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Best Practice Guidelines for Use of Mobility Equipment

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					Best Practice Guidelines for Use
of Mobility Equipment within the
    Educational Environment


    Department for Education Project
            2011 – 2013
Outline of Presentation
• Introduction
• Advantages of Independent Mobility
• Educational Outcomes of Independent Mobility
• Wheelchair Skills Training
• Risk Assessment
• Wheelchair Provision during Transitional Stages
• Guidance on Use of Transport Services
Introduction to Whizz-Kidz
•   Medium sized national charity
•   Independence to enjoy an active childhood
•   Life Journey approach
•   Highly qualified mobility therapists
•   Partnership working within the NHS


What we do
We give disabled children and young people across the UK customised
mobility equipment, training, advice and life skills.

But more than this, we give them the independence to be
themselves. We make an immediate and life changing difference to them,
their families and their communities.
Introduction
Number of disabled children using
assistive technology has increased
by 60%

(Long et al 2003)


“…the window that enables a child to
have greater independence and more
active involvement in play.”

(Judge 2002)
Advantages of Independent Mobility
• A child is expected to learn
  more about their world           Lack of independence may mean:
  through movement                 •decreased motivation
                                   •reduced confidence
• Benefits increase interactions   •feelings of frustration
  with people, objects and         •passive
  surrounding environments         •incurious
• Aids the development of          •learned helplessness
  cognitive, emotional and                                  Nisbet 2002
  psychological skills
• Interactions create sense of
  achievement and autonomy
  leading onto further
  exploration
Advantages of Independent Mobility

             Research shows that children should be
             provided with equipment to enable them to
             become independent as close as possible to
             the age when mobility would be occurring
             naturally within normal childhood
             development
                                              Butler 1986
Educational Outcomes of
Independent Mobility
• Current inclusive education polices and integrated therapy approaches
• Inclusive education means more prominent existence of wheelchairs in
  educational milieu
• “…the culture and curriculum of a school has the flexibility to include
  children whatever the nature or extent of their special educational
  needs.” (Mackey & McQueen 1998)
• “Through the use of AT devices many students can decrease their
  isolation and become an important part of a regular classroom; their
  least restrictive environment.” (Cavanaugh 2002)
Educational Outcomes of
Independent Mobility
Educational outcomes:               Section 351 of Education Act 1996:

•   Specified National Curriculum
    standards                       1) Promotes the spiritual, moral,
                                       cultural, mental and physical
•   Attainment of formal
                                       development of pupils at the school
    qualifications
                                       and of society.
•   Friendships that will be made
                                    2) Prepares pupils at the school for the
•   Acceptable social behaviours
                                       opportunities, responsibilities and
    that will be shaped
                                       experiences of adult life.
Educational Outcomes of
Independent Mobility
The Child / Young Person

• Provision of right equipment at the right
  time
• Active responsibility for their learning
• Taking some responsibility for the
  equipment prescribed
• Provided equipment will enable meeting of
  educational outcomes
Educational Outcomes of
Independent Mobility
The Teachers / School

•   Use of staff when training a child in
    using their wheelchair
•   Staff are then able to reinforce skills
    and ensure equipment aids the
    personal and educational outcomes
•   Close communication and
    involvement within all wheelchair
    service processes
Educational Outcomes of
Independent Mobility
Whizz-Kidz aims to:
1. Involve school staff and therapists as much as possible within their
   processes
2. Carry out assessment and fitting clinics held within school
   environments
3. Provide advice and training to schools regarding posture, seating
   and general use of powered and manual wheelchairs
4. Organise Wheelchair Skills Training courses within school
   environments
Wheelchair Skills Training
• Providing disabled children
  with wheelchairs means
  making sure they know how to
  use them to their full potential
• Improving confidence and
  independence in the process
• Achieving individual potential
  through a codified programme
  of wheelchair skills training
• Schemes of work for complex
  needs, beginners and
  advanced users
Wheelchair Skills Training
                   Whizz-Kidz delivers
                   approximately 72 courses to
                   750 children and young people

                   40 schemes will be held within
                   the school environment

                   Involvement of school staff
                   promotes a ‘carry-over’ effect
                   of skills taught
Wheelchair Skills Training
Wheelchair trainer coordinators are
wheelchair users themselves, which
raises aspirations of the participants
and provides them with valuable role
models.

Running these courses in schools
increases staff confidence and gives
them the chance to see the
equipment in use.
Risk Assessments relating to
Wheelchair Provision
A risk assessment is:
       “…a careful examination of what, in your work, could cause
    harm to people, so that you can weigh up whether you have
    taken enough precautions or should do more to prevent harm.”
    Health and Safety Executive 2011

Three main risk areas associated with wheelchairs:
1) School environment
2) Use of harnesses and belts
3) Manual handling
Risk Assessment
School environment
Key components to consider:
• Access to buildings and play areas
• Steps
• Steepness of ramps
• Doorways
• Corridors
• Turning space
• Toileting and changing facilities
• Storage and charging
Risk Assessment
Use of harnesses and belts

                             Guidance on the Use of Restrictive
                             Physical Interventions

                             “ Devices which are required for therapeutic
                             purpose, such as buggies, wheelchairs and
                             standing frames (including any supporting
                             harness) may also restrict movement.
                             Such devices should never be provided for
                             the purpose of preventing problem
                             behaviour, although, in extreme
                             circumstances, they might be used to
                             manage risks.” DOH 2002
Risk Assessment
Use of harnesses and belts
Managing problem behaviour must
be:
• Risk assessed with MDT, user,
   parents / guardians
• Documented in care plan
• Identify risks to staff and risks of
   not intervening
• Wheelchair providers policy will
   probably state for ‘postural use
   only’ but will not be in a position to
   monitor
Risk Assessment
Manual Handling


                  •   Legislation indicates best practice for
                      pushing / pulling of wheelchairs
                  •   Size and type prescribed based on user’s
                      needs
                  •   Consideration given to change of
                      environment
                  •   Implications on postural and pressure
                      management equipment when slings left in
                      situ
Wheelchair provision during
transitional stages
•   Transition between primary and
    secondary school is a difficult time.
•   Increased anxieties for child,
    increased expectations for parents.
•   Children often fall behind in their
    learning, which increases stress and
    trepidation.
•   DfES Five Year Strategy for Children
    and Learners (2004)
Wheelchair provision during
transitional stages
Whizz-Kidz endeavours to pre-empt key transitional stages within a child
and young person’s life, so that the right mobility equipment is provided at
the right time.

Primary School- to move from a buggy to a wheelchair

• Independence
• Interaction with peers
• Element of growth in equipment
• Low seat to ground height
Wheelchair provision during
transitional stages
Secondary School – to move towards powered mobility


•   Proceeding 12 months
•   Powered mobility for less efficient self-
    propellers
•   Increase independence
•   Conserve energy
•   Risers for accessing alternative school
    environment
Wheelchair provision during
transitional stages
Adulthood – further education, employment, socialising

• Additional features onto
  powered wheelchairs i.e.
  lights, indicators, increased
  speeds
• Promote independence
• Improve social, educational
  and employment interactions
Whizz-Kidz support during
transitional stages




  Ambassador Clubs
   Kidz Unlimited
Whizz-Kidz support during
transitional stages

   Skillz for Life
 Camp Whizz-Kidz
 Work Experience
   Placements
Guidance on the use of transport
services
Medical Devices Agency (MDA) 2001 states:

• 750,000 wheelchair users within the UK – very few problems or
  incidents occurring
• Minimum standards which are advocated for a user who travels in their
  equipment in a vehicle
• Individual manufacturers’ guidelines and standards set by International
  Standards Organisation (ISO)

Guidance on the Safe Transportation of Wheelchairs (MDA 2001)
Guidance on the use of transport
services
ISO 7176-19:2008 Wheeled mobility devices for use as seats in motor
vehicles
Crash test: full frontal collision, 48 km/h, deceleration of 20g with a 75kg
test dummy.
Minimum standards = suitable for use in transport

ISO 10542 1-5:2001 Wheelchair Tie-Down and Occupant Restraint
Systems (WTORS)

Crash test: full frontal collision, 48 km/h, deceleration of 20g with a 75kg
test dummy and 85kg surrogate wheelchair
Minimum standards = suitable for use in transport, however, some
systems have been tested exceeding minimum standards
Guidance on the use of transport
services
According to the MDA 2001:
    “… in the small number of injuries and fatalities recorded,
    investigations reveal that the cause is rarely attributed to a piece of
    faulty equipment. The majority are the result of inappropriate,
    inadequate or incorrectly used equipment.”

Main problems include:
1) Lack of consistent communication
2) Lack of product information
3) Inadequate training
4) Inappropriate use of WTORS
5) Not securing unoccupied wheelchairs
6) Incorrect use of tail lifts / ramps
Guidance on the use of transport
services
•   Holistic assessment considers
    the use of equipment in family
    or school transport.
•   Advises transferring out of
    equipment where possible.
•   Does not advocate
    compromising on prescription
    for transportation needs.
•   Encourages communication
    between schools, wheelchair
    service provider and
    community transport.
References
Butler C (1986) Effects of Powered Mobility on Self-Initiated Behaviours of Very Young
Children with Locomotor Disability Developmental Medicine & Child Neurology Vol 28: 325-332

Cavanaugh T (2002) The Need for Assistive Technology in Educational Technology
Educational Technology Review Vol 10(1)

Department for Education and Skills (2004) Five Year Strategy for Children and
Learners: putting people at the heart of public services London: HM Government

Department of Health (2002) Guidance for restrictive physical interventions: How to provide
safe services for people with learning disabilities and autistic spectrum disorder London:
Department of Health

Education Act (1996) (c.56) London: HMSO

Health and Safety Executive (2011) Five Steps to Risk Assessment London: Health and Safety
Executive
Judge S (2002) Family-Centered Assistive Technology Assessment and Intervention Practices
for Early Intervention Infants and Young Children Vol 15(1): 60-68
References
Long T, Huang L, Woodbridge M, Woolverton M, Minkel J (2003) Integrating Assistive
Technology Into an Outcome-Driven Model of Service Delivery Infants and Young Children
Vol 16(4): 272-283

Mackey S, McQueen J (1998) Exploring the Association Between Integrated Therapy and
Inclusive Education British Journal of Special Education Vol 25(1): 22-27

Medical Devices Agency (2001) Guidance on the Safe Transportation of Wheelchairs Belfast:
Northern Ireland Adverse Incident Centre

Nisbet P.D (2002) Assessment and Training of Children for Powered Mobility in the UK
Technology and Disability Vol 14: 173-182

ISO 10542 1-5:2001 Wheelchair Tie-Down and Occupant Restraint Systems Geneva:
International Organisation for Standardisation

ISO 7176-19:2008 Wheelchairs - Part 19: Wheeled mobility devices for use as seats in motor
vehicles Geneva: International Organisation for Standardisation

				
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