Relationships between Cognitive Functioning and Powered Mobility Device Use: A Scoping Review

Pellichero, Alice; Kenyon, Lisa K.; Best, Krista L.; Lamontagne, Marie-Eve; Lavoie, Marie Denise; Sorita, Éric; Routhier, François · 2021 · Crossref

DOI: 10.3390/ijerph182312467

archive: archived pipeline: cataloged verified

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Summary

This scoping review investigates the relationship between cognitive functioning and the use of powered mobility devices (PMDs), such as powered wheelchairs and scooters. The study was motivated by the clinical reality that individuals with dual cognitive and mobility impairments are often denied access to PMDs due to subjective clinician judgments regarding safety and capability. This exclusion limits their independence and social participation. The authors aimed to identify the specific cognitive functions necessary for PMD use, determine which assessments are used to evaluate these functions, and describe available PMD training approaches to provide evidence-based guidance for clinicians. The researchers conducted a scoping review adhering to PRISMA guidelines, with the protocol registered in PROSPERO. They searched four online databases (MEDLINE, CINAHL, PsycINFO, and Web of Science) from inception to March 2020. Inclusion criteria required peer-reviewed studies reporting original data on cognitive functioning and PMD use outcomes in users of any age or diagnosis. After screening 4,253 titles and reviewing 126 full texts, 17 studies were included. The methodological quality of these studies was appraised using the Mixed Methods Appraisal Tool (MMAT). The included studies were categorized into two groups: those examining predictive or correlational relationships between cognition and PMD use, and those evaluating the effects of PMD provision or training on user capacity and cognitive outcomes. The review found that specific cognitive functions are critical for PMD operation. Intellectual functions, visual and visuospatial perception, attention, abstraction, judgment, organization, planning, problem-solving, and memory were identified as having significant relationships with PMD use outcomes. For instance, better scores in verbal memory and overall impairment indices predicted more frequent indoor PMD use, while delayed story recall predicted outdoor use. Furthermore, the review highlighted that training is effective; thirteen studies reported significant improvements in PMD capacities following training interventions. Notably, six studies found that PMD training also led to improved cognitive scores, suggesting a reciprocal benefit where mobility training may enhance cognitive functioning. The significance of these findings lies in challenging the practice of excluding individuals with cognitive impairments from PMD provision based on subjective assessments. The results demonstrate that cognitive functioning is indeed required for PMD use, but that individuals with heterogeneous cognitive impairments can improve their operational capacities through targeted training. This evidence supports a shift toward more inclusive, evidence-based practices in rehabilitation, encouraging clinicians to utilize specific cognitive assessments and implement structured training programs rather than denying access. This approach can enhance the independence, social participation, and quality of life for a broader population of individuals with mobility limitations.

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• cognitive impairment