The Driving to Learn project explored ways to help people with profound cognitive disabilities practice operating a joystick-operated powered wheelchair. The project used a grounded theory approach with constant comparative analysis and was carried out over 12 yr. The participants were 45 children and adults with profound cognitive disabilities. Reference groups included 17 typically developing infants and 64 participants with lesser degrees of cognitive disability. The data sources included video recordings, field notes, open interviews, and a rich mixture of literature. The findings that emerged yielded strategies for facilitating achievements, an 8-phase learning process, an assessment tool, and a grounded theory of deplateauing explaining the properties necessary for participants to exceed expected limitations and plateaus. Eight participants with profound cognitive disabilities reached goal-directed driving or higher. Participants were empowered by attaining increased control over tool use, improving their autonomy and quality of life.Nilsson, L., Eklund, M., Nyberg, P., & Thulesius, H. (2011). Driving to learn in a powered wheelchair: The process of learning joystick use in people with profound cognitive disabilities.

Abstract-Collaboration by two grounded theory researchers, who each had developed a learning continuum instrument, led to the emergence of a new tool for assessment of learning powered mobility use. We undertook a rigorous process of comparative reanalysis that included merging, modifying, and expanding our previous research findings. A new instrument together with its facilitating strategies emerged in the course of revisits to our existing rich account of data taken from real environment powered mobility practice over an extensive time period. Instrument descriptors, categories, phases, and stages allow a facilitator to assess actual phase and plot actual occupational performance and provide a learner with the just right challenge through the learning process. Facilitating strategies are described for each of the phases and provide directions for involvement during learner performance. The learning approach is led by a belief system that the intervention is user-led, working in partnership and empowering the learner. The new assessment tool is inclusive of every potential powered mobility user because it focuses on the whole continuum of the learning process of powered mobility use from novice to expert. The new tool was appraised by clinicians and has been used successfully in clinical practice in the United Kingdom and Sweden.

Analysis of the case studies of two preschool children with profound cognitive disabilities indicates that training in a powered wheelchair can increase wakefulness and alertness, stimulate a limited use of the arms and hands, and promote the understanding of very simple cause-and-effect relationships. The enhanced activity level had a positive influence on the children's ability to react to external stimuli and invitations to interact. These effects in turn promoted the development of initiative and exploratory behavior. Because of their profound cognitive disabilities, neither of the children was able to reach the normative training goal-to be able to drive purposefully and safely. In this paper the target group is defined according to criteria for the prescription of powered wheelchairs and the resulting new concept of 'driving to learn' is described and discussed from different aspects.

Aim The Driving to Learn project focused on people with profound cognitive disabilities and their possible achievements from practicing joystick-use in a powered wheelchair. The aim of this study within the project was to statistically analyse the participants' outcomes, and to explore factors, in terms of participant and training characteristics, associated with a favourable outcome of training joystick-use. Methods In this study, previously collected and analysed data and findings from 45 participants (aged 12 months to 52 years) were used to extract participant and training characteristics. Associations between participant and training characteristics and the participant's outcome of joystick-use were calculated. Results The results showed that training characteristics were decisive for reaching steering control, whereas participant characteristics were not. Factors significantly associated with participant's reaching ‘control of steering’ were: taking part in more than 30 training sessions (p=0.004), training at two or more training venues (p=0.007), undergoing a training period longer than two years (p=0.016), and a high degree of training with professional trainers (p=0.045). Conclusions Appropriate training characteristics assisted growing consciousness of joystick-use in people with profound cognitive disabilities. Findings from the project also include the identification of an eight-phase process of growing consciousness of joystick-use and the development of a tool for assessment of phases, which were used to measure the participants outcome.

When comparing the three raters' assessments with that of LN (N = 72), the calculation gave a weighted kappa value of 0.85. All raters judged the tool as having a high degree of usability for assessing phases of joystick-use. Minimal differences were found between the experienced and inexperienced raters. CONCLUSION AND SIGNIFICANCE OF THE STUDY: The inter-rater reliability of the assessment tool was very good. The findings indicate that the tool is reliable and has clinical usability in occupational therapy practice.