Lisbeth Nilsson
PhD, occupational
therapist and
specialist
Associated to Lund
University and
Norrbotten Health
County Council
Learn to understand the own body and the lived experience
Learn to influence, direct and control
A gate to becoming a tool user
Driving to Learn™
The method was developed for children, youth and
adults with severe cognitive disabilities
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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
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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.
Driving to Learn – what develops?
Own initiatives
to activity
Motivation
emotions
Motor skill
perception
Body-awareness
sense of self
Neural
plasticity
Responsibility
Problem-solving
Becoming a
Executive functions
tool user
Multi-tasking
Explorative behaviour
Executive
Attention regulation
functions
Alertness
Wakefulness
Independent
mobility
Memory
Interaction
communication
A tool for learning
A powered wheelchair for practice
Can be used in many different practices
Only for use in clinics, schools, day care and alike
TIRO – the learning tool
The design is based on the findings in the
Driving to Learn project
Three prototypes were clinically tested
Predictable functions
Good properties for learning
Stable active sitting
A ”one-for-al” seating unit
Developed in co-operation with Permobil
AB, Sweden and Permobil Europe
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.
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 unit
Makes 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
Electronic box on
the back rest
Quick adjustment
of tray height
Sliding rail for
back rest + tray
Seating depth
Plexi-glass tray
with mid-placed
joystick
Mechanical
bumper
ALP = Assessment of Learning Powered mobility use
A tool for assessment and facilitation of tool-use learning
The ALP-tool
involves 2 parts
The ALP-instrument
 The 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
The ALP – instrument (Nilsson & Durkin, JRRD, 2014)
7
Multi- channelled
attention
Generally focused
Occupation for its
own sake
Fluent precise use of tool Happiness
Satisfaction
Concurrent interactions
6
Multi-channelled
attention but easily
disrupted
Activity
Serious
Contented
Laugh
Excited
Consecutive interactions
Goal-directed
Competent use
of tool
5
Two-channelled
attention
Sequences of
chains of acts
Idea of competent tool
use is born
Eager, smile
Serious
Frustration
Reciprocated interaction
Triadic interaction
4
Single channelled
attention but able to
shift spontaneously
Chains of acts
Exploration of extended
tool use
Serious
Smile
Sometimes
laugh
Mutual interaction
3
Single channelled
attention but able to
shift attention
Act
Basic use of tool
Serious
Contented
Smile
Initiates interaction
2
Single channelled
attention
Pre-act
Idea of basic tool use is
born
Contented
Curious
Anxious
Angry
Responds to interaction
1
Extreme
distractibility
Passive or anxious
Excited
Non-act
Rejection
No or vague idea of tool
use
Open
Neutral
Anxiety
No response
Avoidance
Explore
Dependent on
Multi-level integrated
the doing of
interactions
other activities
Explore
Integrated
tool use
Explore
Occupation
composed of two
or more activities
Body, & machine
Attention well
established and
sustained
STAGE
FUNCTIONS
8
directed
Interaction &
Communication
SEQUENCING
Expressions
& Emotions
PERFORMANCE
Understanding of
tool use
Body, machine, &
environment
Activity &
Movement
Body, machine, environment, &
occupation
Phase Attention
Strategies facilitating learning
Dialogue pedagogy
Mutual interaction
Co-construction of the practice session
Facilitation of problem solving ability
Shifts between difficult – tension and easy - relaxation
Shifts between seriousness and fun, playfulness
Hand over responsibility for the situation to the learner
Evidence of today
Ongoing research
Where the method is implemented
Evidence for Driving to Learn™
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Research has been carried out since 1993
Qualitative method
Studies carried out in clinical practices
Participants aged from 3 months to 86 years
Dissertation 2007: results from
 109 children and adults with cognitive disabilities
 17 infants with typical development
 Various aetiologies causing the cognitive limitations
 Walking participants
Publications – in journals
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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), 447454.
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 causeeffect relationships: case studies. Technology and Disability, 11, 35-38.
Driving to Learn™ - further research
SWEDEN
R&D-project Region Skåne BoU-rehabilition 2007 – 2011
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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 BoUhabilitering 2010 –
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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 –
SWITZERLAND
Research 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 information
Contact:
Lisbeth Nilsson
Mail address: Box 158, 960 33 Murjek, SWEDEN
E-mail: [email protected]
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