title: Environmental control systems - the experiences of people with spinal cord injury and the implications for prescribers.
abstract: Environmental control systems (ECSs) can potentially influence comfort, safety, security and independence for people with severe impairment from spinal cord injury (SCI). This study, aimed at informing prescription practises, investigated ECS prescription and utilisation from the consumer perspective.
  
  
  
  Qualitative inquiry, through 15 semi-structured interviews, explored the perspectives of people with high level SCI who use ECSs. Data were coded and clustered to provide a description of their perspectives and interpret lessons for prescribers.
  
  
  
  The data were grouped into six coding clusters related to readiness to engage, training, autonomy, utility, utilisation and attitudes towards the ECS. Data revealed variability in readiness to embrace ECSs during rehabilitation, some frustration related to setting up systems and instances of ECSs not being used to their full potential. Some highly motivated participants found reward through perseverance. All participants valued having some level of autonomy and personal security. Significant implications for prescribers are described.
  
  
  
  Understanding the influence of factors related to devices, personal characteristics and individual context on ECS usage can guide clinicians in prescription and training processes to facilitate maximum and ongoing benefit from ECSs. A culture of follow-up and evaluation is to be encouraged. Implications for Rehabilitation A variety of factors may influence whether a person with severe impairment from spinal cord injury fully utilises and persists with using an environmental control system (ECS). Findings from this study illustrate the importance of client readiness for prescription and the influence of client perceptions of value, convenience and aesthetics on ECS use. Prescribers should seek to understand what each client needs to become engaged and proficient with ECS use. Prescribers should be knowledgeable about suggested ECSs. Prescribers should prepare clients for potential difficulties in establishing reliable ECS use and establish support mechanisms to facilitate perseverance until effective ECS use is established.
authors.affiliation: a Spinal Outreach Team, Princess Alexandra Hospital, Metro South Hospital and Health Service , Brisbane , Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Myburg
authors.affiliation: a Spinal Outreach Team, Princess Alexandra Hospital, Metro South Hospital and Health Service , Brisbane , Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Allan
authors.affiliation: b Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Canada.
authors.forename: Emily
authors.initials: E
authors.lastname: Nalder
authors.affiliation: a Spinal Outreach Team, Princess Alexandra Hospital, Metro South Hospital and Health Service , Brisbane , Australia.
authors.forename: Sarita
authors.initials: S
authors.lastname: Schuurs
authors.affiliation: a Spinal Outreach Team, Princess Alexandra Hospital, Metro South Hospital and Health Service , Brisbane , Australia.
authors.forename: Delena
authors.initials: D
authors.lastname: Amsters
mesh_terms: D000328:Adult; D000368:Aged; D003200:Computer User Training; D006233:Persons with Disabilities / Q000523:psychology*; D004780:Environment, Controlled; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D012656:Self-Help Devices; D013119:Spinal Cord Injuries / Q000534:rehabilitation*
keywords: Environmental control systems; equipment prescription; spinal cord injury; tetraplegia