Who we are

1. Opportunity for meaningful occupation through powered mobility in old ageLisbeth Nilsson, Reg. OT, PhD Rosalie Wang, BSC.(OT), PhD

2. Who we are Lisbeth Nilsson Murjek, Norrbotten, Sweden Rosalie Wang Toronto, Ontario, Canada

3. Objectives This session will review and elucidate on several areas pertaining to improving opportunities for meaningful occupation through powered mobility use in old age for people with declining cognitive abilities

4. 1) Implications of growing older with disability and mobility loss Old age may be accompanied by decreased physical activity, fatigue, motor impairments, slower reactions, and declining memory. The effects resulting from these executive and bodily transformations may be the need for assistance, or withdrawal from previously preferred arenas for activity and social engagement.

5. Risks • Decline of abilities • Decline of access to activities and participation • Decreased self-esteem and self-efficacy • Decreased trust in own potential • Withdrawal from social life • Decreasing social network

6. Drive If the drive for activity and participation in life is declined there is a risk for occupational deprivation with resignation and alienation as possible consequences Kronenberg & Pollard (2006). Political dimensions of occupation and the roles of occupational therapy. The American Journal of Occupational Therapy, 60 (6), 617-625

7. Meaningful occupation Is considered to be an important factor for an individual’s perception of health and well-being. When growing older it is important to remain a person who is believed to hold potential to learn and to keep up abilities by using remaining capacities. Townsend & Wilcock (2004). Occupational justice and client-centered practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71 (2), 75-87

8. Occupational justice Occupation produces • health • well-being • justice Examples of occupational injustice • Occupational alienation • Occupational deprivation • Occupational marginalization • Occupational imbalance Townsend & Wilcock(2004). Occupational justice and client-centered practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71 (2), 75-87 Nilsson, I., & Townsend, E.A. (2010). Occupational justice – Bridging theory and practice. Scandinavian Journal of Occupational Therapy, 17, 57-63.

9. 2) Benefits of powered mobility technology for individuals growing older with a disability The ability to be mobile is empowering and provides opportunities to be active and participate in life. If physical limitations restrict walking or use of manual wheelchairs, scooters or powered wheelchairs may be used to enable occupation, empower the user and re-cultivate his/her sense of control.

10. Enablement and empowerment • Autonomous participation in meaningful activities • Health-building occupations • Choice and control regarding activity and participation

11. 3) Learning and re-learning in old age • Low expectations – self and others • Takes longer time • Re-learning more difficult Required properties for learning: • Motivation • Endurance • Responsiveness • Adaptation • Useful and predictable resources

12. 4) Obstacles for powered mobility access • Social beliefs and policy • Provision rules • Professional guidelines and attitudes • Prioritization of safety • Attitudes and routines in care homes • Architectural barriers

13. 5) New products and approaches • New knowledge and new insights may change attitudes about peoples’ abilities • Provide opportunities for powered mobility in old age Nilsson, L. (2007). Driving to Learn. The process of growing consciousness of tool use – a grounded theory of de-plateauing. PhD thesis, Lund University, Sweden, March 2007. Wang, R. (2010). Enabling Power Wheelchair Mobility with Long-Term Care Home Residents with Cognitive Impairments. PhD thesis, University of Toronto, Canada, December 2010.

14. Enablers Knowledge of the tool use learning process • Assessing powered mobility use • Apply appropriate facilitation Improved ease of learning and control • Customized programming • Good learning properties • Improved feedback to increase performance Improved safety and energy conservation • Obstacle avoidance • Line-follower • Collaborative control

15. Examples of outcomes • Increased control • Increased autonomy • Improved health and well-being • Empowerment • Delayed physical and cognitive decline. • Increased activity and participation

16. Awareness of the benefits of meaningful occupation and power mobility use, and subsequent improvements in the current practice of power mobility provision for older people with disabilities may result in delayed decline of executive functions; and improved activity and social engagement, which in turn may limit occupational deprivation, injustice and health disparities.

17. Thank you for attending! Lisbeth Nilsson, PhD, Reg.OT Affiliated with Lund University, Sweden Box 158, S-960 33 Murjek, Sweden Phone (day time): +46 705838596 lisbeth.nilsson@med.lu.se lisbeth.nilsson@kiruna.nu Rosalie Wang, BSc.(OT), PhD  Toronto Rehabilitation Institute IATSL, Room 438, 500 University Avenue Toronto, Canada, M5G 1V7 Phone (day time): 416.946.8573 wang.rosalie@torontorehab.on.ca