Driving to Learn™ – a stimulating practice

Lisbeth NilssonPhD, occupational

therapist and specialist

Associated to Lund University and Norrbotten Health County

Council

The method Driving to Learn™Learn to understand the own body and the lived experience Learn to influence, direct and controlA gate to becoming a tool user

Driving to Learn™The method was developed for children, youth and

adults with severe cognitive disabilities Nilsson, L. (1996). What can be achieved by training in powered wheelchair. A study of two

multihandicapped preschool children. Masters thesis, Lund university

The Driving to Learn project was carried out 1993 – 2007 Project Paediatric rehabilitation, Norrbotten 1993-2007 Project Luleå, Special school 1997 – 1999 Project Jokkmokk, Primary Health day-care service 1999 – 2001 R&D-project, Jokkmokk, Day centre, special school 2003 – 2006

Doctoral dissertation Lund 2007 Nilsson, L. (2007). Driving to Learn. The process of growing consciousness of tool use – a grounded

theory of de-plateauing. Dissertation, Lund University, Lund, Sweden.

ResponsibilityProblem-solving

Executive functionsMulti-tasking

Explorative behaviourAttention regulation

AlertnessWakefulness

Becoming a tool user

Neural plasticity

Independent mobility

Body-awareness

sense of self

Memory

Motor skill perception

Own initiatives to

activity

Interaction communicatio

n

Motivation emotions

Executive

functions

Driving to Learn – what develops?

TIRO – the learning toolA tool for learningA powered wheelchair for practiceCan be used in many different practicesOnly for use in clinics, schools, day care and alike

TIRO – the learning toolThe design is based on the findings in the Driving to Learn projectThree prototypes were clinically tested

Predictable functionsGood properties for learningStable active sittingA ”one-for-al” seating unit

Developed in co-operation with Permobil AB, Sweden and Permobil EuropeNilsson, L., & Eklund, M. (2006). Driving to Learn. Powered wheelchair training for those with cognitive disabilities. International Journal of Therapy andRehabilitation, 13(11), 517-527.

TIRO – a wheelchair for practice

TIRO makes practice safer for people who have physical limitations or cognitive disabilities

Seating unit that quickly can be adjusted in-between child and adult size without using any hand tools

Joystick mounted in the center of a Plexiglass tray that is attached to the armrests - possibility to choose best hand for operation or use both hands

Electronics with a special programming that makes driving safer and facilitates learning

One-for-all seating unitMakes it possible to use ONE powered wheelchair for

many who needs practice – both children and adults

Opens opportunities for those who needs very long periods of practice to learn

If rehabilitation practices are located in the same building complex they can have one TIRO together and share the costs

Assistive technology providers can have a TIRO for assessment and rental

Multi-sensory Centres can have a TIRO to provide movement experiences in action

TIRO – quick shift adult – child size

Quick adjustment of tray height

Electronic box on the back rest

Mechanical bumper

Sliding rail for back rest + tray

Plexi-glass tray with mid-placed

joystick

Seating depth

ALP - toolALP = Assessment of Learning Powered mobility use

A tool for assessment and facilitation of tool-use learning

The ALP-tool involves 2 parts

The ALP-instrumentThe learning process has eight phases:

from 1 – novice to 8 expert The phases are grouped in three stages:

exploration of functions, sequencing and performance

AND

Strategies facilitating learning

Phase

Attention Activity & Movement

Understanding of tool use

Expressions & Emotions

Interaction & Communication

STAGE

8 Attention well established and sustained

Occupation composed of two or more activities

Integratedtool use

Dependent on the doing of other activities

Multi-level integrated interactions

Explore

PERFORMANCEBody, machi

ne, environment,

& occupa

tion

7 Multi- channelled attentionGenerally focused

Occupation for its own sake

Fluent precise use of tool

Happiness Satisfaction

Concurrent interactions

6 Multi-channelled attention but easily disrupted

ActivityGoal-directed

Competent use of tool

Serious Contented LaughExcited

Consecutive interactions

5 Two-channelled attention

Sequences of chains of acts

Idea of competent tool use is born

Eager, smileSeriousFrustration

Reciprocated interactionTriadic interaction

Explore

SEQUENCING

Body, machine, & environment

4 Single channelled attention but able to shift spontaneously

Chains of acts Exploration of extended tool use

Serious SmileSometimes laugh

Mutual interaction

3 Single channelled attention but able to shift attention

Actdirected

Basic use of tool SeriousContentedSmile

Initiates interactionExplor

e FUNCTION

SBody,

& machi

ne

2 Single channelled attention

Pre-act Idea of basic tool use is born

ContentedCuriousAnxiousAngry

Responds to interaction

1 Extreme distractibilityPassive or anxious

ExcitedNon-actRejection

No or vague idea of tool use

OpenNeutralAnxiety

No response

Avoidance

The ALP – instrument (Nilsson & Durkin, JRRD, 2014)

Strategies facilitating learning

Dialogue pedagogyMutual interaction Co-construction of the practice session Facilitation of problem solving abilityShifts between difficult – tension and easy - relaxationShifts between seriousness and fun, playfulnessHand over responsibility for the situation to the

learner

Evidence and researchEvidence of todayOngoing researchWhere the method is implemented

Evidence for Driving to Learn™

Research has been carried out since 1993Qualitative methodStudies carried out in clinical practices Participants aged from 3 months to 86 yearsDissertation 2007: results from

109 children and adults with cognitive disabilities 17 infants with typical development

Various aetiologies causing the cognitive limitationsWalking participants

Publications – in journals Nilsson, L., & Durkin, J. (2014). Assessment of learning powered mobility use – applying Grounded

Theory to occupational performance. Journal of rehabilitation research and development, 51(6),963–74

Nilsson, L. (2012). Driving to Learn. A new intervention for people with stroke and spatial neglect. Posture and Mobility Group Journal 29(2),15-19.

Nilsson, L., Eklund, M., & Nyberg, P. (2011). Driving to Learn in powered wheelchair. The inter-rater reliability of a tool for assessment of joystick-use. Australian Occupational Therapy Journal, (58), 447-454.

Nilsson, L., Eklund, M., Nyberg, P., & Thulesius, H. (2011). Driving to Learn in a Powered Wheelchair: Identification of the Process of Growing Consciousness of Joystick-use in People with Profound Cognitive Disabilities. The American Journal of Occupational Therapy, (65)6, 652-660.

Nilsson, L. (2011). Communication mediated by a powered wheelchair: People with profound cognitive disabilities. Disability Studies Quarterly, 31(04)

Nilsson, L., Nyberg, P., & Eklund, M. (2010). Training characteristics important for growing consciousness of joystick-use in people with profound cognitive disabilities. International Journal of Therapy and Rehabilitation, 17(11), 588-595.

Nilsson, L., & Eklund, M. (2006). Driving to Learn. Powered wheelchair training for those with cognitive disabilities. International Journal of Therapy and Rehabilitation, 13(11), 517-527.

Nilsson, L., & Nyberg, P. (2003). Driving to Learn. A new concept for training children with profound cognitive disabilities in powered wheelchair. American Journal of Occupational Therapy, 57, 229-233.

Nilsson, L., & Nyberg, P. (1999). Single-switch control versus powered wheelchair for training cause-effect relationships: case studies. Technology and Disability, 11, 35-38.

Driving to Learn™ - further research

SWEDENR&D-project Region Skåne BoU-rehabilition 2007 – 2011

Svensson, E., & Nilsson, L. (2009). Köra för Lära. Kort Fou-rapport nr 3-2009. FoU Habilitering & Hjälpmedel, Region Skåne. (in Swedish)

R&D-project Norrbotten, Stroke-rehabilitation and BoU-habilitering 2010 –

Nilsson, L. (2012). Köra för att Lära™ stimulerar utveckling och lärande hos personer med kognitiva funktionsnedsättningar. Tidskriften Arbetsterapeuten, nr 8, Forskning i praxis. (in Swedish)

R&D-project, Norrbotten, Nursing home 2011 – R&D-project, KI, Stockholm, small children 2013 –

SWITZERLANDResearch project, St Gallen, children with CP aged 2-4

years 2015 –

Close to 4 months - driving TIRO

Exploring functions and sequencing phases 3-4-5

Contact and informationContact: Lisbeth NilssonMail address: Box 158, 960 33 Murjek, SWEDENE-mail: lisbeth.nilsson@med.lu.se

Information:Homepage: www.lisbethnilsson.se/en/ ResearchGate: http://

www.researchgate.net/profile/Lisbeth_Nilsson LinkedIn: http://se.linkedin.com/pub/lisbeth-nilsson/25/745/1a2