Lisbeth Nilsson, Mona Eklund, Per Nyberg, Hans Thulesius; Driving to Learn in a Powered Wheelchair: The Process of Learning Joystick Use in People With Profound Cognitive Disabilities. Am J Occup Ther 2011;65(6):652-660. doi: 10.5014/ajot.2011.001750.
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© 2019 American Occupational Therapy Association
The Driving to Learn project explored ways to help people with profound cognitive disabilities practice operating a joystick-operated powered wheelchair. The project used a grounded theory approach with constant comparative analysis and was carried out over 12 yr. The participants were 45 children and adults with profound cognitive disabilities. Reference groups included 17 typically developing infants and 64 participants with lesser degrees of cognitive disability. The data sources included video recordings, field notes, open interviews, and a rich mixture of literature. The findings that emerged yielded strategies for facilitating achievements, an 8-phase learning process, an assessment tool, and a grounded theory of deplateauing explaining the properties necessary for participants to exceed expected limitations and plateaus. Eight participants with profound cognitive disabilities reached goal-directed driving or higher. Participants were empowered by attaining increased control over tool use, improving their autonomy and quality of life.
Using reassuring, calming interaction to build a reliable and mutual relationship
Coupling cause–effect relationships (i.e., the participant’s own activity on the joystick set the chair in motion; thus, the chair should move only when the participant was involved in the joystick activation)
Providing manual guidance to show functions and facilitate activity or to demonstrate possible joystick use and problem solving
Directing attention to the consequences of activity and interaction
Emphasizing effects from the participant’s own activity to stimulate development of a sense of self and agency
Using meaning-making language with descriptions, interpretations, explanations, and questions to enhance understanding of effects and consequences
Allowing long time sequences for responses and initiative to act and interact
Allowing collisions to provide bodily experiences of bumping into things
Offering contact and interaction to facilitate object manipulation
Encouraging reflection, touch, manipulation, exploration, experimentation, turn taking, and choice making
Using verbal encouragement, prompting, and single words or very short sentences imperatively to instill words with meaning
Connecting doing (i.e., the act) with language by verbal labeling of body parts, objects, acts, and interactions
Avoiding isolated judging comments or loud expressions that might cause anxiety, passivity, fright, or shame
Stimulating mutual interaction, discourse, and dialogic inquiry
Inspiring the participant’s own initiative to act on or act with the joystick to drive or navigate
Deciding on options, proposals, exercises, and setting of rules in cooperation.
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