Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study


  • Alice Pellichero Department of Rehabilitation, Université Laval, 2Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, QC, Canada
  • Krista Best
  • Jean Leblond
  • Pauline Coignard
  • Éric Sorita
  • François Routhier



wheelchair, cognition disorders, self-efficacy, mobility limitation, power wheelchair


Objectives: To explore: (i) relationships between power wheelchair performance, confidence, mobility and the severity of user’s cognitive impairment; (ii) relationships between cognitive functioning and power wheelchair performance, confidence and mobility; and (iii) how cognitive scores influence power wheelchair performance, confidence and mobility.

Design: Cross-sectional exploratory study.

Subjects: Independent power wheelchair users; ≥18 years.

Outcome measures: Cognitive assessments (Montreal Cognitive Assessment, Motor-Free Visual Perception Test, and Dysexecutive Questionnaire) and power wheelchair driving assessments (Power mobility Indoor Driving Assessment, Wheelchair-Skills-Test-Questionnaire, and Life-Space Assessment). Analyses were completed using multivariate analysis of variance and principal component analysis.

Results: There were a total of 30 participants (with a mean (SD) age of 58 (15) years, who had a mean (SD) of 3 (6.2) years of experience of power wheelchair use, and a mean (SD) score of 22 (5) on the Montreal Cognitive Assessment. There were statistically significant differences in all power wheelchair driving assessments, depending on the severity of cognitive impairment (moderate, p = 0.009; mild, p = <0.001; none, p = 0.009). The first principal component suggested that cognitive functioning, visual perception, and performance explained 69% of the variability in the first principle componenent. The second and third principal components suggested that confidence and the built and social environments also played significant roles in power wheelchair use.

Conclusion: There are correlations between cognitive functioning and power wheelchair use in experienced users, with the severity of cognitive impairment influencing power wheelchair driving outcomes.

Lay abstract

Clinicians report cognitive impairment as a concern when providing power wheelchairs. This study explored differ-ences in power wheelchair use (performance, confidence and mobility) between users with different levels of cognitive impairment, and determined how cognitive impairment influenced power wheelchair use. A total of 30 power wheelchair users completed power wheelchair, cognitive and perceptual assessments. There were statistically significant differences in all power wheelchair assessments depending on the severity of the subject’s cognitive impairment. Cognitive functioning and visual perception were important for power wheelchair performance. Cognitive functioning also influenced power wheelchair confidence, while the built and social environments played significant roles in power wheelchair use. In clinical practice, Montreal Cognitive Assessment scores may provide information to complement power wheelchair assessments, but when used alone may miss some important information. The Power mobility Indoor Driving Assessment, Wheelchair Skills Test Questionnaire, and Life-Space Assessment represent complementary power wheelchair assessments to understand power wheelchair use in adults.


Fasciglione M. Article 20 [Personal mobility]. In: Della Fina V, Cera R, Palmisano G, éditeurs. The United Nations Convention on the Rights of Persons with Disabilities [Internet]. Cham: Springer International Publishing; 2017 [cited 2021 Feb 17]. p. 375–85. Available from:

Carver J, Ganus A, Ivey JM, Plummer T, Eubank A. The impact of mobility assistive technology devices on participation for individuals with disabilities. Disabil Rehabil Assist Technol 2015; 1–10.

Pettersson I, Törnquist K, Ahlström G. The effect of an outdoor powered wheelchair on activity and participation in users with stroke. Disabil Rehabil Assist Technol 2006; 1: 235–243.

Fomiatti R, Richmond J, Moir L, Millsteed J. A systematic review of the impact of powered mobility devices on older adults’ activity engagement. Phys Occupat Ther Geriatr 2013; 31: 297–309.

Frank A, Neophytou C, Frank J, de Souza L. Electric-powered indoor/outdoor wheelchairs (EPIOCs): users’ views of influence on family, friends and carers. Disabil Rehabil Assist Technol 2010; 5: 327–338.

Smith EM, Giesbrecht EM, Mortenson WB, Miller WC. Prevalence of wheelchair and scooter use among community-dwelling Canadians. Phys Ther 2016; 96: 1135–42.

Cullen B, O’Neill B, Evans JJ. Neuropsychological predictors of powered wheelchair use: a prospective follow-up study. Clin Rehabil 2008; 22: 836–846.

Massengale S, Folden D, McConnell P, Stratton L, Whitehead V. Effect of visual perception, visual function, cognition, and personality on power wheelchair use in adults. Assist Technol 2005; 17: 108–121.

Routhier F, Vincent C, Desrosiers J, Nadeau S. Mobility of wheelchair users: a proposed performance assessment framework. Disabil Rehabil 003; 25: 19–34.

Smith EM, Mortenson WB, Mihailidis A, Miller WC. Understanding the task demands for powered wheelchair driving: a think-aloud task analysis. Disabil Rehabil Assist Technol 2020; 1–8.

Rushton PW, Miller WC, Lee Kirby R, Eng JJ, Yip J. Development and content validation of the Wheelchair Use Confidence Scale: a mixed-methods study. Disabil Rehabil Assist Technol 2011; 6: 57–66.

World Health Organization (WHO). International Classification of Functioning, Disability and Health: ICF. Version 1.0. Geneva: WHO; 2001, p.1.

Mortenson WB, Clarke LH, Best K. Prescribers’ experiences with powered mobility prescription among older adults. Am J Occupat Ther 2013; 67: 100–107.

Rice LA, Sung J, Peters J, Bartlo WD, Sosnoff JJ. Perceptions of fall circumstances, injuries and recovery techniques among power wheelchair users: a qualitative study. Clin Rehabil 2018; 32: 985–993.

Mendoza R, Pittenger D, Saftler Savage F, Weinstein C. A protocol for assessment of risk in wheelchair driving within a healthcare facility. Disabil Rehabil 2003; 25: 520–526.

Bandura A. Self-efficacy: the exercise of control. New York: WH Freeman; 1997, p. 604.

Fugl-Meyer AR, Hellström K, Lindmark B, Wahlberg B. Self-efficacy in relation to impairments and activities if daily living disability in elderly patients with stroke: a prospective investigation. J Rehabil Med 2003; 35: 202–207.

Kandasamy D, Williamson K, Carr DB, Abbott D, Betz ME. The utility of the Montreal Cognitive Assessment in predicting need for fitness to drive evaluations in older adults. J Transport Health 2019; 13: 19–25.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment: J Amer Geriatr Socy 2005; 53: 695–699.

Nasreddine ZS. MoCA cognitive assessment FAQ. MoCA cognitive assessment. [cited 2021 July 28]. Available from:

Colarusso R, Hammill DD. MVPT-3rd: motor-free visual perception test ; Manual. 3. ed. Novato, CA: Academic Therapy Publications; 2003, p. 95.

Brown T, Sutton E, Burgess D, Elliott S, Bourne R, Wigg S, et al. The reliability of three visual perception tests used to assess adults. Percept Mot Skills 2010; 111: 45–59.

Wilson BA, Evans JJ, Emslie H, Alderman N, Burgess P. The development of an ecologically valid test for assessing patients with a dysexecutive syndrome. Neuropsychol Rehabil 1998; 8: 213–228.

Bennett PC, Ong B, Ponsford J. Measuring executive dysfunction in an acute rehabilitation setting: using the dysexecutive questionnaire (DEX). J Int Neuropsychol Soc 2005; 11: 376–385.

Dawson D, Chan R, Kaiserman E. Development of the Power-Mobility Indoor Driving Assessment for residents of long-term care facilities: a preliminary report. Can J Occup Ther 1994; 61: 269–276.

Kirby RL, Rushton PW, Smith C, Routhier F, Axelson P, Best KL, et al. Guide du Programme d’habiletés en fauteuil roulant version 5.1 (2020). Publié électroniquement à l’Université Dalhousie, Halifax, Nouvelle-Écosse, Canada. Wheelchair Skills Program. 2020. Available from:

Rushton PW, Kirby RL, Miller WC. Manual wheelchair skills: objective testing versus subjective questionnaire. Arch Phys Med Rehabil 2012; 93: 2313–2318.

Baker PS, Bodner EV, Allman RM. Measuring life-space mobility in community-dwelling older adults. J Am Geriatr Soc 2003; 51: 1610–1614.

Auger C, Demers L, Gélinas I, Miller WC, Jutai JW, Noreau L. Life-space mobility of middle-aged and older adults at various stages of usage of power mobility devices. Arch Phys Med Rehabil 2010; 91: 765–773.

Gooden JR, Ponsford JL, Charlton JL, Ross P, Marshall S, Gagnon S, et al. Self-regulation upon return to driving after traumatic brain injury. Neuropsychol Rehabil 2019; 29: 92–106.

Jolliffe IT, Cadima J. Principal component analysis: a review and recent developments. Phil Trans R Soc A 2016; 374: 20150202.

Furumasu J, Guerette P, Tefft D. Relevance of the Pediatric Powered Wheelchair Screening Test for children with cerebral palsy. Dev Med Child Neurol 2007; 46: 468–474.

Heaton RK, Marcotte TD, Mindt MR, Sadek J, Moore DJ, Bentley H, et al. The impact of HIV-associated neuropsychological impairment on everyday functioning. J Inter Neuropsych Soc 2004 [cited 2021 Feb 13]; 10 (03). Available from:

Hollis AM, Duncanson H, Kapust LR, Xi PM, O’Connor MG. Validity of the Mini-Mental State Examination and the Montreal Cognitive Assessment in the Prediction of Driving Test Outcome. J Am Geriatr Soc 2015; 63: 988–992.

Smith EM, Rismani S, Ben Mortenson W, Mihailidis A, Miller WC. “A Chance to Try”: exploring the clinical utility of shared-control teleoperation for powered wheelchair assessment and training. Am J Occup Ther 2019; 73: 7306205020p1.

National Research Council. Learning, remembering, believing: enhancing human performance. Washington, DC: National Academies Press; 1994 [cited 2021 Feb 23]. Available from:

Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Personal Social Psychol 1999; 77: 1121–1134.

Inkpen P, Parker K, Kirby RL. Manual wheelchair skills capacity versus performance. Archi Phys Med Rehabil 2012; 93: 1009–1013.

Sakakibara BM, Miller WC, Souza M, Nikolova V, Best KL. Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: a pilot study. Archi Phys Med Rehabil 2013; 94: 1031–1037.

Rushton PW, Routhier F, Miller WC. Measurement properties of the WheelCon for powered wheelchair users. Disabil Rehabil Assist Technol 2018; 13: 614–619.




How to Cite

Pellichero, A., Best, K., Leblond, J., Coignard, P., Sorita, Éric, & Routhier, F. (2021). Relationships between cognitive functioning and power wheelchair performance, confidence and life-space mobility among experienced power wheelchair users: An exploratory study. Journal of Rehabilitation Medicine, 53(9 (September), jrm00226.