Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study.

Abstract

ObjectivesTo explore: (i) relationships between power wheelchair performance, confidence, mobility and the severity of user’s cognitive impairment; (ii) relationships between cognitive functioning and power wheelchair performance, confidence and mobility; and (iii) how cognitive scores influence power wheelchair performance, confidence and mobility.DesignCross-sectional exploratory study.SubjectsIndependent power wheelchair users; ≥18 years.Outcome measuresCognitive assessments (Montreal Cognitive Assessment, Motor-Free Visual Perception Test, and Dysexecutive Questionnaire) and power wheelchair driving assessments (Power mobility Indoor Driving Assessment, Wheelchair-Skills-Test-Questionnaire, and Life-Space Assessment). Analyses were completed using multivariate analysis of variance and principal component analysis.ResultsThere were a total of 30 participants (with a mean (SD) age of 58 (15) years, who had a mean (SD) of 3 (6.2) years of experience of power wheelchair use, and a mean (SD) score of 22 (5) on the Montreal Cognitive Assessment. There were statistically significant differences in all power wheelchair driving assessments, depending on the severity of cognitive impairment (moderate, p = 0.009; mild, p = <0.001; none, p = 0.009). The first principal component suggested that cognitive functioning, visual perception, and performance explained 69% of the variability in the first principle componenent. The second and third principal components suggested that confidence and the built and social environments also played significant roles in power wheelchair use.ConclusionThere are correlations between cognitive functioning and power wheelchair use in experienced users, with the severity of cognitive impairment influencing power wheelchair driving outcomes.LAY ABSTRACTClinicians report cognitive impairment as a concern when providing power wheelchairs. This study explored differences in power wheelchair use (performance, confidence and mobility) between users with different levels of cognitive impairment, and determined how cognitive impairment influenced power wheelchair use. A total of 30 power wheelchair users completed power wheelchair, cognitive and perceptual assessments. There were statistically significant differences in all power wheelchair assessments depending on the severity of the subject’s cognitive impairment. Cognitive functioning and visual perception were important for power wheelchair performance. Cognitive functioning also influenced power wheelchair confidence, while the built and social environments played significant roles in power wheelchair use. In clinical practice, Montreal Cognitive Assessment scores may provide information to complement power wheelchair assessments, but when used alone may miss some important information. The Power mobility Indoor Driving Assessment, Wheelchair Skills Test Questionnaire, and Life-Space Assessment represent complementary power wheelchair assessments to understand power wheelchair use in adults.