MY TEN-MINUTE of so-called fame on television was probably the highlight of my weekend.
I was fortunate to have been given the opportunity for an interview by the malay primetime news Berita on Suria channel (only because I was malay-speaking haha). It has come to the attention of the reporter about the rising incident of accidents involving motorised scooters in Britain, and she wanted to do a feature story on possible similar issues in Singapore.
An excerpt of the interview (in Malay) can be found here, where different stakeholders were featured – a client who has benefitted from the use of scooter, vendor Falcon Mobility, myself as an occupational therapist and my senior colleague Dr Chan Mei Leng who has had a larger involvement in the local driving rehabilitation scene as well as clinical interests in driving and licensing policy.
Lights, camera, action
Interviewer: More elderly are now using the motorized scooters, instead of wheelchairs. Is this a positive trend we are seeing?
Yes, positive in a way that brings benefits to its users. The elderly who may previously not been able to get out in the community, can now do so. Scooters do not have a negative connotation of “disability” compared to being seen in a motorised wheelchair. As such, people are naturally more accepting of its use. We also see constituencies like Radin Mas and Bukit Merah who have started motorised scooter rentals for its elderly residents with walking difficulties to make use of for their daily commute in the neighbourhood.
Interviewer: How does a mobility scooter benefit its elderly users?
An elderly may have cardiovascular conditions of heart or lung diseases, or osteoarthritis in the knee that may limit their ability for long-distance walking. With the motorised scooter, they are now able to improve their community mobility – be able to go marketing, visit friends, travel to polyclinic for medical appointments. We know that health is not merely the absence of disease, as healthy ageing includes engagement in social and productive activities. As such, the elderly do not have to depend on a caregiver to get their community tasks and needs done as the motorised scooter provides them the avenue to be independent. Well-elderly studies have shown how engagement in these valued activities improves one’s quality of life, potentially leading longer happy healthy lives.
Interviewer: But wouldn’t such scooters, at the same time, discourage the elderly from walking, hence worsening their condition over time?
There is some truth in that the lack of walking may increase one’s risk of cardiovascular diseases, increase risks of further weight gain, reduces joint weight bearing and increases likelihood of muscle atrophy from disuse. Therefore, there needs to be a balance between two. The motorised scooter should be an aid to mobility but not a replacement. Examples can include using the scooter to get to the nearest exercise corner in the neighbourhood, or joining community-based activities like Taichi to remain active. The Health Promotion Board (HPB) recommends 150 minutes/week of moderate intensity exercise like brisk walking, dancing and doing household chores.
Interviewer: How do you assess if an elderly is fit to operate a mobility scooters?
Firstly we look at the reason for the need of a motorised scooter – is it a medical condition that limits their lifestyle needs? How often and in which places does the elderly require the use of the scooter? Does he require taking the public transport? The distance, frequency and terrain of travel would determine the type of scooter being prescribed. We would also assess the elderly’s vision and perception as this is an important aspect to road safety. Cognitively, they should ideally be able to obey commands and have sufficient safety awareness. The therapist would assess the function of the hand and seating posture.
Lastly, as occupational therapists we do not just assess the person but also the environment. Are there kerbs in the house or obstacles in the community that pose potential difficulties for scooter use? We would then proceed to trial and train the elderly for scooter use in the clinic, at home and in community places as well as the MRT public transport. Training typically involves 3-4 sessions. The last stage would involve prescribing proper scooter features to match the person’s needs and affordability; working alongside the vendors.
Interviewer: Do you see such scooters being misused here? In the U.K, even those who can walk, would buy such scooters as a means of transport. http://www.dailymail.co.uk/news/article-2143307/Britain-mobility-scooter-capital-Europe-300-000-roads.html
Not that I have seen, as the cases that we see in the seating clinic would have been referred from the doctor and usually have a genuine cause for referral. But with the ageing population and greater awareness of such devices alongside greater disposable income, this may potentially become a rising issue in the near future.
Interviewer: Is it illegal to buy a scooter without a disability?
No such law, anyone can purchase a motorized scooter from a vendor if they have the means to afford them.
Interviewer: Who qualifies to buy such scooters?
If a person requires government funding for the device, for example through the Senior Mobility and Enabling Fund (SMF), they would typically obtain it from a healthcare institution. The person would require a doctor’s referral and a registered occupational therapist’s assessment, followed by training for motorised scooter use.
Interviewer: Those who receive the subsidized scooters under the Senior Mobility and Enabling Fund will have to undergo health assessment and therapy before they can start using the scooter. But what about those who go directly to the retailer?
Unfortunately, no. As long as they can afford the cost of the scooter, they can purchase and use the scooter.
Interviewer: What are the dangers of not having proper training and health assessment before operating such scooters?
Buying a scooter is not as easy as choosing which colour you prefer, hopping on it and driving off. Just like driving a car, training needs to be done. The dangers of not having one is improper fit. Therapists are equipped with the skils and knowledge to train the person, to modify the device or the environment to have a person-environment-device fit for optimal function. Skills like getting on/off MRT trains, making a turn in tight spaces, negotiating small kerbs are important skills set that may not be implicit to first-time users. With proper fit and training, this reduces the risk of accidents that may potentially endanger not just users by also passers-by in public.
Screenshot from feature story on Berita 10 Jan 2016
In the latter part of the interview, Dr Chan Mei Leng added that the use of motorized scooter involves multiple stakeholders. Occupational therapists need to work hand in hand with family members to ensure that patients are able to use their scooters safely. She stressed that as occupational therapists head out into the community for training, it becomes a platform to look at issues of accessibility in the surrounding built environment. We are in the best position to give feedback to relevant authorities like Land Transport Authority (LTA) to make necessary adjustments for improvement. Dr Chan also urged members of the public to be more accepting towards users with motorized scooters around their neighbourhood.
What was interesting is that vendor Falcon Mobility commented on the need for scooter users to get personal insurance. He also suggested exploring a system of registering each individual scooter as a medical device and tagging it to its users.
It was nice hearing perspectives on a single issue from different angles. At the end of the day, I felt excited at the prospect of how pervasive the issue of powered mobility has become in view of the ageing population, increase use and rising sales of these devices. What was equally exciting to note is the increasing awareness of the profession’s role in the assessment and training of motorised scooter users, to stand for what occupational therapists believe in – person-environment-device fit to ultimately empower occupations.