(Dickson, Unsworth & Gohil 2021)
PMD type recommendation: A powered mobility device can be either a powered wheelchair or a motorised mobility scooter, collectively referred to as a Powered Mobility Device (PMD). For reasons of safety, clarity and transparency, the authors of the Powered Mobility Device Autonomy Residential Screen (PoMoDARS) recommend that residential aged care facilities independently document a clear distinction between PMD types for INDOOR access. As a guide, a mobility scooter, with central tiller (see Table 1), is preferred for OUTDOOR use ONLY due to limited maneuverability for indoor spaces and in many instances, a larger footprint size. Residents using mobility scooters typically walk indoors and use the scooter for longer outdoor distances. A powered wheelchair (see Table 1) can be used in multiple settings and by residents who have little to no mobility, due to the open front access for hoist transfers, smaller footprint, up to 360 maneuverability and option to add specialised seating supports. Among powered wheelchairs, the mid-wheel drive model is preferred for the tightest spaces, including bedrooms, bathrooms, and lifts, also having the option of upgrades to suspension and torque for safe use on hills and cambered outdoor surfaces. If in doubt about any of the equipment or processes discussed here, consultation with an allied health professional with specialist skills in powered mobility (occupational therapist or physiotherapist) is advised.
Part 1: Capacity for PMD use (Features and factors that may impact on performance)
The aim for part 1 is to examine the PMD user’s general health, level of function and recent past performance to isolate risk factors that may impact upon safe use of a PMD. You, the assessor will examine the following:
General health/ medical condition: – General wellness, type and number of medical diagnoses, and stability of condition/s should be examined to provide a rating. Score (1) where health is stable and relatively uncomplicated; score (2) where slightly more complicated, such as where resident has regular ‘off-days’; score (3) for neurological or progressive diagnoses e.g. cerebral palsy, multiple sclerosis, stroke, motor neuron disease, brain injury, Parkinson’s disease; or score (4) for more than one recent episode of rapid change, or large or frequent fluctuation in function or level of alertness, indicating instability or permanent change e.g. metabolic/ cardiovascular/ systemic.
Visual function: – Assessors should consider visual acuity and whether direction, guidance or support is needed for mobility in everyday activities. Visual perceptual ability is included as will contribute to the amount of guidance needed. Three levels are outlined; for no guidance score (1); for visual difficulty with no physical guidance to move around score (3); and for physical assistance where one to one guidance is needed to move around, score (4) and note – incompatible with independent PMD use.
Cognitive function: – Cognitive function descriptors allow for ratings of nil, mild, moderate or safety risk, based on knowledge of resident functioning in activities of daily living. Observations can include, but are not limited to, planning and sequencing of activities like dressing, brushing teeth or using a telephone to call a relative, naming items, recalling details, attention span, reasoning skills, ability to learn and orientation to time, place and person. Although not essential, common cognitive screening tools can be used within the PMD screening process. The Psychogeriatric Assessment Scale (PAS), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Standardised Mini-Mental State Examination (SMMSE), Rowland Universal Dementia Assessment Score (Rudas) or the Addenbrooke’s Cognitive Examination III (Acer III) are examples of cognitive screens. If two scores are on the record, assessors should consider which is most recent and whether the chosen score accurately reflects the resident, as current level of function for the individual is needed when choosing a rating. Assessors can refer to the Cognitive Screen Score Conversion (Table 2)to determine a rating of 1-4 for the PoMoDARS or select the appropriate descriptor.
Motor control: – Assessors should consider motor function for joystick or tiller use, hands or other. Hemiplegia should be rated based on whether the PMD can be successfully operated using the uninvolved side alone. Choose from three options; score (1) for smooth control; score (3) for some difficulty such as tremor, pain, or grasp, where modifications such as large grip joystick or alternate controls are used; score (4) for inadequate control where safety concerns exist.
Transfers: – Assessors should consider safety of transfer from bed to chair or wheelchair, considering recent history. Score (1) for stable independent transfers and fully supported transfers, such as hoist; score (2) for assisted transfers where safely performed; score (3) for unsteady, assisted, or unassisted transfers with falls risk; or score (4) for unsafe transfers with frequent falls. Note: a score of (4) for transfers is likely to co-exist with higher score/s for behaviour/ medication/ substances/ incident history items.
Behaviour: – Altered behaviour in combination with control of a PMD and close proximity to others, can pose safety concerns in residential care. Assessors should look for evidence or indication of altered behaviour, such as elevated risk taking, impulsiveness, agitation, anxiety, or depression for an average 24-hour period. As per the descriptors, the severity of behaviour should be considered in the rating. Caution: Assessors should ensure resident behaviour is accurately reflected and reports are current.
Medication: – Assessors should consider motor function for joystick or tiller use, hands or other. Hemiplegia should be rated based on whether the PMD can be successfully operated using the uninvolved side alone. Choose from three options; score (1) for smooth control; score (3) for some difficulty such as tremor, pain, or grasp, where modifications such as large grip joystick or alternate controls are used; score (4) for inadequate control where safety concerns exist.
Substances: – Assessors should consider whether there is evidence in behaviour or performance to indicate current overuse of substances such as alcohol or drugs. Past overuse should be reviewed, but not prioritised for scoring. Score (1) for no evidence of overuse; or score (4) for overuse evident and likely to impact PMD use.
PMD Incident History: – Assessors should review the records for the past 6 months and check with PMD user, staff, and/ or family as appropriate, to determine the number and severity of incidents related to PMD use. Score (1) for no incident history; score (2) for minor incident involving self or property; score (3) for regular minor incidents; score (4) for any incident involving another person, medical attention, or hospital transfer. NOTE for NEW PMD users with no incident history score (1).
Capacity Score: – On completion of Part 1, assessors will tally the scores in the right-hand column, multiply the result by 100, then divide by 36 to produce a capacity percentage score (C%). Record C% in the box provided.
Part 2: Performance Score
For this section, assessors should rate the PMD user based on average everyday performance, choosing to observe across a 24- hour period if necessary, indoors, outdoors, or both, according to individual need and PMD type. For NEW PMD users, trial/ loan equipment is required, as it is recommended that PoMoDARS should be completed prior to purchase of a new PMD.
Ability to Go: – Assessors should consider ability to start the PMD, either using a key or a switch, having detached the battery charger. PMD will not start when connected to a charger. (If physical assistance is needed to detach the charger, PMD user must demonstrate full understanding of the task by providing clear and complete instructions to the carer. If unable, check whether verbal prompting assists problem solving). Assessors should observe PMD user as they check the environment for safety, travel straight, turn a 90° corner and 180° change of direction. These items are placed together because they are each essential to autonomous use of a PMD. If assistance is needed for any part of starting, travelling straight or turning, consider whether the action can be completed with verbal prompting alone, score (2); occasional physical assistance/ correction, score (3); or whether unable to complete the task without regular or continuous physical assistance, score (4). Where performance between the items varies, the rating should be based on average performance, prioritising safety of PMD user, other residents, staff, visitors.
Ability to Stop: – Assessors should consider stopping speed and accuracy in response to obstacles in the path and to a command of ‘stop’. These skills are critical to safe, autonomous use of a PMD. Assessors must consider the outcomes of stopping speed and accuracy in the environment of use to rate 1-4. Stopping will be further reviewed within items such as attention and alertness and giving way to ambulant pedestrians.
Attention and Alertness: – Assessors should consider attention and alertness to changes as they occur in the environment, such as surface texture, camber, edges, or obstacles and determine how much input is needed and whether that is acceptable. Look for responses such as, head turning, verbal acknowledgement and stopping when distractions occur.
Giving way to ambulant pedestrians: – Giving way to ambulant pedestrians is a critical skill in residential care. Assessors must consider how closely the PMD user will follow recommended safety measures. Only three descriptors are provided because if physical assistance is needed to prevent collision with an ambulant pedestrian, the PMD user would be considered unsafe to use the device. If a lack of understanding of pedestrian needs is evident during screening, one to one training sessions can be applied to improve performance prior to re-assessment.
Speed control: – Assessors should consider whether the PMD user understands the need and can adjust speed dial or switches for different environments to reduce speed (like a car accelerator). If unsure, ask PMD user to explain the speed controls.
Navigating narrow spaces: – Assessors should consider ability to travel in narrow spaces such as doorways, lifts, paths, ramps, bedside areas, or bathrooms as appropriate. This skill is challenging and needs to be attempted after developing prior skills. Assessors will decide whether the performance is; scored (1) achieved autonomously with self-correction alone; scored (2) for minor errors correctable with verbal prompting only; scored (3) for physical assistance to correct occasional errors of minor contact; or scored (4) for unsafe performance based on the frequency, speed, or force of any impact. Consider if training can be used to improve performance.
Switching off: – Switching the PMD OFF is both a memory task and a safety requirement. Failure to switch off may cause accidental activation by self, other resident, or staff, with risk of serious injury.
Sitting posture & tolerance: – Sitting posture and tolerance are prerequisites to PMD use, as the trunk must be stable to support use of PMD controls. This item must be assessed toward the end of the session to determine whether fatigue is likely to impact posture after a minimum of one hour in the seat. Specialised seating is included in the score of (1) if it contributes to a stable, well tolerated posture; or (3) where physical assistance is required to re-position over time, indicating slow change of position in relation to the controls; or (4) where sitting posture is noted to be unstable such as sliding down in the seat or leaning to the side significantly, and is likely to impact control of the PMD.
Recall of control functions: – Assessors should consider the accuracy of recall for the function buttons or switches located on the control box alongside the joystick or tiller on the PMD. Assessment will include problem solving, planning, and sequencing, depending on the complexity of controls. It is important to determine when the use or selection of the controls becomes inconsistent with safe PMD use, random, incorrect, or unsafe (4).
Performance Score: – On completion of part 2, assessors will tally the scores from the right-hand column, then multiply the result by 100, then divide by 36 to produce a performance percentage score (P%). Record P% in the box provided.
TOTAL score: – To determine the Total score, add (C% + P%) and divide by 2 to produce T% (total mean score). Round to whole numbers. Record T% in the lower right corner box.
PoMoDARS: Outcome Table
Instructions: Transfer the T% result to Table 3 to determine a suggested PMD supervision recommendation.
Please use suggested supervision recommendation as a guide to assist with intervention and care planning and note this does not replace independent clinical reasoning and review.
PoMoDARS 