Mounting Assistive Technology Part 2: Considering the Abilities and Needs of the Technology User

-- by Liza MacLean, OT

If you have read my previous article Mounting Assistive Technology Part 1: Where to Start, you’ll be aware that mounting systems are essential for many people with disabilities to ensure they can access their assistive technology effectively. When prescribing a mounting system there are many things that need to be considered to ensure you choose the best system for the user. These include:

The persons abilities and needs
The device that needs to be mounted
The equipment the device needs to be mounted to e.g. wheelchair, desk or bed.

As with all assistive technology assessment and prescription, we should always start with the needs of the user, the following are some of the important user considerations to help with your clinical reasoning and risk assessment.

User Parameters

For people with physical disabilities, it is important to consider whether they have any uncontrollable movements such as ataxia, athetosis, dystonia, or reflexes or postures such as startle or extensor reflexes. In this case, consider carefully where the device and mounting can be positioned on the wheelchair and if this will cause injury to the user. If so, consider repositioning the device and/or mount where it can’t injure them (without compromising their ability to access the device) or use padding on hard surfaces like mounting poles and corners of devices.

Will the position of the mount affect the centre of gravity and the stability of the wheelchair? This is particularly important for manual wheelchairs and with mounts that swing or fold to the side or eye gaze systems which need to be mounted at a certain distance in front of the user. This can be a bigger risk for people that tend to lean forward or to the side of their wheelchairs.

If the user has any behavioural issues where they are likely to grab, pull or bang on the device or the mount, you should consider a rigid style mount with a lockable frame clamp and no moveable parts.

Consider the activities the user needs to perform like toileting and feeding, access to a desk/computer for work or school and trial the mounting system to ensure it is compatible with how the user needs to perform these activities.

If there are likely to be any changes in the user’s weight, wheelchair or seating system, other technology or equipment they use or the environments they access, consider whether the mount prescribed will still meet the user’s needs with these potential changes.

Transfers

If the user can manage a standing transfer, consider how the device and mount can be swung or folded to the side and which side they transfer to and whether this affects the stability of the wheelchair when the chair is empty.

It is very important to consider whether the user needs to transfer independently, in which case a thorough trial of the mounting system in all environments is required to ensure the user can safely and independently remove the mount or move it to the side, particularly in confined spaces like toilets.

If the user is hoisted for transfers, ensure that the device and mount can be completely and easily removed by carers to enable sling and hoist positioning.

Wheelchair Propulsion

How does the user propel their wheelchair? If it is a self propelled manual wheelchair, will the device or mounting impede their access to the wheels for pushing? If so, consider how the mount needs to be positioned for both device access and wheelchair propulsion and try to find a happy medium.

If they use a powered wheelchair, how accurate is the user at moving around, particularly through narrow spaces like doorways? Consider whether the mount or device is like to get bumped or damaged, particularly if it is positioned outside the footprint of the wheelchair. Mounting would usually be positioned on the opposite side to wheelchair joystick to ensure it doesn’t impede access to the joystick.

Access Options

How will the user be accessing the device e.g. with their hand/finger, a switch, head mouse or eye gaze system? You will need to assess the angle/height/distance that the device needs to be from the user and then consider which mount systems will best facilitate the position required.

Some people use more than one access method for different activities or at different times of the day when they are fatigued. If so, you will need to consider a mount that can be adjusted to allow different positions for the different access methods.

Eye gaze systems have a manufacturer specification of a minimum height and distance that they should be positioned in front of the user to enable the camera to track the user’s eye movements. This can cause issues with the centre of gravity of the wheelchair. Not all wheelchairs are suitable for mounting eye gaze systems, particularly paediatric manual wheelchairs. Eye gaze systems can also impede the user’s vision for propelling the wheelchair so careful risk assessment is required when mounting eye gaze systems.

Environment

It is important to consider the environmental factors such as terrain and lighting. Will the wheelchair be going over rough terrain? How secure is the mount and device to withstand these bumps and does it need additional mounting parts to further secure the system?

Some devices need to be positioned at a certain angle when outdoors so the screen can be seen so it is important to trial the device and mount both indoors and outdoors.

Transport

If the user travels in a vehicle in their wheelchair then it is always advisable that the device and mounting are removed for travel. Mounting systems have not been crash tested like wheelchairs. They could come loose in the case of an accident and become a missile in the vehicle and a hard mounting pole in front of a user could cause abdominal injury in an accident.

The device should be removed from the mount and placed in a padded bag and stored securely in the vehicle. The mount should also be removed and stored securely. If the user travels independently, check whether they can manage this themselves, or if they will need help from a driver, if so, it is always advisable to have written instructions with photographs to help the driver remove and replace the device and mount correctly.

So now you have considered the user’s needs and abilities. The next step when prescribing a mounting system is to take into account the device and equipment aspects. My final article in this series, Mounting Assistive Technology Part 3: Device and Equipment Considerations addresses these considerations.

Want to learn more? Follow this link for Mounting and Postioning of Assistive Technology - Part 3: Device Considerations