Individuals with mobility impairments can benefit from power wheelchair (PWC) mobility. Benefits of PWC use include increased independence, social engagement, and better mobility, and can improve participation and quality of life. In addition, enabling independent mobility through PWCs can reduce reliance on caregivers. However, PWC provision is complex. Ensuring safe an effective driving requires consideration of diagnosis and prognosis, motor cognitive and perceptual capacities, and environments. Although cognition is a large concern that is expressed by clinicians when prescribing PWCs, existing PWC driving tools do not fully include cognitive items. Moreover, there are limited validated screening tools to assess readiness for PWCs, and current validated tools focus predominantly on performance and driving skills. Additionally, existing PWC training programs focus mainly on the principles of motor learning. It is likely that individuals with cognitive impairments due to brain injury could benefit from PWCs, but they may be precluded from provision of a PWC due to premature clinical judgement about cognitive readiness for PWC driving. It is critical to examine methods for assessing and training the cognitive skills required to drive a PWC. 

The aim of this presentation is to describe the protocol for a program of research designed to enhance PWC provision through better assessment and training of cognitive capacity and ability to learn according to various cognitive factors (e.g., executive function, problem solving). The following 4-step sequential process and methodologies will be used: Study 1) A systematic review to identify factors related to PWC driving and cognition that are present in existing outcome tools and training programs, Study 2) A cross-sectional study with n=40 PWC users with varied cognitive functioning to explore the relationship between the skills required for PWC driving and cognitive functioning, Study 3) A cognition-enhanced PWC driver program will be developed using an integrated approach to identify the cognitive factors that are critical for PWC driving, and Study 4) A pre-post feasibility design will be used to develop and evaluate a cognition-enhanced PWC training program.

The proposed protocol outlines the steps for selecting adequate screening tools for cognitive readiness for PWC driving, methods for selecting and implementing evidence-based approaches to develop a cognition-enhanced PWC driving program, and a plan to evaluate the feasibility and influence of a novel intervention. Realization of the proposed research will lead to the development of a novel intervention that will be evaluated in a future clinical trial. If feasible and effective, a cognitive-enhanced PWC driving program may improve access to PWC mobility for individuals with brain injury, who may have otherwise been excluded. In turn, successful PWC mobility could improve participation and quality of life for the individuals, while reducing caregiver burden.

Cognitive functioning: a determinant of safe and effective driving in power wheelchair