadian Journal of Rehabilitation, 11 (7), 123– 129. Mortenson, W., Miller, W., Boily, J., Steele, B., Odell, L., Crawford, M. et al. (2005). Perceptions of power mobility use and safety within residential facilities. Canadian Journal of Occupational Therapy, 72 (3), 142–152. Nitz, J. (2008). Evidence from a cohort of able bodied adults to support the need for driver training for motorized scooters before community participation. Patient Education & Counselling, 70, 276–280. On your scooter (2006). Retrieved 14 January, 2013, from www.choice.com.au Sutton, L. & Hill, K. (2010). Transport and getting around later in life. Resources in Later Life Research, 1–11.
© 2013 Occupational Therapy Australia
