Wheel Chat - Your Go-To Mobility Podcast

Wheel Chat: Episode 12 – Power Mobility After Stroke: Clinical Barriers, Smart Solutions and Why Practice Matters with Alex Chesney

• Wheel Chat • Season 1 • Episode 12

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In this episode of Wheel Chat, hosts Anton Mitchell and Justin Boulos are joined by Alex Chesney, a neurological occupational therapist and clinical educator with Quantum Rehab, for a deep dive into the intersection of stroke rehabilitation and powered mobility.

With a strong clinical and research-based perspective, Alex challenges common assumptions about safety, cognition, and visual neglect in post-stroke clients, making the case for more trial, more programming, and less premature judgment when it comes to powered chairs.

What’s in this episode:

  • Why visual neglect doesn’t automatically disqualify someone from using a power wheelchair
  • How short, structured training can dramatically improve outcomes
  • Key programming adjustments every therapist should consider
  • Rethinking mobility goals: independence versus recovery
  • How smart technologies like cameras and sensors are redefining safety and access
  • The critical role of therapists in enabling—not limiting—mobility options

Packed with practical strategies, clinical reasoning, and real-world tips, this conversation will leave therapists, assistive tech professionals, and rehab providers with a refreshed perspective on what’s possible in post-stroke mobility.

Connect with Alexandra Chesney:

👉 LinkedIn: https://www.linkedin.com/in/alexandrachesney/

Email us :
We’d love to hear from you. If you have any questions about this podcast, please email us at wheelchatpod@gmail.com

Follow us : TikTok : https://www.tiktok.com/@wheelchat_podcast

Instagram : https://www.instagram.com/wheelchat_podcast/

Disclaimer: The views and opinions expressed in this podcast are solely those of Anthony and Justin.

Anton: Hello everyone and welcome back to Wheel Chat. You're with your favourite guests, favourite hosts?! What am I talking about?! Anton and Justin. Justin, how are you? 

Justin: Yeah, I'm good. But I think we do, are going to have our favourite guest. We've got, we've got Alex on today and we just had a bit of a pre-chat before the podcast and I'm actually so excited for this talk.

Anton: Yeah me too. But it was my job to introduce Alex, and you've already killed it. Let's just get straight in because I actually genuinely- 

Justin: Who's Alex mate? 

Anton: Yeah!

Justin: Who's Alex? Tell people who is Alex? 

Anton: Well Alex, but her Sunday name is actually Alexandra. So I-

Alex: That's right

Anton: Only Alex to her friends, which is everyone on this Wheel Chat podcast! So we're all good. So welcome to the chat Alex Chesney all the way from Texas, which yeah as I was just saying to Alex before I could listen to her voice all day, but just to give you guys an understanding before we completely get Alex and we can just listen to Alex all day. Alex is a neurological occupational therapist, who has a huge demonstration of history working with inpatient rehab and specialist in spinal cord injury. She is a huge experience in activity based and electrical stimulation therapies, along with seating and mobility. So we are absolutely honoured. Pleasure. She's currently and has been for the last six, seven years working with Quantum Rehab as their clinical educator, so a huge amount of knowledge, a huge amount of experience, but more importantly really, really, really enjoyable to listen to.

Anton: Alex, welcome to Wheel Chat! 

Alex: Oh my gosh. Thanks y'all for having me. So there's the Texas is going to come out the whole time.

Anton: See guys I wasn't lying, like genuinely, like what? I love it. We're all going to be yeehawing the whole way home. But no, most importantly, it's just great to have you and really thank you for joining us.

Alex: Yeah no, I really appreciate it. 

Anton: No, that's cool. So we want to chat about quite a few things today but we are pros at moving in different tangents and chatting about what we're not meant to be chatting about. So Justin, I'm going to pass this to you to kick things off today because I know as an OT, a fellow OT like Alex, you've got lots of questions, lots of things that you're, that we've been chatting about. So should we just go straight into it and just fire away and see what Alex is all about? 

Justin: Yeah. Actually one, one topic that we even chatted about quickly before the podcast and I'm so excited to ask you about, is the appropriateness of power wheelchairs for people who are post-stroke. Now, when we're post-stroke what can happen is that we have a visual perception neglect. So it's not so much that we can't see one side of the body but it's just our perception of it. Like our, I always explained like you're wearing clothes right now. You don't feel the clothes until you think about it, and you're like 'oh yeah', that's our perception now. So it's not like we can't feel our clothes, we just, we don't think about it.

Justin: But when we're prompted to think about our clothes, we can see our clothes. Which if you have one side of your visual field that is out of perception perhaps, or yeah... how appropriate is it for people with, to have a stroke or who have had a stroke in their abilities to drive a power wheelchair. Now Alex you mentioned that you geeked out on this topic. I've got my bro sides on, like my experience over the past 10 years but what is your clinical science around this particular topic and what should therapists or care facilities know about this topic? 

Alex: Yeah, so I'm super passionate about this topic because I feel like there is such an unknown when somebody is recovering from a stroke or a traumatic brain injury. Obviously you know you don't necessarily know everything that's going on. Just like we talked about perception can be off, somebody's attention can be off, their speech or ability to communicate with you. So it can be really hard to understand, am I setting somebody up for success and are they going to be safe? And so I think there is a huge hesitation to power a lot of times in this population because of the safety concern but a lot of that coming from a good place, but a place of maybe not knowing the capabilities of the equipment to make your client safe. So a lot of times I run into, or what the research shows is that we have out of the goodness of therapists being concerned, we kind of put these patients at a disadvantage sometimes of being a little biased and not allowing them that access to trial some of this assistive technology that's out there. So when you look at that I think the biggest thing is just if you don't know, that's okay. Just collaborate with, you know, those that do know. Collaborate with other clinicians that might know tips and tricks, collaborate with you know your providers, whoever's providing that equipment or who represents that equipment and express your concerns, but we never want to take away that independence somebody could have. So especially with vision, completely understand the concern about vision. I mean we all get concerned I think even as we age of when can, when are we taking away your driver's licence if we need to? So-

Anton: Right?

Alex: Vision can be very scary. It's how we perceive our world, how we know we're safe. And so what they actually show in the research that's super interesting is for those that have visual neglect, when they look at this and they compare it to those that don't have visual neglect, with power mobility they actually show that visual neglect component does not impact their capacity to learn or their potential to improve. And what's nice about this is it shows that even with a little bit of training, the research is so slight of, you know, in some of the studies they did it was like they only did five sessions, 30 minutes each doing trials with power mobility. Other than that, they were never even in the power chair and all of them improved about 30 to 40% of their, of their capabilities. So I always try to remind therapists too, you're doing so much with this population with that neuro recovery component, you know looking at the power chair or their mobility, that doesn't have to be your whole rehab goal. We're talking about these studies were so realistic of they only did it five times for 30 minutes. They didn't have, you know, every session to dedicate to this. But that little bit showed improvement. They can build upon that in the future. And one really interesting study looked at the mobility of those with that kind of visual neglect and they compared it to those that were walking up and down a hallway and those that were driving a power chair up and down the hallway, similar you know controls, they just kinda had that visual neglect component in which they found is that our motor perceptual, kind of spectrum is different. So I can't remember the exact sides but those that were walking tended to veer one direction, and those that were in the power chair tended to veer a different direction. 

Anton: No way.

Justin: Really?

Alex: So it kind of just pointed out that the type of mobility can have a different performance factor, even though you can control for everything else. So it really is unique and it's on this spectrum.

Anton: Wow. 

Justin: Interesting because what I've always found is that if you've got a neglect on, so explain that to me about the walking versus power chair one. Because I found that if someone is, let's say they're right side affected, they would tend to, they won't perceive their right side.

Justin: So say they're driving down the hallway and what they'll tend to do is they want steer clear of the left side of the hallway and they keep on bumping onto the right walls because they're not perceiving it. Are you saying that's different for when they're walking or what what, like can you clarify that bit? 

Alex: They just found when they were walking, the direction of which they veered was different so yeah essentially which side they kind of favoured. Now I think that could be due to several things. They also kind of did a similar test looking at just those in power mobility going through wide gaps and narrow gaps, kind of like doorways; they called it a doorway test. So on the wider doorways, they actually tended to veer towards their non neglect side, like they overcompensated of 'oh, I know that I tend to run into things on this side. I'm going to scoot over to where I know I'm good' and they'd bump into the wall. Whereas if it's narrow, you know when it's narrow, you're like 'okay, the side I'm paying attention to, oh my gosh, I'm so close to this door', so then they went and they hit on the neglect side, so it kind of makes sense. So I could see how if you're walking or using a power chair, depending on you know where your attention or your focus is and what your environment is, they just see this difference of where you tend to kind of deviate.

Justin: Yeah, absolutely. That makes a lot of sense actually. The narrow and wide thing makes sense. I was also thinking as you were talking, it would make sense that if you're walking you would favour your good side because it's like your safety, right? 'Oh, I want to stay close to the wall, maybe I want to grab onto a wall. Maybe I'm unstable.' And you'd go to your good side. But if you're in a power chair you're like 'I don't want to damage the, Gyprock or the drywall, you know, so I'll go away from it.' So that's actually that's very interesting. When you, when we're talking about people though, in their, in their power wheelchairs, how can a therapist know if someone is worth, like is there sort of like a, a, checklist of people who might be appropriate? Because the stroke can affect people amongst the spectrum, right? People can be severely affected and slightly affected. Is there any sort of things that they should be looking out for to be like, all right, if they've got this, this, this it's worth even trialling. Or should everyone just be trialled? What's your thoughts? 

Alex: Yeah, I think it, I think it depends. I think a lot of times and, and honestly why I kind of dove into this topic and, and I can fully admit back in my clinical days you know, we are very driven by this recovery model which is great; we want everybody to recover. But at, we have to balance all the things and look at the expense of what in their day. So a lot of times I feel like I'm getting feedback from those that are more the providers and they're like

Alex: "Hey, well you talk to therapists about so many of these patients that are maybe getting a manual chair after a stroke. When they go home, they aren't moving around and actually they're like laying in bed or they're just not, they have too much fatigue."

Alex: So I think a lot of times power is overlooked because it's just like

Alex: "Oh, you can just hemi propel down the flat hallway of the hospital you know 10 feet, you're good!"

Alex: And it's like well that's just not really realistic for somebody's day to day. So I think people forget that that mobility component, it's not exercise. It is somebody's mobility and efficiency. And so if they're not efficient, that should be your number one factor of could we look to power? Now you can go down a whole rabbit hole of what does that look like of, you know, are we using a joystick? Do we need different types of drive controls? But even for those with the most profound deficits, I would say you don't know until you try.

Alex: Because there's no way, and they've shown this, there's no way that you can replicate what it's like to use a power chair in any type of assessment. You can't use switches. You can't use computers or things to try to mimic that. You have to put somebody in that chair and give them the opportunity to move and get that direct cause and effect, that vestibular movement. You're getting a lot of visual feedback, cognitive processing, so it's such a whole body process that there's not really this easy checklist. It's more of like 'is the lower level mobility that we're trialling, is it the most efficient for them?'

Alex: They can focus on everything else in their day and that mobility is going to be efficient for them without a doubt. If not then let's look into what are my options if I try to go to a power chair. Let's not jump to the conclusion of, 'oh, how do I transport it? It's so big and bulky.' 

Anton: Yeah.

Alex: No; let's just first figure out is that even an option for somebody? And kind of a unique story but it kind of makes me laugh as a therapist because, you know, we try to be as creative as possible. We were working with a gentleman that, he was previously in the Disorders of Consciousness Program, so he was minimally conscious, emerged and he was in outpatient therapy and all they were working on was neck flexion and extension. So I'm sure as a therapist, there's only so many ways you can think of how exciting it's going to be to ask your patient to look at the ceiling that's blank. So this therapist was just like "Could y'all bring a power chair and you know, a head control?"

Alex: And we were like

Alex: "Sure."

Alex: So all we did is, we put him in the chair and all they worked on was him looking up to the ceiling but the chair would move. And then he would relax. And then he'd look up and move and he like was totally getting it. We did right and left for him. We did all the hard stuff but it was way more motivating.

Anton: Yeah.

Alex: And it gave the therapist and the patient a chance to see is this even something we explore? But for that day it was just neck flexion and extension. We just happened to be in a chair. 

Anton: I love that. I actually love that. I'm definitely going to learn something there about just application of thinking outside the box and just trying to engage that client.

Anton: But that's yeah, I've not heard of that before. That's a new one for sure. But yeah, I mean certainly such great, great advice. I'm just... are we very quick then in terms of just taking on board what you're saying? Are we very quick to think, 'oh, we must get somebody mobile. It's our priority.' We're overlooking the fact that actually asking the client 'what are your goals? What are your objectives?' Or what's realistic? Is functional activity maybe more than just walking, which is, don't get me wrong I get it. That's why we go there. But I think what I'm taking from you is, should we consider a power chair actually, if this person's capabilities are not quite where we maybe want them to be or we're not quite understanding of what that person's capabilities ultimately are yet? Are we dismissing the power chair then a little bit in that stage, in that at that point? Is that fair or is that, am I picking that up right?

Alex: Yeah. Yeah. And I feel like I look at things a little bit differently. I try to explain to people that no matter what mobility device you choose it's a tool. I'm never saying you're not going to walk. I'm never saying you're not going to recover. I'm saying this is a tool you need for right now. Just like you might need a reacher or a sock aid or something like that.

Anton: Yeah.

Alex: This is just a tool. So I see it as kind of two buckets; that we're working on mobility from two perspectives. We have a rehab mobility focus and that's more of 'okay, what are your goals?' And many times people are going to say 'my goal is to walk.' That would be my goal as well. We want to return to kind of that independence level. And so that's a great goal. Let's keep working on that, mobility as a rehab and we're going to do everything we can to focus on that. But then the other bucket is, 'what is your functional mobility? What's realistic that outside of that time that we are spending this concerted focused effort on that recovery? What helps you live life?' Because your recovery process is probably going to be a while. You had some complex reason you're even needing this equipment. It's going to be a complex recovery process. So how do we balance that to maybe get you to your recovery faster because we're not physiologically burning you out.

Anton: That's so cool. Right? Yeah. So I'm like, I'm already thinking does it need to be like 'do you want to try your rehab chair as opposed to wheelchair?' - Like putting a little bit more of a spin on it and a real, not being embarrassed about saying that, or shy about saying it to say

Anton: "No we actually do look at it as part of the rehabilitation process."

Alex: Yeah. I love that phrase. I'm going to use that now. 

Anton: You can't Alex, it's not-

Justin: He's trademarked it!

Alex: Dang it trademarked already!

Anton: Yeah. No, but I'm getting there is something in this massively. I mean I'm sure this is what you, I know this is what you do and, and train and go around learning and helping people.

Anton: But I just... I'm, I think I'm only taking this on board right now. Justin what are your feelings listening to that?

Justin: Yeah.

Anton: Is that something that you on a day to day? 

Justin: I think it's great. I think, yeah, I think mobility can definitely be a form of, a form of therapy. And Alex I like what you said, it's just a tool, right? Like just say our shoes are a tool for our mobility you know. It doesn't necessarily negate one or the other. And I talk about this often with kids in mobility, you know, when they're, the goal so much is for physical rehab and of course the parents and the therapists and the physios or the physical therapists want the children to encourage walking and powered mobility can seem as something that's taken away from that but there's definitely room for both, for both in that aspect. And Alex I love what you said earlier that if someone's just at home not engaged with the world, then that's not helping anybody. If the only way to mobilise is painful, slow, boring you know, you mentioned with for a stroke patient you said I think you said, 'hemi propelled' which could be like a foot propel or a lever drive or something like that's going to get you from a flat surface to another flat surface. Like if you actually want people engaged and mentally stimulated, then mobility is such a, such an important tool. And I want to get back to that; like how do we actually help people with that, that mobility post-stroke? So say we are, we're with the client, right? The client's got a, a pretty dense hemiplegia and we're really not sure if we can, they can drive, but we've sit them up in the power chair, we've got the attend control on there because they're, maybe they're a big, they're a big guy and they don't want to push around a tilt in space manual wheelchair. So we definitely want it for attendant, but we're exploring the idea of using it as a, as the wheelchair user can, can operate the device. What are some tips or some things that you can do to help people learn that, as opposed to just saying, 'just sit in it and try.' What are the tips that you give? And I'll, I can share my tips as well of what I do but what would you encourage the therapist to try when they're first getting someone in there and they're just driving into the weak side wall? 

Alex: Yeah, so I think that for sure your setup is key. So like set yourself up for success.

Alex: Part of that is you know checking in with where is your patient that day? Was it a good day? Did we sleep well? Did they start a new medication? Were they agitated? Little things I've run into before like an hour before I came to work on a power chair, speech was there working on using a Dynavox for an hour. Okay maybe you just had to use your eyes for an hour and not move any part of your body and then now I show up and I'm asking you to use your body for mobility. That's, that's maybe conflictual information that day. Maybe we give your brain a break and we wait and we bring it back another day. So I always want to make sure the client is set up for success. For sure I want to make sure my chair, that number one concern of safety. Let's make it easy. Let's make it really safe. Let's turn the speed down. We're not trying to, we're not at the racetrack day one, let's turn it way down.

Anton: Yeah.

Alex: We can do things that I always like to let people know that you can turn the power of these chairs down or the torque so you can turn that down enough that if you put your foot in front of the power chair and the chair bumps into your foot, it's going to stop.

Alex: Not good long term, because we probably want to get over thresholds, but for training and letting somebody maybe get close and bump into a wall, we'll be okay. So I think setting your chair up for success, limiting distractions, and then making sure you're going to an area that's not distracting as well. And then get somebody positioned as best as you can. But I wouldn't say finick with it. Don't finick with it the first time. Just set yourself up in a calm, open environment and whatever method of driving you've chosen to start with, explain it.

Anton: Yep.

Alex: You might need to do some hand over hand just to show somebody how it works and then let them attempt what you displayed for them and see. And again same thing, don't fuss over if they're doing it a hundred percent correctly. More so give positive feedback for when they do engage it the way you want.

Anton: Yeah.

Alex: And just let them move.

Justin: Yeah, I love that Alex. I think it's really good to be positive and give people a chance when they're actually trying to try these things, because I think like anyone we can all struggle when the first time we try something. And if you've got a disability that affects half of your perception then of course it's not going to be perfect first time. Some things I like to do to help people get that correct, get their driving as good as possible at least on the trial because I'm just there for the, present for the trial is I always say to focus on the good side. So Alex you mentioned earlier when they're walking they tend to favour their good side.

Justin: I always just say that to the clients I'm working with. I'm saying 'listen', I explain to them what I explained to them before is that, you know, it's understandable that the perception on this side, on the weak side is not going to be good. So let's focus on the good side. So if we're going down a hallway or a corridor, I want you to get this arm rest as close as you can to this wall. Just focus on that as you're driving along and when we're turning I want you to really hug that corner and then the other side will just take care of itself. Granted at this point there'll be carers around to see if you're going to hit a wall and you're going to explore areas that what's possible and what's not possible.

Justin: But if it is possible to fit the chair through the hallway, just no matter what, how, no matter what's going on on the weak side. Focus on the good side and you'll be good. And that is actually a tip that my mother gave me when I was driving because we've got a really long, narrow driveway. And I was always like looking at both mirrors going left and right.

Justin: She's just like 

Justin: "Justin, just pick one side and just be really close to that side. And then, and then the other side will look after itself."

Justin: And she's absolutely right. Like if you're trying to do two, it's just too hard. But if you've got one side good, you'll be sweet. So thanks mom, appreciate that.

Anton: Oh what a tip! Thank you Mom. Mom Boulos, thank you so much. 

Justin: No, she's good. So I think when, when I do that with people, I think that's always really good. Same tips I give to everyone else which is just like you know, I usually stand like maybe 10 metres or 10 feet... I don't know how, how far 10 feet is over there in the US.

Alex: I'll have to do that conversion. 

Justin: Yeah, maybe like three or say like three big steps in front of him or something. Three or four steps in front of him. 

Alex: There you go. 

Anton: Yards. Do, do you work in yards? 

Justin: Yards maybe. Yeah. So say about... I always say stare at my feet. So about three metres ahead I'll say stare at my feet. So I'm like

Justin: "Look at my shoes. What color are my shoes?"

Justin: Like get them to focus on something as they drive and then obviously on their good side, and that just helps with their, with their driving. And that's for, it goes for any, any, any driver. Whether they've got a perception issue or not if your eyes are focused onto something, if you're aiming for something at darts or whatever-

Alex: Yeah.

Justin: Your hand eye coordination is really important, so stopping them from looking at the joystick, not looking at what's whatever they're being distracted, focus on something ahead, I think is really good. And like what you said Alex, we need to give people the opportunity to practice. I don't know what it's like in the states but do you guys get the option of renting chairs in your funding model?

Alex: That is a loaded question... no, not really. I mean you can if you're going to self rent it, you can. A lot of times I would say we're really generous here that again, I always just tell therapists and people use your resources; resources exist for a reason. So if you know, you know the manufacturer of that chair, you know a really strong provider, a lot of times they for us are able to provide like loaners. So they'll let you like borrow it and use it for a while, before they're going to solidify, 'okay this is what we're going with', so that we are pretty good here at making sure somebody can trial it. But sometimes you can't. Sometimes it's a one, one time deal. You're trying to get it right. 

Anton: I'm all up for that as a provider, which we are. I'm all up for trying that. However, there are some cheeky OTs and physios out there that will happily just say

Anton: "Oh yeah, can we loan that?"

Anton: And two months later the person's left rehab, thankfully they've gone

Anton: "Oh no, we don't, we don't, we don't need that anymore."

Alex: It disappears. Things tend to disappear. I don't know what you're talking about. 

Anton: Yeah, yeah, yeah. No, that was just a $15,000 wheelchair or pounds wheelchair. Yeah. No but, no but it you know, you're absolutely right. A good provider will offer that opportunity when they can but we're talking about prescriptive equipment. It's not always feasible due to expense, finance or safety for that matter in terms of just concerns around it. I've got a question guys, just while we're flowing in that. As a provider who, and I know Justin's the same but I know obviously from what you know, your experience in working with chairs and now in the clinical education side of things Alex, what's your thoughts in terms of safety, in terms of where do we make that decision? How do we consciously make that decision without stopping somebody having that opportunity to trial it for periods of time? But when and how do we decide actually this isn't safe, and actually how do we break that to the client? What's the best way of doing that? And do you have a measuring tool to be able to actually feel morally that you've given the best, the person the best opportunity, you've given them the time but actually know this is not safe for them or for surrounding people around the area etc. So yeah that, that's my question to both of you actually.

Anton: Alex, do you want to pick that up first? 

Alex: Yeah. I feel like again it comes to a lot, you know, we always talk about being client centred and it truly is. And looking at what is their support system as well? I think that that approach is very different of if they have reliable caregivers that are with them all the time,

Alex: and they are going to do training and they're going to take ownership of continuing to help that person progress in their independence or their safety, I think that's one thing. And then it depends on, okay if this person's going to go maybe have to live at a facility where the caregiver time is very divided, you are expected to be pretty independent safety wise, you know we want to consider that; and I think that's a little bit more of a spectrum. And I think then you look at 'what can I do to make this person more successful?' Whether that's programming I feel like honestly a lot of times 95% of the time, somebody hates their chair or things aren't going well the programming needs to be adjusted, which makes sense; they're custom chairs. They are basically computers on wheels, so we need to go and tell that computer what we need. You need to go, I tell people all the time, if your patient has to go somewhere and they are safe at 0.1 mile per hour, it could take them all day to get to the front of the building, I don't care! All day. But you can have an attendant control and somebody can drive faster if they need to, but if they're independent, I don't need to take away their independence. They can just- 

Anton: I love that.

Alex: Cruise on down the, down the hall. And then it's little stuff too. We've had several clients and I will say really do appreciate our company for taking time to, to look into this, but we did come out with a backup camera. So there, there's a camera you can use and that's great. Patients have always asked about backup cameras; our cars have them. But really where I see it having more of a profound impact is, we've had several scenarios where facilities have wanted to take away somebody's chair that had visual neglect because they're worried 'oh they're going to bump into their roommate's bed, the room is smaller, they're going to hit the walls and damage the walls', and we've been able to mount that camera on their side of neglect, give them that visual cue on their non neglect side and they can use that as a way to scan their environment where they tend to kind of cut off from scanning. So we've been able to at least put that on chairs to try and say "Hey if we have this tool would this make them safer and do you feel more comfortable with that?" So I think it's seeing what tools you have.

Anton: That's cool. Because there's the product out in the US, we don't have it in the UK yet, I don't know if Australia has it Justin, but it's the Luci?

Justin: No, I know what it is but yeah we don't have it yet. I believe it's coming but that's, that's been out for years and I just don't know why it hasn't been across? Why it hasn't been standardised yet? 

Anton: Yeah. I spoke to the guys from Luci years ago. You probably know them Alex, just from being in the US and having... well you're just so much cooler than us and more important but yeah, I'm not saying that about Justin, just me. I'll use me. But no, I spoke to them years ago and they were great guys and their passion for developing that product and making it safer and basically doing what we are talking about, making options available to people who maybe have been discounted the option before. But that's an interesting concept because that's got the sensors on front and back for anyone who doesn't know. That's got where it would automatically cut out, so it would detect a risk whether it be human or the environment going through a doorway, whatever, it would also circumnavigate that; it would help sort of pivot that's right? From what I see. Do you think that's the future for us? Do you think that's something that a lot of power chair manufacturers will start? I mean you can see it anyway. We have got sensors and stuff and you've just used a backup camera as an another example of sort of using it, you know, technology to, to improve. From your insight at the moment is that where things are going, do you think?

Alex: I think things are trying, we're trying to use these smarter technologies and interface them with medical equipment. And I always tell people, that's what you have to remember is so tricky. So like the back up camera, that's an easy one. You just toss it on there just like you go get it at an auto store, honestly, and like I've had patients rig it up themselves. And then you have things like the Braze system is out there; that is more of like our cars of where it tells you how close you are to something and it can either make noise, visual alerts. So I do like that when people are talking about cognition, I like that from the perspective of it's going to give me an alert, but I need to have decision making capacity. Because I think that's where a lot of this we have to make sure that we're not... we're using it as a safety backup. We're not using it to take over someone's performance. So I tell people all the time like Luci will stop your chair which is great, but I tell people you still have to make sure, you know, I know my car, my car technology now. It'll stop if I'm not going to stop. It'll break for me. I don't go to every stoplight and go "Alright car. Hope, hope for the best!"

Alex: You know, it's there if I'm distracted, if I'm too close. So that's where I just tell people you still have to remember it's not there to be a catchall; it's there to be a backup. So we want to make sure first that person pays attention to that. But I think there's a lot of things and I think Justin I saw it from you, that you got to saw at Reha Care or somewhere- the one that they are like making it to where it can like scan your house. And it basically, it's almost like a Roomba, but it's on your chair and knows how to guide you. 

Justin: Yeah. That's, that, that's one I saw. There was like a similar company that in Australia they've got like these, it might be a data technology, it might be a futuristic technology, but they've got like stickers on the roof or something that can like track where you are kind of like yeah, your Robovac. But you could say like so if someone's doing visual, if someone has got an eye gaze rather than doing forward, left, right, all that, they can just be like 'all right bedroom' and then the chair knows to go here, here, here and just like your vacuum if it, if your shoes are in the way, it will know that and it will drive around it as best as it can. But I think all those technologies are so, they're so interesting and there's so much room for them in this space. I think it would be really good if you had those things to program them because I know some doorways, like you’re scrape, you are almost like scraping the armrest as you're going in. So if you were like... I'm like that would annoy me so much.

Anton: Oh yeah.

Alex: Yeah. 

Justin: Or if you, if it was cutting you out it'd be like, sometimes you just need to like gently touch the wall as you're going through.

Alex: Yeah.

Justin: The castors might need to do it. So there's, I guess there's tricky bits there. Like imagine with the Luci if you're, if you're driving in your tight bathroom space and then it like does not compute and you're like

Justin: "Ah, now I'm stuck!"

Justin: So that would suck.

Anton: Yeah.

Justin: So I'm sure there has to be ways around that but exactly what you said Alex, there has to be like that decision making people need to understand how to drive and it should be just be there as a backup for the times that your decision making fails you, like it does for all of us.

Anton: Yeah. I think actually I just wanted to come back to one point that you were making before Alex, which was actually really simple and it's kind of resonated with me actually. And I think I've overlooked this more than I should have actually which is programming. Because I program the chairs all the time. Our engineers do. We all get involved. But actually I think now I'm being honest with myself maybe I don't, it's not such a natural go-to thought like... 

Alex: Yeah!

Anton: Should I just tweak that a bit? Because I normally think that on the point of handover a lot, but at the point of assessment, am I doing enough programming? Maybe I'm not actually, if I'm being honest, maybe. Maybe that's something I do need to review on my own there. 

Justin: Well, Alex, what would you say? Quantum has amazing expandable controls in terms of you can program it. What would you say are the top three things therapists should consider programming when they're doing a delivery for a client. What are the three most effective ones or the three most useful programming parameters that you've used that have really good effects on clients?

Alex: So one of the biggest ones is definitely your turn accelerations. I feel like that's where you get the feedback the most of

Alex: "Oh, this chair's too finicky." Or

Alex: "We go in the bathroom and I just can't even get out of there. It's just too squirrely."

Alex: Like people just use these descriptions of, usually when your, your chair is like a bucking bronco here in Texas. You want to check those turn accelerations. Exactly. Exactly.

Justin: Sorry, Alex. You were, you were setting him off Alex! 

Alex: Oh, I know, I know. But that one, that one's kind of a crazy one. And I think it's hard too. And when you talk about trials I think that's an important one at some of these facilities or when you've been trialling it and made programming adjustments, you have to double check. Like one time I had a chair with a client that I think there was a Head Array or a chin control or something on it. Alright, well at my hospital they kind of just take stuff off and you're passing it on. And so I had a patient, just a joystick driver. That chair was crazy. I left it in the elevator. I couldn't get off the elevator. I literally left it and was like somebody else has got to get it. I can't get it out of the elevator because the turns were crazy. But it was set up for an alternative drive control before, so it doesn't go across the board. So definitely your turn accelerations are a huge one. Ones that sometimes people I think forget about as well too, that applies to paediatrics or adults or anybody that feels like... I always get the comment of, and it's, sorry I make voices, but I always get the comment of like

Alex: "Ooh, it's so sensitive."

Alex: And I'm like, well the chair's supposed to be sensitive, but you can increase that centre deadband of a joystick. So, you know, just that I always tell people, centre deadband is when you just go move the joystick, you hear those motors kick in and it's pretty instant. You move it a little bit and it goes click, click. It's ready to go. So if I increase that, it just means I'm going to have to move that joystick a little bit further for my chair to go, 'oh, okay we're going' and it to kick in. So that's nice because it just makes someone's movement a little more intentional and they feel a little more control over the chair and so I think that is a huge one. And then now there's a lot of kind of key differences of depending on how somebody's using the chair or if you're talking about different drive wheel configurations, your chair has the large drive wheel in the front or it's got it in the middle.

Alex: There are various things coming out like shaping settings. So kind of the feel or the quality of your turn. Do you want it to be a sharper turn or do you want it to be a wider turn? Because I think turns really impact people, especially if you're talking about in a home environment versus a wide open space.

Anton: Yeah, they're great tips. I love the deadband because that's something that I'm very aware of, but actually the way you put it spot on; spot on. Yeah. I think everyone, I just want to go back to the first point you made because that was to do with the turning speed. 

Alex: Yes the turn speed, turn accelerations.

Anton: Yeah. So it's just to expand on that to more, for the listeners to understand a little bit in how you've explained just what, what do we mean by that and how would we change that and what benefit would that give? Just a little bit more on that, if you don't mind Alex. 

Alex: Yeah. So sometimes when I'm mentioning that, you'll notice it a lot of if I turn speed or my turn accelerations up really high, if I start then going into my bathroom and I'm trying to make a little pivot into the doorway, it might do what feels like it just whiplashes me.

Anton: Yeah.

Alex: And it's not that the chair is is crazy. You're just in such a small space but that acceleration and that speed are very reactive. So you need to turn that down for that environment. And what's nice about the things we're talking about, these can be done in different profiles on your chair. So you can have a profile that's like, 'oh, this is my bathroom narrow hallway doorway profile, where I know those turn accelerations and speeds are lower',

Alex: versus 'oh, I am at work or school or somewhere more wide open. I want my turns to be very reactive because I'm in big spaces. I want a quick sharp right turn down the hallway.' Then I would increase those turn accelerations or depending on what you have at home, do you have thick ply carpet? If your turn accelerations down, you're going to get a big lag and you're going to be like, 'my chair doesn't work!'

Alex: It works. You just need to look at okay, now we have shag carpet versus our you know flat tile hallway. 

Anton: For sure.

Justin: Yeah, it's always crazy right? Like it's, some people are saying it's too sensitive and some people are saying it's not sensitive enough and this is where the confusion can come in I'm sure for a lot of therapists. I was, I'll jump on that and say I think for kids sometimes I'll ramp up the acceleration if, or if someone not necessarily for kids, someone who's an early power wheelchair user and they don't necessarily understand cause and effect. Sometimes I like to make it super sensitive so they do something and then something happens. Because you, I don't know, you guys probably work with those really young kids and they're, maybe they're eating the joystick knob or something and they do it and nothings really happening and it's kind of like, well I don't understand the cause and effect. But when you ramp up the acceleration and they do something, their eyes would be like

Justin: 'what's that?!' Now this isn't a practical parameter that I would use, but just in like the trial stage that's something that I would do to get a bit of excitement or get a bit of what's going on here you know, safe open environment. I think that's like one parameter that I'll use quite a bit. And I think another one is before you go into alternative control. So Alex, we could do a whole other episode on alternative controls, is one that I think people will sleep on is throw-

Alex: yes!

Justin: And what throw is. Let's say the joysticks in the middle, and then you push it all the way forward. All the way forward would be a hundred. Now if someone doesn't have the strength to push it all the way forward, you can change the throw to say 50%. And what that means is that if you push the joystick knob 50%, the computer will read that as a 100%. So now someone who doesn't have the strength to go all the way forward, you can give them a full range of their joystick even though they can't push the joy, even if they don't have the strength to go all the way forward. So I think those are the kind of like parameters that therapists can be thinking of. And I know it's a lot. And if you are a therapist don't be like, 'oh my God, I need to remember all this.' This is really like, this is I would say, look definitely in Australia I don't know what it's like in the UK and the US, it's definitely something that would fall more onto the ATPs and they should know about.

Justin: So if there's any ATPs listening, make sure you speak to people like Alex from Quantum or your local Quantum provider or your local whatever provider! 

Alex: Whoever! 

Justin: Whoever! And really learn about this stuff because this is like what can make some, make or break some trials. 

Anton: 100%. And I think in closing I think that's the thing, no matter what the chair is or who we're buying it from or whatever, the technology that we have now even, and we have had for quite a long time, we're really lucky like the parameters and the program. So it is coming back to the understanding the program. I really have taken a lot from that point Alex. I think that's just been displayed in our conversation. There's definitely a lot more training to be done around this. I think that too many times we'll go out and see wheelchairs that, it's not a critique against people that have provided, I'm sure they've done a great job, but they just say 'profile one, profile two, profile three, profile four.' And that actually tells me that actually how much programming have they done? Because we a lot of the time would always promote exactly what you suggested- indoor, outdoor, chill out zone, whatever it is that that person, bathroom mode, whatever those things. And that means that they've concentrated, they've understood the environment for the client, and they're working towards a better option for them and then that can always be good. We often go back, a month later we often do a handover and say we're coming back in two weeks because you're going to be able to tell us more in two weeks than what you can feel right now. They're going to give us better feedback.

Alex: Yeah. I love that.

Anton: "I've been to the park, I've been here, I've been there and actually I wanted more of that when I was out but when I was indoors I'm really struggling with those couple of moves."

Anton: "Cool. No problem. Let's have a play. Let's have a..."

Anton: Because you never get it right on the day. There's no possible way of doing that. It's usually late at night, somebody's having dinner and they're making it. You're doing a handover and it's like, you know, you need to get out of the house. You're there for you...you've overstayed your welcome right?! Oh, maybe that's just me! Actually that could just be me! 

Alex: No I love that! 

Justin: You would never overstay your welcome Anton. Everyone would love to have you in there. 

Alex: No, I love that. 

Justin: Yeah. I'll say one more thing on programming before we wrap up. And I want to do our good take home messages at the end of our message. 

Anton: Oh yes. 

Justin: As much as you can program everything, I would also say don't jump to it. Like I think especially for attendant controls Alex you said it so perfectly, the first thing people say is 'it's so sensitive.' Alright you've, you've driven it for like four minutes. Let's just, let's give it an hour alright! Let's, let's put in our head that we need to do six hours of practice before we even do program it. And I'm not saying you do it for everyone but this is like, I think we can sometimes jump to programming too much. But like Quantum, the other brands out there, they do a good job on programming these things out of the box and they're programmed this way for a reason. So as much as you have the option to program, don't like I wouldn't say just jump to it, like have really purpose for it. Like I said with active throw, with turning sensitivity, like what Alex mentioned, like have a real idea of doing it. Don't just start messing around with the parameters because you're like

Justin: "Oh, it's too hard to drive."

Justin: Focus on your key characteristics. And we can do a whole other episode on driving tips. But I think have people's thoughts in the head, like 'how long have you had your finger on this joystick?' Probably 12 minutes and you are saying that you can't do it. Okay, let's get 60 minutes. Then once you've done that, let's do 6 hours. And then we can say,

Justin: "Alright, is this the right offer? Is this not?"

Justin: And this is where, whether it be for an attendant or for a user, this is where rentals can really make a big difference. Or really helpful suppliers like Anton who let you borrow it for two months. 

Anton: No, no that's only just every so often. Please. 

Alex: He's just tossing that out there. 

Justin: See Anton if you want a two month free, free trial. 

Anton: Yeah. Yeah. But we do rent. We do rent. But this is not a promotion of Anton. But... it can be. I mean yeah but no, I joking aside, I think that's actually brilliant Justin. Because I've... I totally get what you're saying and actually I, again I'm thinking to myself have I given that enough time? I'm true, you know you do. That's a brilliant point like actually am I too quick to program? We should program, but are we too quick? That's, that's great that that's, yeah, you're right. That's what Alex was mentioning. So please take, give us some more take homes. Come on Justin. 

Justin: Oh, yeah. Oh I guess take... well let's go from the start. So I think take home that I really like with Alex that you said that people with visual perception can learn and there is evidence to suggest that, and I would love if you could link me that evidence so I could put that in my spiel when I'm speaking with therapists if they're, not sure about this. I think that was a really good one. We spoke about the idea of programming and knowing the options of programming, but also not programming too much. I gave some tips for people about if you are having a visual, if you do have someone with a visual perception, focus on your good side. Get really, really close to your good side, and then the not so good side will look after itself. I love the idea of what Alex said about mounts in the reverse camera on the weak side and then you can have a double screen or something. I've never heard that but that's, that would be a pretty cool option. I think there's a lot of cool stuff coming out into the in the future about what's going to happen to help people with all this. Yeah Anton, did you have any other take home messages, anything that you learned or you think the viewers should take away from this? 

Anton: Yeah I mean there's loads, but one of the things that just to for me to close on is environment support is the key to success is what I've wrote. And I think that, that support is why we're all here, why we're on the Wheel Chat. It's what we're, it's driving us. It's why you get up in the morning Alex and probably have that urge to help people and it's where we're coming from. So whether it's support from far away or it's a family network or carer network, at the end of the day if we all pull together I think we're going to see much more success. So that's just a great positive way to finish Wheel Chat today. I just want to say a huge thank you to Alex Chesney again for coming on and being an amazing guest. I've learned loads today. 

Justin: She was so good! 

Anton: No, she really was. I mean, genuinely. 

Justin: So good. 

Anton: Yeah, I could be losing my job here but yeah.

Justin: Alex, let's talk after this!

Anton: Yeah no, for sure. Alex, thank you so much. Justin, what do they, what does everyone need to do? 

Justin: They need to find a way to like, comment and subscribe. I don't know how you, I don't even know how you'd even do that if this is on Spotify. I don't know how you'd do any of that stuff. But if you find the opportunity! 

Alex: You can save it. You could save it. 

Justin: There you go. You can save it, tell your friends about it. But also basically just let us know if you want someone, if you are someone that wants to come on, if you know someone that should come on, if you have questions about certain topics; Anton and I will probably have the same questions or have a unique take on it, and we'll have a guest with another unique take. So this is what we're trying to do, is to bring the, bring a bit of fun into this, what people will see as a boring or scary industry. But I think it's fun, it's technology, it's work changing people's lives. Let's keep it fun. 

Anton: I love it. Guys, if you have got any questions like Justin said please just email them over. All the details are below. Please just get in touch and we will fire them over to our guests and I'm sure they'll be able to come back and help us and we will answer those in the future.

Anton: Thanks again Alex. And thanks everyone that's listening. 

Alex: Thank you.

Anton: Oh, it's a pleasure. It's a pleasure. Thanks to everyone that's listening. Don't forget guys you've been listening to Wheel Chat with Justin and Anton