Wheelchairs - Whizz-Kidz

Report
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
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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
through movement
• Benefits increase interactions
with people, objects and
surrounding environments
• Aids the development of
cognitive, emotional and
psychological skills
• Interactions create sense of
achievement and autonomy
leading onto further
exploration
Lack of independence may mean:
•decreased motivation
•reduced confidence
•feelings of frustration
•passive
•incurious
•learned helplessness
Nisbet 2002
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:
• Specified National Curriculum
standards
• Attainment of formal
qualifications
• Friendships that will be made
• Acceptable social behaviours
that will be shaped
Section 351 of Education Act 1996:
1) Promotes the spiritual, moral,
cultural, mental and physical
development of pupils at the school
and of society.
2) Prepares pupils at the school for the
opportunities, responsibilities and
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
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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 selfpropellers
• 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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