Evaluating movement for switch use in an adult with severe physical and cognitive impairments.

Miranda's family members are most supportive of the goal for her to have a powered wheelchair and encourage her when they visit. Motivation has been the key to Miranda's success at learning to operate switches in order to explore and learn from her environment. As long as the outcome available from operation of a switch is desirable for Miranda, she works hard at controlling her movements so as to activate it. Conversely, if the ultimate advantage of operating the switch is unclear to her, she is unwilling to make the effort. The occupational therapist's role is crucial, in that she realizes the importance of motivation and consequently designs activities and rewards that are important and meaningful for Miranda. Miranda's life has been considerably enriched by the introduction of mechanical aids into her leisure sphere. She has become more interested in her surroundings and is excited about exploring possibilities for future rewarding activities, such as academics. A notable additional benefit has been that Miranda now displays a more assertive attitude on her own behalf.