Wheelchair service training of trainers package

車椅子サービス 教習員養成教習パッケージ 中級教習ハンドブック 車椅子サービス教習員養成教習パッケージ・中級教習ハンドブック © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: ToT handbook intermediate level. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: ToT handbook intermediate level. ジュネーブ: 世界保健機関; 2017. ライセンス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワールド・ ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: ToT Handbook Intermediate Level” の全訳である。序章の「はじめに」で述べている通り、本書を含むこ の「車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings” （訳訳 「動車車椅子与 の世界ガイドライン 低リソース 状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたものである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移車支援機器与 に関する共同方針提言書：個人的移車性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子与 ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬授業実習からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳と校閲では以下の方々のご協力をいただきました。ここにお名前を 記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: ToT handbook Intermediate Level, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 模擬授業準備の手引き xiii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 3 ToT.3 模擬授業について 10 ToT.4 多様性に備える 15 ToT.5 成人学習 20 ToT.6 準備時間について 27 ToT.7 プレゼンテーションとファシリテーション 28 ToT.8 コミュニケーションスキル 33 ToT.9 指針文書の知識 37 ToT.10 視聴覚ツールおよび機材 55 ToT.11 フィードバック 61 ToT.12 グループダイナミクスを取り仕切る 63 中級教習モジュール 68 A.1: 付加姿勢支持が有益な車椅子ユーザー 69 A.2: 障害児 71 B.1: 事前評価の概略・事前評価インタビュー 73 B.2: 身体的事前評価−支えなしの座位姿勢 75 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック 78 B.4: 身体的事前評価−ハンド・シミュレーション 81 B.5: 身体的事前評価−身体計測 85 B.6: 車椅子およびクッションの選択 88 B.7: 姿勢支持具の処方（選択）−はじめに 91 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる 93 B.9: 姿勢支持具の処方（選択）−股関節を支える 100 B.10: 姿勢支持具の処方（選択）−体幹を支える 101 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を支える 105 B.12: 製品（車椅子）の下準備 107 B.13: フィッティング 108 B.14: ユーザー教習 109 B.16: メンテナンス・修理・フォローアップ 110 実習 1〜4 112 B.15&17: 総まとめ&教習員からのフィードバック・討論・閉講式 115 教習運営実務と準備 116 付録 121 付録１：WSTPtot必須授業時間割 121 付録２：WSTPtot 中級教習時間割 122 付録 3：WSTPtot 模擬授業フィードバックシート 124 付録 4：技術に関する付録：中級WSTP向け 127 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHOは、WSTPtotの発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtotは、単一の「必須教習技能」モジュール3、および既成の 4教習パッケージ（2012年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtotでは、WSTPmとWSTPsは、一つの教習パッケージ別モジュールと して統合されている。 WSTPtotは 40時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtotの修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi ToT ハンドブックの使い方 この ToT ハンドブックは、教習パッケージ別モジュールの教授法に関する情報を含む、WSTPtot へのステップバイステップの手引き書である。本書は、実習生5が WSTPtot プログラム中に使い、 また将来、WSTPを計画し、実施する際の参考資料として持っておくために開発された。 対象者 WSTPtot は、以下 4つのモジュールからなる： • 必須教習技能6：2日間 • 基礎教習（WSTPb）：3日間 • 中級教習（WSTPi）：3日間 • 管理者/関係者向け教習（WSTPm/s）：3日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向けおよび関係者向け WSTP の実施を計 画している教習員が対象である。実習生がWSTPtot 管理者/関係者向け教習から最大限の成果を 得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業の 必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習7 の機会を得る必要がある。 5 [原文] you [訳注] この教習パッケージ（WSTPtot）を受講する実習生 (模擬授業では教習員). 以下同様. 6 [原文] Core Training Skills 7 [原文] co-training xii 模擬授業8の割り当て 「必須教習技能」モジュールを修了後、実習生はWSTPtot の第 2 部に進み、そこで各自のWSTP 授業を実施することで学んだ技能を実践する。 実習生には、「必須教習技能」モジュール初日に「ToT.3 模擬授業について9」で担当授業が割り振 られる。その際、各実習生にメンター10として ToT 教習員ひとりが割り振られる。教習プログラム には授業を準備し、またメンターの ToT 教習員と相談する時間が盛り込まれている。模擬授業の後 にフィードバックと話し合いが持たれ、このプロセス全体を通して ToT 教習員が実習生の技能を 観察し、評価できるようになっている。 WSTPtot への準備をじゅうぶん行なえるよう、実習生には予め教習パッケージ別教材資料が送付 される。実習生は、どの授業でも実施できるよう準備万端で臨むべきである。 注記： 模擬授業の中には、WSTPtot に合わせて時間配分を短縮するか、授業の一部を割愛するよう 改変したものもある。これらの改変はWSTPtot の目的に合わせただけのもので、WSTP 実施の 際にまねてはならない。 8 [原文] practice delivery 9 [原文] practice delivery sessions 10 [原文] mentor [訳注] 本書では助言指導 mentor, その行為mentoringと指導者mentorは「メンター」に一括. xiii 模擬授業準備の動引き リーダー役実習生 • 担当する授業についてWSTP「教習員用指導書」の授業計画を読み、授業内容をすべて理解して いることを確かめよ。活動は自分でやってみて、受講者に何をやることが期待されているのか、 自分が理解していることを確かめよ。自分が担当する節/授業のみ準備せよ。 • 基礎/中級/管理者向け WSTP「受講者用参考書」と「受講者用ワークブック」（これらは関係者 向けWSTPにはない）の、該当箇所を読め。 • 担当授業について、「ToT ハンドブック」の「この授業を教えるための主な留意点」など関係する 節を読め。 • WSTPの教材にはいくつかの誤りが判明しており、それはこのハンドブックに挙げている。担当 授業について誤りがあるか調べ、あれば推奨されている変更を加えよ。 • 必要に応じて、PPT スライドを編集せよ。 • 適切ならば、ケーススタディなど自分の知識や経験を盛り込め。 • 授業実施を、時間配分も含め予行演習せよ。 • 補助役実習生と話し合い、チームとしてどう作業するか計画せよ： o 役割を割り振る。例えばタイムキーパーや板書など。 o 実技を含むグループ活動については、いっしょに予行演習し、どの誤りに注意が必要で、どう やってそれを訂正するか話し合う。 補助役実習生 • 自分の「教習員用指導書」の授業計画を読め。 • 指示に応じて、リーダー役実習生を補助せよ。 授業開始の前に • 自分の PPT スライドを、当該教習日の開始前に、教習用ノート PCへアップロードせよ。 • 必要に応じて、教室を設営し教習資材を設定せよ。 • 視聴覚機材が設定され、正常に動作することを確認せよ。 xiv 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員といっしょに見習い教習を実施し、自らの技能を育成 し続けなければならない。見習い教習では、教習指導員 1名に対して見習い教習員 2〜4 名の割合 を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、「WSTPtot 模擬授業フィードバックシート」に記録して、実習生と共有される。 メンター11およびピアサポート12 実習生にはWSTPtot 教習後も自分の ToT 教習員と連絡を取り合い、進境を報告し、相談して助言 をもらうよう勧める。実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各自の技能 と自信とを養うために役立つ。実習生がソーシャルメディア上のグループに参加するかグループを 立ち上げ、質問したり学習経験を共有したりできると有益であろう。 11 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 12 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 車椅子サービス教習員養成教習パッケージ (WSTPtot) の構成 WSTPtot プログラムは2日間の「必須教習技能」モジュールと、続く基礎（WSTPb）、中級（WSTPi）、 管理者向け（WSTPm）・関係者向け（WSTPs）から一つ選択する、3日間のモジュールとからなる。 この教習パッケージ別モジュールでは、実習機会を与えて実習生の WSTP 教習員としての技能と 自信を育てる。ここではWSTP実施の際に起こりがちな課題も明らかにし、解決策を提示する。 WSTPtot 課程の概観 ToT プログラム修了後、実習生は、自立した教習員としての自信と能力が備わるまで、見習い教習 を行なわねばならない。見習い教習の回数は、人によって異なる。ToT 教習員と、見習い教習中に 実習生のメンターを務める教習員は、実習生が見習い教習を継続すべきか、ひとり立ちして教習を 実施すべきか、決めるのを手伝う。 必須教習技能 教習パッケージ別 見習い教習員 教習員 実習生が、対面でのToT教習後に経験豊富な教習員との見習い教習を行なえない場合、WHOでは、 実習生にバーチャルな支援やコーチを探し、また他の ToT 実習生と連携し、助け合って、WSTPの 計画、準備、実施を行なうよう奨励している。 フィードバックおよび自己評価 教習パッケージ別モジュールの模擬授業中、実習生は、実習生の技能一覧表を含む「WSTPtot 模擬 授業フィードバックシート」を用いて自分の出来ばえを評価する。ToT 教習員は ToT プログラムの 最後に、このフォームに書面でのフィードバックを与える。これは、実習生が教習技能を向上させ 続けるために役立つ。このフォームは、本書の付録に載っている。 3 ToT.2 車椅子サービス教習パッケージについて 沿革 WSTP（車椅子サービス教習パッケージ）は、2006 年 11 月に インド・バンガロールで開かれた、「開発途上国への車椅子に 関する合意形成会議(1)」に端を発している。 この合意形成会議が基礎となり、WHO「手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて(2)」が作成され、 国際義肢装具学会（ISPO）及び米国国際開発庁（USAID）との 提携のもと、2008 年にWHOから発行された。 車椅子は、個人的移動を可能にするために最もよく使われる支援機器の一つであるが、サービス 供与者には、車椅子ユーザーが最大限に自立した個人的移動を達成し、生産的で高い生活の質を 享受できるようにするための教習を受ける機会がほとんどなかった。 基礎・中級 WSTP の開発目的は、低リソース状況の車椅子サービス職員に包括的車椅子サービス 供与教習を行なうことにより、より多くの大人や子どもが自分のニーズを満たす車椅子を手に入れ られるようになることによって「車椅子ガイドライン」が実行されることである。 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006年 11月 6〜11日. インド, バンガロール: 世界保健機関, 2006]. 2 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 4 4 つのWSTP 基礎車椅子サービス教習パッケージ (基礎WSTP、WSTPb)(3)は、 移動に障害があるものの、付加姿勢支持なしでまっすぐに座れる 男女の子どもや大人に、適正な手動車椅子およびクッションを 供与する職員への教習を助ける。 中級車椅子サービス教習パッケージ (中級WSTP、WSTPi)(4)は、 まっすぐに座るには付加姿勢支持が必要な男女の子どもや大人 に、適正な手動車椅子およびクッションを供与する職員への教習 を助ける。 基礎 WSTP、中級 WSTP とも最短 5 日間で実施できるように設計されている。しかし、各授業に 要する実際の時間はさまざまである。以下のような場合は、追加時間が必要になる： • 授業計画に教材資料を追加する。 • 状況や受講者の技能レベルに対して適切な、追加授業を盛り込む。 • 車椅子ユーザーとの実習回数を増やす。 • 通訳が必要。 • 教習で使用する製品に対して、さらに下準備の時間を取る。 • 現地の事情に合わせて、教習日数を短縮する。 • 教えている受講者に、経験や公式の資格といった面で制約がある。 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版：基礎車椅子サービス教習パ ッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版：中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 5 教習時間割に授業を追加したい場合、国際車椅子専門家学会（ISWP）のウェブサイトに追加教材 が載っている。以下を参照：http://wheelchairnet.org/resources5 管理者向け車椅子サービス教習パッケージ (管理者向け WSTP、 WSTPm)(6)は、事業管理者が、適正な車椅子供与を効果的に支援 する指針となるように設計されている。これには、適正な車椅子 供与の確立に向けて事業管理者や関係者の参画を推進すること も含まれる。管理者向けWSTPは最短 2日で実施できる。 関係者向け車椅子サービス教習パッケージ (関係者向け WSTP、 WSTPi)(7)は、国/地域における適正な車椅子供与の確立に向けて、 全関係者の意識を啓発し、技能や知識を育成するために設計され ている。最短 4時間で実施できる。 • どちらの教習パッケージも、通訳、より詳細な討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るために、期間を延長して実施できる。 5 [訳注] 2022年 10月 28日現在, リンク切れ. 6 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 7 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 20 15 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 6 指針原則 WSTPは、以下の一群の指針原則8に従って作成された： • 車椅子ユーザーを車椅子サービスの中心に置く、ユーザー中心で人権に根ざしたアプローチ9。 • 手に入るエビデンスに基づく10、国際的な最良の実践例11にならう。 • 低リソース状況12に重点を置き、状況に対して適正な製品と教習を採用する。 • 全教習パッケージにおける、教習員や教習対象者としての車椅子ユーザーのインクルージョン。 • 取っ付きやすい非医療的なことばづかいと用語13を用い、それによって： o 臨床や技術の資格を持たない受講者も教習を受けられ、 o サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになる。 WSTP の構成要素 各教習パッケージは、さまざまな教材からなっている。 基礎WSTP 中級WSTP 管理者向け WSTP 関係者向け WSTP 教習員用指導書 ✔︎ ✔︎ ✔︎ パワーポイントのプレゼンテーション ✔︎ ✔︎ ✔︎ 動画 ✔︎ ✔︎ ✔︎ ポスターセット ✔︎ 選択した ポスター 選択した ポスター 補助資料：車椅子ガイドライン、障害者権利条約 ✔︎ ✔︎ ✔︎ 受講者用参考書 ✔︎ 合本 受講者用ワークブック ✔︎ 各種フォーム＆確認表 ✔︎ － 補助教材：工具、器材、各種フォームなど － ✔︎ 8 [原文] guiding principles 9 [原文] user-centered and rights-based approach 10 [原文] available evidence-based 11 [原文] best practice 12 [原文] less-resourced settings 13 [原文] accessible, non-medical language and terminology 7 活車１：「教習員用指導書」をよく知る グループで協力し、「教習員用指導書」を用いながら以下の問いに答えなさい。答えは各問いの横 に書きなさい。 問い 答え 1. 「教習員用指導書」全内容の一覧は、 どこで見つかりますか？ 2. グループ活動は授業の中でどう示され ていますか？ 3. 教習パッケージ全体のねらいや目的 は、どこで分かりますか？ 4. 授業計画で、教習員が PPTスライド を映写すべきタイミングはどこに示さ れていますか？ 5. 教習授業の実行に必要な施設、教材、 設備はどこで分かりますか？ 8 WSTP「教習員用指導書」の使い方 マニュアル 各「教習員用指導書」は教習員に当該パッケージの概観をもたらし、その具体的な手引き書となる ものである。各項目は、WSTPの実施準備前に注意深く読み返すべきである。 付録 補足情報を与える付録は基礎・中級・関係者向けの「教習員用指導書」の末尾に載っており、各種 フォームや確認表も含んでいる。 授業計画 授業計画は、授業を通して教習員を導くレシピのように働く。授業計画に従うのは以下の面で有効： • 学習目標への集中を保つ • 時間を守る • 関連トピックについての、フォーカスグループ活動、話し合い、質問 車画コラム 動画を上映すべきところには、右の動画アイコンのどちら かが付いた動画コラムが「教習員用指導書」に載っている。 • すべての動画の内容、関連性、タイミングを熟知して おくことが重要。 教習員への注記 教習員への注記は、「教習員用指導書」全体に盛り込まれており、内容は： • 質問に対する最も重要な答え • グループ活動への手引き • 教習員が受講者からの質問に答えるのを支援する補足情報 9 活車コラム 活動コラムは、下記の情報を提供する教習員の手引き である： • グループ：活動のために、どうグループ全体を分け るか。 • 指導内容：活動をどのように実施すべきか、受講者 に何を話すべきか。 • モニター：活動中、どのようにグループをモニター して正しい作業を行なうようにするか。 • 時間：活動時間の長さおよび最後のフィードバック 時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき 要点、受講者の思考や感覚を引き出すやり方。 要点のまとめ どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」（管理者向け WSTP の場合）である。 10 ToT.3 模擬授業について はじめに ここで学ぶ、WSTPパッケージを教授することへどれくらい自信を感じるか 1〜10点で記録せよ： 1 2 3 4 5 6 7 8 9 10 自信がない たいへん自信がある 教習パッケージ別モジュールの構成とねらい 教習パッケージ別モジュールには、習得を選択したWSTPの授業を実施する機会が含まれる。 これは実習生14が、以下ができることをねらいとしている： • WSTPの教習教材を使う練習をする。 • 教習仲間を相手に授業を実施する練習をする。 • WSTPの理論、原則、技能、方法論への自分の理解を明確にする。 • 教習時に発生する、よくある問題について学び、それに対処するやり方を見出す。 • 自分の、実習生としての技能（各自の「ToT ハンドブック」付録の「WSTPtot 模擬授業フィード バックシート」の一覧表を参照）を育成する。 リーダー役・補助役教習員および模擬受講者の役割 • 実習生には、リーダー役教習員15と補助役教習員16の両方になる機会がある。 • 同じ授業にリーダー役教習員が複数割り当てられた場合、プレゼンテーションを行なっていない 人はそのあいだ自動的に補助役教習員役に回る。 • 一つの授業にリーダー役教習員が一人だけの場合、その人は他の模擬受講者に補助を頼んでよい。 • 模擬授業では、補助役教習員に特定の役割が割り当てられる場合もある。 14 [原文] you [訳注] 原著では, 本書の対象者で ToT教習を受ける実習生 traineeを, 模擬授業で教える役割にある 場合のみ教習員 trainer, それ以外では youと呼びかけているが, 二人称は日本語的でないため「実習生」の訳語を 充てた. ToT教習員は, WSTPtot教習員用指導書でも ToTハンドブックでも「ToT教習員 ToT trainer」である. 15 [原文] lead trainer [訳注] 実習生 traineeが, 模擬授業で教える際に務める役割の一つ. 16 [原文] support trainer [訳注] 同上. 11 活車１：リーダー役教習員と補助役教習員 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ 12 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役教習員を調整する。 • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー 役実習生にもたらす。 • 授業実施に関する全体的フィードバック/ 振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消し やブラインドの開閉を行なう。 チームワーク 実習生はチームとして、協力して授業を実施すべきである。例えば、以下を助け合うことなど： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 時間管理 • 授業実施中の誤りの指摘 • 受講者からの質問に答える • 妨害や割り込みへの対処 お動本17としての教習員 教習員は、プロとしての行動と実践のポジティブな手本を示すべきである。受講者に求める行動に は、その模範を示せ。例えば： • 時間を守り、じゅうぶん準備する。 • 困難な状況で、問題を解決し解決策を見出す。 • ポジティブなフィードバック、および建設的なフィードバックを与える。 • 上手に自己管理する：例えばストレス管理のため、授業準備とじゅうぶんな睡眠・よい食事との バランスを取るなど。 17 [原文] role models [訳注] そのまま「ロールモデル」と呼ばれることも多い. 13 留意事項：優れた教習員であり、動本であるとは、常に質問への答えを知っていなければならない ということではない。 質問を受けたが答えを知らない場合に、答えを知っているふりをしてはならない。代わりにできる ことは： • 補助役教習員に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 振り返り18とフィードバック 自分自身の教えぶりを振り返ることを学ぶのは、教習員にとって重要な技能である。教習員には、 教習受講者に、建設的な指針となるフィードバックを与えられることも重要である。 これが、振り返りとフィードバックの技能が ToT プログラムに組み込まれている理由である。 各模擬授業の終わりに、リーダー役教習員は次を振り返るよう求められる： • 何がよかったか、また何がうまく行ったか。 • 何に改善の余地があるか。 ToT 教習員は模擬受講者からの簡潔なフィードバックを促し、リーダー役教習員や模擬受講者が挙 げていなかった点があれば、最後に ToT 教習員から付け加える。 模擬授業の準備 模擬授業の準備には、以下が含まれるべきである： • 「教習員用指導書」の授業計画を読み、授業内容をすべて理解していることを確かめる。 • 「受講者用参考書」と「受講者用ワークブック」（関係者向け以外のWSTPで使う）の該当箇所 を読む。 • PPT に適切な変更/補足を加える。 • 適切ならば自分自身の知識や経験を組み込み、自分のケーススタディを活用する。 • 授業実施を、時間配分を含め予行演習する。 • 補助役教習員と、チームとして協力する。 • 授業に必要な教材を準備する。 授業が ToT 教習員によるデモを含む場合は、ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせよ。 18 [原文] Reflection 14 判明している誤り WSTP の「教習員用指導書」「受講者用参考書」「受講者用ワークブック」および PPT の中には、 いくつかの誤りが判明している。 • 判明している誤りは各自の「ToT ハンドブック」で挙げている。 • 授業を準備するさい、担当授業に誤りがないか確かめ、必要な変更を加えよ。 • 模擬受講者と誤りについては話さず、授業のプレゼンテーションは通常の WSTP 教習と同様に 行なえ。 授業プレゼンテーションにおける自信 • 最初の模擬授業では、教習仲間や ToT 教習員を前にしてアガるかもしれない。それが普通だ19！ • さらに授業を実施するにつれ、技能と自信がついてくる。 • 「必須教習技能」モジュールのあいだ、グループ活動からのフィードバックを発表するよう求め られる。その機会を活かし、仲間へのプレゼンテーションを練習せよ。 PPT（パワーポイント）のプレゼンテーション • 各授業の標準版 PPT は、動画を埋め込んだものが教習用ノート PCで使用可能。 • 自分の PPT に、スライドの追加などの変更を加えた場合は、模擬授業前に教習用ノート PC へ それをアップロードしておく必要がある。 模擬授業の制限時間 • 模擬授業のあいだ、時間は厳しくモニターされる。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止させて次の教習員に移るか、授業を終了する。 19 [原文] This is normal! 15 ToT.4 多様性に備える20 WSTP教習員はしばしば多様性21に遭遇するため、多様な受講者集団を取り仕切るやり方を、必ず 把握しているべきである。多数派の中にいると、人はえてして力強さや自信を感じる。少数派の中 にいると、人は孤立や疎外を感じることがある。集団は文化22や多様性によって分かれ、あるいは まとまる。 文化と多様性 文化：人びとを同じにするもの • 共有あるいは共通の、価値観23、意識24、道徳、伝統、信念25などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団26、ジェンダー、性自認27、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを忘れないように。 文化的能力28 文化的能力とは、個々人が自分の文化とは異なる文化との効果的かつ敬意をもった関わり方を学ぶ、 能動的プロセスである。 それは個人や集団、組織に関係するものであり、また学ぶことができるものである。 文化的能力に通常含まれること： • 自分の文化的慣行への自覚 • 異なる文化的慣行に関する知識 • 文化の違いに対するポジティブな姿勢 • 文化が人的交流へどのように影響を及ぼすかの理解 20 [原文] Preparing for diversity 21 [原文] diversity 22 [原文] culture 23 [原文] values 24 [原文] attitudes 25 [原文] beliefs 26 [原文] ethnicity 27 [原文] gender identity 28 [原文] cultural competence [訳注] 国際保健用語では「文化能力」とも訳される. 16 教習員の文化的能力 教習員は文化の違いを理解し、よさを分かるために必要な知識、技能、意識を必ず持つように せよ。これには他者の文化的な信念、ふるまい、ニーズを尊重し、受容することが含まれる。 WSTP 教習員が文化の違いを理解あるいは尊重しなければ、こうした違いは、誤解、失望、混乱、 困惑、怒り、侮蔑などを引き起こすことがある。 ありうる文化的留意事項 • 身体的接触：女性教習員が男性車椅子ユーザーを事前評価する、または男性教習員が女性車椅子 ユーザーを事前評価することは、文化的に不適切な場合がある。 • 服装：服装は、必ず文化的に適切であるようにせよ。 • コミュニケーション：文化によっては、直接聞かれない限り受講者が質問に答えない場合がある。 • アイコンタクト29：直接相手を見ながら話しかけることが、失礼に当たる場合がある。 • フィードバック：受講者が、人前で建設的な批判/フィードバックを与えたり受けたりする際に、 どこまでそれを受容できるか、よく気をつけよ。 • ジェンダー：文化によっては、男女がペアを組んで活動したり、いっしょに食事をしたりするの は不適切な場合がある。これは、グループ作業や休憩時間の組み方に影響しよう。 • 宗教的信念：現地の宗教的慣行、例えば祭礼、断食、礼拝などに合わせて、休憩時間の延長や、 開始/終了時間の変更が必要になる場合がある。 活車２：文化的能力 自分の文化とは違う文化を経験したときの例について考え、書き出しなさい。 それはどういうものでしたか？ 29 [原文] Eye contact 17 どう感じましたか？ その経験から何を学びましたか？ 車椅子ユーザーはじめ障害者のWSTP へのインクルージョン WSTP（車椅子サービス教習パッケージ）は、教習 チームへの、また受講者としての、車椅子ユーザー はじめ障害者のインクルージョンを推進している。 これが重要な理由は： • 車椅子ユーザーは、自分の体験や視点を活かして WSTPの学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子 サービスにおける車椅子ユーザーの中心的役割 を強化する。 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、差別・ 偏見とたたかい30、CRPD（障害者の権利に関する条約）の原則を強調するために役立つ。 30 [原文] combat stigma 18 車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁 車椅子ユーザーはじめ障害者の WSTP へのインクルージョンのために、WSTP 教習員は、障害者 の社会へのインクルージョンを阻むものは何か、必ず理解しておくべきである。 認識 人びとは障害についてよく知らないことが多いため、障害者に対して誤った思い込みを抱く。 • 多くの人は、障害者は家族、仕事、余暇、社会生活、個人生活に関して同じゴールや夢を持って いないか、それらを達成する能力がないと考える。 • 身体障害があることから、この人には認知障害もあると考え、その人を子ども扱いし、ゆっくり と、あるいは大声で話し、あるいは障害者に付き添っている人に話しかける。 意識31 障害者に対するネガティブな意識の例 • 障害者は、その機能障害ゆえに社会での価値は低いとする見方。 • 障害者を慈善の対象として恩を着せる32。 • 障害者を、よく知らないために、あるいは失言をやらかすのを恐れて忌避する。 • 家族、地域リーダー、学校などの機関が、障害児教育に低い価値を置く。障害者は、教育抜きに は機会が限られる。 信念 信念は意識と密接に関係し、また障壁もつくり上げる。例えば、機能障害がある人は、そのために 任務を達成できないと、実際はできるにもかかわらず信じることなど。 31 [原文] Attitudes 32 [原文] Patronizing 19 文化 文化的信念、規範、価値観も障壁をつくり上げる。文化によっては、障害者は祟られていると信じ、 そのけっか障害者が地域や家族から閉め出され、引きこもり隠れてしまう場合もある。 ステレオタイプ33 これらは障害者を、自分自身の関心や技能を持ち社会に貢献する個人として認識しないネガティブ な見方である。 法令および政策 障害者の権利を保護する法令や政策は、あっても執行されないことが多い。例えば、国によっては 一定枠の障害者を雇用することを要件とするか、被雇用者への合理的配慮を規定した雇用法制を 持っている。強制力を伴わなければ、こうした法律や政策は効果を発揮しない。 環境の障壁 物理的な障壁は障害者の参加や統合への制約になる。屋外生活でのそうした例は傾斜、砂、草、川 などで、また屋内での移動や自立には階段、狭い戸口、家具、カーペットなどが妨げになる。 支援機器の欠如 これはインクルージョンへの大きな障壁の一つで、WSTP（車椅子サービス教習パッケージ）は、 CRPD（障害者の権利に関する条約）に沿って適正な車椅子の入手しやすさを改善する取り組みの 一つである。 33 [原文] Stereotypes 20 ToT.5 成人学習34 効果的な教習員となるためには、大人にとって最良の学び方を理解し、さまざまな学習スタイルに ついて知ることが重要である。 活車１：成人学習の原則 これまでの、自分のポジティブな学習経験について考え、その経験がどのようにポジティブだった のか書き出しなさい。 下欄を用い、活動中に考えたことを書き出しなさい。 ポジティブな学習経験 34 [原文] adult learning 21 活車２：自分の選好学習スタイル35を判定する 自分の学び方を反映している文にマルを付けなさい A. ステップバイステップの指導に従って B. 新しいものごとを経験することによって C. 間違えることによって D. 推論によって E. 教わった内容の理論を理解することによって F. 学んだことを適用することによって G. 自分の経験を当てはめることによって H. 動画を視聴することによって I. 選択肢を評価することによって J. 自分の感覚に依拠することによって K. 人と交流することによって L. 人がやって見せるのを見まもることによって M. 感受することによって N. 大局を分かる36ことによって O. そばに付いて見まもることによって P. やり方の説明を傾聴することによって Q. そのトピックについて書かれたものを調べることによって R. 人と関わり合うことによって S. 学んでいる内容を試してみることによって T. ものごとの一般的原理を理解することによって U. 講義に参加することによって V. 実体験を通して W. 自分の観察に頼ることによって X. ものごとに個人的に関わることによって Y. ものごとに対する自分の感じ方を探ることによって Z. 活動的になることによって AA. 教習員を観察することによって BB. 実験によって 35 [原文] preferred learning style [訳注]「選好する/好みの学習スタイル」の意. 36 [原文] seeing the big picture 22 選好学習スタイル集計表 質問表に付けたものと同じ記号をマルで囲みなさい。マルで囲んだ記号が最も多い列が、自分の 選好学習スタイルになります。 複数列が同数だった場合、それは強いこだわりがないということです。 経験によって 観察によって 思考によって 実行によって B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB 合計： 合計： 合計： 合計： 学習経験サイクル37 選好される学びの 4つのスタイル： 1. 経験による学び 2. 観察/感受による学び 3. 思考/理解による学び 4. 実行/適用による学び 4 つの学習スタイルは、学習経験サイクルと一致する。 スタイルは人によってさまざまでも、新しい知識や技能を学ぶには、この 4つの段階のそれぞれを 経るのが最も効果的である。 37 [原文] Experiential learning cycle 23 WSTPには、全受講者の参加を得るため、学びの 4段階/種類をそれぞれ含めている。 • ロールプレイングやシミュレーションは、経験から最もよく学ぶ人に最適である。 • 観察から最もよく学ぶ人には、デモ、動画、教習員や車椅子ユーザーを視るのが最も有益である。 • 概念を論じ、枠組みや定義、理論をもたらす発表や読み物は、大局的に考え、理解することから 最もよく学ぶ人に役立つ。 • 車椅子ユーザーとの実習（基礎WSTPや中級WSTPなどの）は、理論的な説明を適用するので、 実行によって学ぶ人に最適である。 グループの話し合い、ケーススタディ、質疑応答、ワークブックの課題、フィードバック時間は すべて、異なる学習スタイルにアピールする授業方法なので、それらの目的、および各場面に適合 する活用方法をよく考える必要がある。 教習員自身にも、自分の選好スタイルがある。重要なことは、それを認識していることと、特定の アプローチをおろそかにしないよう気をつけることである。 どの段階も飛ばさないように！ 「経験」の部分が欠けると何が起こるか？学びが実生活との接点を失い、受講者個人の経験に根を 下ろさない、抽象的なものになる。 「観察」の部分が欠けると何が起こるか？学習者が、自分の個人的経験がより広い抽象的な概念や 枠組みとどう結びついているのか、探求したり確かめたりできなくなる。 「思考」の部分が欠けると何が起こるか？学習者はある経験から別の経験へ、それらどうしの関連 を分からないまま進むことになる。そうした人は、経験を有意義なやり方で整理するために役立つ 枠組みから得るものがない。 「実行（練習）」の部分が欠けると何が起こるか？学習者は、理論や枠組みを職場や自分の生活に 適用するやり方を見出すことがない。 24 活車３：学習への選好と活車をマッチさせる この教習活動はこの人の学習スタイルに最も効果的、と思う人の名前の下に「X」を付けなさい。 最後の列には、比較として自分自身のスタイルについて記入しなさい。 • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解することによって最もよく学びます。 カ ル ロ ス ミ リ ア ム シ ー タ ア フ マ ド 自 分 自 身 1. 車椅子ユーザー教習の練習としてロールプレイングを 行なう 2. 教習員が新規車椅子ユーザーへの身体計測のやり方を 示すところを観察する 3. 自国の車椅子サービスに関する、法律や規制についての 政府職員の発表に出席する 4. 車椅子に乗っている人がやりたいことを実行している のを観察する 5. 車椅子サービスに関連する重要文書について学習する 6. 他の受講者と、フォローアップをユーザーの家で行なう ことの長所と短所について話し合う 7. CRPD（障害者の権利に関する条約）の最も重要な条文 に関する、教習員の説明を聴く 8. 除圧クッションをつくる 9. 車椅子で走り、車椅子ユーザーが経験する障壁を体感 する 10. 教習員が事前評価を実施する様子を観察する 11. 新規車椅子ユーザーに対する事前評価インタビューを 実施する 12. 車椅子サービス事業を既存のリハビリテーション サービスに追加することによる費用節減を算定する 25 成人学習を支援する だれにも選好学習スタイルがある一方、あらゆる大人の学習者に ついての共通項もある。 大人の学習者は主体的38で自分の学習に責任を持つため、積極的 参加を促すことで支援せよ。 大人の学習者は、学びに自分自身の知識や経験をもたらすため、 その経験を他者と共有し、また他者から学ぶよう奨励せよ。 大人の学習者は、関連が明らかで実践的な39学びを求め、学んだことを適用したいと望む。業務へ 実際に適用できる、明確な学習目標を置くことで支援せよ。 活車４：問題解決40 「問題解決」とは、問題に対して最適解を見出すプロセスのことです。 これは成人学習の重要部分で、車椅子サービス供与における重要技能です。 受講者が問題解決を行ない、自分自身の解決策を見出すには、どう動伝えばよいでしょうか？ 38 [原文] self-directed 39 [原文] relevant and practical 40 [原文] problem solving 26 受講者の問題解決を助ける • オープンクエスチョン41（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ42：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のために 教習を訪れた、個々のユーザーについて話せ。 • 「分かりません」で答えを終わらせるな43：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ44：課題を個別のステップに分解し、ステップバイステップに45質問し、 問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的46に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 留意事項 • 車椅子供与教習（基礎WSTP・中級WSTP）の受講者には、単純な答えがない場合もある。 • 臨床場面では、処方や改造、姿勢支持具が、技術的にはよい解決策であっても、機能的な障壁や 制約をこしらえてしまう場合もある。 • 完璧な解決策は、たいてい一つではないことを認識せよ。車椅子サービス供与には、顧客ニーズ と手に入る製品の範囲との間での妥協が求められる。 41 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 42 [原文] Ask rather than tell 43 [原文] Don’t take ‘I don’t know’ for an answer 44 [原文] One step at a time 45 [原文] step-by-step 46 [原文] laterally 27 ToT.6 準備時間について 準備時間は、ToT の時間割に盛り込まれている。この時間は、以下のことに活用できる： • 「保留スペース」の質問に答える。 • ToT 教習員と面談し： o 質問する。 o フィードバックをもらう。 • 自分の模擬授業を準備する： o 教習員仲間を調整する。 o デモ用資材や視聴覚機器を準備する。 28 ToT.7 プレゼンテーション47とファシリテーション48 活車１：教習員のふるまい49 過去に自分が教習を受けた人を思い出し、だれが効果的な教習員だったと思われるか特定しなさい。 それは、学ぶべきことを学べるようにし、ポジティブで価値ある経験をもたらした人です。 下欄に自分の経験を振り返りなさい。 その人のどんなふるまいが効果的でしたか？ 47 [原文] presenting [訳注] 意味は p.29本文を参照. 48 [原文] facilitating [訳注] 適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 49 [原文] behaviour 29 プレゼンテーションとファシリテーション プレゼンテーションとは、受講者が情報を与えら れる、一方通行のプロセスである。プレゼンテー ションでは情報、事実、数字を提供し、誤情報を 訂正する。 事実、理論、枠組みのプレゼンテーションを行な う際には、対象者がその情報を知らないか、思い 出す必要があるという前提でのぞむ。したがって 全受講者は、たとえその情報をすでに知っている 人がいても同様に扱われる。 ファシリテーションとは「ものごとを容易にする」という意味である。ファシリテーションを 行なうのは、受講者にとり、以下が容易になる場合である： • 理論的概念と現実の課題や任務との結びつきを理解する。 • 自分自身の経験を振り返る。 • 自分自身の経験や見方を、新しい情報と結びつける。 プレゼンテーションとファシリテーションの優れた実践 プレゼンテーション： • 話のペースやトーンに変化をつけよ。 • 教室内の自分の立ち位置に注意し、変化をつけよ。 • 質問し、励ましてグループに貢献を促せ。 • 試験済みで時間が設定されている、WSTP「教習員用指導書」の指示にならうこと。 • 映しているスライドが、話している内容と一致していることを確かめよ。スライドは「教習員用 指導書」と同期させよ。 • スライドを読む時、グループに背を向けてはならない。 ファシリテーション： • 活動は授業前にやってみること。そうすると活動の目的がわかる。 • 自分で考える間 [ま]50を与えよ。沈黙をおそれるな。 • 受講者からの質問は、自分で答える前にグループへ問いかけよ。 • 受講者には明確な指示を出し、自分自身がその指示を理解しているか授業前に確かめておけ。 • 受講者をモニターし、授業の要点を学んでいるか確かめよ。 50 [原文] time and space to think 30 エナジャイザー(51) どんな教習の中でも、活力レベルが落ちてくる時間はあるものだ。暑い気候、空気のよどんだ部屋、 豪華な昼食、教習の長い一日からの疲れは、注意を散漫にし、グループの活力を落ち込ませる。 これに対処する最善策は、みなが気軽に動いて交流する機会を設けることにより、教室へ活発さや 楽しさを注入することである。 これは活気をもたらすための、教習の一環としても、単独の活動によっても達成できる。以下は、 いくつかのアイデアである。 教習の一環として： • グループ全体へひんぱんに質問し、一人を指名して答えてもらう。 • 受講者に、隣どうし顔を合わせて質問やトピックへの答えを話し合ったり、出たばかりの意見に 対して異なる意見を探ったりしてもらう。 • 受講者に、立ち上がって何か（車椅子やポスター、フリップチャート、デモ）を見に来てもらう。 • 可能であれば、気分転換や運動をもたらすため、授業を他の部屋や屋外へ移動して行なう。 単独の活車として： • いっしょに歌う。 • 立ち上がって簡単なストレッチ体操を行なう。 • 「サイモンが言った52」で遊ぶ：指示を出し（「跳び上がれ」、「つま先に触れ」、「空を指させ」、 「振り返れ」など）、受講者は、指示が「サイモンが言った」で始まった時だけ、それに従わねば ならない。 • 3 分間ストレッチを行ない、休憩する。 • 受講者のひとり、あるいはグループをよび、2〜3 分、エナジャイザー活動を指揮してもらう。 かれらは、グループ全体で共有できる、別の現地に合った活動を知っているだろう。 51 With thanks to Robert Chambers for some of them [感謝: このいくつかはロバート・チェンバースに 負っている]. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 (https://www.routledge.com/Participatory-Workshops-A- Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). [原文] Energizers 52 [原文] Simon says [訳注] 日本の「船長さんの命令」と同じルールで行なわれるゲーム. 詳細は例えば (https:// yamatoco.theblog.me/posts/4946847/, 2023年 7月 1日アクセス済) などを参照. 31 留意事項： • 文化、ジェンダー、障害による違いを認識し、また敏感であれ。 • 受講者ができない、あるいはやりたくないことは、いっさい強制するな。 • ゆっくりと始め、より元気のある活動へと盛り上げよ。 • 可能な時は、自分も参加せよ。 • 楽しんで！ 時間管理 教習員は、必ず教習が時間通り進むようにすべきである。数多くの授業や活動がある一方、それら を完了するための時間は限られている。持てる時間を最大限に利用するには、行動や活動の修正が しばしば必要になる。 活車２：時間管理 ペアを組んで話し合いなさい：教習が時間通り進むためには、どうしたらよいでしょうか？ 思いついたことを書き出しなさい： 32 教習を予定通りに保つための提案 • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者を 待たせて不利益を負わせるな53。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTPに資料やあまりにも多くの実例 を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留54」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば、「15 分休憩、10:45 には戻って下さい」 「自分のグループでの話し合いに 10分、フィードバックに 5分使えます」 • 教習員仲間55と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には予備計画56を立てておけ。例えば、雨で車椅子の移動技能 の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 53 [原文] avoid penalizing 54 [原文] Park 55 [原文] co-trainers 56 [原文] back-up plan [訳注]「プラン B」とも呼ばれる. 33 ToT.8 コミュニケーションスキル 活車１：コミュニケーションスキル 下表のうち、自分のグループに割り当てられた情報を読みなさい。続いて他の実習生がその要点を 把握できる発表を作成しなさい。 グループで作業し、情報をどのようにプレゼンテーションし、だれがどの部分をプレゼンテーション するか決めなさい。発表には、グループ全員が参加しなさい。フリップチャートやホワイトボード などの小道具は、自由に用いてかまいません。発表では、創造性を発揮しなさい。 準備には 20分使えます。皆への発表時間は 5分あります。 グループ１：言語的技能： • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語57や「無意味な語58」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な59ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 57 [原文] slang 58 [原文] ‘non-speak’ 59 [原文] simple and non-medical 34 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 自分のボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える60な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン61（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 60 [原文] jump to answer 61 [原文] closed questions 35 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ62（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば、「あなたはどう思い ますか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論63 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな64。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴65：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・車画・通訳について 以下は教習でデモを行ない、動画を上映し、外国語と手話、両方の通訳を用いる場合の優れた実践 である。 デモを行なう： デモを行なう際には： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 62 [原文] challenge 63 [原文] clinical reasoning 64 [原文] Never make up an answer if you do not know. 65 [原文] Listen 36 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎WSTPと中級 WSTPのデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 車画を用いる： WSTPでは、ほとんどの実技のデモに動画を用いている。動画を上映する前に： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や動話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2倍時間を要する。 37 ToT.9 指針文書66の知識 「指針文書」とは何か？ 指針文書とは、出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、 規則を与え、また車椅子サービス供与関係者の指針となるものである。 多くの政府、国際機関、資金供与者67その他の関係者は、これらの国際的枠組みに沿って開発事業 を計画し、資金を供与する。 これらについての知識があれば、より強い立ち位置から、車椅子サービス供与に向けた啓発や政策 提言を行なえる。 国や地域の法令および政策は、現地の車椅子サービス供与に影響を及ぼす。話し合いを導くうえで、 そうした文書は熟知しておく必要がある。 次節からは、車椅子サービス供与に関係するさまざまな指針文書を概観する。そのいくつかは WSTP用 USB メモリ68に収めており、その他はインターネット上でアクセスできる。 「国際連合 障害者の権利に関する条約 (CRPD)」 「国際連合 障害者の権利に関する条約」は一般に「CRPD」、 時に「UNCRPD」とも呼ばれる69。CRPDは障害者に関する最も 重要な国際条約だと広く考えられている。 2008 年に発効し、発効日には 82か国が CRPDに署名、その選択 議定書に 44か国が署名した。 これは国連の条約中、発効日の署名国数では史上最多である。 CRPDは、障害者への社会の見方と処遇のあり方を変革するため、国際社会の代表者によって策定 された。 この条約の策定に参画した代表者は障害者、政府当局者、非政府組織（NGO）の代表などである。 66 [原文] guiding documents 67 [原文] donors 68 [原文] WSTP Pen Drive [訳注] 英語版のみがWHOより配布されている. 各資料の日本語版入手先は訳注を参照. 特に指定していないものは, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 69 [訳注] 日本では「障害者権利条約」と略されることも多い. 38 CRPDが重要である理由は、障害者が他のあらゆる人びとと同じ権利と機会へアクセスできるよう になるためのツールだからである。 年々、ますます多くの国ぐにが CRPDに署名している。CRPDおよびその選択議定書への署名国に 関する最新情報は、国際連合のウェブサイト(70)上で確認できる。 CRPDには車椅子サービス与 に関連するいくつもの条文がある： 最も関連がある こちらも関連がある • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション71および リハビリテーション • 32条：国際協力 • 19条：自立生活および地域社会への インクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30 条：文化的生活・レクリエーション・ 余暇・スポーツへの参加 CRPDの他の多くの条文が、間接的に車椅子サービス供与と関連している。例えば、第 6条は女性 障害者の具体的なインクルージョン、第 7条は子どもの平等に関わる。 70 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 71 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 39 子どもや女性がさらにぶつかる障壁には何があるだろうか？ • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持72を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉73を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 WSTP受講者がCRPDを熟知していることは重要： • CRPDの人権に基づくアプローチを、障害者への車椅子サービス供与の発展に役立つように活用 するため。 • CRPDの条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえで 役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 72 [原文] supportive seating 73 [原文] stigma 40 主要条文の詳細： 第 4条 第 4条 一般的義務 によると締約国は： 障害に基づくいかなる種類の差別もない、すべての障害者のあらゆる人権および基本的自由の完 全な実現を保証し、また促進することを約束する。 第 4条 (g)項によると： 障害者に適した、情報通信技術、移動補助具、支援機器、支援技術などの新技術について、研究 開発を実行または推進し、またその入手しやすさと利用とを増進し、そこでは価格に無理のない 技術を優先する。 同 (h)項によると： 障害者へ、新技術を含む移動補助具、支援機器、支援技術についての利用しやすい情報を、他の 形態の支援、支援サービス、施設と並んで供する。 同 (i)項によると： この条約が認める権利について障害者と協働する専門家および職員への研修を推進し、それらの 諸権利が保証する支援およびサービスが、よりよく供されるようにする。 第 20条 第 20条 個人的移動性 は車椅子サービス供与に最も関連する条文である。これの要件は： 締約国は、最大限に自立した個人的移動を障害者へ保証するための実効ある施策を講じ、以下の ことなどを行なう： (a) 障害者の、自分が選んだ方法で、自分が選んだ時に、無理のない費用で行なう個人的移動を 容易にする。 (b) 質の高い移動補助具、補装具、支援技術、人や動物による支援、仲介サービスを、障害者が 利用しやすくなるようにし、とりわけ無理のない費用でこれらが手に入るようにする。 (c) 障害者、および障害者と協働する専門職員に対して、移動技能の教習を提供する。 (d) 移動補助具、補装具、支援技術の生産に当たる事業体が、障害者の移動についてのあらゆる 側面を考慮するよう奨励する。 41 第 26条 第 26条 ハビリテーションおよびリハビリテーション に含まれる要件： 締約国は、障害者のために設計された支援機器および支援技術について、ハビリテーション およびリハビリテーションと連携するので、それらの入手しやすさ、知識、利用を増進する。 「ハビリテーション」と「リハビリテーション 」の定義： • リハビリテーションの言葉はよく知られているが、ハビリテーションはあまり使われない。 • リハビリテーションの重点は能力を回復することで、いっぽうハビリテーションは新規に能力 を習得し、構築することに関わる。 第 32条 第 32 条は、例えば支援技術の利用促進などの国際協力を推進することから、広い意味で車椅子 サービス供与に関連する。 42 WHO「動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて」 WHOの「手動車椅子供与の世界ガイドライン 低リソース状況の 克服に向けて (車椅子ガイドライン)74」は、車椅子供与に焦点を 置いた、最も重要な国際的文書である。 「車椅子ガイドライン」は、現在世界的に理解されている適正な 車椅子供与枠組みをまとめたものである。「車椅子ガイドライン」 の発行以前、車椅子供与に関わる諸組織は、車椅子の設計や生産； サービス提供システムの確立；職員教習；車椅子供与に関連する 政策策定に当たり考慮すべき重要事項は何か、共通理解を持って いなかった。 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画により作成された。これは合意 された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子サービスの政策 提言のために役立つ、強力なツールとなる。「車椅子ガイドライン」は、低・中・高リソース状況で 普遍的に達成可能な基準を反映している。 車椅子が適正であるとは： ✓ ユーザーのニーズおよび環境条件に合い、 ✓ 適切にフィットして姿勢を支え、 ✓ 安全で耐久性があり、 ✓ 国内に用意され、 ✓ 入手・メンテナンス・継続したサービスが国内で、無理のない価格で可能であること。 これは、教習員およびWSTP受講者が知っておくべき重要な定義である。 74 [訳注] これに加え, 2023年 6月にWHOから「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024年に発行予定. 43 「車椅子ガイドライン」では、車椅子に関する以下の項目も 取り上げている： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 WSTP教習員の、「車椅子ガイドライン」に関する知識は、 包括的でなければならない。教習員として、機会あるごとに その意識を喚起すること。 「車椅子ガイドライン」は、WHOのウェブサイトで各言語版75を入手できる。 「低リソース状況での移車支援機器与 に関する共同方針提言書」 WHO の「低リソース状況での移動支援機器供与に関する共同 方針提言書(76)」は、各国が CRPD の移動支援機器供与関連の 条文を履行できるよう、2011 年に発行された。 この文書は、移動支援機器へのアクセスに対する障壁、移動支援 機器へのアクセスを増やすための要件、各国および国際的な関係 者への提言などの貴重な情報を提供する。 75 (https://www.who.int/publications/i/item/9789241547482). [訳注] フランス語・スペイン語を含む. (https://apps.who.int/iris/handle/10665/43960). [訳注] 日本語・ベトナム語を含む. 76 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) re lated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URLおよび https://j-aws.jp/who/). 44 「地域に根ざしたリハビリテーション：CBRガイドライン」 WHOの「地域に根ざしたリハビリテーション：CBR ガイドライ ン(77)」は 2010 年に発表され、CBR78への世界共通の理解および 取り組みを提示したものである。 CBR は、低リソース状況における障害者のリハビリテーションへ のアクセスを、地域リソースの最適な活用によって改善するため の方策である。「CBR ガイドライン」は行動への枠組みを提供し、 実施への実践的な提案を示している。 「CBR ガイドライン」の導入ブックレットと保健コンポーネント はWSTP用 USB メモリに資料として収められている79が、WSTP で特に触れてはいない。 CBR は 90超の国ぐにで実施され、CRPDの条文を実現する最も 効果的な方法の一つだと、ますます考えられるようになっている ため、「CBR ガイドライン」についてよく知るよう推奨する。 CBR はしばしば「地域に根ざしたインクルーシブ開発 (CBID)80」とも呼ばれ、WSTP でも話題に 上る可能性が高い。CBR の多くの側面が車椅子サービス供与に関連しており、例えば、紹介・相談 ネットワーク、地域の保健センター、CBR ワーカーなどがある。 77 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBRガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 78 [訳注] Community-based rehabilitationの略称. 79 [訳注] 英語版のみ. ウェブ上で入手する場合は例えば: 日本語版 (公益財団法人日本障害者リハビリテーション協 会訳) https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html その他各言語版：https://www.wh o.int/publications/i/item/9789241548052 80 [原文] community-based inclusive development 45 CBRマトリックス CBR マトリックス(81)は「CBR ガイドライン」の土台の一つである。その 5つの領域82として保健、 教育、生計83、社会、能力強化 (エンパワーメント)84があり、さらにマトリックスの各領域は５つ ずつの要素85を含むため、合計で 25要素がある。 81 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 82 [原文] components 83 [原文] Livelihood 84 [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_security/human_security_ap proach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと考え併記した. 85 [原文] elements 46 活車１：CBRマトリックス グループで作業し、車椅子サービス与 が CBR マトリックスの自分たちに割り当てられた領域 （保健、教育、生計、社会、能力強化（エンパワーメント））に、どう関連するか列記しなさい。 さらに詳しい情報および「CBRガイドライン」全文は、WHOのウェブサイト(86)を参照。 86 (http://www.who.int/disabilities/cbr/guidelines/en/). 47 車椅子サービス与 とCBRの 5領域 保健 教育 • リハビリテーション：長期および短期の • 健康増進や二次障害予防：例えば早期発見 と早期介入による側弯や褥瘡の予防 • 保健医療サービスへのアクセス • 学校、教育プログラム、職業訓練プログラムへ のアクセスを可能にする 社会 • 社会およびレクリエーション活動へのアクセス 増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス エンパワーメント • 自己イメージや自信の向上 • ピアサポート（当事者支援） 「アクセシビリティのためのデザインの留意事項」 「アクセシビリティのためのデザインの留意事項(87)」は、車椅子 サービスを訪れる場合およびその他の環境の両方で、アクセスが あらゆる面について考慮されるようにする方法に関する、有益な 情報をもたらす。ここで取り上げているのは： • 障害者用保留スペース • 切り下げ縁石 • 通り道 • スロープ • 階段 • 手すり • ドアおよび戸口 • 廊下 • トイレ 87 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled Pe ople; 2006 (http://ascon.info/publications/accessibility.pdf). 48 「持続可能な開発目標（SDGs）」 「持続可能な開発目標 (SDGs)(88)」は、2015 年 9 月、歴史的な 「国連サミット」で世界の指導者たちが採択し、2016 年 1月 1日 に発効した。続く 15 年にわたり、各国は持続可能な開発の 3 つ の側面（環境、経済、社会）すべてに努力を結集し、17のゴール を達成すべく尽力する。 SDGs は、2015 年に最終報告書を出した「ミレニアム開発目標 (MDGs)89」を継承するもので、2012 年の「国連持続可能な開発 会議 (リオ+20)」で始まった共同開発プロセスの成果である。 WSTP モジュールの開発は SDGs の発表前だったため、教習パッケージではそれに触れていない。 しかし、政府、開発・援助機関の多くが SDGs への取り組みに集中するため、実習生や受講者が、 それを意識して適正な車椅子サービス供与が SDG の課題90にどう適合するか見極めることは重要 である。 SDGs は 17 のゴールと関連する 169 のターゲットからなる。 SDGs 宣言の第 4パラグラフでは、重要な誓約がなされている： この偉大なる共同の旅へ乗り出すにあたって、我われはだれひとり取り残さないことを誓う。 我われは、人間の尊厳は根本をなすものであると認識し、この目標とターゲットとがあらゆる 国ぐにと人びと、そして社会のあらゆる部分で満たされるよう希願する。そして我われは、 その最後に取り残されたものへ、最初に手を差し伸べるべく尽力する。 障害者への言及は、そこなわれやすい91人びとに関する第 23パラグラフにも盛り込まれている： そこなわれやすい人びとは、必ず力づけられるべきである。そのニーズが課題に反映されている 人びとには、すべての子ども、若者、（その 80%超が貧困のうちに暮らしている）障害者、 HIV/AIDS と共に生きる人びと、高齢者、先住民、難民および国内避難民、移民などがある。 我われは、複合的な人道的危機に見舞われた地域や、テロリズムに襲われた地域に住む人びとの 障壁や束縛を取り除き、支援を強化し、特別なニーズを満たすべく、国際法にのっとり、さらに 効果的な措置と行動をとることを決意する。 88 The sustainable development goals [website]. New York: United Nations (http://www.un.org/su stainabledevelopment/sustainable-development-goals/). 89 [原文] Millennium Development Goals [訳注] 2015年までに 8目標・21ターゲットの達成を掲げた. 90 [原文] agenda [訳注] 日本語でも, そのまま「アジェンダ」と呼ばれることも多い. 91 [原文] vulnerable populations 49 障害と SDGs ゴール 4：すべての人に、インクルーシブで公正な質の高い教育と 生涯学習機会を保証するため、教育におけるジェンダー格差を取りの ぞき、障害者などそこなわれやすい人びとへの、あらゆる水準の教育 と職業訓練への平等なアクセスを保証することに重点を置く。さらに 提案書では、子ども、障害、ジェンダーに配慮して教育施設を建設ま たは改装し、すべての人に安全で、非暴力的で、インクルーシブかつ 効果的な学習環境をもたらすよう求めている。 ゴール 8：継続的でインクルーシブかつ持続可能な経済成長、および、 すべての人の完全かつ生産的な雇用と真っ当な仕事92を促進するため、 国際社会は障害者を含むすべての男女の完全かつ生産的な雇用および 真っ当な仕事、および等価値の仕事への平等な賃金93の達成をめざす。 ゴール 10：障害者を含むすべての人の能力強化（エンパワーメント） および社会・経済・政治的インクルージョンの推進により、各国内 および各国間の不平等を縮小すべく尽力する。 92 [原文] decent work 93 [原文] equal pay for work of equal value 50 ゴール 11：インクルーシブ、安全、強靭94で持続可能な、まちと住み 場づくりをめざす。このゴールの実現のため締約国に求められること は、とりわけ障害者などそこなわれやすい人びとのニーズに特に配慮 した公共交通の拡大を通じた交通安全の向上により、安全で、料金に 無理がなく、利用しやすい、持続可能な交通システムへのアクセスを すべての人にもたらすことである。加えて提案書では、特に障害者に とり、安全かつインクルーシブで利用しやすい緑地と公共スペースへ のユニバーサルアクセスを求めている。 ゴール 17：持続可能な開発に向けた実施手段を強化し、グローバルな 連携を活性化するには、SDGs に関するデータ収集、モニタリングと 説明責任が極めて重要だと強調している。締約国には後発開発途上国95 や小島嶼開発途上国96など開発途上国への力量構築97支援が求められ、 それは質が高くタイムリーで信頼でき、さらに障害別にも分類された データの入手可能性を、著しく向上させる。 SDGsに関するさらに詳しい情報は、国際連合のウェブサイト(98)を参照。 「支援技術に関する世界協力（GATE）」 WHO の推計では現在 10 億超の人が 1 つ以上の支援製品、例えば 車椅子、補聴器、歩行器、眼鏡、ピルケース、コミュニケーション ボード99などを必要としている。 世界的な人口高齢化および非感染性疾患の増加に伴い、WHOの 予測では、この数は 2050 年までに 20 億人を超え、多くの高齢者 には、加齢に伴い複数の製品が必要になる。 94 [原文] resilient 95 [原文] least developed countries 96 [原文] small island developing states 97 [原文] capacity-building 98 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 99 [原文] communication board 51 支援製品には、教育や生計手段へのアクセスを可能にし、自立を維持し、世界とつながるうえで 極めて重要な役割がある。しかし現在、製品を必要とする人のうち、アクセスできるのは 10人に ひとりに過ぎず、製品がなければ社会参加から排除され、孤立し、貧困のうちに閉じ込められる。 WHO は、この巨大で満たされざる世界規模のニーズ100に応え、CRPD 第 32 条を実現するため、 GATE の取り組みを調整している。GATE が取り組むゴールは一つだけである。それは、高品質で 価格に無理のない支援製品へのアクセスを、全世界で向上させることである。これを達成するため、 GATE は、製品、人材、供与、政策という 4つの相互連関する行動領域に重点を置いている。 「WHO 必須医薬品範例リスト101」の先例にならい、GATE が最優先で作成したのが「WHO 優先 的支援製品リスト (APL)(102)」である。APL には、世界中で最も必要とされる 50 の支援製品を収 めている。そこには、4 種類の車椅子、除圧クッション、可搬式スロープ、またその他の移動性、 聴覚、認知、コミュニケーション、視覚を向上させる製品が含まれる。 APLは制約を与えるリストではなく、締約国が、現地のニーズと利用可能なリソースに沿った国内 向け APLを作成するたたき台103の提供が目的である。そこに込められた期待は、現地の関係者が、 アクセス増大への努力を相乗させるための結集点となることである。 GATE が現在取り組んでいるのは、APL実施の支援ツール、例えばニーズ評価ツールキット、教習 パッケージ、政策枠組み、サービス供与モデルなどの開発である。 GATEに関するさらに詳しい情報は、WHOのウェブサイト(104)を参照。 100 [原文] huge and unmet global need 101 [原文] WHO Model List of Essential Medicines 102 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/implementation/assistive_technology/global_survey-apl/en/). 103 [原文] blueprint 104 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 52 「障害に関する世界報告書」 2011 年、WHOと世界銀行が共同作成した、初の「障害に関する 世界報告書(105)」が発行された。 報告書によれば、障害者は障害がない人に比べ、総じて健康状態 が悪く、教育水準が低く、経済的機会に乏しく、貧困率が高い。 これは障害者が利用できるサービスの欠如と、障害者が日常生活 でぶつかる多くの障壁によるところが大きい。 この報告書は、保健医療・リハビリテーション・教育・雇用・支援サービスへの障壁を克服する 方途に関する、エビデンスに基づく提言を与えている。また、障害者が活躍できる支援的な環境を つくり出すうえで、何が有効かを明らかにしている。 「障害に関する世界報告書」は以下の障壁を強調している： • 不適切な政策や基準 • ネガティブな意識 • サービス供与の欠如 • サービス提供における問題 • 不十分な資金 • アクセスの欠如 • 協議と参画の欠如 • データとエビデンスの欠如 これらはすべて車椅子サービス供与に関連するため、本書は有用な背景文書106である。この報告書 の提言 2「障害者のための特別なプログラムやサービスに投資すること」では、車椅子の重要性に 言及している： 車椅子や補聴器などの支援技術を含むリハビリテーションは、機能と自立を向上させる。地域の さまざまな調整が行き届いた補助および支援サービスはケアへのニーズを満たし、人びとが自立 して暮らし、経済・社会・文化的生活に参加できるようにする。 105 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/en/). 106 [原文] background document 53 本報告書の、要約および提言はWHOのウェブサイト(107)を参照。 「WHO世界障害者行車計画」 「WHO世界障害者行動計画 2014-2021(108)」は、「障害に関する 世界報告書」の提言に基づき、また CRPDに沿ったものである。 これは締約国、国連諸機関、障害者団体などの国内および国際的 パートナーとの協議を経て作成された。 この計画は、障害者と障害がない人との格差への対処を目指して いる。これによると、世界中で障害者は、障害がない人に比べて 必要とする保健医療を受けておらず、健康状態が悪い。障害者は、 2 倍超の確率で技能や施設が不十分な保健医療供与者に当たり、 3 倍近くの確率で保健医療を拒絶され、4 倍の確率で劣悪な処置 を受ける。 行車計画の 3つの目標： • 障壁を取り除き、保健サービス・プログラムへのアクセスを向上させる • リハビリテーション、ハビリテーション、支援技術、援助および支援サービス、地域に根ざした リハビリテーションを強化し拡張する • 障害に関する、妥当かつ国際的に比較可能なデータ収集を強化し、障害や関連サービスの研究を 支援する。 締約国は、提案された行動を国の優先事項および状況に合わせて調整し、実施するよう要請されて いる。 全文は、WHOのウェブサイト(109)を参照。 107 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.wh o.int/iris/bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) [日本語訳 (概要): 障害に関する世界報告書, 国立障害者リハビリテーションセンター訳 (https://ww w.dinf.ne.jp/doc/japanese/intl/un/wrod_sum_jp.html)]. 108 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 109 (http://www.who.int/disabilities/actionplan/en/). 54 「障害と開発に関する国連総会高級事務レベル会合」 2013 年 9 月 23 日、国連総会高級事務レベル会合(110)が障害に関して 「前進への道：2015 年以降に向けた障害インクルーシブな開発実施 計画」という主題のもとに、一日開催された。 参加者は、締約国、オブザーバー、国連の代表者、また市民社会、 障害者団体、民間セクターの代表者などであった。 この会合の「成果文書」では、(a)から(q)までの誓約を列記している。 誓約(h)： ユニバーサルデザインの手法に従い、物理的環境、交通、雇用、教育、保健、サービス、情報、 情報通信技術はじめ支援機器に対する障壁を取り除き、遠隔地や農村地域においても、障害者が その全生涯にわたって最大限の可能性を実現するための、アクセスしやすさを保証する。 この会合の背景および成果を伝える冊子は、国際連合のウェブサイト(111)を参照。 110 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 111 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 55 ToT.10 視聴覚ツールおよび機材 教習員が、さまざまな視聴覚機材の使用に精通し自信を持つことは、教習授業を円滑に進めるうえ で重要である。 パワーポイント (PPT) と PDF WSTP のプレゼンテーションは、パワーポイントと PDF 両方の形式が用意されている。各形式の 利点と難点を下表にまとめた。 利点 難点 PPT • パワーポイントは個々のプレゼンテー ションスタイルに合わせて、また現地 の状況に当てはまるように変更可能。 • テキストの削減/簡略化が可能。 • 新しい内容や話し合いでの質問を押さ えたスライドの追加が可能。これは、 グループが異なる言語や方言を話す、 あるいは教習員の訛りを聞き取れない 場合に有効。 • コンピューターのスクリーンセーバー は、プレゼンテーションが「スライド ショー」モードであれば起動しない。 • 動画は自分で読み込む必要がある。 • ファイル全体のサイズは大きくなる。 • パワーポイントのファイル編集には、 時間を要する。 PDF • この PDF は、4種の動画形式すべて にリンクしている。望む形式をクリッ クすれば、動画を再生する。 • フォーマットや互換性について、問題 ないことが確認済み。 • ファイルサイズは、編集可能なものに 比べ小さい。 • 内容は固定され、現地事情や、自分の プレゼンテーションスタイルに合わせ た修正は不可能。 • 各スライドのテキストは、全部いちど に表示され（編集可能版にあるような スライドの「ビルド」効果がない）、 学習の要点を一つひとつ紹介すること はできない。 • 内容が多いスライドについてテキスト の簡略化や削減はできない。 • PDF なのでコンピューターのスクリ ーンセーバーが起動するため、それを プレゼンテーション開始前に機能停止 しておく必要がある（コンピューター の「システム環境設定」で可能）。 56 PPTにスライドを追加する スライドを追加する場合、その目的は「教習員用指導書」に沿うことであって、主題からそれては ならない。以下の理由であれば、PPT にスライドを追加してもよい： • スライドがない節に対して。 • 話し合いのための大事な質問で、いきおい解答に移らないことを覚えておくため。 • これから始まる活動のリマインダーとして、また指示を盛り込むため。 以下の理由であれば、PPTに変更を加えてもよい： • スライドを現地の事情/状況に適合させる。 • 翻訳を提供する。 • スライドの本文を減らすか、内容が多いスライド一枚を複数スライドに分割する。 • 教習授業を拡張するか増やす場合に、資料を追加する。 授業内容を追加する場合は、授業時間にも追加が必要であることに留意せよ。 PPTの統一性を保つ • すべての新規スライドおよび既成スライドへの変更について、必ず PPT 原版と同じ形式、 スタイル、フォントに従うこと。 • 追加あるいは変更したスライドから、WHO および WSTP のロゴを忘れずに削除せよ。既成の WSTP プレゼンテーションに同じ形式を維持しながらスライドを追加する最も簡便なやり方は、 既成のスライドを複製して、その本文を変更することである。 • 複雑なアニメーションを追加してはならない。 • PPT マスターを利用してスライドを追加してもよい。 • 動画ファイルは、すべて mp4 と wmv の二形式が用意されている。mp4 形式はアップルコンピ ューター用、wmv 形式はウィンドウズコンピューター用である。ウィンドウズコンピューター でQuickTime Player を搭載したものであれば、mp4動画を使用できる。 • 動画によっては字幕入りも用意されており、そちらの使用を推奨する。音質が悪い、外の騒音が ある、きつい方言が話されている、といった場合に受講者の理解を助ける。 • 動画は埋め込むことも、リンクを張ることも可能である。埋め込みを推奨するが、その理由は、 ファイルサイズは増えるが動画を PPT ファイルに内蔵でき、ファイルを他のコンピューターに コピーしても動画が失われないからである。 57 PPTに車画を埋め込む PPT 2010 以降の112ソフトで動画を埋め込むには、 次の手順に従う： • 「Presentations」＞「PowerPoint」フォルダー を開く。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入する。 • 動画フレームがスクリーンいっぱいに表示され ない場合は、サイズ調整する。 112 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 58 • 変更を保存。 • 以上で、動画が PPT の一部になった。 動画を自動的にフルスクリーン表示するには (Windows)： • 「ビデオツール」の「再生」タブの「全画面表示 の再生」チェックボックスをオンにする。 動画を自動的にフルスクリーン表示するには (Mac)： • 「ビデオ形式」タブの「再生オプション」をクリ ックし、ドロップダウンリストの「全画面再生」 を選択 困難があれば、PPT のヘルプメニューで質問せよ。 59 視聴覚機材を用いる際の優れた実践 「スライドショー」で実行して確認 • PPT の授業を練習する時は、「スライドショー」モードを用いよ。それによってトランジション、 アニメーション、フローなどの問題を発見できる。 • 教習で使用する「スライドショー」モードのコンピューターおよびプロジェクターを用い、スラ イドおよび動画を通しで実行せよ。自分のコンピューターを用いない場合に、設定が異なる別の コンピューターではプレゼンテーションを予定通りに実行しないことがあるため、これは重要。 • 教習中のプレゼンテーションは、すべて一台のコンピューターで行なうことを検討せよ。これで、 プレゼンターごとの切り替え時間が省ける。 プロジェクター・リモコン・レーザーポインター • できれば、予備のプロジェクターまたはプロジェクター用ランプを用意せよ。 • 休憩時間や実習中は、プロジェクターの電源を切ってランプの使用を節約せよ。 • 黒色あるいは白色のスクリーンに映写する必要がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キーを打つと黒いスクリーンになる。 • リモコンを用い、クリックしてスライドを切り替えるようにすると、プレゼンテーションの間に コンピューターの横に立たなくて済む。 • レーザーポインターはスライドの個別の項目について、受講者の注意を引くために使える。 スピーカー • スピーカーは、毎日のはじめに接続し、テストしてから接続したままにしておけ。 • 携帯電話その他の電子信号を拾うため、スピーカーの電源は、動画再生時だけ入れよ。 ケーブルおよびアダプター • 必要なケーブルが、ノートパソコン、プロジェクター、スピーカーについて、すべて揃っている ことを確かめよ。 • プラグアダプター類が、予備 2、3個も含め揃っていることを再確認せよ。 • ケーブルが電源まで届かない場合に備え、予備の延長コードを持参せよ。 60 活車１：ホワイトボード/フリップチャートを視覚教材に用いる 自分のグループに割り当てられた情報を通読し、ホワイトボード/フリップチャートを活用して、 他のグループへの発表を作成せよ。 スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正113に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 ホワイトボードの動入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間114」で 姿勢を描くなど）。 113 [原文] neat 114 [原文] ‘stick-draw’ 61 ToT.11 フィードバック フィードバックとは何か？ フィードバックとは、だれかに提供する以下についての情報である： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を支援できることは 重要。 通常、よい出来ばえにフィードバックを与えることに、だれも問題はない。間違いや改善が必要な 出来ばえの場合には、必ず自信をもって建設的なフィードバックを与えなければならない。 活車１：フィードバックをもらう 自分の学びに役立ったフィードバック、また自分が身構えるか動転して役に立たなかったフィード バックについて考えなさい。 下欄に自分の振り返りを記録しなさい フィードバックを えるさい、教習員が考慮すべきことは何でしょうか？ 62 望ましいフィードバック： • タイムリーに115：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 建設的なフィードバックをもたらす時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に与えよ。意識、行動、 規律に関わる問題には、非公開で対処せよ116。 • 受講者の視点に立って：まず、受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者の違う取り組み方を支援せよ：建設的なフィードバックを与える前に、受講者が完了した 活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。受講者のサー ビス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 115 [原文] Be timely 116 [原文] deal with them in private 63 ToT.12 グループダイナミクスを取り仕切る117 WSTP 教習員が、グループで、効率よく効果的に作業するやり方を知っていることは重要である。 この授業では小グループ活動を促進し、時間を管理し、妨害行動へ対処するやり方を見て行く。 なぜグループ活車を用いるのか？ 教習においてグループ作業は重要である。なぜなら： • 受講者が、考察、知識、経験を共有できる。これによって教習員は、受講者がすでに持っている 専門性をよりよく知ることができ、どこにギャップがあり、授業をどう調節すべきかが分かる。 • 教室内にすでにある智慧、経験、技能が尊重される。これによって、経験や専門知識をより多く 持つ人が、他とそれを共有できる。 • 教習員が関心から外れる。受講者が経験を共有し、自分たちがすでに何を知っているか見出す ことが、自信の構築に役立つ。 • 全受講者が語り出し、貢献できる環境をつくり出す。内気な、または年若い受講者も小グループ の中では気後れせず発言できる。これは、自分の考えが評価されていると気づくことで、自信を つくり上げる。 グループ活車を組織し取り仕切る 受講者をグループ分けする際の重要な留意事項 • グループのサイズを決める。 • 各グループに、だれが入るか決める。 • グループづくりの手法。 グループのサイズを決定する要因 • 時間：グループが多いほど、フィードバックにもより時間が必要になる。持ち時間が少なければ 大きいグループをつくれ。ただし、1グループの人数は 6名を超えないようにせよ。 • プライバシー/内密さ118：気をつかうトピック、内気な人、言語の壁がある場合の話し合いには ペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な、機材/消耗品の分量。例えば、作業場が 3か所あれば、3グループ まで対応が可能になる。 117 [原文] Managing group dynamics 118 [原文] confidentiality 64 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や来歴を持った人を同じグループに入れる（臨床家全員が 協働するように配置する、あるいは技工職全員が同じグループにいるなど）か、逆にわざと同じ グループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、グループにする方が 適切な場合と分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混成：これは、お互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ、有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混成：作業への文化、宗教、社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が互いに協力して作業し、学び合いの機会119が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 グループづくりの動法 各WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与えて いる。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ分け の手法をいくつか掲げる： • フルーツサラダ法120：同じ果物カードを 3、4 枚ずつ、さまざまな種類の果物で受講者の人数分 になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ （1人 1種類の）」でいっしょになる、など指定する。 • 番号点呼121：必要なグループ数の番号を点呼する。例えば、3 グループに分ける必要があれば、 最初の人が「一」、次が「二」、その次が「三」、そして再び「一」に戻って数を点呼するよう指示 し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分けて おく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3人、次の 3人と まとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1人または 2人、自分が組んだことがない人を選んでもらう。ただし 3人を超えると、 自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4人ずつのグループに有効。 119 [原文] peer learning opportunities 120 [原文] The fruit salad method 121 [原文] Count off 65 受講者をグループ分けする際には明確な指示を えよ • だれがどのグループに入るか。 • 何をグループにやってほしいのか（その課題は何か）。 • どこへグループに行ってほしいのか（各部屋へ分かれるのか、大部屋のスペースか）。 • いつグループは報告を返す用意ができているべきなのか。 • どうやってグループに報告してほしいのか（フリップチャートで、全体グループへ口頭で、各自 の席にいるグループへ非公式に、グループ自身が選んで創造的に発表、など）。 • どれくらいの時間、報告しなければならないか。 小グループ活動はつねにモニターし、受講者が各自のワークブックの正しいページを用い予定した 課題に取り組んでいることを確かめよ。必要なら促しや誘導的な質問によって助け、解決策を教え たり、自分が長々としゃべったりするな。気をつけて時間を守るよう念押しせよ。 妨害行車に対処する いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、ポジティブだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 66 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、他の受講者には、知識を共有し、質問に答え、グル ープ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っているかのよう に振る舞う。 場を仕切る受講者への対処： • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える機会 を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく、特定の受講者に質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は最有力な受講者とのペアあるいはグループに入れ、内気 な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 ふざける受講者への対処： • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動中 のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 攻撃的な受講者 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。または教習員の技能・ 知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 攻撃的な受講者への対処： • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとって本当なのですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 ネガティブな受講者への対処： • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由を 説明する機会を与えよ。他の受講者に賛成するか尋ねよ。他の受講者も同意見であれば、「どう すればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 67 寡黙な受講者 もともと寡黙あるいは内気で、大人数の前でしゃべりグループ活動へ貢献することには気が進まな い受講者。 寡黙な受講者への対処： • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3名の）を活用せよ。 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいはその 人に反対するのをためらうかもしれない。 年長の受講者への対処： • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話すよう 呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 注意散漫な受講者への対処： • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習を妨げるのか話せ。規則を念押しせよ。 68 中級教習モジュール 69 A.1: 付加姿勢支持が有益な車椅子ユーザー この授業を教えるための主な留意点 a. 全般 • グループでの話し合いは、教習員が、受講者の既有の知識・経験の程度を理解するために役立つ。 • 個々の姿勢支持具（PSDs）に関する細かい議論は避けよ。それらは以後の授業で取り上げる。 b. 第 3節：いつ付加姿勢支持が必要なのか？ 準備のコツ • 活動：中級 WSTP「教習員用指導書」p.34-35 のキャッチボールおよび水飲みの活動について、 椅子がじゅうぶん丈夫なことを確かめよ。適当な椅子がなければ、車椅子を使ってもよい。 内容 • 多くの中級レベル適応の車椅子ユーザーは、褥瘡発生の危険が大きい。その理由は： 圧力 − 非対称な（不均等な）姿勢1 − 不動性2（動けないこと） − 虚弱さ3 − バランスの乏しさ − 姿位4を変えられない、あるいは除圧動作を実行できない。 剪断 − 虚弱さの結果としての不安定な姿勢 − 緊張（固さ）の増大5 − 制御できない運動6 − 関節の拘縮7 − 対処されていない脚長の左右差 1 [原文] asymmetrical (uneven) posture 2 [原文] immobility 3 [原文] weakness 4 [原文] position [訳注] 本書では postureの訳語に「姿勢」, positionの訳語 (の一つ) に「姿位」を用いている. 5 [原文] increased tone (stiffness) 6 [原文] uncontrolled movement 7 [原文] joint contractures 70 摩擦 − 姿勢支持が足りないと、車椅子ユーザーの身体の一部が車椅子や姿勢支持具と 擦れる。 − 制御できない運動や筋攣縮 [きんれんしゅく]8 − 移乗中に起こる負傷：例えば車椅子ユーザーの臀部が、持ち上げても9車椅子から 離れなかった場合、皮膚が引きずられて摩擦を生じる。 • 中級レベル適応の車椅子ユーザーは、除圧クッションだけでは褥瘡の予防に不十分な場合がある。 • 車椅子ユーザーを安定させ、適切な姿勢支持具で姿勢を支え、ユーザーおよび/またはその介助 者を教育することが、褥瘡の発生・悪化10を予防するために役立つ。 • 褥瘡は、車椅子ユーザーの身体と車椅子、クッション、姿勢支持具との、あらゆる接点で発生・ 悪化しうることに留意せよ。 c. 第 4節：車いすユーザーは何を望んでいるのか？ • 「教習員用指導書」p.38に列記した「車椅子ユーザーが付加姿勢支持を備えた車椅子を拒否する 理由」に追加するとよい答えの例： o 費用：ユーザーが、付加姿勢支持を備えた車椅子には追加料金を払う必要がある。 o サイズ：多くの姿勢支持付き車椅子は折りたたみできず、より大きくまた重い。 o 姿勢支持車椅子には決まった種類の姿勢支持具一式が付属しているが、その中には当該車椅子 ユーザーには必要ないものもある。 o 車椅子に付加した姿勢支持具への余分なメンテナンス。 8 [原文] spasms 9 [原文] when lifting 10 [原文] developing 71 A.2: 障害児 この授業を教えるための主な留意点 a. 第 3節：さまざまな体位 • 6歳まで子どもの股関節は、大きい子どもや成人のように完全にまっすぐに（伸展）したり内転 したりできない。これが、子どもの立位や座位の姿勢が異なる理由である。 • 小さい子どもは、したがって股関節がわずかに屈曲し両膝が開いてわずかに外向きになるように 立つ。その股関節を無理にまっすぐにしては絶対にならず、足を真正面に向けさせてはならない。 うつ伏せに寝る時には、股関節がわずかに屈曲し、膝が外を向いているようにすること。 • ポスタ 「ーさまざまな体位」のイラストは、股関節がすでにまっすぐになって（伸展して）いる、 大きい子どものそれである。 立位 • 立つことが重要な理由に関する注記（「教習員用指導書」p.44）に「骨折の予防」を追加せよ。 これは重要な点である。 • 他の立つことの有益な点で、挙げられていなかったものとしては： o 痙縮 [けいしゅく] (筋肉の硬直)11の制御を助ける。 o 消化を助ける。 o 排便・排尿を助ける。 o 座骨からの圧力を緩和する。 o 骨の発達を助け、骨密度（強度）の低下を抑える。 • 「教習員用指導書」p.45・スライド 8：小さい子どもの立位に関する注意への追加項目として、 立位台の膝への支えは決して膝蓋に直接ではなく、その下に設けなければならない。その理由： o 膝蓋は敏感なため、そこへの圧力は痛みや不快感を生じる。 o 膝の、体重が自然にかかる部位は膝蓋のすぐ下である。ここは下腿義足12が体重を支える部位 でもある。 11 [原文] spasticity (muscle stiffness) 12 [原文] below-knee prostheses 72 b. 第 4節：子どもを早期紹介する重要さ • 車椅子の供与が、子どもの歩くことへの欲求や歩行能力を奪うことはない。 • 子どもへの車椅子供与は、子どもが以下を行なうために役立つ： o 友だちと遊ぶ。 o 学校へ通う。 o 自分のことをやる。 o 家の手伝いをする。 • 車椅子を使うと、歩行器に比べてエネルギー消費が少なく、子どもは行動半径を広げ、より完全 に参加できるようになる。 • 子どもの歩行は、車椅子を使用することで改善する場合があり、それは子どもがより少なく歩き、 費やす労力も少なくなることが、歩行の質的向上を助けるためである。 c. 第 5節：子どもと働く • この授業で述べる子どもの安全のための慣行は、子どもと働くために最低限必要なものである。 • 受講者には、各自のサービスにおける、子どもの安全に関する行動規範を策定するよう勧めよ。 行動規範は、職員が子どもとの安全な関わり方を理解するのを助ける。児童保護に関する資料と しては： o 児童保護に関する、現地の国や機関の法令や政策 o オーストラリア国際開発評議会：「児童保護政策策定のための行動規範ガイドライン(13)」 o 国際児童基金（UNICEF）ウェブサイト(14)の「児童保護」 13 ACFID Code of conduct guidelines for the development of a child protection policy. Canberra: Australian Council for International Development; 2016 (https://acfid.asn.au/resources). 14 Child protection. In: Disabilities in programmes, UNICEF [website]. New York: UNICEF; Sept 2015 (http://www.unicef.org/disabilities/index_65309.html). [2023年 8月 17日：リンク切れ] 73 B.1: 事前評価の概略・事前評価インタビュー WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • 「教習員用指導書」に記した 1〜3節への時間配分は、下記のように修正すべきである： o 第 1節15 2分 o 第 2節16 3分 o 第 3節17 65分 「教習員用指導書」p.53 の授業計画の「あらすじ」、および同書 p.53・54の各節への時間配分を 変更せよ。合計の授業時間に変更はない。 b. 第 3節：事前評価インタビュー（実習活車を含む） • 「教習員用指導書」p.56の活動への指導内容に、一点誤りがある。指導内容では「各グループに 番号（1〜5）を付与し」となっているが、これは「1〜4」とすべきである。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 事前評価フォームに現地のサービス供与者が加えたどんな変更も、授業に組み込むよう考慮せよ。 • グループ活動に盛り込まれた障害や疾患の種類を、状況に応じて調整せよ。 内容 • 受講者は基礎 WSTP の事前評価インタビューには精通しているはずである。したがって、中級 レベル適応の車椅子ユーザー向けの新しい内容に集中せよ。 15 [訳注] 日本語版の「1. はじめに」 16 [訳注] 日本語版の「2. 事前評価」 17 [訳注] 日本語版の「3. 事前評価インタビュー」 74 b. 第 3節：事前評価インタビュー • この節の合計時間は 65分である（上記、誤記訂正の項を参照）。内容は活動への指導・説明18を 含む授業紹介を 5分と、60分の活動である。 • 活動では、さまざまな障害の知識をより多く持つ受講者に他のグループメンバーを支援するよう 励ませ。 • 単一の疾患/身体的問題について、長々と話し合うのは避けよ。 • 車椅子ユーザーによっては診断を受けていないか、誤診を受けている場合がある。したがって、 ユーザーが受けた診断は貴重な情報をもたらすが、重要なのは事前評価を完全に実施することで ある。そのあらゆる情報が、最適な車椅子の選択に必要となる。 18 [原文] instruction 75 B.2: 身体的事前評価−支えなしの座位姿勢 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 5節：小さい子どものまっすぐな座位姿勢 • 「教習員用指導書」p.68のスライド 10の最初の箇条は「背中は 平らで腰椎のカーブがなく」とすべきである。PPTスライドおよ びスライドへの注記から「や胸郭19」を削除し、語句を訂正せよ。 • イラスト（図 1）から判る通り胸椎には前方へのカーブがあり、 その結果、子どもの肩は耳や股関節よりもわずかに前方に出る。 ここの重要なメッセージは、5歳未満の子どもの「まっすぐな」 姿勢は大人のそれとは異なる、ということである。 図 1 小さい子どもの まっすぐな姿勢 b. 第 7節：座位姿勢を観察する • スライド 18 が PPTと「教習員用指導書」とで異なっている。「教習員用指導書」では肩の右側 が低いと述べているが、スライドの図は肩の左側が低くなっている。「教習員用指導書」p.72の 語句を「両肩が水平でない（左側が低い）」に訂正せよ。 19 [訳注] 日本語版ではこのスライドの thoracic curveを「胸郭のカーブ」と訳している. これは「胸椎のカーブ」 とすべきであったが, いずれにせよこの訂正により上記の通り削除することとなった. 76 c. 第 8節：姿勢を記録する • 「教習員用指導書」の活動（p.76）には線画が欠落している20。それらを図 2に示す： 教習員向けの線画の見本 図 2 線画の見本21 この授業を教えるための主な留意点 a. 第 4節：まっすぐな座位姿勢 • 「固まった姿勢」、「ニュートラル姿勢になる柔軟さ」、「ニュートラル姿勢途中の柔軟さ」の 用語は、車椅子ユーザーの全身姿勢にではなく、個々の関節に対して用いるべきである。例えば、 左股関節が「固まって」いても、右股関節には「ニュートラル姿勢途中の柔軟さ」がありうる。 b. 第 5節：小さい子どものまっすぐな座位姿勢 • 子どもの腰椎と胸椎のカーブは、立つことによって発達する。立ったことがまったくない子ども は、長じてもこれらのカーブが発達することはない。 20 [訳注] 教習員用指導書の「教習員用の線画の例題」の下に位置するべき解答である. 21 [訳注] いちばん左のイラストは、例題とは左右が逆になっている. 77 c. 第 6節：骨盤は座位姿勢の基礎 • 受講者全員が、座骨（ITs）、上前腸骨棘（ASIS）、上後腸骨棘（PSIS）の位置を見出せることを 確かめてから次へ進むこと。 • 拘縮や変形、肥満のため骨の指標部位22を見つけるのが難しい場合もある。受講者に、肥満した 車椅子ユーザーでも、正中線に対する ITs・ASIS・PSIS の位置は変わらないのだと念押しせよ。 受講者は、触診（指標部位を感じ取る）を始める前に、解剖学の知識を駆使して骨の指標部位が どこか見当をつけておくべきである。 • 骨盤に関する「まっすぐ/ニュートラル」の語について： o 「水平な骨盤」とは、前方/正面から見た骨盤に関わる。水平な骨盤は、正面から見て左右に 傾いておらず、左右の ASIS が横一直線上にある。 o 「まっすぐな/ニュートラルな骨盤」とは、側方/横から見た骨盤に関わる。まっすぐな骨盤は、 横からみて前傾も後傾もしておらず、座骨の上でバランスが取れている。 d. 第 7節：座位姿勢を観察する • 車椅子ユーザーの姿勢を観察するさい、評価ベッドなり椅子の脇に座れるよう、ユーザーに多少 支えが必要になることもある。ただし、この支えがユーザーの姿勢を矯正してはならない。 • 「教習員用指導書」p.72 のスライド 19への注記のうち「体幹がやや（左側が後方へ）回旋して いる」および「左脚が内旋している」については、納得しない受講者もあろう。その場合は： o 受講者に主要な偏り、すなわち骨盤の回旋と右脚の外旋に注目するよう求めよ。 o 一方向からだけの観察で、姿勢の微妙な変化を見定めるのは難しいことを認めよ。人の姿勢を 十全に理解するには、必ず正面、横、背後から、主要な解剖学的/骨の指標部位を確かめつつ 観察しなければならない。 e. 第 8節：姿勢を記録する 姿勢を描くコツ • 姿勢を描くのが受講者には難しいようなら、まず姿勢の線を人体イラストに描き込み、それから フリーハンドで指定欄に描き取るよう勧めよ。 • 骨盤の小丸と点/角は、骨盤の ASIS・PSIS ・ITs など骨の指標部位を表している。 • 骨盤に付ける小丸は不可欠ではないが、骨盤の位置を強調するために有効である。 • 教習員は、大腿の描き方は一通りを選択し、ずっとそれで通すことが重要である23。 22 [原文] bony landmarks 23 [訳注] 大腿の描き方が複数紹介されているための注記. 詳細は教習員用指導書 p.75「教習員への注記」を参照. 78 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：骨盤と股関節の姿勢チェック • PPTファイルからスライド 6が欠落している24。PDF版は正しい。 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役実習生と補助役実習生は、この授業をいっしょに準備し、実技の教え方に統一性を 持たせよ。例えば、正しい手の位置、角度計 ゴニオメーター］の使い方、モデルの車椅子ユー ザーの正しい姿位など。 • 一時的支持部は予め準備しておく必要があり、現地の、最も広く使われているクッション基層の 材料でつくるべきである。 • 脊椎および短く大腿骨が付いた骨盤の人体骨格模型や子どもの体格の人形（あれば）は、一時的 支持の適用法をやって見せるために役立つ。 b. 第 2節：骨盤と股関節の姿勢チェック • 車椅子ユーザーの周囲を移動するようにし、その上に身を乗り出さないなど、敬意のこもった 立ち位置を取れ25。 • 腰を痛めないために： o 身を乗り出さないで済むよう、車椅子ユーザーの位置は評価ベッドの端の方にする。 o かがまないでひざまずく。 24 [訳注] この日本語版作成の時点で, WHOの配布教材ではすでに修正されていた. 25 [原文] Be respectful in how you position yourself 79 • 最初に車椅子ユーザーの姿勢を臥位で確認してから、骨盤と股関節の姿勢チェックを始めよ26。 その内容は： o 肩を水平にせよ：ベッドの前後辺を基準点に用いよ。 o 頭・首・体幹上部を、ベッドの側辺を基準点に用いて配列せよ27。 • 車椅子ユーザーの四肢および身体の上手な扱い方28をやって見せよ。強くつかみすぎると不快感 を生じる。 • 股関節の緊張をゆるめるため、骨盤と股関節の姿勢チェックは車椅子ユーザーの膝を支えながら 実施せよ。股関節周りの緊張が非常に強いと、車椅子ユーザーの骨盤が、ニュートラルでない 姿勢へ引かれかねない。 • 車椅子ユーザーの衣服が、股関節の動きの自由を妨げないようにせよ。 • 評価者と助手両方の、手の位置を（「教習員用指導書」p.84で詳述している通りに）強調せよ。 助手からのフィードバックは、精確なチェックの要諦である。 o 評価者の手は、脚の重さを支える。膝裏の緊張（固いハムストリングス）によって骨盤が動く ことで膝が曲がる（屈曲する）のを、評価者の手が制限してはならない。 • 角度計の正しい使い方をやって見せよ。 • 受講者が 動きの］制限を真似てみることがある。これは通常、混乱のもとである。受講者には 手順と技法の習得に集中するよう戒めよ。そうすれば、実習中に本物の制限を感じることになる。 まとめとして動画を上映せよ。 ジェンダー/文化への配慮 • 骨盤と股関節の姿勢チェックをやって見せ、また受講者に実施してもらう際には、ジェンダーに 基づいて受講者をグループ分けせよ。 26 [訳注] 日本でのいわゆる「マット評価」で, WSTPtotで追加された内容である. 27 [原文] line up 28 [原文] good handling [訳注] 文意から, 療法技術としての「ハンドリング」との混同を避けた. 80 c. 第 4節：固まった水平でない骨盤への一時的支持のデモ • 受講者が、骨盤を水平にするため、低い側に支えを付加してはと提案した場合の説明： o 骨盤姿勢は、矯正しても水平でニュートラルな骨盤にはできない。 o 水平でない骨盤の座骨を圧迫すると強い圧力を生じ、褥瘡につながる。 • 骨盤と股関節の姿勢チェックからの所見を強調せよ。受講者が臥位で骨盤を水平にできなかった 場合、座位でも骨盤は水平でないままである。 • この姿勢支持具は、単独では使われない。固まった水平でない骨盤の車椅子ユーザーには、姿勢 を支えるために他の姿勢支持具がいくつか必要になる。 d. 第 5節：ニュートラルな座位姿勢まで屈曲しない股関節への一時的支持 のデモ • 希望者を募る前に、人体骨格模型か人形 を用いてやって見せることを検討せよ。 • 臥位で、股関節がニュートラル姿勢まで 曲がらないところをやって見せよ。 • 膝裏から評価ベッドに下ろした垂線 図中の点線］がつくる、三角形の空間 を強調せよ（図 3）。 図 3 一時的支持 • 垂線から座骨までの距離が、大腿が骨盤を押して後傾させるのを止めるために必要な、一時的 支持部の高さである。 • 体幹〜大腿の角度を測れ。 • 人形/モデルを一時的支持部に座らせよ。 • 体幹〜大腿の角度が同じであることを示せ。 • 大腿下の三角形のすき間は、ニュートラル姿勢まで曲がらない股関節に形を合わせる側の、 クッション前部に必ず設けるべきものの形状である。 • 受講者が、この大腿下の三角スペースをウェッジで埋めてはと提案する場合もある。これは可能 ではあるが不必要で、なぜなら骨盤の最終姿勢には変化を及ぼさないからである。 81 B.4: 身体的事前評価−ハンド・シミュレーション WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 3節：ハンド・シミュレーションの結果を記録する • 「教習員用指導書」p.101の活動への「答え」欄に、エニスの股関節姿勢がニュートラルとして 記録されている。これは誤りなので、左右の股関節へのチェック印✔︎を「いいえ」に変更。 • 注記の「体幹〜大腿の角度が 90度超」は正しい。 この授業を教えるための主な留意点 a. 全般 • 受講者が、ハンド・シミュレーションやユーザーの姿勢分析に慣れていなければ、さらに時間が 必要になる。 • 動画でのケーススタディすべてを通して、段階を踏んで取り組むことを強調せよ： o 助手に明確な指示を与える。 o 最初に骨盤の姿位を決めてから、他の部位への支えに移る。 • ハンド・シミュレーションでとれた最終姿勢は、必要な支えと併せて、絶対に文書化しなければ ならないことを、受講者が理解するようにせよ。文書化は、描画、ことばによる説明、事前評価 フォームに載っている身体の各部位についての確認表記入などによる。 • 写真がサービス文書の標準項目となっている場合は、だれかに姿勢を変えるごとに写真を撮って もらえ。 o サービス職員は、それぞれの写真を見直して、車椅子ユーザーへ設ける支えをどう変更するか 判断できる。 o 身体への操作を最小限にできる29ため、時間を節約できる。 • 教習プログラム中に写真を用いる場合は、受講者に、最終写真を指針に用いて、自分が担当する 車椅子ユーザーへのハンド・シミュレーションの結果を記録するよう指示せよ。 • 車椅子ユーザーの資料作成には最終写真のみを用い、他の写真はすべて削除せよ。 29 [原文] can minimize handling 82 b. 第 2節：ハンド・シミュレーションのやり方 • 身体的にはもっとまっすぐに座れるものの、その姿位では維持できない車椅子ユーザーもいる。 そうしたユーザーには、車椅子を一日じゅう使えるように、あまり起こしすぎない、骨盤後傾の 姿位での支えが必要な場合もある。より起こした姿位から、ユーザーの頭と体幹のバランスが 取れる最適な姿位のところまで、徐々に車椅子ユーザーの骨盤を後ろへ傾けさせよ。 • 助手が複数いても、手だけでは与えられない強い支えが必要な場合があり、ハンド・シミュレー ションが常に実施できるとは限らない。そうした場合は、以下の使用を検討せよ： o より安定して支えるための、カバーが付いた板、フォーム材、セラピー用ブロック30 o 姿勢支持部を仮設した模擬 [仮合わせ]31の車椅子 • 小さい子どもへのハンド・シミュレーションは、その子が怖がっている間は実施が困難である。 以下を検討せよ： o 子どもを親/介助者の膝の上に横向きに座らせる。 o ちょくちょく休憩を取る。 o 親/介助者を事前評価に、例えば子どもの足や肩を支えて参加してもらう。どれくらいの強さ で支える必要があるか、適切な指示を出すようにせよ。 • ハンド・シミュレーションでとれた最終姿勢を、骨盤と股関節の姿勢チェックの結果と比較する ことは重要である。骨盤と股関節の最終姿位は通常同じになる。違いが生じた場合の理由： o 骨盤と股関節の姿勢チェックで力を加えすぎていた。 o 座位での支えが不十分。 30 [原文] foam or therapy blocks 31 [原文] mocked-up with temporary postural supports 83 c. 第 3節：ハンド・シミュレーションの結果を記録する 内容 • 姿勢全体が目に見えない場合は、「教習員用指導書」の「教習員への注記」を用いて明確にせよ。 • 全受講者が最後のハンド・シミュレーション、姿勢の描画・説明の記録を練習する時間を取れ。 • ニュートラルな姿勢だと記録するには、必ず正面と横から見てニュートラルでなければならない。 • 「はい」にチェックを付ける身体部位は、ハンド・シミュレーションで、付加姿勢支持の有無に かかわらずニュートラルな姿勢をとれた部位である。 • ニュートラルでない姿勢（固まった姿勢、あるいはニュートラル姿勢途中の柔軟さ）の場合は、 すべて「いいえ」に印を付けること。 • 骨盤の水平およびニュートラルな股関節可動域は骨盤と股関節の姿勢チェックで識別されるが、 最終姿勢の決定はハンド・シミュレーションによる。骨盤の最終姿位が（ニュートラルでない） 前傾/後傾の場合、その結果、股関節はニュートラル姿勢より伸びる/曲がる32。骨盤がニュート ラルでも、安定性をもたらすために座面前方のかさ上げを付加した場合、股関節は曲がる。 エニス • エニスへの骨盤と股関節の姿勢チェックからは、両股関節がニュートラルな座位姿勢まで曲がる ことが判っている。 • エニスの両股関節は臥位では 90 度になるが、骨盤が後傾したまま固まっているため、その体位 では座れない。 • ハンド・シミュレーションの結果を記録する際には、最終的にとれた姿勢を精確に記録せよ。 • 体幹〜大腿の角度を狭めるため、姿勢支持具として、座面前方のかさ上げを提案する受講者もあ ろう。それが可能であることは受けとめ承認せよ。しかし受講者には、決定は車椅子ユーザーの ニーズの全体像に基づくことを念押しせよ。座面前方のかさ上げを最終処方に盛り込んだ場合、 移乗や机・テーブルの下へ入り込むことなど、他の要素に影響を及ぼす可能性がある。 • 「教習員用指導書」ではエニスとバハティの最終姿勢を詳述している。以下を最終姿勢の描画に 用いよ。 32 [原文] open/closed [訳注] 語順としては, 骨盤前傾/後傾に対して股関節が曲がる/伸びる場合が一般的であろう. 84 エニス 各身体部位が、動の支えでニュートラルな座位姿勢になれば「はい」、ならなければ「いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 □ ✔︎ 体幹 □ ✔︎ 頭 ✔︎ □ 左股関節 □ ✔︎ 右股関節 □ ✔︎ 大腿 □ ✔︎ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ バハティ 各身体部位が、動の支えでニュートラルな座位姿勢になれば「はい」、ならなければ「いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 ✔︎ □ 体幹 ✔︎ □ 頭 ✔︎ □ 左股関節 ✔︎ □ 右股関節 ✔︎ □ 大腿 ✔︎ □ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ 85 B.5: 身体的事前評価−身体計測 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • 以下は教材リストに挙げられていないため、追加すべきものである： o 3人ひと組の各グループに、クリップボードを 2枚ずつ o さまざまな高さ（厚さ）の足乗せブロックを 1セット b. 第 2節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.112 の、スライド 6 のマダヴィの姿勢の線画には誤りがある。線画では、 腰椎がニュートラルなカーブを描いている。しかしユーザーが骨盤を後傾/後ろに倒して座ると、 腰椎がカーブせず33、体幹が円背になり34、それが「崩れた35」姿勢を引き起こす。 • 「受講者用参考書」p.67にも同じ誤りがある。受講者に、それを各自の参考書について訂正する よう指示せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「教習員用指導書」の身体計測への注記を読み直し、身体計測をやって見せる練習を、統一性を 持たせるために全教習員とやっておけ。 • ありがちな誤りで、活動のあいだ目を配るべきものの例： o 車椅子ユーザーの姿勢/支え o 不精確な計測技法、例えばクリップボードを斜めに当てる、巻尺で測り始める端を間違える、 巻尺を読み取る頭の高さが不適切 • 受講者をデモに用いるのは避け、受講者が観察できるようにせよ。 • 状況に合わせて調整せよ (寒冷な気候で厚着している場合など)。 • 時間が許せば、この授業は延長して、各受講者が中級レベルの身体計測をすべて練習できるよう にすることを検討せよ。 33 [原文] flattens 34 [原文] the trunk will be rounded 35 [原文] slumped 86 b. 第 2節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.110 の項目 I は「座面〜骨盤上端（PSIS36）」と題されている。しかし、 PSISは骨盤の上端ではない。骨盤の上端は腸骨稜37である。 • 教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある： o 選択肢１：この語句から「骨盤上端」を削除し、PSISのみに言及する。したがって「受講者用 参考書」p.70も変更が必要になる。 o 選択肢 2：「骨盤上端」を一般的な呼び名として用いる。この選択肢を採用した場合、受講者 が、PSISは骨盤の「上端」より下に位置することを理解するのが重要である。 • この節を通して、以下の点を常に強調せよ： o 身体計測は、車椅子ユーザーを、最終姿勢（ハンド・シミュレーションで決定した）で支えて いる状態で行なうこと。 o 選択した車椅子の種類および必要な姿勢支持具が、どの身体寸法が必要かを決める。例えば、 背中全体の高さの背もたれが必要な車椅子ユーザーには身体寸法 F: 座面〜肩上端 の高さ］ を選ぶ。身体寸法 D: 座面〜胸郭下端 の高さ］や身体寸法 E: 座面〜肩甲骨下端 の高さ］は 不要になる。 • 車椅子ユーザーが、骨盤が後傾したまま固まっている、あるいは 体幹が円背のまま固まっている場合、受講者は、これが車椅子に どう収まるか考える必要がある。このため、座面奥行きの測り方 を変更することもある。 • 背もたれをリクライニングできる場合：骨盤背面の下端から膝裏 までの直線距離を測る（図 4）。 図 4 リクライニングした 背もたれの計測 36 [訳注] 上後腸骨棘. 37 [原文] iliac crest [訳注] ICとも略される. 87 • 背もたれがリクライニングせず「座面〜背もたれ角度を開ける」 が処方された場合は、車椅子の座面奥行き内で収まる必要がある。 • 「座面〜背もたれ角度を開ける」ための身体計測で必ず含むべき 項目： o C字カーブ38の頂点から座面上端までの距離（Z） o C 字カーブの頂点から座面上端へ下ろした垂線と、骨盤背面の 下端との間の距離（X）（図 5） 図 5 「座面〜背もたれ角度を 開ける」ための身体計測 • 図 6 を使い「座面〜背もたれ角度を開ける」姿勢支持を用いる際の座面奥行きの計算法を示せ。 図 6 座面奥行きの計算 • 身体計測のあいだ、車椅子ユーザーを最終姿勢で支えておくのが難しい場合もある。これに対処 する方策としては： o ちょくちょく休憩を取る。 o 姿勢を支えたり、身体計測を行なったりする助手を、さらに手配する。 38 [原文] c-shaped curve [訳注] ここでは身体を横から見た場合の, 円背になった脊柱の形状を指す. 車椅子および姿勢支持具 寸法（mm） （Z）三角形の高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 座面〜背もたれ 角度を開ける： 88 B.6: 車椅子およびクッションの選択 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • この授業に 60分では不十分である。第２節に 60分取り、授業時間を合計 70分にせよ。 b. 第 2節：車椅子およびクッションの種類 • 「教習員用指導書」p.119 のスライド 12・13 のリクライニング背もたれのイラストに、腰椎や 骨盤の支持部の形状を含めるべきではなかった。処方の適応（スライドへの注記で挙げている） から考えて、この車椅子ユーザーは骨盤が後傾しており、その結果、腰椎がカーブしていないか 屈曲して39いる。 • この背もたれ下部は、以下のように表すべきである： o 平らに、あるいは o 「座面〜背もたれ角度を開ける」ウェッジ（これは列挙した状況から想定される姿勢支持具） を付けて • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 • 「教習員用指導書」p.119 の、スライド 13の横の最初の箇条「股関節や膝の屈曲に拘縮を伴う、 後傾したまま固まった骨盤」は正しくない。ティルトインスペースは、股関節や膝の屈曲に拘縮 を伴う、後傾したまま固まった骨盤への適応ではない。この最初の箇条を削除し、以下の箇条を 追加せよ： o 頭の位置およびコントロールを改善するため o バランスを改善するため • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 39 [原文] flat or flexed lumbar spine 89 この授業を教えるための主な留意点 a. 全般 準備のコツ • 現地で手に入る車椅子および姿勢支持具の部材を熟知していることを確かめよ： o 製造者からの情報を研究せよ。 o 手に入るサイズの範囲を知れ。 o 調節可能部分/機能の範囲を調べ、これらを説明できるか、やって見せられるようにしておけ。 o 手に入るあらゆる付属品を含め、何をカスタマイズできるか40見定めよ。 • この授業の実施前に、現地での処方フォームへの変更を熟知しているか確かめ、適切であれば、 それを授業に取り入れよ。 • 現地の処方フォームは、以下の内容を含んでいるべきである： o 車椅子およびクッションの、種類およびサイズの指定 o 身体および理想的な車椅子の、詳細な寸法 o 姿勢支持具についての詳細説明 o 車椅子ユーザーの合意署名 b. 第 1節：はじめに • 受講者に、適正な車椅子の定義は「車椅子ガイドライン」に従うことと、支えを追加した車椅子 と座位保持専用シート41のどちらが最適か、常に検討が必要であることを念押しせよ。 c. 第 2節：車椅子およびクッションの種類 準備のコツ • 環境、機能、フィッティング、姿勢支持に関係する、さまざまな機能をやって見せられるだけの 多様な車椅子が揃っているようにせよ。 • 車椅子は、姿勢支持機能専用のものと、姿勢支持具を付加できるものの両方を揃えよ。 40 [原文] what can be customized [訳注]「カスタマイズ」の方がむしろ一般的かもしれない. 41 [原文] dedicated supportive seat [訳注] ここでは以下の「姿勢支持専用車椅子」と同義であろう. 90 内容 • 姿勢支持具付き手動車椅子だけあればよいユーザーには、姿勢支持専用車椅子42から生じる以下 の制約を考慮せよ： o 姿勢支持車椅子43は、手に入る設計やサイズの種類が限られる場合がある。 o 不必要な機能が盛り込まれ、重量や費用がかさむ場合がある。 o 姿勢支持車椅子は、運搬が難しい場合がある。 • 座角44が「固定」される車椅子：車椅子ユーザーを支える最適な角度を、必ず処方時に選択しな ければならない。 • 「クイックリリース」あるいは 「調節可能な」ティルトを備えた車椅子：傾き度合いを、一日の 間に容易に調節でき、必要に応じて多く、あるいは少なく支えられる。これは重傷からの回復中、 あるいは頭のコントロールなどの技能を習得中で、一日中まっすぐに座れない車椅子ユーザーに は助かる。こうした機能を備えた車椅子を指摘せよ。 • 受講者に、必要な車椅子および姿勢支持具が、必要となる車椅子のサイズを決めることを念押し せよ。例えば、体幹側方サポートと背もたれパイプの間でリクライニングする背もたれが必要な 場合、車椅子の幅を決めるのは： o 身体寸法 Gの「体幹幅」足す； o 両側の体幹側方サポートの厚さ (B x 2)（以上は背もたれ パイプ内側の間隔に等しい）足す； o 両側の背もたれパイプの幅 (A x 2)（図 7） • 背もたれを背もたれパイプの前に組み付ける場合は、車椅子 ユーザーの体幹幅 足す 両側の体幹側方サポートの厚さ、 または骨盤/大腿の幅（どちらか広い方）が車椅子の幅 （車椅子各部の寸法の 1か 2）を決める。 図 7 車椅子の幅 42 [原文] dedicated posture support wheelchair 43 [原文] posture support wheelchairs 44 [原文] tilt. 91 B.7: 姿勢支持具の処方（選択）−はじめに この授業を教えるための主な留意点 a. 全般 準備のコツ • 個々の姿勢支持具に関する質問は「保留スペース」に停めておけ。これらは、次の授業から取り 上げる。 • この授業の実施前に、現地での処方フォームへの変更を熟知し、適切であれば現地のフォームを 授業へ組み込むようにせよ。 • デモ用に、現地の姿勢支持具の見本を調達せよ。 • 費用や供給者に関する情報は予め作成し、別個に配布資料としてまとめよ。これは授業の一部と して話し合うべきではない。 b. 第 2節：姿勢支持具とは何か？ • 姿勢支持具の選択は、ハンド・シミュレーションで見定めた必要な支えによって違ってくる。 o 要求されるサイズ（高さと奥行き）は、必要な支えの量に関係する。必要な支えが多いほど、 姿勢支持具の表面積は広くなる。 o 素材の選択は、支えの強固さによって違ってくる。例えば、軽い支えが必要な場合は体幹側方 ウェッジ（硬いウレタンフォームでつくり柔らかいウレタンフォームの下に置く）を処方でき よう。強固な支えが必要ならば硬い構造材（木、金属、プラスチックなど）でつくり柔らかい 素材（ウレタンフォーム、EVAなど）を貼った、体幹側方サポートを処方するとよい。 o 支えの形状は、身体のどの部分を支えるかによって異なる。例えばひじ掛けが手こぎの邪魔に なるなど、身体の他の部分の動きを制限するようであってはならない。骨ばった部位、例えば 体幹の弯曲に形を合わせた際の肋骨の上などに、高い圧力が集中する形状であってはならない。 支えの成形しだいで、圧力を広い面積に分散させる（褥瘡の危険を減らす）ことができる。 o 圧力は非常に重要である。姿勢支持具の、身体に近く褥瘡を引き起こしうるほど硬いあらゆる 部分は、適切な形状にして、柔らかい適切な素材（ウレタンフォーム、EVA、ネオプレンなど） のクッションを入れるべきである。 92 c. 第 3節：中級車椅子処方（選択）フォームに姿勢支持具を記録する • 「教習員用指導書」p.130 のスライド 8・9 に処方フォームに姿勢支持具を描いた見本が載って おり、寸法線と記号で計測が必要なところを表している。 • 処方フォーム上に描画するさい、受講者は硬いウレタンフォームの形状とサイズに集中すべきで ある。どの部分も柔らかいウレタンフォーム層で覆う必要はあるが、それまで描く必要はないと 説明せよ。 • 補助線45は、姿勢支持具を描きやすくする目安で ある。必ず用いるべきサイズや形状を示している わけではない。 • 描画の目的は、必要な姿勢支持具の種類、形状、サイズ を伝達することなので、明確に描くことが重要である。 • 背もたれと足台に補助線を追加すると、姿勢支持具を スケッチしやすくなる。 • この補助線を PPT および各自の処方フォームに追加 するとよい。この図はWSTP用 USB メモリに収載46 している。 図 8 姿勢支持具の描画 に用いる補助線 45 [原文] shadow lines 46 [訳注] 日本車椅子シーティング協会のダウンロードサイトでは「補足資料」フォルダに収載. 93 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：問題：骨盤が後傾および/または横滑りする • 「教習員用指導書」p.136 のスライド 8 は、座骨 前方（アンカー）サポートが付いたクッションを 示している。 • このイラストは、誤解を招く恐れがある。以下を 説明せよ： o クッション基層は硬いウレタンフォームである こと o 柔らかいウレタンフォームの表層は、座骨前方 （アンカー）サポートに、必ずしっかりと接着 すること • スライド 8 のイラストを、WSTP 用 USB メモリ に収めた新しいもの（図 9）に差し替えよ47。 図 9 座骨前方（アンカー）サポート が付いたクッション • 「教習員用指導書」p.137 のスライド 11 のイラストは、マリアンの姿勢支持具の寸法を示して いる。この図では 2つの寸法を示しているが、骨盤後方パッドの寸法線が、誤って座面上端から 骨盤後方パッドの下端へ引かれている。この線は、座面上端から骨盤後方パッドの中央高さまで でなければならない。 • 中級WSTPパッケージには、その版によって PPT（スライド 11）にもこの誤りがみられる。 • 「教習員用指導書」および（必要ならば）PPTについて、これを差し替えよ48。 • 「受講者用ワークブック」p.26では、この寸法線が誤って座面上端から骨盤後方パッドの上端へ 引かれている。受講者に、ここを訂正49するよう指示せよ。 47 [訳注] 日本語版でも修正が必要. 48 [訳注] 日本語版の作成段階で PPTは修正済みで, そのスライドを用いた日本語版教習員用指導書も修正済み. 49 [訳注] ここは日本語版でも修正が必要. 94 この授業を教えるための主な留意点 a. 全般 準備のコツ • 人体骨格/脊椎/骨盤/股関節模型は、授業ツールとしてたいへん有用である。教習員は、模型を 以下のことに活用できる： o 骨の指標部位を特定する。 o どこに支えを設けるべきか、やって見せる。 o 骨盤と股関節の姿勢チェック、（適切であれば）一時的支持、ハンド・シミュレーションから の所見を関連づける。 • 適切なサイズのウレタンフォーム製のブロックおよびウェッジを用意しておけば、クッションの 解決策の見本を素早く組み立てられる。例えば、第 2節の座面前方のかさ上げや、積み増しして 第 3節の座骨前方（アンカー）サポート付きクッションにするなど50。 内容 クッション • あらゆる中級レベル適応の車椅子ユーザーに、骨盤を 支える適切なクッションを供与すべきである。 • 中級レベル適応の車椅子ユーザーのほとんどには骨盤 の前滑りを止める、座骨前方（アンカー）サポートの 付いたクッションが必要である。座骨前方（アンカー） サポートには、座骨からの圧力を逃がす51（除圧する） 効果もある。 • 座骨前方（アンカー）サポートが必要で、さらに褥瘡 発生の危険がある中級レベル適応の車椅子ユーザーに は、骨盤井 [こつばんせい]52を設けたクッションを 処方するとよい（図 10）。 図 10 骨盤井を設けたクッション • 骨盤井は、座骨前方（アンカー）サポートと同じように姿勢を支え、さらに体重を分散して大腿 上部（転子部）の下に加重することで、さらに除圧をもたらす。 50 [訳注] 本書の付録 4 (p.133-137) にその例が図示されている. 51 [原文] move some pressure away from their seat bones 52 [原文] pelvic well [訳注] 基礎・中級WSTP教材でいう seat bones well (座骨井) と同じもの. 95 大腿内側ウェッジ付きの骨盤井クッション：基層 大腿内側ウェッジ付きの骨盤井クッション b. 第 2節：問題：骨盤が後傾および/または横滑りする 準備のコツ • 「教習員用指導書」p.136のスライド 9には「骨盤後方パッドは、骨盤を上端（上後腸骨棘（PSIS） の高さ）で支え」と注記されている。しかし、PSISは骨盤の上端ではない。骨盤の上端は腸骨稜 である。教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある53。 • 選択肢１：この文から「骨盤上端」の語を削除し、PSISのみに言及する。この変更を行なう場合 は、以下も変更する必要がある。 o 「受講者用ワークブック」p.25の身体計測表 o 「受講者用参考書」p. 95（後ろから 3段落目） o 中級車椅子事前評価フォームの寸法 I • 選択肢 2：「骨盤上端」を、骨盤背面の上端を指す一般的な呼び名として用いる。この選択肢を 採用した場合、受講者が PSISは骨盤の「上端」より下に位置することを理解するのが重要。 53 [訳注] 同じ用語の問題を扱っている, 本書 p.86も参照. 96 PSISを見つける • 両手を骨盤上縁に当て、両手を優しく絞り込みながら 柔らかい部位を見つける。それから、親指を（親指の 水かきを張り広げながら）他の指より下に移動する。 親指は骨盤上縁より下の、PSIS に近い位置に来る （図 11）。 図 11 PSISを見つける 内容 • 骨盤ベルトを配置する適切な角度は、45度と 90度の 間である（図 12）。 • しかし 45度のベルトは、特に強い支えが必要な場合、 車椅子ユーザーが座った時に骨盤後傾を助長する。 • 座面上で前滑りする傾向がある車椅子ユーザーには、 60〜90度が効果的な角度である。 図 12 骨盤ベルトの配置 脊柱に自然なカーブがある大人への骨盤後方の支え • 骨盤後方パッドは、腰椎/胸椎に通常のカーブがある車椅子ユーザーに対して、骨盤をまっすぐ に起こして保ち、骨盤後傾を防ぐように設計されている。 • これは、背もたれが平らな車椅子での骨盤〜胸郭前後差54 （骨盤背面と胸椎背面の位置の前後差） を埋め合わせるように設計されている。 • 骨盤をニュートラル姿勢まで矯正できないか、車椅子ユーザーの脊柱にニュートラルなカーブが ない場合、骨盤後方パッドは用いるべきでない。 54 [原文] pelvic-trunk offset [原文] 訳語はシーティングエンジニアの講習等で一般的な名称. 西方倫彰氏の教示に よる. 97 骨盤〜胸郭前後差 骨盤後方パッドを垂直な背もたれと併用 • 後方に曲げた背もたれや張り調整背もたれは、骨盤をまっすぐに起こして支えられる（さらに 脊柱の自然なカーブに形を合わせられる）ため、骨盤後方パッドが不要な場合もある。 • さらに支えが必要な場合、骨盤後方パッドを上記のような背もたれに付加してもよい。 後方に曲げた背もたれ 張り調整背もたれ • 骨盤を矯正し過ぎてはならない。車椅子ユーザーがまっすぐか、まっすぐに近い姿勢に耐えられ ない場合は、支えを減らして、ユーザーが骨盤を後傾させて座れるようにせよ。そうした車椅子 ユーザーには座面〜背もたれ角度を開け、それほどまっすぐでない姿勢で支えるのが有益な場合 もある。 98 脊柱に自然なカーブがある子どもへの骨盤後方の支え • 骨盤後方パッドは、小さい子どもには使用禁止55である。 • 小さい子どもは、ニュートラルな姿勢では腰椎のカーブが なく、胸椎は前に曲がる56（図 13）。 • 骨盤後方パッドを用いると、骨盤を前へ押し出して前傾させ、 かつ/または車椅子ユーザーを背もたれから押し出す。これは 不快感、苦痛、姿勢の問題の原因となる。 図 13 小さい子どもの まっすぐな姿勢 c. 第 3節：問題：骨盤が側傾している（固まった水平でない骨盤） 固まった水平でない骨盤 • 骨盤下の積み増しの高さは、ハンド・シミュレーションで用いた一時的支持部と同じ高さになる。 • 一時的支持部の高さは、最も矯正された（骨盤と股関節の姿勢チェックで決定した）骨盤姿勢で の、左右の ASISの高さの差と同じになる。 水平でない骨盤：ニュートラル姿勢になる柔軟さがある • 車椅子ユーザーの骨盤にニュートラル姿勢になる柔軟さがある時、受講者が、低い側の骨盤下を 積み増しして矯正してはと提案する場合がある。これは、低い側の座骨下の圧力を増すため安全 ではない。 • 骨盤側方パッドとしっかりした骨盤ベルトを設けて骨盤を支えると、配置が適切で57バランスが 取れた姿勢になる。車椅子ユーザーの体幹にも支えが必要な場合がある。 55 [原文] must not be used 56 [原文] forward bend 57 [原文] aligned 99 d. 第 4節：問題：骨盤が片側に寄る 準備のコツ • 「教習員用指導書」p.143のスライド 22への注記に、以下を追加： o 「骨盤を両肩との垂直線上まで矯正できなければ、骨盤側方パッドを中心からずらし58ます。」 • 受講者に、上の一文を「受講者用参考書」(p.96のいちばん下) に追加するよう指示せよ。 内容 • 骨盤側方パッドは座面、ひじ掛け、背もたれ、背もたれパイプに固定できる。 • 骨盤パッドをひじ掛けや座面に固定する場合、形状が適切でなければ大腿部に干渉しやすい。 • 背もたれあるいは背もたれパイプに取り付けると干渉しにくい。これらは骨盤上端から大腿上端 のすぐ上までの形状にするとよい。 • 骨盤側方パッドを中心からずらして配置したい場合、以下の方法が可能： o 片方の骨盤側方パッドを、反対側より厚くする。 o パッドを非対称に/中心からずらして取り付ける。 e. 第 6節：要点のまとめ • 受講者に、実習および自分のサービス事業で車椅子ユーザーと協働するさい、車椅子ユーザーと さまざまな選択肢やアプローチを試みるよう奨励せよ。 58 [原文] off-centre 100 B.9: 姿勢支持具の処方（選択）−股関節を支える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業を通して、骨盤と股関節の姿勢チェック、必要な一時的支持、ハンド・シミュレーションの 結果と、姿勢とを関連づけよ。 b. 第 2節：股関節を支える 準備のコツ • 人体骨格模型があれば、さまざまな姿勢をやって見せるために役立つ。 内容 • ニュートラル姿勢まで屈曲しない股関節に対する一時的支持部の高さの決め方のコツは、授業 「B.3: 身体的事前評価−骨盤と股関節の姿勢チェック」の注記を参照せよ。 • 両側の座骨を一時的支持部に乗せて座ると、股関節の可動域制限（拘縮）から影響を受けること なく、脊柱を事前評価できる。 • 脊柱を事前評価したら、一時的支持部を取り除き、骨盤を後傾した位置にせよ。 101 B.10: 姿勢支持具の処方（選択）−体幹を支える WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：体幹を支える ケーススタディ：ジョセフィン • 「受講者用ワークブック」(p.34-35) のジョセフィンのケーススタディで、彼女は長いホイール ベースの車椅子を使っていると述べているが、イラストには、短いホイールベースの車椅子に 乗っているジョセフィンが描かれている。 • ジョセフィンのケーススタディに取り組むグループには、長いホイールベースの車椅子を与えて ワークブックのその誤りに注記しておくよう助言せよ。 • ジョセフィンへのハンド・シミュレーション結果に、左股関節がニュートラル姿勢になると記録 されている。これは誤りで、骨盤がニュートラル姿勢でないのに左股関節がニュートラル姿勢に なるはずがない。 • 受講者に、「受講者用ワークブック」p.34-35 のコラム内のケーススタディへの情報について、 上記の情報を変更するよう指示せよ。 • 「教習員用指導書」p.160に、上記の変更について注記せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • この授業には、予め準備が必要なたくさんの教材が要求される。将来の教習プログラムで再使用 できる、教習教材キットの作成を検討せよ。 • 受講者が、姿勢支持具を成形し切断する必要がある場合は、「教習員用指導書」の教材リストに 必要な工具を追加せよ。 • 受講者が姿勢支持具の実物大模型をつくるための、接着テープ数巻を教材リストに追加せよ。 この資材およびその取り付け方法は、教習のみを目的としていることを強調せよ。 • 姿勢支持具キットおよび姿勢支持具の材料を準備する際には、受講者が自分の職場で使うことに なる姿勢支持具および資材を用いるようにせよ。それらが手に入らなければ、低コストの代用品 下記］を用いてもよい。受講者には、それが教習のみを目的としていることを説明せよ： 102 o ソリッド座面/背もたれ、体幹/骨盤の側方支持具について、段ボールを木材の代用にする。 o 発泡スチロール、梱包材廃棄物の合成樹脂フォーム、草を編んだマットをウレタンフォームの 代用にする。 • 模擬品 [仮合わせの車椅子]59を完成するための資材がじゅうぶんない場合は、受講者に、加え ようとする変化、およびその作り方を詳述してもらえ。 • ケーススタディでは各ユーザー用車椅子の種類を詳述しているが： o その種類の車椅子が手に入らなければ、現地で手に入る代替品を提供し、 o その車椅子には、いかなる姿勢支持具も取り付けられていないようにして、 o その車椅子について受講グループで話し合え：提供した車椅子とケーススタディで述べている 車椅子との、主な変更点をすべて特定せよ • シアン（ケーススタディ 3）用に、子ども用サイズの車椅子が用意できなければ、受講者には、 異なるサイズのものを用い、必要となる姿勢支持に集中するよう助言せよ。 b. 第 2節：体幹を支える 準備のコツ 受講者全体での活動（「教習員用指導書」p.156）について： • 受講者が座る、ベンチあるいはテーブルの幅が広すぎないことを確かめよ。さもなければ受講者 の脚が伸びてしまうからである。座面が平らで水平な椅子があれば、壁に横向きに当てて置くと 代用になる。 内容 活動のケーススタディについて： • 受講者に、活動の中心は問題解決で、あらゆる可能な解決策を検討すべきだと念押しせよ。 • 受講者に、まず骨盤と股関節への支えを含む座面60から始め、続いてハンド・シミュレーション と同じ順序に沿って行くよう指示せよ。 • 受講者が適切でない解決策を選んだ場合は、その理由を説明するよう求めよ。受講者の解決策が 引き起こしうる臨床的または機能的な問題に関する話し合いを先導し、その克服のためには何が できるかを問え。 59 [原文] mock-ups 60 [原文] seat base 103 よくある誤解の修正：ケーススタディ 1：マーク • 高すぎる背もたれ：受講者に、ハンド・シミュレーションの所見は、車椅子ユーザーに肩甲骨の 背面に支えが必要であることを示していると念押しせよ。これは、背中への支えに必要な高さは 肩の上端ではなく胸郭の中ほどであることを示している。肩甲骨の高さの背もたれは、腕の機能 に影響を及ぼす。 • 背もたれは、ハンド・シミュレーションで判明した支えの高さにすべきである。 • 背もたれが低いと、車椅子ユーザーが不安定になる可能性がある。 • 肩甲骨背面への支えは、通常、肩の機能には影響しない。 よくある誤解の修正：ケーススタディ 2：ジョセフィン • 骨盤後方パッドを、「座面〜背もたれ角度を開ける」の代わりに選択：授業「B.8: 姿勢支持具の 処方（選択）−骨盤を安定させる：第 2節：問題：骨盤が後傾および/または前滑りする」 （「教習員用指導書」p.134）の、骨盤への支えに関する解説を参照。 • 座骨前方サポートが処方されない。 • 片側の座面前方下げの角度が不適切：ニュートラル姿勢まで屈曲しない側の股関節に対する片側 の座面前方下げの傾斜は、座骨前方サポートのすぐ前方から始まる必要がある。 • リクライニングしすぎ：背もたれを、背もたれパイプの間でリクライニングさせる場合、車椅子 ユーザーの肩が背もたれパイプに触れる直前でリクライニングは止めるべきである。 • 座面＆背もたれティルト61を用いる：受講者はまず骨盤と股関節、続いて体幹への姿勢支持具に 集中し、ティルトさせる必要を調べるのはそれからにすべきである。 • ジョセフィンの骨盤後傾による体幹〜大腿の角度が、股関節がニュートラル姿勢にならないこと による体幹〜大腿の角度と同じ、あるいはより大きければ、クッションの改造は不要。 よくある誤解の修正：ケーススタディ 3：シアン • 骨盤の低い側を積み増し：授業「B.8: 姿勢支持具の処方（選択）−骨盤を安定させる：第 3節： 問題：骨盤が側傾している62」の、骨盤への支えに関する解説を参照。 • 座面前方のかさ上げの位置：座面前方のかさ上げの傾斜は、座骨前方サポートのすぐ前方から 始まり、クッション前端まで続く必要がある。 • 骨盤後方パッドを付加：シアンは 3歳なので腰椎のカーブは発達していない。この年齢の子ども には、平らな背もたれ63が適切である。 61 [原文] seat and back rest tilt [訳注] 座面と背もたれが一体化して傾く, 日本語のいわゆる「ティルト」を指す. 本書には, 同じ機能を tilt in space「ティルトインスペース」と呼んでいる箇所 (p.104) もある. 62 [訳注] 中級WSTP「教習員用指導書」p.141. 63 [原文] flat backrest [訳注] いわゆる腰椎 (ランバー) サポートのない背もたれ, と解すべきであろう. 104 体幹と頭のコントロールに乏しい子ども： • 子どもは、ニュートラルな姿勢では、骨盤がまっすぐに 起き、腰部のカーブがなく、胸椎がわずかに屈曲し、 体幹上部がわずかに前傾する（図 14）。 • つまり子どもの体幹上部は、平らな背もたれには密着 しないのである。 • いっぱんに、筋力が弱い/体幹のコントロールに乏しい 子どもは、体幹上部と頭をまっすぐに起こして保つのが 困難である。 • 子どもによっては、さらに支えが必要である。 図 14 子どものニュートラルな姿勢 子どもをよりまっすぐに座らせるには： 座骨前方サポートを付加し、座面〜背もたれ角度を 開け、骨盤ベルトを付加して、評価せよ： • この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合： • テーブルを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ • 肩ハーネスを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合：座面および背のティルト （ティルトインスペース）を付加せよ（図 16）。 図 15 座面〜背もたれ角度を開ける 図 16 ティルトインスペース 105 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を 支える WSTP（車椅子サービス教習パッケージ）教材の誤り a. 受講者用参考書 • 「受講者用参考書」p.106の見出し「問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢 よりも小さい角度のまま固まっている」に続く（ ）内の語「大腿〜下腿の角度が 90 度超」を 「大腿〜下腿の角度が 90度未満」に差し替えよ64。受講者に、自分の参考書にこの変更を加える よう指示せよ。 この授業を教えるための主な留意点 a. 第 3節：大腿を支える 内容 活動のケーススタディに対するよくある誤り： • まず車椅子および/またはクッションの問題に対処するより先に姿勢支持具を付加する：姿勢の しっかりした土台を構築するうえで、基礎レベルの車椅子の原則が重要であることを強調せよ。 • 車椅子ユーザーの大腿へじゅうぶんな支えを設けない：ハンド・シミュレーションの結果から、 どこを支える必要があり、どの程度支えが必要なのかが示される。これには姿勢支持具のサイズ、 形状、強固さなどが含まれる。 • 車椅子および/またはクッションへ付加する姿勢支持具が機能（例えば車椅子の移乗や推進）に 及ぼす影響へ対処していない：。 • 「教習員用指導書」p.169 のスライド 11 のイラストは、骨盤井があるクッション上の大腿外側 ウェッジを示している。これは一つのクッションに複数の姿勢支持具を組み合わせた一例である。 大腿外側ウェッジを組み付けたクッションには必ず骨盤井が必要、という意味ではない。 • 上記は「教習員用指導書」p.170のスライド 15にも当てはまり、こちらは、骨盤井クッションに 設けた大腿内側ウェッジを示している。骨盤井の詳細は、本書「B.8: 姿勢支持具の処方（選択） −骨盤を安定させる」の「この授業を教えるための主な留意点」を参照。 • 「教習員用指導書」p.169 のスライド 13 の膝分離パッド：座骨前方サポートや座面前方のかさ 上げを付加した場合、クッション前部は高さが増す。これは、膝分離パッドの設計によっては、 車椅子ユーザーの膝に対するパッド位置に影響を及ぼす。 64 [訳注] 日本語版では注記済み. 106 b. 第 4節：下腿と足を支える 問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢より小さい角度のまま固まって いる（「教習員用指導書」p.173） • 追加の（列挙されていない）解決策として座面前方のかさ上げがある。これは股関節を屈曲させ （体幹〜大腿の角度を狭め）、足を座面の真下から前方へ持っていく。 • 股関節をニュートラル姿勢より屈曲させて座っても、ニュートラル姿勢で座るより拘縮が発生・ 悪化する危険が増すことはない。しかし、車椅子ユーザーへの以下の助言は優れた実践である： o 毎日、車椅子を降りてうつ伏せになって休憩し、股関節を伸ばしなさい。 o 毎日、立位台で過ごす時間を設けなさい。 107 B.12: 製品（車椅子）の下準備 この授業を教えるための主な留意点 a. 全般 準備のコツ • 教習員は、現地で手に入る車椅子と資材を熟知している必要がある。教習プログラムの計画段階 で、しっかりと把握しておけ。教習員が現地を拠点としていない場合、これは以下のようにして 行なうとよい： o 現地のサービス事業者に、手に入る資材の情報と写真を送ってもらうよう依頼する。 o プログラム開始前に到着し、用意された資材を確認し、必要ならば代替品を探すためのじゅう ぶんな時間を確保する。 • 教習プログラムに必要なリソースは、実施地ごとに、以下の条件に従い変わってくる： o 現地で服、靴、バックパックを製造していれば、さまざまな種類の布地、ベルト地、バックル、 面ファスナー、EVAが手に入る可能性が高くなる。 o 現地に家具製造業や建設業があれば、木材、合板、留め具、鋼管などさまざまな種類の材料が 手に入る可能性が高くなる。 • 姿勢支持具の部材は、国際的ドナーからの寄付によることも可能である。例えば、ベルト、頭部 支持具、ハーネス、体幹側方サポートなど。 • 「受講者用参考書」p.110の初めに載っている情報を、資材と工具に関する一般的情報について 読み直し、話し合いの場で参照できるようにしておけ。 • この授業には、技術的専門知識が豊富な教習員がおり、製品の下準備に関する技術的支援を得ら れると助かる。 b. 第 1節：はじめに • どの車椅子が、その車椅子ユーザーの環境および機能的ニーズに対して最適な特色をもたらすか、 また必要な姿勢支持具の付加によって、ユーザーのフィッティングおよび姿勢支持へのニーズが じゅうぶんに満たされるかどうか検討せよ。必要な姿勢支持機能のみをもたらすよう、ハンド・ シミュレーションで設けた支えに基づいて姿勢支持具を選択することが、最良の解決策となる。 • 姿勢支持専用車椅子は、車椅子ユーザーが必要とするよりも多くの機能を提供する場合がある。 可能であれば、不必要な機能は取り除くこと。 108 B.13: フィッティング この授業を教えるための主な留意点 a. 全般 • 受講者は、基礎WSTPのフィッティング手順を熟知していなければならない。 • 基礎レベルのサービス供与は、単線的プロセス（順々にステップを踏む）である。中級レベルの サービス供与は、循環を経て完結する。受講者は、車椅子と姿勢支持具が最初の処方から調整や 改造を経るに従い、フィッティング確認表を繰り返し用いる必要がある（「教習員用指導書」p.183 のスライド 3を参照）。 • 時間が許せば、教習員はこの授業をより対話的にするとよい。例えば： o 志願者を募り、受講者に、基礎レベルで学んだ確認で確認表に載っている項目をやって見せて もらう。 • ほとんどの基礎レベル適応の車椅子ユーザーは、フィッティング手順の終わりにはまっすぐに/ ニュートラルな姿勢で座れるようになる。中級レベルでは、多くの車椅子ユーザーはまっすぐに /ニュートラルな姿勢では座れない。受講者は、ユーザーが可能な限り最良の姿勢になったのか 確信が持てないかもしれない。そうした場合には： o 骨盤と股関節の姿勢チェックおよびハンド・シミュレーションからの所見を、フィッティング 手順の終わりにとれた最終姿勢と関連づけよ。 • 最終姿勢が、ハンド・シミュレーションの終わりに到達した姿勢とぴったり一致しない場合は、 以下のような理由による： o 骨盤と股関節の姿勢チェックでの評価を誤った。 o ハンド・シミュレーションで、姿勢の問題を矯正しすぎている。この場合は、新しい姿勢での 快適さ、バランス、耐久性65を向上させるため、最終処方を調整する必要がある。 o 事前評価から最終フィッティングまでに時間が空き、車椅子ユーザーの姿勢が事前評価の時点 から変化した。この場合は、骨盤と股関節の姿勢チェックおよびハンド・シミュレーションの やり直しが必要かもしれない。 65 [原文] tolerance 109 B.14: ユーザー教習 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役教習員と補助役教習員とで、車椅子での移動と移乗に関する技能を復習し、練習して やり方に統一性を持たせるべきである。 • 車椅子が正常に動作し、すべての部品が取り付けられていることを確認せよ。 • 選んだ車椅子は、各々の例話に登場する製品と、なるべくぴったり合致させよ。 o ジョシュア：ティルトインスペースと転倒防止の機能を備えた製品 o サンギータ：クイックリリース車輪、骨盤ベルト、骨盤パッドを備えた（できれば）子ども用 の製品 o キム・ソム：クッションと背もたれに姿勢支持具を備えた、標準的な車椅子 b. 第 2節：ユーザー教習：車椅子ユーザーの例話 • 車椅子サービス職員役を割り当てられるのは各グループに一人だけだが、グループには、教えら れるべきそれぞれの技能、およびその正しい教え方を、協力して見定めるよう指示せよ。 • この配役は、車椅子ユーザー教習のさまざまな側面を強調することを意図しており、この活動を 一人だけで完結することは想定していない。 • 技能をどう教えているか注意深くモニターせよ。受講者は説明し、やって見せ、練習するところ を観察し、フィードバックを伝えるべきである。 • 例えば折りたたみ、駆動輪やテーブルなど着脱式部品の取り外し/取り付けをはじめ、車椅子の あらゆる機能を、分かりやすく車椅子ユーザーとその家族にやって見せていることを確認せよ。 • 中級WSTP受講者にはそうした機能を理解し、それをユーザーおよび/またはその家族に上手に やって見せられる能力が不可欠である。 110 B.16: メンテナンス・修理・フォローアップ この授業を教えるための主な留意点 a. フォローアップ実習 準備のコツ • 教習時間割に、フォローアップ実習は含まれていない。時間が許せば、教習員は、現地の車椅子 ユーザーとの、サービス施設あるいは在宅環境でのフォローアップ面接予約を段取るとよい。 • 学習の要点を強調し、受講者からの質問に答えるため、現地で手に入る車椅子を用意しておけ。 • 一般的な手入れ・メンテナンス・修理用工具一式を用意し、受講者に見せられるようにしておけ。 b. 第 2節：フォローアップの概略 • あらゆる中級レベル適応の車椅子ユーザーにとって、定期的フォローアップは有益である。 • よりひんぱん（3〜6か月ごと）なフォローアップが必要な車椅子ユーザーの例： o 子ども：成長による、または機能（例えば頭や腕のコントロール）や姿勢における変化に形を 合わせるため、姿勢支持具の調整が必ず必要 o 進行性疾患がある、または機能的能力や体重が変化しそうな車椅子ユーザー • フォローアップは車椅子サービス供与の最も難しい側面で、特に車椅子ユーザーの家でフォロー アップを行なう場合がそうである。その原因は移動のリソースに制約がある、都合がつく職員に 限りがある、サービスセンターから車椅子ユーザーの家までが遠いことなどによる。 • フォローアップ面接はたいへん重要である。そこでサービス供与者ができること： o 車椅子ユーザーが、自分の車椅子を安全に使えていることを確かめる。 o 車椅子が、適切に動作していることを確かめる。 o タイヤの空気入れ、ブレーキの調整など基本的なメンテナンスを実施する。 o 追加の車椅子ユーザー教習を提供する。 o サービスの出来ばえに関するフィードバックをもらう。 o サービスの必要性を立証する、車椅子ユーザーの体験談を集める。 o 製品の使われ方、および製品が使用環境や期待された機能に対して適切かどうかを把握する。 111 • フォローアップに障壁があるところでは、教習員は、現地での解決策を見出すための話し合いを （時間が許せば）先導してもよい。その内容として考えられること： o フォローアップ実施のために、地域に根ざした組織を活用する。 o 車椅子ユーザーがフォローアップに出かけられるよう、移動への支援を提供する。 o 地域ごとのフォローアップ日程を決め、職員が一地域で数件の家庭訪問を行なう。 o 車椅子ユーザーがすでに他の予約、例えば医師との面接などでその地域にいる時に合わせて、 フォローアップの面接予約を入れる。 c. 第 3節：車椅子フォローアップフォーム • 受講者に、中級レベル適応の車椅子ユーザーには、メンテナンスや修理がより多く必要になると 念押しせよ。なぜなら： o 通常、車椅子に、摩耗したりゆるんだりしがちな部品が多くなるため。 o 中級レベル適応の車椅子ユーザーの場合、激しい筋攣縮 きんれんしゅく］や、座り方の パターン66のために、姿勢支持具に通常以上の圧力が加わることがあるため。 66 [原文] patterns of sitting 112 実習 1〜4 この授業を教えるための主な留意点 a. 全般 準備のコツ 注意義務67 • 教習員は、教習プログラムに参加した車椅子ユーザーに適正な車椅子、クッション、姿勢支持具 が供与されたことを確かめる、注意義務を負っている。 • ユーザーやその家族にとって安全でない、または機能的ではないと教習員が感じるような製品の ままで、車椅子ユーザーを教習プログラムから去らせてはならない。車椅子を供与できなかった 場合は、ユーザーの地元のサービス事業者との面接予約を別に取り、処方、フィッティング、 ユーザー教習が完結するようにせよ。 • 教習員は、車椅子ユーザーへのフォローアップを担当するサービス事業者またはサービス職員を、 必ず確定しなければならない。そのサービス供与者には、事前評価フォームや処方フォームなど 関連書類をすべて提供しなければならない。 • 教習員は、車椅子ユーザーに、支援、修理、フォローアップを提供できる地元のサービス供与者 の連絡先を、必ず伝えなければならない。 車椅子ユーザー • 主催団体または教習チームから、連絡担当者を指名せよ。その役割は： o 車椅子ユーザーが実習に到着したら出迎える。 o 実習に到着していない車椅子ユーザーへの対応を行なう。 o サービス事業と教習チームとの間の連絡をとる。 o 車椅子ユーザーおよびその家族が自分の面接が始まるまで待機する、適切な場所を指定する。 o 食事や軽食を提供する場合、全員の希望を前日までにはケータリング68業者に確認する。 o 写真撮影許可が完了していることを、写真を撮る前に確認する。 67 [原文] Duty of care 68 [原文] catering 113 グループ分け • 優れた学習経験ができるためには、受講者をどうグループ分けするのがよいかよく考えよ： o 同じサービス事業所からの受講者をいっしょのグループにしたり、臨床職と技術職の受講者の 混成グループにしたりすると有効な場合がある。 o 自信満々の/饒舌な69受講者と、自信のない/寡黙な受講者をいっしょのグループにし、揃った ペースで作業できるようにすることを検討せよ。 o ことばや、事前評価をジェンダー混合のグループで行なうかどうかなど、文化的配慮を考えよ。 実習中のグループへの教育指導70 • 各グループに、個別の教習員を配置して実習の調整を手伝わせよ。 • できれば、リーダー役教習員が教育指導するグループ数は減らし、補助役教習員との確認作業に じゅうぶん時間を取れるようにせよ。 • 「教習員用指導書」に沿って、受講者にステップごとの時間を予告せよ。 • 時間経過に気をつけ、受講者へ定期的に残り時間を知らせよ。 • 実習を通して、各グループに同じ教習員が付くようにせよ。 b. 実習 1: 事前評価および処方（選択） 準備のコツ • 各グループに、事前評価を人目に触れないように71実施するじゅうぶんなスペースがあるように、 実習エリアを設営せよ。 • 個室を用意できない場合は、間仕切りを活用するとよい（例えば、褥瘡を観察するため）。 • 各グループに、事前評価と処方に必要な器材を支給せよ。グループの一人を、「実習 3」終了後 に器材を返却する責任者に任命せよ。 • 事前評価と処方の各パートで、別のチームメンバーがリーダーを務めるように配置し、グループ メンバー間でその経験を共有するようにせよ。 • 受講者には、事前評価プロセスが円滑に流れ、焦点を車椅子ユーザーに置き続けられるように、 同僚が各々の項目を終えるまで待ってから追加の質問をするよう勧めよ。 69 [原文] talkative 70 [原文] Supervision 71 [原文] privately 114 内容 • 身体的事前評価を注意深くモニターし、グループが、処方に影響を及ぼしうる誤りはすべて修正 するよう手助けせよ （例えば、骨盤と股関節の姿勢チェックやハンド・シミュレーションの誤り、 正しくない計測技法など）。 • 教習員は、受講者の所見を検証するため、骨盤と股関節の姿勢チェックを独自にやるとよい。 • 受講者が、事前評価フォームの順序に従うようにせよ。例えば、身体寸法は、車椅子処方を決定 する前に車椅子寸法に換算されている必要がある。 • 車椅子ユーザーは、処方プロセスへの積極的参加者であるべき。車椅子の選択肢や特色について、 受講者が車椅子ユーザーと話し合ったうえで最終処方をつくり上げるようにせよ。 • 車椅子ユーザーや家族に、見本の車椅子を示せるように用意し、じゅうぶんに情報を得たうえで 決定できるようにせよ。 • 受講者の各グループに、処方フォームへの署名前に、処方の臨床推論72を説明してもらえ。 c. 実習 2: 製品（車椅子）の下準備 準備のコツ • 製品の下準備用に教室を設営するやり方の詳細は、本書「技術に関する付録」を参照。 d. 実習 3: フィッティングおよびユーザー教習 • ユーザー教習にはじゅうぶん時間をかけられるようにし、慌ただしくならないようにせよ。 e. 実習 4: 事前評価・処方（選択）・製品（車椅子）の下準備・ フィッティング・ユーザー教習 • 学習成果を高めるため、受講者を異なるグループに編成することを検討せよ。 • 受講者へ、車椅子サービス提供の最初の 5ステップを所定の時間内に完了できるよう、計画的に 作業するよう念押しせよ。 • 受講者は、必ずグループ全員で作業を分担すること。例えば製品の下準備では、一人が車椅子の 調整をやり上げ、他の一人がクッションを下準備し、もう一人が姿勢支持具を下準備するなど。 • 上手に作業を分担すると、すべてのステップが所定の時間内に完了するようになる。 72 [原文] clinical reasoning 115 B.15&17: 総まとめ&教習員からのフィードバック・ 討論・閉講式 この授業を教えるための主な留意点 準備のコツ • 教習員の一人に、各発表の説明に必要な、ビフォーアフター73の写真をダウンロードして整理 する役を割り当てよ。この作業は休憩時間に行なうこと。 • ビフォーアフターの写真を並べて表示せよ。これは、フィッティングの効果と成果とを示す、 効果的な方法である。 内容 • グループの準備を手伝う補助役教習員を配置せよ。 • 受講者へ、各発表が制限時間 10分に収まるよう、残り 5分と 1分で合図することを伝えよ。 • 発表に盛り込む情報を選ぶために、支援が必要な受講者もあろう。「受講者用ワークブック」p.49 の「総まとめ」の項目を指針に用いよ。 • 発表およびファシリテーションでは、教習員は以下を強調せよ： o 骨盤と股関節の姿勢チェック、ハンド・シミュレーション、最終的にとれた姿勢の関連 o ハンド・シミュレーションで見定めた支えと、最終的に選択した姿勢支持具との関連 o 選択した車椅子の特色が、環境および機能に対するユーザーのニーズをどのように満たすか • 発表のケーススタディに関する討論を促し、グループからの質問やフィードバックを、バランス が取れ、重要な事前評価の所見および介入に焦点を当てたものにせよ。 • 低リソース状況では、手に入る車椅子や姿勢支持具の範囲には限りがある。 • 妥協は常に必要である。問題は、車椅子ユーザーにとって最善の成果と、常にユーザーの安全を 確保することとの、適切なバランスを見出すことである。 73 [原文] before and after 116 教習運営実務と準備 「教習員用指導書」には、中級WSTP教習プログラムがうまく行くために必要な施設、印刷教材、 資材、器材の包括的一覧表が載っている。教習プログラム調整役の教習員は通常、現地の主催者と 連絡を取り合い、教習運営実務と準備の各部面の責任者を決定する。 実習生は見習い教習を通して、教習運営実務と準備における任務を処理する、経験と技能とを獲得 する。教習員の調整役は、これらの活動を実習生に分担させ、さらに実習生をモニターし支援する。 施設74 必要な施設の完全な確認表は、「教習員用指導書」p.14 に収載。 中級WSTP教習員が、受講者と同じことばを話さない場合は、通訳サービスが必要になる。通常、 こうしたサービスは需要が大きいため、じゅうぶん前もって予約しておくべきである。費用を教習 予算に追加する必要があろう。 印刷教材 資料は、必ずすべて現地で印刷すべきである。中級WSTPに必要な印刷教材の完全な一覧は、中級 WSTP 「教習員用指導書」p.15-16 を参照。「教習員用指導書」の確認表を用い、正しい数量の資料 が印刷されていることを確認せよ。 資材および器材 中級WSTPに必要な資材および器材の一覧は、中級WSTP「教習員用指導書」p.17-18 を参照。 74 [訳注]「中級教習員指導書」の対応する見出しは「施設およびサービス」. 117 車椅子 「教習員用指導書」p.18 の最初で、現地で手に入る車椅子とクッションについて述べている。多種 多様な車椅子が手に入る場合は最もよく使われる種類を選択し、できれば幼児用座椅子75を含めよ。 電動車椅子は含めないこと。それは中級WSTPの範囲ではないため。 どの車椅子も正常に動作し（タイヤに空気が入り、ボルトが締まっており）、クッションが付いて いることを確かめよ。 実習に参加する各車椅子ユーザーについて車椅子、クッション、姿勢支持具、あるいはクッション と姿勢支持具をつくるための資材が必要である。 技工作業エリア 改造に必要な種々の工具と資材を備えた、技工作業エリアを利用できるようにするか設置すべきで ある。これは教習予算に影響しうる。 電力与給 電源が不安定な地域では、非常用として無停電電源装置内蔵の発電機を手配すべきである。これは 「教習員用指導書」p.17 の「器材」一覧表にも追加する必要がある。 教習に向けた計画 中級WSTP教習プログラムの計画について、以下、最も重要な活動とおおよその日程を列記する： 8〜12 か月前 • 教習プログラムの予算を立てる。 • 複数のパートナーが参画する場合は、各パートナーの責任について合意する。 • 日程、会場、教習員、受講者の概要、現地事情に関する情報（現地の、車椅子に関する活動や サービスの指針となる一般的な方針や手続き、手に入る車椅子、クッション、その他手に入る 資材の種類、現地の文化や受講者の多様性に関する情報、参画する組織など）を確定する。 • 教習に必要な日数を算定し、毎日の開始と終了時刻、および通訳が必要かどうかを確定する。 75 [原文] a floor seat for infants 118 4〜6 か月前 • 各受講者に、教習プログラムの詳細（日程、会場、運営に関する情報）が載った招待状を送付し、 記入して返送してもらう。 • 受講者の職歴や技能に関する情報を集め、それに従って授業計画を適合できるようにする。 • 教習器材を予約する。 • 模擬授業に必要な、デモ用器材やその他のリソースを調達する。例えば処置用ベッド、足置き、 スライディングボードなど。 • 消耗品を調達する。 • ユーザー用の器材を調達する（ユーザー用器材を、寄付金および/または教習予算の一部に依る 場合、器材調達はもっと早く始める必要がある）。 • 状況と受講者についての概要を各教習員に伝え、授業と役割の分担について合意する。 • ケータリングサービスを予約する。 • 必要ならば、通訳および翻訳設備を手配する。 4〜6 週間前 • すべての必要な資料について、現地での印刷を手配する。 • 車椅子ユーザーを選んで招聘する。 • 登録の詳細を最終決定。例えば、名札と登録簿の手配、登録作業に当たる人への連絡など。 • 参加確認/事前情報を参加者、車椅子ユーザー、教習員に送付する。 • ケータリング業者、会場、その他の教習運営実務を確定する 1〜2 週間前 • 注文品が配達済みか確認する。 • 会場のトイレ、および水道と電気が通っているのを確認する。 • 清掃スケジュールを確認する。 教習チームの地元でない場合は、プログラム開始の 2〜3 日前に到着し、設備と会場の確認、教習 プログラムを支援する車椅子ユーザーとの打ち合わせ、必要な残り資材の購入ができれば最善。 調整役の教習員と他の教習員、主催団体、他の関係機関との間には、定期的なコミュニケーション が必要である。 119 車椅子ユーザー 中級 WSTP の間に実習が 4 回あり、そこに 2 グループの車椅子ユーザーが参加する。最初のグル ープは、2つ別の日に参加する。 教習員は教習プログラムの前に、実習に参加する意思があり、また参加が可能な車椅子ユーザーを 見定めて招く必要がある。「教習員用指導書」p.11 の確認表は、車椅子ユーザーを見極めるために 役立つ。 主催団体および教習企画者と、車椅子ユーザーのために使える予算と施設について連絡を取り合え。 車椅子ユーザーに移動手段が提供されるか、または交通費が支払われるかどうか確かめよ。 車椅子ユーザーの参加が 1 日だけの場合、プログラムを再編成し、ユーザーグループ 1 に対する 「実習 1」と「実習 2」を同じ日に収めよ。時間割を調整する際には、サービスステップ 2〜7 を 必ず「実習 3」より前に完了せよ。 可能ならば、教習員が直接車椅子ユーザーを審査すべきである。教習員が現地を拠点にしていない 場合は地元のサービス供与者に、可能性がある車椅子ユーザーを見定め、教習レベルに適合するか 教習員が判断するための写真と情報を事前に送ってもらうよう依頼するとよい。 車椅子ユーザーへの招聘状 車椅子ユーザーへの招聘状を作成する際には、以下の項目を考慮せよ（WSTP 用 USB メモリ内に ひな形を用意している76）： • 何が、実習へ参加すると起こるのかの詳細。 • 授業の日時および期間 • だれかといっしょに来てもよいのか？ • 授業で車椅子を受け取れるのか？車椅子にフォローアップが必要になったり、問題が起きたり した場合はどうなるのか？ • 教習後、どこでフォローアップサービスを受けられるのか？ • 会場にはどうやって行くのか？交通費は支払われるのか？ • 軽食や昼食は持参しなければならないのか？ • 参加に対して報酬は出るのか？ 76 [訳注] 英語版のみ. 120 各車椅子ユーザーが、これらの情報を記載した書面の招聘状を受け取るようにすべきである。ユー ザーは、参加や写真を撮られることへの意向を示すため、同意フォームにも署名する必要がある。 写真は、小グループが他の受講グループへ発表を行なう際に用いる。 注意深い計画にもかかわらず、車椅子ユーザーが、到着してみると褥瘡があったり授業日に体調を 崩したりする場合もある。これらの可能性は事前に主催団体と話し合い、こうした事態が発生した 場合に対処する準備を整え、また交替の車椅子ユーザーの参加を手配できるようにしておけ。 車椅子ユーザーが授業中、膀胱や腸のアクシデントに遭った場合に、ユーザーと設備を清潔にする 物品を準備せよ。また小さい応急処置キットを、受講者と車椅子ユーザー両方の打撲やすり傷に 備えて用意しておくこと。 121 付録 付録１：WSTPtot必須授業時間割 第 1日 第 2日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 122 付録２：WSTPtot 中級教習時間割1 第 1日 第 2日 第 3日 8:30 はじめに B.5: 身体的事前評価－ 身体計測 B.10: 車椅子の処方（選択）－ 体幹を支える (パート 2)2 8:45 9:00 B.2: 身体的事前評価－ 支えなしの座位姿勢 B.10: フィードバック （パート 2） 9:15 B.11: 車椅子の処方（選択） －頭・大腿・下腿を支える 9:30 B.5: フィードバック 9:45 B.8: 車椅子の処方（選択） －骨盤を安定させる 10:00 午前の休憩 10:15 B.2: 身体的事前評価－ 支えなしの座位姿勢 (続き) 午前の休憩 午前の休憩 10:30 B.8: 車椅子の処方（選択） －骨盤を安定させる（続き） B.11: 車椅子の処方（選択） －頭・大腿・下腿を支える （続き） 10:45 B.2: フィードバック 11:00 11:15 B.3: 身体的事前評価－ 骨盤と股関節の姿勢チェック （ToT 訓練員のデモ授業） 11:30 B.8: フィードバック B.11: フィードバック 11:45 B.9: 車椅子の処方（選択） －股関節を支える B.12: 製品の下準備 12:00 12:15 12:30 昼休み B.9: フィードバック 12:45 昼休み B.12: フィードバック 1:00 昼休み 1:15 1:30 B.3: 身体的事前評価－ 骨盤と股関節の姿勢チェック （続き） 1:45 B.10: 車椅子の処方（選択） －体幹を支える（パート１） 2:00 B.13: フィッティング 2:15 B.4: 身体的事前評価－ ハンド・シミュレーション 1 [訳注] この時間割表の内容および時間配分は, ページ xiii「教習の概略」の表とは異なっている. 2 [訳注] ページ xiii「教習の概略」には存在しない授業. 123 2:30 午後の休憩 2:45 午後の休憩 B.10: 車椅子の処方（選択）－ 体幹を支える（パート１）（続 き） 3:00 B.4: 身体的事前評価－ ハンド・シミュレーション （続き） B.13: フィードバック 3:15 午後の休憩 3:30 B.4: フィードバック ToT 教習員の個別フィード バック 3:45 「保留スペース」 4:00 授業準備 ToT 教習員の個別フィード バック B.10: フィードバック （パート１） 4:15 「保留スペース」 4:30 授業準備 ToT 教習員の個別フィード バック 閉講式 4:45 5:00 注3 5:15 3 [訳注] ページ xiii「教習の概略」では, ここに授業 B.5と B.8 (B.6あるいは B.7の誤記か) の一部が入る. 124 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 125 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 126 ToT教習員への指示：WSTPtotの終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 127 付録 4：技術に関する付録：中級WSTP向け この付録は、教習員の中級WSTPでの実習準備に役立つことが目的である。中級レベルでは、適正 な車椅子の組み立てがもっと複雑で、実地訓練での要求がさらに厳しくなり、技術者の役割の重要 性への理解が大切になる。計画段階で、教習員は、教習授業での工具と資材および経験豊富な技術 的支援を確保する方法について考えておく必要がある。また、より多くの技術者に、サービス事業 を支援するために中級教習を受けるよう奨励することも重要である。 中級サービス与 における技術職 一連の教習プログラムの一環として、WHO は、幅広い種類の車椅子に適用されることを意図した 座位保持の原理を教え、また姿勢支持具（PSDs）の例を示している。ユーザーを事前評価し、どの 姿勢支持具が必要か処方（選択）し伝達するのは臨床職の役割である。技術職の役割は、最終的に 必要な姿勢支持を達成する、なるべく実用的で、安全で、耐久性があり、取り扱いが楽な車椅子を、 手に入る工具、設備、資材、部品を用いてつくり上げる方法を把握することである。 基礎レベルでの技術者の役割は、ユーザーに合わせて車椅子を組み立てて調節することだと明確に 定義され、そのプロセスは単線的で、役割はより単純である。中級レベルに取り組む技術者には、 車椅子の組み立てのみならず、以下が求められる： • プロセス全体を通じて、ユーザーと臨床職により深く関わる。 • より独立して問題を解決できる。 • 容易に、立体形状をイメージして方向を定められる4。 • さまざまな材料や部品から、適正な姿勢支持具をつくる技工的技能を有する。 臨床職とのチームワークおよび優れたコミュニケーションは、非常に重要である。技術者の役割は、 工房での安全な作業環境を維持することや、工具と設備の手入れにも及ぶ。 臨床職/技術者チームは経験を積み、さらに複雑な姿勢支持ニーズを持つ車椅子ユーザーと関わる 中で自らの技能に挑戦し、それを高めて行く。経験豊富な技術者は、利用できるリソースを用いて 安全に達成できることは何か、その限界を把握することを学ぶ。複雑な姿勢支持具をつくれても、 それがユーザーとその家族にとって、適正、安全、あるいは長持ちする解決策である保証はない。 例えば、ユーザーをうまく支える姿勢支持具であっても、材料に耐久性がないか取り付けが不安定 であれば短期間しか持たず、したがって適正な解決策とはならない。 4 [原文] imagine and orientate 128 もっと多くの技術者に教習を 基礎WSTPと中級WSTPは、低リソース状況において車椅子を供与する実務家の量と質を高める ことが目的である。組み立てと調整 の方法］は車椅子の種類によって非常に特殊化しているため、 こうした情報は教習プログラムには盛り込まず、教習実施団体から別途提供することが多い。 中級 WSTP 受講者として技術者の参画を得ることは非常に有益である。技術者の車椅子サービス の 8 ステップへの理解が深まるほど、よりよい技術的支援ができるようになる。組織によっては、 教習は技術と臨床の職員へ同時に行なうが、サービス供与での継続的役割に応じて、技術レベルで 到達すべき能力への要求を違えている。 各サービス供与者や教習実施団体は、より複雑なニーズを満たすために、技術者が中級レベルの 力量を養うのを支援する最良の方法を見定める必要がある。 中級WSTP教習における技術者の役割 教習員には、中級 WSTP の実習中に支援を与える経験豊富な中級レベルの車椅子技術者を最低 1 名手配しておくよう勧める。これは、在庫品や既製品を用いないで姿勢支持具をつくる予定の場合、 特に重要である。 車椅子と姿勢支持具に関する技術的な内容を教授し、技術関連の質問に答えるために、経験豊富な 中級レベルの技術者および/または技術教習員を、教習全体を通じて教習チームに加えよ。 実習用の教室設営 姿勢支持具づくりには注意深さと時間が要求されるため、教習員 と技術者は、時間割を守れるようにきちんと計画しておくことが 絶対に必要である。一般的に使われる姿勢支持具のいくつかは、 予めつくっておくことを検討してもよい。 129 以下は、安全で整理整頓された教習用工房の設営に役立つ提案である： • 独立した仮設スペースを、以下のように整えよ： o 臨床教室の近くにある。 o じゅうぶんな照明とよい換気を備えている。 o 各々の技術者用の作業台か丈夫なテーブルを置ける、じゅうぶんなスペースがある。 o 換気のよい場所に接着作業用の作業台を別に備えている。 o 電動工具や機械を用いる場合のスペースを別に取っている。 • 散らかった工房は安全ではなく、事故の危険が増す。一日の終わりにはスペースを整頓し、工具 を片付け、床を掃くこと。 • 作業台やテーブルの表面を厚紙で保護せよ。これは、ウレタンフォームを切ったり貼ったりする さい、とりわけ重要である。 • ウレタンフォームを切った端材は一般ゴミとは分け、箱に入れて保管せよ。受講者には、新しい ウレタンフォームを切るより先に端材を活用するよう勧めること。 • 技工チームと働く、あるいは技術者への教習を行なう際には、各々に特定の責任を割り当てよ。 例えば、技術者の一人が特定の工具キットに責任を負い、一日の終わりにすべての工具を回収し、 帰る前に工具キットを確認してもらうようにするなど。 立位台 立位台にはさまざまな設計のものがあり、現地でつくることもできる。 立位台を処方する以前に、サービス職員は車椅子ユーザーの立位姿勢、 およびユーザーを直立した体位で支えるさまざまな方法を、完全に把握 している必要がある。「中級WSTP教習員用指導書」p.45 の指針に従う ことは重要である。 考慮すべき主な技術的課題として、以下の三つがある： • 強度：立位台には、ユーザーの体重を安全に支える、じゅうぶんな強度が必要である。立位台を 構成する材料の接合部と長い部品5にはじゅうぶん強度があり、しっかり接合されていることが 絶対に必要である。ユーザーは動くこともあるので、それによって立位台に加わる力を考慮せよ。 新しい機器は、使用前に強度と安定性を試験せよ。 5 [原文] The joints and lengths of material 130 • 安定性：立位台は、ユーザーが体勢を整える時や立ち上がる時を含め、使用中は完全に安定して いることが重要である。これは通常、接地して支える基底面を広く取ることで達成される。 • 支持面の安定性と快適さ：膝へ圧力が直接かからないことを確かめよ。立位台が身体と接触する 支持面には、除圧クッションと同様にクッションを効かせること。 さらに考慮すべき点： • 立位台は、車椅子に乗って近づいても簡単に使える設計であること。 • さまざまな身長や年齢のユーザーに対応するには、股関節、膝、骨盤、体幹への支えにある程度 高さ調節が必要になる。 • 立ちながら活動ができる平面を、トレイやテーブルなどで設けること。 ウレタンフォーム ポリウレタン（PU）フォームの品質を評価するには、以下の二通りの尺度が用いられる： • 硬度：支えの程度。硬度は密度と混同されがちだが、別の属性である。硬度は完成したウレタン フォームの物理的属性で、生産工程でウレタンフォームの化学反応により調節される。ウレタン フォームは硬くなればなるほど圧縮しにくい。ウレタンフォーム硬度は、それを圧縮するために 要する力を記録して測定できる。 • 密度：立方メートル当たりキログラム（kg/㎥）で表わす単位体積当たり質量（重さ）の測定値。 密度はウレタンフォーム生産に用いる化学物質と添加剤の関数で、ウレタンフォームの耐久性に 影響を与える。通常ウレタンフォームは、密度が高くなればなるほどより長期にわたって性質を 保ち、支えと快適さをもたらす。 131 ウレタンフォーム試験装置 下記のウレタンフォーム試験装置（図 1）を用い、簡便な圧縮試験を実施して、ウレタンフォーム 標本の硬度を算出せよ。キログラム単位で測定すると、その結果を比較基準および他の入手できる ウレタンフォームと比較できる。 ウレタンフォーム試験装置は金属部品 2個からなり、下に異なる角度から見たところを示す： 図 1 ウレタンフォーム試験装置 これらの部品は、計量器やばねばかりから吊り下げる（図 2） 132 図 2 圧縮試験の動順 50 %圧縮試験の手順は以下の通り： 手順 3：計量器 1. ウレタンフォームを、なるべく 正確に 50 x 50 x 50 mm の標本 に切り、直径 6.5〜7.5 mmの穴 を中央に貫通させる。 2. 計量器/ばねばかりを掛ける。 手に下げないこと。 3. 標本を試験装置に通し、計量器 /ばねばかりから吊り下げる。 4. はかりの表示をゼロに調整。 5. 上側の板だけ均等に押し下げ、 標本を 50 %まで圧縮。試験装置 に付いた25 mmの刻みを注目。 6. 重さをキログラム単位で記録。 手順 1 ：試験用に調製した ウレタンフォーム標本 手順 5 ：上側の板だけ押し下げる 133 試験での注意事項 • 最低 3回測定し、結果の平均をとること。誤差を最小限に抑えるため、すべての測定を同じ人が 実施すること。 • 成形ウレタンフォームから切り取った標本の場合、ウレタンフォームの外皮部分は含めないこと。 各種ウレタンフォームの使用目安 以下の数値は、あくまで目安とするのが目的である。ウレタンフォームを用いた新しい姿勢支持具 や除圧クッションは、すべて試作してユーザー試用を経るよう推奨する。硬度試験の結果は前述の 試験手順で得られたものである。 名称 用途 密度 50 %圧縮試験 (kg) 中くらいの PUフォーム 心地よい層：クッションの表層・外層 30〜60 kg/㎥ 2.2〜3.5 kg* 硬い PUフォーム 支える層：(心地よい層の下の) 基層**、 起伏、クッションのウェッジ 30〜60 kg/㎥ 3.5〜5.8 kg PU：ポリウレタン *この kgの許容範囲は±0.3 kgのばらつき6を含む。 **チップ/複合/再生/接着ウレタンも使用可能であるが、産業廃棄物からの製品であるため、硬度 にはばらつきがありうる。 一時的支持部および模擬姿勢支持具用ウレタンフォームの形状 教習には、さまざまな硬いウレタンフォームのブロックとウェッジが役立つ。一時的支持部に使う 基本的なブロックに加え他の形状のものも用いると、車椅子ユーザーの座部のさまざまな選択肢を 模擬するために役立つ。例えば： • 「座面〜背もたれ角度を開ける」を模擬するため、背もたれ前面にウレタンフォームウェッジを 付加する。 • より狭めた座幅を模擬するため、骨盤側方パッドにさらにウレタンフォームを付加する。 • 大腿外側ウェッジを模擬するため、座面にウレタンフォームを付加する。 • 「片側の座面前方下げ」のさまざまな角度を模擬するため、ウレタンフォームブロックを組み 合わせて付加する。 6 [原文] variation 134 ユーザーの姿勢支持ニーズが非常に複雑な場合、状況によっては、まず姿勢支持具のサイズ、形状、 位置を、より安価な材料でつくったもので最終決定することが必要になる。姿勢支持具の最終的な 処方（選択）が合意されたら、それらをもっと質のよいウレタンフォームでつくるとよい。 広く動に入るウレタンフォームの厚さは 25 mm か 35 mm である。もっと薄いウレタンフォーム （10 mmや 15 mm厚など）は、たいへん小さい子どもや、例えば「骨盤下の積み増し」のように ほんの少しだけ変更が必要な場合に便利である。薄いウレタンフォームは、厚いウレタンフォーム から切り出さなければならない場合もある。この場合は、できる限り高品質のウレタンフォームと、 非常に鋭利な刃物を用いることが重要である。 下のイラスト（図 3）に基本的なウレタンフォーム形状の例を示す。寸法は状況に応じて調整可能。 例として、大人用の一時的支持部の一般的サイズは 200 x 200 mm で、子ども用は 200 x 100 mm である。 図 3 一時的支持部用の基本的ウレタンフォーム形状の寸法案（単位：mm） 135 ウェッジは、さまざまな寸法や厚さのものがあると、教習用にたいへん便利である。下のイラスト （図 4〜8）にウレタンフォームウェッジの例を示す。寸法は状況に合わせて調整してよい。一般的 な厚さは 35 mm と 50 mm、奥行きの範囲は 100 から 200 mmの間である。 図 4 ウレタンフォームウェッジの例 136 図 5 一時的支持部の使用例 図 6 「片側の座面前方下げ」の模擬でのウェッジの使用例 図 7 大腿外側ウェッジの使用例 137 図 8 「座面〜背もたれ角度を開ける」および座骨前方サポートの例 138 座位保持シミュレーター7の利点と難点 座位保持シミュレーターとは、臨床職や技術者が最終の車椅子を下準備する前に、車椅子ユーザー がとる姿勢を「模擬8」するために使用することがある装置のこと。この装置は、ユーザーを支える ために必要なあらゆる調節方法ができるよう、特別に設計されている。シミュレーターは事前評価 プロセスの終わりに、ハンド・シミュレーションの後で使用し、車椅子処方への情報をもたらす。 座位保持シミュレーターの使用には利点と難点とがある： 利点 • ムダを省く：座位保持シミュレーターは、車椅子と姿勢支持具の下準備がユーザーの最終姿勢を シミュレーター上でとれてからだけでよくなるため、廃棄物を（したがってサービスの反復費用 も）最小にすることが可能。 • 時間を節約：座位保持シミュレーターは、車椅子を下準備する前に最終姿勢を把握できるため、 経験豊富な臨床職や技術者には、車椅子と姿勢支持具をフィッティングする時間の節約になる。 難点 • 抜け道：経験が浅い職員は、事前評価とハンド・シミュレーションのプロセスを完全に行なって から必要な姿勢支持を決める代わりに、座位保持シミュレーターを抜け道に使うかもしれない。 そのため、検討する姿勢支持の種類が、座位保持シミュレーターに付いていたものに限定される ことがありうる。その結果、ユーザーが、自分の姿勢の可能性を、最終の車椅子上で完全に発揮 できない可能性がある。 • 熟達した技術者：安全で耐久性がある座位保持シミュレーターの設計には、技工的技能が必要で ある。また、座位保持シミュレーターが与えた支えを最終の車椅子と姿勢支持具に翻訳するにも、 技能が必要である。これはサービス事業が、いろいろなやり方で姿勢を支えるさまざまな種類の 車椅子を使用する場合、とりわけ難題となる。 • 費用：座位保持シミュレーターを購入する単発の初期費用は高く付くかもしれないが、サービス の反復費用が後のち節約されることで相殺されうる。費用節減のため、サービス事業で一般的に 使用する車椅子（および姿勢支持具）を改造して調節機能を追加し、座位保持シミュレーターに 転用することも可能である。 • 重くて大きい：座位保持シミュレーターは、たいてい最終の車椅子より大きくて重い。このため、 シミュレーターを持ってサービスセンターの外へ移動するのは難しい。 7 [原文] seating simulator [訳注] 日本では「計測椅子」の名称で呼ばれることもある. ビーズ等を封入したいわゆ る「シミュレーター」とは別物. 8 [原文] simulate [訳注] 斜字になっている. 139 「合計座面奥行き」ツール紹介 骨盤の後ろに置く姿勢支持具（PSDs）には 2 種類ある。それが車椅子上で占めるスペースを把握 したうえで、ユーザーが快適に収まるかどうか、あるいは別の車椅子が必要なのか判断することが 重要である。以下は、中級車椅子事前評価フォームの寸法を用いて、合計の座面奥行き（「座面〜 背もたれ角度を開ける」ための三角形あるいは骨盤後方パッドの前後厚さを含む）を割り出すのに 役立つ、簡便なツールである： 図 9 「合計座面奥行き」の計算 選択した車椅子がじゅうぶん大きく「合計座面奥行き」を収められれば、ユーザーの座底長に合い、 また姿勢支持具を座面に収められる。 車椅子および姿勢支持具 寸法（mm） 骨盤後方の支え： （Z）三角形の高さ あるいは（9）中央までの高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 骨盤後方パッド：□ 座面〜背もたれ 角度を開ける：□ 140 製品の下準備 中級レベルの製品下準備は、中級対応の車椅子の 組み立てと姿勢支持具の製作とを含む。車椅子の 組み立てプロセスが単線的な基礎レベルよりも、 問題解決がより多く必要とされる。 ユーザーの姿勢を支えるのに必要な形状を把握 して適正な姿勢支持具をつくるには、立体形状を イメージし方向を定める9 ことがたいてい必要に なる。このプロセスは中級車椅子処方フォームの 「補助線」が付いた描画ツールを用いると容易に なる (図 10)。 図 10 中級車椅子処方フォームの 描画ツール 提案された姿勢支持具のサイズと形状を明確にしたあと、技術者はそれをどうやってつくり、どの 資材を用いるかを決める。最終的な姿勢支持具は、実用的で、安全で、耐久性があり、可能な限り 使いやすいことが重要である。 技術者の仕事は、ユーザーが小柄で姿勢の問題が少ない場合、また多様な姿勢支持具を組み込んだ 調整可能な座位保持製品を用いる場合は容易になる。一方、ユーザーが大柄で複雑な姿勢の問題と 激しい制御できない運動とをあわせ持っている場合、作業はより困難になる。そうしたユーザーに 適正な姿勢支持具を製作するには技能、技術的知識、時間、資材と部品、問題解決能力が、はるか に多く必要である。 技術者は、利用できる車椅子の種類ごとの組み立て方を熟知している必要がある。車椅子の種類が 違えば、姿勢支持具をつくり、取り付けるやり方も違う。技術的業務は、調節可能な姿勢支持具が 組み込まれた姿勢支持専用車椅子が手に入る場合、 「病院型」車椅子10やその他の手動車椅子で作業 する場合と比べ違ってくる。 9 [原文] orthopaedic style wheelchair 10 [原文] imagining and orientating 141 車椅子どうしの違い、姿勢支持具のつくり方の違い、ユーザーの座り方の個別性11にもかかわらず、 製品の下準備には一般的順序がある： 1. 座面奥行き：臨床職が骨盤から始めて遠位部へと作業する12よう教わるのと同様、技術者も、 骨盤を支える姿勢支持具から始めるべきである。「合計座面奥行き」ツールを用いると車椅子 や座面の最適なサイズの処方（選択）が容易になる。次に技術者は座骨前方サポート（および その他の座面の姿勢支持具、例えば「片側の座面前方下げ」や「座面前方のかさ上げ」など） をつくるとよい。座面の姿勢支持具をウレタンフォームでつくる場合、接着剤は、初回フィッ ティングで姿勢支持具を定位置へ固定するのに必要最小限だけ用いよ。姿勢支持具のサイズや 位置は変化しうる（特に教習中）からである。 2. 骨盤ベルト：出発点として13、骨盤ベルトは座面に対し 60〜90度の角度で座骨前方サポート とほぼ同じ位置に取り付けるべきである。 3. 骨盤側方パッドまたは座幅：座面がユーザーの臀部をどう支えれば、その横滑りを防げるかを 割り出すことが重要である。多くの場合、受け具とパッドを用いる。 4. その他の座面の姿勢支持具：車椅子によっては、座面に付加するその他の姿勢支持具、例えば 膝分離パッドを装着するための金具などをすべて取り付けてから、車椅子の他の部分へと移る 必要がある。 座面が完成してから、技術者は、頭と足へ作業を広げて行く14とよい： 5. 背もたれ：背もたれ高を設定してから、背もたれに装着する姿勢支持具を取り付けること。 6. 頭の支持具：頭の支持具が必要な場合は、それを設置してから他の必要な調整をせよ。 7. 足台：足台の高さ、角度、位置を設定する必要がある。足台ウェッジ、足台の積み増し、足首 や足ベルトなどの姿勢支持具は、たいてい初回フィッティングで再配置が必要になる。 8. 肩ハーネス：ハーネスが必要な場合、最上端はユーザーの肩と同じ高さかその上に取り付ける こと。ハーネスを肩上端より下に取り付けると、ユーザーの肩を引き下げがちになる。 11 [原文] individual natures of each user’s seat 12 [原文] work outwards 13 [原文] As a starting point 14 [原文] work outwards towards the head and feet 142 どの車椅子にも、フィッティングのたびにユーザーが安全に座れることは重要である。これに関し、 技術者と臨床職は、褥瘡の危険がある部位、または使用中だが未完成の姿勢支持具へ、特に注意を 払いながら判断する必要がある。 「安全・準備完了確認表」は活用すべきだが、車椅子部材には、初回フィッティングで 100 %完成 していなくてよいものもある。例えば： • 布製カバーは外しておいてもよい。 • ウレタンフォーム製部材は、変更が必要な場合に簡単にはがせるよう、接着剤を全面にではなく 「点々と15」塗って貼り付けよ。 • 例えば体幹側方パッドや肩ハーネスなど、特別な姿勢支持具の要不要についてチームでも確信が 持てない場合、それは付けないでおいて、初回フィッティングで判断してもかまわない16。 • 足台は、計測した身体寸法に従って取り付けよ。ただし、足首や足ベルトは、ユーザーが車椅子 に座ってフットプレートの最終位置が決まるまで付けないでおけ。 • テーブルのフィッティングを行なう場合、ユーザーが最終姿勢で車椅子に座ってから調整せよ。 安全ではないため、以下は禁止： • フレームのボルトがゆるんだまま。 • 駆動輪、キャスター輪、手押しハンドル、座面、背もたれ、ブレーキ、姿勢支持具を取り付ける ボルトがゆるんだまま。 • 鋭い角が始末されていないか、露出したまま。 最終フィッティングの後、教習員の一人が車椅子と姿勢支持具を確認してその署名をすべきである。 これは、チームが（「点々と」接着した残りのウレタンフォームすべての）全面的な接着、カバーの 完成、部材の塗装/ニスがけなどの最終仕上げを完了する前に行なうべきである。 包括的な 「安全・準備完了」確認は、ユーザーとその家族が、車椅子を持ち帰る前に完了している べきである。 15 [訳注] フィッティング前に受注見積もりを確定しなければならない等の事情がある場合は別だが, 一般論として. 16 [原文] ‘spots’ 143 技術に関する補足資料 資料 内容/参照ページ 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて • 製品試験を含む、車椅子の設計および生産の 関連情報、p.37-65 基礎車椅子サービス教習パッケージ 受講者用参考書 • 除圧クッションづくり、p.57-60 中級車椅子サービス教習パッケージ 受講者用参考書 • 姿勢支持具のつくり方、p.112-128 管理者向け車椅子サービス教習パッケージ 補足資料 • 事業管理者がサービスを育成するのを支援 する情報、技術リソースの運用に関する情報 を含む 車椅子サービス教習員養成教習パッケージ 中級教習ハンドブック 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

DR AF T Wheelchair Service Training O F TrainerS Package IntermedIate LeveL ToT handbook DR AF T DR AF T Wheelchair Service Training O F TrainerS Package IntermedIate LeveL ToT handbook Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology the following terms used throughout the WStPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainee in specific WSTPb/i/ m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms the following acronyms used throughout the WStPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package C O n t en t S x about the Wheelchair Service Training of Trainers Package xiii Guidelines for preparing practice delivery sessions 1 core training skills module 2 tot.1 Introduction to the Wheelchair Service training of trainers Package (WStPtot) 3 tot.2 Wheelchair service training packages 10 tot.3 Practice delivery sessions 15 tot.4 Preparing for diversity 20 tot.5 adult learning 27 tot.6 Preparation time 28 tot.7 Presenting and facilitating 33 tot.8 Communication skills 37 tot.9 Knowledge of guiding documents 55 tot.10 audio-visual tools and equipment 61 tot.11 Feedback 63 tot.12 managing group dynamics 68 Intermediate Level module 69 a.1: Wheelchair users who benefit from additional postural support 71 a.2: Children with disabilities 73 B.1: assessment overview and assessment interview 75 B.2: Physical assessment – sitting posture without support 78 B.3: Physical assessment – pelvis and hip posture screen 81 B.4: Physical assessment – hand simulation 85 B.5: Physical assessment – taking measurements 88 B.6: Selecting wheelchairs and cushions 91 B.7: Prescription (selection) of Postural Support devices (PSds) – introduction 93 B.8: Prescription (selection) of PSds – stabilizing the pelvis 100 B.9: Prescription (selection) of PSds – supporting the hips 101 B.10: Prescription (selection) of PSds – supporting the trunk 105 B.11: Prescription (selection) of PSds – supporting the head, thighs and lower legs 107 B.12: Product (wheelchair) preparation 108 B.13: Fitting 109 B.14: User training 110 B.16: maintenance, repairs and follow up 112 Practicals one to four 115 B.15 and B.17: Putting it all together and trainer’s feedback, discussion and closing ceremony 116 Logistics and Preparation 121 Annexes 121 annex 1: timetable for WStPtot core sessions 122 annex 2: WStPtot Intermediate Level timetable 124 annex 3: Feedback sheet for WSPttot practice delivery sessions 127 annex 4: technical annex WStPi x about the Wheelchair Service training of trainers PackageToT Handbook about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United States agency for International development (USaId) developed a series of four training packages to increase wheelchair access in developing countries. the Wheelchair Service Training of Trainers Package (WStPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. the need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WStPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. the WStPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WStPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WStPi) 2013; the Wheelchair Service Training Package for Managers (WStPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WStPs) published in 2015. the WStPm and WStPs have been combined into one package-specific module within the WStPtot. the WStPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WStPtot, you will go forward to deliver the training packages alongside experienced trainers, allowing you to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiabout the Wheelchair Service training of trainers PackageToT Handbook how to use the ToT Handbook this ToT Handbook provides a step-by-step guide to the WStPtot including information on how to deliver the package-specific modules. It has been developed for you to use during the WStPtot programme itself and to keep as a reference when planning and delivering the WStP in the future. Target audience the WStPtot is made up of four modules: • Core training skills – two days • Basic Level (WStPb) – three days • Intermediate Level (WStPi) – three days • Managers and Stakeholders (WStPm/s) – three days. You should complete the Core training skills module followed by one of the package-specific modules, which will be chosen based on your training goals: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WStPb. Previous experience providing basic-level wheelchairs is essential; the WStPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WStPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WStPi. Previous experience providing intermediate-level wheelchairs is essential; the WStPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WStPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WStPm and WStPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the Managers and Stakeholders module. You should have access to co-training opportunities within three months of completing the WStPtot in order to consolidate and practise newly acquired skills. assignment of practice deliveries after completing the Core Training Skills module, you will go on to the second part of the WStPtot where you will practise the skills you have learnt by delivering sessions from your WStP. xii about the Wheelchair Service training of trainers PackageToT Handbook You will be allocated sessions on the first day of the Core training skills module, during tot.3 Practice delivery sessions. You will also be assigned a tot trainer as a mentor at this time. time is included within the training programme to prepare for your session and consult with your tot trainer mentor. the practice delivery session is followed by feedback and discussion, and the whole process allows the tot trainer to observe and assess your skills. to enable you to prepare well for the WStPtot, you will be sent the package- specific materials in advance. You should arrive prepared to deliver any session. Note: Some practice delivery sessions have been adapted for the WSTPtot, by either shortening the time allocated or not delivering parts of the session. These changes are for the purposes of the WSTPtot only and should not be followed when delivering the WSTP. xiiiGuidelines for preparing practice delivery sessionsToT Handbook guidelines for preparing practice delivery sessions lead trainee • read the session plan assigned to you in your WStP Trainer’s Manual and make sure you understand all the material. try out the activities yourself to make sure you know what your participants will be expected to do. Only prepare for the specific sections/sessions allocated to you. • read the relevant sections of the WStPb/i/m Reference Manual for Participants and Participant’s Workbook (not available for the WStPs). • read the relevant section of the ToT Handbook for your session/s including the Key considerations for teaching this session. • there are some known errors in the WStP materials that are listed in this handbook; check your session to see if it has errors and make the recommended changes. • edit the PPt slides as appropriate. • Incorporate your own knowledge and experience, including case studies if appropriate. • Practise your delivery, including timing. • meet with your support trainers and plan how to work as a team: – assign roles, such as timekeeping or writing on the board – for group activities involving practical skills, practise together and discuss which errors to look out for and how to correct them. Support trainee/s • read the session plan in your Trainer’s Manual. • Support the lead trainee as requested. Before the session starts • Upload your PPt slides onto the training laptop before the start of the training day. • Set up the room and training materials as needed. • Check that the audio-visual equipment is set up and working correctly. xiv Guidelines for preparing practice delivery sessionsToT Handbook co-training after completing the WStPtot, you should continue to develop your skills by co-training alongside experienced trainers. the recommended ratio for co-training is one mentor trainer to two-to-four co-trainers. In some cases, tot trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. this information will be recorded in the Feedback sheet for WSTPtot practice delivery sessions and shared with the trainee. Mentoring and peer support You are encouraged to keep in contact with your tot trainer/s after the WStPtot to update them on progress and to consult them for advice. You can also get valuable ongoing support from your peers, which will help to develop your skills and confidence. You may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. Core training skills module 1Core training skills moduleToT Handbook ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot) Structure of the WSTPtot The ToT programme consists of a two-day Core training skills module followed by a three-day module chosen from the basic (WSTPb), intermediate (WSTPi) or managers (WSTPm) and stakeholders (WSTPs) series. This package-specific module provides practical opportunities to develop your skills and confidence as a WSTP trainer. It will also highlight some of the common challenges that can come up when delivering the WSTP and will offer solutions. Overview of the WSTPtot process After the completion of the ToT programme, you should co-train until you are confident and competent to be an independent trainer. The number of co-trainings will vary from person to person. ToT trainers and trainers who mentor you while co-training will support you to decide whether you should continue co-training or train independently. Core training skills Package- specific Co-trainer Trainer If you are not able to co-train with a more experienced trainer after the in-person ToT, WHO encourages you to seek virtual support and coaching from a ToT trainer and to connect with other ToT trainees to support each other through the planning, preparation and delivery of the WSTP. Feedback and self-assessment During practice deliveries in the package-specific modules, you will use the Feedback sheet for WSTPtot practice delivery sessions, including a list of trainee skills, to reflect on your performance. The ToT trainer will provide written feedback on this form at the end of the ToT programme, which will help you to continue to improve your training skills moving forward. This form can be found in the annexes of this manual. 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot)ToT Handbook ToT.2 Wheelchair service training packages Background1 2 The WSTP have their origins in the Consensus Conference on Wheelchairs for Developing Countries held in Bangalore, India, in November 2006.1 The consensus conference laid the foundation for the development of the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings,2 which were published by WHO in partnership with the International Society for Prosthetics and Orthotics (ISPO) and the US Agency for International Development (USAID) in 2008. The wheelchair is one of the most commonly used assistive devices for enabling personal mobility, but there were very few training opportunities for service providers to ensure that wheelchair users could attain personal mobility with the greatest possible independence, be productive and enjoy a high quality of life. The WSTP Basic and Intermediate Level were developed to implement the Wheelchair Guidelines, by training wheelchair service personnel in less-resourced settings in comprehensive wheelchair service provision, which enables increasing numbers of adults and children to receive a wheelchair which meets their needs. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 3ToT.2 Wheelchair service training packagesToT Handbook The four WSTP3 4 The Wheelchair Service Training Package – Basic Level3 (WSTPb) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. The Wheelchair Service Training Package – Intermediate Level4 (WSTPi) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. Both WSTPb and WSTPi are designed to be delivered in a minimum of five days. However, the actual time required for each session will vary. Additional time will be needed if you: • Add material to session plans • Include additional sessions relevant for the context or skill level of participants • Increase the number of practical sessions with wheelchair users • Require translation • Provide more preparation time for products used during the training • Reduce the length of the training days to fit local contexts • Are teaching participants with limited experience or formal qualifications. 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who. int/disabilities/technology/wheelchairpackage/en/). 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4 ToT.2 Wheelchair service training packagesToT Handbook If you would like to add sessions to the training timetable, The International Society for Wheelchair Professionals (ISWP) has a website which contains some additional resources. Please see: http://wheelchairnet.org/resources. The Wheelchair Service Training Package for Managers5 (WSTPm) is designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. It can be delivered in a minimum of two days. The Wheelchair Service Training Package for Stakeholders6 (WSTPs) is designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting.5 6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 5ToT.2 Wheelchair service training packagesToT Handbook Guiding principles The WSTP has been developed following a set of guiding principles: • user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service. • following available evidence-based, international best practice. • a focus on less-resourced settings, with products and training appropriate for the setting. • inclusion of wheelchair users as trainers and participants in all training packages. • use of accessible, non-medical language and terminology so that: – participants without clinical or technical qualifications can be trained – service personnel can use terms that are easily understood by wheelchair users. WSTP components Each package contains a range of resources. WSTPb, WSTPi WSTPm WSTPs Trainer’s Manual ü ü ü PowerPoint presentations ü ü ü Videos ü ü ü Set of posters ü selected posters selected posters Supplementary resources: Wheelchair Guidelines, CRPD ü ü ü Reference Manual for participants ü combined Participant Workbook ü Forms and checklists ü – Additional Resources: including tools, equipment, and forms – ü 6 ToT.2 Wheelchair service training packagesToT Handbook Activity 1: Getting to know the Trainer’s Manual Working together in your group, use your Trainer’s Manual to answer the questions below. Write your answers next to the question. Question Answer 1. Where can you see a list of everything included in the Trainer’s Manual? 2. How are group activities shown in the sessions? 3. Where can you find the overall aim or purpose of the training package? 4. How does the session plan indicate when the trainer should show a PowerPoint slide? 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? 7ToT.2 Wheelchair service training packagesToT Handbook How to use the WSTP Trainer’s Manual Manual Each Trainer’s Manual gives an overview of the relevant package and provides specific guidance notes for trainers. Each section should be reviewed carefully before preparing to deliver the WSTP. Annexes Annexes with supporting information can be found in the back of the Trainers’ Manuals for WSTPb, WSTPi and WSTPs; they include copies of forms and checklists. Session plans Individual session plans work like a recipe to guide trainers through the session. Following the session plans will help you to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Video boxes When a video needs to be shown, a video box is included in the Trainer’s Manual along with one of the video icons. • It is important for you to be familiar with the content, relevance and timing of all the videos. Trainer’s notes Trainer’s notes are included throughout the WSTP, including: • most important answers to questions • guidance about group activities or • additional information that can assist trainers to answer questions from participants. 8 ToT.2 Wheelchair service training packagesToT Handbook Activity boxes Activity boxes guide trainers by providing the following information: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Key point summary Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 9ToT.2 Wheelchair service training packagesToT Handbook ToT.3 Practice delivery sessions Introduction Record how confident you feel to deliver the WSTP package/s you are here to learn, on a scale of one to 10: 1 2 3 4 5 6 7 8 9 10 Not confident Very confident Structure and aims of the package-specific modules Package-specific modules include opportunities for you to deliver sessions from the WSTP you have chosen to learn. The aim is to enable you to: • practise using the WSTP training materials • practise delivering sessions to your peers • clarify your understanding of the WSTP theory, principles, skills and methodology • learn about the common challenges that can occur when training and find ways to manage them • develop your trainee skills (see the list in the Feedback sheet for WSPTtot practice delivery sessions in the Annexes of your ToT Handbook). Roles of lead and support trainers and ToT participants • You will have the opportunity to be both a lead trainer and a support trainer. • When two or more lead trainers are allocated to the same session, one will automatically assume the support trainer role when they are not presenting. • If there is only one lead trainer for a session, he/she may request help from any of the other ToT participants. • For some practical sessions, the support trainer may have a specific role identified and assigned. 10 ToT.3 Practice delivery sessionsToT Handbook Activity 1: Lead and support trainers What are the roles of the lead trainer? What are the roles of the support trainer? 11ToT.3 Practice delivery sessionsToT Handbook What are the roles of the lead trainer? What are the roles of the support trainer? • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainer • contributing to the overall feedback/ reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Teamwork Trainees will need to work together as a team to deliver their sessions. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage session time • clarify errors during the session delivery • answer questions from participants • manage disruptions and interruptions. Trainers as role models Trainers should set positive examples of professional behaviour and practice. Model the behaviour you want to see from participants by: • being on time and well prepared • problem solving and finding solutions for challenging situations • providing positive and constructive feedback • managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. 12 ToT.3 Practice delivery sessionsToT Handbook Remember, being a good trainer and role model does not mean you always need to know the answers to questions. If asked questions you do not know the answer to, do not pretend to know the answer. Instead you can: • Ask support trainers if they know the answer • Ask participants if they know the answer • Agree to find out the answer before the training programme finishes (add to Car Park). Reflection and feedback Learning to reflect on your own delivery is an important skill for a trainer. It is also important that trainers are able to give constructive, guiding feedback to training participants. This is why reflection and feedback skills are incorporated into the ToT programme. At the end of each practice delivery session the lead trainer/s will be asked to reflect on: • what was good and what went well • what can be improved. The ToT trainer will then facilitate brief feedback from ToT participants, and finally the ToT trainer will add anything not already mentioned by the lead trainer or ToT participants. Preparing for practice delivery sessions Your preparation for a practice delivery should include the following: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainer. • Prepare the resources you need for the session. 13ToT.3 Practice delivery sessionsToT Handbook If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. Known errors There are some known errors in the WSTP Trainer’s Manual, Participant Workbooks and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Confidence in presenting • You may feel nervous during your first session deliveries in front of your peers and ToT trainers. This is normal! • You will grow in skills and confidence as you deliver more sessions. • You will be required to present feedback from group activities during the Core training skills module – use this as an opportunity to practise presenting to your peers. PPT presentations • The standard PPT for each session will be available on the training laptop with the video already embedded. • If you make any changes to your PPT such as adding slides, you will need to upload it onto the training laptop before your practice delivery. Time limits for session delivery • Time will be strictly monitored during practice deliveries. • If you go over your time, the ToT trainers will stop you and move onto the next trainer, or end the session. 14 ToT.3 Practice delivery sessionsToT Handbook ToT.4 Preparing for diversity WSTP trainers often encounter diversity and must understand how to manage a diverse training group. People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity. Culture and diversity Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Remember that we all belong to more than one cultural group and we are all diverse in many ways. Cultural competence Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. It can relate to individuals, groups or organizations and it can be learned. Cultural competency typically involves: • awareness of your own cultural practices • knowledge of different cultural practices • a positive attitude towards cultural differences • understanding how culture impacts on interactions. Cultural competence for trainers You must ensure they have the required knowledge, skills and attitudes to understand and appreciate cultural differences; this includes respecting and accommodating other people’s cultural beliefs, behaviour and needs. 15ToT.4 Preparing for diversityToT Handbook If differences in culture are not understood and respected by WSTP trainers, these differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. Potential cultural considerations • Physical contact: It may be culturally inappropriate for a female trainer or participant to assess a male wheelchair user, or for a male trainer or participant to assess a female wheelchair user. • Clothing: You must ensure that your dress is culturally appropriate. • Communication: In some cultures participants may not answer questions unless they are asked directly. • Eye contact: It may be impolite to look at someone directly when you are speaking to them. • Feedback: Be aware of what is acceptable for participants when giving and receiving constructive criticism/feedback in their society. • Gender: In some cultures it will not be appropriate for men and women to be paired together for activities, or to eat together; this may affect the organization of group work and refreshment breaks. • Religious beliefs: Longer break times, or different start/finish times, may be needed to fit in with local religious practices such as festivals, fasting or prayer. Activity 2: Cultural competence Think about and write down examples of when you experienced a culture different from your own. What was it like? 16 ToT.4 Preparing for diversityToT Handbook How did you feel? What did you learn from the experience? Including wheelchair users and people with disabilities in the WSTP The WSTP promotes the inclusion of wheelchair users in training teams and as participants. This is important because: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of, combat stigma, and reinforce the principles of the CRPD. 17ToT.4 Preparing for diversityToT Handbook Barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society To include wheelchair users and other people with disabilities in the WSTP, WSTP trainers must understand what might prevent people with disabilities from being included in society. Perceptions People are often not familiar with disability and have incorrect assumptions about people with disabilities. • Many people think that persons with disabilities do not have, or are not able to achieve the same goals and dreams related to family, work, leisure, social and personal lives. • They think that because someone has a physical disability they also have a cognitive impairment and treat the person like a child, talking slowly and loudly, or they address the person accompanying the person with a disability. Attitudes Negative attitudes towards people with disabilities can include: • A view that people with disabilities have less value in society because of their impairments. • Patronizing people with disabilities as objects of charity. • Avoidance of people with disabilities because they are unfamiliar with them, or because they are afraid to say the wrong thing. • Low value put on educating children with disabilities by families, community leaders and institutions such as schools. People with disabilities have limited opportunities without an education. Beliefs Beliefs are closely related to attitudes and can also create barriers. For instance, believing that someone’s impairment will prevent them from accomplishing tasks that they are in fact able to do. 18 ToT.4 Preparing for diversityToT Handbook Culture Cultural beliefs, norms and values may also create barriers. In some cultures, it is believed that people with disabilities are cursed so they are excluded from their families and communities; sometimes they will isolate themselves and hide away. Stereotypes These are negative views that do not recognize people with disabilities as individuals with their own interests and skills who can contribute to society. Legislation and policies Legislation and policies protecting the rights of people with disabilities often exist but are not enforced. For example, some countries have employment legislation that includes a requirement to employ a quota of people with disabilities, or that stipulates reasonable accommodation be provided to employees. Without enforcement, such laws and policies are ineffective. Environmental barriers Physical barriers can limit the participation and integration of people with disabilities. In outdoor life these include gradients, sand, grass and rivers; while mobility and independence indoors can be hampered by stairs, narrow doorways, furniture and carpets. Lack of assistive devices This is a major barrier to inclusion and the WSTP is one initiative to help improve the availability of appropriate wheelchairs in line with the CRPD. 19ToT.4 Preparing for diversityToT Handbook ToT.5 Adult learning To be an effective trainer it is important to understand how adults learn best and to know about the different styles of learning. Activity 1: Principles of adult learning Think about positive learning experiences you have had and write down in what way the experiences were positive. Use the space below to record your reflections during the activity. Positive learning experiences 20 ToT.5 Adult learningToT Handbook Activity 2: Determining your preferred learning style Circle the statements that reflect how you learn A. By following instructions step-by-step B. By experiencing new things C. By making mistakes D. By reasoning E. By understanding the theory of what is being taught F. By applying what I learned G. By drawing on my own experience H. By watching a video I. By evaluating options J. By relying on my feelings K. By interacting with people L. By watching someone demonstrate something M. By reflecting on something N. By seeing the big picture O. By staying on the side and watching P. By listening to someone describe how to do something Q. By studying what others have written about the topic R. By engaging with others S. By trying out what I am learning T. By understanding the general principles of something U. By attending a lecture V. Through hands-on experience W. By relying on my observations X. By being personally involved in something Y. By exploring how I feel about something Z. By being active AA. By observing the trainer BB. By experimenting 21ToT.5 Adult learningToT Handbook Scoring sheet for preferred learning styles Now circle the same letters on the list. Whichever column has the most letters circled represents your preferred learning style. If two or more have the same number it means you do not have a strong preference. Learning by experiencing Learning by observing Learning by thinking Learning by doing B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB Total: Total: Total: Total: Experiential learning cycle Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 1 The four preferred styles of learning are: 1. Learning by experiencing 2. Learning by observing/reflecting 3. Learning by thinking/understanding 4. Learning by doing/applying. The four learning styles match the experiential learning cycle. While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. 22 ToT.5 Adult learningToT Handbook In the WSTP, each of the four stages or types of learning are included so that all participants are involved. • Role plays and simulations are most appropriate for those who learn best from experiencing. • Those who learn best by observing and reflecting will benefit most from demonstrations, videos, and watching the trainer and wheelchair users. • Presentations or reading materials that discuss concepts, provide frameworks, definitions or theories, are helpful to those who learn by thinking and understanding the big picture. • Practical sessions with wheelchair users (as in WSTPb and WSTPi), that apply what was explained in theory, are most appropriate for those who learn by doing. Group discussions, case studies, question-and-answer sessions, workbook assignments and feedback sessions are all teaching methods that can appeal to different learning styles; you will need to think about their purpose and how they are used to ensure they are adapted to each situation. You also have your own preferred style. It is important to be aware of this and to take care not to neglect a particular approach. Do not skip a phase! What would happen if we missed out the experience part? The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. What would happen if we missed out the observation part? The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. What would happen if we missed out the thinking part? The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. What would happen if we missed out the doing (practice) part? The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 23ToT.5 Adult learningToT Handbook Activity 3: Matching activities with learning preferences Put an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Fill in the last column with your own style as a comparison. • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. C ar lo s M ir ia m S it a A hm ad S el f 1. Using a role play to practise wheelchair user training 2. Watching the trainer show how to measure a new wheelchair user 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country 4. Watching people in wheelchairs doing the things they want to do 5. Learning about the key documents that are relevant to wheelchair services 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home 7. Listening to the trainer reviewing the most important articles in the CRPD 8. Making a pressure-relief cushion 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience 10. Observing the trainer conduct an assessment 11. Doing an assessment interview with a new user 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services 24 ToT.5 Adult learningToT Handbook Supporting adult learning While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. Support them by encouraging active participation. Adult learners bring their own knowledge and experience to learning. Encourage them to share their experience with others and learn from others. Adult learners need learning to be relevant and practical, and they want to apply what they learn. Support them by having clear learning objectives with practical applications to their roles. Activity 4: Problem solving Problem solving is the process of finding the best solution to a challenge. It is an important part of adult learning and an important skill in wheelchair service provision. How can we help participants to problem solve and find their own solutions? 25ToT.5 Adult learningToT Handbook Help participants problem solve • Ask open ended questions – Open-ended questions cannot be answered with a simple ‘yes’ or ‘no’. They require participants to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer you expect. • Ask rather than tell – Ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together – teamwork and good communication helps to solve problems. Remember • When training participants to provide wheelchairs (WSTPb, WSTPi) there may be no simple answers. • In the clinical context, some prescriptions, modifications or postural support devices may provide a good technical solution, but they may also create functional barriers or limitations. • Acknowledge that often there is not one perfect solution. Wheelchair service provision requires compromise between what a client needs and the range of products available. 26 ToT.5 Adult learningToT Handbook ToT.6 Preparation time Preparation time has been included in the ToT timetable. This time will be used for: • Answering car park questions. • Meeting ToT trainers: – asking questions – receiving feedback. • Preparing for your practice delivery sessions: – coordinating with co-trainers – preparing demonstration materials and AV equipment. 27ToT.6 Preparation timeToT Handbook ToT.7 Presenting and facilitating Activity 1: Trainer behaviour Think about people who have trained you in the past and identify who you consider to have been an effective trainer. In other words, people who enabled you to learn what you needed to and who gave you positive and worthwhile experiences. Reflect on your experience in the space below. What was effective in their behaviour? 28 ToT.7 Presenting and facilitatingToT Handbook Presenting and facilitating ToT.7 Presenting and facilitating: 1 Presenting Facilitating Presenting is a one-way process where participants are given information. Presentations are used to provide information, facts and figures, and correct misinformation. When we present facts, theories or frameworks, we assume people don’t know the information or they need to be reminded. Thus we treat all participants in the same way even if some may know the information already. Facilitating means ‘making things easier’. When we facilitate we make it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect their own experience or views with new information. Good practice for presenting and facilitating Presenting: • Vary the pace and tone of speech. • Be aware of your position in the room and vary it. • Ask questions and encourage contributions from the group. • Follow the instructions in the WSTP Trainer’s Manual as these have been tested and timed. • Make sure the slide shown corresponds with what you are saying. Keep the slide synchronized with the Trainer’s Manual. • Do not turn your back to the group when reading from a slide. Facilitating: • Try the activity out before the session so you understand its purpose. • Give people time and space to think for themselves. Be comfortable with silence. • Refer participants' questions to the group before answering yourself. • Give clear instructions to participants, and make sure you understand them yourself before the session. • Monitor participants to ensure they are learning the key points for the session. 29ToT.7 Presenting and facilitatingToT Handbook Energizers7 There are times during any training when energy levels start to drop. Hot weather, stuffy rooms, a big lunch or tiredness from a long day of training can cause attention to wander and group energy to falter. The best way to deal with this is to inject some activity and fun into the training room by creating an opportunity for people to move and interact in a light-hearted way. This can be achieved either as part of the training or as a one-off activity to liven things up. Here are a few ideas. As part of the training: • Ask frequent questions to the whole group, picking a specific person to answer. • Ask participants to face their neighbour to discuss the answer to a question or topic, or to explore a different opinion to the one just expressed. • Ask participants to stand up and come to look at something (a wheelchair, a poster, a flipchart or a demonstration). • If possible, move the session to a different room or outside to create some change and movement. As separate activities: • Sing a song together. • Stand and do some simple stretching exercises. • Play “Simon says”: give instructions (“jump in the air”, “touch your toes”, “point to the sky”, “turn around” and so on). Participants should only follow when the instruction is preceded by “Simon Says”. • Have a three-minute stretch and comfort break. • Invite a participant, or group of participants, to lead an energizer activity for a few minutes. They are likely to have different and locally-appropriate activities to share with the whole group. 7 With thanks to Robert Chambers for some of them. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 ( https://www.routledge.com/ Participatory-Workshops-A-Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). 30 ToT.7 Presenting and facilitatingToT Handbook Remember: • be aware of, and sensitive to, differences in culture, gender and disability • don’t force participants to do anything they can’t or don’t want to do • start slowly and build up to more energetic activities • join in yourself when you can • have fun! Managing time You need to make sure that the training runs to time. There are many sessions and activities and a limited amount of time to complete them. We will often need to modify our behaviour and activities to make the best use of the time we have available. Activity 2: Managing time In pairs, discuss: What can we do to keep the training running on time? Write your ideas here: 31ToT.7 Presenting and facilitatingToT Handbook Ideas for keeping the training on schedule • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 32 ToT.7 Presenting and facilitatingToT Handbook ToT.8 Communication skills Activity 1: Communication skills Read the information assigned to your group from the table below. Develop a presentation to ensure other trainees understand the key points. Work as a group to decide how you will present the information and who will present which parts. Everyone in the group should participate in the presentation. You may use flipcharts, the whiteboard, or other props as desired. Be creative in your presentation. You have 20 minutes to prepare. You will have five minutes to present to the others. Group 1 – Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what you say. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 33ToT.8 Communication skillsToT Handbook Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, stand at the front or side – participants should be able to see and hear you – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and you need to read the PowerPoint slides – depending on the context, it may be appropriate for you to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 34 ToT.8 Communication skillsToT Handbook Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. Demonstrations, videos and interpreters Below are good practices for giving demonstrations, showing videos, and using both foreign language and sign languages interpreters during training. Giving demonstrations When giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) 35ToT.8 Communication skillsToT Handbook • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. Using videos The WSTP use videos to demonstrate most practical skills. Before showing the videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 36 ToT.8 Communication skillsToT Handbook ToT.9 Knowledge of guiding documents What is a guiding document? Guiding documents are publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision and which guide stakeholders in the provision of wheelchair services. Many governments, international agencies, donors, and other stakeholders plan and fund development work in line with these international frameworks. Your knowledge of them will put you in a stronger position to educate and advocate for appropriate wheelchair service provision. National or Regional laws and policies will impact local wheelchair service provision. You need to be familiar with the documents to guide discussion. The following section gives an overview of a range of guiding documents as they relate to wheelchair service provision. Some of these are included on the WSTP Pen Drive and others can be accessed via the internet. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) The United Nations Convention on the Rights of Persons with Disabilities is commonly known as the CRPD or sometimes the UNCRPD. The CRPD is widely considered to be the most important international treaty relating to people with a disability. It came into force in 2008 and on its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol. This was the highest number of signatories to a UN Convention on its opening day in history. The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. 37ToT.9 Knowledge of guiding documentsToT Handbook Representatives involved in the development of the Convention included people with disabilities, government officials, and representatives of nongovernmental organizations. The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Each year more countries sign the CRPD. Up to date information on which countries have signed the CRPD and its optional protocol can be found on the UN website.8 The CRPD has several articles relevant to wheelchair service provision: Most relevant Also relevant • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. 8 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 38 ToT.9 Knowledge of guiding documentsToT Handbook What additional barriers can women and children face? • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. It is important that WSTP participants are familiar with the CRPD: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. 39ToT.9 Knowledge of guiding documentsToT Handbook Key articles in detail: Article 4 Article 4 General obligations, states that States Parties: Undertake to ensure and promote the full realization of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability. Point (g) of Article 4 states: To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. Point (h) states: To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities. Point (i) states: To promote the training of professionals and staff working with persons with disabilities in the rights recognized in this Convention so as to better provide the assistance and services guaranteed by those rights. Article 20 Article 20 Personal Mobility, is the article most relevant to wheelchair service provision. It requires that: States Parties take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by: (a) Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost; (b) Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost; (c) Providing training in mobility skills to persons with disabilities and to specialist staff working with persons with disabilities; (d) Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities. 40 ToT.9 Knowledge of guiding documentsToT Handbook Article 26 Article 26 Habilitation and Rehabilitation, includes the requirement that: States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation. Definitions of rehabilitation and habilitation: • Rehabilitation is a very well-known word but habilitation is used less often. • Rehabilitation is focused on restoring abilities whereas habilitation is about learning or building abilities for the first time. Article 32 Article 32 is relevant to wheelchair service provision in a broader sense as it promotes international cooperation; for example, in facilitating access to assistive technology. 41ToT.9 Knowledge of guiding documentsToT Handbook WHO Guidelines on the provision of manual wheelchairs in less-resourced settings The WHO Guidelines on the provision of manual wheelchairs in less-resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider when designing or producing wheelchairs; establishing service delivery systems; training staff; or developing policies related to wheelchair provision. The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. A wheelchair is appropriate when it: ü Meets the user’s needs and environmental conditions ü Provides proper fit and postural support ü Is safe and durable ü Is available in the country ü Can be obtained and maintained and services sustained in the country at an affordable cost. This is an important definition for trainers and WSTP participants to know. 42 ToT.9 Knowledge of guiding documentsToT Handbook The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; as trainers, you should try to raise awareness of them whenever you have the opportunity. The Wheelchair Guidelines are available on the WHO website in a range of languages.9 10 Joint position paper on the provision of mobility devices in less-resourced settings The WHO Joint position paper on the provision of mobility devices in less-resourced settings10 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. The paper provides valuable information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 9 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 10 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/publications/technology/jpp_ final.pdf). 43ToT.9 Knowledge of guiding documentsToT Handbook Community-based rehabilitation: CBR Guidelines11 The WHO Community-based rehabilitation: CBR Guidelines11 were launched in 2010 and present a common understanding and approach to CBR globally. CBR is a strategy to improve access to rehabilitation services for people with disabilities in less-resourced countries, by making optimal use of local resources. The CBR Guidelines provide a framework for action and offer practical suggestions for implementation. The introductory booklet and health component of the CBR Guidelines are included on the WSTP Pen Drive as resources but are not referred to specifically in the WSTP. A good knowledge of the CBR Guidelines is recommended as CBR is currently being implemented in over 90 countries and is increasingly seen as one of the most effective ways of realizing the articles of the CRPD. CBR, also referred to as Community-Based Inclusive Development (CBID), is likely to come up in discussions during the WSTP. Many aspects of CBR are highly relevant to wheelchair service provision: for example, referral networks; community health centres; and CBR workers. 11 WHO Community-based rehabilitation: CBR guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 44 ToT.9 Knowledge of guiding documentsToT Handbook CBR Matrix The CBR Matrix12 is one of the cornerstones of the CBR Guidelines. The five components are: Health, Education, Livelihood, Social and Empowerment. Each component of the Matrix has five elements within it, so there are a total of 25. 12 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr/matrix/en/). 45ToT.9 Knowledge of guiding documentsToT Handbook Activity 1: CBR Matrix Working in your group, list how wheelchair service provision relates to the component of the CBR Matrix you have been assigned: Health, Education, Livelihood, Social or Empowerment. Further information and the full CBR Guidelines can be found on the WHO website13 13 (http://who.int/disabilities/cbr/guidelines/en/). 46 ToT.9 Knowledge of guiding documentsToT Handbook Wheelchair service provision and the five components of CBR Health Education • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. • Enables access to school, educational programmes and vocational programmes. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Empowerment • Improved self-image and confidence. • Peer support. Design considerations for accessibility14 Design considerations for accessibility14 gives useful information on how to ensure all aspects of access are considered, both when visiting the wheelchair service and in other environments. It covers: • disabled car parking • curb ramps • pathways • ramps • stairways • handrails • doors and doorways • corridors • toilets. 14 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 47ToT.9 Knowledge of guiding documentsToT Handbook Sustainable Development Goals (SDGs) The Sustainable Development Goals15 were adopted by world leaders in September 2015 at a historic United Nations Summit and came into force on 1 January 2016. Over the next 15 years, countries will mobilize efforts to address all three dimensions of sustainable development (environmental, economic and social) and strive to achieve the 17 goals. The SDGs succeed the Millennium Development Goals (MDGs), which reached their conclusion in 2015; they are the outcome of a collaborative development process that started at the 2012 United Nations Conference on Sustainable Development (Rio+20). As the WTSP modules were developed before the SDGs were launched, they are not mentioned in the packages. However, as many governments, development and donor organizations will be focusing on addressing the SDGs, it is important for trainers and participants to be aware of them and to identify how appropriate wheelchair service provision can fit into the SDG agenda. The SDGs are made up of 17 goals and 169 associated targets. In Paragraph 4 of the preamble of the SDGs an important commitment is made: As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all segments of society. And we will endeavour to reach the furthest behind first. A reference to persons with disabilities is also included in Paragraph 23 on vulnerable populations: People who are vulnerable and must be empowered. Those whose needs are reflected in the Agenda include all children, youth, persons with disabilities (of whom more than 80% live in poverty), people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants. We resolve to take further effective measures and actions, in conformity with international law, to remove obstacles and constraints, strengthen support and 15 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 48 ToT.9 Knowledge of guiding documentsToT Handbook meet the special needs of people living in areas affected by complex humanitarian emergencies and in areas affected by terrorism. Disability and the SDGs Goal 4: to ensure inclusive and equitable quality education and promotion of life-long learning opportunities for all, focuses on eliminating gender disparities in education and ensuring equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities. In addition, the proposal calls for building and upgrading education facilities that are child, disability and gender sensitive and also provide safe, non-violent, inclusive and effective learning environments for all. Goal 8: to promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all, the international community aims to achieve full and productive employment and decent work for all women and men, including for persons with disabilities, and equal pay for work of equal value. Goal 10: strives to reduce inequality within and among countries by empowering and promoting the social, economic and political inclusion of all, including persons with disabilities. 49ToT.9 Knowledge of guiding documentsToT Handbook Goal 11: aims to make cities and human settlements inclusive, safe, resilient and sustainable. To realize this goal, Member States are called upon to provide access to safe, affordable, accessible and sustainable transportation systems for all; improving road safety, notably by expanding public transportation, with special attention to the needs of those in vulnerable situations, such as persons with disabilities. In addition, the proposal calls for universal access to safe, inclusive and accessible green and public spaces, particularly for persons with disabilities. Goal 17: stresses that in order to strengthen the means of implementation and revitalize the global partnership for sustainable development, the collection of data, monitoring and accountability of the SDGs are crucial. Member States are called upon to enhance capacity- building support to developing countries, including least developed countries and small island developing states, which would significantly increase the availability of high- quality, timely and reliable data that is also disaggregated by disability. For further information on the SDGs see the UN website.16 Global Cooperation on Assistive Technology (GATE) WHO estimates that today more than 1 billion people need one or more assistive products, such as wheelchairs, hearing aids, walking frames, spectacles, pill organizers and communication boards. With a global ageing population and a rise in noncommunicable diseases, WHO expects that this number will rise beyond 2 billion by 2050, with many older people needing two or more products as they age. 16 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 50 ToT.9 Knowledge of guiding documentsToT Handbook Assistive products play a crucial role in enabling access to education and livelihoods, maintaining independence and being connected to the world. However, today only one in 10 people in need have access to the products they need; without them they are excluded from participating in society, isolated and locked into poverty. WHO is coordinating the GATE initiative to address this huge and unmet global need and to realize Article 32 of the CRPD. The GATE initiative has only one goal: to improve access to high-quality affordable assistive products globally. To achieve this, GATE is focusing on four interlinked action areas: products, personnel, provision and policy. Following the example of the WHO Model List of Essential Medicines, GATE’s first priority was to develop a WHO Priority Assistive Products List (APL). The APL includes the 50 assistive products that are most needed across the world. This includes four types of wheelchair, pressure cushions and portable ramps, as well as other products to enhance mobility, hearing, cognition, communication and vision. The APL is not a restrictive list but aims to provide Member States with a blueprint to develop a national APL in line with local need and available resources. The hope is that it will provide a rallying point for local stakeholders to synergize efforts to increase access. GATE is now working on developing tools to support the implementation of the APL, including a needs assessment toolkit, a training package, a policy framework and model of service provision. For more information on GATE see the WHO Website.17 18 17 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 18 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 51ToT.9 Knowledge of guiding documentsToT Handbook World report on disability In 2011 the first ever World report on disability was published, produced jointly by WHO and the World Bank.18 The report states that people with disabilities have generally poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their daily lives. The report provides evidence-based recommendations on ways to overcome barriers to health care, rehabilitation, education, employment and support services. It also highlights what works to create supportive environments that will enable people with disabilities to flourish. The World report on disability highlights the following barriers: • inadequate policies and standards • negative attitudes • lack of service provision • problems with service delivery • inadequate funding • lack of access • lack of consultation and involvement • lack of data and evidence. As these all relate to wheelchair service provision this is a useful background document. The report’s second recommendation to, Invest in specific programmes and services for people with disabilities, mentions the importance of wheelchairs: Rehabilitation – including assistive technologies such as wheelchairs or hearing aids – improves functioning and independence. A range of well-regulated assistance and support services in the community can meet needs for care, enable people to live independently and participate in the economic, social, and cultural lives of their communities. 52 ToT.9 Knowledge of guiding documentsToT Handbook A summary of the report together with its recommendations can be found on the WHO website.19 20 WHO Global disability action plan The WHO Global disability action plan 2014–202120 is based on the recommendations of the World report on disability and is in line with the CRPD. It was developed in consultation with Member States, UN organizations, national and international partners including organizations of people with disabilities. The plan seeks to address the disparities between people with disabilities and those without. It states that across the world, people with disabilities do not receive the health care they need and have poorer health than people without disabilities. They are more than twice as likely to find health-care providers’ skills and facilities inadequate; nearly three times more likely to be denied health care; and four times more likely to be treated badly. The action plan has three objectives: • to remove barriers and improve access to health services and programmes • to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation • to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services. Member States are urged to implement the proposed actions adapted in line with national priorities and circumstances. The full report can be found on the WHO website.21 19 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.who.int/iris/ bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) 20 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 21 (http://www.who.int/disabilities/actionplan/en/). 53ToT.9 Knowledge of guiding documentsToT Handbook High-level meeting of the General Assembly on disability and development 22 A one day High-Level Meeting of the General Assembly on disability22 was held on 23 September 2013 under the theme: The way forward: a disability-inclusive development agenda towards 2015 and beyond. Participants included Member States, observers and representatives of the United Nations, as well as representatives of civil society, organizations of people with disabilities and the private sector. The Outcome Document from the meeting lists commitments from (a) to (q). Commitment (h) states: Ensure accessibility, following the universal design approach, by removing barriers to the physical environment, transportation, employment, education, health, services, information and assistive devices, such as information and communications technologies, including in remote or rural areas, to achieve the fullest potential throughout the whole life cycle of persons with disabilities. A booklet giving the background to the meeting and the outcomes can be found on the UN website.23 22 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 23 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 54 ToT.9 Knowledge of guiding documentsToT Handbook ToT.10 Audio-visual tools and equipment It is important that you are familiar and confident with using a range of audio-visual (AV) tools when facilitating training sessions. PowerPoint (PPT) and Portable Document Format (PDF) Presentations for the WSTP are available in both PowerPoint and PDF format. The advantages and disadvantages of each format are summarized in the table below. Advantages Disadvantages PPT • The PPT can be changed to fit your individual presentation style and be relevant to the local context. • Text can be reduced/simplified. • Extra slides can be added to cover new content or questions for discussion. This is helpful when the group speaks different languages or dialects, and may find it difficult to follow your accent. • The computer’s screen saver will not come on when the presentation is in “Slide Show” mode. • Videos must be loaded manually. • Overall file size is larger. • Time is needed to edit the PPT files. PDF • The PDF is complete with links to all four video formats. You can simply click on the format you want and the video will play. • It has been tested and there should be no formatting or compatibility issues. • The files are smaller than the editable files. • The content is fixed and cannot be customized for local context or to fit your presentation style. • All text on the slide will appear at once (slides will not ‘build’ as some of them do in the editable version) and key learning points cannot be introduced individually. • Text can’t be simplified or reduced on slides with a lot of content. • Because it is a PDF, the computer’s screen saver will come on and needs to be deactivated before you start the presentation. (This can be done in “System Preferences” on your computer). 55ToT.10 Audio-visual tools and equipmentToT Handbook Adding slides to the PPTs When adding slides, the aim is to follow the Trainer’s Manual and not to move off the subject. You may want to add slides to the PPTs for the following reasons: • for sections where there are none • for key discussion questions, to remind you not to move on to the answers too soon • as a reminder about an activity that is coming up, and include instructions. You may want to make changes to the PPTs for the following reasons: • to adapt slides for local context • to provide translations • to reduce the text on some slides or divide a lot of content on one slide into two or more slides • to add material when you are expanding or adding training sessions. Remember, when you add content you will need to add more time to the session. Maintaining consistency of the PPT • All new slides, or changes to existing slides, must follow the same format, style and font as the original PPT. • Remember to delete the WHO and WSTP logos from slides you add or change. The simplest way to add slides to an existing WSTP presentation while keeping the same format is to duplicate an existing slide and then change the text. • Do not add complex animations. • You can also add slides using the PPT master. • All video clips are available in two formats: mp4 and wmv. The mp4 format is for use on Apple computers and the wmv format is for Windows computers. If you have a Windows computer with a QuickTime player installed, you can also use mp4 videos. • Some video clips come with subtitles which are recommended to use. They can help participants understand better when there is poor sound quality, external noise or strong regional accents are used. • Video clips can be embedded or linked. We recommend embedding because although this makes the file larger, the video is stored inside the PPT and not lost when you copy the file to another computer. 56 ToT.10 Audio-visual tools and equipmentToT Handbook Embedding videos into a PPT To embed a video in PPT 2010 onwards, follow these steps: • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it. • Resize the video frame if it does not fill the screen properly. 57ToT.10 Audio-visual tools and equipmentToT Handbook • Save your changes • The video is now part of the PPT. To automatically play the video in full screen mode (Windows): • In the “Video”/“Tools”/ “Playback” tab, check the box called “Play Full Screen”. To automatically play the video in full screen mode (Mac): • In the “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. If you have any difficulties, consult the PPT help menu. 58 ToT.10 Audio-visual tools and equipmentToT Handbook Good practice when using audio-visual equipment Making sure the “Slide Show” plays • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. Data projector, remote and pointers • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. • Using a remote control to click between slides means that you do not need to stand next to the computer during your presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. Speakers • Plug in and test the speakers at the start of each day and leave them plugged in. • Only switch the speakers on when you are playing videos as they can pick up cell phone or other electronic signals. Cables and adapters • Ensure that you have all the necessary cables for the laptop, data projector and speakers. • Double check you have plug adapters including a few spares. • Bring extra extension cords in case your cables won’t reach the power outlets. 59ToT.10 Audio-visual tools and equipmentToT Handbook Activity 1: Using the board/flipchart as a visual aid Read the information assigned to your group and prepare a presentation to the rest of the group using the board/flipchart. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 60 ToT.10 Audio-visual tools and equipmentToT Handbook ToT.11 Feedback What is feedback? Feedback is information given to someone about: • What they are doing well – positive feedback. • What they need to improve on – constructive feedback. It is important that you have the skills to give feedback well, and that you can support positive learning outcomes for participants. Usually people have no problem giving feedback about good performance. When mistakes are made or performance needs improvement, you must be confident in giving constructive feedback. Activity 1: Receiving feedback Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Record your reflections below What should trainers consider when providing feedback? 61ToT.11 FeedbackToT Handbook Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on the behaviour not the person when providing constructive feedback. • Start with the positive – point out what was done well before talking about what needs to be improved. End on a positive note if you can. • Be delivered in different ways – give constructive feedback and praise to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their own performance first. They may already understand what went well and what they need to improve. • Support participants in their different approaches – before giving constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same way as you. 62 ToT.11 FeedbackToT Handbook ToT.12 Managing group dynamics It is important that the WSTP trainer knows how to work effectively and efficiently with groups. This session looks at facilitating small group activities, managing time and dealing with disruptive behaviour. Why use groups? Group work is important in training because it: • Allows participants to share ideas, knowledge and experience. This allows you to find out more about the participants’ existing expertise so that you know where the gaps are and how to pitch the session. • Honours the existing wisdom, experience and skills in the room. This allows those with more experience and expertise to share it with others. • Takes the focus off the trainer. As the participants share experiences and find out what they already know, this helps to build their confidence. • Creates an environment that enables everyone to speak and contribute. Shy or more junior participants will be more comfortable speaking out in a small group. This builds confidence as they discover their ideas are valued. Organizing and managing group activities What to consider when dividing a large group into smaller groups • Determine group size • Determine who is in each group • Methods to create groups. Factors to determine the size of the groups • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. 63ToT.12 Managing group dynamicsToT Handbook • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups of three, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. 64 ToT.12 Managing group dynamicsToT Handbook • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. Give clear directions when dividing participants into groups: • who goes into which group • what you want groups to do (what is their task) • where you want groups to go (break-out rooms, or areas of a large room) • when the group should be ready to report back • how you want groups to report (using a flipchart; verbal presentation to the whole group; informal report to the group sitting in their seat; creative presentation chosen by the group itself) • how much time will they have to report back. Always monitor small group activities to ensure participants are working on the intended task and using the correct page in their workbook. Help them if necessary, by prompting and asking leading questions; don’t provide the solutions or take too much time talking yourself. Remind them to keep an eye on the time. Managing disruptive behaviour In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. 65ToT.12 Managing group dynamicsToT Handbook The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. Managing a dominant participant: • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. Managing ‘the joking’ participant: • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test your skills and knowledge – and demonstrate that they are superior. Managing an argumentative participant: • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. The negative participant The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 66 ToT.12 Managing group dynamicsToT Handbook Managing a negative participant: • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? The quiet participant The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. Managing a quiet participant: • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The higher status/senior participant If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. Managing a senior participant: • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone. Managing a distracted participant: • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. 67ToT.12 Managing group dynamicsToT Handbook Intermediate Level module 68 Intermediate Level moduleToT Handbook 69A.1: Wheelchair users who benefit from additional postural supportToT Handbook A.1: Wheelchair users who benefit from additional postural support Key considerations for teaching this session a. General • Group discussions will help the trainers understand the existing level of knowledge and experience of the participants. • Avoid discussing individual postural support devices (PSDs) in detail. They will be covered in later sessions. b. Section 3. When is additional postural support needed? Tips for preparation • For the activity: Throwing a ball and drinking on pages 34–35 of the WSTPi Trainer’s Manual, ensure that the chairs are suitably strong. Wheelchairs can be used if there are no suitable chairs. Content • Many intermediate level wheelchair users are at higher risk of developing a pressure sore due to: 1. Pressure – asymmetrical (uneven) posture – immobility (being unable to move) – weakness – poor balance – inability to change position or carry out pressure relief techniques. 2. Shear – unstable posture as a result of weakness – increased tone (stiffness) – uncontrolled movement – joint contractures – leg length discrepancies which have not been accommodated. 70 A.1: Wheelchair users who benefit from additional postural supportToT Handbook 3. Friction – poor posture support can lead to parts of the wheelchair user’s body rubbing against the wheelchair or PSDs – uncontrolled movement or spasms – injuries that occur during transfers: for example, if the wheelchair user’s bottom does not clear the wheelchair when lifting, the skin will drag causing friction. • For intermediate wheelchair users, a pressure relief cushion alone may not be enough to prevent pressure sores. • Stabilizing the wheelchair user, supporting their posture with appropriate PSDs and educating the user and/or their caregivers can help to prevent pressure sores from developing. • Remember a pressure sore can develop at any point of contact between the wheelchair user’s body and the wheelchair, cushion or PSD. c. Section 4. What do wheelchair users want? • Additional answers to those listed on page 38 of the Trainer’s Manual, “The reasons why the wheelchair users may reject a wheelchair with additional postural support”, can include: – cost: users may pay extra fees for wheelchairs with additional postural supports – size: most posture-support wheelchairs are non-folding, larger and heavier – posture-support wheelchairs come with a fixed range of PSDs some of which the wheelchair user does not require – additional maintenance of the PSDs that are added to the wheelchair. 71A.2: Children with disabilitiesToT Handbook A.2: Children with disabilities Key considerations for teaching this session a. Section 3. Different positions • Up to 6 years of age, children’s hips cannot fully straighten (extend) or rotate inwards like an older child or adult. This is one reason why their standing and sitting postures are different. • Young children will therefore stand with slightly bent hips, their knees apart and pointing slightly outwards. Their hips should never be forced straight and the feet should not be turned in to face forward. When lying on their front their hips should remain slightly bent and their knees and feet face out. • The illustrations in the Different positions poster are of older children who already have a straightened (extended) hip. Standing • Add “prevention of fractures” to the notes on why standing is important (page 44 of the Trainer’s Manual), as this is a key point. • Other benefits of standing that are not listed include: – helps to manage spasticity (muscle stiffness) – helps digestion – helps bowel movement and bladder emptying – relieves pressure from the seat bones – helps the bones to develop and reduces loss of bone density (strength). • On page 45, slide 8: Standing posture for young children, an additional point to note is that the knee support of a standing frame should be positioned below the knee caps and never directly on them because: – The knee caps are sensitive and pressure on them will lead to pain and discomfort. – The natural weight bearing area for the knee is just below the knee cap. This is also the area for weight bearing in below-knee prostheses. 72 A.2: Children with disabilitiesToT Handbook b. Section 4. Importance of an early referral for children • Providing a wheelchair does not take away a child’s desire or ability to walk. • Providing wheelchairs for children helps them to: – play with their friends – go to school – do things for themselves – help in the home. • Using a wheelchair takes less energy than using walking aids and allows a child to cover longer distances and participate more fully. • A child’s walking may improve as a result of using a wheelchair as the child walks less and uses less effort, helping to improve the quality of their walking. c. Section 5. Working with children • The child-safe practices described in this session are the minimum necessary when working with children. • Encourage participants to create a child-safe code of conduct for their service. Codes of conduct help personnel understand how to work with children safely. Child protection resources include: – local country and organization acts and policies on child protection – Australian Council for International Development: Code of conduct guidelines for the development of a child protection policy.1 – Child protection, UNICEF website2 1 ACFID Code of conduct guidelines for the development of a child protection policy. Canberra: Australian Council for International Development; 2016 (https://acfid.asn.au/resources). 2 Child protection. In: Disabilities in programmes, UNICEF [website]. New York: UNICEF; Sept 2015 (http://www. unicef.org/disabilities/index_65309.html). 73B.1: Assessment overview and assessment interview ToT Handbook B.1: Assessment overview and assessment interview Errors in the WSTP materials a. General • The time allocations noted in the Trainer’s Manual for sessions 1–3 should be corrected as follows: – Section 1 2 minutes – Section 2 3 minutes – Section 3 65 minutes Change the time allocations in the Trainers Manual session plan outline on page 53 and in the individual sections on pages 53 and 54. The total session length remains unchanged. b. Section 3. Assessment interview, including the practical activity • There is an error in the instructions for the activity on page 56. The instruction states: “Give each group a number (1–5)”. This should be 1–4. Key considerations for teaching this session a. General Tips for preparation • Consider incorporating any changes made to the assessment form by local service providers into the session. • Adjust the types of disabilities and health conditions included in the group activity for the context. 74 B.1: Assessment overview and assessment interview ToT Handbook Content • Participants should be familiar with the WSTPb assessment interview. Therefore focus on the content that is new for intermediate level wheelchair users. b. Section 3. Assessment interview • The total time for this section is 65 minutes (see error section above). This includes a 5 minute introduction to the session, including the instruction for the activity and 60 minutes for the activity. • For the activity, encourage participants with more knowledge of different disabilities to support other group members. • Avoid long discussions about a single diagnosis/physical issue. • Some wheelchair users will not have a diagnosis and some users may have an incorrect diagnosis. Therefore, while the wheelchair user’s diagnosis can give valuable information, it is important to complete a full assessment. All of this information is required in order to select the most appropriate wheelchair. 75B.2: Physical assessment – sitting posture without supportToT Handbook B.2: Physical assessment – sitting posture without support Errors in the WSTP materials a. Section 5. Upright sitting posture for young children • On page 68 of the Trainer’s Manual, the first bullet point of slide 10 should state: “Flat back with no lumbar curves”. Correct the text by deleting “or thoracic” from the PPT slide and the slide notes. • As observed in the drawing (Figure 1), there is a forward thoracic curve that results in the shoulders being slightly further forward than the child’s ears and hips. The key message is that children under 5 years of age have a different ‘upright’ posture to that of an adult. Figure 1.Upright posture in young children b. Section 7. Observing sitting posture • Slide 18 is different in the PPT and the Trainer’s Manual. In the Trainer’s Manual, it shows shoulders lower on the right, and on the slide it shows shoulders lower on the left. Correct the text on page 72 of your Trainer’s Manual to say “shoulders not level (lower on the left)”. 76 B.2: Physical assessment – sitting posture without supportToT Handbook c. Section 8. Recording posture • In the activity (page 76) the line drawings are missing from the Trainer’s Manual. They are shown below in Figure 2: Example line drawings for trainers Figure 2. Example line drawings Key considerations for teaching this session a. Section 4. Upright sitting posture • The terms ‘fixed posture’, ‘flexible posture’ and ‘flexible partway to neutral posture’ should be applied to individual joints and not the wheelchair user’s whole posture. For example, the left hip can be ‘fixed’ while the right hip can be ‘flexible partway to neutral’. b. Section 5. Upright sitting posture for young children • Children’s lumbar and thoracic curves develop as a result of standing. For those children who never stand, these curves will not develop as they get older. c. Section 6. The pelvis is the foundation of sitting posture • Check that all participants can locate the seat bones (ITs), ASIS and PSIS on each other before moving on. 77B.2: Physical assessment – sitting posture without supportToT Handbook • Locating bony landmarks can be difficult due to contractures, deformities or obesity. Remind participants that for obese wheelchair users, the position of the ITs, ASIS and PSIS will not change relative to the midline of the body. Participants should use their knowledge of anatomy to work out where the bony landmarks should be before they begin palpating (feeling for landmarks). • Regarding the terms ‘upright/neutral’ in relation to the pelvis: – ‘Level pelvis’ refers to the pelvis from the anterior/front view. A level pelvis has no sideways tilt from the front. Both ASIS are in line with each other. – ‘Upright/neutral pelvis’ refers to the pelvis from the lateral/side view. An upright pelvis has no anterior or posterior pelvis tilt from the side. It is balanced on the seat bones. d. Section 7. Observing sitting posture • When observing the wheelchair user’s posture, some support may be needed to assist them to sit on the side of the assessment bed or chair. However, this support should not correct their posture. • The slide notes for slide 19 (page 72) in the Trainer’s Manual includes “some trunk rotation (back on the left side)” and “the left leg has rolled inwards”. There may be disagreement from some participants. If this happens: – Ask participants to focus on the major deviations: the rotation of the pelvis and rolling outwards of the right leg. – Acknowledge that it is difficult to identify subtle postural changes by observing from one angle only. To understand a person’s posture fully you must observe from the front, side and back along with identification of key anatomical/bony landmarks. e. Section 8. Recording posture Posture drawing tips • If participants find it difficult to draw the postures, suggest that they draw posture lines onto the body of the person in the illustration, before drawing the posture freehand in the box provided. • The small circles and points/corners on the pelvis represent the bony landmarks of the pelvis – the ASIS, PSIS and ITs. • The small circles drawn on the pelvis are not essential, but they can be helpful to emphasize the position of the pelvis. • It is important for trainers to choose one way to draw the thighs and to be consistent. 78 B.3: Physical assessment – pelvis and hip posture screenToT Handbook B.3: Physical assessment – pelvis and hip posture screen Errors in the WSTP materials a. Section 2. Pelvis and hip posture screen • Slide 6 is missing from the PPT file. The PDF version is correct. Key considerations for teaching this session a. General Tips for preparation • Lead and support trainers should prepare for this session together to ensure consistency in teaching the practical skills. For example, correct hand placement, use of the goniometer, and correct position of the model wheelchair user. • Temporary supports need to be prepared in advance and should be made from the local material most commonly used for the cushion base. • An anatomical model of the spine and pelvis with short femurs, or a child size doll (if available), can help to demonstrate the application of temporary supports. b. Section 2. Pelvis and hip posture screen • Be respectful in how you position yourself – move around the wheelchair user and avoid leaning over them. • Protect your back by: – positioning the wheelchair user near the side of the assessment bed to avoid leaning over them – kneeling down rather than bending. 79B.3: Physical assessment – pelvis and hip posture screenToT Handbook • Begin by checking the wheelchair user’s posture in lying before starting the pelvis and hip screen. This includes: – level the shoulders – using the end of the bed as a reference point – line up the head, neck and upper trunk with the side of the bed as a reference point. • Demonstrate good handling of the wheelchair user’s limbs and body. Gripping too hard may cause discomfort. • To relieve tension in the hips, support the wheelchair user’s knees when carrying out the pelvis and hip screen. If there is too much tension around the hips it can pull the wheelchair user’s pelvis into a non-neutral posture. • Ensure the wheelchair user’s clothing is not preventing free movement of their hips. • Emphasize the hand placement of both the assessor and the assistant (as described on page 84 of the Trainer’s Manual). Feedback from the assistant is key to an accurate screening. – The assessor’s hands support the weight of the legs. The assessor’s hands should not restrict knee bending (flexion) as tension at the back of the knee (tight hamstrings) may cause the pelvis to move. • Demonstrate correct use of the goniometer. • Sometimes participants try to mimic a restriction. This usually only causes confusion. Remind them to focus on learning the steps and the technique, and they will feel real restrictions during the practical sessions. Summarize by showing the DVD. Considerations for gender/culture • When demonstrating, or asking participants to carry out a pelvis and hip posture screen, divide participants into groups based on gender. 80 B.3: Physical assessment – pelvis and hip posture screenToT Handbook c. Section 4. Demonstration of temporary support for fixed unlevel pelvis • If participants suggest adding a support under the lower side in order to level the pelvis: – explain that the pelvis posture cannot be corrected to a level neutral pelvis – pushing against the seat bones of an unlevel pelvis will cause high pressure, which may lead to a pressure sore. • Emphasize the findings in the pelvis and hip posture screen. If participants were not able to level the pelvis in lying, the pelvis will remain unlevel in sitting. • This PSD is not used in isolation. Wheelchair users with a fixed unlevel pelvis may need several other PSDs to support their posture. d. Section 5. Demonstration of temporary support for the hips that cannot bend or open to neutral sitting posture • Consider demonstrating using an anatomical spine or doll before requesting a volunteer. • Demonstrate that the hip cannot bend to neutral in lying. • Highlight the triangular space created by a vertical line from the back of the knee to the assessment bed (Figure 3). • The distance from the line to the seat bone is the height of the temporary support required to stop the thigh pushing the pelvis into a posterior pelvic tilt. • Measure the trunk to thigh angle. • Sit the doll/model on a temporary support. • Show the trunk to thigh angle is the same. • The triangle gap under the thigh is the shape that must be created in the front section of the cushion on that side to accommodate the hip that cannot bend to neutral. • Participants sometimes suggest filling the triangular space under the thigh with a wedge. This is possible but not necessary as it does not change the final posture of the pelvis. Figure 3.Temporary support 81B.4: Physical assessment – hand simulation ToT Handbook B.4: Physical assessment – hand simulation Errors in the WSTP materials a. Section 3. Recording the results of a hand simulation • On page 101 of the Trainer’s Manual in the activity answer box, Enith’s hip postures have been recorded as neutral. This is not correct, change the tick box to: “No” for the L Hip and R Hip. • The notes are correct: “trunk to thigh angle more than 90 degrees”. Key considerations for teaching this session a. General • More time may be required if participants are not familiar with hand simulations or analysis of a wheelchair user’s posture. • Throughout the DVD case studies, emphasize the step by step approach: – give clear instructions to the assistant – begin with the position of the pelvis before moving to support other areas. • Ensure participants understand that the final posture achieved during the hand simulation must be documented together with the supports needed. Documentation includes drawings, written descriptions and completing the checklist for each part of the body listed on the assessment form. • If photographs are a standard part of service documentation, ask someone to take a picture after each change in posture. – Service personnel can review each photograph to help decide how they might change the support provided to the wheelchair user. – This can minimize handling and saves time. • If photographs are used during the training programme, ask participants to record the results of hand simulations for wheelchair users they work with using the final photograph as a guide. 82 B.4: Physical assessment – hand simulation ToT Handbook • Delete all other photographs and use only the final photograph in the documentation for the wheelchair user. b. Section 2. How to carry out a hand simulation • Some wheelchair users are physically able to sit more upright but they are unable to maintain this position. These users may need to be supported in a less upright position, with their pelvis in a posterior pelvic tilt, to be able to use their wheelchair throughout the day. From the more upright position, allow the wheelchair user’s pelvis to gradually roll backwards, until you have found the best position where the user’s head and trunk are balanced. • Even with multiple assistants it is not always possible to carry out a hand simulation because firmer support is needed than can be provided with your hands alone. If this happens, consider using: – upholstered boards, foam or therapy blocks to provide more stable support – a wheelchair that can be mocked-up with temporary postural supports. • It can be difficult carrying out a hand simulation with small children when they are upset. Consider: – sitting them sideways on the parent/caregiver’s lap – taking frequent breaks – including the parent/caregiver in the assessment, for instance ask them to hold the child’s feet or shoulders. Ensure that you give appropriate guidance about how much support they need to provide. • It is important to compare the final posture achieved during the hand simulation with the results of the pelvis and hip posture screen. The final position of the pelvis and hips will usually be the same. Differences can be caused by: – using too much force during the pelvis and hip posture screen – insufficient support in sitting. 83B.4: Physical assessment – hand simulation ToT Handbook c. Section 3. Recording the results of a hand simulation Content • Use the Notes for trainers included in the Trainer’s Manual to provide clarification when the whole posture is not visible. • Allow time for all participants to practise how to record the final hand simulation, posture drawings and descriptions. • To record a neutral posture, it must be neutral both from the front and the side. • “Yes” is ticked for parts of the body that have achieved neutral posture with or without additional postural support during the hand simulation. • All non-neutral postures (fixed or flexible part way to neutral) should be marked “No”. • Although the pelvis and hip posture screen may identify a level pelvis and neutral hip range, the final posture is determined by the hand simulation. The final pelvis position may be in anterior/posterior tilt (non-neutral), resulting in the hips being open/closed more than neutral. The pelvis may be neutral but the hips closed because a raised seat front may have been added to provide stability. Enith • Enith’s pelvis and hip screen found that both her hips could bend to a neutral sitting posture. • While both of her hips can come to 90 degrees in lying, she cannot sit in that position because her pelvis is fixed in a posterior pelvic tilt. • When recording the results of the hand simulation, record the final posture achieved accurately. • Some participants may suggest using a raised seat front PSD to close the trunk to thigh angle. Acknowledge that this can be done, but remind participants that the decision will be based on a whole picture of the wheelchair user’s needs. Including a raised seat front in the final prescription may affect other things such as transfers and access under desks or tables. • The Trainer’s Manual describes the final posture of Enith and Bahati. See below for their final posture drawings. 84 B.4: Physical assessment – hand simulation ToT Handbook Enith For each body part: If neutral sitting posture is possible with hand support, tick “Yes”. If not, tick ”No”. Part Yes No Describe or line draw final sitting posture achieved by the wheelchair user with hand support. Describe or line draw the support provided to achieve that sitting posture. Pelvis □ □ Trunk □ □ Head □ □ L Hip □ □ R Hip □ □ Thighs □ □ L Knee □ □ R Knee □ □ L Ankle □ □ R Ankle □ □ Bahati For each body part: If neutral sitting posture is possible with hand support, tick “Yes”. If not, tick “No”. Part Yes No Describe or line draw final sitting posture achieved by the wheelchair user with hand support. Describe or line draw the support provided to achieve that sitting posture. Pelvis □ □ Trunk □ □ Head □ □ L Hip □ □ R Hip □ □ Thighs □ □ L Knee □ □ R Knee □ □ L Ankle □ □ R Ankle □ □ 85B.5: Physical assessment – taking measurementsToT Handbook B.5: Physical assessment – taking measurements Errors in the WSTP materials a. General • The following are not listed in the resources and should be added: – two clipboards for each group of three participants – a set of foot blocks of different heights (or thickness). b. Section 2. Measuring a wheelchair user to select the correct wheelchair size and location of PSDs • On page 112 of the Trainer’s Manual the drawing of Madavi’s posture on slide 6 is incorrect. The drawing shows a lumbar spine with a neutral curve. However, when a user sits with their pelvis in a posterior/backwards tilt, their lumbar spine flattens and the trunk will be rounded – which causes a ‘slumped’ posture. • The same error is in the Reference Manual for Participants on page 67. Guide participants to correct this in their manuals. Key considerations for teaching this session a. General Tips for preparation • Review the measurement notes in the Trainer’s Manual and practise the measurement demonstration with all trainers to ensure consistency. • Common errors to look out for during the activity may include: – the posture/support of the wheelchair user – inaccurate measurement techniques including: positioning the clipboards on an angle; starting from the wrong end of the tape measure; reading the tape measure with the head at an incorrect level. 86 B.5: Physical assessment – taking measurementsToT Handbook • Avoid using participants for the demonstration, so that they are able to observe. • Adjust for the context (such as thicker clothes in cold climates). • If time permits, consider lengthening this session to allow each participant to practise taking all the intermediate-level body measurements. b. Section 2. Measuring a wheelchair user to select the correct wheelchair size and location of PSDs • In the Trainer’s Manual, page 110, section I is titled: “Seat to the top of the pelvis (PSIS)”. However, the PSIS is not the top of the pelvis. The top of the pelvis is the iliac crest. • Trainers need to decide how best to approach this with their participants: – Option 1: Delete “to the top of the pelvis” from this sentence, and only refer to the PSIS. You will then need to change the Reference Manual for Participants on page 70. – Option 2: Use “the top of the pelvis” as a general term. If you choose this option, it is important for participants to understand that the PSIS sits below the “top” of the pelvis. • Throughout the section emphasize the following points: – Take the measurements while the wheelchair user is still being supported in their final posture (as assessed during the hand simulation). – The type of wheelchair selected and PSDs required will help determine which measurements are needed. For example, for a wheelchair user who needs a full height backrest select measurement F: seat to top of shoulder. Measurement D: seat to bottom of rib cage and measurement E: seat to shoulder blade will not be necessary. • If a wheelchair user has a fixed posterior tilt of the pelvis or a fixed forward curved trunk, participants need to think about how this will be accommodated in the wheelchair. This may change the way the seat depth measurement is taken. • If the backrest can recline: measure from the bottom of the back of the pelvis to the back of the knee in a straight line (Figure 4). Figure 4. Measuring for a reclining backrest 87B.5: Physical assessment – taking measurementsToT Handbook • If the backrest does not recline and an open seat to back angle is prescribed, it will need to be accommodated in the seat depth of the wheelchair. • Body measurements for an open seat to back angle must include: – The distance from the apex of the c-shaped curve to the top of the seat (z). – The distance between the vertical line from the apex of the c-shaped curve to the top of the seat and the back of the pelvis (x) (Figure 5). • Show how to calculate the total seat depth required when using an open seat to back angle PSD using Figure 6. • It can sometimes be difficult to support wheelchair users in their final posture while taking measurements. Strategies to manage this include: – take frequent breaks – have more assistants available to provide postural support or to take measurements. Figure 6.Calculating seat depth Figure 5. Measuring for an open seat to backrest angle 88 B.6: Selecting wheelchairs and cushions ToT Handbook B.6: Selecting wheelchairs and cushions Errors in the WSTP materials a. General • Sixty minutes is not sufficient time for this session. Allow 60 minutes for section 2 and 70 minutes for the total session time. b. Section 2. Type of wheelchair and cushion • In the Trainer’s Manual on page 119, the drawings of the reclining backrest in slides 12 and 13 should not include a lumbar or rear pelvis support shape. Considering the indications for prescription (as listed in the slide notes), the wheelchair user will present with a pelvis in posterior tilt and consequently a flat or flexed lumbar spine. • The lower section of the backrest should be represented as: – flat, or – with an open back to seat angle wedge (a likely PSD for the scenarios listed). • Ask participants to correct the same error in the Reference Manual for Participants on page 74. • On page 119 of the Trainer’s Manual, the first bullet point next to slide 13: “Fixed posterior pelvis tilt with hip and knee flexion contractures” is not correct. Tilt in space is not an indication for fixed posterior pelvis tilt with hip and knee contractures. Delete the first bullet and add the following bullet points: – to improve head position and control – to improve balance. • Ask participants to correct the same error in the Reference Manual for Participants on page 74. 89B.6: Selecting wheelchairs and cushions ToT Handbook Key considerations for teaching this session a. General Tips for preparation • Ensure you are familiar with the wheelchairs and PSD components that are available locally: – study the manufacturers’ information – know the available size range – check the adjustability options/range of features and ensure you can explain or demonstrate these – find out what can be customized, including any accessories available. • Ensure that you are familiar with any changes to the local prescription forms before you deliver this session and incorporate them if appropriate. • Local prescription forms should include the following: – identification of the type and size of wheelchair and cushion – detailed body and ideal wheelchair measurements – descriptions of PSDs – wheelchair user agreement signatures. b. Section 1. Introduction • Remind participants that an appropriate wheelchair is defined according to the Wheelchair Guidelines and that they should always consider whether a wheelchair with extra supports, or a dedicated supportive seat, would be most appropriate. c. Section 2. Type of wheelchair and cushion Tips for preparation • Ensure that a range of wheelchairs, which demonstrate different features related to environment, function, fit and posture support, is available. • Include both wheelchairs with dedicated posture support features and those to which PSDs can be added. Content • Consider the limitations of a dedicated posture support wheelchair for a user who only needs a manual wheelchair with PSDs: 90 B.6: Selecting wheelchairs and cushions ToT Handbook – There may be a limited range of designs and sizes of posture support wheelchairs available. – They may include features that are not needed, adding weight and cost. – Posture support wheelchairs can be difficult to transport. • For a wheelchair with ‘fixed’ tilt: the angle that will best support the wheelchair user must be selected at the time of prescription. • For a wheelchair with ‘quick release’ or ‘adjustable’ tilt: the amount of tilt can be easily adjusted throughout the day to provide more or less support as needed. This can be helpful for a wheelchair user who is recovering after a serious injury or learning skills such as head control, and may not be able to sit in a more upright position for the whole day. Point out the wheelchairs that have these features. • Remind participants that the wheelchair and PSDs required will also help determine the size of wheelchair required. For example, for a person who needs trunk side supports and a backrest that reclines between the back posts, the width of the wheelchair is determined by: – Body measurement G. Trunk width plus; – the thickness of both trunk side supports (B x 2) (this equals the inside measurement between the back posts), plus; – width of the two back posts (A x 2) (Figure 7). • If the backrest is to be mounted in front of the back posts, the width of the wheelchair user’s trunk plus the thickness of both trunk side supports or pelvis/thighs (whichever is the widest) will help to identify the ideal width of the wheelchair (wheelchair component measurement 1 or 2). Figure 7. Width of a wheelchair 91B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction ToT Handbook B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction Key considerations for teaching this session a. General Tips for preparation • Park questions about specific PSDs in the Car Park as they will be covered in the following sessions. • Ensure that you are familiar with any changes to local prescription forms before you deliver this session. Incorporate local forms into the session if appropriate. • Source examples of local PSDs for demonstration. • Information about costs and suppliers can be prepared in advance and included as a separate handout. They should not be discussed as part of the session. b. Section 2. What is a PSD? • The selection of PSDs depends on the support needed, as identified during the hand simulation. – The size required (height and depth) is related to the amount of support needed. The more support needed, the larger the surface area of the PSD. – The materials selected depend on the firmness of support. For example, if light support is needed, you may prescribe trunk side wedges (made of firm foam underneath softer foam). If firm support is needed, you may prescribe trunk side supports made with a rigid structure (such as wood, metal, plastic) and lined with a softer material (such as foam, EVA). – The shape of the support depends on which part of the body is being supported. It should not restrict movement of another part of the body; for example, an armrest can interfere with propelling. The shape should not concentrate high pressure on a bony area, such as over the ribs, when accommodating a curve in the trunk. Shaping the support can spread the pressure over a larger area (reducing the risk of a pressure sore). – Pressure is very important. Every part of a PSD that is close to the body and hard enough to cause a pressure sore should be shaped appropriately and padded with an appropriate softer material (such as foam, EVA or neoprene). 92 B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction ToT Handbook c. Section 3. Recording PSDs on the intermediate wheelchair prescription (selection) form • In slides 8 and 9 on page 130 there are examples of PSDs drawn onto a prescription form, with lines and letters representing where measurements are needed. • When drawing on the prescription form, participants should concentrate on the shape and size of the firm foam only. Explain that every part will need to be covered with a softer foam layer, but it is not necessary to draw this. • The shadow lines are there as a guide to make it easier to draw the PSDs. They do not represent a size or shape that you must use. • The purpose of the drawing is to communicate the type, shape and size of PSDs required, so it is important that the drawing is clear. • Adding shadow lines to the backrest and footrest drawings (Figure 8) can make it easier to sketch in the PSDs. • You can add this shadow line drawing to the PPT and your assessment forms. A copy of the drawing is on the WSTP Pen Drive. Figure 8. Using shadow lines to draw PSDs 93B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook B.8: Prescription (selection) of PSDs – stabilizing the pelvis Errors in the WSTP materials a. Section 2. Problem: Pelvis is in posterior tilt and/ or slides forward • In the Trainer’s Manual on page 136, slide 8 shows a cushion with a pre-seat bone shelf. • The illustration can sometimes be misunderstood. Explain that: – the bottom layer of the cushion is firm foam – the top layer of soft foam should be glued firmly to the pre-seat bone shelf. • Replace the illustration on slide 8, with this new one (Figure 9) which can be found on the WSTP Pen Drive. Figure 9. Cushion with pre-seat bone shelf • In the Trainer’s Manual on page 137 the illustration on slide 11 shows the dimensions for Marian’s PSDs. The diagram shows two measurements. For the rear pelvis pad, the measurement line is incorrectly shown from the top of the seat to the bottom of the rear pelvis pad. The line should be from the top of the seat to the mid-height of the rear pelvis pad. • For some versions of the WSTPi package, this error is also in the PPT (slide 11). • Change this in your Trainer’s Manual and PPT (if necessary). • The measurement line is incorrectly shown from the top of the seat to the top of the rear pelvis pad in the Participant’s Workbook on page 26. Guide participants to correct this. 94 B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook Key considerations for teaching this session a. General Tips for preparation • An anatomical model of the skeleton/spine/pelvis/hip is a very useful teaching tool. Trainers can use the model to: – identify bony landmarks – demonstrate where support needs to be provided – link the pelvis and hip posture screen, temporary supports (where appropriate) and hand simulation findings. • Have the correct size and width of foam blocks and wedges available so you can quickly assemble the sample cushion solutions. For example, the raised seat front cushion in section 2 and the build-up for the pre-seat bone shelf cushion in section 3. Content Cushions • All intermediate level wheelchair users should be provided with an appropriate cushion that supports their pelvis. • Most intermediate level wheelchair users will need a cushion with a pre-seat bone shelf to help stop the pelvis from sliding forward. The pre seat bone shelf will also move some pressure away from their seat bones (providing pressure relief). • Intermediate level wheelchair users who need a pre seat bone shelf and who are at high risk of developing pressure sores could be prescribed a cushion with a pelvic well (Figure 10). • A pelvic well provides the same postural support as a pre seat bone shelf, and provides more pressure relief by further redistributing the weight and loading under the upper thighs (trochanters). Figure 10. Cushion with a pelvic well 95B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook Pelvic well cushion shown with an inside thigh wedge: base layer Pelvic well cushion shown with an inside thigh wedge. b. Section 2. Problem: Pelvis is in posterior tilt and/ or slides forward Tips for preparation • In the Trainer’s Manual on page 136 the trainer’s notes for slide 9 state: “A rear pelvis pad provides support at the top of the pelvis (at the level of the PSIS)”. However, the PSIS is not the top of the pelvis. The top of the pelvis is the iliac crest. Trainers need to decide how best to approach this with their participants. • Option one: delete “at the top of the pelvis” from this sentence, and only refer to the PSIS. If you make this change, you will also need to change: – the measurement table on page 25 of the Participant’s Workbook – the Reference Manual for Participants on page 95 (third last paragraph) – measurement l in the Intermediate wheelchair assessment form. • Option two: use “the top of the pelvis” as a general term for describing the top of the back of the pelvis. If you choose this option, it is important for participants to understand that the PSIS sits below the “top” of the pelvis. 96 B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook Finding the PSIS • Place hands on top of the pelvis and gently squeeze in to find the soft area. Then move the thumbs down below the level of the fingers (stretching the web of the thumb). The thumbs will be positioned close to where the PSIS are located, below the top of the pelvis (Figure 11). Figure 11. Finding the PSIS Content • The appropriate angle to position a pelvic strap is between 45 degrees and 90 degrees (Figure 12). • However, a 45 degree belt can encourage the wheelchair user to sit with a posterior pelvic tilt, especially when firm support is needed. • An angle of 60 to 90 degrees is more effective for a wheelchair user who tends to slide forward on the seat. Figure 12. Positioning a pelvic strap Rear pelvis support for adults with neutral curves of the spine • A rear pelvis pad is designed to keep the pelvis upright and prevent posterior pelvic tilt for wheelchair users with normal lumbar/thoracic curves. • It is designed to fill up the pelvic-trunk offset (the difference between the back of the pelvis and back of the thoracic spine) in a wheelchair with a flat backrest. • If the pelvis cannot be corrected to neutral, or the wheelchair user does not have neutral curves of the spine, a rear pelvis pad should not be used. 45º 90º 97B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook Pelvic-trunk offset A rear pelvis pad used with a straight backrest • If the backrest has a backwards bend, or is a tension adjustable backrest that supports the pelvis to be upright (and accommodates the neutral curves of the spine), a rear pelvis pad may not be needed. • A rear pelvis pad can be added to these types of backrests if more support is needed. Backrest with a backwards bend Tension adjustable backrest • Do not over correct the pelvis. If the wheelchair user cannot tolerate an upright or close to upright posture, provide less support and allow the user to sit with a posterior pelvis tilt. The wheelchair user may benefit from an open seat to back angle to support the less upright posture. 98 B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook Rear pelvis support for children with neutral curves of the spine • Rear pelvis pads must not be used with young children. • For young children, a neutral posture has a flat lumbar spine and a forward bend in the thoracic area (Figure 13). • If a rear pelvis pad is used, it will push the pelvis forward into anterior tilt and/or push the wheelchair user away from the backrest. This can cause discomfort, pain and postural problems. Figure 13. Neutral posture in young children c. Section 3: Problem: Pelvis is in lateral tilt (fixed unlevel pelvis) Fixed unlevel pelvis • The height of a build-up under the pelvis will be a similar size to the height of the temporary support used during the hand simulation. • The height of the temporary support is similar to the difference in height between the two ASIS in the most corrected pelvis posture (as determined in the pelvis and hip posture screen). Unlevel pelvis – flexible to neutral • Sometimes when a wheelchair user’s pelvis is flexible to neutral, participants suggest building up the pelvis under the low side to correct it. This is unsafe, because it increases the pressure underneath the lower seat bone. • Providing pelvis side pads and a firm pelvic strap to support the pelvis will help to achieve an aligned and balanced posture. You may also need to provide support to the wheelchair user’s trunk. 99B.8: Prescription (selection) of PSDs – stabilizing the pelvisToT Handbook d. Section 4: Problem: Pelvis moves to one side Tips for preparation • Add the following note to slide 22 on page 143 of the Trainer’s Manual: – “If the pelvis can no longer be corrected to be in line with the shoulders, the pelvis side pads will be off-centre”. • Ask participants to add this sentence to the Reference Manual for Participants (at the bottom of page 96). Content • Pelvis side pads can be fixed to the seat, armrests, backrest or the back posts. • Pelvis pads fixed to armrests or seats are more likely to interfere with the thighs, unless they are shaped correctly. • Those attached to the backrest or back posts are less likely to interfere. These can be shaped from the top of the pelvis to just above the top of the thighs. • If you need to position the pelvis side pads off-centre, you can achieve this by: – making one pelvis side pad thicker than the other – attaching the pads asymmetrically/off-centre. e. Section 6. Key point summary • Encourage participants to try different options and approaches with the wheelchair users in the practical sessions and when working with wheelchair users in their own services. 100 B.9: Prescription (selection) of PSDs – supporting the hipsToT Handbook B.9: Prescription (selection) of PSDs – supporting the hips Key considerations for teaching this session a. General Tips for preparation • Throughout the session, link the postures to: the pelvis and hip posture screen; temporary supports needed; and the hand simulation results. b. Section 2. Supporting the hips Tips for preparation • If available, an anatomical model of the skeleton can help to demonstrate various postures. Content • Refer to notes for session B.3: Physical assessment – pelvis and hip posture screen, for tips on how to determine the height of the temporary support for hips that cannot bend to neutral. • Sitting with both seat bones on a temporary support allows the spine to be assessed without the influence of the limited hip movement (contractures). • Once the spine has been assessed, remove the temporary support and position the pelvis in a posterior pelvic tilt. 101B.10: Prescription (selection) of PSDs – supporting the trunkToT Handbook B.10: Prescription (selection) of PSDs – supporting the trunk Errors in the WSTP materials a. Section 2. Supporting the trunk Case study: Josephine • In the Participant’s Workbook (pages 34–35) Josephine’s case study states that she is using a long wheelbase wheelchair, however the illustration shows Josephine in a short wheelbase wheelchair. • Provide a long wheelbase wheelchair to the group working on Josephine’s case study, and advise them to note the error in their workbook. • Josephine’s hand simulation results record that her left hip can come to neutral. This is incorrect – if the pelvis is not neutral, the L hip cannot be neutral. • Guide participants to change this information in their case study information in the boxes on pages 34–35. • Make a note of this change in the Trainer’s Manual on page 160. Key considerations for teaching this session b. General Tips for preparation • This session requires a number of resources that need to be prepared in advance. Consider creating a training resource kit that can be reused in future training programmes. • If participants need to shape and cut PSDs, add the tools required to the resources list in the Trainer’s Manual. • Add rolls of tape to the resources list for participants to mock up the PSDs. Emphasize that these materials and their methods of attachment are for training purposes only. • When preparing PSD kits and PSD materials, try to use the same type of PSDs and materials that participants will use in their workplace. If these are not available, you can use low-cost replacements. Explain to participants that this is for training purposes only: 102 B.10: Prescription (selection) of PSDs – supporting the trunkToT Handbook – use cardboard to represent wood for a solid back/seat and trunk/pelvis side supports – use Styrofoam, plastic foam pieces from discarded packaging material or woven grass mats to represent foam. • If there aren’t enough materials to complete mock-ups, ask participants to describe the changes they would make and how they would make them. • The case studies describe the type of wheelchair for each user: – if the type of wheelchair is not available, provide a locally available alternative – ensure the wheelchair does not have any PSDs attached – discuss the wheelchair with the group; identify any key changes between the wheelchair provided and the wheelchair described in the case study. • If a child size wheelchair is not available for Sian (case study 3), advise participants to use a different size and focus on the postural support required. c. Section 2. Supporting the trunk Tips for preparation For the whole group activity (page 156): • Ensure that the benches or tables that the participants sit on are not too wide, or it will cause their legs to straighten. Chairs with flat, horizontal seats can also be used by placing the side of the chair against the wall. Content For the case studies in the activity: • Remind participants that the focus is to problem solve and consider all possible solutions. • Ask them to start with the seat base, which includes pelvis and hip supports, and then to follow the same sequence as hand simulation. • If participants are choosing solutions that are not appropriate, ask them to explain their reasoning. Lead a discussion on the clinical or functional problem that their solution may create and ask what they can do to overcome it. 103B.10: Prescription (selection) of PSDs – supporting the trunkToT Handbook Correction of common misunderstandings. Case study 1: Mark • Backrest too high. Remind participants that the findings of the hand simulation indicated that the wheelchair user needed support behind his shoulder blades. This indicates that back support to mid thoracic level is needed, not to the top of his shoulders. A backrest at the level of the shoulder blades will affect arm function. • The backrest should provide the level and height of support as indicated by the hand simulation. • If a lower backrest is provided, the wheelchair user may not be stable. • The support behind the shoulder blades will not usually affect shoulder function. Correction of common misunderstandings. Case study 2: Josephine • The rear pelvis pad is selected instead of an open seat to back angle: Refer to the discussion about supporting the pelvis in session B.8: Prescription (selection) of PSDs – stabilizing the pelvis; Section 2. Pelvis is in posterior tilt and/or slides forward (Trainer’s Manual page 134). • No pre-seat bone shelf is prescribed. • Incorrect position of lowered seat front on one side. For a hip that cannot bend to neutral, the slope of the lowered seat front on one side should start just in front of the pre seat bone shelf. • Too much recline. When reclining the backrest between the back posts, stop reclining just before the wheelchair user’s shoulders make contact with the back posts. • Using seat and back rest tilt. Participants should first focus on the pelvis and hip PSDs, followed by trunk support, before checking the need for tilt. • If the trunk to thigh angle caused by her posterior pelvic tilt is the same or greater than the trunk to thigh angle caused by her hip not being in neutral (100 degrees), no cushion modification will be needed. Correction of common misunderstandings. Case study 3: Sian • Building-up under the low side of the pelvis. Refer back to the discussion on supporting the pelvis in Session B.8: Prescription (selection) of PSDs – stabilizing the pelvis; Section 3: Problem: Pelvis is in lateral tilt (fixed unlevel pelvis). • Raised seat front position. The raised seat front slope should start directly in front of the pre-seat bone shelf and extend to the front of the cushion. • Adding a rear pelvis pad. Sian is 3 years of age; his lumbar curves will not have developed. A flat backrest is appropriate for children of this age. 104 B.10: Prescription (selection) of PSDs – supporting the trunkToT Handbook Children with poor trunk and head control: • A child’s neutral posture has an upright pelvis, flat lower back with a slight bend in the thoracic spine, with the upper trunk leaning slightly forward (Figure 14). • This means that a child’s upper trunk does not make firm contact with a flat backrest. • Children with low muscle strength/poor trunk control will generally find it difficult to keep their upper trunk and head upright. • Some children may need more support. Figure 14. A child’s neutral posture To help a child sit more upright: 1. Add a pre seat bone shelf, open seat to back angle and pelvic strap – assess: • Are they able to maintain this posture? Do they need more support? 2. If they need more support: • Add a tray – assess: – Are they able to maintain this posture? Do they need more support? • Add a shoulder harness – assess: – Are they able to maintain this posture? Do they need more support? 3. If they need more support: Add tilt seat and back (tilt in space) (Figure 16). Figure 15. Open seat to backrest angle Figure 16. Tilt in space 105B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legsToT Handbook B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs Errors in the WSTP materials a. Reference Manual for Participants • On page 106 of the Reference Manual for Participants, in the heading “Problem: one or both knees bend and are fixed less than neutral sitting posture”, replace the text in the brackets “‘trunk to thigh angle is more than 90 degrees” with “thigh to lower leg angle is less than 90 degrees”. Guide participants to make this change in their manuals. Key considerations for teaching this session b. Section 3. Supporting the thighs Content Common errors in the activity case studies: • Adding PSDs before first addressing problems with the wheelchair and/ or cushion. Emphasize the importance of basic level wheelchair principles in creating a good foundation for posture. • Not providing enough support for the wheelchair user’s thighs. Hand simulation results indicate where supports are needed and how much support is required. This includes the size, shape and firmness of the PSDs. • Not addressing functional implications of any PSD added to the wheelchair and/ or cushion – such as transfers or propelling of the wheelchair. • Slide 11 on page 169 of the Trainer’s Manual shows an illustration of outside thigh wedges on a cushion with a pelvic well. This is an example of combining more than one PSD on a cushion. Not all cushions that include an outside thigh wedge need to have a pelvic well. • This also applies to slide 15 on page 170, which shows inside thigh wedges with a pelvic well cushion. For more information on pelvic wells, see Key considerations for teaching this session for B.8: Prescription (selection) of PSDs – stabilizing the pelvis. 106 B.11: Prescription (selection) of PSDs –supporting the head, thighs and lower legs ToT Handbook • Slide 13: Knee separator pad. The height of the cushion increases at the front when a pre-seat bone shelf or raised seat front is added. Depending on the design of the knee separator pad this may affect its position in relation to the wheelchair user’s knees. c. Section 4. Supporting the lower legs and feet Problem: one or both knees bent and fixed less than neutral sitting posture (page 173). • An additional solution (not listed) is to add a raised seat front. This flexes the hips (closes the trunk to thigh angle) and brings the feet forward from underneath the seat. • Sitting with hips bent more than neutral does not increase the risk of developing contractures more than sitting in a neutral posture. However, it is good practice to advise wheelchair users to: – rest out of their wheelchair lying on their stomach to stretch their hips each day – spend time in their standing frame each day. 107B.12: Product (wheelchair) preparationToT Handbook B.12: Product (wheelchair) preparation Key considerations for teaching this session a. General Tips for preparation • Trainers need to be familiar with wheelchairs and materials that are locally available. Familiarize yourself during the planning stages of the training programme. If you are not based locally, you can do this by: – asking local services to send information and photographs of available materials – arriving before the training programme starts, with sufficient time to review prepared materials and to search for alternatives if necessary. • Resources required for the training programme may vary in each location depending on: – local manufacturing of garments, shoes or backpacks, which may increase access to different types of fabrics, webbing, buckles, Velcro and EVA – local furniture making and construction industries may increase access to different materials such as timber, plywood, fasteners and steel tubing. • There may be a supply of donated PSD components from international donors. For example, straps, head supports, harnesses or trunk side supports. • Review the information beginning on page 110 of the Reference Manual for Participants for general information about materials and tools, so that you can refer to it during the discussions. • It is helpful to have a trainer with good technical expertise for this session, and to have technical assistance for the product preparation. b. Section 1. Introduction • Consider which wheelchair offers the best features for the environmental and functional needs of the wheelchair user, and whether their fit and posture support needs can be adequately met by adding the required PSDs. Choosing your PSD’s based on the support provided during the hand simulation will give the best solution, as only the necessary posture support features will be provided. • Dedicated posture support wheelchairs can offer more features than the wheelchair user needs. If possible, remove those that are not needed. 108 B.13: FittingToT Handbook B.13: Fitting Key considerations for teaching this session a. General • Participants should be familiar with the fitting process from the WSTPb. • Basic level service provision is a linear process (one step after the other). Intermediate level provision is completed in cycles. Participants may need to use the fitting checklist repeatedly as the wheelchair and PSDs are adjusted and modified from the initial prescription (see slide 3, page 182). • If time allows, trainers can make the session more interactive. For example: – Using a volunteer, ask participants to demonstrate items on the checklist that they learned at the basic level check. • Most basic level wheelchair users are able to sit in an upright/neutral posture by the end of the fitting process. At the intermediate level, many wheelchair users will not be able to sit in an upright/neutral posture. Participants may be unsure if they have achieved the best possible posture for the user. If this happens: – Link the findings of the pelvis and hip posture screen and hand simulation to the final posture achieved at the end of the fitting process. • If the final posture does not closely match the posture achieved at the end of hand simulation, it may be due to: – assessment errors in the pelvis and hip posture screen – overcorrection of the postural problems during the hand simulation; which then require adjustment of the final prescription to improve comfort, balance or tolerance of the new posture – a long delay between assessment and final fitting; the wheelchair user’s posture may have changed since the assessment. In this instance, you may need to repeat the pelvis and hip posture screen and hand simulation. 109B.14: User trainingToT Handbook B.14: User training Key considerations for teaching this session a. General Tips for preparation • Lead and support trainers should review and practise the skills related to wheelchair mobility and transfers to ensure they are consistent in their approach. • Check that wheelchairs are in working order with all parts attached. • Make sure the wheelchairs chosen match the products in each of the stories as closely as possible. – Joshua: a product with tilt-in-space and anti-tip features. – Sangita: a children’s product (if possible) with quick release wheels, pelvis strap and pads. – Kim Som: a standard wheelchair with cushion and backrest PSDs. b. Section 2. User training – wheelchair user’s stories • Although only one person in each group is designated as the wheelchair service personnel, ask groups to work together to identify each skill that needs to be taught and the correct way to teach it. • The roles are designed to highlight the different aspects of wheelchair user training; it is not expected that only one person will complete the activity. • Closely monitor how the skills are taught. Participants should explain, demonstrate, observe the practice and give feedback. • Check that all the wheelchair features such as folding, removing/fitting removable parts such as rear wheels and trays, are demonstrated clearly to wheelchair users and their families. • It is essential that WSTPi participants understand the features and can demonstrate them competently to the user and / or their family. 110 B.16: Maintenance, repairs and follow upToT Handbook B.16: Maintenance, repairs and follow up Key considerations for teaching this session a. Practical follow-up activities Tips for preparation • The training timetable does not include practical follow up sessions. If time allows, trainers can arrange follow up appointments with local wheelchair users, either in a service or home environment. • Have some local wheelchairs available for this session to highlight any learning points or answer questions from participants. • Have a set of common care, maintenance and repair tools available to show participants. b. Section 2. Overview of follow up • All intermediate level wheelchair users will benefit from regular follow up. • Wheelchair users who need more frequent follow up (every 3 to 6 months) include: – children: PSDs must be adjusted to accommodate changes in growth, function (such as head or arm control) and/or posture – wheelchair users with progressive conditions or whose functional abilities or weight are likely to change. • Follow up can be the most difficult aspect of wheelchair service provision, especially follow up in the wheelchair user’s home. This may be due to limited resources for transportation; limited personnel available; or long distances between the service centre and the wheelchair user’s home. • Follow up appointments are very important. They help service providers to: – check that wheelchair users are able to use their wheelchairs safely – check that the wheelchair is working properly – carry out basic maintenance such as pumping up tyres and adjusting brakes – provide additional wheelchair user training – receive feedback on how the service is performing – collect wheelchair user stories that demonstrate the need for the service – understand how the products are being used and if they are appropriate for their environment and intended function. 111B.16: Maintenance, repairs and follow upToT Handbook • Where there are barriers to follow up, trainers can lead a discussion to find local solutions (if time permits). These could include: – using community-based organizations to carry out follow up – providing transportation assistance for wheelchair users to attend follow up appointments – creating a community schedule for follow-up, with personnel completing several home visits in one area – arranging follow up appointments when the wheelchair user is already in the area for another appointment, for example a doctor’s appointment. c. Section 3. Wheelchair follow up form • Remind participants that more maintenance and repairs may be required for intermediate level wheelchair users because: – their wheelchairs generally have more parts that can wear out or come loose – some intermediate level wheelchair users have strong spasms or patterns of sitting that can put extra pressure on PSDs. 112 Practicals one to fourToT Handbook Practicals one to four Key considerations for teaching this session a. General Tips for preparation Duty of care • Trainers have a duty of care to ensure appropriate wheelchairs, cushions and postural support devices have been provided to wheelchair users who have participated in the training programme. • Wheelchair users should not leave the training programme with a product that the trainer feels is unsafe or not functional for them or their family. If a wheelchair cannot be provided, ensure that another appointment is made with the user’s local service provider to complete the prescription, fitting and user training. • Trainers must identify the service or service personnel who are responsible for following up wheelchair users. All relevant documentation should be provided to the service provider, including assessment and prescription forms. • Trainers must provide wheelchair users with contact details of a local service provider who can provide assistance, repairs and follow up. Wheelchair users • Nominate a liaison person from the host organization or training team. Their role is to: – greet wheelchair users as they arrive for practical sessions – follow up with any wheelchair users who have not arrived for practical sessions – liaise between the service and the training team – identify a suitable area where wheelchair users and their families can wait for their appointments to begin – where food and refreshments are being provided, remind the catering service of everyone’s needs at least one day in advance – ensure photo permissions have been completed before any pictures are taken. 113Practicals one to fourToT Handbook Group allocation • Consider how you divide participants into groups to ensure a good learning experience: – It may be helpful to group participants from the same service together and to mix clinical and technical participants. – Consider grouping more confident/talkative participants together and less confident/quieter participants together as they may work at a similar pace. – Think about cultural considerations such as language and whether to have mixed-gender groups for assessments. Supervision of groups during the practical sessions • Allocate specific trainers to each group to help them coordinate practical sessions. • The lead trainer should supervise fewer groups if possible, so that they have enough time to check in with the support trainers. • Give participants the timing for each step in line with the Trainer’s Manual. • Monitor the time and regularly update participants on the time remaining. • Keep groups with the same trainer throughout the practical sessions. b. Practical One: Assessment and prescription (selection) Tips for preparation • Set up the practical area so that each group has enough space to complete their assessments privately. • A screen can be used if private rooms are not available (for example, to look at a pressure sore). • Provide each group with the equipment needed for the assessment and prescription. Assign responsibility to one group member to return the equipment after Practical Three. • Allocate a different team member to lead each part of the assessment and prescription to share the experience between the group members. • Encourage participants to wait for their colleague to finish each section before asking additional questions; the assessment process will flow more smoothly and the focus will stay on the wheelchair user. 114 Practicals one to fourToT Handbook Content • Monitor the physical assessment closely and help groups to correct errors that will influence the prescription (for example, errors with the pelvis and hip posture screen, hand simulation or incorrect measuring technique). • Trainers may want to perform the pelvis and hip posture screen independently to verify the participant’s findings. • Ensure that participants follow the sequence on the assessment form. For example, body measurements need to be converted to wheelchair measurements before deciding the wheelchair prescription. • The wheelchair user should be an active participant during the prescription process. Ensure that participants have discussed wheelchair options and features with the wheelchair user before the final prescription is made. • Have sample wheelchairs available to show wheelchair users and family members; this will help them to make informed decisions. • Ask each group of participants to explain the clinical reasoning for their prescription before signing their prescription form. c. Practical Two: Product (wheelchair) preparation Tips for preparation • Refer to the Technical Annex in this manual for more information on how to set up the room for product preparation. d. Practical Three: Fitting and user training • Ensure that sufficient time is allocated for user training; it should not be rushed. e. Practical Four: Assessment, prescription (selection), product (wheelchair) preparation, fitting and user training • Consider organizing participants into different groups to enhance their learning outcomes. • Remind participants to work in a structured manner to complete the first five steps of wheelchair service delivery in the time allocated. • Participants must allocate tasks to all members of their group. For example, during product preparation one person can complete wheelchair adjustments; another can prepare the cushion; and another can prepare PSDs. • Good task allocation will ensure that all steps are completed within the allocated time. 115B.15 and B.17: Putting it all together and Trainer’s feedback, discussion and closing ceremonyToT Handbook B.15 and B.17: Putting it all together and Trainer’s feedback, discussion and closing ceremony Key considerations for teaching this session Tips for preparation • Allocate a trainer to download and organize the before and after photographs needed to illustrate each presentation. This task should be done during a break. • Display before and after photographs side by side as an effective way of showing the impact and outcome of the fitting. Content • Allocate support trainers to help the groups prepare. • Tell participants that you will give them 5 and 1 minute warnings to ensure that each presentation is limited to 10 minutes. • Some participants may need support when choosing which information to include in their presentation. Use the Putting it all together section on page 49 of the Participant’s Workbook as a guide. • During the presentation and facilitation, trainers should highlight: – the link between the pelvis and hip posture screen, hand simulation and the final posture achieved – the link between the supports identified during hand simulation and final PSDs selected – how the selected wheelchair features meet the wheelchair user’s environmental and functional needs. • Facilitate discussion about the case studies presented, ensuring that questions and feedback from the group are balanced and focused on key assessment findings and interventions. • In less-resourced settings there is a limited range of wheelchairs and PSDs available. • Compromises are always necessary, it is a matter of finding the right balance between achieving the best possible outcome for the wheelchair user and keeping them safe at all times. 116 Logistics and PreparationToT Handbook Logistics and Preparation The Trainer’s Manual includes a comprehensive list of facilities, printed resources, materials and equipment needed to successfully organize a WSTPi training programme. The trainer coordinating the training programme will usually liaise with the local host to decide who takes responsibility for each aspect of the logistics and preparation. The trainees will gain experience and skills in handling logistics and preparation tasks during their co-training. The trainer coordinator will divide up these activities among trainees and then monitor and support them. Facilities A full list of facilities needed is included on page 14 of the Trainer’s Manual. Translation services may be needed if the WSTPi trainers do not speak the same language as participants. These services are usually in high demand and should be booked well in advance. Costs will need to be added to the training budget. Printed resources Materials must all be printed locally. A full list of printed resources needed for the WSTPi can be found on pages 15–16 of the WSTPi Trainer’s Manual. Use the checklist in the Trainer’s Manual to ensure that you have printed the correct number of materials. Materials and Equipment A list of materials and equipment needed for the WSTPi can be found on pages 17–18 of the WSTPi Trainer’s Manual. Wheelchairs The Trainer’s Manual, at the top of page 18, refers to examples of locally available wheelchairs and cushions. If there are many different wheelchairs available, select a range of the most commonly used models. If possible, include a floor seat for infants. Do not include motorized wheelchairs as these are not covered in the WSTPi. 117Logistics and PreparationToT Handbook Ensure that all wheelchairs are in good working order (tyres pumped up and bolts tightened) and have a cushion. There should be a wheelchair, cushion and postural supports – or materials to make cushions and postural supports – for each wheelchair user who attends the practical sessions. Technical work area A technical work area with a variety of tools and materials needed for modifications should be made available or created. This may have budget implications for the training. Power supply Where there is unreliable electricity, a generator with an in-line uninterruptible power supply (UPS) should be arranged for back-up. This also needs to be added to the equipment list on page 17 of the Trainer’s Manual. Planning for training The most important activities and approximate timelines for planning a WSTPi training programme are listed here. 8 to 12 months in advance • Develop a budget for the training programme. • When multiple partners are involved, agree on the responsibilities of different partners. • Identify dates, a venue, trainers, participant profiles and information on the local context such as: general policies and procedures that guide local wheelchair practice and services; types of wheelchairs, cushions and other materials available; information on local culture and diversity of the participants; and organizations involved. • To work out how many days are required for the training, confirm start and finish times for each day and whether translation will be required. 4 to 6 months in advance • Send invitation letters to each participant with details of the training programme (dates, venue, logistical information) to complete and return. 118 Logistics and PreparationToT Handbook • Gather information on the professional background and skills of participants so that you can adapt session plans accordingly. • Book training equipment. • Source demonstration equipment and other resources needed for the practical sessions, such as treatment beds, foot supports, and transfer boards. • Source consumables. • Source equipment for users (if user equipment is dependent on donor funds and/ or part of the training budget, sourcing equipment may need to start earlier). • Brief trainers on the context and participants, and agree on the division of sessions and roles. • Book catering services. • Arrange for translators and translation facilities if needed. 4 to 6 weeks in advance • Arrange for local printing of all necessary materials. • Screen and invite wheelchair users. • Finalize registration details: for example, arrange for name tags and registers; and liaise with whoever will carry out the registration. • Send final written confirmation/pre-course information to participants, wheelchair users and trainers. • Confirm caterers, venue and other logistics. 1 to 2 weeks in advance • Confirm that any ordered items have been delivered. • Check toilets, water and electricity supply at venue. • Confirm cleaning schedules. If the training team is not local, it is best to arrive a few days before the programme begins to check the equipment and the venue; meet with wheelchair users supporting the training programme; and to buy any remaining materials required. Regular communication will be needed between the coordinating trainer and other trainers, the host organization and other organizations involved. 119Logistics and PreparationToT Handbook Wheelchair users During the WSTPi, there are four practical sessions in which two groups of wheelchair users participate. The first group attends on two different days. Before the training programme, trainers need to identify and invite wheelchair users who are willing and able to attend the practical sessions. There is a checklist on page 11 of the Trainer’s Manual that helps to identify appropriate wheelchair users. Liaise with the host organization and training organizers regarding budgets and facilities available for wheelchair users. Find out if transport will be provided for wheelchair users or whether they will be reimbursed for costs. If wheelchair users are only able to attend on one day, the programme can be rearranged to accommodate Practical One and Practical Two for user group one on the same day. When adjusting the timetable, make sure service steps 2–7 have been covered before Practical Three. Where possible, trainers should screen wheelchair users in person. If trainers are not based locally, a local service provider can be asked to identify potential wheelchair users and send photos and information in advance for trainers to confirm their suitability for the training level. Invitations to wheelchair users When drafting invitations to wheelchair users think about the following issues (a template is available on the WSTP Pen Drive): • A description of what will happen when they attend the session. • The time, date and the duration of the session. • Can they bring someone with them? • Will they receive a wheelchair at the session? What happens if they need follow up or have any problems with the wheelchair? • Where will they receive follow-up services after the training? • How will they get to the venue? Will their transportation costs be reimbursed? • Do they have to bring refreshments and lunch? • Will they receive payment for attending? 120 Logistics and PreparationToT Handbook Each wheelchair user should receive an invitation letter with this information in writing. They should also sign a consent form to indicate their willingness to take part and to be photographed. The photographs are used when the small groups present back to the rest of the group. Despite careful planning, a wheelchair user may arrive with a pressure sore or fall ill on the day of the session. Discuss this possibility in advance with the host organization so that they are ready to manage the situation if it arises, and can arrange for a back-up wheelchair user to attend. If a wheelchair user has a bladder or bowel accident during the session, have supplies ready to clean the user and the equipment. Also, a small first aid kit should be available in case of bumps and scrapes to both participants and wheelchair users. 121AnnexesTrainer's manual Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equip- ment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 122 AnnexesTrainer's manual Annex 2: WSTPtot Intermediate Level Timetable Day one Day two Day three 8:30 Introduction B.5: Physical assessment – taking measurements B.10: Prescription (selection) of PSDs – supporting the trunk part II8:45 9:00 B.2: Physical assessment – sitting posture without support B.10: Feedback part II 9:15 B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs 9:30 B.5: Feedback 9:45 B.8: Prescription (selection) of PSDs – stabilising the pelvis10:00 Morning break 10:15 B.2: Physical assessment – sitting posture without support continued Morning break Morning break 10:30 B.8: Prescription (selection) of PSDs – stabilising the pelvis continued B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs 10:45 B.2: Feedback 11:00 11:15 B.3: Physical assessment – pelvis and hip posture screen ToT Trainer demon- stration session 11:30 B.8: Feedback B.11: Feedback 11:45 B.9: Prescription (selection) of PSDs – supporting the hips B.12: Product (wheelchair) preparation 12:00 12:15 12:30 Lunch break B.9: Feedback 12:45 Lunch break B.12: Feedback 1:00 Lunch break 1:15 1:30 B.3: Physical assessment – pelvis and hip posture screen continued1:45 B.10: Prescription (selection) of PSDs – supporting the trunk part I2:00 B.13: Fitting Afternoon break 2:15 B.4: Physical assessment – hand simulation 123AnnexesTrainer's manual 2:30 Afternoon break 2:45 Afternoon break B.10: Prescription (selection) of PSDs – supporting the trunk part I continued 3:00 B.4: Physical assessment – hand simulation continued B.13: Feedback 3:15 Afternoon break 3:30 B.4: Feedback ToT Trainer individual feedback 3:45 Car park 4:00 Session preparation ToT Trainer individual feedback B.10: Feedback part I 4:15 Car park 4:30 Session preparation ToT Trainer individual feedback Closing ceremony 4:45 5:00 5:15 124 AnnexesTrainer's manual Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 125AnnexesTrainer's manual Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 126 AnnexesTrainer's manual Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 127AnnexesTrainer's manual Annex 4: Technical annex WSTPi This annex aims to help trainers prepare for WSTPi practical sessions. At an intermediate level building an appropriate wheelchair becomes more complex; hands-on training is more demanding and it is important to understand the crucial role of the technician. At the planning stage trainers need to think about tools and materials, and how to get experienced technical support for training sessions. It is also important to encourage more technicians to train at an intermediate level to support the service. The technical role in intermediate level service provision As part of its suite of training programmes, WHO teaches seating principles and gives examples of postural support devices (PSDs) that are intended to be applied to a range of different wheelchairs. It is the clinician’s role to assess the user, prescribe (select) and communicate which PSDs are required. It is the technician’s role to understand how to build a wheelchair that will achieve the final postural support needed; that is practical, safe, durable and as easy to use as possible, using the wheelchairs, tools and equipment, materials and parts that are available. At basic level the technician’s role is clearly defined as assembling and adjusting the wheelchair to suit the user; the process is more linear and the role simpler. As well as assembling wheelchairs, a technician working at an intermediate level needs to: • be more involved with the user and the clinician throughout the process • be able to problem solve more independently • easily imagine and orientate three-dimensional shapes • have the technical skills to make appropriate PSDs from a range of materials and parts. Teamwork and good communication with the clinician is very important. The role of the technician extends to maintaining a safe working environment in the workshop and looking after tools and equipment. As the clinical/technical team gradually gain experience and have exposure to wheelchair users with more complex postural support needs, they will challenge and improve their skills. An experienced technician learns to understand the limits of what can be safely achieved with the available resources. It may be possible to make a complex PSD, but that doesn’t guarantee that it will be an appropriate, safe or durable solution for the user and their family. For example, a PSD that supports the 128 AnnexesTrainer's manual user well but is made from materials that are not durable or are attached insecurely, is only going to last a short time and is therefore not an appropriate solution. Training more technicians The WSTPb and WSTPi are intended to increase both the quantity and quality of practitioners providing wheelchairs in less-resourced settings. Assembly and adjustment is very specific to each type of wheelchair, which is why this information is not included in the training packages and is often covered separately by the organization delivering the training. Involving technicians as participants in the WSTPi is very beneficial. The more they understand about the eight wheelchair service steps, the better technical support they can give. Some organizations train technical and clinical personnel at the same time, but require them to achieve different competencies at this level depending on what their on-going role in service provision will be. Each service provider or training organization will need to identify the best way to support technicians to develop intermediate level capacities to help meet more complex needs. The role of technicians in WSTPi training Trainers are encouraged to have at least one experienced intermediate-level wheelchair technician available to assist during WSTPi practical sessions. This is particularly important if you plan to make PSDs, and are not using off the shelf or pre-fabricated PSDs. Include an experienced intermediate level technician and/or technical trainer on the training team throughout the course to deliver technical content and answer technically-related questions about wheelchairs and PSDs. Setting up the training room for practical sessions Making PSDs requires care and time, so trainers and technicians must be well organized to keep to the timetable. You might want to consider making some common PSDs in advance. 129AnnexesTrainer's manual The following suggestions will help you to set up a safe, well-organized training workshop: • Arrange a separate temporary space which: – is close to the clinical training room – has enough light and is well ventilated – has enough space for each technician to have a work bench or strong table – has space for a separate work bench for glueing in a well-ventilated location – has a separate area set aside if using power tools and machinery. • An untidy workshop is unsafe and will increase the risk of accidents. Tidy the space at the end of every day, putting tools away and sweeping floors. • Protect the surface of benches and tables with cardboard. This is particularly important when cutting and glueing foam. • Left-over foam off-cuts should be separated from general waste and kept in boxes. Participants should be encouraged to use off-cuts first, before cutting into new foam. • When working with a technical team, or training technicians, assign specific responsibilities to each of them. For example make a technician responsible for a specific tool kit, ask them to collect all the tools at the end of each day and check the tool kit is complete before leaving. Standing frames There are many designs of standing frames and they can be made locally. Before prescribing a frame, service personnel need to fully understand the wheelchair user’s standing posture and the different ways to support them in an upright position. It is important to follow the guidance on page 45 of the WSTPi Trainer’s Manual. There are three main technical issues to consider: • Strength – A standing frame needs to be strong enough to safely support the body weight of the user. The joints and lengths of material that make up the frame must be strong enough and connected securely together. The person might move around so consider the force that this will put on the frame. Test the strength and stability of a new device before use. 130 AnnexesTrainer's manual • Stability – It is important that a standing frame remains completely stable while in use, including when the user is getting into position and when standing up. This is usually achieved by having a wide base of support on the ground. • Safety and comfort of support surfaces – Make sure there is no direct pressure on the knees. The support surfaces of the frame that come into contact with the body should be padded just like a pressure relief cushion. Further considerations: • Frame design should allow for easy access when approaching in a wheelchair. • Some degree of height adjustment to the hip, knee, pelvis and trunk support will be needed to accommodate wheelchair users of different heights or ages. • A flat surface such as a tray or table should be included, to enable activities while standing. Foam Two measures are used to assess the quality of polyurethane (PU) foam: • Firmness − the degree of support provided. Firmness is often confused with density, but is a different property. Firmness is a physical property of the finished foam and is controlled by the chemistry of the foam during the production process. The firmer the foam, the harder it is to compress. The firmness of the foam can be measured by recording the amount of force needed to compress the foam. • Density − a measurement of the mass (weight) per unit volume expressed in kilograms per cubic metre (kg/m3). Density is a function of the chemicals and additives used to produce the foam and affects the foam’s durability. Typically, the higher the density, the better the foam will retain its properties and provide support and comfort over a longer period. 131AnnexesTrainer's manual Foam testing device Use the foam testing device below (Figure 1) to carry out a simple compression test to calculate firmness of a foam sample. Measured in kilograms the results can be compared against a benchmark and other available foams. The foam testing device consists of two metal parts, that are shown from different angles here: Figure 1. Foam testing device These parts are suspended from a weighing scale or spring balance (Figure 2). 132 AnnexesTrainer's manual Figure 2. Compression testing procedure The procedure for 50% compression testing is as follows: Step 3.Weighing scale 1. Cut the 50 x 50 x 50 mm foam sam- ple as accurately as possible and punch a 6.5−7.5 mm hole in the centre. Step 1. Foam sample ready for testing 2. Hang up the scale or spring balance; do not hold it. 3. Place sample in testing device and hang from scale or spring balance. 4. Check that scale reads zero. 5. Push down evenly on the top plate only, compressing sample to 50%. Note 25 mm marks on testing device. Step 5. Push down on the top plate only 6. Record weight in kg. 133AnnexesTrainer's manual Testing notes • Take at least three measurements and average the results. To minimize error the same person should take all the measurements. • When testing samples cut from moulded foam do not include any external foam skin. Guidelines for the use of different types of foam The following numbers are intended as guidelines only; it is always recommended to prototype and user-trial any new PSD or Pressure Relief Cushion which uses foam. Firmness test results were produced using the testing procedure outlined previously Name Application Density 50% compression test (kg) Medium PU foam Comfort layer : top cushion layer, surface layer 30 kg/m3 to 60 kg/m3 2.2 to 3.5 kg* Firm PU foam Supportive layer : base layer,** contours, cushion wedges (under comfort layer) 30 kg/m3 to 60 kg/m3 3.5 to 5.8 kg PU: polyurethane. * This acceptable range of kg includes a variation in test results of ± 0.3 kg. ** Chip, composite, re-bonded or bonded foam can also be used, but can vary in firmness because it is an industry waste product. Foam shapes for temporary support and PSD simulation A range of firm foam blocks and wedges are useful for training. In addition to the basic blocks used for temporary support, other shapes can be used to help simulate different options in the wheelchair user’s chair. For example: • Adding a wedge of foam to the front of the backrest to simulate an open seat-to- backrest angle. • Adding extra foam to the pelvis side pads to simulate a narrower seat width. • Adding foam to the seat to simulate outside thigh wedges. • Adding foam blocks together to simulate different angles for a lowered seat front one side. 134 AnnexesTrainer's manual In some situations where the user’s postural support needs are very complex, it may be necessary to first finalize the size, shape and location of PSDs by making them with a less expensive material. Once the final prescription (selection) for the PSDs has been agreed, they can then be made using better-quality foam. Commonly available foam thicknesses are: 25 mm or 35 mm. Thinner foam (such as 10 mm or 15 mm) may be useful for very small children or when only slight increments of change are required, for instance when constructing a build-up under pelvis. Thinner foam may need to be cut from thicker foam. When doing this it is important to have the best quality foam available and a very sharp knife. Illustrations below (Figure 3) show sample basic foam shapes; dimensions can be adjusted to suit the context. For example, common sizes for adult temporary supports are 200 x 200 mm and for children, 200 x 100 mm. Figure 3. Suggested dimensions (in mm) of the basic foam shapes for temporary supports 135AnnexesTrainer's manual Wedges of various dimensions and thicknesses are very useful for training purposes. The illustrations below (Figures 4−8) show sample foam wedges; dimensions can be adjusted to suit the context. Common thicknesses are 35 and 50 mm, common lengths range between 100 and 200 mm. Figure 4. Sample foam wedges 136 AnnexesTrainer's manual Figure 5. Example use of temporary supports Figure 6. Example use of wedges to simulate a lowered seat front on one side Figure 7. Example use of outside thigh wedges 137AnnexesTrainer's manual Figure 8. Example of open seat-to-backrest angle wedge and pre-seat bone shelf Advantages and disadvantages of seating simulators A seating simulator is a device that clinicians and technicians sometimes use to simulate the posture that a wheelchair user will adopt, before preparing the final wheelchair. They are specifically designed to be adjustable in every way necessary to support the user. The simulator is used at the end of the assessment process, after the hand simulation, to inform the wheelchair prescription. There are advantages and disadvantages of using seating simulators: Advantages • Less waste − Seating simulators can minimize wastage (and therefore recurring service costs) because the wheelchair and PSDs are only prepared after the user’s final posture has been achieved in the simulator. • Save time − Seating simulators can save experienced clinicians’ and technicians’ time when fitting the wheelchair and PSDs, as the final posture is already known before the wheelchair is prepared. 138 AnnexesTrainer's manual Disadvantages • Short cuts − Less experienced personnel may use the seating simulator as a short cut instead of performing a full assessment and hand simulation process to determine the postural supports needed. It might also limit the type of postural supports considered to include only those on the seating simulator. This could result in the user not achieving their full postural potential in the final wheelchair. • Skilled technicians – It takes technical skill to design and make a safe and durable seating simulator. It also takes skill to translate the support provided by a seating simulator into the final wheelchair and PSDs. It is particularly challenging if the service uses a range of different wheelchairs that provide postural support in various ways. • Cost – The initial one-off cost to buy seating simulators may be high but could be offset against savings made later in recurring service costs. It may also be possible to reduce the costs by converting a wheelchair (and PSDs) commonly used by the service into a seating simulator, by modifying it and adding adjustments. • Heavy and large – Seating simulators are often larger and heavier than the final wheelchairs. This makes it more difficult to travel with them away from service centre. Introducing the total seat depth tool There are two postural support devices (PSDs) that are placed behind the pelvis. It is important to understand the space that they take up in the wheelchair before deciding whether the user will fit in comfortably as well, or whether a different wheelchair is needed. Here is a simple tool to help work out the total seat depth (including the thickness of either an open seat-to-back angle triangle or a rear pelvis pad) using measurements from the intermediate assessment form: 139AnnexesTrainer's manual Figure 9. Calculating total seat depth Wheelchair & PSDs Dimensions (mm) Support behind pelvis: (Z) Height of triangle or (9) Height to midpoint (Y) Thickness (3) Seat depth (3 + Y) Total seat depth If the chosen wheelchair is big enough to accommodate the total seat depth, then it will fit the user’s seat depth and their PSDs will fit into the seat. (3) (Y) (9) (Z) (Y) Open seat-to- back angle:  Rear pelvis pad:  (3) Product preparation Product preparation at an intermediate level involves the assembly of intermediate wheelchairs and the fabrication of PSDs. More problem solving is required than at the basic level, which is a straightforward process of assembling wheelchairs. Understanding what shape is required to support the user’s posture and then making an appropriate PSD, often requires imagining and orienting three-dimensional shapes. This process is made easier by using the drawing tool on the Intermediate prescription form, which has ‘shadow’ lines (Figure 10). After defining the size and shape of the proposed PSD, the technician decides how to make it and which materials to use. It is important that the final PSD is practical, safe, durable and as easy to use as possible. The technician’s role is easier when the user is smaller, has fewer postural issues and is using an adjustable seating product that incorporates various PSDs. However, the task becomes more challenging when the user is larger, has a combination of complex postural issues and makes strong, uncontrolled movements. A great deal more skill, technical knowledge, time, materials and parts, and problem solving ability is needed to fabricate appropriate PSDs for these users. The technician needs to be familiar with how to assemble each type of wheelchair available to them. The way that PSDs are made and attached differs from one type of wheelchair to another. The technical role is different if a dedicated posture support wheelchair with built-in adjustable postural supports is available, compared to working with an orthopaedic style or other manual wheelchair. Figure 10. Intermediate prescription form drawing tool 141AnnexesTrainer's manual Despite the differences in the wheelchairs, the different methods of making PSDs and the individual nature of each user’s seat; there is a general order for product preparation: 1. Seat depth – Just as clinicians are taught to start with the pelvis and work outwards, so a technician should start with the PSDs that support the pelvis. Using the total seat depth tool will make it easier to prescribe (select) the most appropriate size of wheelchair or seat. Next, the technician can make the pre- seat bone shelf (and any other PSDs on the seat such as lower seat front one side, or raise seat front). If the PSDs on the seat are being made from foam, use the minimum amount of glue necessary to hold them in place for the first fitting, as their size and location are likely to change (particularly during training). 2. Pelvis strap – As a starting point, the pelvis strap should be fitted between 60 and 90 degrees to the seat, at approximately the same location as the pre-seat bone shelf. 3. Pelvis side pads or seat width − It is important to work out how the seat will support the user’s hips, to prevent them from sliding sideways. In many situations a bracket and pad will be used. 4. Remaining seat PSDs − On some wheelchairs it is necessary to attach all remaining PSDs that are going to be added to the seat, for example any hardware needed for mounting a knee separator pad, before moving on to other parts of the wheelchair. After the seat is complete, technicians can work outwards towards the head and feet: 5. Backrest − The height of the backrest should be set and any backrest-mounted PSDs should be attached. 6. Head support − If a head support is required, set it and make any other adjustments necessary. 7. Footrests − The height, angle and position of the footrests should be set. PSDs such as foot wedges, foot build-ups, ankle or foot straps will often need to be repositioned during the first fitting. 8. Shoulder harness − If a harness is required, the uppermost end should be attached level with or above the user’s shoulder. Harnesses attached below the top of the shoulders will tend pull the user’s shoulders down. 142 AnnexesTrainer's manual It is important that every wheelchair is safe for the user to sit in for each fitting. The technician and clinician need to make a judgement about this, paying particular attention to areas at risk of pressure sores, or PSDs that are being used but are not completely finished. The Safe and ready checklist should be used, however some parts of the wheelchair do not need to be 100% complete for the first fitting. For example: • The fabric upholstery can be left off. • Attach foam parts with ‘spots’ of glue rather than full coverage so that they are easier to separate if changes are required. • If the team is unsure whether a particular PSD is required or not, it is acceptable to leave it off and make a decision during the first fitting; for example, trunk side wedges or a shoulder harness. • Attach the footrests according to the body measurements that were taken, but leave ankle or foot straps off until the user is sitting in the wheelchair and the final location of the footplates is set. • If fitting a tray, leave it until the user is sitting in the wheelchair in their final posture before adjusting it. Because it is not safe, do not: • leave frame bolts loose • leave bolts attaching the rear or castor wheels, push handles, seat, backrest, brakes or any PSDs loose • leave sharp edges unfinished or exposed. After the final fitting, the wheelchair and PSDs should be checked and signed off by one of the trainers. This should happen before the team completes final finishing such as full coverage glueing (for all remaining ‘spot’ glued foam), finalizing the upholstery, or painting/varnishing components. A comprehensive Safe and ready check must be completed before the user and their family leave with the wheelchair. 143AnnexesTrainer's manual Additional technical resources Resource Content/page references Guidelines on the provision of manual wheelchairs in less resourced settings • Wheelchair design and production-related information, including testing, page 37–65 WSTPb Reference Manual for Participants • Making a pressure relief cushion, page 57−60 WSTPi Reference Manual for Participants • How to make PSDs, page 112−128 WSTPm Additional Resources for Managers • Information to support managers developing services, including information about technical resource management

146 AnnexesTrainer's manual For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/

DR AF T Managers and Stakeholders Wheelchair Service Training OF Traine rS Package ToT handbook DR AF T DR AF T Managers and Stakeholders Wheelchair Service Training OF Traine rS Package ToT handbook Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. 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Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology The following terms used throughout the WSTPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainee in specific WSTPb/i/ m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms The following acronyms used throughout the WSTPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package C O N T EN T S x about the Wheelchair Service Training of Trainers Package xiii Guidelines for preparing practice delivery sessions 1 core training skills module 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot) 3 ToT.2 Wheelchair service training packages 10 ToT.3 Practice delivery sessions 15 ToT.4 Preparing for diversity 20 ToT.5 Adult learning 27 ToT.6 Preparation time 28 ToT.7 Presenting and facilitating 33 ToT.8 Communication skills 37 ToT.9 Knowledge of guiding documents 55 ToT.10 Audio-visual tools and equipment 61 ToT.11 Feedback 63 ToT.12 Managing group dynamics 68 Managers/Stakeholders module 69 Introduction to the WSTPtot Managers 75 WSTPm logistics and preparation 77 WSTPm Practice deliveries 78 Welcome, introduction and overview 79 A.1: What is appropriate wheelchair provision? 81 A.2: Service delivery 82 A.3: Managers who lead change 83 B.1: Accessing services 84 B.2: Facilities and equipment 86 B.3: Range of appropriate wheelchairs 88 B.4: Align personnel 91 B.5: What does a wheelchair service cost? 92 C.1: How do you know if your service is working? 94 C.2: Managing demand 96 C.3: Planning follow-up 97 C.4: Planning for financial sustainability 98 Putting it all together 101 WSTPtot Stakeholders reference material 102 Introduction to the WSTPtot Stakeholders programme 105 WSTP Stakeholders – logistics and preparation 109 WSTPs practice deliveries 110 S.1: Introduction 112 S.2: Policy to practice 115 S.3: Range of appropriate wheelchairs 117 S.4: Working together for change 119 Closing address 120 Annexes 120 Annex 1: Timetable for WSTPtot core sessions 121 Annex 2: WSTPtot Managers and Stakeholders Timetable 123 Annex 3: Feedback sheet for WSPTtot practice delivery sessions 126 Annex 4: WSTPm/s planning tool x About the Wheelchair Service Training of Trainers PackageToT Handbook about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United States Agency for International Development (USAID) developed a series of four training packages to increase wheelchair access in developing countries. The Wheelchair Service Training of Trainers Package (WSTPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. The need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WSTPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. The WSTPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WSTPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WSTPi) 2013; the Wheelchair Service Training Package for Managers (WSTPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WSTPs) published in 2015. The WSTPm and WSTPs have been combined into one package-specific module within the WSTPtot. The WSTPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WSTPtot, you will go forward to deliver the training packages alongside experienced trainers, allowing you to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiAbout the Wheelchair Service Training of Trainers PackageToT Handbook how to use the ToT Handbook This ToT Handbook provides a step-by-step guide to the WSTPtot including information on how to deliver the package-specific modules. It has been developed for you to use during the WSTPtot programme itself and to keep as a reference when planning and delivering the WSTP in the future. Target audience The WSTPtot is made up of four modules: • Core training skills – two days • Basic Level (WSTPb) – three days • Intermediate Level (WSTPi) – three days • Managers and Stakeholders (WSTPm/s) – three days. You should complete the Core training skills module followed by one of the package-specific modules, which will be chosen based on your training goals: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WSTPb. Previous experience providing basic-level wheelchairs is essential; the WSTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WSTPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WSTPi. Previous experience providing intermediate-level wheelchairs is essential; the WSTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WSTPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WSTPm and WSTPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the Managers and Stakeholders module. You should have access to co-training opportunities within three months of completing the WSTPtot in order to consolidate and practise newly acquired skills. assignment of practice deliveries After completing the Core Training Skills module, you will go on to the second part of the WSTPtot where you will practise the skills you have learnt by delivering sessions from your WSTP. xii About the Wheelchair Service Training of Trainers PackageToT Handbook You will be allocated sessions on the first day of the Core training skills module, during ToT.3 Practice delivery sessions. You will also be assigned a ToT trainer as a mentor at this time. Time is included within the training programme to prepare for your session and consult with your ToT trainer mentor. The practice delivery session is followed by feedback and discussion, and the whole process allows the ToT trainer to observe and assess your skills. To enable you to prepare well for the WSTPtot, you will be sent the package- specific materials in advance. You should arrive prepared to deliver any session. Note: Some practice delivery sessions have been adapted for the WSTPtot, by either shortening the time allocated or not delivering parts of the session. These changes are for the purposes of the WSTPtot only and should not be followed when delivering the WSTP. xiiiGuidelines for preparing practice delivery sessionsToT Handbook guidelines for preparing practice delivery sessions lead trainee • Read the session plan assigned to you in your WSTP Trainer’s Manual and make sure you understand all the material. Try out the activities yourself to make sure you know what your participants will be expected to do. Only prepare for the specific sections/sessions allocated to you. • Read the relevant sections of the WSTPb/i/m Reference Manual for Participants and Participant’s Workbook (not available for the WSTPs). • Read the relevant section of the ToT Handbook for your session/s including the Key considerations for teaching this session. • There are some known errors in the WSTP materials that are listed in this handbook; check your session to see if it has errors and make the recommended changes. • Edit the PPT slides as appropriate. • Incorporate your own knowledge and experience, including case studies if appropriate. • Practise your delivery, including timing. • Meet with your support trainers and plan how to work as a team: – assign roles, such as timekeeping or writing on the board – for group activities involving practical skills, practise together and discuss which errors to look out for and how to correct them. Support trainee/s • Read the session plan in your Trainer’s Manual. • Support the lead trainee as requested. Before the session starts • Upload your PPT slides onto the training laptop before the start of the training day. • Set up the room and training materials as needed. • Check that the audio-visual equipment is set up and working correctly. xiv Guidelines for preparing practice delivery sessionsToT Handbook co-training After completing the WSTPtot, you should continue to develop your skills by co-training alongside experienced trainers. The recommended ratio for co-training is one mentor trainer to two-to-four co-trainers. In some cases, ToT trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. This information will be recorded in the Feedback sheet for WSTPtot practice delivery sessions and shared with the trainee. Mentoring and peer support You are encouraged to keep in contact with your ToT trainer/s after the WSTPtot to update them on progress and to consult them for advice. You can also get valuable ongoing support from your peers, which will help to develop your skills and confidence. You may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. Core training skills module 1Core training skills moduleToT Handbook ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot) Structure of the WSTPtot The ToT programme consists of a two-day Core training skills module followed by a three-day module chosen from the basic (WSTPb), intermediate (WSTPi) or managers (WSTPm) and stakeholders (WSTPs) series. This package-specific module provides practical opportunities to develop your skills and confidence as a WSTP trainer. It will also highlight some of the common challenges that can come up when delivering the WSTP and will offer solutions. Overview of the WSTPtot process After the completion of the ToT programme, you should co-train until you are confident and competent to be an independent trainer. The number of co-trainings will vary from person to person. ToT trainers and trainers who mentor you while co-training will support you to decide whether you should continue co-training or train independently. Core training skills Package- specific Co-trainer Trainer If you are not able to co-train with a more experienced trainer after the in-person ToT, WHO encourages you to seek virtual support and coaching from a ToT trainer and to connect with other ToT trainees to support each other through the planning, preparation and delivery of the WSTP. Feedback and self-assessment During practice deliveries in the package-specific modules, you will use the Feedback sheet for WSTPtot practice delivery sessions, including a list of trainee skills, to reflect on your performance. The ToT trainer will provide written feedback on this form at the end of the ToT programme, which will help you to continue to improve your training skills moving forward. This form can be found in the annexes of this manual. 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot)ToT Handbook ToT.2 Wheelchair service training packages Background1 2 The WSTP have their origins in the Consensus Conference on Wheelchairs for Developing Countries held in Bangalore, India, in November 2006.1 The consensus conference laid the foundation for the development of the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings,2 which were published by WHO in partnership with the International Society for Prosthetics and Orthotics (ISPO) and the US Agency for International Development (USAID) in 2008. The wheelchair is one of the most commonly used assistive devices for enabling personal mobility, but there were very few training opportunities for service providers to ensure that wheelchair users could attain personal mobility with the greatest possible independence, be productive and enjoy a high quality of life. The WSTP Basic and Intermediate Level were developed to implement the Wheelchair Guidelines, by training wheelchair service personnel in less-resourced settings in comprehensive wheelchair service provision, which enables increasing numbers of adults and children to receive a wheelchair which meets their needs. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 3ToT.2 Wheelchair service training packagesToT Handbook The four WSTP3 4 The Wheelchair Service Training Package – Basic Level3 (WSTPb) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. The Wheelchair Service Training Package – Intermediate Level4 (WSTPi) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. Both WSTPb and WSTPi are designed to be delivered in a minimum of five days. However, the actual time required for each session will vary. Additional time will be needed if you: • Add material to session plans • Include additional sessions relevant for the context or skill level of participants • Increase the number of practical sessions with wheelchair users • Require translation • Provide more preparation time for products used during the training • Reduce the length of the training days to fit local contexts • Are teaching participants with limited experience or formal qualifications. 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who. int/disabilities/technology/wheelchairpackage/en/). 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4 ToT.2 Wheelchair service training packagesToT Handbook If you would like to add sessions to the training timetable, The International Society for Wheelchair Professionals (ISWP) has a website which contains some additional resources. Please see: http://wheelchairnet.org/resources. The Wheelchair Service Training Package for Managers5 (WSTPm) is designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. It can be delivered in a minimum of two days. The Wheelchair Service Training Package for Stakeholders6 (WSTPs) is designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting.5 6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 5ToT.2 Wheelchair service training packagesToT Handbook Guiding principles The WSTP has been developed following a set of guiding principles: • user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service. • following available evidence-based, international best practice. • a focus on less-resourced settings, with products and training appropriate for the setting. • inclusion of wheelchair users as trainers and participants in all training packages. • use of accessible, non-medical language and terminology so that: – participants without clinical or technical qualifications can be trained – service personnel can use terms that are easily understood by wheelchair users. WSTP components Each package contains a range of resources. WSTPb, WSTPi WSTPm WSTPs Trainer’s Manual ü ü ü PowerPoint presentations ü ü ü Videos ü ü ü Set of posters ü selected posters selected posters Supplementary resources: Wheelchair Guidelines, CRPD ü ü ü Reference Manual for participants ü combined Participant Workbook ü Forms and checklists ü – Additional Resources: including tools, equipment, and forms – ü 6 ToT.2 Wheelchair service training packagesToT Handbook Activity 1: Getting to know the Trainer’s Manual Working together in your group, use your Trainer’s Manual to answer the questions below. Write your answers next to the question. Question Answer 1. Where can you see a list of everything included in the Trainer’s Manual? 2. How are group activities shown in the sessions? 3. Where can you find the overall aim or purpose of the training package? 4. How does the session plan indicate when the trainer should show a PowerPoint slide? 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? 7ToT.2 Wheelchair service training packagesToT Handbook How to use the WSTP Trainer’s Manual Manual Each Trainer’s Manual gives an overview of the relevant package and provides specific guidance notes for trainers. Each section should be reviewed carefully before preparing to deliver the WSTP. Annexes Annexes with supporting information can be found in the back of the Trainers’ Manuals for WSTPb, WSTPi and WSTPs; they include copies of forms and checklists. Session plans Individual session plans work like a recipe to guide trainers through the session. Following the session plans will help you to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Video boxes When a video needs to be shown, a video box is included in the Trainer’s Manual along with one of the video icons. • It is important for you to be familiar with the content, relevance and timing of all the videos. Trainer’s notes Trainer’s notes are included throughout the WSTP, including: • most important answers to questions • guidance about group activities or • additional information that can assist trainers to answer questions from participants. 8 ToT.2 Wheelchair service training packagesToT Handbook Activity boxes Activity boxes guide trainers by providing the following information: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Key point summary Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 9ToT.2 Wheelchair service training packagesToT Handbook ToT.3 Practice delivery sessions Introduction Record how confident you feel to deliver the WSTP package/s you are here to learn, on a scale of one to 10: 1 2 3 4 5 6 7 8 9 10 Not confident Very confident Structure and aims of the package-specific modules Package-specific modules include opportunities for you to deliver sessions from the WSTP you have chosen to learn. The aim is to enable you to: • practise using the WSTP training materials • practise delivering sessions to your peers • clarify your understanding of the WSTP theory, principles, skills and methodology • learn about the common challenges that can occur when training and find ways to manage them • develop your trainee skills (see the list in the Feedback sheet for WSPTtot practice delivery sessions in the Annexes of your ToT Handbook). Roles of lead and support trainers and ToT participants • You will have the opportunity to be both a lead trainer and a support trainer. • When two or more lead trainers are allocated to the same session, one will automatically assume the support trainer role when they are not presenting. • If there is only one lead trainer for a session, he/she may request help from any of the other ToT participants. • For some practical sessions, the support trainer may have a specific role identified and assigned. 10 ToT.3 Practice delivery sessionsToT Handbook Activity 1: Lead and support trainers What are the roles of the lead trainer? What are the roles of the support trainer? 11ToT.3 Practice delivery sessionsToT Handbook What are the roles of the lead trainer? What are the roles of the support trainer? • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainer • contributing to the overall feedback/ reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Teamwork Trainees will need to work together as a team to deliver their sessions. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage session time • clarify errors during the session delivery • answer questions from participants • manage disruptions and interruptions. Trainers as role models Trainers should set positive examples of professional behaviour and practice. Model the behaviour you want to see from participants by: • being on time and well prepared • problem solving and finding solutions for challenging situations • providing positive and constructive feedback • managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. 12 ToT.3 Practice delivery sessionsToT Handbook Remember, being a good trainer and role model does not mean you always need to know the answers to questions. If asked questions you do not know the answer to, do not pretend to know the answer. Instead you can: • Ask support trainers if they know the answer • Ask participants if they know the answer • Agree to find out the answer before the training programme finishes (add to Car Park). Reflection and feedback Learning to reflect on your own delivery is an important skill for a trainer. It is also important that trainers are able to give constructive, guiding feedback to training participants. This is why reflection and feedback skills are incorporated into the ToT programme. At the end of each practice delivery session the lead trainer/s will be asked to reflect on: • what was good and what went well • what can be improved. The ToT trainer will then facilitate brief feedback from ToT participants, and finally the ToT trainer will add anything not already mentioned by the lead trainer or ToT participants. Preparing for practice delivery sessions Your preparation for a practice delivery should include the following: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainer. • Prepare the resources you need for the session. 13ToT.3 Practice delivery sessionsToT Handbook If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. Known errors There are some known errors in the WSTP Trainer’s Manual, Participant Workbooks and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Confidence in presenting • You may feel nervous during your first session deliveries in front of your peers and ToT trainers. This is normal! • You will grow in skills and confidence as you deliver more sessions. • You will be required to present feedback from group activities during the Core training skills module – use this as an opportunity to practise presenting to your peers. PPT presentations • The standard PPT for each session will be available on the training laptop with the video already embedded. • If you make any changes to your PPT such as adding slides, you will need to upload it onto the training laptop before your practice delivery. Time limits for session delivery • Time will be strictly monitored during practice deliveries. • If you go over your time, the ToT trainers will stop you and move onto the next trainer, or end the session. 14 ToT.3 Practice delivery sessionsToT Handbook ToT.4 Preparing for diversity WSTP trainers often encounter diversity and must understand how to manage a diverse training group. People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity. Culture and diversity Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Remember that we all belong to more than one cultural group and we are all diverse in many ways. Cultural competence Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. It can relate to individuals, groups or organizations and it can be learned. Cultural competency typically involves: • awareness of your own cultural practices • knowledge of different cultural practices • a positive attitude towards cultural differences • understanding how culture impacts on interactions. Cultural competence for trainers You must ensure they have the required knowledge, skills and attitudes to understand and appreciate cultural differences; this includes respecting and accommodating other people’s cultural beliefs, behaviour and needs. 15ToT.4 Preparing for diversityToT Handbook If differences in culture are not understood and respected by WSTP trainers, these differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. Potential cultural considerations • Physical contact: It may be culturally inappropriate for a female trainer or participant to assess a male wheelchair user, or for a male trainer or participant to assess a female wheelchair user. • Clothing: You must ensure that your dress is culturally appropriate. • Communication: In some cultures participants may not answer questions unless they are asked directly. • Eye contact: It may be impolite to look at someone directly when you are speaking to them. • Feedback: Be aware of what is acceptable for participants when giving and receiving constructive criticism/feedback in their society. • Gender: In some cultures it will not be appropriate for men and women to be paired together for activities, or to eat together; this may affect the organization of group work and refreshment breaks. • Religious beliefs: Longer break times, or different start/finish times, may be needed to fit in with local religious practices such as festivals, fasting or prayer. Activity 2: Cultural competence Think about and write down examples of when you experienced a culture different from your own. What was it like? 16 ToT.4 Preparing for diversityToT Handbook How did you feel? What did you learn from the experience? Including wheelchair users and people with disabilities in the WSTP The WSTP promotes the inclusion of wheelchair users in training teams and as participants. This is important because: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of, combat stigma, and reinforce the principles of the CRPD. 17ToT.4 Preparing for diversityToT Handbook Barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society To include wheelchair users and other people with disabilities in the WSTP, WSTP trainers must understand what might prevent people with disabilities from being included in society. Perceptions People are often not familiar with disability and have incorrect assumptions about people with disabilities. • Many people think that persons with disabilities do not have, or are not able to achieve the same goals and dreams related to family, work, leisure, social and personal lives. • They think that because someone has a physical disability they also have a cognitive impairment and treat the person like a child, talking slowly and loudly, or they address the person accompanying the person with a disability. Attitudes Negative attitudes towards people with disabilities can include: • A view that people with disabilities have less value in society because of their impairments. • Patronizing people with disabilities as objects of charity. • Avoidance of people with disabilities because they are unfamiliar with them, or because they are afraid to say the wrong thing. • Low value put on educating children with disabilities by families, community leaders and institutions such as schools. People with disabilities have limited opportunities without an education. Beliefs Beliefs are closely related to attitudes and can also create barriers. For instance, believing that someone’s impairment will prevent them from accomplishing tasks that they are in fact able to do. 18 ToT.4 Preparing for diversityToT Handbook Culture Cultural beliefs, norms and values may also create barriers. In some cultures, it is believed that people with disabilities are cursed so they are excluded from their families and communities; sometimes they will isolate themselves and hide away. Stereotypes These are negative views that do not recognize people with disabilities as individuals with their own interests and skills who can contribute to society. Legislation and policies Legislation and policies protecting the rights of people with disabilities often exist but are not enforced. For example, some countries have employment legislation that includes a requirement to employ a quota of people with disabilities, or that stipulates reasonable accommodation be provided to employees. Without enforcement, such laws and policies are ineffective. Environmental barriers Physical barriers can limit the participation and integration of people with disabilities. In outdoor life these include gradients, sand, grass and rivers; while mobility and independence indoors can be hampered by stairs, narrow doorways, furniture and carpets. Lack of assistive devices This is a major barrier to inclusion and the WSTP is one initiative to help improve the availability of appropriate wheelchairs in line with the CRPD. 19ToT.4 Preparing for diversityToT Handbook ToT.5 Adult learning To be an effective trainer it is important to understand how adults learn best and to know about the different styles of learning. Activity 1: Principles of adult learning Think about positive learning experiences you have had and write down in what way the experiences were positive. Use the space below to record your reflections during the activity. Positive learning experiences 20 ToT.5 Adult learningToT Handbook Activity 2: Determining your preferred learning style Circle the statements that reflect how you learn A. By following instructions step-by-step B. By experiencing new things C. By making mistakes D. By reasoning E. By understanding the theory of what is being taught F. By applying what I learned G. By drawing on my own experience H. By watching a video I. By evaluating options J. By relying on my feelings K. By interacting with people L. By watching someone demonstrate something M. By reflecting on something N. By seeing the big picture O. By staying on the side and watching P. By listening to someone describe how to do something Q. By studying what others have written about the topic R. By engaging with others S. By trying out what I am learning T. By understanding the general principles of something U. By attending a lecture V. Through hands-on experience W. By relying on my observations X. By being personally involved in something Y. By exploring how I feel about something Z. By being active AA. By observing the trainer BB. By experimenting 21ToT.5 Adult learningToT Handbook Scoring sheet for preferred learning styles Now circle the same letters on the list. Whichever column has the most letters circled represents your preferred learning style. If two or more have the same number it means you do not have a strong preference. Learning by experiencing Learning by observing Learning by thinking Learning by doing B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB Total: Total: Total: Total: Experiential learning cycle Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 1 The four preferred styles of learning are: 1. Learning by experiencing 2. Learning by observing/reflecting 3. Learning by thinking/understanding 4. Learning by doing/applying. The four learning styles match the experiential learning cycle. While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. 22 ToT.5 Adult learningToT Handbook In the WSTP, each of the four stages or types of learning are included so that all participants are involved. • Role plays and simulations are most appropriate for those who learn best from experiencing. • Those who learn best by observing and reflecting will benefit most from demonstrations, videos, and watching the trainer and wheelchair users. • Presentations or reading materials that discuss concepts, provide frameworks, definitions or theories, are helpful to those who learn by thinking and understanding the big picture. • Practical sessions with wheelchair users (as in WSTPb and WSTPi), that apply what was explained in theory, are most appropriate for those who learn by doing. Group discussions, case studies, question-and-answer sessions, workbook assignments and feedback sessions are all teaching methods that can appeal to different learning styles; you will need to think about their purpose and how they are used to ensure they are adapted to each situation. You also have your own preferred style. It is important to be aware of this and to take care not to neglect a particular approach. Do not skip a phase! What would happen if we missed out the experience part? The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. What would happen if we missed out the observation part? The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. What would happen if we missed out the thinking part? The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. What would happen if we missed out the doing (practice) part? The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 23ToT.5 Adult learningToT Handbook Activity 3: Matching activities with learning preferences Put an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Fill in the last column with your own style as a comparison. • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. C ar lo s M ir ia m S it a A hm ad S el f 1. Using a role play to practise wheelchair user training 2. Watching the trainer show how to measure a new wheelchair user 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country 4. Watching people in wheelchairs doing the things they want to do 5. Learning about the key documents that are relevant to wheelchair services 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home 7. Listening to the trainer reviewing the most important articles in the CRPD 8. Making a pressure-relief cushion 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience 10. Observing the trainer conduct an assessment 11. Doing an assessment interview with a new user 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services 24 ToT.5 Adult learningToT Handbook Supporting adult learning While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. Support them by encouraging active participation. Adult learners bring their own knowledge and experience to learning. Encourage them to share their experience with others and learn from others. Adult learners need learning to be relevant and practical, and they want to apply what they learn. Support them by having clear learning objectives with practical applications to their roles. Activity 4: Problem solving Problem solving is the process of finding the best solution to a challenge. It is an important part of adult learning and an important skill in wheelchair service provision. How can we help participants to problem solve and find their own solutions? 25ToT.5 Adult learningToT Handbook Help participants problem solve • Ask open ended questions – Open-ended questions cannot be answered with a simple ‘yes’ or ‘no’. They require participants to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer you expect. • Ask rather than tell – Ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together – teamwork and good communication helps to solve problems. Remember • When training participants to provide wheelchairs (WSTPb, WSTPi) there may be no simple answers. • In the clinical context, some prescriptions, modifications or postural support devices may provide a good technical solution, but they may also create functional barriers or limitations. • Acknowledge that often there is not one perfect solution. Wheelchair service provision requires compromise between what a client needs and the range of products available. 26 ToT.5 Adult learningToT Handbook ToT.6 Preparation time Preparation time has been included in the ToT timetable. This time will be used for: • Answering car park questions. • Meeting ToT trainers: – asking questions – receiving feedback. • Preparing for your practice delivery sessions: – coordinating with co-trainers – preparing demonstration materials and AV equipment. 27ToT.6 Preparation timeToT Handbook ToT.7 Presenting and facilitating Activity 1: Trainer behaviour Think about people who have trained you in the past and identify who you consider to have been an effective trainer. In other words, people who enabled you to learn what you needed to and who gave you positive and worthwhile experiences. Reflect on your experience in the space below. What was effective in their behaviour? 28 ToT.7 Presenting and facilitatingToT Handbook Presenting and facilitating ToT.7 Presenting and facilitating: 1 Presenting Facilitating Presenting is a one-way process where participants are given information. Presentations are used to provide information, facts and figures, and correct misinformation. When we present facts, theories or frameworks, we assume people don’t know the information or they need to be reminded. Thus we treat all participants in the same way even if some may know the information already. Facilitating means ‘making things easier’. When we facilitate we make it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect their own experience or views with new information. Good practice for presenting and facilitating Presenting: • Vary the pace and tone of speech. • Be aware of your position in the room and vary it. • Ask questions and encourage contributions from the group. • Follow the instructions in the WSTP Trainer’s Manual as these have been tested and timed. • Make sure the slide shown corresponds with what you are saying. Keep the slide synchronized with the Trainer’s Manual. • Do not turn your back to the group when reading from a slide. Facilitating: • Try the activity out before the session so you understand its purpose. • Give people time and space to think for themselves. Be comfortable with silence. • Refer participants' questions to the group before answering yourself. • Give clear instructions to participants, and make sure you understand them yourself before the session. • Monitor participants to ensure they are learning the key points for the session. 29ToT.7 Presenting and facilitatingToT Handbook Energizers7 There are times during any training when energy levels start to drop. Hot weather, stuffy rooms, a big lunch or tiredness from a long day of training can cause attention to wander and group energy to falter. The best way to deal with this is to inject some activity and fun into the training room by creating an opportunity for people to move and interact in a light-hearted way. This can be achieved either as part of the training or as a one-off activity to liven things up. Here are a few ideas. As part of the training: • Ask frequent questions to the whole group, picking a specific person to answer. • Ask participants to face their neighbour to discuss the answer to a question or topic, or to explore a different opinion to the one just expressed. • Ask participants to stand up and come to look at something (a wheelchair, a poster, a flipchart or a demonstration). • If possible, move the session to a different room or outside to create some change and movement. As separate activities: • Sing a song together. • Stand and do some simple stretching exercises. • Play “Simon says”: give instructions (“jump in the air”, “touch your toes”, “point to the sky”, “turn around” and so on). Participants should only follow when the instruction is preceded by “Simon Says”. • Have a three-minute stretch and comfort break. • Invite a participant, or group of participants, to lead an energizer activity for a few minutes. They are likely to have different and locally-appropriate activities to share with the whole group. 7 With thanks to Robert Chambers for some of them. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 ( https://www.routledge.com/ Participatory-Workshops-A-Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). 30 ToT.7 Presenting and facilitatingToT Handbook Remember: • be aware of, and sensitive to, differences in culture, gender and disability • don’t force participants to do anything they can’t or don’t want to do • start slowly and build up to more energetic activities • join in yourself when you can • have fun! Managing time You need to make sure that the training runs to time. There are many sessions and activities and a limited amount of time to complete them. We will often need to modify our behaviour and activities to make the best use of the time we have available. Activity 2: Managing time In pairs, discuss: What can we do to keep the training running on time? Write your ideas here: 31ToT.7 Presenting and facilitatingToT Handbook Ideas for keeping the training on schedule • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 32 ToT.7 Presenting and facilitatingToT Handbook ToT.8 Communication skills Activity 1: Communication skills Read the information assigned to your group from the table below. Develop a presentation to ensure other trainees understand the key points. Work as a group to decide how you will present the information and who will present which parts. Everyone in the group should participate in the presentation. You may use flipcharts, the whiteboard, or other props as desired. Be creative in your presentation. You have 20 minutes to prepare. You will have five minutes to present to the others. Group 1 – Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what you say. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 33ToT.8 Communication skillsToT Handbook Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, stand at the front or side – participants should be able to see and hear you – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and you need to read the PowerPoint slides – depending on the context, it may be appropriate for you to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 34 ToT.8 Communication skillsToT Handbook Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. Demonstrations, videos and interpreters Below are good practices for giving demonstrations, showing videos, and using both foreign language and sign languages interpreters during training. Giving demonstrations When giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) 35ToT.8 Communication skillsToT Handbook • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. Using videos The WSTP use videos to demonstrate most practical skills. Before showing the videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 36 ToT.8 Communication skillsToT Handbook ToT.9 Knowledge of guiding documents What is a guiding document? Guiding documents are publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision and which guide stakeholders in the provision of wheelchair services. Many governments, international agencies, donors, and other stakeholders plan and fund development work in line with these international frameworks. Your knowledge of them will put you in a stronger position to educate and advocate for appropriate wheelchair service provision. National or Regional laws and policies will impact local wheelchair service provision. You need to be familiar with the documents to guide discussion. The following section gives an overview of a range of guiding documents as they relate to wheelchair service provision. Some of these are included on the WSTP Pen Drive and others can be accessed via the internet. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) The United Nations Convention on the Rights of Persons with Disabilities is commonly known as the CRPD or sometimes the UNCRPD. The CRPD is widely considered to be the most important international treaty relating to people with a disability. It came into force in 2008 and on its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol. This was the highest number of signatories to a UN Convention on its opening day in history. The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. 37ToT.9 Knowledge of guiding documentsToT Handbook Representatives involved in the development of the Convention included people with disabilities, government officials, and representatives of nongovernmental organizations. The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Each year more countries sign the CRPD. Up to date information on which countries have signed the CRPD and its optional protocol can be found on the UN website.8 The CRPD has several articles relevant to wheelchair service provision: Most relevant Also relevant • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. 8 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 38 ToT.9 Knowledge of guiding documentsToT Handbook What additional barriers can women and children face? • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. It is important that WSTP participants are familiar with the CRPD: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. 39ToT.9 Knowledge of guiding documentsToT Handbook Key articles in detail: Article 4 Article 4 General obligations, states that States Parties: Undertake to ensure and promote the full realization of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability. Point (g) of Article 4 states: To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. Point (h) states: To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities. Point (i) states: To promote the training of professionals and staff working with persons with disabilities in the rights recognized in this Convention so as to better provide the assistance and services guaranteed by those rights. Article 20 Article 20 Personal Mobility, is the article most relevant to wheelchair service provision. It requires that: States Parties take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by: (a) Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost; (b) Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost; (c) Providing training in mobility skills to persons with disabilities and to specialist staff working with persons with disabilities; (d) Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities. 40 ToT.9 Knowledge of guiding documentsToT Handbook Article 26 Article 26 Habilitation and Rehabilitation, includes the requirement that: States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation. Definitions of rehabilitation and habilitation: • Rehabilitation is a very well-known word but habilitation is used less often. • Rehabilitation is focused on restoring abilities whereas habilitation is about learning or building abilities for the first time. Article 32 Article 32 is relevant to wheelchair service provision in a broader sense as it promotes international cooperation; for example, in facilitating access to assistive technology. 41ToT.9 Knowledge of guiding documentsToT Handbook WHO Guidelines on the provision of manual wheelchairs in less-resourced settings The WHO Guidelines on the provision of manual wheelchairs in less-resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider when designing or producing wheelchairs; establishing service delivery systems; training staff; or developing policies related to wheelchair provision. The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. A wheelchair is appropriate when it: ü Meets the user’s needs and environmental conditions ü Provides proper fit and postural support ü Is safe and durable ü Is available in the country ü Can be obtained and maintained and services sustained in the country at an affordable cost. This is an important definition for trainers and WSTP participants to know. 42 ToT.9 Knowledge of guiding documentsToT Handbook The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; as trainers, you should try to raise awareness of them whenever you have the opportunity. The Wheelchair Guidelines are available on the WHO website in a range of languages.9 10 Joint position paper on the provision of mobility devices in less-resourced settings The WHO Joint position paper on the provision of mobility devices in less-resourced settings10 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. The paper provides valuable information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 9 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 10 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/publications/technology/jpp_ final.pdf). 43ToT.9 Knowledge of guiding documentsToT Handbook Community-based rehabilitation: CBR Guidelines11 The WHO Community-based rehabilitation: CBR Guidelines11 were launched in 2010 and present a common understanding and approach to CBR globally. CBR is a strategy to improve access to rehabilitation services for people with disabilities in less-resourced countries, by making optimal use of local resources. The CBR Guidelines provide a framework for action and offer practical suggestions for implementation. The introductory booklet and health component of the CBR Guidelines are included on the WSTP Pen Drive as resources but are not referred to specifically in the WSTP. A good knowledge of the CBR Guidelines is recommended as CBR is currently being implemented in over 90 countries and is increasingly seen as one of the most effective ways of realizing the articles of the CRPD. CBR, also referred to as Community-Based Inclusive Development (CBID), is likely to come up in discussions during the WSTP. Many aspects of CBR are highly relevant to wheelchair service provision: for example, referral networks; community health centres; and CBR workers. 11 WHO Community-based rehabilitation: CBR guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 44 ToT.9 Knowledge of guiding documentsToT Handbook CBR Matrix The CBR Matrix12 is one of the cornerstones of the CBR Guidelines. The five components are: Health, Education, Livelihood, Social and Empowerment. Each component of the Matrix has five elements within it, so there are a total of 25. 12 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr/matrix/en/). 45ToT.9 Knowledge of guiding documentsToT Handbook Activity 1: CBR Matrix Working in your group, list how wheelchair service provision relates to the component of the CBR Matrix you have been assigned: Health, Education, Livelihood, Social or Empowerment. Further information and the full CBR Guidelines can be found on the WHO website13 13 (http://who.int/disabilities/cbr/guidelines/en/). 46 ToT.9 Knowledge of guiding documentsToT Handbook Wheelchair service provision and the five components of CBR Health Education • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. • Enables access to school, educational programmes and vocational programmes. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Empowerment • Improved self-image and confidence. • Peer support. Design considerations for accessibility14 Design considerations for accessibility14 gives useful information on how to ensure all aspects of access are considered, both when visiting the wheelchair service and in other environments. It covers: • disabled car parking • curb ramps • pathways • ramps • stairways • handrails • doors and doorways • corridors • toilets. 14 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 47ToT.9 Knowledge of guiding documentsToT Handbook Sustainable Development Goals (SDGs) The Sustainable Development Goals15 were adopted by world leaders in September 2015 at a historic United Nations Summit and came into force on 1 January 2016. Over the next 15 years, countries will mobilize efforts to address all three dimensions of sustainable development (environmental, economic and social) and strive to achieve the 17 goals. The SDGs succeed the Millennium Development Goals (MDGs), which reached their conclusion in 2015; they are the outcome of a collaborative development process that started at the 2012 United Nations Conference on Sustainable Development (Rio+20). As the WTSP modules were developed before the SDGs were launched, they are not mentioned in the packages. However, as many governments, development and donor organizations will be focusing on addressing the SDGs, it is important for trainers and participants to be aware of them and to identify how appropriate wheelchair service provision can fit into the SDG agenda. The SDGs are made up of 17 goals and 169 associated targets. In Paragraph 4 of the preamble of the SDGs an important commitment is made: As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all segments of society. And we will endeavour to reach the furthest behind first. A reference to persons with disabilities is also included in Paragraph 23 on vulnerable populations: People who are vulnerable and must be empowered. Those whose needs are reflected in the Agenda include all children, youth, persons with disabilities (of whom more than 80% live in poverty), people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants. We resolve to take further effective measures and actions, in conformity with international law, to remove obstacles and constraints, strengthen support and 15 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 48 ToT.9 Knowledge of guiding documentsToT Handbook meet the special needs of people living in areas affected by complex humanitarian emergencies and in areas affected by terrorism. Disability and the SDGs Goal 4: to ensure inclusive and equitable quality education and promotion of life-long learning opportunities for all, focuses on eliminating gender disparities in education and ensuring equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities. In addition, the proposal calls for building and upgrading education facilities that are child, disability and gender sensitive and also provide safe, non-violent, inclusive and effective learning environments for all. Goal 8: to promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all, the international community aims to achieve full and productive employment and decent work for all women and men, including for persons with disabilities, and equal pay for work of equal value. Goal 10: strives to reduce inequality within and among countries by empowering and promoting the social, economic and political inclusion of all, including persons with disabilities. 49ToT.9 Knowledge of guiding documentsToT Handbook Goal 11: aims to make cities and human settlements inclusive, safe, resilient and sustainable. To realize this goal, Member States are called upon to provide access to safe, affordable, accessible and sustainable transportation systems for all; improving road safety, notably by expanding public transportation, with special attention to the needs of those in vulnerable situations, such as persons with disabilities. In addition, the proposal calls for universal access to safe, inclusive and accessible green and public spaces, particularly for persons with disabilities. Goal 17: stresses that in order to strengthen the means of implementation and revitalize the global partnership for sustainable development, the collection of data, monitoring and accountability of the SDGs are crucial. Member States are called upon to enhance capacity- building support to developing countries, including least developed countries and small island developing states, which would significantly increase the availability of high- quality, timely and reliable data that is also disaggregated by disability. For further information on the SDGs see the UN website.16 Global Cooperation on Assistive Technology (GATE) WHO estimates that today more than 1 billion people need one or more assistive products, such as wheelchairs, hearing aids, walking frames, spectacles, pill organizers and communication boards. With a global ageing population and a rise in noncommunicable diseases, WHO expects that this number will rise beyond 2 billion by 2050, with many older people needing two or more products as they age. 16 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 50 ToT.9 Knowledge of guiding documentsToT Handbook Assistive products play a crucial role in enabling access to education and livelihoods, maintaining independence and being connected to the world. However, today only one in 10 people in need have access to the products they need; without them they are excluded from participating in society, isolated and locked into poverty. WHO is coordinating the GATE initiative to address this huge and unmet global need and to realize Article 32 of the CRPD. The GATE initiative has only one goal: to improve access to high-quality affordable assistive products globally. To achieve this, GATE is focusing on four interlinked action areas: products, personnel, provision and policy. Following the example of the WHO Model List of Essential Medicines, GATE’s first priority was to develop a WHO Priority Assistive Products List (APL). The APL includes the 50 assistive products that are most needed across the world. This includes four types of wheelchair, pressure cushions and portable ramps, as well as other products to enhance mobility, hearing, cognition, communication and vision. The APL is not a restrictive list but aims to provide Member States with a blueprint to develop a national APL in line with local need and available resources. The hope is that it will provide a rallying point for local stakeholders to synergize efforts to increase access. GATE is now working on developing tools to support the implementation of the APL, including a needs assessment toolkit, a training package, a policy framework and model of service provision. For more information on GATE see the WHO Website.17 18 17 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 18 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 51ToT.9 Knowledge of guiding documentsToT Handbook World report on disability In 2011 the first ever World report on disability was published, produced jointly by WHO and the World Bank.18 The report states that people with disabilities have generally poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their daily lives. The report provides evidence-based recommendations on ways to overcome barriers to health care, rehabilitation, education, employment and support services. It also highlights what works to create supportive environments that will enable people with disabilities to flourish. The World report on disability highlights the following barriers: • inadequate policies and standards • negative attitudes • lack of service provision • problems with service delivery • inadequate funding • lack of access • lack of consultation and involvement • lack of data and evidence. As these all relate to wheelchair service provision this is a useful background document. The report’s second recommendation to, Invest in specific programmes and services for people with disabilities, mentions the importance of wheelchairs: Rehabilitation – including assistive technologies such as wheelchairs or hearing aids – improves functioning and independence. A range of well-regulated assistance and support services in the community can meet needs for care, enable people to live independently and participate in the economic, social, and cultural lives of their communities. 52 ToT.9 Knowledge of guiding documentsToT Handbook A summary of the report together with its recommendations can be found on the WHO website.19 20 WHO Global disability action plan The WHO Global disability action plan 2014–202120 is based on the recommendations of the World report on disability and is in line with the CRPD. It was developed in consultation with Member States, UN organizations, national and international partners including organizations of people with disabilities. The plan seeks to address the disparities between people with disabilities and those without. It states that across the world, people with disabilities do not receive the health care they need and have poorer health than people without disabilities. They are more than twice as likely to find health-care providers’ skills and facilities inadequate; nearly three times more likely to be denied health care; and four times more likely to be treated badly. The action plan has three objectives: • to remove barriers and improve access to health services and programmes • to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation • to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services. Member States are urged to implement the proposed actions adapted in line with national priorities and circumstances. The full report can be found on the WHO website.21 19 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.who.int/iris/ bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) 20 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 21 (http://www.who.int/disabilities/actionplan/en/). 53ToT.9 Knowledge of guiding documentsToT Handbook High-level meeting of the General Assembly on disability and development 22 A one day High-Level Meeting of the General Assembly on disability22 was held on 23 September 2013 under the theme: The way forward: a disability-inclusive development agenda towards 2015 and beyond. Participants included Member States, observers and representatives of the United Nations, as well as representatives of civil society, organizations of people with disabilities and the private sector. The Outcome Document from the meeting lists commitments from (a) to (q). Commitment (h) states: Ensure accessibility, following the universal design approach, by removing barriers to the physical environment, transportation, employment, education, health, services, information and assistive devices, such as information and communications technologies, including in remote or rural areas, to achieve the fullest potential throughout the whole life cycle of persons with disabilities. A booklet giving the background to the meeting and the outcomes can be found on the UN website.23 22 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 23 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 54 ToT.9 Knowledge of guiding documentsToT Handbook ToT.10 Audio-visual tools and equipment It is important that you are familiar and confident with using a range of audio-visual (AV) tools when facilitating training sessions. PowerPoint (PPT) and Portable Document Format (PDF) Presentations for the WSTP are available in both PowerPoint and PDF format. The advantages and disadvantages of each format are summarized in the table below. Advantages Disadvantages PPT • The PPT can be changed to fit your individual presentation style and be relevant to the local context. • Text can be reduced/simplified. • Extra slides can be added to cover new content or questions for discussion. This is helpful when the group speaks different languages or dialects, and may find it difficult to follow your accent. • The computer’s screen saver will not come on when the presentation is in “Slide Show” mode. • Videos must be loaded manually. • Overall file size is larger. • Time is needed to edit the PPT files. PDF • The PDF is complete with links to all four video formats. You can simply click on the format you want and the video will play. • It has been tested and there should be no formatting or compatibility issues. • The files are smaller than the editable files. • The content is fixed and cannot be customized for local context or to fit your presentation style. • All text on the slide will appear at once (slides will not ‘build’ as some of them do in the editable version) and key learning points cannot be introduced individually. • Text can’t be simplified or reduced on slides with a lot of content. • Because it is a PDF, the computer’s screen saver will come on and needs to be deactivated before you start the presentation. (This can be done in “System Preferences” on your computer). 55ToT.10 Audio-visual tools and equipmentToT Handbook Adding slides to the PPTs When adding slides, the aim is to follow the Trainer’s Manual and not to move off the subject. You may want to add slides to the PPTs for the following reasons: • for sections where there are none • for key discussion questions, to remind you not to move on to the answers too soon • as a reminder about an activity that is coming up, and include instructions. You may want to make changes to the PPTs for the following reasons: • to adapt slides for local context • to provide translations • to reduce the text on some slides or divide a lot of content on one slide into two or more slides • to add material when you are expanding or adding training sessions. Remember, when you add content you will need to add more time to the session. Maintaining consistency of the PPT • All new slides, or changes to existing slides, must follow the same format, style and font as the original PPT. • Remember to delete the WHO and WSTP logos from slides you add or change. The simplest way to add slides to an existing WSTP presentation while keeping the same format is to duplicate an existing slide and then change the text. • Do not add complex animations. • You can also add slides using the PPT master. • All video clips are available in two formats: mp4 and wmv. The mp4 format is for use on Apple computers and the wmv format is for Windows computers. If you have a Windows computer with a QuickTime player installed, you can also use mp4 videos. • Some video clips come with subtitles which are recommended to use. They can help participants understand better when there is poor sound quality, external noise or strong regional accents are used. • Video clips can be embedded or linked. We recommend embedding because although this makes the file larger, the video is stored inside the PPT and not lost when you copy the file to another computer. 56 ToT.10 Audio-visual tools and equipmentToT Handbook Embedding videos into a PPT To embed a video in PPT 2010 onwards, follow these steps: • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it. • Resize the video frame if it does not fill the screen properly. 57ToT.10 Audio-visual tools and equipmentToT Handbook • Save your changes • The video is now part of the PPT. To automatically play the video in full screen mode (Windows): • In the “Video”/“Tools”/ “Playback” tab, check the box called “Play Full Screen”. To automatically play the video in full screen mode (Mac): • In the “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. If you have any difficulties, consult the PPT help menu. 58 ToT.10 Audio-visual tools and equipmentToT Handbook Good practice when using audio-visual equipment Making sure the “Slide Show” plays • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. Data projector, remote and pointers • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. • Using a remote control to click between slides means that you do not need to stand next to the computer during your presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. Speakers • Plug in and test the speakers at the start of each day and leave them plugged in. • Only switch the speakers on when you are playing videos as they can pick up cell phone or other electronic signals. Cables and adapters • Ensure that you have all the necessary cables for the laptop, data projector and speakers. • Double check you have plug adapters including a few spares. • Bring extra extension cords in case your cables won’t reach the power outlets. 59ToT.10 Audio-visual tools and equipmentToT Handbook Activity 1: Using the board/flipchart as a visual aid Read the information assigned to your group and prepare a presentation to the rest of the group using the board/flipchart. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 60 ToT.10 Audio-visual tools and equipmentToT Handbook ToT.11 Feedback What is feedback? Feedback is information given to someone about: • What they are doing well – positive feedback. • What they need to improve on – constructive feedback. It is important that you have the skills to give feedback well, and that you can support positive learning outcomes for participants. Usually people have no problem giving feedback about good performance. When mistakes are made or performance needs improvement, you must be confident in giving constructive feedback. Activity 1: Receiving feedback Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Record your reflections below What should trainers consider when providing feedback? 61ToT.11 FeedbackToT Handbook Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on the behaviour not the person when providing constructive feedback. • Start with the positive – point out what was done well before talking about what needs to be improved. End on a positive note if you can. • Be delivered in different ways – give constructive feedback and praise to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their own performance first. They may already understand what went well and what they need to improve. • Support participants in their different approaches – before giving constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same way as you. 62 ToT.11 FeedbackToT Handbook ToT.12 Managing group dynamics It is important that the WSTP trainer knows how to work effectively and efficiently with groups. This session looks at facilitating small group activities, managing time and dealing with disruptive behaviour. Why use groups? Group work is important in training because it: • Allows participants to share ideas, knowledge and experience. This allows you to find out more about the participants’ existing expertise so that you know where the gaps are and how to pitch the session. • Honours the existing wisdom, experience and skills in the room. This allows those with more experience and expertise to share it with others. • Takes the focus off the trainer. As the participants share experiences and find out what they already know, this helps to build their confidence. • Creates an environment that enables everyone to speak and contribute. Shy or more junior participants will be more comfortable speaking out in a small group. This builds confidence as they discover their ideas are valued. Organizing and managing group activities What to consider when dividing a large group into smaller groups • Determine group size • Determine who is in each group • Methods to create groups. Factors to determine the size of the groups • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. 63ToT.12 Managing group dynamicsToT Handbook • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups of three, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. 64 ToT.12 Managing group dynamicsToT Handbook • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. Give clear directions when dividing participants into groups: • who goes into which group • what you want groups to do (what is their task) • where you want groups to go (break-out rooms, or areas of a large room) • when the group should be ready to report back • how you want groups to report (using a flipchart; verbal presentation to the whole group; informal report to the group sitting in their seat; creative presentation chosen by the group itself) • how much time will they have to report back. Always monitor small group activities to ensure participants are working on the intended task and using the correct page in their workbook. Help them if necessary, by prompting and asking leading questions; don’t provide the solutions or take too much time talking yourself. Remind them to keep an eye on the time. Managing disruptive behaviour In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. 65ToT.12 Managing group dynamicsToT Handbook The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. Managing a dominant participant: • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. Managing ‘the joking’ participant: • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test your skills and knowledge – and demonstrate that they are superior. Managing an argumentative participant: • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. The negative participant The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 66 ToT.12 Managing group dynamicsToT Handbook Managing a negative participant: • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? The quiet participant The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. Managing a quiet participant: • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The higher status/senior participant If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. Managing a senior participant: • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone. Managing a distracted participant: • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. 67ToT.12 Managing group dynamicsToT Handbook Managers/Stakeholders module 68 Managers/Stakeholders moduleToT Handbook 69Introduction to the WSTPtot Managers ToT Handbook Introduction to the WSTPtot Managers 1. Background The aim of the WSTPtot Managers is to equip trainees with the skills and knowledge needed to deliver and adapt the WSTPm for different contexts. The WSTPtot Managers is the first part of this module, and is followed by the WSTPtot Stakeholders. The WSTPtot Stakeholders also includes sessions that cover the WSTPm and WSTPs logistics, preparation, and planning. Adapt WSTPm so it is well suited to local needs. An estimated 1% of any population requires a wheelchair, yet in many places wheelchair services are not available or are very underdeveloped. The WSTPm was developed to support managers to effectively manage appropriate wheelchair provision. It is aimed at personnel responsible for implementing, managing and evaluating wheelchair services. WSTPm participants are usually involved in the management or administration of rehabilitation services but may not have specific experience in wheelchair service management. Therefore the training includes basic information about managing appropriate wheelchair services. Managers attending the training without experience In some circumstances a manager may attend the WSTPm training programme but not have experience of wheelchair service management. For example: • when a new service is being established or considered • when a service is expanding to include wheelchair provision – such as a prosthetic and orthotic service • when a manager is new to an existing wheelchair provision service • when a wheelchair producer is looking to develop their wheelchair provision service • when someone wants to learn more about appropriate wheelchair provision, for example a government department manager. 70 Introduction to the WSTPtot Managers ToT Handbook Managers attending the training with experience Managers who do have experience in wheelchair service management may attend the WSTPm training for other reasons, such as: • to find answers to challenges they are facing • to learn more about international policies, guidelines, and conventions related to wheelchair provision • to understand more about appropriate wheelchair provision according to the Wheelchair Guidelines1 and the eight steps of wheelchair service delivery • to increase their understanding of different service delivery models • to learn new ways to improve their management skills • to be able to manage and support staff who have been trained in WSTPb and WSTPi modules • to understand the role managers can play in leading change to improve wheelchair provision. The WSTPm provides an overview of the wheelchair service manager’s role in an appropriate and effective wheelchair service that fulfils the eights steps of wheelchair service delivery.1 Eight steps of wheelchair service delivery 1. Referral and appointment 2. Assessment 3. Prescription (selection) 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Follow-up, maintenance and repair. The WSTPm includes information on the resources required to fulfil all eight steps. The knowledge gained through participating in a WSTPm training programme can help managers to: • better plan wheelchair provision • increase the quality of wheelchair service delivery • improve staff retention • enable more users to receive a wheelchair that meets their needs • increase the sustainability of their wheelchair service. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 71Introduction to the WSTPtot Managers ToT Handbook Some of the activities managers might carry out to support the work of wheelchair clinicians and technicians are given in the box below. How managers can support the work of wheelchair service staff • Ensure that appropriate wheelchairs and materials are in stock • Make sure funding is available for wheelchairs • Help plan the number of service users so staff are not too busy but have enough to do • Ensure service users have appropriate and well-maintained equipment and facilities • Provide administrative support for smooth running of services • Prepare and manage the budget for the service • Help promote a professional service • Advocate to government in support of staff positions • Support collaboration between government and other stakeholders such as Community-Based Rehabilitation (CBR) programmes. 2. Scope and timetable of the WSTPm As outlined on page 3 of the Trainer’s Manual, the WSTPm can be delivered in 13 – 14 hours and adapted to suit local needs and resources – for instance adding extra time for translation. Do not reduce the time allocation. WSTPm sessions can be combined with other activities as appropriate to the specific local context and aims. For example, extra sessions could be included to cover: • Presentations by stakeholders on their organization or work • Presentations by wheelchair producers or suppliers on their products • Case studies on wheelchair users • Information on implications of inappropriate wheelchairs • Research results of wheelchair related studies • Review of policies relating to wheelchair provision. A sample timetable for the WSTPm is available on the WSTP Pen Drive. This is based on running a training programme using all of the WSTPm resources in a two day training. 3. WSTPm/s planning tool • The WSTPm/s planning tool has been developed as part of the ToT package. It can be found in the Annexes of this manual on page 129 and on your WSTP Pen Drive. The WSTPm/s planning tool is recommended to provide an overview of the local situation and establish desired outcomes. This will help identify which sessions to include in your delivery of the WSTPm or WSTPs. 72 Introduction to the WSTPtot Managers ToT Handbook • The tool covers 10 areas of policy, products, services and training in line with the Wheelchair Guidelines and gives example situations for each of the 10 areas ranging from ‘early stages’ to ‘developing’, ‘maturing’ and ‘well-functioning’. Make sure you begin the planning process as far ahead of the training as possible so you have enough time to gather the necessary information. 4. Trainers and participants for the WSTPm It is recommended that there is one trainer for every 8–10 participants. This will usually result in a minimum of two trainers. The WSTPm is typically run for 5–15 participants and can work well for any number in this range. It is an advantage to have an experienced wheelchair user on the training team, ideally someone who knows the subject and training package well. If you are not a wheelchair user, consider this when identifying a second trainer. At least one trainer should have local wheelchair provision experience and knowledge. This will enrich discussions and ensure the training is relevant. One trainer should have good international knowledge of wheelchair provision and relevant international guidelines, conventions and goals. The same person could potentially hold this knowledge. 5. The WSTPm resources The WSTPm includes three manuals: • Trainer’s Manual • Reference Manual and Workbook • Additional Resources. Trainer’s Manual The first section of the Trainer’s Manual, About the WSTPm, covers the Target Audience, Purpose and Scope, the skills and numbers to consider when selecting Trainers and How to get started. The next section (page 5) is Guidance notes for trainers. This includes an overview of the training programme, brief information on the session plans, the accompanying PowerPoint presentations (PPTs), and good-practice training tips. An evaluation of the programme is recommended after each delivery. 73Introduction to the WSTPtot Managers ToT Handbook The detailed session plans begin in the next section of the manual, on page 12. There are 12 sessions grouped into three sections: • A. Core knowledge • B. Starting a wheelchair service • C. Running a wheelchair service. Reference Manual and Workbook The second manual is the Reference Manual and Workbook for participants. Unlike the WSTPb and WSTPi, this Reference Manual and Workbook are combined into one book. The format of the manual follows the same order as the Trainer’s Manual in both the reference and workbook sections. The manual is divided in two sections: the reference manual section provides more detail on each of the topics to supplement the sessions. The workbook section includes forms and resources for participants to complete as part of the exercises in the sessions. Develop a thorough knowledge of the manual before you conduct your own training programme and encourage your future participants to read the manual thoroughly during and after the training programme. Additional Resources Manual This brings together many forms and reference documents that managers and wheelchair service staff will find useful in their services. The manual includes the following: 1. Possible strategies for developing a wheelchair service programme 2. Basic Wheelchair Service Referral Form 3. Intermediate Wheelchair Service Referral Form 4. List of service forms and checklists for basic and intermediate services 5. Making an Assessment Box 6. Making an Assessment Bed 7. Making Foot Blocks 8. Examples of Measuring Tools 9. Guide to Technical Facilities: Workbench and Ground Work Area 10. Guide to Basic Service Technical Resources 11. Guide to Intermediate Service Technical Resources 12. Preparing a Hacksaw Blade for Foam Cutting 13. Guide to Basic and Intermediate Service – Materials 74 Introduction to the WSTPtot Managers ToT Handbook 14. Guide to Setting up a Mobility Skills Area 15. Comparison of different methods of supplying wheelchairs 16. Tool for Measuring Participation at time of assessment for assistive technology 17. Tool for Measuring Satisfaction and outcomes at time of follow-up of assistive technology 18. Accessibility information Some of these resources will be referred to in the WSTPm sessions but most are specifically relevant to the WSTPb and WSTPi modules. Videos There are six videos included in the WSTPm package. These are referenced in the PPTs but may not be embedded. Always check in advance that you have the videos ready, either embedded in the PPTs or uploaded to your desktop ready to play. Posters The WSTP posters can be found within the basic and intermediate packages: folders 3 and 4 of the WSTP Pen Drive. Supplementary resources Additional documents are included on the WSTP Pen Drive in the folder labelled Supplementary resources. Most of these are discussed in detail within the WSTPtot Core training skills module as they are relevant for all WSTP. One supplementary resource that is more specific to the WSTPm and not covered in the Core training skills module is Managers who lead. This provides information about leading and influencing change in organizations and is particularly relevant for session A.3: Managers who lead change. Translations The latest versions of the WSTPm resources, as well as any available translations, can be found at: http://www.who.int/disabilities/technology/wheelchairpackage/ wstpmanagers/en/ 75WSTPm logistics and preparationToT Handbook WSTPm logistics and preparation Guidance notes for trainers are provided in the WSTPm Trainer’s Manual beginning on page 5. Study them carefully as they are a good place to start thinking about preparing your WSTPm delivery. In addition, here are some useful extra points. 1. Local context is key When planning an WSTPm delivery it is very important to ensure that the sessions are adapted and run in a way that is relevant to the local context and the outcomes you want to achieve. WSTPm participants will often have different levels of knowledge, experience and responsibility and therefore some sessions may be more relevant than others to them. Trainers have generally found the WSTPm challenging to deliver in the time allocated. Most topics will generate valuable discussion that needs to be accommodated to maximize the value of the training. In this situation, you can allow discussion and reduce the set activities. However, participants aren’t always motivated: sometimes they have been told to attend without really understanding why. In this case it is important to include the activities to get everyone engaged. A WSTPm/s planning tool has been developed to help trainers with an overview of the current situation in the training country/region, and to decide on the outcomes you hope to achieve. This tool will help identify which WSTPm sessions to include in the programme. Start the planning process as early as possible to allow enough time to gather the necessary information and discuss the situation with relevant stakeholders. The tool can be found in the Annexes of this handbook. Time management is also important. Two days is usually a realistic amount of time for managers to be released for training; but if developing detailed plans or strategies is an objective, extra time will be needed or WSTPm sessions must be reduced. When less than two days is available, you will need to prioritize which sessions to include. For example, if you are delivering training in a region that already has wheelchair services in place, you may choose to exclude or reduce some of the Starting a wheelchair service sessions. Try to contact some of the participants in advance, or consult someone who knows them, to get a sense of their knowledge and skill levels. This will help you to make the training is as relevant and useful as possible. 76 WSTPm logistics and preparationToT Handbook 2. Resources and equipment Resources Each participant must be given a WSTPm Reference Manual and Workbook. WSTPm trainers can also provide other key resources in a format of their choice. For example, you could give participants a DVD or Pen Drive containing the WHO Wheelchair Guidelines, the United Nations Convention on the Rights of Persons with Disabilities (CRPD), the Sustainable Development Goals (SDGs), the Community-Based Rehabilitation (CBR) Guidelines, and the Joint position paper on the provision of mobility devices in less-resourced settings. These can all be found on the WSTP Pen Drive. Equipment The training programme will benefit from having a few locally-available wheelchairs on site in the training room. These can be referred to during discussions and presentations. Participants can try them out and look them over during breaks, taking into account their safe use. Try to include wheelchairs with different features suitable for a variety of environments and needs; for example a folding wheelchair, a non-folding wheelchair, and a child’s wheelchair with postural support devices. 77WSTPm Practice deliveries ToT Handbook WSTPm Practice deliveries 78 Welcome, introduction and overviewToT Handbook Welcome, introduction and overview Key considerations for teaching this session a. General • You may prefer to swap Sections 3 and 4 to cover housekeeping issues before the workshop overview. b. Section 1. Opening ceremony • The timetable allows 10 minutes for a brief opening ceremony, for instance a welcome from the head of the institution where the training programme is being conducted. If a more extensive ceremony is needed, adjust the timetable accordingly. c. Section 3. Workshop overview Tips for preparation • Check if the video Wheelchair service delivery is embedded in the PPT on the WSTP Pen Drive. If it is not, embed it or have it easily accessible on your desktop. Content • Before showing this video, ask participants to look out for the different steps of wheelchair service delivery while they are watching. After showing the video, point out the Wheelchair service steps poster and list the eight steps of wheelchair service delivery. Refer back to the poster whenever it comes up during the rest of the training programme. d. Section 4. Training programme timetable, housekeeping and ground rules Tips for preparation • It is useful to have a wheelchair available when explaining the safety issues. Content • Point out the different components of the wheelchair as you discuss them (for example, spokes, brakes and footrests). Explain that participants should lean forward when going up slopes and lean back when going down, even with an assistant behind them. 79A.1: What is appropriate wheelchair provision?ToT Handbook A.1: What is appropriate wheelchair provision? Errors in the WSTP materials a. Section 4. Supporting appropriate wheelchair provision • In the activity on page 22, the Trainer’s Manual gives one example of national policy but the Reference Manual and Workbook gives two. Chose the example that is most appropriate for the context: there is not enough time to use both. • The text in the Reference Manual and Workbook is different from the text in the Trainer’s Manual. Read the text from the Reference Manual to make it easier for the participants to follow. Key considerations for teaching this session a. General Content • The timing of this session is generous for Section 3 but short for Section 4, so overall it should work out. If your time is running short, limit the number of participant responses. b. Section 2. What is the need and unmet need for wheelchairs? Tips for preparation • Personalize slide A.1.4 with the relevant census data and a calculation on national wheelchair need. If you are training participants from more than one country, list them all on this slide. • If the census is out of date, try to find a more recent estimate from the National Statistics Office or another government department. • To calculate 1% of the population, divide the total population by 100. Some examples are given below. 80 A.1: What is appropriate wheelchair provision?ToT Handbook Population 1% of population 45 060 436 450 604 14 538 933 145 389 3 785 566 378 556 c. Section 3. Right to personal mobility • Have a good understanding of the UN Convention on the Rights of Persons with Disabilities (CRPD) and find out whether it has been signed and ratified by the country where your training programme is taking place. d. Section 4. Supporting appropriate wheelchair provision Tips for preparation • The Incheon Strategy is not included as a resource but if you are training in a country covered by the Strategy in Asia and the Pacific, it can be downloaded at: http://www.unescap.org/resources/ incheon-strategy-“make-right-real”-persons-disabilities-asia-and-pacific Content • In the feedback section of the activity you can also suggest that if national policy doesn’t exist, participants can refer to the WHO Disability Action Plan 2014–20212 for guidance on how to set one up. 2 WHO Global disability action p.an 2014 – 2021. Geneva: World Health Organization; 2015 (http://www.who.int/ disabilities/actionplan/en/). 81A.2: Service delivery ToT Handbook A.2: Service delivery Errors in the WSTP materials a. Section 4. Broader roles of a manager Tips for preparation • Some of the text on Slide A.2.12 is different from the version of this diagram in the Reference Manual and Workbook. Replace the slide with the new version provided on your WSTP Pen Drive and make a note in your Trainer’s Manual that the PPT slide is an update of the thumbprint version shown in the manual. Key considerations for teaching this session a. Section 2. Service delivery levels • Emphasize that the level of service is not linked to the age of the wheelchair user or their disability. Many regions or countries may only have a basic level service (if any), but the aim is for each country or region to have both available. An intermediate level service needs different resources and staff skills compared to a basic level service. Knowledge of the local context will be useful here so that you can give examples of existing basic and intermediate level facilities. b. Section 3. Service delivery models • There is not much time for the activity in this section. Ask the groups to sit or stand near the Wheelchair service steps poster while they discuss their answers and to stick their Post-it notes next to the relevant service step as they write them. This will make the feedback session quicker. c. Section 4. Broader roles of a manager • As an alternative to projecting the slide Roles of a manager, you may prefer to use a poster of the diagram. Participants can stick Post-it notes onto the poster and it can stay up on the wall throughout the training programme. d. Section 5. Active involvement of wheelchair users in service delivery • An extra slide showing the Romanian case study is provided on your WSTP Pen Drive and can be added to the PPT for this session. 82 A.3: Managers who lead changeToT Handbook A.3: Managers who lead change Key considerations for teaching this session a. General Tips for preparation • Consider distributing Chapter 6 of Managers who lead as a handout. This is available on the WSTP Pen Drive in Supplementary Resources. • Slide A.3.3 lists the four factors for success. Each of these is then covered in more detail. For clarity, consider duplicating this slide and repeating it at the start of each of the following sections – with the relevant bullet point highlighted. Content • Highlight that change is often seen as something frightening or problematic. Remind participants that it is our reaction to change that makes it good or bad; change in itself is neutral. • There is not much time for this session: leave some questions out if necessary. b. Section 1. Manager’s role in leading the change process • The Trainer’s Manual suggests that you link this session with previous sessions. Highlight that we have discussed appropriate wheelchair provision and the role of a manager, which includes the responsibility to develop a well-functioning service and a motivated well-trained workforce. c. Section 4. Align personnel and resources • Highlight the Notes for trainers (page 38) and emphasize that participants should not spend all their time talking about funding. Funding is an issue that affects every aspect of services and it is more important to draw out how managers can bring together the human and material resources needed. d. Section 6. Summary of action points for managers • The activity on page 42 asks participants to put their ideas up on four sheets of flipchart paper at the end of each session. As time is short, and this is not referred to again until the end of the programme, remind participants to do this at the end of every session. 83B.1: Accessing servicesToT Handbook B.1: Accessing services Key considerations for teaching this session a. Section 2. What is an equitable service? • On page 43 of the Trainer’s Manual ask the question before showing the Equitable services slide. Consider adding a new slide with the title of the session: Accessing services, or displaying the question. b. Section 3. Referral and appointment • There is not much time for this activity. • This activity may generate a lot of discussion about the reluctance of referral network partners to complete forms. Keep the discussion focused on how managers can encourage partners to use the referral forms. For instance: provide blank forms for completion; keep the form as simple as possible; arrange to collect forms on a regular basis; and give feedback on wheelchair users who have accessed the service (so that those referring can see the benefits). c. Section 4. What can managers do to ensure their service is equitable? • Highlight the importance of making sure the service is equitable. Remind participants of the articles of the CRPD that highlight the needs of women, children, older people, poor people, and those living in rural areas. Managers must work to ensure that these groups are addressed and not marginalized in wheelchair service provision. d. End of the session • At the end of the session, ask participants to record actions in their workbook and remind them to write on the four flipchart sheets put up during the previous session. 84 B.2: Facilities and equipmentToT Handbook B.2: Facilities and equipment Key considerations for teaching this session a. Section 2. Facilities and service flow • If your training programme is taking place in a service centre, this session will include a walk through the service. Ask the group to respect the wheelchair users and staff in the centre and to keep their voices low to avoid disruption. • There is not much time for this section. Plan your route in detail beforehand. To speed things up, consider splitting participants into smaller groups starting at different points. Make sure you have permission to go to each area and ensure staff are aware of your visit. • If you are not based in a service centre, spend more time explaining the service flow slide (B.2.3) in detail. Consider taking video footage or photographs of an actual walk through to show instead. • You can prepare cards with names of the service areas and pin them around the training room or adjacent hallways, allowing participants to rearrange the cards to improve service flow. This will stimulate discussion about what to consider when planning a service. • Refer to page 22 of the Reference Manual and Workbook and highlight the following: – All areas of the service, including the entrance, must be fully wheelchair accessible. – When people arrive at the service there must be an area for registration and space for them to wait to be seen. – It is helpful to have posters, leaflets and video resources in the waiting area, as well as toys for children. – Some people may have travelled long distances and may need to lie down, for example if they have a pressure sore on a weight-bearing area of their body. – Water should be available for everyone on arrival, as well as information on where refreshments are available. – An accessible toilet should also be located near the reception area. – Assessment area/s should be close to the reception/waiting area. They should be quiet, private and have the equipment required for assessments. This includes an assessment bed or bench, privacy screens, foot blocks, tape measures and a camera for recording key stages in the assessment and fitting process. 85B.2: Facilities and equipmentToT Handbook – A technical area is needed for wheelchair preparation, maintenance and repair with floor and bench space. Ideally, this should be close to the assessment areas, but far enough away to reduce noise disturbance. The area should be well-lit, ventilated, waterproof and a good temperature for working. It should have a clean area for final assembly and product adjustment that is separate from the drilling, sanding and painting sections. Technical activities may be split between an area convenient to the other service aspects and another location further away or even outsourced. – A mobility skills area should be located close to the assessment and fitting area. It can be an indoor or outdoor area and should offer a variety of surfaces and obstacles. – A secure storage area is required and should be located close to the technical area. – An office area is needed for the administration aspects of the service, such as preparation and storing of records, and staff meetings. b. Section 4. Organization of facilities • Explain that government facilities often have a requirement to keep broken equipment and old paperwork until it is officially removed from the government inventory. This often means that workshops are filled with redundant equipment and paperwork. To ensure that working areas remain clutter free, encourage managers to store these items, possibly using a container if space is tight. c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 86 B.3: Range of appropriate wheelchairsToT Handbook B.3: Range of appropriate wheelchairs Key considerations for teaching this session a. General Tips for preparation • Have a variety of wheelchairs available with different features related to the environment, function and posture support; also have one or two pressure relief cushions to illustrate points made in this session. Content • This is one of the most important sessions in the WSTPm. Many stakeholders have little knowledge of wheelchairs or the difference that an appropriate wheelchair can make. • This session must be inspirational and persuasive so that managers understand the impact of an appropriate wheelchair. • Adding photographs or case studies relevant to the local context will increase the impact. a. Section 2. What is an appropriate wheelchair and cushion? • Managers need a good understanding of what an appropriate wheelchair means, and to know that what is appropriate for one person will not be appropriate for another. A wheelchair is only inappropriate in reference to the user’s needs. • Because of individual needs and diversity in environment and function, a service cannot provide only one type of wheelchair. Various models are needed to fully meet wheelchair users’ diverse needs. • Emphasize that a cushion is not optional; it is an essential component of an appropriate wheelchair. b. Section 3. Providing proper fit and postural support • The support a person needs to sit well in their wheelchair is individualized. It is not possible to have only one product giving extra support; multiple products are needed which can be adjusted, modified or have options to enable them to be fitted to an individual. A service may have dedicated supportive seats or optional postural support devices (PSDs) that can be added to a wheelchair to 87B.3: Range of appropriate wheelchairsToT Handbook provide different types and levels of postural support. If available, show some examples of PSDs during this session or add some slides showing pictures of different wheelchair users with varying levels of postural support needs. c. Section 4. Meeting the user’s needs and environment • In this section, explain that a wheelchair user’s needs may be different depending on whether they live in an urban or rural environment. For example, someone travelling frequently on public transport or by car may benefit from a lightweight wheelchair that folds or breaks down in some way. Someone living in a rural setting who does not travel will find those features less important, but may benefit from a rigid frame and a longer wheelbase to give them more stability on rough surfaces. d. Section 5. Importance of a safe and durable product • Cover some of the contents of the box on page 34 of the Reference Manual and Workbook in more depth. Managers can be tempted to accept any wheelchairs offered or to select the cheapest models to get the maximum quantity. Managers should know the questions to ask potential donor or suppliers. For example, they should consider whether the wheelchair has been tested to any certified standards for performance and durability, such as ISO standards (International Organization for Standardization) or local standards. • Donors and funders can pressure managers and teams to choose the cheapest wheelchair. It is important to highlight the cost-per-month/year consideration cheap wheelchairs often break down very quickly whereas a good-quality wheelchair can last at least 3–5 years if regularly maintained. Wheelchair model Cost of purchase Years of use Cost per year of use Wheelchair A US$ 80 0.5 US$ 160 Wheelchair B US$ 150 1 US$ 150 Wheelchair C US$ 300 3 US$ 100 Wheelchair D US$ 300 5 US$ 60 e. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 88 B.4: Align personnelToT Handbook B.4: Align personnel Errors in the WSTP materials a. Section 5. Assessing service capacity • Have a calculator available for the session. Add this to the Trainer’s Manual session plan under Resources. Key considerations for teaching this session a. Section 2. Roles in a wheelchair service • Explain that if a region does not have an intermediate level service, the manager of the basic level service should consider how this can be planned for the future and discuss with staff and other stakeholders. b. Section 5. Assessing service capacity Tips for preparation • If you are not confident calculating the figures, practise until you feel prepared. Content • Exit “Slide Show” mode when you get to slide B.4.11 if you are going to complete the table on screen. You will need to click on the edge of the PPT table to enter numbers in the slide. Alternatively, draw the table on a flipchart beforehand and add the numbers during the session. c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. • Remove any data added to slide B.4.11 during the session. 89B.4: Align personnelToT Handbook Activity Work alone for this activity. You will need a calculator. Working with the data in your assigned chart below, fill in the grey cells below columns A-F. Final numbers can be rounded up or down. Option one Planning the working week Scenario A B C D E F Number of working days per week 4 2 5 4 2 5 Number of working weeks per year 40 42 46 40 42 46 Estimating service capacity Basic Intermediate Number of working hours per day 6.5 5 7 6.5 5 7 Estimated number of hours per user 2.5 3 3.5 6 5 5.5 Number of service users per day Number of service users per week Number of service users per year Subtract 15% (contingency for unexpected events) Estimated number of users per year 90 B.4: Align personnelToT Handbook Option two Planning the working week Scenario A B C D E F Number of working days per week 3 2.5 5 3 2.5 5 Number of working weeks per year 44 46 42 44 46 42 Estimating service capacity Basic Intermediate Number of working hours per day 7 6 8 7 6 8 Estimated number of hours per user 3 2.5 3 7 5 6 Number of service users per day Number of service users per week Number of service users per year Subtract 15% (contingency for unexpected events) Estimated number of users per year 91B.5: What does a wheelchair service cost?ToT Handbook B.5: What does a wheelchair service cost? Key considerations for teaching this session a. General • The session is about encouraging managers to think about the different cost areas of a wheelchair service. Do not allow too much discussion on budget lines. • This session can be too detailed for managers who need an overview but have an accountant who works out the details. At the start ask participants if they are involved in detailed budgeting for their service. If not, consider turning the activities into whole group discussions to save time. b. Section 2. Budget guide • For the practice delivery, run the activity in one group for a shorter period to save time. • The following budget headings should be written on the board: Start-up costs and Operational costs. Be clear that you are asking participants to think about the type of costs that would come under each heading. • Emphasize that a manager and team should be clear about: the personnel and equipment needed for each service step, and whether it will take place in the service or the community. c. Section 3. Benefits of integrating services • This section also has an activity that is financially oriented and could be left out, particularly as the concepts are explained in Section 4. Benefits of cost sharing through partnerships. d. Section 4. Benefits of cost sharing through partnerships Tips for preparation • Consider adding a slide at the start of this section asking: “What is cost sharing? What are the benefits of cost sharing?” e. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 92 C.1: How do you know if your service is working?ToT Handbook C.1: How do you know if your service is working? Key considerations for teaching this session a. Section 2: What is monitoring and evaluation? • If time is running short during this session, have a general discussion about the benefits of monitoring and evaluation instead of doing the activity. b. Section 3: Efficient and effective services • Consider running this as a full group activity to give time for more discussion. Ask questions as you complete the table on pages 100–101 in the Reference Manual and Workbook to stimulate discussion. For example, for the first blank box in column two on the second row: – Ask participants: what would be a reasonable time for the performance target? – If one person suggests an answer, ask others if they agree. This will stimulate discussion. – Talk through areas of the table that are already complete as examples of what to do. – Ask participants to look at row two in the third column, “On the user’s file record the date when the referral was received and the assessment date”. Ask who would fill in this information in their own service and how would the data be collated to identify whether the target was met? – Ask what action they could take if the target was repeatedly missed? – Refer to the blank box in the third row of the table under “Information collection” target for the “Number of users who receive a wheelchair”, against a target of 20 per month. – Ask: Where would information be stored about who has received a wheelchair? – This would be recorded in the user files. However, to monitor the total number, managers would also need to compile a master list of wheelchairs distributed. – Ask: How would this be managed? – The purpose of the activity is to encourage participants to think about strategies to record and review information about their service. Keep working through the table encouraging discussion on each item. 93C.1: How do you know if your service is working?ToT Handbook c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 94 C.2: Managing demandToT Handbook C.2: Managing demand Key considerations for teaching this session a. Section 2. Creating demand Tips for preparation • The activity directs you to read out the Bangladesh example of success. Add the slide provided on the WSTP Pen Drive to your presentation so that participants can refer to it during the discussion, or provide a copy on a handout. • In the Most important answers section (second box, page 98) additional reasons why demand might be low include: problems with service delivery; dissatisfaction with the service; or poor reputation of the service. If services are providing low quality or expensive products, or have long waiting times, service users may choose to go elsewhere or to go without a wheelchair. Suggest participants add this information to the list in their Trainer’s Manual. b. Section 4. The importance of early referral for children Tips for preparation • Consider adding a slide showing the benefits of early referral as outlined below. Content • Parents can be reluctant to bring their child for a wheelchair assessment for many reasons (see Most important answers, page 103). They may fear that their child will no longer try to walk or will become lazy. Emphasize that an appropriate wheelchair with the right support often means the child’s walking will improve as they don’t have to go so far. It will also help them conserve energy, which can be used to get involved in other things. With better function they will be able to get out of their wheelchair for an activity on the floor or in a standing position. c. Section 5. Running efficient and effective services • Limit the discussion on the time needed for each stage; this will vary between services. Use this section to help managers understand how to calculate realistic targets for their services. 95C.2: Managing demandToT Handbook • Highlight that the time allocations shown in slide C.2.13 are averages. These will vary between services depending on the range of wheelchairs and PSDs available and the skills of the service staff. Depending on context the times could be double those shown for some service users. d. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 96 C.3: Planning follow-upToT Handbook C.3: Planning follow-up Key considerations for teaching this session a. Section 2. Importance of follow-up • When identifying a wheelchair user to share their experience in this session, ensure they experienced appropriate follow-up. Discuss their experience beforehand to help them highlight the important aspects. b. Section 4. Planning for follow-up Tips for preparation • Slides C.3.7 and C.3.8 are not clear. Replace the existing slides with new ones from your WSTP Pen Drive. Content • As illustrated on the slides, highlight that by providing follow-up a service may provide fewer wheelchairs in year 2 onwards unless human resources are increased. • Emphasize that a service’s effectiveness should be measured on more than just the number of wheelchairs distributed. c. Section 6. Inclusion and participation in the community Tips for preparation • In the example from Sri Lanka on page 122, convert the US$ figures into local currency to help those not familiar with US$. Content • Do not focus on the actual US$ amounts, but on the principle of how much cost is incurred by long stays in hospital because people cannot return home. d. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 97C.4: Planning for financial sustainabilityToT Handbook C.4: Planning for financial sustainability Key considerations for teaching this session a. Section 3. Planning for financial sustainability • Make sure you understand the concept of non-monetary support. • Gifts in kind are sometimes easier to secure than financial contributions and should be considered in all areas of the service. However, some in-kind donations may need maintenance, such as a vehicle, so make sure you include this in your budget. b. Section 4. Identify initial funding sources • Remind participants to think about lead times for funding when considering who to approach. Trusts, foundations and governments can have long review processes whereas corporate donors or individuals may respond more quickly. An ideal strategy will include approaches to a range of sources. c. Section 5. Planning a fundraising strategy • The topic of fundraising can generate a lot of discussion. Keep the group on track. • Participants are often unrealistic about the amount of donations they are likely to receive. Emphasize that successful fundraising takes a lot of effort and it is common to only receive small amounts until you have a track record with a donor. • Highlight that potential donors will want to see that the service has carried out proper planning and budgeting and has good financial accountability. • Emphasize the need for high quality and timely reporting to donors. Provide regular progress updates. Unless a donor has a policy of not giving a repeat donation, you are more likely to secure a second donation from a source you have built a relationship with and have kept well informed. • Encourage participants to set realistic expectations. For example, do not ask donors to fund 200 wheelchairs over three months if your provision capacity is 30 wheelchairs per month. 98 Putting it all togetherToT Handbook Putting it all together Key considerations for teaching this session a. Section 2. Actions to lead change • The aim of this session is to agree on actions to improve wheelchair provision in the country. Focus on gathering inputs from the group members. • When delivering WSTPm you will use the “change facilitators” introduced in session A.3: Managers who lead change. Remind participants to keep adding ideas to the four flipchart sheets on the wall throughout the two days. These lists will form the basis of your discussions. Here are some examples: Actions managers can take to create a shared vision of appropriate wheelchair provision • Involve all team members in deciding the overall objectives of the service and creating a vision and mission statement. • Review the shared vision regularly and ensure that all team members are contributing to its achievement. • Make sure the overall shared vision is user-based: it should be developed with the involvement of wheelchair users. Actions managers can take to communicate the importance of appropriate wheelchair provision • Give presentations to wheelchair sponsors or donors. • Raise awareness of the Wheelchair Guidelines with government ministries and departments, nongovernmental organizations, Disabled People’s Organizations and rehabilitation professionals. • Organize joint awareness raising events and activities with other stakeholders particularly on the International Day of Persons with Disabilities. • Raise awareness of the articles of the UN Convention on the Rights of Persons with Disabilities (CRPD) that relate to assistive products. • Highlight which of the Sustainable Development Goals (SDGs) promote the importance of appropriate provision of assistive products. • Organize meetings with rehabilitation and community-based rehabilitation training schools to raise awareness and promote the Wheelchair Guidelines. • Collect case studies and ‘before’ and ‘after’ pictures of wheelchair service users to share and show the benefits of a professional service. 99Putting it all togetherToT Handbook Actions managers can take to align personnel and resources • Make sure all the wheelchair service steps are assigned to people who have the skills and time to fulfil them. • Involve wheelchair users in the service where possible, particularly for user training and follow-up. • Make sure that personnel fulfilling the clinical, technical and training roles have received the appropriate training. • Ensure your service targets are realistic based on the staff and resources available. • Monitor the service regularly to check that personnel roles, responsibilities and workloads are appropriate. Actions managers can take to motivate, engage and commit personnel • Organize team meetings for all team members to agree on and understand targets. • Ensure that all members of the team see the benefits of a professional service and the dangers of poor service by asking wheelchair users to share their personal stories. • Offer incentives to staff such as bonuses, holidays or “person of the month” awards for exceptional work. • Hold team building events to strengthen teamwork and build morale. • Thank staff when they do work well or achieve a service milestone. The most important part of this session is to discuss what should happen after the training programme. Emphasize the need to agree on next steps while they are together, even if it is only for a follow-up meeting where more detailed planning will be carried out. Encourage participants to nominate people to take things further and to agree on how to communicate with each other after the training programme. Your role is to help participants set specific actions to help them make progress and be successful after the meeting. The Trainer’s Manual suggests you ask these questions: What will be the next steps? Are you going to form a task force to initiate some of the actions proposed? Who will take these actions further? Are you going to meet again? When? Encourage participants to be specific in their answers. If they say they will form a task force, ask who will take responsibility for this? Who will be represented? How many members will there be? What will be the terms of reference? Will there be any meeting costs and who will pay? What will stop them from taking the next steps and how can they overcome these barriers? How will the full group get feedback? 100 Putting it all togetherToT Handbook Encourage participants to commit to something individually or as an organization. For example, organizing or hosting the next meeting; writing an article about the training programme for the local newspaper to promote awareness about wheelchair services. 101WSTPtot Stakeholders reference materialToT Handbook WSTPtot Stakeholders reference material 102 Introduction to the WSTPtot Stakeholders programme ToT Handbook Introduction to the WSTPtot Stakeholders programme Planning a WSTPs delivery Many of the resources discussed in the WSTPtot Core training skills and WSTPtot Managers modules are also relevant to stakeholders. For example, a thorough knowledge of the CRPD, the WHO Wheelchair Guidelines and the laws and policies of the country or region where the training programme is being delivered, is essential to facilitators of the WSTPs. As with the WSTPm, the WSTPs will rarely be delivered exactly in line with the sample timetable. Content will depend on the local situation and desired outcomes. For example, if a coordinating body already exists it will be able to guide and oversee commitments for action (such as advocacy and awareness raising initiatives, and/or mobilizing resources). If no such structure is in place, the workshop can help bring stakeholders together to share knowledge and build relationships. In this case creating a shared vision becomes very important and can get stakeholders working together to advance appropriate wheelchair provision in the country. This happened in the Philippines where a society was set up following a WSTP Stakeholder Workshop. It is important to establish who will take the lead in following up on agreed actions. This will help maintain the momentum created by the workshop to meet participants’ expectations. It will often be appropriate for a representative of the workshop’s main host organization to fulfill this role. The workshop may elect a task force or committee to move decisions forward, however this person can still take responsibility for keeping all participants updated on progress. It will often be more relevant to use the WSTPs programme in combination with sessions and activities planned specifically to suit the local context. The WSTPs sessions can be delivered in a minimum of 240 minutes (four hours), which represents a half-day workshop. This may be the most time that high-level government personnel can commit. However, it is strongly recommended that you schedule a one-day workshop and preferably one that runs for two days to allow you to meet specific local needs. 103Introduction to the WSTPtot Stakeholders programme ToT Handbook Consider including opening presentations from high-level officials, such as a government minister, to increase the likelihood of the event being reported by the media. Also consider inviting high-level officials to attend the opening and closing sessions to: raise their awareness of the major challenges in the sector; share the outcomes of the workshop with them; and request that they commit their support in specific ways. The WSTPs Trainer’s Manual gives detailed information on all aspects of preparing for a WSTPs delivery. The following sections provide extra information to help guide your planning and delivery. WSTPs resources The Trainer’s Manual is the main resource for the WSTPs; there is no participant manual. It is advisable to give participants some of the key resources on a DVD or Pen Drive, for instance the Wheelchair Guidelines, CRPD and WSTP logo. It is also recommended that you give participants a copy of the Wheelchair service steps poster, which can be printed from the WSTP Pen Drive. Target audience for the WSTPs Page 2 of the Trainer’s Manual lists the personnel who may be included in a Stakeholder Workshop. This list should always include government agencies with responsibility for disability issues (usually health, social welfare, or veteran affairs; sometimes urban development, transport and housing), NGOs, DPOs, rehabilitation professionals, wheelchair producers and suppliers, external donors, religious organizations (who may be donors, suppliers or rehabilitation professionals), and international agencies working in the rehabilitation sector. As you prepare, ask people with local knowledge about organizations present in the region who should be invited. Ensure that there is a good gender balance of wheelchair users and that specific groups are well represented including, if possible, people with spinal cord injuries (paraplegic and quadriplegic), amputation, cerebral palsy, elderly people and people with degenerative conditions. Also ensure that parents’ groups are included and consider inviting human rights organizations. 104 Introduction to the WSTPtot Stakeholders programme ToT Handbook Purpose and scope of the WSTPs The purpose of the WSTPs is to raise awareness and increase the knowledge of all personnel involved in establishing appropriate wheelchair provision in their country or region (stakeholders). The WSTPs consists of four sessions that each have a PPT presentation and session plan. There are also four videos to present: check that these are embedded in the PPTs beforehand. See the Core training skills module for information on how to do this. The Stakeholder Workshop is the most contextual of all the WSTP and should be used in a flexible way to suit the level of the participants, their desired outcomes and the time available. Trainers and participants for the WSTPs Although the term ‘trainer’ is used throughout the WSTP, the WSTPs requires a facilitator more than a trainer. There will be a wide range of participants and good facilitation is needed to ensure that everyone gets the opportunity to contribute. A ratio of one trainer for every 8–10 participants is recommended. The number of participants will depend on many factors including the region covered and outcomes required. Numbers could range from 12 to 40, or more. If your meeting is national, ensure that all regions of the country are represented. Also, check that women, youth and children with mobility disabilities are fairly represented. WSTPs download The WSTPs can be downloaded from the WHO website at: http://www.who.int/ disabilities/technology/wheelchairpackage/wstpmanagers/en/ 105WSTP Stakeholders – logistics and preparationToT Handbook WSTP Stakeholders – logistics and preparation Planning One of the main preparation requirements of a Stakeholder Workshop is to know the current wheelchair provision situation in the country or region concerned. Page 8 of the Trainer’s Manual lists the key information that is needed. To gather this material you will need to consult a wide variety of organizations and individuals. The box below gives some suggestions on who to contact. Decisions on who to invite to the workshop should be made after completing these consultations. A WSTPm/s planning tool has been developed to help trainers in the planning stage to get an overview of the current situation and to decide on the outcomes to be achieved. This can be found in the Annexes of this manual and on your WSTP Pen Drive. Possible organizations/individuals to contact • Key government ministries or departments dealing with disability, such as health, social welfare, disability affairs or child welfare • DPOs and NGOs working in disability including any umbrella DPO (for instance the National Federation for People with Disabilities or a National Association for People with Physical Disabilities) • Staff of rehabilitation centres working in the wheelchair or prosthetic/orthotic fields • People with disabilities and their families/carers • Community-based rehabilitation organizations • Academic institutions running disability programmes • World Health Organization and international NGOs working in the country within the rehabilitation field • Rehabilitation equipment producers/suppliers • Donor organizations supporting disability initiatives • Disability-specific organizations such as those run by, or working with, people with cerebral palsy, spinal injuries, amputation or veterans • Human rights organizations • Organizations involved in reporting on the CRPD. 106 WSTP Stakeholders – logistics and preparationToT Handbook Identifying participants The success of the Stakeholder Workshop will depend on setting a clear purpose, or desired outcome, and then in line with this ensuring that the most appropriate stakeholders are invited. The number of people attending will depend on the area the workshop is covering, the budget available and the intended outcomes. Typically between 12 and 40 participants will be involved. If the workshop is national make sure there is good representation from all regions of the country or from national organizations. This may have budget implications but is important for credibility and for the successful implementation of any plans. If you do not have good representation from all relevant sectors and regions, there is a risk that: • discussions do not represent all interested parties • decisions are made without important viewpoints being considered • participants may leave with an incomplete picture of the current situation as important voices have been left out • participants get frustrated because the workshop is not representative of the sector • agreed plans do not have credibility or cannot be implemented as they lack support from all stakeholder groups. Ensure all identified stakeholders are invited and that invitations are followed up. Identifying and preparing guest speakers Pages 10 and 11 of the Trainer’s Manual give guidance on how to identify and prepare guest speakers. They will help set the scene for the meeting and highlight the importance of appropriate wheelchair provision. Identify speakers well in advance and discuss the focus of their presentation, whether they will use slides, and the time available to them. If guest speakers are planning to use a PPT presentation, try to get it ahead of time and load it on the laptop you plan to use throughout the Stakeholder Workshop. The boxes below give suggestions of sectors to approach for a guest speaker. 107WSTP Stakeholders – logistics and preparationToT Handbook Possible guest speakers: • minister or senior delegate from a relevant ministry (Ministry of Health, Ministry of Social Welfare or Ministry of Veteran Affairs) • head of an agency, department or directorate concerned with disability affairs • technical specialist knowledgeable about the country’s disability sector. Make sure the person you invite is generally accepted as an effective and positive influencer. Annex 1 (page 49) of the Trainer’s Manual gives information on how to brief a government representative about their speech. It is important to do this to ensure the most important issues relevant to wheelchair service provision are covered; such as the responsibilities of the speaker’s department, the current situation of wheelchair provision and the status of any relevant legislation. Possible wheelchair user representative: • familiar with the importance of appropriate wheelchair service provision • can explain from personal experience the value of an appropriate wheelchair • has knowledge and experience of local wheelchair service provision • confident speaking passionately in front of a group • knowledge of the CRPD • willing to share their own story to highlight challenges faced by wheelchair users. Try to identify a disability rights advocate as they will take a rights-based approach to the subject and will have a good awareness of local politics and context. They are likely to have good knowledge of the CRPD but may not necessarily be aware of the Wheelchair Guidelines. They can be briefed as part of their preparation. Page 51 of the Trainer’s Manual gives advice to the wheelchair user representative on what to cover in their speech. Talk it over with them to help bring to life what it is like to be a wheelchair user and what they hope will be achieved in the future. Page 53 of the Trainer’s Manual (Annex 3) gives some quotes and statistics that speakers and trainers can refer to in their presentations. Encourage speakers to talk about the bigger picture rather than focusing narrowly on their own organization’s work. Highlighting the strengths, weaknesses, opportunities and threats within the wheelchair service provision sector will be useful to stimulate discussion. 108 WSTP Stakeholders – logistics and preparationToT Handbook Trainers’ roles The WSTPs is a workshop rather than a training programme and requires the trainer to adopt more of a facilitator role. Trainers should have a thorough knowledge of the wheelchair and disability sector generally, as well as the local context. This will enable them to plan and manage the sessions most effectively. WSTPs trainers should have a good understanding of the importance of appropriate wheelchair provision and a strong commitment to it. Trainers who are familiar with health policy and the functioning of government are also valuable assets. It is particularly beneficial if one of the trainers is a wheelchair user with some or all the skills and knowledge outlined above, and who also knows the training package. If all the trainers come from outside the local region, allow for extra time before the workshop for them to meet local stakeholders to discuss the local context. 109WSTPs practice deliveriesToT Handbook WSTPs practice deliveries 110 S.1: Introduction ToT Handbook S.1: Introduction Key considerations for teaching this session a. Introduction • If you are running a half day workshop and the group is large, the 5 minutes allocated will not be enough for individual introductions. As an alternative, you could call out categories (for example, therapist, government, DPO, NGO, donor, media) and ask the members of each group to identify themselves by standing up or raising their hand. • When a key purpose of the meeting is to establish relationships, personal introductions become important. Include a few minutes for people to introduce themselves at each table and then reassign people to different tables for subsequent sessions to increase the relationships established. • Encourage participants to give their name and organization when they contribute in the following sessions. b. Guest speakers and Keynote address – wheelchair user/ representative Tips for preparation • The Trainer’s Manual mentions up to three guest speakers in this session. The time allocated is only 20 minutes in total, and guest speakers frequently talk over their allotted time. • If you have more time available, consider extending this session. If well chosen and well briefed, guest speaker’s testimonies can be extremely powerful and will lay good foundations for the workshop. Tips to ensure speakers are relevant and keep to time • Avoid PPTs or limit to no more than three or four slides. • Ask local contacts about the invited speakers. If they tend to go over time, reduce the number of speakers. • Brief the guest speaker in advance about time constraints. Tell them you will hold up a sign when there are 2 minutes left, to help them keep to time. Ask for any PPT presentations in advance so you can check and upload them on the computer. 111S.1: Introduction ToT Handbook c. Questions and answers • Only 5 minutes are allowed for guest speaker questions and answers. Limit the number of questions and encourage speakers to keep their answers brief. If guest speakers are attending the whole workshop, encourage participants to ask more questions during breaks. 112 S.2: Policy to practiceToT Handbook S.2: Policy to practice Key considerations for teaching this session a. General Tips for preparation • The Trainer’s Manual includes a checklist of key resources to create a legal- framework handout for this session. Speak to government representatives, NGOs, DPOs and other stakeholders, and carry out internet searches to collect this information. • For a more comprehensive overview of the situation in the country, complete the WSTPm/s planning tool, which can be found in the Annexes of this manual and on your WSTP Pen Drive. b. Section 2. What is the need and unmet need? Tips for preparation • Add national population statistics to the first slide and calculate 1% of this figure to give the estimated number of people who need a wheelchair according to WHO.3 Ask your co-trainer/s to check the calculation is correct. Search on the Internet for the latest census information or look for a more recent estimate from the government department of statistics or other reputable source. 3 http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/ 113S.2: Policy to practiceToT Handbook Content • WHO estimates that approximately 15% of any population are people with disabilities4 and 1% need a wheelchair. Census information on the total percentage of people with disabilities is usually much lower than the WHO estimates and varies between countries (it is usually closer to 2–5%). Therefore, participants may question the WHO estimates. Explain that disability is generally under-reported for a number of reasons: – disabled family members may be hidden away inside the home and not counted in a census – people do not always admit to their disability on a census form – census forms do not always capture relevant information, so many people with disabilities may not be identified. c. Section 3. Importance of wheelchair provision Tips for preparation • Ensure the video is embedded in the WSTP Pen Drive, or easy to locate, before the session starts. • This is a 3-minute section and the video is two and a half minutes so there is not time to include Shobha from India’s story unless the session time is extended. There is another example from India later (page 27). d. Section 5. Everyone has rights • Read the full CRPD, not just the highlighted articles. This will put the articles in context and give a more comprehensive understanding of the rights enshrined in the Convention. e. Section 6. Policy reaches the individual through services • This section includes a slide showing the wheelchair service steps. Have the poster on the wall and refer to it. • This is the first mention of the Wheelchair Guidelines in the WSTPs. If awareness of them is low, and you are not running a separate session on them, use this opportunity to emphasize the importance of the guidelines and the eight steps of wheelchair provision. 4 http://www.who.int/mediacentre/factsheets/fs352/en/ 114 S.2: Policy to practiceToT Handbook f. Section 7. Make rights real with a national plan • There is not much time to complete the activity in Section 7. Run this exercise with the group as a whole, or allow more time for the exercise and less time for feedback. Ask for general feedback rather than from each of the four groups separately. g. Section 9. Key point summary • At the end of this session, emphasize that all sectors of government have a role to play in achieving appropriate wheelchair provision. National and international policies, conventions and laws are only meaningful when enforced by the different stakeholders, and in some cases this will only happen through advocacy and lobbying. The compliance, commitment and accountability of all stakeholders is critical. • All stakeholders have a part to play in addressing the urgent need for improved wheelchair provision systems (including wheelchair design, production, supply and service delivery), and to ensure that service delivery follows the eight steps covered in Section 6. 115S.3: Range of appropriate wheelchairsToT Handbook S.3: Range of appropriate wheelchairs Key considerations for teaching this session a. General Tips for preparation • Add “different types of wheelchairs” and “cushions” to the resources box in the session plan. Highlight different features and designs; encourage questions and use them to engage participants. • Before the session starts, ensure the two videos are embedded in the WSTP Pen Drive, or easy to locate. b. Section 2. Importance of an appropriate wheelchair and cushion Tips for preparation • Slide 3.5: Convert the US$ figures into local currency so that everyone understands the amounts. • This section focuses on the importance of an appropriate wheelchair and cushion. If you have time add your own case studies to show the impact of inappropriate wheelchairs and cushions. Content • Emphasize that pressure sores can develop quickly and can be fatal and that a cushion is an integral component of an appropriate wheelchair. Wheelchair users may have to stay in bed for months or years to heal from pressure sores. • Keep the conversation focused on how to provide an appropriate wheelchair – focus on user needs and the importance of being able to choose from a range of wheelchairs. Try to avoid getting bogged down in details about wheelchair production or particular brands, unless these have been identified as important topics. 116 S.3: Range of appropriate wheelchairsToT Handbook c. Section 4. Meeting the user’s needs and environment • Participants are asked to observe how the different wheelchairs help people in the video to carry out their activities. Highlight the different environments that are featured. Use the resource wheelchairs to show the flip-up footplates or folding mechanism demonstrated in the video. d. Section 5. Importance of a safe and durable product • Emphasize that it is important for services to find out about safety and durability when they are considering new products. For example, does the wheelchair come with a pressure relief cushion? Has the wheelchair passed any certification checks (such as ISO tests)? Has the design been used in similar environments elsewhere? Does it come with spare parts? Can the frame be repaired locally? 117S.4: Working together for change ToT Handbook S.4: Working together for change Errors in the WSTP materials a. Section 6. How to provide support and remove obstacles • The last slide thumbnail in this section has an incorrect heading. The correct heading: Key point summary is on the PPT slide. Correct it in your Trainer’s Manual. Key considerations for teaching this session a. General • Emphasize that the participants of the Stakeholder Workshop are critical both in creating and promoting change. Relate the content of these sections to the participants. For example, highlight the need to identify early adopters who could champion appropriate wheelchair provision. Highlight the need to identify the organizations who most desire change and could be a driving force for wheelchair provision. b. Section 1. Introduction • The introduction suggests linking this session to previous similar sessions about unmet need and the benefits of appropriate wheelchairs. Flag up the guiding documents again including any international, national, or local policies. c. Section 2. How to communicate a sense of urgency • Participants often comment that there are no statistics available and therefore the need for wheelchairs is unknown. Persuade them that this should not be a reason for inaction. The WHO statistic of 1% is a credible statistic that can be used for estimating and planning purposes. d. Section 6. How to provide support and remove obstacles • Slide 4.12: edit the slide to include the population of the country where you are training and calculate the estimated 1% of the population requiring wheelchairs. You should already have this data from the slide in session S.2. 118 S.4: Working together for change ToT Handbook e. Section 7. Strategies to help the change process • What will be the next steps? (page 47): If possible, increase the time allocated to discuss the actions listed on the flipchart sheets. It is important that there is agreement on how to move forward before the workshop breaks up. For instance, plans for a follow-up meeting after participants have had time to reflect and consult with colleagues. • To save time, consider running the activity in Section 7 either for the group as a whole or by dividing into three groups. Show the groups how to record their answers directly onto the flipchart paper or via Post-it notes. f. End of session • The last two slides are for the closing address. Consider inserting a blank slide before the first to avoid moving on to the closing address in error. 119Closing address ToT Handbook Closing address Key considerations for teaching this session a. General • The two slides for the Closing address are at the end of the PPT for Session S.4. Working together for change. b. Closing address and logo • Highlight that the WSTP logo is provided on the WSTP Pen Drive. c. Evaluation and feedback to WHO • Evaluation and feedback is very important to WHO as it enables ongoing improvement and development of the WSTP materials. Encourage participants to join in this process. 120 AnnexesToT Handbook Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equip- ment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 121 ToT Handbook Annex 2: WSTPtot Managers and Stakeholders Timetable Day one Day two Day three 8:30 Introduction to the WSTPtot Managers (85) B.5: What does a wheelchair service cost? (60) Introduction to the WSTPtot Stakeholders (35) 8:45 9:00 S.2: Policy to practice (45) 9:15 9:30 B.5: What does a wheelchair service cost? Feedback (30) 9:45 S.2: Policy to practice: Feedback (25) 10:00 Morning break Morning break 10:15 Welcome, introduction and overview (10) C.2: Managing demand (85) Morning break 10:30 Welcome, introduction and overview: Feedback (15) S.3: Range of appropriate wheelchairs (30) 10:45 A.1: What is appropriate wheelchair provision? (50)11:00 S.3: Range of appropriate wheelchairs: Feedback (20) 11:15 S.4: Working together for change (part I) (57)11:30 A.1: What is appropriate wheelchair provision? Feedback (25) 11:45 C.2: Managing demand: Feedback (35) 12:00 Lunch break 12:15 Lunch break Lunch break 12:30 12:45 1:00 A.2: Service delivery (40) 1:15 C.4: Planning for financial sustainability (70) S.4: Working together for change (part II) (43)1:30 1:45 A.2: Service delivery: Feedback (20) 2:00 A.3: Managers who lead change (45) S.4: Working together for change: Feedback (30)2:15 2:30 C.4: Planning for financial sustainability: Feedback (30) WSTPm and WSTPs logistics and preparation (30) 2:45 A.3: Managers who lead change: Feedback (30) 3:00 Afternoon break Afternoon break 122 ToT Handbook 3:15 Afternoon break WSTPm non-practice sessions (105) WSTPm and WSTPs timetable options (45) 3:30 B.1: Accessing services (45) 3:45 4:00 Car park 4:15 B.1: Accessing services: Feedback (25) ToT trainer individual feedback (65) 4:30 4:45 Car park 5:00 Session preparation ToT trainer individual feedback (30) Session preparation ToT trainer individual feedback (30) 5:15 WSTPtot Managers and Stakeholders evaluation and closing (10) 123 ToT Handbook Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 124 ToT Handbook Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 125 ToT Handbook Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 126 ToT Handbook Annex 4: WSTPm/s planning tool Country _____________________ Completed by ________________________ Contact details ____________________ Date: ___________________________ 1. How to use the tool The tool is designed to help gather a general overview of the situation in the country and to help set the desired training and workshop outcomes. It is recommended that you work with stakeholders to complete the following table as follows: 1. Circle or highlight the box that most closely describes the situation in the country. 2. Complete the white ‘Summary’ boxes in the left-hand column to give brief details of the actual situation for that area. 3. Consider what sessions to include in your training based on the local situation and time available, drawing from local knowledge and the ‘consider including session/s on’ lines, and the possible outcomes page. 2. Summary of main stakeholders in the country to involve in research and planning Consult/include these stakeholders as listed in the WSTPs: • Policy planners and implementers (including Government departments – especially those with responsibility for wheelchair provision). • Umbrella disability organization/s. • Organizations of disabled people (ODPs). • Influential leaders or politicians. • Wheelchair users, their families and caregivers. • Philanthropists/funders/donors. • Media: print and digital. • Wheelchair manufacturers and suppliers. • Professional groups (Physiotherapists, Occupational therapists, CBR professionals, Prosthetists, Orthotists and others). Also consider inviting stakeholders from other countries who can share their experiences. 127 ToT Handbook 3. W ST P m /s p la nn in g to ol B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng C om pl et e th e w hi te su m m ar y bo xe s be lo w C ir cl e/ bo ld t he m os t re le va nt w hi te b ox fo r ea ch o f t he 1 0 ar ea s 1. P ol ic y an d P la nn in g: P ol ic ie s / N at io na l D is ab ili ty P la ns / le gi sl at io n re la ti ng t o w he el ch ai r se rv ic e de liv er y Su m m ar y: N o po lic ie s/ pl an s ex ist w hi ch s pe ci fic al ly re fe re nc e pr ov isi on o f as sis tiv e de vi ce s. N o na tio na l s tr at eg ie s ar e in p la ce . So m e ge ne ra l p ol ic ie s/ pl an s ar e in p la ce b ut no t a lig ne d w ith th e C RP D o r W he el ch ai r G ui de lin es o r w el l kn ow n by s ta ke ho ld er s. Th ey a re n ot e nf or ce d an d ar e ou t o f d at e. Po lic ie s/ pl an s ar e in pl ac e an d ar e kn ow n by m os t s ta ke ho ld er s. Th ey a re to s om e ex te nt in li ne w ith th e W he el ch ai r G ui de lin es an d C RP D b ut a re n ot en fo rc ed . Po lic ie s/ pl an s ar e in pl ac e, in li ne w ith C RP D a nd W he el ch ai r G ui de lin es . T he y ar e re gu la rly r ev ie w ed , w el l k no w n by a ll st ak eh ol de rs , a nd la rg el y en fo rc ed . C on sid er in cl ud in g se ss io n/ s on : Fo rm ul at io n/ dr af tin g of p ol ic ie s/ N at io na l di sa bi lit y pl an s/ st an da rd s in li ne w ith C RP D / W H O G ui de lin es . Re vi ew in g po lic ie s w ith re fe re nc e to C RP D / W H O G ui de lin es . H ow to o pe ra tio na liz e po lic ie s th at a dv oc at e fo r ap pr op ria te w he el ch ai r se rv ic es . U sin g po lic ie s to st re ng th en w he el ch ai r de liv er y. H ow to a ss ist o th er co un tr ie s to d ev el op / im pl em en t p ol ic ie s. 128 ToT Handbook B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 2. P ol ic y an d P la nn in g: C on ve nt io n on t he r ig ht s of p er so ns w it h di sa bi lit ie s (C R P D ) Su m m ar y: C RP D h as n ot b ee n sig ne d an d th er e is no lo ca l c om m itm en t f ro m go ve rn m en t t o th e C on ve nt io n. C RP D h as b ee n sig ne d bu t n ot r at ifi ed a nd is no t w el l k no w n or p ro m ot ed w ith in co un tr y. C RP D h as b ee n sig ne d an d ra tifi ed bu t k no w le dg e an d m on ito rin g of it is w ea k. C ou nt ry h as s ig ne d an d ra tifi ed th e C RP D a nd ha s st ro ng m on ito rin g m ec ha ni sm s in p la ce to ev al ua te p ro gr es s. C on sid er in cl ud in g se ss io n/ s on : Ra isi ng a w ar en es s of th e C RP D a nd it s re le va nc e to w he el ch ai r se rv ic e de liv er y. H ow to p ro m ot e C RP D a nd it s re le va nc e to w he el ch ai r se rv ic e de liv er y. Re vi ew in g/ de ve lo pi ng m on ito rin g sy st em s an d st ru ct ur es in r el at io n to w he el ch ai r se rv ic es . Re vi ew in g m on ito rin g da ta to h ig hl ig ht st re ng th s an d w ea kn es se s of w he el ch ai r se rv ic es in re la tio n to C RP D . 3. P ol ic y an d P la nn in g: K no w le dg e of W H O G ui de lin es o n th e pr ov is io n of m an ua l w he el ch ai rs in le ss re so ur ce d se tt in gs ( W he el ch ai r G ui de lin es ) Su m m ar y: Th er e is lit tle o r no kn ow le dg e of th e G ui de lin es e ve n am on g st ak eh ol de rs w or ki ng in w he el ch ai r se rv ic e de liv er y. A li m ite d nu m be r of st ak eh ol de rs a re a w ar e of th e G ui de lin es b ut th ei r ci rc ul at io n ha s be en v er y lim ite d. G ui de lin es a re w el l kn ow n am on gs t ke y w he el ch ai r st ak eh ol de rs b ut n ot w ith in G ov er nm en t o r m ai ns tr ea m d isa bi lit y/ de ve lo pm en t a ct or s. G ui de lin es a re w el l kn ow n an d us ed a s a ke y gu id in g re so ur ce b y G ov er nm en t a nd o th er ac to rs to p la n an d im pl em en t w he el ch ai r se rv ic es . C on sid er in cl ud in g se ss io n/ s on : Pr es en ta tio n on th e G ui de lin es c on te nt a nd ba ck gr ou nd . D ev el op in g a ge ne ra l st ra te gy to p ro m ot e th e G ui de lin es . St ra te gy to p ro m ot e th e G ui de lin es to sp ec ifi c se ct or s. N at io na l/I nt er na tio na l ca se s tu di es o f h ow G ui de lin es a re b ei ng m et . 129 ToT Handbook B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 4. P ol ic y an d P la nn in g: C ou nt ry in fr as tr uc tu re a nd c oo rd in at io n of w he el ch ai r pr ov is io n ef fo rt s Su m m ar y: C ou nt ry is in a v ol at ile / em er ge nc y sit ua tio n w ith li tt le fo rm al in fr as tr uc tu re . Re ha bi lit at io n ef fo rt s ar e m in im al a nd m os tly ru n by IN G O /N G O se ct or . C ou nt ry is p oo rly or ga ni ze d an d re so ur ce d an d st ru ct ur es a re w ea k. Re ha bi lit at io n is no t pr io rit ize d an d ef fo rt s ar e no t c oo rd in at ed . Sk ille d na tio na l s ta ff ar e sc ar ce . In fr as tr uc tu re is in pl ac e an d re ha bi lit at io n se rv ic es a nd s ta ff ex ist b ut s er vi ce s ar e no t w el l c oo rd in at ed or r es ou rc ed a nd ar e lim ite d in q ua lit y, vo lu m e an d re ac h. C ou nt ry h as a s ou nd in fr as tr uc tu re th at in cl ud es w el l-e st ab lis he d an d co or di na te d re ha bi lit at io n se rv ic es in a ll re gi on s of th e co un tr y. C on sid er in cl ud in g se ss io n/ s on : Ra isi ng a w ar en es s of a pp ro pr ia te w he el ch ai r de liv er y am on gs t I N G O /N G O re ha bi lit at io n ac to rs . H ow to c oo rd in at e w he el ch ai r se rv ic e de liv er y in iti at iv es in th e co un tr y. Fo rm ul at io n of Ta sk Fo rc e or N at io na l as so ci at io n. H ow to c oo rd in at e w he el ch ai r se rv ic e de liv er y in iti at iv es in th e co un tr y. En su rin g su st ai na bi lit y an d pl an ni ng fo r th e fu tu re : t he c ha ng in g w he el ch ai r se rv ic e ne ed s in a n ag ei ng po pu la tio n. 5. P ol ic y an d P la nn in g: S tr en gt h of d is ab ili ty m ov em en t an d le ve l o f i nc lu si on o f p er so ns w it h di sa bi lit ie s Su m m ar y: O rg an iza tio ns o f pe rs on s w ith d isa bi lit ie s (O PD ) ar e w ea k or a bs en t. Pe rs on s w ith d isa bi lit ie s ar e m ar gi na liz ed , st ig m at ize d, a nd sh un ne d. Th er e is a w ea k di sa bi lit y m ov em en t w ith s om e O PD s an d N G O s w or ki ng in di sa bi lit y bu t w or k is no t c oo rd in at ed o r im pa ct fu l. P W D s ar e la rg el y ex cl ud ed . G ro w in g di sa bi lit y m ov em en t w ith in cr ea sin g O PD st re ng th . P W D s in cl ud ed in s om e as pe ct s of li fe a nd aw ar en es s is in cr ea sin g of th ei r rig ht s in li ne w ith th e C RP D . V ib ra nt d isa bi lit y m ov em en t w ith s tr on g O PD s st ru ct ur e. P W D s in vo lv ed in w he el ch ai r se rv ic e de liv er y an d th ei r rig ht s in li ne w ith C RP D a re r ec og ni ze d in m os t a re as . C on sid er in cl ud in g se ss io n/ s on : W he el ch ai r us er rig ht s an d th e ro le o f w he el ch ai r us er s an d th ei r or ga ni za tio ns in w he el ch ai r se rv ic e de liv er y. Po te nt ia l r ol es o f se lf- he lp g ro up s in w he el ch ai r de liv er y: ca se s tu dy e xa m pl es . H ow to in cr ea se th e ro le o f O PD s in w he el ch ai r se rv ic e de liv er y. Ro le o f O PD s in pr om ot in g ap pr op ria te w he el ch ai r de liv er y na tio na lly a nd in te rn at io na lly . 130 ToT Handbook B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 6. P ro du ct s: A va ila bi lit y of a pp ro pr ia te w he el ch ai rs a nd s up po rt iv e se at in g Su m m ar y: Th er e is a la ck o f a ny w he el ch ai rs a t a ll, an d th os e av ai la bl e ar e no t ap pr op ria te fo r m os t pe op le ’s ne ed s. Th er e ar e 1– 2 ap pr op ria te w he el ch ai rs bu t t he se a re n ot w id el y av ai la bl e, a nd d o no t s er ve th e ne ed s. Th er e is lit tle o r no su pp or tiv e se at in g. Th er e is a fu ll/ lim ite d ra ng e of a pp ro pr ia te w he el ch ai rs a nd /o r su pp or tiv e se at in g bu t vo lu m e/ qu al ity /r ea ch to al l r eg io ns is li m ite d. Th er e is a co m pr eh en siv e ra ng e of ap pr op ria te w he el ch ai rs an d su pp or tiv e se at s in a ll re gi on s of th e co un tr y. C on sid er in cl ud in g se ss io n/ s on : Ra ng e of a pp ro pr ia te w he el ch ai rs . Ev al ua tin g lo ca lly av ai la bl e pr od uc ts ag ai ns t G ui de lin es . Ex pa nd in g th e re ac h an d ra ng e of ap pr op ria te w he el ch ai rs an d in tr od uc in g su pp or tiv e se at in g. Ex pa nd in g th e re ac h an d ra ng e of ap pr op ria te w he el ch ai rs an d se at in g. Pr es en ta tio n of su cc es s st or ie s to em ph as ize im po rt an ce of m ai nt ai ni ng a co m pr eh en siv e ra ng e. 7. S er vi ce s: S ta tu s of w he el ch ai r se rv ic es Su m m ar y: N o go ve rn m en t se rv ic es . R el ia nc e on s po ra di c m as s di st rib ut io ns b y N G O s w ith ou t a ss es sm en t a nd pr es cr ip tio n se rv ic es ac co rd in g to G ui de lin es . So m e ba sic s er vi ce s in p la ce o f v ar yi ng st an da rd s ru n by go ve rn m en t o r N G O s. N o in te rm ed ia te le ve l se rv ic es . P oo r re fe rr al an d fo llo w u p. So m e ba sic a nd in te rm ed ia te se rv ic es o pe ra tin g to W he el ch ai r G ui de lin es s ta nd ar d bu t i ns uf fic ie nt fo r ne ed s, no t i nt eg ra te d in to g ov er nm en t r eh ab se rv ic es , a nd m in im al us er in vo lv em en t o r fo llo w u p. A n et w or k of q ua lit y ba sic a nd in te rm ed ia te le ve l s er vi ce s ar e in te gr at ed in to n at io na l go ve rn m en t s er vi ce s an d m ee tin g ne ed s on a lo ca l a nd n at io na l l ev el w ith fu ll in vo lv em en t o f us er s. C on sid er in cl ud in g se ss io n/ s on : St ar tin g a w he el ch ai r se rv ic e Ru nn in g a w he el ch ai r se rv ic e H ow to u ps ca le th e po sit iv e as pe ct s of se rv ic e de liv er y to m ee t n at io na l n ee ds . Th e w ay fo rw ar d fo r on go in g de ve lo pm en t of s er vi ce s. H ow to s up po rt o th er co un tr ie s to d ev el op se rv ic es . 131 ToT Handbook B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 8. S er vi ce s: A va ila bi lit y of r eh ab ili ta ti on p ro fe ss io na ls / C B R s er vi ce s / S ta ff tr ai ne d in w he el ch ai r de liv er y sk ill s Su m m ar y: Th er e ar e ve ry fe w ph ys io th er ap ist s/ O cc up at io na l t he ra pi st s or C BR p ro fe ss io na ls. N o or fe w p eo pl e in th e co un tr y ha ve s ki lls re la te d to w he el ch ai r de liv er y. Th er e ar e a lim ite d nu m be r of q ua lifi ed pr of es sio na ls an d tr ai ne d C BR w or ke rs . H ow ev er v er y fe w pe op le h av e sp ec ifi c sk ills in w he el ch ai r de liv er y. Q ua lifi ed p ro fe ss io na ls ar e pr es en t i n m os t ar ea s an d C BR w or ke rs ar e pr es en t i n m os t di st ric ts . T he re a re s om e pe op le w ho h av e be en tr ai ne d in s pe ci fic s ki lls of w he el ch ai r de liv er y in s om e re gi on s. Th er e is a ne tw or k of tr ai ne d re ha bi lit at io n an d C BR p ro fe ss io na ls co ve rin g al l o r m os t re gi on s an d a hi gh nu m be r of p eo pl e w ho ha ve b ee n tr ai ne d in sk ills o f w he el ch ai r de liv er y. C on sid er in cl ud in g se ss io n/ s on : A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es H ow to in te gr at e W ST P m od ul es in to re ha bi lit at io n cu rr ic ul a. H ow to in te gr at e W ST P m od ul es in to re ha bi lit at io n cu rr ic ul a. 9. S er vi ce s: A va ila bi lit y of fu nd in g Su m m ar y: Li tt le o r no fu nd in g av ai la bl e lo ca lly fo r re ha bi lit at io n. M os t re ha bi lit at io n fu nd in g is pr ov id ed b y IN G O s/ In te rn at io na l or ga ni za tio ns . M in im al fu nd in g is av ai la bl e fo r se rv ic es bu t n o fu nd in g is co m m itt ed to w he el ch ai r pr ov isi on . M od es t l ev el o f f un di ng is av ai la bl e fo r bo th se rv ic es a nd p ro du ct s bu t i s in ad eq ua te fo r ne ed s. Se rv ic es a re w el l re so ur ce d an d al l/ m os t w he el ch ai rs a nd su pp or tiv e se at s ar e fu nd ed th ro ug h th e st at e sy st em . C on sid er in cl ud in g se ss io n/ s on : A w ar en es s- ra isi ng am on g IN G O /N G O ac to rs o n im po rt an ce of a pp ro pr ia te w he el ch ai r pr ov isi on . Pr es en ta tio n of c as e st ud ie s de m on st ra tin g he al th c os t s av in gs o f ap pr op ria te w he el ch ai r pr ov isi on a nd in cl us io n of P W D s. Im po rt an ce o f a ra ng e of a pp ro pr ia te w he el ch ai rs a t d iff er en t co st s to s ui t v ar yi ng ne ed s. C as e st ud ie s of th e be ne fit s of th e ef fe ct iv e se rv ic es to e ns ur e th ey ar e m ai nt ai ne d an d le ss on s sh ar ed w ith ot he rs . 132 ToT Handbook B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 10 . T ra in in g: T ra in in g av ai la bl e fo r w he el ch ai r se rv ic e pe rs on ne l i nc lu di ng w he el ch ai r us er s Su m m ar y: Tr ai ni ng in w he el ch ai r de liv er y is no t p ro vi de d at a ll w ith in th e co un tr y. C ou nt ry d oe s no t h av e re ha bi lit at io n tr ai ni ng sc ho ol s. So m e lim ite d tr ai ni ng in w he el ch ai r de liv er y is in cl ud ed in C BR / ot he r tr ai ni ng c ou rs es bu t i s no t i n lin e w ith W he el ch ai r G ui de lin es . N o w he el ch ai r us er sk ills tr ai ni ng . So m e tr ai ni ng is pr ov id ed to v ar io us ca dr es a nd th er e ar e a lim ite d nu m be r of pe op le a bl e to tr ai n W ST P or e qu iv al en t pa ck ag es . S om e w he el ch ai r us er tr ai ni ng . Re gu la r co ur se s in w he el ch ai r de liv er y sk ills a t b as ic a nd in te rm ed ia te le ve l i n lin e w ith W he el ch ai r G ui de lin es a re o ffe re d an d in te gr at ed in to c ur ric ul a of ot he r re ha bi lit at io n pr of es sio na ls. C on sid er in cl ud in g se ss io n/ s on : A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es . Tr ai ni ng n ee ds a na ly sis ag ai ns t d iff er en t s ec to rs . A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es . A w ar en es s of p ee r tr ai ni ng fo r w he el ch ai r us er s. D ev el op in g a st ra te gy to in cr ea se th e w he el ch ai r de liv er y sk ills o f r eh ab ilit at io n pr of es sio na ls an d w he el ch ai r us er s. St ra te gy to d ev el op th e sk ills o f w he el ch ai r pr of es sio na ls to in te rm ed ia te /a dv an ce d le ve l. 133 ToT Handbook 4. Possible outcomes to set for a Wheelchair Service Managers Training and/or Stakeholder Workshop Identify the most appropriate and achievable outcomes and consider how much time is needed to cover each. Expand the time of sessions or range of sessions as appropriate. Consider these areas identified in the packages: WSTPm • Increased awareness of the eight steps of wheelchair service delivery. • Increased knowledge and skills of how to start a wheelchair service. • Increased knowledge and skills in how to run a wheelchair service. • Raising awareness of how to make wheelchair provision sustainable. • Increased quality of wheelchair service delivery. WSTPs • Improved understanding about the need for and benefit of an appropriate wheelchair. • Inform stakeholders of their role in developing appropriate wheelchair service delivery. • Attain better understanding of barrier free environments. • Gain more commitment to seek/provide budgetary support. • Increase sustainability of wheelchair service delivery. Consider these additional possible outputs or identify your own based on the local context and needs. • Formulation/Drafting of a national policy for wheelchair service delivery. • Formulation/Drafting of a national strategy for wheelchair service delivery. • Appointment of a Task Force to coordinate and drive wheelchair issues. • Establishment of a Wheelchair/Assistive Devices society or group. • Agreeing national standards for wheelchair service delivery. • Existing wheelchair and seating range evaluated against the WHO Wheelchair Guidelines. • Increased awareness of the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings. • Increased awareness of the CRPD and other International instruments and how they relate to wheelchair service delivery. • Improved coordination of wheelchair service delivery. • Improved skills of personnel involved in wheelchair service management. 134 ToT Handbook • Increased understanding of the global/regional/national situation for wheelchair service delivery. • Completion of training needs analysis for wheelchair service delivery.

140 ToT Handbook For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/

DR AF T Managers and Stakeholders Wheelchair Service Training OF Traine rS Package Trainer’s Manual DR AF T For more information, contact. World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/ dar@who.int DR AF T Managers and Stakeholders Wheelchair Service Training OF Traine rS Package Trainer’s Manual Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Wheelchair service training of trainers package. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology The following terms used throughout the WSTPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainee in specific WSTPb/i/ m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms The following acronyms used throughout the WSTPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package C O N T EN T S x About the Wheelchair Service Training of Trainers Package xiii 1. Guidance notes for ToT trainers xvii 2. How to prepare to deliver the training package xxiv Core training skills module 1 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package 12 ToT.2 Wheelchair Service Training Packages 25 ToT.3 Practice delivery sessions 36 ToT.4 Preparing for diversity 43 ToT.5 Adult learning 55 ToT.6 Preparation time 58 ToT.7 Presenting and facilitating 67 ToT.8 Communication skills 75 ToT.9 Knowledge of guiding documents 92 ToT.10 Audio-visual tools and equipment 103 ToT.11 Feedback 109 ToT.12 Managing group dynamics 117 Managers/Stakeholders module 118 Introduction to the WSTPtot Managers 133 Welcome, introduction and overview 134 A.1: What is appropriate wheelchair provision? 136 A.2: Service delivery 137 A.3: Managers who lead change 138 B.1: Accessing services 139 B.2: Facilities and equipment 141 B.3: Range of appropriate wheelchairs 143 B.4: Align personnel 145 B.5: What does a wheelchair service cost? 146 C.1: How do you know if your service is working? 147 C.2: Managing demand 149 C.3: Planning follow-up 150 C.4: Planning for financial sustainability 151 Putting it all together 164 Introduction to the WSTPtot Stakeholders 172 S.1: Introduction 174 S.2: Policy to practice 177 S.3: Range of appropriate wheelchairs 179 S.4: Working together for change 181 Closing address 182 WSTPm and WSTPs logistics and preparation 191 WSTPm and WSTPs timetable options 201 WSTPtot Managers and Stakeholders evaluation and closing 203 Annexes 203 Annex 1: Timetable for WSTPtot core sessions 204 Annex 2: WSTPtot Managers and Stakeholders Timetable 206 Annex 3: Feedback sheet for WSPTtot practice delivery sessions 209 Annex 4: WSTPm/s planning tool x About the Wheelchair Service Training of Trainers PackageTrainer's Manual about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United States Agency for International Development (USAID) developed a series of four training packages to increase wheelchair access in developing countries. The Wheelchair Service Training of Trainers Package (WSTPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. The need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WSTPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. The WSTPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WSTPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WSTPi) 2013; the Wheelchair Service Training Package for Managers (WSTPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WSTPs) published in 2015. The WSTPm and WSTPs have been combined into one package-specific module within the WSTPtot. The WSTPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WSTPtot, a trainee should go forward to deliver their training package alongside an experienced trainer, allowing them to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiAbout the Wheelchair Service Training of Trainers PackageTrainer's Manual Target audience The WSTPtot is made up of four modules: • Core training skills – two days • Basic Level (WSTPb) – three days • Intermediate Level (WSTPi) – three days • Managers and Stakeholders (WSTPm/s) – three days. All trainees should complete the Core training skills module followed by one of the package-specific modules: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WSTPb. Previous experience providing basic-level wheelchairs is essential; the WSTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WSTPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WSTPi. Previous experience providing intermediate-level wheelchairs is essential; the WSTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WSTPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WSTPm and WSTPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the WSTPtot Managers and Stakeholders module. Trainees should have access to co-training opportunities within three months of completing the WSTPtot in order to consolidate and practise newly acquired skills. xii About the Wheelchair Service Training of Trainers PackageTrainer's Manual Trainers Skills: The ToT trainers delivering this package should have: • significant experience delivering the WSTPm/s and mentoring others to deliver them • a good understanding of the context in which they are delivering the WSTPtot • extensive knowledge or experience of wheelchair services’ management in a variety of countries/contexts • knowledge of international guiding documents related to wheelchair provision • the experience and ability to engage stakeholders in discussions about wheelchair provision. Wheelchair users: As with the other WSTP, inclusion of wheelchair users in the training team is highly recommended. Wheelchair users can draw on their own experiences to give a valuable perspective on how appropriate wheelchair provision affected their feeling of inclusion and quality of life. They can also talk about the central role wheelchair users play in the selection of their own wheelchair. number of ToT trainers: Trainees need to be closely supported, so it is recommended that there is one ToT trainer for every four to five trainees for the Basic and Intermediate modules, and one ToT trainer for every six trainees for the Managers and Stakeholders module. how to get started Before running the ToT programme, copy the WSTPtot folder from the WSTP Pen Drive to your computer’s hard drive. • Read 1. Guidance notes for ToT trainers below. Prepare materials in the tables on pages xviii–xxi. • Make all the necessary arrangements, as described in the section How to prepare to deliver the training package. • Give each trainee a full set of the training materials listed on pages xviii–xx of this manual. xiii1. Guidance notes for ToT trainersTrainer's Manual 1. guidance notes for ToT trainers Training overview Core training skills module Minutes Day ToT.1 Introduction to the Wheelchair Service Training of Trainers Package 75 D ay 1 ToT.2 Wheelchair service training packages 90 ToT.3 Practice delivery sessions 60 ToT.4 Preparing for diversity 60 ToT.5 Adult learning 85 ToT.6 Preparation time 15 Preparation 45 ToT.7 Presenting and facilitating 60 D ay 2 ToT.8 Communication skills 90 ToT.9 Knowledge of guiding documents 75 ToT.10 Audio-visual tools and equipment 45 ToT.11 Feedback 45 ToT.12 Managing group dynamics 40 Preparation 75 Managers/Stakeholders module Introduction to the WSTPtot Managers 85 D ay 3 Welcome, introduction and overview 25 A.1 What is appropriate wheelchair provision? 75 A.2: Service delivery 60 A.3: Managers who lead change 75 B.1: Accessing services 70 Car Park, Session preparation, ToT trainer individual feedback 60 B.5: What does a wheelchair service cost? 90 D ay 4 C.2: Managing demand 120 C.4: Planning for financial sustainability 100 WSTPm non-practice sessions 105 Session preparation, ToT trainer individual feedback 30 xiv 1. Guidance notes for ToT trainersTrainer's Manual Introduction to the WSTPtot Stakeholders 35 D ay 5 S.2 Policy to practice 70 S.3 Range of appropriate wheelchairs 50 S.4: Working together for change 130 WSTPm and WSTPs logistics and preparation 30 WSTPm and WSTPs timetable options 45 Car Park, ToT trainer individual feedback 80 WSTPtot Managers and Stakeholders evaluation and closing 10 Total training time 2205 Training package timetable and duration The WSTPtot Core training skills and Managers/Stakeholders modules can be delivered on consecutive days or in blocks over a period of time. A sample five-day timetable is available in the WSTPtot folder on the WSTP Pen Drive. ToT trainers are encouraged to adapt and modify the timetable to suit the local context and the learning needs of trainees. Core training skills session plans The Core training skills module is made up of 12 sessions that each begin with a detailed session plan. The plan covers the following key points and is designed to help ToT trainers organize and deliver the sessions. • Aim – what is the aim of the session • Learning objectives – what will trainees have achieved by the end of the session • Resources – what resources are needed for the session • To prepare – checklist to help the ToT trainer prepare for the session • Outline – the main contents of the session with timing. ToT trainers are encouraged to bring their own knowledge, skills and style to the sessions and to draw out the trainees’ experience throughout the WSTPtot. xv1. Guidance notes for ToT trainersTrainer's Manual WSTPm/s session plans After completing the Core training skills module, trainees go on to the second part of the WSTPtot where they will practise the training skills they have learnt by delivering sessions from the WSTPm and WSTPs. Sessions are allocated to trainees and their delivery is followed by feedback and discussion. The practice delivery sessions allow the ToT trainer to observe and assess the trainees’ skills. • Practice delivery: Each practice delivery includes presentations of allocated sections of a session by the trainee. • ToT trainer demonstrations: some sessions include a section that the ToT trainer will deliver as an example of good practice. • Feedback: After the session, the ToT trainer will facilitate feedback from the trainee and the ToT participants. Further instructions for providing feedback can be found on page xxii–xxiii of this manual, Guide to facilitating practice delivery sessions. Prepare trainees for practice deliveries To enable trainees to prepare well for the WSTPtot, it is important to give them the WSTPm and WSTPs materials in advance. This can be a paper copy of the package, an e-copy or a link to download it. Trainees should be prepared to deliver any of the sessions. A sample letter for trainees to prepare for the WSTPtot can be found in the WSTPtot folder on the WSTP Pen Drive. Practice delivery allocations Example practice delivery allocations can be found in the WSTPtot Managers/ Stakeholders allocation document in the WSTPtot folder. ToT trainers should modify this to their training context and trainee numbers. Practice delivery sessions are assigned during the first day of the Core training skills module in session ToT.3 Practice delivery sessions. Note: If trainees have already attended the Core training skills module and will begin directly with the WSTPm/s module, they should be notified of their practice delivery sessions two-to-three days in advance. xvi 1. Guidance notes for ToT trainersTrainer's Manual Mentoring and peer support The ToT trainer has an important role to play as a mentor. Each trainee must be allocated a mentor ToT trainer at the beginning of the training programme. ToT trainers should divide trainees equally between them. As a mentor the ToT trainer is the trainee’s main point of contact for questions about their practice delivery sessions and is also there to provide feedback on the trainee’s progress. ToT trainers are encouraged to continue to mentor trainees after the WSTPtot. Trainees can also get valuable ongoing support from their peers, which will help them to develop their skills and confidence. Trainees may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. co-training After completing the WSTPtot, trainees should continue to develop their skills by co-training alongside experienced trainers. ToT trainers should promote co-training experiences as the best way for trainees to continue to develop their training skills after completing the WSTPtot. The recommended ratio for co-training is one mentor trainer for every two to four co-trainers. In some cases, ToT trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. This information should be recorded in the feedback from practice deliveries and shared with the trainee. evaluating the ToT programme after each delivery It is good practice to evaluate every training programme after it has been delivered. ToT trainers should gather regular feedback from trainees and record their own thoughts during the ToT programme. This will help ToT trainers to improve both the WSTPtot and their own training skills. It is very helpful if you can provide feedback and data including: • participant registration and evaluation forms • your reflections or comments on the WSTPtot. Training programme evaluation forms are available in the WSTPtot folder on the WSTP Pen Drive and can be adapted by ToT trainers to meet their specific needs. xvii2. How to prepare to deliver the training packageTrainer's Manual 2. how to prepare to deliver the training package know the background of each trainee It is important to be familiar with the background of each trainee. This includes: • understanding what experience the trainee already has in wheelchair provision • being aware of any training programmes the trainee has already attended or delivered • knowledge of future opportunities for the trainee to deliver the WSTPm and WSTPs. Find out how wheelchair service delivery and training fits within the trainee’s overall duties at their place of work. Prepare the training facilities To run the WSTPtot you will need: • one large training room (or space) that is big enough to allow trainees to divide up and work together in small groups and quiet enough to enable trainees to concentrate • a separate space for lunch/refreshments • clean toilets. all areas, including toilets, must be wheelchair accessible. xviii 2. How to prepare to deliver the training packageTrainer's Manual The following checklist can be used to assess and prepare training facilities. Facilities checklist Training room Lecture area  Chairs for each trainee with a flap-tray or other facility so trainees can write notes  Space for trainees to break into small groups of two-to-four people  Space to display at least three wheelchairs and be able to move them around  Adequate lighting and ventilation  Lockable/secure space  lunch/refreshment area Clean area for eating  Tables and chairs  Nearby space for washing hands – clean towels and soap  Toilets Clean toilets supplied with water, toilet paper, washing facilities and bins  Prepare the training resources and equipment WSTPtot printed resources resource Quantity X comments/instructions Manuals ToT Trainer’s Manual 1 per ToT trainer (for each module delivered)  Print and bind. ToT Handbook 1 per trainee (for each module delivered) and 1 per ToT trainer  Print and bind. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 1 per trainee  Print and bind or provide a soft copy. United Nations Convention on the Rights of Persons with Disabilities (CRPD) 1 per trainee  Print and bind or provide a soft copy. Set of printed resources for package-specific module (WSTPm and WSTPs) 1 per trainee and ToT trainer  This includes manuals, workbooks, posters, forms and checklists. See table below for more details. xix2. How to prepare to deliver the training packageTrainer's Manual Training programme forms Participant registration form 1 per programme  Use this form to keep a record of trainees attending. Name tags 1 per trainee and per ToT trainer  – Timetables (Core training skills and package-specific module) 1 per trainee for each relevant module  Sample for each module available on WSTP Pen Drive; adjust to suit local context. Photo consent form 1 form  Adapt this form for the host/ training organization; translate into local language; ensure any person who is photographed signs this form. Trainee certificate 1 per trainee  Prepare trainee certificates or adapt the template provided on the WSTP Pen Drive. Training programme evaluation forms • Core training skills • Package-specific module 1 per trainee  Collate information after delivery and share with WHO. Feedback sheet for WSTPtot practice delivery sessions ToT trainer will require 1 per trainee.  Print at least 1 per trainee. This sheet can be used to provide feedback on up to 3 practice deliveries. xx 2. How to prepare to deliver the training packageTrainer's Manual WSTPm and WSTPs printed resources resource Quantity X comments/instructions Manuals, workbook and posters WSTPm Trainer’s Manual 1 per trainee and ToT trainer  Print and bind. WSTPm Reference Manual and Workbook 1 per trainee and ToT trainer  Print and bind. WSTPm Additional Resources 1 per trainee and ToT trainer  Print and bind. WSTPs Trainer’s Manual 1 per trainee and ToT trainer  Print and bind. Set of posters, including: • Wheelchair service steps • Wheelchair mobility skills • Pressure sores • How to care for a wheelchair at home • Children and wheelchairs • Different positions • Postural Support Device (PSD) table • Intermediate-wheelchair user training checklist. 1 per trainee and ToT trainer  – Joint position paper on the provision of assistive devices in less-resourced settings At least 1 sample copy  Resource on WSTP Pen Drive. CBR Guidelines Introductory booklet and Health component At least 1 sample copy  Resource on WSTP Pen Drive. Managers Who Lead At least 1 sample copy  Resource on WSTP Pen Drive. Design Considerations for Accessibility At least 1 sample copy  Resource on WSTP Pen Drive. xxi2. How to prepare to deliver the training packageTrainer's Manual equipment general training equipment item Quantity X comments/instructions Large whiteboard 1  – Whiteboard marker pens 3–4  Various colours Data projector 1  – Computer 1  – Portable speakers 1 set  To improve video sound quality Pointer/remote control 1  – Flipchart stand and paper 1–2 stands and 1 pack of paper  – Flipchart pens 3–4  Various colours Post-it notes 3–4 blocks  Various colours Masking tape or similar 1 roll  To attach flipchart sheets and posters to walls Extension cord At least 1  – Multi-plugs/adapters As needed  – xxii 2. How to prepare to deliver the training packageTrainer's Manual get to know the training resources As a ToT trainer, you will need a comprehensive knowledge of all the WSTPm and WSTPs resources. This includes familiarizing yourself with all aspects of the package-specific Trainer’s Manual as well as the Reference Manual for Participants, Participant’s Workbook and other resources on the WSTP Pen Drive. You should also be familiar with all sections of the ToT Trainer’s Manual and the ToT Handbook. You may be co-training the WSTPtot with another ToT trainer, however it is important for you to be familiar with all sessions. For example, you will need a good understanding of all the Core training skills taught in the WSTPtot and to model them as good practice during your own session deliveries. guide to facilitating practice delivery sessions • Monitor the delivery time and stop the trainee when their allocated time is up, even if they have not finished. • Where a session is shared by two or more trainees, to keep things moving run the whole session before facilitating feedback for each of the trainees in turn (unless the session requires a break due to WSTPtot timing). • Be familiar with the Errors in the WSTP materials and Key considerations for teaching this session in the ToT Trainer’s Manual, and watch to see if the trainee has addressed them. • Follow the session in the WSTP Trainer’s Manual and the ToT Trainer’s Manual. • During the delivery, complete the Feedback sheet for WSTPtot practice delivery sessions, found on the WSTP Pen Drive. • During practical activities don’t step in too quickly if the session is not running smoothly. Allow the trainees time to rectify the situation and redirect participants themselves. Only step in if there are safety concerns, or if trainees are unable to bring the session back on track themselves. xxiii2. How to prepare to deliver the training packageTrainer's Manual Facilitating feedback after practice deliveries Your role is to facilitate the feedback sessions and ensure they are brief, constructive and relevant. After the practice delivery is completed, go through the following process. * Found in the Feedback sheet for WSPTtot practice delivery sessions. Closely monitor the feedback to ensure that it is constructive. Step in if a participant gives feedback that is negative or hurtful. Give examples of how to rephrase feedback so that it is constructive. individual feedback Based on the ToT trainer mentor allocations, ToT trainers arrange a time to discuss feedback with each lead trainee, using the Feedback sheet for WSTPtot practice delivery sessions as a guide. Use this time to also feedback any additional or sensitive comments. Self- reection Participant feedback • Ask trainee to comment on what they did well, followed by what can be improved. • Facilitate feedback from ToT participants, asking them to provide one comment on what the trainee did well, followed by one comment on what can be improved. • Discuss any Key considerations for teaching this session not yet addressed through the trainee’s delivery and/or by the ToT trainer feedback. ToT trainer feedback Key points • ToT trainers to feedback, using the trainee skills list* for guidance. It is not necessary to comment on every competency: focus only on the areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. Do not repeat what has already been mentioned by the trainee or ToT participants. xxiv Core training skills moduleTrainer's Manual core training skills module 1ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the Wheelchair Service Training of Trainers Package A IM To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and objectives of the ToT programme □□ explain the ToT programme timetable and WSTPtot process. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.1: Introduction to the WSTPtot □□ name tag for each ToT trainer. For each trainee: □□ different coloured sticky notes (A5 or similar): 3 or 4 pieces □□ ToT Handbook □□ module-specific WSTP trainer’s manual, participant’s reference manual and workbook, posters and WSTP Pen Drive □□ WHO Wheelchair Guidelines and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ timetables for Core training skills module and package-specific module □□ blank name tag. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Arrange a short opening ceremony for the WSTPtot as locally appropriate. □□ Prepare the housekeeping information. □□ Prepare flipchart papers for Ground Rules and Car Park. □□ Set up the training room: tables and chairs; projector, computer and screen; whiteboard; flipchart stand and paper; and markers. □□ Sort resources into sets for each participant and set them out. To avoid confusion only provide trainees with the ToT Handbook, their package-specific WSTP Trainer’s Manual and the ToT timetable at the start of the day. Provide remaining resources at the end of the day. □□ Prepare a Wall of Experience. Print or write headings given in Section 5 on large sticky notes or A5 paper and put them on the wall under a Wall of Experience heading. 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual O U T L IN E 1. Opening ceremony 2. Welcome and introductions 3. Introduction to this session 4. Housekeeping and Ground Rules 5. Wall of Experience 6. Overview of the WSTPtot 7. Key point summary 10 10 1 10 15 27 2 Total session time 75 1. Opening ceremony (10 minutes) In collaboration with the host organization, hold an opening ceremony for the WSTPtot as locally appropriate. 2. Welcome and introductions (10 minutes) Introductions ToT.1 Introduction to the WSTPtot: 2 ToT trainers: Welcome everyone and introduce yourselves. Give a brief overview of your background and your experience in wheelchair provision and training. Ask trainees to introduce themselves, giving their name, job role and organization. Give out name tags and ask trainees to write their name. 3. Introduction to this session (1 minute) Aim: To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). Objectives: • describe the aim and objectives of the ToT programme • explain the ToT programme timetable and WSTPtot process. ToT.1 Introduction to the WSTPtot: 3 Explain the aim and objectives of the session. 3ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 4. Housekeeping and Ground Rules (10 minutes) • Toilets • Refreshments and lunch • Accessibility • Emergency exits. ToT.1 Introduction to the WSTPtot: 4 Explain the following, as required: • location of toilets • refreshments and lunch arrangements • any accessibility issues • what to do if there is an emergency • any other administration issues. Setting the Ground Rules Discuss with your neighbour the Ground Rules you would like to have in place for the week. ToT.1 Introduction to the WSTPtot: 5 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Explain: We will now establish the Ground Rules for this training. Ask trainees to briefly discuss the Ground Rules they would like to have in place for the week. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for the activity and 5 minutes for feedback. Feedback: Ask each pair to give one item from their list and record each rule on the flipchart until there are no more ideas. Gather feedback from trainees to ensure they agree on the rules. Ask how the group wants to manage people who break these rules. Pin up the Ground Rules on the wall for reference throughout the ToT programme. 4 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Notes for ToT trainers: • Explain that everyone is responsible for enforcing the Ground Rules, not just the ToT trainer. • Refer trainees to the list each time a Ground Rule is broken. Examples of Ground Rules include: • mobile phones – switch to silent • no side talking or talking over other people • respect for others’ points of view • be on time for all sessions • keep the training area clean and tidy • contribute to the discussions • use appropriate disability terminology. • Use positive terminology • Use the terms: ‘persons with disabilities’ or ‘people with disabilities’. ToT.1 Introduction to the WSTPtot: 6 Explain: • The WSTP promotes the use of positive terminology in relation to people with disabilities. • Trainers must model good practice and follow the language guidance set out in the WSTP and the CRPD. • Terms such as ‘the disabled’ or ‘disabled people’ or ‘special people’ are not appropriate, and should not be used. • Always use ‘persons with disabilities’ or ‘people with disabilities’. • Avoid using the term ‘normal people’ when referring to people without disabilities. Add ‘use appropriate disability terminology’ as a Ground Rule if it is not listed. Suggest that trainees monitor the use of positive terminology throughout the ToT. Notes for ToT trainers: • Although we recommend avoiding use of the term ‘disabled people’, the terms ‘Disabled People’s Organization’ and ‘DPO’ are still in wide use and generally accepted. Encourage the use of the term ‘Organization of Persons/People with Disabilities’ (OPD), which is becoming increasingly common. 5ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Sometimes called Parking Lot • Topics and questions that come up in a session but are outside the content or cannot be covered immediately will be ‘parked’ and discussed at a later time. ToT.1 Introduction to the WSTPtot: 7 Explain: • During the training, you may have questions that the trainers are unable to answer immediately, or that may be covered during a later session. • These questions will be placed in the Car Park to be discussed at an appropriate time. Pin up the Car Park flipchart on the wall. 5. Wall of experience (15 minutes) Creating a Wall of Experience Write about yourself on sticky notes. Include: • Number of years and type/s of experience related to assistive devices • WSTP training given or received • Professional background • Languages spoken. There is no need to include your name. ToT.1 Introduction to the WSTPtot: 8 Show the slide throughout the activity. 6 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Activity 2 Groups: Ask trainees to work alone. Instructions: Put the Wall of Experience headings on the wall, including: • WSTP training given or received • number of years and type/s of experience related to assistive devices • professional background • languages spoken. Explain: We all come to this training with different types of experience, knowledge and skills. We will create a Wall of Experience together. Write your answers using sticky notes in a different colour for each heading (or more than one if required). Ask trainees to write clearly and then stick their notes up onto the wall under each heading. Monitor: Monitor the trainees and assist as needed. Check that trainees are writing clearly, with one statement on each piece of paper/card. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Ask trainees to comment on the Wall of Experience. Draw attention to the wealth of existing knowledge, skills and experience in the room. Emphasize that trainees have already progressed a long way to get to this point and they will build up even more experience from here. Notes for ToT trainers: • Keep referring to this Wall throughout the programme and link this to other parts of the training as appropriate. 7ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 6. Overview of the WSTPtot (27 minutes) Aim: To equip new trainers with knowledge and skills to deliver the WSTP. Objectives: • demonstrate the qualities of a good trainer • create an effective learning environment • reflect on their own training performance • co-train on the appropriate WSTP. ToT.1 Introduction to the WSTPtot: 9 Explain the aim and objectives of the WSTPtot. Day 1 Core training skills Day 2 Core training skills Day 3 Package-specific Day 4 Package-specific Day 5 Package-specific ToT.1 Introduction to the WSTPtot: 10 Ask trainees to look at their copy of the ToT timetable. Explain: the ToT is divided into two sections: • Core training skills module • package-specific module, during which trainees will practise delivering WSTP sessions to their peers. Notes for ToT trainers: • While there are four Wheelchair Service Training Packages, there are only three package-specific modules because the Managers and Stakeholders packages are covered in one module. Introduce the resources that are being provided to each trainee. Briefly explain and show each one. Explain that some of the materials will be distributed at the end of the day. 8 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Completed one or more WSTP • Experience in wheelchair service provision or the disability sector • Language proficiency • Experience as a trainer or facilitator • Opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 11 Explain: in order to get the most out of the WSTPtot, trainees should: • have completed one or more WSTP • have experience in wheelchair service provision or the disability sector • be able to read and write in the language used to deliver the ToT programme • have some experience of training or facilitating • have opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 12 Core training skills Package-specific Co-trainer Trainer Explain: • Co-training takes place after the ToT programme and before trainees train independently. Co-training experiences are the best way to further develop your training skills after completion of the WSTPtot. • After completing the ToT programme, all trainees should have at least one co-training experience. • Co-training with an experienced trainer will help strengthen your training skills including: – planning and preparing to deliver the WSTP – presenting and facilitating – mentoring participants – coordinating training logistics. 9ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Co-training is the best way to develop your skills • Other ways to get support include: – distance support from experienced trainers – connecting with other ToT trainees. ToT.1 Introduction to the WSTPtot: 13 Explain: if you are unable to co-train with experienced trainers consider other ways to get the support you need, such as: • contacting experienced trainers and asking them to mentor you from a distance – through email and phone contact • connecting with other ToT trainees and supporting each other through the planning, preparation and delivery of the WSTP. • Number and timing of co-trainings will vary by trainee • ToT trainers will help decide how many co- trainings you should complete • Logistics are a part of co-training. ToT.1 Introduction to the WSTPtot: 14 Explain: • The number of co-trainings you will complete will vary by trainee. • The timeframe for becoming a trainer will also vary based on when co-trainings are available and how many co-trainings you complete. • ToT trainers and trainers who mentor you while co-training will support you in deciding how many co-trainings you should complete before training on your own. 10 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the WSTPtot: 1 Ask trainees to look at their copy of the Feedback sheet for WSTPtot practice delivery sessions in their ToT Handbook on page 126–128. Explain: • Reflecting or thinking about what you do well and what can be improved will help you to become a better trainer. • The Feedback sheet for WSTPtot practice delivery sessions includes a list of the trainee skills that this training aims to develop. • The feedback sheet will be used to guide feedback to trainees after each practice delivery. • ToT trainers will also use it to provide feedback to lead trainees at the end of each day, and written feedback at the end of the ToT programme. 7. Key point summary (2 minutes) • Observe the Ground Rules and use appropriate disability terminology • The Wall of Experience shows there is a lot of knowledge and experience in the room • Structure of the WSTPtot and process after the ToT programme. ToT.1 Introduction to the WSTPtot: 16 Read the key points. Ask whether there are any questions. 11ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual WALL OF EXPERIENCE Number of years and type/s of experience related to assistive devices WSTP training given or received Professional background Languages spoken 12 ToT.2 Wheelchair Service Training Packages Trainer's Manual ToT.2 Wheelchair Service Training Packages A IM To introduce the WSTP, its components and methodology. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the four WSTP □□ list the guiding principles of the WSTP □□ describe the format of the trainers’ manuals for each package. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.2: Wheelchair Service Training Packages □□ hard copy of the Trainer’s Manual for each trainee: WSTPb, WSTPi or WSTPm and WSTPs, according to the package-specific modules trainees will attend after the Core training skills module. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ If possible, embed the WSTP Pen Drive link into PPT slide 20 to demonstrate its use. O U T L IN E 1. Introduction 2. Background and rationale of the four WSTP 3. Structure of the different WSTP 4. Getting to know the Trainer’s Manual 5. How to use the WSTP 6. Key point summary 2 15 5 30 35 3 Total session time 90 13ToT.2 Wheelchair Service Training Packages Trainer's Manual 1. Introduction (2 minutes)1 2 Aim: To introduce the WSTP, its components and methodology. Objectives: • list the four WSTP training packages • list the guiding principles of the WSTP • describe the format of the trainers’ manuals. ToT.2 Wheelchair Service Training Packages: 1 Explain the aim and objectives of the session. 2. Background and rationale of the four WSTP (15 minutes) • 2006: Consensus Conference, Bangalore • 2008: Wheelchair Guidelines published • Need for training opportunities identified. ToT.2 Wheelchair Service Training Packages: 3 Explain: • The Consensus Conference on Wheelchairs for Developing Countries, held in Bangalore, India, in November 20061 laid the foundation for the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings.2 • The Wheelchair Guidelines identified the need for training opportunities, which led to the development of the WSTP Basic, Intermediate, Managers, and Stakeholders. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 14 ToT.2 Wheelchair Service Training Packages Trainer's Manual • Basic Level (WSTPb) • Intermediate Level (WSTPi) ToT.2 Wheelchair Service Training Packages: 4 Explain: • The WSTPb3 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. • The WSTPi4 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. More days may be added in order to: • add material • add sessions • increase number of practical sessions • add time for product preparation • support translation • shorten the training day • provide extra teaching time. ToT.2 Wheelchair Service Training Packages: 5 Explain: • Both the WSTPb and WSTPi are designed to be delivered in a minimum of five days. • Extra time can be added to the training programme to: – add material to the session plans – add sessions – increase the number of practical sessions with wheelchair users – provide more preparation time for products used in the training – allow for translation – reduce the length of training days – provide extra time to learn key concepts. f3,4 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 http://www.who. int/disabilities/technology/wheelchairpackage/en/ 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 15ToT.2 Wheelchair Service Training Packages Trainer's Manual • Managers (WSTPm) • Stakeholders (WSTPs) ToT.2 Wheelchair Service Training Packages: 6 Explain: • The WSTPb and the WSTPi are intended to increase the number of personnel trained in wheelchair service delivery. • However, trained personnel alone cannot ensure appropriate wheelchair provision without higher-level involvement. • To support the development of services, WHO developed: – WSTPm5 – designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. WSTPm can be delivered in a minimum of two days. – WSTPs6 – designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. • Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting. f5,6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 16 ToT.2 Wheelchair Service Training Packages Trainer's Manual • User centred • Rights based • International best practice (evidence based) • Less-resourced settings • Wheelchair users as participants • Accessible language and terminology. ToT.2 Wheelchair Service Training Packages: 7 Explain: The WSTP has been developed following a set of guiding principles, including: • a user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service • following available evidence-based, international best practice • a focus on less-resourced settings • inclusion of wheelchair users as trainers and target participants in all training packages. Explain: The WSTP uses accessible, non-medical language and terminology so that: • participants without clinical or technical qualifications can be trained • service personnel can use terms that are easily understood by wheelchair users. 3. Structure of the different WSTP (5 minutes) Notes for ToT trainers: • Keep this section brief, as more details are given later in the ToT programme during the package-specific modules that follow the Core training skills. Focus on the WSTP the trainees will deliver during the following package-specific module. Basic and Intermediate Managers Stakeholders Trainer’s Manual    PowerPoint presentations    Videos    Set of posters  selected posters selected posters Supplementary resources    Reference Manual for participants   combined Participant Workbook  Forms and checklists  – Additional Resources: including tools, equipment. –  ToT.2 Wheelchair Service Training Packages: 8 Explain: Each package contains a range of resources: • a Trainer’s Manual, PPT presentations, videos and posters • reference manuals for participants are available for WSTPb, WSTPi and WSTPm • service forms, checklists and a separate participant workbook are included in the WSTPb and WSTPi. 17ToT.2 Wheelchair Service Training Packages Trainer's Manual Explain: All the WSTP materials are provided on the WSTP Pen Drive included in your training resources. They can also be downloaded from the WHO website. • Copies of certificates • Trainer’s observation checklists • Session and course evaluation forms. ToT.2 Wheelchair Service Training Packages: 9 Explain: The WSTP Pen Drive also contains: • certificates • trainer’s observation checklists • evaluation forms. These will not be used during the ToT, but should be used during delivery of the WSTP. 4. Getting to know the Trainer’s Manual (30 minutes) Getting to know the Trainer’s Manual Working together in your group, use the Trainer’s Manual you have been given to answer the questions in the ToT Handbook. Write your answers next to the question. ToT.2 Wheelchair Service Training Packages: 1 Explain: While the four WSTP cover different subjects, they all have the same structure and approach. We will become more familiar with the structure during this activity. Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. If trainees will be attending different package- specific modules after the Core training skills module, pair trainees with others who will learn to train the same package. Instructions: Each pair will need at least one copy of the Trainer’s Manual for the WSTPb, WSTPi or WSTPm. Explain that the aim of this activity is to familiarize trainees with the Trainer’s Manual. Ask pairs to work together to answer the questions in the ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 15 minutes to find the answers and 10 minutes to feedback. 18 ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Questions Answers 1. Where can you see a list of everything included in the Trainer’s Manual? In the list of contents at the beginning of the manual. 2. How are group activities shown in the sessions? There is an Activity table describing the groups, instructions, monitoring, time and feedback for each activity. 3. Where can you find the overall aim or purpose of the training package? In the section headed Purpose on page 2. 4. How does the session plan indicate when the trainer should show a PowerPoint slide? An image of each slide is shown on the left-hand side of the page in the session plan, in the order of delivery, next to the related text. 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? Lists are provided in Section 2 of the Trainer’s Manual: How to prepare to deliver the training package: • on page 14 in WSTPb, and WSTPi • on page 9 in WSTPm. 5. How to use the WSTP (35 minutes) Ask participants to turn to the first section of the Trainer’s Manual: About the Wheelchair Service Training Package. Explain: There are helpful notes and guidance for trainers in the front of each Trainer’s Manual. Ask one of the participants to read out the headings in this section of the Trainer’s Manual. Most important answers: • Introduction • Target audience • Purpose • Scope • Trainers • How to get started. 19ToT.2 Wheelchair Service Training Packages Trainer's Manual • Request from WHO for feedback and data • Send copies of participants’ registration and evaluation forms • Reflections on strengths and weaknesses of the training. ToT.2 Wheelchair Service Training Packages: 11 Explain: • On the WSTP Pen Drive you will see a file called Read Me First. This is an important document. • It includes a request from WHO to provide feedback and data from the WSTP training programmes that you deliver including: – participant registration and evaluation forms – trainer’s reflections or comments on the training. Explain that section 2 of the Trainer’s Manual is called How to prepare to deliver the training package (or for WSTPs How to prepare for the Stakeholder Workshop). Getting to know the ‘How to prepare’ section Work with your partner to read and discuss the section in the Trainer’s Manual, How to prepare to deliver the training package. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 12 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to look through the section on How to prepare to deliver the training package with their partner, reading and discussing the different sections. Ask trainees to write down any questions they have. Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. Feedback: Ask the whole group if they have any questions related to their training package. Broader questions about the training can be parked in the Car Park if you do not have time to cover them, or if they will be covered in a later session. 20 ToT.2 Wheelchair Service Training Packages Trainer's Manual Notes for ToT trainers: • There are variations in the section headings between the packages. Session plans help trainers to: • focus on the learning objectives • keep to time • support group activities. ToT.2 Wheelchair Service Training Packages: 13 Explain: Session plans work like a recipe to guide trainers through the session. Following the session plans will help trainers to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Getting to know the session plans Work with your partner to read and discuss a detailed session plan from your Trainer’s Manual. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 14 Show the slide throughout the activity. Activity 3 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to read and discuss a detailed session plan with their partner, and to write down any questions for discussion with the group. Allocate a session from the following list, according to which package each pair is going to present during the ToT: • WSTPb: Trainer’s Manual, page 99: A.8: Transfers. • WSTPi: Trainer’s Manual, page 52: B.1: Assessment overview and assessment interview. • WSTPm: Trainer’s Manual, page 15: A.1: What is appropriate wheelchair provision? Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. 21ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Ask the whole group for any questions or clarifications. Park any questions on changing PowerPoint slides in the Car Park. These can be addressed in session ToT.10 Audio-visual tools and equipment. Explain: There is a session summary box at the beginning of each session plan. Ask one of the pairs: What are the different sections of the session summary? Most important answers: • Objectives: describes the aims of the session. • Resources: any resources required for the session. • Context (For WSTPi this is called Context and prior learning): Suggested adjustments to suit the local context/country/service. • To prepare: things to prepare before the session starts. • Outline: summarizes sections of the session with timings. Ask another pair: What is the purpose of the Context or the Context and Prior Learning box? Most important answer: • It provides trainers with guidance about how the session plan could be adapted for the local situation or the type of participants attending the training. Ask another pair: What might influence the context of the training? Acknowledge responses. ToT.2 Wheelchair Service Training Packages: 15 Explain: Sessions can be influenced by different: • service delivery models • levels of experience among participants • institutional, regional or national policies • available products for prescription. 22 ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: How do the session plans indicate that a video should be shown? Most important answer: • A video box is shown, with a video icon. ToT.2 Wheelchair Service Training Packages: 16 Explain: • It is important for trainees to be familiar with the content, relevance and timing of all the videos. • More details on the use of videos are given later in the ToT. Explain: The Trainer’s Manual uses different words in bold to guide trainers. This includes words such as: Ask, Explain, Show. ToT.2 Wheelchair Service Training Packages: 17 Explain: Extra information to help to guide trainers is provided in the Trainer’s Manual, including: • additional information that can assist trainers to answer questions from participants • most important answers to questions • guidance about group activities. ToT.2 Wheelchair Service Training Packages: 18 23ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: What information is provided in the Activity table in the session plans? Most important answers: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Explain: The electronic copy of the WSTP can be run either on a computer hard drive or via an external storage device (DVD or WSTP Pen Drive). Exit slideshow mode. Pull up the WSTP Pen Drive folder, from the WSTP Pen Drive or from the files on your computer. Show the electronic copy of the START.pdf file on the projector. Explain: Resources can be accessed from the standard WSTP Pen Drive menu or by clicking on the “Start” menu. Show the links. Click on one or two sessions to show the PPTs. Explain: • Videos are embedded into the PPTs in the PDF versions of the files. • All individual PPT files are available, and can be modified if necessary. Modifying PPTs will be discussed in a later session. Show how to find the manuals, posters and forms. Notes for ToT trainers: • Macintosh (Mac) computers cannot open the “Start” file and use the “Start” menu links unless the file is opened with Adobe Pro or similar. Explain: Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 24 ToT.2 Wheelchair Service Training Packages Trainer's Manual 6. Key point summary (3 minutes) • Four wheelchair service training packages: WSTPb, WSTPi, WSTPm and WSTPs. • Developed to address the training needs of service providers and other stakeholders to meet the Wheelchair Guidelines. • Each package includes a range of components to help trainers plan and deliver consistent and relevant training. ToT.2 Wheelchair Service Training Packages: 20 Read the key points. Ask whether there are any questions. 25ToT.3 Practice delivery sessionsTrainer's Manual ToT.3 Practice delivery sessions A IM To provide details of the package-specific modules and the roles of ToT participants and trainers. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and structure of the WSTPtot practice delivery sessions □□ describe the roles and responsibilities of lead and support trainees □□ know which practice sessions they are to present □□ know how to prepare for the practice delivery sessions. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.3: Practice delivery sessions □□ WSTPtot allocation (trainee copy) for the package-specific module: one for each trainee □□ Lucky Dip trainee numbers on pieces of paper □□ flipchart sheet with trainee numbers written on it. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Refer to the terminology box at the beginning of this manual. □□ Finalize and copy the WSTPtot allocation for the package specific module based on the number of trainees. □□ Prepare Lucky Dip trainee numbers in bucket/hat based on final numbers. □□ Prepare a flipchart sheet with the trainee numbers and a space to add participants’ names once their numbers are selected. □□ Discuss how you will allocate trainees for mentoring with their co-trainer. Give participants this information during the session, or at the beginning of ToT.6 Preparation time. O U T L IN E 1. Introduction 2. Structure and aims of the package-specific module 3. Format of practice delivery sessions 4. Roles of lead and support trainees and ToT participants 5. Reflection and feedback 6. Preparing for practice delivery sessions 7. Key point summary 4 3 2 15 5 30 1 Total session time 60 26 ToT.3 Practice delivery sessionsTrainer's Manual 1. Introduction (4 minutes) How confident do you feel to deliver the WSTP package you are here to learn? ToT.3 Practice delivery sessions: 2 Ask: How confident do you feel to deliver the WSTP package/s you are here to learn, on a scale of one to ten? • One means you are not at all confident • Ten means you are very confident. Explain: • Record your score on page 10 of your ToT Handbook. • At the end of the ToT programme, we will ask you to record how confident you now feel. • You will add both scores to your confidential ToT evaluation form. Aim: to provide details of the package-specific modules and roles of ToT participants and trainers. Objectives: • explain the structure of the practice deliveries • define roles of lead and support trainees • prepare for practice deliveries • know which practice delivery sessions you are to present. ToT.3 Practice delivery sessions: 3 Explain the aim and objectives of the session. 2. Structure and aims of the package-specific module (3 minutes) • Practice delivery sessions by trainees • Discussion or demonstrations lead by ToT trainers • Combination sessions. ToT.3 Practice delivery sessions: 4 Explain: • After the Core training skills sessions, you will begin your package-specific module. • Package-specific modules include: – opportunities to deliver sessions from the WSTP you have chosen to learn – discussion sessions or demonstrations led by ToT trainers, or – a combination of the above. 27ToT.3 Practice delivery sessionsTrainer's Manual 3. Format of practice delivery sessions (2 minutes) • Session allocation will be done by Lucky Dip (lottery) • All trainees will have similar presenting time • Trainees allocated lead and support trainee roles. ToT.3 Practice delivery sessions: 5 Explain: • Allocation of practice delivery sessions will be done by lottery (Lucky Dip) at the end of this session. • Each trainee will have a similar amount of presenting time. • You will be allocated roles as both a lead and support trainee. • When two or more lead trainees are allocated to the same session, one will automatically assume the support trainee role when they are not presenting. 4. Roles of lead and support trainees and ToT participants (15 minutes) Lead and support trainees Working in pairs, answer the following question: • What are the main roles of the lead and support trainees? ToT.3 Practice delivery sessions: 6 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask participants to discuss with their partner what they think are the main roles of the lead and support trainee. Ask participants to record their ideas in their ToT Handbook on page 11. Monitor: Monitor the groups and assist as needed. Time: Allow 3 minutes for the activity and 5 minutes for feedback. Feedback: Ask: What are the main roles of the lead and support trainees? Discuss and clarify answers, record the most important answers on the board. Ask participants to record the correct information in their ToT Handbook. 28 ToT.3 Practice delivery sessionsTrainer's Manual Most important answers: The role of the lead trainee includes: • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. The role of the support trainee includes: • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainee • contributing to the overall feedback/reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Trainees should work together as a team to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session. ToT.3 Practice delivery sessions: 7 Explain: During the practice delivery sessions, trainees should work together as a team. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session, including: – managing time – clarifying errors – answering questions from participants – managing disruptions and interruptions. 29ToT.3 Practice delivery sessionsTrainer's Manual Being a role model includes: • being on time • being well prepared • problem solving • being positive and constructive • being responsible for yourself. ToT.3 Practice delivery sessions: 8 Explain: • Trainers should set positive examples of professional behaviour and practice. • Model the behaviour you want to see from participants by: – being on time and well prepared – problem solving and finding solutions for challenging situations – providing positive and constructive feedback – managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. What could you do if you are asked a question and do not know the answer? ToT.3 Practice delivery sessions: 9 Explain: Being a good trainer and role model does not mean you always need to know the answers to questions. Ask: What could you do if you are asked a question and do not know the answer? Most important answers: • Ask support trainees if they know the answer. • Ask participants if they know the answer. • Do not pretend to know the answer. • Agree to find out the answer before the training programme finishes (add to Car Park). 30 ToT.3 Practice delivery sessionsTrainer's Manual • Taking part in the case studies and practical activities • Asking and answering questions • Engaging in discussions. ToT.3 Practice delivery sessions: 10 Explain: • While your fellow trainees are delivering their sessions, you will play the role of the WSTP participant. • This includes: – taking part in the case studies and practical activities – asking and answering questions – engaging in discussions. • While it is important to participate actively to create a ‘realistic’ training situation, do not purposefully act in a challenging manner. • Put away your WSTPtot Trainer’s Manual and your ToT Handbook during the session delivery. 5. Reflection and feedback (5 minutes) Trainers need to be able to: • reflect on their training skills • provide constructive feedback. ToT.3 Practice delivery sessions: 11 Explain: • It is important that trainers learn to reflect on their own training skills. • It is also important that trainers are able to give constructive feedback to training participants. • Both of these skills are incorporated into the ToT programme. 31ToT.3 Practice delivery sessionsTrainer's Manual • Lead trainees reflect on: • what went well • what can be improved. • ToT participants feedback to lead trainees on: • what went well • what can be improved. ToT.3 Practice delivery sessions: 12 Explain: • At the end of each practice delivery session, the lead trainee/s will be asked to reflect on: – what was good and what went well – what can be improved. • ToT participants will provide brief feedback to lead trainee/s. We will discuss this further in ToT.11: Feedback. • The ToT trainer will give feedback, adding anything not already mentioned by the lead trainee or ToT participants. 6. Preparing for practice delivery sessions (30 minutes) • Read the session plan in the Trainer’s Manual • Read the relevant sections of the Reference Manual and Workbook • Edit the PPT • Practice delivering the session • Work with support trainees • Prepare resources. ToT.3 Practice delivery sessions: 13 Explain: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainee. • Prepare the resources you need for the session. Explain: If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. 32 ToT.3 Practice delivery sessionsTrainer's Manual • Known errors are listed in your ToT Handbook • Do not discuss changes made to the PPT with ToT participants • Present as if it is a standard WSTP training. ToT.3 Practice delivery sessions: 14 Explain: • There are some known errors in the WSTP Trainer’s Manual, Participant Manuals and Workbooks, and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Notes for ToT trainers: • The WSTP has some known errors that will not be corrected until a second edition is published. The errors are listed in the ToT Handbook so that trainees can make corrections to their materials. Using the resources • Working in pairs, look at the session in your Trainer’s Manual • Find related notes in your ToT Handbook • Read through both to understand how they relate to each other • Locate and review the Guidelines for preparing practice delivery sessions. ToT.3 Practice delivery sessions: 1 Show the slide throughout the activity. 33ToT.3 Practice delivery sessionsTrainer's Manual Activity 2 Groups: Divide trainees into pairs. Instructions: Ask the trainees to look at the following sessions in their Trainer’s Manual and find the notes relating to this session in their ToT Handbook. Ask them to read through both to understand how they relate to each other, and how they would be used to prepare to deliver a session. • WSTPb: Session A.6: Appropriate wheelchairs. • WSTPi: Session B.8: Prescription (selection) of PSDs – stabilizing the pelvis. • WSTPm: Session A.1: What is appropriate wheelchair provision? Ask them to also locate the Guidelines for preparing practice delivery sessions in the introduction to the ToT Handbook and to briefly review it. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Emphasize the following: • Trainees should follow the instructions in the Trainer’s Manual and their ToT Handbook for the practice deliveries and all future co-training deliveries. • They should allow enough time to follow instructions dealing with errors in the WSTP materials; take account of gender and cultural considerations; and tips on session preparation, presentations and logistics to improve flow and timing. • During the practice deliveries, trainees are responsible for setting up the training areas as needed. Ask whether there are any questions. 34 ToT.3 Practice delivery sessionsTrainer's Manual • Some session preparation time is included in the ToT timetable • ToT trainers are available during this time, or at breaks • Ask for help if you have questions or concerns. ToT.3 Practice delivery sessions: 16 Explain: • There will be time at the end of each day to prepare for future practice delivery sessions. We will discuss this more in session ToT.6. • ToT trainers will be available during breaks and at the end of the day. Ask for help if you have questions or concerns. • It is normal to feel nervous when delivering the sessions in front of your peers and the ToT trainers. • You will grow in skills and confidence as you deliver more sessions. • Remember that it is not a competition, everyone has different training styles. • You will be required to present feedback from group activities over the next two days – use this as an opportunity to practise presenting to your peers. • Time will be strictly monitored • ToT trainers will end the session at the correct time • Learning to keep to time is an important skill. ToT.3 Practice delivery sessions: 17 Explain: • Time will be strictly monitored during practice deliveries to ensure trainees are treated equally. • If you go over your time, the ToT trainers will stop you and move on to the next trainer, or end the session. • Learn how to keep to time. It is an important skill, and you will improve with practice. • The standard PPT for each session will be available on the training laptop • If you make any changes to your PPT, you will need to provide it to ToT trainers before your session. ToT.3 Practice delivery sessions: 18 Explain: • The standard PPT for each session will be available on the training laptop with videos already embedded. • If you make any changes to your PPT, you will need to upload it onto the training laptop before your practice delivery. 35ToT.3 Practice delivery sessionsTrainer's Manual Notes for ToT trainers: • Tell participants when you need the PPT to be loaded on to the computer; for instance, 30 minutes before training begins or at break time before a session. • Time for LUCKY DIP! • Pick a number • Complete the Practice delivery session allocation sheet • Note who is your ToT trainer mentor. ToT.3 Practice delivery sessions: 19 Explain: Now we will allocate the sessions. Ask each trainee to pick a number. Ask each trainee to write their name on their WSTPtot allocation (trainee copy) for the package-specific module. Ask each trainee to tell the group their number and to record this on their list. Record the trainee names next to the relevant numbers you have listed on the prepared flipchart paper. Explain: Each trainee has been assigned a ToT trainer as his or her mentor. Your mentor will: • assist you with preparation • provide individual feedback on your presentation skills. 7. Key point summary (1 minute) • As lead/support trainee: • practise the responsibilities of the role you are allocated • be a role model and work as a team. • As a ToT participant: • give clear and specific feedback. ToT.3 Practice delivery sessions: 20 Read the key points. Ask whether there are any questions. 36 ToT.4 Preparing for diversityTrainer's Manual ToT.4 Preparing for diversity A IM To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the difference between culture and diversity □□ understand the importance of cultural competence □□ discuss challenges of cross cultural communication □□ identify challenges to integrating wheelchair users into training and work environments. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.4: Preparing for diversity □□ masking tape or similar. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Plan appropriate ‘divisions’ to use for the first activity, based on local context and trainee group characteristics. □□ Put a line of masking tape down the centre of an open area of the room to use for the first activity. O U T L IN E 1. Introduction 2. Culture and diversity 3. Cultural competence 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities 5. Key point summary 20 5 20 14 1 Total session time 60 37ToT.4 Preparing for diversityTrainer's Manual 1. Introduction (20 minutes) Activity 1 Groups: Whole group. Instructions: Draw attention to the line of masking tape down the middle of the floor. Ask everyone to move to one side of the room. Ask all the men to stand on one side of the line and all the women to stand on the other. Explain this is our first diverse grouping: men and women. We are going to look at different aspects of diversity. Ask everyone who has children to stand on one side, and all the people who don’t to stand on the other side. Ask everyone who is over 50 years of age to stand on one side of the room. Ask everyone else to stand on the other side. Continue with the exercise for at least six rounds. Divisions could include: • languages spoken • country or region of origin • presence or absence of disability • professional background. Monitor: Ensure that participants are not embarrassed or uncomfortable. Time: Allow 10 minutes for the exercise and 10 minutes for feedback. Feedback: Ask people how they felt about the divisions. Ask how did you feel when you were in the larger group? Ask how did you feel when you were alone or in a minority? Explain that for some this may be a negative experience, but for others it may be positive. Explain: People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity and we are going to look at these two concepts in more detail. 38 ToT.4 Preparing for diversityTrainer's Manual Aim: To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. Objectives: • understand the difference between culture and diversity • understand the importance of cultural competence • discuss challenges of cross cultural communication • identify factors and challenges to integrating wheelchair users into training and work environments. ToT.4 Preparing for diversity: 2 Explain the aim and objectives of the session. 2. Culture and diversity (5 minutes) Write the words culture and diversity on either side of a board or flipchart with a line running down the middle. Ask: What do you understand the terms culture and diversity to mean? Encourage responses and write on the board. Most important answers: Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Explain: Culture and diversity can be viewed in different ways. • Are they seen as strengths and encouraged? • Or are they seen as a source of conflict and disharmony? • Are they a distraction? Ask the group to reflect on the diversity and cultures present among themselves that we experienced in the earlier activity. Ask: Is the group diverse? Ask: What types of diversity does the group include? 39ToT.4 Preparing for diversityTrainer's Manual Ask: What cultures do we share? Acknowledge responses. Explain: Remember that we all belong to more than one cultural group and we are all diverse in many ways. 3. Cultural competence (20 minutes) Ask: What is cultural competence? Acknowledge responses. • Awareness of your own cultural practices • Knowledge of different cultural practices • A positive attitude towards cultural differences • Understanding how culture impacts on interactions. ToT.4 Preparing for diversity: 3 Explain: • Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. • It is about having a positive attitude towards cultural differences and accommodating them. • It is about being conscious of how culture impacts on interactions between people. Explain: Cultural differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. For example, a comment made without offence intended may be insulting to someone from another culture. Explain: WSTP training may be delivered by trainers from a different culture to that of the participants. Some examples of how different cultural considerations may affect training are given in the ToT Handbook on page 16. 40 ToT.4 Preparing for diversityTrainer's Manual Cultural competence • Think about examples of when you experienced a culture different from your own • Write down what it was like, how you felt and what you learned • Discuss the experience with your partner. ToT.4 Preparing for diversity: 4 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask trainees to think about examples of when they experienced a culture different from their own. Write down what it was like, how they felt and what they learned. Ask trainees to discuss the experience with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 8 minutes for discussion and 5 minutes for feedback. Feedback: Ask 4–5 people to share their experiences with the group. 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities (14 minutes) The WSTP promotes the inclusion of wheelchair users and people with disabilities in training teams and as participants. ToT.4 Preparing for diversity: 5 Explain: • Disability is one aspect of diversity. • The WSTP promotes the inclusion of wheelchair users in training teams and as participants. Ask: Why is this important? 41ToT.4 Preparing for diversityTrainer's Manual Most important answers: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. • The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of; combat stigma, and reinforce the principles of the CRPD. • Can draw on their own experiences • Promote a user-centred and rights-based approach to wheelchair provision • Act as role models of empowerment. ToT.4 Preparing for diversity: 6 Read the slide. Ask: What are some of the barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society? Most important answers: • Attitudinal barriers. • Environmental barriers: lack of access to homes, schools and community buildings. • Lack of assistive devices. • Cultural beliefs that see disability negatively. • Lack of supportive legislation about disability rights. • Lack of funding for services and support. 42 ToT.4 Preparing for diversityTrainer's Manual • Attitudinal • Environmental • Institutional. ToT.4 Preparing for diversity: 7 Explain: • Attitudinal barriers can include: – assumptions about what is possible for a person with a disability – assumptions that people with a disability cannot make decisions for themselves – treating people with disabilities as objects of charity – in some cultures, it is believed that people with disabilities are cursed and they are excluded from their communities and/or families as a result. • Environmental barriers can include: – the natural environment – such as rocky or steep terrain – the built environment – such as inaccessible homes, schools and community buildings – a lack of assistive devices. • Institutional barriers can include: – a lack of government legislation and policies that support the rights of people with disabilities – rules and regulations regarding admission criteria for school or university. 5. Key point summary (1 minute) • Consider culture and diversity issues when you plan and deliver training • Demonstrate cultural competence • Promote the inclusion of wheelchair users and people with disabilities. ToT.4 Preparing for diversity: 8 Read the key points. Ask whether there are any questions. 43ToT.5 Adult learning Trainer's Manual ToT.5 Adult learning A IM To introduce the concepts of adult learning and different styles of learning: to understand how these approaches can improve delivery of the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how adults learn □□ describe four preferred learning styles, including their own □□ explain why understanding learning styles ensures the effective delivery of the WSTP □□ describe how trainers can support participants with problem solving. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.5: Adult learning. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Preferred learning styles 3. Experiential learning cycle 4. Supporting adult learning 5. Helping participants to problem solve 6. Key point summary 2 25 30 10 15 3 Total session time 85 44 ToT.5 Adult learning Trainer's Manual 1. Introduction (2 minutes) ToT.5 Adult learning: 2 Aim: To introduce the concepts of adult learning and different styles of learning and to understand how these approaches can improve delivery of the WSTP. Objectives: • describe how adults learn • describe four preferred learning styles, including your own • explain why learning styles are relevant in delivering the WSTP • describe how trainers can support participants with problem solving. Explain the aim and objectives of the session. 2. Preferred learning styles (25 minutes) Adult learning • Think about positive learning experiences you have had • Write down how they were positive • Share your experiences with your partner. ToT.5 Adult learning: 3 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask trainees to: • Think about positive learning experiences they have had. • Write down in what way the experiences were positive in the table on page 20 of their ToT Handbook. • Share experiences with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for individual reflection and discussion in pairs, and 5 minutes for feedback. Feedback: Ask each pair to read out one item from their list, going around the room until all the experiences are written on the board. Allow brief discussion. 45ToT.5 Adult learning Trainer's Manual Explain: We can see from the positive learning experiences discussed during the last activity that there are different ways that we prefer to learn. What is your learning style? • Individually, think about how you learn best, how you like to learn new things. • On the question sheet, circle all of your preferences. • On the scoring sheet, circle the same letters and add up how many circles you have in each column to find your preferred learning style. ToT.5 Adult learning: 4 Show the slide throughout the activity. Activity 2 Groups: Ask trainees to work alone. Instructions: Ask trainees to turn to page 21 in their ToT Handbook. Explain that there is a list of statements in the ToT Handbook that relate to learning. Ask trainees to circle all of their preferences and transfer the information to the scoring sheet on the next page. Ask trainees to add up the number of circles to see which column has the highest number. The column with the highest number is their preferred learning style. Monitor: Monitor trainees and assist as needed. Time: Allow 10 minutes for the activity and 3 minutes for feedback. Feedback: Ask each trainee to share their preferred learning style with their neighbour. Highlight that if some people have two or more styles with the same or similar number, this means they have no strong preferences and are comfortable with more than one way of learning. Ask trainees if their learning style/s match their positive learning experiences. 46 ToT.5 Adult learning Trainer's Manual 3. Experiential learning cycle (30 minutes) Explain: • Each of us has a preferred learning style or styles. • However, learning new information and skills is most effective when we learn the information in multiple ways. Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 5 Explain: • Each stage of the experiential learning cycle matches the four learning styles. • While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. • This is why each of the four phases or types of learning are included in the WSTP. • We can start anywhere in this cycle: with an experience; with a reflection or observation; with a theory or definition/ explanation of a concept; or by doing. • Role plays and simulations for ‘experiencers’ • Videos and demonstrations for ‘observers’ • Lectures on theories and frameworks for ‘thinkers’ • Practice sessions for ‘doers’. ToT.5 Adult learning: 6 Explain: When developing the WSTP, preferred learning styles and adult learning concepts were incorporated into the structure of individual session plans and the overall training timetable. 47ToT.5 Adult learning Trainer's Manual Explain: The WSTP follows these four phases to ensure that learning happens. • During WSTPb, participants try different mobility skills in a wheelchair. This is experiencing. • During WSTPi, participants watch a video of wheelchair users and their families talking about the positive impact of postural support devices. This is observing or reflecting. • During WSTPm, participants learn about concepts and principles related to wheelchair service delivery. This is thinking or understanding. • During WSTPb and WSTPi, participants work with wheelchair users and provide them with an appropriate wheelchair and cushion. This is doing or applying. Ask: What would happen if we missed out the experience part? Most important answer: • The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. Ask: What would happen if we missed out the observation part? Most important answer: • The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. Ask: What would happen if we missed out the thinking part? Most important answer: • The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. Ask: What would happen if we missed out the doing (practice) part? Most important answer: • The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 48 ToT.5 Adult learning Trainer's Manual Explain: It is important that trainers support all learning styles, not just the ones that we personally prefer. Putting concepts into practice • Read what styles of learning Carlos, Miriam, Sita and Ahmad prefer. • Read each of the training activities listed and decide who would find the activity most appealing, considering their learning style. • Later you can review the list of activities with respect to your own preferred style. ToT.5 Adult learning: 7 Explain: Now that we have looked at the concept of learning styles and the experiential learning cycle, let’s put this into practice and learn by doing. Show the slide throughout the activity. Activity 3 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to look at the Matching activities with learning preferences sheet in the ToT Handbook (pg. 24). Explain: • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. Ask trainees to place an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Suggest that after the session each participant should fill in the last column with their own preference. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Review the answers with the whole group as follows: Ask trainees to volunteer answers. Check if everyone agrees. If there is no disagreement, acknowledge the answer (if it is correct) and move to the next line. If not everyone has the same answer prompt the correct answer and clarify. Allow only brief discussion. 49ToT.5 Adult learning Trainer's Manual Notes for ToT trainers: • In the answer box below, x indicates the best answer; (x) indicates other possible answers that are also correct. If trainees have answers other than those marked, ask them to explain their reasoning and discuss it with the group. If you are comfortable that their reasoning is good, and that they understand the differences between the learning styles, they do not need to correct their answer. Key learning from this exercise is awareness that people do not all learn in the same way. Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 1. Using a role play to practise wheelchair user training x (x) 2. Watching the trainer show how to measure a new wheelchair user x 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country x 4. Watching people in wheelchairs doing the things they want to do x 5. Learning about the key documents that are relevant to wheelchair services x 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home x 7. Listening to the trainer review the most important articles in the CRPD x 50 ToT.5 Adult learning Trainer's Manual Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 8. Making a pressure- relief cushion x (x) 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience x 10. Observing the trainer conduct an assessment x 11. Doing an assessment interview with a new user (x) x 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services x (x) 51ToT.5 Adult learning Trainer's Manual 4. Supporting adult learning (10 minutes) Explain: While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. ToT.5 Adult learning: 8 Explain: • Adult learners are self-directed and responsible for their own learning. • This means supporting them to be: – active participants – engaged in discussions and group activities. Adult learners bring their own knowledge and experience to learning. ToT.5 Adult learning: 9 Explain: • Adult learners bring their own knowledge and experience to each learning activity, including: – work-related experience – previous education – life and family experience. Adult learners need learning to be relevant and practical. ToT.5 Adult learning: 10 Explain: • Adult learners need learning to be relevant and practical. • Adults must see a reason for learning the new information – and be able to apply it to their situation. • Training should have: – clear learning objectives – obvious practical application. 52 ToT.5 Adult learning Trainer's Manual Adult learners want to apply what they have learned. ToT.5 Adult learning: 11 Explain: Adult learners want to apply what they have learned. • Use examples to help them see the connection between what they are learning during training and what they will do after the training programme is over • Use problem-solving activities • Create learning-action plans. 5. Helping participants to problem solve (15 minutes) What is problem solving? ToT.5 Adult learning: 12 Ask: What is problem solving? Most important answer: • The process of finding the best solution to a problem. It is an important part of adult learning. Why is problem solving an important life skill? ToT.5 Adult learning: 13 Ask: Why is problem solving an important life skill? Most important answers: • Because we all set goals and face challenges to achieve them. • Because we need to find ways to overcome barriers we encounter. Explain: • Problem solving is an important skill in wheelchair service provision where solutions to problems may be complex. • We have an important role as trainers to develop participants’ problem-solving skills, so they can find solutions to the difficulties they come across in their work. 53ToT.5 Adult learning Trainer's Manual Problem solving How can we help participants to problem solve and find their own solutions? ToT.5 Adult learning: 14 Show the slide throughout the activity. Activity 4 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to brainstorm how they can help participants to problem solve and find their own solutions. Take 2 minutes to think about it individually, then share with your group members to create a list of ideas. Monitor: Monitor the groups and assist as needed. Time: Allow 12 minutes for this activity. Feedback: • Ask open-ended questions • Ask rather than tell • Invite others to participate • Avoid ‘I don’t know’ • Be patient • One step at a time • Encourage creativity • Encourage teamwork. ToT.5 Adult learning: 15 Ask each group in turn to describe one way to support participants in problem solving. Continue until there are no new ideas. Record each new idea on the board using only a few key words. Acknowledge good examples of things to consider. Correct/clarify any misunderstandings. Show the slide to summarize. 54 ToT.5 Adult learning Trainer's Manual Most important answers: • Ask open-ended questions – these cannot be answered with a simple ‘yes’ or ‘no’. Open-ended questions require trainees to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer that the trainer expects. • Ask rather than tell – ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together; teamwork and good communication helps to solve problems. 6. Key point summary (3 minutes) • Everyone has a preferred style of learning: • by experiencing • by observing • by thinking • by doing. • WSTP is designed to appeal to all learning styles. ToT.5 Adult learning: 16 Read the key points. Ask whether there are any questions. 55ToT.6 Preparation time Trainer's Manual ToT.6 Preparation time A IM To ensure trainees use the preparation time effectively at the end of each day. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the purpose of the preparation time at the end of each day □□ discuss any questions related to their practice deliveries. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.6: Preparation time. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Review the Car Park and prepare to answer any questions. O U T L IN E 1. Review of Car Park 2. Purpose of preparation time 10 5 Total session time 15 56 ToT.6 Preparation time Trainer's Manual 1. Review of Car Park (10 minutes) Review the Car Park with trainees. If any items need to be clarified before the next day, provide answers or explanations as needed. 2. Purpose of preparation time (5 minutes) • Car Park • Feedback from ToT trainers • Practice delivery preparation. ToT.6 Preparation time: 2 Explain: After our first day, we have time set aside for: • reviewing any remaining Car Park items • trainees to meet with ToT trainers for feedback • preparing for practice deliveries. One-on-one meeting between ToT trainer and trainee to: • give feedback • discuss practice delivery. ToT.6 Preparation time: 3 Explain: • ToT trainers will set up short, one- on-one meetings with lead trainees to give feedback and discuss their practice delivery. • It is an opportunity for trainees to ask questions about how to apply this feedback to future practice deliveries. • We will discuss how to give and receive feedback in more detail in ToT.11. 57ToT.6 Preparation time Trainer's Manual • Coordinate with trainees assigned to the session • Prepare materials or flipcharts • Raise questions with ToT trainers • Check PPT presentations • Study session plans. ToT.6 Preparation time: 4 Explain: When you are not meeting with ToT trainers to discuss feedback, you should use this time to: • coordinate with your co-trainers • prepare demonstration materials and AV equipment needed for your session • clarify any content of your session that you do not understand with the ToT trainers • check that your PPT presentation is working correctly. Ask whether there are any questions. Remind trainees of any logistics they need to remember before the start of the training day tomorrow. Notes for ToT trainers: • After the first day of the WSTPtot, use this time to arrange logistics related to practice deliveries during the rest of the programme. For example, can trainees come to the site early to set up for their session; or, when should trainees upload any modified PPTs for use the next day ? 58 ToT.7 Presenting and facilitatingTrainer's Manual ToT.7 Presenting and facilitating A IM To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the behaviour of a good trainer □□ explain the difference between presenting and facilitating □□ list examples of good practice by presenters and facilitators □□ describe three strategies to keep to time. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.7: Presenting and facilitating. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Trainer skills 3. Presenting and facilitating 4. Good practices for presenting and facilitating 5. Managing time 6. Key point summary 3 15 5 15 20 2 Total session time 60 59ToT.7 Presenting and facilitatingTrainer's Manual 1. Introduction (3 minutes) Aim: To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. Objectives: • list the behaviour of a good trainer • explain the difference between presenting and facilitating • list examples of good practice by presenters and facilitators • describe three strategies to keep to time. ToT.7 Presenting and facilitating: 2 Explain the aim and objectives of the session. 2. Trainer skills (15 minutes) Explain: You need to develop a variety of skills to deliver a successful training programme. In this session we look at the skills of a trainer, both as a presenter of information and as a facilitator of learning. Effective trainer behaviour is critical to bring about participants’ learning and create a positive learning environment. Effective trainers Think about people who have trained you in the past and who you consider to be effective trainers. What was effective in their behaviour? Write your ideas in the ToT Handbook (on page 28) and then discuss with the members of your group. ToT.7 Presenting and facilitating: 1 Show the slide throughout the activity. 60 ToT.7 Presenting and facilitatingTrainer's Manual Activity 1 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to think about people who have trained them in the past and to identify who they consider to have been effective trainers. In other words, people who enabled them to learn what they needed to and who gave them positive and worthwhile experiences. Ask trainees to take a few minutes to reflect on the effective trainers’ behaviour and write their ideas in the space on page 28. in the ToT Handbook headed: What was effective in their behaviour? Ask trainees to share their thoughts with the member/s of their group. Ask groups to consider all aspects of their previous trainers’ behaviour: • how they presented themselves • how they interacted with the trainees • how they managed the training • how they created a positive environment. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 10 minutes for feedback. Feedback: Ask the groups to report back, giving one idea each until all ideas have been presented. Record ideas on the board. Refer trainees to the information in their ToT Handbook. Remind trainees that they will have a chance to practise the behaviour later in the week. Suggest that trainees use the list of Good practice for presenting and facilitating in the ToT Handbook (pg. 29) to help them to identify behaviour they need to work on. Explain that the list can be used for self-assessment if desired. 61ToT.7 Presenting and facilitatingTrainer's Manual 3. Presenting and facilitating (5 minutes) ToT.7 Presenting and facilitating: 4 Presenting Facilitating Explain: The role of the trainer in the WSTP switches frequently between presenting and facilitating. Ask: What do you think the difference is between presenting and facilitating? Allow trainees a few minutes to think about this, then collect responses from the group. Show the next slides and acknowledge responses already given. • One-way • Provides information • Corrects misinformation • Assumes what is presented is not known • Treats all participants equally. ToT.7 Presenting and facilitating: 5 Read the slide content, expand if needed. Facilitating makes it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect this with new information. ToT.7 Presenting and facilitating: 6 Read the slide content, expand if needed. Explain that in the WSTP a combination of presenting and facilitating is used. The Trainer’s Manual indicates when to present and when to facilitate. 62 ToT.7 Presenting and facilitatingTrainer's Manual 4. Good practice for presenting and facilitating (15 minutes) What do you consider good practice when presenting? ToT.7 Presenting and facilitating: 7 Ask trainees to reflect on what they consider good practice when giving a presentation. Collect responses from the group. Notes for ToT trainers: • ToT trainers must ensure they are a model of good practice throughout the ToT, especially during this session. Make sure you practise everything you say. • Vary the pace and tone of speech • Be aware of your position in the room • Ask questions and encourage contributions from the group. ToT.7 Presenting and facilitating: 8 Read the slides and acknowledge examples already given by the participants when reviewing. • Follow the instructions in the Trainer’s Manual • Watch your audience – are they listening, interested, awake? • Break for a few minutes if necessary or insert a short energizer. ToT.7 Presenting and facilitating: 9 63ToT.7 Presenting and facilitatingTrainer's Manual Ask: Who knows what we mean by an energizer? Acknowledge responses. Explain: • An energizer is a short activity designed to enliven and re-energize a group of participants. • Often, but not always, the energizer is unrelated to the content of the session. • There is a section about energizers, with examples, in the ToT Handbook on page 30–31. Ask a trainee to lead a short energizer for the group. Ask trainees what the energizer did to the group. Notes for ToT trainers: • Most trainees will know some energizers from previous training experiences. Be prepared to give an example if no one volunteers. • Use slides as a prompt • Allow time for participants to absorb the content • Match slides to what you are saying • Avoid reading from screen • Avoid blocking the beam. ToT.7 Presenting and facilitating: 10 Explain: • Use the slides as a prompt and to show the key messages. • Allow time for participants to absorb the content of each slide. This will take longer for those working in a foreign language. • Add variety by asking participants to read slide messages out loud. • Make sure the slide shown corresponds with what you are saying. • Keep the slides synchronized with the Trainer’s Manual. • Avoid reading from the screen. • If you do read from the screen, do not look over your shoulder or stand with your back to the audience. • Avoid blocking the beam. Demonstrate these last three points by showing how you can move to the side of the training room or behind the participants. 64 ToT.7 Presenting and facilitatingTrainer's Manual Ask: How will your presentation style and session planning change when participants have a visual impairment? Acknowledge answers. Most important answers: • Read information on the slides to ensure participants with visual impairments get all of the information. • Make sure the presentations are in a large font and that the screen is as large as possible for those who are partially sighted. • Meet with participants before the training to understand their needs. • If participants use a screen reader, provide documents and presentations ahead of time so they can review before the training starts. • Provide documents in braille if applicable. • Understand the purpose of the activity • Give people time and space to think for themselves • Ask rather than tell • Give clear instructions • Check on learning. ToT.7 Presenting and facilitating: 11 Read the slide. Refer trainees to the key points in the ToT Handbook. Expand as needed. Where did you see us presenting and where did you see us facilitating in the ToT so far? ToT.7 Presenting and facilitating: 12 Ask: Can anyone think of examples where the trainers have been presenting and where they have been facilitating in the sessions we have done so far? Ask: How do the two methods feel different to you as a trainee? Acknowledge responses. Remind trainees that they will have the opportunity to observe and practise both presenting and facilitating as the ToT continues. 65ToT.7 Presenting and facilitatingTrainer's Manual 5. Managing time (20 minutes) Explain: • Trainers and participants need to make sure that the training programme runs on time. • There are many sessions and activities and a limited amount of time to complete them. Keeping to time What can we do to keep the training running on time? ToT.7 Presenting and facilitating: 13 Show the slide throughout the activity. Activity 2 Groups: Divide the trainees into pairs. Instructions: Ask What can we do to keep the training running on time? Ask trainees to write ideas down in their ToT Handbook on page 31. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Feedback as a whole group, taking suggestions from pairs in turn. Acknowledge responses and add to them using the Notes for ToT trainers below. 66 ToT.7 Presenting and facilitatingTrainer's Manual Notes for ToT trainers: • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 6. Key point summary (2 minutes) • Factors contributing to the quality of training • Characteristics of presenting and facilitating • Good practice for presenters and facilitators. ToT.7 Presenting and facilitating: 14 Read the key points. Ask whether there are any questions. 67ToT.8 Communication skillsTrainer's Manual ToT.8 Communication skills A IM To discuss communication skills and put presentation skills into practice. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the importance of communication skills and put presentation skills into practice □□ explain how to give good demonstrations □□ describe how to work well with interpreters. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.8: Communication skills. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Types of communication 3. Demonstrations, videos and interpreters 4. Key point summary 2 55 30 3 Total session time 90 68 ToT.8 Communication skillsTrainer's Manual 1. Introduction (2 minutes) Aim: To discuss communication skills and put presentation skills into practice. Objectives: • explain the importance of communication skills and put presentation skills into practice • explain how to give good demonstrations • describe how to work well with interpreters. ToT.8 Communication skills: 2 Explain the aim and objectives of the session. 2. Types of communication (55 minutes) Explain: • Communication skills are key to becoming a good trainer. • In this activity you will have the opportunity to practise your communication skills. • You will take on the role of trainer and present the key learning points for your topic yourself. • This is a chance for you to put some of the skills discussed in the Presenting and facilitating session into practice. Communication skills • In your groups, read and discuss the key points for your topic (pages 33-35 of the ToT Handbook) • Prepare a five minute presentation to explain the key points • Use a variety of styles to convey the information such as presentation, demonstration, or role play. ToT.8 Communication skills: 1 Show the slide throughout the activity. 69ToT.8 Communication skillsTrainer's Manual Activity 1 Groups: Divide trainees into four groups. Instructions: Assign each group one of the topics listed in the Notes for ToT trainers that follow and direct trainees to page 33–35 in the ToT Handbook. Each group should present the information listed under their topic. Encourage groups to be creative and to use props, flipcharts, or the board as desired. Monitor: Monitor the groups and assist as needed. Time: Allow 20 minutes for groups to prepare the task; 5 minutes for each group to present; 2 minutes for discussion after each presentation; and 5 minutes for final feedback and consolidation by the ToT trainer. Feedback: Refer trainees to their ToT Handbook to check if all the information was communicated in the session. Focus feedback on the content of the session and the different communication skills. The ToT trainer should briefly summarize any key points not clearly presented by the group. Notes for ToT trainers: Group 1 - Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what the trainer says. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 70 ToT.8 Communication skillsTrainer's Manual Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, the trainer should stand at the front or side – participants should be able to see and hear the trainer – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and the trainer needs to read their PowerPoint slides – depending on the context, it may be appropriate for the trainer to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 71ToT.8 Communication skillsTrainer's Manual Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. 3. Demonstrations, videos and interpreters (30 minutes) • Giving demonstrations • Using videos • Communicating through foreign language and sign language interpreters. ToT.8 Communication skills: 4 Explain: We will now look at three more aspects of communication. Read the slide. 72 ToT.8 Communication skillsTrainer's Manual Demonstrations, videos and interpreters • In your group, discuss what to consider when delivering training about your topic. – Group 1: Good practice for giving demonstrations and showing videos – Group 2: Working with foreign language and sign language interpreters. • Close your ToT Handbook during this activity. ToT.8 Communication skills: 5 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into two groups. Instructions: Ask trainees to close their ToT Handbook (the answers are in the book). Assign one topic to each group: • Ask group 1 to consider : Good practice for giving demonstrations and showing videos. • Ask group 2 to consider : Working with foreign language and sign language interpreters. Ask trainees to discuss what to consider when delivering training about your topic and to write it on a flipchart to present to the other group. Refer trainees to the activity instructions on the PPT slide. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the groups to develop their lists; 5 minutes for each group to present; and 5 minutes for additional key points after each presentation. Feedback: Ask group 1 to present their findings to group 2. Add in any key points missed from the trainer’s notes below. Ask group 2 to present their findings to group 1. Add in any key points missed from the Notes for ToT trainers below. Refer trainees to the reference material in the ToT Handbook. 73ToT.8 Communication skillsTrainer's Manual Notes for ToT trainers: Giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. Using videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters: Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 74 ToT.8 Communication skillsTrainer's Manual 4. Key point summary (3 minutes) • Think about all aspects of your communication • Best practice for giving demonstrations and using videos • Meet with interpreters before the training to discuss your needs and set expectations. ToT.8 Communication skills: 6 Read the key points. Ask whether there are any questions. 75ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents A IM To introduce trainees to the WSTP guiding documents and explain their relevance. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the WSTP guiding documents □□ explain their importance for WSTP trainers and participants. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.9: Knowledge of guiding documents □□ Video: Sustainable Development Goals. One copy of each of the following resources: □□ United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ WHO Guidelines on the provision of manual wheelchairs in less-resourced settings □□ WHO Joint position paper on the provision of mobility devices in less-resourced settings □□ WHO CBR Guidelines: Introductory Booklet and Health Component □□ Design Considerations for Accessibility. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Ensure thorough knowledge of all guiding documents. □□ Consult the UN website to check the total number of countries that have signed the CRPD at the time of your training programme. Check whether the trainees’ countries have signed and ratified the CRPD so that you can mention this and answer any questions. http://www.un.org/disabilities/ O U T L IN E 1. Introduction 2. The CRPD as it relates to wheelchair service provision 3. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 4. CBR Guidelines 5. Other guiding documents 6. Key point summary 8 20 5 25 15 2 Total session time 75 76 ToT.9 Knowledge of guiding documentsTrainer's Manual 1. Introduction (8 minutes) Aim: To introduce trainees to the WSTP guiding documents and explain their relevance. Objectives: • list the WSTP guiding documents • explain their importance for WSTP trainers and participants. ToT.9 Knowledge of guiding documents: 2 Explain the aim and objectives of the session. What do we mean by guiding documents? ToT.9 Knowledge of guiding documents: 3 Ask: What do we mean by guiding documents? Acknowledge answers. Most important answers: • Publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision. • Resources that guide stakeholders in the provision of wheelchair services. Why is it important for you to be aware of these documents? ToT.9 Knowledge of guiding documents: 4 Ask: Why is it important for you as trainers to be aware of these documents? Acknowledge answers. 77ToT.9 Knowledge of guiding documentsTrainer's Manual Most important answers: • Many governments, international agencies, donors and other stakeholders plan and fund development work in line with these international frameworks. • To be in a stronger position to educate and advocate for appropriate wheelchair service provision. Trainers need to have a good understanding of: • international conventions/goals • international documents • national laws and policies. ToT.9 Knowledge of guiding documents: 5 Explain: • When running a WSTP training programme, it is important to be aware of these guiding documents to help you educate and advocate for appropriate wheelchair provision. • Local documents are likely to be referred to by participants and trainers will need a good understanding of them too. Explain: A good understanding of these resources can contribute to the quality of your training delivery. There is more information on all guiding documents in your ToT Handbook Ask: What are the two most important guiding documents that relate to wheelchair service provision? Most important answers: • United Nations Convention on the Rights of Persons with Disabilities • WHO Guidelines on the provision of manual wheelchairs in less-resourced settings. 78 ToT.9 Knowledge of guiding documentsTrainer's Manual 2. The CRPD as it relates to wheelchair service provision (20 minutes)7 • Most important international treaty relating to disability • Came into force in 2008 • Designed to change the way people with disabilities are viewed and treated. ToT.9 Knowledge of guiding documents: 6 Explain: • We will look first at the United Nations Convention on the Rights of Persons with Disabilities,7 commonly known as the CRPD. • The CRPD is widely considered to be the most important international treaty relating to people with a disability. • The CRPD came into force in 2008. Explain: • On its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol: the highest number of signatories to a UN Convention on its opening day in history. • The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. • Representatives included people with disabilities, government officials and representatives of nongovernmental organizations. • The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Notes for ToT trainers: • Look up the total number of countries that have signed the CRPD at the time of your training programme and check whether the participants’ country/countries have signed and ratified the Convention. 7 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611 (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 79ToT.9 Knowledge of guiding documentsTrainer's Manual Why is it important for participants of the WSTP to be familiar with the CRPD? ToT.9 Knowledge of guiding documents: 1 Ask: Why is it important for participants of the WSTP to be familiar with the CRPD? Acknowledge responses. Most important answers: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. Which articles of the CRPD are most relevant? ToT.9 Knowledge of guiding documents: 8 Explain: The CRPD has several articles relevant to wheelchair service provision. Ask: Without looking at your ToT Handbook, can anyone remind us which articles are the most relevant? Acknowledge responses. Most important answers: • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. 80 ToT.9 Knowledge of guiding documentsTrainer's Manual Other answers may include: • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. • Facilitate personal mobility with consideration of personal choice and cost • Facilitate access to quality mobility aids • Provide training in mobility skills to wheelchair users and service personnel • Encourage production of mobility devices to consider all aspects of mobility. ToT.9 Knowledge of guiding documents: 9 Explain: • CRPD Article 20 is the most relevant to wheelchair service provision. • It requires States Parties to take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities. To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. ToT.9 Knowledge of guiding documents: 10 Explain: Article 4 covers General obligations and includes this statement. • Article 19: Living independently and being included in the community • Article 24: Education • Article 25: Health • Article 26: Habilitation and Rehabilitation • Article 27: Work and employment • Article 30: Participation in cultural life, recreation, leisure and sport • Article 32: International cooperation. ToT.9 Knowledge of guiding documents: 11 Explain: • These articles are also relevant because, for example, they mention the importance of assistive devices, reasonable accommodation, and mobility skills training. • Article 26 is particularly important as it deals with Habilitation and Rehabilitation. 81ToT.9 Knowledge of guiding documentsTrainer's Manual Explain: Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. What additional barriers can women and children face when accessing services? ToT.9 Knowledge of guiding documents: 12 Ask: What additional barriers can women and children face when accessing wheelchair services? Ask participants to take one or two minutes to discuss this with the person next to them and then collect feedback. Acknowledge responses and add any important points not mentioned. Most important answers: • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. Wheelchair provision services must specifically ensure the needs of women and children are considered. ToT.9 Knowledge of guiding documents: 13 Explain: To meet Articles 6 and 7 of the CRPD, wheelchair provision services must specifically ensure the needs of women and children are considered. 82 ToT.9 Knowledge of guiding documentsTrainer's Manual 3. WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (5 minutes) Explain: The WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. Acknowledge that most trainees will be very familiar with the Wheelchair Guidelines. • Framework by which appropriate wheelchair provision is understood internationally • Developed with involvement of a cross section of stakeholders • They are a powerful tool. ToT.9 Knowledge of guiding documents: 14 Explain: • The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. • Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider. Explain: • The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. • They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. • The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. Ask: Who can remember the definition of an appropriate wheelchair? Acknowledge answers. 83ToT.9 Knowledge of guiding documentsTrainer's Manual • Meets the user’s needs and environmental conditions • Provides proper fit and postural support • Is safe and durable • Is available in the country • Can be obtained and maintained and services sustained in the country at an affordable cost. ToT.9 Knowledge of guiding documents: 15 Read the points on the slide. • Design and production • Service delivery • Training • Policy and planning. ToT.9 Knowledge of guiding documents: 16 Explain: The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. Ask: Who has read the Wheelchair Guidelines in the last year? Encourage all trainees to read the Wheelchair Guidelines thoroughly. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; trainers should try to raise awareness of them whenever they have the opportunity. Explain: The Wheelchair Guidelines are available on the WHO website in a range of languages.8 8 8 http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/ 84 ToT.9 Knowledge of guiding documentsTrainer's Manual 4. CBR Guidelines (25 minutes)9 10 Explain: There are several other guiding documents included in the supplementary resources section on the WSTP Pen Drive. You should be familiar with these, so that you can explain their importance and relevance to others. Explain: Community-Based Rehabilitation (CBR) is likely to come up in discussions during the WSTP. It is therefore important that trainers have a good understanding of the CBR Guidelines,9 particularly the health component. • Seen as an effective way of implementing the CRPD • Many aspects relevant to wheelchair service provision. ToT.9 Knowledge of guiding documents: 17 Explain: • CBR, also often called Community- Based Inclusive Development (CBID), is increasingly seen as one of the most effective ways of implementing the CRPD. • Many aspects of CBR are relevant to wheelchair service provision. For example, referral networks, community health centres and CBR workers. ToT.9 Knowledge of guiding documents: 18 Explain: The CBR Matrix10 is one of the cornerstones of the CBR Guidelines. Ask: What are the five key components of the CBR Matrix? Acknowledge answers. 9 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 10 The CBR Matrix. Geneva: World Health Organization (http://www.who.int/disabilities/cbr/matrix/en/). 85ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents: 19 Explain: • The five components are: Health, Education, Livelihood, Social and Empowerment. • Each component of the Matrix has five elements within it, so there are a total of 25. CBR Matrix In groups, identify two ways wheelchair provision relates to the component of the CBR Matrix you are assigned. Example: in the livelihood category, having an appropriate wheelchair can help someone get to work and earn their living. ToT.9 Knowledge of guiding documents: 20 Show the slide throughout the activity. 86 ToT.9 Knowledge of guiding documentsTrainer's Manual Activity 1 Groups: Divide trainees into five groups. Create a mix of gender, experience/ knowledge and skills in each group. Instructions: Refer trainees to their copy of the CBR Matrix on page 45 of the ToT Handbook. Allocate one component of the matrix to each group to discuss. Ask trainees to consider the ways in which wheelchair service provision relates to their component and to be ready to feedback to the group on two of them. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Ask each group for their first answer in turn. Then ask each group for their second answer in the same way. Answers may include: Health • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. Education • Enables access to school, educational programmes and vocational programmes. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Empowerment • Improved self-image and confidence. • Peer support. 87ToT.9 Knowledge of guiding documentsTrainer's Manual Health: Health benefits, importance in prevention of secondary complications. Education: Enables access to school and vocational training, to sit upright for function and interaction. Livelihood: Access to workplace, increased mobility and independence to work, earn and contribute. Social: Access to social/recreation activities. Empowerment: Confidence, peer training/support. ToT.9 Knowledge of guiding documents: 21 Explain: • This slide summarizes how appropriate wheelchair provision can improve the key aspects of life identified in the CBR Matrix. • There is further information on the CBR Guidelines and Matrix in the ToT Handbook. 5. Other guiding documents (15 minutes)11 Provides information on: • barriers to accessing mobility devices • increasing access to mobility devices • recommendations for national and international level stakeholders. ToT.9 Knowledge of guiding documents: 22 Explain: • The WHO Joint position paper on the provision of mobility devices in less-resourced settings11 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. • It includes information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 11 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 88 ToT.9 Knowledge of guiding documentsTrainer's Manual An overview of some of the basic features to consider when ensuring public buildings are accessible. ToT.9 Knowledge of guiding documents: 23 Explain: • The final guiding document included on the WSTP Pen Drive is Design considerations for accessibility.12 • This gives useful information on how to ensure all aspects of access are considered; both when visiting the wheelchair service and in other environments. Explain: There are a number of other guiding documents that you should be familiar with as a trainer of the WSTP. Ask: Another major international instrument has been launched since the development of the WSTP: Can anyone tell us what that is? Acknowledge answers. Most important answer: Sustainable Development Goals (SDGs).13 • Follow up to the Millennium Development Goals • Launched in September 2015 • Timeline 2015 – 2030. ToT.9 Knowledge of guiding documents: 24 Explain: • The SDGs are a follow up to the Millennium Development Goals (MDGs). • They were launched in September 2015 and have a timeline of 2015 to 2030. 12 13 12 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 13 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 89ToT.9 Knowledge of guiding documentsTrainer's Manual Sustainable Development Goals ToT.9 Knowledge of guiding documents: 25 Introduce video: Sustainable Development Goals. Ask participants to watch this United Nations video on the 17 SDGs. Show video. ToT.9 Knowledge of guiding documents: 26 Explain: • Five SDGs make specific references to disability: 4, 8, 10, 11 and 17. • Nine global indicators relate to disability. As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all people. And we will endeavor to reach the furthest behind first. ToT.9 Knowledge of guiding documents: 27 Explain: • The SDGs aim to reach the most vulnerable and commit to reach the furthest behind first. • Many stakeholders will be addressing the SDGs so it is important to consider how appropriate wheelchair service provision can contribute to meeting the goals. 90 ToT.9 Knowledge of guiding documentsTrainer's Manual • Priority Assistive Products List (APL) launched in May 2016 • 50 priority assistive products, including 4 types of wheelchairs. ToT.9 Knowledge of guiding documents: 28 Explain: • WHO’s Global Cooperation on Assistive Technology (GATE) initiative is another important step forward. • GATE was created to improve access to assistive technology globally. • GATE’s first outcome is the WHO Priority Assistive Products List (APL),14 launched in May 2016. • The APL features the 50 priority assistive products/devices that governments should make available at an affordable cost, including four different types of wheelchairs. ToT.9 Knowledge of guiding documents: 29 Explain: Other relevant documents detailed in the ToT Handbook include the: • WHO World Report on Disability15 • WHO Global Disability Action Plan16 • UN High Level Meeting on Disability.17 14 15 16 17 14 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/ implementation/assistive_technology/global_survey-apl/en/). 15 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 16 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 17 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 91ToT.9 Knowledge of guiding documentsTrainer's Manual 6. Key point summary (2 minutes) • Wide range of relevant guiding documents to help educate and advocate for appropriate wheelchair service provision. • A thorough knowledge will enhance training and help you educate stakeholders and advocate for appropriate wheelchair provision. • Dynamic field: be aware of new guiding documents. ToT.9 Knowledge of guiding documents: 30 Read the key points. Ask whether there are any questions. 92 ToT.10 Audio-visual tools and equipmentTrainer's Manual ToT.10 Audio-visual tools and equipment A IM To enable trainees to use PowerPoint (PPT) presentations and audio-visual equipment effectively. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the advantages and disadvantages of the available PPTs in the WSTP □□ make changes to and embed videos into PPTs □□ describe good practice in the use of audio-visual equipment □□ use the board and flipchart effectively as a visual aid. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.10: Audio-visual tools and equipment □□ remote control slide changer and laser pointer if available. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Familiarize yourself with the equipment and with using the PPT (including embedding videos) beforehand, so you can answer questions, give a good demonstration and know what kinds of problems trainees might experience. O U T L IN E 1. Introduction 2. PowerPoints in the WSTP 3. Using the board and flipchart as a visual aid 4. Key point summary 4 20 20 1 Total session time 45 93ToT.10 Audio-visual tools and equipmentTrainer's Manual 1. Introduction (4 minutes) Aim: To enable trainees to use PPT presentations and audio visual equipment effectively. Objectives: • explain the advantages and disadvantages of available PPTs • make changes and embed videos into PPTs • describe good practice in the use of audio-visual equipment • use the board and flipchart effectively as a visual aid. ToT.10 Audio-visual tools and equipment: 2 Explain the aim and objectives of the session. Ask: What types of audio-visual (AV) equipment have we used so far in the training? Most important answers: • Data projector for ppts and videos • Board • Flipchart • Sticky notes on wall. Ask: In what ways was the equipment useful? Most important answers: Flipchart and whiteboard: • highlighted key information/learning points during sessions and for future reference (for example Ground Rules) • visual reminder of answers already given • assist with technical explanations. PPTs and videos: • opportunity to show diagrams to explain concepts • reinforced learning by showing images/messages as well as speaking • helped to focus attention. 94 ToT.10 Audio-visual tools and equipmentTrainer's Manual 2. PowerPoints (PPTs) in the WSTP (20 minutes) PDF files: • smaller file size • cannot be edited • no animations • videos embedded. ToT.10 Audio-visual tools and equipment: 3 PPT files: • larger file size • can be edited • animations • videos not embedded. Explain: • WSTP PPTs are available in two versions, non-editable PDF files and editable PPT. • PDF versions are: – smaller in size and have the videos embedded – cannot be edited – do not include ‘builds’ or ‘reveals’ where bullet points appear one by one. • PPT versions are: – larger in size – can be edited – do not come with the videos embedded – include animations. 95ToT.10 Audio-visual tools and equipmentTrainer's Manual • Key discussion questions • Reminders of the key points • For activities. ToT.10 Audio-visual tools and equipment: 4 Explain: Trainers may want to add slides to include the following: • Key questions: – the Trainer’s Manual includes questions for trainers to ask participants. – adding the question to a slide can remind you to ask the question and not to move on to the answers too soon. • Key points: – some sections of the Trainer’s Manual have large amounts of text without reminder slides. – adding key points can help you to remember to cover all aspects of the session plan. • Instructions for activities: – key questions or key instructions that relate to activities can be added to slides. • Local context • Translation • Reduce or divide the text. ToT.10 Audio-visual tools and equipment: 5 Explain: Trainers many want to change slides to: • adapt for the local context • provide translation or locally relevant terms • reduce the text or divide content into two or more slides. Explain: It is important not to change the meaning of the content or the methodology of the WSTP. 96 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Must follow the same format as the original PPT • Do not to change the meaning and the core content of the WSTP • Delete the WHO logo. ToT.10 Audio-visual tools and equipment: 6 Explain: If you modify slides or add extra slides you must: • follow the same style as the original PPT • not change the meaning and core content of the WSTP • delete the WHO logo (in line with WHO’s copyright policy). • ADDING SLIDES TO PRESENTATIONS • In different sizes and fonts • And using ‘special effects’ • CAN BE VERY DISTRACTING • And look unprofessional • So avoid it! ToT.10 Audio-visual tools and equipment: 7 Explain: Do not change the style, font or colour, or add complex animations. 97ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding slides Come out of “Slide Show” mode and demonstrate the following using the next slide. • The simplest method is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Another method of adding slides is to change the “Slide Master” to ensure consistency in layout. ToT.10 Audio-visual tools and equipment: 8 Explain: • The simplest way to add slides to an existing WSTP presentation is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Remember to remove the WHO logo from any slides that you add. • More details on how to do this are included in your ToT Handbook. Inserting video clips (Using Office 2013) 1. Choose your format: • mp4 – Apple computers or Windows computers with Quicktime player • wmv – Windows computers 2. Choose with or without subtitles • subtitles recommended. ToT.10 Audio-visual tools and equipment: 9 Explain: • All video clips are available in two formats, mp4 and wmv. Select the appropriate format for your computer. • Some video clips are available with subtitles. Using the clips with subtitles is recommended to: – allow for any difficulty understanding regional accents – overcome poor sound quality or external noise – be accessible to people with hearing impairments. • The video is stored inside the PPT when it is embedded • Video will remain embedded when you copy the file to another computer • Increases the overall file size. ToT.10 Audio-visual tools and equipment: 10 Explain: • Embedding videos is recommended. • When embedded, the video is stored inside the PPT. • This makes the file larger, but the video should not get lost when you copy the file to another computer. 98 ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding a video here… ToT.10 Audio-visual tools and equipment: 11 Demonstrate the following: To embed the video in PPT 2010 onwards, follow these steps. • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it • Save your changes • The video is now part of the PPT. Explain: • It is possible to set the video to always play in full screen mode. • Windows computers: In the “Video”/“Tools”/“Playback” tab, check the box called “Play Full Screen”. • Mac computers: “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. Return to “Slide Show” mode and show how to play the video. Play the first few seconds and then go to the next slide. Notes for ToT trainers: • Let participants know that they can practise these skills during the preparation time at the end of the day. • Local photos or illustrations can be added to the slides to give them context. • Translation of the slides can be done locally – always check with WHO first to see if the slides have already been translated. 99ToT.10 Audio-visual tools and equipmentTrainer's Manual • Run the presentation in “Slide Show” mode on your computer when practising for your session • Run the full presentation in “Slide Show” mode on the computer and data projector that will be used during the training. ToT.10 Audio-visual tools and equipment: 12 Explain: • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. • This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. • Have a spare data projector or projector lamp • Switch off projector during breaks and practical sessions • To project a black or white screen: – Type W – Type B. ToT.10 Audio-visual tools and equipment: 13 Explain: • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. Demonstrate how to get a black or white screen. 100 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Use remote control to forward slides • Use laser pointer to draw attention • Test the speakers for sound quality and volume. ToT.10 Audio-visual tools and equipment: 14 Explain: • Using a remote control to click between slides means that trainers do not need to stand next to the computer during their presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. • Test the speakers each morning to ensure they are connected properly. Demonstrate using a remote control with a laser pointer (if available). 3. Using the board and flipchart as a visual aid (20 minutes) Using the board/flipchart as a visual aid • The ToT Handbook includes a table with five boxes of information related to using the board/flipchart as a visual aid. • Using the information about your topic plan a 2 minute presentation to the group with the board/flipchart. ToT.10 Audio-visual tools and equipment: 15 Show the slide throughout the activity. 101ToT.10 Audio-visual tools and equipmentTrainer's Manual Activity 1 Groups: Divide trainees into 5 groups. Instructions: Refer trainees to the table on Using the board/flipchart as a visual aid on page 60 of the ToT Handbook. Allocate one topic from the table to each group and ask them to read through the information provided and plan how to communicate this to the rest of the group using the board/flipchart. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for preparation and 2 minutes for each group to present. Feedback: Add any information missed in the presentations. Using the board/flipchart as a visual aid 1. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. 2. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. 3. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). 4. What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. 102 ToT.10 Audio-visual tools and equipmentTrainer's Manual 5. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 4. Key point summary (1 minute) • Know how to use AV equipment • Use PPT versions of presentations and tailor them to suit your context and presentation style • Practise your presentations in “Slide Show” mode on the computer you will use to deliver the training • Understand and follow the guidelines for effective use of the board/flipchart. ToT.10 Audio-visual tools and equipment: 16 Read the key points. Ask whether there are any questions. 103ToT.11 FeedbackTrainer's Manual ToT.11 Feedback A IM To explore the role and skills of the trainer in providing useful feedback. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how to give useful feedback □□ describe the process of providing feedback at the end of each practice delivery session. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.11: Feedback. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Prepare a flipchart sheet with the four feedback steps: 1. Self-reflection by the trainee 2. ToT participants’ feedback 3. ToT trainers’ feedback 4. ToT trainers discuss key points. O U T L IN E 1. Introduction 2. Giving feedback 3. The feedback process after practice deliveries 4. Key point summary 2 35 7 1 Total session time 45 104 ToT.11 FeedbackTrainer's Manual 1. Introduction (2 minutes) Aim: To explore the role and skills of the trainer in providing useful feedback. Objectives: • describe how to give useful feedback • describe the process of providing feedback at the end of each practice delivery session. ToT.11 Feedback: 2 Explain the aim and objectives of the session. 2. Giving feedback (35 minutes) Ask: What is feedback? Most important answers: • What I am doing well – positive feedback. • What I need to improve on – constructive feedback. Explain: It is important that trainers have the skills to give feedback well, and that they can support positive learning outcomes for participants. Receiving feedback: • Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. • Reflect on this individually, then discuss and compare your conclusions with your partner. ToT.11 Feedback: 3 Show the slide throughout the activity. 105ToT.11 FeedbackTrainer's Manual Activity 1a Groups: Divide trainees into pairs. Instructions: Ask: What experiences have you had of receiving feedback? Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Ask trainees to record their reflections on page 61 of their ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 5 minutes for feedback to the group. Feedback: Ask participants to provide examples. Record key words on the board. Giving feedback What should trainers consider when providing feedback? ToT.11 Feedback: 4 Show the slide throughout the activity. 106 ToT.11 FeedbackTrainer's Manual Activity 1b Groups: Divide into the same pairs. Instructions: Ask: What should trainers consider when providing feedback? Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Monitor: Monitor the pairs and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 10 minutes for feedback. Feedback: Ask each group in turn to describe one or two important considerations when giving feedback. Acknowledge good examples to consider. Correct/clarify any misunderstandings. Use the notes below to ensure the appropriate answers have been discussed by the group. Notes for ToT trainers: Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. This will help participants to connect the feedback with the recent learning or activity. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on behaviour – when providing constructive feedback, focus on the behaviour not the person. • Start with the positive – point out what was done well before talking about what needs improvement. If possible, also end on a positive note. • Be delivered in different ways – feedback on practice deliveries is useful to everyone. Praise and provide constructive feedback publicly to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their performance first. They may already understand what went well and what they need to improve. • Support participants, we are all different – before providing constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same was as you. 107ToT.11 FeedbackTrainer's Manual 3. The feedback process after practice deliveries (7 minutes) Explain: ToT trainers will observe sessions from the back of the room but will move to the front of the room to facilitate the feedback. • Trainee reflects on delivery Self- reflection • ToT participants’ feedback Participant feedback • ToT trainers’ feedback ToT trainer feedback • ToT trainers discuss key points relevant to all trainees Key points ToT.11 Feedback: 1 Pin up the prepared flipchart sheet showing the four feedback steps and leave this on the wall for the rest of the week as a reference. Explain: There are four feedback steps after practice deliveries. 1. Self-reflection by trainee: lead trainee reflects on their performance, including: • what went well? • what could be improved? 2. ToT participants’ feedback: provide brief, specific feedback to the lead trainee, including one comment on: • what went well? • what could be improved? 3. ToT trainers’ feedback: ToT trainers will provide additional feedback, concentrating on areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. 4. ToT trainers discuss key points: ToT trainers discuss points about the session relevant to all trainees. 108 ToT.11 FeedbackTrainer's Manual Explain: When providing feedback, it is important to: • Look at the person you are talking about and address them directly. • Be specific. For example, rather than saying, ‘That was really good’, you should say ‘I liked the way you divided the groups, and provided clear instructions’. • Feedback from participants should always be constructive. • If feedback is hurtful or insensitive to the trainee, the ToT trainer must step in to rephrase the feedback so it is more constructive. • The feedback process will give you the opportunity to put the learning from this session into practice. More formal one-on-one feedback to trainees will happen at the end of each day during the preparation session. Ask if there are any questions. 4. Key point summary (1 minute) Feedback should: • Be timely • Be specific • Focused on behaviour • Start with the positive • Be provided in private if it is sensitive. ToT.11 Feedback: 6 Read the key points. Ask whether there are any questions. 109ToT.12 Managing group dynamics Trainer's Manual ToT.12 Managing group dynamics A IM To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ use a variety of methods to create small groups for an activity, considering skill, expertise and experience □□ manage disruptive behaviour in a group. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.12: Managing group dynamics □□ prepare the disruptive behaviour cards: print and cut out the cards at the end of this session plan or write them out by hand. Have a hat or bucket ready. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Organizing and managing group activities 3. Managing disruptive behaviour 4. Key point summary 3 10 25 2 Total session time 40 110 ToT.12 Managing group dynamics Trainer's Manual 1. Introduction (3 minutes) Aim: To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. Objectives: • use a variety of methods to create small groups for an activity, considering skill, expertise and experience • manage disruptive behaviour in a group. ToT.12 Managing group dynamics: 2 Explain the aim and objectives of the session. Why are group activities included in the WSTP? ToT.12 Managing group dynamics: 3 Ask: Why are group activities included in the WSTP? Acknowledge answers. Record them on the board. • Allows trainers to find out how much is already known • Supports sharing of knowledge and experience • Builds confidence • Allows all participants to contribute. ToT.12 Managing group dynamics: 4 Explain: • There are always different levels of experience and expertise in the room. • Group work allows: – trainers to find out how much is already known – those with more experience and expertise to share it with others – participants to build confidence as they find out they already know a lot from their experience – shy or more junior participants to be more comfortable speaking out in a small group. 111ToT.12 Managing group dynamics Trainer's Manual 2. Organizing and managing group activities (10 minutes) What is important to consider when dividing participants into groups? ToT.12 Managing group dynamics: 5 Ask: What is important to consider when dividing participants into groups? Acknowledge answers. Ask trainees to turn to page 63–65 in their ToT Handbook and talk through the list highlighting content not raised by trainees. Notes for ToT trainers: Factors to determine the size of the group • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. 112 ToT.12 Managing group dynamics Trainer's Manual Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. 3. Managing disruptive behaviour (25 minutes) Disruptive behaviour With your partner, discuss what kinds of disruptive behaviour you have seen in trainings. ToT.12 Managing group dynamics: 6 Show the slide throughout the activity. 113ToT.12 Managing group dynamics Trainer's Manual Activity 1 Groups: Divide trainees into pairs. Instructions: Explain that every group of participants has a range of personalities, skills, experience and learning styles. Only when specific behaviour disrupts the session should the trainer respond. Ask trainees to discuss with their partner what kind of disruptive behaviour they have seen in trainings? Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for discussion and 3 minutes for feedback. Feedback: Collect one response from each pair until no new ideas are given. Write responses on the board. Managing disruptive behaviour • Select a ‘disruptive behaviour’ • Discuss how you would handle the behaviour described. ToT.12 Managing group dynamics: 7 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask each pair in turn to select a card at random from the hat/bucket. Ask the pair to discuss how they would handle the behaviour described. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Ask each group to share their ideas: how would they handle such a problem in the group? What works/does not work? After each group has provided their feedback, ask if any other trainees have ideas to share. 114 ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. The higher status/senior participant • If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The dominant participant • The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The quiet participant • The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The argumentative participant • The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. • Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. 115ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: The distracted participant • The participant who is easily distracted, always in and out of the training room or on the phone. • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. The joking participant • The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The negative participant • The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? 4. Key point summary (2 minutes) • Group work is an important training tool • Ensure you make the most of group work by carefully considering how you divide the participants, and how you support them • Managing disruptive behaviour is a key trainer skill. ToT.12 Managing group dynamics: 8 Read the key points. Ask whether there are any questions. 116 ToT.12 Managing group dynamics Trainer's Manual Disruptive behaviour cards – photocopy or write out by hand and cut out The higher status/senior participant If there is a participant who is in a position of authority over others in the group, participants may be reluctant to speak, answer questions or disagree with them. The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate by talking loudly or for a long time. This person behaves like they know everything already. The quiet participant The participant who is shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe are true, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. The negative participant The participant who tends to be negative or to discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 117Managers/Stakeholders moduleTrainer's Manual Managers/Stakeholders module 118 Introduction to the WSTPtot ManagersTrainer's Manual Introduction to the WSTPtot Managers A IM To familiarize trainees with the Wheelchair Service Training Package for Managers (WSTPm) and the aim and structure of the ToT programme for this package. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the target audience, scope and purpose of the WSTPm □□ describe the composition of the training team and ideal ratio of participants to trainers □□ explain the aim of the WSTPm and its timetable □□ adapt the WSTPm to local needs □□ list the WSTPm resources. R E S O U R C E S For the session: □□ PPT slides: 1. Introduction to the WSTPtot Managers □□ Wheelchair service steps poster. Each trainee requires the following WSTPm resources: □□ Trainer’s Manual □□ Reference Manual and Workbook □□ Additional Resources □□ Set of WSTP posters. Each trainee requires the following WSTPtot Managers/Stakeholders resources: □□ ToT Handbook □□ WSTPtot Managers and Stakeholders timetable □□ WSTP Pen Drive. T O P R E PA R E □□ Gather resources, review PPT slides and read through this session plan. □□ Set up training room and check equipment. □□ Check WHO website to see which translations are available and to confirm up-to-date references for package resources. □□ Arrange for name tags and trainee resources to be distributed at registration unless already provided. 119Introduction to the WSTPtot ManagersTrainer's Manual O U T L IN E 1. Introduction of ToT trainers and trainees 2. Housekeeping and ground rules 3. Introduction to the module 4. Timetable and aim of the WSTPtot Managers 5. Target audience and purpose of the WSTPm 6. Adapting the WSTPm to local needs 7. Trainers and participants for the WSTPm 8. WSTPm resources 9. Key point summary 15 2 2 8 10 30 3 10 5 Total session time 85 1. Introduction of ToT trainers and trainees (15 minutes) Notes for ToT trainers: • Sections 1 and 2 are only necessary if there are trainees who did not attend the WSTPtot Core training skills module. Introductions Introduction to the WSTPtot Managers: 2 ToT trainers: Introduce yourselves. Give a brief overview of your background and experience in wheelchair provision. Ask trainees to introduce themselves giving the name of their organization, their experience in wheelchair service provision, and any training they have attended including WSTPtot modules. Include an icebreaker. 120 Introduction to the WSTPtot ManagersTrainer's Manual 2. Housekeeping and ground rules (2 minutes) Explain: • the location of toilets • refreshments and lunch arrangements • any accessibility issues • what to do if there is an emergency • any other administrative issues. Explain the following ground rules to trainees: • be ready to begin each session on time • turn off mobile phones during sessions • questions are encouraged. 3. Introduction to the module (2 minutes) Explain: This is a three-day module. The first two days will focus on the WSTPm; the third day will cover the WSTPs and some sessions relevant to both the WSTPm and WSTPs. • Aim: To familiarize trainees with the WSTPm and the aim and structure of the ToT programme. • Objectives: By the end of the session you will be able to: • describe the target audience, scope and purpose • describe the ideal ratio of participants and trainers • explain the WSTPm aim, structure and timetable • adapt the WSTPm to local needs • list the WSTPm resources. Introduction to the WSTPtot Managers: 3 Explain the aim and learning objectives of the session. 121Introduction to the WSTPtot ManagersTrainer's Manual 4. Timetable and aim of the WSTPtot Managers (8 minutes) Ask participants to refer to their WSTPtot Managers and Stakeholders timetable. • Familiarize trainees with resources • Practise delivering the sessions to peers (ToT participants) and ToT trainers • Highlight known challenges and give session tips. Introduction to the WSTPtot Managers: 4 Explain: Days one and two include three types of session to: • Familiarize trainees with the WSTPm resources. • Practise delivering sessions. • Highlight known challenges and give tips on sessions not included in the practice deliveries. • The aim of the WSTPtot Managers is to equip trainees with the skills and knowledge to: • deliver the WSTPm • adapt the WSTPm for different contexts. Introduction to the WSTPtot Managers: 5 Explain: The aim of the WSTPtot Managers is to equip trainees with the skills and knowledge to: • deliver the WSTPm • adapt the WSTPm so it is well suited to local needs. Explain: We will discuss how the WSTPm can be adapted to different circumstances. For example, the number of practical exercises can be increased or decreased depending on the participants’ level of engagement. The exercises are important when trainees are not very motivated, but less so when they are enthusiastic. Remember to use a variety of training and facilitation techniques because people have different learning styles. 122 Introduction to the WSTPtot ManagersTrainer's Manual 5. Target audience and purpose of the WSTPm (10 minutes) Developed to help managers effectively support an appropriate wheelchair service. Introduction to the WSTPtot Managers: 6 Read the slide. Ask: Who remembers what percentage of people in any population needs a wheelchair, according to WHO? Most important answer: • An estimated 1% of any population requires a wheelchair1. • WSTPm is aimed at personnel responsible for implementing, managing and evaluating wheelchair services • Participants usually involved in management or administration of rehabilitation services. Introduction to the WSTPtot Managers: 7 Explain: • An estimated 1% of any population requires a wheelchair, yet in many places wheelchair services are not available or are very underdeveloped. • The WSTPm is aimed at personnel responsible for implementing, managing and evaluating wheelchair services. • WSTPm participants will usually be involved in the management or administration of rehabilitation services but may not have first-hand experience in wheelchair service management. This is why the WSTPm includes basic information about managing appropriate wheelchair services. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 123Introduction to the WSTPtot ManagersTrainer's Manual Ask: In what circumstances might a manager come on the WSTPm training programme but not have experience in wheelchair service management? Acknowledge answers. • New service being established • Service expanding to include wheelchair provision • New manager • Producer expanding wheelchair provision service • Increase knowledge of wheelchair provision. Introduction to the WSTPtot Managers: 8 Explain: Reasons could include: • when a new service is being established or considered • when a service is expanding to include wheelchair provision – such as a prosthetic and orthotic service • when a manager is new to an existing wheelchair provision service • when a wheelchair producer is looking to develop their wheelchair provision service • when someone wants to learn more about appropriate wheelchair provision, for example a government department manager. Ask: Why would a manager who has experience in wheelchair service management come on the WSTPm training programme? Acknowledge answers. 124 Introduction to the WSTPtot ManagersTrainer's Manual • Better plan wheelchair provision • Find answers to challenges • Information on international policies and guidelines • New tools and approaches • Improved management of WSTP-trained staff • Understand how to lead change. Introduction to the WSTPtot Managers: 9 Explain: Some reasons could be: • to find answers to challenges they are facing • to learn more about international policies, guidelines, and conventions related to wheelchair provision • to understand more about appropriate wheelchair provision according to the Wheelchair Guidelines2 and the eight steps of wheelchair service delivery • to increase their understanding of different service delivery models • to learn new ways to improve their management skills • to be able to manage and support staff who have been trained in WSTPb and WSTPi modules • to understand the role managers can play in leading change to improve wheelchair provision. • 2012: WSTPb launched • 2013: WSTPi launched • 2015: WSTPm launched to support training of managers to provide services which fulfil the eight steps of wheelchair service delivery • Part of a package with WSTPs. Introduction to the WSTPtot Managers: 10 Explain: • The WSTPm followed the development of the WSTPb and WSTPi. • The package helps managers to deliver an appropriate and effective wheelchair service that fulfils the eight steps of wheelchair service delivery. • The WSTPm is the third part of the WSTP. 2 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 125Introduction to the WSTPtot ManagersTrainer's Manual Ask: What are the eight steps of wheelchair service delivery? Write answers on the board until all eight are correctly identified. If trainees skip a step, leave a space and come back to it at the end. Pin up the Wheelchair service steps poster and leave it up for the duration of the training programme. Eight steps of wheelchair service delivery 1. Referral and appointment 2. Assessment 3. Prescription (selection) 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Follow-up, maintenance and repair. 1. Referral and appointment 2. Assessment 3. Prescription (selection) 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Follow-up, maintenance and repair. Introduction to the WSTPtot Managers: 11 Explain: • The eight steps of wheelchair service delivery are outlined in more detail in the WHO Wheelchair Guidelines. They were discussed in the Core training skills session, Knowledge of guiding documents. You should be very familiar with them. Help managers to: • plan wheelchair provision better • increase quality of wheelchair service delivery • improve staff retention • enable more users to receive a wheelchair that meets their needs • increase sustainability. Introduction to the WSTPtot Managers: 12 Explain: • The WSTPm includes information on the resources required to fulfil all eight steps. • Knowledge gained through the WSTPm can help managers in many areas of their work. 126 Introduction to the WSTPtot ManagersTrainer's Manual Ask trainees to list activities carried out by managers that can support the work of wheelchair clinicians and technicians. Acknowledge answers. Most important answers: • Ensure that appropriate wheelchairs and materials are in stock • Make sure funding is available for wheelchairs • Help plan the number of service users so staff are not too busy but have enough to do • Ensure service users have appropriate and well-maintained equipment and facilities • Provide administrative support for smooth running of services • Prepare and manage the budget for the service • Help promote a professional service • Advocate to government in support of staff positions • Support collaboration between government and other stakeholders such as Community- Based Rehabilitation (CBR) programmes. 6. Adapting the WSTPm to local needs (30 minutes) • WSTPm can be delivered in 13 – 14 hours • Sample timetable on WSTP Pen Drive • Sessions can be mixed with other activities. Introduction to the WSTPtot Managers: 13 Explain: • The WSTPm can be delivered in 13–14 hours and adapted to suit local needs and resources – for instance adding extra time for translation. • Do not reduce the time. • A sample timetable for the WSTPm is available on the WSTP Pen Drive. • WSTPm sessions can be combined with other activities that are specific to the local context and aims. 127Introduction to the WSTPtot ManagersTrainer's Manual Introduction to the WSTPtot Managers: 1 • Refer trainees to the WSTPm/s planning tool in the Annexes of their ToT Handbook. Explain: • The WSTPm/s planning tool is recommended to help identify which sessions to include and what outcomes you hope to achieve in the country/region where you will be training. • The tool covers 10 areas of policy, products, services and training in line with the Wheelchair Guidelines. • It gives example situations for each of the 10 areas ranging from ‘early stages’ to ‘developing’, ‘maturing’ and ‘well-functioning’. • Begin the planning process as far ahead of the training as possible so you have enough time to gather the necessary information. • Go through the WSTPm/s planning tool and circle the box that most applies to your context for each of the 10 areas. • Expand on your answer in the ‘summary’ box on the left side. Introduction to the WSTPtot Managers: 15 Show the slide throughout the activity. 128 Introduction to the WSTPtot ManagersTrainer's Manual Activity 1 Groups: Divide trainees into groups with others from their country. If all trainees are from the same country, divide into groups of two or three. Instructions: Explain that the aim is to familiarize trainees with the WSTPm/s planning tool. Ask groups to go through the tool and circle the white box for each statement that most applies to their situation: either early stage, developing, maturing or well-functioning. Ask them to add a sentence or two in the left-hand Summary box to expand on their answers. Monitor: Monitor the groups and assist as needed. Time: Allow 15 minutes for the activity and 10 minutes for feedback. Feedback: Ask the first group to feedback with their answers to item 1, giving the stage they circled and any comment added; then ask the second group to feedback with the answer to item 2 and so on, until all 10 areas have been covered. Explain that at the end of the WSTPtot Stakeholders we will carry out an exercise using information gathered with the WSTPm/s planning tool. 7. Trainers and participants for the WSTPm (3 minutes) • One trainer for every 8 – 10 participants • Average 5 – 15 participants on WSTPm • Wheelchair user trainer is an asset • Local knowledge and experience important • International knowledge. Introduction to the WSTPtot Managers: 16 Explain: • The recommended trainer ratio is one trainer for every 8–10 participants. • The WSTPm is typically run for 5–15 participants. • It is an advantage to have an experienced wheelchair user on the training team, ideally someone who knows the subject and training package well. • At least one trainer should have local wheelchair provision experience and knowledge. This will enrich discussions and ensure the training is relevant. • One trainer should have good international knowledge of wheelchair provision and relevant international guidelines, conventions and goals. 129Introduction to the WSTPtot ManagersTrainer's Manual 8. WSTPm resources (10 minutes) Introduction to the WSTPtot Managers: 17 Explain: The WSTPm includes three manuals. • Trainer’s Manual • Reference Manual and Workbook • Additional Resources. Ask trainees to open the Trainer’s Manual. Explain: The first section, About the WSTPm on pages 1–4, covers the Target Audience, Purpose and Scope, the skills and numbers to consider when selecting Trainers and How to get started. Explain: Guidance notes for trainers, on page 5, includes an overview of the training programme, brief information on the session plans, the accompanying PowerPoint presentations (PPTs), and good-practice training tips. An evaluation of the programme is recommended after each delivery. Explain: How to prepare to deliver the training package, which starts on page 8, emphasizes the need to know the current situation, and context, of wheelchair service provision where you will be training. Grouped under: • A. Core knowledge • B. Starting a wheelchair service • C. Running a wheelchair service. Introduction to the WSTPtot Managers: 18 Explain: • The detailed session plans begin in the next section on page 12. There are 12 sessions grouped into three sections. 130 Introduction to the WSTPtot ManagersTrainer's Manual • Reference manual provides additional information • Workbook completed by participants as part of the activities. Introduction to the WSTPtot Managers: 19 Ask trainees to look at the Reference Manual and Workbook. • The Reference Manual provides more detail on each of the topics to supplement the sessions. • The Workbook includes forms and resources for participants to complete as part of the activities in the sessions. Introduction to the WSTPtot Managers: 20 Ask trainees to look at the third manual, Additional Resources. • This is sometimes printed and bound together with the Reference Manual and Workbook. • It includes useful forms and reference documents. For example, how to make an assessment box and assessment bed when working with clients, and how to set up a mobility skills area. Encourage trainees to develop a thorough knowledge of all three manuals. Ask if there are any questions on the manuals. 131Introduction to the WSTPtot ManagersTrainer's Manual • Introduction • Core knowledge • Starting a wheelchair service • Running a wheelchair service • Putting it all together • Six short videos. Introduction to the WSTPtot Managers: 21 Explain: • There are five types of PPT presentations: – introduction – core knowledge – starting a wheelchair service – running a wheelchair service – putting it all together, which summarizes all the information. • There are no ‘aim and objectives’ slides in the WSTPm package, but you can add your own using the objectives given in each session plan. • You can also create and add slides to highlight activities and provide extra instructions. There are six videos available on the WSTP Pen Drive. These are referenced in the PPTs but may not be embedded. Always check in advance that you have the videos ready, either embedded in the PPTs or uploaded to your desktop ready to play. Explain: You will also need the WSTP posters, which can be found on the WSTP Pen Drive. Explain: Supplementary resources are included on the WSTP Pen Drive, most of which were discussed in the Core training skills module. Look out for Managers who lead, which provides information about leading and influencing change in organizations and is particularly relevant for session A.3: Managers who lead change. Ask if there are any questions on the resources. 132 Introduction to the WSTPtot ManagersTrainer's Manual • Latest version of the WSTPm and translations on the WHO website • URL reference can be found in ToT Handbook. Introduction to the WSTPtot Managers: 22 Explain: • The latest versions of the WSTPm resources, as well as any available translations, can be found on the WHO website3. • This link can be found in the ToT Handbook. • Published WSTP manuals can only be changed when a formal review of materials is held. • The ToT Handbook: – provides supplementary information – highlights any errors. Introduction to the WSTPtot Managers: 23 Explain: The ToT Handbook provides supplementary information based on the experiences of trainers who have delivered the packages. It also highlights any errors in the published resources. 9. Key point summary (5 minutes) • Aimed at personnel responsible for implementing, managing and evaluating services • Ensure at least one trainer has local experience and knowledge • Use the WSTPm/s planning tool to begin planning the WSTPm and WSTPs. Introduction to the WSTPtot Managers: 24 Read the key points. Ask whether there are any questions. 3 http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ 133Welcome, introduction and overviewTrainer's Manual Welcome, introduction and overview Key considerations for teaching this session a. General • You may prefer to swap Sections 3 and 4 to cover housekeeping issues before the workshop overview. b. Section 1. Opening ceremony • The timetable allows 10 minutes for a brief opening ceremony, for instance a welcome from the head of the institution where the training programme is being conducted. If a more extensive ceremony is needed, adjust the timetable accordingly. c. Section 3. Workshop overview Tips for preparation • Check if the video Wheelchair service delivery is embedded in the PPT on the WSTP Pen Drive. If it is not, embed it or have it easily accessible on your desktop. Content • Before showing this video, ask participants to look out for the different steps of wheelchair service delivery while they are watching. After showing the video, point out the Wheelchair service steps poster and list the eight steps of wheelchair service delivery. Refer back to the poster whenever it comes up during the rest of the training programme. d. Section 4. Training programme timetable, housekeeping and ground rules Tips for preparation • It is useful to have a wheelchair available when explaining the safety issues. Content • Point out the different components of the wheelchair as you discuss them (for example, spokes, brakes and footrests). Explain that participants should lean forward when going up slopes and lean back when going down, even with an assistant behind them. 134 A.1: What is appropriate wheelchair provision?Trainer's Manual A.1: What is appropriate wheelchair provision? Errors in the WSTP materials a. Section 4. Supporting appropriate wheelchair provision • In the activity on page 22, the Trainer’s Manual gives one example of national policy but the Reference Manual and Workbook gives two. Chose the example that is most appropriate for the context: there is not enough time to use both. • The text in the Reference Manual and Workbook is different from the text in the Trainer’s Manual. Read the text from the Reference Manual to make it easier for the participants to follow. Key considerations for teaching this session a. General Content • The timing of this session is generous for Section 3 but short for Section 4, so overall it should work out. If your time is running short, limit the number of participant responses. 135A.1: What is appropriate wheelchair provision?Trainer's Manual b. Section 2. What is the need and unmet need for wheelchairs? Tips for preparation • Personalize slide A.1.4 with the relevant census data and a calculation on national wheelchair need. If you are training participants from more than one country, list them all on this slide. • If the census is out of date, try to find a more recent estimate from the National Statistics Office or another government department. • To calculate 1% of the population, divide the total population by 100. Some examples are given below. Population 1% of population 45 060 436 450 604 14 538 933 145 389 3 785 566 378 556 c. Section 3. Right to personal mobility • Have a good understanding of the UN Convention on the Rights of Persons with Disabilities (CRPD) and find out whether it has been signed and ratified by the country where your training programme is taking place. d. Section 4. Supporting appropriate wheelchair provision Tips for preparation • The Incheon Strategy is not included as a resource but if you are training in a country covered by the Strategy in Asia and the Pacific, it can be downloaded at: http://www.unescap.org/resources/ incheon-strategy-“make-right-real”-persons-disabilities-asia-and-pacific Content • In the feedback section of the activity you can also suggest that if national policy doesn’t exist, participants can refer to the WHO Disability Action Plan 2014–20214 for guidance on how to set one up. 4 WHO Global disability action p.an 2014 – 2021. Geneva: World Health Organization; 2015 (http://www.who.int/ disabilities/actionplan/en/). 136 A.2: Service delivery Trainer's Manual A.2: Service delivery Errors in the WSTP materials a. Section 4. Broader roles of a manager Tips for preparation • Some of the text on Slide A.2.12 is different from the version of this diagram in the Reference Manual and Workbook. Replace the slide with the new version provided on your WSTP Pen Drive and make a note in your Trainer’s Manual that the PPT slide is an update of the thumbprint version shown in the manual. Key considerations for teaching this session a. Section 2. Service delivery levels • Emphasize that the level of service is not linked to the age of the wheelchair user or their disability. Many regions or countries may only have a basic level service (if any), but the aim is for each country or region to have both available. An intermediate level service needs different resources and staff skills compared to a basic level service. Knowledge of the local context will be useful here so that you can give examples of existing basic and intermediate level facilities. b. Section 3. Service delivery models • There is not much time for the activity in this section. Ask the groups to sit or stand near the Wheelchair service steps poster while they discuss their answers and to stick their Post-it notes next to the relevant service step as they write them. This will make the feedback session quicker. c. Section 4. Broader roles of a manager • As an alternative to projecting the slide Roles of a manager, you may prefer to use a poster of the diagram. Participants can stick Post-it notes onto the poster and it can stay up on the wall throughout the training programme. d. Section 5. Active involvement of wheelchair users in service delivery • An extra slide showing the Romanian case study is provided on your WSTP Pen Drive and can be added to the PPT for this session. 137A.3: Managers who lead changeTrainer's Manual A.3: Managers who lead change Key considerations for teaching this session a. General Tips for preparation • Consider distributing Chapter 6 of Managers who lead as a handout. This is available on the WSTP Pen Drive in Supplementary Resources. • Slide A.3.3 lists the four factors for success. Each of these is then covered in more detail. For clarity, consider duplicating this slide and repeating it at the start of each of the following sections – with the relevant bullet point highlighted. Content • Highlight that change is often seen as something frightening or problematic. Remind participants that it is our reaction to change that makes it good or bad; change in itself is neutral. • There is not much time for this session: leave some questions out if necessary. b. Section 1. Manager’s role in leading the change process • The Trainer’s Manual suggests that you link this session with previous sessions. Highlight that we have discussed appropriate wheelchair provision and the role of a manager, which includes the responsibility to develop a well-functioning service and a motivated well-trained workforce. c. Section 4. Align personnel and resources • Highlight the Notes for trainers (page 38) and emphasize that participants should not spend all their time talking about funding. Funding is an issue that affects every aspect of services and it is more important to draw out how managers can bring together the human and material resources needed. d. Section 6. Summary of action points for managers • The activity on page 42 asks participants to put their ideas up on four sheets of flipchart paper at the end of each session. As time is short, and this is not referred to again until the end of the programme, remind participants to do this at the end of every session. 138 B.1: Accessing servicesTrainer's Manual B.1: Accessing services Key considerations for teaching this session a. Section 2. What is an equitable service? • On page 43 of the Trainer’s Manual ask the question before showing the Equitable services slide. Consider adding a new slide with the title of the session: Accessing services, or displaying the question. b. Section 3. Referral and appointment • There is not much time for this activity. • This activity may generate a lot of discussion about the reluctance of referral network partners to complete forms. Keep the discussion focused on how managers can encourage partners to use the referral forms. For instance: provide blank forms for completion; keep the form as simple as possible; arrange to collect forms on a regular basis; and give feedback on wheelchair users who have accessed the service (so that those referring can see the benefits). c. Section 4. What can managers do to ensure their service is equitable? • Highlight the importance of making sure the service is equitable. Remind participants of the articles of the CRPD that highlight the needs of women, children, older people, poor people, and those living in rural areas. Managers must work to ensure that these groups are addressed and not marginalized in wheelchair service provision. d. End of the session • At the end of the session, ask participants to record actions in their workbook and remind them to write on the four flipchart sheets put up during the previous session. 139B.2: Facilities and equipmentTrainer's Manual B.2: Facilities and equipment Key considerations for teaching this session a. Section 2. Facilities and service flow • If your training programme is taking place in a service centre, this session will include a walk through the service. Ask the group to respect the wheelchair users and staff in the centre and to keep their voices low to avoid disruption. • There is not much time for this section. Plan your route in detail beforehand. To speed things up, consider splitting participants into smaller groups starting at different points. Make sure you have permission to go to each area and ensure staff are aware of your visit. • If you are not based in a service centre, spend more time explaining the service flow slide (B.2.3) in detail. Consider taking video footage or photographs of an actual walk through to show instead. • You can prepare cards with names of the service areas and pin them around the training room or adjacent hallways, allowing participants to rearrange the cards to improve service flow. This will stimulate discussion about what to consider when planning a service. • Refer to page 22 of the Reference Manual and Workbook and highlight the following: – All areas of the service, including the entrance, must be fully wheelchair accessible. – When people arrive at the service there must be an area for registration and space for them to wait to be seen. – It is helpful to have posters, leaflets and video resources in the waiting area, as well as toys for children. – Some people may have travelled long distances and may need to lie down, for example if they have a pressure sore on a weight-bearing area of their body. – Water should be available for everyone on arrival, as well as information on where refreshments are available. – An accessible toilet should also be located near the reception area. – Assessment area/s should be close to the reception/waiting area. They should be quiet, private and have the equipment required for assessments. This includes an assessment bed or bench, privacy screens, foot blocks, tape measures and a camera for recording key stages in the assessment and fitting process. 140 B.2: Facilities and equipmentTrainer's Manual – A technical area is needed for wheelchair preparation, maintenance and repair with floor and bench space. Ideally, this should be close to the assessment areas, but far enough away to reduce noise disturbance. The area should be well-lit, ventilated, waterproof and a good temperature for working. It should have a clean area for final assembly and product adjustment that is separate from the drilling, sanding and painting sections. Technical activities may be split between an area convenient to the other service aspects and another location further away or even outsourced. – A mobility skills area should be located close to the assessment and fitting area. It can be an indoor or outdoor area and should offer a variety of surfaces and obstacles. – A secure storage area is required and should be located close to the technical area. – An office area is needed for the administration aspects of the service, such as preparation and storing of records, and staff meetings. b. Section 4. Organization of facilities • Explain that government facilities often have a requirement to keep broken equipment and old paperwork until it is officially removed from the government inventory. This often means that workshops are filled with redundant equipment and paperwork. To ensure that working areas remain clutter free, encourage managers to store these items, possibly using a container if space is tight. c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 141B.3: Range of appropriate wheelchairsTrainer's Manual B.3: Range of appropriate wheelchairs Key considerations for teaching this session a. General Tips for preparation • Have a variety of wheelchairs available with different features related to the environment, function and posture support; also have one or two pressure relief cushions to illustrate points made in this session. Content • This is one of the most important sessions in the WSTPm. Many stakeholders have little knowledge of wheelchairs or the difference that an appropriate wheelchair can make. • This session must be inspirational and persuasive so that managers understand the impact of an appropriate wheelchair. • Adding photographs or case studies relevant to the local context will increase the impact. a. Section 2. What is an appropriate wheelchair and cushion? • Managers need a good understanding of what an appropriate wheelchair means, and to know that what is appropriate for one person will not be appropriate for another. A wheelchair is only inappropriate in reference to the user’s needs. • Because of individual needs and diversity in environment and function, a service cannot provide only one type of wheelchair. Various models are needed to fully meet wheelchair users’ diverse needs. • Emphasize that a cushion is not optional; it is an essential component of an appropriate wheelchair. b. Section 3. Providing proper fit and postural support • The support a person needs to sit well in their wheelchair is individualized. It is not possible to have only one product giving extra support; multiple products are needed which can be adjusted, modified or have options to enable them to be fitted to an individual. A service may have dedicated supportive seats or optional postural support devices (PSDs) that can be added to a wheelchair to 142 B.3: Range of appropriate wheelchairsTrainer's Manual provide different types and levels of postural support. If available, show some examples of PSDs during this session or add some slides showing pictures of different wheelchair users with varying levels of postural support needs. c. Section 4. Meeting the user’s needs and environment • In this section, explain that a wheelchair user’s needs may be different depending on whether they live in an urban or rural environment. For example, someone travelling frequently on public transport or by car may benefit from a lightweight wheelchair that folds or breaks down in some way. Someone living in a rural setting who does not travel will find those features less important, but may benefit from a rigid frame and a longer wheelbase to give them more stability on rough surfaces. d. Section 5. Importance of a safe and durable product • Cover some of the contents of the box on page 34 of the Reference Manual and Workbook in more depth. Managers can be tempted to accept any wheelchairs offered or to select the cheapest models to get the maximum quantity. Managers should know the questions to ask potential donor or suppliers. For example, they should consider whether the wheelchair has been tested to any certified standards for performance and durability, such as ISO standards (International Organization for Standardization) or local standards. • Donors and funders can pressure managers and teams to choose the cheapest wheelchair. It is important to highlight the cost-per-month/year consideration: cheap wheelchairs often break down very quickly whereas a good-quality wheelchair can last at least 3–5 years if regularly maintained. Wheelchair model Cost of purchase Years of use Cost per year of use Wheelchair A US$ 80 0.5 US$ 160 Wheelchair B US$ 150 1 US$ 150 Wheelchair C US$ 300 3 US$ 100 Wheelchair D US$ 300 5 US$ 60 e. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 143B.4: Align personnelTrainer's Manual B.4: Align personnel Errors in the WSTP materials a. Section 5. Assessing service capacity • Have a calculator available for the session. Add this to the Trainer’s Manual session plan under Resources. Key considerations for teaching this session a. Section 2. Roles in a wheelchair service • Explain that if a region does not have an intermediate level service, the manager of the basic level service should consider how this can be planned for the future and discuss with staff and other stakeholders. b. Section 5. Assessing service capacity Tips for preparation • If you are not confident calculating the figures, practise until you feel prepared. Content • Exit “Slide Show” mode when you get to slide B.4.11 if you are going to complete the table on screen. You will need to click on the edge of the PPT table to enter numbers in the slide. Alternatively, draw the table on a flipchart beforehand and add the numbers during the session. c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. • Remove any data added to slide B.4.11 during the session. 144 B.4: Align personnelTrainer's Manual Activity Work alone for this activity. You will need a calculator. Working with the data in your assigned chart below, fill in the grey cells below columns A-F. Final numbers can be rounded up or down. Option one Planning the working week Scenario A B C D E F Number of working days per week 4 2 5 4 2 5 Number of working weeks per year 40 42 46 40 42 46 Estimating service capacity Basic Intermediate Number of working hours per day 6.5 5 7 6.5 5 7 Estimated number of hours per user 2.5 3 3.5 6 5 5.5 Number of service users per day Number of service users per week Number of service users per year Subtract 15% (contingency for unexpected events) Estimated number of users per year Option two Planning the working week Scenario A B C D E F Number of working days per week 3 2.5 5 3 2.5 5 Number of working weeks per year 44 46 42 44 46 42 Estimating service capacity Basic Intermediate Number of working hours per day 7 6 8 7 6 8 Estimated number of hours per user 3 2.5 3 7 5 6 Number of service users per day Number of service users per week Number of service users per year Subtract 15% (contingency for unexpected events) Estimated number of users per year 145B.5: What does a wheelchair service cost?Trainer's Manual B.5: What does a wheelchair service cost? Key considerations for teaching this session a. General • The session is about encouraging managers to think about the different cost areas of a wheelchair service. Do not allow too much discussion on budget lines. • This session can be too detailed for managers who need an overview but have an accountant who works out the details. At the start ask participants if they are involved in detailed budgeting for their service. If not, consider turning the activities into whole group discussions to save time. b. Section 2. Budget guide • For the practice delivery, run the activity in one group for a shorter period to save time. • The following budget headings should be written on the board: Start-up costs and Operational costs. Be clear that you are asking participants to think about the type of costs that would come under each heading. • Emphasize that a manager and team should be clear about: the personnel and equipment needed for each service step, and whether it will take place in the service or the community. c. Section 3. Benefits of integrating services • This section also has an activity that is financially oriented and could be left out, particularly as the concepts are explained in Section 4. Benefits of cost sharing through partnerships. d. Section 4. Benefits of cost sharing through partnerships Tips for preparation • Consider adding a slide at the start of this section asking: “What is cost sharing? What are the benefits of cost sharing?” e. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 146 C.1: How do you know if your service is working?Trainer's Manual C.1: How do you know if your service is working? Key considerations for teaching this session a. Section 2: What is monitoring and evaluation? • If time is running short during this session, have a general discussion about the benefits of monitoring and evaluation instead of doing the activity. b. Section 3: Efficient and effective services • Consider running this as a full group activity to give time for more discussion. Ask questions as you complete the table on pages 100–101 in the Reference Manual and Workbook to stimulate discussion. For example, for the first blank box in column two on the second row: – Ask participants: what would be a reasonable time for the performance target? – If one person suggests an answer, ask others if they agree. This will stimulate discussion. – Talk through areas of the table that are already complete as examples of what to do. – Ask participants to look at row two in the third column, “On the user’s file record the date when the referral was received and the assessment date”. Ask who would fill in this information in their own service and how would the data be collated to identify whether the target was met? – Ask what action they could take if the target was repeatedly missed? – Refer to the blank box in the third row of the table under “Information collection” target for the “Number of users who receive a wheelchair”, against a target of 20 per month. – Ask: Where would information be stored about who has received a wheelchair? – This would be recorded in the user files. However, to monitor the total number, managers would also need to compile a master list of wheelchairs distributed. – Ask: How would this be managed? – The purpose of the activity is to encourage participants to think about strategies to record and review information about their service. Keep working through the table encouraging discussion on each item. c. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 147C.2: Managing demandTrainer's Manual C.2: Managing demand Key considerations for teaching this session a. Section 2. Creating demand Tips for preparation • The activity directs you to read out the Bangladesh example of success. Add the slide provided on the WSTP Pen Drive to your presentation so that participants can refer to it during the discussion, or provide a copy on a handout. • In the Most important answers section (second box, page 98) additional reasons why demand might be low include: problems with service delivery; dissatisfaction with the service; or poor reputation of the service. If services are providing low quality or expensive products, or have long waiting times, service users may choose to go elsewhere or to go without a wheelchair. Suggest participants add this information to the list in their Trainer’s Manual. b. Section 4. The importance of early referral for children Tips for preparation • Consider adding a slide showing the benefits of early referral as outlined below. Content • Parents can be reluctant to bring their child for a wheelchair assessment for many reasons (see Most important answers, page 103). They may fear that their child will no longer try to walk or will become lazy. Emphasize that an appropriate wheelchair with the right support often means the child’s walking will improve as they don’t have to go so far. It will also help them conserve energy, which can be used to get involved in other things. With better function they will be able to get out of their wheelchair for an activity on the floor or in a standing position. 148 C.2: Managing demandTrainer's Manual c. Section 5. Running efficient and effective services • Limit the discussion on the time needed for each stage; this will vary between services. Use this section to help managers understand how to calculate realistic targets for their services. • Highlight that the time allocations shown in slide C.2.13 are averages. These will vary between services depending on the range of wheelchairs and PSDs available and the skills of the service staff. Depending on context the times could be double those shown for some service users. d. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 149C.3: Planning follow-upTrainer's Manual C.3: Planning follow-up Key considerations for teaching this session a. Section 2. Importance of follow-up • When identifying a wheelchair user to share their experience in this session, ensure they experienced appropriate follow-up. Discuss their experience beforehand to help them highlight the important aspects. b. Section 4. Planning for follow-up Tips for preparation • Slides C.3.7 and C.3.8 are not clear. Replace the existing slides with new ones from your WSTP Pen Drive. Content • As illustrated on the slides, highlight that by providing follow-up a service may provide fewer wheelchairs in year 2 onwards unless human resources are increased. • Emphasize that a service’s effectiveness should be measured on more than just the number of wheelchairs distributed. c. Section 6. Inclusion and participation in the community Tips for preparation • In the example from Sri Lanka on page 122, convert the US$ figures into local currency to help those not familiar with US$. Content • Do not focus on the actual US$ amounts, but on the principle of how much cost is incurred by long stays in hospital because people cannot return home. d. End of session • At the end of the session remind participants to keep adding their ideas to the four flipchart sheets on the wall. Review the contents and if necessary repeat instructions to keep everyone on track. 150 C.4: Planning for financial sustainabilityTrainer's Manual C.4: Planning for financial sustainability Key considerations for teaching this session a. Section 3. Planning for financial sustainability • Make sure you understand the concept of non-monetary support. • Gifts in kind are sometimes easier to secure than financial contributions and should be considered in all areas of the service. However, some in-kind donations may need maintenance, such as a vehicle, so make sure you include this in your budget. b. Section 4. Identify initial funding sources • Remind participants to think about lead times for funding when considering who to approach. Trusts, foundations and governments can have long review processes whereas corporate donors or individuals may respond more quickly. An ideal strategy will include approaches to a range of sources. c. Section 5. Planning a fundraising strategy • The topic of fundraising can generate a lot of discussion. Keep the group on track. • Participants are often unrealistic about the amount of donations they are likely to receive. Emphasize that successful fundraising takes a lot of effort and it is common to only receive small amounts until you have a track record with a donor. • Highlight that potential donors will want to see that the service has carried out proper planning and budgeting and has good financial accountability. • Emphasize the need for high quality and timely reporting to donors. Provide regular progress updates. Unless a donor has a policy of not giving a repeat donation, you are more likely to secure a second donation from a source you have built a relationship with and have kept well informed. • Encourage participants to set realistic expectations. For example, do not ask donors to fund 200 wheelchairs over three months if your provision capacity is 30 wheelchairs per month. 151Putting it all togetherTrainer's Manual Putting it all together Key considerations for teaching this session a. Section 2. Actions to lead change • The aim of this session is to agree on actions to improve wheelchair provision in the country. Focus on gathering inputs from the group members. • When delivering WSTPm you will use the “change facilitators” introduced in session A.3: Managers who lead change. Remind participants to keep adding ideas to the four flipchart sheets on the wall throughout the two days. These lists will form the basis of your discussions. Here are some examples: Actions managers can take to create a shared vision of appropriate wheelchair provision • Involve all team members in deciding the overall objectives of the service and creating a vision and mission statement. • Review the shared vision regularly and ensure that all team members are contributing to its achievement. • Make sure the overall shared vision is user-based: it should be developed with the involvement of wheelchair users. Actions managers can take to communicate the importance of appropriate wheelchair provision • Give presentations to wheelchair sponsors or donors. • Raise awareness of the Wheelchair Guidelines with government ministries and departments, nongovernmental organizations, Disabled People’s Organizations and rehabilitation professionals. • Organize joint awareness raising events and activities with other stakeholders particularly on the International Day of Persons with Disabilities. • Raise awareness of the articles of the UN Convention on the Rights of Persons with Disabilities (CRPD) that relate to assistive products. • Highlight which of the Sustainable Development Goals (SDGs) promote the importance of appropriate provision of assistive products. • Organize meetings with rehabilitation and community-based rehabilitation training schools to raise awareness and promote the Wheelchair Guidelines. • Collect case studies and ‘before’ and ‘after’ pictures of wheelchair service users to share and show the benefits of a professional service. Actions managers can take to align personnel and resources 152 Putting it all togetherTrainer's Manual • Make sure all the wheelchair service steps are assigned to people who have the skills and time to fulfil them. • Involve wheelchair users in the service where possible, particularly for user training and follow-up. • Make sure that personnel fulfilling the clinical, technical and training roles have received the appropriate training. • Ensure your service targets are realistic based on the staff and resources available. • Monitor the service regularly to check that personnel roles, responsibilities and workloads are appropriate. Actions managers can take to motivate, engage and commit personnel • Organize team meetings for all team members to agree on and understand targets. • Ensure that all members of the team see the benefits of a professional service and the dangers of poor service by asking wheelchair users to share their personal stories. • Offer incentives to staff such as bonuses, holidays or “person of the month” awards for exceptional work. • Hold team building events to strengthen teamwork and build morale. • Thank staff when they do work well or achieve a service milestone. The most important part of this session is to discuss what should happen after the training programme. Emphasize the need to agree on next steps while they are together, even if it is only for a follow-up meeting where more detailed planning will be carried out. Encourage participants to nominate people to take things further and to agree on how to communicate with each other after the training programme. Your role is to help participants set specific actions to help them make progress and be successful after the meeting. The Trainer’s Manual suggests you ask these questions: What will be the next steps? Are you going to form a task force to initiate some of the actions proposed? Who will take these actions further? Are you going to meet again? When? Encourage participants to be specific in their answers. If they say they will form a task force, ask who will take responsibility for this? Who will be represented? How many members will there be? What will be the terms of reference? Will there be any meeting costs and who will pay? What will stop them from taking the next steps and how can they overcome these barriers? How will the full group get feedback? Encourage participants to commit to something individually or as an organization. For example, organizing or hosting the next meeting; writing an article about the training programme for the local newspaper to promote awareness about wheelchair services. 153WSTPm Non-practice sessionsTrainer's Manual WSTPm Non-practice sessions A IM To provide further information on WSTP sessions not covered in the practice delivery sessions. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain and address session challenges. R E S O U R C E S For the session: □□ PPT slides: WSTPtot Managers: Non-practice sessions □□ coloured card or Post-it notes: approximately six for each participant □□ four sample “change facilitator” sheets □□ each trainee will need a calculator for Activity 1. If not available trainees can share and work in groups. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Prepare four sample “change facilitator” sheets on flipchart paper and Post-it notes, using the lists at the end of the session. O U T L IN E 1. Introduction 2. Session B.2: Facilities and equipment 3. Session B.3: Range of appropriate wheelchairs 4. Session B.4: Align personnel 5. Session C.1: How do you know if your service is working? 6. Session C.3: Planning follow-up 7. Key point summary 2 15 10 30 20 27 1 Total session time 111 154 WSTPm Non-practice sessionsTrainer's Manual 1. Introduction (2 minutes) Aim: To provide further information on WSTPm sessions not covered in the practice delivery sessions. Objectives By the end of this session you will be able to: • explain and address session challenges. WSTPtot Managers: Non-practice sessions: 2 Explain the aim and objectives of the session. Explain: There are guidance notes on each of these sessions in the ToT Handbook. We will discuss a few aspects in more detail here. 2. Session B.2: Facilities and equipment (15 minutes) Ask participants to turn to page 52 of their Trainer’s Manual and page 22 of their Reference Manual and Workbook. Talk through the contents of pages 22–29. Emphasize the need to be familiar with the facilities and equipment required for basic and intermediate level services before running the WSTPm. • Services should be user-centred and rights- based • Have information posters, leaflets and video resources in the waiting area as well as toys for children. WSTPtot Managers: Non-practice sessions: 3 Explain: • Services should be user-centred and rights-based. • Have information posters, leaflets and video resources in the waiting area as well as toys for children. For example, the wheelchair service steps poster and information about how the service works. Ask participants to turn to page 53 of their Trainer’s Manual. 155WSTPm Non-practice sessionsTrainer's Manual • Add time for a service centre walk through • Plan the route in detail before the session • Take video footage or photographs to use instead • Name different service areas on cards placed around the room. WSTPtot Managers: Non-practice sessions: 4 Explain: • The activity on page 53 includes a service centre walk through. More time must be added for this. • Plan the route in detail before the session. • If the training programme is not based in a service centre, spend more time explaining the service flow using slide B.2.3. See the ToT Handbook for more information. • Consider taking video footage or photographs of an actual service walk through to show instead. • Prepare cards with names of the service areas and pin them around the training room or adjacent hallways, allowing participants to rearrange the cards to improve service flow. This will stimulate discussion about what to consider when planning a service. 3. Session B.3: Range of appropriate wheelchairs (10 minutes) Ask participants to turn to page 57 of their Trainer’s Manual. • One of most important sessions • Managers often lack knowledge of appropriate wheelchairs and the difference they can make • Should be inspirational and persuasive • Use photographs or case studies with the local context. WSTPtot Managers: Non-practice sessions: 5 Explain: • This is one of the most important sessions in the WSTPm. Many stakeholders have little knowledge of wheelchairs or the difference an appropriate wheelchair can make. • This session must be inspirational and persuasive enough to communicate the impact of an appropriate wheelchair. • Adding photographs or case studies from local context will increase impact. 156 WSTPm Non-practice sessionsTrainer's Manual • Managers need a good understanding of appropriate wheelchairs • A wheelchair is only inappropriate if it doesn’t meet the user’s needs • A service or country needs various models with different features to meet wheelchair users’ needs. • A cushion is not optional. WSTPtot Managers: Non-practice sessions: 6 Explain: • Managers need a good understanding of what an appropriate wheelchair means, and that what is appropriate for one person will not be appropriate for another. A wheelchair is only inappropriate in reference to the user’s needs. • Because of individual needs and diversity in environment and function, a service must provide various models not just one type of wheelchair. • A cushion is an essential component of an appropriate wheelchair, not an optional extra. Ask trainees to turn to the table on page 34 of the Reference Manual and Workbook. • Temptation to accept any wheelchairs offered or purchase the cheapest models • Know the questions to ask donors or suppliers • Donors can put pressure on managers to choose the cheapest wheelchair. WSTPtot Managers: Non-practice sessions: 7 Explain: • Managers can be tempted to accept any wheelchairs offered or to select the cheapest models to get the maximum quantity. • Know the questions to ask potential donors or suppliers. See page 34 of the Reference Manual and Workbook. • Donors can put pressure on managers to choose the cheapest wheelchair so that more can be provided. WSTPtot Managers: Non-practice sessions: 8 Wheelchair model Cost of purchase Years of use Cost per year of use Wheelchair A US$ 80 0.5 US$ 160 Wheelchair B US$ 150 1 US$ 150 Wheelchair C US$ 300 3 US$ 100 Wheelchair D US$ 300 5 US$ 60 • Highlight the cost-per-month/year consideration to donors: cheap wheelchairs often break down very quickly whereas good quality wheelchairs can last for 3 to 5 years if regularly maintained. • Wheelchairs that are more expensive to buy are often cheaper when the cost- per-year of use is considered, as shown in this table. 157WSTPm Non-practice sessionsTrainer's Manual 4. Session B.4: Align personnel (30 minutes) Align personnel You will be assigned to Option one or two from your ToT Handbook. Calculate the estimated number of basic and intermediate users to be seen by a team for three scenarios. WSTPtot Managers: Non-practice sessions: 9 Ask trainees to turn to page 72 of the WSTPm Trainer’s Manual. Show the slide throughout the activity. Activity 1 Groups: Ask trainees to work alone. Instructions: Explain: We are going to practise completing the tables in Section B.5: Assessing service capacity. Highlight that the number of working hours per day may look low, but most people have administration and other responsibilities alongside their clinical work. Assign the trainees to Option one or Option two from the ToT Handbook to calculate the estimated number of basic and intermediate level wheelchair users that will be seen in each of the three scenarios. Explain that final numbers can be rounded up or down Monitor: Monitor the trainees and help them if necessary. Check their calculations as you move around the room. Remind them to subtract the 15% contingency. Time: Allow 20 minutes for the activity and 5 minutes for demonstrating the calculations. Feedback: At the end of the activity, slowly write out the calculations for each option under: • A in Option one • D in Option two Write on the slide directly for Option one and on the board for Option two. This shows the method of calculation and also two methods of presenting. Suggest that trainees check your figures against their answers and make any corrections. They will then have a reference to use later. Ask who can give the bottom line answers for the other four options? Emphasize that those who are less confident should practise before running this session until they feel prepared. 158 WSTPm Non-practice sessionsTrainer's Manual Option one Planning the working week A B C D E F Number of working days per week 4 2 5 4 2 5 Number of working weeks per year 40 42 46 40 42 46 Estimating service capacity Basic Intermediate Number of working hours per day 6.5 5 7 6.5 5 7 Estimated number of hours per user 2.5 3 3.5 6 5 5.5 Number of service users per day 2.6 1.67 2 1.08 1 1.27 Number of service users per week 10.4 3.33 10 4.33 2 6.36 Number of service users per year 416 140 460 173 84 293 Subtract 15% (contingency for unexpected events) 62.4 21 69 26 13 44 Estimated number of users per year 354 199 391 147 71 249 Option two Planning the working week A B C D E F Number of working days per week 3 2.5 5 3 2.5 5 Number of working weeks per year 44 46 42 44 46 42 Estimating service capacity Basic Intermediate Number of working hours per day 7 6 8 7 6 8 Estimated number of hours per user 3 2.5 3 7 5 6 Number of service users per day 2.3 2.4 2.67 1 1.2 1.33 Number of service users per week 7 6 13.33 3 3 6.67 Number of service users per year 308 276 560 132 138 280 Subtract 15% (contingency for unexpected events) 46 41 84 20 21 42 Estimated number of users per year 262 235 476 112 117 238 159WSTPm Non-practice sessionsTrainer's Manual 5. Session C.1: How do you know if your service is working? (20 minutes) Ask trainees to close the Trainer’s Manual and ToT Handbook for this section and to turn to page 100 of their WSTPm Reference Manual and Workbook. Explain: This session highlights areas of the service that can be monitored, possible performance targets, and how to collect information. This activity is one you will run yourself; it will help familiarize you with the concepts of monitoring. Monitoring Working on your assigned area of the table on page 100 – 101 of the Reference Manual and Workbook, fill in the blanks. WSTPtot Managers: Non-practice sessions: 10 Show the slide throughout the activity. Notes for ToT trainers: • Run the activity on page 90 of the WSTPm Trainer’s Manual and cover rest of the information up to the end of Section 3. Refer to the extra information in the ToT Handbook and incorporate the suggestions in the activity. 160 WSTPm Non-practice sessionsTrainer's Manual 6. Session C.3: Planning follow-up (27 minutes) • An area often neglected in wheelchair services • This session can help you emphasize its importance to managers • Check that wheelchair users had good follow-up experience before involving them. WSTPtot Managers: Non-practice sessions: 11 Explain: • Follow-up is often neglected in wheelchair service provision. Personnel may not get permission to carry it out or get their travel costs refunded. • This session can help you emphasize the importance of follow-up to managers. • When including a wheelchair user to share experience in this session, ensure their follow-up was appropriate. Talk to them beforehand and help them to highlight the important aspects. C.3.8 Planning follow-up Explain: Slides C.3.7 and C.3.8 in the original package are not clear and have therefore been replaced. These revised slides are on the WSTP Pen Drive. Make a note in your Trainer’s Manual. C.3.8 Planning follow-up Explain: • As illustrated on the slides, the impact of follow-up means that a service may provide fewer wheelchairs in Year 2 onwards unless human resources are increased. • Emphasize that the number of wheelchairs provided should not be the only way that a service’s effectiveness is measured. 161WSTPm Non-practice sessionsTrainer's Manual • Look at ideas on the four sheets of change facilitators • Discuss and add your own ideas. WSTPtot Managers: Non-practice sessions: 14 Show the slide throughout the activity. Activity 2 Groups: Divide the group into pairs. Instructions: Pin up the four sheets of “change facilitators” on the wall with the Post-It notes suggesting ideas that can be found at the end of this session. Ask each pair to move around the room reviewing what the four lists and to add any more ideas using Post-it notes (or coloured cards). Monitor: Move between the groups and help as needed. Time: Allow 12 minutes for the activity and 10 minutes for discussion. Feedback: Ask the groups to gather around each sheet in turn to discuss the contents. Add any ideas that come up through discussion. Emphasize that this activity will only work well if participants have added ideas throughout the training. If not, trainees can allow more time now to think about each area. 7. Key point summary (1 minutes) • Ensure you are familiar with WSTPm concepts and resources: – Trainer’s Manual – Reference Manual and Workbook – ToT Handbook – Guiding documents. WSTPtot Managers: Non-practice sessions: 15 Read the key points. Ask whether there are any questions. Explain: The following day’s programme will cover the WSTPs but some sessions will include more information about the WSTPm including logistics and timetable options. 162 WSTPm Non-practice sessionsTrainer's Manual Preparing the “change facilitator” sample sheets Write the four headings on separate sheets of flipchart paper and add the list items on individual Post-it notes. You may add other actions appropriate to the local context. Actions managers can take to create a shared vision of appropriate wheelchair provision • Involve all team members in deciding on the overall objectives of the service and creating a vision and mission statement • Review the shared vision regularly and ensure that all team members are contributing to its achievement • Make sure the overall shared vision is user-based: it should be developed with the involvement of wheelchair users. Actions managers can take to communicate the importance of appropriate wheelchair provision • Give presentations to wheelchair sponsors or donors. • Raise awareness of the Wheelchair Guidelines with government ministries and departments, nongovernmental organizations, Disabled People’s Organizations and rehabilitation professionals. • Organize joint awareness raising events and activities with other stakeholders particularly on the International Day of Persons with Disabilities. • Raise awareness of the articles of the UN Convention on the Rights of Persons with Disabilities that relate to assistive products. • Highlight which of the Sustainable Development Goals (SDGs) promote the importance of appropriate provision of assistive products. • Organize meetings with rehabilitation and community-based rehabilitation training schools to raise awareness and promote the Wheelchair Guidelines. • Collect case studies and before and after pictures of wheelchair service users to share and show the benefits of a professional service. 163WSTPm Non-practice sessionsTrainer's Manual Actions managers can take to align personnel and resources • Make sure the wheelchair service steps are assigned to people who have the skills and time to fulfill them. • Involve wheelchair users in the service where possible, particularly for user training and follow-up. • Make sure that personnel fulfilling the clinical, technical and training roles have received the appropriate training. • Ensure your service targets are realistic based on the staff and resources available. • Monitor the service regularly to check that personnel roles, responsibilities and workloads are appropriate. Actions managers can take to motivate, engage and commit personnel • Organize team meetings for all team members to agree and understand targets. • Ensure that all members of the team see the benefits of a professional service and the dangers of poor service by asking wheelchair users to share their personal stories. • Offer incentives to staff such as bonuses, holidays, or ‘person of the month’ awards for exceptional work. • Hold team building events to strengthen teamwork and build morale. • Thank staff when they do work well or achieve a service milestone. 164 Introduction to the WSTPtot StakeholdersTrainer's Manual Introduction to the WSTPtot Stakeholders A IM To familiarize the trainees with the WSTPs and the aim and structure of the ToT programme for Stakeholders. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to describe: □□ the target audience, scope and purpose of the WSTPs □□ the ideal number and ratio of participants and trainers for a WSTPs □□ the WSTPs structure and timetable □□ the aims and objectives of the WSTPs ToT programme □□ the WSTPs resources and their use. R E S O U R C E S For the session: □□ PPT slides: 3. Introduction to the WSTPtot Stakeholders. Each trainee requires the following WSTPs resources: □□ Trainer’s Manual □□ Set of WSTP posters Each trainee requires the following WSTPtot Managers/Stakeholders resources: □□ ToT Handbook □□ Managers and Stakeholders timetable □□ WSTP Pen Drive. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Set up training room and check equipment. O U T L IN E 1. Overview of the WSTPtot Stakeholders 2. ToT one-day programme timetable 3. Introduction to the WSTPs and its resources 4. Target audience 5. Purpose and scope 6. Trainers and participants 7. Opening session and guest speakers 8. Key point summary 5 3 3 5 6 3 8 2 Total session time 35 165Introduction to the WSTPtot StakeholdersTrainer's Manual 1. Overview of the WSTPtot Stakeholders (5 minutes) Explain: Many of the resources discussed in the WSTPtot Managers are also relevant to the WSTPtot Stakeholders. Aim: To familiarize trainees with the WSTPs and the aim and structure of the WSTPs ToT programme. Objectives: By the end of the session you will be able to describe: • the target audience, scope and purpose • the ideal number and ratio of participants to trainers • structure and timetable • WSTPs resources and their use. Introduction to the WSTPtot Stakeholders: 2 Explain the aim and objectives of the session. • Developed to raise awareness and increase knowledge • Rarely delivered as half day timetable • 1-2 day workshop recommended • Tailor to local context. Introduction to the WSTPtot Stakeholders: 3 Explain: • The WSTPs was developed to raise awareness and increase knowledge of stakeholders with an interest in appropriate wheelchair services. • Content will depend on the local situation and desired outcomes. • If there is already a structure in place, the meeting could produce commitments for future action and more support. • If there is no structure the meeting can be used to share knowledge and establish a task force. Creating a shared vision is important to give legitimacy to the stakeholders. • Add extra sessions and activities tailored to the local context if needed. • The WSTPs can be delivered in a minimum of 4 hours. It can be extended to one or two days if time is available. 166 Introduction to the WSTPtot StakeholdersTrainer's Manual Explain: • We will cover all the WSTPs sessions in order, and will discuss how they can be used as part of a broader stakeholder workshop. • The WSTPs is a meeting rather than a training programme, so group discussions, brainstorming or visioning will be more appropriate than exercises and activities. 2. ToT one-day programme timetable (3 minutes) Ask trainees to refer to their copy of the Managers and Stakeholders timetable. Explain: The WSTPs ToT programme will run in the same format as the WSTPm ToT. 3. Introduction to the WSTPs and its resources (3 minutes) • Trainer’s Manual is main resource • No participant manual but can share resources: – CRPD – Wheelchair Guidelines – Wheelchair service steps poster. Introduction to the WSTPtot Stakeholders: 5 Explain: • The Trainer’s Manual is the main resource for the WSTPs. There is no participant manual. Give out key package resources on a DVD or the WSTP Pen Drive. • If possible, give participants a copy of the wheelchair service steps poster. This can be printed from the WSTP Pen Drive. • The WSTPs can be downloaded from the WHO website5. Ask trainees to turn to page 1 of the Trainer’s Manual. Explain: The first section is an introduction giving the context for the development of the package. It explains the Target Audience, Purpose and Scope of the training programme, gives recommendations on the number and skills of WSTPs trainers and advises how to get started. 5 http://www.who.int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/ 167Introduction to the WSTPtot StakeholdersTrainer's Manual • Four sessions each with a PPT and session plan • Four videos • WSTP logo. Introduction to the WSTPtot Stakeholders: 6 Explain: • There are four WSTPs sessions with accompanying PPT presentations and session plans. • There are four videos. • The closing address includes an introduction to the WSTP logo (which participants are encouraged to use) and a video: A take home message. 4. Target audience (5 minutes) Ask: Without looking at the Trainer’s Manual, can you suggest stakeholders to be invited to the workshop? Write responses on the board until most or all have been identified. Ask trainees to turn to page 2 of the Trainer’s Manual and compare their answers with the list under Target Audience. Ask those with local knowledge which organizations should be invited. Include human rights organizations. 5. Purpose and scope (6 minutes) • Higher level involvement needed to establish or improve services • Create awareness, develop skills and knowledge. Introduction to the WSTPtot Stakeholders: 7 Explain: • Trained personnel alone cannot ensure appropriate wheelchair provision. They need back up at a higher level to establish or improve wheelchair provision. • The purpose of the WSTPs is to create awareness and develop the skills and knowledge of all those involved in establishing appropriate wheelchair provision. 168 Introduction to the WSTPtot StakeholdersTrainer's Manual • Improve understanding of need and benefits • Be better informed about their role • Increase quality of wheelchair services • Increase commitment and budgetary support and move towards sustainability. Introduction to the WSTPtot Stakeholders: 8 Explain the scope of the WSTPs. • Most contextual package: use in a flexible way • Open with high level presentation to increase media coverage • For longer meetings, invite key people to opening and closing sessions. Introduction to the WSTPtot Stakeholders: 9 Explain: • The Stakeholder Workshop needs to be run in a flexible way to suit the intended outcomes, the level of participants and the time available. • Half a day is the minimum required. Senior stakeholders may be unable to attend for longer periods. • Consider including opening presentations from key stakeholders who may attract media attention. • Consider inviting high-level officials to attend the opening and closing sessions to raise their awareness of challenges in the sector, share workshop outcomes and request their support. • Use the WSTPm/s planning tool to help design the WSTPs if you have more than half a day available. Be clear about the outcomes you want to achieve; but be realistic given the time available and the responsibilities of the people attending. 169Introduction to the WSTPtot StakeholdersTrainer's Manual 6. Trainers and participants (3 minutes) • Facilitators more than trainers • At least two facilitators for 12-40 participants • Three facilitators if more than 40 participants • Need prior experience training and facilitating plus managing multilevel meetings • Ability to listen and welcome different opinions. Introduction to the WSTPtot Stakeholders: 10 Explain: • Although the term trainer is used throughout the WSTP, the WSTPs requires a facilitator more than a trainer. There will be a diverse range of participants and good facilitation will enable everyone’s views to be heard. • It is recommended that at least two trainers facilitate the WSTPs. If the group is large (more than 40) three trainers will give more flexibility (two can sit in on small group discussions or provide information about wheelchair services that may be missing). • It is recommended that WSTPs trainers have: – experience training and facilitating people at an appropriate level – experience managing multi-stakeholder and multi-level audiences – a strong conviction that introducing appropriate wheelchair provision is beneficial to wheelchair users – the ability to listen and welcome different opinions, while ensuring the core principles of appropriate wheelchair provision are maintained and the purpose of the workshop is upheld. 170 Introduction to the WSTPtot StakeholdersTrainer's Manual 7. Opening session and guest speakers (8 minutes) Ask trainees to turn to page 16 of the WSTPs Trainer’s Manual. Explain: If you are running a half day workshop and the group is large, the 5 minutes allocated will not be enough for individual introductions. As an alternative you could call out categories (for example, therapist, government, DPO, NGO, donor, media) and ask the members of each group to identify themselves by standing up or raising their hand. • Five minute time allocation • Can ask people to identify themselves by category • Allow time at the start of group work • Encourage people to give their name when answering questions. Introduction to the WSTPtot Stakeholders: 11 Explain: • Establishing relationships is a key purpose of the workshop, so personal introductions are important. Extend this time if possible and allow a few minutes for introductions during group work. • Encourage participants to state their name and organization when contributing in the following sessions. 171Introduction to the WSTPtot StakeholdersTrainer's Manual • Avoid PPTs or limit to 3 – 4 slides • Hold up a sign when 2 minutes remaining • Limit questions • Encourage speakers to keep their answers brief. Introduction to the WSTPtot Stakeholders: 12 Explain: • The Trainer’s Manual mentions up to three guest speakers. The time allocated is only 20 minutes in total, and guest speakers frequently talk over their allotted time. • Tips to ensure that speakers are relevant and keep to time: – Avoid PPTs or limit to 3–4 slides provided in advance. – Tell the speaker you will hold up a sign when there are two minutes remaining. – Limit the number of questions to each speaker. – Encourage speakers to keep their answers brief. If guest speakers are attending the whole workshop, participants can ask more questions during breaks. • If you have more time, consider extending this session. If guest speakers are well chosen and well briefed, their testimonies can be extremely powerful and will lay a good foundation for the workshop. 8. Key point summary (2 minutes) • Developed to raise awareness and increase knowledge • Involve a broad range of stakeholders • Tailor the content to the local context • Increase the length of the workshop if possible. Introduction to the WSTPtot Stakeholders: 13 Read the key points. Ask whether there are any questions. 172 S.1: Introduction Trainer's Manual S.1: Introduction Key considerations for teaching this session a. Introduction • If you are running a half day workshop and the group is large, the 5 minutes allocated will not be enough for individual introductions. As an alternative, you could call out categories (for example, therapist, government, DPO, NGO, donor, media) and ask the members of each group to identify themselves by standing up or raising their hand. • When a key purpose of the meeting is to establish relationships, personal introductions become important. Include a few minutes for people to introduce themselves at each table and then reassign people to different tables for subsequent sessions to increase the relationships established. • Encourage participants to give their name and organization when they contribute in the following sessions. b. Guest speakers and Keynote address – wheelchair user/ representative Tips for preparation • The Trainer’s Manual mentions up to three guest speakers in this session. The time allocated is only 20 minutes in total, and guest speakers frequently talk over their allotted time. • If you have more time available, consider extending this session. If well chosen and well briefed, guest speaker’s testimonies can be extremely powerful and will lay good foundations for the workshop. Tips to ensure speakers are relevant and keep to time • Avoid PPTs or limit to no more than three or four slides. • Ask local contacts about the invited speakers. If they tend to go over time, reduce the number of speakers. • Brief the guest speaker in advance about time constraints. Tell them you will hold up a sign when there are 2 minutes left, to help them keep to time. Ask for any PPT presentations in advance so you can check and upload them on the computer. 173S.1: Introduction Trainer's Manual c. Questions and answers • Only 5 minutes are allowed for guest speaker questions and answers. Limit the number of questions and encourage speakers to keep their answers brief. If guest speakers are attending the whole workshop, encourage participants to ask more questions during breaks. 174 S.2: Policy to practiceTrainer's Manual S.2: Policy to practice Key considerations for teaching this session a. General Tips for preparation • The Trainer’s Manual includes a checklist of key resources to create a legal- framework handout for this session. Speak to government representatives, NGOs, DPOs and other stakeholders, and carry out internet searches to collect this information. • For a more comprehensive overview of the situation in the country, complete the WSTPm/s planning tool, which can be found in the Annexes of this manual and on your WSTP Pen Drive. b. Section 2. What is the need and unmet need? Tips for preparation • Add national population statistics to the first slide and calculate 1% of this figure to give the estimated number of people who need a wheelchair according to WHO.6 Ask your co-trainer/s to check the calculation is correct. Search on the Internet for the latest census information or look for a more recent estimate from the government department of statistics or other reputable source. 6 http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/ 175S.2: Policy to practiceTrainer's Manual Content • WHO estimates that approximately 15% of any population are people with disabilities7 and 1% need a wheelchair. Census information on the total percentage of people with disabilities is usually much lower than the WHO estimates and varies between countries (it is usually closer to 2–5%). Therefore, participants may question the WHO estimates. Explain that disability is generally under-reported for a number of reasons: – disabled family members may be hidden away inside the home and not counted in a census – people do not always admit to their disability on a census form – census forms do not always capture relevant information, so many people with disabilities may not be identified. c. Section 3. Importance of wheelchair provision Tips for preparation • Ensure the video is embedded in the WSTP Pen Drive, or easy to locate, before the session starts. • This is a 3-minute section and the video is two and a half minutes so there is not time to include Shobha from India’s story unless the session time is extended. There is another example from India later (page 27). d. Section 5. Everyone has rights • Read the full CRPD, not just the highlighted articles. This will put the articles in context and give a more comprehensive understanding of the rights enshrined in the Convention. e. Section 6. Policy reaches the individual through services • This section includes a slide showing the wheelchair service steps. Have the poster on the wall and refer to it. • This is the first mention of the Wheelchair Guidelines in the WSTPs. If awareness of them is low, and you are not running a separate session on them, use this opportunity to emphasize the importance of the guidelines and the eight steps of wheelchair provision. 7 http://www.who.int/mediacentre/factsheets/fs352/en/ 176 S.2: Policy to practiceTrainer's Manual f. Section 7. Make rights real with a national plan • There is not much time to complete the activity in Section 7. Run this exercise with the group as a whole, or allow more time for the exercise and less time for feedback. Ask for general feedback rather than from each of the four groups separately. g. Section 9. Key point summary • At the end of this session, emphasize that all sectors of government have a role to play in achieving appropriate wheelchair provision. National and international policies, conventions and laws are only meaningful when enforced by the different stakeholders, and in some cases this will only happen through advocacy and lobbying. The compliance, commitment and accountability of all stakeholders is critical. • All stakeholders have a part to play in addressing the urgent need for improved wheelchair provision systems (including wheelchair design, production, supply and service delivery), and to ensure that service delivery follows the eight steps covered in Section 6. 177S.3: Range of appropriate wheelchairsTrainer's Manual S.3: Range of appropriate wheelchairs Key considerations for teaching this session a. General Tips for preparation • Add “different types of wheelchairs” and “cushions” to the resources box in the session plan. Highlight different features and designs; encourage questions and use them to engage participants. • Before the session starts, ensure the two videos are embedded in the WSTP Pen Drive, or easy to locate. b. Section 2. Importance of an appropriate wheelchair and cushion Tips for preparation • Slide 3.5: Convert the US$ figures into local currency so that everyone understands the amounts. • This section focuses on the importance of an appropriate wheelchair and cushion. If you have time add your own case studies to show the impact of inappropriate wheelchairs and cushions. Content • Emphasize that pressure sores can develop quickly and can be fatal and that a cushion is an integral component of an appropriate wheelchair. Wheelchair users may have to stay in bed for months or years to heal from pressure sores. • Keep the conversation focused on how to provide an appropriate wheelchair – focus on user needs and the importance of being able to choose from a range of wheelchairs. Try to avoid getting bogged down in details about wheelchair production or particular brands, unless these have been identified as important topics. 178 S.3: Range of appropriate wheelchairsTrainer's Manual c. Section 4. Meeting the user’s needs and environment • Participants are asked to observe how the different wheelchairs help people in the video to carry out their activities. Highlight the different environments that are featured. Use the resource wheelchairs to show the flip-up footplates or folding mechanism demonstrated in the video. d. Section 5. Importance of a safe and durable product • Emphasize that it is important for services to find out about safety and durability when they are considering new products. For example, does the wheelchair come with a pressure relief cushion? Has the wheelchair passed any certification checks (such as ISO tests)? Has the design been used in similar environments elsewhere? Does it come with spare parts? Can the frame be repaired locally? 179S.4: Working together for change Trainer's Manual S.4: Working together for change Errors in the WSTP materials a. Section 6. How to provide support and remove obstacles • The last slide thumbnail in this section has an incorrect heading. The correct heading: Key point summary is on the PPT slide. Correct it in your Trainer’s Manual. Key considerations for teaching this session a. General • Emphasize that the participants of the Stakeholder Workshop are critical both in creating and promoting change. Relate the content of these sections to the participants. For example, highlight the need to identify early adopters who could champion appropriate wheelchair provision. Highlight the need to identify the organizations who most desire change and could be a driving force for wheelchair provision. b. Section 1. Introduction • The introduction suggests linking this session to previous similar sessions about unmet need and the benefits of appropriate wheelchairs. Flag up the guiding documents again including any international, national, or local policies. c. Section 2. How to communicate a sense of urgency • Participants often comment that there are no statistics available and therefore the need for wheelchairs is unknown. Persuade them that this should not be a reason for inaction. The WHO statistic of 1% is a credible statistic that can be used for estimating and planning purposes. d. Section 6. How to provide support and remove obstacles • Slide 4.12: edit the slide to include the population of the country where you are training and calculate the estimated 1% of the population requiring wheelchairs. You should already have this data from the slide in session S.2. 180 S.4: Working together for change Trainer's Manual e. Section 7. Strategies to help the change process • What will be the next steps? (page 47): If possible, increase the time allocated to discuss the actions listed on the flipchart sheets. It is important that there is agreement on how to move forward before the workshop breaks up. For instance, plans for a follow-up meeting after participants have had time to reflect and consult with colleagues. • To save time, consider running the activity in Section 7 either for the group as a whole or by dividing into three groups. Show the groups how to record their answers directly onto the flipchart paper or via Post-it notes. f. End of session • The last two slides are for the closing address. Consider inserting a blank slide before the first to avoid moving on to the closing address in error. 181Closing address Trainer's Manual Closing address Key considerations for teaching this session a. General • The two slides for the Closing address are at the end of the PPT for Session S.4. Working together for change. b. Closing address and logo • Highlight that the WSTP logo is provided on the WSTP Pen Drive. c. Evaluation and feedback to WHO • Evaluation and feedback is very important to WHO as it enables ongoing improvement and development of the WSTP materials. Encourage participants to join in this process. 182 WSTPm and WSTPs logistics and preparationTrainer's Manual WSTPm and WSTPs logistics and preparation A IM To introduce trainees to the logistics and preparation needed to deliver the WSTPm and WSTPs. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the importance of knowing the current wheelchair provision situation □□ plan a programme using the WSTPm/s sessions as appropriate □□ identify and prepare appropriate WSTPs guest speakers and participants. R E S O U R C E S For the session: □□ PPT slides: 4. WSTPm and WSTPs logistics and preparation □□ WSTPm Trainer’s Manual □□ WSTPs Trainer’s Manual. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Gather basic information on local wheelchair service delivery. O U T L IN E 1. Introduction 2. Planning WSTPm and WSTPs delivery based on local context 3. Identifying participants for WSTPs 4. Identifying and preparing guest speakers for WSTPs 5. Trainers’ roles for the WSTPs 6. Closing reflection 2 5 8 8 5 2 Total session time 30 183WSTPm and WSTPs logistics and preparationTrainer's Manual 1. Introduction (2 minutes) Aim: Introduce the logistics and preparation needed to deliver the WSTPm and WSTPs. Objectives: By the end of this session trainees will be able to: • explain why it is important to know current situation • plan a programme using WSTPm/s sessions • organize WSTPs guest speakers and participants. WSTPm and WSTPs logistics and preparation 2 Explain the aim and objectives of the session. • Trainer’s Manual provides detailed guidance on all areas • ToT Handbook gives additional information. WSTPm and WSTPs logistics and preparation 3 Explain: • The WSTPm and WSTPs Trainer’s Manuals give detailed guidance on delivering the packages and are a good starting point for trainees. • The ToT Handbook gives additional information. 2. Planning WSTPm and WSTPs delivery based on local context (5 minutes) • Identify stakeholders • Understand existing wheelchair provision • Know about gaps in wheelchair provision • Research relevant laws, strategies, policies and action plans. WSTPm and WSTPs logistics and preparation 4 Explain: • Knowing the local context is very important. • Adapt the sessions to ensure they are relevant to the local context and will achieve your intended outcomes. 184 WSTPm and WSTPs logistics and preparationTrainer's Manual • Reduce activities to encourage discussion if necessary • Use the WSTPm/s planning tool to: – Get an overview of current situation – Identify which sessions to include. WSTPm and WSTPs logistics and preparation 5 Explain: • Trainers have found it is difficult to deliver the packages in the allotted time. • Most topics generate valuable discussion which needs to be accommodated to maximize the value of the training. It is better to allow discussion and reduce the number of activities. • Make sure you include session content that satisfies all learning styles. • Use the WSTPm/s planning tool to get an overview of the current situation and help you identify which sessions to include. • Two-day training • Extend to allow more time or to cover extra topics. WSTPm and WSTPs logistics and preparation 6 Explain: The WSTPm is designed as a two- day programme but can be extended to allow more time or to add extra topics. • Half day workshop (4 hours) • With additional time: – add sessions tailored to local context – combine with another event such as a rehabilitation conference, or disability awareness event. WSTPm and WSTPs logistics and preparation 7 Explain: • The WSTPs is planned as a half day workshop. Either follow all the sessions or use some of them in combination with other activities relevant to the local context. • The minimum time needed for the four sessions within the WSTPs is 4 hours. 185WSTPm and WSTPs logistics and preparationTrainer's Manual Explain: Time is a critical factor. Two days is usually realistic for managers attending the WSTPm, while senior level stakeholders should be able to commit half or one day to the WSTPs. When less time is available, prioritize which sessions to include. For example, in a region that already has wheelchair services in place, it would be reasonable to exclude or reduce some of the Starting a wheelchair service sessions. Likewise, in a region with no established services, you would want to reduce the Running a wheelchair service sessions. 3. Identifying participants for WSTPs (8 minutes) Ask: What types of stakeholder organizations would you invite to a workshop in your country, and why? Acknowledge answers. Most important answers: Below is a list of stakeholders that have attended WSTPs in the past. • Key government ministries or departments dealing with disability, such as health, social welfare, disability affairs or child welfare • Umbrella disability NGOs such as a national federations or national associations • Rehabilitation centre staff working in wheelchairs or prosthetic/orthotics • People with disabilities and their families/carers • Community-based rehabilitation organizations • Academic institutions running disability programmes • World Health Organization and international NGOs working locally in the rehabilitation field • Rehabilitation equipment producers and suppliers • Donor organizations supporting disability initiatives • Disability-specific organizations such as those focusing on people with cerebral palsy, spinal injuries, amputation or veterans • Human rights organizations • Mainstream development organizations • Organizations involved in reporting on the CRPD. 186 WSTPm and WSTPs logistics and preparationTrainer's Manual Most important answers: Decisions on most appropriate attendees should be made after full consultation. Reasons for stakeholders to attend: • To influence government policy and planning to ensure the needs of wheelchair users are met. • To encourage them to understand and represent the needs of wheelchair users in their work. • To understand the relationship between international and national policies and conventions and the needs of wheelchair users. • To introduce them to the Wheelchair guidelines and appropriate wheelchair provision. • Invite all stakeholder groups well in advance • Set a clear purpose and outcomes • Typical number of participants: 12 – 40 • If national, ensure national representation. WSTPm and WSTPs logistics and preparation 8 Explain: • Ensure that everyone is invited well in advance and that the purpose of the workshop is clearly explained. • The success of the workshop will depend on: clarity of its purpose, how realistic the desired outcomes are, and having the right people in the room. Explain: The number and types of stakeholders invited will depend on the region being covered, the budget available and the outcomes you want to achieve. Aim for between 12 and 40 participants. If the workshop is national, make sure you have good representation from all regions and organizations. This may have budget implications but it is important for credibility and implementation of any plans. Ask: What is the risk if some stakeholders are not represented? Acknowledge answers. 187WSTPm and WSTPs logistics and preparationTrainer's Manual Most important answers: • Discussions do not represent all interested parties • Decisions are made without important viewpoints being considered • Participants leave with an incomplete picture of the current situation as some important voices have been left out • Participants get frustrated because the workshop is not representative of the sector • Agreed plans do not have credibility or cannot be implemented as they lack the support of all stakeholder groups. Explain: ensure all invitations are sent out and followed up to confirm attendance. 4. Identifying and preparing guest speakers for the WSTPs (8 minutes) • Help set the scene • Highlight importance of appropriate wheelchair provision • Identify speakers well in advance • Brief them on content and time available • Load PPT onto computer before workshop. WSTPm and WSTPs logistics and preparation 9 Explain: • Begin the workshop with one or two brief presentations from guest speakers. These will help set the scene and highlight the importance of appropriate wheelchair provision. • Identify speakers well in advance and discuss the focus of their presentation, whether they will use slides, and the time available. If guest speakers are planning to use a PPT presentation, try to get it ahead of time and load it onto the laptop you plan to use throughout the Stakeholder Workshop. Explain: Annexes 1 and 2 of the Trainer’s Manual give guidance on the introductory presentations and Annex 3 provides useful quotes and statistics on disability generally. It would be helpful to add local statistics. 188 WSTPm and WSTPs logistics and preparationTrainer's Manual The presentations should be realistic but also hopeful that positive change is possible. The aim is to create an environment where the challenges and urgency of addressing the situation are recognized, while indicating that the time for collaborative action is now. If possible, include one representative from government and one wheelchair user. Ask: Who might be an appropriate representative from the government? Acknowledge answers. Most important answers: • The minister or senior delegate from a relevant ministry (health, social welfare or veteran affairs). • The head of an agency, department or directorate concerned with disability affairs. • A technical specialist on the country’s disability sector. Note: • If you can attract a high-profile ministry representative you are more likely to get media coverage, which will help raise the profile of wheelchair provision issues. It will then be easier to follow-up on commitments made at the meeting. If a senior person cannot attend the whole workshop, encourage them to stay for the other speaker so that they (and the media) can hear about the challenges facing wheelchair users. • Consider local politics when selecting speakers. Make sure the person you invite is well regarded as an effective and positive influence. You may not want a controversial figure to set the tone at this important meeting. Ask: What characteristics might you look for in the wheelchair user representative? Acknowledge answers. 189WSTPm and WSTPs logistics and preparationTrainer's Manual Most important answers: • Knows about the importance of appropriate wheelchair provision • Can explain the value of an appropriate wheelchair from personal experience • Knowledge and experience of local wheelchair provision • Confident to speak passionately in front of a group • Knowledge of the CRPD • Willing to share their own story to highlight challenges faced by wheelchair users. Note: Try to identify a disability rights advocate who will take a rights-based approach to the subject and be aware of local politics and context. They are likely to have good knowledge of the CRPD but may not necessarily be aware of the Wheelchair guidelines. Ask trainees to turn to page 49 of their Trainer’s Manual: Annex 1: Brief for government representative. Explain: This guides the government representative to cover the most critical issues relevant to wheelchair service provision such as: their department’s responsibilities, the current situation for wheelchair provision, and any relevant legislation. Ask trainees to turn to page 51 of their Trainer’s Manual: Annex 2: Brief for wheelchair user representative. Explain: The key here is for the wheelchair user to speak from first-hand experience about their life and what they hope will be achieved in the future. Explain: Annex 3 (page 53) gives some common quotes and statistics for speakers or trainers to use in their presentations. Encourage speakers to talk about the bigger picture of wheelchair provision and to highlight the strengths, weaknesses, opportunities and threats within the wheelchair service provision sector. 190 WSTPm and WSTPs logistics and preparationTrainer's Manual 5. Trainers’ roles for the WSTPs (5 minutes) • More a facilitator than trainer • Thorough knowledge of sector • Strong understanding of appropriate wheelchair provision • Commitment to appropriate provision • Beneficial if one trainer is a wheelchair user. WSTPm and WSTPs logistics and preparation 10 Explain: • The WSTPs is a workshop (rather than a training programme) and requires a facilitator more than a trainer. • Trainers should have a thorough knowledge of the wheelchair and disability sector, as well as the local context, to plan and manage the sessions effectively. • WSTPs trainers should have a good understanding of the importance of appropriate wheelchair provision and a strong commitment to it. • A trainer familiar with health policy and the functioning of government would be an asset to your team. 6. Key point summary (2 minutes) • Adapt sessions based on their relevance to local context. • Discussion is valuable: fewer activities will allow more time. • Use the WSTPm/s planning tool. WSTPm and WSTPs logistics and preparation 11 Read the key points. Ask whether there are any questions. 191WSTPm and WSTPs timetable optionsTrainer's Manual WSTPm and WSTPs timetable options A IM To enable trainees to develop a WSTPm or WSTPs timetable and familiarize them with the WSTPm/s planning tool. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ use the WSTPm/s planning tool □□ develop a WSTPm or WSTPs timetable. R E S O U R C E S For the session: □□ PPT presentation: 5. WSTPms timetable options □□ four sets of the session cards provided at the end of the session plan. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Print four sets of the session cards on coloured cards in line with instructions. If possible laminate them before cutting them up. Include the blanks. O U T L IN E 1. Introduction 2. Developing a timetable 3. Key point summary 2 40 3 Total session time 45 192 WSTPm and WSTPs timetable optionsTrainer's Manual 1. Introduction (2 minutes) Aim and objectives: To enable trainees to develop a timetable and become familiar with the WSTPm/s planning tool. WSTPm and WSTPs timetable options 2 Explain the aim and objectives of the session. 2. Developing a timetable (40 minutes) Explain: You can deliver the WSTPm and WSTPs exactly in line with the packages, but they will be more relevant if you tailor them to the local context as follows. Using the WSTPm/s planning tool • Select a two-day WSTPm programme based on your scenario • Use the cards, write extra session names on the blank cards • If new sessions are added others must be reduced or left out. WSTPm and WSTPs timetable options 3 Show the slide for the first half of the activity. Using the WSTPm/s planning tool • Select a one-day WSTPs programme based on your scenario • Use the cards, write extra session names on the blank cards • The standard WSTPs is a half day programme so you can expand sessions or add sessions. WSTPm and WSTPs timetable options 4 Show the slide for the second half of the activity. 193WSTPm and WSTPs timetable optionsTrainer's Manual Activity 1 Groups: Divide trainees into two groups. Split by country or region if appropriate. Instructions: Hand out copies of the same scenario to both groups. Hand out a set of the session cards. Explain that all the WSTPm cards are in one colour and all the WSTPs ones are in another. Other topics and some blank cards are in a third colour. Ask groups to design a two-day WSTPm programme based on the information in their scenario using the set of cards. They can write extra sessions on the blank cards. Remind the groups that the WSTPm is two days long so if they want to add sessions they must reduce or leave others out. Allow 15 minutes. Change the slide to give the WSTPs set of instructions. Give the groups a second set of cards and ask them to choose a one- day WSTPs programme for the same scenario. Allow 15 minutes. Remind groups that the full WSTPs is half a day, so they can add extra sessions for another half a day and choose to use some or all of the standard WSTPs sessions. Monitor: Monitor the groups, listen to their reasoning as they discuss and make decisions. Ensure your co-trainer supports the second group. Offer input as appropriate. Time: Allow 30 minutes for discussion in groups and 5 minutes for feedback on the process. Feedback: Explain: there is no specific right or wrong answer but it is important you consider the objectives and outcomes you are trying to achieve in the planning stages and to take this into account when planning your training programme. Ask 1–2 trainees from each group to reflect on the process. Note: The main purpose of the activity is to encourage trainees to plan their timetables based on the local context. 194 WSTPm and WSTPs timetable optionsTrainer's Manual 3. Key point summary (2 minutes) • Plan the timetables based on the local context and your objectives. • Always include a discussion on next steps so that there is follow up. WSTPm and WSTPs timetable options 5 Read the key points. Ask whether there are any questions. Scenario: The infrastructure in the country is weak but stable. There is a National Disability Plan that was developed in 1992 but has not been updated. The CRPD has been signed and ratified. Knowledge of the Wheelchair guidelines is weak among all stakeholders. People with disabilities are marginalized in society and most frequently seen as a burden. There are no strong disability organizations in the country and most wheelchair users have very poor wheelchair mobility skills. There is some local production of poor-quality wheelchairs but only in small numbers. A few years ago, a large number of wheelchairs were donated that did not meet the needs of most people and quickly broke down. Most people who need a wheelchair don’t have one. The country has a population of 1.5 million people and doesn’t have its own training schools for rehabilitation professionals. There is some funding but mostly from the international NGO sector. No one has been trained in wheelchair delivery skills so far. Most of the people who will attend the training have little or no knowledge of appropriate wheelchair provision. Wheelchair users are very disempowered. 195WSTPm and WSTPs timetable optionsTrainer's Manual Session cards for Activity 1 Colour A: WSTPm sessions W ST P m Welcome, introduction and overview W ST P m What is appropriate wheelchair provision? W ST P m Service delivery W ST P m Managers who lead change W ST P m Starting a wheelchair service: Accessing services W ST P m Starting a wheelchair service: Facilities and equipment W ST P m Starting a wheelchair service: Range of appropriate wheelchairs 196 WSTPm and WSTPs timetable optionsTrainer's Manual W ST P m Starting a wheelchair service: Align personnel W ST P m Starting a wheelchair service: What does a wheelchair service cost? W ST P m Running a wheelchair service: How do you know if your service is working? W ST P m Running a wheelchair service: Managing demand W ST P m Running a wheelchair service: Planning follow-up W ST P m Running a wheelchair service: Planning for financial sustainability W ST P m Putting it all together 197WSTPm and WSTPs timetable optionsTrainer's Manual Session cards for Activity 1 Colour B: WSTPs sessions W S T P s Introduction W S T P s Policy to practice W S T P s Range of appropriate wheelchairs W S T P s Working together for change 198 WSTPm and WSTPs timetable optionsTrainer's Manual Session cards for Activity 1 Colour C: Other topics. Print full pages and use bottom boxes as blank cards for participants’ own topics. O th er t o pi c Drafting a national policy for wheelchair service delivery O th er t o pi c Drafting a national strategy for wheelchair service delivery O th er t o pi c Appointment of a Task Force to coordinate and drive wheelchair issues O th er t o pi c Establishment of a Wheelchair/ Assistive Products society O th er t o pi c Agreeing to national standards for wheelchair service delivery O th er t o pi c 199WSTPm and WSTPs timetable optionsTrainer's Manual O th er t o pi c Evaluating existing wheelchair and seating range against the WHO Wheelchair Guidelines O th er t o pi c Increased awareness of the WHO Wheelchair Guidelines O th er t o pi c Improved coordination of wheelchair service delivery O th er t o pi c Increased awareness of the CRPD and other international instruments and how they relate to wheelchair service delivery O th er t o pi c Improved skills of personnel involved in wheelchair service management 200 WSTPm and WSTPs timetable optionsTrainer's Manual O th er t o pi c Increased understanding of the global, regional or national situation for wheelchair service delivery O th er t o pi c Training needs analysis for wheelchair service delivery O th er t o pi c O th er t o pi c O th er t o pi c O th er t o pi c 201WSTPtot Managers and Stakeholders evaluation and closingTrainer's Manual WSTPtot Managers and Stakeholders evaluation and closing A IM To address any final questions from trainees and collect their completed evaluation forms. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ deliver the WSTPm and WSTPs as a co-trainer. R E S O U R C E S For the session: □□ PPT slides: 6. WSTPtot Managers and Stakeholders closing session □□ Evaluation forms. T O P R E PA R E □□ Gather resources and read through the session plan. O U T L IN E 1. Final questions and comments and completion of evaluation forms 10 Total session time 10 202 WSTPtot Managers and Stakeholders evaluation and closingTrainer's Manual 1. Final questions and comments and completion of evaluation forms (10 minutes) • Do you feel ready to co-train on the WSTPm and WSTPs? • Any questions or comments? WSTPm and WSTPs closing session: 2 Ask if trainees feel ready to co-train on the WSTPm and WSTPs? Distribute evaluation forms. Highlight the section that asks “How confident were you to deliver the WSTPm and WSTPs before the ToT?” Ask them to add the ranking they gave themselves at the beginning of the ToT before answering: “How confident are you now to deliver the WSTPm and WSTPs?” Encourage trainees to complete the comments sections on the form. Ask whether there are any questions. Thank you and good luck! WSTPm and WSTPs closing session: 3 Explain: You will be able to ask for advice and guidance from co-trainers as you plan to deliver the WSTPm or WSTPs. Thank the trainees for their contributions and wish them luck in their future co-training experiences! Close the ToT programme. 203AnnexesTrainer's Manual Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equipment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 204 AnnexesTrainer's Manual Annex 2: WSTPtot Managers and Stakeholders Timetable Day one Day two Day three 8:30 Introduction to the WSTPtot Managers (85) B.5: What does a wheelchair service cost? (60) Introduction to the WSTPtot Stakeholders (35) 8:45 9:00 S.2: Policy to practice (45) 9:15 9:30 B.5: What does a wheelchair service cost? Feedback (30) 9:45 S.2: Policy to practice: Feedback (25) 10:00 Morning break Morning break 10:15 Welcome, introduction and overview (10) C.2: Managing demand (85) Morning break 10:30 Welcome, introduction and overview: Feedback (15) S.3: Range of appropriate wheelchairs (30) 10:45 A.1: What is appropriate wheelchair provision? (50)11:00 S.3: Range of appropriate wheelchairs: Feedback (20) 11:15 S.4: Working together for change (part I) (57)11:30 A.1: What is appropriate wheelchair provision? Feedback (25) 11:45 C.2: Managing demand: Feedback (35) 12:00 Lunch break 12:15 Lunch break Lunch break 12:30 12:45 1:00 A.2: Service delivery (40) 1:15 C.4: Planning for financial sustainability (70) S.4: Working together for change (part II) (43)1:30 1:45 A.2: Service delivery: Feedback (20) 2:00 A.3: Managers who lead change (45) S.4: Working together for change: Feedback (30)2:15 2:30 C.4: Planning for financial sustainability: Feedback (30) WSTPm and WSTPs logistics and preparation (30) 2:45 A.3: Managers who lead change: Feedback (30) 3:00 Afternoon break Afternoon break 205AnnexesTrainer's Manual 3:15 Afternoon break WSTPm non-practice sessions (105) WSTPm and WSTPs timetable options (45) 3:30 B.1: Accessing services (45) 3:45 4:00 Car park 4:15 B.1: Accessing services: Feedback (25) ToT trainer individual feedback (65) 4:30 4:45 Car park 5:00 Session preparation ToT trainer individual feedback (30) Session preparation ToT trainer individual feedback (30) 5:15 WSTPtot Managers and Stakeholders evaluation and closing (10) 206 AnnexesTrainer's Manual Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 207AnnexesTrainer's Manual Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 208 AnnexesTrainer's Manual Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 209AnnexesTrainer's Manual Annex 4: WSTPm/s planning tool Country _____________________ Completed by ________________________ Contact details ____________________ Date: ___________________________ 1. How to use the tool The tool is designed to help gather a general overview of the situation in the country and to help set the desired training and workshop outcomes. It is recommended that you work with stakeholders to complete the following table as follows: 1. Circle or highlight the box that most closely describes the situation in the country. 2. Complete the white ‘Summary’ boxes in the left-hand column to give brief details of the actual situation for that area. 3. Consider what sessions to include in your training based on the local situation and time available, drawing from local knowledge and the ‘consider including session/s on’ lines, and the possible outcomes page. 2. Summary of main stakeholders in the country to involve in research and planning Consult/include these stakeholders as listed in the WSTPs: • Policy planners and implementers (including Government departments – especially those with responsibility for wheelchair provision). • Umbrella disability organization/s. • Organizations of disabled people (ODPs). • Influential leaders or politicians. • Wheelchair users, their families and caregivers. • Philanthropists/funders/donors. • Media: print and digital. • Wheelchair manufacturers and suppliers. • Professional groups (Physiotherapists, Occupational therapists, CBR professionals, Prosthetists, Orthotists and others). Also consider inviting stakeholders from other countries who can share their experiences. 210 AnnexesTrainer's Manual 3. W ST P m /s p la nn in g to ol B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng C om pl et e th e w hi te su m m ar y bo xe s be lo w C ir cl e/ bo ld t he m os t re le va nt w hi te b ox fo r ea ch o f t he 1 0 ar ea s 1. P ol ic y an d P la nn in g: P ol ic ie s / N at io na l D is ab ili ty P la ns / le gi sl at io n re la ti ng t o w he el ch ai r se rv ic e de liv er y Su m m ar y: N o po lic ie s/ pl an s ex ist w hi ch s pe ci fic al ly re fe re nc e pr ov isi on o f as sis tiv e de vi ce s. N o na tio na l s tr at eg ie s ar e in p la ce . So m e ge ne ra l p ol ic ie s/ pl an s ar e in p la ce b ut no t a lig ne d w ith th e C RP D o r W he el ch ai r G ui de lin es o r w el l kn ow n by s ta ke ho ld er s. Th ey a re n ot e nf or ce d an d ar e ou t o f d at e. Po lic ie s/ pl an s ar e in pl ac e an d ar e kn ow n by m os t s ta ke ho ld er s. Th ey a re to s om e ex te nt in li ne w ith th e W he el ch ai r G ui de lin es an d C RP D b ut a re n ot en fo rc ed . Po lic ie s/ pl an s ar e in pl ac e, in li ne w ith C RP D a nd W he el ch ai r G ui de lin es . T he y ar e re gu la rly r ev ie w ed , w el l k no w n by a ll st ak eh ol de rs , a nd la rg el y en fo rc ed . C on sid er in cl ud in g se ss io n/ s on : Fo rm ul at io n/ dr af tin g of p ol ic ie s/ N at io na l di sa bi lit y pl an s/ st an da rd s in li ne w ith C RP D / W H O G ui de lin es . Re vi ew in g po lic ie s w ith re fe re nc e to C RP D / W H O G ui de lin es . H ow to o pe ra tio na liz e po lic ie s th at a dv oc at e fo r ap pr op ria te w he el ch ai r se rv ic es . U sin g po lic ie s to st re ng th en w he el ch ai r de liv er y. H ow to a ss ist o th er co un tr ie s to d ev el op / im pl em en t p ol ic ie s. 211AnnexesTrainer's Manual B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 2. P ol ic y an d P la nn in g: C on ve nt io n on t he r ig ht s of p er so ns w it h di sa bi lit ie s (C R P D ) Su m m ar y: C RP D h as n ot b ee n sig ne d an d th er e is no lo ca l c om m itm en t f ro m go ve rn m en t t o th e C on ve nt io n. C RP D h as b ee n sig ne d bu t n ot r at ifi ed a nd is no t w el l k no w n or p ro m ot ed w ith in co un tr y. C RP D h as b ee n sig ne d an d ra tifi ed bu t k no w le dg e an d m on ito rin g of it is w ea k. C ou nt ry h as s ig ne d an d ra tifi ed th e C RP D a nd ha s st ro ng m on ito rin g m ec ha ni sm s in p la ce to ev al ua te p ro gr es s. C on sid er in cl ud in g se ss io n/ s on : Ra isi ng a w ar en es s of th e C RP D a nd it s re le va nc e to w he el ch ai r se rv ic e de liv er y. H ow to p ro m ot e C RP D a nd it s re le va nc e to w he el ch ai r se rv ic e de liv er y. Re vi ew in g/ de ve lo pi ng m on ito rin g sy st em s an d st ru ct ur es in r el at io n to w he el ch ai r se rv ic es . Re vi ew in g m on ito rin g da ta to h ig hl ig ht st re ng th s an d w ea kn es se s of w he el ch ai r se rv ic es in re la tio n to C RP D . 3. P ol ic y an d P la nn in g: K no w le dg e of W H O G ui de lin es o n th e pr ov is io n of m an ua l w he el ch ai rs in le ss re so ur ce d se tt in gs ( W he el ch ai r G ui de lin es ) Su m m ar y: Th er e is lit tle o r no kn ow le dg e of th e G ui de lin es e ve n am on g st ak eh ol de rs w or ki ng in w he el ch ai r se rv ic e de liv er y. A li m ite d nu m be r of st ak eh ol de rs a re a w ar e of th e G ui de lin es b ut th ei r ci rc ul at io n ha s be en v er y lim ite d. G ui de lin es a re w el l kn ow n am on gs t ke y w he el ch ai r st ak eh ol de rs b ut n ot w ith in G ov er nm en t o r m ai ns tr ea m d isa bi lit y/ de ve lo pm en t a ct or s. G ui de lin es a re w el l kn ow n an d us ed a s a ke y gu id in g re so ur ce b y G ov er nm en t a nd o th er ac to rs to p la n an d im pl em en t w he el ch ai r se rv ic es . C on sid er in cl ud in g se ss io n/ s on : Pr es en ta tio n on th e G ui de lin es c on te nt a nd ba ck gr ou nd . D ev el op in g a ge ne ra l st ra te gy to p ro m ot e th e G ui de lin es . St ra te gy to p ro m ot e th e G ui de lin es to sp ec ifi c se ct or s. N at io na l/I nt er na tio na l ca se s tu di es o f h ow G ui de lin es a re b ei ng m et . 212 AnnexesTrainer's Manual B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 4. P ol ic y an d P la nn in g: C ou nt ry in fr as tr uc tu re a nd c oo rd in at io n of w he el ch ai r pr ov is io n ef fo rt s Su m m ar y: C ou nt ry is in a v ol at ile / em er ge nc y sit ua tio n w ith li tt le fo rm al in fr as tr uc tu re . Re ha bi lit at io n ef fo rt s ar e m in im al a nd m os tly ru n by IN G O /N G O se ct or . C ou nt ry is p oo rly or ga ni ze d an d re so ur ce d an d st ru ct ur es a re w ea k. Re ha bi lit at io n is no t pr io rit ize d an d ef fo rt s ar e no t c oo rd in at ed . Sk ille d na tio na l s ta ff ar e sc ar ce . In fr as tr uc tu re is in pl ac e an d re ha bi lit at io n se rv ic es a nd s ta ff ex ist b ut s er vi ce s ar e no t w el l c oo rd in at ed or r es ou rc ed a nd ar e lim ite d in q ua lit y, vo lu m e an d re ac h. C ou nt ry h as a s ou nd in fr as tr uc tu re th at in cl ud es w el l-e st ab lis he d an d co or di na te d re ha bi lit at io n se rv ic es in a ll re gi on s of th e co un tr y. C on sid er in cl ud in g se ss io n/ s on : Ra isi ng a w ar en es s of a pp ro pr ia te w he el ch ai r de liv er y am on gs t I N G O /N G O re ha bi lit at io n ac to rs . H ow to c oo rd in at e w he el ch ai r se rv ic e de liv er y in iti at iv es in th e co un tr y. Fo rm ul at io n of Ta sk Fo rc e or N at io na l as so ci at io n. H ow to c oo rd in at e w he el ch ai r se rv ic e de liv er y in iti at iv es in th e co un tr y. En su rin g su st ai na bi lit y an d pl an ni ng fo r th e fu tu re : t he c ha ng in g w he el ch ai r se rv ic e ne ed s in a n ag ei ng po pu la tio n. 5. P ol ic y an d P la nn in g: S tr en gt h of d is ab ili ty m ov em en t an d le ve l o f i nc lu si on o f p er so ns w it h di sa bi lit ie s Su m m ar y: O rg an iza tio ns o f pe rs on s w ith d isa bi lit ie s (O PD ) ar e w ea k or a bs en t. Pe rs on s w ith d isa bi lit ie s ar e m ar gi na liz ed , st ig m at ize d, a nd sh un ne d. Th er e is a w ea k di sa bi lit y m ov em en t w ith s om e O PD s an d N G O s w or ki ng in di sa bi lit y bu t w or k is no t c oo rd in at ed o r im pa ct fu l. P W D s ar e la rg el y ex cl ud ed . G ro w in g di sa bi lit y m ov em en t w ith in cr ea sin g O PD st re ng th . P W D s in cl ud ed in s om e as pe ct s of li fe a nd aw ar en es s is in cr ea sin g of th ei r rig ht s in li ne w ith th e C RP D . V ib ra nt d isa bi lit y m ov em en t w ith s tr on g O PD s st ru ct ur e. P W D s in vo lv ed in w he el ch ai r se rv ic e de liv er y an d th ei r rig ht s in li ne w ith C RP D a re r ec og ni ze d in m os t a re as . C on sid er in cl ud in g se ss io n/ s on : W he el ch ai r us er rig ht s an d th e ro le o f w he el ch ai r us er s an d th ei r or ga ni za tio ns in w he el ch ai r se rv ic e de liv er y. Po te nt ia l r ol es o f se lf- he lp g ro up s in w he el ch ai r de liv er y: ca se s tu dy e xa m pl es . H ow to in cr ea se th e ro le o f O PD s in w he el ch ai r se rv ic e de liv er y. Ro le o f O PD s in pr om ot in g ap pr op ria te w he el ch ai r de liv er y na tio na lly a nd in te rn at io na lly . 213AnnexesTrainer's Manual B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 6. P ro du ct s: A va ila bi lit y of a pp ro pr ia te w he el ch ai rs a nd s up po rt iv e se at in g Su m m ar y: Th er e is a la ck o f a ny w he el ch ai rs a t a ll, an d th os e av ai la bl e ar e no t ap pr op ria te fo r m os t pe op le ’s ne ed s. Th er e ar e 1– 2 ap pr op ria te w he el ch ai rs bu t t he se a re n ot w id el y av ai la bl e, a nd d o no t s er ve th e ne ed s. Th er e is lit tle o r no su pp or tiv e se at in g. Th er e is a fu ll/ lim ite d ra ng e of a pp ro pr ia te w he el ch ai rs a nd /o r su pp or tiv e se at in g bu t vo lu m e/ qu al ity /r ea ch to al l r eg io ns is li m ite d. Th er e is a co m pr eh en siv e ra ng e of ap pr op ria te w he el ch ai rs an d su pp or tiv e se at s in a ll re gi on s of th e co un tr y. C on sid er in cl ud in g se ss io n/ s on : Ra ng e of a pp ro pr ia te w he el ch ai rs . Ev al ua tin g lo ca lly av ai la bl e pr od uc ts ag ai ns t G ui de lin es . Ex pa nd in g th e re ac h an d ra ng e of ap pr op ria te w he el ch ai rs an d in tr od uc in g su pp or tiv e se at in g. Ex pa nd in g th e re ac h an d ra ng e of ap pr op ria te w he el ch ai rs an d se at in g. Pr es en ta tio n of su cc es s st or ie s to em ph as ize im po rt an ce of m ai nt ai ni ng a co m pr eh en siv e ra ng e. 7. S er vi ce s: S ta tu s of w he el ch ai r se rv ic es Su m m ar y: N o go ve rn m en t se rv ic es . R el ia nc e on s po ra di c m as s di st rib ut io ns b y N G O s w ith ou t a ss es sm en t a nd pr es cr ip tio n se rv ic es ac co rd in g to G ui de lin es . So m e ba sic s er vi ce s in p la ce o f v ar yi ng st an da rd s ru n by go ve rn m en t o r N G O s. N o in te rm ed ia te le ve l se rv ic es . P oo r re fe rr al an d fo llo w u p. So m e ba sic a nd in te rm ed ia te se rv ic es o pe ra tin g to W he el ch ai r G ui de lin es s ta nd ar d bu t i ns uf fic ie nt fo r ne ed s, no t i nt eg ra te d in to g ov er nm en t r eh ab se rv ic es , a nd m in im al us er in vo lv em en t o r fo llo w u p. A n et w or k of q ua lit y ba sic a nd in te rm ed ia te le ve l s er vi ce s ar e in te gr at ed in to n at io na l go ve rn m en t s er vi ce s an d m ee tin g ne ed s on a lo ca l a nd n at io na l l ev el w ith fu ll in vo lv em en t o f us er s. C on sid er in cl ud in g se ss io n/ s on : St ar tin g a w he el ch ai r se rv ic e Ru nn in g a w he el ch ai r se rv ic e H ow to u ps ca le th e po sit iv e as pe ct s of se rv ic e de liv er y to m ee t n at io na l n ee ds . Th e w ay fo rw ar d fo r on go in g de ve lo pm en t of s er vi ce s. H ow to s up po rt o th er co un tr ie s to d ev el op se rv ic es . 214 AnnexesTrainer's Manual B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 8. S er vi ce s: A va ila bi lit y of r eh ab ili ta ti on p ro fe ss io na ls / C B R s er vi ce s / S ta ff tr ai ne d in w he el ch ai r de liv er y sk ill s Su m m ar y: Th er e ar e ve ry fe w ph ys io th er ap ist s/ O cc up at io na l t he ra pi st s or C BR p ro fe ss io na ls. N o or fe w p eo pl e in th e co un tr y ha ve s ki lls re la te d to w he el ch ai r de liv er y. Th er e ar e a lim ite d nu m be r of q ua lifi ed pr of es sio na ls an d tr ai ne d C BR w or ke rs . H ow ev er v er y fe w pe op le h av e sp ec ifi c sk ills in w he el ch ai r de liv er y. Q ua lifi ed p ro fe ss io na ls ar e pr es en t i n m os t ar ea s an d C BR w or ke rs ar e pr es en t i n m os t di st ric ts . T he re a re s om e pe op le w ho h av e be en tr ai ne d in s pe ci fic s ki lls of w he el ch ai r de liv er y in s om e re gi on s. Th er e is a ne tw or k of tr ai ne d re ha bi lit at io n an d C BR p ro fe ss io na ls co ve rin g al l o r m os t re gi on s an d a hi gh nu m be r of p eo pl e w ho ha ve b ee n tr ai ne d in sk ills o f w he el ch ai r de liv er y. C on sid er in cl ud in g se ss io n/ s on : A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es H ow to in te gr at e W ST P m od ul es in to re ha bi lit at io n cu rr ic ul a. H ow to in te gr at e W ST P m od ul es in to re ha bi lit at io n cu rr ic ul a. 9. S er vi ce s: A va ila bi lit y of fu nd in g Su m m ar y: Li tt le o r no fu nd in g av ai la bl e lo ca lly fo r re ha bi lit at io n. M os t re ha bi lit at io n fu nd in g is pr ov id ed b y IN G O s/ In te rn at io na l or ga ni za tio ns . M in im al fu nd in g is av ai la bl e fo r se rv ic es bu t n o fu nd in g is co m m itt ed to w he el ch ai r pr ov isi on . M od es t l ev el o f f un di ng is av ai la bl e fo r bo th se rv ic es a nd p ro du ct s bu t i s in ad eq ua te fo r ne ed s. Se rv ic es a re w el l re so ur ce d an d al l/ m os t w he el ch ai rs a nd su pp or tiv e se at s ar e fu nd ed th ro ug h th e st at e sy st em . C on sid er in cl ud in g se ss io n/ s on : A w ar en es s- ra isi ng am on g IN G O /N G O ac to rs o n im po rt an ce of a pp ro pr ia te w he el ch ai r pr ov isi on . Pr es en ta tio n of c as e st ud ie s de m on st ra tin g he al th c os t s av in gs o f ap pr op ria te w he el ch ai r pr ov isi on a nd in cl us io n of P W D s. Im po rt an ce o f a ra ng e of a pp ro pr ia te w he el ch ai rs a t d iff er en t co st s to s ui t v ar yi ng ne ed s. C as e st ud ie s of th e be ne fit s of th e ef fe ct iv e se rv ic es to e ns ur e th ey ar e m ai nt ai ne d an d le ss on s sh ar ed w ith ot he rs . 215AnnexesTrainer's Manual B ri ef in fo rm at io n to ex pl ai n gr ad e E ar ly S ta ge D ev el op in g M at ur in g W el l-f un ct io ni ng 10 . T ra in in g: T ra in in g av ai la bl e fo r w he el ch ai r se rv ic e pe rs on ne l i nc lu di ng w he el ch ai r us er s Su m m ar y: Tr ai ni ng in w he el ch ai r de liv er y is no t p ro vi de d at a ll w ith in th e co un tr y. C ou nt ry d oe s no t h av e re ha bi lit at io n tr ai ni ng sc ho ol s. So m e lim ite d tr ai ni ng in w he el ch ai r de liv er y is in cl ud ed in C BR / ot he r tr ai ni ng c ou rs es bu t i s no t i n lin e w ith W he el ch ai r G ui de lin es . N o w he el ch ai r us er sk ills tr ai ni ng . So m e tr ai ni ng is pr ov id ed to v ar io us ca dr es a nd th er e ar e a lim ite d nu m be r of pe op le a bl e to tr ai n W ST P or e qu iv al en t pa ck ag es . S om e w he el ch ai r us er tr ai ni ng . Re gu la r co ur se s in w he el ch ai r de liv er y sk ills a t b as ic a nd in te rm ed ia te le ve l i n lin e w ith W he el ch ai r G ui de lin es a re o ffe re d an d in te gr at ed in to c ur ric ul a of ot he r re ha bi lit at io n pr of es sio na ls. C on sid er in cl ud in g se ss io n/ s on : A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es . Tr ai ni ng n ee ds a na ly sis ag ai ns t d iff er en t s ec to rs . A w ar en es s of W he el ch ai r G ui de lin es an d W ST P m od ul es . A w ar en es s of p ee r tr ai ni ng fo r w he el ch ai r us er s. D ev el op in g a st ra te gy to in cr ea se th e w he el ch ai r de liv er y sk ills o f r eh ab ilit at io n pr of es sio na ls an d w he el ch ai r us er s. St ra te gy to d ev el op th e sk ills o f w he el ch ai r pr of es sio na ls to in te rm ed ia te /a dv an ce d le ve l. 216 AnnexesTrainer's Manual 4. Possible outcomes to set for a Wheelchair Service Managers Training and/or Stakeholder Workshop Identify the most appropriate and achievable outcomes and consider how much time is needed to cover each. Expand the time of sessions or range of sessions as appropriate. Consider these areas identified in the packages: WSTPm • Increased awareness of the eight steps of wheelchair service delivery. • Increased knowledge and skills of how to start a wheelchair service. • Increased knowledge and skills in how to run a wheelchair service. • Raising awareness of how to make wheelchair provision sustainable. • Increased quality of wheelchair service delivery. WSTPs • Improved understanding about the need for and benefit of an appropriate wheelchair. • Inform stakeholders of their role in developing appropriate wheelchair service delivery. • Attain better understanding of barrier free environments. • Gain more commitment to seek/provide budgetary support. • Increase sustainability of wheelchair service delivery. Consider these additional possible outputs or identify your own based on the local context and needs. • Formulation/Drafting of a national policy for wheelchair service delivery. • Formulation/Drafting of a national strategy for wheelchair service delivery. • Appointment of a Task Force to coordinate and drive wheelchair issues. • Establishment of a Wheelchair/Assistive Devices society or group. • Agreeing national standards for wheelchair service delivery. • Existing wheelchair and seating range evaluated against the WHO Wheelchair Guidelines. • Increased awareness of the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings. • Increased awareness of the CRPD and other International instruments and how they relate to wheelchair service delivery. • Improved coordination of wheelchair service delivery. • Improved skills of personnel involved in wheelchair service management. 217AnnexesTrainer's Manual • Increased understanding of the global/regional/national situation for wheelchair service delivery. • Completion of training needs analysis for wheelchair service delivery.

220 AnnexesTrainer's Manual DR AF T For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/

IntermedIate LeveL Wheelchair Service Training O F TrainerS Package Trainer’s Manual

IntermedIate LeveL Wheelchair Service Training O F TrainerS Package Trainer’s Manual Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. 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Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology the following terms used throughout the WStPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainer/trainee in specific WSTPb/i/m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms the following acronyms used throughout the WStPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package C O n t en t S x About the Wheelchair Service Training of Trainers Package xiii 1. Guidance notes for tot trainers xvii 2. How to prepare to deliver the training package 1 Core training skills module 2 tot.1 Introduction to the Wheelchair Service training of trainers Package 13 tot.2 Wheelchair Service training Packages 26 tot.3 Practice delivery sessions 37 tot.4 Preparing for diversity 44 tot.5 adult learning 56 tot.6 Preparation time 59 tot.7 Presenting and facilitating 68 tot.8 Communication skills 76 tot.9 Knowledge of guiding documents 93 tot.10 audio-visual tools and equipment 104 tot.11 Feedback 110 tot.12 managing group dynamics 118 Intermediate Level module 119 a.1: Wheelchair users who benefit from additional postural support 121 a.2: Children with disabilities 123 B.1: assessment overview and assessment interview 125 B.2: Physical assessment – sitting posture without support 128 B.3: Physical assessment – pelvis and hip posture screen 131 B.4: Physical assessment – hand simulation 135 B.5: Physical assessment – taking measurements 138 B.6: Selecting wheelchairs and cushions 141 B.7: Prescription (selection) of Postural Support devices (PSds) – introduction 143 B.8: Prescription (selection) of PSds – stabilizing the pelvis 150 B.9: Prescription (selection) of PSds – supporting the hips 151 B.10: Prescription (selection) of PSds – supporting the trunk 155 B.11: Prescription (selection) of PSds – supporting the head, thighs and lower legs 157 B.12: Product (wheelchair) preparation 158 B.13: Fitting 159 B.14: User training 160 B.16: maintenance, repairs and follow up 162 Practicals one to four 165 B.15 and B.17: Putting it all together and trainer’s feedback, discussion and closing ceremony 166 Logistics and Preparation 171 Annexes 171 annex 1: timetable for WStPtot core sessions 172 annex 2: WStPtot Intermediate Level timetable 174 annex 3: Feedback sheet for WSPttot practice delivery sessions 177 annex 4: technical annex WStPi x about the Wheelchair Service training of trainers PackageTrainer's Manual about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United States agency for International development (USaId) developed a series of four training packages to increase wheelchair access in developing countries. the Wheelchair Service Training of Trainers Package (WStPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. the need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WStPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. the WStPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WStPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WStPi) 2013; the Wheelchair Service Training Package for Managers (WStPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WStPs) published in 2015. the WStPm and WStPs have been combined into one package-specific module within the WStPtot. the WStPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WStPtot, a trainee should go forward to deliver their training package alongside an experienced trainer, allowing them to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiabout the Wheelchair Service training of trainers PackageTrainer's Manual Target audience the WStPtot is made up of four modules: • Core training skills – two days • Basic Level (WStPb) – three days • Intermediate Level (WStPi) – three days • Managers and Stakeholders (WStPm/s) – three days. all trainees should complete the Core training skills module followed by one of the package-specific modules: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WStPb. Previous experience providing basic-level wheelchairs is essential; the WStPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WStPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WStPi. Previous experience providing intermediate-level wheelchairs is essential; the WStPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WStPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WStPm and WStPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the WSTPtot Managers and Stakeholders module. trainees should have access to co-training opportunities within three months of completing the WStPtot in order to consolidate and practise newly acquired skills. xii about the Wheelchair Service training of trainers PackageTrainer's Manual Trainers Skills: the tot trainers delivering this package should have: • significant experience delivering the WStPi and mentoring others to deliver them • a good understanding of the context in which they are delivering the WStPtot • knowledge of international guiding documents related to wheelchair provision • the experience and ability to engage stakeholders in discussions about wheelchair provision. Wheelchair users: as with the other WStP, inclusion of wheelchair users in the training team is highly recommended. Wheelchair users can draw on their own experiences to give a valuable perspective on how appropriate wheelchair provision affected their feeling of inclusion and quality of life. they can also talk about the central role wheelchair users play in the selection of their own wheelchair. number of ToT trainers: trainees need to be closely supported, so it is recommended that there is one tot trainer for every four to five trainees for the Basic and Intermediate modules, and one tot trainer for every six trainees for the Managers and Stakeholders module. how to get started Before running the tot programme, copy the WStPtot folder from the WStP Pen drive to your computer’s hard drive. • read 1. Guidance notes for ToT trainers below. Prepare materials in the tables on pages xviii–xxiv. • make all the necessary arrangements, as described in the section How to prepare to deliver the training package. • Give each trainee a full set of the training materials listed on pages xviii–xx of this manual. xiii1. Guidance notes for tot trainersTrainer's Manual 1. guidance notes for ToT trainers Training overview Core training skills module Minutes Day ToT.1 Introduction to the Wheelchair Service Training of Trainers Package 75 D ay 1 ToT.2 Wheelchair service training packages 90 ToT.3 Practice delivery sessions 60 ToT.4 Preparing for diversity 60 ToT.5 Adult learning 85 ToT.6 Preparation time 15 Preparation 45 ToT.7 Presenting and facilitating 60 D ay 2 ToT.8 Communication skills 90 ToT.9 Knowledge of guiding documents 75 ToT.10 Audio-visual tools and equipment 45 ToT.11 Feedback 45 ToT.12 Managing group dynamics 40 Preparation 75 Intermediate Level module B.2: Physical assessment – sitting posture without support 120 D ay 3 B.3: Physical assessment – pelvis and hip posture screen 120 B.4: Physical assessment – hand simulation 75 Session preparation, ToT trainer individual feedback 75 B.5: Physical assessment – taking measurements 47 B.8: Prescription (selection) of PSDs – stabilising the pelvis 75 B.5: Physical assessment – taking measurements 75 D ay 4 B.8: Prescription (selection) of PSDs – stabilising the pelvis 135 B.9: Prescription (selection) of PSDs – supporting the hips 60 B.10: Prescription (selection) of PSDs – supporting the trunk (part I) 135 Session preparation, ToT trainer individual feedback 75 B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs 135 D ay 5 B.12: Product (wheelchair) preparation 75 B.13: Fitting 75 B.14: User training 75 ToT Trainer individual feedback 30 Closing ceremony 15 Total training time 2180 xiv 1. Guidance notes for tot trainersTrainer's Manual Training package timetable and duration the WStPtot Core training skills and Intermediate Level modules can be delivered on consecutive days or in blocks over a period of time. a sample five-day timetable is available in the WStPtot folder on the WStP Pen drive. tot trainers are encouraged to adapt and modify the timetable to suit the local context and the learning needs of trainees. Core training skills session plans the Core training skills module is made up of 12 sessions that each begin with a detailed session plan. the plan covers the following key points and is designed to help tot trainers organize and deliver the sessions. • aim – what is the aim of the session • Learning objectives – what will trainees have achieved by the end of the session • resources – what resources are needed for the session • to prepare – checklist to help the tot trainer prepare for the session • Outline – the main contents of the session with timing. tot trainers are encouraged to bring their own knowledge, skills and style to the sessions and to draw out the trainees’ experience throughout the WStPtot. WSTPi session plans after completing the Core training skills module, trainees go on to the second part of the WStPtot where they will practise the training skills they have learnt by delivering sessions from the WStPi. Sessions are allocated to trainees and their delivery is followed by feedback and discussion. the practice delivery sessions allow the tot trainer to observe and assess the trainees’ skills. • Practice delivery: each practice delivery includes presentations of allocated sections of a session by the trainee. • ToT trainer demonstrations: some sessions include a section that the tot trainer will deliver as an example of good practice. • Feedback: after the session, the tot trainer will facilitate feedback from the trainee and the tot participants. Further instructions for providing feedback can be found on page xxv–xxvi of this manual, Guide to facilitating practice delivery sessions. xv1. Guidance notes for tot trainersTrainer's Manual Prepare trainees for practice deliveries to enable trainees to prepare well for the WStPtot, it is important to give them the WStPi materials in advance. this can be a paper copy of the package, an e-copy or a link to download it. trainees should be prepared to deliver any of the sessions. a sample letter for trainees to prepare for the WStPtot can be found in the WStPtot folder on the WStP Pen drive. Practice delivery allocations example practice delivery allocations can be found in the WSTPtot Intermediate Level allocation document in the WStPtot folder. tot trainers should modify this to their training context and trainee numbers. Practice delivery sessions are assigned during the first day of the Core training skills module in session ToT.3 Practice delivery sessions. Note: If trainees have already attended the Core training skills module and will begin directly with the WSTPi module, they should be notified of their practice delivery sessions two-to-three days in advance. Mentoring and peer support the tot trainer has an important role to play as a mentor. each trainee must be allocated a mentor tot trainer at the beginning of the training programme. tot trainers should divide trainees equally between them. as a mentor the tot trainer is the trainee’s main point of contact for questions about their practice delivery sessions and is also there to provide feedback on the trainee’s progress. tot trainers are encouraged to continue to mentor trainees after the WStPtot. trainees can also get valuable ongoing support from their peers, which will help them to develop their skills and confidence. trainees may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. co-training after completing the WStPtot, trainees should continue to develop their skills by co-training alongside experienced trainers. tot trainers should promote co-training experiences as the best way for trainees to continue to develop their training skills after completing the WStPtot. xvi 1. Guidance notes for tot trainersTrainer's Manual the recommended ratio for co-training is one mentor trainer for every two to four co-trainers. In some cases, tot trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. this information should be recorded in the feedback from practice deliveries and shared with the trainee. evaluating the ToT programme after each delivery It is good practice to evaluate every training programme after it has been delivered. tot trainers should gather regular feedback from trainees and record their own thoughts during the tot programme. this will help tot trainers to improve both the WStPtot and their own training skills. It is very helpful if you can provide feedback and data including: • participant registration and evaluation forms • your reflections or comments on the WStPtot. training programme evaluation forms are available in the WStPtot folder on the WStP Pen drive and can be adapted by tot trainers to meet their specific needs. xvii2. How to prepare to deliver the training packageTrainer's Manual 2. how to prepare to deliver the training package know the background of each trainee It is important to be familiar with the background of each trainee. this includes: • understanding what experience the trainee already has in wheelchair provision • being aware of any training programmes the trainee has already attended or delivered • knowledge of future opportunities for the trainee to deliver the WStPi. Find out how wheelchair service delivery and training fits within the trainee’s overall duties at their place of work. Prepare the training facilities to run the WStPtot you will need: • one large training room (or space) that is big enough to allow trainees to divide up and work together in small groups and quiet enough to enable trainees to concentrate • a separate space for lunch/refreshments • clean toilets. all areas, including toilets, must be wheelchair accessible. xviii 2. How to prepare to deliver the training packageTrainer's Manual the following checklist can be used to assess and prepare training facilities. Facilities checklist Training room Lecture area  Chairs for each trainee with a flap-tray or other facility so trainees can write notes  Space for trainees to break into small groups of two-to-four people  Space to display at least three wheelchairs and be able to move them around  Adequate lighting and ventilation  Lockable/secure space  lunch/refreshment area Clean area for eating  Tables and chairs  Nearby space for washing hands – clean towels and soap  Toilets Clean toilets supplied with water, toilet paper, washing facilities and bins  Prepare the training resources and equipment WSTPtot printed resources resource Quantity X comments/instructions Manuals ToT Trainer’s Manual 1 per ToT trainer (for each module delivered)  Print and bind. ToT Handbook 1 per trainee (for each module delivered) and 1 per ToT trainer  Print and bind. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 1 per trainee  Print and bind or provide a soft copy. United Nations Convention on the Rights of Persons with Disabilities (CRPD) 1 per trainee  Print and bind or provide a soft copy. Set of printed resources for package-specific module (WSTPi) 1 per trainee and ToT trainer  This includes manuals, workbooks, posters, forms and checklists. See table below for more details. xix2. How to prepare to deliver the training packageTrainer's Manual Training programme forms Participant registration form 1 per programme  Use this form to keep a record of trainees attending. Name tags 1 per trainee and per ToT trainer  – Timetables (Core training skills and package-specific module) 1 per trainee for each relevant module  Sample for each module available on WSTP Pen Drive; adjust to suit local context. Photo consent form 1 form  Adapt this form for the host/ training organization; translate into local language; ensure any person who is photographed signs this form. Trainee certificate 1 per trainee  Prepare trainee certificates or adapt the template provided on the WSTP Pen Drive. Training programme evaluation forms • Core training skills • Package-specific module 1 per trainee  Collate information after delivery and share with WHO. Feedback sheet for WSTPtot practice delivery sessions ToT trainer will require 1 per trainee.  Print at least 1 per trainee. This sheet can be used to provide feedback on up to 3 practice deliveries. xx 2. How to prepare to deliver the training packageTrainer's Manual WSTPi printed resources resource Quantity X comments/instructions Manuals, workbook and posters Trainer’s Manual 1 per trainee and ToT trainer  Print and bind. Reference Manual 1 per trainee and ToT trainer  Print and bind. Participant’s Workbook 1 per trainee and ToT trainer  Print and bind. Set of posters, including: Children and wheelchairs Different positions Postural Support Device (PSD) table Intermediate-wheelchair user training checklist. 1 per trainee and ToT trainer  – Wheelchair service forms and checklists: Intermediate wheelchair assessment form 1 per trainee and ToT trainer  – Intermediate wheelchair prescription form  – Intermediate wheelchair fitting checklist  Print and laminate. Checklists can be found in the WSTPi resources under Forms, and checklists. Intermediate wheelchair user training checklist  Intermediate wheelchair safe and ready checklist  Postural support device (PSD) table  xxi2. How to prepare to deliver the training packageTrainer's Manual equipment general training equipment item Quantity X comments/instructions Large whiteboard 1  – Whiteboard marker pens 3–4  Various colours Data projector 1  – Computer 1  – Portable speakers 1 set  To improve video sound quality Pointer/remote control 1  – Flipchart stand and paper 1–2 stands and 1 pack of paper  – Flipchart pens 3–4  Various colours Post-it notes 3–4 blocks  Various colours Masking tape or similar 1 roll  To attach flipchart sheets and posters to walls Extension cord At least 1  – Multi-plugs/adapters As needed  – xxii 2. How to prepare to deliver the training packageTrainer's Manual intermediate level equipment item Quantity X comments/instructions Blocks of firm foam 30 mm x 150 mm x 300 mm 9  – Wedges of firm foam 30 mm x 150 mm x 200 mm 9  See diagram in WSTPi Trainer’s Manual Annex II. Cardboard/plastic goniometers 3  – Tape measure 3  Firm retractable tape measure in mm (not soft dressmaker’s tape measure). Clipboards 6  – Assessment beds 3  A bench/assessment bed or plinth. The height should be level with average wheelchair- seat height. Avoid a hard surface if possible – if using benches provide a thin foam layer and cover, or yoga mat. Set of foot blocks 3  Wooden blocks to provide support for wheelchair user’s feet when sitting on the assessment bed. Several different heights should be available. Wheelchairs: at least 1 of each locally-available wheelchair and supportive seat. ensure all wheelchairs are in good working order and have a cushion. Wheelchairs with supportive seat 2–3 – Manual wheelchair, folding frame, basic or adjustable, 4-wheeler 2–3 commonly used Range with no arm rests/different style arm rests  –  – Manual wheelchair, rigid frame, 4-wheeler  – Static seat 1–2 if commonly used  – Manual wheelchair with slung seat and backrest (use for session B10) 1  – xxiii2. How to prepare to deliver the training packageTrainer's Manual Manual wheelchair with long wheelbase, if possible with solid backrest and seat (use for session B10)  – Manual wheelchair, folding frame, kids size, slung seat and backrest (use for session B10) 1  – Basic toolbox – to make adjustments to wheelchairs used during the training 1  – cushions Cushion that has been modified to support fixed unlevel pelvis 1  – Cushion that has been modified to support a hip that cannot bend to neutral sitting posture (trunk-to-thigh angle more than 90 degrees) 1  – Cushion (standard) with large wedge (minimum 20 cm high) to demonstrate how to accommodate both hips that cannot bend to neutral sitting posture (trunk-to-thigh angle more than 90 degrees) 1  – Cushion that has been modified to support one hip or both hips that cannot open to neutral for sitting posture (trunk-to-thigh angle less than 90 degrees) 1  – Cushion that has been modified with wedge for anterior tilt 1  – Cushion to fit each wheelchair above Cushions for each wheelchair above  – xxiv 2. How to prepare to deliver the training packageTrainer's Manual PSD kit: Locally-available examples of the following PSDs will help to demonstrate the different supports taught in this training programme. Trainers should aim to have a sample of any commonly-available pre-fabricated PSDs. Pelvis side pads 2  – Outside thigh pads 2  – Knee separator pad 1  – Tension adjustable backrest 1  – Trunk side pads 2  – Headrest 1  – Pelvis strap 1 per group  – Calf strap 1  – Foot straps 2  – Shoulder harness 1  – Samples of the following locally-used materials, for demonstration purposes only, for session B12: Product preparation Wood/metal/plastic for rigid seats and backrests 1 of each type locally available  – Firm foam (chip foam) 5  50 x 400 x 400 mm pieces Soft foam 5  50 x 400 x 400 mm pieces Eva foam 5  50 x 400 x 400 mm pieces Sample fabric for cushion covers Fabric: 1 of each type locally available  Stretchy, strong, and water resistant Nylon webbing 1 of each type locally available  – Velcro with buckles 1 of each type locally available  – Fasteners 1 of each type locally available  – Nuts and bolts 1 of each type locally available  – xxv2. How to prepare to deliver the training packageTrainer's Manual get to know the training resources as a tot trainer, you will need a comprehensive knowledge of all the WStPi resources. this includes familiarizing yourself with all aspects of the package- specific Trainer’s Manual as well as the Reference Manual for Participants, Participant’s Workbook and other resources on the WStP Pen drive. You should also be familiar with all sections of the ToT Trainer’s Manual and the ToT Handbook. You may be co-training the WStPtot with another tot trainer, however it is important for you to be familiar with all sessions. For example, you will need a good understanding of all the Core training skills taught in the WStPtot and to model them as good practice during your own session deliveries. guide to facilitating practice delivery sessions • monitor the delivery time and stop the trainee when their allocated time is up, even if they have not finished. • Where a session is shared by two or more trainees, to keep things moving run the whole session before facilitating feedback for each of the trainees in turn (unless the session requires a break due to WStPtot timing). • Be familiar with the Errors in the WSTP materials and Key considerations for teaching this session in the ToT Trainer’s Manual, and watch to see if the trainee has addressed them. • Follow the session in the WStP Trainer’s Manual and the ToT Trainer’s Manual. • during the delivery, complete the Feedback sheet for WSTPtot practice delivery sessions, found on the WStP Pen drive. • during practical activities don’t step in too quickly if the session is not running smoothly. allow the trainees time to rectify the situation and redirect participants themselves. Only step in if there are safety concerns, or if trainees are unable to bring the session back on track themselves. xxvi 2. How to prepare to deliver the training packageTrainer's Manual Facilitating feedback after practice deliveries Your role is to facilitate the feedback sessions and ensure they are brief, constructive and relevant. after the practice delivery is completed, go through the following process. * Found in the Feedback sheet for WSPTtot practice delivery sessions. Closely monitor the feedback to ensure that it is constructive. Step in if a participant gives feedback that is negative or hurtful. Give examples of how to rephrase feedback so that it is constructive. individual feedback Based on the tot trainer mentor allocations, tot trainers arrange a time to discuss feedback with each lead trainee, using the Feedback sheet for WSTPtot practice delivery sessions as a guide. Use this time to also feedback any additional or sensitive comments. Self- reection Participant feedback • Ask trainee to comment on what they did well, followed by what can be improved. • Facilitate feedback from ToT participants, asking them to provide one comment on what the trainee did well, followed by one comment on what can be improved. • Discuss any Key considerations for teaching this session not yet addressed through the trainee’s delivery and/or by the ToT trainer feedback. ToT trainer feedback Key points • ToT trainers to feedback, using the trainee skills list* for guidance. It is not necessary to comment on every competency: focus only on the areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. Do not repeat what has already been mentioned by the trainee or ToT participants. 1Core training skills moduleTrainer's Manual Core training skills module 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the Wheelchair Service Training of Trainers Package A IM To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and objectives of the ToT programme □□ explain the ToT programme timetable and WSTPtot process. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.1: Introduction to the WSTPtot □□ name tag for each ToT trainer. For each trainee: □□ different coloured sticky notes (A5 or similar): 3 or 4 pieces □□ ToT Handbook □□ module-specific WSTP trainer’s manual, participant’s reference manual and workbook, posters and WSTP Pen Drive □□ WHO Wheelchair Guidelines and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ timetables for Core training skills module and package-specific module □□ blank name tag. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Arrange a short opening ceremony for the WSTPtot as locally appropriate. □□ Prepare the housekeeping information. □□ Prepare flipchart papers for Ground Rules and Car Park. □□ Set up the training room: tables and chairs; projector, computer and screen; whiteboard; flipchart stand and paper; and markers. □□ Sort resources into sets for each participant and set them out. To avoid confusion only provide trainees with the ToT Handbook, their package-specific WSTP Trainer’s Manual and the ToT timetable at the start of the day. Provide remaining resources at the end of the day. □□ Prepare a Wall of Experience. Print or write headings given in Section 5 on large sticky notes or A5 paper and put them on the wall under a Wall of Experience heading. 3ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual O U T L IN E 1. Opening ceremony 2. Welcome and introductions 3. Introduction to this session 4. Housekeeping and Ground Rules 5. Wall of Experience 6. Overview of the WSTPtot 7. Key point summary 10 10 1 10 15 27 2 Total session time 75 1. Opening ceremony (10 minutes) In collaboration with the host organization, hold an opening ceremony for the WSTPtot as locally appropriate. 2. Welcome and introductions (10 minutes) Introductions ToT.1 Introduction to the WSTPtot: 2 ToT trainers: Welcome everyone and introduce yourselves. Give a brief overview of your background and your experience in wheelchair provision and training. Ask trainees to introduce themselves, giving their name, job role and organization. Give out name tags and ask trainees to write their name. 3. Introduction to this session (1 minute) Aim: To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). Objectives: • describe the aim and objectives of the ToT programme • explain the ToT programme timetable and WSTPtot process. ToT.1 Introduction to the WSTPtot: 3 Explain the aim and objectives of the session. 4 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 4. Housekeeping and Ground Rules (10 minutes) • Toilets • Refreshments and lunch • Accessibility • Emergency exits. ToT.1 Introduction to the WSTPtot: 4 Explain the following, as required: • location of toilets • refreshments and lunch arrangements • any accessibility issues • what to do if there is an emergency • any other administration issues. Setting the Ground Rules Discuss with your neighbour the Ground Rules you would like to have in place for the week. ToT.1 Introduction to the WSTPtot: 5 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Explain: We will now establish the Ground Rules for this training. Ask trainees to briefly discuss the Ground Rules they would like to have in place for the week. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for the activity and 5 minutes for feedback. Feedback: Ask each pair to give one item from their list and record each rule on the flipchart until there are no more ideas. Gather feedback from trainees to ensure they agree on the rules. Ask how the group wants to manage people who break these rules. Pin up the Ground Rules on the wall for reference throughout the ToT programme. 5ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Notes for ToT trainers: • Explain that everyone is responsible for enforcing the Ground Rules, not just the ToT trainer. • Refer trainees to the list each time a Ground Rule is broken. Examples of Ground Rules include: • mobile phones – switch to silent • no side talking or talking over other people • respect for others’ points of view • be on time for all sessions • keep the training area clean and tidy • contribute to the discussions • use appropriate disability terminology. • Use positive terminology • Use the terms: ‘persons with disabilities’ or ‘people with disabilities’. ToT.1 Introduction to the WSTPtot: 6 Explain: • The WSTP promotes the use of positive terminology in relation to people with disabilities. • Trainers must model good practice and follow the language guidance set out in the WSTP and the CRPD. • Terms such as ‘the disabled’ or ‘disabled people’ or ‘special people’ are not appropriate, and should not be used. • Always use ‘persons with disabilities’ or ‘people with disabilities’. • Avoid using the term ‘normal people’ when referring to people without disabilities. Add ‘use appropriate disability terminology’ as a Ground Rule if it is not listed. Suggest that trainees monitor the use of positive terminology throughout the ToT. Notes for ToT trainers: • Although we recommend avoiding use of the term ‘disabled people’, the terms ‘Disabled People’s Organization’ and ‘DPO’ are still in wide use and generally accepted. Encourage the use of the term ‘Organization of Persons/People with Disabilities’ (OPD), which is becoming increasingly common. 6 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Sometimes called Parking Lot • Topics and questions that come up in a session but are outside the content or cannot be covered immediately will be ‘parked’ and discussed at a later time. ToT.1 Introduction to the WSTPtot: 7 Explain: • During the training, you may have questions that the trainers are unable to answer immediately, or that may be covered during a later session. • These questions will be placed in the Car Park to be discussed at an appropriate time. Pin up the Car Park flipchart on the wall. 5. Wall of experience (15 minutes) Creating a Wall of Experience Write about yourself on sticky notes. Include: • Number of years and type/s of experience related to assistive devices • WSTP training given or received • Professional background • Languages spoken. There is no need to include your name. ToT.1 Introduction to the WSTPtot: 8 Show the slide throughout the activity. 7ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Activity 2 Groups: Ask trainees to work alone. Instructions: Put the Wall of Experience headings on the wall, including: • WSTP training given or received • number of years and type/s of experience related to assistive devices • professional background • languages spoken. Explain: We all come to this training with different types of experience, knowledge and skills. We will create a Wall of Experience together. Write your answers using sticky notes in a different colour for each heading (or more than one if required). Ask trainees to write clearly and then stick their notes up onto the wall under each heading. Monitor: Monitor the trainees and assist as needed. Check that trainees are writing clearly, with one statement on each piece of paper/card. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Ask trainees to comment on the Wall of Experience. Draw attention to the wealth of existing knowledge, skills and experience in the room. Emphasize that trainees have already progressed a long way to get to this point and they will build up even more experience from here. Notes for ToT trainers: • Keep referring to this Wall throughout the programme and link this to other parts of the training as appropriate. 8 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 6. Overview of the WSTPtot (27 minutes) Aim: To equip new trainers with knowledge and skills to deliver the WSTP. Objectives: • demonstrate the qualities of a good trainer • create an effective learning environment • reflect on their own training performance • co-train on the appropriate WSTP. ToT.1 Introduction to the WSTPtot: 9 Explain the aim and objectives of the WSTPtot. Day 1 Core training skills Day 2 Core training skills Day 3 Package-specific Day 4 Package-specific Day 5 Package-specific ToT.1 Introduction to the WSTPtot: 10 Ask trainees to look at their copy of the ToT timetable. Explain: the ToT is divided into two sections: • Core training skills module • package-specific module, during which trainees will practise delivering WSTP sessions to their peers. Notes for ToT trainers: • While there are four Wheelchair Service Training Packages, there are only three package-specific modules because the Managers and Stakeholders packages are covered in one module. Introduce the resources that are being provided to each trainee. Briefly explain and show each one. Explain that some of the materials will be distributed at the end of the day. 9ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Completed one or more WSTP • Experience in wheelchair service provision or the disability sector • Language proficiency • Experience as a trainer or facilitator • Opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 11 Explain: in order to get the most out of the WSTPtot, trainees should: • have completed one or more WSTP • have experience in wheelchair service provision or the disability sector • be able to read and write in the language used to deliver the ToT programme • have some experience of training or facilitating • have opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 12 Core training skills Package-specific Co-trainer Trainer Explain: • Co-training takes place after the ToT programme and before trainees train independently. Co-training experiences are the best way to further develop your training skills after completion of the WSTPtot. • After completing the ToT programme, all trainees should have at least one co-training experience. • Co-training with an experienced trainer will help strengthen your training skills including: – planning and preparing to deliver the WSTP – presenting and facilitating – mentoring participants – coordinating training logistics. 10 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Co-training is the best way to develop your skills • Other ways to get support include: –distance support from experienced trainers –connecting with other ToT trainees. ToT.1 Introduction to the WSTPtot: 13 Explain: if you are unable to co-train with experienced trainers consider other ways to get the support you need, such as: • contacting experienced trainers and asking them to mentor you from a distance – through email and phone contact • connecting with other ToT trainees and supporting each other through the planning, preparation and delivery of the WSTP. • Number and timing of co-trainings will vary by trainee • ToT trainers will help decide how many co- trainings you should complete • Logistics are a part of co-training. ToT.1 Introduction to the WSTPtot: 14 Explain: • The number of co-trainings you will complete will vary by trainee. • The timeframe for becoming a trainer will also vary based on when co-trainings are available and how many co-trainings you complete. • ToT trainers and trainers who mentor you while co-training will support you in deciding how many co-trainings you should complete before training on your own. 11ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the WSTPtot: 1 Ask trainees to look at their copy of the Feedback sheet for WSTPtot practice delivery sessions in their ToT Handbook on page 124-126. Explain: • Reflecting or thinking about what you do well and what can be improved will help you to become a better trainer. • The Feedback sheet for WSTPtot practice delivery sessions includes a list of the trainee skills that this training aims to develop. • The feedback sheet will be used to guide feedback to trainees after each practice delivery. • ToT trainers will also use it to provide feedback to lead trainees at the end of each day, and written feedback at the end of the ToT programme. 7. Key point summary (2 minutes) • Observe the Ground Rules and use appropriate disability terminology • The Wall of Experience shows there is a lot of knowledge and experience in the room • Structure of the WSTPtot and process after the ToT programme. ToT.1 Introduction to the WSTPtot: 16 Read the key points. Ask whether there are any questions. 12 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual WALL OF EXPERIENCE Number of years and type/s of experience related to assistive devices WSTP training given or received Professional background Languages spoken 13ToT.2 Wheelchair Service Training Packages Trainer's Manual ToT.2 Wheelchair Service Training Packages A IM To introduce the WSTP, its components and methodology. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the four WSTP □□ list the guiding principles of the WSTP □□ describe the format of the trainers’ manuals for each package. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.2: Wheelchair Service Training Packages □□ hard copy of the Trainer’s Manual for each trainee: WSTPb, WSTPi or WSTPm and WSTPs, according to the package-specific modules trainees will attend after the Core training skills module. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ If possible, embed the WSTP Pen Drive link into PPT slide 20 to demonstrate its use. O U T L IN E 1. Introduction 2. Background and rationale of the four WSTP 3. Structure of the different WSTP 4. Getting to know the Trainer’s Manual 5. How to use the WSTP 6. Key point summary 2 15 5 30 35 3 Total session time 90 14 ToT.2 Wheelchair Service Training Packages Trainer's Manual 1. Introduction (2 minutes)1 2 Aim: To introduce the WSTP, its components and methodology. Objectives: • list the four WSTP training packages • list the guiding principles of the WSTP • describe the format of the trainers’ manuals. ToT.2 Wheelchair Service Training Packages: 1 Explain the aim and objectives of the session. 2. Background and rationale of the four WSTP (15 minutes) • 2006: Consensus Conference, Bangalore • 2008: Wheelchair Guidelines published • Need for training opportunities identified. ToT.2 Wheelchair Service Training Packages: 3 Explain: • The Consensus Conference on Wheelchairs for Developing Countries, held in Bangalore, India, in November 20061 laid the foundation for the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings.2 • The Wheelchair Guidelines identified the need for training opportunities, which led to the development of the WSTP Basic, Intermediate, Managers, and Stakeholders. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 15ToT.2 Wheelchair Service Training Packages Trainer's Manual • Basic Level (WSTPb) • Intermediate Level (WSTPi) ToT.2 Wheelchair Service Training Packages: 4 Explain: • The WSTPb3 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. • The WSTPi4 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. More days may be added in order to: • add material • add sessions • increase number of practical sessions • add time for product preparation • support translation • shorten the training day • provide extra teaching time. ToT.2 Wheelchair Service Training Packages: 5 Explain: • Both the WSTPb and WSTPi are designed to be delivered in a minimum of five days. • Extra time can be added to the training programme to: – add material to the session plans – add sessions – increase the number of practical sessions with wheelchair users – provide more preparation time for products used in the training – allow for translation – reduce the length of training days – provide extra time to learn key concepts. f3,4 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 http://www.who. int/disabilities/technology/wheelchairpackage/en/ 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 16 ToT.2 Wheelchair Service Training Packages Trainer's Manual • Managers (WSTPm) • Stakeholders (WSTPs) ToT.2 Wheelchair Service Training Packages: 6 Explain: • The WSTPb and the WSTPi are intended to increase the number of personnel trained in wheelchair service delivery. • However, trained personnel alone cannot ensure appropriate wheelchair provision without higher-level involvement. • To support the development of services, WHO developed: – WSTPm5 – designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. WSTPm can be delivered in a minimum of two days. – WSTPs6 – designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. • Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting. f5,6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 17ToT.2 Wheelchair Service Training Packages Trainer's Manual • User centred • Rights based • International best practice (evidence based) • Less-resourced settings • Wheelchair users as participants • Accessible language and terminology. ToT.2 Wheelchair Service Training Packages: 7 Explain: The WSTP has been developed following a set of guiding principles, including: • a user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service • following available evidence-based, international best practice • a focus on less-resourced settings • inclusion of wheelchair users as trainers and target participants in all training packages. Explain: The WSTP uses accessible, non-medical language and terminology so that: • participants without clinical or technical qualifications can be trained • service personnel can use terms that are easily understood by wheelchair users. 3. Structure of the different WSTP (5 minutes) Notes for ToT trainers: • Keep this section brief, as more details are given later in the ToT programme during the package-specific modules that follow the Core training skills. Focus on the WSTP the trainees will deliver during the following package-specific module. Basic and Intermediate Managers Stakeholders Trainer’s Manual    PowerPoint presentations    Videos    Set of posters  selected posters selected posters Supplementary resources    Reference Manual for participants   combined Participant Workbook  Forms and checklists  – Additional Resources: including tools, equipment. –  ToT.2 Wheelchair Service Training Packages: 8 Explain: Each package contains a range of resources: • a Trainer’s Manual, PPT presentations, videos and posters • reference manuals for participants are available for WSTPb, WSTPi and WSTPm • service forms, checklists and a separate participant workbook are included in the WSTPb and WSTPi. 18 ToT.2 Wheelchair Service Training Packages Trainer's Manual Explain: All the WSTP materials are provided on the WSTP Pen Drive included in your training resources. They can also be downloaded from the WHO website. • Copies of certificates • Trainer’s observation checklists • Session and course evaluation forms. ToT.2 Wheelchair Service Training Packages: 9 Explain: The WSTP Pen Drive also contains: • certificates • trainer’s observation checklists • evaluation forms. These will not be used during the ToT, but should be used during delivery of the WSTP. 4. Getting to know the Trainer’s Manual (30 minutes) Explain: While the four WSTP cover different subjects, they all have the same structure and approach. We will become more familiar with the structure during this activity. Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. If trainees will be attending different package- specific modules after the Core training skills module, pair trainees with others who will learn to train the same package. Instructions: Each pair will need at least one copy of the Trainer’s Manual for the WSTPb, WSTPi or WSTPm. Explain that the aim of this activity is to familiarize trainees with the Trainer’s Manual. Ask pairs to work together to answer the questions in the ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 15 minutes to find the answers and 10 minutes to feedback. 19ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Questions Answers 1. Where can you see a list of everything included in the Trainer’s Manual? In the list of contents at the beginning of the manual. 2. How are group activities shown in the sessions? There is an Activity table describing the groups, instructions, monitoring, time and feedback for each activity. 3. Where can you find the overall aim or purpose of the training package? In the section headed Purpose on page 2. 4. How does the session plan indicate when the trainer should show a PowerPoint slide? An image of each slide is shown on the left-hand side of the page in the session plan, in the order of delivery, next to the related text. 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? Lists are provided in Section 2 of the Trainer’s Manual: How to prepare to deliver the training package: • on page 14 in WSTPb, and WSTPi • on page 9 in WSTPm. 5. How to use the WSTP (35 minutes) Ask participants to turn to the first section of the Trainer’s Manual: About the Wheelchair Service Training Package. Explain: There are helpful notes and guidance for trainers in the front of each Trainer’s Manual. Ask one of the participants to read out the headings in this section of the Trainer’s Manual. Most important answers: • Introduction • Target audience • Purpose • Scope • Trainers • How to get started. 20 ToT.2 Wheelchair Service Training Packages Trainer's Manual • Request from WHO for feedback and data • Send copies of participants’ registration and evaluation forms • Reflections on strengths and weaknesses of the training. ToT.2 Wheelchair Service Training Packages: 11 Explain: • On the WSTP Pen Drive you will see a file called Read Me First. This is an important document. • It includes a request from WHO to provide feedback and data from the WSTP training programmes that you deliver including: – participant registration and evaluation forms – trainer’s reflections or comments on the training. Explain that section 2 of the Trainer’s Manual is called How to prepare to deliver the training package (or for WSTPs How to prepare for the Stakeholder Workshop). Getting to know the ‘How to prepare’ section Work with your partner to read and discuss the section in the Trainer’s Manual, How to prepare to deliver the training package. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 12 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to look through the section on How to prepare to deliver the training package with their partner, reading and discussing the different sections. Ask trainees to write down any questions they have. Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. Feedback: Ask the whole group if they have any questions related to their training package. Broader questions about the training can be parked in the Car Park if you do not have time to cover them, or if they will be covered in a later session. 21ToT.2 Wheelchair Service Training Packages Trainer's Manual Notes for ToT trainers: • There are variations in the section headings between the packages. Session plans help trainers to: • focus on the learning objectives • keep to time • support group activities. ToT.2 Wheelchair Service Training Packages: 13 Explain: Session plans work like a recipe to guide trainers through the session. Following the session plans will help trainers to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Getting to know the session plans Work with your partner to read and discuss a detailed session plan from your Trainer’s Manual. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 14 Show the slide throughout the activity. Activity 3 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to read and discuss a detailed session plan with their partner, and to write down any questions for discussion with the group. Allocate a session from the following list, according to which package each pair is going to present during the ToT: • WSTPb: Trainer’s Manual, page 99: A.8: Transfers. • WSTPi: Trainer’s Manual, page 52: B.1: Assessment overview and assessment interview. • WSTPm: Trainer’s Manual, page 15: A.1: What is appropriate wheelchair provision? Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. 22 ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Ask the whole group for any questions or clarifications. Park any questions on changing PowerPoint slides in the Car Park. These can be addressed in session ToT.10 Audio-visual tools and equipment. Explain: There is a session summary box at the beginning of each session plan. Ask one of the pairs: What are the different sections of the session summary? Most important answers: • Objectives: describes the aims of the session. • Resources: any resources required for the session. • Context (For WSTPi this is called Context and prior learning): Suggested adjustments to suit the local context/country/service. • To prepare: things to prepare before the session starts. • Outline: summarizes sections of the session with timings. Ask another pair: What is the purpose of the Context or the Context and Prior Learning box? Most important answer: • It provides trainers with guidance about how the session plan could be adapted for the local situation or the type of participants attending the training. Ask another pair: What might influence the context of the training? Acknowledge responses. ToT.2 Wheelchair Service Training Packages: 15 Explain: Sessions can be influenced by different: • service delivery models • levels of experience among participants • institutional, regional or national policies • available products for prescription. 23ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: How do the session plans indicate that a video should be shown? Most important answer: • A video box is shown, with a video icon. ToT.2 Wheelchair Service Training Packages: 16 Explain: • It is important for trainees to be familiar with the content, relevance and timing of all the videos. • More details on the use of videos are given later in the ToT. Explain: The Trainer’s Manual uses different words in bold to guide trainers. This includes words such as: Ask, Explain, Show. ToT.2 Wheelchair Service Training Packages: 17 Explain: Extra information to help to guide trainers is provided in the Trainer’s Manual, including: • additional information that can assist trainers to answer questions from participants • most important answers to questions • guidance about group activities. ToT.2 Wheelchair Service Training Packages: 18 24 ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: What information is provided in the Activity table in the session plans? Most important answers: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Explain: The electronic copy of the WSTP can be run either on a computer hard drive or via an external storage device (DVD or WSTP Pen Drive). Exit slideshow mode. Pull up the WSTP Pen Drive folder, from the WSTP Pen Drive or from the files on your computer. Show the electronic copy of the START.pdf file on the projector. Explain: Resources can be accessed from the standard WSTP Pen Drive menu or by clicking on the “Start” menu. Show the links. Click on one or two sessions to show the PPTs. Explain: • Videos are embedded into the PPTs in the PDF versions of the files. • All individual PPT files are available, and can be modified if necessary. Modifying PPTs will be discussed in a later session. Show how to find the manuals, posters and forms. Notes for ToT trainers: • Macintosh (Mac) computers cannot open the “Start” file and use the “Start” menu links unless the file is opened with Adobe Pro or similar. Explain: Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 25ToT.2 Wheelchair Service Training Packages Trainer's Manual 6. Key point summary (3 minutes) • Four wheelchair service training packages: WSTPb, WSTPi, WSTPm and WSTPs. • Developed to address the training needs of service providers and other stakeholders to meet the Wheelchair Guidelines. • Each package includes a range of components to help trainers plan and deliver consistent and relevant training. ToT.2 Wheelchair Service Training Packages: 20 Read the key points. Ask whether there are any questions. 26 ToT.3 Practice delivery sessionsTrainer's Manual ToT.3 Practice delivery sessions A IM To provide details of the package-specific modules and the roles of ToT participants and trainers. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and structure of the WSTPtot practice delivery sessions □□ describe the roles and responsibilities of lead and support trainees □□ know which practice sessions they are to present □□ know how to prepare for the practice delivery sessions. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.3: Practice delivery sessions □□ WSTPtot allocation (trainee copy) for the package-specific module: one for each trainee □□ Lucky Dip trainee numbers on pieces of paper □□ flipchart sheet with trainee numbers written on it. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Refer to the terminology box at the beginning of this manual. □□ Finalize and copy the WSTPtot allocation for the package specific module based on the number of trainees. □□ Prepare Lucky Dip trainee numbers in bucket/hat based on final numbers. □□ Prepare a flipchart sheet with the trainee numbers and a space to add participants’ names once their numbers are selected. □□ Discuss how you will allocate trainees for mentoring with their co-trainer. Give participants this information during the session, or at the beginning of ToT.6 Preparation time. O U T L IN E 1. Introduction 2. Structure and aims of the package-specific module 3. Format of practice delivery sessions 4. Roles of lead and support trainees and ToT participants 5. Reflection and feedback 6. Preparing for practice delivery sessions 7. Key point summary 4 3 2 15 5 30 1 Total session time 60 27ToT.3 Practice delivery sessionsTrainer's Manual 1. Introduction (4 minutes) How confident do you feel to deliver the WSTP package you are here to learn? ToT.3 Practice delivery sessions: 2 Ask: How confident do you feel to deliver the WSTP package/s you are here to learn, on a scale of one to ten? • One means you are not at all confident • Ten means you are very confident. Explain: • Record your score on page 10 of your ToT Handbook. • At the end of the ToT programme, we will ask you to record how confident you now feel. • You will add both scores to your confidential ToT evaluation form. Aim: to provide details of the package-specific modules and roles of ToT participants and trainers. Objectives: • explain the structure of the practice deliveries • define roles of lead and support trainees • prepare for practice deliveries • know which practice delivery sessions you are to present. ToT.3 Practice delivery sessions: 3 Explain the aim and objectives of the session. 2. Structure and aims of the package-specific module (3 minutes) • Practice delivery sessions by trainees • Discussion or demonstrations lead by ToT trainers • Combination sessions. ToT.3 Practice delivery sessions: 4 Explain: • After the Core training skills sessions, you will begin your package-specific module. • Package-specific modules include: – opportunities to deliver sessions from the WSTP you have chosen to learn – discussion sessions or demonstrations led by ToT trainers, or – a combination of the above. 28 ToT.3 Practice delivery sessionsTrainer's Manual 3. Format of practice delivery sessions (2 minutes) • Session allocation will be done by Lucky Dip (lottery) • All trainees will have similar presenting time • Trainees allocated lead and support trainee roles. ToT.3 Practice delivery sessions: 5 Explain: • Allocation of practice delivery sessions will be done by lottery (Lucky Dip) at the end of this session. • Each trainee will have a similar amount of presenting time. • You will be allocated roles as both a lead and support trainee. • When two or more lead trainees are allocated to the same session, one will automatically assume the support trainee role when they are not presenting. 4. Roles of lead and support trainees and ToT participants (15 minutes) Lead and support trainees Working in pairs, answer the following question: • What are the main roles of the lead and support trainees? ToT.3 Practice delivery sessions: 6 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask participants to discuss with their partner what they think are the main roles of the lead and support trainee. Ask participants to record their ideas in their ToT Handbook on page 10. Monitor: Monitor the groups and assist as needed. Time: Allow 3 minutes for the activity and 5 minutes for feedback. Feedback: Ask: What are the main roles of the lead and support trainees? Discuss and clarify answers, record the most important answers on the board. Ask participants to record the correct information in their ToT Handbook. 29ToT.3 Practice delivery sessionsTrainer's Manual Most important answers: The role of the lead trainee includes: • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. The role of the support trainee includes: • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainee • contributing to the overall feedback/reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Trainees should work together as a team to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session. ToT.3 Practice delivery sessions: 7 Explain: During the practice delivery sessions, trainees should work together as a team. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session, including: – managing time – clarifying errors – answering questions from participants – managing disruptions and interruptions. 30 ToT.3 Practice delivery sessionsTrainer's Manual Being a role model includes: • being on time • being well prepared • problem solving • being positive and constructive • being responsible for yourself. ToT.3 Practice delivery sessions: 8 Explain: • Trainers should set positive examples of professional behaviour and practice. • Model the behaviour you want to see from participants by: – being on time and well prepared – problem solving and finding solutions for challenging situations – providing positive and constructive feedback – managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. What could you do if you are asked a question and do not know the answer? ToT.3 Practice delivery sessions: 9 Explain: Being a good trainer and role model does not mean you always need to know the answers to questions. Ask: What could you do if you are asked a question and do not know the answer? Most important answers: • Ask support trainees if they know the answer. • Ask participants if they know the answer. • Do not pretend to know the answer. • Agree to find out the answer before the training programme finishes (add to Car Park). 31ToT.3 Practice delivery sessionsTrainer's Manual • Taking part in the case studies and practical activities • Asking and answering questions • Engaging in discussions. ToT.3 Practice delivery sessions: 10 Explain: • While your fellow trainees are delivering their sessions, you will play the role of the WSTP participant. • This includes: – taking part in the case studies and practical activities – asking and answering questions – engaging in discussions. • While it is important to participate actively to create a ‘realistic’ training situation, do not purposefully act in a challenging manner. • Put away your WSTPtot Trainer’s Manual and your ToT Handbook during the session delivery. 5. Reflection and feedback (5 minutes) Trainers need to be able to: • reflect on their training skills • provide constructive feedback. ToT.3 Practice delivery sessions: 11 Explain: • It is important that trainers learn to reflect on their own training skills. • It is also important that trainers are able to give constructive feedback to training participants. • Both of these skills are incorporated into the ToT programme. 32 ToT.3 Practice delivery sessionsTrainer's Manual • Lead trainees reflect on: • what went well • what can be improved. • ToT participants feedback to lead trainees on: • what went well • what can be improved. ToT.3 Practice delivery sessions: 12 Explain: • At the end of each practice delivery session, the lead trainee/s will be asked to reflect on: – what was good and what went well – what can be improved. • ToT participants will provide brief feedback to lead trainee/s. We will discuss this further in ToT.11: Feedback. • The ToT trainer will give feedback, adding anything not already mentioned by the lead trainee or ToT participants. 6. Preparing for practice delivery sessions (30 minutes) • Read the session plan in the Trainer’s Manual • Read the relevant sections of the Reference Manual and Workbook • Edit the PPT • Practice delivering the session • Work with support trainees • Prepare resources. ToT.3 Practice delivery sessions: 13 Explain: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainee. • Prepare the resources you need for the session. Explain: If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. 33ToT.3 Practice delivery sessionsTrainer's Manual • Known errors are listed in your ToT Handbook • Do not discuss changes made to the PPT with ToT participants • Present as if it is a standard WSTP training. ToT.3 Practice delivery sessions: 14 Explain: • There are some known errors in the WSTP Trainer’s Manual, Participant Manuals and Workbooks, and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Notes for ToT trainers: • The WSTP has some known errors that will not be corrected until a second edition is published. The errors are listed in the ToT Handbook so that trainees can make corrections to their materials. Getting to know the Trainer’s Manual Working together in your group, use the Trainer’s Manual you have been given to answer the questions in the ToT Handbook. Write your answers next to the question. ToT.2 Wheelchair Service Training Packages: 1 Show the slide throughout the activity. 34 ToT.3 Practice delivery sessionsTrainer's Manual Activity 2 Groups: Divide trainees into pairs. Instructions: Ask the trainees to look at the following sessions in their Trainer’s Manual and find the notes relating to this session in their ToT Handbook. Ask them to read through both to understand how they relate to each other, and how they would be used to prepare to deliver a session. • WSTPb: Session A.6: Appropriate wheelchairs. • WSTPi: Session B.8: Prescription (selection) of PSDs – stabilizing the pelvis. • WSTPm: Session A.1: What is appropriate wheelchair provision? Ask them to also locate the Guidelines for preparing practice delivery sessions in the introduction to the ToT Handbook and to briefly review it. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Emphasize the following: • Trainees should follow the instructions in the Trainer’s Manual and their ToT Handbook for the practice deliveries and all future co-training deliveries. • They should allow enough time to follow instructions dealing with errors in the WSTP materials; take account of gender and cultural considerations; and tips on session preparation, presentations and logistics to improve flow and timing. • During the practice deliveries, trainees are responsible for setting up the training areas as needed. Ask whether there are any questions. 35ToT.3 Practice delivery sessionsTrainer's Manual • Some session preparation time is included in the ToT timetable • ToT trainers are available during this time, or at breaks • Ask for help if you have questions or concerns. ToT.3 Practice delivery sessions: 16 Explain: • There will be time at the end of each day to prepare for future practice delivery sessions. We will discuss this more in session ToT.6. • ToT trainers will be available during breaks and at the end of the day. Ask for help if you have questions or concerns. • It is normal to feel nervous when delivering the sessions in front of your peers and the ToT trainers. • You will grow in skills and confidence as you deliver more sessions. • Remember that it is not a competition, everyone has different training styles. • You will be required to present feedback from group activities over the next two days – use this as an opportunity to practise presenting to your peers. • Time will be strictly monitored • ToT trainers will end the session at the correct time • Learning to keep to time is an important skill. ToT.3 Practice delivery sessions: 17 Explain: • Time will be strictly monitored during practice deliveries to ensure trainees are treated equally. • If you go over your time, the ToT trainers will stop you and move on to the next trainer, or end the session. • Learn how to keep to time. It is an important skill, and you will improve with practice. • The standard PPT for each session will be available on the training laptop • If you make any changes to your PPT, you will need to provide it to ToT trainers before your session. ToT.3 Practice delivery sessions: 18 Explain: • The standard PPT for each session will be available on the training laptop with videos already embedded. • If you make any changes to your PPT, you will need to upload it onto the training laptop before your practice delivery. 36 ToT.3 Practice delivery sessionsTrainer's Manual Notes for ToT trainers: • Tell participants when you need the PPT to be loaded on to the computer; for instance, 30 minutes before training begins or at break time before a session. • Time for LUCKY DIP! • Pick a number • Complete the Practice delivery session allocation sheet • Note who is your ToT trainer mentor. ToT.3 Practice delivery sessions: 19 Explain: Now we will allocate the sessions. Ask each trainee to pick a number. Ask each trainee to write their name on their WSTPtot allocation (trainee copy) for the package-specific module. Ask each trainee to tell the group their number and to record this on their list. Record the trainee names next to the relevant numbers you have listed on the prepared flipchart paper. Explain: Each trainee has been assigned a ToT trainer as his or her mentor. Your mentor will: • assist you with preparation • provide individual feedback on your presentation skills. 7. Key point summary (1 minute) • As lead/support trainee: • practise the responsibilities of the role you are allocated • be a role model and work as a team. • As a ToT participant: • give clear and specific feedback. ToT.3 Practice delivery sessions: 20 Read the key points. Ask whether there are any questions. 37ToT.4 Preparing for diversityTrainer's Manual ToT.4 Preparing for diversity A IM To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the difference between culture and diversity □□ understand the importance of cultural competence □□ discuss challenges of cross cultural communication □□ identify challenges to integrating wheelchair users into training and work environments. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.4: Preparing for diversity □□ masking tape or similar. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Plan appropriate ‘divisions’ to use for the first activity, based on local context and trainee group characteristics. □□ Put a line of masking tape down the centre of an open area of the room to use for the first activity. O U T L IN E 1. Introduction 2. Culture and diversity 3. Cultural competence 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities 5. Key point summary 20 5 20 14 1 Total session time 60 38 ToT.4 Preparing for diversityTrainer's Manual 1. Introduction (20 minutes) Activity 1 Groups: Whole group. Instructions: Draw attention to the line of masking tape down the middle of the floor. Ask everyone to move to one side of the room. Ask all the men to stand on one side of the line and all the women to stand on the other. Explain this is our first diverse grouping: men and women. We are going to look at different aspects of diversity. Ask everyone who has children to stand on one side, and all the people who don’t to stand on the other side. Ask everyone who is over 50 years of age to stand on one side of the room. Ask everyone else to stand on the other side. Continue with the exercise for at least six rounds. Divisions could include: • languages spoken • country or region of origin • presence or absence of disability • professional background. Monitor: Ensure that participants are not embarrassed or uncomfortable. Time: Allow 10 minutes for the exercise and 10 minutes for feedback. Feedback: Ask people how they felt about the divisions. Ask how did you feel when you were in the larger group? Ask how did you feel when you were alone or in a minority? Explain that for some this may be a negative experience, but for others it may be positive. Explain: People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity and we are going to look at these two concepts in more detail. 39ToT.4 Preparing for diversityTrainer's Manual Aim: To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. Objectives: • understand the difference between culture and diversity • understand the importance of cultural competence • discuss challenges of cross cultural communication • identify factors and challenges to integrating wheelchair users into training and work environments. ToT.4 Preparing for diversity: 2 Explain the aim and objectives of the session. 2. Culture and diversity (5 minutes) Write the words culture and diversity on either side of a board or flipchart with a line running down the middle. Ask: What do you understand the terms culture and diversity to mean? Encourage responses and write on the board. Most important answers: Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Explain: Culture and diversity can be viewed in different ways. • Are they seen as strengths and encouraged? • Or are they seen as a source of conflict and disharmony? • Are they a distraction? Ask the group to reflect on the diversity and cultures present among themselves that we experienced in the earlier activity. Ask: Is the group diverse? Ask: What types of diversity does the group include? 40 ToT.4 Preparing for diversityTrainer's Manual Ask: What cultures do we share? Acknowledge responses. Explain: Remember that we all belong to more than one cultural group and we are all diverse in many ways. 3. Cultural competence (20 minutes) Ask: What is cultural competence? Acknowledge responses. • Awareness of your own cultural practices • Knowledge of different cultural practices • A positive attitude towards cultural differences • Understanding how culture impacts on interactions. ToT.4 Preparing for diversity: 3 Explain: • Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. • It is about having a positive attitude towards cultural differences and accommodating them. • It is about being conscious of how culture impacts on interactions between people. Explain: Cultural differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. For example, a comment made without offence intended may be insulting to someone from another culture. Explain: WSTP training may be delivered by trainers from a different culture to that of the participants. Some examples of how different cultural considerations may affect training are given in the ToT Handbook on page 16. 41ToT.4 Preparing for diversityTrainer's Manual Cultural competence • Think about examples of when you experienced a culture different from your own • Write down what it was like, how you felt and what you learned • Discuss the experience with your partner. ToT.4 Preparing for diversity: 4 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask trainees to think about examples of when they experienced a culture different from their own. Write down what it was like, how they felt and what they learned. Ask trainees to discuss the experience with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 8 minutes for discussion and 5 minutes for feedback. Feedback: Ask 4–5 people to share their experiences with the group. 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities (14 minutes) The WSTP promotes the inclusion of wheelchair users and people with disabilities in training teams and as participants. ToT.4 Preparing for diversity: 5 Explain: • Disability is one aspect of diversity. • The WSTP promotes the inclusion of wheelchair users in training teams and as participants. Ask: Why is this important? 42 ToT.4 Preparing for diversityTrainer's Manual Most important answers: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. • The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of; combat stigma, and reinforce the principles of the CRPD. • Can draw on their own experiences • Promote a user-centred and rights-based approach to wheelchair provision • Act as role models of empowerment. ToT.4 Preparing for diversity: 6 Read the slide. Ask: What are some of the barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society? Most important answers: • Attitudinal barriers. • Environmental barriers: lack of access to homes, schools and community buildings. • Lack of assistive devices. • Cultural beliefs that see disability negatively. • Lack of supportive legislation about disability rights. • Lack of funding for services and support. 43ToT.4 Preparing for diversityTrainer's Manual • Attitudinal • Environmental • Institutional. ToT.4 Preparing for diversity: 7 Explain: • Attitudinal barriers can include: – assumptions about what is possible for a person with a disability – assumptions that people with a disability cannot make decisions for themselves – treating people with disabilities as objects of charity – in some cultures, it is believed that people with disabilities are cursed and they are excluded from their communities and/or families as a result. • Environmental barriers can include: – the natural environment – such as rocky or steep terrain – the built environment – such as inaccessible homes, schools and community buildings – a lack of assistive devices. • Institutional barriers can include: – a lack of government legislation and policies that support the rights of people with disabilities – rules and regulations regarding admission criteria for school or university. 5. Key point summary (1 minute) • Consider culture and diversity issues when you plan and deliver training • Demonstrate cultural competence • Promote the inclusion of wheelchair users and people with disabilities. ToT.4 Preparing for diversity: 8 Read the key points. Ask whether there are any questions. 44 ToT.5 Adult learning Trainer's Manual ToT.5 Adult learning A IM To introduce the concepts of adult learning and different styles of learning: to understand how these approaches can improve delivery of the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how adults learn □□ describe four preferred learning styles, including their own □□ explain why understanding learning styles ensures the effective delivery of the WSTP □□ describe how trainers can support participants with problem solving. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.5: Adult learning. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Preferred learning styles 3. Experiential learning cycle 4. Supporting adult learning 5. Helping participants to problem solve 6. Key point summary 2 25 30 10 15 3 Total session time 85 45ToT.5 Adult learning Trainer's Manual 1. Introduction (2 minutes) ToT.5 Adult learning: 2 Aim: To introduce the concepts of adult learning and different styles of learning and to understand how these approaches can improve delivery of the WSTP. Objectives: • describe how adults learn • describe four preferred learning styles, including your own • explain why learning styles are relevant in delivering the WSTP • describe how trainers can support participants with problem solving. Explain the aim and objectives of the session. 2. Preferred learning styles (25 minutes) Adult learning • Think about positive learning experiences you have had • Write down how they were positive • Share your experiences with your partner. ToT.5 Adult learning: 3 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask trainees to: • Think about positive learning experiences they have had. • Write down in what way the experiences were positive in the table on page 20 of their ToT Handbook. • Share experiences with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for individual reflection and discussion in pairs, and 5 minutes for feedback. Feedback: Ask each pair to read out one item from their list, going around the room until all the experiences are written on the board. Allow brief discussion. 46 ToT.5 Adult learning Trainer's Manual Explain: We can see from the positive learning experiences discussed during the last activity that there are different ways that we prefer to learn. What is your learning style? • Individually, think about how you learn best, how you like to learn new things. • On the question sheet, circle all of your preferences. • On the scoring sheet, circle the same letters and add up how many circles you have in each column to find your preferred learning style. ToT.5 Adult learning: 4 Show the slide throughout the activity. Activity 2 Groups: Ask trainees to work alone. Instructions: Ask trainees to turn to page 21 in their ToT Handbook. Explain that there is a list of statements in the ToT Handbook that relate to learning. Ask trainees to circle all of their preferences and transfer the information to the scoring sheet on the next page. Ask trainees to add up the number of circles to see which column has the highest number. The column with the highest number is their preferred learning style. Monitor: Monitor trainees and assist as needed. Time: Allow 10 minutes for the activity and 3 minutes for feedback. Feedback: Ask each trainee to share their preferred learning style with their neighbour. Highlight that if some people have two or more styles with the same or similar number, this means they have no strong preferences and are comfortable with more than one way of learning. Ask trainees if their learning style/s match their positive learning experiences. 47ToT.5 Adult learning Trainer's Manual 3. Experiential learning cycle (30 minutes) Explain: • Each of us has a preferred learning style or styles. • However, learning new information and skills is most effective when we learn the information in multiple ways. Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 5 Explain: • Each stage of the experiential learning cycle matches the four learning styles. • While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. • This is why each of the four phases or types of learning are included in the WSTP. • We can start anywhere in this cycle: with an experience; with a reflection or observation; with a theory or definition/ explanation of a concept; or by doing. • Role plays and simulations for ‘experiencers’ • Videos and demonstrations for ‘observers’ • Lectures on theories and frameworks for ‘thinkers’ • Practice sessions for ‘doers’. ToT.5 Adult learning: 6 Explain: When developing the WSTP, preferred learning styles and adult learning concepts were incorporated into the structure of individual session plans and the overall training timetable. 48 ToT.5 Adult learning Trainer's Manual Explain: The WSTP follows these four phases to ensure that learning happens. • During WSTPb, participants try different mobility skills in a wheelchair. This is experiencing. • During WSTPi, participants watch a video of wheelchair users and their families talking about the positive impact of postural support devices. This is observing or reflecting. • During WSTPm, participants learn about concepts and principles related to wheelchair service delivery. This is thinking or understanding. • During WSTPb and WSTPi, participants work with wheelchair users and provide them with an appropriate wheelchair and cushion. This is doing or applying. Ask: What would happen if we missed out the experience part? Most important answer: • The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. Ask: What would happen if we missed out the observation part? Most important answer: • The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. Ask: What would happen if we missed out the thinking part? Most important answer: • The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. Ask: What would happen if we missed out the doing (practice) part? Most important answer: • The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 49ToT.5 Adult learning Trainer's Manual Explain: It is important that trainers support all learning styles, not just the ones that we personally prefer. Putting concepts into practice • Read what styles of learning Carlos, Miriam, Sita and Ahmad prefer. • Read each of the training activities listed and decide who would find the activity most appealing, considering their learning style. • Later you can review the list of activities with respect to your own preferred style. ToT.5 Adult learning: 7 Explain: Now that we have looked at the concept of learning styles and the experiential learning cycle, let’s put this into practice and learn by doing. Show the slide throughout the activity. Activity 3 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to look at the Matching activities with learning preferences sheet in the ToT Handbook (pg. 24). Explain: • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. Ask trainees to place an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Suggest that after the session each participant should fill in the last column with their own preference. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Review the answers with the whole group as follows: Ask trainees to volunteer answers. Check if everyone agrees. If there is no disagreement, acknowledge the answer (if it is correct) and move to the next line. If not everyone has the same answer prompt the correct answer and clarify. Allow only brief discussion. 50 ToT.5 Adult learning Trainer's Manual Notes for ToT trainers: • In the answer box below, x indicates the best answer; (x) indicates other possible answers that are also correct. If trainees have answers other than those marked, ask them to explain their reasoning and discuss it with the group. If you are comfortable that their reasoning is good, and that they understand the differences between the learning styles, they do not need to correct their answer. Key learning from this exercise is awareness that people do not all learn in the same way. Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 1. Using a role play to practise wheelchair user training x (x) 2. Watching the trainer show how to measure a new wheelchair user x 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country x 4. Watching people in wheelchairs doing the things they want to do x 5. Learning about the key documents that are relevant to wheelchair services x 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home x 7. Listening to the trainer review the most important articles in the CRPD x 51ToT.5 Adult learning Trainer's Manual Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 8. Making a pressure- relief cushion x (x) 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience x 10. Observing the trainer conduct an assessment x 11. Doing an assessment interview with a new user (x) x 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services x (x) 52 ToT.5 Adult learning Trainer's Manual 4. Supporting adult learning (10 minutes) Explain: While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. ToT.5 Adult learning: 8 Explain: • Adult learners are self-directed and responsible for their own learning. • This means supporting them to be: – active participants – engaged in discussions and group activities. Adult learners bring their own knowledge and experience to learning. ToT.5 Adult learning: 9 Explain: • Adult learners bring their own knowledge and experience to each learning activity, including: – work-related experience – previous education – life and family experience. Adult learners need learning to be relevant and practical. ToT.5 Adult learning: 10 Explain: • Adult learners need learning to be relevant and practical. • Adults must see a reason for learning the new information – and be able to apply it to their situation. • Training should have: – clear learning objectives – obvious practical application. 53ToT.5 Adult learning Trainer's Manual Adult learners want to apply what they have learned. ToT.5 Adult learning: 11 Explain: Adult learners want to apply what they have learned. • Use examples to help them see the connection between what they are learning during training and what they will do after the training programme is over • Use problem-solving activities • Create learning-action plans. 5. Helping participants to problem solve (15 minutes) What is problem solving? ToT.5 Adult learning: 12 Ask: What is problem solving? Most important answer: • The process of finding the best solution to a problem. It is an important part of adult learning. Why is problem solving an important life skill? ToT.5 Adult learning: 13 Ask: Why is problem solving an important life skill? Most important answers: • Because we all set goals and face challenges to achieve them. • Because we need to find ways to overcome barriers we encounter. Explain: • Problem solving is an important skill in wheelchair service provision where solutions to problems may be complex. • We have an important role as trainers to develop participants’ problem-solving skills, so they can find solutions to the difficulties they come across in their work. 54 ToT.5 Adult learning Trainer's Manual Problem solving How can we help participants to problem solve and find their own solutions? ToT.5 Adult learning: 14 Show the slide throughout the activity. Activity 4 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to brainstorm how they can help participants to problem solve and find their own solutions. Take 2 minutes to think about it individually, then share with your group members to create a list of ideas. Monitor: Monitor the groups and assist as needed. Time: Allow 12 minutes for this activity. Feedback: • Ask open-ended questions • Ask rather than tell • Invite others to participate • Avoid ‘I don’t know’ • Be patient • One step at a time • Encourage creativity • Encourage teamwork. ToT.5 Adult learning: 15 Ask each group in turn to describe one way to support participants in problem solving. Continue until there are no new ideas. Record each new idea on the board using only a few key words. Acknowledge good examples of things to consider. Correct/clarify any misunderstandings. Show the slide to summarize. 55ToT.5 Adult learning Trainer's Manual Most important answers: • Ask open-ended questions – these cannot be answered with a simple ‘yes’ or ‘no’. Open-ended questions require trainees to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer that the trainer expects. • Ask rather than tell – ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together; teamwork and good communication helps to solve problems. 6. Key point summary (3 minutes) • Everyone has a preferred style of learning: • by experiencing • by observing • by thinking • by doing. • WSTP is designed to appeal to all learning styles. ToT.5 Adult learning: 16 Read the key points. Ask whether there are any questions. 56 ToT.6 Preparation time Trainer's Manual ToT.6 Preparation time A IM To ensure trainees use the preparation time effectively at the end of each day. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the purpose of the preparation time at the end of each day □□ discuss any questions related to their practice deliveries. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.6: Preparation time. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Review the Car Park and prepare to answer any questions. O U T L IN E 1. Review of Car Park 2. Purpose of preparation time 10 5 Total session time 15 57ToT.6 Preparation time Trainer's Manual 1. Review of Car Park (10 minutes) Review the Car Park with trainees. If any items need to be clarified before the next day, provide answers or explanations as needed. 2. Purpose of preparation time (5 minutes) • Car Park • Feedback from ToT trainers • Practice delivery preparation. ToT.6 Preparation time: 2 Explain: After our first day, we have time set aside for: • reviewing any remaining Car Park items • trainees to meet with ToT trainers for feedback • preparing for practice deliveries. One-on-one meeting between ToT trainer and trainee to: • give feedback • discuss practice delivery. ToT.6 Preparation time: 3 Explain: • ToT trainers will set up short, one- on-one meetings with lead trainees to give feedback and discuss their practice delivery. • It is an opportunity for trainees to ask questions about how to apply this feedback to future practice deliveries. • We will discuss how to give and receive feedback in more detail in ToT.11. 58 ToT.6 Preparation time Trainer's Manual • Coordinate with trainees assigned to the session • Prepare materials or flipcharts • Raise questions with ToT trainers • Check PPT presentations • Study session plans. ToT.6 Preparation time: 4 Explain: When you are not meeting with ToT trainers to discuss feedback, you should use this time to: • coordinate with your co-trainers • prepare demonstration materials and AV equipment needed for your session • clarify any content of your session that you do not understand with the ToT trainers • check that your PPT presentation is working correctly. Ask whether there are any questions. Remind trainees of any logistics they need to remember before the start of the training day tomorrow. Notes for ToT trainers: • After the first day of the WSTPtot, use this time to arrange logistics related to practice deliveries during the rest of the programme. For example, can trainees come to the site early to set up for their session; or, when should trainees upload any modified PPTs for use the next day ? 59ToT.7 Presenting and facilitatingTrainer's Manual ToT.7 Presenting and facilitating A IM To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the behaviour of a good trainer □□ explain the difference between presenting and facilitating □□ list examples of good practice by presenters and facilitators □□ describe three strategies to keep to time. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.7: Presenting and facilitating. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Trainer skills 3. Presenting and facilitating 4. Good practices for presenting and facilitating 5. Managing time 6. Key point summary 3 15 5 15 20 2 Total session time 60 60 ToT.7 Presenting and facilitatingTrainer's Manual 1. Introduction (3 minutes) Aim: To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. Objectives: • list the behaviour of a good trainer • explain the difference between presenting and facilitating • list examples of good practice by presenters and facilitators • describe three strategies to keep to time. ToT.7 Presenting and facilitating: 2 Explain the aim and objectives of the session. 2. Trainer skills (15 minutes) Explain: You need to develop a variety of skills to deliver a successful training programme. In this session we look at the skills of a trainer, both as a presenter of information and as a facilitator of learning. Effective trainer behaviour is critical to bring about participants’ learning and create a positive learning environment. Effective trainers Think about people who have trained you in the past and who you consider to be effective trainers. What was effective in their behaviour? Write your ideas in the ToT Handbook (on page 28) and then discuss with the members of your group. ToT.7 Presenting and facilitating: 1 Show the slide throughout the activity. 61ToT.7 Presenting and facilitatingTrainer's Manual Activity 1 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to think about people who have trained them in the past and to identify who they consider to have been effective trainers. In other words, people who enabled them to learn what they needed to and who gave them positive and worthwhile experiences. Ask trainees to take a few minutes to reflect on the effective trainers’ behaviour and write their ideas in the space on page 28. in the ToT Handbook headed: What was effective in their behaviour? Ask trainees to share their thoughts with the member/s of their group. Ask groups to consider all aspects of their previous trainers’ behaviour: • how they presented themselves • how they interacted with the trainees • how they managed the training • how they created a positive environment. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 10 minutes for feedback. Feedback: Ask the groups to report back, giving one idea each until all ideas have been presented. Record ideas on the board. Refer trainees to the information in their ToT Handbook. Remind trainees that they will have a chance to practise the behaviour later in the week. Suggest that trainees use the list of Good practice for presenting and facilitating in the ToT Handbook (pg. 29) to help them to identify behaviour they need to work on. Explain that the list can be used for self-assessment if desired. 62 ToT.7 Presenting and facilitatingTrainer's Manual 3. Presenting and facilitating (5 minutes) ToT.7 Presenting and facilitating: 4 Presenting Facilitating Explain: The role of the trainer in the WSTP switches frequently between presenting and facilitating. Ask: What do you think the difference is between presenting and facilitating? Allow trainees a few minutes to think about this, then collect responses from the group. Show the next slides and acknowledge responses already given. • One-way • Provides information • Corrects misinformation • Assumes what is presented is not known • Treats all participants equally. ToT.7 Presenting and facilitating: 5 Read the slide content, expand if needed. Facilitating makes it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect this with new information. ToT.7 Presenting and facilitating: 6 Read the slide content, expand if needed. Explain that in the WSTP a combination of presenting and facilitating is used. The Trainer’s Manual indicates when to present and when to facilitate. 63ToT.7 Presenting and facilitatingTrainer's Manual 4. Good practice for presenting and facilitating (15 minutes) What do you consider good practice when presenting? ToT.7 Presenting and facilitating: 7 Ask trainees to reflect on what they consider good practice when giving a presentation. Collect responses from the group. Notes for ToT trainers: • ToT trainers must ensure they are a model of good practice throughout the ToT, especially during this session. Make sure you practise everything you say. • Vary the pace and tone of speech • Be aware of your position in the room • Ask questions and encourage contributions from the group. ToT.7 Presenting and facilitating: 8 Read the slides and acknowledge examples already given by the participants when reviewing. • Follow the instructions in the Trainer’s Manual • Watch your audience – are they listening, interested, awake? • Break for a few minutes if necessary or insert a short energizer. ToT.7 Presenting and facilitating: 9 64 ToT.7 Presenting and facilitatingTrainer's Manual Ask: Who knows what we mean by an energizer? Acknowledge responses. Explain: • An energizer is a short activity designed to enliven and re-energize a group of participants. • Often, but not always, the energizer is unrelated to the content of the session. • There is a section about energizers, with examples, in the ToT Handbook on page 30. Ask a trainee to lead a short energizer for the group. Ask trainees what the energizer did to the group. Notes for ToT trainers: • Most trainees will know some energizers from previous training experiences. Be prepared to give an example if no one volunteers. • Use slides as a prompt • Allow time for participants to absorb the content • Match slides to what you are saying • Avoid reading from screen • Avoid blocking the beam. ToT.7 Presenting and facilitating: 10 Explain: • Use the slides as a prompt and to show the key messages. • Allow time for participants to absorb the content of each slide. This will take longer for those working in a foreign language. • Add variety by asking participants to read slide messages out loud. • Make sure the slide shown corresponds with what you are saying. • Keep the slides synchronized with the Trainer’s Manual. • Avoid reading from the screen. • If you do read from the screen, do not look over your shoulder or stand with your back to the audience. • Avoid blocking the beam. Demonstrate these last three points by showing how you can move to the side of the training room or behind the participants. 65ToT.7 Presenting and facilitatingTrainer's Manual Ask: How will your presentation style and session planning change when participants have a visual impairment? Acknowledge answers. Most important answers: • Read information on the slides to ensure participants with visual impairments get all of the information. • Make sure the presentations are in a large font and that the screen is as large as possible for those who are partially sighted. • Meet with participants before the training to understand their needs. • If participants use a screen reader, provide documents and presentations ahead of time so they can review before the training starts. • Provide documents in braille if applicable. • Understand the purpose of the activity • Give people time and space to think for themselves • Ask rather than tell • Give clear instructions • Check on learning. ToT.7 Presenting and facilitating: 11 Read the slide. Refer trainees to the key points in the ToT Handbook. Expand as needed. Where did you see us presenting and where did you see us facilitating in the ToT so far? ToT.7 Presenting and facilitating: 12 Ask: Can anyone think of examples where the trainers have been presenting and where they have been facilitating in the sessions we have done so far? Ask: How do the two methods feel different to you as a trainee? Acknowledge responses. Remind trainees that they will have the opportunity to observe and practise both presenting and facilitating as the ToT continues. 66 ToT.7 Presenting and facilitatingTrainer's Manual 5. Managing time (20 minutes) Explain: • Trainers and participants need to make sure that the training programme runs on time. • There are many sessions and activities and a limited amount of time to complete them. Keeping to time What can we do to keep the training running on time? ToT.7 Presenting and facilitating: 13 Show the slide throughout the activity. Activity 2 Groups: Divide the trainees into pairs. Instructions: Ask What can we do to keep the training running on time? Ask trainees to write ideas down in their ToT Handbook on page 31. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Feedback as a whole group, taking suggestions from pairs in turn. Acknowledge responses and add to them using the Notes for ToT trainers below. 67ToT.7 Presenting and facilitatingTrainer's Manual Notes for ToT trainers: • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 6. Key point summary (2 minutes) • Factors contributing to the quality of training • Characteristics of presenting and facilitating • Good practice for presenters and facilitators. ToT.7 Presenting and facilitating: 14 Read the key points. Ask whether there are any questions. 68 ToT.8 Communication skillsTrainer's Manual ToT.8 Communication skills A IM To discuss communication skills and put presentation skills into practice. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the importance of communication skills and put presentation skills into practice □□ explain how to give good demonstrations □□ describe how to work well with interpreters. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.8: Communication skills. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Types of communication 3. Demonstrations, videos and interpreters 4. Key point summary 2 55 30 3 Total session time 90 69ToT.8 Communication skillsTrainer's Manual 1. Introduction (2 minutes) Aim: To discuss communication skills and put presentation skills into practice. Objectives: • explain the importance of communication skills and put presentation skills into practice • explain how to give good demonstrations • describe how to work well with interpreters. ToT.8 Communication skills: 2 Explain the aim and objectives of the session. 2. Types of communication (55 minutes) Explain: • Communication skills are key to becoming a good trainer. • In this activity you will have the opportunity to practise your communication skills. • You will take on the role of trainer and present the key learning points for your topic yourself. • This is a chance for you to put some of the skills discussed in the Presenting and facilitating session into practice. Communication skills • In your groups, read and discuss the key points for your topic (pages 33-35 of the ToT Handbook) • Prepare a five minute presentation to explain the key points • Use a variety of styles to convey the information such as presentation, demonstration, or role play. ToT.8 Communication skills: 1 Show the slide throughout the activity. 70 ToT.8 Communication skillsTrainer's Manual Activity 1 Groups: Divide trainees into four groups. Instructions: Assign each group one of the topics listed in the Notes for ToT trainers that follow and direct trainees to page 33–35 in the ToT Handbook. Each group should present the information listed under their topic. Encourage groups to be creative and to use props, flipcharts, or the board as desired. Monitor: Monitor the groups and assist as needed. Time: Allow 20 minutes for groups to prepare the task; 5 minutes for each group to present; 2 minutes for discussion after each presentation; and 5 minutes for final feedback and consolidation by the ToT trainer. Feedback: Refer trainees to their ToT Handbook to check if all the information was communicated in the session. Focus feedback on the content of the session and the different communication skills. The ToT trainer should briefly summarize any key points not clearly presented by the group. Notes for ToT trainers: Group 1 - Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what the trainer says. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 71ToT.8 Communication skillsTrainer's Manual Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, the trainer should stand at the front or side – participants should be able to see and hear the trainer – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and the trainer needs to read their PowerPoint slides – depending on the context, it may be appropriate for the trainer to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 72 ToT.8 Communication skillsTrainer's Manual Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. 3. Demonstrations, videos and interpreters (30 minutes) • Giving demonstrations • Using videos • Communicating through foreign language and sign language interpreters. ToT.8 Communication skills: 4 Explain: We will now look at three more aspects of communication. Read the slide. 73ToT.8 Communication skillsTrainer's Manual Demonstrations, videos and interpreters • In your group, discuss what to consider when delivering training about your topic. – Group 1: Good practice for giving demonstrations and showing videos – Group 2: Working with foreign language and sign language interpreters. • Close your ToT Handbook during this activity. ToT.8 Communication skills: 5 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into two groups. Instructions: Ask trainees to close their ToT Handbook (the answers are in the book). Assign one topic to each group: • Ask group 1 to consider : Good practice for giving demonstrations and showing videos. • Ask group 2 to consider : Working with foreign language and sign language interpreters. Ask trainees to discuss what to consider when delivering training about your topic and to write it on a flipchart to present to the other group. Refer trainees to the activity instructions on the PPT slide. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the groups to develop their lists; 5 minutes for each group to present; and 5 minutes for additional key points after each presentation. Feedback: Ask group 1 to present their findings to group 2. Add in any key points missed from the trainer’s notes below. Ask group 2 to present their findings to group 1. Add in any key points missed from the Notes for ToT trainers below. Refer trainees to the reference material in the ToT Handbook. 74 ToT.8 Communication skillsTrainer's Manual Notes for ToT trainers: Giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. Using videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters: Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 75ToT.8 Communication skillsTrainer's Manual 4. Key point summary (3 minutes) • Think about all aspects of your communication • Best practice for giving demonstrations and using videos • Meet with interpreters before the training to discuss your needs and set expectations. ToT.8 Communication skills: 6 Read the key points. Ask whether there are any questions. 76 ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents A IM To introduce trainees to the WSTP guiding documents and explain their relevance. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the WSTP guiding documents □□ explain their importance for WSTP trainers and participants. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.9: Knowledge of guiding documents □□ Video: Sustainable Development Goals. One copy of each of the following resources: □□ United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ WHO Guidelines on the provision of manual wheelchairs in less-resourced settings □□ WHO Joint position paper on the provision of mobility devices in less-resourced settings □□ WHO CBR Guidelines: Introductory Booklet and Health Component □□ Design Considerations for Accessibility. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Ensure thorough knowledge of all guiding documents. □□ Consult the UN website to check the total number of countries that have signed the CRPD at the time of your training programme. Check whether the trainees’ countries have signed and ratified the CRPD so that you can mention this and answer any questions. http://www.un.org/disabilities/ O U T L IN E 1. Introduction 2. The CRPD as it relates to wheelchair service provision 3. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 4. CBR Guidelines 5. Other guiding documents 6. Key point summary 8 20 5 25 15 2 Total session time 75 77ToT.9 Knowledge of guiding documentsTrainer's Manual 1. Introduction (8 minutes) Aim: To introduce trainees to the WSTP guiding documents and explain their relevance. Objectives: • list the WSTP guiding documents • explain their importance for WSTP trainers and participants. ToT.9 Knowledge of guiding documents: 2 Explain the aim and objectives of the session. What do we mean by guiding documents? ToT.9 Knowledge of guiding documents: 3 Ask: What do we mean by guiding documents? Acknowledge answers. Most important answers: • Publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision. • Resources that guide stakeholders in the provision of wheelchair services. Why is it important for you to be aware of these documents? ToT.9 Knowledge of guiding documents: 4 Ask: Why is it important for you as trainers to be aware of these documents? Acknowledge answers. 78 ToT.9 Knowledge of guiding documentsTrainer's Manual Most important answers: • Many governments, international agencies, donors and other stakeholders plan and fund development work in line with these international frameworks. • To be in a stronger position to educate and advocate for appropriate wheelchair service provision. Trainers need to have a good understanding of: • international conventions/goals • international documents • national laws and policies. ToT.9 Knowledge of guiding documents: 5 Explain: • When running a WSTP training programme, it is important to be aware of these guiding documents to help you educate and advocate for appropriate wheelchair provision. • Local documents are likely to be referred to by participants and trainers will need a good understanding of them too. Explain: A good understanding of these resources can contribute to the quality of your training delivery. There is more information on all guiding documents in your ToT Handbook Ask: What are the two most important guiding documents that relate to wheelchair service provision? Most important answers: • United Nations Convention on the Rights of Persons with Disabilities • WHO Guidelines on the provision of manual wheelchairs in less-resourced settings. 79ToT.9 Knowledge of guiding documentsTrainer's Manual 2. The CRPD as it relates to wheelchair service provision (20 minutes)7 • Most important international treaty relating to disability • Came into force in 2008 • Designed to change the way people with disabilities are viewed and treated. ToT.9 Knowledge of guiding documents: 6 Explain: • We will look first at the United Nations Convention on the Rights of Persons with Disabilities,7 commonly known as the CRPD. • The CRPD is widely considered to be the most important international treaty relating to people with a disability. • The CRPD came into force in 2008. Explain: • On its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol: the highest number of signatories to a UN Convention on its opening day in history. • The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. • Representatives included people with disabilities, government officials and representatives of nongovernmental organizations. • The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Notes for ToT trainers: • Look up the total number of countries that have signed the CRPD at the time of your training programme and check whether the participants’ country/countries have signed and ratified the Convention. 7 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611 (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 80 ToT.9 Knowledge of guiding documentsTrainer's Manual Why is it important for participants of the WSTP to be familiar with the CRPD? ToT.9 Knowledge of guiding documents: 1 Ask: Why is it important for participants of the WSTP to be familiar with the CRPD? Acknowledge responses. Most important answers: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. Which articles of the CRPD are most relevant? ToT.9 Knowledge of guiding documents: 8 Explain: The CRPD has several articles relevant to wheelchair service provision. Ask: Without looking at your ToT Handbook, can anyone remind us which articles are the most relevant? Acknowledge responses. Most important answers: • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. 81ToT.9 Knowledge of guiding documentsTrainer's Manual Other answers may include: • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. • Facilitate personal mobility with consideration of personal choice and cost • Facilitate access to quality mobility aids • Provide training in mobility skills to wheelchair users and service personnel • Encourage production of mobility devices to consider all aspects of mobility. ToT.9 Knowledge of guiding documents: 9 Explain: • CRPD Article 20 is the most relevant to wheelchair service provision. • It requires States Parties to take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities. To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. ToT.9 Knowledge of guiding documents: 10 Explain: Article 4 covers General obligations and includes this statement. • Article 19: Living independently and being included in the community • Article 24: Education • Article 25: Health • Article 26: Habilitation and Rehabilitation • Article 27: Work and employment • Article 30: Participation in cultural life, recreation, leisure and sport • Article 32: International cooperation. ToT.9 Knowledge of guiding documents: 11 Explain: • These articles are also relevant because, for example, they mention the importance of assistive devices, reasonable accommodation, and mobility skills training. • Article 26 is particularly important as it deals with Habilitation and Rehabilitation. 82 ToT.9 Knowledge of guiding documentsTrainer's Manual Explain: Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. What additional barriers can women and children face when accessing services? ToT.9 Knowledge of guiding documents: 12 Ask: What additional barriers can women and children face when accessing wheelchair services? Ask participants to take one or two minutes to discuss this with the person next to them and then collect feedback. Acknowledge responses and add any important points not mentioned. Most important answers: • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. Wheelchair provision services must specifically ensure the needs of women and children are considered. ToT.9 Knowledge of guiding documents: 13 Explain: To meet Articles 6 and 7 of the CRPD, wheelchair provision services must specifically ensure the needs of women and children are considered. 83ToT.9 Knowledge of guiding documentsTrainer's Manual 3. WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (5 minutes) Explain: The WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. Acknowledge that most trainees will be very familiar with the Wheelchair Guidelines. • Framework by which appropriate wheelchair provision is understood internationally • Developed with involvement of a cross section of stakeholders • They are a powerful tool. ToT.9 Knowledge of guiding documents: 14 Explain: • The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. • Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider. Explain: • The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. • They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. • The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. Ask: Who can remember the definition of an appropriate wheelchair? Acknowledge answers. 84 ToT.9 Knowledge of guiding documentsTrainer's Manual • Meets the user’s needs and environmental conditions • Provides proper fit and postural support • Is safe and durable • Is available in the country • Can be obtained and maintained and services sustained in the country at an affordable cost. ToT.9 Knowledge of guiding documents: 15 Read the points on the slide. • Design and production • Service delivery • Training • Policy and planning. ToT.9 Knowledge of guiding documents: 16 Explain: The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. Ask: Who has read the Wheelchair Guidelines in the last year? Encourage all trainees to read the Wheelchair Guidelines thoroughly. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; trainers should try to raise awareness of them whenever they have the opportunity. Explain: The Wheelchair Guidelines are available on the WHO website in a range of languages.8 8 8 http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/ 85ToT.9 Knowledge of guiding documentsTrainer's Manual 4. CBR Guidelines (25 minutes)9 10 Explain: There are several other guiding documents included in the supplementary resources section on the WSTP Pen Drive. You should be familiar with these, so that you can explain their importance and relevance to others. Explain: Community-Based Rehabilitation (CBR) is likely to come up in discussions during the WSTP. It is therefore important that trainers have a good understanding of the CBR Guidelines,9 particularly the health component. • Seen as an effective way of implementing the CRPD • Many aspects relevant to wheelchair service provision. ToT.9 Knowledge of guiding documents: 17 Explain: • CBR, also often called Community- Based Inclusive Development (CBID), is increasingly seen as one of the most effective ways of implementing the CRPD. • Many aspects of CBR are relevant to wheelchair service provision. For example, referral networks, community health centres and CBR workers. ToT.9 Knowledge of guiding documents: 18 Explain: The CBR Matrix10 is one of the cornerstones of the CBR Guidelines. Ask: What are the five key components of the CBR Matrix? Acknowledge answers. 9 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 10 The CBR Matrix. Geneva: World Health Organization (http://www.who.int/disabilities/cbr/matrix/en/). 86 ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents: 19 Explain: • The five components are: Health, Education, Livelihood, Social and Empowerment. • Each component of the Matrix has five elements within it, so there are a total of 25. CBR Matrix In groups, identify two ways wheelchair provision relates to the component of the CBR Matrix you are assigned. Example: in the livelihood category, having an appropriate wheelchair can help someone get to work and earn their living. ToT.9 Knowledge of guiding documents: 20 Show the slide throughout the activity. 87ToT.9 Knowledge of guiding documentsTrainer's Manual Activity 1 Groups: Divide trainees into five groups. Create a mix of gender, experience/ knowledge and skills in each group. Instructions: Refer trainees to their copy of the CBR Matrix on page 45 of the ToT Handbook. Allocate one component of the matrix to each group to discuss. Ask trainees to consider the ways in which wheelchair service provision relates to their component and to be ready to feedback to the group on two of them. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Ask each group for their first answer in turn. Then ask each group for their second answer in the same way. Answers may include: Health • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. Education • Enables access to school, educational programmes and vocational programmes. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Empowerment • Improved self-image and confidence. • Peer support. 88 ToT.9 Knowledge of guiding documentsTrainer's Manual Health: Health benefits, importance in prevention of secondary complications. Education: Enables access to school and vocational training, to sit upright for function and interaction. Livelihood: Access to workplace, increased mobility and independence to work, earn and contribute. Social: Access to social/recreation activities. Empowerment: Confidence, peer training/support. ToT.9 Knowledge of guiding documents: 21 Explain: • This slide summarizes how appropriate wheelchair provision can improve the key aspects of life identified in the CBR Matrix. • There is further information on the CBR Guidelines and Matrix in the ToT Handbook. 5. Other guiding documents (15 minutes)11 Provides information on: • barriers to accessing mobility devices • increasing access to mobility devices • recommendations for national and international level stakeholders. ToT.9 Knowledge of guiding documents: 22 Explain: • The WHO Joint position paper on the provision of mobility devices in less-resourced settings11 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. • It includes information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 11 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 89ToT.9 Knowledge of guiding documentsTrainer's Manual An overview of some of the basic features to consider when ensuring public buildings are accessible. ToT.9 Knowledge of guiding documents: 23 Explain: • The final guiding document included on the WSTP Pen Drive is Design considerations for accessibility.12 • This gives useful information on how to ensure all aspects of access are considered; both when visiting the wheelchair service and in other environments. Explain: There are a number of other guiding documents that you should be familiar with as a trainer of the WSTP. Ask: Another major international instrument has been launched since the development of the WSTP: Can anyone tell us what that is? Acknowledge answers. Most important answer: Sustainable Development Goals (SDGs).13 • Follow up to the Millennium Development Goals • Launched in September 2015 • Timeline 2015 – 2030. ToT.9 Knowledge of guiding documents: 24 Explain: • The SDGs are a follow up to the Millennium Development Goals (MDGs). • They were launched in September 2015 and have a timeline of 2015 to 2030. 12 13 12 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 13 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 90 ToT.9 Knowledge of guiding documentsTrainer's Manual Sustainable Development Goals ToT.9 Knowledge of guiding documents: 25 Introduce video: Sustainable Development Goals. Ask participants to watch this United Nations video on the 17 SDGs. Show video. ToT.9 Knowledge of guiding documents: 26 Explain: • Five SDGs make specific references to disability: 4, 8, 10, 11 and 17. • Nine global indicators relate to disability. As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all people. And we will endeavor to reach the furthest behind first. ToT.9 Knowledge of guiding documents: 27 Explain: • The SDGs aim to reach the most vulnerable and commit to reach the furthest behind first. • Many stakeholders will be addressing the SDGs so it is important to consider how appropriate wheelchair service provision can contribute to meeting the goals. 91ToT.9 Knowledge of guiding documentsTrainer's Manual • Priority Assistive Products List (APL) launched in May 2016 • 50 priority assistive products, including 4 types of wheelchairs. ToT.9 Knowledge of guiding documents: 28 Explain: • WHO’s Global Cooperation on Assistive Technology (GATE) initiative is another important step forward. • GATE was created to improve access to assistive technology globally. • GATE’s first outcome is the WHO Priority Assistive Products List (APL),14 launched in May 2016. • The APL features the 50 priority assistive products/devices that governments should make available at an affordable cost, including four different types of wheelchairs. ToT.9 Knowledge of guiding documents: 29 Explain: Other relevant documents detailed in the ToT Handbook include the: • WHO World Report on Disability15 • WHO Global Disability Action Plan16 • UN High Level Meeting on Disability.17 14 15 16 17 14 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/ implementation/assistive_technology/global_survey-apl/en/). 15 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 16 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 17 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 92 ToT.9 Knowledge of guiding documentsTrainer's Manual 6. Key point summary (2 minutes) • Wide range of relevant guiding documents to help educate and advocate for appropriate wheelchair service provision. • A thorough knowledge will enhance training and help you educate stakeholders and advocate for appropriate wheelchair provision. • Dynamic field: be aware of new guiding documents. ToT.9 Knowledge of guiding documents: 30 Read the key points. Ask whether there are any questions. 93ToT.10 Audio-visual tools and equipmentTrainer's Manual ToT.10 Audio-visual tools and equipment A IM To enable trainees to use PowerPoint (PPT) presentations and audio-visual equipment effectively. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the advantages and disadvantages of the available PPTs in the WSTP □□ make changes to and embed videos into PPTs □□ describe good practice in the use of audio-visual equipment □□ use the board and flipchart effectively as a visual aid. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.10: Audio-visual tools and equipment □□ remote control slide changer and laser pointer if available. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Familiarize yourself with the equipment and with using the PPT (including embedding videos) beforehand, so you can answer questions, give a good demonstration and know what kinds of problems trainees might experience. O U T L IN E 1. Introduction 2. PowerPoints in the WSTP 3. Using the board and flipchart as a visual aid 4. Key point summary 4 20 20 1 Total session time 45 94 ToT.10 Audio-visual tools and equipmentTrainer's Manual 1. Introduction (4 minutes) Aim: To enable trainees to use PPT presentations and audio visual equipment effectively. Objectives: • explain the advantages and disadvantages of available PPTs • make changes and embed videos into PPTs • describe good practice in the use of audio-visual equipment • use the board and flipchart effectively as a visual aid. ToT.10 Audio-visual tools and equipment: 2 Explain the aim and objectives of the session. Ask: What types of audio-visual (AV) equipment have we used so far in the training? Most important answers: • Data projector for ppts and videos • Board • Flipchart • Sticky notes on wall. Ask: In what ways was the equipment useful? Most important answers: Flipchart and whiteboard: • highlighted key information/learning points during sessions and for future reference (for example Ground Rules) • visual reminder of answers already given • assist with technical explanations. PPTs and videos: • opportunity to show diagrams to explain concepts • reinforced learning by showing images/messages as well as speaking • helped to focus attention. 95ToT.10 Audio-visual tools and equipmentTrainer's Manual 2. PowerPoints (PPTs) in the WSTP (20 minutes) PDF files: • smaller file size • cannot be edited • no animations • videos embedded. ToT.10 Audio-visual tools and equipment: 3 PPT files: • larger file size • can be edited • animations • videos not embedded. Explain: • WSTP PPTs are available in two versions, non-editable PDF files and editable PPT. • PDF versions are: – smaller in size and have the videos embedded – cannot be edited – do not include ‘builds’ or ‘reveals’ where bullet points appear one by one. • PPT versions are: – larger in size – can be edited – do not come with the videos embedded – include animations. 96 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Key discussion questions • Reminders of the key points • For activities. ToT.10 Audio-visual tools and equipment: 4 Explain: Trainers may want to add slides to include the following: • Key questions: – the Trainer’s Manual includes questions for trainers to ask participants. – adding the question to a slide can remind you to ask the question and not to move on to the answers too soon. • Key points: – some sections of the Trainer’s Manual have large amounts of text without reminder slides. – adding key points can help you to remember to cover all aspects of the session plan. • Instructions for activities: – key questions or key instructions that relate to activities can be added to slides. • Local context • Translation • Reduce or divide the text. ToT.10 Audio-visual tools and equipment: 5 Explain: Trainers many want to change slides to: • adapt for the local context • provide translation or locally relevant terms • reduce the text or divide content into two or more slides. Explain: It is important not to change the meaning of the content or the methodology of the WSTP. 97ToT.10 Audio-visual tools and equipmentTrainer's Manual • Must follow the same format as the original PPT • Do not to change the meaning and the core content of the WSTP • Delete the WHO logo. ToT.10 Audio-visual tools and equipment: 6 Explain: If you modify slides or add extra slides you must: • follow the same style as the original PPT • not change the meaning and core content of the WSTP • delete the WHO logo (in line with WHO’s copyright policy). • ADDING SLIDES TO PRESENTATIONS • In different sizes and fonts • And using ‘special effects’ • CAN BE VERY DISTRACTING • And look unprofessional • So avoid it! ToT.10 Audio-visual tools and equipment: 7 Explain: Do not change the style, font or colour, or add complex animations. 98 ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding slides Come out of “Slide Show” mode and demonstrate the following using the next slide. • The simplest method is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Another method of adding slides is to change the “Slide Master” to ensure consistency in layout. ToT.10 Audio-visual tools and equipment: 8 Explain: • The simplest way to add slides to an existing WSTP presentation is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Remember to remove the WHO logo from any slides that you add. • More details on how to do this are included in your ToT Handbook. Inserting video clips (Using Office 2013) 1. Choose your format: • mp4 – Apple computers or Windows computers with Quicktime player • wmv – Windows computers 2. Choose with or without subtitles • subtitles recommended. ToT.10 Audio-visual tools and equipment: 9 Explain: • All video clips are available in two formats, mp4 and wmv. Select the appropriate format for your computer. • Some video clips are available with subtitles. Using the clips with subtitles is recommended to: – allow for any difficulty understanding regional accents – overcome poor sound quality or external noise – be accessible to people with hearing impairments. • The video is stored inside the PPT when it is embedded • Video will remain embedded when you copy the file to another computer • Increases the overall file size. ToT.10 Audio-visual tools and equipment: 10 Explain: • Embedding videos is recommended. • When embedded, the video is stored inside the PPT. • This makes the file larger, but the video should not get lost when you copy the file to another computer. 99ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding a video here… ToT.10 Audio-visual tools and equipment: 11 Demonstrate the following: To embed the video in PPT 2010 onwards, follow these steps. • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it • Save your changes • The video is now part of the PPT. Explain: • It is possible to set the video to always play in full screen mode. • Windows computers: In the “Video”/“Tools”/“Playback” tab, check the box called “Play Full Screen”. • Mac computers: “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. Return to “Slide Show” mode and show how to play the video. Play the first few seconds and then go to the next slide. Notes for ToT trainers: • Let participants know that they can practise these skills during the preparation time at the end of the day. • Local photos or illustrations can be added to the slides to give them context. • Translation of the slides can be done locally – always check with WHO first to see if the slides have already been translated. 100 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Run the presentation in “Slide Show” mode on your computer when practising for your session • Run the full presentation in “Slide Show” mode on the computer and data projector that will be used during the training. ToT.10 Audio-visual tools and equipment: 12 Explain: • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. • This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. • Have a spare data projector or projector lamp • Switch off projector during breaks and practical sessions • To project a black or white screen: –Type W –Type B. ToT.10 Audio-visual tools and equipment: 13 Explain: • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. Demonstrate how to get a black or white screen. 101ToT.10 Audio-visual tools and equipmentTrainer's Manual • Use remote control to forward slides • Use laser pointer to draw attention • Test the speakers for sound quality and volume. ToT.10 Audio-visual tools and equipment: 14 Explain: • Using a remote control to click between slides means that trainers do not need to stand next to the computer during their presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. • Test the speakers each morning to ensure they are connected properly. Demonstrate using a remote control with a laser pointer (if available). 3. Using the board and flipchart as a visual aid (20 minutes) Using the board/flipchart as a visual aid • The ToT Handbook includes a table with five boxes of information related to using the board/flipchart as a visual aid. • Using the information about your topic plan a 2 minute presentation to the group with the board/flipchart. ToT.10 Audio-visual tools and equipment: 15 Show the slide throughout the activity. 102 ToT.10 Audio-visual tools and equipmentTrainer's Manual Activity 1 Groups: Divide trainees into 5 groups. Instructions: Refer trainees to the table on Using the board/flipchart as a visual aid on page 60 of the ToT Handbook. Allocate one topic from the table to each group and ask them to read through the information provided and plan how to communicate this to the rest of the group using the board/flipchart. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for preparation and 2 minutes for each group to present. Feedback: Add any information missed in the presentations. Using the board/flipchart as a visual aid 1. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. 2. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. 3. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). 4. What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. 103ToT.10 Audio-visual tools and equipmentTrainer's Manual 5. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 4. Key point summary (1 minute) • Know how to use AV equipment • Use PPT versions of presentations and tailor them to suit your context and presentation style • Practise your presentations in “Slide Show” mode on the computer you will use to deliver the training • Understand and follow the guidelines for effective use of the board/flipchart. ToT.10 Audio-visual tools and equipment: 16 Read the key points. Ask whether there are any questions. 104 ToT.11 FeedbackTrainer's Manual ToT.11 Feedback A IM To explore the role and skills of the trainer in providing useful feedback. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how to give useful feedback □□ describe the process of providing feedback at the end of each practice delivery session. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.11: Feedback. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Prepare a flipchart sheet with the four feedback steps: 1. Self-reflection by the trainee 2. ToT participants’ feedback 3. ToT trainers’ feedback 4. ToT trainers discuss key points. O U T L IN E 1. Introduction 2. Giving feedback 3. The feedback process after practice deliveries 4. Key point summary 2 35 7 1 Total session time 45 105ToT.11 FeedbackTrainer's Manual 1. Introduction (2 minutes) Aim: To explore the role and skills of the trainer in providing useful feedback. Objectives: • describe how to give useful feedback • describe the process of providing feedback at the end of each practice delivery session. ToT.11 Feedback: 2 Explain the aim and objectives of the session. 2. Giving feedback (35 minutes) Ask: What is feedback? Most important answers: • What I am doing well – positive feedback. • What I need to improve on – constructive feedback. Explain: It is important that trainers have the skills to give feedback well, and that they can support positive learning outcomes for participants. Receiving feedback: • Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. • Reflect on this individually, then discuss and compare your conclusions with your partner. ToT.11 Feedback: 3 Show the slide throughout the activity. 106 ToT.11 FeedbackTrainer's Manual Activity 1a Groups: Divide trainees into pairs. Instructions: Ask: What experiences have you had of receiving feedback? Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Ask trainees to record their reflections on page 61 of their ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 5 minutes for feedback to the group. Feedback: Ask participants to provide examples. Record key words on the board. Giving feedback What should trainers consider when providing feedback? ToT.11 Feedback: 4 Show the slide throughout the activity. 107ToT.11 FeedbackTrainer's Manual Activity 1b Groups: Divide into the same pairs. Instructions: Ask: What should trainers consider when providing feedback? Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Monitor: Monitor the pairs and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 10 minutes for feedback. Feedback: Ask each group in turn to describe one or two important considerations when giving feedback. Acknowledge good examples to consider. Correct/clarify any misunderstandings. Use the notes below to ensure the appropriate answers have been discussed by the group. Notes for ToT trainers: Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. This will help participants to connect the feedback with the recent learning or activity. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on behaviour – when providing constructive feedback, focus on the behaviour not the person. • Start with the positive – point out what was done well before talking about what needs improvement. If possible, also end on a positive note. • Be delivered in different ways – feedback on practice deliveries is useful to everyone. Praise and provide constructive feedback publicly to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their performance first. They may already understand what went well and what they need to improve. • Support participants, we are all different – before providing constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same was as you. 108 ToT.11 FeedbackTrainer's Manual 3. The feedback process after practice deliveries (7 minutes) Explain: ToT trainers will observe sessions from the back of the room but will move to the front of the room to facilitate the feedback. • Trainee reflects on delivery Self- reflection • ToT participants’ feedback Participant feedback • ToT trainers’ feedback ToT trainer feedback • ToT trainers discuss key points relevant to all trainees Key points ToT.11 Feedback: 1 Pin up the prepared flipchart sheet showing the four feedback steps and leave this on the wall for the rest of the week as a reference. Explain: There are four feedback steps after practice deliveries. 1. Self-reflection by trainee: lead trainee reflects on their performance, including: • what went well? • what could be improved? 2. ToT participants’ feedback: provide brief, specific feedback to the lead trainee, including one comment on: • what went well? • what could be improved? 3. ToT trainers’ feedback: ToT trainers will provide additional feedback, concentrating on areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. 4. ToT trainers discuss key points: ToT trainers discuss points about the session relevant to all trainees. 109ToT.11 FeedbackTrainer's Manual Explain: When providing feedback, it is important to: • Look at the person you are talking about and address them directly. • Be specific. For example, rather than saying, ‘That was really good’, you should say ‘I liked the way you divided the groups, and provided clear instructions’. • Feedback from participants should always be constructive. • If feedback is hurtful or insensitive to the trainee, the ToT trainer must step in to rephrase the feedback so it is more constructive. • The feedback process will give you the opportunity to put the learning from this session into practice. More formal one-on-one feedback to trainees will happen at the end of each day during the preparation session. Ask if there are any questions. 4. Key point summary (1 minute) Feedback should: • Be timely • Be specific • Focused on behaviour • Start with the positive • Be provided in private if it is sensitive. ToT.11 Feedback: 6 Read the key points. Ask whether there are any questions. 110 ToT.12 Managing group dynamics Trainer's Manual ToT.12 Managing group dynamics A IM To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ use a variety of methods to create small groups for an activity, considering skill, expertise and experience □□ manage disruptive behaviour in a group. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.12: Managing group dynamics □□ prepare the disruptive behaviour cards: print and cut out the cards at the end of this session plan or write them out by hand. Have a hat or bucket ready. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Organizing and managing group activities 3. Managing disruptive behaviour 4. Key point summary 3 10 25 2 Total session time 40 111ToT.12 Managing group dynamics Trainer's Manual 1. Introduction (3 minutes) Aim: To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. Objectives: • use a variety of methods to create small groups for an activity, considering skill, expertise and experience • manage disruptive behaviour in a group. ToT.12 Managing group dynamics: 2 Explain the aim and objectives of the session. Why are group activities included in the WSTP? ToT.12 Managing group dynamics: 3 Ask: Why are group activities included in the WSTP? Acknowledge answers. Record them on the board. • Allows trainers to find out how much is already known • Supports sharing of knowledge and experience • Builds confidence • Allows all participants to contribute. ToT.12 Managing group dynamics: 4 Explain: • There are always different levels of experience and expertise in the room. • Group work allows: – trainers to find out how much is already known – those with more experience and expertise to share it with others – participants to build confidence as they find out they already know a lot from their experience – shy or more junior participants to be more comfortable speaking out in a small group. 112 ToT.12 Managing group dynamics Trainer's Manual 2. Organizing and managing group activities (10 minutes) What is important to consider when dividing participants into groups? ToT.12 Managing group dynamics: 5 Ask: What is important to consider when dividing participants into groups? Acknowledge answers. Ask trainees to turn to page 63–65 in their ToT Handbook and talk through the list highlighting content not raised by trainees. Notes for ToT trainers: Factors to determine the size of the group • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. 113ToT.12 Managing group dynamics Trainer's Manual Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. 3. Managing disruptive behaviour (25 minutes) Disruptive behaviour With your partner, discuss what kinds of disruptive behaviour you have seen in trainings. ToT.12 Managing group dynamics: 6 Show the slide throughout the activity. 114 ToT.12 Managing group dynamics Trainer's Manual Activity 1 Groups: Divide trainees into pairs. Instructions: Explain that every group of participants has a range of personalities, skills, experience and learning styles. Only when specific behaviour disrupts the session should the trainer respond. Ask trainees to discuss with their partner what kind of disruptive behaviour they have seen in trainings? Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for discussion and 3 minutes for feedback. Feedback: Collect one response from each pair until no new ideas are given. Write responses on the board. Managing disruptive behaviour • Select a ‘disruptive behaviour’ • Discuss how you would handle the behaviour described. ToT.12 Managing group dynamics: 7 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask each pair in turn to select a card at random from the hat/bucket. Ask the pair to discuss how they would handle the behaviour described. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Ask each group to share their ideas: how would they handle such a problem in the group? What works/does not work? After each group has provided their feedback, ask if any other trainees have ideas to share. 115ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. The higher status/senior participant • If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The dominant participant • The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The quiet participant • The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The argumentative participant • The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. • Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. 116 ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: The distracted participant • The participant who is easily distracted, always in and out of the training room or on the phone. • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. The joking participant • The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The negative participant • The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? 4. Key point summary (2 minutes) • Group work is an important training tool • Ensure you make the most of group work by carefully considering how you divide the participants, and how you support them • Managing disruptive behaviour is a key trainer skill. ToT.12 Managing group dynamics: 8 Read the key points. Ask whether there are any questions. 117ToT.12 Managing group dynamics Trainer's Manual Disruptive behaviour cards – photocopy or write out by hand and cut out The higher status/senior participant If there is a participant who is in a position of authority over others in the group, participants may be reluctant to speak, answer questions or disagree with them. The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate by talking loudly or for a long time. This person behaves like they know everything already. The quiet participant The participant who is shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe are true, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. The negative participant The participant who tends to be negative or to discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 118 Intermediate Level moduleTrainer's Manual Intermediate Level module 119A.1: Wheelchair users who benefit from additional postural supportTrainer's Manual A.1: Wheelchair users who benefit from additional postural support Key considerations for teaching this session a. General • Group discussions will help the trainers understand the existing level of knowledge and experience of the participants. • Avoid discussing individual postural support devices (PSDs) in detail. They will be covered in later sessions. b. Section 3. When is additional postural support needed? Tips for preparation • For the activity: Throwing a ball and drinking on pages 34–35 of the WSTPi Trainer’s Manual, ensure that the chairs are suitably strong. Wheelchairs can be used if there are no suitable chairs. Content • Many intermediate level wheelchair users are at higher risk of developing a pressure sore due to: 1. Pressure – asymmetrical (uneven) posture – immobility (being unable to move) – weakness – poor balance – inability to change position or carry out pressure relief techniques. 2. Shear – unstable posture as a result of weakness – increased tone (stiffness) – uncontrolled movement – joint contractures – leg length discrepancies which have not been accommodated. 120 A.1: Wheelchair users who benefit from additional postural supportTrainer's Manual 3. Friction – poor posture support can lead to parts of the wheelchair user’s body rubbing against the wheelchair or PSDs – uncontrolled movement or spasms – injuries that occur during transfers: for example, if the wheelchair user’s bottom does not clear the wheelchair when lifting, the skin will drag causing friction. • For intermediate wheelchair users, a pressure relief cushion alone may not be enough to prevent pressure sores. • Stabilizing the wheelchair user, supporting their posture with appropriate PSDs and educating the user and/or their caregivers can help to prevent pressure sores from developing. • Remember a pressure sore can develop at any point of contact between the wheelchair user’s body and the wheelchair, cushion or PSD. c. Section 4. What do wheelchair users want? • Additional answers to those listed on page 38 of the Trainer’s Manual, “The reasons why the wheelchair users may reject a wheelchair with additional postural support”, can include: – cost: users may pay extra fees for wheelchairs with additional postural supports – size: most posture-support wheelchairs are non-folding, larger and heavier – posture-support wheelchairs come with a fixed range of PSDs some of which the wheelchair user does not require – additional maintenance of the PSDs that are added to the wheelchair. 121A.2: Children with disabilitiesTrainer's Manual A.2: Children with disabilities Key considerations for teaching this session a. Section 3. Different positions • Up to 6 years of age, children’s hips cannot fully straighten (extend) or rotate inwards like an older child or adult. This is one reason why their standing and sitting postures are different. • Young children will therefore stand with slightly bent hips, their knees apart and pointing slightly outwards. Their hips should never be forced straight and the feet should not be turned in to face forward. When lying on their front their hips should remain slightly bent and their knees and feet face out. • The illustrations in the Different positions poster are of older children who already have a straightened (extended) hip. Standing • Add “prevention of fractures” to the notes on why standing is important (page 44 of the Trainer’s Manual), as this is a key point. • Other benefits of standing that are not listed include: – helps to manage spasticity (muscle stiffness) – helps digestion – helps bowel movement and bladder emptying – relieves pressure from the seat bones – helps the bones to develop and reduces loss of bone density (strength). • On page 45, slide 8: Standing posture for young children, an additional point to note is that the knee support of a standing frame should be positioned below the knee caps and never directly on them because: – The knee caps are sensitive and pressure on them will lead to pain and discomfort. – The natural weight bearing area for the knee is just below the knee cap. This is also the area for weight bearing in below-knee prostheses. 122 A.2: Children with disabilitiesTrainer's Manual b. Section 4. Importance of an early referral for children • Providing a wheelchair does not take away a child’s desire or ability to walk. • Providing wheelchairs for children helps them to: – play with their friends – go to school – do things for themselves – help in the home. • Using a wheelchair takes less energy than using walking aids and allows a child to cover longer distances and participate more fully. • A child’s walking may improve as a result of using a wheelchair as the child walks less and uses less effort, helping to improve the quality of their walking. c. Section 5. Working with children • The child-safe practices described in this session are the minimum necessary when working with children. • Encourage participants to create a child-safe code of conduct for their service. Codes of conduct help personnel understand how to work with children safely. Child protection resources include: – local country and organization acts and policies on child protection – Australian Council for International Development: Code of conduct guidelines for the development of a child protection policy.1 – Child protection, UNICEF website2 1 ACFID Code of conduct guidelines for the development of a child protection policy. Canberra: Australian Council for International Development; 2016 (https://acfid.asn.au/resources). 2 Child protection. In: Disabilities in programmes, UNICEF [website]. New York: UNICEF; Sept 2015 (http://www. unicef.org/disabilities/index_65309.html). 123B.1: Assessment overview and assessment interview Trainer's Manual B.1: Assessment overview and assessment interview Errors in the WSTP materials a. General • The time allocations noted in the Trainer’s Manual for sessions 1–3 should be corrected as follows: – Section 1 2 minutes – Section 2 3 minutes – Section 3 65 minutes Change the time allocations in the Trainers Manual session plan outline on page 53 and in the individual sections on pages 53 and 54. The total session length remains unchanged. b. Section 3. Assessment interview, including the practical activity • There is an error in the instructions for the activity on page 56. The instruction states: “Give each group a number (1–5)”. This should be 1–4. Key considerations for teaching this session a. General Tips for preparation • Consider incorporating any changes made to the assessment form by local service providers into the session. • Adjust the types of disabilities and health conditions included in the group activity for the context. 124 B.1: Assessment overview and assessment interview Trainer's Manual Content • Participants should be familiar with the WSTPb assessment interview. Therefore focus on the content that is new for intermediate level wheelchair users. b. Section 3. Assessment interview • The total time for this section is 65 minutes (see error section above). This includes a 5 minute introduction to the session, including the instruction for the activity and 60 minutes for the activity. • For the activity, encourage participants with more knowledge of different disabilities to support other group members. • Avoid long discussions about a single diagnosis/physical issue. • Some wheelchair users will not have a diagnosis and some users may have an incorrect diagnosis. Therefore, while the wheelchair user’s diagnosis can give valuable information, it is important to complete a full assessment. All of this information is required in order to select the most appropriate wheelchair. 125B.2: Physical assessment – sitting posture without supportTrainer's Manual B.2: Physical assessment – sitting posture without support Errors in the WSTP materials a. Section 5. Upright sitting posture for young children • On page 68 of the Trainer’s Manual, the first bullet point of slide 10 should state: “Flat back with no lumbar curves”. Correct the text by deleting “or thoracic” from the PPT slide and the slide notes. • As observed in the drawing (Figure 1), there is a forward thoracic curve that results in the shoulders being slightly further forward than the child’s ears and hips. The key message is that children under 5 years of age have a different ‘upright’ posture to that of an adult. Figure 1.Upright posture in young children b. Section 7. Observing sitting posture • Slide 18 is different in the PPT and the Trainer’s Manual. In the Trainer’s Manual, it shows shoulders lower on the right, and on the slide it shows shoulders lower on the left. Correct the text on page 72 of your Trainer’s Manual to say “shoulders not level (lower on the left)”. 126 B.2: Physical assessment – sitting posture without supportTrainer's Manual c. Section 8. Recording posture • In the activity (page 76) the line drawings are missing from the Trainer’s Manual. They are shown below in Figure 2: Example line drawings for trainers Figure 2. Example line drawings Key considerations for teaching this session a. Section 4. Upright sitting posture • The terms ‘fixed posture’, ‘flexible posture’ and ‘flexible partway to neutral posture’ should be applied to individual joints and not the wheelchair user’s whole posture. For example, the left hip can be ‘fixed’ while the right hip can be ‘flexible partway to neutral’. b. Section 5. Upright sitting posture for young children • Children’s lumbar and thoracic curves develop as a result of standing. For those children who never stand, these curves will not develop as they get older. c. Section 6. The pelvis is the foundation of sitting posture • Check that all participants can locate the seat bones (ITs), ASIS and PSIS on each other before moving on. 127B.2: Physical assessment – sitting posture without supportTrainer's Manual • Locating bony landmarks can be difficult due to contractures, deformities or obesity. Remind participants that for obese wheelchair users, the position of the ITs, ASIS and PSIS will not change relative to the midline of the body. Participants should use their knowledge of anatomy to work out where the bony landmarks should be before they begin palpating (feeling for landmarks). • Regarding the terms ‘upright/neutral’ in relation to the pelvis: – ‘Level pelvis’ refers to the pelvis from the anterior/front view. A level pelvis has no sideways tilt from the front. Both ASIS are in line with each other. – ‘Upright/neutral pelvis’ refers to the pelvis from the lateral/side view. An upright pelvis has no anterior or posterior pelvis tilt from the side. It is balanced on the seat bones. d. Section 7. Observing sitting posture • When observing the wheelchair user’s posture, some support may be needed to assist them to sit on the side of the assessment bed or chair. However, this support should not correct their posture. • The slide notes for slide 19 (page 72) in the Trainer’s Manual includes “some trunk rotation (back on the left side)” and “the left leg has rolled inwards”. There may be disagreement from some participants. If this happens: – Ask participants to focus on the major deviations: the rotation of the pelvis and rolling outwards of the right leg. – Acknowledge that it is difficult to identify subtle postural changes by observing from one angle only. To understand a person’s posture fully you must observe from the front, side and back along with identification of key anatomical/bony landmarks. e. Section 8. Recording posture Posture drawing tips • If participants find it difficult to draw the postures, suggest that they draw posture lines onto the body of the person in the illustration, before drawing the posture freehand in the box provided. • The small circles and points/corners on the pelvis represent the bony landmarks of the pelvis – the ASIS, PSIS and ITs. • The small circles drawn on the pelvis are not essential, but they can be helpful to emphasize the position of the pelvis. • It is important for trainers to choose one way to draw the thighs and to be consistent. 128 B.3: Physical assessment – pelvis and hip posture screenTrainer's Manual B.3: Physical assessment – pelvis and hip posture screen Errors in the WSTP materials a. Section 2. Pelvis and hip posture screen • Slide 6 is missing from the PPT file. The PDF version is correct. Key considerations for teaching this session a. General Tips for preparation • Lead and support trainers should prepare for this session together to ensure consistency in teaching the practical skills. For example, correct hand placement, use of the goniometer, and correct position of the model wheelchair user. • Temporary supports need to be prepared in advance and should be made from the local material most commonly used for the cushion base. • An anatomical model of the spine and pelvis with short femurs, or a child size doll (if available), can help to demonstrate the application of temporary supports. ToT trainer demonstrations/explanations Follow the instructions on page 79 of the WSTPi Trainer’s Manual to introduce the pelvis and hip posture screen, and facilitate the activity. b. Section 2. Pelvis and hip posture screen Emphasize the following: • Be respectful in how you position yourself – move around the wheelchair user and avoid leaning over them. • Protect your back by: – positioning the wheelchair user near the side of the assessment bed to avoid leaning over them – kneeling down rather than bending. 129B.3: Physical assessment – pelvis and hip posture screenTrainer's Manual • Begin by checking the wheelchair user’s posture in lying before starting the pelvis and hip screen. This includes: – level the shoulders – using the end of the bed as a reference point – line up the head, neck and upper trunk with the side of the bed as a reference point. • Demonstrate good handling of the wheelchair user’s limbs and body. Gripping too hard may cause discomfort. • To relieve tension in the hips, support the wheelchair user’s knees when carrying out the pelvis and hip screen. If there is too much tension around the hips it can pull the wheelchair user’s pelvis into a non-neutral posture. • Ensure the wheelchair user’s clothing is not preventing free movement of their hips. • Emphasize the hand placement of both the assessor and the assistant (as described on page 84 of the Trainer’s Manual). Feedback from the assistant is key to an accurate screening. – The assessor’s hands support the weight of the legs. The assessor’s hands should not restrict knee bending (flexion) as tension at the back of the knee (tight hamstrings) may cause the pelvis to move. • Demonstrate correct use of the goniometer. • Sometimes participants try to mimic a restriction. This usually only causes confusion. Remind them to focus on learning the steps and the technique, and they will feel real restrictions during the practical sessions. Summarize by showing the DVD. Considerations for gender/culture • When demonstrating, or asking participants to carry out a pelvis and hip posture screen, divide participants into groups based on gender. 130 B.3: Physical assessment – pelvis and hip posture screenTrainer's Manual Key considerations for teaching this session a. Section 4. Demonstration of temporary support for fixed unlevel pelvis • If participants suggest adding a support under the lower side in order to level the pelvis: – explain that the pelvis posture cannot be corrected to a level neutral pelvis – pushing against the seat bones of an unlevel pelvis will cause high pressure, which may lead to a pressure sore. • Emphasize the findings in the pelvis and hip posture screen. If participants were not able to level the pelvis in lying, the pelvis will remain unlevel in sitting. • This PSD is not used in isolation. Wheelchair users with a fixed unlevel pelvis may need several other PSDs to support their posture. b. Section 5. Demonstration of temporary support for the hips that cannot bend or open to neutral sitting posture • Consider demonstrating using an anatomical spine or doll before requesting a volunteer. • Demonstrate that the hip cannot bend to neutral in lying. • Highlight the triangular space created by a vertical line from the back of the knee to the assessment bed (Figure 3). • The distance from the line to the seat bone is the height of the temporary support required to stop the thigh pushing the pelvis into a posterior pelvic tilt. • Measure the trunk to thigh angle. • Sit the doll/model on a temporary support. • Show the trunk to thigh angle is the same. • The triangle gap under the thigh is the shape that must be created in the front section of the cushion on that side to accommodate the hip that cannot bend to neutral. • Participants sometimes suggest filling the triangular space under the thigh with a wedge. This is possible but not necessary as it does not change the final posture of the pelvis. Figure 3.Temporary support 131B.4: Physical assessment – hand simulation Trainer's Manual B.4: Physical assessment – hand simulation Errors in the WSTP materials a. Section 3. Recording the results of a hand simulation • On page 101 of the Trainer’s Manual in the activity answer box, Enith’s hip postures have been recorded as neutral. This is not correct, change the tick box to: “No” for the L Hip and R Hip. • The notes are correct: “trunk to thigh angle more than 90 degrees”. ToT trainer demonstrations/explanations a. Section 2. How to carry out a hand simulation Key considerations for teaching this session • Some wheelchair users are physically able to sit more upright but they are unable to maintain this position. These users may need to be supported in a less upright position, with their pelvis in a posterior pelvic tilt, to be able to use their wheelchair throughout the day. From the more upright position, allow the wheelchair user’s pelvis to gradually roll backwards, until you have found the best position where the user’s head and trunk are balanced. • Even with multiple assistants it is not always possible to carry out a hand simulation because firmer support is needed than can be provided with your hands alone. If this happens, consider using: 132 B.4: Physical assessment – hand simulation Trainer's Manual – upholstered boards, foam or therapy blocks to provide more stable support – a wheelchair that can be mocked-up with temporary postural supports. • It can be difficult carrying out a hand simulation with small children when they are upset. Consider: – sitting them sideways on the parent/caregiver’s lap – taking frequent breaks – including the parent/caregiver in the assessment, for instance ask them to hold the child’s feet or shoulders. Ensure that you give appropriate guidance about how much support they need to provide. • It is important to compare the final posture achieved during the hand simulation with the results of the pelvis and hip posture screen. The final position of the pelvis and hips will usually be the same. Differences can be caused by: – using too much force during the pelvis and hip posture screen – insufficient support in sitting. Key considerations for teaching this session a. General • More time may be required if participants are not familiar with hand simulations or analysis of a wheelchair user’s posture. • Throughout the DVD case studies, emphasize the step by step approach: – give clear instructions to the assistant – begin with the position of the pelvis before moving to support other areas. • Ensure participants understand that the final posture achieved during the hand simulation must be documented together with the supports needed. Documentation includes drawings, written descriptions and completing the checklist for each part of the body listed on the assessment form. • If photographs are a standard part of service documentation, ask someone to take a picture after each change in posture. – Service personnel can review each photograph to help decide how they might change the support provided to the wheelchair user. – This can minimize handling and saves time. • If photographs are used during the training programme, ask participants to record the results of hand simulations for wheelchair users they work with using the final photograph as a guide. • Delete all other photographs and use only the final photograph in the documentation for the wheelchair user. 133B.4: Physical assessment – hand simulation Trainer's Manual b. Section 3. Recording the results of a hand simulation Content • Use the Notes for trainers included in the Trainer’s Manual to provide clarification when the whole posture is not visible. • Allow time for all participants to practise how to record the final hand simulation, posture drawings and descriptions. • To record a neutral posture, it must be neutral both from the front and the side. • “Yes” is ticked for parts of the body that have achieved neutral posture with or without additional postural support during the hand simulation. • All non-neutral postures (fixed or flexible part way to neutral) should be marked “No”. • Although the pelvis and hip posture screen may identify a level pelvis and neutral hip range, the final posture is determined by the hand simulation. The final pelvis position may be in anterior/posterior tilt (non-neutral), resulting in the hips being open/closed more than neutral. The pelvis may be neutral but the hips closed because a raised seat front may have been added to provide stability. Enith • Enith’s pelvis and hip screen found that both her hips could bend to a neutral sitting posture. • While both of her hips can come to 90 degrees in lying, she cannot sit in that position because her pelvis is fixed in a posterior pelvic tilt. • When recording the results of the hand simulation, record the final posture achieved accurately. • Some participants may suggest using a raised seat front PSD to close the trunk to thigh angle. Acknowledge that this can be done, but remind participants that the decision will be based on a whole picture of the wheelchair user’s needs. Including a raised seat front in the final prescription may affect other things such as transfers and access under desks or tables. • The Trainer’s Manual describes the final posture of Enith and Bahati. See below for their final posture drawings. 134 B.4: Physical assessment – hand simulation Trainer's Manual Enith For each body part: If neutral sitting posture is possible with hand support, tick “Yes”. If not, tick ”No”. Part Yes No Describe or line draw final sitting posture achieved by the wheelchair user with hand support. Describe or line draw the support provided to achieve that sitting posture. Pelvis □ □ Trunk □ □ Head □ □ L Hip □ □ R Hip □ □ Thighs □ □ L Knee □ □ R Knee □ □ L Ankle □ □ R Ankle □ □ Bahati For each body part: If neutral sitting posture is possible with hand support, tick “Yes”. If not, tick “No”. Part Yes No Describe or line draw final sitting posture achieved by the wheelchair user with hand support. Describe or line draw the support provided to achieve that sitting posture. Pelvis □ □ Trunk □ □ Head □ □ L Hip □ □ R Hip □ □ Thighs □ □ L Knee □ □ R Knee □ □ L Ankle □ □ R Ankle □ □ 135B.5: Physical assessment – taking measurementsTrainer's Manual B.5: Physical assessment – taking measurements Errors in the WSTP materials a. General • The following are not listed in the resources and should be added: – two clipboards for each group of three participants – a set of foot blocks of different heights (or thickness). b. Section 2. Measuring a wheelchair user to select the correct wheelchair size and location of PSDs • On page 112 of the Trainer’s Manual the drawing of Madavi’s posture on slide 6 is incorrect. The drawing shows a lumbar spine with a neutral curve. However, when a user sits with their pelvis in a posterior/backwards tilt, their lumbar spine flattens and the trunk will be rounded – which causes a ‘slumped’ posture. • The same error is in the Reference Manual for Participants on page 67. Guide participants to correct this in their manuals. Key considerations for teaching this session a. General Tips for preparation • Review the measurement notes in the Trainer’s Manual and practise the measurement demonstration with all trainers to ensure consistency. • Common errors to look out for during the activity may include: – the posture/support of the wheelchair user – inaccurate measurement techniques including: positioning the clipboards on an angle; starting from the wrong end of the tape measure; reading the tape measure with the head at an incorrect level. 136 B.5: Physical assessment – taking measurementsTrainer's Manual • Avoid using participants for the demonstration, so that they are able to observe. • Adjust for the context (such as thicker clothes in cold climates). • If time permits, consider lengthening this session to allow each participant to practise taking all the intermediate-level body measurements. b. Section 2. Measuring a wheelchair user to select the correct wheelchair size and location of PSDs • In the Trainer’s Manual, page 110, section I is titled: “Seat to the top of the pelvis (PSIS)”. However, the PSIS is not the top of the pelvis. The top of the pelvis is the iliac crest. • Trainers need to decide how best to approach this with their participants: – Option 1: Delete “to the top of the pelvis” from this sentence, and only refer to the PSIS. You will then need to change the Reference Manual for Participants on page 70. – Option 2: Use “the top of the pelvis” as a general term. If you choose this option, it is important for participants to understand that the PSIS sits below the “top” of the pelvis. • Throughout the section emphasize the following points: – Take the measurements while the wheelchair user is still being supported in their final posture (as assessed during the hand simulation). – The type of wheelchair selected and PSDs required will help determine which measurements are needed. For example, for a wheelchair user who needs a full height backrest select measurement F: seat to top of shoulder. Measurement D: seat to bottom of rib cage and measurement E: seat to shoulder blade will not be necessary. • If a wheelchair user has a fixed posterior tilt of the pelvis or a fixed forward curved trunk, participants need to think about how this will be accommodated in the wheelchair. This may change the way the seat depth measurement is taken. • If the backrest can recline: measure from the bottom of the back of the pelvis to the back of the knee in a straight line (Figure 4). Figure 4. Measuring for a reclining backrest 137B.5: Physical assessment – taking measurementsTrainer's Manual • If the backrest does not recline and an open seat to back angle is prescribed, it will need to be accommodated in the seat depth of the wheelchair. • Body measurements for an open seat to back angle must include: – The distance from the apex of the c-shaped curve to the top of the seat (z). – The distance between the vertical line from the apex of the c-shaped curve to the top of the seat and the back of the pelvis (x) (Figure 5). • Show how to calculate the total seat depth required when using an open seat to back angle PSD using Figure 6. • It can sometimes be difficult to support wheelchair users in their final posture while taking measurements. Strategies to manage this include: – take frequent breaks – have more assistants available to provide postural support or to take measurements. Figure 6.Calculating seat depth Figure 5. Measuring for an open seat to backrest angle 138 B.6: Selecting wheelchairs and cushions Trainer's Manual B.6: Selecting wheelchairs and cushions Errors in the WSTP materials a. General • Sixty minutes is not sufficient time for this session. Allow 60 minutes for section 2 and 70 minutes for the total session time. b. Section 2. Type of wheelchair and cushion • In the Trainer’s Manual on page 119, the drawings of the reclining backrest in slides 12 and 13 should not include a lumbar or rear pelvis support shape. Considering the indications for prescription (as listed in the slide notes), the wheelchair user will present with a pelvis in posterior tilt and consequently a flat or flexed lumbar spine. • The lower section of the backrest should be represented as: – flat, or – with an open back to seat angle wedge (a likely PSD for the scenarios listed). • Ask participants to correct the same error in the Reference Manual for Participants on page 74. • On page 119 of the Trainer’s Manual, the first bullet point next to slide 13: “Fixed posterior pelvis tilt with hip and knee flexion contractures” is not correct. Tilt in space is not an indication for fixed posterior pelvis tilt with hip and knee contractures. Delete the first bullet and add the following bullet points: – to improve head position and control – to improve balance. • Ask participants to correct the same error in the Reference Manual for Participants on page 74. 139B.6: Selecting wheelchairs and cushions Trainer's Manual Key considerations for teaching this session a. General Tips for preparation • Ensure you are familiar with the wheelchairs and PSD components that are available locally: – study the manufacturers’ information – know the available size range – check the adjustability options/range of features and ensure you can explain or demonstrate these – find out what can be customized, including any accessories available. • Ensure that you are familiar with any changes to the local prescription forms before you deliver this session and incorporate them if appropriate. • Local prescription forms should include the following: – identification of the type and size of wheelchair and cushion – detailed body and ideal wheelchair measurements – descriptions of PSDs – wheelchair user agreement signatures. b. Section 1. Introduction • Remind participants that an appropriate wheelchair is defined according to the Wheelchair Guidelines and that they should always consider whether a wheelchair with extra supports, or a dedicated supportive seat, would be most appropriate. c. Section 2. Type of wheelchair and cushion Tips for preparation • Ensure that a range of wheelchairs, which demonstrate different features related to environment, function, fit and posture support, is available. • Include both wheelchairs with dedicated posture support features and those to which PSDs can be added. Content • Consider the limitations of a dedicated posture support wheelchair for a user who only needs a manual wheelchair with PSDs: 140 B.6: Selecting wheelchairs and cushions Trainer's Manual – There may be a limited range of designs and sizes of posture support wheelchairs available. – They may include features that are not needed, adding weight and cost. – Posture support wheelchairs can be difficult to transport. • For a wheelchair with ‘fixed’ tilt: the angle that will best support the wheelchair user must be selected at the time of prescription. • For a wheelchair with ‘quick release’ or ‘adjustable’ tilt: the amount of tilt can be easily adjusted throughout the day to provide more or less support as needed. This can be helpful for a wheelchair user who is recovering after a serious injury or learning skills such as head control, and may not be able to sit in a more upright position for the whole day. Point out the wheelchairs that have these features. • Remind participants that the wheelchair and PSDs required will also help determine the size of wheelchair required. For example, for a person who needs trunk side supports and a backrest that reclines between the back posts, the width of the wheelchair is determined by: – Body measurement G. Trunk width plus; – the thickness of both trunk side supports (B x 2) (this equals the inside measurement between the back posts), plus; – width of the two back posts (A x 2) (Figure 7). • If the backrest is to be mounted in front of the back posts, the width of the wheelchair user’s trunk plus the thickness of both trunk side supports or pelvis/thighs (whichever is the widest) will help to identify the ideal width of the wheelchair (wheelchair component measurement 1 or 2). Figure 7. Width of a wheelchair 141B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction Trainer's Manual B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction Key considerations for teaching this session a. General Tips for preparation • Park questions about specific PSDs in the Car Park as they will be covered in the following sessions. • Ensure that you are familiar with any changes to local prescription forms before you deliver this session. Incorporate local forms into the session if appropriate. • Source examples of local PSDs for demonstration. • Information about costs and suppliers can be prepared in advance and included as a separate handout. They should not be discussed as part of the session. b. Section 2. What is a PSD? • The selection of PSDs depends on the support needed, as identified during the hand simulation. – The size required (height and depth) is related to the amount of support needed. The more support needed, the larger the surface area of the PSD. – The materials selected depend on the firmness of support. For example, if light support is needed, you may prescribe trunk side wedges (made of firm foam underneath softer foam). If firm support is needed, you may prescribe trunk side supports made with a rigid structure (such as wood, metal, plastic) and lined with a softer material (such as foam, EVA). – The shape of the support depends on which part of the body is being supported. It should not restrict movement of another part of the body; for example, an armrest can interfere with propelling. The shape should not concentrate high pressure on a bony area, such as over the ribs, when accommodating a curve in the trunk. Shaping the support can spread the pressure over a larger area (reducing the risk of a pressure sore). – Pressure is very important. Every part of a PSD that is close to the body and hard enough to cause a pressure sore should be shaped appropriately and padded with an appropriate softer material (such as foam, EVA or neoprene). 142 B.7: Prescription (selection) of Postural Support Devices (PSDs) – introduction Trainer's Manual c. Section 3. Recording PSDs on the intermediate wheelchair prescription (selection) form • In slides 8 and 9 on page 130 there are examples of PSDs drawn onto a prescription form, with lines and letters representing where measurements are needed. • When drawing on the prescription form, participants should concentrate on the shape and size of the firm foam only. Explain that every part will need to be covered with a softer foam layer, but it is not necessary to draw this. • The shadow lines are there as a guide to make it easier to draw the PSDs. They do not represent a size or shape that you must use. • The purpose of the drawing is to communicate the type, shape and size of PSDs required, so it is important that the drawing is clear. • Adding shadow lines to the backrest and footrest drawings (Figure 8) can make it easier to sketch in the PSDs. • You can add this shadow line drawing to the PPT and your assessment forms. A copy of the drawing is on the WSTP Pen Drive. Figure 8. Using shadow lines to draw PSDs 143B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual B.8: Prescription (selection) of PSDs – stabilizing the pelvis Errors in the WSTP materials a. Section 2. Problem: Pelvis is in posterior tilt and/ or slides forward • In the Trainer’s Manual on page 136, slide 8 shows a cushion with a pre-seat bone shelf. • The illustration can sometimes be misunderstood. Explain that: – the bottom layer of the cushion is firm foam – the top layer of soft foam should be glued firmly to the pre-seat bone shelf. • Replace the illustration on slide 8, with this new one (Figure 9) which can be found on the WSTP Pen Drive. Figure 9. Cushion with pre-seat bone shelf • In the Trainer’s Manual on page 137 the illustration on slide 11 shows the dimensions for Marian’s PSDs. The diagram shows two measurements. For the rear pelvis pad, the measurement line is incorrectly shown from the top of the seat to the bottom of the rear pelvis pad. The line should be from the top of the seat to the mid-height of the rear pelvis pad. • For some versions of the WSTPi package, this error is also in the PPT (slide 11). • Change this in your Trainer’s Manual and PPT (if necessary). • The measurement line is incorrectly shown from the top of the seat to the top of the rear pelvis pad in the Participant’s Workbook on page 26. Guide participants to correct this. 144 B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual Key considerations for teaching this session a. General Tips for preparation • An anatomical model of the skeleton/spine/pelvis/hip is a very useful teaching tool. Trainers can use the model to: – identify bony landmarks – demonstrate where support needs to be provided – link the pelvis and hip posture screen, temporary supports (where appropriate) and hand simulation findings. • Have the correct size and width of foam blocks and wedges available so you can quickly assemble the sample cushion solutions. For example, the raised seat front cushion in section 2 and the build-up for the pre-seat bone shelf cushion in section 3. Content Cushions • All intermediate level wheelchair users should be provided with an appropriate cushion that supports their pelvis. • Most intermediate level wheelchair users will need a cushion with a pre-seat bone shelf to help stop the pelvis from sliding forward. The pre seat bone shelf will also move some pressure away from their seat bones (providing pressure relief). • Intermediate level wheelchair users who need a pre seat bone shelf and who are at high risk of developing pressure sores could be prescribed a cushion with a pelvic well (Figure 10). • A pelvic well provides the same postural support as a pre seat bone shelf, and provides more pressure relief by further redistributing the weight and loading under the upper thighs (trochanters). Figure 10. Cushion with a pelvic well 145B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual Pelvic well cushion shown with an inside thigh wedge: base layer Pelvic well cushion shown with an inside thigh wedge. b. Section 2. Problem: Pelvis is in posterior tilt and/ or slides forward Tips for preparation • In the Trainer’s Manual on page 136 the trainer’s notes for slide 9 state: “A rear pelvis pad provides support at the top of the pelvis (at the level of the PSIS)”. However, the PSIS is not the top of the pelvis. The top of the pelvis is the iliac crest. Trainers need to decide how best to approach this with their participants. • Option one: delete “at the top of the pelvis” from this sentence, and only refer to the PSIS. If you make this change, you will also need to change: – the measurement table on page 25 of the Participant’s Workbook – the Reference Manual for Participants on page 95 (third last paragraph) – measurement l in the Intermediate wheelchair assessment form. • Option two: use “the top of the pelvis” as a general term for describing the top of the back of the pelvis. If you choose this option, it is important for participants to understand that the PSIS sits below the “top” of the pelvis. 146 B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual Finding the PSIS • Place hands on top of the pelvis and gently squeeze in to find the soft area. Then move the thumbs down below the level of the fingers (stretching the web of the thumb). The thumbs will be positioned close to where the PSIS are located, below the top of the pelvis (Figure 11). Figure 11. Finding the PSIS Content • The appropriate angle to position a pelvic strap is between 45 degrees and 90 degrees (Figure 12). • However, a 45 degree belt can encourage the wheelchair user to sit with a posterior pelvic tilt, especially when firm support is needed. • An angle of 60 to 90 degrees is more effective for a wheelchair user who tends to slide forward on the seat. Figure 12. Positioning a pelvic strap Rear pelvis support for adults with neutral curves of the spine • A rear pelvis pad is designed to keep the pelvis upright and prevent posterior pelvic tilt for wheelchair users with normal lumbar/thoracic curves. • It is designed to fill up the pelvic-trunk offset (the difference between the back of the pelvis and back of the thoracic spine) in a wheelchair with a flat backrest. • If the pelvis cannot be corrected to neutral, or the wheelchair user does not have neutral curves of the spine, a rear pelvis pad should not be used. 45º 90º 147B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual Pelvic-trunk offset A rear pelvis pad used with a straight backrest • If the backrest has a backwards bend, or is a tension adjustable backrest that supports the pelvis to be upright (and accommodates the neutral curves of the spine), a rear pelvis pad may not be needed. • A rear pelvis pad can be added to these types of backrests if more support is needed. Backrest with a backwards bend Tension adjustable backrest • Do not over correct the pelvis. If the wheelchair user cannot tolerate an upright or close to upright posture, provide less support and allow the user to sit with a posterior pelvis tilt. The wheelchair user may benefit from an open seat to back angle to support the less upright posture. 148 B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual Rear pelvis support for children with neutral curves of the spine • Rear pelvis pads must not be used with young children. • For young children, a neutral posture has a flat lumbar spine and a forward bend in the thoracic area (Figure 13). • If a rear pelvis pad is used, it will push the pelvis forward into anterior tilt and/or push the wheelchair user away from the backrest. This can cause discomfort, pain and postural problems. Figure 13. Neutral posture in young children c. Section 3: Problem: Pelvis is in lateral tilt (fixed unlevel pelvis) Fixed unlevel pelvis • The height of a build-up under the pelvis will be a similar size to the height of the temporary support used during the hand simulation. • The height of the temporary support is similar to the difference in height between the two ASIS in the most corrected pelvis posture (as determined in the pelvis and hip posture screen). Unlevel pelvis – flexible to neutral • Sometimes when a wheelchair user’s pelvis is flexible to neutral, participants suggest building up the pelvis under the low side to correct it. This is unsafe, because it increases the pressure underneath the lower seat bone. • Providing pelvis side pads and a firm pelvic strap to support the pelvis will help to achieve an aligned and balanced posture. You may also need to provide support to the wheelchair user’s trunk. 149B.8: Prescription (selection) of PSDs – stabilizing the pelvisTrainer's Manual d. Section 4: Problem: Pelvis moves to one side Tips for preparation • Add the following note to slide 22 on page 143 of the Trainer’s Manual: – “If the pelvis can no longer be corrected to be in line with the shoulders, the pelvis side pads will be off-centre”. • Ask participants to add this sentence to the Reference Manual for Participants (at the bottom of page 96). Content • Pelvis side pads can be fixed to the seat, armrests, backrest or the back posts. • Pelvis pads fixed to armrests or seats are more likely to interfere with the thighs, unless they are shaped correctly. • Those attached to the backrest or back posts are less likely to interfere. These can be shaped from the top of the pelvis to just above the top of the thighs. • If you need to position the pelvis side pads off-centre, you can achieve this by: – making one pelvis side pad thicker than the other – attaching the pads asymmetrically/off-centre. e. Section 6. Key point summary • Encourage participants to try different options and approaches with the wheelchair users in the practical sessions and when working with wheelchair users in their own services. 150 B.9: Prescription (selection) of PSDs – supporting the hipsTrainer's Manual B.9: Prescription (selection) of PSDs – supporting the hips Key considerations for teaching this session a. General Tips for preparation • Throughout the session, link the postures to: the pelvis and hip posture screen; temporary supports needed; and the hand simulation results. b. Section 2. Supporting the hips Tips for preparation • If available, an anatomical model of the skeleton can help to demonstrate various postures. Content • Refer to notes for session B.3: Physical assessment – pelvis and hip posture screen, for tips on how to determine the height of the temporary support for hips that cannot bend to neutral. • Sitting with both seat bones on a temporary support allows the spine to be assessed without the influence of the limited hip movement (contractures). • Once the spine has been assessed, remove the temporary support and position the pelvis in a posterior pelvic tilt. 151B.10: Prescription (selection) of PSDs – supporting the trunkTrainer's Manual B.10: Prescription (selection) of PSDs – supporting the trunk Errors in the WSTP materials a. Section 2. Supporting the trunk Case study: Josephine • In the Participant’s Workbook (pages 34–35) Josephine’s case study states that she is using a long wheelbase wheelchair, however the illustration shows Josephine in a short wheelbase wheelchair. • Provide a long wheelbase wheelchair to the group working on Josephine’s case study, and advise them to note the error in their workbook. • Josephine’s hand simulation results record that her left hip can come to neutral. This is incorrect – if the pelvis is not neutral, the L hip cannot be neutral. • Guide participants to change this information in their case study information in the boxes on pages 34–35. • Make a note of this change in the Trainer’s Manual on page 160. Key considerations for teaching this session b. General Tips for preparation • This session requires a number of resources that need to be prepared in advance. Consider creating a training resource kit that can be reused in future training programmes. • If participants need to shape and cut PSDs, add the tools required to the resources list in the Trainer’s Manual. • Add rolls of tape to the resources list for participants to mock up the PSDs. Emphasize that these materials and their methods of attachment are for training purposes only. • When preparing PSD kits and PSD materials, try to use the same type of PSDs and materials that participants will use in their workplace. If these are not available, you can use low-cost replacements. Explain to participants that this is for training purposes only: 152 B.10: Prescription (selection) of PSDs – supporting the trunkTrainer's Manual – use cardboard to represent wood for a solid back/seat and trunk/pelvis side supports – use Styrofoam, plastic foam pieces from discarded packaging material or woven grass mats to represent foam. • If there aren’t enough materials to complete mock-ups, ask participants to describe the changes they would make and how they would make them. • The case studies describe the type of wheelchair for each user: – if the type of wheelchair is not available, provide a locally available alternative – ensure the wheelchair does not have any PSDs attached – discuss the wheelchair with the group; identify any key changes between the wheelchair provided and the wheelchair described in the case study. • If a child size wheelchair is not available for Sian (case study 3), advise participants to use a different size and focus on the postural support required. c. Section 2. Supporting the trunk Tips for preparation For the whole group activity (page 156): • Ensure that the benches or tables that the participants sit on are not too wide, or it will cause their legs to straighten. Chairs with flat, horizontal seats can also be used by placing the side of the chair against the wall. Content For the case studies in the activity: • Remind participants that the focus is to problem solve and consider all possible solutions. • Ask them to start with the seat base, which includes pelvis and hip supports, and then to follow the same sequence as hand simulation. • If participants are choosing solutions that are not appropriate, ask them to explain their reasoning. Lead a discussion on the clinical or functional problem that their solution may create and ask what they can do to overcome it. 153B.10: Prescription (selection) of PSDs – supporting the trunkTrainer's Manual Correction of common misunderstandings. Case study 1: Mark • Backrest too high. Remind participants that the findings of the hand simulation indicated that the wheelchair user needed support behind his shoulder blades. This indicates that back support to mid thoracic level is needed, not to the top of his shoulders. A backrest at the level of the shoulder blades will affect arm function. • The backrest should provide the level and height of support as indicated by the hand simulation. • If a lower backrest is provided, the wheelchair user may not be stable. • The support behind the shoulder blades will not usually affect shoulder function. Correction of common misunderstandings. Case study 2: Josephine • The rear pelvis pad is selected instead of an open seat to back angle: Refer to the discussion about supporting the pelvis in session B.8: Prescription (selection) of PSDs – stabilizing the pelvis; Section 2. Pelvis is in posterior tilt and/or slides forward (Trainer’s Manual page 134). • No pre-seat bone shelf is prescribed. • Incorrect position of lowered seat front on one side. For a hip that cannot bend to neutral, the slope of the lowered seat front on one side should start just in front of the pre seat bone shelf. • Too much recline. When reclining the backrest between the back posts, stop reclining just before the wheelchair user’s shoulders make contact with the back posts. • Using seat and back rest tilt. Participants should first focus on the pelvis and hip PSDs, followed by trunk support, before checking the need for tilt. • If the trunk to thigh angle caused by her posterior pelvic tilt is the same or greater than the trunk to thigh angle caused by her hip not being in neutral (100 degrees), no cushion modification will be needed. Correction of common misunderstandings. Case study 3: Sian • Building-up under the low side of the pelvis. Refer back to the discussion on supporting the pelvis in Session B.8: Prescription (selection) of PSDs – stabilizing the pelvis; Section 3: Problem: Pelvis is in lateral tilt (fixed unlevel pelvis). • Raised seat front position. The raised seat front slope should start directly in front of the pre-seat bone shelf and extend to the front of the cushion. • Adding a rear pelvis pad. Sian is 3 years of age; his lumbar curves will not have developed. A flat backrest is appropriate for children of this age. 154 B.10: Prescription (selection) of PSDs – supporting the trunkTrainer's Manual Children with poor trunk and head control: • A child’s neutral posture has an upright pelvis, flat lower back with a slight bend in the thoracic spine, with the upper trunk leaning slightly forward (Figure 14). • This means that a child’s upper trunk does not make firm contact with a flat backrest. • Children with low muscle strength/poor trunk control will generally find it difficult to keep their upper trunk and head upright. • Some children may need more support. Figure 14. A child’s neutral posture To help a child sit more upright: 1. Add a pre seat bone shelf, open seat to back angle and pelvic strap – assess: • Are they able to maintain this posture? Do they need more support? 2. If they need more support: • Add a tray – assess: – Are they able to maintain this posture? Do they need more support? • Add a shoulder harness – assess: – Are they able to maintain this posture? Do they need more support? 3. If they need more support: Add tilt seat and back (tilt in space) (Figure 16). Figure 15. Open seat to backrest angle Figure 16. Tilt in space 155B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legsTrainer's Manual B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs Errors in the WSTP materials a. Reference Manual for Participants • On page 106 of the Reference Manual for Participants, in the heading “Problem: one or both knees bend and are fixed less than neutral sitting posture”, replace the text in the brackets “‘trunk to thigh angle is more than 90 degrees” with “thigh to lower leg angle is less than 90 degrees”. Guide participants to make this change in their manuals. Key considerations for teaching this session b. Section 3. Supporting the thighs Content Common errors in the activity case studies: • Adding PSDs before first addressing problems with the wheelchair and/ or cushion. Emphasize the importance of basic level wheelchair principles in creating a good foundation for posture. • Not providing enough support for the wheelchair user’s thighs. Hand simulation results indicate where supports are needed and how much support is required. This includes the size, shape and firmness of the PSDs. • Not addressing functional implications of any PSD added to the wheelchair and/ or cushion – such as transfers or propelling of the wheelchair. • Slide 11 on page 169 of the Trainer’s Manual shows an illustration of outside thigh wedges on a cushion with a pelvic well. This is an example of combining more than one PSD on a cushion. Not all cushions that include an outside thigh wedge need to have a pelvic well. • This also applies to slide 15 on page 170, which shows inside thigh wedges with a pelvic well cushion. For more information on pelvic wells, see Key considerations for teaching this session for B.8: Prescription (selection) of PSDs – stabilizing the pelvis. 156 B.11: Prescription (selection) of PSDs –supporting the head, thighs and lower legs Trainer's Manual • Slide 13: Knee separator pad. The height of the cushion increases at the front when a pre-seat bone shelf or raised seat front is added. Depending on the design of the knee separator pad this may affect its position in relation to the wheelchair user’s knees. c. Section 4. Supporting the lower legs and feet Problem: one or both knees bent and fixed less than neutral sitting posture (page 173). • An additional solution (not listed) is to add a raised seat front. This flexes the hips (closes the trunk to thigh angle) and brings the feet forward from underneath the seat. • Sitting with hips bent more than neutral does not increase the risk of developing contractures more than sitting in a neutral posture. However, it is good practice to advise wheelchair users to: – rest out of their wheelchair lying on their stomach to stretch their hips each day – spend time in their standing frame each day. 157B.12: Product (wheelchair) preparationTrainer's Manual B.12: Product (wheelchair) preparation Key considerations for teaching this session a. General Tips for preparation • Trainers need to be familiar with wheelchairs and materials that are locally available. Familiarize yourself during the planning stages of the training programme. If you are not based locally, you can do this by: – asking local services to send information and photographs of available materials – arriving before the training programme starts, with sufficient time to review prepared materials and to search for alternatives if necessary. • Resources required for the training programme may vary in each location depending on: – local manufacturing of garments, shoes or backpacks, which may increase access to different types of fabrics, webbing, buckles, Velcro and EVA – local furniture making and construction industries may increase access to different materials such as timber, plywood, fasteners and steel tubing. • There may be a supply of donated PSD components from international donors. For example, straps, head supports, harnesses or trunk side supports. • Review the information beginning on page 110 of the Reference Manual for Participants for general information about materials and tools, so that you can refer to it during the discussions. • It is helpful to have a trainer with good technical expertise for this session, and to have technical assistance for the product preparation. b. Section 1. Introduction • Consider which wheelchair offers the best features for the environmental and functional needs of the wheelchair user, and whether their fit and posture support needs can be adequately met by adding the required PSDs. Choosing your PSD’s based on the support provided during the hand simulation will give the best solution, as only the necessary posture support features will be provided. • Dedicated posture support wheelchairs can offer more features than the wheelchair user needs. If possible, remove those that are not needed. 158 B.13: FittingTrainer's Manual B.13: Fitting Key considerations for teaching this session a. General • Participants should be familiar with the fitting process from the WSTPb. • Basic level service provision is a linear process (one step after the other). Intermediate level provision is completed in cycles. Participants may need to use the fitting checklist repeatedly as the wheelchair and PSDs are adjusted and modified from the initial prescription (see slide 3, page 182). • If time allows, trainers can make the session more interactive. For example: – Using a volunteer, ask participants to demonstrate items on the checklist that they learned at the basic level check. • Most basic level wheelchair users are able to sit in an upright/neutral posture by the end of the fitting process. At the intermediate level, many wheelchair users will not be able to sit in an upright/neutral posture. Participants may be unsure if they have achieved the best possible posture for the user. If this happens: – Link the findings of the pelvis and hip posture screen and hand simulation to the final posture achieved at the end of the fitting process. • If the final posture does not closely match the posture achieved at the end of hand simulation, it may be due to: – assessment errors in the pelvis and hip posture screen – overcorrection of the postural problems during the hand simulation; which then require adjustment of the final prescription to improve comfort, balance or tolerance of the new posture – a long delay between assessment and final fitting; the wheelchair user’s posture may have changed since the assessment. In this instance, you may need to repeat the pelvis and hip posture screen and hand simulation. 159B.14: User trainingTrainer's Manual B.14: User training Key considerations for teaching this session a. General Tips for preparation • Lead and support trainers should review and practise the skills related to wheelchair mobility and transfers to ensure they are consistent in their approach. • Check that wheelchairs are in working order with all parts attached. • Make sure the wheelchairs chosen match the products in each of the stories as closely as possible. – Joshua: a product with tilt-in-space and anti-tip features. – Sangita: a children’s product (if possible) with quick release wheels, pelvis strap and pads. – Kim Som: a standard wheelchair with cushion and backrest PSDs. b. Section 2. User training – wheelchair user’s stories • Although only one person in each group is designated as the wheelchair service personnel, ask groups to work together to identify each skill that needs to be taught and the correct way to teach it. • The roles are designed to highlight the different aspects of wheelchair user training; it is not expected that only one person will complete the activity. • Closely monitor how the skills are taught. Participants should explain, demonstrate, observe the practice and give feedback. • Check that all the wheelchair features such as folding, removing/fitting removable parts such as rear wheels and trays, are demonstrated clearly to wheelchair users and their families. • It is essential that WSTPi participants understand the features and can demonstrate them competently to the user and / or their family. 160 B.16: Maintenance, repairs and follow upTrainer's Manual B.16: Maintenance, repairs and follow up Key considerations for teaching this session a. Practical follow-up activities Tips for preparation • The training timetable does not include practical follow up sessions. If time allows, trainers can arrange follow up appointments with local wheelchair users, either in a service or home environment. • Have some local wheelchairs available for this session to highlight any learning points or answer questions from participants. • Have a set of common care, maintenance and repair tools available to show participants. b. Section 2. Overview of follow up • All intermediate level wheelchair users will benefit from regular follow up. • Wheelchair users who need more frequent follow up (every 3 to 6 months) include: – children: PSDs must be adjusted to accommodate changes in growth, function (such as head or arm control) and/or posture – wheelchair users with progressive conditions or whose functional abilities or weight are likely to change. • Follow up can be the most difficult aspect of wheelchair service provision, especially follow up in the wheelchair user’s home. This may be due to limited resources for transportation; limited personnel available; or long distances between the service centre and the wheelchair user’s home. • Follow up appointments are very important. They help service providers to: – check that wheelchair users are able to use their wheelchairs safely – check that the wheelchair is working properly – carry out basic maintenance such as pumping up tyres and adjusting brakes – provide additional wheelchair user training – receive feedback on how the service is performing – collect wheelchair user stories that demonstrate the need for the service – understand how the products are being used and if they are appropriate for their environment and intended function. 161B.16: Maintenance, repairs and follow upTrainer's Manual • Where there are barriers to follow up, trainers can lead a discussion to find local solutions (if time permits). These could include: – using community-based organizations to carry out follow up – providing transportation assistance for wheelchair users to attend follow up appointments – creating a community schedule for follow-up, with personnel completing several home visits in one area – arranging follow up appointments when the wheelchair user is already in the area for another appointment, for example a doctor’s appointment. c. Section 3. Wheelchair follow up form • Remind participants that more maintenance and repairs may be required for intermediate level wheelchair users because: – their wheelchairs generally have more parts that can wear out or come loose – some intermediate level wheelchair users have strong spasms or patterns of sitting that can put extra pressure on PSDs. 162 Practicals one to fourTrainer's Manual Practicals one to four Key considerations for teaching this session a. General Tips for preparation Duty of care • Trainers have a duty of care to ensure appropriate wheelchairs, cushions and postural support devices have been provided to wheelchair users who have participated in the training programme. • Wheelchair users should not leave the training programme with a product that the trainer feels is unsafe or not functional for them or their family. If a wheelchair cannot be provided, ensure that another appointment is made with the user’s local service provider to complete the prescription, fitting and user training. • Trainers must identify the service or service personnel who are responsible for following up wheelchair users. All relevant documentation should be provided to the service provider, including assessment and prescription forms. • Trainers must provide wheelchair users with contact details of a local service provider who can provide assistance, repairs and follow up. Wheelchair users • Nominate a liaison person from the host organization or training team. Their role is to: – greet wheelchair users as they arrive for practical sessions – follow up with any wheelchair users who have not arrived for practical sessions – liaise between the service and the training team – identify a suitable area where wheelchair users and their families can wait for their appointments to begin – where food and refreshments are being provided, remind the catering service of everyone’s needs at least one day in advance – ensure photo permissions have been completed before any pictures are taken. 163Practicals one to fourTrainer's Manual Group allocation • Consider how you divide participants into groups to ensure a good learning experience: – It may be helpful to group participants from the same service together and to mix clinical and technical participants. – Consider grouping more confident/talkative participants together and less confident/quieter participants together as they may work at a similar pace. – Think about cultural considerations such as language and whether to have mixed-gender groups for assessments. Supervision of groups during the practical sessions • Allocate specific trainers to each group to help them coordinate practical sessions. • The lead trainer should supervise fewer groups if possible, so that they have enough time to check in with the support trainers. • Give participants the timing for each step in line with the Trainer’s Manual. • Monitor the time and regularly update participants on the time remaining. • Keep groups with the same trainer throughout the practical sessions. b. Practical One: Assessment and prescription (selection) Tips for preparation • Set up the practical area so that each group has enough space to complete their assessments privately. • A screen can be used if private rooms are not available (for example, to look at a pressure sore). • Provide each group with the equipment needed for the assessment and prescription. Assign responsibility to one group member to return the equipment after Practical Three. • Allocate a different team member to lead each part of the assessment and prescription to share the experience between the group members. • Encourage participants to wait for their colleague to finish each section before asking additional questions; the assessment process will flow more smoothly and the focus will stay on the wheelchair user. 164 Practicals one to fourTrainer's Manual Content • Monitor the physical assessment closely and help groups to correct errors that will influence the prescription (for example, errors with the pelvis and hip posture screen, hand simulation or incorrect measuring technique). • Trainers may want to perform the pelvis and hip posture screen independently to verify the participant’s findings. • Ensure that participants follow the sequence on the assessment form. For example, body measurements need to be converted to wheelchair measurements before deciding the wheelchair prescription. • The wheelchair user should be an active participant during the prescription process. Ensure that participants have discussed wheelchair options and features with the wheelchair user before the final prescription is made. • Have sample wheelchairs available to show wheelchair users and family members; this will help them to make informed decisions. • Ask each group of participants to explain the clinical reasoning for their prescription before signing their prescription form. c. Practical Two: Product (wheelchair) preparation Tips for preparation • Refer to the Technical Annex in this manual for more information on how to set up the room for product preparation. d. Practical Three: Fitting and user training • Ensure that sufficient time is allocated for user training; it should not be rushed. e. Practical Four: Assessment, prescription (selection), product (wheelchair) preparation, fitting and user training • Consider organizing participants into different groups to enhance their learning outcomes. • Remind participants to work in a structured manner to complete the first five steps of wheelchair service delivery in the time allocated. • Participants must allocate tasks to all members of their group. For example, during product preparation one person can complete wheelchair adjustments; another can prepare the cushion; and another can prepare PSDs. • Good task allocation will ensure that all steps are completed within the allocated time. 165B.15 and B.17: Putting it all together and Trainer’s feedback, discussion and closing ceremonyTrainer's Manual B.15 and B.17: Putting it all together and Trainer’s feedback, discussion and closing ceremony Key considerations for teaching this session Tips for preparation • Allocate a trainer to download and organize the before and after photographs needed to illustrate each presentation. This task should be done during a break. • Display before and after photographs side by side as an effective way of showing the impact and outcome of the fitting. Content • Allocate support trainers to help the groups prepare. • Tell participants that you will give them 5 and 1 minute warnings to ensure that each presentation is limited to 10 minutes. • Some participants may need support when choosing which information to include in their presentation. Use the Putting it all together section on page 49 of the Participant’s Workbook as a guide. • During the presentation and facilitation, trainers should highlight: – the link between the pelvis and hip posture screen, hand simulation and the final posture achieved – the link between the supports identified during hand simulation and final PSDs selected – how the selected wheelchair features meet the wheelchair user’s environmental and functional needs. • Facilitate discussion about the case studies presented, ensuring that questions and feedback from the group are balanced and focused on key assessment findings and interventions. • In less-resourced settings there is a limited range of wheelchairs and PSDs available. • Compromises are always necessary, it is a matter of finding the right balance between achieving the best possible outcome for the wheelchair user and keeping them safe at all times. 166 Logistics and PreparationTrainer's Manual Logistics and Preparation Notes for ToT trainers: • This session is not for presentation or discussion. It is included in the ToT Handbook as background information for trainees. Trainees will be exposed to logistics and preparation issues during co-training experiences where they can raise questions with trainers. The Trainer’s Manual includes a comprehensive list of facilities, printed resources, materials and equipment needed to successfully organize a WSTPi training programme. The trainer coordinating the training programme will usually liaise with the local host to decide who takes responsibility for each aspect of the logistics and preparation. The trainees will gain experience and skills in handling logistics and preparation tasks during their co-training. The trainer coordinator will divide up these activities among trainees and then monitor and support them. Facilities A full list of facilities needed is included on page 14 of the Trainer’s Manual. Translation services may be needed if the WSTPi trainers do not speak the same language as participants. These services are usually in high demand and should be booked well in advance. Costs will need to be added to the training budget. Printed resources Materials must all be printed locally. A full list of printed resources needed for the WSTPi can be found on pages 15–16 of the WSTPi Trainer’s Manual. Use the checklist in the Trainer’s Manual to ensure that you have printed the correct number of materials. Materials and Equipment A list of materials and equipment needed for the WSTPi can be found on pages 17–18 of the WSTPi Trainer’s Manual. 167Logistics and PreparationTrainer's Manual Wheelchairs The Trainer’s Manual, at the top of page 18, refers to examples of locally available wheelchairs and cushions. If there are many different wheelchairs available, select a range of the most commonly used models. If possible, include a floor seat for infants. Do not include motorized wheelchairs as these are not covered in the WSTPi. Ensure that all wheelchairs are in good working order (tyres pumped up and bolts tightened) and have a cushion. There should be a wheelchair, cushion and postural supports – or materials to make cushions and postural supports – for each wheelchair user who attends the practical sessions. Technical work area A technical work area with a variety of tools and materials needed for modifications should be made available or created. This may have budget implications for the training. Power supply Where there is unreliable electricity, a generator with an in-line uninterruptible power supply (UPS) should be arranged for back-up. This also needs to be added to the equipment list on page 17 of the Trainer’s Manual. Planning for training The most important activities and approximate timelines for planning a WSTPi training programme are listed here. 8 to 12 months in advance • Develop a budget for the training programme. • When multiple partners are involved, agree on the responsibilities of different partners. • Identify dates, a venue, trainers, participant profiles and information on the local context such as: general policies and procedures that guide local wheelchair practice and services; types of wheelchairs, cushions and other materials available; information on local culture and diversity of the participants; and organizations involved. 168 Logistics and PreparationTrainer's Manual • To work out how many days are required for the training, confirm start and finish times for each day and whether translation will be required. 4 to 6 months in advance • Send invitation letters to each participant with details of the training programme (dates, venue, logistical information) to complete and return. • Gather information on the professional background and skills of participants so that you can adapt session plans accordingly. • Book training equipment. • Source demonstration equipment and other resources needed for the practical sessions, such as treatment beds, foot supports, and transfer boards. • Source consumables. • Source equipment for users (if user equipment is dependent on donor funds and/ or part of the training budget, sourcing equipment may need to start earlier). • Brief trainers on the context and participants, and agree on the division of sessions and roles. • Book catering services. • Arrange for translators and translation facilities if needed. 4 to 6 weeks in advance • Arrange for local printing of all necessary materials. • Screen and invite wheelchair users. • Finalize registration details: for example, arrange for name tags and registers; and liaise with whoever will carry out the registration. • Send final written confirmation/pre-course information to participants, wheelchair users and trainers. • Confirm caterers, venue and other logistics. 1 to 2 weeks in advance • Confirm that any ordered items have been delivered. • Check toilets, water and electricity supply at venue. • Confirm cleaning schedules. If the training team is not local, it is best to arrive a few days before the programme begins to check the equipment and the venue; meet with wheelchair users supporting the training programme; and to buy any remaining materials required. Regular communication will be needed between the coordinating trainer and other trainers, the host organization and other organizations involved. 169Logistics and PreparationTrainer's Manual Wheelchair users During the WSTPi, there are four practical sessions in which two groups of wheelchair users participate. The first group attends on two different days. Before the training programme, trainers need to identify and invite wheelchair users who are willing and able to attend the practical sessions. There is a checklist on page 11 of the Trainer’s Manual that helps to identify appropriate wheelchair users. Liaise with the host organization and training organizers regarding budgets and facilities available for wheelchair users. Find out if transport will be provided for wheelchair users or whether they will be reimbursed for costs. If wheelchair users are only able to attend on one day, the programme can be rearranged to accommodate Practical One and Practical Two for user group one on the same day. When adjusting the timetable, make sure service steps 2–7 have been covered before Practical Three. Where possible, trainers should screen wheelchair users in person. If trainers are not based locally, a local service provider can be asked to identify potential wheelchair users and send photos and information in advance for trainers to confirm their suitability for the training level. Invitations to wheelchair users When drafting invitations to wheelchair users think about the following issues (a template is available on the WSTP Pen Drive): • A description of what will happen when they attend the session. • The time, date and the duration of the session. • Can they bring someone with them? • Will they receive a wheelchair at the session? What happens if they need follow up or have any problems with the wheelchair? • Where will they receive follow-up services after the training? • How will they get to the venue? Will their transportation costs be reimbursed? • Do they have to bring refreshments and lunch? • Will they receive payment for attending? 170 Logistics and PreparationTrainer's Manual Each wheelchair user should receive an invitation letter with this information in writing. They should also sign a consent form to indicate their willingness to take part and to be photographed. The photographs are used when the small groups present back to the rest of the group. Despite careful planning, a wheelchair user may arrive with a pressure sore or fall ill on the day of the session. Discuss this possibility in advance with the host organization so that they are ready to manage the situation if it arises, and can arrange for a back-up wheelchair user to attend. If a wheelchair user has a bladder or bowel accident during the session, have supplies ready to clean the user and the equipment. Also, a small first aid kit should be available in case of bumps and scrapes to both participants and wheelchair users. 171AnnexesTrainer's manual Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equip- ment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 172 AnnexesTrainer's manual Annex 2: WSTPtot Intermediate Level Timetable Day one Day two Day three 8:30 Introduction B.5: Physical assessment – taking measurements B.10: Prescription (selection) of PSDs – supporting the trunk part II8:45 9:00 B.2: Physical assessment – sitting posture without support B.10: Feedback part II 9:15 B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs 9:30 B.5: Feedback 9:45 B.8: Prescription (selection) of PSDs – stabilising the pelvis10:00 Morning break 10:15 B.2: Physical assessment – sitting posture without support continued Morning break Morning break 10:30 B.8: Prescription (selection) of PSDs – stabilising the pelvis continued B.11: Prescription (selection) of PSDs – supporting the head, thighs and lower legs 10:45 B.2: Feedback 11:00 11:15 B.3: Physical assessment – pelvis and hip posture screen ToT Trainer demon- stration session 11:30 B.8: Feedback B.11: Feedback 11:45 B.9: Prescription (selection) of PSDs – supporting the hips B.12: Product (wheelchair) preparation 12:00 12:15 12:30 Lunch break B.9: Feedback 12:45 Lunch break B.12: Feedback 1:00 Lunch break 1:15 1:30 B.3: Physical assessment – pelvis and hip posture screen continued1:45 B.10: Prescription (selection) of PSDs – supporting the trunk part I2:00 B.13: Fitting Afternoon break 2:15 B.4: Physical assessment – hand simulation 173AnnexesTrainer's manual 2:30 Afternoon break 2:45 Afternoon break B.10: Prescription (selection) of PSDs – supporting the trunk part I continued 3:00 B.4: Physical assessment – hand simulation continued B.13: Feedback 3:15 Afternoon break 3:30 B.4: Feedback ToT Trainer individual feedback 3:45 Car park 4:00 Session preparation ToT Trainer individual feedback B.10: Feedback part I 4:15 Car park 4:30 Session preparation ToT Trainer individual feedback Closing ceremony 4:45 5:00 5:15 174 AnnexesTrainer's manual Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 175AnnexesTrainer's manual Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 176 AnnexesTrainer's manual Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 177AnnexesTrainer's manual Annex 4: Technical annex WSTPi This annex aims to help trainers prepare for WSTPi practical sessions. At an intermediate level building an appropriate wheelchair becomes more complex; hands-on training is more demanding and it is important to understand the crucial role of the technician. At the planning stage trainers need to think about tools and materials, and how to get experienced technical support for training sessions. It is also important to encourage more technicians to train at an intermediate level to support the service. The technical role in intermediate level service provision As part of its suite of training programmes, WHO teaches seating principles and gives examples of postural support devices (PSDs) that are intended to be applied to a range of different wheelchairs. It is the clinician’s role to assess the user, prescribe (select) and communicate which PSDs are required. It is the technician’s role to understand how to build a wheelchair that will achieve the final postural support needed; that is practical, safe, durable and as easy to use as possible, using the wheelchairs, tools and equipment, materials and parts that are available. At basic level the technician’s role is clearly defined as assembling and adjusting the wheelchair to suit the user; the process is more linear and the role simpler. As well as assembling wheelchairs, a technician working at an intermediate level needs to: • be more involved with the user and the clinician throughout the process • be able to problem solve more independently • easily imagine and orientate three-dimensional shapes • have the technical skills to make appropriate PSDs from a range of materials and parts. Teamwork and good communication with the clinician is very important. The role of the technician extends to maintaining a safe working environment in the workshop and looking after tools and equipment. As the clinical/technical team gradually gain experience and have exposure to wheelchair users with more complex postural support needs, they will challenge and improve their skills. An experienced technician learns to understand the limits of what can be safely achieved with the available resources. It may be possible to make a complex PSD, but that doesn’t guarantee that it will be an appropriate, safe or durable solution for the user and their family. For example, a PSD that supports the 178 AnnexesTrainer's manual user well but is made from materials that are not durable or are attached insecurely, is only going to last a short time and is therefore not an appropriate solution. Training more technicians The WSTPb and WSTPi are intended to increase both the quantity and quality of practitioners providing wheelchairs in less-resourced settings. Assembly and adjustment is very specific to each type of wheelchair, which is why this information is not included in the training packages and is often covered separately by the organization delivering the training. Involving technicians as participants in the WSTPi is very beneficial. The more they understand about the eight wheelchair service steps, the better technical support they can give. Some organizations train technical and clinical personnel at the same time, but require them to achieve different competencies at this level depending on what their on-going role in service provision will be. Each service provider or training organization will need to identify the best way to support technicians to develop intermediate level capacities to help meet more complex needs. The role of technicians in WSTPi training Trainers are encouraged to have at least one experienced intermediate-level wheelchair technician available to assist during WSTPi practical sessions. This is particularly important if you plan to make PSDs, and are not using off the shelf or pre-fabricated PSDs. Include an experienced intermediate level technician and/or technical trainer on the training team throughout the course to deliver technical content and answer technically-related questions about wheelchairs and PSDs. Setting up the training room for practical sessions Making PSDs requires care and time, so trainers and technicians must be well organized to keep to the timetable. You might want to consider making some common PSDs in advance. 179AnnexesTrainer's manual The following suggestions will help you to set up a safe, well-organized training workshop: • Arrange a separate temporary space which: – is close to the clinical training room – has enough light and is well ventilated – has enough space for each technician to have a work bench or strong table – has space for a separate work bench for glueing in a well-ventilated location – has a separate area set aside if using power tools and machinery. • An untidy workshop is unsafe and will increase the risk of accidents. Tidy the space at the end of every day, putting tools away and sweeping floors. • Protect the surface of benches and tables with cardboard. This is particularly important when cutting and glueing foam. • Left-over foam off-cuts should be separated from general waste and kept in boxes. Participants should be encouraged to use off-cuts first, before cutting into new foam. • When working with a technical team, or training technicians, assign specific responsibilities to each of them. For example make a technician responsible for a specific tool kit, ask them to collect all the tools at the end of each day and check the tool kit is complete before leaving. Standing frames There are many designs of standing frames and they can be made locally. Before prescribing a frame, service personnel need to fully understand the wheelchair user’s standing posture and the different ways to support them in an upright position. It is important to follow the guidance on page 45 of the WSTPi Trainer’s Manual. There are three main technical issues to consider: • Strength – A standing frame needs to be strong enough to safely support the body weight of the user. The joints and lengths of material that make up the frame must be strong enough and connected securely together. The person might move around so consider the force that this will put on the frame. Test the strength and stability of a new device before use. 180 AnnexesTrainer's manual • Stability – It is important that a standing frame remains completely stable while in use, including when the user is getting into position and when standing up. This is usually achieved by having a wide base of support on the ground. • Safety and comfort of support surfaces – Make sure there is no direct pressure on the knees. The support surfaces of the frame that come into contact with the body should be padded just like a pressure relief cushion. Further considerations: • Frame design should allow for easy access when approaching in a wheelchair. • Some degree of height adjustment to the hip, knee, pelvis and trunk support will be needed to accommodate wheelchair users of different heights or ages. • A flat surface such as a tray or table should be included, to enable activities while standing. Foam Two measures are used to assess the quality of polyurethane (PU) foam: • Firmness − the degree of support provided. Firmness is often confused with density, but is a different property. Firmness is a physical property of the finished foam and is controlled by the chemistry of the foam during the production process. The firmer the foam, the harder it is to compress. The firmness of the foam can be measured by recording the amount of force needed to compress the foam. • Density − a measurement of the mass (weight) per unit volume expressed in kilograms per cubic metre (kg/m3). Density is a function of the chemicals and additives used to produce the foam and affects the foam’s durability. Typically, the higher the density, the better the foam will retain its properties and provide support and comfort over a longer period. 181AnnexesTrainer's manual Foam testing device Use the foam testing device below (Figure 1) to carry out a simple compression test to calculate firmness of a foam sample. Measured in kilograms the results can be compared against a benchmark and other available foams. The foam testing device consists of two metal parts, that are shown from different angles here: Figure 1. Foam testing device These parts are suspended from a weighing scale or spring balance (Figure 2). 182 AnnexesTrainer's manual Figure 2. Compression testing procedure The procedure for 50% compression testing is as follows: Step 3.Weighing scale 1. Cut the 50 x 50 x 50 mm foam sam- ple as accurately as possible and punch a 6.5−7.5 mm hole in the centre. Step 1. Foam sample ready for testing 2. Hang up the scale or spring balance; do not hold it. 3. Place sample in testing device and hang from scale or spring balance. 4. Check that scale reads zero. 5. Push down evenly on the top plate only, compressing sample to 50%. Note 25 mm marks on testing device. Step 5. Push down on the top plate only 6. Record weight in kg. 183AnnexesTrainer's manual Testing notes • Take at least three measurements and average the results. To minimize error the same person should take all the measurements. • When testing samples cut from moulded foam do not include any external foam skin. Guidelines for the use of different types of foam The following numbers are intended as guidelines only; it is always recommended to prototype and user-trial any new PSD or Pressure Relief Cushion which uses foam. Firmness test results were produced using the testing procedure outlined previously Name Application Density 50% compression test (kg) Medium PU foam Comfort layer : top cushion layer, surface layer 30 kg/m3 to 60 kg/m3 2.2 to 3.5 kg* Firm PU foam Supportive layer : base layer,** contours, cushion wedges (under comfort layer) 30 kg/m3 to 60 kg/m3 3.5 to 5.8 kg PU: polyurethane. * This acceptable range of kg includes a variation in test results of ± 0.3 kg. ** Chip, composite, re-bonded or bonded foam can also be used, but can vary in firmness because it is an industry waste product. Foam shapes for temporary support and PSD simulation A range of firm foam blocks and wedges are useful for training. In addition to the basic blocks used for temporary support, other shapes can be used to help simulate different options in the wheelchair user’s chair. For example: • Adding a wedge of foam to the front of the backrest to simulate an open seat-to- backrest angle. • Adding extra foam to the pelvis side pads to simulate a narrower seat width. • Adding foam to the seat to simulate outside thigh wedges. • Adding foam blocks together to simulate different angles for a lowered seat front one side. 184 AnnexesTrainer's manual In some situations where the user’s postural support needs are very complex, it may be necessary to first finalize the size, shape and location of PSDs by making them with a less expensive material. Once the final prescription (selection) for the PSDs has been agreed, they can then be made using better-quality foam. Commonly available foam thicknesses are: 25 mm or 35 mm. Thinner foam (such as 10 mm or 15 mm) may be useful for very small children or when only slight increments of change are required, for instance when constructing a build-up under pelvis. Thinner foam may need to be cut from thicker foam. When doing this it is important to have the best quality foam available and a very sharp knife. Illustrations below (Figure 3) show sample basic foam shapes; dimensions can be adjusted to suit the context. For example, common sizes for adult temporary supports are 200 x 200 mm and for children, 200 x 100 mm. Figure 3. Suggested dimensions (in mm) of the basic foam shapes for temporary supports 185AnnexesTrainer's manual Wedges of various dimensions and thicknesses are very useful for training purposes. The illustrations below (Figures 4−8) show sample foam wedges; dimensions can be adjusted to suit the context. Common thicknesses are 35 and 50 mm, common lengths range between 100 and 200 mm. Figure 4. Sample foam wedges 186 AnnexesTrainer's manual Figure 5. Example use of temporary supports Figure 6. Example use of wedges to simulate a lowered seat front on one side Figure 7. Example use of outside thigh wedges 187AnnexesTrainer's manual Figure 8. Example of open seat-to-backrest angle wedge and pre-seat bone shelf Advantages and disadvantages of seating simulators A seating simulator is a device that clinicians and technicians sometimes use to simulate the posture that a wheelchair user will adopt, before preparing the final wheelchair. They are specifically designed to be adjustable in every way necessary to support the user. The simulator is used at the end of the assessment process, after the hand simulation, to inform the wheelchair prescription. There are advantages and disadvantages of using seating simulators: Advantages • Less waste − Seating simulators can minimize wastage (and therefore recurring service costs) because the wheelchair and PSDs are only prepared after the user’s final posture has been achieved in the simulator. • Save time − Seating simulators can save experienced clinicians’ and technicians’ time when fitting the wheelchair and PSDs, as the final posture is already known before the wheelchair is prepared. 188 AnnexesTrainer's manual Disadvantages • Short cuts − Less experienced personnel may use the seating simulator as a short cut instead of performing a full assessment and hand simulation process to determine the postural supports needed. It might also limit the type of postural supports considered to include only those on the seating simulator. This could result in the user not achieving their full postural potential in the final wheelchair. • Skilled technicians – It takes technical skill to design and make a safe and durable seating simulator. It also takes skill to translate the support provided by a seating simulator into the final wheelchair and PSDs. It is particularly challenging if the service uses a range of different wheelchairs that provide postural support in various ways. • Cost – The initial one-off cost to buy seating simulators may be high but could be offset against savings made later in recurring service costs. It may also be possible to reduce the costs by converting a wheelchair (and PSDs) commonly used by the service into a seating simulator, by modifying it and adding adjustments. • Heavy and large – Seating simulators are often larger and heavier than the final wheelchairs. This makes it more difficult to travel with them away from service centre. Introducing the total seat depth tool There are two postural support devices (PSDs) that are placed behind the pelvis. It is important to understand the space that they take up in the wheelchair before deciding whether the user will fit in comfortably as well, or whether a different wheelchair is needed. Here is a simple tool to help work out the total seat depth (including the thickness of either an open seat-to-back angle triangle or a rear pelvis pad) using measurements from the intermediate assessment form: 189AnnexesTrainer's manual Figure 9. Calculating total seat depth Wheelchair & PSDs Dimensions (mm) Support behind pelvis: (Z) Height of triangle or (9) Height to midpoint (Y) Thickness (3) Seat depth (3 + Y) Total seat depth If the chosen wheelchair is big enough to accommodate the total seat depth, then it will fit the user’s seat depth and their PSDs will fit into the seat. (3) (Y) (9) (Z) (Y) Open seat-to- back angle:  Rear pelvis pad:  (3) Product preparation Product preparation at an intermediate level involves the assembly of intermediate wheelchairs and the fabrication of PSDs. More problem solving is required than at the basic level, which is a straightforward process of assembling wheelchairs. Understanding what shape is required to support the user’s posture and then making an appropriate PSD, often requires imagining and orienting three-dimensional shapes. This process is made easier by using the drawing tool on the Intermediate prescription form, which has ‘shadow’ lines (Figure 10). After defining the size and shape of the proposed PSD, the technician decides how to make it and which materials to use. It is important that the final PSD is practical, safe, durable and as easy to use as possible. The technician’s role is easier when the user is smaller, has fewer postural issues and is using an adjustable seating product that incorporates various PSDs. However, the task becomes more challenging when the user is larger, has a combination of complex postural issues and makes strong, uncontrolled movements. A great deal more skill, technical knowledge, time, materials and parts, and problem solving ability is needed to fabricate appropriate PSDs for these users. The technician needs to be familiar with how to assemble each type of wheelchair available to them. The way that PSDs are made and attached differs from one type of wheelchair to another. The technical role is different if a dedicated posture support wheelchair with built-in adjustable postural supports is available, compared to working with an orthopaedic style or other manual wheelchair. Figure 10. Intermediate prescription form drawing tool 191AnnexesTrainer's manual Despite the differences in the wheelchairs, the different methods of making PSDs and the individual nature of each user’s seat; there is a general order for product preparation: 1. Seat depth – Just as clinicians are taught to start with the pelvis and work outwards, so a technician should start with the PSDs that support the pelvis. Using the total seat depth tool will make it easier to prescribe (select) the most appropriate size of wheelchair or seat. Next, the technician can make the pre- seat bone shelf (and any other PSDs on the seat such as lower seat front one side, or raise seat front). If the PSDs on the seat are being made from foam, use the minimum amount of glue necessary to hold them in place for the first fitting, as their size and location are likely to change (particularly during training). 2. Pelvis strap – As a starting point, the pelvis strap should be fitted between 60 and 90 degrees to the seat, at approximately the same location as the pre-seat bone shelf. 3. Pelvis side pads or seat width − It is important to work out how the seat will support the user’s hips, to prevent them from sliding sideways. In many situations a bracket and pad will be used. 4. Remaining seat PSDs − On some wheelchairs it is necessary to attach all remaining PSDs that are going to be added to the seat, for example any hardware needed for mounting a knee separator pad, before moving on to other parts of the wheelchair. After the seat is complete, technicians can work outwards towards the head and feet: 5. Backrest − The height of the backrest should be set and any backrest-mounted PSDs should be attached. 6. Head support − If a head support is required, set it and make any other adjustments necessary. 7. Footrests − The height, angle and position of the footrests should be set. PSDs such as foot wedges, foot build-ups, ankle or foot straps will often need to be repositioned during the first fitting. 8. Shoulder harness − If a harness is required, the uppermost end should be attached level with or above the user’s shoulder. Harnesses attached below the top of the shoulders will tend pull the user’s shoulders down. 192 AnnexesTrainer's manual It is important that every wheelchair is safe for the user to sit in for each fitting. The technician and clinician need to make a judgement about this, paying particular attention to areas at risk of pressure sores, or PSDs that are being used but are not completely finished. The Safe and ready checklist should be used, however some parts of the wheelchair do not need to be 100% complete for the first fitting. For example: • The fabric upholstery can be left off. • Attach foam parts with ‘spots’ of glue rather than full coverage so that they are easier to separate if changes are required. • If the team is unsure whether a particular PSD is required or not, it is acceptable to leave it off and make a decision during the first fitting; for example, trunk side wedges or a shoulder harness. • Attach the footrests according to the body measurements that were taken, but leave ankle or foot straps off until the user is sitting in the wheelchair and the final location of the footplates is set. • If fitting a tray, leave it until the user is sitting in the wheelchair in their final posture before adjusting it. Because it is not safe, do not: • leave frame bolts loose • leave bolts attaching the rear or castor wheels, push handles, seat, backrest, brakes or any PSDs loose • leave sharp edges unfinished or exposed. After the final fitting, the wheelchair and PSDs should be checked and signed off by one of the trainers. This should happen before the team completes final finishing such as full coverage glueing (for all remaining ‘spot’ glued foam), finalizing the upholstery, or painting/varnishing components. A comprehensive Safe and ready check must be completed before the user and their family leave with the wheelchair. 193AnnexesTrainer's manual Additional technical resources Resource Content/page references Guidelines on the provision of manual wheelchairs in less resourced settings • Wheelchair design and production-related information, including testing, page 37–65 WSTPb Reference Manual for Participants • Making a pressure relief cushion, page 57−60 WSTPi Reference Manual for Participants • How to make PSDs, page 112−128 WSTPm Additional Resources for Managers • Information to support managers developing services, including information about technical resource management

196 AnnexesTrainer's manual For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/

DR AF TWhe elchair Service Training O F TrainerS Package Basic LeveL Trainer’s Manual For more information, contact. World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/ DR AF T Wheelchair Service Training O F TrainerS Package Basic LeveL Trainer’s Manual Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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Wheelchair service training of trainers package. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology The following terms used throughout the WsTPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainee in specific WSTPb/i/ m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms The following acronyms used throughout the WsTPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package c O N T eN T s x About the Wheelchair Service Training of Trainers Package xiii 1. Guidance notes for ToT trainers xvii 2. How to prepare to deliver the training package 1 Core training skills module 2 ToT.1 introduction to the Wheelchair service Training of Trainers Package 13 ToT.2 Wheelchair service Training Packages 26 ToT.3 Practice delivery sessions 37 ToT.4 Preparing for diversity 44 ToT.5 adult learning 56 ToT.6 Preparation time 59 ToT.7 Presenting and facilitating 68 ToT.8 communication skills 76 ToT.9 Knowledge of guiding documents 93 ToT.10 audio-visual tools and equipment 104 ToT.11 Feedback 110 ToT.12 Managing group dynamics 118 Basic Level module 119 a.1: Wheelchair users 120 a.2: Wheelchair services 121 a.3: Wheelchair mobility 125 a.4: sitting upright 127 a.5: Pressure sores 129 a.6: appropriate wheelchair 132 a.7: cushions 137 a.8: Transfers 141 B.1: Referral and appointment 142 B.2: assessment 143 B.3: assessment interview 144 B.4: Physical assessment 151 B.5: Prescription (selection) 153 B.6: Funding and ordering 154 B.7: Product (wheelchair) preparation 156 B.8: cushion fabrication 158 B.9: Fitting 159 B.10: Problem solving 164 B.11: User training 165 B.12: Maintenance and repairs 167 B.13: Follow up 168 B.14a: Practicals one to four 172 B.14: Putting it all together 174 Logistics and preparation 179 Annexes 179 annex 1: Timetable for WsTPtot core sessions 180 annex 2: WsTPtot Basic Level Timetable 182 annex 3: Feedback sheet for WsPTtot practice delivery sessions 185 annex 4: cushions annex 190 annex 5: Updated Wheelchair assessment Form x about the Wheelchair service Training of Trainers PackageTrainer's Manual about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United states agency for international Development (UsaiD) developed a series of four training packages to increase wheelchair access in developing countries. The Wheelchair Service Training of Trainers Package (WsTPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. The need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WsTPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. The WsTPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WsTPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WsTPi) 2013; the Wheelchair Service Training Package for Managers (WsTPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WsTPs) published in 2015. The WsTPm and WsTPs have been combined into one package-specific module within the WsTPtot. The WsTPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WsTPtot, a trainee should go forward to deliver their training package alongside an experienced trainer, allowing them to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiabout the Wheelchair service Training of Trainers PackageTrainer's Manual Target audience The WsTPtot is made up of four modules: • Core training skills – two days • Basic Level (WsTPb) – three days • Intermediate Level (WsTPi) – three days • Managers and Stakeholders (WsTPm/s) – three days. all trainees should complete the Core training skills module followed by one of the package-specific modules: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WsTPb. Previous experience providing basic-level wheelchairs is essential; the WsTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WsTPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WsTPi. Previous experience providing intermediate-level wheelchairs is essential; the WsTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WsTPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WsTPm and WsTPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the WSTPtot Managers and Stakeholders module. Trainees should have access to co-training opportunities within three months of completing the WsTPtot in order to consolidate and practise newly acquired skills. xii about the Wheelchair service Training of Trainers PackageTrainer's Manual Trainers Skills: The ToT trainers delivering this package should have: • significant experience delivering the WsTPb and mentoring others to deliver them • a good understanding of the context in which they are delivering the WsTPtot • knowledge of international guiding documents related to wheelchair provision • the experience and ability to engage stakeholders in discussions about wheelchair provision. Wheelchair users: as with the other WsTP, inclusion of wheelchair users in the training team is highly recommended. Wheelchair users can draw on their own experiences to give a valuable perspective on how appropriate wheelchair provision affected their feeling of inclusion and quality of life. They can also talk about the central role wheelchair users play in the selection of their own wheelchair. number of ToT trainers: Trainees need to be closely supported, so it is recommended that there is one ToT trainer for every four to five trainees for the Basic and Intermediate modules, and one ToT trainer for every six trainees for the Managers and Stakeholders module. how to get started Before running the ToT programme, copy the WsTPtot folder from the WsTP Pen Drive to your computer’s hard drive. • Read 1. Guidance notes for ToT trainers below. Prepare materials in the tables on pages xviii-xxiv. • Make all the necessary arrangements, as described in the section How to prepare to deliver the training package. • Give each trainee a full set of the training materials listed on pages xviii-xxii of this manual. xiii1. Guidance notes for ToT trainersTrainer's Manual 1. guidance notes for ToT trainers Training overview Core training skills module Minutes Day ToT.1 Introduction to the Wheelchair Service Training of Trainers Package 75 D ay 1 ToT.2 Wheelchair service training packages 90 ToT.3 Practice delivery sessions 60 ToT.4 Preparing for diversity 60 ToT.5 Adult learning 85 ToT.6 Preparation time 15 Preparation 45 ToT.7 Presenting and facilitating 60 D ay 2 ToT.8 Communication skills 90 ToT.9 Knowledge of guiding documents 75 ToT.10 Audio-visual tools and equipment 45 ToT.11 Feedback 45 ToT.12 Managing group dynamics 40 Preparation 75 Basic Level module A.1 Wheelchair users 35 D ay 3 A.3 Wheelchair mobility 120 A.4 Sitting upright 55 A.5 Pressure sores 70 A.6 Appropriate wheelchairs (part 1) 45 Session preparation, ToT trainer individual feedback 75 A.6 Appropriate wheelchairs (part 2) 88 D ay 4 A.7 Cushions 85 A.8 Transfers 90 B.3 Assessment interview 100 Session preparation, ToT trainer individual feedback 60 xiv 1. Guidance notes for ToT trainersTrainer's Manual Basic level module B.4 Physical assessment 95 D ay 5 B.5 Prescription 135 B.7 Product preparation 45 B.9 Fitting 70 B.13 Follow-up 40 Evaluation 15 Closing ceremony 15 Total training time 2100 Training package timetable and duration The WsTPtot Core training skills and Basic Level modules can be delivered on consecutive days or in blocks over a period of time. a sample five-day timetable is available in the WsTPtot folder on the WsTP Pen Drive. ToT trainers are encouraged to adapt and modify the timetable to suit the local context and the learning needs of trainees. Core training skills session plans The Core training skills module is made up of 12 sessions that each begin with a detailed session plan. The plan covers the following key points and is designed to help ToT trainers organize and deliver the sessions. • aim – what is the aim of the session • Learning objectives – what will trainees have achieved by the end of the session • Resources – what resources are needed for the session • To prepare – checklist to help the ToT trainer prepare for the session • Outline – the main contents of the session with timing. ToT trainers are encouraged to bring their own knowledge, skills and style to the sessions and to draw out the trainees’ experience throughout the WsTPtot. xv1. Guidance notes for ToT trainersTrainer's Manual WSTPb session plans after completing the Core training skills module, trainees go on to the second part of the WsTPtot where they will practise the training skills they have learnt by delivering sessions from the WsTPb. sessions are allocated to trainees and their delivery is followed by feedback and discussion. The practice delivery sessions allow the ToT trainer to observe and assess the trainees’ skills. • Practice delivery: each practice delivery includes presentations of allocated sections of a session by the trainee. • ToT trainer demonstrations: some sessions include a section that the ToT trainer will deliver as an example of good practice. • Feedback: after the session, the ToT trainer will facilitate feedback from the trainee and the ToT participants. Further instructions for providing feedback can be found on page xxiii–xxiv of this manual, Guide to facilitating practice delivery sessions. Prepare trainees for practice deliveries To enable trainees to prepare well for the WsTPtot, it is important to give them the WsTPb materials in advance. This can be a paper copy of the package, an e-copy or a link to download it. Trainees should be prepared to deliver any of the sessions. a sample letter for trainees to prepare for the WsTPtot can be found in the WsTPtot folder on the WsTP Pen Drive. Practice delivery allocations example practice delivery allocations can be found in the WSTPtot Basic Level allocation document in the WsTPtot folder. ToT trainers should modify this to their training context and trainee numbers. Practice delivery sessions are assigned during the first day of the Core training skills module in session ToT.3 Practice delivery sessions. Note: If trainees have already attended the Core training skills module and will begin directly with the WSTPb module, they should be notified of their practice delivery sessions two-to-three days in advance. xvi 1. Guidance notes for ToT trainersTrainer's Manual Mentoring and peer support The ToT trainer has an important role to play as a mentor. each trainee must be allocated a mentor ToT trainer at the beginning of the training programme. ToT trainers should divide trainees equally between them. as a mentor the ToT trainer is the trainee’s main point of contact for questions about their practice delivery sessions and is also there to provide feedback on the trainee’s progress. ToT trainers are encouraged to continue to mentor trainees after the WsTPtot. Trainees can also get valuable ongoing support from their peers, which will help them to develop their skills and confidence. Trainees may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. co-training after completing the WsTPtot, trainees should continue to develop their skills by co-training alongside experienced trainers. ToT trainers should promote co-training experiences as the best way for trainees to continue to develop their training skills after completing the WsTPtot. The recommended ratio for co-training is one mentor trainer for every two to four co-trainers. in some cases, ToT trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. This information should be recorded in the feedback from practice deliveries and shared with the trainee. evaluating the ToT programme after each delivery it is good practice to evaluate every training programme after it has been delivered. ToT trainers should gather regular feedback from trainees and record their own thoughts during the ToT programme. This will help ToT trainers to improve both the WsTPtot and their own training skills. it is very helpful if you can provide feedback and data including: • participant registration and evaluation forms • your reflections or comments on the WsTPtot. Training programme evaluation forms are available in the WsTPtot folder on the WsTP Pen Drive and can be adapted by ToT trainers to meet their specific needs. xvii2. How to prepare to deliver the training packageTrainer's Manual 2. how to prepare to deliver the training package know the background of each trainee it is important to be familiar with the background of each trainee. This includes: • understanding what experience the trainee already has in wheelchair provision • being aware of any training programmes the trainee has already attended or delivered • knowledge of future opportunities for the trainee to deliver the WsTPb. Find out how wheelchair service delivery and training fits within the trainee’s overall duties at their place of work. Prepare the training facilities To run the WsTPtot you will need: • one large training room (or space) that is big enough to allow trainees to divide up and work together in small groups and quiet enough to enable trainees to concentrate • a separate space for lunch/refreshments • clean toilets all areas, including toilets, must be wheelchair accessible. xviii 2. How to prepare to deliver the training packageTrainer's Manual The following checklist can be used to assess and prepare training facilities. Facilities checklist Training room Lecture area  Chairs for each trainee with a flap-tray or other facility so trainees can write notes  Space for trainees to break into small groups of two-to-four people  Space to display at least three wheelchairs and be able to move them around  Adequate lighting and ventilation  Lockable/secure space  lunch/refreshment area Clean area for eating  Tables and chairs  Nearby space for washing hands – clean towels and soap  Toilets Clean toilets supplied with water, toilet paper, washing facilities and bins  Prepare the training resources and equipment WSTPtot printed resources resource Quantity X comments/instructions Manuals ToT Trainer’s Manual 1 per ToT trainer (for each module delivered)  Print and bind. ToT Handbook 1 per trainee (for each module delivered) and 1 per ToT trainer  Print and bind. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 1 per trainee  Print and bind or provide a soft copy. United Nations Convention on the Rights of Persons with Disabilities (CRPD) 1 per trainee  Print and bind or provide a soft copy. Set of printed resources for package-specific module (WSTPb) 1 per trainee and ToT trainer  This includes manuals, workbooks, posters, forms and checklists. See table below for more details. xix2. How to prepare to deliver the training packageTrainer's Manual Training programme forms Participant registration form 1 per programme  Use this form to keep a record of trainees attending. Name tags 1 per trainee and per ToT trainer  – Timetables (Core training skills and package-specific module) 1 per trainee for each relevant module  Sample for each module available on WSTP Pen Drive; adjust to suit local context. Photo consent form 1 form  Adapt this form for the host/ training organization; translate into local language; ensure any person who is photographed signs this form. Trainee certificate 1 per trainee  Prepare trainee certificates or adapt the template provided on the WSTP Pen Drive. Training programme evaluation forms • Core training skills • Package-specific module 1 per trainee  Collate information after delivery and share with WHO. Feedback sheet for WSTPtot practice delivery sessions ToT trainer will require 1 per trainee  Print at least 1 per trainee. This sheet can be used to provide feedback on up to 3 practice deliveries. xx 2. How to prepare to deliver the training packageTrainer's Manual WSTPb printed resources resource Quantity X comments/instructions Manuals, workbook and posters Trainer’s Manual 1 per trainee and ToT trainer  Print and bind. Reference Manual 1 per trainee and ToT trainer  Print and bind. Participant’s Workbook 1 per trainee and ToT trainer  Print and bind. Set of posters, including: Wheelchair service steps Wheelchair mobility skills Pressure sores How to care for a wheelchair at home. 1 per trainee and ToT trainer  – Wheelchair service forms and checklists: Wheelchair service referral form 1 per trainee and ToT trainer  – Wheelchair assessment form  Print the updated form from the WSTP Pen Drive. Wheelchair prescription (selection) form  – Wheelchair summary form  – Wheelchair follow up form  – Wheelchair fitting checklist  Print and laminate. Checklists can be found in the WSTPb resources under Forms, and checklists. Wheelchair user training checklist  Wheelchair safe and ready checklist  xxi2. How to prepare to deliver the training packageTrainer's Manual equipment general training equipment item Quantity X comments/instructions Large whiteboard 1  – Whiteboard marker pens 3–4  Various colours Data projector 1  – Computer 1  – Portable speakers 1 set  To improve video sound quality Pointer/remote control 1  – Flipchart stand and paper 1–2 stands and 1 pack of paper  – Flipchart pens 3–4  Various colours Post-it notes 3–4 blocks  Various colours Masking tape or similar 1 roll  To attach flipchart sheets and posters to walls Extension cord At least 1  – Multi-plugs/adapters As needed  – xxii 2. How to prepare to deliver the training packageTrainer's Manual Basic level equipment item Quantity X comments/instructions Assessment bed 3  – Set of foot blocks 2  – Transfer board 3  – Tape measures 4  Firm retractable tape measure in mm (not soft dressmaker’s tape measure). Anatomical model of the spine and pelvis 1  Preferably with short femurs (if available) Wheelchairs and cushions, including: • Rigid frame 3-wheel • Rigid frame 4-wheel • Folding frame with adjustment options • Basic folding frame (such as hospital or transfer type). At least 1 of each locally available  Ensure all wheelchairs are in good working order and have cushions. Ensure there is at least one good example of a pressure relief cushion. Examples should include a mix of short and long wheel bases and a variety of arm and foot rests. Sample contoured foam pressure relief cushion and cover 1  – Sample cushion lift 1  – Hacksaw blades or long knives 1 per 3 participants  – Black permanent markers 1 per 3 participants  – Firm foam (chip foam)  5 50 x 400 x 400 mm pieces Soft foam  5 50 x 400 x 400 mm pieces Sample fabric for cushion covers 1 of each type locally available  – xxiii2. How to prepare to deliver the training packageTrainer's Manual get to know the training resources as a ToT trainer, you will need a comprehensive knowledge of all the WsTPb resources. This includes familiarizing yourself with all aspects of the package- specific Trainer’s Manual as well as the Reference Manual for Participants, Participant’s Workbook and other resources on the WsTP Pen Drive. You should also be familiar with all sections of the ToT Trainer’s Manual and the ToT Handbook. You may be co-training the WsTPtot with another ToT trainer, however it is important for you to be familiar with all sessions. For example, you will need a good understanding of all the Core training skills taught in the WsTPtot and to model them as good practice during your own session deliveries. guide to facilitating practice delivery sessions • Monitor the delivery time and stop the trainee when their allocated time is up, even if they have not finished. • Where a session is shared by two or more trainees, to keep things moving run the whole session before facilitating feedback for each of the trainees in turn (unless the session requires a break due to WsTPtot timing). • Be familiar with the Errors in the WSTP materials and Key considerations for teaching this session in the ToT Trainer’s Manual, and watch to see if the trainee has addressed them. • Follow the session in the WsTP Trainer’s Manual and the ToT Trainer’s Manual. • During the delivery, complete the Feedback sheet for WSTPtot practice delivery sessions, found on the WsTP Pen Drive. • During practical activities don’t step in too quickly if the session is not running smoothly. allow the trainees time to rectify the situation and redirect participants themselves. Only step in if there are safety concerns, or if trainees are unable to bring the session back on track themselves. xxiv 2. How to prepare to deliver the training packageTrainer's Manual Facilitating feedback after practice deliveries Your role is to facilitate the feedback sessions and ensure they are brief, constructive and relevant. after the practice delivery is completed, go through the following process. * Found in the Feedback sheet for WSPTtot practice delivery sessions. Closely monitor the feedback to ensure that it is constructive. Step in if a participant gives feedback that is negative or hurtful. Give examples of how to rephrase feedback so that it is constructive. individual feedback Based on the ToT trainer mentor allocations, ToT trainers arrange a time to discuss feedback with each lead trainee, using the Feedback sheet for WSTPtot practice deliveries as a guide. Use this time to also feedback any additional or sensitive comments. Self- reection Participant feedback • Ask trainee to comment on what they did well, followed by what can be improved. • Facilitate feedback from ToT participants, asking them to provide one comment on what the trainee did well, followed by one comment on what can be improved. • Discuss any Key considerations for teaching this session not yet addressed through the trainee’s delivery and/or by the ToT trainer feedback. ToT trainer feedback Key points • ToT trainers to feedback, using the trainee skills list* for guidance. It is not necessary to comment on every competency: focus only on the areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. Do not repeat what has already been mentioned by the trainee or ToT participants. 1Core training skills moduleTrainer's Manual Core training skills module 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the Wheelchair Service Training of Trainers Package A IM To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and objectives of the ToT programme □□ explain the ToT programme timetable and WSTPtot process. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.1: Introduction to the WSTPtot □□ name tag for each ToT trainer. For each trainee: □□ different coloured sticky notes (A5 or similar): 3 or 4 pieces □□ ToT Handbook □□ module-specific WSTP trainer’s manual, participant’s reference manual and workbook, posters and WSTP Pen Drive □□ WHO Wheelchair Guidelines and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ timetables for Core training skills module and package-specific module □□ blank name tag. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Arrange a short opening ceremony for the WSTPtot as locally appropriate. □□ Prepare the housekeeping information. □□ Prepare flipchart papers for Ground Rules and Car Park. □□ Set up the training room: tables and chairs; projector, computer and screen; whiteboard; flipchart stand and paper; and markers. □□ Sort resources into sets for each participant and set them out. To avoid confusion only provide trainees with the ToT Handbook, their package-specific WSTP Trainer’s Manual and the ToT timetable at the start of the day. Provide remaining resources at the end of the day. □□ Prepare a Wall of Experience. Print or write headings given in Section 5 on large sticky notes or A5 paper and put them on the wall under a Wall of Experience heading. 3ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual O U T L IN E 1. Opening ceremony 2. Welcome and introductions 3. Introduction to this session 4. Housekeeping and Ground Rules 5. Wall of Experience 6. Overview of the WSTPtot 7. Key point summary 10 10 1 10 15 27 2 Total session time 75 1. Opening ceremony (10 minutes) In collaboration with the host organization, hold an opening ceremony for the WSTPtot as locally appropriate. 2. Welcome and introductions (10 minutes) Introductions ToT.1 Introduction to the WSTPtot: 2 ToT trainers: Welcome everyone and introduce yourselves. Give a brief overview of your background and your experience in wheelchair provision and training. Ask trainees to introduce themselves, giving their name, job role and organization. Give out name tags and ask trainees to write their name. 3. Introduction to this session (1 minute) Aim: To introduce trainees to the Wheelchair Service Training of Trainers Package (WSTPtot). Objectives: • describe the aim and objectives of the ToT programme • explain the ToT programme timetable and WSTPtot process. ToT.1 Introduction to the WSTPtot: 3 Explain the aim and objectives of the session. 4 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 4. Housekeeping and Ground Rules (10 minutes) • Toilets • Refreshments and lunch • Accessibility • Emergency exits. ToT.1 Introduction to the WSTPtot: 4 Explain the following, as required: • location of toilets • refreshments and lunch arrangements • any accessibility issues • what to do if there is an emergency • any other administration issues. Setting the Ground Rules Discuss with your neighbour the Ground Rules you would like to have in place for the week. ToT.1 Introduction to the WSTPtot: 5 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Explain: We will now establish the Ground Rules for this training. Ask trainees to briefly discuss the Ground Rules they would like to have in place for the week. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for the activity and 5 minutes for feedback. Feedback: Ask each pair to give one item from their list and record each rule on the flipchart until there are no more ideas. Gather feedback from trainees to ensure they agree on the rules. Ask how the group wants to manage people who break these rules. Pin up the Ground Rules on the wall for reference throughout the ToT programme. 5ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Notes for ToT trainers: • Explain that everyone is responsible for enforcing the Ground Rules, not just the ToT trainer. • Refer trainees to the list each time a Ground Rule is broken. Examples of Ground Rules include: • mobile phones – switch to silent • no side talking or talking over other people • respect for others’ points of view • be on time for all sessions • keep the training area clean and tidy • contribute to the discussions • use appropriate disability terminology. • Use positive terminology • Use the terms: ‘persons with disabilities’ or ‘people with disabilities’. ToT.1 Introduction to the WSTPtot: 6 Explain: • The WSTP promotes the use of positive terminology in relation to people with disabilities. • Trainers must model good practice and follow the language guidance set out in the WSTP and the CRPD. • Terms such as ‘the disabled’ or ‘disabled people’ or ‘special people’ are not appropriate, and should not be used. • Always use ‘persons with disabilities’ or ‘people with disabilities’. • Avoid using the term ‘normal people’ when referring to people without disabilities. Add ‘use appropriate disability terminology’ as a Ground Rule if it is not listed. Suggest that trainees monitor the use of positive terminology throughout the ToT. Notes for ToT trainers: • Although we recommend avoiding use of the term ‘disabled people’, the terms ‘Disabled People’s Organization’ and ‘DPO’ are still in wide use and generally accepted. Encourage the use of the term ‘Organization of Persons/People with Disabilities’ (OPD), which is becoming increasingly common. 6 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Sometimes called Parking Lot • Topics and questions that come up in a session but are outside the content or cannot be covered immediately will be ‘parked’ and discussed at a later time. ToT.1 Introduction to the WSTPtot: 7 Explain: • During the training, you may have questions that the trainers are unable to answer immediately, or that may be covered during a later session. • These questions will be placed in the Car Park to be discussed at an appropriate time. Pin up the Car Park flipchart on the wall. 5. Wall of experience (15 minutes) Creating a Wall of Experience Write about yourself on sticky notes. Include: • Number of years and type/s of experience related to assistive devices • WSTP training given or received • Professional background • Languages spoken. There is no need to include your name. ToT.1 Introduction to the WSTPtot: 8 Show the slide throughout the activity. 7ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual Activity 2 Groups: Ask trainees to work alone. Instructions: Put the Wall of Experience headings on the wall, including: • WSTP training given or received • number of years and type/s of experience related to assistive devices • professional background • languages spoken. Explain: We all come to this training with different types of experience, knowledge and skills. We will create a Wall of Experience together. Write your answers using sticky notes in a different colour for each heading (or more than one if required). Ask trainees to write clearly and then stick their notes up onto the wall under each heading. Monitor: Monitor the trainees and assist as needed. Check that trainees are writing clearly, with one statement on each piece of paper/card. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Ask trainees to comment on the Wall of Experience. Draw attention to the wealth of existing knowledge, skills and experience in the room. Emphasize that trainees have already progressed a long way to get to this point and they will build up even more experience from here. Notes for ToT trainers: • Keep referring to this Wall throughout the programme and link this to other parts of the training as appropriate. 8 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual 6. Overview of the WSTPtot (27 minutes) Aim: To equip new trainers with knowledge and skills to deliver the WSTP. Objectives: • demonstrate the qualities of a good trainer • create an effective learning environment • reflect on their own training performance • co-train on the appropriate WSTP. ToT.1 Introduction to the WSTPtot: 9 Explain the aim and objectives of the WSTPtot. Day 1 Core training skills Day 2 Core training skills Day 3 Package-specific Day 4 Package-specific Day 5 Package-specific ToT.1 Introduction to the WSTPtot: 10 Ask trainees to look at their copy of the ToT timetable. Explain: the ToT is divided into two sections: • Core training skills module • package-specific module, during which trainees will practise delivering WSTP sessions to their peers. Notes for ToT trainers: • While there are four Wheelchair Service Training Packages, there are only three package-specific modules because the Managers and Stakeholders packages are covered in one module. Introduce the resources that are being provided to each trainee. Briefly explain and show each one. Explain that some of the materials will be distributed at the end of the day. 9ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Completed one or more WSTP • Experience in wheelchair service provision or the disability sector • Language proficiency • Experience as a trainer or facilitator • Opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 11 Explain: in order to get the most out of the WSTPtot, trainees should: • have completed one or more WSTP • have experience in wheelchair service provision or the disability sector • be able to read and write in the language used to deliver the ToT programme • have some experience of training or facilitating • have opportunities to deliver the package after the ToT programme. ToT.1 Introduction to the WSTPtot: 12 Core training skills Package-specific Co-trainer Trainer Explain: • Co-training takes place after the ToT programme and before trainees train independently. Co-training experiences are the best way to further develop your training skills after completion of the WSTPtot. • After completing the ToT programme, all trainees should have at least one co-training experience. • Co-training with an experienced trainer will help strengthen your training skills including: – planning and preparing to deliver the WSTP – presenting and facilitating – mentoring participants – coordinating training logistics. 10 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual • Co-training is the best way to develop your skills • Other ways to get support include: –distance support from experienced trainers –connecting with other ToT trainees. ToT.1 Introduction to the WSTPtot: 13 Explain: if you are unable to co-train with experienced trainers consider other ways to get the support you need, such as: • contacting experienced trainers and asking them to mentor you from a distance – through email and phone contact • connecting with other ToT trainees and supporting each other through the planning, preparation and delivery of the WSTP. • Number and timing of co-trainings will vary by trainee • ToT trainers will help decide how many co- trainings you should complete • Logistics are a part of co-training. ToT.1 Introduction to the WSTPtot: 14 Explain: • The number of co-trainings you will complete will vary by trainee. • The timeframe for becoming a trainer will also vary based on when co-trainings are available and how many co-trainings you complete. • ToT trainers and trainers who mentor you while co-training will support you in deciding how many co-trainings you should complete before training on your own. 11ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual ToT.1 Introduction to the WSTPtot: 1 Ask trainees to look at their copy of the Feedback sheet for WSTPtot practice delivery sessions in their ToT Handbook on page 132–134. Explain: • Reflecting or thinking about what you do well and what can be improved will help you to become a better trainer. • The Feedback sheet for WSTPtot practice delivery sessions includes a list of the trainee skills that this training aims to develop. • The feedback sheet will be used to guide feedback to trainees after each practice delivery. • ToT trainers will also use it to provide feedback to lead trainees at the end of each day, and written feedback at the end of the ToT programme. 7. Key point summary (2 minutes) • Observe the Ground Rules and use appropriate disability terminology • The Wall of Experience shows there is a lot of knowledge and experience in the room • Structure of the WSTPtot and process after the ToT programme. ToT.1 Introduction to the WSTPtot: 16 Read the key points. Ask whether there are any questions. 12 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package Trainer's Manual WALL OF EXPERIENCE Number of years and type/s of experience related to assistive devices WSTP training given or received Professional background Languages spoken 13ToT.2 Wheelchair Service Training Packages Trainer's Manual ToT.2 Wheelchair Service Training Packages A IM To introduce the WSTP, its components and methodology. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the four WSTP □□ list the guiding principles of the WSTP □□ describe the format of the trainers’ manuals for each package. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.2: Wheelchair Service Training Packages □□ hard copy of the Trainer’s Manual for each trainee: WSTPb, WSTPi or WSTPm and WSTPs, according to the package-specific modules trainees will attend after the Core training skills module. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ If possible, embed the WSTP Pen Drive link into PPT slide 20 to demonstrate its use. O U T L IN E 1. Introduction 2. Background and rationale of the four WSTP 3. Structure of the different WSTP 4. Getting to know the Trainer’s Manual 5. How to use the WSTP 6. Key point summary 2 15 5 30 35 3 Total session time 90 14 ToT.2 Wheelchair Service Training Packages Trainer's Manual 1. Introduction (2 minutes)1 2 Aim: To introduce the WSTP, its components and methodology. Objectives: • list the four WSTP training packages • list the guiding principles of the WSTP • describe the format of the trainers’ manuals. ToT.2 Wheelchair Service Training Packages: 1 Explain the aim and objectives of the session. 2. Background and rationale of the four WSTP (15 minutes) • 2006: Consensus Conference, Bangalore • 2008: Wheelchair Guidelines published • Need for training opportunities identified. ToT.2 Wheelchair Service Training Packages: 3 Explain: • The Consensus Conference on Wheelchairs for Developing Countries, held in Bangalore, India, in November 20061 laid the foundation for the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings.2 • The Wheelchair Guidelines identified the need for training opportunities, which led to the development of the WSTP Basic, Intermediate, Managers, and Stakeholders. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 15ToT.2 Wheelchair Service Training Packages Trainer's Manual • Basic Level (WSTPb) • Intermediate Level (WSTPi) ToT.2 Wheelchair Service Training Packages: 4 Explain: • The WSTPb3 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. • The WSTPi4 trains personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. More days may be added in order to: • add material • add sessions • increase number of practical sessions • add time for product preparation • support translation • shorten the training day • provide extra teaching time. ToT.2 Wheelchair Service Training Packages: 5 Explain: • Both the WSTPb and WSTPi are designed to be delivered in a minimum of five days. • Extra time can be added to the training programme to: – add material to the session plans – add sessions – increase the number of practical sessions with wheelchair users – provide more preparation time for products used in the training – allow for translation – reduce the length of training days – provide extra time to learn key concepts. f3,4 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 http://www.who. int/disabilities/technology/wheelchairpackage/en/ 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 16 ToT.2 Wheelchair Service Training Packages Trainer's Manual • Managers (WSTPm) • Stakeholders (WSTPs) ToT.2 Wheelchair Service Training Packages: 6 Explain: • The WSTPb and the WSTPi are intended to increase the number of personnel trained in wheelchair service delivery. • However, trained personnel alone cannot ensure appropriate wheelchair provision without higher-level involvement. • To support the development of services, WHO developed: – WSTPm5 – designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. WSTPm can be delivered in a minimum of two days. – WSTPs6 – designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. • Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting. f5,6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/). 17ToT.2 Wheelchair Service Training Packages Trainer's Manual • User centred • Rights based • International best practice (evidence based) • Less-resourced settings • Wheelchair users as participants • Accessible language and terminology. ToT.2 Wheelchair Service Training Packages: 7 Explain: The WSTP has been developed following a set of guiding principles, including: • a user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service • following available evidence-based, international best practice • a focus on less-resourced settings • inclusion of wheelchair users as trainers and target participants in all training packages. Explain: The WSTP uses accessible, non-medical language and terminology so that: • participants without clinical or technical qualifications can be trained • service personnel can use terms that are easily understood by wheelchair users. 3. Structure of the different WSTP (5 minutes) Notes for ToT trainers: • Keep this section brief, as more details are given later in the ToT programme during the package-specific modules that follow the Core training skills. Focus on the WSTP the trainees will deliver during the following package-specific module. Basic and Intermediate Managers Stakeholders Trainer’s Manual    PowerPoint presentations    Videos    Set of posters  selected posters selected posters Supplementary resources    Reference Manual for participants   combined Participant Workbook  Forms and checklists  – Additional Resources: including tools, equipment. –  ToT.2 Wheelchair Service Training Packages: 8 Explain: Each package contains a range of resources: • a Trainer’s Manual, PPT presentations, videos and posters • reference manuals for participants are available for WSTPb, WSTPi and WSTPm • service forms, checklists and a separate participant workbook are included in the WSTPb and WSTPi. 18 ToT.2 Wheelchair Service Training Packages Trainer's Manual Explain: All the WSTP materials are provided on the WSTP Pen Drive included in your training resources. They can also be downloaded from the WHO website. • Copies of certificates • Trainer’s observation checklists • Session and course evaluation forms. ToT.2 Wheelchair Service Training Packages: 9 Explain: The WSTP Pen Drive also contains: • certificates • trainer’s observation checklists • evaluation forms. These will not be used during the ToT, but should be used during delivery of the WSTP. 4. Getting to know the Trainer’s Manual (30 minutes) Explain: While the four WSTP cover different subjects, they all have the same structure and approach. We will become more familiar with the structure during this activity. Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. If trainees will be attending different package- specific modules after the Core training skills module, pair trainees with others who will learn to train the same package. Instructions: Each pair will need at least one copy of the Trainer’s Manual for the WSTPb, WSTPi or WSTPm. Explain that the aim of this activity is to familiarize trainees with the Trainer’s Manual. Ask pairs to work together to answer the questions in the ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 15 minutes to find the answers and 10 minutes to feedback. 19ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Questions Answers 1. Where can you see a list of everything included in the Trainer’s Manual? In the list of contents at the beginning of the manual. 2. How are group activities shown in the sessions? There is an Activity table describing the groups, instructions, monitoring, time and feedback for each activity. 3. Where can you find the overall aim or purpose of the training package? In the section headed Purpose on page 2. 4. How does the session plan indicate when the trainer should show a PowerPoint slide? An image of each slide is shown on the left-hand side of the page in the session plan, in the order of delivery, next to the related text. 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? Lists are provided in Section 2 of the Trainer’s Manual: How to prepare to deliver the training package: • on page 14 in WSTPb, and WSTPi • on page 9 in WSTPm. 5. How to use the WSTP (35 minutes) Ask participants to turn to the first section of the Trainer’s Manual: About the Wheelchair Service Training Package. Explain: There are helpful notes and guidance for trainers in the front of each Trainer’s Manual. Ask one of the participants to read out the headings in this section of the Trainer’s Manual. Most important answers: • Introduction • Target audience • Purpose • Scope • Trainers • How to get started. 20 ToT.2 Wheelchair Service Training Packages Trainer's Manual • Request from WHO for feedback and data • Send copies of participants’ registration and evaluation forms • Reflections on strengths and weaknesses of the training. ToT.2 Wheelchair Service Training Packages: 11 Explain: • On the WSTP Pen Drive you will see a file called Read Me First. This is an important document. • It includes a request from WHO to provide feedback and data from the WSTP training programmes that you deliver including: – participant registration and evaluation forms – trainer’s reflections or comments on the training. Explain that section 2 of the Trainer’s Manual is called How to prepare to deliver the training package (or for WSTPs How to prepare for the Stakeholder Workshop). Getting to know the ‘How to prepare’ section Work with your partner to read and discuss the section in the Trainer’s Manual, How to prepare to deliver the training package. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 12 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to look through the section on How to prepare to deliver the training package with their partner, reading and discussing the different sections. Ask trainees to write down any questions they have. Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. Feedback: Ask the whole group if they have any questions related to their training package. Broader questions about the training can be parked in the Car Park if you do not have time to cover them, or if they will be covered in a later session. 21ToT.2 Wheelchair Service Training Packages Trainer's Manual Notes for ToT trainers: • There are variations in the section headings between the packages. Session plans help trainers to: • focus on the learning objectives • keep to time • support group activities. ToT.2 Wheelchair Service Training Packages: 13 Explain: Session plans work like a recipe to guide trainers through the session. Following the session plans will help trainers to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Getting to know the session plans Work with your partner to read and discuss a detailed session plan from your Trainer’s Manual. Write down any questions to ask the trainer during feedback. ToT.2 Wheelchair Service Training Packages: 14 Show the slide throughout the activity. Activity 3 Groups: Divide trainees into the same pairs as the previous activity. Instructions: Ask trainees to read and discuss a detailed session plan with their partner, and to write down any questions for discussion with the group. Allocate a session from the following list, according to which package each pair is going to present during the ToT: • WSTPb: Trainer’s Manual, page 99: A.8: Transfers. • WSTPi: Trainer’s Manual, page 52: B.1: Assessment overview and assessment interview. • WSTPm: Trainer’s Manual, page 15: A.1 : What is appropriate wheelchair provision? Monitor: Monitor the groups and assist as needed. Time: Allow 7 minutes to discuss and 5 minutes to answer questions. 22 ToT.2 Wheelchair Service Training Packages Trainer's Manual Feedback: Ask the whole group for any questions or clarifications. Park any questions on changing PowerPoint slides in the Car Park. These can be addressed in session ToT.10 Audio-visual tools and equipment. Explain: There is a session summary box at the beginning of each session plan. Ask one of the pairs: What are the different sections of the session summary? Most important answers: • Objectives: describes the aims of the session. • Resources: any resources required for the session. • Context (For WSTPi this is called Context and prior learning): Suggested adjustments to suit the local context/country/service. • To prepare: things to prepare before the session starts. • Outline: summarizes sections of the session with timings. Ask another pair: What is the purpose of the Context or the Context and Prior Learning box? Most important answer: • It provides trainers with guidance about how the session plan could be adapted for the local situation or the type of participants attending the training. Ask another pair: What might influence the context of the training? Acknowledge responses. ToT.2 Wheelchair Service Training Packages: 15 Explain: Sessions can be influenced by different: • service delivery models • levels of experience among participants • institutional, regional or national policies • available products for prescription. 23ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: How do the session plans indicate that a video should be shown? Most important answer: • A video box is shown, with a video icon. ToT.2 Wheelchair Service Training Packages: 16 Explain: • It is important for trainees to be familiar with the content, relevance and timing of all the videos. • More details on the use of videos are given later in the ToT. Explain: The Trainer’s Manual uses different words in bold to guide trainers. This includes words such as: Ask, Explain, Show. ToT.2 Wheelchair Service Training Packages: 17 Explain: Extra information to help to guide trainers is provided in the Trainer’s Manual, including: • additional information that can assist trainers to answer questions from participants • most important answers to questions • guidance about group activities. ToT.2 Wheelchair Service Training Packages: 18 24 ToT.2 Wheelchair Service Training Packages Trainer's Manual Ask another pair: What information is provided in the Activity table in the session plans? Most important answers: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Explain: The electronic copy of the WSTP can be run either on a computer hard drive or via an external storage device (DVD or WSTP Pen Drive). Exit slideshow mode. Pull up the WSTP Pen Drive folder, from the WSTP Pen Drive or from the files on your computer. Show the electronic copy of the START.pdf file on the projector. Explain: Resources can be accessed from the standard WSTP Pen Drive menu or by clicking on the “Start” menu. Show the links. Click on one or two sessions to show the PPTs. Explain: • Videos are embedded into the PPTs in the PDF versions of the files. • All individual PPT files are available, and can be modified if necessary. Modifying PPTs will be discussed in a later session. Show how to find the manuals, posters and forms. Notes for ToT trainers: • Macintosh (Mac) computers cannot open the “Start” file and use the “Start” menu links unless the file is opened with Adobe Pro or similar. Explain: Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 25ToT.2 Wheelchair Service Training Packages Trainer's Manual 6. Key point summary (3 minutes) • Four wheelchair service training packages: WSTPb, WSTPi, WSTPm and WSTPs. • Developed to address the training needs of service providers and other stakeholders to meet the Wheelchair Guidelines. • Each package includes a range of components to help trainers plan and deliver consistent and relevant training. ToT.2 Wheelchair Service Training Packages: 20 Read the key points. Ask whether there are any questions. 26 ToT.3 Practice delivery sessionsTrainer's Manual ToT.3 Practice delivery sessions A IM To provide details of the package-specific modules and the roles of ToT participants and trainers. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe the aim and structure of the WSTPtot practice delivery sessions □□ describe the roles and responsibilities of lead and support trainees □□ know which practice sessions they are to present □□ know how to prepare for the practice delivery sessions. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.3: Practice delivery sessions □□ WSTPtot allocation (trainee copy) for the package-specific module: one for each trainee □□ Lucky Dip trainee numbers on pieces of paper □□ flipchart sheet with trainee numbers written on it. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Refer to the terminology box at the beginning of this manual. □□ Finalize and copy the WSTPtot allocation for the package specific module based on the number of trainees. □□ Prepare Lucky Dip trainee numbers in bucket/hat based on final numbers. □□ Prepare a flipchart sheet with the trainee numbers and a space to add participants’ names once their numbers are selected. □□ Discuss how you will allocate trainees for mentoring with their co-trainer. Give participants this information during the session, or at the beginning of ToT.6 Preparation time. O U T L IN E 1. Introduction 2. Structure and aims of the package-specific module 3. Format of practice delivery sessions 4. Roles of lead and support trainees and ToT participants 5. Reflection and feedback 6. Preparing for practice delivery sessions 7. Key point summary 4 3 2 15 5 30 1 Total session time 60 27ToT.3 Practice delivery sessionsTrainer's Manual 1. Introduction (4 minutes) How confident do you feel to deliver the WSTP package you are here to learn? ToT.3 Practice delivery sessions: 2 Ask: How confident do you feel to deliver the WSTP package/s you are here to learn, on a scale of one to ten? • One means you are not at all confident • Ten means you are very confident. Explain: • Record your score on page 10 of your ToT Handbook. • At the end of the ToT programme, we will ask you to record how confident you now feel. • You will add both scores to your confidential ToT evaluation form. Aim: to provide details of the package-specific modules and roles of ToT participants and trainers. Objectives: • explain the structure of the practice deliveries • define roles of lead and support trainees • prepare for practice deliveries • know which practice delivery sessions you are to present. ToT.3 Practice delivery sessions: 3 Explain the aim and objectives of the session. 2. Structure and aims of the package-specific module (3 minutes) • Practice delivery sessions by trainees • Discussion or demonstrations lead by ToT trainers • Combination sessions. ToT.3 Practice delivery sessions: 4 Explain: • After the Core training skills sessions, you will begin your package-specific module. • Package-specific modules include: – opportunities to deliver sessions from the WSTP you have chosen to learn – discussion sessions or demonstrations led by ToT trainers, or – a combination of the above. 28 ToT.3 Practice delivery sessionsTrainer's Manual 3. Format of practice delivery sessions (2 minutes) • Session allocation will be done by Lucky Dip (lottery) • All trainees will have similar presenting time • Trainees allocated lead and support trainee roles. ToT.3 Practice delivery sessions: 5 Explain: • Allocation of practice delivery sessions will be done by lottery (Lucky Dip) at the end of this session. • Each trainee will have a similar amount of presenting time. • You will be allocated roles as both a lead and support trainee. • When two or more lead trainees are allocated to the same session, one will automatically assume the support trainee role when they are not presenting. 4. Roles of lead and support trainees and ToT participants (15 minutes) Lead and support trainees Working in pairs, answer the following question: • What are the main roles of the lead and support trainees? ToT.3 Practice delivery sessions: 6 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask participants to discuss with their partner what they think are the main roles of the lead and support trainee. Ask participants to record their ideas in their ToT Handbook on page 11. Monitor: Monitor the groups and assist as needed. Time: Allow 3 minutes for the activity and 5 minutes for feedback. Feedback: Ask: What are the main roles of the lead and support trainees? Discuss and clarify answers, record the most important answers on the board. Ask participants to record the correct information in their ToT Handbook. 29ToT.3 Practice delivery sessionsTrainer's Manual Most important answers: The role of the lead trainee includes: • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. The role of the support trainee includes: • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainee • contributing to the overall feedback/reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Trainees should work together as a team to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session. ToT.3 Practice delivery sessions: 7 Explain: During the practice delivery sessions, trainees should work together as a team. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage the session, including: – managing time – clarifying errors – answering questions from participants – managing disruptions and interruptions. 30 ToT.3 Practice delivery sessionsTrainer's Manual Being a role model includes: • being on time • being well prepared • problem solving • being positive and constructive • being responsible for yourself. ToT.3 Practice delivery sessions: 8 Explain: • Trainers should set positive examples of professional behaviour and practice. • Model the behaviour you want to see from participants by: – being on time and well prepared – problem solving and finding solutions for challenging situations – providing positive and constructive feedback – managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. What could you do if you are asked a question and do not know the answer? ToT.3 Practice delivery sessions: 9 Explain: Being a good trainer and role model does not mean you always need to know the answers to questions. Ask: What could you do if you are asked a question and do not know the answer? Most important answers: • Ask support trainees if they know the answer. • Ask participants if they know the answer. • Do not pretend to know the answer. • Agree to find out the answer before the training programme finishes (add to Car Park). 31ToT.3 Practice delivery sessionsTrainer's Manual • Taking part in the case studies and practical activities • Asking and answering questions • Engaging in discussions. ToT.3 Practice delivery sessions: 10 Explain: • While your fellow trainees are delivering their sessions, you will play the role of the WSTP participant. • This includes: – taking part in the case studies and practical activities – asking and answering questions – engaging in discussions. • While it is important to participate actively to create a ‘realistic’ training situation, do not purposefully act in a challenging manner. • Put away your WSTPtot Trainer’s Manual and your ToT Handbook during the session delivery. 5. Reflection and feedback (5 minutes) Trainers need to be able to: • reflect on their training skills • provide constructive feedback. ToT.3 Practice delivery sessions: 11 Explain: • It is important that trainers learn to reflect on their own training skills. • It is also important that trainers are able to give constructive feedback to training participants. • Both of these skills are incorporated into the ToT programme. 32 ToT.3 Practice delivery sessionsTrainer's Manual • Lead trainees reflect on: • what went well • what can be improved. • ToT participants feedback to lead trainees on: • what went well • what can be improved. ToT.3 Practice delivery sessions: 12 Explain: • At the end of each practice delivery session, the lead trainee/s will be asked to reflect on: – what was good and what went well – what can be improved. • ToT participants will provide brief feedback to lead trainee/s. We will discuss this further in ToT.11: Feedback. • The ToT trainer will give feedback, adding anything not already mentioned by the lead trainee or ToT participants. 6. Preparing for practice delivery sessions (30 minutes) • Read the session plan in the Trainer’s Manual • Read the relevant sections of the Reference Manual and Workbook • Edit the PPT • Practice delivering the session • Work with support trainees • Prepare resources. ToT.3 Practice delivery sessions: 13 Explain: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainee. • Prepare the resources you need for the session. Explain: If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. 33ToT.3 Practice delivery sessionsTrainer's Manual • Known errors are listed in your ToT Handbook • Do not discuss changes made to the PPT with ToT participants • Present as if it is a standard WSTP training. ToT.3 Practice delivery sessions: 14 Explain: • There are some known errors in the WSTP Trainer’s Manual, Participant Manuals and Workbooks, and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Notes for ToT trainers: • The WSTP has some known errors that will not be corrected until a second edition is published. The errors are listed in the ToT Handbook so that trainees can make corrections to their materials. Getting to know the Trainer’s Manual Working together in your group, use the Trainer’s Manual you have been given to answer the questions in the ToT Handbook. Write your answers next to the question. ToT.2 Wheelchair Service Training Packages: 1 Show the slide throughout the activity. 34 ToT.3 Practice delivery sessionsTrainer's Manual Activity 2 Groups: Divide trainees into pairs. Instructions: Ask the trainees to look at the following sessions in their Trainer’s Manual and find the notes relating to this session in their ToT Handbook. Ask them to read through both to understand how they relate to each other, and how they would be used to prepare to deliver a session. • WSTPb: Session A.6: Appropriate wheelchairs. • WSTPi: Session B.8: Prescription (selection) of PSDs – stabilizing the pelvis. • WSTPm: Session A.1: What is appropriate wheelchair provision? Ask them to also locate the Guidelines for preparing practice delivery sessions in the introduction to the ToT Handbook and to briefly review it. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 5 minutes for feedback. Feedback: Emphasize the following: • Trainees should follow the instructions in the Trainer’s Manual and their ToT Handbook for the practice deliveries and all future co-training deliveries. • They should allow enough time to follow instructions dealing with errors in the WSTP materials; take account of gender and cultural considerations; and tips on session preparation, presentations and logistics to improve flow and timing. • During the practice deliveries, trainees are responsible for setting up the training areas as needed. Ask whether there are any questions. 35ToT.3 Practice delivery sessionsTrainer's Manual • Some session preparation time is included in the ToT timetable • ToT trainers are available during this time, or at breaks • Ask for help if you have questions or concerns. ToT.3 Practice delivery sessions: 16 Explain: • There will be time at the end of each day to prepare for future practice delivery sessions. We will discuss this more in session ToT.6. • ToT trainers will be available during breaks and at the end of the day. Ask for help if you have questions or concerns. • It is normal to feel nervous when delivering the sessions in front of your peers and the ToT trainers. • You will grow in skills and confidence as you deliver more sessions. • Remember that it is not a competition, everyone has different training styles. • You will be required to present feedback from group activities over the next two days – use this as an opportunity to practise presenting to your peers. • Time will be strictly monitored • ToT trainers will end the session at the correct time • Learning to keep to time is an important skill. ToT.3 Practice delivery sessions: 17 Explain: • Time will be strictly monitored during practice deliveries to ensure trainees are treated equally. • If you go over your time, the ToT trainers will stop you and move on to the next trainer, or end the session. • Learn how to keep to time. It is an important skill, and you will improve with practise. • The standard PPT for each session will be available on the training laptop • If you make any changes to your PPT, you will need to provide it to ToT trainers before your session. ToT.3 Practice delivery sessions: 18 Explain: • The standard PPT for each session will be available on the training laptop with videos already embedded. • If you make any changes to your PPT, you will need to upload it onto the training laptop before your practice delivery. 36 ToT.3 Practice delivery sessionsTrainer's Manual Notes for ToT trainers: • Tell participants when you need the PPT to be loaded on to the computer; for instance, 30 minutes before training begins or at break time before a session. • Time for LUCKY DIP! • Pick a number • Complete the Practice delivery session allocation sheet • Note who is your ToT trainer mentor. ToT.3 Practice delivery sessions: 19 Explain: Now we will allocate the sessions. Ask each trainee to pick a number. Ask each trainee to write their name on their WSTPtot allocation (trainee copy) for the package-specific module. Ask each trainee to tell the group their number and to record this on their list. Record the trainee names next to the relevant numbers you have listed on the prepared flipchart paper. Explain: Each trainee has been assigned a ToT trainer as his or her mentor. Your mentor will: • assist you with preparation • provide individual feedback on your presentation skills. 7. Key point summary (1 minute) • As lead/support trainee: • practise the responsibilities of the role you are allocated • be a role model and work as a team. • As a ToT participant: • give clear and specific feedback. ToT.3 Practice delivery sessions: 20 Read the key points. Ask whether there are any questions. 37ToT.4 Preparing for diversityTrainer's Manual ToT.4 Preparing for diversity A IM To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the difference between culture and diversity □□ understand the importance of cultural competence □□ discuss challenges of cross cultural communication □□ identify challenges to integrating wheelchair users into training and work environments. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.4: Preparing for diversity □□ masking tape or similar. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Plan appropriate ‘divisions’ to use for the first activity, based on local context and trainee group characteristics. □□ Put a line of masking tape down the centre of an open area of the room to use for the first activity. O U T L IN E 1. Introduction 2. Culture and diversity 3. Cultural competence 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities 5. Key point summary 20 5 20 14 1 Total session time 60 38 ToT.4 Preparing for diversityTrainer's Manual 1. Introduction (20 minutes) Activity 1 Groups: Whole group. Instructions: Draw attention to the line of masking tape down the middle of the floor. Ask everyone to move to one side of the room. Ask all the men to stand on one side of the line and all the women to stand on the other. Explain this is our first diverse grouping: men and women. We are going to look at different aspects of diversity. Ask everyone who has children to stand on one side, and all the people who don’t to stand on the other side. Ask everyone who is over 50 years of age to stand on one side of the room. Ask everyone else to stand on the other side. Continue with the exercise for at least six rounds. Divisions could include: • languages spoken • country or region of origin • presence or absence of disability • professional background. Monitor: Ensure that participants are not embarrassed or uncomfortable. Time: Allow 10 minutes for the exercise and 10 minutes for feedback. Feedback: Ask people how they felt about the divisions. Ask how did you feel when you were in the larger group? Ask how did you feel when you were alone or in a minority? Explain that for some this may be a negative experience, but for others it may be positive. Explain: People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity and we are going to look at these two concepts in more detail. 39ToT.4 Preparing for diversityTrainer's Manual Aim: To understand culture, diversity, cultural competence and the importance of these concepts in relation to training the WSTP. Objectives: • understand the difference between culture and diversity • understand the importance of cultural competence • discuss challenges of cross cultural communication • identify factors and challenges to integrating wheelchair users into training and work environments. ToT.4 Preparing for diversity: 2 Explain the aim and objectives of the session. 2. Culture and diversity (5 minutes) Write the words culture and diversity on either side of a board or flipchart with a line running down the middle. Ask: What do you understand the terms culture and diversity to mean? Encourage responses and write on the board. Most important answers: Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Explain: Culture and diversity can be viewed in different ways. • Are they seen as strengths and encouraged? • Or are they seen as a source of conflict and disharmony? • Are they a distraction? Ask the group to reflect on the diversity and cultures present among themselves that we experienced in the earlier activity. Ask: Is the group diverse? Ask: What types of diversity does the group include? 40 ToT.4 Preparing for diversityTrainer's Manual Ask: What cultures do we share? Acknowledge responses. Explain: Remember that we all belong to more than one cultural group and we are all diverse in many ways. 3. Cultural competence (20 minutes) Ask: What is cultural competence? Acknowledge responses. • Awareness of your own cultural practices • Knowledge of different cultural practices • A positive attitude towards cultural differences • Understanding how culture impacts on interactions. ToT.4 Preparing for diversity: 3 Explain: • Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. • It is about having a positive attitude towards cultural differences and accommodating them. • It is about being conscious of how culture impacts on interactions between people. Explain: Cultural differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. For example, a comment made without offence intended may be insulting to someone from another culture. Explain: WSTP training may be delivered by trainers from a different culture to that of the participants. Some examples of how different cultural considerations may affect training are given in the ToT Handbook on page 16. 41ToT.4 Preparing for diversityTrainer's Manual Cultural competence • Think about examples of when you experienced a culture different from your own • Write down what it was like, how you felt and what you learned • Discuss the experience with your partner. ToT.4 Preparing for diversity: 4 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask trainees to think about examples of when they experienced a culture different from their own. Write down what it was like, how they felt and what they learned. Ask trainees to discuss the experience with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 8 minutes for discussion and 5 minutes for feedback. Feedback: Ask 4–5 people to share their experiences with the group. 4. Encouraging diversity: inclusion of wheelchair users and people with disabilities (14 minutes) The WSTP promotes the inclusion of wheelchair users and people with disabilities in training teams and as participants. ToT.4 Preparing for diversity: 5 Explain: • Disability is one aspect of diversity. • The WSTP promotes the inclusion of wheelchair users in training teams and as participants. Ask: Why is this important? 42 ToT.4 Preparing for diversityTrainer's Manual Most important answers: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. • The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of; combat stigma, and reinforce the principles of the CRPD. • Can draw on their own experiences • Promote a user-centred and rights-based approach to wheelchair provision • Act as role models of empowerment. ToT.4 Preparing for diversity: 6 Read the slide. Ask: What are some of the barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society? Most important answers: • Attitudinal barriers. • Environmental barriers: lack of access to homes, schools and community buildings. • Lack of assistive devices. • Cultural beliefs that see disability negatively. • Lack of supportive legislation about disability rights. • Lack of funding for services and support. 43ToT.4 Preparing for diversityTrainer's Manual • Attitudinal • Environmental • Institutional. ToT.4 Preparing for diversity: 7 Explain: • Attitudinal barriers can include: – assumptions about what is possible for a person with a disability – assumptions that people with a disability cannot make decisions for themselves – treating people with disabilities as objects of charity – in some cultures, it is believed that people with disabilities are cursed and they are excluded from their communities and/or families as a result. • Environmental barriers can include: – the natural environment – such as rocky or steep terrain – the built environment – such as inaccessible homes, schools and community buildings – a lack of assistive devices. • Institutional barriers can include: – a lack of government legislation and policies that support the rights of people with disabilities – rules and regulations regarding admission criteria for school or university. 5. Key point summary (1 minute) • Consider culture and diversity issues when you plan and deliver training • Demonstrate cultural competence • Promote the inclusion of wheelchair users and people with disabilities. ToT.4 Preparing for diversity: 8 Read the key points. Ask whether there are any questions. 44 ToT.5 Adult learning Trainer's Manual ToT.5 Adult learning A IM To introduce the concepts of adult learning and different styles of learning: to understand how these approaches can improve delivery of the WSTP. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how adults learn □□ describe four preferred learning styles, including their own □□ explain why understanding learning styles ensures the effective delivery of the WSTP □□ describe how trainers can support participants with problem solving. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.5: Adult learning. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Preferred learning styles 3. Experiential learning cycle 4. Supporting adult learning 5. Helping participants to problem solve 6. Key point summary 2 25 30 10 15 3 Total session time 85 45ToT.5 Adult learning Trainer's Manual 1. Introduction (2 minutes) ToT.5 Adult learning: 2 Aim: To introduce the concepts of adult learning and different styles of learning and to understand how these approaches can improve delivery of the WSTP. Objectives: • describe how adults learn • describe four preferred learning styles, including your own • explain why learning styles are relevant in delivering the WSTP • describe how trainers can support participants with problem solving. Explain the aim and objectives of the session. 2. Preferred learning styles (25 minutes) Adult learning • Think about positive learning experiences you have had • Write down how they were positive • Share your experiences with your partner. ToT.5 Adult learning: 3 Show the slide throughout the activity. Activity 1 Groups: Divide trainees into pairs. Instructions: Ask trainees to: • Think about positive learning experiences they have had. • Write down in what way the experiences were positive in the table on page 20 of their ToT Handbook. • Share experiences with their partner. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for individual reflection and discussion in pairs, and 5 minutes for feedback. Feedback: Ask each pair to read out one item from their list, going around the room until all the experiences are written on the board. Allow brief discussion. 46 ToT.5 Adult learning Trainer's Manual Explain: We can see from the positive learning experiences discussed during the last activity that there are different ways that we prefer to learn. What is your learning style? • Individually, think about how you learn best, how you like to learn new things. • On the question sheet, circle all of your preferences. • On the scoring sheet, circle the same letters and add up how many circles you have in each column to find your preferred learning style. ToT.5 Adult learning: 4 Show the slide throughout the activity. Activity 2 Groups: Ask trainees to work alone. Instructions: Ask trainees to turn to page 21 in their ToT Handbook. Explain that there is a list of statements in the ToT Handbook that relate to learning. Ask trainees to circle all of their preferences and transfer the information to the scoring sheet on the next page. Ask trainees to add up the number of circles to see which column has the highest number. The column with the highest number is their preferred learning style. Monitor: Monitor trainees and assist as needed. Time: Allow 10 minutes for the activity and 3 minutes for feedback. Feedback: Ask each trainee to share their preferred learning style with their neighbour. Highlight that if some people have two or more styles with the same or similar number, this means they have no strong preferences and are comfortable with more than one way of learning. Ask trainees if their learning style/s match their positive learning experiences. 47ToT.5 Adult learning Trainer's Manual 3. Experiential learning cycle (30 minutes) Explain: • Each of us has a preferred learning style or styles. • However, learning new information and skills is most effective when we learn the information in multiple ways. Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 5 Explain: • Each stage of the experiential learning cycle matches the four learning styles. • While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. • This is why each of the four phases or types of learning are included in the WSTP. • We can start anywhere in this cycle: with an experience; with a reflection or observation; with a theory or definition/ explanation of a concept; or by doing. • Role plays and simulations for ‘experiencers’ • Videos and demonstrations for ‘observers’ • Lectures on theories and frameworks for ‘thinkers’ • Practice sessions for ‘doers’. ToT.5 Adult learning: 6 Explain: When developing the WSTP, preferred learning styles and adult learning concepts were incorporated into the structure of individual session plans and the overall training timetable. 48 ToT.5 Adult learning Trainer's Manual Explain: The WSTP follows these four phases to ensure that learning happens. • During WSTPb, participants try different mobility skills in a wheelchair. This is experiencing. • During WSTPi, participants watch a video of wheelchair users and their families talking about the positive impact of postural support devices. This is observing or reflecting. • During WSTPm, participants learn about concepts and principles related to wheelchair service delivery. This is thinking or understanding. • During WSTPb and WSTPi, participants work with wheelchair users and provide them with an appropriate wheelchair and cushion. This is doing or applying. Ask: What would happen if we missed out the experience part? Most important answer: • The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. Ask: What would happen if we missed out the observation part? Most important answer: • The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. Ask: What would happen if we missed out the thinking part? Most important answer: • The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. Ask: What would happen if we missed out the doing (practice) part? Most important answer: • The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 49ToT.5 Adult learning Trainer's Manual Explain: It is important that trainers support all learning styles, not just the ones that we personally prefer. Putting concepts into practice • Read what styles of learning Carlos, Miriam, Sita and Ahmad prefer. • Read each of the training activities listed and decide who would find the activity most appealing, considering their learning style. • Later you can review the list of activities with respect to your own preferred style. ToT.5 Adult learning: 7 Explain: Now that we have looked at the concept of learning styles and the experiential learning cycle, let’s put this into practice and learn by doing. Show the slide throughout the activity. Activity 3 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to look at the Matching activities with learning preferences sheet in the ToT Handbook (pg. 24). Explain: • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. Ask trainees to place an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Suggest that after the session each participant should fill in the last column with their own preference. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Review the answers with the whole group as follows: Ask trainees to volunteer answers. Check if everyone agrees. If there is no disagreement, acknowledge the answer (if it is correct) and move to the next line. If not everyone has the same answer prompt the correct answer and clarify. Allow only brief discussion. 50 ToT.5 Adult learning Trainer's Manual Notes for ToT trainers: • In the answer box below, x indicates the best answer; (x) indicates other possible answers that are also correct. If trainees have answers other than those marked, ask them to explain their reasoning and discuss it with the group. If you are comfortable that their reasoning is good, and that they understand the differences between the learning styles, they do not need to correct their answer. Key learning from this exercise is awareness that people do not all learn in the same way. Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 1. Using a role play to practise wheelchair user training x (x) 2. Watching the trainer show how to measure a new wheelchair user x 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country x 4. Watching people in wheelchairs doing the things they want to do x 5. Learning about the key documents that are relevant to wheelchair services x 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home x 51ToT.5 Adult learning Trainer's Manual Answers Doing Observing Experiencing Understanding Carlos Miriam Sita Ahmad 7. Listening to the trainer review the most important articles in the CRPD x 8. Making a pressure- relief cushion x (x) 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience x 10. Observing the trainer conduct an assessment x 11. Doing an assessment interview with a new user (x) x 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services x (x) 52 ToT.5 Adult learning Trainer's Manual 4. Supporting adult learning (10 minutes) Explain: While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. ToT.5 Adult learning: 8 Explain: • Adult learners are self-directed and responsible for their own learning. • This means supporting them to be: – active participants – engaged in discussions and group activities. Adult learners bring their own knowledge and experience to learning. ToT.5 Adult learning: 9 Explain: • Adult learners bring their own knowledge and experience to each learning activity, including: – work-related experience – previous education – life and family experience. Adult learners need learning to be relevant and practical. ToT.5 Adult learning: 10 Explain: • Adult learners need learning to be relevant and practical. • Adults must see a reason for learning the new information – and be able to apply it to their situation. • Training should have: – clear learning objectives – obvious practical application. 53ToT.5 Adult learning Trainer's Manual Adult learners want to apply what they have learned. ToT.5 Adult learning: 11 Explain: Adult learners want to apply what they have learned. • Use examples to help them see the connection between what they are learning during training and what they will do after the training programme is over • Use problem-solving activities • Create learning-action plans. 5. Helping participants to problem solve (15 minutes) What is problem solving? ToT.5 Adult learning: 12 Ask: What is problem solving? Most important answer: • The process of finding the best solution to a problem. It is an important part of adult learning. Why is problem solving an important life skill? ToT.5 Adult learning: 13 Ask: Why is problem solving an important life skill? Most important answers: • Because we all set goals and face challenges to achieve them. • Because we need to find ways to overcome barriers we encounter. Explain: • Problem solving is an important skill in wheelchair service provision where solutions to problems may be complex. • We have an important role as trainers to develop participants’ problem-solving skills, so they can find solutions to the difficulties they come across in their work. 54 ToT.5 Adult learning Trainer's Manual Problem solving How can we help participants to problem solve and find their own solutions? ToT.5 Adult learning: 14 Show the slide throughout the activity. Activity 4 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to brainstorm how they can help participants to problem solve and find their own solutions. Take 2 minutes to think about it individually, then share with your group members to create a list of ideas. Monitor: Monitor the groups and assist as needed. Time: Allow 12 minutes for this activity. Feedback: • Ask open-ended questions • Ask rather than tell • Invite others to participate • Avoid ‘I don’t know’ • Be patient • One step at a time • Encourage creativity • Encourage teamwork. ToT.5 Adult learning: 15 Ask each group in turn to describe one way to support participants in problem solving. Continue until there are no new ideas. Record each new idea on the board using only a few key words. Acknowledge good examples of things to consider. Correct/clarify any misunderstandings. Show the slide to summarize. 55ToT.5 Adult learning Trainer's Manual Most important answers: • Ask open-ended questions – these cannot be answered with a simple ‘yes’ or ‘no’. Open-ended questions require trainees to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer that the trainer expects. • Ask rather than tell – ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together; teamwork and good communication helps to solve problems. 6. Key point summary (3 minutes) • Everyone has a preferred style of learning: • by experiencing • by observing • by thinking • by doing. • WSTP is designed to appeal to all learning styles. ToT.5 Adult learning: 16 Read the key points. Ask whether there are any questions. 56 ToT.6 Preparation time Trainer's Manual ToT.6 Preparation time A IM To ensure trainees use the preparation time effectively at the end of each day. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ understand the purpose of the preparation time at the end of each day □□ discuss any questions related to their practice deliveries. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.6: Preparation time. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Review the Car Park and prepare to answer any questions. O U T L IN E 1. Review of Car Park 2. Purpose of preparation time 10 5 Total session time 15 57ToT.6 Preparation time Trainer's Manual 1. Review of Car Park (10 minutes) Review the Car Park with trainees. If any items need to be clarified before the next day, provide answers or explanations as needed. 2. Purpose of preparation time (5 minutes) • Car Park • Feedback from ToT trainers • Practice delivery preparation. ToT.6 Preparation time: 2 Explain: After our first day, we have time set aside for: • reviewing any remaining Car Park items • trainees to meet with ToT trainers for feedback • preparing for practice deliveries. One-on-one meeting between ToT trainer and trainee to: • give feedback • discuss practice delivery. ToT.6 Preparation time: 3 Explain: • ToT trainers will set up short, one- on-one meetings with lead trainees to give feedback and discuss their practice delivery. • It is an opportunity for trainees to ask questions about how to apply this feedback to future practice deliveries. • We will discuss how to give and receive feedback in more detail in ToT.11. 58 ToT.6 Preparation time Trainer's Manual • Coordinate with trainees assigned to the session • Prepare materials or flipcharts • Raise questions with ToT trainers • Check PPT presentations • Study session plans. ToT.6 Preparation time: 4 Explain: When you are not meeting with ToT trainers to discuss feedback, you should use this time to: • coordinate with your co-trainers • prepare demonstration materials and AV equipment needed for your session • clarify any content of your session that you do not understand with the ToT trainers • check that your PPT presentation is working correctly. Ask whether there are any questions. Remind trainees of any logistics they need to remember before the start of the training day tomorrow. Notes for ToT trainers: • After the first day of the WSTPtot, use this time to arrange logistics related to practice deliveries during the rest of the programme. For example, can trainees come to the site early to set up for their session; or, when should trainees upload any modified PPTs for use the next day ? 59ToT.7 Presenting and facilitatingTrainer's Manual ToT.7 Presenting and facilitating A IM To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the behaviour of a good trainer □□ explain the difference between presenting and facilitating □□ list examples of good practice by presenters and facilitators □□ describe three strategies to keep to time. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.7: Presenting and facilitating. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Trainer skills 3. Presenting and facilitating 4. Good practices for presenting and facilitating 5. Managing time 6. Key point summary 3 15 5 15 20 2 Total session time 60 60 ToT.7 Presenting and facilitatingTrainer's Manual 1. Introduction (3 minutes) Aim: To highlight what makes a good trainer and demonstrate the difference between presenting and facilitating. Objectives: • list the behaviour of a good trainer • explain the difference between presenting and facilitating • list examples of good practice by presenters and facilitators • describe three strategies to keep to time. ToT.7 Presenting and facilitating: 2 Explain the aim and objectives of the session. 2. Trainer skills (15 minutes) Explain: You need to develop a variety of skills to deliver a successful training programme. In this session we look at the skills of a trainer, both as a presenter of information and as a facilitator of learning. Effective trainer behaviour is critical to bring about participants’ learning and create a positive learning environment. Effective trainers Think about people who have trained you in the past and who you consider to be effective trainers. What was effective in their behaviour? Write your ideas in the ToT Handbook (on page 28) and then discuss with the members of your group. ToT.7 Presenting and facilitating: 1 Show the slide throughout the activity. 61ToT.7 Presenting and facilitatingTrainer's Manual Activity 1 Groups: Divide trainees into groups of two or three. Instructions: Ask trainees to think about people who have trained them in the past and to identify who they consider to have been effective trainers. In other words, people who enabled them to learn what they needed to and who gave them positive and worthwhile experiences. Ask trainees to take a few minutes to reflect on the effective trainers’ behaviour and write their ideas in the space on page 28. in the ToT Handbook headed: What was effective in their behaviour? Ask trainees to share their thoughts with the member/s of their group. Ask groups to consider all aspects of their previous trainers’ behaviour: • how they presented themselves • how they interacted with the trainees • how they managed the training • how they created a positive environment. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 10 minutes for feedback. Feedback: Ask the groups to report back, giving one idea each until all ideas have been presented. Record ideas on the board. Refer trainees to the information in their ToT Handbook. Remind trainees that they will have a chance to practise the behaviour later in the week. Suggest that trainees use the list of Good practice for presenting and facilitating in the ToT Handbook (pg. 29) to help them to identify behaviour they need to work on. Explain that the list can be used for self-assessment if desired. 62 ToT.7 Presenting and facilitatingTrainer's Manual 3. Presenting and facilitating (5 minutes) ToT.7 Presenting and facilitating: 4 Presenting Facilitating Explain: The role of the trainer in the WSTP switches frequently between presenting and facilitating. Ask: What do you think the difference is between presenting and facilitating? Allow trainees a few minutes to think about this, then collect responses from the group. Show the next slides and acknowledge responses already given. • One-way • Provides information • Corrects misinformation • Assumes what is presented is not known • Treats all participants equally. ToT.7 Presenting and facilitating: 5 Read the slide content, expand if needed. Facilitating makes it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect this with new information. ToT.7 Presenting and facilitating: 6 Read the slide content, expand if needed. Explain that in the WSTP a combination of presenting and facilitating is used. The Trainer’s Manual indicates when to present and when to facilitate. 63ToT.7 Presenting and facilitatingTrainer's Manual 4. Good practice for presenting and facilitating (15 minutes) What do you consider good practice when presenting? ToT.7 Presenting and facilitating: 7 Ask trainees to reflect on what they consider good practice when giving a presentation. Collect responses from the group. Notes for ToT trainers: • ToT trainers must ensure they are a model of good practice throughout the ToT, especially during this session. Make sure you practise everything you say. • Vary the pace and tone of speech • Be aware of your position in the room • Ask questions and encourage contributions from the group. ToT.7 Presenting and facilitating: 8 Read the slides and acknowledge examples already given by the participants when reviewing. • Follow the instructions in the Trainer’s Manual • Watch your audience – are they listening, interested, awake? • Break for a few minutes if necessary or insert a short energizer. ToT.7 Presenting and facilitating: 9 64 ToT.7 Presenting and facilitatingTrainer's Manual Ask: Who knows what we mean by an energizer? Acknowledge responses. Explain: • An energizer is a short activity designed to enliven and re-energize a group of participants. • Often, but not always, the energizer is unrelated to the content of the session. • There is a section about energizers, with examples, in the ToT Handbook on page 30–31. Ask a trainee to lead a short energizer for the group. Ask trainees what the energizer did to the group. Notes for ToT trainers: • Most trainees will know some energizers from previous training experiences. Be prepared to give an example if no one volunteers. • Use slides as a prompt • Allow time for participants to absorb the content • Match slides to what you are saying • Avoid reading from screen • Avoid blocking the beam. ToT.7 Presenting and facilitating: 10 Explain: • Use the slides as a prompt and to show the key messages. • Allow time for participants to absorb the content of each slide. This will take longer for those working in a foreign language. • Add variety by asking participants to read slide messages out loud. • Make sure the slide shown corresponds with what you are saying. • Keep the slides synchronized with the Trainer’s Manual. • Avoid reading from the screen. • If you do read from the screen, do not look over your shoulder or stand with your back to the audience. • Avoid blocking the beam. Demonstrate these last three points by showing how you can move to the side of the training room or behind the participants. 65ToT.7 Presenting and facilitatingTrainer's Manual Ask: How will your presentation style and session planning change when participants have a visual impairment? Acknowledge answers. Most important answers: • Read information on the slides to ensure participants with visual impairments get all of the information. • Make sure the presentations are in a large font and that the screen is as large as possible for those who are partially sighted. • Meet with participants before the training to understand their needs. • If participants use a screen reader, provide documents and presentations ahead of time so they can review before the training starts. • Provide documents in braille if applicable. • Understand the purpose of the activity • Give people time and space to think for themselves • Ask rather than tell • Give clear instructions • Check on learning. ToT.7 Presenting and facilitating: 11 Read the slide. Refer trainees to the key points in the ToT Handbook. Expand as needed. Where did you see us presenting and where did you see us facilitating in the ToT so far? ToT.7 Presenting and facilitating: 12 Ask: Can anyone think of examples where the trainers have been presenting and where they have been facilitating in the sessions we have done so far? Ask: How do the two methods feel different to you as a trainee? Acknowledge responses. Remind trainees that they will have the opportunity to observe and practise both presenting and facilitating as the ToT continues. 66 ToT.7 Presenting and facilitatingTrainer's Manual 5. Managing time (20 minutes) Explain: • Trainers and participants need to make sure that the training programme runs on time. • There are many sessions and activities and a limited amount of time to complete them. Keeping to time What can we do to keep the training running on time? ToT.7 Presenting and facilitating: 13 Show the slide throughout the activity. Activity 2 Groups: Divide the trainees into pairs. Instructions: Ask What can we do to keep the training running on time? Ask trainees to write ideas down in their ToT Handbook on page 31. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Feedback as a whole group, taking suggestions from pairs in turn. Acknowledge responses and add to them using the Notes for ToT trainers below. 67ToT.7 Presenting and facilitatingTrainer's Manual Notes for ToT trainers: • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 6. Key point summary (2 minutes) • Factors contributing to the quality of training • Characteristics of presenting and facilitating • Good practice for presenters and facilitators. ToT.7 Presenting and facilitating: 14 Read the key points. Ask whether there are any questions. 68 ToT.8 Communication skillsTrainer's Manual ToT.8 Communication skills A IM To discuss communication skills and put presentation skills into practice. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the importance of communication skills and put presentation skills into practice □□ explain how to give good demonstrations □□ describe how to work well with interpreters. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.8: Communication skills. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Types of communication 3. Demonstrations, videos and interpreters 4. Key point summary 2 55 30 3 Total session time 90 69ToT.8 Communication skillsTrainer's Manual 1. Introduction (2 minutes) Aim: To discuss communication skills and put presentation skills into practice. Objectives: • explain the importance of communication skills and put presentation skills into practice • explain how to give good demonstrations • describe how to work well with interpreters. ToT.8 Communication skills: 2 Explain the aim and objectives of the session. 2. Types of communication (55 minutes) Explain: • Communication skills are key to becoming a good trainer. • In this activity you will have the opportunity to practise your communication skills. • You will take on the role of trainer and present the key learning points for your topic yourself. • This is a chance for you to put some of the skills discussed in the Presenting and facilitating session into practice. Communication skills • In your groups, read and discuss the key points for your topic (pages 33-35 of the ToT Handbook) • Prepare a five minute presentation to explain the key points • Use a variety of styles to convey the information such as presentation, demonstration, or role play. ToT.8 Communication skills: 1 Show the slide throughout the activity. 70 ToT.8 Communication skillsTrainer's Manual Activity 1 Groups: Divide trainees into four groups. Instructions: Assign each group one of the topics listed in the Notes for ToT trainers that follow and direct trainees to page 33–35 in the ToT Handbook. Each group should present the information listed under their topic. Encourage groups to be creative and to use props, flipcharts, or the board as desired. Monitor: Monitor the groups and assist as needed. Time: Allow 20 minutes for groups to prepare the task; 5 minutes for each group to present; 2 minutes for discussion after each presentation; and 5 minutes for final feedback and consolidation by the ToT trainer. Feedback: Refer trainees to their ToT Handbook to check if all the information was communicated in the session. Focus feedback on the content of the session and the different communication skills. The ToT trainer should briefly summarize any key points not clearly presented by the group. Notes for ToT trainers: Group 1 - Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what the trainer says. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 71ToT.8 Communication skillsTrainer's Manual Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, the trainer should stand at the front or side – participants should be able to see and hear the trainer – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and the trainer needs to read their PowerPoint slides – depending on the context, it may be appropriate for the trainer to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 72 ToT.8 Communication skillsTrainer's Manual Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. 3. Demonstrations, videos and interpreters (30 minutes) • Giving demonstrations • Using videos • Communicating through foreign language and sign language interpreters. ToT.8 Communication skills: 4 Explain: We will now look at three more aspects of communication. Read the slide. 73ToT.8 Communication skillsTrainer's Manual Demonstrations, videos and interpreters • In your group, discuss what to consider when delivering training about your topic. – Group 1: Good practice for giving demonstrations and showing videos – Group 2: Working with foreign language and sign language interpreters. • Close your ToT Handbook during this activity. ToT.8 Communication skills: 5 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into two groups. Instructions: Ask trainees to close their ToT Handbook (the answers are in the book). Assign one topic to each group: • Ask group 1 to consider : Good practice for giving demonstrations and showing videos. • Ask group 2 to consider : Working with foreign language and sign language interpreters. Ask trainees to discuss what to consider when delivering training about your topic and to write it on a flipchart to present to the other group. Refer trainees to the activity instructions on the PPT slide. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the groups to develop their lists; 5 minutes for each group to present; and 5 minutes for additional key points after each presentation. Feedback: Ask group 1 to present their findings to group 2. Add in any key points missed from the trainer’s notes below. Ask group 2 to present their findings to group 1. Add in any key points missed from the Notes for ToT trainers below. Refer trainees to the reference material in the ToT Handbook. 74 ToT.8 Communication skillsTrainer's Manual Notes for ToT trainers: Giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. Using videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters: Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 75ToT.8 Communication skillsTrainer's Manual 4. Key point summary (3 minutes) • Think about all aspects of your communication • Best practice for giving demonstrations and using videos • Meet with interpreters before the training to discuss your needs and set expectations. ToT.8 Communication skills: 6 Read the key points. Ask whether there are any questions. 76 ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents A IM To introduce trainees to the WSTP guiding documents and explain their relevance. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ list the WSTP guiding documents □□ explain their importance for WSTP trainers and participants. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.9: Knowledge of guiding documents □□ Video: Sustainable Development Goals. One copy of each of the following resources: □□ United Nations Convention on the Rights of Persons with Disabilities (CRPD) □□ WHO Guidelines on the provision of manual wheelchairs in less-resourced settings □□ WHO Joint position paper on the provision of mobility devices in less-resourced settings □□ WHO CBR Guidelines: Introductory Booklet and Health Component □□ Design Considerations for Accessibility. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Ensure thorough knowledge of all guiding documents. □□ Consult the UN website to check the total number of countries that have signed the CRPD at the time of your training programme. Check whether the trainees’ countries have signed and ratified the CRPD so that you can mention this and answer any questions. http://www.un.org/disabilities/ O U T L IN E 1. Introduction 2. The CRPD as it relates to wheelchair service provision 3. WHO Guidelines on the provision of manual wheelchairs in less-resourced settings 4. CBR Guidelines 5. Other guiding documents 6. Key point summary 8 20 5 25 15 2 Total session time 75 77ToT.9 Knowledge of guiding documentsTrainer's Manual 1. Introduction (8 minutes) Aim: To introduce trainees to the WSTP guiding documents and explain their relevance. Objectives: • list the WSTP guiding documents • explain their importance for WSTP trainers and participants. ToT.9 Knowledge of guiding documents: 2 Explain the aim and objectives of the session. What do we mean by guiding documents? ToT.9 Knowledge of guiding documents: 3 Ask: What do we mean by guiding documents? Acknowledge answers. Most important answers: • Publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision. • Resources that guide stakeholders in the provision of wheelchair services. Why is it important for you to be aware of these documents? ToT.9 Knowledge of guiding documents: 4 Ask: Why is it important for you as trainers to be aware of these documents? Acknowledge answers. 78 ToT.9 Knowledge of guiding documentsTrainer's Manual Most important answers: • Many governments, international agencies, donors and other stakeholders plan and fund development work in line with these international frameworks. • To be in a stronger position to educate and advocate for appropriate wheelchair service provision. Trainers need to have a good understanding of: • international conventions/goals • international documents • national laws and policies. ToT.9 Knowledge of guiding documents: 5 Explain: • When running a WSTP training programme, it is important to be aware of these guiding documents to help you educate and advocate for appropriate wheelchair provision. • Local documents are likely to be referred to by participants and trainers will need a good understanding of them too. Explain: A good understanding of these resources can contribute to the quality of your training delivery. There is more information on all guiding documents in your ToT Handbook Ask: What are the two most important guiding documents that relate to wheelchair service provision? Most important answers: • United Nations Convention on the Rights of Persons with Disabilities • WHO Guidelines on the provision of manual wheelchairs in less-resourced settings. 79ToT.9 Knowledge of guiding documentsTrainer's Manual 2. The CRPD as it relates to wheelchair service provision (20 minutes)7 • Most important international treaty relating to disability • Came into force in 2008 • Designed to change the way people with disabilities are viewed and treated. ToT.9 Knowledge of guiding documents: 6 Explain: • We will look first at the United Nations Convention on the Rights of Persons with Disabilities,7 commonly known as the CRPD. • The CRPD is widely considered to be the most important international treaty relating to people with a disability. • The CRPD came into force in 2008. Explain: • On its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol: the highest number of signatories to a UN Convention on its opening day in history. • The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. • Representatives included people with disabilities, government officials and representatives of nongovernmental organizations. • The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Notes for ToT trainers: • Look up the total number of countries that have signed the CRPD at the time of your training programme and check whether the participants’ country/countries have signed and ratified the Convention. 7 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611 (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 80 ToT.9 Knowledge of guiding documentsTrainer's Manual Why is it important for participants of the WSTP to be familiar with the CRPD? ToT.9 Knowledge of guiding documents: 1 Ask: Why is it important for participants of the WSTP to be familiar with the CRPD? Acknowledge responses. Most important answers: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. Which articles of the CRPD are most relevant? ToT.9 Knowledge of guiding documents: 8 Explain: The CRPD has several articles relevant to wheelchair service provision. Ask: Without looking at your ToT Handbook, can anyone remind us which articles are the most relevant? Acknowledge responses. Most important answers: • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. 81ToT.9 Knowledge of guiding documentsTrainer's Manual Other answers may include: • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. • Facilitate personal mobility with consideration of personal choice and cost • Facilitate access to quality mobility aids • Provide training in mobility skills to wheelchair users and service personnel • Encourage production of mobility devices to consider all aspects of mobility. ToT.9 Knowledge of guiding documents: 9 Explain: • CRPD Article 20 is the most relevant to wheelchair service provision. • It requires States Parties to take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities. To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. ToT.9 Knowledge of guiding documents: 10 Explain: Article 4 covers General obligations and includes this statement. • Article 19: Living independently and being included in the community • Article 24: Education • Article 25: Health • Article 26: Habilitation and Rehabilitation • Article 27: Work and employment • Article 30: Participation in cultural life, recreation, leisure and sport • Article 32: International cooperation. ToT.9 Knowledge of guiding documents: 11 Explain: • These articles are also relevant because, for example, they mention the importance of assistive devices, reasonable accommodation, and mobility skills training. • Article 26 is particularly important as it deals with Habilitation and Rehabilitation. 82 ToT.9 Knowledge of guiding documentsTrainer's Manual Explain: Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. What additional barriers can women and children face when accessing services? ToT.9 Knowledge of guiding documents: 12 Ask: What additional barriers can women and children face when accessing wheelchair services? Ask participants to take one or two minutes to discuss this with the person next to them and then collect feedback. Acknowledge responses and add any important points not mentioned. Most important answers: • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. Wheelchair provision services must specifically ensure the needs of women and children are considered. ToT.9 Knowledge of guiding documents: 13 Explain: To meet Articles 6 and 7 of the CRPD, wheelchair provision services must specifically ensure the needs of women and children are considered. 83ToT.9 Knowledge of guiding documentsTrainer's Manual 3. WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (5 minutes) Explain: The WHO Guidelines on the provision of manual wheelchairs in less- resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. Acknowledge that most trainees will be very familiar with the Wheelchair Guidelines. • Framework by which appropriate wheelchair provision is understood internationally • Developed with involvement of a cross section of stakeholders • They are a powerful tool. ToT.9 Knowledge of guiding documents: 14 Explain: • The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. • Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider. Explain: • The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. • They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. • The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. Ask: Who can remember the definition of an appropriate wheelchair? Acknowledge answers. 84 ToT.9 Knowledge of guiding documentsTrainer's Manual • Meets the user’s needs and environmental conditions • Provides proper fit and postural support • Is safe and durable • Is available in the country • Can be obtained and maintained and services sustained in the country at an affordable cost. ToT.9 Knowledge of guiding documents: 15 Read the points on the slide. • Design and production • Service delivery • Training • Policy and planning. ToT.9 Knowledge of guiding documents: 16 Explain: The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. Ask: Who has read the Wheelchair Guidelines in the last year? Encourage all trainees to read the Wheelchair Guidelines thoroughly. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; trainers should try to raise awareness of them whenever they have the opportunity. Explain: The Wheelchair Guidelines are available on the WHO website in a range of languages.8 8 8 http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/ 85ToT.9 Knowledge of guiding documentsTrainer's Manual 4. CBR Guidelines (25 minutes)9 10 Explain: There are several other guiding documents included in the supplementary resources section on the WSTP Pen Drive. You should be familiar with these, so that you can explain their importance and relevance to others. Explain: Community-Based Rehabilitation (CBR) is likely to come up in discussions during the WSTP. It is therefore important that trainers have a good understanding of the CBR Guidelines,9 particularly the health component. • Seen as an effective way of implementing the CRPD • Many aspects relevant to wheelchair service provision. ToT.9 Knowledge of guiding documents: 17 Explain: • CBR, also often called Community- Based Inclusive Development (CBID), is increasingly seen as one of the most effective ways of implementing the CRPD. • Many aspects of CBR are relevant to wheelchair service provision. For example, referral networks, community health centres and CBR workers. ToT.9 Knowledge of guiding documents: 18 Explain: The CBR Matrix10 is one of the cornerstones of the CBR Guidelines. Ask: What are the five key components of the CBR matrix? Acknowledge answers. 9 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 10 The CBR Matrix. Geneva: World Health Organization (http://www.who.int/disabilities/cbr/matrix/en/). 86 ToT.9 Knowledge of guiding documentsTrainer's Manual ToT.9 Knowledge of guiding documents: 19 Explain: • The five components are: Health, Education, Livelihood, Social and Empowerment. • Each component of the Matrix has five elements within it, so there are a total of 25. CBR Matrix In groups, identify two ways wheelchair provision relates to the component of the CBR Matrix you are assigned. Example: in the livelihood category, having an appropriate wheelchair can help someone get to work and earn their living. ToT.9 Knowledge of guiding documents: 20 Show the slide throughout the activity. 87ToT.9 Knowledge of guiding documentsTrainer's Manual Activity 1 Groups: Divide trainees into five groups. Create a mix of gender, experience/ knowledge and skills in each group. Instructions: Refer trainees to their copy of the CBR Matrix on page 45 of the ToT Handbook. Allocate one component of the matrix to each group to discuss. Ask trainees to consider the ways in which wheelchair service provision relates to their component and to be ready to feedback to the group on two of them. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for the activity and 10 minutes for feedback. Feedback: Ask each group for their first answer in turn. Then ask each group for their second answer in the same way. Answers may include: Health • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. Education • Enables access to school, educational programmes and vocational programmes. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Empowerment • Improved self-image and confidence. • Peer support. 88 ToT.9 Knowledge of guiding documentsTrainer's Manual Health: Health benefits, importance in prevention of secondary complications. Education: Enables access to school and vocational training, to sit upright for function and interaction. Livelihood: Access to workplace, increased mobility and independence to work, earn and contribute. Social: Access to social/recreation activities. Empowerment: Confidence, peer training/support. ToT.9 Knowledge of guiding documents: 21 Explain: • This slide summarizes how appropriate wheelchair provision can improve the key aspects of life identified in the CBR Matrix. • There is further information on the CBR Guidelines and Matrix in the ToT Handbook. 5. Other guiding documents (15 minutes)11 Provides information on: • barriers to accessing mobility devices • increasing access to mobility devices • recommendations for national and international level stakeholders. ToT.9 Knowledge of guiding documents: 22 Explain: • The WHO Joint position paper on the provision of mobility devices in less-resourced settings11 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. • It includes information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 11 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 89ToT.9 Knowledge of guiding documentsTrainer's Manual An overview of some of the basic features to consider when ensuring public buildings are accessible. ToT.9 Knowledge of guiding documents: 23 Explain: • The final guiding document included on the WSTP Pen Drive is Design considerations for accessibility.12 • This gives useful information on how to ensure all aspects of access are considered; both when visiting the wheelchair service and in other environments. Explain: There are a number of other guiding documents that you should be familiar with as a trainer of the WSTP. Ask: Another major international instrument has been launched since the development of the WSTP: Can anyone tell us what that is? Acknowledge answers. Most important answer: Sustainable Development Goals (SDGs).13 • Follow up to the Millennium Development Goals • Launched in September 2015 • Timeline 2015 – 2030. ToT.9 Knowledge of guiding documents: 24 Explain: • The SDGs are a follow up to the Millennium Development Goals (MDGs). • They were launched in September 2015 and have a timeline of 2015 to 2030. 12 13 12 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 13 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 90 ToT.9 Knowledge of guiding documentsTrainer's Manual Sustainable Development Goals ToT.9 Knowledge of guiding documents: 25 Introduce video: Sustainable Development Goals. Ask participants to watch this United Nations video on the 17 SDGs. Show video. ToT.9 Knowledge of guiding documents: 26 Explain: • Five SDGs make specific references to disability: 4, 8, 10, 11 and 17. • Nine global indicators relate to disability. As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all people. And we will endeavor to reach the furthest behind first. ToT.9 Knowledge of guiding documents: 27 Explain: • The SDGs aim to reach the most vulnerable and commit to reach the furthest behind first. • Many stakeholders will be addressing the SDGs so it is important to consider how appropriate wheelchair service provision can contribute to meeting the goals. 91ToT.9 Knowledge of guiding documentsTrainer's Manual • Priority Assistive Products List (APL) launched in May 2016 • 50 priority assistive products, including 4 types of wheelchairs. ToT.9 Knowledge of guiding documents: 28 Explain: • WHO’s Global Cooperation on Assistive Technology (GATE) initiative is another important step forward. • GATE was created to improve access to assistive technology globally. • GATE’s first outcome is the WHO Priority Assistive Products List (APL),14 launched in May 2016. • The APL features the 50 priority assistive products/devices that governments should make available at an affordable cost, including four different types of wheelchairs. ToT.9 Knowledge of guiding documents: 29 Explain: Other relevant documents detailed in the ToT Handbook include the: • WHO World Report on Disability15 • WHO Global Disability Action Plan16 • UN High Level Meeting on Disability.17 14 15 16 17 14 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/ implementation/assistive_technology/global_survey-apl/en/). 15 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 16 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 17 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 92 ToT.9 Knowledge of guiding documentsTrainer's Manual 6. Key point summary (2 minutes) • Wide range of relevant guiding documents to help educate and advocate for appropriate wheelchair service provision. • A thorough knowledge will enhance training and help you educate stakeholders and advocate for appropriate wheelchair provision. • Dynamic field: be aware of new guiding documents. ToT.9 Knowledge of guiding documents: 30 Read the key points. Ask whether there are any questions. 93ToT.10 Audio-visual tools and equipmentTrainer's Manual ToT.10 Audio-visual tools and equipment A IM To enable trainees to use PowerPoint (PPT) presentations and audio-visual equipment effectively. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ explain the advantages and disadvantages of the available PPTs in the WSTP □□ make changes to and embed videos into PPTs □□ describe good practice in the use of audio-visual equipment □□ use the board and flipchart effectively as a visual aid. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.10: Audio-visual tools and equipment □□ remote control slide changer and laser pointer if available. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Familiarize yourself with the equipment and with using the PPT (including embedding videos) beforehand, so you can answer questions, give a good demonstration and know what kinds of problems trainees might experience. O U T L IN E 1. Introduction 2. PowerPoints in the WSTP 3. Using the board and flipchart as a visual aid 4. Key point summary 4 20 20 1 Total session time 45 94 ToT.10 Audio-visual tools and equipmentTrainer's Manual 1. Introduction (4 minutes) Aim: To enable trainees to use PPT presentations and audio visual equipment effectively. Objectives: • explain the advantages and disadvantages of available PPTs • make changes and embed videos into PPTs • describe good practice in the use of audio-visual equipment • use the board and flipchart effectively as a visual aid. ToT.10 Audio-visual tools and equipment: 2 Explain the aim and objectives of the session. Ask: What types of audio-visual (AV) equipment have we used so far in the training? Most important answers: • Data projector for ppts and videos • Board • Flipchart • Sticky notes on wall. Ask: In what ways was the equipment useful? Most important answers: Flipchart and whiteboard: • highlighted key information/learning points during sessions and for future reference (for example Ground Rules) • visual reminder of answers already given • assist with technical explanations. PPTs and videos: • opportunity to show diagrams to explain concepts • reinforced learning by showing images/messages as well as speaking • helped to focus attention. 95ToT.10 Audio-visual tools and equipmentTrainer's Manual 2. PowerPoints (PPTs) in the WSTP (20 minutes) PDF files: • smaller file size • cannot be edited • no animations • videos embedded. ToT.10 Audio-visual tools and equipment: 3 PPT files: • larger file size • can be edited • animations • videos not embedded. Explain: • WSTP PPTs are available in two versions, non-editable PDF files and editable PPT. • PDF versions are: – smaller in size and have the videos embedded – cannot be edited – do not include ‘builds’ or ‘reveals’ where bullet points appear one by one. • PPT versions are: – larger in size – can be edited – do not come with the videos embedded – include animations. 96 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Key discussion questions • Reminders of the key points • For activities. ToT.10 Audio-visual tools and equipment: 4 Explain: Trainers may want to add slides to include the following: • Key questions: – the Trainer’s Manual includes questions for trainers to ask participants. – adding the question to a slide can remind you to ask the question and not to move on to the answers too soon. • Key points: – some sections of the Trainer’s Manual have large amounts of text without reminder slides. – adding key points can help you to remember to cover all aspects of the session plan. • Instructions for activities: – key questions or key instructions that relate to activities can be added to slides. • Local context • Translation • Reduce or divide the text. ToT.10 Audio-visual tools and equipment: 5 Explain: Trainers many want to change slides to: • adapt for the local context • provide translation or locally relevant terms • reduce the text or divide content into two or more slides. Explain: It is important not to change the meaning of the content or the methodology of the WSTP. 97ToT.10 Audio-visual tools and equipmentTrainer's Manual • Must follow the same format as the original PPT • Do not to change the meaning and the core content of the WSTP • Delete the WHO logo. ToT.10 Audio-visual tools and equipment: 6 Explain: If you modify slides or add extra slides you must: • follow the same style as the original PPT • not change the meaning and core content of the WSTP • delete the WHO logo (in line with WHO’s copyright policy). • ADDING SLIDES TO PRESENTATIONS • In different sizes and fonts • And using ‘special effects’ • CAN BE VERY DISTRACTING • And look unprofessional • So avoid it! ToT.10 Audio-visual tools and equipment: 7 Explain: Do not change the style, font or colour, or add complex animations. 98 ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding slides Come out of “Slide Show” mode and demonstrate the following using the next slide. • The simplest method is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Another method of adding slides is to change the “Slide Master” to ensure consistency in layout. ToT.10 Audio-visual tools and equipment: 8 Explain: • The simplest way to add slides to an existing WSTP presentation is to duplicate another slide, delete the text in the header and body of the slide, and change the number in the footer. • Remember to remove the WHO logo from any slides that you add. • More details on how to do this are included in your ToT Handbook. Inserting video clips (Using Office 2013) 1. Choose your format: • mp4 – Apple computers or Windows computers with Quicktime player • wmv – Windows computers 2. Choose with or without subtitles • subtitles recommended. ToT.10 Audio-visual tools and equipment: 9 Explain: • All video clips are available in two formats, mp4 and wmv. Select the appropriate format for your computer. • Some video clips are available with subtitles. Using the clips with subtitles is recommended to: – allow for any difficulty understanding regional accents – overcome poor sound quality or external noise – be accessible to people with hearing impairments. • The video is stored inside the PPT when it is embedded • Video will remain embedded when you copy the file to another computer • Increases the overall file size. ToT.10 Audio-visual tools and equipment: 10 Explain: • Embedding videos is recommended. • When embedded, the video is stored inside the PPT. • This makes the file larger, but the video should not get lost when you copy the file to another computer. 99ToT.10 Audio-visual tools and equipmentTrainer's Manual Adding a video here… ToT.10 Audio-visual tools and equipment: 11 Demonstrate the following: To embed the video in PPT 2010 onwards, follow these steps. • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it • Save your changes • The video is now part of the PPT. Explain: • It is possible to set the video to always play in full screen mode. • Windows computers: In the “Video”/“Tools”/“Playback” tab, check the box called “Play Full Screen”. • Mac computers: “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. Return to “Slide Show” mode and show how to play the video. Play the first few seconds and then go to the next slide. Notes for ToT trainers: • Let participants know that they can practise these skills during the preparation time at the end of the day. • Local photos or illustrations can be added to the slides to give them context. • Translation of the slides can be done locally – always check with WHO first to see if the slides have already been translated. 100 ToT.10 Audio-visual tools and equipmentTrainer's Manual • Run the presentation in “Slide Show” mode on your computer when practising for your session • Run the full presentation in “Slide Show” mode on the computer and data projector that will be used during the training. ToT.10 Audio-visual tools and equipment: 12 Explain: • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. • This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. • Have a spare data projector or projector lamp • Switch off projector during breaks and practical sessions • To project a black or white screen: –Type W –Type B. ToT.10 Audio-visual tools and equipment: 13 Explain: • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. Demonstrate how to get a black or white screen. 101ToT.10 Audio-visual tools and equipmentTrainer's Manual • Use remote control to forward slides • Use laser pointer to draw attention • Test the speakers for sound quality and volume. ToT.10 Audio-visual tools and equipment: 14 Explain: • Using a remote control to click between slides means that trainers do not need to stand next to the computer during their presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. • Test the speakers each morning to ensure they are connected properly. Demonstrate using a remote control with a laser pointer (if available). 3. Using the board and flipchart as a visual aid (20 minutes) Using the board/flipchart as a visual aid • The ToT Handbook includes a table with five boxes of information related to using the board/flipchart as a visual aid. • Using the information about your topic plan a 2 minute presentation to the group with the board/flipchart. ToT.10 Audio-visual tools and equipment: 15 Show the slide throughout the activity. 102 ToT.10 Audio-visual tools and equipmentTrainer's Manual Activity 1 Groups: Divide trainees into 5 groups. Instructions: Refer trainees to the table on Using the board/flipchart as a visual aid on page 60 of the ToT Handbook. Allocate one topic from the table to each group and ask them to read through the information provided and plan how to communicate this to the rest of the group using the board/flipchart. Monitor: Monitor the groups and assist as needed. Time: Allow 10 minutes for preparation and 2 minutes for each group to present. Feedback: Add any information missed in the presentations. Using the board/flipchart as a visual aid 1. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. 2. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. 3. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). 4. What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. 103ToT.10 Audio-visual tools and equipmentTrainer's Manual 5. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 4. Key point summary (1 minute) • Know how to use AV equipment • Use PPT versions of presentations and tailor them to suit your context and presentation style • Practise your presentations in “Slide Show” mode on the computer you will use to deliver the training • Understand and follow the guidelines for effective use of the board/flipchart. ToT.10 Audio-visual tools and equipment: 16 Read the key points. Ask whether there are any questions. 104 ToT.11 FeedbackTrainer's Manual ToT.11 Feedback A IM To explore the role and skills of the trainer in providing useful feedback. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ describe how to give useful feedback □□ describe the process of providing feedback at the end of each practice delivery session. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.11: Feedback. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. □□ Prepare a flipchart sheet with the four feedback steps: 1. Self-reflection by the trainee 2. ToT participants’ feedback 3. ToT trainers’ feedback 4. ToT trainers discuss key points. O U T L IN E 1. Introduction 2. Giving feedback 3. The feedback process after practice deliveries 4. Key point summary 2 35 7 1 Total session time 45 105ToT.11 FeedbackTrainer's Manual 1. Introduction (2 minutes) Aim: To explore the role and skills of the trainer in providing useful feedback. Objectives: • describe how to give useful feedback • describe the process of providing feedback at the end of each practice delivery session. ToT.11 Feedback: 2 Explain the aim and objectives of the session. 2. Giving feedback (35 minutes) Ask: What is feedback? Most important answers: • What I am doing well – positive feedback. • What I need to improve on – constructive feedback. Explain: It is important that trainers have the skills to give feedback well, and that they can support positive learning outcomes for participants. Receiving feedback: • Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. • Reflect on this individually, then discuss and compare your conclusions with your partner. ToT.11 Feedback: 3 Show the slide throughout the activity. 106 ToT.11 FeedbackTrainer's Manual Activity 1a Groups: Divide trainees into pairs. Instructions: Ask: What experiences have you had of receiving feedback? Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Ask trainees to record their reflections on page 61 of their ToT Handbook. Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 5 minutes for feedback to the group. Feedback: Ask participants to provide examples. Record key words on the board. Giving feedback What should trainers consider when providing feedback? ToT.11 Feedback: 4 Show the slide throughout the activity. 107ToT.11 FeedbackTrainer's Manual Activity 1b Groups: Divide into the same pairs. Instructions: Ask: What should trainers consider when providing feedback? Ask trainees to briefly reflect on this question individually, and then share and discuss it with their partner. Monitor: Monitor the pairs and assist as needed. Time: Allow 2 minutes for reflection, 3 minutes for working in pairs and 10 minutes for feedback. Feedback: Ask each group in turn to describe one or two important considerations when giving feedback. Acknowledge good examples to consider. Correct/clarify any misunderstandings. Use the notes below to ensure the appropriate answers have been discussed by the group. Notes for ToT trainers: Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. This will help participants to connect the feedback with the recent learning or activity. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on behaviour – when providing constructive feedback, focus on the behaviour not the person. • Start with the positive – point out what was done well before talking about what needs improvement. If possible, also end on a positive note. • Be delivered in different ways – feedback on practice deliveries is useful to everyone. Praise and provide constructive feedback publicly to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their performance first. They may already understand what went well and what they need to improve. • Support participants, we are all different – before providing constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same was as you. 108 ToT.11 FeedbackTrainer's Manual 3. The feedback process after practice deliveries (7 minutes) Explain: ToT trainers will observe sessions from the back of the room but will move to the front of the room to facilitate the feedback. • Trainee reflects on delivery Self- reflection • ToT participants’ feedback Participant feedback • ToT trainers’ feedback ToT trainer feedback • ToT trainers discuss key points relevant to all trainees Key points ToT.11 Feedback: 1 Pin up the prepared flipchart sheet showing the four feedback steps and leave this on the wall for the rest of the week as a reference. Explain: There are four feedback steps after practice deliveries. 1. Self-reflection by trainee: lead trainee reflects on their performance, including: • what went well? • what could be improved? 2. ToT participants’ feedback: provide brief, specific feedback to the lead trainee, including one comment on: • what went well? • what could be improved? 3. ToT trainers’ feedback: ToT trainers will provide additional feedback, concentrating on areas the group as a whole can learn from, and which reinforce learning from the Core training skills sessions. 4. ToT trainers discuss key points: ToT trainers discuss points about the session relevant to all trainees. 109ToT.11 FeedbackTrainer's Manual Explain: When providing feedback, it is important to: • Look at the person you are talking about and address them directly. • Be specific. For example, rather than saying, ‘That was really good’, you should say ‘I liked the way you divided the groups, and provided clear instructions’. • Feedback from participants should always be constructive. • If feedback is hurtful or insensitive to the trainee, the ToT trainer must step in to rephrase the feedback so it is more constructive. • The feedback process will give you the opportunity to put the learning from this session into practice. More formal one-on-one feedback to trainees will happen at the end of each day during the preparation session. Ask if there are any questions. 4. Key point summary (1 minute) Feedback should: • Be timely • Be specific • Focused on behaviour • Start with the positive • Be provided in private if it is sensitive. ToT.11 Feedback: 6 Read the key points. Ask whether there are any questions. 110 ToT.12 Managing group dynamics Trainer's Manual ToT.12 Managing group dynamics A IM To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. L E A R N IN G O B JE C T IV E S By the end of this session trainees will be able to: □□ use a variety of methods to create small groups for an activity, considering skill, expertise and experience □□ manage disruptive behaviour in a group. R E S O U R C E S For the session: □□ PPT slides: Core training skills ToT.12: Managing group dynamics □□ prepare the disruptive behaviour cards: print and cut out the cards at the end of this session plan or write them out by hand. Have a hat or bucket ready. T O P R E PA R E □□ Gather resources, review PPT slides and read through the session plan. □□ Review related notes in the ToT Handbook. O U T L IN E 1. Introduction 2. Organizing and managing group activities 3. Managing disruptive behaviour 4. Key point summary 3 10 25 2 Total session time 40 111ToT.12 Managing group dynamics Trainer's Manual 1. Introduction (3 minutes) Aim: To explore how to work efficiently and effectively in groups and manage different behaviours that individuals display in a group. Objectives: • use a variety of methods to create small groups for an activity, considering skill, expertise and experience • manage disruptive behaviour in a group. ToT.12 Managing group dynamics: 2 Explain the aim and objectives of the session. Why are group activities included in the WSTP? ToT.12 Managing group dynamics: 3 Ask: Why are group activities included in the WSTP? Acknowledge answers. Record them on the board. • Allows trainers to find out how much is already known • Supports sharing of knowledge and experience • Builds confidence • Allows all participants to contribute. ToT.12 Managing group dynamics: 4 Explain: • There are always different levels of experience and expertise in the room. • Group work allows: – trainers to find out how much is already known – those with more experience and expertise to share it with others – participants to build confidence as they find out they already know a lot from their experience – shy or more junior participants to be more comfortable speaking out in a small group. 112 ToT.12 Managing group dynamics Trainer's Manual 2. Organizing and managing group activities (10 minutes) What is important to consider when dividing participants into groups? ToT.12 Managing group dynamics: 5 Ask: What is important to consider when dividing participants into groups? Acknowledge answers. Ask trainees to turn to page 63–65 in their ToT Handbook and talk through the list highlighting content not raised by trainees. Notes for ToT trainers: Factors to determine the size of the group • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. 113ToT.12 Managing group dynamics Trainer's Manual Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. 3. Managing disruptive behaviour (25 minutes) Disruptive behaviour With your partner, discuss what kinds of disruptive behaviour you have seen in trainings. ToT.12 Managing group dynamics: 6 Show the slide throughout the activity. 114 ToT.12 Managing group dynamics Trainer's Manual Activity 1 Groups: Divide trainees into pairs. Instructions: Explain that every group of participants has a range of personalities, skills, experience and learning styles. Only when specific behaviour disrupts the session should the trainer respond. Ask trainees to discuss with their partner what kind of disruptive behaviour they have seen in trainings? Monitor: Monitor the groups and assist as needed. Time: Allow 2 minutes for discussion and 3 minutes for feedback. Feedback: Collect one response from each pair until no new ideas are given. Write responses on the board. Managing disruptive behaviour • Select a ‘disruptive behaviour’ • Discuss how you would handle the behaviour described. ToT.12 Managing group dynamics: 7 Show the slide throughout the activity. Activity 2 Groups: Divide trainees into pairs. Instructions: Ask each pair in turn to select a card at random from the hat/bucket. Ask the pair to discuss how they would handle the behaviour described. Monitor: Monitor the groups and assist as needed. Time: Allow 5 minutes for discussion and 15 minutes for feedback. Feedback: Ask each group to share their ideas: how would they handle such a problem in the group? What works/does not work? After each group has provided their feedback, ask if any other trainees have ideas to share. 115ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. The higher status/senior participant • If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The dominant participant • The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The quiet participant • The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The argumentative participant • The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. • Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. 116 ToT.12 Managing group dynamics Trainer's Manual Notes for ToT trainers: The distracted participant • The participant who is easily distracted, always in and out of the training room or on the phone. • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. The joking participant • The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The negative participant • The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? 4. Key point summary (2 minutes) • Group work is an important training tool • Ensure you make the most of group work by carefully considering how you divide the participants, and how you support them • Managing disruptive behaviour is a key trainer skill. ToT.12 Managing group dynamics: 8 Read the key points. Ask whether there are any questions. 117ToT.12 Managing group dynamics Trainer's Manual Disruptive behaviour cards – photocopy or write out by hand and cut out The higher status/senior participant If there is a participant who is in a position of authority over others in the group, participants may be reluctant to speak, answer questions or disagree with them. The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate by talking loudly or for a long time. This person behaves like they know everything already. The quiet participant The participant who is shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe are true, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test the trainers’ skills and knowledge – and demonstrate that they are superior. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. The negative participant The participant who tends to be negative or to discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 118 Basic Level moduleTrainer's Manual Basic Level module A.1: Wheelchair users Key considerations for teaching this session a. General Tips for preparation • Make copies of the CRPD available for participants to look at during breaks. If possible, provide each participant with a printed copy. b. Section 4. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) • Section 4 of the WSTPb Trainer’s Manual (pages 26–28) focuses on the right to personal mobility (CRPD Article 20). Facilitate a discussion between participants, to ensure that they understand and agree with the overarching principles of the CRPD and of a rights-based approach. In addition to Article 20, highlight: – Article 1: Purpose of CRPD: everyone has rights and people with disabilities should have the same rights as everyone else. – Article 3: General principles of CRPD: that we are all equal and everyone should be treated with dignity and respect. – The CRPD is based on the principles of respect for dignity; non- discrimination; participation and inclusion; respect for difference; equality of opportunity; accessibility; equality between men and women; and respect for children. c. Section 5. Wheelchair users are equal partners in service delivery • The activity on page 28 of the Trainer’s Manual needs to be introduced and explained well as it does not have a worksheet in the Participant’s Workbook. 119A.1: Wheelchair users Trainer's Manual A.2: Wheelchair services Key considerations for teaching this session a. Section 2. Wheelchair services Tips for preparation • This section does not have any PPT slides and can easily be forgotten. Consider adding a slide for each of the questions within this section. b. Section 3. Wheelchair service personnel roles • Do not add detail to the service steps. Each step will be covered in more detail in later sessions. Park any questions requiring a more detailed explanation in the Car Park. • All wheelchair users need access to the eight steps of service delivery. These can be delivered by one organization or by different organizations working in partnership. It is important that participants understand the role of everyone involved in each service step so that they can work together effectively. 120 A.2: Wheelchair services Trainer's Manual A.3: Wheelchair mobility Key considerations for teaching this session a. General • If you have additional time available, this session can be extended to allow for more practice time, or for teaching additional wheelchair mobility skills. It can also be delivered over multiple days. b. Section 4. Wheelchair mobility skills – demonstration and practice Tips for preparation • The Trainer’s Manual does not specify the type of wheelchair required for this activity. If possible, include all of the following: – orthopaedic-style wheelchairs – active wheelchairs with the rear wheel in the active position – long-wheelbase wheelchairs – three-wheel wheelchairs. • Check there are appropriate sizes of wheelchairs available so all participants have an opportunity to practise the mobility skills. • It is important that lead and support trainees demonstrate all skills in the same way. Before the session, review and practise the skills together to ensure consistency. Use the Trainer’s Manual for guidance. • In preparation for the pushing and turning section, check that lead and support trainees agree where 10 and 2 o’clock hand positions are as this varies depending from which side you are looking at the wheel. Mobility training areas • Identify appropriate areas in advance. • Choose areas that are close together to save time moving. • Plan how the rotations will be done, for example: With or without trainers? Do wheelchairs stay with participants or at the mobility training areas? • If training areas are outside and not covered, plan around local weather condi- tions and run the session during the driest, warmest or coolest part of the day. 121A.3: Wheelchair mobility Trainer's Manual Content • Use the video to introduce the different mobility skills. Read out the captions in the skills sections of the video to emphasize the key learning points. • Pause the video at 2’39” (straight side on view) and point out how far forward the head and shoulders are when going up slopes. • It may be necessary to demonstrate some of the mobility skills again during the activity. • Ask participants to try a range of wheelchairs during the practical activity to experience the differences: – Over rough ground and slopes: encourage participants to try pushing with all types of wheelchairs available. – For partial wheelies: suggest participants use an orthopaedic-style wheelchair and an active-style wheelchair with the rear wheel in the more active position for comparison. • The position of the rear wheel affects the effort needed to propel the wheelchair or do a wheelie. The further back the rear wheel is, relative to the user, the harder it will be to push the wheelchair or do a wheelie. • Do not assume that a long-wheelbase wheelchair is heavier than a short- wheelbase wheelchair and therefore harder to wheelie. It is the position of the rear wheel that affects how difficult it is to do a wheelie. • Emphasize correct practice of key skills as described on page 42 of the Trainer’s Manual. Add these points: – Up slopes: lean forward. Participants and new wheelchair users usually do not lean forward enough. – Down slopes: do not use the brakes to slow down. – Up a series of steps with assistance: never go up forwards. – Down a series of steps with assistance: never go down backwards. • Participants can injure themselves during this activity. Closely monitor the groups and step in as needed. • Give clear instructions on group management and safety. • A spotter strap is used to prevent the wheelchair user from tipping backwards and is a useful tool in wheelchair skills training. It also enables the assistant to be in contact with the wheelchair user, without interfering with the skill being learnt (Figures 1 & 2). 122 A.3: Wheelchair mobility Trainer's Manual Figure 1. Using a spotter strap Figure 2. spotter straps18 Considerations for gender/culture18 • Before the session begins ask any wheelchair users in the group if they want to try out the practice wheelchairs. If they do, ask if they need assistance or equipment to transfer between the wheelchairs and make arrangements accordingly. Appoint a support trainee to assist them as required. • Participants work in pairs for this activity, with one person ready to assist to prevent tips or falls. If any participant has an impairment or physical disability, ask them before the session begins if they feel comfortable to assist others. They may need to position themselves differently during the activity. • If any participants are unable to participate in this activity, identify a role they can perform instead, for example observing other participants and providing feedback. 18 Wheelchair skills assessment and training 2015. Canada: Dalhousie University; 2015 (http://www.wheelchairskillsprogram.ca/eng/manual.php). 123A.3: Wheelchair mobility Trainer's Manual ToT trainer demonstrations/explanations a. Section 4. Wheelchair mobility skills – demonstration and practice Demonstrate the partial wheelie Follow the instructions on page 43 of the Trainer’s Manual. Emphasize the following points: • It is harder to do a wheelie in wheelchairs where the rear wheel is in a safe position. The technique described in the Trainer’s Manual makes it easier to do a wheelie: – place hands on the 1 o’clock position on the rear wheel – roll the wheel backwards until the hands are at the 10 o’clock position. Without stopping, change direction and push forward quickly. • If the rear wheel is in a more active position, it may be possible to do a partial wheelie by pushing forwards without rolling backwards first. • It can be helpful to stretch out a rope on the ground so participants can do a partial wheelie over it. • Divide participants into groups of three for practice. Common errors include: – starting with the hands too far from the 1 o’clock position – not going far enough back with the hands – stopping when changing direction or not changing direction quickly enough – not pushing forward far enough or hard enough. 124 A.3: Wheelchair mobility Trainer's Manual A.4: Sitting upright Errors in the WSTP materials a. Section 2. Sitting upright/neutral sitting posture • On slide 5, when listing the key points for sitting upright as seen from the front, the trunk has been omitted and the head is not listed in the correct order. The correct order is: – pelvis (level) – trunk (upright and symmetrical) – shoulders (level) – head (balanced centrally over the body) – thighs (thighs slightly open/abducted). Key considerations for teaching this session a. General • Keep emphasizing the correct order when describing posture. Start at the pelvis and move up, then go to the hips and move down. b. Section 2. Sitting upright/neutral sitting posture Tips for preparation • Have a stool or an assessment bed available for the volunteer to sit on. • If the volunteer sits on a chair, their posture will change if they lean against the backrest. If you only have access to a chair, make sure that the seat is level and ask the volunteer to sit sideways on the chair (with the backrest on one side) so they cannot lean on it. c. Section 3. How the pelvis affects the way we sit • Do not assume that participants are familiar with the terminology used in the WSTPb (for example: anterior, posterior, ASIS). • If available, use a model skeleton to demonstrate the important bony landmarks and movements of the pelvis. 125A.4: Sitting upright Trainer's Manual • Allow time for participants to locate and feel bony landmarks on their own body. • Remind participants to keep the typical size of the adult skeleton in mind when locating bony landmarks on users who are overweight (relate to model pelvis if available). • When demonstrating the movements of the pelvis with participants, emphasize what is happening above the pelvis in the spine and below pelvis in the hips with each movement. This will help participants to link posture with the position of the pelvis. 126 A.4: Sitting upright Trainer's Manual A.5: Pressure sores Key considerations for teaching this session a. General • Use the Car Park for any questions about pressure relief cushions, their design features and how to protect the cushion from moisture. This information is explained in detail in A.7: Cushions. b. Section 3. When and where to get help • Do not offer advice about medical treatment or dressings used for pressure sores. This is not the focus of the session and is outside the scope of the WSTPb. • Warn users against any home remedies unless recommended or approved by the health care professional who is managing the wound. c. Section 4. What causes pressure sores? • Shear may be a new concept for participants. It needs to be explained well to avoid confusion with friction. To explain shear, ask participants to place their knuckle against the table top with enough pressure so that when the knuckle is moved forward and back only the bone moves over the stationary skin. • Preventing the wheelchair user from slumping or sliding in the wheelchair will reduce shear and the risk of pressure sores. d. Section 8. Pressure relief techniques • This section is 10 minutes long and includes both the explanation and the activity. • Each participant should practise being both the wheelchair user and the assistant. • Participants are likely to ask how often, and for how long, pressure relief should be done. The usual guideline is every 30 minutes, for 2 minutes, to allow blood flow to return to the area. • The push-up technique (lifting by pushing up on both arms) is not taught in the WSTPb for the following reasons: 127A.5: Pressure sores Trainer's Manual – the strain and potential injury to the shoulders – few people can sustain the position for the 2 minutes needed to fully restore blood flow – the possibility of injury to the skin if the user loses control and drops down too hard. • When leaning to the side, lean only as far as necessary for the pelvis to tilt and free the seat bone of pressure. When teaching this technique to a wheelchair user, place your hand under the user’s seat bone and give them feedback once the pressure is relieved. 128 A.5: Pressure sores Trainer's Manual A.6: Appropriate wheelchair Errors in the WSTP materials a. Section 3. Meeting the wheelchair user’s needs • In the table on pages 76–77 of the Trainer’s Manual the entries for Roger, Dawid and Pinky mention a short wheelbase. This is the first time the wheelbase length is mentioned. Note that the overall length of the wheelchair will also affect the ability to turn and move in small spaces. Key considerations for teaching this session a. General Tips for preparation • If possible, have demonstration wheelchairs available to explain the features. Prepare before the session starts so that you can show how to make adjustments where appropriate to: – a folding frame and a rigid frame wheelchair (both 3-wheel and 4-wheel) – removable and fixed armrests – fixed footrest hangers and footrest hangers that flip up and swing away – short and long wheelbase wheelchairs – footrests set in highest and lowest, or forward and back, positions – backrests set in highest and lowest positions – rear wheels in safe and active positions. • Set up the area so that all the participants can see the demonstration wheelchairs. b. Section 3. Meeting the wheelchair user’s needs Section 3.2: Pushing the wheelchair • Lightweight wheelchairs are particularly important for children; those with progressive conditions; wheelchair users with limited strength (for example a high spinal cord lesion); those who frequently push long distances; and caregivers who push the wheelchair user. 129A.6: Appropriate wheelchair Trainer's Manual • The position of the rear wheel in relation to the seat impacts on how light the wheelchair feels. The rear wheel axle should be positioned under the wheelchair user. • With the rear wheel in an active position, the wheelchair is easier to push and wheelie both for wheelchair users who self-propel and caregivers who push the wheelchair. • Older wheelchair users and people with leg amputation (whose weight is distributed differently in the wheelchair) do not automatically require a ‘safe’ rear wheel position. Factors that will influence the rear wheel position include: – the user’s overall function: strength, balance and transfer skills – how they push their wheelchair – activities they do in their wheelchair – their level of understanding and insight – other conditions, for example spasms or uncontrolled movements. • You can consider providing temporary additional stability to users who may become more active. For example, you can add weight to the front of the wheelchair and gradually reduce it over time or use anti-tip bars while they learn to balance and propel. Section 3.3. Folding the wheelchair • Folding-frame wheelchairs are not the only option available when using transportation. Demonstrate how a lightweight 4-wheel rigid-frame wheelchair with removable wheels can be transported, by removing the rear wheels and then positioning the frame on the wheelchair user’s lap, when the vehicle is full and the wheelchair user is a passenger. Only the rear wheels have to be stored elsewhere in the vehicle. c. Section 4. Meeting the wheelchair user’s environment • Slide 23 introduces the wheelbase. The picture is of a wheelchair with a short wheelbase. When discussing this point, it is helpful to have two wheelchairs, one with a short and another with a long wheelbase. • Remember that the length of the wheelbase is measured with the castor wheel in the rear (trail) position. • An orthopaedic-style wheelchair is not automatically more stable than an active wheelchair. Orthopaedic-style wheelchairs generally have these features: 130 A.6: Appropriate wheelchair Trainer's Manual – short wheelbase: resulting in the front castors being heavily loaded so the wheelchair can tip forward easily – seat is high above the rear wheel axle: resulting in instability to the side, back and front – rear wheel is set back (behind the seat): when combined with a short wheelbase this results in the front castors being loaded and makes the wheelchair more difficult to push and turn. • The orthopaedic-style wheelchair is not suitable for active and outdoor use on rough terrain. Remind participants how hard it was to push the orthopaedic- style wheelchair on uneven ground and how difficult it was to do a partial wheelie compared to other types of wheelchairs. d. Section 5. Providing proper fit and postural support • Sometimes there is only one type of wheelchair available and it is not possible to prescribe a product appropriate for the environment. Always select the most appropriate size and take steps to ensure the best fit and postural support. 131A.6: Appropriate wheelchair Trainer's Manual A.7: Cushions Key considerations for teaching this session a. General • This session links with A.5: Pressure sores. Refer back to A.5 if necessary, focusing on the following key points: – the areas of the body that are most at risk of developing pressure sores – the main causes of pressure sores (pressure, friction and shear). • These key learning points will allow you to highlight and explain the well feature of the pressure relief cushion. • The dimensions of the seat bone well will be discussed and practised during B.8: Cushion fabrication. Tips for preparation • To prepare for the session, gather locally available cushions, materials and fabrics. If available, include the following: – a contoured cushion (with a seat bone well) – a flat cushion (at least two layers, with no seat bone well and a flat base) – a single layer of foam – any other locally available cushions that are commonly used. • Set out wheelchairs, with cushions, for the finger pressure test activity. • If you need to make cushions for this session, further information is available in the Cushions Annex on page 185. b. Section 4. Pressure relief cushions Tips for preparation • Slide 6: Add to the text of the second bullet in the Trainer’s Manual: “This will make sure the cushion keeps its shape, provides good support for the user and does not move when the user moves”. 132 A.7: Cushions Trainer's Manual Content • Slide 5: A seat bone well can provide both pressure relief and postural support. The well reduces the pressure under the seat bones and the seat bone shelf helps to keep the pelvis more upright and prevent it from sliding forward. This reduces shear caused by sliding. • It is important to check that the shelf is in the correct place by completing a pressure test. Which cushion to use? • Good pressure relief, postural support and pressure redistribution are achieved by a combination of the shape of the cushion and its material. • When selecting the most appropriate cushion for a user, consider: – The shape. Is there a pre-seat bone shelf or a seat bone well to prevent sliding and help to keep the pelvis upright? Are there grooves or gutters to rest the thighs in? – The material. Is it sufficiently firm to provide good support and soft enough to be comfortable? – Pressure redistribution. Does it pass the pressure test when the user is sitting on it in their wheelchair? – Comfort. This is subjective. All cushions should be comfortable because they provide pressure relief and postural support. An air/fluid/gel cushion is not automatically more comfortable than foam. • Remember, cushions vary in shape and quality: – Shape. A well-designed contoured (shaped) foam cushion can provide better pressure relief than a poorly designed air/fluid/gel cushion. – Material. A well-designed air/fluid/gel cushion may be the most appropriate solution for someone with very high risk of pressure sores, where a well- designed foam cushion does not offer adequate protection. – As the lifespan of a foam cushion is much shorter than the lifespan of the wheelchair, local support services must be able to replace the cushions as needed. Cushion covers • Additional considerations for moisture or incontinence management (on page 94 of the Trainer’s Manual) are covered in the Cushions Annex (page 185). 133A.7: Cushions Trainer's Manual c. Section 5. How to test if a pressure relief cushion is working Tips for preparation • Ensure that group participants have access to a wheelchair that fits them. Content Before participants practise the pressure test, highlight the following points: • Remove jewellery from hands before starting. • If it is difficult to get to the seat bones from behind the wheelchair: – Stand at the back corner of the wheelchair and place your hand underneath the seat bone (Figure 3). – Do not place your arm between the backrest and the user as this will push them forward. Check that the wheelchair user is sitting symmetrically and has their back against the backrest. Figure 3. Checking pressure on the seat bones 134 A.7: Cushions Trainer's Manual • If participants have difficulty finding the seat bones: – Use the skeleton to remind participants how far forward and close together the seat bones are (Figure 4). – Demonstrate how fingers should be positioned underneath the seat bone. If you do not have a skeleton, use the bottom of your fist to represent the seat bone. – Ask participants to find their own seat bones when sitting; to pay attention to where they are located as well as the distance between them. Figure 4. Diagram of seat bones • If the wheelchair user’s pressure is grade 3 (unsafe), do not force your fingers out from underneath their seat bones; ask them to lean forward or to the side so that you can slide your fingers out. • The seat bones could have different pressure going through them. Assess each side separately. • If questioned on the research and validity of the pressure test, emphasize that its purpose is to ensure the safety of individual wheelchair users. Our hands are an accurate way to measure the pressure between a person’s body and the wheelchair. Our hands are very sensitive and by practising this test frequently, we will continue to develop further sensitivity to evaluate pressure. 135A.7: Cushions Trainer's Manual d. Section 6. What action can be taken to reduce pressure? • See Figure 5 and highlight the following points about the lift: – It must be a U-shape. Do not use a lift under the thighs only as this will change the angle of the seat. – The thickness of the lift should be approximately 20 mm. – Dimensions of the seat bone well are covered in session B.8: Cushion fabrication. • To reduce unsafe pressure add a ‘lift’ on top of the base layer and under the comfort foam layer. A.7. Cushions:12 Figure 5. Reducing unsafe pressure • The aim of the lift is to move weight off the seat bones and on to the upper and distal parts of the thigh. • A layered cushion allows the lift to be positioned between the layers. With a one-piece moulded cushion, the lift is positioned underneath. • There are some other ways to improve the pressure relief qualities of a foam cushion that are not described in the Trainer’s Manual: – if the top layer is very soft or thin, increase its firmness and thickness – if the base layer is soft, and does not maintain its shape or contours when the wheelchair user is on it, replace the base layer with a firmer material. 136 A.7: Cushions Trainer's Manual A.8: Transfers Errors in the WSTP materials a. Section 4. Three ways to get in and out of a wheelchair and individual feedback • In the video clip: Independent transfer through sitting (wheelchair to bed): note that the wheelchair user pushes down on the back upholstery during the transfer. This is not recommended. Key considerations for teaching this session a. General Tips for preparation • Set out the equipment for the practical activity. For sideways transfers, do not use wheelchairs with fixed, full depth armrests. • Decide what the lead trainer and each of the support trainers will be responsible for before the session. Ensure the training team is consistent in its approach to carrying out and teaching the transfers. b. Section 4. Three ways to get in and out of a wheelchair and individual feedback Participants may suggest alternative ways to do these transfers – they may have learnt different techniques or developed alternative methods. Acknowledge suggestions by participants but remind them that the video demonstrates basic, safe techniques. • Participants should follow these techniques during the WSTPb. Some variations are acceptable to accommodate individual body shape, such as height, weight and strength. • Techniques that require rotation (twisting) of the assistant’s back, or where the wheelchair user holds on to the assistant’s shoulders or neck are not acceptable as they pose a risk of injury to the assistant. • To increase the stability of the wheelchair for transfers, position the castor wheel forward. • Highlight the key points during the video by reading them from the screen. 137A.8: Transfers Trainer's Manual 1. Independent transfer through sitting (wheelchair to bed) • Explain why the wheelchair user needs to move to the front of the wheelchair. This is to ensure that they don’t make contact with or bump the rear wheel during the transfer as this might damage their skin and lead to a pressure sore. 2. Assisted transfer through sitting with a transfer board (wheelchair to bed) • Pause when the following subtitle disappears: 3. Place transfer board under buttocks across the wheelchair and bed. • Emphasize that the wheelchair user must be assisted to lean sideways and to place the transfer board. • One end of the board is placed under one side of the wheelchair user’s buttocks. The board is placed at an angle between the wheelchair seat and the bed so that it misses the arch of the rear wheel. • Continue the video. • Pause at the next subtitle: 4. Assistant stands behind the user. • Emphasize the assistant’s position behind the wheelchair user during this transfer. In this position the assistant does not block the forward movement of the wheelchair user’s head and trunk. The assistant also has good control of any forward sliding during the transfer. If the wheelchair user is worried about falling forward, a second helper can stand in front of them. • Emphasize the assistant’s position. The assistant kneels with one knee on the bed. The other leg is placed between the bed and wheelchair. • Continue the video. • Pause at the next subtitle just before the user lifts: 5. User lifts as much as they are able. • Explain how the assistant grips around the wheelchair user’s pelvis to assist with the sideways movement to the bed (the assistant should not grip the top of the user’s trousers or belt). • Emphasize: The user’s hands are placed on top of the transfer board and his/ her fingers should not curl around the edge of the board as this may lead to injury when transfer commences and weight is placed on the board. • Emphasize the text: 5. User lifts as much as they are able. Add that the user can do the transfer using multiple small lifts. • Repeat the key points on page 104 of the Trainer’s Manual after the video. • Ask the participants if they would like you to play the video again before they practise. 138 A.8: Transfers Trainer's Manual 3. Assisted standing transfer (bed to wheelchair) • Pause at the subtitle: 4. Assist user to move forward on the bed, place user’s feet on the floor. • Explain: The assistant uses his/her legs to support the user’s knees from the side (do not block the user’s knees from the front). • Explain: The user rests their hands either on the assistant’s shoulders (hand resting on the shoulders, not gripping around the neck) or the assistant’s hips/ pelvis. • Continue the video. • Pause at the next subtitle: For taller and heavier clients, support may be given higher (shoulder blades). • Explain: the assistant can support the wheelchair user at the pelvis or on the trunk just below the shoulder blades. The assistant should take care to allow the user enough space to bring their head and shoulders forward over their feet. • Continue the video. • Pause at the next subtitle: 5. Twist the user toward the wheelchair and help her sit down gently. • Explain: Ensure the wheelchair user comes to a fully upright standing position. Only then twist to the side of the bed and allow the user to sit down again. • Continue the video. • Repeat the key points on page 104 of the Trainer’s Manual after the video. • Ask the participants if they would like you to play the video again before they practise.· 139A.8: Transfers Trainer's Manual ToT trainer demonstrations/explanations a. Section 5. Independent transfer from floor to wheelchair • Some wheelchair users may not have the strength or balance to transfer from the floor to their wheelchair seat. Users can transfer in two stages: – From the floor to a step. For example, the step could be the frame of a three- wheel wheelchair, a wooden box, a stack of newspapers, or a low stool. – From the step to their wheelchair seat. • Note that the step/wheelchair must be stable and positioned safely. • Instead of the seat, wheelchair users may be able to place one hand on the top of the footrest hanger or other part of the frame for transfers. • Wheelchair users who are at a high risk of developing pressure sores need to take care not to bump any wheelchair parts. • Emphasize that developing the correct technique and being able to perform this transfer independently may require a lot of practice under supervision. It is important to problem solve with the wheelchair user and their family to develop a safe transfer method. • If someone in the group is able to demonstrate the transfer, ask them to do it at the end. 140 A.8: Transfers Trainer's Manual B.1: Referral and appointment Key considerations for teaching this session a. General Tips for preparation • Ask participants to bring a copy of the wheelchair referral form used by their service, if one is used, to share during the session. This will make it more interactive. b. Section 2. Referral • Encourage participants to share experiences about their service settings, including: – existing referral systems (if wheelchair-specific referral systems are not in place, discuss other referral systems) – whether their referral systems are working – how the systems could be improved – how referrals are made (for example: by telephone, referral letter, email) and what information is included in a referral – wheelchair service referral forms brought by participants or the sample wheelchair referral form in the WSTP Additional Resources manual. • If no referral systems exist in the participants’ workplaces, share experiences from your own work as an example. This may include how your referral system was established and how the wheelchair service has benefited or changed. • Encourage participants to take this issue up with their service managers and to assist in: – putting together information needed to guide referral sources – developing a referral letter – identifying and contacting referral sources – holding a wheelchair service open day and other initiatives to raise awareness about the service – building up referrals in line with the capacity of the service. 141B.1: Referral and appointment Trainer's Manual B.2: Assessment Key considerations for teaching this session a. General • This is a short session designed to introduce participants to the WSTPb assessment process. • Park questions about the assessment interview and the physical assessment in the Car Park as these are covered in the following two sessions. b. Section 2. Who needs a wheelchair? • Emphasize that using a wheelchair will not make a person ‘lazy’ or cause the person to stop walking. Walking with a mobility impairment uses more energy than walking without a mobility impairment. That is why using a combination of wheelchair and walking aids is often best. • Wheelchairs enable: – community participation and integration – individuals to cover longer distances – access to rougher terrain – a faster pace than walking would allow – a person who uses crutches to stand and balance can do more when sitting down in a wheelchair with their hands free. c. Section 3. Why do you need an assessment? • The WSTPb assessment form only covers the essential information needed for a basic level wheelchair assessment. • Service providers may need to collect additional information for other types of services they offer. This will not be covered during the WSTPb. d. Section 4. Where to carry out assessment • Encourage participants to be creative when carrying out assessments in the community or at the wheelchair user’s home. For example: measurements can be taken with the person sitting on a bench or sideways on a chair; bricks can be used to build a foot support to ensure that the wheelchair user’s feet are supported. 142 B.2: Assessment Trainer's Manual B.3: Assessment interview Key considerations for teaching this session a. General Tips for preparation • Many participants may not have seen or used a wheelchair assessment form before. Encourage participants to follow the session using the form on page 42 of the Reference Manual for Participants. b. Section 2. Information about the wheelchair user • While participants are learning, they may prefer to rely on the form. As they become more comfortable, encourage them to approach the assessment as a discussion. • Encourage participants to think about how the information being gathered relates back to decisions about the wheelchair. c. Section 3. Physical condition • Draw input and ideas from the experiences of participants to make this section more interactive. • Look at this statement on page 121 of the Trainer’s Manual: “It is helpful (although not always necessary) to know which condition a wheelchair user has”. Discuss this with the whole group. Emphasize that knowing the medical diagnosis is helpful but not essential for a wheelchair assessment. A thorough assessment interview and physical assessment are the essential elements of a good wheelchair prescription. d. Section 6. Assessment interview practice • Trainers should monitor participants to ensure they are discussing the assessment and not just ticking the list of questions. 143B.3: Assessment interview Trainer's Manual B.4: Physical assessment Errors in the WSTP materials a. Section 6. How to take body measurements • This heading in the Trainer’s Manual is confusing. This section covers how body measurements relate to wheelchair measurements. Change the heading to How body measurements relate to wheelchair measurements. • Add the following to the list of resources on pg. 131: A copy of the amended Basic wheelchair assessment form for each participant. • An amended version of the assessment form is included in the annexes of this manual and can be downloaded from the WSTP Pen Drive. • There are some errors in the Measurement Table in the assessment form in the column Change body measurement to ideal wheelchair size for measurements C, D and E. • The following slides in the Trainer’s Manual and PPT need correcting with the information in the amended Measurement Table (Table 1) below: – Slide 10: page 138 – Slide 12: page 140 – Slide 19: page 143. • Ask participants to make the same correction on page 48 of the Reference Manual for Participants and on pages 18 and 19 of the Participant’s Workbook. 144 B.4: Physical assessment Trainer's Manual Table 1. Body measurements for wheelchair conversion Body Measurement Measurement (mm) Change body measurement to ideal wheelchair size Wheelchair measurement A Hip width Hip width = seat width B Seat depth L B less 30–50 mm = seat depth (if length is different, use shorter one) R C Calf length L (C less cushion height*) C less cushion height* = seat to top of footplate or seat to floor, depending on user’s needs R D Bottom of rib cage (D or E [depending on user’s needs] + cushion height*) D or E (depending on user’s needs) + cushion height* = seat to top of backrest E Bottom of shoulder blade L: left; R: right. *Check the height of the wheelchair user’s cushion. Key considerations for teaching this session a. Section 3. Presence, risk of, or history of, pressure sores • Link this section to A.5: Pressure sores. Briefly review risk factors and remind participants when a pressure relief cushion is indicated. b. Section 4. Method of pushing Tips for preparation • Identify the practical area beforehand and set out wheelchairs with footrests that move out of the way. 145B.4: Physical assessment Trainer's Manual Content Pushing with feet activity on page 136 of the Trainer’s Manual • Three-wheel wheelchairs are generally not suitable, as the beam will interfere with foot propelling. • Advise wheelchair users to avoid pushing/propelling backwards as they are unable to see where they are going. It can also result in poor sitting posture. However, pushing backwards is easier when going uphill or over soft terrain or small obstacles. Encourage participants to experience the difference of pushing backwards up a slope. – For most people, the standard seat height of a wheelchair is too high to effectively foot propel forwards. – It will be difficult for the user to maintain good posture and propel forwards if the seat is not low enough. – The user’s heel should comfortably reach the floor and remain firmly on the floor as they apply force to propel. • Wheelchairs with lower seats are not widely available so modifications must be made to allow the user to reach the floor with ease, for instance: – Reduce the overall height of the cushion. – Attach a solid seat lower than the original seat. Suspend the board from the seat rail on hooks so that it can be removed for folding if necessary (Figure 6). On folding-frame wheelchairs, cut reliefs for the top of the cross brace. The board will also rest on the cross brace. Figure 6. Seat board with hooks • Modify the seat and cushion • Combinations of the above are often required and are described in the Cushions Annex on page 185. 146 B.4: Physical assessment Trainer's Manual c. Section 5. Taking measurements Tips for preparation • Set out the equipment needed for the measurement activity for each group of three participants, including: tape measure, two clipboards and one set of foot blocks. • With a support trainer, prepare to demonstrate finding the lower ribs and bottom of the shoulder blade during the video: measurement demonstration: back height. Content • Use the video as described below to emphasize key learning points. • Read all the subtitles. • Prepare – Pause where the assessor calls the helper at the subtitle: Make sure the wheelchair user is sitting upright. – Explain: If the wheelchair user is unable to sit upright without assistance, a helper is needed. – Continue the video. – Pause where the helper is sitting next to the wheelchair user and the assessor starts to check the posture. – Explain: The assessor guides the helper and then checks the posture. The pelvis, trunk, head and neck should be upright and in line. – Continue the video. – Explain as the video continues: The hips, knees and ankles are flexed to 90 degrees. Take measurements – Pause at the subtitle: Hip width: hips or widest part of thighs. – Emphasize: Ensure that the clipboards are parallel and upright. – Continue the video. • Pause at the subtitle: Bend down to read the tape measure. • Emphasize the following: – measure the inside distance between the two clipboards – bend down to read the tape measure otherwise readings will be inaccurate. • Continue the video. • Pause at the subtitle: Seat depth: back of pelvis to back of knee. 147B.4: Physical assessment Trainer's Manual • Emphasize the following: – keep the clipboard upright and level with the front of the bed – measure from the front of the clipboard to the back of the knee – measure both sides. • Continue the video. • Pause at the subtitle: Seat depth: Calf length: back of knee to base of heel. • Emphasize the following: – For best accuracy, measure from the heel to the back of the knee. This is different from the text on page 140 of the Trainer’s Manual – Bend down to read the tape measure. • Continue the video. • Pause at the subtitle: Back height: seat to bottom of rib cage. • Demonstrate: There are two ways to locate the lower ribs. – Place the hands on the sides of the ribs and gently squeeze them together as you slide down the rib cage until you find the soft area and the bottom of the rib cage. – Alternatively, place hands on top of the pelvis and gently squeeze in to find the soft area. Gradually move up and in towards the centre until you feel the ribs. • Continue the video. • Pause where the measurement is taken. • Emphasize the following: – measure from the seat to the bottom of the rib cage – bend down to read the tape measure • Continue the video. • Emphasize the next subtitle: For a higher backrest, measure from seat to bottom of shoulder blades. As this is a frozen frame, there is no need to pause the video. • Explain: To help locate the shoulder blades ask the person being measured to shrug their shoulders. • Repeat the video without pausing. • Ask whether there are any questions. 148 B.4: Physical assessment Trainer's Manual d. Section 6. How to take body measurements (Corrected session title: How body measurements relate to wheelchair measurements) • This section sometimes causes confusion, particularly measuring the backrest and footplate height. • When we take measurements on the bed the reference point is the bed surface, which represents the seat of the wheelchair. • Because wheelchairs should always be prescribed with a cushion, when we convert the body measurement to the wheelchair measurement we must adjust for the cushion (Figure 7). Figure 7. Body measurements are taken from the top of the assessment bed Footrest • The body measurement C equals the wheelchair measurement from the top of the seat cushion to top of the footplate or floor (Figure 8). • To calculate the footplate height: wheelchair seat to top of the footplate: Body measurement C less cushion height. For foot propellers • The cushion raises the user up and away from the seat. • To be able to foot propel, the user’s foot should reach the floor when sitting on the cushion. • To calculate the seat height: Body measurement C less cushion height. • The wheelchair measurement for foot propelling is always shorter than the body measurement. Figure 8. Body measurement C: wheelchair measurements: seat cushion to top of footplate or seat cushion to floor 149B.4: Physical assessment Trainer's Manual Backrest • The body measurements D and E = measurement from the top of seat cushion to top of backrest. • The measurement you will use depends on a user’s needs. • Because a person should always sit on a cushion, a calculation must be made to include the cushion. • To calculate the wheelchair measurement (seat to top of backrest) the cushion height must be added to the body measurement (D or E). • Wheelchair measurement (seat to top of backrest) = Body measurement D or E + cushion height. • Sometimes cushions are quite thick but made from soft foam. In this situation, it may be more accurate to halve the height of the cushion for calculations, as it will compress approximately this much when a person sits on it. Figure 9. Body measurement D/E: wheelchair measurement: seat cushion to top of backrest 150 B.4: Physical assessment Trainer's Manual B.5: Prescription (selection) Errors in the WSTP materials a. Section 5. Selecting the right wheelchair size • In the table on pages 153–154 of the Trainer’s Manual, correct the information in the column Change body measurement to ideal wheelchair size in line with Table 1 in B.4: Physical assessment on page 145 of this Trainer's Manual. Key considerations for teaching this session a. General Tips for preparation • Place a demonstration wheelchair in the theory area, raise it on a table or box if this gives a better view. • Organize photocopies of the completed Wheelchair summary forms and the Wheelchair prescription forms, ready to hand out to participants. These are also an important reference for after the training programme. • Keep in mind that participants often think of prescription as determining the size of the wheelchair only. Remind participants of the key elements in the definition of an appropriate wheelchair; environment, function (daily activities and lifestyle), fit (size) and posture support needs. First determine the wheelchair features that match these needs. Second, makes and models of wheelchairs that have these features and are the right size can be identified. • Try to give each group a set of hand tools as this will be quicker than if they have to share. b. Section 3. Locally available wheelchairs and cushions • If possible, have one technical participant in each group. Technical participants may be more familiar with the various features of the wheelchair. • Wheelchair back height dimensions are measured from the wheelchair seat to the top of the backrest without a cushion. • Participants are often unsure about how to use the wheelchair summary sheet in service delivery. Explain that it is a good tool for comparing existing and new 151B.5: Prescription (selection) Trainer's Manual products against the same criteria. It can also help with prescription choices particularly for users who need more complex wheelchair adjustments. c. Section 5. Selecting the right wheelchair size • The activity on page 152 of the Trainer’s Manual requires a clear understanding of the cushion calculations covered in B.4 Physical assessment. • Participants may decide that none of the available wheelchairs are the correct size for the two case studies in the Participant’s Workbook. This issue will be addressed in B.10: Problem solving. Acknowledge the observation and park it in the Car Park. d. Section 6. Recording the prescription (selection) • Ask participants to follow on page 51 of the Reference Manual for Participants when showing the slides of the Wheelchair prescription form. Participants can make notes on the form during the presentation and discussion. • Highlight the importance of wheelchair user involvement in the prescription process. 152 B.5: Prescription (selection) Trainer's Manual B.6: Funding and ordering Key considerations for teaching this session a. General Tips for preparation • The content of this session is influenced by the wheelchair funding and ordering process in each country/context. • To prepare for the session, find out what funding options are available and which, if any, ordering processes are followed. • Context-specific information and discussions will make this session more relevant to participants. • The trainers can also share examples of models from their own experiences. Content • Keep in mind that many less-resourced settings rely solely on donations, with no formal funding and ordering processes. • The most appropriate wheelchair is selected from what is available. Where possible, give wheelchair users a choice between the most appropriate wheelchairs. Discuss the challenges of using this system, and how to manage them, with participants. • Recommend that participants establish a database of wheelchair users. This will enable them to engage with potential donors or funders regarding the needs of wheelchair users at their service. A database can also make the ordering process easier as the wheelchair specifications for each user are recorded. – When setting up a database, service providers will need to consider the privacy and security of users’ personal information. This must include guidelines about what is shared, when it is shared, and who it can be shared with. • Advise that participants may use the wheelchair summary form as a guide when ordering an appropriate wheelchair for each user. This will save time and is particularly useful for makes and models that offer multiple options. 153B.6: Funding and ordering Trainer's Manual B.7: Product (wheelchair) preparation Key considerations for teaching this session a. General Tips for preparation • Laminating the Wheelchair safe and ready checklist will allow participants to reuse it. • Go through the prescription forms before the session. Highlight which groups might need more complex technical adjustments and modifications and have materials and extra tools ready for those groups. • Arrange for additional technical staff to support the session if many or complex adjustments and modifications will be needed. Consider whether the technical staff need briefing or training prior to the session. b. Section 2. Preparing the wheelchair Tips for preparation • Find out if all participants are familiar with handling the tools and the basic precautions to take in the workshop. For any participants who are not, discuss any questions/concerns at the beginning of the session and review the following basic workshop safety points: – wear covered shoes when working with tools – keep the work area neat and clean – never cut towards yourself or others – ask for help if you are not familiar with power tools – use safety glasses when using power tools or sharp tools – secure your work piece when cutting or drilling. • Introduce the tools that are going to be used at the beginning of the session. • The only available wheelchairs may have very different dimensions (such as too wide, or footrests too low) to those prescribed by participants. In this case, extra technical staff will be needed to support the session and to ensure the participants complete the activity in the allocated time. Technical staff can make more substantial modifications after the session, but these need to be completed before Practical Two: Fitting and user training. 154 B.7: Product (wheelchair) preparation Trainer's Manual • In settings where wheelchairs require multiple adjustments, either allocate more time to the session or ensure that technical staff are available to make certain adjustments (such as to the rear wheel position, or advanced technical adjustments). • Where wheelchair users are not able to attend over two days, this session will take place before the user prescriptions have been done. In this case, exclude the activity on page 165 of the Trainer’s Manual under Section 2. Preparing the wheelchair. Only do this on the day the wheelchair users attend, as part of the practical. Content • The PPT describes a clear step-by- step process for product preparation. Reinforce this process during the activity on page 165 of the Trainer’s Manual. • Ensure that groups are working safely and able to finish in the allocated time. c. Section 3. Wheelchair safe and ready checklist Tips for preparation • Where wheelchair users are not able to attend over two days, this session will take place before the user prescriptions are done. In this case, trainers can prepare one wheelchair with minor problems for each group of participants. This could include placing the cushion upside down/back-to-front in the cover and on the wheelchair; loosening a few bolts; lowering one foot plate; and/or deflating a tyre. Content • Before showing the video, provide each participant with a copy of the checklist to follow while watching. 155B.7: Product (wheelchair) preparation Trainer's Manual B.8: Cushion fabrication Key considerations for teaching this session a. General Tips for preparation • Have one pressure relief cushion (top layer and base) with a lift available, to be passed around during the presentation. • Preparation for this session will vary depending on the context. If materials for the cushion base need to be fabricated, start at least two days in advance. More details are covered in the Cushions Annex on page 185. • This session reviews information covered in A.7: Cushions. Use the presentation as an opportunity to evaluate participants’ understanding by asking them to explain the principles summarized in the slides. b. Section 2. Cushion features and dimensions • The seat bone-well dimensions shown on page 173 of the Trainer’s Manual need to be clearly explained, using the correct terminology and reference points, as this is often a new concept to participants. • Remind participants they must check that the seat bones fit correctly into the well during the fitting process, using the pressure test. The well should be adjusted if necessary. c. Section 4. How to make a cushion base – practice • If no locally made cushions are available, this session can be used to make a cushion for the wheelchair users assessed in Practical One. Ask participants to work in the same groups as for Practical One and to use the dimensions calculated during the prescription session. • If choosing to glue the top and base layers together, take care to mould the top layer to the contours created by the base layer (if it is pulled tight over the contours, the pressure relief qualities of the cushion will be lost). • Where possible, include a technical trainer for this session and allocate one technical participant to each group to guide fellow participants during the activity. • Encourage participants to double check the cushion measurements once they have finished drawing the dimensions on to their piece of foam. 156 B.8: Cushion fabrication Trainer's Manual • Allow 10 to 12 minutes for marking and drawing. • Participants who finish quickly and neatly can support the slower groups. d. Section 6. Frequently asked questions about foam pressure relief cushions • “Does this cushion work for all users?” No cushion works for all users. • “Do all wheelchair users need a pressure relief cushion?” Remind participants of the following: – A wheelchair user with altered or no sensation, must be provided with a pressure relief cushion. – Wheelchair users with sensation, and who have three or more risk factors, also require a pressure relief cushion. – Wheelchair users who do not have any pressure-sore risk factors require either a comfort cushion or a postural support cushion. A pressure relief cushion can be used to provide postural support, as the pre-seat bone shelf (front of the well) prevents the wheelchair user from slumping/sliding and improves posture. 157B.8: Cushion fabrication Trainer's Manual B.9: Fitting Key considerations for teaching this session a. General Tips for preparation • Place a wheelchair in the theory area if you plan to demonstrate any of the fitting check activities during the presentation. Ensure that the wheelchair is visible to all participants. Considerations for gender/culture • When dividing the groups, consider whether participants should be grouped according to gender. b. Section 2. Good practice in fitting • After showing the video on the fitting sequence (page 183 of the Trainer’s Manual), highlight how important it is to follow the sequence in the Wheelchair fitting checklist. c. Section 3. Fitting practice Tips for preparation • Ensure group participants have access to a wheelchair that fits them. Content • Checking seat width: the thigh can make contact with the side/armrest of the wheelchair. The seat width is adequate if the assessor can slide their fingers in between the thigh and the wheelchair smoothly. Pressure between the thigh and the armrest/side should be avoided. • Checking seat depth: there may be contact between the cushion and the back of the calf, but there should be no pressure. • Footrest height: about 5 cm clearance is required between the footrest and the ground, which means there is a limit to the length adjustment of the footrest. • Foot propelling: if the seat is too high and the wheelchair user cannot put their foot flat on the ground, make the modifications (to the cushion or the wheelchair) as described in the Technical Annex. 158 B.9: Fitting Trainer's Manual B.10: Problem solving Errors in the WSTP materials • Section 1. Introduction: In slide 2 modify the last bullet to be a level one bullet (the same as the first bullet point). • Section 2. Seat depth too short or too long. This section is incorrectly marked as Section 1. Key considerations for teaching this session a. General Tips for preparation • It would help to have a technical co-trainer for this session. • Prepare materials to use in the five problem-solving sessions: – Select appropriate wheelchairs and have some fabric and straps ready to demonstrate how to lengthen the seat. – Pre-cut a wood board to fit one of the sample wheelchairs, and demonstrate how to attach it to the seat rails on the wheelchair. • As well as presenting the session, use your facilitation skills to encourage participants to find solutions. For example, ask them which materials they would use to resolve a problem, and how and where they would attach it to the wheelchair. Highlight that solutions must not interfere with functions such as transfers, or folding the wheelchair. • If the participants are experienced, consider dividing them into groups with a wheelchair each and giving them a few problems to brainstorm. 159B.10: Problem solving Trainer's Manual b. Section 2. Seat depth too short or too long Problem: Seat depth too short • The solution should not interfere with the folding mechanism of the wheelchair. • When lengthening the seat, using wood or other solid material, suspend the board from the seat rail on hooks so that it can be removed for folding if necessary (Figure 10). • On folding-frame wheelchairs, cut reliefs for the top of the cross brace. The board will also rest on the cross brace. If fixing the seat to the top of the seat rails, keep in mind that it will effectively raise the seat and may affect reach to the back wheel, foot support and back support. Figure 10. Lengthening seat depth • An alternative option is to use a thin board, such as hardboard, cut to fit between the seat rails and extending over the edge of the seat. If light, it can also be attached to the bottom of the extended wheelchair cushion. • If extending the existing cushion, do so at the front. Do not extend from the back of the cushion because any ridges from the glue will increase the user’s risk of developing pressure sores. Demonstrate how to extend seat rails and attach new upholstery to help participants see how this would be done. Problem: Seat depth too long • Shortening an upholstery seat: there is usually a metal strip that reinforces the sides of the seat. The strip will also have to be shortened when the upholstery is cut and re-stitched. Alternatively, a slot can be left in the front of the upholstery to allow the metal strip to be reattached. This allows the metal strips to remain intact when the upholstery needs to be lengthened (for example with growing children). • Another way to shorten the seat, but to allow for a child’s growth, is to cut a small slot in the sleeve that the metal strip fits into on the top side of the upholstery. The metal strip is pushed through this slot and the upholstery folded over at that level. The folded part can be glued together, or stabilized with a few overhand stitches. A reinforcement strap is added to the front of the seat (in between the folded part of the seat) before it is reattached. The reinforcement 160 B.10: Problem solving Trainer's Manual strap must be attached directly to the seat rails or looped around the seat rails and attached back to itself. • Adding a cushion to the backrest is not a solution because: – it limits access to the rear wheel for self-propelling – the wheelchair user’s weight is shifted forwards, loading the front castors and increasing the risk of the wheelchair tipping forwards. c. Section 3. Footrests height too low or too high Tips for preparation Problem: Footrests’ height is too low • Cut a foam block to fit one of the flip-up footplates on the sample wheelchairs. Make the block thick enough, so that the footplate does not flip-up properly. Make another sample with a channel cut out to remove the interference with the frame tube. Problem: Footrests’ height is too high • Cut a piece of firm foam to fit an existing wheelchair seat. If possible, demonstrate how it fits inside the cushion cover. Content Problem: Footrests’ height is too low • Rubber/EVA/wood or similar solid materials work well if the footrest needs building up. The build-up can be glued on to the footrest. If it is not possible to glue on to the footplate, then use a wood cut-out, bolt the wood to the footplate, and glue the foam to the wood. • Modifications should not interfere with the flip-up or swing-away mechanism of the footrest. Use the two pre-made samples discussed in the Tips for preparation section, to demonstrate this point, and how to solve it. Problem: Footrests’ height is too high • There must be at least 5 cm clearance between the bottom of the footrest and the ground. • Raising the height of the cushion is provided as a solution to a high footrest problem in the session plan. Highlight the effect of raising the cushion on: 161B.10: Problem solving Trainer's Manual backrest height, armrest height and access to the rear wheel. In practice, participants need to consider all three and then decide if raising the cushion is a functional solution for each individual wheelchair user. d. Section 4. Legs tend to roll inwards or outwards Tips for preparation • Cut firm foam wedges to fit one of the sample wheelchair cushions. Content • Demonstrate how wedges are glued on to the base of the cushion and are then covered by the top layer of the cushion. Reinforce this point, when showing slide 12 on page 191 of the Trainer’s Manual, as participants sometimes think that the illustrations are showing the wedges glued on to the top layer of the cushion. • If a wheelchair cushion does not have a removable top layer of foam, show participants how the cushion can be cut on the side and the wedges placed and glued in. • Wedges should not interfere with transfers. • Discuss size and types of material that can be used for wedges (usually the same material as the base of the cushion). • If the seat sags in the middle and the design makes it difficult to tighten the seat tension, a sling-filler pad can also be used to stop the legs rolling inwards (Figure 11). Figure 11. Sling-filler pad e. Section 5. Feet tend to slide off the footrests • Discuss different positions/attachments for a calf/ankle strap. • Straps should not interfere with the mechanism of the footrests (for example their swing-away action) and therefore may need to be detachable. 162 B.10: Problem solving Trainer's Manual f. Section 6. Wheelchair is too wide Tips for preparation • Cut samples from EVA or other firm foam and have some ‘outer layer’ materials to show how the foam can be covered with fabric, leather or EVA foam. Content • Discuss which materials the pad could be made from (EVA/rubber/chip foam, with a cover). • Discuss how and where the pad should be attached (on the wheelchair or the cushion; removable or fixed). Discuss advantages and disadvantages of the various solutions and how these might interfere with functions such as the folding mechanism of the wheelchair or transfers. • The cushion should remain the same size as the wheelchair seat. Pads are placed above or on top of the cushion. 163B.10: Problem solving Trainer's Manual B.11: User training Key considerations for teaching this session a. General • Park questions about wheelchair maintenance in the Car Park. These will be covered in B12: Maintenance and repairs. • User training skills included in the checklist are covered in sessions A.3: Wheelchair mobility, A.5: Pressure sores, and A.8: Transfers. • As trainers or service providers, it is important to be confident in all the wheelchair skills yourself before teaching them. • Organize the session to ensure that there is sufficient time for user training. • Emphasize that user training is an essential step in wheelchair service provision and time must always be allowed for it in the training programme. A user could have an appropriate and well-fitting wheelchair but not be able to leave their home because they lack confidence in transfer and mobility skills. b. Section 2. What are helpful skills for wheelchair users? • Not all six skills need to be taught to every wheelchair user. Participants need to identify which skills are relevant to the user, based on the information gathered during the wheelchair assessment. c. Section 3. Wheelchair user training practice • Encourage participants to follow the three steps of good teaching: explain, demonstrate, practise. • Explain why everyone involved with the wheelchair user (family member, caregiver) needs to learn the skills too. • Highlight the benefits of peer training. Talking with other wheelchair users and learning from them can be very helpful, especially for new users. Based on their first-hand experience and understanding of particular situations, existing wheelchair users are best placed to demonstrate and teach skills to their peers. 164 B.11: User training Trainer's Manual B.12: Maintenance and repairs Key considerations for teaching this session a. General Tips for preparation • Before the session starts, find out which lubricants are available locally and which components need to be lubricated on local wheelchairs. Put together one home maintenance tool kit per group (or ask groups to share items). The kit should include: a spanner, allen keys, screwdriver, tyre pump, puncture repair kit, lubricating oil, bucket, soap, cloth and sandpaper. • If possible, allocate one participant with technical experience to assist and guide each group. Content • Check that participants understand the difference between maintenance and repair: – maintenance refers to regular care that helps to prevent of damage and breakdowns – repairs refer to components that are broken and need to be repaired or replaced. b. Section 2. Prevent repairs: home maintenance Tips for preparation • Identify an area that is suitable for washing wheelchairs with soap and water. This is for the maintenance activity on page 205 of the Trainer’s Manual. Content • Be clear on the maintenance requirements of local wheelchairs. For example, some may have sealed bearings that do not need any lubrication. Give participants a guide on appropriate lubricating oils. Recommend a light oil such as sewing machine oil; heavy oils, such as engine oil, are not suitable. Organic natural oils, (coconut or olive oil), can be used if there is no alternative but tend 165B.12: Maintenance and repairs Trainer's Manual to attract unwanted attention from insects. Synthetic oils are more effective and will last longer. • Video clip. In the section on Oil moving parts, there are two points that often cause confusion: – The sealed bearing in the castor barrel does not require lubrication. However, the island climate featured in the video is one of high humidity and salt, so a small amount of oil is used on top of the castor barrel to help reduce rust. – The nut on the front castor axle is not a moving part and does not need to be oiled. Again, due to the example of an island climate, a small amount of oil can be used to reduce rust. • If one or two isolated spokes come loose, these should be tightened as a home maintenance activity using a spoke key. Take care not to over-tighten the spoke. You can check this by seeing how much force is needed on the spoke nipples next to it (located at the wheel rim), and use the same force on the loose spoke. If the spokes are very loose or fall out, take the wheel to a bicycle repair shop. c. Section 3. Common wheelchair and cushion repairs • For the activity on page 206 of the Trainer’s Manual, participants must identify the repairs that their wheelchair needs and decide where these repairs will be done. They do not need to carry out the repairs themselves. • If there are no used wheelchairs with problems available, create some problems in the wheelchairs that you do have. For example, loosen the axle, brake or castor fork bolts and nuts; deflate a tyre; loosen the upholstery bolts and nuts. Remember to fix these problems again at the end of the session – use the Wheelchair safe and ready checklist. • Repairs also include re-aligning (bending back into the correct shape) or replacement of bent components. 166 B.12: Maintenance and repairs Trainer's Manual B.13: Follow up Key considerations for teaching this session a. Section 2. What is follow up and how does it happen? • When discussing how often follow up should happen, on page 214 of the Trainer’s Manual, the following points can be used for guidance: – A wheelchair user should be followed up four to eight weeks after receiving their first wheelchair. – Children and wheelchair users with progressive illnesses should be followed up every four to six months as their needs may change very quickly. – Wheelchair users who have a stable condition and have been using a wheelchair for a long time can be followed up annually. – Look at an individual’s needs when setting a follow-up date. b. Section 5. Key point summary • Emphasize that follow up should be more than simply completing a checklist. • Encourage participants to think critically about each question and how wheelchair user responses will influence the actions that need to be taken. • The wheelchair user’s feedback at follow up provides insight into their lived experience and gives invaluable feedback to service providers. 167B.13: Follow up Trainer's Manual B.14a: Practicals one to four Key considerations for teaching this session a. General Tips for preparation Training area and set up • Set up the practical area so that each group has enough space to carry out their interview and physical assessments privately. Group allocations • Consider grouping participants from the same service together and/or to mixing clinical and technical participants. Group more confident/talkative participants and quieter/less sure participants so they can work with others at a similar pace. Supervision • Allocate a supervising trainer to each group. The lead trainer should supervise fewer groups as they need enough time to check in with the support trainers and keep the session on track. Wheelchair users • Identify a link person from the host organization to liaise between the service and the training programme. Their role will include: receiving wheelchair users; following up on latecomers; and coordinating user follow up after the training programme. • Have a back-up wheelchair user available in case someone is no longer able to attend. • Temporary wheelchairs and cushions should be available for those wheelchair users who do not have their own wheelchairs when they arrive. • Ensure that food and drinks are available for wheelchair users. 168 B.14a: Practicals one to four Trainer's Manual Taking photographs • Check that wheelchair users and participants have agreed to be photographed and have signed the consent forms. • Any modifications made to the cushion should be photographed before the cover is put on. • During the practical sessions take before and after images, as well as close-ups of modifications; this will make the participant presentations in B.14 Putting it all together more useful as a learning exercise. • Allocate one trainer to take photographs. This allows participants to focus on the practical and makes it easier to download and organize photos afterwards. b. Practical One: Assessment and prescription (selection) • Before starting, participants need to decide who will be responsible for which part (interview, physical assessment, measurement, fitting and training). Participants should not interrupt each other but wait for a colleague to finish before adding a comment and moving on to the next part. • Ask participants to complete the assessment interview in 20 to 25 minutes. • Closely monitor the physical assessment and correct any errors (for example, incorrect measuring technique) that would influence the prescription. • Body measurements need to be converted to wheelchair measurements before preparing the wheelchair prescription. • The wheelchair user should be an active participant during the prescription process. Ensure that participants have discussed wheelchair options and features with the wheelchair user before the final prescription is made. If demonstration wheelchairs are available, these can be used to explain specific wheelchair features to the user and to answer any questions. • Ask each group of participants to explain the clinical reasoning for the prescription they have chosen. c. Practical Two: Fitting and user training • Trainers should supervise the same groups as for Practical One. • Participants should do an initial check of the seat width and depth, and the footrest height with the user in the wheelchair. Then ask the wheelchair user to propel (with arms or feet) over relevant surfaces while another participant watches closely. This helps determine if any major adjustments need to be done, for instance moving the position of the rear wheel or increasing backrest height. 169B.14a: Practicals one to four Trainer's Manual Participants can then complete the Wheelchair fitting checklist and prepare to finalize all adjustments. • Check all adjustments and modifications before participants glue/fix them in place. • Review the final fitting check before participants begin user training. • Before wheelchair users depart, give them the name and contact details of someone to help if they have any problems or questions about the wheelchair. Organize a follow-up appointment for the wheelchair user at a service that is easily accessible. • If applicable and time allows, finish with a short feedback session. d. Practical Three: Follow up Tips for preparation • In some situations, there is a lot of pressure to complete all repairs and adjustments. However, follow up is the focus of the training and these additional requests often cannot be accommodated at the same time. It is important that wheelchair users are fully informed so their expectations are realistic. Content • Allocate participants to new groups. • Monitor the groups and ask questions to see whether participants understand the information they are getting and can take appropriate action. • Any modifications or changes that are needed should be documented and discussed with the trainers. They can only be done if they are simple and fit into the allotted time. e. Practical Four: Assessment, prescription (selection), product (wheelchair) preparation, fitting and user training • Allocate participants to new groups. During the introduction, explain how much time is allocated for each step (listed on page 224 of the Trainer’s Manual). Write this information on the board to help participants keep to time. Participants can tick as they complete each step and indicate how much time it took. • Depending on the experience and availability of technical staff, consider allocating one of them to each group as this will speed things up. 170 B.14a: Practicals one to four Trainer's Manual • If any groups do not have time to complete all the steps, organize an appointment for the work to be completed at a service accessible to the wheelchair user. • Explain to participants that they should allocate tasks within their group. For example, during product preparation one person can adjust the footplate; another cuts the cushion well and a third cuts pads to narrow the wheelchair. Explain that good task allocation will ensure that all steps are completed within the allocated time. 171B.14a: Practicals one to four Trainer's Manual B.14: Putting it all together Errors in the WSTP materials a. Section 2. Participants’ questions • The time section in the activity on page 225 of the Trainer’s Manual should say ‘Allow 5 minutes in total’ instead of 10 minutes. Key considerations for teaching this session a. Section 3. Participants’ preparation Tips for preparation • Allocate a trainer to download and organize the before and after photographs needed to illustrate each presentation. This task should be done during a break. • Display before and after photographs side by side as an effective way of showing the impact and outcome of the fitting. Content • Allocate support trainers to help the groups prepare. • Tell participants that you will give them 5 and 1 minute warnings to ensure that each presentation is limited to 10 minutes. b. Section 4. Participants’ presentations • Facilitate the presentations to ensure that they remain focused and that participants explain key learning points clearly. • During the presentation and facilitation, link how the wheelchair and cushion features meet the user’s environmental, functional and postural support and fitting needs. • Where wheelchair options and choices are limited, highlight where compromises have been made. Emphasize that any compromise needs to be discussed and agreed with the wheelchair user. 172 B.14: Putting it all together Trainer's Manual c. Section 5. Question-and-answer session • Encourage participants to set up a support network for continuing professional development and generally to keep supporting and learning from each other. • This could be done in-person or online using a social media platform. • A support network may include a forum to post and discuss clinical questions; to share information and latest research; or more formal meetings to present and discuss case studies. • Confidential information about service users should never be shared without written permission. d. Section 6. Key points • Encourage participants to practise and apply all the skills and knowledge they have gained during the programme (practice makes perfect!). 173B.14: Putting it all together Trainer's Manual Logistics and preparation Notes for ToT trainers: • This session is not for presentation or discussion. It is included in the ToT Handbook as background information for trainees. Trainees will be exposed to logistics and preparation issues during co-training experiences where they can raise questions with trainers. The Trainer’s Manual includes a comprehensive list of facilities, printed resources, materials and equipment needed to successfully organize a WSTPb training programme. The trainer coordinating the training programme will usually liaise with the local host to decide who takes responsibility for each aspect of the logistics and preparation. The trainees will gain experience and skills in handling logistics and preparation tasks during their co-training. The trainer coordinator will divide up these activities among trainees and then monitor and support them. Facilities and services A facilities checklist is included on page 14 of the Trainer’s Manual. Translation services may be needed if the WSTPb trainers do not speak the same language as participants. These services are usually in high demand and should be booked well in advance. Costs will need to be added to the training budget. Printed resources Materials must all be printed locally. A full list of the printed resources needed for the WSTPb can be found on pages 14 – 16 of the Trainer’s Manual. Use the checklist in the Trainer’s Manual to ensure that you have printed the correct number of materials. Materials and equipment A list of materials and equipment needed for the WSTPb can be found on pages 17–18 of the WSTPb Trainer’s Manual. 174 Logistics and preparation Trainer's Manual Wheelchairs The last row on page 17 of the Trainer’s Manual refers to locally available wheelchairs and cushions. If there are many different wheelchairs available, select the models that are used most often ensuring that the following wheelchairs/ features are included: • rigid frame 3-wheel wheelchair • rigid frame 4-wheel wheelchair • folding-frame wheelchair with adjustment options • basic folding-frame (orthopaedic-style) wheelchair • short-wheelbase wheelchair (4-wheel wheelchair) • long-wheelbase (3- and 4-wheel wheelchairs). In less-resourced settings where there are no long-wheelbase four-wheel or three- wheel wheelchairs available, consider introducing examples to participants. The benefits of long-wheelbase wheelchairs in less-resourced settings have been well documented and they are often the most appropriate design for active wheelchair users. Funds to purchase these samples should be included in the training budget. Do not include motorized wheelchairs or wheelchairs that have supportive seating/additional postural support devices as these are not covered in the WSTPb. Ensure that all wheelchairs are in good working order (tyres pumped up and bolts tightened) and have a cushion. There should be a wheelchair and cushion – or materials to make a cushion – for each wheelchair user who attends the practical sessions, as well as basic items like ankle and calf straps. Consumables Page 18 of the Trainer’s Manual lists the foam needed for the cushion fabrication practical. Additional foam, glue, upholstery, nuts/bolts and other components and spares may be needed to make basic modifications to wheelchairs. These should be added to the Materials table at the top of page 17 in the Trainer’s Manual. The complete list of resources needed will depend on the context. Depending on the resources available, technical assistance may be arranged for modifications (for example shortening/extending seats or footrest hangers). 175Logistics and preparation Trainer's Manual Technical work area A technical work area with a variety of tools and materials needed for modifications should be made available or created. This may have budget implications for the training. Power supply Where there is unreliable electricity, a generator with an in-line uninterruptible power supply should be arranged for back-up. This also needs to be added to the equipment list on page 17 of the Trainer’s Manual. Planning for training The most important activities and approximate timelines for planning a WSTPb training programme are listed here. 8 to 12 months in advance • Develop a budget for the training programme. • When multiple partners are involved, agree on the responsibilities of different partners. • Identify dates, a venue, trainers, participant profiles and information on the local context such as: general policies and procedures that guide local wheelchair practice and services; types of wheelchairs, cushions and other materials available; information on local culture and diversity of the participants; and organizations involved. • To work out how many days are required for the training, confirm start and finish times for each day and whether translation will be required. 4 to 6 months in advance • Send invitation letters to each participant with details of the training programme (dates, venue, logistical information) to complete and return. • Gather information on the professional background and skills of participants so that you can adapt session plans accordingly. • Book training equipment. • Source demonstration equipment and other resources needed for the practical sessions, such as treatment beds, foot supports, and transfer boards. • Source consumables. • Source equipment for users (if user equipment is dependent on donor funds and/ or part of the training budget, sourcing equipment may need to start earlier). 176 Logistics and preparation Trainer's Manual • Brief trainers on the context and participants, and agree on the division of sessions and roles. • Book catering services. • Arrange for translators and translation facilities if needed. 4 to 6 weeks in advance • Arrange for local printing of all necessary materials. • Screen and invite wheelchair users. • Finalize registration details: for example, arrange for name tags and registers; and liaise with whoever will carry out the registration. • Send final written confirmation/pre-course information to participants, wheelchair users and trainers. • Confirm caterers, venue and other logistics. 1 to 2 weeks in advance • Confirm that any ordered items have been delivered. • Check toilets, water and electricity supply at venue. • Confirm cleaning schedules. If the training team is not local, it is best to arrive a few days before the programme begins to check the equipment and the venue; meet with wheelchair users supporting the training programme; and to buy any remaining materials required. Regular communication will be needed between the coordinating trainer and other trainers, the host organization and other organizations involved. Wheelchair users During the WSTPb, there are four practical sessions in which three groups of wheelchair users participate. The first group attends on two different days. Before the training programme, trainers need to identify and invite wheelchair users who are willing and able to attend the practical sessions. There is a checklist on page 11 of the Trainer’s Manual that helps to identify wheelchair users. Liaise with the host organization and training organizers regarding budgets and facilities available for wheelchair users. Find out if transport will be provided for wheelchair users or whether they will be reimbursed for costs. If wheelchair users are only able to attend on one day, the programme can be rearranged to accommodate Practical One and Practical Two for user group one on 177Logistics and preparation Trainer's Manual the same day. When adjusting the timetable, make sure service steps 2–7 have been covered before Practical Three. Where possible, trainers should screen wheelchair users in person. If trainers are not based locally, a local service provider can be asked to identify potential wheelchair users and send photos and information in advance for trainers to confirm their suitability for the training level. Invitations to wheelchair users When drafting invitations to wheelchair users think about the following issues (a template is available on the WSTP Pen Drive): • A description of what will happen when they attend the session. • The time, date and the duration of the session. • Can they bring someone with them? • Will they receive a wheelchair at the session? What happens if they need follow up or have any problems with the wheelchair? • Where will they receive follow-up services after the training? • How will they get to the venue? Will their transportation costs be reimbursed? • Do they have to bring refreshments and lunch? • Will they receive payment for attending? Each wheelchair user should receive an invitation letter with this information in writing. They should also sign a consent form to indicate their willingness to take part and to be photographed. The photographs are used when the small groups present back to the rest of the group. Despite careful planning, a wheelchair user may arrive with a pressure sore or fall ill on the day of the session. Discuss this possibility in advance with the host organization so that they are ready to manage the situation if it arises, and can arrange for a back-up wheelchair user to attend. If a wheelchair user has a bladder or bowel accident during the session, have supplies ready to clean the user and the equipment. Also, a small first aid kit should be available in case of bumps and scrapes to both participants and wheelchair users. 178 Logistics and preparation Trainer's Manual 179AnnexesTrainer's Manual Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages (90) 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equip- ment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 180 AnnexesTrainer's Manual Annex 2: WSTPtot Basic Level Timetable Day one Day two Day three 8:30 Introduction 30 A.6 Appropriate wheelchairs Part 2 (78) B.4 Physical assessment 85 8:45 9:00 A.1: Wheelchair users 25 9:15 9:30 A.1: Feedback 10 9:45 A.3 Wheelchair mobility 90 10:00 Part I (37) A.6 Feedback 5+5 B.4 Feedback 5+5 10:15 Morning break Morning break Morning break 10:30 A.3 Wheelchair mobility (43) A.7 Cushions 75 B.5 Prescription 120 10:45 11:00 11:15 A.3 Partial wheelie 10 11:30 A.3 Feedback 20 11:45 A.4 Sitting upright 45 A.7 Feedback 5+5 12:00 A.8 Transfers 65 12:15 12:30 A.4 Feedback 10 Lunch break B.5 Feedback 5+5+5 12:45 Lunch break Lunch break 1:00 1:15 1:30 A.8 Transfers 1:45 A.5 pressure sores 60 B.7 Product preparation 40 2:00 2:15 A.8 Feedback 5+5+5 2:30 A.8 Floor to chair 10 B.7 Feedback 5 181AnnexesTrainer's Manual 2:45 A.5 Feedback 10 B.3 Assessment interview 90 Part 1 (47) B.9 Fitting 60 3:00 Afternoon break 3:15 A.6 Appropriate wheelchairs 120 Part 1 (42)3:30 Afternoon break B.9 Feedback 5+5 3:45 A.6 Feedback 5 B.3 Assessment interview Part 2 (43) Afternoon break 4:00 Car park 15 B.13 Follow-up 35 4:15 Session preparation ToT Trainer individual feedback B.3 Feedback 5+5 4:30 Session preparation ToT Trainer individual feedback B.13 Follow-up 5 4:45 Car park 15 5:00 Evaluation 15 5:15 Closing ceremony 15 182 AnnexesTrainer's Manual Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 183AnnexesTrainer's Manual Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 184 AnnexesTrainer's Manual Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 185AnnexesTrainer's Manual Annex 4: Cushions Annex Preparations The resources available for sessions A.7: Cushions and B.8: Cushion Fabrication will vary depending on the context of the training course. Aim to use materials and fabric that will be accessible and affordable for participants after the training. In some contexts ready-made cushions may be available. If not, source or buy appropriate materials and make sample cushions before the training starts. When using glue, ensure that you leave enough time for it to dry. This is particularly important if you are glueing several layers together to create the required thickness. Fabricating cushions and cushion covers Look in the local market and visit foam, shoe, mattress and furniture factories to find locally-available foam. Ensure that you have the correct firmness of foam: • The base layer materials must be firm enough to maintain their shape under the weight of the user. Suitable materials for the cushion base are often hard to source. Where resources are scarce, alternatives can include layered ethyl vinyl acetate (EVA), chip foam or rubber (such as a yoga mat). • The top layer should be soft enough to allow the seat bones to sink into it, but should not be so soft that the seat bones can sink all to the bottom to rest on the solid base of the wheelchair seat. See the Technical Annex for more information about how to test foam firmness. Aim to have different thicknesses of foam available (30−50 mm) for demonstration and provision to wheelchair users. Figure 1. Pressure relief cushion 186 AnnexesTrainer's Manual For the cushion cover: • Choose a fabric with two-way stretch that follows the shape of the cushion, such as T-shirt material or lycra. • If stretchy fabric is not available, ensure there is enough room in the cover to fit into the contours of the cushion. Pleats in the cushion cover may also allow it to fit the shape of the cushion better (especially in the well area). • Avoid thick folds that mark the skin. The fabric should be thin enough to avoid causing ridge marks when sitting on a fold. Samples for participants Have examples of suitable and unsuitable materials (foams, rubbers, fabrics) for the base layer, the top layer and cushion cover. Samples of materials should be a minimum of a 50 x 50 mm and fabric 100 x 100 mm. This will help participants to understand which materials are acceptable and which are not. If possible, put together a small sample kit of good examples for each participant to take home. Moisture and incontinence management Water-resistant or waterproof cushion covers for users who are incontinent can be difficult to source. Options include: • Providing two cushions so that one can be used, while the other is being washed and dried. • Covering the cushion with a thin plastic bag. When covering a cushion with a very thin plastic bag: • Ensure it is loose enough to allow the wheelchair user to sink into the soft top layer of the cushion. This will ensure the user continues to benefit from posture support and pressure relief aspects of the cushion. If providing a cushion with more than one layer, consider only covering the base layer with a plastic bag. • The top layer can then be removed and replaced as necessary. • Providing more than one layer to the user will help them to wash and dry the top layers each time they get wet or soiled. 187AnnexesTrainer's Manual Covering the cushion with a plastic bag may create heat and cause sweating/ moisture for the user, which are risk factors for pressure sores. • Talk with users about the increased risk of developing a pressure sore. • Encourage them to check their skin regularly. Remember that wheelchair users should never sit directly on the plastic; the cushion should always be used with a cover. Tools for cushion fabrication For some participants, it may be their first experience of making a cushion. Give them some practical tips on the tools and materials they will be using, for example: Apply masking tape to one end of the hacksaw blade to create a grip, to make cutting easier and more effective (Figure 2). The tooth edge of the saw blade should be ground down for foam cutting. For more details on preparing a hacksaw blade for cutting, refer to the WSTPm additional resources. Figure 2. Hacksaw blade Create a guide when fabricating a cushion A visual guide can be made out of cardboard or wood. A guide is helpful for marking up a cushion before cutting, for example when removing a small bevel from the edges of the well (Figure 3). Figure 3. Using a guide when cutting 188 AnnexesTrainer's Manual A guide can also be useful when cutting a consistent shape or straight line (Figure 4). Figure 4. Cutting a straight line Seat and cushion modifications to enable foot propelling When modifying a wheelchair to allow the user’s foot to comfortably reach the floor (session B.4: Physical assessment) consider the following options. Reduce the overall height of the cushion • Use a thinner base layer or top layer of foam on the cushion. • If the user is at risk for pressure sores, use the finger pressure test to ensure that the cushion provides enough pressure relief. Lower the seat of folding-frame wheelchairs by attaching a solid seat • Suspend the seat board from the seat rail on hooks, then it can be removed easily (Figure 5). • Cut reliefs for the top of the cross brace. Figure 5. Solid seat with hooks 189AnnexesTrainer's Manual Modify the cushion by adding a lowered seat front Add a lowered seat front to the cushion on the side of the leg that needs to reach the floor (Figure 6). • The length of the lowered seat front starts from the shelf and extends down to the front edge of the cushion. • The width of the lowered seat front is half of the overall width of the cushion. • There should be even contact under the user’s seat bones and thighs. Figure 6. Lowered seat front Modify both the seat and cushion Shorten the seat and cushion on the side of the propelling leg (Figure 7). • Solid seat: Shorten the seat and the cushion to the required length on the side which needs to reach the floor. This should be combined with a lowered seat front. • Fabric slung seat: Shorten the entire seat to the desired length. Add a board the same shape as the cushion, extending over the edge of the seat. It may be necessary to replace the fabric seat with a lowered solid seat. Figure 7. Shortened seat and cushion 190 AnnexesTrainer's Manual Annex 5: Updated Wheelchair Assessment Form For assessment of wheelchair users who can sit upright easily. Wheelchair users who cannot sit upright easily may need assessment by a person with ‘intermediate’ level training. Keep this form in the wheelchair user’s file. Assessor’s name: Date of assessment: 1: Interview Assessment Information about the wheelchair user Name: Number: Age: Male Female Phone no.: Address: Goals: Physical condition Cerebral palsy Polio Spinal cord injury Stroke Frail Spasms or uncontrolled movements Amputation: R above knee R below knee L above knee L below knee Bladder problems Bowel problems If the wheelchair user has bladder or bowel problems, is this managed? Yes No Others: __________________________________________________________________ Lifestyle and environment Describe where the wheelchair user will use their wheelchair: ___________________________________________________________________ Distance travelled per day: Up to 1 km 1– 5 km More than 5 km 191AnnexesTrainer's Manual Hours per day using wheelchair? Less than 1 1-3 3-5 5-8 more than 8 hours When out of the wheelchair, where does the user sit or lie down and how (posture and the surface? ___________________________________________________________________ Transfer: Independent Assisted Standing Non-Standing Lifted Other Type of toilet (if transferring to a toilet): Squat Western Adapted Does the wheelchair user often use public/private transport? Yes No If yes, then what kind: Car Taxi Bus Other _________________________ Existing wheelchair (if a person already has a wheelchair) Does the wheelchair meet the user’s needs? Yes No Does the wheelchair meet the user’s environmental conditions? Yes No Does the wheelchair provide proper fit and postural support? Yes No Is the wheelchair safe and durable? (Consider whether there is a cushion) Yes No Does the cushion provide proper pressure relief (if user has pressure sore risk)? Yes No Comments: _________________________________________________________ If yes to all questions, the user may not need a new wheelchair. If no to any of these questions, the user needs a different wheelchair or cushion; or the existing wheelchair or cushion needs repair or modifications. 192 AnnexesTrainer's Manual 2: Physical Assessment Presence, risk of or history of pressure sores /// = does not feel O = previous pressure sore l = existing pressure sore Can feel normally? Yes No Previous pressure sore? Yes No Current pressure sore? Yes No If yes, is it an open sore (stage 1– 4)? Yes No Duration and cause: ________________________ ______________________________________ Is this person at risk* of a pressure sore? *A person who cannot feel or has 3 or more risk factors is at risk. Risk factors: cannot move, moisture, poor posture, previous / current pressure sore, poor diet, ageing, under or over weight. Yes No Method of pushing How will the wheelchair user push their wheelchair? Both arms Left arm Right arm Both legs Left leg Right leg Pushed by a helper Comment: __________________________________________________________ 193AnnexesTrainer's Manual Measurements Body Measurement Measurement (mm) Change body meas- urement to ideal wheelchair size Wheelchair measurement A Hip width Hip width = seat width B Seat depth L B less 30 – 50 mm = seat depth (if length is different, use shorter one) R C Calf length L (C less cushion height*) C less cushion height* = seat to top of footplate or seat to floor depending on user’s needs R D Bottom of rib cage (D or E [depending on user’s needs] + cushion height*) D or E (depending on user’s needs) + cushion height* = seat to top of backrest E Bottom of shoulder blade *check the height of the cushion that the wheelchair user will use.

196 AnnexesTrainer's Manual For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/

車椅子サービス 教習員養成教習パッケージ 管理者/関係者向け教習 ハンドブック 車椅子サービス教習員養成教習パッケージ・管理者/関係者向け教習ハンドブック © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: ToT handbook managers and stakeholders. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: ToT handbook managers and stakeholders. ジュネーブ: 世界保健機関; 2017. ライセン ス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワールド・ ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: ToT Handbook Managers and Stakeholders” の全訳である。序章の「はじめに」で述べている通り、本 書を含むこの「車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings”（邦訳「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたも のである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移動支援機器供与に関する共同方針提言書：個人的移動性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子供与ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬模擬授業からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳の確認と校閲については、以下の方々のご協力をいただきました。 ここにお名前を記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: ToT handbook Managers and Stakeholders, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 模擬授業準備の手引き xiii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 3 ToT.3 模擬授業 10 ToT.4 多様性への心構え 15 ToT.5 成人学習 20 ToT.6 準備時間について 27 ToT.7 提示とファシリテーション 28 ToT.8 コミュニケーション技能 33 ToT.9 指針文書の知識 37 ToT.10 視聴覚ツールおよび機材 55 ToT.11 フィードバック 61 ToT.12 集団力学を司る 63 管理者/関係者向け教習モジュール 68 WSTPtot 管理者向け教習のはじめに 69 管理者向け WSTP 教習運営実務と準備 75 管理者向け WSTP 模擬授業 77 あいさつ・自己紹介・概略 78 A.1: 適正な車椅子供与とは何か? 79 A.2: サービス提供 81 A.3: 変革を導く管理者 82 B.1: サービスへのアクセス 83 B.2: 施設および設備 84 B.3: 適正な車椅子を取り揃える 86 B.4: 職員の配置 88 B.5: 車椅子サービスはどうお金がかかるのか? 91 C.1: サービス事業が機能しているか判るには？ 92 C.2: 需要管理 94 C.3: フォローアップ計画 96 C.4: 持続可能な財政計画 97 総まとめ 98 WSTPtot 関係者向け参考資料 101 WSTPtot 関係者向け教習プログラムのはじめに 102 関係者向け WSTP：教習運営実務と準備 105 関係者向け WSTP 模擬授業 109 S.1: はじめに 110 S.2: 政策から実践へ 112 S.3: 適正な車椅子を取り揃える 115 S.4: 変革に向け協働を 117 閉会のことば 119 付録 120 付録１：WSTPtot 必須授業時間割 120 付録２：WSTPtot 管理者/関係者向け教習時間割 121 付録 3：WSTPtot 模擬授業フィードバックシート 123 付録 4：管理者/関係者向け WSTP 計画ツール 126 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008 年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4 種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHO は、WSTPtot の発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtot は、単一の「必須教習技能」モジュール3、および既成の 4 教習パッケージ（2012 年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013 年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015 年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtot では、WSTPm と WSTPs は、一つの教習パッケージ別モジュールと して統合されている。 WSTPtot は 40 時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtot の修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi ToT ハンドブックの使い方 この ToT ハンドブックは、教習パッケージ別モジュールの教授法に関する情報を含む、WSTPtot へのステップバイステップの手引き書である。本書は、実習生5が WSTPtot プログラム中に使い、 また将来、WSTP を計画し、実施する際の参考資料として持っておくために開発された。 対象者 WSTPtot は、以下 4 つのモジュールからなる： • 必須教習技能6：2 日間 • 基礎教習（WSTPb）：3 日間 • 中級教習（WSTPi）：3 日間 • 管理者/関係者向け教習（WSTPm/s）：3 日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向けおよび関係者向け WSTP の実施を計 画している教習員が対象である。実習生が WSTPtot 管理者/関係者向け教習から最大限の成果を 得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業の 必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習7 の機会を得る必要がある。 5 [原文] you [訳注] この教習パッケージ（WSTPtot）を受講する実習生 (模擬授業では教習員). 以下同様. 6 [原文] Core Training Skills 7 [原文] co-training xii 模擬授業8の割り当て 「必須教習技能」モジュールを修了後、実習生は WSTPtot の第 2 部に進み、そこで各自の WSTP 授業を実施することで学んだ技能を実践する。 実習生には、「必須教習技能」モジュール初日に「ToT.3 模擬授業について9」で担当授業が割り振 られる。その際、各実習生にメンター10として ToT 教習員ひとりが割り振られる。教習プログラム には授業を準備し、またメンターの ToT 教習員と相談する時間が盛り込まれている。模擬授業の後 にフィードバックと話し合いが持たれ、このプロセス全体を通して ToT 教習員が実習生の技能を 観察し、評価できるようになっている。 WSTPtot への準備をじゅうぶん行なえるよう、実習生には予め教習パッケージ別教材資料が送付 される。実習生は、どの授業でも実施できるよう準備万端で臨むべきである。 注記： 模擬授業の中には、WSTPtot に合わせて時間配分を短縮するか、授業の一部を割愛するよう 改変したものもある。これらの改変はWSTPtot の目的に合わせただけのもので、WSTP 実施の 際にまねてはならない。 8 [原文] practice delivery 9 [原文] practice delivery sessions 10 [原文] mentor [訳注] 本書では助言指導 mentor, その行為 mentoring と指導者 mentor は「メンター」に一括. xiii 模擬授業準備の手引き リーダー役実習生 • 担当する授業について WSTP「教習員用指導書」の授業計画を読み、授業内容をすべて理解して いることを確かめよ。活動は自分でやってみて、受講者に何をやることが期待されているのか、 自分が理解していることを確かめよ。自分が担当する節/授業のみ準備せよ。 • 基礎/中級/管理者向け WSTP「受講者用参考書」と「受講者用ワークブック」（これらは関係者 向け WSTP にはない）の、該当箇所を読め。 • 担当授業について、「ToT ハンドブック」の「この授業を教えるための主な留意点」など関係する 節を読め。 • WSTP の教材にはいくつかの誤りが判明しており、それはこのハンドブックに挙げている。担当 授業について誤りがあるか調べ、あれば推奨されている変更を加えよ。 • 必要に応じて、PPT スライドを編集せよ。 • 適切ならば、ケーススタディなど自分の知識や経験を盛り込め。 • 授業実施を、時間配分も含め予行演習せよ。 • 補助役実習生と話し合い、チームとしてどう作業するか計画せよ： o 役割を割り振る。例えばタイムキーパーや板書など。 o 実技を含むグループ活動については、いっしょに予行演習し、どの誤りに注意が必要で、どう やってそれを訂正するか話し合う。 補助役実習生 • 自分の「教習員用指導書」の授業計画を読め。 • 指示に応じて、リーダー役実習生を補助せよ。 授業開始の前に • 自分の PPT スライドを、当該教習日の開始前に、教習用ノート PC へアップロードせよ。 • 必要に応じて、教室を設営し教習資材を設定せよ。 • 視聴覚機材が設定され、正常に動作することを確認せよ。 xiv 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員といっしょに見習い教習を実施し、自らの技能を育成 し続けなければならない。見習い教習では、教習指導員 1 名に対して見習い教習員 2〜4 名の割合 を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、「WSTPtot 模擬授業フィードバックシート」に記録して、実習生と共有される。 メンター11およびピアサポート12 実習生には WSTPtot 教習後も自分の ToT 教習員と連絡を取り合い、進境を報告し、相談して助言 をもらうよう勧める。実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各自の技能 と自信とを養うために役立つ。実習生がソーシャルメディア上のグループに参加するかグループを 立ち上げ、質問したり学習経験を共有したりできると有益であろう。 11 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 12 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 車椅子サービス教習員養成教習パッケージ (WSTPtot) の構成 WSTPtot プログラムは 2 日間の「必須教習技能」モジュールと、続く基礎（WSTPb）、中級（WSTPi）、 管理者向け（WSTPm）・関係者向け（WSTPs）から一つ選択する、3 日間のモジュールとからなる。 この教習パッケージ別モジュールでは、実習機会を与えて実習生の WSTP 教習員としての技能と 自信を育てる。ここでは WSTP 実施の際に起こりがちな課題も明らかにし、解決策を提示する。 WSTPtot 課程の概観 ToT プログラム修了後、実習生は、自立した教習員としての自信と能力が備わるまで、見習い教習 を行なわねばならない。見習い教習の回数は、人によって異なる。ToT 教習員と、見習い教習中に 実習生のメンターを務める教習員は、実習生が見習い教習を継続すべきか、ひとり立ちして教習を 実施すべきか、決めるのを手伝う。 必須教習技能 教習パッケージ別 見習い教習員 教習員 実習生が、対面での ToT 教習後に経験豊富な教習員との見習い教習を行なえない場合、WHO では、 実習生にバーチャルな支援やコーチを探し、また他の ToT 実習生と連携し、助け合って、WSTP の 計画、準備、実施を行なうよう奨励している。 フィードバックおよび自己評価 教習パッケージ別モジュールの模擬授業中、実習生は、実習生の技能一覧表を含む「WSTPtot 模擬 授業フィードバックシート」を用いて自分の出来ばえを評価する。ToT 教習員は ToT プログラムの 最後に、このフォームに書面でのフィードバックを与える。これは、実習生が教習技能を向上させ 続けるために役立つ。このフォームは、本書の付録に載っている。 3 ToT.2 車椅子サービス教習パッケージについて 沿革 WSTP（車椅子サービス教習パッケージ）は、2006 年 11 月に インド・バンガロールで開かれた、「開発途上国への車椅子に 関する合意形成会議(1)」に端を発している。 この合意形成会議が基礎となり、WHO「手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて(2)」が作成され、 国際義肢装具学会（ISPO）及び米国国際開発庁（USAID）との 提携のもと、2008 年に WHO から発行された。 車椅子は、個人的移動を可能にするために最もよく使われる支援機器の一つであるが、サービス 供与者には、車椅子ユーザーが最大限に自立した個人的移動を達成し、生産的で高い生活の質を 享受できるようにするための教習を受ける機会がほとんどなかった。 基礎・中級 WSTP の開発目的は、低リソース状況の車椅子サービス職員に包括的車椅子サービス 供与教習を行なうことにより、より多くの大人や子どもが自分のニーズを満たす車椅子を手に入れ られるようになることによって「車椅子ガイドライン」が実行されることである。 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006 年 11 月 6〜11 日. インド, バンガロール: 世界保健機関, 2006]. 2 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 4 4 つの WSTP 基礎車椅子サービス教習パッケージ (基礎 WSTP、WSTPb)(3)は、 移動に障害があるものの、付加姿勢支持なしでまっすぐに座れる 男女の子どもや大人に、適正な手動車椅子およびクッションを 供与する職員への教習を助ける。 中級車椅子サービス教習パッケージ (中級 WSTP、WSTPi)(4)は、 まっすぐに座るには付加姿勢支持が必要な男女の子どもや大人 に、適正な手動車椅子およびクッションを供与する職員への教習 を助ける。 基礎 WSTP、中級 WSTP とも最短 5 日間で実施できるように設計されている。しかし、各授業に 要する実際の時間はさまざまである。以下のような場合は、追加時間が必要になる： • 授業計画に教材資料を追加する。 • 状況や受講者の技能レベルに対して適切な、追加授業を盛り込む。 • 車椅子ユーザーとの実習回数を増やす。 • 通訳が必要。 • 教習で使用する製品に対して、さらに下準備の時間を取る。 • 現地の事情に合わせて、教習日数を短縮する。 • 教えている受講者に、経験や公式の資格といった面で制約がある。 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版：基礎車椅子サービス教習パ ッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版：中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 5 教習時間割に授業を追加したい場合、国際車椅子専門家学会（ISWP）のウェブサイトに追加教材 が載っている。以下を参照：http://wheelchairnet.org/resources5 管理者向け車椅子サービス教習パッケージ (管理者向け WSTP、 WSTPm)(6)は、事業管理者が、適正な車椅子供与を効果的に支援 する指針となるように設計されている。これには、適正な車椅子 供与の確立に向けて事業管理者や関係者の参画を推進すること も含まれる。管理者向け WSTP は最短 2 日で実施できる。 関係者向け車椅子サービス教習パッケージ (関係者向け WSTP、 WSTPi)(7)は、国/地域における適正な車椅子供与の確立に向けて、 全関係者の意識を啓発し、技能や知識を育成するために設計され ている。最短 4 時間で実施できる。 • どちらの教習パッケージも、通訳、より詳細な討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るために、期間を延長して実施できる。 5 [訳注] 2022 年 10 月 28 日現在, リンク切れ. 6 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 7 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 20 15 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 6 指針原則 WSTP は、以下の一群の指針原則8に従って作成された： • 車椅子ユーザーを車椅子サービスの中心に置く、ユーザー中心で人権に根ざしたアプローチ9。 • 手に入るエビデンスに基づく10、国際的な最良の実践例11にならう。 • 低リソース状況12に重点を置き、状況に対して適正な製品と教習を採用する。 • 全教習パッケージにおける、教習員や教習対象者としての車椅子ユーザーのインクルージョン。 • 取っ付きやすい非医療的なことばづかいと用語13を用い、それによって： o 臨床や技術の資格を持たない受講者も教習を受けられ、 o サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになる。 WSTP の構成要素 各教習パッケージは、さまざまな教材からなっている。 基礎 WSTP 中級 WSTP 管理者向け WSTP 関係者向け WSTP 教習員用指導書 ✔︎ ✔︎ ✔︎ パワーポイントのプレゼンテーション ✔︎ ✔︎ ✔︎ 動画 ✔︎ ✔︎ ✔︎ ポスターセット ✔︎ 選択した ポスター 選択した ポスター 補助資料：車椅子ガイドライン、障害者権利条約 ✔︎ ✔︎ ✔︎ 受講者用参考書 ✔︎ 合本 受講者用ワークブック ✔︎ 各種フォーム＆確認表 ✔︎ － 補助教材：工具、器材、各種フォームなど － ✔︎ 8 [原文] guiding principles 9 [原文] user-centered and rights-based approach 10 [原文] available evidence-based 11 [原文] best practice 12 [原文] less-resourced settings 13 [原文] accessible, non-medical language and terminology 7 活動１：「教習員用指導書」をよく知る グループで協力し、「教習員用指導書」を用いながら以下の問いに答えなさい。答えは各問いの横 に書きなさい。 問い 答え 1. 「教習員用指導書」全内容の一覧は、 どこで見つかりますか？ 2. グループ活動は授業の中でどう示され ていますか？ 3. 教習パッケージ全体のねらいや目的 は、どこで分かりますか？ 4. 授業計画で、教習員が PPT スライドを 映写すべきタイミングはどこに示され ていますか？ 5. 教習授業の実行に必要な施設、教材、 設備はどこで分かりますか？ 8 WSTP「教習員用指導書」の使い方 マニュアル 各「教習員用指導書」は教習員に当該パッケージの概観をもたらし、その具体的な手引き書となる ものである。各項目は、WSTP の実施準備前に注意深く読み返すべきである。 付録 補足情報を与える付録は基礎・中級・関係者向けの「教習員用指導書」の末尾に載っており、各種 フォームや確認表も含んでいる。 授業計画 授業計画は、授業を通して教習員を導くレシピのように働く。授業計画に従うのは以下の面で有効： • 学習目標への集中を保つ • 時間を守る • 関連トピックについての、フォーカスグループ活動、話し合い、質問 動画コラム 動画を上映すべきところには、右の動画アイコンのどちら かが付いた動画コラムが「教習員用指導書」に載っている。 • すべての動画の内容、関連性、タイミングを熟知して おくことが重要。 教習員への注記 教習員への注記は、「教習員用指導書」全体に盛り込まれており、内容は： • 質問に対する最も重要な答え • グループ活動への手引き • 教習員が受講者からの質問に答えるのを支援する補足情報 9 活動コラム 活動コラムは、下記の情報を提供する教習員の手引き である： • グループ：活動のために、どうグループ全体を分け るか。 • 指導内容：活動をどのように実施すべきか、受講者 に何を話すべきか。 • モニター：活動中、どのようにグループをモニター して正しい作業を行なうようにするか。 • 時間：活動時間の長さおよび最後のフィードバック 時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき 要点、受講者の思考や感覚を引き出すやり方。 要点のまとめ どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」（管理者向け WSTP の場合）である。 10 ToT.3 模擬授業について はじめに ここで学ぶ、WSTP パッケージを教授することへどれくらい自信を感じるか 1〜10 点で記録せよ： 1 2 3 4 5 6 7 8 9 10 自信がない たいへん自信がある 教習パッケージ別モジュールの構成とねらい 教習パッケージ別モジュールには、習得を選択した WSTP の授業を実施する機会が含まれる。 これは実習生14が、以下ができることをねらいとしている： • WSTP の教習教材を使う練習をする。 • 教習仲間を相手に授業を実施する練習をする。 • WSTP の理論、原則、技能、方法論への自分の理解を明確にする。 • 教習時に発生する、よくある問題について学び、それに対処するやり方を見出す。 • 自分の、実習生としての技能（各自の「ToT ハンドブック」付録の「WSTPtot 模擬授業フィード バックシート」の一覧表を参照）を育成する。 リーダー役・補助役教習員および模擬受講者の役割 • 実習生には、リーダー役教習員15と補助役教習員16の両方になる機会がある。 • 同じ授業にリーダー役教習員が複数割り当てられた場合、プレゼンテーションを行なっていない 人はそのあいだ自動的に補助役教習員役に回る。 • 一つの授業にリーダー役教習員が一人だけの場合、その人は他の模擬受講者に補助を頼んでよい。 • 模擬授業では、補助役教習員に特定の役割が割り当てられる場合もある。 14 [原文] you [訳注] 原著では, 本書の対象者で ToT 教習を受ける実習生 trainee を, 模擬授業で教える役割にある 場合のみ教習員 trainer, それ以外では you と呼びかけているが, 二人称は日本語的でないため「実習生」の訳語を 充てた. ToT 教習員は, WSTPtot 教習員用指導書でも ToT ハンドブックでも「ToT 教習員 ToT trainer」である. 15 [原文] lead trainer [訳注] 実習生 trainee が, 模擬授業で教える際に務める役割の一つ. 16 [原文] support trainer [訳注] 同上. 11 活動１：リーダー役教習員と補助役教習員 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ 12 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役教習員を調整する。 • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー 役実習生にもたらす。 • 授業実施に関する全体的フィードバック/ 振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消し やブラインドの開閉を行なう。 チームワーク 実習生はチームとして、協力して授業を実施すべきである。例えば、以下を助け合うことなど： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 時間管理 • 授業実施中の誤りの指摘 • 受講者からの質問に答える • 妨害や割り込みへの対処 お手本17としての教習員 教習員は、プロとしての行動と実践のポジティブな手本を示すべきである。受講者に求める行動に は、その模範を示せ。例えば： • 時間を守り、じゅうぶん準備する。 • 困難な状況で、問題を解決し解決策を見出す。 • ポジティブなフィードバック、および建設的なフィードバックを与える。 • 上手に自己管理する：例えばストレス管理のため、授業準備とじゅうぶんな睡眠・よい食事との バランスを取るなど。 17 [原文] role models [訳注] そのまま「ロールモデル」と呼ばれることも多い. 13 留意事項：優れた教習員であり、手本であるとは、常に質問への答えを知っていなければならない ということではない。 質問を受けたが答えを知らない場合に、答えを知っているふりをしてはならない。代わりにできる ことは： • 補助役教習員に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 振り返り18とフィードバック 自分自身の教えぶりを振り返ることを学ぶのは、教習員にとって重要な技能である。教習員には、 教習受講者に、建設的な指針となるフィードバックを与えられることも重要である。 これが、振り返りとフィードバックの技能が ToT プログラムに組み込まれている理由である。 各模擬授業の終わりに、リーダー役教習員は次を振り返るよう求められる： • 何がよかったか、また何がうまく行ったか。 • 何に改善の余地があるか。 ToT 教習員は模擬受講者からの簡潔なフィードバックを促し、リーダー役教習員や模擬受講者が挙 げていなかった点があれば、最後に ToT 教習員から付け加える。 模擬授業の準備 模擬授業の準備には、以下が含まれるべきである： • 「教習員用指導書」の授業計画を読み、授業内容をすべて理解していることを確かめる。 • 「受講者用参考書」と「受講者用ワークブック」（関係者向け以外の WSTP で使う）の該当箇所 を読む。 • PPT に適切な変更/補足を加える。 • 適切ならば自分自身の知識や経験を組み込み、自分のケーススタディを活用する。 • 授業実施を、時間配分を含め予行演習する。 • 補助役教習員と、チームとして協力する。 • 授業に必要な教材を準備する。 授業が ToT 教習員によるデモを含む場合は、ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせよ。 18 [原文] Reflection 14 判明している誤り WSTP の「教習員用指導書」「受講者用参考書」「受講者用ワークブック」および PPT の中には、 いくつかの誤りが判明している。 • 判明している誤りは各自の「ToT ハンドブック」で挙げている。 • 授業を準備するさい、担当授業に誤りがないか確かめ、必要な変更を加えよ。 • 模擬受講者と誤りについては話さず、授業のプレゼンテーションは通常の WSTP 教習と同様に 行なえ。 授業プレゼンテーションにおける自信 • 最初の模擬授業では、教習仲間や ToT 教習員を前にしてアガるかもしれない。それが普通だ19！ • さらに授業を実施するにつれ、技能と自信がついてくる。 • 「必須教習技能」モジュールのあいだ、グループ活動からのフィードバックを発表するよう求め られる。その機会を活かし、仲間へのプレゼンテーションを練習せよ。 PPT（パワーポイント）のプレゼンテーション • 各授業の標準版 PPT は、動画を埋め込んだものが教習用ノート PC で使用可能。 • 自分の PPT に、スライドの追加などの変更を加えた場合は、模擬授業前に教習用ノート PC へ それをアップロードしておく必要がある。 模擬授業の制限時間 • 模擬授業のあいだ、時間は厳しくモニターされる。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止させて次の教習員に移るか、授業を終了する。 19 [原文] This is normal! 15 ToT.4 多様性に備える20 WSTP 教習員はしばしば多様性21に遭遇するため、多様な受講者集団を取り仕切るやり方を、必ず 把握しているべきである。多数派の中にいると、人はえてして力強さや自信を感じる。少数派の中 にいると、人は孤立や疎外を感じることがある。集団は文化22や多様性によって分かれ、あるいは まとまる。 文化と多様性 文化：人びとを同じにするもの • 共有あるいは共通の、価値観23、意識24、道徳、伝統、信念25などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団26、ジェンダー、性自認27、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを忘れないように。 文化的能力28 文化的能力とは、個々人が自分の文化とは異なる文化との効果的かつ敬意をもった関わり方を学ぶ、 能動的プロセスである。 それは個人や集団、組織に関係するものであり、また学ぶことができるものである。 文化的能力に通常含まれること： • 自分の文化的慣行への自覚 • 異なる文化的慣行に関する知識 • 文化の違いに対するポジティブな姿勢 • 文化が人的交流へどのように影響を及ぼすかの理解 20 [原文] Preparing for diversity 21 [原文] diversity 22 [原文] culture 23 [原文] values 24 [原文] attitudes 25 [原文] beliefs 26 [原文] ethnicity 27 [原文] gender identity 28 [原文] cultural competence [訳注] 国際保健用語では「文化能力」とも訳される. 16 教習員の文化的能力 教習員は文化の違いを理解し、よさを分かるために必要な知識、技能、意識を必ず持つようにせ よ。これには他者の文化的な信念、ふるまい、ニーズを尊重し、受容することが含まれる。 WSTP 教習員が文化の違いを理解あるいは尊重しなければ、こうした違いは、誤解、失望、混乱、 困惑、怒り、侮蔑などを引き起こすことがある。 ありうる文化的留意事項 • 身体的接触：女性教習員が男性車椅子ユーザーを事前評価する、または男性教習員が女性車椅子 ユーザーを事前評価することは、文化的に不適切な場合がある。 • 服装：服装は、必ず文化的に適切であるようにせよ。 • コミュニケーション：文化によっては、直接聞かれない限り受講者が質問に答えない場合がある。 • アイコンタクト29：直接相手を見ながら話しかけることが、失礼に当たる場合がある。 • フィードバック：受講者が、人前で建設的な批判/フィードバックを与えたり受けたりする際に、 どこまでそれを受容できるか、よく気をつけよ。 • ジェンダー：文化によっては、男女がペアを組んで活動したり、いっしょに食事をしたりするの は不適切な場合がある。これは、グループ作業や休憩時間の組み方に影響しよう。 • 宗教的信念：現地の宗教的慣行、例えば祭礼、断食、礼拝などに合わせて、休憩時間の延長や、 開始/終了時間の変更が必要になる場合がある。 活動２：文化的能力 自分の文化とは違う文化を経験したときの例について考え、書き出しなさい。 それはどういうものでしたか？ 29 [原文] Eye contact 17 どう感じましたか？ その経験から何を学びましたか？ 車椅子ユーザーはじめ障害者の WSTP へのインクルージョン WSTP（車椅子サービス教習パッケージ）は、教習 チームへの、また受講者としての、車椅子ユーザー はじめ障害者のインクルージョンを推進している。 これが重要な理由は： • 車椅子ユーザーは、自分の体験や視点を活かして WSTP の学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子 サービスにおける車椅子ユーザーの中心的役割 を強化する。 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、差別・ 偏見とたたかい30、CRPD（障害者の権利に関する条約）の原則を強調するために役立つ。 30 [原文] combat stigma 18 車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁 車椅子ユーザーはじめ障害者の WSTP へのインクルージョンのために、WSTP 教習員は、障害者 の社会へのインクルージョンを阻むものは何か、必ず理解しておくべきである。 認識 人びとは障害についてよく知らないことが多いため、障害者に対して誤った思い込みを抱く。 • 多くの人は、障害者は家族、仕事、余暇、社会生活、個人生活に関して同じゴールや夢を持って いないか、それらを達成する能力がないと考える。 • 身体障害があることから、この人には認知障害もあると考え、その人を子ども扱いし、ゆっくり と、あるいは大声で話し、あるいは障害者に付き添っている人に話しかける。 意識31 障害者に対するネガティブな意識の例 • 障害者は、その機能障害ゆえに社会での価値は低いとする見方。 • 障害者を慈善の対象として恩を着せる32。 • 障害者を、よく知らないために、あるいは失言をやらかすのを恐れて忌避する。 • 家族、地域リーダー、学校などの機関が、障害児教育に低い価値を置く。障害者は、教育抜きに は機会が限られる。 信念 信念は意識と密接に関係し、また障壁もつくり上げる。例えば、機能障害がある人は、そのために 任務を達成できないと、実際はできるにもかかわらず信じることなど。 31 [原文] Attitudes 32 [原文] Patronizing 19 文化 文化的信念、規範、価値観も障壁をつくり上げる。文化によっては、障害者は祟られていると信じ、 そのけっか障害者が地域や家族から閉め出され、引きこもり隠れてしまう場合もある。 ステレオタイプ33 これらは障害者を、自分自身の関心や技能を持ち社会に貢献する個人として認識しないネガティブ な見方である。 法令および政策 障害者の権利を保護する法令や政策は、あっても執行されないことが多い。例えば、国によっては 一定枠の障害者を雇用することを要件とするか、被雇用者への合理的配慮を規定した雇用法制を 持っている。強制力を伴わなければ、こうした法律や政策は効果を発揮しない。 環境の障壁 物理的な障壁は障害者の参加や統合への制約になる。屋外生活でのそうした例は傾斜、砂、草、川 などで、また屋内での移動や自立には階段、狭い戸口、家具、カーペットなどが妨げになる。 支援機器の欠如 これはインクルージョンへの大きな障壁の一つで、WSTP（車椅子サービス教習パッケージ）は、 CRPD（障害者の権利に関する条約）に沿って適正な車椅子の入手しやすさを改善する取り組みの 一つである。 33 [原文] Stereotypes 20 ToT.5 成人学習34 効果的な教習員となるためには、大人にとって最良の学び方を理解し、さまざまな学習スタイルに ついて知ることが重要である。 活動１：成人学習の原則 これまでの、自分のポジティブな学習経験について考え、その経験がどのようにポジティブだった のか書き出しなさい。 下欄を用い、活動中に考えたことを書き出しなさい。 ポジティブな学習経験 34 [原文] adult learning 21 活動２：自分の選好学習スタイル35を判定する 自分の学び方を反映している文にマルを付けなさい A. ステップバイステップの指導に従って B. 新しいものごとを経験することによって C. 間違えることによって D. 推論によって E. 教わった内容の理論を理解することによって F. 学んだことを適用することによって G. 自分の経験を当てはめることによって H. 動画を視聴することによって I. 選択肢を評価することによって J. 自分の感覚に依拠することによって K. 人と交流することによって L. 人がやって見せるのを見まもることによって M. 感受することによって N. 大局を分かる36ことによって O. そばに付いて見まもることによって P. やり方の説明を傾聴することによって Q. そのトピックについて書かれたものを調べることによって R. 人と関わり合うことによって S. 学んでいる内容を試してみることによって T. ものごとの一般的原理を理解することによって U. 講義に参加することによって V. 実体験を通して W. 自分の観察に頼ることによって X. ものごとに個人的に関わることによって Y. ものごとに対する自分の感じ方を探ることによって Z. 活動的になることによって AA. 教習員を観察することによって BB. 実験によって 35 [原文] preferred learning style [訳注]「選好する/好みの学習スタイル」の意. 36 [原文] seeing the big picture 22 選好学習スタイル集計表 質問表に付けたものと同じ記号をマルで囲みなさい。マルで囲んだ記号が最も多い列が、自分の 選好学習スタイルになります。 複数列が同数だった場合、それは強いこだわりがないということです。 経験によって 観察によって 思考によって 実行によって B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB 合計： 合計： 合計： 合計： 学習経験サイクル37 選好される学びの 4 つのスタイル： 1. 経験による学び 2. 観察/感受による学び 3. 思考/理解による学び 4. 実行/適用による学び 4 つの学習スタイルは、学習経験サイクルと一致する。 スタイルは人によってさまざまでも、新しい知識や技能を学ぶには、この 4 つの段階のそれぞれを 経るのが最も効果的である。 37 [原文] Experiential learning cycle 23 WSTP には、全受講者の参加を得るため、学びの 4 段階/種類をそれぞれ含めている。 • ロールプレイングやシミュレーションは、経験から最もよく学ぶ人に最適である。 • 観察から最もよく学ぶ人には、デモ、動画、教習員や車椅子ユーザーを視るのが最も有益である。 • 概念を論じ、枠組みや定義、理論をもたらす発表や読み物は、大局的に考え、理解することから 最もよく学ぶ人に役立つ。 • 車椅子ユーザーとの実習（基礎 WSTP や中級 WSTP などの）は、理論的な説明を適用するので、 実行によって学ぶ人に最適である。 グループの話し合い、ケーススタディ、質疑応答、ワークブックの課題、フィードバック時間は すべて、異なる学習スタイルにアピールする授業方法なので、それらの目的、および各場面に適合 する活用方法をよく考える必要がある。 教習員自身にも、自分の選好スタイルがある。重要なことは、それを認識していることと、特定の アプローチをおろそかにしないよう気をつけることである。 どの段階も飛ばさないように！ 「経験」の部分が欠けると何が起こるか？学びが実生活との接点を失い、受講者個人の経験に根を 下ろさない、抽象的なものになる。 「観察」の部分が欠けると何が起こるか？学習者が、自分の個人的経験がより広い抽象的な概念や 枠組みとどう結びついているのか、探求したり確かめたりできなくなる。 「思考」の部分が欠けると何が起こるか？学習者はある経験から別の経験へ、それらどうしの関連 を分からないまま進むことになる。そうした人は、経験を有意義なやり方で整理するために役立つ 枠組みから得るものがない。 「実行（練習）」の部分が欠けると何が起こるか？学習者は、理論や枠組みを職場や自分の生活に 適用するやり方を見出すことがない。 24 活動３：学習への選好と活動をマッチさせる この教習活動はこの人の学習スタイルに最も効果的、と思う人の名前の下に「X」を付けなさい。 最後の列には、比較として自分自身のスタイルについて記入しなさい。 • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解することによって最もよく学びます。 カ ル ロ ス ミ リ ア ム シ ー タ ア フ マ ド 自 分 自 身 1. 車椅子ユーザー教習の練習としてロールプレイングを 行なう 2. 教習員が新規車椅子ユーザーへの身体計測のやり方を 示すところを観察する 3. 自国の車椅子サービスに関する、法律や規制についての 政府職員の発表に出席する 4. 車椅子に乗っている人がやりたいことを実行している のを観察する 5. 車椅子サービスに関連する重要文書について学習する 6. 他の受講者と、フォローアップをユーザーの家で行なう ことの長所と短所について話し合う 7. CRPD（障害者の権利に関する条約）の最も重要な条文 に関する、教習員の説明を聴く 8. 除圧クッションをつくる 9. 車椅子で走り、車椅子ユーザーが経験する障壁を体感 する 10. 教習員が事前評価を実施する様子を観察する 11. 新規車椅子ユーザーに対する事前評価インタビューを 実施する 12. 車椅子サービス事業を既存のリハビリテーション サービスに追加することによる費用節減を算定する 25 成人学習を支援する だれにも選好学習スタイルがある一方、あらゆる大人の学習者に ついての共通項もある。 大人の学習者は主体的38で自分の学習に責任を持つため、積極的 参加を促すことで支援せよ。 大人の学習者は、学びに自分自身の知識や経験をもたらすため、 その経験を他者と共有し、また他者から学ぶよう奨励せよ。 大人の学習者は、関連が明らかで実践的な39学びを求め、学んだことを適用したいと望む。業務へ 実際に適用できる、明確な学習目標を置くことで支援せよ。 活動４：問題解決40 「問題解決」とは、問題に対して最適解を見出すプロセスのことです。 これは成人学習の重要部分で、車椅子サービス供与における重要技能です。 受講者が問題解決を行ない、自分自身の解決策を見出すには、どう手伝えばよいでしょうか？ 38 [原文] self-directed 39 [原文] relevant and practical 40 [原文] problem solving 26 受講者の問題解決を助ける • オープンクエスチョン41（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ42：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のために 教習を訪れた、個々のユーザーについて話せ。 • 「分かりません」で答えを終わらせるな43：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ44：課題を個別のステップに分解し、ステップバイステップに45質問し、 問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的46に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 留意事項 • 車椅子供与教習（基礎 WSTP・中級 WSTP）の受講者には、単純な答えがない場合もある。 • 臨床場面では、処方や改造、姿勢支持具が、技術的にはよい解決策であっても、機能的な障壁や 制約をこしらえてしまう場合もある。 • 完璧な解決策は、たいてい一つではないことを認識せよ。車椅子サービス供与には、顧客ニーズ と手に入る製品の範囲との間での妥協が求められる。 41 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 42 [原文] Ask rather than tell 43 [原文] Don’t take ‘I don’t know’ for an answer 44 [原文] One step at a time 45 [原文] step-by-step 46 [原文] laterally 27 ToT.6 準備時間について 準備時間は、ToT の時間割に盛り込まれている。この時間は、以下のことに活用できる： • 「保留スペース」の質問に答える。 • ToT 教習員と面談し： o 質問する。 o フィードバックをもらう。 • 自分の模擬授業を準備する： o 教習員仲間を調整する。 o デモ用資材や視聴覚機器を準備する。 28 ToT.7 プレゼンテーション47とファシリテーション48 活動１：教習員のふるまい49 過去に自分が教習を受けた人を思い出し、だれが効果的な教習員だったと思われるか特定しなさい。 それは、学ぶべきことを学べるようにし、ポジティブで価値ある経験をもたらした人です。 下欄に自分の経験を振り返りなさい。 その人のどんなふるまいが効果的でしたか？ 47 [原文] presenting [訳注] 意味は p.29 本文を参照. 48 [原文] facilitating [訳注] 適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 49 [原文] behaviour 29 プレゼンテーションとファシリテーション プレゼンテーションとは、受講者が情報を与えら れる、一方通行のプロセスである。プレゼンテーシ ョンでは情報、事実、数字を提供し、誤情報を訂正 する。 事実、理論、枠組みのプレゼンテーションを行なう 際には、対象者がその情報を知らないか、思い出す 必要があるという前提でのぞむ。したがって全受 講者は、たとえその情報をすでに知っている人が いても同様に扱われる。 ファシリテーションとは「ものごとを容易にする」という意味である。ファシリテーションを 行なうのは、受講者にとり、以下が容易になる場合である： • 理論的概念と現実の課題や任務との結びつきを理解する。 • 自分自身の経験を振り返る。 • 自分自身の経験や見方を、新しい情報と結びつける。 プレゼンテーションとファシリテーションの優れた実践 プレゼンテーション： • 話のペースやトーンに変化をつけよ。 • 教室内の自分の立ち位置に注意し、変化をつけよ。 • 質問し、励ましてグループに貢献を促せ。 • 試験済みで時間が設定されている、WSTP「教習員用指導書」の指示にならうこと。 • 映しているスライドが、話している内容と一致していることを確かめよ。スライドは「教習員用 指導書」と同期させよ。 • スライドを読む時、グループに背を向けてはならない。 ファシリテーション： • 活動は授業前にやってみること。そうすると活動の目的がわかる。 • 自分で考える間 [ま]50を与えよ。沈黙をおそれるな。 • 受講者からの質問は、自分で答える前にグループへ問いかけよ。 • 受講者には明確な指示を出し、自分自身がその指示を理解しているか授業前に確かめておけ。 • 受講者をモニターし、授業の要点を学んでいるか確かめよ。 50 [原文] time and space to think 30 エナジャイザー(51) どんな教習の中でも、活力レベルが落ちてくる時間はあるものだ。暑い気候、空気のよどんだ部屋、 豪華な昼食、教習の長い一日からの疲れは、注意を散漫にし、グループの活力を落ち込ませる。 これに対処する最善策は、みなが気軽に動いて交流する機会を設けることにより、教室へ活発さや 楽しさを注入することである。 これは活気をもたらすための、教習の一環としても、単独の活動によっても達成できる。以下は、 いくつかのアイデアである。 教習の一環として： • グループ全体へひんぱんに質問し、一人を指名して答えてもらう。 • 受講者に、隣どうし顔を合わせて質問やトピックへの答えを話し合ったり、出たばかりの意見に 対して異なる意見を探ったりしてもらう。 • 受講者に、立ち上がって何か（車椅子やポスター、フリップチャート、デモ）を見に来てもらう。 • 可能であれば、気分転換や運動をもたらすため、授業を他の部屋や屋外へ移動して行なう。 単独の活動として： • いっしょに歌う。 • 立ち上がって簡単なストレッチ体操を行なう。 • 「サイモンが言った52」で遊ぶ：指示を出し（「跳び上がれ」、「つま先に触れ」、「空を指させ」、 「振り返れ」など）、受講者は、指示が「サイモンが言った」で始まった時だけ、それに従わねば ならない。 • 3 分間ストレッチを行ない、休憩する。 • 受講者のひとり、あるいはグループをよび、2〜3 分、エナジャイザー活動を指揮してもらう。 かれらは、グループ全体で共有できる、別の現地に合った活動を知っているだろう。 51 With thanks to Robert Chambers for some of them [感謝: このいくつかはロバート・チェンバースに 負っている]. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 (https://www.routledge.com/Participatory-Workshops-A- Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). [原文] Energizers 52 [原文] Simon says [訳注] 日本の「船長さんの命令」と同じルールで行なわれるゲーム. 詳細は例えば (https:// yamatoco.theblog.me/posts/4946847/, 2023 年 7 月 1 日アクセス済) などを参照. 31 留意事項： • 文化、ジェンダー、障害による違いを認識し、また敏感であれ。 • 受講者ができない、あるいはやりたくないことは、いっさい強制するな。 • ゆっくりと始め、より元気のある活動へと盛り上げよ。 • 可能な時は、自分も参加せよ。 • 楽しんで！ 時間管理 教習員は、必ず教習が時間通り進むようにすべきである。数多くの授業や活動がある一方、それら を完了するための時間は限られている。持てる時間を最大限に利用するには、行動や活動の修正が しばしば必要になる。 活動２：時間管理 ペアを組んで話し合いなさい：教習が時間通り進むためには、どうしたらよいでしょうか？ 思いついたことを書き出しなさい： 32 教習を予定通りに保つための提案 • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者を 待たせて不利益を負わせるな53。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTP に資料やあまりにも多くの実例 を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留54」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば、「15 分休憩、10:45 には戻って下さい」 「自分のグループでの話し合いに 10 分、フィードバックに 5 分使えます」 • 教習員仲間55と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には予備計画56を立てておけ。例えば、雨で車椅子の移動技能 の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 53 [原文] avoid penalizing 54 [原文] Park 55 [原文] co-trainers 56 [原文] back-up plan [訳注]「プラン B」とも呼ばれる. 33 ToT.8 コミュニケーションスキル 活動１：コミュニケーションスキル 下表のうち、自分のグループに割り当てられた情報を読みなさい。続いて他の実習生がその要点を 把握できる発表を作成しなさい。 グループで作業し、情報をどのようにプレゼンテーションし、だれがどの部分をプレゼンテーション するか決めなさい。発表には、グループ全員が参加しなさい。フリップチャートやホワイトボード などの小道具は、自由に用いてかまいません。発表では、創造性を発揮しなさい。 準備には 20 分使えます。皆への発表時間は 5 分あります。 グループ１：言語的技能： • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語57や「無意味な語58」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な59ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 57 [原文] slang 58 [原文] ‘non-speak’ 59 [原文] simple and non-medical 34 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 自分のボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える60な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン61（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 60 [原文] jump to answer 61 [原文] closed questions 35 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ62（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば、「あなたはどう思い ますか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論63 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな64。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴65：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・動画・通訳について 以下は教習でデモを行ない、動画を上映し、外国語と手話、両方の通訳を用いる場合の優れた実践 である。 デモを行なう： デモを行なう際には： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 62 [原文] challenge 63 [原文] clinical reasoning 64 [原文] Never make up an answer if you do not know. 65 [原文] Listen 36 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎 WSTP と中級 WSTP のデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 動画を用いる： WSTP では、ほとんどの実技のデモに動画を用いている。動画を上映する前に： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や手話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1 部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2 倍時間を要する。 37 ToT.9 指針文書66の知識 「指針文書」とは何か？ 指針文書とは、出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、 規則を与え、また車椅子サービス供与関係者の指針となるものである。 多くの政府、国際機関、資金供与者67その他の関係者は、これらの国際的枠組みに沿って開発事業 を計画し、資金を供与する。 これらについての知識があれば、より強い立ち位置から、車椅子サービス供与に向けた啓発や政策 提言を行なえる。 国や地域の法令および政策は、現地の車椅子サービス供与に影響を及ぼす。話し合いを導くうえで、 そうした文書は熟知しておく必要がある。 次節からは、車椅子サービス供与に関係するさまざまな指針文書を概観する。そのいくつかは WSTP 用 USB メモリ68に収めており、その他はインターネット上でアクセスできる。 「国際連合 障害者の権利に関する条約 (CRPD)」 「国際連合 障害者の権利に関する条約」は一般に「CRPD」、 時に「UNCRPD」とも呼ばれる69。CRPD は障害者に関する最も 重要な国際条約だと広く考えられている。 2008 年に発効し、発効日には 82 か国が CRPD に署名、その選択 議定書に 44 か国が署名した。 これは国連の条約中、発効日の署名国数では史上最多である。 CRPD は、障害者への社会の見方と処遇のあり方を変革するため、国際社会の代表者によって策定 された。 この条約の策定に参画した代表者は障害者、政府当局者、非政府組織（NGO）の代表などである。 66 [原文] guiding documents 67 [原文] donors 68 [原文] WSTP Pen Drive [訳注] 英語版のみが WHO より配布されている. 各資料の日本語版入手先は訳注を参照. 特に指定していないものは, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 69 [訳注] 日本では「障害者権利条約」と略されることも多い. 38 CRPD が重要である理由は、障害者が他のあらゆる人びとと同じ権利と機会へアクセスできるよう になるためのツールだからである。 年々、ますます多くの国ぐにが CRPD に署名している。CRPD およびその選択議定書への署名国に 関する最新情報は、国際連合のウェブサイト(70)上で確認できる。 CRPD には車椅子サービス供与に関連するいくつもの条文がある： 最も関連がある こちらも関連がある • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション71および リハビリテーション • 32条：国際協力 • 19条：自立生活および地域社会への インクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30 条：文化的生活・レクリエーション・ 余暇・スポーツへの参加 CRPD の他の多くの条文が、間接的に車椅子サービス供与と関連している。例えば、第 6 条は女性 障害者の具体的なインクルージョン、第 7 条は子どもの平等に関わる。 70 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 71 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 39 子どもや女性がさらにぶつかる障壁には何があるだろうか？ • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持72を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉73を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 WSTP 受講者が CRPD を熟知していることは重要： • CRPD の人権に基づくアプローチを、障害者への車椅子サービス供与の発展に役立つように活用 するため。 • CRPD の条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえで 役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 72 [原文] supportive seating 73 [原文] stigma 40 主要条文の詳細： 第 4 条 第 4 条 一般的義務 によると締約国は： 障害に基づくいかなる種類の差別もない、すべての障害者のあらゆる人権および基本的自由の完 全な実現を保証し、また促進することを約束する。 第 4 条 (g)項によると： 障害者に適した、情報通信技術、移動補助具、支援機器、支援技術などの新技術について、研究 開発を実行または推進し、またその入手しやすさと利用とを増進し、そこでは価格に無理のない 技術を優先する。 同 (h)項によると： 障害者へ、新技術を含む移動補助具、支援機器、支援技術についての利用しやすい情報を、他の 形態の支援、支援サービス、施設と並んで供する。 同 (i)項によると： この条約が認める権利について障害者と協働する専門家および職員への研修を推進し、それらの 諸権利が保証する支援およびサービスが、よりよく供されるようにする。 第 20 条 第 20 条 個人的移動性 は車椅子サービス供与に最も関連する条文である。これの要件は： 締約国は、最大限に自立した個人的移動を障害者へ保証するための実効ある施策を講じ、以下の ことなどを行なう： (a) 障害者の、自分が選んだ方法で、自分が選んだ時に、無理のない費用で行なう個人的移動を 容易にする。 (b) 質の高い移動補助具、補装具、支援技術、人や動物による支援、仲介サービスを、障害者が 利用しやすくなるようにし、とりわけ無理のない費用でこれらが手に入るようにする。 (c) 障害者、および障害者と協働する専門職員に対して、移動技能の教習を提供する。 (d) 移動補助具、補装具、支援技術の生産に当たる事業体が、障害者の移動についてのあらゆる 側面を考慮するよう奨励する。 41 第 26 条 第 26 条 ハビリテーションおよびリハビリテーション に含まれる要件： 締約国は、障害者のために設計された支援機器および支援技術について、ハビリテーション およびリハビリテーションと連携するので、それらの入手しやすさ、知識、利用を増進する。 「ハビリテーション」と「リハビリテーション 」の定義： • リハビリテーションの言葉はよく知られているが、ハビリテーションはあまり使われない。 • リハビリテーションの重点は能力を回復することで、いっぽうハビリテーションは新規に能力 を習得し、構築することに関わる。 第 32 条 第 32 条は、例えば支援技術の利用促進などの国際協力を推進することから、広い意味で車椅子 サービス供与に関連する。 42 WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」 WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の 克服に向けて (車椅子ガイドライン)74」は、車椅子供与に焦点を 置いた、最も重要な国際的文書である。 「車椅子ガイドライン」は、現在世界的に理解されている適正な 車椅子供与枠組みをまとめたものである。「車椅子ガイドライン」 の発行以前、車椅子供与に関わる諸組織は、車椅子の設計や生産； サービス提供システムの確立；職員教習；車椅子供与に関連する 政策策定に当たり考慮すべき重要事項は何か、共通理解を持って いなかった。 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画により作成された。これは合意 された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子サービスの政策 提言のために役立つ、強力なツールとなる。「車椅子ガイドライン」は、低・中・高リソース状況で 普遍的に達成可能な基準を反映している。 車椅子が適正であるとは： ✓ ユーザーのニーズおよび環境条件に合い、 ✓ 適切にフィットして姿勢を支え、 ✓ 安全で耐久性があり、 ✓ 国内に用意され、 ✓ 入手・メンテナンス・継続したサービスが国内で、無理のない価格で可能 であること。 これは、教習員および WSTP 受講者が知っておくべき重要な定義である。 74 [訳注] これに加え, 2023 年 6 月に WHO から「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024 年に発行予定. 43 「車椅子ガイドライン」では、車椅子に関する以下の項目も 取り上げている： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 WSTP 教習員の、「車椅子ガイドライン」に関する知識は、 包括的でなければならない。教習員として、機会あるごとに その意識を喚起すること。 「車椅子ガイドライン」は、WHO のウェブサイトで各言語版75を入手できる。 「低リソース状況での移動支援機器供与に関する共同方針提言書」 WHO の「低リソース状況での移動支援機器供与に関する共同 方針提言書(76)」は、各国が CRPD の移動支援機器供与関連の 条文を履行できるよう、2011 年に発行された。 この文書は、移動支援機器へのアクセスに対する障壁、移動支援 機器へのアクセスを増やすための要件、各国および国際的な関係 者への提言などの貴重な情報を提供する。 75 (https://www.who.int/publications/i/item/9789241547482). [訳注] フランス語・スペイン語を含む. (https://apps.who.int/iris/handle/10665/43960). [訳注] 日本語・ベトナム語を含む. 76 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) re lated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URL および https://j-aws.jp/who/). 44 「地域に根ざしたリハビリテーション：CBR ガイドライン」 WHO の「地域に根ざしたリハビリテーション：CBR ガイドライ ン(77)」は 2010 年に発表され、CBR78への世界共通の理解および 取り組みを提示したものである。 CBR は、低リソース状況における障害者のリハビリテーションへ のアクセスを、地域リソースの最適な活用によって改善するため の方策である。「CBR ガイドライン」は行動への枠組みを提供し、 実施への実践的な提案を示している。 「CBR ガイドライン」の導入ブックレットと保健コンポーネント は WSTP 用 USB メモリに資料として収められている79が、WSTP で特に触れてはいない。 CBR は 90 超の国ぐにで実施され、CRPD の条文を実現する最も 効果的な方法の一つだと、ますます考えられるようになっている ため、「CBR ガイドライン」についてよく知るよう推奨する。 CBR はしばしば「地域に根ざしたインクルーシブ開発 (CBID)80」とも呼ばれ、WSTP でも話題に 上る可能性が高い。CBR の多くの側面が車椅子サービス供与に関連しており、例えば、紹介・相談 ネットワーク、地域の保健センター、CBR ワーカーなどがある。 77 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBR ガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 78 [訳注] Community-based rehabilitation の略称. 79 [訳注] 英語版のみ. ウェブ上で入手する場合は例えば: 日本語版 (公益財団法人日本障害者リハビリテーション協 会訳) https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html その他各言語版：https://www.wh o.int/publications/i/item/9789241548052 80 [原文] community-based inclusive development 45 CBR マトリックス CBR マトリックス(81)は「CBR ガイドライン」の土台の一つである。その 5 つの領域82として保健、 教育、生計83、社会、能力強化 (エンパワーメント)84があり、さらにマトリックスの各領域は５つ ずつの要素85を含むため、合計で 25 要素がある。 81 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 82 [原文] components 83 [原文] Livelihood 84 [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_security/human_security_ap proach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと考え併記した. 85 [原文] elements 46 活動１：CBR マトリックス グループで作業し、車椅子サービス供与が CBR マトリックスの自分たちに割り当てられた領域 （保健、教育、生計、社会、能力強化（エンパワーメント））に、どう関連するか列記しなさい。 さらに詳しい情報および「CBR ガイドライン」全文は、WHO のウェブサイト(86)を参照。 86 (http://www.who.int/disabilities/cbr/guidelines/en/). 47 車椅子サービス供与と CBR の 5 領域 保健 教育 • リハビリテーション：長期および短期の • 健康増進や二次障害予防：例えば早期発見 と早期介入による側弯や褥瘡の予防 • 保健医療サービスへのアクセス • 学校、教育プログラム、職業訓練プログラムへ のアクセスを可能にする 社会 • 社会およびレクリエーション活動へのアクセス 増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス エンパワーメント • 自己イメージや自信の向上 • ピアサポート（当事者支援） 「アクセシビリティのためのデザインの留意事項」 「アクセシビリティのためのデザインの留意事項(87)」は、車椅子 サービスを訪れる場合およびその他の環境の両方で、アクセスが あらゆる面について考慮されるようにする方法に関する、有益な 情報をもたらす。ここで取り上げているのは： • 障害者用保留スペース • 切り下げ縁石 • 通り道 • スロープ • 階段 • 手すり • ドアおよび戸口 • 廊下 • トイレ 87 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled Pe ople; 2006 (http://ascon.info/publications/accessibility.pdf). 48 「持続可能な開発目標（SDGs）」 「持続可能な開発目標 (SDGs)(88)」は、2015 年 9 月、歴史的な 「国連サミット」で世界の指導者たちが採択し、2016 年 1 月 1 日 に発効した。続く 15 年にわたり、各国は持続可能な開発の 3 つ の側面（環境、経済、社会）すべてに努力を結集し、17 のゴール を達成すべく尽力する。 SDGs は、2015 年に最終報告書を出した「ミレニアム開発目標 (MDGs)89」を継承するもので、2012 年の「国連持続可能な開発 会議 (リオ+20)」で始まった共同開発プロセスの成果である。 WSTP モジュールの開発は SDGs の発表前だったため、教習パッケージではそれに触れていない。 しかし、政府、開発・援助機関の多くが SDGs への取り組みに集中するため、実習生や受講者が、 それを意識して適正な車椅子サービス供与が SDG の課題90にどう適合するか見極めることは重要 である。 SDGs は 17 のゴールと関連する 169 のターゲットからなる。 SDGs 宣言の第 4 パラグラフでは、重要な誓約がなされている： この偉大なる共同の旅へ乗り出すにあたって、我われはだれひとり取り残さないことを誓う。 我われは、人間の尊厳は根本をなすものであると認識し、この目標とターゲットとがあらゆる 国ぐにと人びと、そして社会のあらゆる部分で満たされるよう希願する。そして我われは、 その最後に取り残されたものへ、最初に手を差し伸べるべく尽力する。 障害者への言及は、そこなわれやすい91人びとに関する第 23 パラグラフにも盛り込まれている： そこなわれやすい人びとは、必ず力づけられるべきである。そのニーズが課題に反映されている 人びとには、すべての子ども、若者、（その 80%超が貧困のうちに暮らしている）障害者、 HIV/AIDS と共に生きる人びと、高齢者、先住民、難民および国内避難民、移民などがある。 我われは、複合的な人道的危機に見舞われた地域や、テロリズムに襲われた地域に住む人びとの 障壁や束縛を取り除き、支援を強化し、特別なニーズを満たすべく、国際法にのっとり、さらに 効果的な措置と行動をとることを決意する。 88 The sustainable development goals [website]. New York: United Nations (http://www.un.org/su stainabledevelopment/sustainable-development-goals/). 89 [原文] Millennium Development Goals [訳注] 2015 年までに 8 目標・21 ターゲットの達成を掲げた. 90 [原文] agenda [訳注] 日本語でも, そのまま「アジェンダ」と呼ばれることも多い. 91 [原文] vulnerable populations 49 障害と SDGs ゴール 4：すべての人に、インクルーシブで公正な質の高い教育と 生涯学習機会を保証するため、教育におけるジェンダー格差を取りのぞ き、障害者などそこなわれやすい人びとへの、あらゆる水準の教育と職 業訓練への平等なアクセスを保証することに重点を置く。さらに提案書 では、子ども、障害、ジェンダーに配慮して教育施設を建設または改装 し、すべての人に安全で、非暴力的で、インクルーシブかつ効果的な学 習環境をもたらすよう求めている。 ゴール 8：継続的でインクルーシブかつ持続可能な経済成長、および、す べての人の完全かつ生産的な雇用と真っ当な仕事92を促進するため、国 際社会は障害者を含むすべての男女の完全かつ生産的な雇用および 真っ当な仕事、および等価値の仕事への平等な賃金93の達成をめざす。 ゴール 10：障害者を含むすべての人の能力強化（エンパワーメント） および社会・経済・政治的インクルージョンの推進により、各国内 および各国間の不平等を縮小すべく尽力する。 92 [原文] decent work 93 [原文] equal pay for work of equal value 50 ゴール 11：インクルーシブ、安全、強靭94で持続可能な、まちと住み場 づくりをめざす。このゴールの実現のため締約国に求められることは、 とりわけ障害者などそこなわれやすい人びとのニーズに特に配慮した 公共交通の拡大を通じた交通安全の向上により、安全で、料金に無理が なく、利用しやすい、持続可能な交通システムへのアクセスをすべての 人にもたらすことである。加えて提案書では、特に障害者にとり、安全 かつインクルーシブで利用しやすい緑地と公共スペースへのユニバー サルアクセスを求めている。 ゴール 17：持続可能な開発に向けた実施手段を強化し、グローバルな連 携を活性化するには、SDGs に関するデータ収集、モニタリングと 説明責任が極めて重要だと強調している。締約国には後発開発途上国95 や小島嶼開発途上国96など開発途上国への力量構築97支援が求められ、 それは質が高くタイムリーで信頼でき、さらに障害別にも分類された データの入手可能性を、著しく向上させる。 SDGs に関するさらに詳しい情報は、国際連合のウェブサイト(98)を参照。 「支援技術に関する世界協力（GATE）」 WHO の推計では現在 10 億超の人が 1 つ以上の支援製品、例えば 車椅子、補聴器、歩行器、眼鏡、ピルケース、コミュニケーション ボード99などを必要としている。 世界的な人口高齢化および非感染性疾患の増加に伴い、WHO の 予測では、この数は 2050 年までに 20 億人を超え、多くの高齢者 には、加齢に伴い複数の製品が必要になる。 94 [原文] resilient 95 [原文] least developed countries 96 [原文] small island developing states 97 [原文] capacity-building 98 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 99 [原文] communication board 51 支援製品には、教育や生計手段へのアクセスを可能にし、自立を維持し、世界とつながるうえで 極めて重要な役割がある。しかし現在、製品を必要とする人のうち、アクセスできるのは 10 人に ひとりに過ぎず、製品がなければ社会参加から排除され、孤立し、貧困のうちに閉じ込められる。 WHO は、この巨大で満たされざる世界規模のニーズ100に応え、CRPD 第 32 条を実現するため、 GATE の取り組みを調整している。GATE が取り組むゴールは一つだけである。それは、高品質で 価格に無理のない支援製品へのアクセスを、全世界で向上させることである。これを達成するため、 GATE は、製品、人材、供与、政策という 4 つの相互連関する行動領域に重点を置いている。 「WHO 必須医薬品範例リスト101」の先例にならい、GATE が最優先で作成したのが「WHO 優先 的支援製品リスト (APL)(102)」である。APL には、世界中で最も必要とされる 50 の支援製品を収 めている。そこには、4 種類の車椅子、除圧クッション、可搬式スロープ、またその他の移動性、 聴覚、認知、コミュニケーション、視覚を向上させる製品が含まれる。 APL は制約を与えるリストではなく、締約国が、現地のニーズと利用可能なリソースに沿った国内 向け APL を作成するたたき台103の提供が目的である。そこに込められた期待は、現地の関係者が、 アクセス増大への努力を相乗させるための結集点となることである。 GATE が現在取り組んでいるのは、APL 実施の支援ツール、例えばニーズ評価ツールキット、教習 パッケージ、政策枠組み、サービス供与モデルなどの開発である。 GATE に関するさらに詳しい情報は、WHO のウェブサイト(104)を参照。 100 [原文] huge and unmet global need 101 [原文] WHO Model List of Essential Medicines 102 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/implementation/assistive_technology/global_survey-apl/en/). 103 [原文] blueprint 104 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 52 「障害に関する世界報告書」 2011 年、WHO と世界銀行が共同作成した、初の「障害に関する 世界報告書(105)」が発行された。 報告書によれば、障害者は障害がない人に比べ、総じて健康状態 が悪く、教育水準が低く、経済的機会に乏しく、貧困率が高い。 これは障害者が利用できるサービスの欠如と、障害者が日常生活 でぶつかる多くの障壁によるところが大きい。 この報告書は、保健医療・リハビリテーション・教育・雇用・支援サービスへの障壁を克服する 方途に関する、エビデンスに基づく提言を与えている。また、障害者が活躍できる支援的な環境を つくり出すうえで、何が有効かを明らかにしている。 「障害に関する世界報告書」は以下の障壁を強調している： • 不適切な政策や基準 • ネガティブな意識 • サービス供与の欠如 • サービス提供における問題 • 不十分な資金 • アクセスの欠如 • 協議と参画の欠如 • データとエビデンスの欠如 これらはすべて車椅子サービス供与に関連するため、本書は有用な背景文書106である。この報告書 の提言 2「障害者のための特別なプログラムやサービスに投資すること」では、車椅子の重要性に 言及している： 車椅子や補聴器などの支援技術を含むリハビリテーションは、機能と自立を向上させる。地域の さまざまな調整が行き届いた補助および支援サービスはケアへのニーズを満たし、人びとが自立 して暮らし、経済・社会・文化的生活に参加できるようにする。 105 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/en/). 106 [原文] background document 53 本報告書の、要約および提言は WHO のウェブサイト(107)を参照。 「WHO 世界障害者行動計画」 「WHO 世界障害者行動計画 2014-2021(108)」は、「障害に関する 世界報告書」の提言に基づき、また CRPD に沿ったものである。 これは締約国、国連諸機関、障害者団体などの国内および国際的 パートナーとの協議を経て作成された。 この計画は、障害者と障害がない人との格差への対処を目指して いる。これによると、世界中で障害者は、障害がない人に比べて 必要とする保健医療を受けておらず、健康状態が悪い。障害者は、 2 倍超の確率で技能や施設が不十分な保健医療供与者に当たり、 3 倍近くの確率で保健医療を拒絶され、4 倍の確率で劣悪な処置 を受ける。 行動計画の 3 つの目標： • 障壁を取り除き、保健サービス・プログラムへのアクセスを向上させる • リハビリテーション、ハビリテーション、支援技術、援助および支援サービス、地域に根ざした リハビリテーションを強化し拡張する • 障害に関する、妥当かつ国際的に比較可能なデータ収集を強化し、障害や関連サービスの研究を 支援する。 締約国は、提案された行動を国の優先事項および状況に合わせて調整し、実施するよう要請されて いる。 全文は、WHO のウェブサイト(109)を参照。 107 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.wh o.int/iris/bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) [日本語訳 (概要): 障害に関する世界報告書, 国立障害者リハビリテーションセンター訳 (https://ww w.dinf.ne.jp/doc/japanese/intl/un/wrod_sum_jp.html)]. 108 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 109 (http://www.who.int/disabilities/actionplan/en/). 54 「障害と開発に関する国連総会高級事務レベル会合」 2013 年 9 月 23 日、国連総会高級事務レベル会合(110)が障害に関して 「前進への道：2015 年以降に向けた障害インクルーシブな開発実施 計画」という主題のもとに、一日開催された。 参加者は、締約国、オブザーバー、国連の代表者、また市民社会、 障害者団体、民間セクターの代表者などであった。 この会合の「成果文書」では、(a)から(q)までの誓約を列記している。 誓約(h)： ユニバーサルデザインの手法に従い、物理的環境、交通、雇用、教育、保健、サービス、情報、 情報通信技術はじめ支援機器に対する障壁を取り除き、遠隔地や農村地域においても、障害者が その全生涯にわたって最大限の可能性を実現するための、アクセスしやすさを保証する。 この会合の背景および成果を伝える冊子は、国際連合のウェブサイト(111)を参照。 110 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 111 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 55 ToT.10 視聴覚ツールおよび機材 教習員が、さまざまな視聴覚機材の使用に精通し自信を持つことは、教習授業を円滑に進めるうえ で重要である。 パワーポイント (PPT) と PDF WSTP のプレゼンテーションは、パワーポイントと PDF 両方の形式が用意されている。各形式の 利点と難点を下表にまとめた。 利点 難点 PPT • パワーポイントは個々のプレゼンテー ションスタイルに合わせて、また現地 の状況に当てはまるように変更可能。 • テキストの削減/簡略化が可能。 • 新しい内容や話し合いでの質問を押さ えたスライドの追加が可能。これは、 グループが異なる言語や方言を話す、 あるいは教習員の訛りを聞き取れない 場合に有効。 • コンピューターのスクリーンセーバー は、プレゼンテーションが「スライド ショー」モードであれば起動しない。 • 動画は自分で読み込む必要がある。 • ファイル全体のサイズは大きくなる。 • パワーポイントのファイル編集には、 時間を要する。 PDF • この PDF は、4種の動画形式すべて にリンクしている。望む形式をクリッ クすれば、動画を再生する。 • フォーマットや互換性について、問題 ないことが確認済み。 • ファイルサイズは、編集可能なものに 比べ小さい。 • 内容は固定され、現地事情や、自分の プレゼンテーションスタイルに合わせ た修正は不可能。 • 各スライドのテキストは、全部いちど に表示され（編集可能版にあるような スライドの「ビルド」効果がない）、 学習の要点を一つひとつ紹介すること はできない。 • 内容が多いスライドについてテキスト の簡略化や削減はできない。 • PDF なのでコンピューターのスクリ ーンセーバーが起動するため、それを プレゼンテーション開始前に機能停止 しておく必要がある（コンピューター の「システム環境設定」で可能）。 56 PPT にスライドを追加する スライドを追加する場合、その目的は「教習員用指導書」に沿うことであって、主題からそれては ならない。以下の理由であれば、PPT にスライドを追加してもよい： • スライドがない節に対して。 • 話し合いのための大事な質問で、いきおい解答に移らないことを覚えておくため。 • これから始まる活動のリマインダーとして、また指示を盛り込むため。 以下の理由であれば、PPT に変更を加えてもよい： • スライドを現地の事情/状況に適合させる。 • 翻訳を提供する。 • スライドの本文を減らすか、内容が多いスライド一枚を複数スライドに分割する。 • 教習授業を拡張するか増やす場合に、資料を追加する。 授業内容を追加する場合は、授業時間にも追加が必要であることに留意せよ。 PPT の統一性を保つ • すべての新規スライドおよび既成スライドへの変更について、必ず PPT 原版と同じ形式、 スタイル、フォントに従うこと。 • 追加あるいは変更したスライドから、WHO および WSTP のロゴを忘れずに削除せよ。既成の WSTP プレゼンテーションに同じ形式を維持しながらスライドを追加する最も簡便なやり方は、 既成のスライドを複製して、その本文を変更することである。 • 複雑なアニメーションを追加してはならない。 • PPT マスターを利用してスライドを追加してもよい。 • 動画ファイルは、すべて mp4 と wmv の二形式が用意されている。mp4 形式はアップルコンピ ューター用、wmv 形式はウィンドウズコンピューター用である。ウィンドウズコンピューター で QuickTime Player を搭載したものであれば、mp4 動画を使用できる。 • 動画によっては字幕入りも用意されており、そちらの使用を推奨する。音質が悪い、外の騒音が ある、きつい方言が話されている、といった場合に受講者の理解を助ける。 • 動画は埋め込むことも、リンクを張ることも可能である。埋め込みを推奨するが、その理由は、 ファイルサイズは増えるが動画を PPT ファイルに内蔵でき、ファイルを他のコンピューターに コピーしても動画が失われないからである。 57 PPT に動画を埋め込む PPT 2010 以降の112ソフトで動画を埋め込むには、 次の手順に従う： • 「Presentations」＞「PowerPoint」フォルダー を開く。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入する。 • 動画フレームがスクリーンいっぱいに表示され ない場合は、サイズ調整する。 112 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 58 • 変更を保存。 • 以上で、動画が PPT の一部になった。 動画を自動的にフルスクリーン表示するには (Windows)： • 「ビデオツール」の「再生」タブの「全画面表示 の再生」チェックボックスをオンにする。 動画を自動的にフルスクリーン表示するには (Mac)： • 「ビデオ形式」タブの「再生オプション」をクリ ックし、ドロップダウンリストの「全画面再生」 を選択 困難があれば、PPT のヘルプメニューで質問せよ。 59 視聴覚機材を用いる際の優れた実践 「スライドショー」で実行して確認 • PPT の授業を練習する時は、「スライドショー」モードを用いよ。それによってトランジション、 アニメーション、フローなどの問題を発見できる。 • 教習で使用する「スライドショー」モードのコンピューターおよびプロジェクターを用い、スラ イドおよび動画を通しで実行せよ。自分のコンピューターを用いない場合に、設定が異なる別の コンピューターではプレゼンテーションを予定通りに実行しないことがあるため、これは重要。 • 教習中のプレゼンテーションは、すべて一台のコンピューターで行なうことを検討せよ。これで、 プレゼンターごとの切り替え時間が省ける。 プロジェクター・リモコン・レーザーポインター • できれば、予備のプロジェクターまたはプロジェクター用ランプを用意せよ。 • 休憩時間や実習中は、プロジェクターの電源を切ってランプの使用を節約せよ。 • 黒色あるいは白色のスクリーンに映写する必要がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キーを打つと黒いスクリーンになる。 • リモコンを用い、クリックしてスライドを切り替えるようにすると、プレゼンテーションの間に コンピューターの横に立たなくて済む。 • レーザーポインターはスライドの個別の項目について、受講者の注意を引くために使える。 スピーカー • スピーカーは、毎日のはじめに接続し、テストしてから接続したままにしておけ。 • 携帯電話その他の電子信号を拾うため、スピーカーの電源は、動画再生時だけ入れよ。 ケーブルおよびアダプター • 必要なケーブルが、ノートパソコン、プロジェクター、スピーカーについて、すべて揃っている ことを確かめよ。 • プラグアダプター類が、予備 2、3 個も含め揃っていることを再確認せよ。 • ケーブルが電源まで届かない場合に備え、予備の延長コードを持参せよ。 60 活動１：ホワイトボード/フリップチャートを視覚教材に用いる 自分のグループに割り当てられた情報を通読し、ホワイトボード/フリップチャートを活用して、 他のグループへの発表を作成せよ。 スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正113に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 ホワイトボードの手入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間114」で 姿勢を描くなど）。 113 [原文] neat 114 [原文] ‘stick-draw’ 61 ToT.11 フィードバック フィードバックとは何か？ フィードバックとは、だれかに提供する以下についての情報である： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を支援できることは 重要。 通常、よい出来ばえにフィードバックを与えることに、だれも問題はない。間違いや改善が必要な 出来ばえの場合には、必ず自信をもって建設的なフィードバックを与えなければならない。 活動１：フィードバックをもらう 自分の学びに役立ったフィードバック、また自分が身構えるか動転して役に立たなかったフィード バックについて考えなさい。 下欄に自分の振り返りを記録しなさい フィードバックを与えるさい、教習員が考慮すべきことは何でしょうか？ 62 望ましいフィードバック： • タイムリーに115：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 建設的なフィードバックをもたらす時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に与えよ。意識、行動、 規律に関わる問題には、非公開で対処せよ116。 • 受講者の視点に立って：まず、受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者の違う取り組み方を支援せよ：建設的なフィードバックを与える前に、受講者が完了した 活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。受講者のサー ビス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 115 [原文] Be timely 116 [原文] deal with them in private 63 ToT.12 グループダイナミクスを取り仕切る117 WSTP 教習員が、グループで、効率よく効果的に作業するやり方を知っていることは重要である。 この授業では小グループ活動を促進し、時間を管理し、妨害行動へ対処するやり方を見て行く。 なぜグループ活動を用いるのか？ 教習においてグループ作業は重要である。なぜなら： • 受講者が、考察、知識、経験を共有できる。これによって教習員は、受講者がすでに持っている 専門性をよりよく知ることができ、どこにギャップがあり、授業をどう調節すべきかが分かる。 • 教室内にすでにある智慧、経験、技能が尊重される。これによって、経験や専門知識をより多く 持つ人が、他とそれを共有できる。 • 教習員が関心から外れる。受講者が経験を共有し、自分たちがすでに何を知っているか見出す ことが、自信の構築に役立つ。 • 全受講者が語り出し、貢献できる環境をつくり出す。内気な、または年若い受講者も小グループ の中では気後れせず発言できる。これは、自分の考えが評価されていると気づくことで、自信を つくり上げる。 グループ活動を組織し取り仕切る 受講者をグループ分けする際の重要な留意事項 • グループのサイズを決める。 • 各グループに、だれが入るか決める。 • グループづくりの手法。 グループのサイズを決定する要因 • 時間：グループが多いほど、フィードバックにもより時間が必要になる。持ち時間が少なければ 大きいグループをつくれ。ただし、1 グループの人数は 6 名を超えないようにせよ。 • プライバシー/内密さ118：気をつかうトピック、内気な人、言語の壁がある場合の話し合いには ペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な、機材/消耗品の分量。例えば、作業場が 3 か所あれば、3 グループ まで対応が可能になる。 117 [原文] Managing group dynamics 118 [原文] confidentiality 64 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や来歴を持った人を同じグループに入れる（臨床家全員が 協働するように配置する、あるいは技工職全員が同じグループにいるなど）か、逆にわざと同じ グループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、グループにする方が 適切な場合と分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混成：これは、お互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ、有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混成：作業への文化、宗教、社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が互いに協力して作業し、学び合いの機会119が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 グループづくりの手法 各 WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与えて いる。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ分け の手法をいくつか掲げる： • フルーツサラダ法120：同じ果物カードを 3、4 枚ずつ、さまざまな種類の果物で受講者の人数分 になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ （1 人 1 種類の）」でいっしょになる、など指定する。 • 番号点呼121：必要なグループ数の番号を点呼する。例えば、3 グループに分ける必要があれば、 最初の人が「一」、次が「二」、その次が「三」、そして再び「一」に戻って数を点呼するよう指示 し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分けて おく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3 人、次の 3 人と まとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1 人または 2 人、自分が組んだことがない人を選んでもらう。ただし 3 人を超えると、 自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4 人ずつのグループに有効。 119 [原文] peer learning opportunities 120 [原文] The fruit salad method 121 [原文] Count off 65 受講者をグループ分けする際には明確な指示を与えよ • だれがどのグループに入るか。 • 何をグループにやってほしいのか（その課題は何か）。 • どこへグループに行ってほしいのか（各部屋へ分かれるのか、大部屋のスペースか）。 • いつグループは報告を返す用意ができているべきなのか。 • どうやってグループに報告してほしいのか（フリップチャートで、全体グループへ口頭で、各自 の席にいるグループへ非公式に、グループ自身が選んで創造的に発表、など）。 • どれくらいの時間、報告しなければならないか。 小グループ活動はつねにモニターし、受講者が各自のワークブックの正しいページを用い予定した 課題に取り組んでいることを確かめよ。必要なら促しや誘導的な質問によって助け、解決策を教え たり、自分が長々としゃべったりするな。気をつけて時間を守るよう念押しせよ。 妨害行動に対処する いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、ポジティブだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 66 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、他の受講者には、知識を共有し、質問に答え、グル ープ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っているかのよう に振る舞う。 場を仕切る受講者への対処： • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える機会 を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく、特定の受講者に質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は最有力な受講者とのペアあるいはグループに入れ、内気 な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 ふざける受講者への対処： • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動中 のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 攻撃的な受講者 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。または教習員の技能・ 知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 攻撃的な受講者への対処： • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとって本当なのですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 ネガティブな受講者への対処： • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由を 説明する機会を与えよ。他の受講者に賛成するか尋ねよ。他の受講者も同意見であれば、「どう すればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 67 寡黙な受講者 もともと寡黙あるいは内気で、大人数の前でしゃべりグループ活動へ貢献することには気が進まな い受講者。 寡黙な受講者への対処： • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3 名の）を活用せよ。 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいはその 人に反対するのをためらうかもしれない。 年長の受講者への対処： • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話すよう 呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 注意散漫な受講者への対処： • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習を妨げるのか話せ。規則を念押しせよ。 68 管理者/関係者向け教習モジュール 69 WSTPtot 管理者向け教習のはじめに 背景 WSTPtot 管理者向け教習のねらいは、実習生に、管理者向け WSTP を実施し、さまざまな状況に 適合させるための技能と知識を授けることである。WSTPtot 管理者向け教習はこのモジュールの 第 1 部で、これに WSTPtot 関係者向け教習が続く。WSTPtot 関係者向け教習の授業では、管理者 向け WSTP と関係者向け WSTP の教習運営実務、準備、計画も取り上げる。 管理者向け WSTP は、現地のニーズとぴったり合うように調整せよ。 どこでも人口の 1 %には車椅子が必要だと推計されているものの、いまだに多くの場所で、車椅子 サービスは利用できないかたいへん立ち遅れている。管理者向け WSTP は、事業管理者が、適正な 車椅子供与の効果的な運営を支援するために作成された。これは車椅子サービス事業の実施、管理、 評価を担当する人材を対象としている。管理者向け WSTP 受講者は、日ごろリハビリテーション サービスの経営や管理に携わっているが、車椅子サービス管理は直接経験していない人であろう。 そこで、管理者向け WSTP には、適正な車椅子サービス管理に関する基本情報を盛り込んでいる。 経験を持たないで教習に参加する事業管理者： 事情によっては、車椅子サービス管理の経験がない事業管理者が、管理者向け WSTP 教習プロ グラムに参加する場合もある。例えば： • 新しいサービス事業を立ち上げ中か検討中の場合。 • 義肢装具サービスなどのサービス事業が車椅子供与に事業を拡大中の場合。 • 事業管理者が、既存の車椅子供与サービス事業に着任して間もない場合。 • 車椅子生産者が自社による車椅子供与サービス事業の展開を検討している場合。 • 例えば政府部局の管理職が、適正な車椅子供与について、さらに学ぼうとしている場合。 70 経験があって教習に参加する事業管理者： 車椅子サービス管理の経験がある事業管理者が、管理者向け WSTP 教習プログラムに参加する 場合もある。例えば： • 直面している課題への答えを見出すため。 • 車椅子供与関連の国際的な方針・ガイドライン・条約について深く学ぶため。 • 「車椅子ガイドライン(1)」に沿った適正な車椅子供与と、車椅子サービス提供の 8ステップに ついての理解を深めるため。 • さまざまなサービス提供モデルへの理解を深めるため。 • 事業管理技能を改善する、新しいやり方を学ぶため。 • 基礎や中級のWSTPモジュール教習を受けた職員を、管理・支援できるようになるため。 • 車椅子供与を改善する変革を先導するために、事業管理者が果たしうる役割を理解するため。 管理者向け WSTP は、車椅子サービス提供の 8 ステップを全うする適正かつ効果的な車椅子サー ビスにおける、事業管理者の役割の概観を与える。 車椅子サービス提供の 8 ステップ： 紹介・相談および面接予約 事前評価 処方（選択） 資金調達および発注 製品の下準備 フィッティング ユーザー教習 フォローアップ・メンテナンス・修理 管理者向け WSTP の内容は、8 ステップすべてをやり遂げるために必要な、リソースに関する情報 である。管理者向け WSTP 教習プログラムへの参加を通して得られた知識は、事業管理者にとり 以下の役に立つ： • よりよく車椅子供与を計画する。 • 車椅子サービス提供の質が向上する。 • 職員定着率が向上する。 • 自己のニーズを満たす車椅子を手にする、車椅子ユーザーの数が増える。 • 車椅子供与の持続可能性が向上する。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). 71 事業管理者が実施するとよい、車椅子の臨床家と技術者の業務を支援する活動を下に挙げる。 最も重要な答え： • 適正な車椅子および資材の在庫確認。 • 車椅子のために利用できる資金を確保する。 • サービスユーザー数を計画し、職員が忙しすぎず、しかし仕事はじゅうぶんあるようにする。 • サービスユーザーが、適正かつ整備された機器や施設を使えるようにする。 • サービス事業を円滑に運営できるよう、管理上の支援を提供する。 • サービス事業の予算を立て、やりくりする。 • 専門的サービスの普及を支援する。 • 職員の地位に支持を与えるよう、政府に提言する。 • 政府と、地域に根ざしたリハビリテーション（CBR）事業はじめ、その他の関係者との協働を 支援する。 管理者向け WSTP の対象範囲および時間割 「教習員用指導書」p.3 で説明しているように管理者向け WSTP は 13〜14 時間で実施でき、また 例えば通訳の時間を追加するなど、現地のニーズに適合させることも可能である。割り当てられた 時間を削ってはならない。管理者向け WSTP の授業は、現地に特有の状況や目的に応じた、他の 活動と組み合わせることも可能である。例えば、以下を取り上げる追加授業を含めるなど： • 関係者による、その組織や業務に関する発表 • 車椅子生産者あるいは供給者による、その製品に関する発表 • 車椅子ユーザーのケーススタディ • 不適正な車椅子の影響に関する情報 • 車椅子に関連した研究での調査結果 • 車椅子供与に関連する政策の再検討 時間割の例は、WSTP 用 USB メモリに載せたものが利用可能である。これは 2 日間教習で、管理 者向け WSTP の教材をすべて用いて教習プログラムを実行した場合に基づいている。 管理者/関係者向け WSTP 計画ツール • 「管理者/関係者向け WSTP 計画ツール」は、ToT（教習員養成教習）パッケージの一環として 開発された。これは本書 p.129 の付録と WSTP 用 USB メモリに載っている。「管理者/関係者向 け WSTP 計画ツール」は、現地の状況を概観し、期待する成果を確定するために推奨される。こ れは、自分が実施する管理者向け WSTP や関係者向け WSTP にどの授業を組み込むべきか、見 定めるために役立つ。 72 • ツールの対象は「車椅子ガイドライン」に沿って政策、製品、サービス、教習に関する 10 分野 にわたり、10 分野それぞれにつき「初期段階2」から「成長中3」「成熟中4」「じゅうぶんに機能5」 までの状況の例を示している。 計画作業は教習に先立ってなるべく早く始め、必要な情報を集める時間を、じゅうぶん確保せよ。 管理者向け WSTP の教習員と受講者 受講者 8〜10 名ごとに教習員１名を置くよう推奨する。通常、その結果教習員は最低 2 名になる。 管理者向け WSTP は一般的には受講者 5〜15 名で実施し、この範囲の人数がうまく行く。 経験豊富な車椅子ユーザーで、理想的にはこのテーマと教習パッケージをよく知っている人が教習 チームにいるのは強みになる。非車椅子ユーザーの教習員は、もう一人教習員を探す際には、この ことを考慮せよ。 教習員のうち最低 1 名には現地での車椅子供与の経験と知識が必要である。それによって話し合い が豊かになり、当を得た教習になる。教習員の一人には車椅子供与、および関連する国際的ガイド ライン、条約、目標についての国際的知識が必要である。同じ人がこの知識を持っていてもよい。 管理者向け WSTP の教材 管理者向け WSTP には、3 冊のマニュアルがある： • 教習員用指導書 • 参考書＆ワークブック • 補足資料 教習員用指導書 「教習員用指導書」の最初の節「管理者向け車椅子サービス教習パッケージについて」では、その 対象者、目的、対象範囲、教習員を選ぶ際に考慮すべき技能と人数、開始までの流れを述べている。 次の節（p.5）は「教習員への手引き」である。内容は、教習プログラムの概略、授業計画に関する 簡潔な情報、付属のパワーポイントのプレゼンテーション（PPTs）の説明、よい教習を実施する コツなどである。このプログラムを、実施のたびに事後評価するよう推奨している。 2 [原文] early stages 3 [原文] developing 4 [原文] maturing 5 [原文] well-functioning 73 詳しい授業計画は、次の節 p.12 から始まる。12 の授業が以下の 3 部に分けられている： • A: 必須知識 • B: 車椅子サービスを開始する • C: 車椅子サービス事業を運営する 参考書＆ワークブック 2 つ目のマニュアルは「参考書＆ワークブック」である。基礎 WSTP や中級 WSTP とは異なり、 この「参考書」と「ワークブック」は合本して一冊にまとまっている。このマニュアルの構成は、 「参考書」と「ワークブック」のどちらの部も「教習員用指導書」と同じ順序に沿っている。この マニュアルは 2 部に分かれている。「参考書」の部は、授業を補足して各トピックについての詳細 を説明する。「ワークブック」の部には、受講者が、授業での演習の一環として記入するフォームや 資料が載っている。自分の教習プログラムを実施する前にこのマニュアルについての徹底した知識 を養い、また将来の自分の受講者には、教習プログラムの実施中および実施後、このマニュアルを 熟読するよう勧めよ。 補足資料 これは、事業管理者および車椅子サービス職員にとってサービス業務で役立つ、多くのフォームや 参考文書をまとめたものである。このマニュアルの内容は以下の通り： 車椅子供与計画策定のために取りうる方策 車椅子サービス紹介・相談フォーム（基礎） 車椅子サービス紹介・相談フォーム（中級） サービスフォーム・確認表一覧 評価ボックスづくり 評価ベッドづくり 足乗せブロックづくり 計測用具の例 技工施設の手引き：作業台および床上での作業スペース 基礎サービス用技工備品の手引き 中級サービス用技工備品の手引き ウレタンフォーム切削用弓ノコ刃の調製 基礎および中級サービスへの資材の手引き 74 移動練習エリア設営の手引き さまざまな車椅子供給方法の比較 支援機器事前評価時の参加度測定ツール 支援機器フォローアップ時の満足度および成果測定ツール アクセス向上のための情報 これらの資料には、管理者向け WSTP の授業で参照するものもあるが、大半は、特に基礎 WSTP および中級 WSTP に当てはまる。 動画 管理者向け WSTP パッケージには 6 本の動画が含まれる。これらは PPT の中で参照されているが 埋め込まれていない。必ず事前に、動画が PPT 内に準備できているか、自分のデスクトップに アップロードされて再生できるようになっていることを確かめよ。 ポスター この WSTP のポスターは、WSTP 用 USB メモリの基礎および中級パッケージ内に載っている6。 補助教材 追加の文書は WSTP 用 USB メモリの「補助教材」フォルダに収められ7ている。「必須教習技能」 モジュールで、その大半は説明した。管理者向け WSTP に特化した補助教材で、「必須教習技能」 モジュールで取り上げていないのは「先導する管理者8」である。これは組織変革を先導し、そこに 影響を与えることについての情報を与えるもので、特に授業「A.3: 変革を導く管理者」に関連する。 翻訳 最新版の管理者向け WSTP 教材、ならびに既成のあらゆる翻訳は、以下で見つかる9： http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ 6 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイトからダウンロード可能. 7 [訳注] 同上. 8 [原文] Managers Who Lead [訳注] 本書の日本語訳作成時点 (2023.8.17) では、この資料の日本語訳はない. 9 [訳注] 本文 URL はリンク切れ (2023.8.17) のため (https://apps.who.int/iris/handle/10665/246227) を参照. 75 管理者向け WSTP 教習運営実務と準備 管理者向け WSTP「教習員用指導書」の「教習員への手引き」は p.5 からである。これは、各自が 管理者向け WSTP 実施を準備するためのよい出発点であるから、注意深く研究せよ。さらに、以下 有用な追加項目を掲げる。 1. 現地の状況がカギ 管理者向け WSTP の実施を計画するさい、授業を、現地の状況と各自が達成したい成果に対して、 やり方が適切になるよう調整して実行することは非常に重要である。管理者向け WSTP 受講者の 知識水準、経験、職務はさまざまに異なる場合が多く、したがって、受講者にとり、おそらくある 授業は他の授業よりも関連が強くなる。 管理者向け WSTP を時間配分通りに実施するのは困難、というのが教習員の、これまでに一般的 な感想である。大半のトピックは貴重な話し合いを生み出すため、教習の価値を最大にするには、 それに合わせるべきである。こうした状況では話し合わせ、既定の活動を減らす方がよい。しかし、 つねに受講者が意欲的とは限らず、じっさいは理由が分からないまま言われて参加している場合も ある。この場合は、活動を盛り込み、全員を惹き入れることが重要になる。 「管理者/関係者向け WSTP 計画ツール」は、教習員が、教習実施国/地域の現在の概況を収集し、 達成したい成果を決定できるように設計された。このツールは、管理者向け WSTP の授業のどれ を教習プログラムに盛り込むべきか見極めるために役立つ。計画作業はなるべく早く始め、必要な 情報を収集し、関連する関係者と状況について話し合う時間をじゅうぶん確保せよ。このツールは、 本書の付録に載っている。 時間管理も重要である。通常、事業管理者が教習に出張できる期間としては 2 日間が現実的だが、 詳細な計画や方策を立てることが目的であれば、さらに時間が必要になるか、関係者向け WSTP の 授業を減らさなければならない。 持ち時間が 2 日よりも少ない場合は、どの授業を盛り込むべきか、優先順位を付けるべきである。 例えば、教習を車椅子サービス事業がすでに整っている地域で実施する場合、「車椅子サービスを 開始する」の授業を一部省くか減らすことを選択してよい。受講者の何人かに事前に連絡を取るか、 かれらを知る人に相談してその知識や技能の水準を把握せよ。これは教習を、できる限り当を得た、 有用なものにするうえで役立つ。 76 2. 教材および機材 教材 各受講者に、必ず「管理者向け WSTP（車椅子サービス教習パッケージ）参考書＆ワークブック」 を配布せよ。管理者向け WSTP 教習員は、その他の主要な教材を自分が選んだ形式で配布しても よい。例えば、受講者に WHO の「車椅子ガイドライン」「障害者の権利に関する条約（CRPD）」 「持続可能な開発目標（SDGs）」「地域に根ざしたリハビリテーション（CBR）ガイドライン」 「低リソース状況での移動支援機器供与に関する共同方針提言書」を収めた DVD か USB メモリを 配布するとよい。これらはすべて、WSTP 用 USB メモリ10に載っている。 器材 この教習プログラムでは、現地で手に入る車椅子を教室のその場に数台持っておくと有益である。 これらは話し合いや提示で参照に使える。受講者は休憩中、それらの安全な使い方を考慮しながら 試したり観察したりできる。多様な環境やニーズに適する、さまざまな特色を持つ車椅子を揃えよ。 例えば折りたたみ車椅子、折りたためない車椅子、姿勢支持具付きの子ども用車椅子など。 10 [訳注] 各資料の日本語版入手先は, 本書の授業 ToT.9 (p.37-54) の訳注を参照. 77 管理者向け WSTP 模擬授業 78 あいさつ・自己紹介・概略 この授業を教えるための主な留意点 a. 全般 • 第 3 節と第 4 節を入れ替え、庶務連絡等を済ませてからワークショップの概略に入ってもよい。 b. 第 1 節：開講式 • 時間割では、例えば教習プログラム実施機関の長による歓迎あいさつなど簡潔な開講式のために 10 分を見込んでいる。もっと大がかりな儀式が必要であれば、それに応じて時間割を修正せよ。 c. 第 3 節：ワークショップ概略 準備のコツ • WSTP 用 USB メモリの PPT に、動画「車椅子サービス提供」が埋め込まれているか確認せよ。 なければ埋め込むか、デスクトップ上の開きやすい場所に置いておけ。 内容 • この動画の上映前に、受講者へ、車椅子サービス提供のさまざまなステップに注目しながら視聴 するよう指示せよ。動画を上映後、ポスター「車椅子サービスのステップ」を示し、車椅子サー ビス提供の 8 つのステップを列挙せよ。教習プログラムの残りの期間中、このポスターは話題に 上ったらいつでも参照せよ。 d. 第 4 節：教習プログラム時間割・庶務連絡・諸注意 準備のコツ • 安全に関する説明のさい、車椅子を用意しておくと便利。 内容 • 車椅子のさまざまな部材（例えば、スポーク、ブレーキ、足台など）を、説明しながら指示せよ。 受講者は背後に助手が付いている場合も、坂を登る際は前にかがみ、坂を下りる際は後ろにもた れるべきことを説明せよ。 79 A.1: 適正な車椅子供与とは何か? WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 4 節：適正な車椅子供与を支える • 「教習員用指導書」p.22 の活動について、「教習員用指導書」では国の政策の実例を 1 つ示して いるが「参考書＆ワークブック」には 2 つ載っている。両方とも取り上げるには時間が足りない ので、より状況に適する実例を選べ。 • 「参考書＆ワークブック」の本文は、「教習員用指導書」のものと異なっている。受講者に分かり やすいよう「参考書」の方を読み上げよ。 この授業を教えるための主な留意点 a. 全般 • この授業の時間割り振りは、第３節では余裕があるが第 4 節には短めで、全体としては間に合う はずである。残り時間が尽きてきたら、受講者の応答を絞れ。 b. 第 2 節：車椅子へのニーズおよび満たされざるニーズとは何か? 準備のコツ • スライド A.1.4 を、適切な国勢調査データと国全体の車椅子ニーズ計算により、個別設定せよ。 複数国からの受講者に教習を実施する場合は、すべての国を列記せよ。 • 国勢調査が古すぎる場合は、国家統計局その他の政府機関による、より最近の推計を探してみよ。 • 1 %を計算するには、総人口を 100 で割ればよい。以下に例を示す。 人口 人口の 1 % 45 060 436 450 604 14 538 933 145 389 3 785 566 378 55611 11 [訳注] 原文のまま. 37 856 あるいは 37 855 とすべきであろう. 80 c. 第 3 節：個人的移動への権利 • 「国際連合 障害者者の権利に関する条約（CRPD）」をじゅうぶんに理解し、教習プログラムを 実施している国が、すでに署名し批准しているかどうか確かめよ。 d. 第 4 節：適正な車椅子供与を支える 準備のコツ • 仁川方策（インチョン戦略）は教材に含まれていないが、教習を「アジア太平洋障害者の十年12」 の構成国で実施している場合は、以下からダウンロードしておくとよい：http://www.unescap. org/resources/incheon-strategy-“make-right-real”-persons-disabilities-asia-and-pacific 内容 • この活動へのフィードバックとして、国の政策が存在しない場合、受講者に、それを立ち上げる ための指針として「WHO 世界障害者行動計画 2014-2021(13)」を参照するよう提案してもよい。 12 [原文] Strategy in Asia and Pacific 13 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 81 A.2: サービス提供 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 4 節：管理者のより広範な任務 準備のコツ • スライド A.2.12 の文が、「参考書＆ワークブック」の同じ図とは一部異なっている。スライドを WSTP 用 USB メモリに収めた14新版に差し替え、自分の「教習員用指導書」に、PPT スライド がマニュアルに載っているサムネイルのものから更新されている旨をメモせよ。 この授業を教えるための主な留意点 a. 第 2 節：サービス提供のレベル • サービスのレベルは車椅子ユーザーの年齢や障害には関係しないことを強調せよ。多くの地域や 国には（あっても）基礎レベルのサービスしかないが、目標は各々の国や地域で両方のレベルを 利用できることである。中級レベルのサービスでは、基礎レベルサービスとは異なるリソースや 職員の技能が求められる。現地の状況に関する知識は、あると既存の基礎および中級レベル対応 の施設の例を示せるようになるため有用である。 b. 第 3 節：サービス提供モデル • この節の活動にはそれほど時間がない。各グループに「車椅子サービスのステップ」ポスターの 近くに座るか立つかして答えを話し合い、付箋を書いて該当するサービスステップの隣に貼って もらえ。これによってフィードバックがより迅速になる。 c. 第 4 節：管理者のより広範な任務 • 「管理者の任務」スライドを映す代わりに、その図のポスターを用いてもよい。受講者は付箋を ポスターに貼ることができ、それを教習プログラムの期間を通して壁に貼っておける。 d. 第 5 節：車椅子ユーザーのサービス提供への積極的参画 • ルーマニアでのケーススタディを示す追加スライドを、WSTP 用 USB メモリに収載しており15、 この授業の PPT に追加してもよい。 14 [訳注] 日本語版は, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 15 [訳注] 同上. 82 A.3: 変革を導く管理者 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「先導する管理者16」第 6 章を資料として配布することを検討せよ。これは WSTP 用 USB メモ リの「補足資料17」フォルダに用意されている。 • スライド A.3.3 では成功への要因を 4 つ挙げ、続いてそれぞれの詳細を説明している。分かりや すいよう、このスライドを複製し、続く各節の最初で該当する箇条書きを強調しながら再映する ことを検討せよ。 内容 • 変革とは、えてして何か恐ろしい、あるいは疑わしいものと見なされがちであることを強調せよ。 受講者へ、われわれの反応しだいで変革はよいものにも悪いものになり、変革そのものは中立で あることを念押しせよ。 • この節にはそれほど時間がないので、必要ならばいくつかの質問は省いてよい。 b. 第 1 節：変革プロセスを先導する管理者の役割 • 「教習員用指導書」では、この授業をそれまでの授業に結び付けるよう指示している。ここまで で話し合った、適正な車椅子供与とそこでの事業管理者の役割、例えばよく機能するサービスを 開発し、じゅうぶんに教習を受けた職員のやる気を引き出す責任などを強調せよ。 c. 第 4 節：職員とリソースを配置する • p.38 の「教習員への注記」を指摘し、受講者が資金調達に関する話のみに時間を費やすべきでは ないことを強調せよ。資金調達はサービス事業のあらゆる側面に影響する課題だが、必要な人的・ 物的リソースを管理者がどうやってまとめ上げられるか、を案出することの方が重要である。 d. 第 6 節：管理者が取り組むこと • 「教習員用指導書」p.42 の活動では、受講者に、各授業の終わりに自分の考えを 4 枚のフリップ チャート紙に記入するよう指示している。時間が少なく、また教習プログラムの終わりまで再び 言及する機会もないため、受講者には、毎回の授業の終わりにこれを行なうよう念押しせよ。 16 [原文] Managers Who Lead [訳注] 本書の日本語訳作成時点 (2023.8.17) では、この資料の日本語訳はない. 17 [原文] Supplementary Resources [訳注] 英語版のみ 83 B.1: サービスへのアクセス この授業を教えるための主な留意点 a. 第 2 節：公正なサービスとは何か？ • 「教習員用指導書」p.43 では、「公正なサービス」のスライドを映す前に質問が入る。教科名の 「公正なサービス」を入れるかこの質問を表示した、新規スライドの追加を検討せよ。 b. 第 3 節：紹介・相談および面接予約 • この節の活動にはそれほど時間がない。 • この活動は、紹介・相談ネットワークの提携先がフォームへの記入に消極的であることについて、 多くの議論をまき起こすかもしれない。議論を、どうすれば事業管理者が、提携先に紹介・相談 フォームの利用を促せるかに集中せよ。例えば、記入用に白紙のフォームを配布する、フォーム をなるべく簡潔にする、定期的なフォームの回収を手配する、サービスを利用するようになった 車椅子ユーザーについてのフィードバックを返す（と紹介・相談者にその有益さが分かる）など。 c. 第 4 節：管理者は、公正なサービス実現のために何ができるか？ • サービスの公正さを確保することの重要性を強調せよ。受講者に CRPD（障害者の権利に関する 条約）の、女性、子ども、高齢者、貧しい人びと、農村地域に住む人びとのニーズを強調した 諸条文を再認識させよ。事業管理者は、こうした集団が疎外されず対応されるように、必ず働き かけねばならない。 d. 授業のおわりに • 授業のおわりに、受講者へ、取り組むことを各自のワークブックに記録するよう指示し、また、 前の授業で掲示したフリップチャート紙 4 枚に書き込むよう念押しせよ。 84 B.2: 施設および設備 この授業を教えるための主な留意点 a. 第 2 節：施設およびサービスの流れ • 教習プログラムがサービスセンター内で行われる場合は、この授業にはサービス所内を歩き通す ことが含まれる。全体グループに、車椅子ユーザーを尊重すること、および邪魔にならないため に声を低めるよう指示せよ。 • この節にはそれほど時間がないため、経路は予め詳細に計画せよ。進度を上げるには、受講者を 小グループに分けて別々の場所からスタートさせることを検討せよ。各スペースへの訪問許可を 得ていることを確認し、職員が、訪問があることを分かっているようにせよ。 • サービスセンターを拠点としていなければ、スライド「サービスの「流れ」の一例」(B2.3) を より時間をかけて詳しく説明せよ。代替として、実際に歩き通したビデオか写真を撮り、それを 見せることを検討せよ。 • 各サービススペースの名前カードをつくって教室か隣の廊下にぐるりと掲示し、受講者がカード を並べ替えてサービスの流れを改善できるようにするとよい。これは、サービス事業を計画する 際に何を考慮すべきかの話し合いを盛り上げる。 • 「参考書＆ワークブック」p.22 を参照し、以下を強調せよ： o サービス所内のあらゆるスペースは、出入り口も含め、必ず車椅子で完全にアクセスできなけ ればならない。 o サービス所に到着した人には、受付および待合のスペースが絶対に必要である。 o 待合スペースには、ポスター、リーフレット、ビデオ資料、また子ども用のおもちゃを揃えて おくと役に立つ。 o 長距離移動したため、例えば体重がかかる身体部位に褥瘡があるなどの理由で、横にならなけ ればならない人もいる。 o だれにでも到着しだい水が用意されるべきで、また軽食をとれる場所の情報も提供されるべき である。 o アクセスしやすいトイレは、受付スペースの近くにも必要である。 o 事前評価スペースは受付/待合スペースに近くなければならない。静かで人目に触れず、事前 評価に必要な設備を備えていること。例えば評価用のベッドまたはベンチ、目隠しの仕切り、 足乗せブロック、巻尺、事前評価とフィッティングの主要な段階を記録するカメラなどである。 85 o 床面および作業台のエリアを備えた技工スペースが、車椅子の下準備・メンテナンス・修理の ために必要である。事前評価スペースの近くが理想的だが、騒音がじゅうぶん抑えられる程度 に離れていることが望ましい。スペースはじゅうぶん明るく、換気がよく、防水で、作業に適 した温度でなければならない。最終の組み立てと製品の調整のため、穴あけ、ペーパーがけ、 塗装の区域とは別に清潔なスペースが必要である。技工的活動は、サービスの他の部面に都合 のよい場所とは分けて、離れた他の場所に置いても、さらには外注してもよい。 o 移動練習エリアは、事前評価とフィッティングのスペース近くに置くべきである。スペースは 屋内でも屋外でもよく、さまざまな路面や障害物を備えるべきである。 o 安全な収納スペースが必要で、これは技工スペースの近くに設けるべきである。 o 事務スペースは、記録の作成や保管、職員会議などサービス事業の管理業務に必要である。 b. 第 4 節：施設の整理整頓 • 政府の施設では、破損した設備や古い書類も、政府の目録から正式に削除されるまで保管を義務 づけられる場合が多いことを説明せよ。これは、しばしば工房が不要な設備や書類でいっぱいに なることを意味する。作業スペースを整頓して保つため、事業管理者に、こうした物品は収納し、 スペースが狭ければコンテナも活用するよう勧めよ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 86 B.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 環境・機能・姿勢支持について特色が異なるさまざまな車椅子を用意し、また、この授業の要点 を解説するため、除圧クッションを 1・2 枚用意しておけ。 内容 • この授業は、管理者向け WSTP の中で最も重要なものの一つである。関係者の多くは、車椅子や 適正な車椅子がもたらす違いについて、ほとんど知らない。 • 絶対にこの授業は、事業管理者が適正な車椅子の効果を理解するような、心を動かし、説得力に あふれた18ものでなければならない。 • 現地の状況に即した写真やケーススタディを追加すると、効果が高まる。 a. 第 2 節：適正な車椅子およびクッションとは何か? 19 • 事業管理者は、適正な車椅子とは何を意味するのかしっかりと理解し、また、ある人には適正な ものでも、他の人には適正でないことを分かっている必要がある。車椅子が不適正になるのは、 ただユーザーのニーズとの関連においてのみである。 • 個別ニーズおよび環境や機能の多様性から、サービス事業は、ただ一種類の車椅子を供与する だけであってはならない。車椅子ユーザーの多様なニーズを完全に満たすには、さまざまな型式 が必要である。 • クッションは任意のオプション20ではなく、適正な車椅子の不可欠な構成要素であると強調せよ。 b. 第 3 節：適切にフィットし姿勢を支える • 車椅子にしっかりと座るために必要な支えは、一人ひとり異なる。追加の支えを一個の製品だけ で設けることはできず、個々人にフィットするように、調整や改造ができるか選択幅がある複数 の製品が必要である。サービス事業所は、車椅子に付加してさまざまな種類およびレベルの姿勢 支持を設けられる、座位保持専用シート21またはオプションの姿勢支持具（PSDs）を持っておく 18 [原文] inspirational and persuasive 19 [訳注] これ以下の小見出しのアルファベットは原文のまま. 20 [原文] optional 21 [原文] dedicated supportive seat 87 ことになろう。用意できれば、この授業中にいくつか姿勢支持具の見本を見せるか、多様な レベルの姿勢支持ニーズがある、さまざまな車椅子ユーザーの写真をスライドに追加せよ。 c. 第 4 節：ユーザーのニーズおよび環境に合う • この節では、車椅子ユーザーのニーズは、都市と農村のどちらの環境で暮らしているかによって 異なることを説明せよ。例えば、ひんぱんに公共交通機関や車で移動する人には、折りたたみや 分解ができる軽量な車椅子が有益である。農村に住んで移動しない人には、そうした機能はそれ ほど重要ではなく、荒地での安定性が高くなるリジッドフレームと長いホイールベースが有益で あろう。 d. 第 5 節：安全で耐久性がある製品の重要性 • 「参考書＆ワークブック」p.34 のコラムの内容は、さらに深く掘り下げよ。事業管理者は、提示 された車椅子を何でも引き受け、または数量が最大になるよう最も安価な型式を選択する誘惑に 駆られうる。事業管理者は、候補となる寄付者や供給者に尋ねるべき質問を心得ていなければ ならない。例えば、その車椅子が、ISO（国際標準化機構）規格や現地規格など、性能や耐久性 への認証規格について試験を経ているかどうかは考慮すべきである。 • 寄付者や資金供与者が、事業管理者やチームに、最も安価な車椅子を選ぶよう圧力をかける場合 もある。月/年当たり費用を考慮するよう強調することが重要で、なぜなら安物の車椅子はすぐ 壊れることが多い一方、品質のよい車椅子は、定期的にメンテナンスすれば最低 3〜5 年は持つ からである。 車椅子のモデル 購入費用 使用年数 費用/使用年数 車椅子 A 80 米ドル 0.5 160 米ドル 車椅子 B 150 米ドル 1 150 米ドル 車椅子 C 300 米ドル 3 100 米ドル 車椅子 D 300 米ドル 5 60 米ドル e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 88 B.4: 職員の配置 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 5 節：サービス容量を査定する • 授業で計算機を使えるようにしておけ。このことを「教習員用指導書」の授業計画22「教材」欄 に追加せよ。 この授業を教えるための主な留意点 a. 第 2 節：車椅子サービス事業内の業務 • 地域に中級レベルのサービスがない場合、基礎レベルサービス事業の管理者は、将来に向けて、 それをどのように計画できるか検討し、職員や関係者と話し合うべきであると説明せよ b. 第 2 節：車椅子サービス事業内の業務 準備のコツ • 数値の計算に自信がなければ、準備万端だと思えるまで練習せよ。 内容 • スクリーン上の表に記入したい場合は、スライド B.4.11 になったら「スライドショー」モードを 終了せよ。スライドに数字を入力するには、PPT の表の端をクリックすることが必要。代替手段 としては、事前に表をフリップチャートに描いておき、授業中に数字を書き加えよ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 • スライド B.4.11 に授業中追加したデータは、すべて削除せよ。 22 [訳注] p.72 89 活動 この活動は、ひとりで作業せよ。計算機が必要。 下の表で自分に割り当てられたデータを計算し、A〜F 列下部のグレー欄を埋めよ。末尾の数字は 四捨五入してよい。 選択肢１ 週間作業計画 シナリオ A B C D E F 週間勤務日数 4 2 5 4 2 5 年間勤務週数 40 42 46 40 42 46 サービス容量見積もり 基礎 中級 １日当たり作業時間 6.5 5 7 6.5 5 7 ユーザー当たり推定作業時間 2.5 3 3.5 5 5 5.5 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 90 選択肢２ 週間作業計画 シナリオ A B C D E F 週間勤務日数 3 2.5 5 3 2.5 5 年間勤務週数 44 46 42 44 46 42 サービス容量見積もり 基礎 中級 １日当たり作業時間 7 6 8 7 6 8 ユーザー当たり推定作業時間 3 2.5 3 7 5 6 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 91 B.5: 車椅子サービスはどうお金がかかるのか? この授業を教えるための主な留意点 a. 全般 • この授業の目的は、事業管理者に、車椅子サービス事業のさまざまな費用分野について考える よう促すことである。予算枠についてあまり議論しすぎないようにせよ。 • この授業は、概略は知っておく必要があるにせよ、詳細は会計士が詰めてくれる事業管理者には、 詳しすぎるかもしれない。はじめに受講者へ、自分のサービス事業で細かい予算編成に携わって いるかどうかを尋ねよ。そうでなければ、活動をグループ全体での話し合いに切り替え、時間を 節約することを検討せよ。 b. 第 2 節：予算目安 • 模擬授業では、時間を節約するため、1 グループとなって短時間で活動を進めよ。 • 「立ち上げ費用」と「運転費用」の予算項目は、ホワイトボードに書いておくこと。受講者に、 各見出しの下にどんな種類の費用が入るか考えてもらうことを明確にせよ。 • 事業管理者とチームは、各サービスステップに必要な人員と設備について、またサービス事業所 と地域の、どちらでそれを行なうのか明確にすべきだと強調せよ。 c. 第 3 節：サービス統合からの益 • この節にも財務方面の活動があるが省略してよい。特に、ここでの概念は「第 4 節：提携による 費用分担からの益」で説明するからである。 d. 第 4 節：提携による費用分担からの益 準備のコツ • この授業の冒頭に「費用分担とは何でしょうか？費用分担が有益な点には何があるでしょうか？」 と問うスライドの追加を検討せよ。 e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 92 C.1: サービス事業が機能しているか判るには？ この授業を教えるための主な留意点 a. 第 2 節：モニタリングと評価とは何か? • この授業で時間が尽きてきたら、活動を行なう代わりにモニタリングと評価の有益さについての 全般的な話し合いを持て。 b. 第 3 節：効率よく効果的なサービス • 話し合いにより多く時間を割けるよう、これを全体グループの活動として進めることを検討せよ。 「参考書＆ワークブック」p.100-101 の表に記入しながら、発問して話し合いを活性化せよ。例 として、第 2 行 2 列目の最初の空欄について： o 受講者に質問：実績目標として妥当な時間はどれくらいでしょうか？ o だれかが答えを示したら、他の人に賛成かどうか尋ねよ。これは話し合いを活性化する。 o やるべきことの例として、あらかじめ表の記入済みの部分を説明しておけ。 o 受講者に第 2 行 3 列目の欄「ユーザーファイルに、紹介・相談を受けた日付および事前評価日 を記録」を見るよう指示し、各自のサービス事業では、だれがこの情報を記入し、目標を達成 したかどうか見極めるために、どうデータを照合しているのか尋ねよ。 o 目標に届かないことが続いた場合、どんな取り組みができるか尋ねよ。 o 表の第 3 行「車椅子を受け取ったユーザー数」の実績目標である月 20 台に対する「情報収集」 の下の空欄を参照させよ。 o 質問：車椅子を受け取った人に関する情報は、どこに保管すればよいでしょうか？ o これはユーザーファイルに記録する。しかし総数をモニターするには、事業管理者は供給した 車椅子の基本帳簿もまとめておく必要がある。 o 質問：これは、どう管理すればよいでしょうか？ o この活動の目的は、受講者に、各自のサービス事業に関する情報を記録および評価するための 方策を考えてみるよう促すことである。表への作業を続けながら、各項目についての話し合い を促せ。 93 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 94 C.2: 需要管理 この授業を教えるための主な留意点 a. 第 2 節：需要創出 準備のコツ • この授業では、教習員にバングラデシュの成功事例23を読み上げるよう指示している。WSTP 用 USB メモリに収めた24スライドをプレゼンテーションファイルに追加するかコピーを配布して、 受講者が話し合うあいだ参照できるようにせよ。 • 「教習員用指導書」p.98 の二つ目の「最も重要な答え」欄の、なぜ需要が少ないのかの理由に、 「サービス提供に問題がある」「サービスへの不満」「サービスへの悪評」を追加せよ。サービス 事業が、低品質か高価な製品を供与する、または待ち時間が長い場合、サービスユーザーは他を 当たるか、車椅子なしでやって行くことを選ぶであろう。この情報を、各自の「教習員用指導書」 の表に追加するよう、受講者に提案せよ。 b. 第 4 節：子どもを早期紹介する重要さ 準備のコツ • 以下にまとめたような、早期紹介の有益さを示すスライドの追加を検討せよ。 内容 • 親が、子どもを車椅子事前評価へ連れて来るのを渋ることには、多くの理由がある（「教習員用 指導書」p.103 の「最も重要な答え」を参照）。親たちは子どもが歩こうとしなくなるか、怠惰に なることを恐れているのかもしれない。適切な支えを備えた適正な車椅子があると、遠くまで 行かなくて済むため、子どもの歩行は改善することが多いと強調せよ。それは体力を節約して、 他のことへ使えるようにする。機能が改善すれば車椅子を降り、床の上や立位で活動できるよう になる。 23 [訳注]「教習員用指導書」p.99 24 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 95 c. 第 5 節：効率よく効果的なサービス運営 • 各ステップの所要時間に関する議論は、これはサービス事業によって異なるため、限定的なもの にとどめよ。この節は、事業管理者に、各自のサービス事業についての現実的な目標を算定する 方法を理解してもらうために活用せよ。 • スライド C.2 13 に示した時間設定は、平均値であると強調せよ。これらは、手に入る車椅子と 姿勢支持具の種類やサービス職員の技能により、サービス事業で違ってくる。状況によっては、 ここに示した倍の時間を要するサービスユーザーも出てくる。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 96 C.3: フォローアップ計画 この授業を教えるための主な留意点 a. 第 2 節：フォローアップの重要性 • この授業で経験を分かち合う車椅子ユーザーを見定めるさい、適正なフォローアップの経験者で あることを確かめよ。事前に各自の経験について話し合い、重要な側面を強調できるようにせよ。 b. 第 4 節：フォローアップ計画 準備のコツ • スライド C.3.7 と C.3.8 は分かりにくい。既存のスライドを、WSTP 用 USB メモリに収めた 新版25に差し替えよ。 内容 • スライドが示す通り、フォローアップ提供のために、サービス事業が提供できる車椅子は、人的 リソースが増えない限り 2 年目から少なくなる。 • サービス事業の有効性は、単なる車椅子の供給数以上のものとして測るべきであると強調せよ。 c. 第 6 節：地域へのインクルージョンおよび参加 準備のコツ • 「教習員用指導書」p.122 のスリランカの事例について、米ドルでの金額を、米ドルになじみが 薄い人のために現地通貨に換算26せよ。 内容 • 実際の米ドル額ではなく、帰宅できないための長期入院によって、どれほどの費用負担が生じる かに集中せよ。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 25 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 26 [訳注] この注記は, 同書 p.120 のインドネシアの事例にも該当するであろう. 97 C.4: 持続可能な財政計画 この授業を教えるための主な留意点 a. 第 3 節：財政的持続可能性に向けた計画 • 自分自身が、非金銭的支援の概念を理解しているようにせよ。 • 現物供与は寄付金より確保しやすい場合もあり、サービス事業の全分野で検討されるべきである。 しかし寄付品によって、例えば乗り物などはメンテナンスが必要になるため、それを予算に含め ておくようにせよ。 b. 第 4 節：初期財源27を特定する • 受講者に、アプローチ先を検討する際には、資金供与の調達期間28を考慮するよう念押しせよ。 信託、財団、政府の審査プロセスは時間がかかりうる一方、法人寄付者や個人の対応はもっと 素早い。広範な財源へのアプローチを盛り込むのが、理想的な方策である。 c. 第 5 節：資金集め方策を計画する • 資金集めの話題は、受講者に大きな議論を巻きおこしうる。グループが脱線しないようにせよ。 • 受講者は、受けられそうな寄付金額について、非現実的であることが多い。資金集めが成功する にはたいへんな努力が必要で、寄付者に実績を示すまでは少額しか受けられないのが普通である ことを強調せよ。 • 可能性のある寄付者が知りたいのは、そのサービス事業が、適切な計画と予算を立て、財務への 説明責任を全うしていることだと強調せよ。 • 寄付者への、質が高くタイミングのよい報告の必要性を強調せよ。定期的に進捗状況を更新せよ。 寄付者が、くり返し寄付しないという方針を定めていない限り、関係を築き、じゅうぶんに情報 提供している財源からは、2 度目の寄付を得られる可能性が高くなる。 • 受講者に、現実的な予想を立てるよう勧めよ。例えば、車椅子供給能力が月間 30 台のところで、 3 か月にわたる車椅子 200 台への資金供与を寄付者へ求めてはならない。 27 [原文] initial funding source [訳注] 日本語版管理者向け WSTP 教習員用指導書では「可能性のある財源」と なっているが, 誤訳である. 28 [原文] lead times 98 総まとめ この授業を教えるための主な留意点 a. 第 2 節：変革を導く取り組み • この授業のねらいは、国内の車椅子供与改善への取り組みに合意することである。グループメン バーからの意見を集約する29ことに注力せよ。 • 管理者向け WSTP を実施する際には、授業「A.3: 変革を導く管理者」で導入した「変革ファシ リテーター」を活用せよ。受講者には、考えを壁のフリップチャート 4 枚に追加し続けるよう、 2 日間を通して念押しせよ。その一覧が話し合いの土台となるからである。以下に例を掲げる： 適正な車椅子供与に関する共有ビジョンをつくり出すために管理者ができること • 全チームメンバーの参画を得てサービス事業の全体目標を決め、ビジョンとミッションの宣言 をつくり上げる30。 • 共有ビジョンを定期的に見直し、全チームメンバーが、その達成に向けて貢献していることを 確かめる。 • 共有ビジョン全体をユーザーに根ざしたものにする。すなわち、車椅子ユーザーの参画を得て 策定すべきである。 適正な車椅子供与の重要性を伝達するために管理者ができること • 車椅子の後援者や寄付者にプレゼン31を行なう。 • 政府の省庁・部局、非政府組織（NGO）、障害者団体、リハビリテーション専門職に対して、 「車椅子ガイドライン」への認識を高める。 • 他の関係者との合同意識啓発イベント・活動を、特に「国際障害者デー32」に開催する。 • 「障害者の権利に関する条約（CRPD）」の、支援機器に関連する条項への認識を高める。 • 「持続可能な開発目標（SDGs）」のうち、支援機器を適正に供与することの重要性を奨励する 目標を強調する。 • 「車椅子ガイドライン」への認識を高め、それを推進するため、リハビリテーション教育機関 や地域に根ざしたリハビリテーション訓練校との会合を開く。 • 車椅子サービスユーザーについてのケーススタディおよびビフォーアフターの写真を集めて 共有し、専門的サービスの有益さを強調する。 29 [原文] gathering inputs 30 [原文] creating a vision and mission statement 31 [原文] presentations [訳注] 文脈から, 日本語の「プレゼン」に近い内容の活動として訳した. 32 [訳注] 12 月 3 日. 日本では「障害者の日」が 12 月 9 日で, 12 月 3-9 日が「障害者週間」. 99 職員とリソースを配置するために管理者ができること • 車椅子サービスの全ステップに、それをやり遂げる技能と作業時間を持つ人材が配置される ようにする。 • 可能な限りサービス、とくにユーザー教習とフォローアップで車椅子ユーザーの参画を得る。 • 臨床、技術、教習の各業務を果たす職員が、必ず適正な教習を受けているようにする。 • サービス目標が、利用可能な人員とリソースに基づいて現実的であるようにする。 • 定期的にサービスをモニターし、職員の業務、責任、作業負荷が適正であるようにする。 職員を動機付け・惹き込み・注力させるために管理者ができること • 全チームメンバーによるチーム会議を開いて、目標に合意し、それを理解する。 • 車椅子ユーザーに体験談を共有してもらうことで、チームの全メンバーが、専門的サービスの 有益さ、および劣悪なサービスの危険性を分かるようにする。 • ボーナス、休暇、抜きん出た仕事に対する「今月の人」表彰など、職員に動機を与える。 • チームづくり33イベントを開催して、チームワークを強化し意欲を高める。 • 職員が、立派に仕事をし、サービスの重要目標を達成したら感謝する。 この授業で最も重要な部分は、教習プログラムの後に何が始まるのか話し合うことである。それが 単なるフォローアップの会議で、詳細な計画は後に作成される予定であっても、集まっている間に 次のステップについて合意する必要があることを強調せよ。受講者に、事をさらに推し進める役を 指名し、教習プログラム後も互いに連絡を取り合う方法について合意するよう勧めよ。 教習員の役割は、受講者が、会議後に進展と成功を果たすための、具体的取り組みの設定を手伝う ことである。 「教習員用指導書」では、次を問いかけるよう提案している：「次のステップは何でしょうか？」 「提案された取り組みに着手するための作業部会は編成しますか？」「だれが、これらの取り組み をさらに進めて行くのですか？」「また皆さんで集まる予定はありますか？いつ？」。 受講者には、答えが具体的になるよう勧めよ。受講者が作業部会を編成する、と述べたら「責任者 はだれですか？」「だれが参加するのですか？」「メンバーは何人ですか？」「どんな権限が委託 されますか？」「会議費用はかかりますか？だれが支払うのですか？」「何が次の段階へ進む妨げに なるでしょうか？どうその障壁を克服しますか？」「どうやってグループ全体へフィードバック しますか？」などを尋ねよ。 33 [原文] team building [訳注]「チームビルディング」としてビジネス用語にもなっている. 100 受講者に、個人または組織として取り組むよう勧めよ。例えば、次の会議を企画または主催する、 地元の新聞に教習プログラムに関する記事を執筆し、車椅子サービスへの認識を向上させるなど。 101 WSTPtot 関係者向け参考資料 102 WSTPtot 関係者向け教習プログラムのはじめに 関係者向け WSTPtot の実施計画 WSTPtot の「必須教習技能」および WSTPtot 管理者向け教習で論じた教材の多くは、関係者向け 教習にも該当する。例えば「CRPD（障害者の権利に関する条約）」、「車椅子ガイドライン」、教習 プログラムを実施する国や地域の法律や政策に関する徹底した知識は、関係者向け WSTP のファ シリテーターにも必須である。 管理者向け WSTP と同じく関係者向け WSTP も、きっちり時間割例通りに実施されることはまれ である。内容は、現地の状況や望む成果によって変わる。例えば、調整団体がすでにある場合は、 行動への参加（政策提言や意識啓発への取り組みおよび/またはリソース動員34など）を指導・監督 できるだろう。 そうしたしくみがない場合は、このワークショップは、関係者が一堂に会して知識を共有し、関係 を築くために役立てられる。この場合は共有ビジョンをつくり出すことが非常に重要になり、それ によって関係者が協働し、国内の適正な車椅子供与に向けて前進する。これはフィリピンで起きた ことで、関係者向け WSTP ワークショップに続いて協会が設立された。 重要なことは、合意された行動のフォローアップに率先して当たる人の確立である。これはワーク ショップから生まれた勢いを維持し、参加者の期待に応える役に立つ。この役割を果たす適任者は、 ワークショップ主催団体の代表の場合が多い。決定を推し進めるためにワークショップで作業部会 や委員会を選出する場合もあるが、こうした代表者は、全受講者に進捗状況を知らせ続ける役割を 担うことができる。 関係者向け WSTP プログラムは、特に現地の状況に合うよう計画した授業35や活動と結合させる と、より当を得たものになることが多い。関係者向け WSTP は最短 240 分（4 時間）で実施でき、 半日のワークショップに当たる。これは、政府の高職位者が参加できる時間としては最長であろう。 しかし、1 日のワークショップか、できれば現地に特有のニーズを満たせるよう、2 日間の日程を 組むよう強く推奨する。 34 [原文] mobilizing resources 35 [原文] sessions [原文] 他の WSTP や本書の他の部分に合わせて session にはすべて「授業」の訳語を宛ててい るが, 本文でも後述する関係者向け WSTP の性格から, 日本語でも「セッション」のイメージに近いものとなろう. 103 開会式に、例えば大臣など政府高官を含め、イベントをメディアが報道する可能性を高めることを 検討せよ。また、政府高官を開会式と閉会式に招待することも検討せよ。これは、管轄部門の課題 に対する認識を高めてもらい、ワークショップの成果を共有し、具体的なやり方で支援に加わって もらうよう要請するためである。 「関係者向け WSTP 教習員用指導書」では、関係者向け WSTP の実施準備のあらゆる面にわたる 情報を示している。以下の各節では、計画および実施の参考となる追加情報を与える。 関係者向け WSTP および教材の紹介 「教習員用指導書」が関係者向け WSTP の主教材で、受講者用マニュアルはない。受講者には主要 教材、例えば「車椅子ガイドライン」「障害者の権利に関する条約（CRPD）」、WSTP ロゴなどを DVD か USB メモリで配布するのが望ましい。ポスター「車椅子サービスのステップ」を受講者へ 配布することも勧める。これは、WSTP 用 USB メモリから印刷できる。 関係者向け WSTP の対象者 「教習員用指導書」p.2 には、関係者向けワークショップへ参加するとよい人びとを列記している。 この一覧表には、つねに障害問題を担当する政府部局（通常は、保健、社会福祉、退役軍人援護、 時として都市開発、交通、住宅）、NGO（非政府組織）、DPO（障害者団体）、リハビリテーション 専門職、車椅子の生産者と供給者、外部の寄付者、宗教団体（寄付者、供給者、リハビリテーショ ン専門職でもありうる）、リハビリテーション分野で活動する国際機関を含むべきである。準備と して、当該地域の招待すべき団体を、現地の事情を知る人に尋ねよ。車椅子ユーザーのジェンダー 比率が適正で、特定の集団、できれば脊髄損傷（対麻痺や四肢麻痺）、下肢切断、脳性麻痺がある 人、高齢者、変性疾患患者などが、じゅうぶんに代表されるようにせよ。また、親の会が含まれる ようにし、人権団体を招くことを検討せよ。 104 関係者向け WSTP の目的および対象範囲 関係者向け WSTP の目的は、自分の国や地域において適正な車椅子供与の確立に参画するすべて の人びと（関係者）の意識を啓発し、知識を高めることである。 関係者向け WSTP は 4 つの授業からなり、各々に PPT プレゼンテーションおよび授業計画が付属 している。上映すべき動画が 4 本あり、それらが PPT に埋め込まれているか事前に確認せよ。そ のやり方に関する情報は「必須教習技能」モジュールを参照。 関係者向けワークショップは、あらゆる WSTP（車椅子サービス教習パッケージ）の中で最も状況 に依存し、受講者のレベル、期待する成果、使える時間に合わせた柔軟な運用が必要である。 関係者向け WSTP の教習員および受講者 WSTP 全体を通して「教習員36」の語を用いているものの、関係者向け WSTP に求められるのは、 教習員よりもファシリテーターである。受講者が幅広く多様なため、全員に貢献の機会を保証する には、優れたファシリテーションが必要である。 受講者 8〜10 名ごとに教習員１名の比率を推奨する。受講者数は範囲とする地域や求める成果など 多くの要因によって変わる。人数は 12〜40 名、あるいはそれ以上もありうる。全国集会の場合は、 国のすべての地域から代表を得よ。さらに、移動に障害のある女性、若者、子どもが、公平に代表 されるようにせよ。 関係者向け WSTP のダウンロード 関係者向け WSTP は、以下の WHO ウェブサイトからダウンロードできる37： http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ 36 [原文] trainer 37 [訳注] 本文 URL はリンク切れ (2023.8.17) のため (https://apps.who.int/iris/handle/10665/246227) を参照. 105 関係者向け WSTP：教習運営実務と準備 計画 関係者向けワークショップ準備の主な要件の一つに、対象の国あるいは地域での車椅子供与の現況 を知ることがある。それに必要な情報の主なものは「教習員用指導書」p.8 に列記している。 この資料を集めるには、幅広い団体や個人に相談する必要がある。下のコラムはだれに連絡を取る べきかの提案である。だれをワークショップに招くべきかの決定は、こうした相談の後で下すべき である。 「管理者/関係者向け WSTP 計画ツール」は、教習員が、計画段階において現在の概況を把握し、 達成すべき成果を決定するのに役立つよう作成された。このツールは、本書の「付録」および WSTP 用 USB メモリに載っている。 連絡すべき団体/個人の候補： • 障害を管轄する主要な政府省庁、例えば保健、社会福祉、障害問題、児童福祉など • 障害分野のネットワーキングNGO38、例えば全国連盟や全国協会など • 車椅子または義肢装具に携わるリハビリテーションセンター職員 • 障害者およびその家族/介助者 • 地域に根ざしたリハビリテーション組織 • 障害プログラムを実施している学術機関 • 世界保健機関および現地で活動しているリハビリテーション分野の国際 NGO（非政府組織） • リハビリテーション機器の生産者および供給者 • 障害関連の取り組みを支援する資金援助団体 • 脳性麻痺、脊髄損傷、下肢切断、退役軍人などに特化した、障害別の組織 • 人権団体 • 主流をなす開発組織39 • CRPD（障害者の権利に関する条約）の報告に携わる団体 38 [原文] Umbrella disability NGOs 39 [原文] Mainstream development organizations 106 受講者を見定める 関係者向けワークショップの成否は、明確な目的や望まれる成果を設定すること、またそれと並行 して最適な関係者が招かれるようにすることにかかっている。 出席者数は、ワークショップが範囲とする地域、使える予算、求める成果によって変わる。普通は、 受講者 12〜40 名からなる。ワークショップが全国的なものである場合は、必ず国のすべての地域 あるいは国の機関からの、じゅうぶんな出席が得られるようにせよ。これは予算に影響しようが、 どんな計画でも、信頼性と首尾よく実行されるために重要である。あらゆる関連部門や地域からの 出席がうまく得られなかった場合、以下のようになる恐れがある： • 話し合いが、すべての利害関係者を代表したものにならない。 • 話し合いが、考慮すべき重要な視点を欠いたまま行なわれる。 • 受講者が、重要な意見が表明されていないために、現状に対する不完全な図式を持ち帰る。 • 受講者が、ワークショップがその部門を代表しないために、不満をつのらせる。 • 合意された計画が、すべての関係者グループの支持を欠くため、信頼されないか実行できない。 見定めた関係者全員に招待が送られ、続いて出席確認が行なわれたことを確認せよ。 招待講演者を見定め準備する 「教習員用指導書」p.10・11 では、招待講演者を見定め、準備するやり方について助言している。 招待講演者は場の雰囲気づくり40と、適正な車椅子供与の重要性の強調に役立つ。 講演者は、じゅうぶん前もって確定し、その発表の重点、スライドを用いるかどうか、および持ち 時間を話し合っておくこと。招待講演者が PPT プレゼンテーションを用いる予定であれば事前に 頂いて、関係者向けワークショップの間に使うノート PC に読み込んでおくこと。 以下のコラムは、招待講演者についてアプローチする部門についての提案である： 40 [原文] set the scene 107 招待講演者の候補： • 関係省庁（保健、社会福祉、退役軍人）の大臣あるいは次官 • 障害問題に関わる機関、部局、総局の長 • 国の障害部門の、技術的専門家 招聘する人が、効果的でポジティブな影響力があると広く受けとめられていることを確かめよ。 「教習員用指導書」の付録 1（p.49）では、政府代表者とその講演についてどう打ち合わせるかに ついての情報を与えている。そこで重要なことは、車椅子サービス供与に関連する最も重要な話題 （講演者の部局の管轄、車椅子供与の現状、関連する法律の地位など）を押さえることである。 車椅子ユーザー代表者の候補： • 適正な車椅子供与の重要性を分かっている • 実体験から適正な車椅子の価値を説明できる • 現地の車椅子供与に関する知識と経験 • 大勢の前で熱く語る41自信 • CRPD（障害者の権利に関する条約）の知識 • 車椅子ユーザーが直面する課題を強調するために自分の体験談を共有しようという意志 障害者の権利の提唱者で、課題に対して権利に基づいたアプローチをとり、また現地の政治力学 や事情を分かっている人を見出すよう試みよ。CRPDについて知識豊富な可能性は高いにせよ、 「車椅子ガイドライン」を必ず知っているとは限らない。これについては、準備の一環として 打ち合わせるとよい。 「教習員用指導書」p.51 では、車椅子ユーザー代表者に、講演では何を押さえるべきかについての 助言を与えている。講演者と話し合い、車椅子ユーザーであるとはどういうことか、また将来達成 したい希望は何か、生き生きと伝えて頂くようにせよ。 「教習員用指導書」p.53（付録 3）では、講演者や教習員が発表で参照するとよい引用および統計 を与えている。講演者には、自身の組織の活動に絞り込まず、車椅子供与をめぐる大状況について 語って頂くよう促せ。車椅子サービス供与部門内の強み、弱点、機会、脅威42を強調してもらうの は、討論を刺激するために有効である。 41 [原文] speak passionately 42 [原文] threats 108 教習員の役割 関係者向け WSTP は、教習プログラムではなくワークショップであるため、教習員には、よりファ シリテーター役を身につけることが求められる。教習員には、車椅子と障害部門、ならびに現地の 事情への徹底した理解が必要で、これによって授業を最も効果的に計画し運営できるようになる。 関係者向け WSTP 教習員には適正な車椅子供与の重要性への深い理解、およびそれに対する強い 熱意が必要である。保健政策と政府の機能を熟知した教習員は、教習チームの貴重な財産である。 教習員の一人が車椅子ユーザーで、上記の技能や知識を一部、あるいはすべて持ち、さらに教習 パッケージも分かっている人であれば、とりわけ有益である。教習員が全員、現地以外の地域から 来る場合は、ワークショップ前に追加時間を取り、現地の関係者と会って現地の事情について話し 合ってもらうとよい。 109 関係者向け WSTP 模擬授業 110 S.1: はじめに この授業を教えるための主な留意点 a. 参加者紹介 • 進行させるワークショップが半日で、グループが大きい場合、5 分の時間配分では一人ひとりを 紹介するには足りない。かわりに、分野名（例えば、療法士、政府、障害者団体（DPO）、非政 府組織（NGO）、寄付者、メディアなど）で呼び、当該分野の各メンバーに、立ち上がるか手を 挙げて確認してもらうことが可能。 • 集まる主目的が関係づくりであれば、自己紹介が重要になる。数分取って各テーブルで自己紹介 してもらい、その後の授業で違うテーブルに席替えして、より多く関係がつくられるようにせよ。 • 受講者に、以後の授業で発言する際には、名前と所属を示すよう勧めよ。 b. 招待講演者および基調講演：車椅子ユーザー/代表者 準備のコツ • 「教習員用指導書」では、この部の招待講演者は 3 人までと述べている。時間配分は合計 20 分 しかなく、しかも招待講演者は予定時間をオーバーして話すことがしばしばである。 • 時間に余裕があれば、この授業を延長することを検討せよ。招待講演者の人選が適切で、じゅう ぶんに打ち合わせてあれば、その証言は極めて強力になり、ワークショップのよい土台を築くで あろう。 講演者が適切で時間を守るようになるコツ： • PPT は避けるか、スライド 3〜4枚に制限する。 • 現地の窓口に、招待講演者について聞いておく。時間をオーバーしがちな人なら、講演者数を 減らす。 • 招待講演者に、時間に余裕がないことを予め説明しておく。残り時間 2分になったら、時間に 間に合うよう合図を掲げることを伝えておく。PPT のプレゼンテーションは事前に求め、確認 してコンピューターにアップロードできるようにする。 111 c. 質疑応答 • 招待講演者との質疑応答には 5 分しか取っていない。質問数を制限し、講演者には簡潔に答える よう促せ。招待講演者がワークショップ全体に参加する場合、受講者には、休憩時間に追加質問 するよう勧めよ。 112 S.2: 政策から実践へ この授業を教えるための主な留意点 a. 全般 • 「教習員用指導書」に、この授業への法的枠組みの配布資料を作成するための、主要資料の確認 表が載っている。政府代表、非政府組織（NGO）、障害者団体（DPO）その他の関係者と話し、 またインターネットを検索して、この情報を収集せよ。 • 当該国の、より包括的な概況を知るには「管理者/関係者向け WSTP 計画ツール」を完成せよ。 これは本書の「付録」および WSTP 用 USB メモリ43に載っている。 b. 第 2 節：ニーズ、および満たされざるニーズとは何か？ 準備のコツ • 国の人口統計値を最初のスライドに追加し、さらにこの数字の 1 %を計算して、車椅子が必要な 人口の WHO（世界保健機関）に従った推計値(44)を示せ。教習員仲間に計算が正しいか確認して もらうこと。最新の国勢調査情報をインターネットで検索するか、さらに直近の推計値を政府の 統計局あるいはその他の信頼できる情報源で調べよ。 43 [訳注] USB メモリは英語版のみ. 日本語版は右 URL よりダウンロード可能 (https://j-aws.jp/who/). 44 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/が i/item/9789241547482). [日本語版: 手動車椅子供与の世 界ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.w ho.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 113 内容 • WHO は、どこでも人口の約 15 %は障害者で(45)、1 %に車椅子が必要と推定している。国勢調査 の情報46からの障害者の合計割合は、通常 WHO の推計よりずっと低く、また国によりばらつき がある（通常 2〜5 %前後）。したがって WHO の推計に疑問を抱く受講者も出よう。いっぱんに 障害は、多くの理由から過少に報告されることを説明せよ： o 障害を持つ家族は家の中に隠され、国勢調査で数えられない場合がある。 o 自分の障害を、国勢調査の調査票上で認めているとは限らない。 o 国勢調査の調査票が適切な情報を捉えるとは限らず、そのため障害者が特定されていない。 c. 第 3 節：車椅子供与の重要性 準備のコツ • 授業開始前に、動画が WSTP 用 USB メモリに埋め込み済みか簡単に見つかることを確かめよ。 • この節への時間配分は 3 分で、うち 2 分半が動画のため、「インドのショバの例話」は授業時間 を延長しないかぎり盛り込めない。別のインドでの例話が後に出ている（p.27）。 d. 第 5 節：権利は万人のもの • 「障害者の権利に関する条約（CRPD）」は、紹介された条文だけでなく、全文を読んでおけ。 そうすることで、それらの条文の文脈が整理され、同条約がうたう諸権利に関して、より包括的 な理解が得られる。 e. 第 6 節：政策はサービスを通して個人に届く • この節には、車椅子サービスのステップを示すスライドが盛り込まれている。そのポスターを、 壁に貼って参照させよ。 • 関係者向け WSTP では、ここで初めて「車椅子ガイドライン」に触れている。ガイドラインの 認知度が低く、それに関する別の授業も行なわれない場合は、この機会にガイドライン、および 車椅子供与の 8 ステップの重要性を強調せよ。 45 https://www.who.int/en/news-room/fact-sheets/detail/disability-and-health 46 [原文] Census information 114 f. 第 7 節：国の計画によって権利を現実に • 第 7 節の活動は、完結するにはあまり時間がない。この演習をグループ全体で行なうか演習時間 を多く取って、フィードバックの時間を少なくせよ。4 グループから別べつにではなく、全体で フィードバックしてもらえ。 g. 第 9 節：要点のまとめ • この授業のおわりに、適正な車椅子供与の実現において、政府の全部門に果たすべき役割がある ことを強調せよ。国内および国際的な政策・条約・法律は、さまざまな関係者が実行した場合に のみ意味があり、これは政策提言とロビー活動を経なければ実現しない場合もある。全関係者の 順守、参画、説明責任47がたいへん重要である。 • 全関係者に、車椅子供与システム（車椅子の設計、生産、供給、サービス提供など）の改善への 差し迫った必要に対処し、サービス提供が第 6 節で取り上げた 8 ステップに沿うようにするうえ で、担うべき役割がある。 47 [原文] The compliance, commitment and accountability 115 S.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業計画の「教材」欄に「さまざまな種類の車椅子」と「クッション」を追加せよ。さまざまな 特色や設計を強調して質問を促し、受講者を惹きつけるために活用せよ。 • 授業開始前に動画 2 本を、WSTP 用 USB メモリに埋め込み済みか簡単に見つかるようにせよ。 b. 第 2 節：適正な車椅子とクッションの重要性 準備のコツ • スライド 3.5：米ドルの数字を現地通貨に換算し、だれにでも金額が分かるようにせよ。 • この節の焦点は、適正な車椅子とクッションの重要性である。時間があれば、不適正な車椅子と クッションが及ぼす影響を示す、自分のケーススタディを追加せよ。 内容 • 褥瘡はたちどころに発生・悪化し、命に関わることもあるため、クッションが車椅子の不可分な 構成要素であることを強調せよ。車椅子ユーザーは、褥瘡が治るまで何か月や何年も寝たきりを 余儀なくされる場合がある。 • 話を適正な車椅子の供与方法に集中させよ。すなわちユーザーのニーズと、さまざまな車椅子の 中から選べることの重要性に焦点を絞れ。車椅子の生産や特定のブランドについての詳細には、 それが重要なトピックだと判明していない限り、拘泥するのを避けよ。 116 c. 第 4 節：ユーザーのニーズおよび環境に合う • 受講者には、さまざまな車椅子が、動画に登場する人びとが活動をやり遂げるのをどう支援して いるか観察してもらえ。取り上げているさまざまな環境を強調せよ。教材用車椅子を活用して、 動画でやって見せている、はね上げ式足台や折りたたみ機構を示せ。 d. 第 5 節：安全で耐久性がある製品の重要性 • サービス事業所で新製品を検討する際には、安全性と耐久性を調べることが重要だと強調せよ。 例えば、その車椅子には除圧クッションが付属しているか？その車椅子は認証検査（ISO（国際 標準化機構）検査などの）に合格しているか？その設計は、よそで同様の環境で使われたことが あるか？交換用部品は付属しているか？フレームは現地で修理できるか？ 117 S.4: 変革に向け協働を WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 6 節：どうやって支援を与え、障壁を取り除くか • この節の最後のスライドはサムネイルの見出しが誤っている。PPT スライドの「要点のまとめ」 が正しい見出しである。「教習員用指導書」を修正せよ48。 この授業を教えるための主な留意点 a. 全般 • 関係者向けワークショップ受講者は、変革の創出と推進の両面において重要であると強調せよ。 これら各節の内容を、受講者に関連づけよ。例えば、適正な車椅子供与を支持する先行受容者を 見極める必要を強調するなど。最も変革を望み、車椅子供与の原動力となりうる組織を見極める 必要性を強調せよ。 b. 第 1 節：はじめに • 「はじめに」では、この授業を、満たされざるニーズや適正な車椅子の有益さに関する、以前の 同様な授業に結びつけるよう提案している。国際的あるいは国内や現地の政策などの指針文書を 再度掲げよ。 c. 第 2 節：どうやって緊迫感を伝えるか • 受講者が、統計が手に入らないため、車椅子へのニーズが分からないとコメントすることは多い。 かれらに、それが不作為の言い訳49にならないことを納得させよ。WHO 統計の「1 %」は信頼性 が高い統計値で、推計や計画の目的で使用できる。 d. 第 6 節：どうやって支援を与え、障壁を取り除くか • スライド 4.12：スライドを編集して教習実施国の人口を加え、車椅子が必要な人口の 1 %を計算 せよ。このデータは、すでに授業 S.2 のスライドで得ているはずである。 48 [訳注] 関係者向け WSTP 教習員用指導書 p.46. 日本語版サムネイルは翻訳した PPT から生成したため修正済み. 49 [原文] a reason for inaction 118 e. 第 7 節：変革プロセスを支援する方策 • 「次のステップは何でしょうか？」(p.47)：可能であれば、フリップチャート紙に列記した取り 組みを議論するため、時間配分を増やせ。ワークショップ解散前に、どのように前進すべきか 合意していることが重要である。例えば、受講者が振り返り、同僚と協議する時間を置いた後の フォローアップ会議を計画するなど。 • 時間を節約するため、第 7 節の活動をグループ全体か 3 グループに分けるかのどちらかで進める よう検討せよ。各グループに、答えを直接フリップチャート紙に、あるいは付箋紙を介して記録 するやり方を示せ。 f. 授業のおわりに • 最後のスライド 2 枚は「閉会のことば」に用いる。その初めのスライドの前に空白のスライドを 1 枚挿入し、誤って閉会のことばへ移らないようにすることを検討せよ。 119 閉会のことば この授業を教えるための主な留意点 a. 全般 • 「閉会のことば」用のスライド 2 枚は、授業 S.4「変革に向け協働を」用 PPT の最後にある。 b. 閉会のことばおよびロゴ • WSTP（車椅子サービス教習パッケージ）のロゴは、WSTP 用 USB メモリに載っていることを 強調せよ。 c. 事後評価および WHO へのフィードバック • 事後評価およびフィードバックは、WHO にとり、WSTP 教材の継続的な改善および発展を可能 にするため極めて重要である。受講者に、このプロセスへの参加を奨励せよ。 120 付録 付録１：WSTPtot 必須授業時間割 第 1 日 第 2 日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 121 付録２：WSTPtot 管理者/関係者向け教習時間割 第 1 日 第 2 日 第 3 日 8:30 WSTPtot 管理者向け教習の はじめに(85 分) B.5: 車椅子サービスは どうお金がかかるのか？ (60 分) WSTPtot 関係者向け教習の はじめに(35 分) 8:45 9:00 S.2: 政策から実践へ(45 分) 9:15 9:30 B.5: 車椅子サービスは どうお金がかかるのか？ フィードバック(30 分) 9:45 S.2: 政策から実践へ： フィードバック(25 分) 10:00 午前の休憩 午前の休憩 10:15 あいさつ・自己紹介・概略 (10 分) C.2: 需要管理(85 分) 午前の休憩 10:30 あいさつ・自己紹介・概略： フィードバック(15 分) S.3: 適正な車椅子を 取り揃える(30 分) 10:45 A.1: 適正な車椅子供与とは 何か？(50 分) 11:00 S.3: 適正な車椅子を取り揃え る：フィードバック(30 分) 11:15 S.4: 変革に向け協働を (パート 1)(57 分) 11:30 A.1: 適正な車椅子供与とは 何か？フィードバック(25 分) 11:45 C.2: 需要管理： フィードバック(35 分) 12:00 昼休み 12:15 昼休み 昼休み 12:30 12:45 1:00 A.2: サービス提供(40 分) 1:15 C.4: 持続可能な財政計画 (70 分) S.4: 変革に向け協働を (パート 2)(43 分) 1:30 1:45 A.2: サービス提供： フィードバック(20 分) 2:00 A.3: 変革を導く管理者 (45 分) S.4: 変革に向け協働を： フィードバック(30 分) 2:15 2:30 C.4: 持続可能な財政計画： フィードバック(30 分) 管理者/関係者向けWSTPの 教習運営実務と準備 (30 分) 2:45 A.3: 変革を導く管理者： フィードバック(30 分) 3:00 午後の休憩 午後の休憩 122 3:15 午後の休憩 管理者向けWSTPの模擬 授業範囲外の授業(105 分) 管理者/関係者向けWSTP 時間割の選択肢 (45 分) 3:30 B.1: サービスへのアクセス (45 分) 3:45 4:00 「保留スペース」 4:15 B.1: サービスへのアクセス： フィードバック(25 分) ToT 教習員の個別フィード バック(65 分) 4:30 4:45 「保留スペース」 5:00 授業準備・ToT 教習員の個別 フィードバック(30 分) 授業準備・ToT 教習員の個別 フィードバック(30 分) 5:15 WSTPtot 管理者・関係者 向け教習への評価と閉講式 (10 分) 123 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot 実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2 つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP 教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 124 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 125 ToT 教習員への指示：WSTPtot の終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 126 付録 4：管理者/関係者向け WSTP 計画ツール 国：________________________________ 記入者：_____________________________________ 連絡先：____________________________ 日付：______________________________________ 1. このツールの使い方 このツールは、当該国の一般的状況を収集し、教習やワークショップの望ましい成果を設定できる ように設計された。関係者と協力して、下表を次の手順で記入するよう推奨する。 当該国の状況に最も近い内容が述べられている欄を、マルで囲むかマーカーで強調する。 左端の列、白地の「要約」欄に、当該地域の状況の詳細を手短に記入する。 現地への知識、「追加を検討する授業」の行、可能な成果のページを利用し、現地の状況と 持ち時間に基づいて、自分の教習にどの授業を盛り込むか検討する。 2. 調査と計画への参画を得る国内の主な関係者の概要 関係者向け WSTP で挙げた、以下の関係者に相談し/参加を得よ： • 政策の企画者および実施者（例えば政府部局の、特に車椅子供与を担当するところ） • 障害分野のネットワーキング組織 • 障害者団体（ODP） • 影響力のある指導者や政治家 • 車椅子ユーザー、およびその家族/介助者 • 慈善家/資金供与者/寄付者 • メディア（電子および印刷） • 車椅子の製造者および供給者 • 専門家集団（理学療法士、作業療法士、CBR（地域に根ざしたリハビリテーション）専門職、 義肢/装具士その他） 経験を共有できる、海外の関係者を招待することも検討せよ。 1 2 7 3. 管理者/関係者向け WSTP 計画ツール 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 下の白地要約欄に記入 10 分野の各々について、最もよく当てはまる白地欄をマルで囲む/強調する 1. 政策および政策策定：政策/国家障害者計画/車椅子サービス提供に関連する法律 要約： 支援機器供与に、具体的に 言及した政策/計画が存在 しない。 国としての方策はない。 一般的な政策/計画はある が、CRPD（障害者の権利に 関する条約）や車椅子ガイ ドラインに沿っていないか 関係者に知られていない。 それらは実行されておらず また時代遅れである。 政策/計画があり、ほとんど の関係者に知られている。 それらは、CRPD や車椅子 ガイドラインにある程度は 沿っているが実行されてい ない。 政策/計画があり、CRPDと 車椅子ガイドラインに沿 っている。それらは定期的 に見直され、あらゆる関係 者によく知られており、広 く実行されている。 追加を検討する授業： CRPD/WHO ガイドライン に沿って政策/国家障害者 計画/国の基準を策定/起草 する。 CRPD/車椅子ガイドライ ンを基準に政策を見直す。 適正な車椅子サービスを 提唱する政策を運用可能 にする方法。 政策を活用して車椅子提供 を強化する。 他国が政策を開発/実施 するのを支援する方法。 1 2 8 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 2. 政策および政策策定：障害者の権利に関する条約（CRPD） 要約： CRPD に署名しておらず、 政府も同条約に関する国内 での取り組みを行なってい ない。 CRPDには署名しているが 批准していない。国内では よく知られておらず、推進 もされていない。 CRPDに署名しそれを批准 しているが、同条約に対す る認知やモニタリングは 弱い。 国は CRPD に署名し批准 しており、その進捗を評価 するための、強力なモニタ リングのしくみを備えて いる。 追加を検討する授業： CRPD およびその車椅子 サービス提供との関連へ の認識を高める。 CRPD およびその車椅子 サービス提供との関連を 宣伝する方法。 車椅子サービスに関する モニタリングのしくみ/ 組織を見直す/開発する。 モニタリングのデータを 見直し、CRPDに関する車 椅子サービス事業の強み と弱点を明確にする。 3. 政策および政策策定：WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて（車椅子ガイドライン）」に関する知識 要約： 同ガイドラインについては 車椅子サービス提供に携わ る関係者の間でもほとんど あるいはまったく知られて いない。 同ガイドラインについて、 限られた人数の関係者は 知っているが、その普及は 非常に限られている。 同ガイドラインは、主要な 車椅子関係者間ではよく 知られているが、政府や 主流の障害/開発関係者の 間では知られていない。 同ガイドラインはよく知 られており、政府その他の 関係者の間で、車椅子サー ビス事業を計画・実施する ための主要な指針資料と して活用されている。 追加を検討する授業： 同ガイドラインの内容およ び背景に関する提示。 同ガイドラインを推進 するための、一般的方策を 策定する。 特定部門に対して同ガイ ドラインを普及するため の方策。 同ガイドラインの達成状 況に関する国内の/国際的 なケーススタディ。 1 2 9 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 4. 政策および政策策定：国の社会基盤および車椅子供与への取り組みの調和 要約： 国が状況不安定/緊急事態 で、公的社会基盤がほとん ど存在しない。 リハビリテーションへの取 り組みは最低限度で、その ほとんどは国際 NGO/国内 NGO部門が運営している。 国の組織化と資金力が貧弱 で、構造が脆弱である。リハ ビリテーションは優先され ておらず取り組みも調和さ れていない。国の熟練した 人材は希少である。 社会基盤が整備され、リハ ビリテーションのサービス 事業と職員は存在するが、 各サービスの調和が取れて いないか資金力が乏しく、 その品質・量・普及範囲に は制約がある。 国のあらゆる地域に、確立 して調和されたリハビリテ ーションサービスがあるな ど、国に堅実な社会基盤が ある。 追加を検討する授業： 国際 NGO/NGO のリハビ リテーション関係者の間 の、適正な車椅子提供への 認識を高める。 国内の車椅子サービス提供 への取り組みを調和させる 方法。 作業部会または全国協会 を編成する。 国内の車椅子サービス提供 の取り組みを、調和させる 方法。 持続可能性の確保と将来、 すなわち人口高齢化に伴う 車椅子サービスへのニーズ の変化に対する計画： 5. 政策および政策策定：障害者運動の力量および障害者のインクルージョンの水準 要約： OPD（障害者団体）が弱いか 存在しない。障害者は、のけ 者にされ、差別・偏見にさら され敬遠されている。 OPD や NGO が障害分野で 活動する弱い障害者運動は あるが、活動が調和されて おらず、影響力に欠ける。 障害者はほとんど排除され ている。 OPD の力量が増すにつれ 障害者運動が成長中。生活 場面によっては、障害者の インクルージョンがあり、 CRPD に沿う障害者の権利 への認識も高まっている。 活発な障害者運動と強力な OPDの組織がある。障害者 は車椅子サービス提供に参 画しCRPDに沿った障害者 の権利もほとんどの場所で 認識されている。 追加を検討する授業： 車椅子ユーザーの権利と車 椅子サービス提供における 車椅子ユーザーおよびその 組織の役割。 車椅子提供における、自助 グループの役割の可能性： ケーススタディと共に。 どうやって車椅子サービス 提供における OPD の役割 を向上させるか。 国内の、および国際的な、 適正な車椅子サービス提供 推進におけるOPDの役割。 1 3 0 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 6. 製品：適正な車椅子および座位保持装置の入手可能性 要約： どんな車椅子も完全に不足 しており、手に入るものは 大半の人のニーズに対して 適正ではない。 1・2種類の適正な車椅子は あるが広く普及しておらず ニーズに対応できていな い。座位保持装置は、ほとん ど、あるいはまったくない。 じゅうぶんな/限られた種 類の適正な車椅子および/ または座位保持装置がある が、数量/品質/全地域への 普及には制約がある。 国のあらゆる地域に適正な 車椅子および座位保持装置 が包括的に取り揃えられて いる。 追加を検討する授業： 適正な車椅子を取り揃える。 上記ガイドラインを基準に 現地で手に入る製品を評価 する。 適正な車椅子の普及範囲 と種類の拡張、および座位 保持装置の導入。 適正な車椅子と座位保持 装置の、普及範囲と種類を 拡張する。 包括的な種類を揃えて おくことの重要性を強調 する成功談の発表。 7. サービス：車椅子サービスの状況 要約： 政府のサービスはない。 NGO による散発的な大量 配布に依存し、上記ガイド ラインに従った事前評価や 処方サービスはない。 政府やNGOの運営による、 バラついた水準の基礎的な サービス。中級レベルのサ ービスはない。紹介・相談と フォローアップは乏しい。 基礎と中級のサービスを、 車椅子ガイドラインの基準 に沿って運用しているが、 ニーズに対して不十分で、 政府のリハビリテーション サービスに統合されておら ず、ユーザーの参画やフォ ローアップは最低限度。 良質な基礎と中級レベルの サービスネットワークが、 政府の全国的サービスに統 合され、地方・国レベルで ニーズを満たしユーザーが 全面的に参画している。 追加を検討する授業： 車椅子サービスを開始する 車椅子サービス事業を 運営する 全国的ニーズに応えるため にサービス提供のポジティ ブな側面を拡大する方法。 サービスの継続的発展への 方途。 他国のサービス開発を支援 する方法。 1 3 1 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 8. サービス：リハビリテーション専門職/地域に根ざしたリハビリテーション(CBR)サービス/車椅子提供技能教習を受けた職員の利用可能性 要約： 理学/作業療法士や、CBR 専門職はほとんどいない。 車椅子提供の関連技能を持 つ人は、国内にまったく、 あるいはほとんどいない。 限られた人数の有資格専 門職と教習を受けた CBR ワーカーがいる。しかし、 車椅子提供の専門技能を 持つ人はほとんどいない。 有資格専門職がほとんど の地域に、CBRワーカーが ほとんどの地区に配置さ れている。地方によって は、車椅子提供の専門技能 教習を受けた人がいる。 全国かほとんどの地方を、 教習を受けたリハビリテー ションとCBR専門職の ネットワークが覆い車椅子 提供の技能教習を受けた人 が多数いる。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ガイドラインと、 WSTPモジュールへの認識 WSTPモジュールをリハビ リテーション教程に統合 する方法。 WSTPモジュールをリハビ リテーション教程に統合 する方法。 9. サービス：資金供与の利用可能性 要約： リハビリテーションのため に国内で利用できる資金は ほとんどあるいはまったく ない。ほとんどのリハビリ テーション資金は、国際 NGO/国際機関が供与。 サービスには最低限度の資 金を利用できるが、車椅子 供与に関与する資金供与は ない。 サービスと製品の両方で、 そこそこの水準の資金は 利用できるが、ニーズには 不十分である。 サービスにじゅうぶん資金 力があり、すべて/ほとんど の車椅子と座位保持装置は 国の制度を通して資金供与 される。 追加を検討する授業： 国際 NGO/NGO 関係者の 間の、適正な車椅子供与へ の認識を高める。 適正な車椅子供与と障害者 のインクルージョンによる 保健医療費用節減を示す、 ケーススタディの発表。 多様なニーズに合う、さま ざまなコストでさまざまな 種類の適正な車椅子が揃う ことの重要性。 効果的なサービスの有益さ に関するケーススタディ で、それらが維持されるた め、また教訓として他者と 共有されるためのもの。 1 3 2 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 10. 教習：車椅子ユーザーを含む、車椅子サービス職員が受けられる教習 要約： 車椅子提供教習が国内では まったく受けられない。国 のリハビリテーション訓練 学校がない。 限定的な車椅子提供教習が CBR/その他の教習コース に含まれているが、車椅子 ガイドラインに沿ったもの ではない。車椅子ユーザー の技能教習はない。 さまざまな幹部職員には 教習が提供され、WSTPか 同等のパッケージの教習 を実施できる限られた数 の人がいる。若干の車椅子 ユーザー教習がある。 車椅子ガイドラインに沿っ た基礎および中級レベルの 車椅子提供技能教習コース が定期的に実施され、他の リハビリテーション専門職 教程に統合されている。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 さまざまな部門に対する、 教習ニーズの分析。 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ユーザーに対する、 ピア教習への認識。 リハビリテーション専門職 および車椅子ユーザーの、 車椅子提供技能を向上させ る方策を開発する。 車椅子専門職の技能を、 中級/上級レベルへ発展 させる方策。 133 4. 車椅子サービス管理者向け教習や関係者向けワークショップの設定可能な成果 最も適切かつ達成可能な成果を見定め、それを押さえるためにはどれくらい時間が必要か検討せよ。 適切であれば、授業時間または授業範囲を拡張せよ。 教習パッケージで特定した、以下の領域を考慮せよ： 管理者向け WSTP • 車椅子サービス提供の 8 ステップへの認識を高める。 • 車椅子サービス事業を開始する方法への知識と技能を高める。 • 車椅子サービス事業を運営する方法への知識と技能を高める。 • 車椅子供与を持続可能にする方法への認識を高める。 • 車椅子サービス提供の質を高める。 関係者向け WSTP • 適正な車椅子へのニーズおよびその有益さについての理解を深める。 • 関係者に、適正な車椅子サービス提供を発展させるうえでの各自の役割を伝える。 • バリアフリー環境への理解を深める。 • 予算支援を見出す/提供することへのより深い関与を得る。 • 車椅子サービス提供の持続可能性を高める。 現地の状況およびニーズに基づき、以下の可能な追加的成果を検討するか、独自の成果を特定せよ。 • 車椅子サービス提供のための国の政策を策定/起草する。 • 車椅子サービス提供のための国の方策を策定/起草する。 • 車椅子問題を調整し推進する作業部会を任命する。 • 車椅子/支援製品協会あるいは研究会を設立する。 • 車椅子サービス提供のための国の基準に合意する。 • 既存の車椅子と座位保持の種類を、WHO 車椅子ガイドラインに照らし評価する • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」への認識を高める。 • CRPD その他の国際的法律文書と、それらと車椅子サービス提供との関連への認識を高める。 • 車椅子サービス提供をよりよく調整する。 • 車椅子サービス事業管理に携わる職員の技能を向上させる。 134 • 車椅子サービス提供の、世界/地域/国内における状況に対する理解を深める。 • 車椅子サービス提供教習へのニーズ分析を完成する。 車椅子サービス教習員養成教習パッケージ 管理者/関係者向け教習ハンドブック 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

車椅子サービス 教習員養成教習パッケージ 管理者/関係者向け教習 ハンドブック 車椅子サービス教習員養成教習パッケージ・管理者/関係者向け教習ハンドブック © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: ToT handbook managers and stakeholders. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: ToT handbook managers and stakeholders. ジュネーブ: 世界保健機関; 2017. ライセン ス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワールド・ ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: ToT Handbook Managers and Stakeholders” の全訳である。序章の「はじめに」で述べている通り、本 書を含むこの「車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings”（邦訳「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたも のである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移動支援機器供与に関する共同方針提言書：個人的移動性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子供与ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬模擬授業からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳の確認と校閲については、以下の方々のご協力をいただきました。 ここにお名前を記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: ToT handbook Managers and Stakeholders, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 模擬授業準備の手引き xiii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 3 ToT.3 模擬授業 10 ToT.4 多様性への心構え 15 ToT.5 成人学習 20 ToT.6 準備時間について 27 ToT.7 提示とファシリテーション 28 ToT.8 コミュニケーション技能 33 ToT.9 指針文書の知識 37 ToT.10 視聴覚ツールおよび機材 55 ToT.11 フィードバック 61 ToT.12 集団力学を司る 63 管理者/関係者向け教習モジュール 68 WSTPtot 管理者向け教習のはじめに 69 管理者向け WSTP 教習運営実務と準備 75 管理者向け WSTP 模擬授業 77 あいさつ・自己紹介・概略 78 A.1: 適正な車椅子供与とは何か? 79 A.2: サービス提供 81 A.3: 変革を導く管理者 82 B.1: サービスへのアクセス 83 B.2: 施設および設備 84 B.3: 適正な車椅子を取り揃える 86 B.4: 職員の配置 88 B.5: 車椅子サービスはどうお金がかかるのか? 91 C.1: サービス事業が機能しているか判るには？ 92 C.2: 需要管理 94 C.3: フォローアップ計画 96 C.4: 持続可能な財政計画 97 総まとめ 98 WSTPtot 関係者向け参考資料 101 WSTPtot 関係者向け教習プログラムのはじめに 102 関係者向け WSTP：教習運営実務と準備 105 関係者向け WSTP 模擬授業 109 S.1: はじめに 110 S.2: 政策から実践へ 112 S.3: 適正な車椅子を取り揃える 115 S.4: 変革に向け協働を 117 閉会のことば 119 付録 120 付録１：WSTPtot 必須授業時間割 120 付録２：WSTPtot 管理者/関係者向け教習時間割 121 付録 3：WSTPtot 模擬授業フィードバックシート 123 付録 4：管理者/関係者向け WSTP 計画ツール 126 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008 年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4 種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHO は、WSTPtot の発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtot は、単一の「必須教習技能」モジュール3、および既成の 4 教習パッケージ（2012 年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013 年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015 年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtot では、WSTPm と WSTPs は、一つの教習パッケージ別モジュールと して統合されている。 WSTPtot は 40 時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtot の修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi ToT ハンドブックの使い方 この ToT ハンドブックは、教習パッケージ別モジュールの教授法に関する情報を含む、WSTPtot へのステップバイステップの手引き書である。本書は、実習生5が WSTPtot プログラム中に使い、 また将来、WSTP を計画し、実施する際の参考資料として持っておくために開発された。 対象者 WSTPtot は、以下 4 つのモジュールからなる： • 必須教習技能6：2 日間 • 基礎教習（WSTPb）：3 日間 • 中級教習（WSTPi）：3 日間 • 管理者/関係者向け教習（WSTPm/s）：3 日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向けおよび関係者向け WSTP の実施を計 画している教習員が対象である。実習生が WSTPtot 管理者/関係者向け教習から最大限の成果を 得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業の 必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習7 の機会を得る必要がある。 5 [原文] you [訳注] この教習パッケージ（WSTPtot）を受講する実習生 (模擬授業では教習員). 以下同様. 6 [原文] Core Training Skills 7 [原文] co-training xii 模擬授業8の割り当て 「必須教習技能」モジュールを修了後、実習生は WSTPtot の第 2 部に進み、そこで各自の WSTP 授業を実施することで学んだ技能を実践する。 実習生には、「必須教習技能」モジュール初日に「ToT.3 模擬授業について9」で担当授業が割り振 られる。その際、各実習生にメンター10として ToT 教習員ひとりが割り振られる。教習プログラム には授業を準備し、またメンターの ToT 教習員と相談する時間が盛り込まれている。模擬授業の後 にフィードバックと話し合いが持たれ、このプロセス全体を通して ToT 教習員が実習生の技能を 観察し、評価できるようになっている。 WSTPtot への準備をじゅうぶん行なえるよう、実習生には予め教習パッケージ別教材資料が送付 される。実習生は、どの授業でも実施できるよう準備万端で臨むべきである。 注記： 模擬授業の中には、WSTPtot に合わせて時間配分を短縮するか、授業の一部を割愛するよう 改変したものもある。これらの改変はWSTPtot の目的に合わせただけのもので、WSTP 実施の 際にまねてはならない。 8 [原文] practice delivery 9 [原文] practice delivery sessions 10 [原文] mentor [訳注] 本書では助言指導 mentor, その行為 mentoring と指導者 mentor は「メンター」に一括. xiii 模擬授業準備の手引き リーダー役実習生 • 担当する授業について WSTP「教習員用指導書」の授業計画を読み、授業内容をすべて理解して いることを確かめよ。活動は自分でやってみて、受講者に何をやることが期待されているのか、 自分が理解していることを確かめよ。自分が担当する節/授業のみ準備せよ。 • 基礎/中級/管理者向け WSTP「受講者用参考書」と「受講者用ワークブック」（これらは関係者 向け WSTP にはない）の、該当箇所を読め。 • 担当授業について、「ToT ハンドブック」の「この授業を教えるための主な留意点」など関係する 節を読め。 • WSTP の教材にはいくつかの誤りが判明しており、それはこのハンドブックに挙げている。担当 授業について誤りがあるか調べ、あれば推奨されている変更を加えよ。 • 必要に応じて、PPT スライドを編集せよ。 • 適切ならば、ケーススタディなど自分の知識や経験を盛り込め。 • 授業実施を、時間配分も含め予行演習せよ。 • 補助役実習生と話し合い、チームとしてどう作業するか計画せよ： o 役割を割り振る。例えばタイムキーパーや板書など。 o 実技を含むグループ活動については、いっしょに予行演習し、どの誤りに注意が必要で、どう やってそれを訂正するか話し合う。 補助役実習生 • 自分の「教習員用指導書」の授業計画を読め。 • 指示に応じて、リーダー役実習生を補助せよ。 授業開始の前に • 自分の PPT スライドを、当該教習日の開始前に、教習用ノート PC へアップロードせよ。 • 必要に応じて、教室を設営し教習資材を設定せよ。 • 視聴覚機材が設定され、正常に動作することを確認せよ。 xiv 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員といっしょに見習い教習を実施し、自らの技能を育成 し続けなければならない。見習い教習では、教習指導員 1 名に対して見習い教習員 2〜4 名の割合 を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、「WSTPtot 模擬授業フィードバックシート」に記録して、実習生と共有される。 メンター11およびピアサポート12 実習生には WSTPtot 教習後も自分の ToT 教習員と連絡を取り合い、進境を報告し、相談して助言 をもらうよう勧める。実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各自の技能 と自信とを養うために役立つ。実習生がソーシャルメディア上のグループに参加するかグループを 立ち上げ、質問したり学習経験を共有したりできると有益であろう。 11 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 12 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 車椅子サービス教習員養成教習パッケージ (WSTPtot) の構成 WSTPtot プログラムは 2 日間の「必須教習技能」モジュールと、続く基礎（WSTPb）、中級（WSTPi）、 管理者向け（WSTPm）・関係者向け（WSTPs）から一つ選択する、3 日間のモジュールとからなる。 この教習パッケージ別モジュールでは、実習機会を与えて実習生の WSTP 教習員としての技能と 自信を育てる。ここでは WSTP 実施の際に起こりがちな課題も明らかにし、解決策を提示する。 WSTPtot 課程の概観 ToT プログラム修了後、実習生は、自立した教習員としての自信と能力が備わるまで、見習い教習 を行なわねばならない。見習い教習の回数は、人によって異なる。ToT 教習員と、見習い教習中に 実習生のメンターを務める教習員は、実習生が見習い教習を継続すべきか、ひとり立ちして教習を 実施すべきか、決めるのを手伝う。 必須教習技能 教習パッケージ別 見習い教習員 教習員 実習生が、対面での ToT 教習後に経験豊富な教習員との見習い教習を行なえない場合、WHO では、 実習生にバーチャルな支援やコーチを探し、また他の ToT 実習生と連携し、助け合って、WSTP の 計画、準備、実施を行なうよう奨励している。 フィードバックおよび自己評価 教習パッケージ別モジュールの模擬授業中、実習生は、実習生の技能一覧表を含む「WSTPtot 模擬 授業フィードバックシート」を用いて自分の出来ばえを評価する。ToT 教習員は ToT プログラムの 最後に、このフォームに書面でのフィードバックを与える。これは、実習生が教習技能を向上させ 続けるために役立つ。このフォームは、本書の付録に載っている。 3 ToT.2 車椅子サービス教習パッケージについて 沿革 WSTP（車椅子サービス教習パッケージ）は、2006 年 11 月に インド・バンガロールで開かれた、「開発途上国への車椅子に 関する合意形成会議(1)」に端を発している。 この合意形成会議が基礎となり、WHO「手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて(2)」が作成され、 国際義肢装具学会（ISPO）及び米国国際開発庁（USAID）との 提携のもと、2008 年に WHO から発行された。 車椅子は、個人的移動を可能にするために最もよく使われる支援機器の一つであるが、サービス 供与者には、車椅子ユーザーが最大限に自立した個人的移動を達成し、生産的で高い生活の質を 享受できるようにするための教習を受ける機会がほとんどなかった。 基礎・中級 WSTP の開発目的は、低リソース状況の車椅子サービス職員に包括的車椅子サービス 供与教習を行なうことにより、より多くの大人や子どもが自分のニーズを満たす車椅子を手に入れ られるようになることによって「車椅子ガイドライン」が実行されることである。 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006 年 11 月 6〜11 日. インド, バンガロール: 世界保健機関, 2006]. 2 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 4 4 つの WSTP 基礎車椅子サービス教習パッケージ (基礎 WSTP、WSTPb)(3)は、 移動に障害があるものの、付加姿勢支持なしでまっすぐに座れる 男女の子どもや大人に、適正な手動車椅子およびクッションを 供与する職員への教習を助ける。 中級車椅子サービス教習パッケージ (中級 WSTP、WSTPi)(4)は、 まっすぐに座るには付加姿勢支持が必要な男女の子どもや大人 に、適正な手動車椅子およびクッションを供与する職員への教習 を助ける。 基礎 WSTP、中級 WSTP とも最短 5 日間で実施できるように設計されている。しかし、各授業に 要する実際の時間はさまざまである。以下のような場合は、追加時間が必要になる： • 授業計画に教材資料を追加する。 • 状況や受講者の技能レベルに対して適切な、追加授業を盛り込む。 • 車椅子ユーザーとの実習回数を増やす。 • 通訳が必要。 • 教習で使用する製品に対して、さらに下準備の時間を取る。 • 現地の事情に合わせて、教習日数を短縮する。 • 教えている受講者に、経験や公式の資格といった面で制約がある。 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版：基礎車椅子サービス教習パ ッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版：中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 5 教習時間割に授業を追加したい場合、国際車椅子専門家学会（ISWP）のウェブサイトに追加教材 が載っている。以下を参照：http://wheelchairnet.org/resources5 管理者向け車椅子サービス教習パッケージ (管理者向け WSTP、 WSTPm)(6)は、事業管理者が、適正な車椅子供与を効果的に支援 する指針となるように設計されている。これには、適正な車椅子 供与の確立に向けて事業管理者や関係者の参画を推進すること も含まれる。管理者向け WSTP は最短 2 日で実施できる。 関係者向け車椅子サービス教習パッケージ (関係者向け WSTP、 WSTPi)(7)は、国/地域における適正な車椅子供与の確立に向けて、 全関係者の意識を啓発し、技能や知識を育成するために設計され ている。最短 4 時間で実施できる。 • どちらの教習パッケージも、通訳、より詳細な討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るために、期間を延長して実施できる。 5 [訳注] 2022 年 10 月 28 日現在, リンク切れ. 6 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 7 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 20 15 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 6 指針原則 WSTP は、以下の一群の指針原則8に従って作成された： • 車椅子ユーザーを車椅子サービスの中心に置く、ユーザー中心で人権に根ざしたアプローチ9。 • 手に入るエビデンスに基づく10、国際的な最良の実践例11にならう。 • 低リソース状況12に重点を置き、状況に対して適正な製品と教習を採用する。 • 全教習パッケージにおける、教習員や教習対象者としての車椅子ユーザーのインクルージョン。 • 取っ付きやすい非医療的なことばづかいと用語13を用い、それによって： o 臨床や技術の資格を持たない受講者も教習を受けられ、 o サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになる。 WSTP の構成要素 各教習パッケージは、さまざまな教材からなっている。 基礎 WSTP 中級 WSTP 管理者向け WSTP 関係者向け WSTP 教習員用指導書 ✔︎ ✔︎ ✔︎ パワーポイントのプレゼンテーション ✔︎ ✔︎ ✔︎ 動画 ✔︎ ✔︎ ✔︎ ポスターセット ✔︎ 選択した ポスター 選択した ポスター 補助資料：車椅子ガイドライン、障害者権利条約 ✔︎ ✔︎ ✔︎ 受講者用参考書 ✔︎ 合本 受講者用ワークブック ✔︎ 各種フォーム＆確認表 ✔︎ － 補助教材：工具、器材、各種フォームなど － ✔︎ 8 [原文] guiding principles 9 [原文] user-centered and rights-based approach 10 [原文] available evidence-based 11 [原文] best practice 12 [原文] less-resourced settings 13 [原文] accessible, non-medical language and terminology 7 活動１：「教習員用指導書」をよく知る グループで協力し、「教習員用指導書」を用いながら以下の問いに答えなさい。答えは各問いの横 に書きなさい。 問い 答え 1. 「教習員用指導書」全内容の一覧は、 どこで見つかりますか？ 2. グループ活動は授業の中でどう示され ていますか？ 3. 教習パッケージ全体のねらいや目的 は、どこで分かりますか？ 4. 授業計画で、教習員が PPT スライドを 映写すべきタイミングはどこに示され ていますか？ 5. 教習授業の実行に必要な施設、教材、 設備はどこで分かりますか？ 8 WSTP「教習員用指導書」の使い方 マニュアル 各「教習員用指導書」は教習員に当該パッケージの概観をもたらし、その具体的な手引き書となる ものである。各項目は、WSTP の実施準備前に注意深く読み返すべきである。 付録 補足情報を与える付録は基礎・中級・関係者向けの「教習員用指導書」の末尾に載っており、各種 フォームや確認表も含んでいる。 授業計画 授業計画は、授業を通して教習員を導くレシピのように働く。授業計画に従うのは以下の面で有効： • 学習目標への集中を保つ • 時間を守る • 関連トピックについての、フォーカスグループ活動、話し合い、質問 動画コラム 動画を上映すべきところには、右の動画アイコンのどちら かが付いた動画コラムが「教習員用指導書」に載っている。 • すべての動画の内容、関連性、タイミングを熟知して おくことが重要。 教習員への注記 教習員への注記は、「教習員用指導書」全体に盛り込まれており、内容は： • 質問に対する最も重要な答え • グループ活動への手引き • 教習員が受講者からの質問に答えるのを支援する補足情報 9 活動コラム 活動コラムは、下記の情報を提供する教習員の手引き である： • グループ：活動のために、どうグループ全体を分け るか。 • 指導内容：活動をどのように実施すべきか、受講者 に何を話すべきか。 • モニター：活動中、どのようにグループをモニター して正しい作業を行なうようにするか。 • 時間：活動時間の長さおよび最後のフィードバック 時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき 要点、受講者の思考や感覚を引き出すやり方。 要点のまとめ どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」（管理者向け WSTP の場合）である。 10 ToT.3 模擬授業について はじめに ここで学ぶ、WSTP パッケージを教授することへどれくらい自信を感じるか 1〜10 点で記録せよ： 1 2 3 4 5 6 7 8 9 10 自信がない たいへん自信がある 教習パッケージ別モジュールの構成とねらい 教習パッケージ別モジュールには、習得を選択した WSTP の授業を実施する機会が含まれる。 これは実習生14が、以下ができることをねらいとしている： • WSTP の教習教材を使う練習をする。 • 教習仲間を相手に授業を実施する練習をする。 • WSTP の理論、原則、技能、方法論への自分の理解を明確にする。 • 教習時に発生する、よくある問題について学び、それに対処するやり方を見出す。 • 自分の、実習生としての技能（各自の「ToT ハンドブック」付録の「WSTPtot 模擬授業フィード バックシート」の一覧表を参照）を育成する。 リーダー役・補助役教習員および模擬受講者の役割 • 実習生には、リーダー役教習員15と補助役教習員16の両方になる機会がある。 • 同じ授業にリーダー役教習員が複数割り当てられた場合、プレゼンテーションを行なっていない 人はそのあいだ自動的に補助役教習員役に回る。 • 一つの授業にリーダー役教習員が一人だけの場合、その人は他の模擬受講者に補助を頼んでよい。 • 模擬授業では、補助役教習員に特定の役割が割り当てられる場合もある。 14 [原文] you [訳注] 原著では, 本書の対象者で ToT 教習を受ける実習生 trainee を, 模擬授業で教える役割にある 場合のみ教習員 trainer, それ以外では you と呼びかけているが, 二人称は日本語的でないため「実習生」の訳語を 充てた. ToT 教習員は, WSTPtot 教習員用指導書でも ToT ハンドブックでも「ToT 教習員 ToT trainer」である. 15 [原文] lead trainer [訳注] 実習生 trainee が, 模擬授業で教える際に務める役割の一つ. 16 [原文] support trainer [訳注] 同上. 11 活動１：リーダー役教習員と補助役教習員 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ 12 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役教習員を調整する。 • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー 役実習生にもたらす。 • 授業実施に関する全体的フィードバック/ 振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消し やブラインドの開閉を行なう。 チームワーク 実習生はチームとして、協力して授業を実施すべきである。例えば、以下を助け合うことなど： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 時間管理 • 授業実施中の誤りの指摘 • 受講者からの質問に答える • 妨害や割り込みへの対処 お手本17としての教習員 教習員は、プロとしての行動と実践のポジティブな手本を示すべきである。受講者に求める行動に は、その模範を示せ。例えば： • 時間を守り、じゅうぶん準備する。 • 困難な状況で、問題を解決し解決策を見出す。 • ポジティブなフィードバック、および建設的なフィードバックを与える。 • 上手に自己管理する：例えばストレス管理のため、授業準備とじゅうぶんな睡眠・よい食事との バランスを取るなど。 17 [原文] role models [訳注] そのまま「ロールモデル」と呼ばれることも多い. 13 留意事項：優れた教習員であり、手本であるとは、常に質問への答えを知っていなければならない ということではない。 質問を受けたが答えを知らない場合に、答えを知っているふりをしてはならない。代わりにできる ことは： • 補助役教習員に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 振り返り18とフィードバック 自分自身の教えぶりを振り返ることを学ぶのは、教習員にとって重要な技能である。教習員には、 教習受講者に、建設的な指針となるフィードバックを与えられることも重要である。 これが、振り返りとフィードバックの技能が ToT プログラムに組み込まれている理由である。 各模擬授業の終わりに、リーダー役教習員は次を振り返るよう求められる： • 何がよかったか、また何がうまく行ったか。 • 何に改善の余地があるか。 ToT 教習員は模擬受講者からの簡潔なフィードバックを促し、リーダー役教習員や模擬受講者が挙 げていなかった点があれば、最後に ToT 教習員から付け加える。 模擬授業の準備 模擬授業の準備には、以下が含まれるべきである： • 「教習員用指導書」の授業計画を読み、授業内容をすべて理解していることを確かめる。 • 「受講者用参考書」と「受講者用ワークブック」（関係者向け以外の WSTP で使う）の該当箇所 を読む。 • PPT に適切な変更/補足を加える。 • 適切ならば自分自身の知識や経験を組み込み、自分のケーススタディを活用する。 • 授業実施を、時間配分を含め予行演習する。 • 補助役教習員と、チームとして協力する。 • 授業に必要な教材を準備する。 授業が ToT 教習員によるデモを含む場合は、ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせよ。 18 [原文] Reflection 14 判明している誤り WSTP の「教習員用指導書」「受講者用参考書」「受講者用ワークブック」および PPT の中には、 いくつかの誤りが判明している。 • 判明している誤りは各自の「ToT ハンドブック」で挙げている。 • 授業を準備するさい、担当授業に誤りがないか確かめ、必要な変更を加えよ。 • 模擬受講者と誤りについては話さず、授業のプレゼンテーションは通常の WSTP 教習と同様に 行なえ。 授業プレゼンテーションにおける自信 • 最初の模擬授業では、教習仲間や ToT 教習員を前にしてアガるかもしれない。それが普通だ19！ • さらに授業を実施するにつれ、技能と自信がついてくる。 • 「必須教習技能」モジュールのあいだ、グループ活動からのフィードバックを発表するよう求め られる。その機会を活かし、仲間へのプレゼンテーションを練習せよ。 PPT（パワーポイント）のプレゼンテーション • 各授業の標準版 PPT は、動画を埋め込んだものが教習用ノート PC で使用可能。 • 自分の PPT に、スライドの追加などの変更を加えた場合は、模擬授業前に教習用ノート PC へ それをアップロードしておく必要がある。 模擬授業の制限時間 • 模擬授業のあいだ、時間は厳しくモニターされる。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止させて次の教習員に移るか、授業を終了する。 19 [原文] This is normal! 15 ToT.4 多様性に備える20 WSTP 教習員はしばしば多様性21に遭遇するため、多様な受講者集団を取り仕切るやり方を、必ず 把握しているべきである。多数派の中にいると、人はえてして力強さや自信を感じる。少数派の中 にいると、人は孤立や疎外を感じることがある。集団は文化22や多様性によって分かれ、あるいは まとまる。 文化と多様性 文化：人びとを同じにするもの • 共有あるいは共通の、価値観23、意識24、道徳、伝統、信念25などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団26、ジェンダー、性自認27、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを忘れないように。 文化的能力28 文化的能力とは、個々人が自分の文化とは異なる文化との効果的かつ敬意をもった関わり方を学ぶ、 能動的プロセスである。 それは個人や集団、組織に関係するものであり、また学ぶことができるものである。 文化的能力に通常含まれること： • 自分の文化的慣行への自覚 • 異なる文化的慣行に関する知識 • 文化の違いに対するポジティブな姿勢 • 文化が人的交流へどのように影響を及ぼすかの理解 20 [原文] Preparing for diversity 21 [原文] diversity 22 [原文] culture 23 [原文] values 24 [原文] attitudes 25 [原文] beliefs 26 [原文] ethnicity 27 [原文] gender identity 28 [原文] cultural competence [訳注] 国際保健用語では「文化能力」とも訳される. 16 教習員の文化的能力 教習員は文化の違いを理解し、よさを分かるために必要な知識、技能、意識を必ず持つようにせ よ。これには他者の文化的な信念、ふるまい、ニーズを尊重し、受容することが含まれる。 WSTP 教習員が文化の違いを理解あるいは尊重しなければ、こうした違いは、誤解、失望、混乱、 困惑、怒り、侮蔑などを引き起こすことがある。 ありうる文化的留意事項 • 身体的接触：女性教習員が男性車椅子ユーザーを事前評価する、または男性教習員が女性車椅子 ユーザーを事前評価することは、文化的に不適切な場合がある。 • 服装：服装は、必ず文化的に適切であるようにせよ。 • コミュニケーション：文化によっては、直接聞かれない限り受講者が質問に答えない場合がある。 • アイコンタクト29：直接相手を見ながら話しかけることが、失礼に当たる場合がある。 • フィードバック：受講者が、人前で建設的な批判/フィードバックを与えたり受けたりする際に、 どこまでそれを受容できるか、よく気をつけよ。 • ジェンダー：文化によっては、男女がペアを組んで活動したり、いっしょに食事をしたりするの は不適切な場合がある。これは、グループ作業や休憩時間の組み方に影響しよう。 • 宗教的信念：現地の宗教的慣行、例えば祭礼、断食、礼拝などに合わせて、休憩時間の延長や、 開始/終了時間の変更が必要になる場合がある。 活動２：文化的能力 自分の文化とは違う文化を経験したときの例について考え、書き出しなさい。 それはどういうものでしたか？ 29 [原文] Eye contact 17 どう感じましたか？ その経験から何を学びましたか？ 車椅子ユーザーはじめ障害者の WSTP へのインクルージョン WSTP（車椅子サービス教習パッケージ）は、教習 チームへの、また受講者としての、車椅子ユーザー はじめ障害者のインクルージョンを推進している。 これが重要な理由は： • 車椅子ユーザーは、自分の体験や視点を活かして WSTP の学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子 サービスにおける車椅子ユーザーの中心的役割 を強化する。 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、差別・ 偏見とたたかい30、CRPD（障害者の権利に関する条約）の原則を強調するために役立つ。 30 [原文] combat stigma 18 車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁 車椅子ユーザーはじめ障害者の WSTP へのインクルージョンのために、WSTP 教習員は、障害者 の社会へのインクルージョンを阻むものは何か、必ず理解しておくべきである。 認識 人びとは障害についてよく知らないことが多いため、障害者に対して誤った思い込みを抱く。 • 多くの人は、障害者は家族、仕事、余暇、社会生活、個人生活に関して同じゴールや夢を持って いないか、それらを達成する能力がないと考える。 • 身体障害があることから、この人には認知障害もあると考え、その人を子ども扱いし、ゆっくり と、あるいは大声で話し、あるいは障害者に付き添っている人に話しかける。 意識31 障害者に対するネガティブな意識の例 • 障害者は、その機能障害ゆえに社会での価値は低いとする見方。 • 障害者を慈善の対象として恩を着せる32。 • 障害者を、よく知らないために、あるいは失言をやらかすのを恐れて忌避する。 • 家族、地域リーダー、学校などの機関が、障害児教育に低い価値を置く。障害者は、教育抜きに は機会が限られる。 信念 信念は意識と密接に関係し、また障壁もつくり上げる。例えば、機能障害がある人は、そのために 任務を達成できないと、実際はできるにもかかわらず信じることなど。 31 [原文] Attitudes 32 [原文] Patronizing 19 文化 文化的信念、規範、価値観も障壁をつくり上げる。文化によっては、障害者は祟られていると信じ、 そのけっか障害者が地域や家族から閉め出され、引きこもり隠れてしまう場合もある。 ステレオタイプ33 これらは障害者を、自分自身の関心や技能を持ち社会に貢献する個人として認識しないネガティブ な見方である。 法令および政策 障害者の権利を保護する法令や政策は、あっても執行されないことが多い。例えば、国によっては 一定枠の障害者を雇用することを要件とするか、被雇用者への合理的配慮を規定した雇用法制を 持っている。強制力を伴わなければ、こうした法律や政策は効果を発揮しない。 環境の障壁 物理的な障壁は障害者の参加や統合への制約になる。屋外生活でのそうした例は傾斜、砂、草、川 などで、また屋内での移動や自立には階段、狭い戸口、家具、カーペットなどが妨げになる。 支援機器の欠如 これはインクルージョンへの大きな障壁の一つで、WSTP（車椅子サービス教習パッケージ）は、 CRPD（障害者の権利に関する条約）に沿って適正な車椅子の入手しやすさを改善する取り組みの 一つである。 33 [原文] Stereotypes 20 ToT.5 成人学習34 効果的な教習員となるためには、大人にとって最良の学び方を理解し、さまざまな学習スタイルに ついて知ることが重要である。 活動１：成人学習の原則 これまでの、自分のポジティブな学習経験について考え、その経験がどのようにポジティブだった のか書き出しなさい。 下欄を用い、活動中に考えたことを書き出しなさい。 ポジティブな学習経験 34 [原文] adult learning 21 活動２：自分の選好学習スタイル35を判定する 自分の学び方を反映している文にマルを付けなさい A. ステップバイステップの指導に従って B. 新しいものごとを経験することによって C. 間違えることによって D. 推論によって E. 教わった内容の理論を理解することによって F. 学んだことを適用することによって G. 自分の経験を当てはめることによって H. 動画を視聴することによって I. 選択肢を評価することによって J. 自分の感覚に依拠することによって K. 人と交流することによって L. 人がやって見せるのを見まもることによって M. 感受することによって N. 大局を分かる36ことによって O. そばに付いて見まもることによって P. やり方の説明を傾聴することによって Q. そのトピックについて書かれたものを調べることによって R. 人と関わり合うことによって S. 学んでいる内容を試してみることによって T. ものごとの一般的原理を理解することによって U. 講義に参加することによって V. 実体験を通して W. 自分の観察に頼ることによって X. ものごとに個人的に関わることによって Y. ものごとに対する自分の感じ方を探ることによって Z. 活動的になることによって AA. 教習員を観察することによって BB. 実験によって 35 [原文] preferred learning style [訳注]「選好する/好みの学習スタイル」の意. 36 [原文] seeing the big picture 22 選好学習スタイル集計表 質問表に付けたものと同じ記号をマルで囲みなさい。マルで囲んだ記号が最も多い列が、自分の 選好学習スタイルになります。 複数列が同数だった場合、それは強いこだわりがないということです。 経験によって 観察によって 思考によって 実行によって B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB 合計： 合計： 合計： 合計： 学習経験サイクル37 選好される学びの 4 つのスタイル： 1. 経験による学び 2. 観察/感受による学び 3. 思考/理解による学び 4. 実行/適用による学び 4 つの学習スタイルは、学習経験サイクルと一致する。 スタイルは人によってさまざまでも、新しい知識や技能を学ぶには、この 4 つの段階のそれぞれを 経るのが最も効果的である。 37 [原文] Experiential learning cycle 23 WSTP には、全受講者の参加を得るため、学びの 4 段階/種類をそれぞれ含めている。 • ロールプレイングやシミュレーションは、経験から最もよく学ぶ人に最適である。 • 観察から最もよく学ぶ人には、デモ、動画、教習員や車椅子ユーザーを視るのが最も有益である。 • 概念を論じ、枠組みや定義、理論をもたらす発表や読み物は、大局的に考え、理解することから 最もよく学ぶ人に役立つ。 • 車椅子ユーザーとの実習（基礎 WSTP や中級 WSTP などの）は、理論的な説明を適用するので、 実行によって学ぶ人に最適である。 グループの話し合い、ケーススタディ、質疑応答、ワークブックの課題、フィードバック時間は すべて、異なる学習スタイルにアピールする授業方法なので、それらの目的、および各場面に適合 する活用方法をよく考える必要がある。 教習員自身にも、自分の選好スタイルがある。重要なことは、それを認識していることと、特定の アプローチをおろそかにしないよう気をつけることである。 どの段階も飛ばさないように！ 「経験」の部分が欠けると何が起こるか？学びが実生活との接点を失い、受講者個人の経験に根を 下ろさない、抽象的なものになる。 「観察」の部分が欠けると何が起こるか？学習者が、自分の個人的経験がより広い抽象的な概念や 枠組みとどう結びついているのか、探求したり確かめたりできなくなる。 「思考」の部分が欠けると何が起こるか？学習者はある経験から別の経験へ、それらどうしの関連 を分からないまま進むことになる。そうした人は、経験を有意義なやり方で整理するために役立つ 枠組みから得るものがない。 「実行（練習）」の部分が欠けると何が起こるか？学習者は、理論や枠組みを職場や自分の生活に 適用するやり方を見出すことがない。 24 活動３：学習への選好と活動をマッチさせる この教習活動はこの人の学習スタイルに最も効果的、と思う人の名前の下に「X」を付けなさい。 最後の列には、比較として自分自身のスタイルについて記入しなさい。 • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解することによって最もよく学びます。 カ ル ロ ス ミ リ ア ム シ ー タ ア フ マ ド 自 分 自 身 1. 車椅子ユーザー教習の練習としてロールプレイングを 行なう 2. 教習員が新規車椅子ユーザーへの身体計測のやり方を 示すところを観察する 3. 自国の車椅子サービスに関する、法律や規制についての 政府職員の発表に出席する 4. 車椅子に乗っている人がやりたいことを実行している のを観察する 5. 車椅子サービスに関連する重要文書について学習する 6. 他の受講者と、フォローアップをユーザーの家で行なう ことの長所と短所について話し合う 7. CRPD（障害者の権利に関する条約）の最も重要な条文 に関する、教習員の説明を聴く 8. 除圧クッションをつくる 9. 車椅子で走り、車椅子ユーザーが経験する障壁を体感 する 10. 教習員が事前評価を実施する様子を観察する 11. 新規車椅子ユーザーに対する事前評価インタビューを 実施する 12. 車椅子サービス事業を既存のリハビリテーション サービスに追加することによる費用節減を算定する 25 成人学習を支援する だれにも選好学習スタイルがある一方、あらゆる大人の学習者に ついての共通項もある。 大人の学習者は主体的38で自分の学習に責任を持つため、積極的 参加を促すことで支援せよ。 大人の学習者は、学びに自分自身の知識や経験をもたらすため、 その経験を他者と共有し、また他者から学ぶよう奨励せよ。 大人の学習者は、関連が明らかで実践的な39学びを求め、学んだことを適用したいと望む。業務へ 実際に適用できる、明確な学習目標を置くことで支援せよ。 活動４：問題解決40 「問題解決」とは、問題に対して最適解を見出すプロセスのことです。 これは成人学習の重要部分で、車椅子サービス供与における重要技能です。 受講者が問題解決を行ない、自分自身の解決策を見出すには、どう手伝えばよいでしょうか？ 38 [原文] self-directed 39 [原文] relevant and practical 40 [原文] problem solving 26 受講者の問題解決を助ける • オープンクエスチョン41（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ42：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のために 教習を訪れた、個々のユーザーについて話せ。 • 「分かりません」で答えを終わらせるな43：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ44：課題を個別のステップに分解し、ステップバイステップに45質問し、 問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的46に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 留意事項 • 車椅子供与教習（基礎 WSTP・中級 WSTP）の受講者には、単純な答えがない場合もある。 • 臨床場面では、処方や改造、姿勢支持具が、技術的にはよい解決策であっても、機能的な障壁や 制約をこしらえてしまう場合もある。 • 完璧な解決策は、たいてい一つではないことを認識せよ。車椅子サービス供与には、顧客ニーズ と手に入る製品の範囲との間での妥協が求められる。 41 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 42 [原文] Ask rather than tell 43 [原文] Don’t take ‘I don’t know’ for an answer 44 [原文] One step at a time 45 [原文] step-by-step 46 [原文] laterally 27 ToT.6 準備時間について 準備時間は、ToT の時間割に盛り込まれている。この時間は、以下のことに活用できる： • 「保留スペース」の質問に答える。 • ToT 教習員と面談し： o 質問する。 o フィードバックをもらう。 • 自分の模擬授業を準備する： o 教習員仲間を調整する。 o デモ用資材や視聴覚機器を準備する。 28 ToT.7 プレゼンテーション47とファシリテーション48 活動１：教習員のふるまい49 過去に自分が教習を受けた人を思い出し、だれが効果的な教習員だったと思われるか特定しなさい。 それは、学ぶべきことを学べるようにし、ポジティブで価値ある経験をもたらした人です。 下欄に自分の経験を振り返りなさい。 その人のどんなふるまいが効果的でしたか？ 47 [原文] presenting [訳注] 意味は p.29 本文を参照. 48 [原文] facilitating [訳注] 適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 49 [原文] behaviour 29 プレゼンテーションとファシリテーション プレゼンテーションとは、受講者が情報を与えら れる、一方通行のプロセスである。プレゼンテーシ ョンでは情報、事実、数字を提供し、誤情報を訂正 する。 事実、理論、枠組みのプレゼンテーションを行なう 際には、対象者がその情報を知らないか、思い出す 必要があるという前提でのぞむ。したがって全受 講者は、たとえその情報をすでに知っている人が いても同様に扱われる。 ファシリテーションとは「ものごとを容易にする」という意味である。ファシリテーションを 行なうのは、受講者にとり、以下が容易になる場合である： • 理論的概念と現実の課題や任務との結びつきを理解する。 • 自分自身の経験を振り返る。 • 自分自身の経験や見方を、新しい情報と結びつける。 プレゼンテーションとファシリテーションの優れた実践 プレゼンテーション： • 話のペースやトーンに変化をつけよ。 • 教室内の自分の立ち位置に注意し、変化をつけよ。 • 質問し、励ましてグループに貢献を促せ。 • 試験済みで時間が設定されている、WSTP「教習員用指導書」の指示にならうこと。 • 映しているスライドが、話している内容と一致していることを確かめよ。スライドは「教習員用 指導書」と同期させよ。 • スライドを読む時、グループに背を向けてはならない。 ファシリテーション： • 活動は授業前にやってみること。そうすると活動の目的がわかる。 • 自分で考える間 [ま]50を与えよ。沈黙をおそれるな。 • 受講者からの質問は、自分で答える前にグループへ問いかけよ。 • 受講者には明確な指示を出し、自分自身がその指示を理解しているか授業前に確かめておけ。 • 受講者をモニターし、授業の要点を学んでいるか確かめよ。 50 [原文] time and space to think 30 エナジャイザー(51) どんな教習の中でも、活力レベルが落ちてくる時間はあるものだ。暑い気候、空気のよどんだ部屋、 豪華な昼食、教習の長い一日からの疲れは、注意を散漫にし、グループの活力を落ち込ませる。 これに対処する最善策は、みなが気軽に動いて交流する機会を設けることにより、教室へ活発さや 楽しさを注入することである。 これは活気をもたらすための、教習の一環としても、単独の活動によっても達成できる。以下は、 いくつかのアイデアである。 教習の一環として： • グループ全体へひんぱんに質問し、一人を指名して答えてもらう。 • 受講者に、隣どうし顔を合わせて質問やトピックへの答えを話し合ったり、出たばかりの意見に 対して異なる意見を探ったりしてもらう。 • 受講者に、立ち上がって何か（車椅子やポスター、フリップチャート、デモ）を見に来てもらう。 • 可能であれば、気分転換や運動をもたらすため、授業を他の部屋や屋外へ移動して行なう。 単独の活動として： • いっしょに歌う。 • 立ち上がって簡単なストレッチ体操を行なう。 • 「サイモンが言った52」で遊ぶ：指示を出し（「跳び上がれ」、「つま先に触れ」、「空を指させ」、 「振り返れ」など）、受講者は、指示が「サイモンが言った」で始まった時だけ、それに従わねば ならない。 • 3 分間ストレッチを行ない、休憩する。 • 受講者のひとり、あるいはグループをよび、2〜3 分、エナジャイザー活動を指揮してもらう。 かれらは、グループ全体で共有できる、別の現地に合った活動を知っているだろう。 51 With thanks to Robert Chambers for some of them [感謝: このいくつかはロバート・チェンバースに 負っている]. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 (https://www.routledge.com/Participatory-Workshops-A- Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). [原文] Energizers 52 [原文] Simon says [訳注] 日本の「船長さんの命令」と同じルールで行なわれるゲーム. 詳細は例えば (https:// yamatoco.theblog.me/posts/4946847/, 2023 年 7 月 1 日アクセス済) などを参照. 31 留意事項： • 文化、ジェンダー、障害による違いを認識し、また敏感であれ。 • 受講者ができない、あるいはやりたくないことは、いっさい強制するな。 • ゆっくりと始め、より元気のある活動へと盛り上げよ。 • 可能な時は、自分も参加せよ。 • 楽しんで！ 時間管理 教習員は、必ず教習が時間通り進むようにすべきである。数多くの授業や活動がある一方、それら を完了するための時間は限られている。持てる時間を最大限に利用するには、行動や活動の修正が しばしば必要になる。 活動２：時間管理 ペアを組んで話し合いなさい：教習が時間通り進むためには、どうしたらよいでしょうか？ 思いついたことを書き出しなさい： 32 教習を予定通りに保つための提案 • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者を 待たせて不利益を負わせるな53。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTP に資料やあまりにも多くの実例 を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留54」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば、「15 分休憩、10:45 には戻って下さい」 「自分のグループでの話し合いに 10 分、フィードバックに 5 分使えます」 • 教習員仲間55と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には予備計画56を立てておけ。例えば、雨で車椅子の移動技能 の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 53 [原文] avoid penalizing 54 [原文] Park 55 [原文] co-trainers 56 [原文] back-up plan [訳注]「プラン B」とも呼ばれる. 33 ToT.8 コミュニケーションスキル 活動１：コミュニケーションスキル 下表のうち、自分のグループに割り当てられた情報を読みなさい。続いて他の実習生がその要点を 把握できる発表を作成しなさい。 グループで作業し、情報をどのようにプレゼンテーションし、だれがどの部分をプレゼンテーション するか決めなさい。発表には、グループ全員が参加しなさい。フリップチャートやホワイトボード などの小道具は、自由に用いてかまいません。発表では、創造性を発揮しなさい。 準備には 20 分使えます。皆への発表時間は 5 分あります。 グループ１：言語的技能： • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語57や「無意味な語58」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な59ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 57 [原文] slang 58 [原文] ‘non-speak’ 59 [原文] simple and non-medical 34 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 自分のボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える60な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン61（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 60 [原文] jump to answer 61 [原文] closed questions 35 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ62（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば、「あなたはどう思い ますか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論63 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな64。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴65：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・動画・通訳について 以下は教習でデモを行ない、動画を上映し、外国語と手話、両方の通訳を用いる場合の優れた実践 である。 デモを行なう： デモを行なう際には： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 62 [原文] challenge 63 [原文] clinical reasoning 64 [原文] Never make up an answer if you do not know. 65 [原文] Listen 36 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎 WSTP と中級 WSTP のデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 動画を用いる： WSTP では、ほとんどの実技のデモに動画を用いている。動画を上映する前に： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や手話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1 部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2 倍時間を要する。 37 ToT.9 指針文書66の知識 「指針文書」とは何か？ 指針文書とは、出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、 規則を与え、また車椅子サービス供与関係者の指針となるものである。 多くの政府、国際機関、資金供与者67その他の関係者は、これらの国際的枠組みに沿って開発事業 を計画し、資金を供与する。 これらについての知識があれば、より強い立ち位置から、車椅子サービス供与に向けた啓発や政策 提言を行なえる。 国や地域の法令および政策は、現地の車椅子サービス供与に影響を及ぼす。話し合いを導くうえで、 そうした文書は熟知しておく必要がある。 次節からは、車椅子サービス供与に関係するさまざまな指針文書を概観する。そのいくつかは WSTP 用 USB メモリ68に収めており、その他はインターネット上でアクセスできる。 「国際連合 障害者の権利に関する条約 (CRPD)」 「国際連合 障害者の権利に関する条約」は一般に「CRPD」、 時に「UNCRPD」とも呼ばれる69。CRPD は障害者に関する最も 重要な国際条約だと広く考えられている。 2008 年に発効し、発効日には 82 か国が CRPD に署名、その選択 議定書に 44 か国が署名した。 これは国連の条約中、発効日の署名国数では史上最多である。 CRPD は、障害者への社会の見方と処遇のあり方を変革するため、国際社会の代表者によって策定 された。 この条約の策定に参画した代表者は障害者、政府当局者、非政府組織（NGO）の代表などである。 66 [原文] guiding documents 67 [原文] donors 68 [原文] WSTP Pen Drive [訳注] 英語版のみが WHO より配布されている. 各資料の日本語版入手先は訳注を参照. 特に指定していないものは, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 69 [訳注] 日本では「障害者権利条約」と略されることも多い. 38 CRPD が重要である理由は、障害者が他のあらゆる人びとと同じ権利と機会へアクセスできるよう になるためのツールだからである。 年々、ますます多くの国ぐにが CRPD に署名している。CRPD およびその選択議定書への署名国に 関する最新情報は、国際連合のウェブサイト(70)上で確認できる。 CRPD には車椅子サービス供与に関連するいくつもの条文がある： 最も関連がある こちらも関連がある • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション71および リハビリテーション • 32条：国際協力 • 19条：自立生活および地域社会への インクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30 条：文化的生活・レクリエーション・ 余暇・スポーツへの参加 CRPD の他の多くの条文が、間接的に車椅子サービス供与と関連している。例えば、第 6 条は女性 障害者の具体的なインクルージョン、第 7 条は子どもの平等に関わる。 70 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 71 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 39 子どもや女性がさらにぶつかる障壁には何があるだろうか？ • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持72を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉73を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 WSTP 受講者が CRPD を熟知していることは重要： • CRPD の人権に基づくアプローチを、障害者への車椅子サービス供与の発展に役立つように活用 するため。 • CRPD の条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえで 役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 72 [原文] supportive seating 73 [原文] stigma 40 主要条文の詳細： 第 4 条 第 4 条 一般的義務 によると締約国は： 障害に基づくいかなる種類の差別もない、すべての障害者のあらゆる人権および基本的自由の完 全な実現を保証し、また促進することを約束する。 第 4 条 (g)項によると： 障害者に適した、情報通信技術、移動補助具、支援機器、支援技術などの新技術について、研究 開発を実行または推進し、またその入手しやすさと利用とを増進し、そこでは価格に無理のない 技術を優先する。 同 (h)項によると： 障害者へ、新技術を含む移動補助具、支援機器、支援技術についての利用しやすい情報を、他の 形態の支援、支援サービス、施設と並んで供する。 同 (i)項によると： この条約が認める権利について障害者と協働する専門家および職員への研修を推進し、それらの 諸権利が保証する支援およびサービスが、よりよく供されるようにする。 第 20 条 第 20 条 個人的移動性 は車椅子サービス供与に最も関連する条文である。これの要件は： 締約国は、最大限に自立した個人的移動を障害者へ保証するための実効ある施策を講じ、以下の ことなどを行なう： (a) 障害者の、自分が選んだ方法で、自分が選んだ時に、無理のない費用で行なう個人的移動を 容易にする。 (b) 質の高い移動補助具、補装具、支援技術、人や動物による支援、仲介サービスを、障害者が 利用しやすくなるようにし、とりわけ無理のない費用でこれらが手に入るようにする。 (c) 障害者、および障害者と協働する専門職員に対して、移動技能の教習を提供する。 (d) 移動補助具、補装具、支援技術の生産に当たる事業体が、障害者の移動についてのあらゆる 側面を考慮するよう奨励する。 41 第 26 条 第 26 条 ハビリテーションおよびリハビリテーション に含まれる要件： 締約国は、障害者のために設計された支援機器および支援技術について、ハビリテーション およびリハビリテーションと連携するので、それらの入手しやすさ、知識、利用を増進する。 「ハビリテーション」と「リハビリテーション 」の定義： • リハビリテーションの言葉はよく知られているが、ハビリテーションはあまり使われない。 • リハビリテーションの重点は能力を回復することで、いっぽうハビリテーションは新規に能力 を習得し、構築することに関わる。 第 32 条 第 32 条は、例えば支援技術の利用促進などの国際協力を推進することから、広い意味で車椅子 サービス供与に関連する。 42 WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」 WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の 克服に向けて (車椅子ガイドライン)74」は、車椅子供与に焦点を 置いた、最も重要な国際的文書である。 「車椅子ガイドライン」は、現在世界的に理解されている適正な 車椅子供与枠組みをまとめたものである。「車椅子ガイドライン」 の発行以前、車椅子供与に関わる諸組織は、車椅子の設計や生産； サービス提供システムの確立；職員教習；車椅子供与に関連する 政策策定に当たり考慮すべき重要事項は何か、共通理解を持って いなかった。 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画により作成された。これは合意 された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子サービスの政策 提言のために役立つ、強力なツールとなる。「車椅子ガイドライン」は、低・中・高リソース状況で 普遍的に達成可能な基準を反映している。 車椅子が適正であるとは： ✓ ユーザーのニーズおよび環境条件に合い、 ✓ 適切にフィットして姿勢を支え、 ✓ 安全で耐久性があり、 ✓ 国内に用意され、 ✓ 入手・メンテナンス・継続したサービスが国内で、無理のない価格で可能 であること。 これは、教習員および WSTP 受講者が知っておくべき重要な定義である。 74 [訳注] これに加え, 2023 年 6 月に WHO から「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024 年に発行予定. 43 「車椅子ガイドライン」では、車椅子に関する以下の項目も 取り上げている： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 WSTP 教習員の、「車椅子ガイドライン」に関する知識は、 包括的でなければならない。教習員として、機会あるごとに その意識を喚起すること。 「車椅子ガイドライン」は、WHO のウェブサイトで各言語版75を入手できる。 「低リソース状況での移動支援機器供与に関する共同方針提言書」 WHO の「低リソース状況での移動支援機器供与に関する共同 方針提言書(76)」は、各国が CRPD の移動支援機器供与関連の 条文を履行できるよう、2011 年に発行された。 この文書は、移動支援機器へのアクセスに対する障壁、移動支援 機器へのアクセスを増やすための要件、各国および国際的な関係 者への提言などの貴重な情報を提供する。 75 (https://www.who.int/publications/i/item/9789241547482). [訳注] フランス語・スペイン語を含む. (https://apps.who.int/iris/handle/10665/43960). [訳注] 日本語・ベトナム語を含む. 76 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) re lated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URL および https://j-aws.jp/who/). 44 「地域に根ざしたリハビリテーション：CBR ガイドライン」 WHO の「地域に根ざしたリハビリテーション：CBR ガイドライ ン(77)」は 2010 年に発表され、CBR78への世界共通の理解および 取り組みを提示したものである。 CBR は、低リソース状況における障害者のリハビリテーションへ のアクセスを、地域リソースの最適な活用によって改善するため の方策である。「CBR ガイドライン」は行動への枠組みを提供し、 実施への実践的な提案を示している。 「CBR ガイドライン」の導入ブックレットと保健コンポーネント は WSTP 用 USB メモリに資料として収められている79が、WSTP で特に触れてはいない。 CBR は 90 超の国ぐにで実施され、CRPD の条文を実現する最も 効果的な方法の一つだと、ますます考えられるようになっている ため、「CBR ガイドライン」についてよく知るよう推奨する。 CBR はしばしば「地域に根ざしたインクルーシブ開発 (CBID)80」とも呼ばれ、WSTP でも話題に 上る可能性が高い。CBR の多くの側面が車椅子サービス供与に関連しており、例えば、紹介・相談 ネットワーク、地域の保健センター、CBR ワーカーなどがある。 77 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBR ガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 78 [訳注] Community-based rehabilitation の略称. 79 [訳注] 英語版のみ. ウェブ上で入手する場合は例えば: 日本語版 (公益財団法人日本障害者リハビリテーション協 会訳) https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html その他各言語版：https://www.wh o.int/publications/i/item/9789241548052 80 [原文] community-based inclusive development 45 CBR マトリックス CBR マトリックス(81)は「CBR ガイドライン」の土台の一つである。その 5 つの領域82として保健、 教育、生計83、社会、能力強化 (エンパワーメント)84があり、さらにマトリックスの各領域は５つ ずつの要素85を含むため、合計で 25 要素がある。 81 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 82 [原文] components 83 [原文] Livelihood 84 [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_security/human_security_ap proach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと考え併記した. 85 [原文] elements 46 活動１：CBR マトリックス グループで作業し、車椅子サービス供与が CBR マトリックスの自分たちに割り当てられた領域 （保健、教育、生計、社会、能力強化（エンパワーメント））に、どう関連するか列記しなさい。 さらに詳しい情報および「CBR ガイドライン」全文は、WHO のウェブサイト(86)を参照。 86 (http://www.who.int/disabilities/cbr/guidelines/en/). 47 車椅子サービス供与と CBR の 5 領域 保健 教育 • リハビリテーション：長期および短期の • 健康増進や二次障害予防：例えば早期発見 と早期介入による側弯や褥瘡の予防 • 保健医療サービスへのアクセス • 学校、教育プログラム、職業訓練プログラムへ のアクセスを可能にする 社会 • 社会およびレクリエーション活動へのアクセス 増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス エンパワーメント • 自己イメージや自信の向上 • ピアサポート（当事者支援） 「アクセシビリティのためのデザインの留意事項」 「アクセシビリティのためのデザインの留意事項(87)」は、車椅子 サービスを訪れる場合およびその他の環境の両方で、アクセスが あらゆる面について考慮されるようにする方法に関する、有益な 情報をもたらす。ここで取り上げているのは： • 障害者用保留スペース • 切り下げ縁石 • 通り道 • スロープ • 階段 • 手すり • ドアおよび戸口 • 廊下 • トイレ 87 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled Pe ople; 2006 (http://ascon.info/publications/accessibility.pdf). 48 「持続可能な開発目標（SDGs）」 「持続可能な開発目標 (SDGs)(88)」は、2015 年 9 月、歴史的な 「国連サミット」で世界の指導者たちが採択し、2016 年 1 月 1 日 に発効した。続く 15 年にわたり、各国は持続可能な開発の 3 つ の側面（環境、経済、社会）すべてに努力を結集し、17 のゴール を達成すべく尽力する。 SDGs は、2015 年に最終報告書を出した「ミレニアム開発目標 (MDGs)89」を継承するもので、2012 年の「国連持続可能な開発 会議 (リオ+20)」で始まった共同開発プロセスの成果である。 WSTP モジュールの開発は SDGs の発表前だったため、教習パッケージではそれに触れていない。 しかし、政府、開発・援助機関の多くが SDGs への取り組みに集中するため、実習生や受講者が、 それを意識して適正な車椅子サービス供与が SDG の課題90にどう適合するか見極めることは重要 である。 SDGs は 17 のゴールと関連する 169 のターゲットからなる。 SDGs 宣言の第 4 パラグラフでは、重要な誓約がなされている： この偉大なる共同の旅へ乗り出すにあたって、我われはだれひとり取り残さないことを誓う。 我われは、人間の尊厳は根本をなすものであると認識し、この目標とターゲットとがあらゆる 国ぐにと人びと、そして社会のあらゆる部分で満たされるよう希願する。そして我われは、 その最後に取り残されたものへ、最初に手を差し伸べるべく尽力する。 障害者への言及は、そこなわれやすい91人びとに関する第 23 パラグラフにも盛り込まれている： そこなわれやすい人びとは、必ず力づけられるべきである。そのニーズが課題に反映されている 人びとには、すべての子ども、若者、（その 80%超が貧困のうちに暮らしている）障害者、 HIV/AIDS と共に生きる人びと、高齢者、先住民、難民および国内避難民、移民などがある。 我われは、複合的な人道的危機に見舞われた地域や、テロリズムに襲われた地域に住む人びとの 障壁や束縛を取り除き、支援を強化し、特別なニーズを満たすべく、国際法にのっとり、さらに 効果的な措置と行動をとることを決意する。 88 The sustainable development goals [website]. New York: United Nations (http://www.un.org/su stainabledevelopment/sustainable-development-goals/). 89 [原文] Millennium Development Goals [訳注] 2015 年までに 8 目標・21 ターゲットの達成を掲げた. 90 [原文] agenda [訳注] 日本語でも, そのまま「アジェンダ」と呼ばれることも多い. 91 [原文] vulnerable populations 49 障害と SDGs ゴール 4：すべての人に、インクルーシブで公正な質の高い教育と 生涯学習機会を保証するため、教育におけるジェンダー格差を取りのぞ き、障害者などそこなわれやすい人びとへの、あらゆる水準の教育と職 業訓練への平等なアクセスを保証することに重点を置く。さらに提案書 では、子ども、障害、ジェンダーに配慮して教育施設を建設または改装 し、すべての人に安全で、非暴力的で、インクルーシブかつ効果的な学 習環境をもたらすよう求めている。 ゴール 8：継続的でインクルーシブかつ持続可能な経済成長、および、す べての人の完全かつ生産的な雇用と真っ当な仕事92を促進するため、国 際社会は障害者を含むすべての男女の完全かつ生産的な雇用および 真っ当な仕事、および等価値の仕事への平等な賃金93の達成をめざす。 ゴール 10：障害者を含むすべての人の能力強化（エンパワーメント） および社会・経済・政治的インクルージョンの推進により、各国内 および各国間の不平等を縮小すべく尽力する。 92 [原文] decent work 93 [原文] equal pay for work of equal value 50 ゴール 11：インクルーシブ、安全、強靭94で持続可能な、まちと住み場 づくりをめざす。このゴールの実現のため締約国に求められることは、 とりわけ障害者などそこなわれやすい人びとのニーズに特に配慮した 公共交通の拡大を通じた交通安全の向上により、安全で、料金に無理が なく、利用しやすい、持続可能な交通システムへのアクセスをすべての 人にもたらすことである。加えて提案書では、特に障害者にとり、安全 かつインクルーシブで利用しやすい緑地と公共スペースへのユニバー サルアクセスを求めている。 ゴール 17：持続可能な開発に向けた実施手段を強化し、グローバルな連 携を活性化するには、SDGs に関するデータ収集、モニタリングと 説明責任が極めて重要だと強調している。締約国には後発開発途上国95 や小島嶼開発途上国96など開発途上国への力量構築97支援が求められ、 それは質が高くタイムリーで信頼でき、さらに障害別にも分類された データの入手可能性を、著しく向上させる。 SDGs に関するさらに詳しい情報は、国際連合のウェブサイト(98)を参照。 「支援技術に関する世界協力（GATE）」 WHO の推計では現在 10 億超の人が 1 つ以上の支援製品、例えば 車椅子、補聴器、歩行器、眼鏡、ピルケース、コミュニケーション ボード99などを必要としている。 世界的な人口高齢化および非感染性疾患の増加に伴い、WHO の 予測では、この数は 2050 年までに 20 億人を超え、多くの高齢者 には、加齢に伴い複数の製品が必要になる。 94 [原文] resilient 95 [原文] least developed countries 96 [原文] small island developing states 97 [原文] capacity-building 98 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 99 [原文] communication board 51 支援製品には、教育や生計手段へのアクセスを可能にし、自立を維持し、世界とつながるうえで 極めて重要な役割がある。しかし現在、製品を必要とする人のうち、アクセスできるのは 10 人に ひとりに過ぎず、製品がなければ社会参加から排除され、孤立し、貧困のうちに閉じ込められる。 WHO は、この巨大で満たされざる世界規模のニーズ100に応え、CRPD 第 32 条を実現するため、 GATE の取り組みを調整している。GATE が取り組むゴールは一つだけである。それは、高品質で 価格に無理のない支援製品へのアクセスを、全世界で向上させることである。これを達成するため、 GATE は、製品、人材、供与、政策という 4 つの相互連関する行動領域に重点を置いている。 「WHO 必須医薬品範例リスト101」の先例にならい、GATE が最優先で作成したのが「WHO 優先 的支援製品リスト (APL)(102)」である。APL には、世界中で最も必要とされる 50 の支援製品を収 めている。そこには、4 種類の車椅子、除圧クッション、可搬式スロープ、またその他の移動性、 聴覚、認知、コミュニケーション、視覚を向上させる製品が含まれる。 APL は制約を与えるリストではなく、締約国が、現地のニーズと利用可能なリソースに沿った国内 向け APL を作成するたたき台103の提供が目的である。そこに込められた期待は、現地の関係者が、 アクセス増大への努力を相乗させるための結集点となることである。 GATE が現在取り組んでいるのは、APL 実施の支援ツール、例えばニーズ評価ツールキット、教習 パッケージ、政策枠組み、サービス供与モデルなどの開発である。 GATE に関するさらに詳しい情報は、WHO のウェブサイト(104)を参照。 100 [原文] huge and unmet global need 101 [原文] WHO Model List of Essential Medicines 102 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/implementation/assistive_technology/global_survey-apl/en/). 103 [原文] blueprint 104 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 52 「障害に関する世界報告書」 2011 年、WHO と世界銀行が共同作成した、初の「障害に関する 世界報告書(105)」が発行された。 報告書によれば、障害者は障害がない人に比べ、総じて健康状態 が悪く、教育水準が低く、経済的機会に乏しく、貧困率が高い。 これは障害者が利用できるサービスの欠如と、障害者が日常生活 でぶつかる多くの障壁によるところが大きい。 この報告書は、保健医療・リハビリテーション・教育・雇用・支援サービスへの障壁を克服する 方途に関する、エビデンスに基づく提言を与えている。また、障害者が活躍できる支援的な環境を つくり出すうえで、何が有効かを明らかにしている。 「障害に関する世界報告書」は以下の障壁を強調している： • 不適切な政策や基準 • ネガティブな意識 • サービス供与の欠如 • サービス提供における問題 • 不十分な資金 • アクセスの欠如 • 協議と参画の欠如 • データとエビデンスの欠如 これらはすべて車椅子サービス供与に関連するため、本書は有用な背景文書106である。この報告書 の提言 2「障害者のための特別なプログラムやサービスに投資すること」では、車椅子の重要性に 言及している： 車椅子や補聴器などの支援技術を含むリハビリテーションは、機能と自立を向上させる。地域の さまざまな調整が行き届いた補助および支援サービスはケアへのニーズを満たし、人びとが自立 して暮らし、経済・社会・文化的生活に参加できるようにする。 105 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/en/). 106 [原文] background document 53 本報告書の、要約および提言は WHO のウェブサイト(107)を参照。 「WHO 世界障害者行動計画」 「WHO 世界障害者行動計画 2014-2021(108)」は、「障害に関する 世界報告書」の提言に基づき、また CRPD に沿ったものである。 これは締約国、国連諸機関、障害者団体などの国内および国際的 パートナーとの協議を経て作成された。 この計画は、障害者と障害がない人との格差への対処を目指して いる。これによると、世界中で障害者は、障害がない人に比べて 必要とする保健医療を受けておらず、健康状態が悪い。障害者は、 2 倍超の確率で技能や施設が不十分な保健医療供与者に当たり、 3 倍近くの確率で保健医療を拒絶され、4 倍の確率で劣悪な処置 を受ける。 行動計画の 3 つの目標： • 障壁を取り除き、保健サービス・プログラムへのアクセスを向上させる • リハビリテーション、ハビリテーション、支援技術、援助および支援サービス、地域に根ざした リハビリテーションを強化し拡張する • 障害に関する、妥当かつ国際的に比較可能なデータ収集を強化し、障害や関連サービスの研究を 支援する。 締約国は、提案された行動を国の優先事項および状況に合わせて調整し、実施するよう要請されて いる。 全文は、WHO のウェブサイト(109)を参照。 107 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.wh o.int/iris/bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) [日本語訳 (概要): 障害に関する世界報告書, 国立障害者リハビリテーションセンター訳 (https://ww w.dinf.ne.jp/doc/japanese/intl/un/wrod_sum_jp.html)]. 108 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 109 (http://www.who.int/disabilities/actionplan/en/). 54 「障害と開発に関する国連総会高級事務レベル会合」 2013 年 9 月 23 日、国連総会高級事務レベル会合(110)が障害に関して 「前進への道：2015 年以降に向けた障害インクルーシブな開発実施 計画」という主題のもとに、一日開催された。 参加者は、締約国、オブザーバー、国連の代表者、また市民社会、 障害者団体、民間セクターの代表者などであった。 この会合の「成果文書」では、(a)から(q)までの誓約を列記している。 誓約(h)： ユニバーサルデザインの手法に従い、物理的環境、交通、雇用、教育、保健、サービス、情報、 情報通信技術はじめ支援機器に対する障壁を取り除き、遠隔地や農村地域においても、障害者が その全生涯にわたって最大限の可能性を実現するための、アクセスしやすさを保証する。 この会合の背景および成果を伝える冊子は、国際連合のウェブサイト(111)を参照。 110 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 111 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 55 ToT.10 視聴覚ツールおよび機材 教習員が、さまざまな視聴覚機材の使用に精通し自信を持つことは、教習授業を円滑に進めるうえ で重要である。 パワーポイント (PPT) と PDF WSTP のプレゼンテーションは、パワーポイントと PDF 両方の形式が用意されている。各形式の 利点と難点を下表にまとめた。 利点 難点 PPT • パワーポイントは個々のプレゼンテー ションスタイルに合わせて、また現地 の状況に当てはまるように変更可能。 • テキストの削減/簡略化が可能。 • 新しい内容や話し合いでの質問を押さ えたスライドの追加が可能。これは、 グループが異なる言語や方言を話す、 あるいは教習員の訛りを聞き取れない 場合に有効。 • コンピューターのスクリーンセーバー は、プレゼンテーションが「スライド ショー」モードであれば起動しない。 • 動画は自分で読み込む必要がある。 • ファイル全体のサイズは大きくなる。 • パワーポイントのファイル編集には、 時間を要する。 PDF • この PDF は、4種の動画形式すべて にリンクしている。望む形式をクリッ クすれば、動画を再生する。 • フォーマットや互換性について、問題 ないことが確認済み。 • ファイルサイズは、編集可能なものに 比べ小さい。 • 内容は固定され、現地事情や、自分の プレゼンテーションスタイルに合わせ た修正は不可能。 • 各スライドのテキストは、全部いちど に表示され（編集可能版にあるような スライドの「ビルド」効果がない）、 学習の要点を一つひとつ紹介すること はできない。 • 内容が多いスライドについてテキスト の簡略化や削減はできない。 • PDF なのでコンピューターのスクリ ーンセーバーが起動するため、それを プレゼンテーション開始前に機能停止 しておく必要がある（コンピューター の「システム環境設定」で可能）。 56 PPT にスライドを追加する スライドを追加する場合、その目的は「教習員用指導書」に沿うことであって、主題からそれては ならない。以下の理由であれば、PPT にスライドを追加してもよい： • スライドがない節に対して。 • 話し合いのための大事な質問で、いきおい解答に移らないことを覚えておくため。 • これから始まる活動のリマインダーとして、また指示を盛り込むため。 以下の理由であれば、PPT に変更を加えてもよい： • スライドを現地の事情/状況に適合させる。 • 翻訳を提供する。 • スライドの本文を減らすか、内容が多いスライド一枚を複数スライドに分割する。 • 教習授業を拡張するか増やす場合に、資料を追加する。 授業内容を追加する場合は、授業時間にも追加が必要であることに留意せよ。 PPT の統一性を保つ • すべての新規スライドおよび既成スライドへの変更について、必ず PPT 原版と同じ形式、 スタイル、フォントに従うこと。 • 追加あるいは変更したスライドから、WHO および WSTP のロゴを忘れずに削除せよ。既成の WSTP プレゼンテーションに同じ形式を維持しながらスライドを追加する最も簡便なやり方は、 既成のスライドを複製して、その本文を変更することである。 • 複雑なアニメーションを追加してはならない。 • PPT マスターを利用してスライドを追加してもよい。 • 動画ファイルは、すべて mp4 と wmv の二形式が用意されている。mp4 形式はアップルコンピ ューター用、wmv 形式はウィンドウズコンピューター用である。ウィンドウズコンピューター で QuickTime Player を搭載したものであれば、mp4 動画を使用できる。 • 動画によっては字幕入りも用意されており、そちらの使用を推奨する。音質が悪い、外の騒音が ある、きつい方言が話されている、といった場合に受講者の理解を助ける。 • 動画は埋め込むことも、リンクを張ることも可能である。埋め込みを推奨するが、その理由は、 ファイルサイズは増えるが動画を PPT ファイルに内蔵でき、ファイルを他のコンピューターに コピーしても動画が失われないからである。 57 PPT に動画を埋め込む PPT 2010 以降の112ソフトで動画を埋め込むには、 次の手順に従う： • 「Presentations」＞「PowerPoint」フォルダー を開く。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入する。 • 動画フレームがスクリーンいっぱいに表示され ない場合は、サイズ調整する。 112 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 58 • 変更を保存。 • 以上で、動画が PPT の一部になった。 動画を自動的にフルスクリーン表示するには (Windows)： • 「ビデオツール」の「再生」タブの「全画面表示 の再生」チェックボックスをオンにする。 動画を自動的にフルスクリーン表示するには (Mac)： • 「ビデオ形式」タブの「再生オプション」をクリ ックし、ドロップダウンリストの「全画面再生」 を選択 困難があれば、PPT のヘルプメニューで質問せよ。 59 視聴覚機材を用いる際の優れた実践 「スライドショー」で実行して確認 • PPT の授業を練習する時は、「スライドショー」モードを用いよ。それによってトランジション、 アニメーション、フローなどの問題を発見できる。 • 教習で使用する「スライドショー」モードのコンピューターおよびプロジェクターを用い、スラ イドおよび動画を通しで実行せよ。自分のコンピューターを用いない場合に、設定が異なる別の コンピューターではプレゼンテーションを予定通りに実行しないことがあるため、これは重要。 • 教習中のプレゼンテーションは、すべて一台のコンピューターで行なうことを検討せよ。これで、 プレゼンターごとの切り替え時間が省ける。 プロジェクター・リモコン・レーザーポインター • できれば、予備のプロジェクターまたはプロジェクター用ランプを用意せよ。 • 休憩時間や実習中は、プロジェクターの電源を切ってランプの使用を節約せよ。 • 黒色あるいは白色のスクリーンに映写する必要がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キーを打つと黒いスクリーンになる。 • リモコンを用い、クリックしてスライドを切り替えるようにすると、プレゼンテーションの間に コンピューターの横に立たなくて済む。 • レーザーポインターはスライドの個別の項目について、受講者の注意を引くために使える。 スピーカー • スピーカーは、毎日のはじめに接続し、テストしてから接続したままにしておけ。 • 携帯電話その他の電子信号を拾うため、スピーカーの電源は、動画再生時だけ入れよ。 ケーブルおよびアダプター • 必要なケーブルが、ノートパソコン、プロジェクター、スピーカーについて、すべて揃っている ことを確かめよ。 • プラグアダプター類が、予備 2、3 個も含め揃っていることを再確認せよ。 • ケーブルが電源まで届かない場合に備え、予備の延長コードを持参せよ。 60 活動１：ホワイトボード/フリップチャートを視覚教材に用いる 自分のグループに割り当てられた情報を通読し、ホワイトボード/フリップチャートを活用して、 他のグループへの発表を作成せよ。 スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正113に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 ホワイトボードの手入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間114」で 姿勢を描くなど）。 113 [原文] neat 114 [原文] ‘stick-draw’ 61 ToT.11 フィードバック フィードバックとは何か？ フィードバックとは、だれかに提供する以下についての情報である： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を支援できることは 重要。 通常、よい出来ばえにフィードバックを与えることに、だれも問題はない。間違いや改善が必要な 出来ばえの場合には、必ず自信をもって建設的なフィードバックを与えなければならない。 活動１：フィードバックをもらう 自分の学びに役立ったフィードバック、また自分が身構えるか動転して役に立たなかったフィード バックについて考えなさい。 下欄に自分の振り返りを記録しなさい フィードバックを与えるさい、教習員が考慮すべきことは何でしょうか？ 62 望ましいフィードバック： • タイムリーに115：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 建設的なフィードバックをもたらす時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に与えよ。意識、行動、 規律に関わる問題には、非公開で対処せよ116。 • 受講者の視点に立って：まず、受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者の違う取り組み方を支援せよ：建設的なフィードバックを与える前に、受講者が完了した 活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。受講者のサー ビス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 115 [原文] Be timely 116 [原文] deal with them in private 63 ToT.12 グループダイナミクスを取り仕切る117 WSTP 教習員が、グループで、効率よく効果的に作業するやり方を知っていることは重要である。 この授業では小グループ活動を促進し、時間を管理し、妨害行動へ対処するやり方を見て行く。 なぜグループ活動を用いるのか？ 教習においてグループ作業は重要である。なぜなら： • 受講者が、考察、知識、経験を共有できる。これによって教習員は、受講者がすでに持っている 専門性をよりよく知ることができ、どこにギャップがあり、授業をどう調節すべきかが分かる。 • 教室内にすでにある智慧、経験、技能が尊重される。これによって、経験や専門知識をより多く 持つ人が、他とそれを共有できる。 • 教習員が関心から外れる。受講者が経験を共有し、自分たちがすでに何を知っているか見出す ことが、自信の構築に役立つ。 • 全受講者が語り出し、貢献できる環境をつくり出す。内気な、または年若い受講者も小グループ の中では気後れせず発言できる。これは、自分の考えが評価されていると気づくことで、自信を つくり上げる。 グループ活動を組織し取り仕切る 受講者をグループ分けする際の重要な留意事項 • グループのサイズを決める。 • 各グループに、だれが入るか決める。 • グループづくりの手法。 グループのサイズを決定する要因 • 時間：グループが多いほど、フィードバックにもより時間が必要になる。持ち時間が少なければ 大きいグループをつくれ。ただし、1 グループの人数は 6 名を超えないようにせよ。 • プライバシー/内密さ118：気をつかうトピック、内気な人、言語の壁がある場合の話し合いには ペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な、機材/消耗品の分量。例えば、作業場が 3 か所あれば、3 グループ まで対応が可能になる。 117 [原文] Managing group dynamics 118 [原文] confidentiality 64 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や来歴を持った人を同じグループに入れる（臨床家全員が 協働するように配置する、あるいは技工職全員が同じグループにいるなど）か、逆にわざと同じ グループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、グループにする方が 適切な場合と分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混成：これは、お互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ、有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混成：作業への文化、宗教、社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が互いに協力して作業し、学び合いの機会119が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 グループづくりの手法 各 WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与えて いる。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ分け の手法をいくつか掲げる： • フルーツサラダ法120：同じ果物カードを 3、4 枚ずつ、さまざまな種類の果物で受講者の人数分 になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ （1 人 1 種類の）」でいっしょになる、など指定する。 • 番号点呼121：必要なグループ数の番号を点呼する。例えば、3 グループに分ける必要があれば、 最初の人が「一」、次が「二」、その次が「三」、そして再び「一」に戻って数を点呼するよう指示 し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分けて おく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3 人、次の 3 人と まとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1 人または 2 人、自分が組んだことがない人を選んでもらう。ただし 3 人を超えると、 自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4 人ずつのグループに有効。 119 [原文] peer learning opportunities 120 [原文] The fruit salad method 121 [原文] Count off 65 受講者をグループ分けする際には明確な指示を与えよ • だれがどのグループに入るか。 • 何をグループにやってほしいのか（その課題は何か）。 • どこへグループに行ってほしいのか（各部屋へ分かれるのか、大部屋のスペースか）。 • いつグループは報告を返す用意ができているべきなのか。 • どうやってグループに報告してほしいのか（フリップチャートで、全体グループへ口頭で、各自 の席にいるグループへ非公式に、グループ自身が選んで創造的に発表、など）。 • どれくらいの時間、報告しなければならないか。 小グループ活動はつねにモニターし、受講者が各自のワークブックの正しいページを用い予定した 課題に取り組んでいることを確かめよ。必要なら促しや誘導的な質問によって助け、解決策を教え たり、自分が長々としゃべったりするな。気をつけて時間を守るよう念押しせよ。 妨害行動に対処する いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、ポジティブだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 66 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、他の受講者には、知識を共有し、質問に答え、グル ープ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っているかのよう に振る舞う。 場を仕切る受講者への対処： • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える機会 を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく、特定の受講者に質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は最有力な受講者とのペアあるいはグループに入れ、内気 な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 ふざける受講者への対処： • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動中 のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 攻撃的な受講者 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。または教習員の技能・ 知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 攻撃的な受講者への対処： • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとって本当なのですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 ネガティブな受講者への対処： • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由を 説明する機会を与えよ。他の受講者に賛成するか尋ねよ。他の受講者も同意見であれば、「どう すればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 67 寡黙な受講者 もともと寡黙あるいは内気で、大人数の前でしゃべりグループ活動へ貢献することには気が進まな い受講者。 寡黙な受講者への対処： • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3 名の）を活用せよ。 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいはその 人に反対するのをためらうかもしれない。 年長の受講者への対処： • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話すよう 呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 注意散漫な受講者への対処： • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習を妨げるのか話せ。規則を念押しせよ。 68 管理者/関係者向け教習モジュール 69 WSTPtot 管理者向け教習のはじめに 背景 WSTPtot 管理者向け教習のねらいは、実習生に、管理者向け WSTP を実施し、さまざまな状況に 適合させるための技能と知識を授けることである。WSTPtot 管理者向け教習はこのモジュールの 第 1 部で、これに WSTPtot 関係者向け教習が続く。WSTPtot 関係者向け教習の授業では、管理者 向け WSTP と関係者向け WSTP の教習運営実務、準備、計画も取り上げる。 管理者向け WSTP は、現地のニーズとぴったり合うように調整せよ。 どこでも人口の 1 %には車椅子が必要だと推計されているものの、いまだに多くの場所で、車椅子 サービスは利用できないかたいへん立ち遅れている。管理者向け WSTP は、事業管理者が、適正な 車椅子供与の効果的な運営を支援するために作成された。これは車椅子サービス事業の実施、管理、 評価を担当する人材を対象としている。管理者向け WSTP 受講者は、日ごろリハビリテーション サービスの経営や管理に携わっているが、車椅子サービス管理は直接経験していない人であろう。 そこで、管理者向け WSTP には、適正な車椅子サービス管理に関する基本情報を盛り込んでいる。 経験を持たないで教習に参加する事業管理者： 事情によっては、車椅子サービス管理の経験がない事業管理者が、管理者向け WSTP 教習プロ グラムに参加する場合もある。例えば： • 新しいサービス事業を立ち上げ中か検討中の場合。 • 義肢装具サービスなどのサービス事業が車椅子供与に事業を拡大中の場合。 • 事業管理者が、既存の車椅子供与サービス事業に着任して間もない場合。 • 車椅子生産者が自社による車椅子供与サービス事業の展開を検討している場合。 • 例えば政府部局の管理職が、適正な車椅子供与について、さらに学ぼうとしている場合。 70 経験があって教習に参加する事業管理者： 車椅子サービス管理の経験がある事業管理者が、管理者向け WSTP 教習プログラムに参加する 場合もある。例えば： • 直面している課題への答えを見出すため。 • 車椅子供与関連の国際的な方針・ガイドライン・条約について深く学ぶため。 • 「車椅子ガイドライン(1)」に沿った適正な車椅子供与と、車椅子サービス提供の 8ステップに ついての理解を深めるため。 • さまざまなサービス提供モデルへの理解を深めるため。 • 事業管理技能を改善する、新しいやり方を学ぶため。 • 基礎や中級のWSTPモジュール教習を受けた職員を、管理・支援できるようになるため。 • 車椅子供与を改善する変革を先導するために、事業管理者が果たしうる役割を理解するため。 管理者向け WSTP は、車椅子サービス提供の 8 ステップを全うする適正かつ効果的な車椅子サー ビスにおける、事業管理者の役割の概観を与える。 車椅子サービス提供の 8 ステップ： 紹介・相談および面接予約 事前評価 処方（選択） 資金調達および発注 製品の下準備 フィッティング ユーザー教習 フォローアップ・メンテナンス・修理 管理者向け WSTP の内容は、8 ステップすべてをやり遂げるために必要な、リソースに関する情報 である。管理者向け WSTP 教習プログラムへの参加を通して得られた知識は、事業管理者にとり 以下の役に立つ： • よりよく車椅子供与を計画する。 • 車椅子サービス提供の質が向上する。 • 職員定着率が向上する。 • 自己のニーズを満たす車椅子を手にする、車椅子ユーザーの数が増える。 • 車椅子供与の持続可能性が向上する。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). 71 事業管理者が実施するとよい、車椅子の臨床家と技術者の業務を支援する活動を下に挙げる。 最も重要な答え： • 適正な車椅子および資材の在庫確認。 • 車椅子のために利用できる資金を確保する。 • サービスユーザー数を計画し、職員が忙しすぎず、しかし仕事はじゅうぶんあるようにする。 • サービスユーザーが、適正かつ整備された機器や施設を使えるようにする。 • サービス事業を円滑に運営できるよう、管理上の支援を提供する。 • サービス事業の予算を立て、やりくりする。 • 専門的サービスの普及を支援する。 • 職員の地位に支持を与えるよう、政府に提言する。 • 政府と、地域に根ざしたリハビリテーション（CBR）事業はじめ、その他の関係者との協働を 支援する。 管理者向け WSTP の対象範囲および時間割 「教習員用指導書」p.3 で説明しているように管理者向け WSTP は 13〜14 時間で実施でき、また 例えば通訳の時間を追加するなど、現地のニーズに適合させることも可能である。割り当てられた 時間を削ってはならない。管理者向け WSTP の授業は、現地に特有の状況や目的に応じた、他の 活動と組み合わせることも可能である。例えば、以下を取り上げる追加授業を含めるなど： • 関係者による、その組織や業務に関する発表 • 車椅子生産者あるいは供給者による、その製品に関する発表 • 車椅子ユーザーのケーススタディ • 不適正な車椅子の影響に関する情報 • 車椅子に関連した研究での調査結果 • 車椅子供与に関連する政策の再検討 時間割の例は、WSTP 用 USB メモリに載せたものが利用可能である。これは 2 日間教習で、管理 者向け WSTP の教材をすべて用いて教習プログラムを実行した場合に基づいている。 管理者/関係者向け WSTP 計画ツール • 「管理者/関係者向け WSTP 計画ツール」は、ToT（教習員養成教習）パッケージの一環として 開発された。これは本書 p.129 の付録と WSTP 用 USB メモリに載っている。「管理者/関係者向 け WSTP 計画ツール」は、現地の状況を概観し、期待する成果を確定するために推奨される。こ れは、自分が実施する管理者向け WSTP や関係者向け WSTP にどの授業を組み込むべきか、見 定めるために役立つ。 72 • ツールの対象は「車椅子ガイドライン」に沿って政策、製品、サービス、教習に関する 10 分野 にわたり、10 分野それぞれにつき「初期段階2」から「成長中3」「成熟中4」「じゅうぶんに機能5」 までの状況の例を示している。 計画作業は教習に先立ってなるべく早く始め、必要な情報を集める時間を、じゅうぶん確保せよ。 管理者向け WSTP の教習員と受講者 受講者 8〜10 名ごとに教習員１名を置くよう推奨する。通常、その結果教習員は最低 2 名になる。 管理者向け WSTP は一般的には受講者 5〜15 名で実施し、この範囲の人数がうまく行く。 経験豊富な車椅子ユーザーで、理想的にはこのテーマと教習パッケージをよく知っている人が教習 チームにいるのは強みになる。非車椅子ユーザーの教習員は、もう一人教習員を探す際には、この ことを考慮せよ。 教習員のうち最低 1 名には現地での車椅子供与の経験と知識が必要である。それによって話し合い が豊かになり、当を得た教習になる。教習員の一人には車椅子供与、および関連する国際的ガイド ライン、条約、目標についての国際的知識が必要である。同じ人がこの知識を持っていてもよい。 管理者向け WSTP の教材 管理者向け WSTP には、3 冊のマニュアルがある： • 教習員用指導書 • 参考書＆ワークブック • 補足資料 教習員用指導書 「教習員用指導書」の最初の節「管理者向け車椅子サービス教習パッケージについて」では、その 対象者、目的、対象範囲、教習員を選ぶ際に考慮すべき技能と人数、開始までの流れを述べている。 次の節（p.5）は「教習員への手引き」である。内容は、教習プログラムの概略、授業計画に関する 簡潔な情報、付属のパワーポイントのプレゼンテーション（PPTs）の説明、よい教習を実施する コツなどである。このプログラムを、実施のたびに事後評価するよう推奨している。 2 [原文] early stages 3 [原文] developing 4 [原文] maturing 5 [原文] well-functioning 73 詳しい授業計画は、次の節 p.12 から始まる。12 の授業が以下の 3 部に分けられている： • A: 必須知識 • B: 車椅子サービスを開始する • C: 車椅子サービス事業を運営する 参考書＆ワークブック 2 つ目のマニュアルは「参考書＆ワークブック」である。基礎 WSTP や中級 WSTP とは異なり、 この「参考書」と「ワークブック」は合本して一冊にまとまっている。このマニュアルの構成は、 「参考書」と「ワークブック」のどちらの部も「教習員用指導書」と同じ順序に沿っている。この マニュアルは 2 部に分かれている。「参考書」の部は、授業を補足して各トピックについての詳細 を説明する。「ワークブック」の部には、受講者が、授業での演習の一環として記入するフォームや 資料が載っている。自分の教習プログラムを実施する前にこのマニュアルについての徹底した知識 を養い、また将来の自分の受講者には、教習プログラムの実施中および実施後、このマニュアルを 熟読するよう勧めよ。 補足資料 これは、事業管理者および車椅子サービス職員にとってサービス業務で役立つ、多くのフォームや 参考文書をまとめたものである。このマニュアルの内容は以下の通り： 車椅子供与計画策定のために取りうる方策 車椅子サービス紹介・相談フォーム（基礎） 車椅子サービス紹介・相談フォーム（中級） サービスフォーム・確認表一覧 評価ボックスづくり 評価ベッドづくり 足乗せブロックづくり 計測用具の例 技工施設の手引き：作業台および床上での作業スペース 基礎サービス用技工備品の手引き 中級サービス用技工備品の手引き ウレタンフォーム切削用弓ノコ刃の調製 基礎および中級サービスへの資材の手引き 74 移動練習エリア設営の手引き さまざまな車椅子供給方法の比較 支援機器事前評価時の参加度測定ツール 支援機器フォローアップ時の満足度および成果測定ツール アクセス向上のための情報 これらの資料には、管理者向け WSTP の授業で参照するものもあるが、大半は、特に基礎 WSTP および中級 WSTP に当てはまる。 動画 管理者向け WSTP パッケージには 6 本の動画が含まれる。これらは PPT の中で参照されているが 埋め込まれていない。必ず事前に、動画が PPT 内に準備できているか、自分のデスクトップに アップロードされて再生できるようになっていることを確かめよ。 ポスター この WSTP のポスターは、WSTP 用 USB メモリの基礎および中級パッケージ内に載っている6。 補助教材 追加の文書は WSTP 用 USB メモリの「補助教材」フォルダに収められ7ている。「必須教習技能」 モジュールで、その大半は説明した。管理者向け WSTP に特化した補助教材で、「必須教習技能」 モジュールで取り上げていないのは「先導する管理者8」である。これは組織変革を先導し、そこに 影響を与えることについての情報を与えるもので、特に授業「A.3: 変革を導く管理者」に関連する。 翻訳 最新版の管理者向け WSTP 教材、ならびに既成のあらゆる翻訳は、以下で見つかる9： http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ 6 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイトからダウンロード可能. 7 [訳注] 同上. 8 [原文] Managers Who Lead [訳注] 本書の日本語訳作成時点 (2023.8.17) では、この資料の日本語訳はない. 9 [訳注] 本文 URL はリンク切れ (2023.8.17) のため (https://apps.who.int/iris/handle/10665/246227) を参照. 75 管理者向け WSTP 教習運営実務と準備 管理者向け WSTP「教習員用指導書」の「教習員への手引き」は p.5 からである。これは、各自が 管理者向け WSTP 実施を準備するためのよい出発点であるから、注意深く研究せよ。さらに、以下 有用な追加項目を掲げる。 1. 現地の状況がカギ 管理者向け WSTP の実施を計画するさい、授業を、現地の状況と各自が達成したい成果に対して、 やり方が適切になるよう調整して実行することは非常に重要である。管理者向け WSTP 受講者の 知識水準、経験、職務はさまざまに異なる場合が多く、したがって、受講者にとり、おそらくある 授業は他の授業よりも関連が強くなる。 管理者向け WSTP を時間配分通りに実施するのは困難、というのが教習員の、これまでに一般的 な感想である。大半のトピックは貴重な話し合いを生み出すため、教習の価値を最大にするには、 それに合わせるべきである。こうした状況では話し合わせ、既定の活動を減らす方がよい。しかし、 つねに受講者が意欲的とは限らず、じっさいは理由が分からないまま言われて参加している場合も ある。この場合は、活動を盛り込み、全員を惹き入れることが重要になる。 「管理者/関係者向け WSTP 計画ツール」は、教習員が、教習実施国/地域の現在の概況を収集し、 達成したい成果を決定できるように設計された。このツールは、管理者向け WSTP の授業のどれ を教習プログラムに盛り込むべきか見極めるために役立つ。計画作業はなるべく早く始め、必要な 情報を収集し、関連する関係者と状況について話し合う時間をじゅうぶん確保せよ。このツールは、 本書の付録に載っている。 時間管理も重要である。通常、事業管理者が教習に出張できる期間としては 2 日間が現実的だが、 詳細な計画や方策を立てることが目的であれば、さらに時間が必要になるか、関係者向け WSTP の 授業を減らさなければならない。 持ち時間が 2 日よりも少ない場合は、どの授業を盛り込むべきか、優先順位を付けるべきである。 例えば、教習を車椅子サービス事業がすでに整っている地域で実施する場合、「車椅子サービスを 開始する」の授業を一部省くか減らすことを選択してよい。受講者の何人かに事前に連絡を取るか、 かれらを知る人に相談してその知識や技能の水準を把握せよ。これは教習を、できる限り当を得た、 有用なものにするうえで役立つ。 76 2. 教材および機材 教材 各受講者に、必ず「管理者向け WSTP（車椅子サービス教習パッケージ）参考書＆ワークブック」 を配布せよ。管理者向け WSTP 教習員は、その他の主要な教材を自分が選んだ形式で配布しても よい。例えば、受講者に WHO の「車椅子ガイドライン」「障害者の権利に関する条約（CRPD）」 「持続可能な開発目標（SDGs）」「地域に根ざしたリハビリテーション（CBR）ガイドライン」 「低リソース状況での移動支援機器供与に関する共同方針提言書」を収めた DVD か USB メモリを 配布するとよい。これらはすべて、WSTP 用 USB メモリ10に載っている。 器材 この教習プログラムでは、現地で手に入る車椅子を教室のその場に数台持っておくと有益である。 これらは話し合いや提示で参照に使える。受講者は休憩中、それらの安全な使い方を考慮しながら 試したり観察したりできる。多様な環境やニーズに適する、さまざまな特色を持つ車椅子を揃えよ。 例えば折りたたみ車椅子、折りたためない車椅子、姿勢支持具付きの子ども用車椅子など。 10 [訳注] 各資料の日本語版入手先は, 本書の授業 ToT.9 (p.37-54) の訳注を参照. 77 管理者向け WSTP 模擬授業 78 あいさつ・自己紹介・概略 この授業を教えるための主な留意点 a. 全般 • 第 3 節と第 4 節を入れ替え、庶務連絡等を済ませてからワークショップの概略に入ってもよい。 b. 第 1 節：開講式 • 時間割では、例えば教習プログラム実施機関の長による歓迎あいさつなど簡潔な開講式のために 10 分を見込んでいる。もっと大がかりな儀式が必要であれば、それに応じて時間割を修正せよ。 c. 第 3 節：ワークショップ概略 準備のコツ • WSTP 用 USB メモリの PPT に、動画「車椅子サービス提供」が埋め込まれているか確認せよ。 なければ埋め込むか、デスクトップ上の開きやすい場所に置いておけ。 内容 • この動画の上映前に、受講者へ、車椅子サービス提供のさまざまなステップに注目しながら視聴 するよう指示せよ。動画を上映後、ポスター「車椅子サービスのステップ」を示し、車椅子サー ビス提供の 8 つのステップを列挙せよ。教習プログラムの残りの期間中、このポスターは話題に 上ったらいつでも参照せよ。 d. 第 4 節：教習プログラム時間割・庶務連絡・諸注意 準備のコツ • 安全に関する説明のさい、車椅子を用意しておくと便利。 内容 • 車椅子のさまざまな部材（例えば、スポーク、ブレーキ、足台など）を、説明しながら指示せよ。 受講者は背後に助手が付いている場合も、坂を登る際は前にかがみ、坂を下りる際は後ろにもた れるべきことを説明せよ。 79 A.1: 適正な車椅子供与とは何か? WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 4 節：適正な車椅子供与を支える • 「教習員用指導書」p.22 の活動について、「教習員用指導書」では国の政策の実例を 1 つ示して いるが「参考書＆ワークブック」には 2 つ載っている。両方とも取り上げるには時間が足りない ので、より状況に適する実例を選べ。 • 「参考書＆ワークブック」の本文は、「教習員用指導書」のものと異なっている。受講者に分かり やすいよう「参考書」の方を読み上げよ。 この授業を教えるための主な留意点 a. 全般 • この授業の時間割り振りは、第３節では余裕があるが第 4 節には短めで、全体としては間に合う はずである。残り時間が尽きてきたら、受講者の応答を絞れ。 b. 第 2 節：車椅子へのニーズおよび満たされざるニーズとは何か? 準備のコツ • スライド A.1.4 を、適切な国勢調査データと国全体の車椅子ニーズ計算により、個別設定せよ。 複数国からの受講者に教習を実施する場合は、すべての国を列記せよ。 • 国勢調査が古すぎる場合は、国家統計局その他の政府機関による、より最近の推計を探してみよ。 • 1 %を計算するには、総人口を 100 で割ればよい。以下に例を示す。 人口 人口の 1 % 45 060 436 450 604 14 538 933 145 389 3 785 566 378 55611 11 [訳注] 原文のまま. 37 856 あるいは 37 855 とすべきであろう. 80 c. 第 3 節：個人的移動への権利 • 「国際連合 障害者者の権利に関する条約（CRPD）」をじゅうぶんに理解し、教習プログラムを 実施している国が、すでに署名し批准しているかどうか確かめよ。 d. 第 4 節：適正な車椅子供与を支える 準備のコツ • 仁川方策（インチョン戦略）は教材に含まれていないが、教習を「アジア太平洋障害者の十年12」 の構成国で実施している場合は、以下からダウンロードしておくとよい：http://www.unescap. org/resources/incheon-strategy-“make-right-real”-persons-disabilities-asia-and-pacific 内容 • この活動へのフィードバックとして、国の政策が存在しない場合、受講者に、それを立ち上げる ための指針として「WHO 世界障害者行動計画 2014-2021(13)」を参照するよう提案してもよい。 12 [原文] Strategy in Asia and Pacific 13 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 81 A.2: サービス提供 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 4 節：管理者のより広範な任務 準備のコツ • スライド A.2.12 の文が、「参考書＆ワークブック」の同じ図とは一部異なっている。スライドを WSTP 用 USB メモリに収めた14新版に差し替え、自分の「教習員用指導書」に、PPT スライド がマニュアルに載っているサムネイルのものから更新されている旨をメモせよ。 この授業を教えるための主な留意点 a. 第 2 節：サービス提供のレベル • サービスのレベルは車椅子ユーザーの年齢や障害には関係しないことを強調せよ。多くの地域や 国には（あっても）基礎レベルのサービスしかないが、目標は各々の国や地域で両方のレベルを 利用できることである。中級レベルのサービスでは、基礎レベルサービスとは異なるリソースや 職員の技能が求められる。現地の状況に関する知識は、あると既存の基礎および中級レベル対応 の施設の例を示せるようになるため有用である。 b. 第 3 節：サービス提供モデル • この節の活動にはそれほど時間がない。各グループに「車椅子サービスのステップ」ポスターの 近くに座るか立つかして答えを話し合い、付箋を書いて該当するサービスステップの隣に貼って もらえ。これによってフィードバックがより迅速になる。 c. 第 4 節：管理者のより広範な任務 • 「管理者の任務」スライドを映す代わりに、その図のポスターを用いてもよい。受講者は付箋を ポスターに貼ることができ、それを教習プログラムの期間を通して壁に貼っておける。 d. 第 5 節：車椅子ユーザーのサービス提供への積極的参画 • ルーマニアでのケーススタディを示す追加スライドを、WSTP 用 USB メモリに収載しており15、 この授業の PPT に追加してもよい。 14 [訳注] 日本語版は, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 15 [訳注] 同上. 82 A.3: 変革を導く管理者 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「先導する管理者16」第 6 章を資料として配布することを検討せよ。これは WSTP 用 USB メモ リの「補足資料17」フォルダに用意されている。 • スライド A.3.3 では成功への要因を 4 つ挙げ、続いてそれぞれの詳細を説明している。分かりや すいよう、このスライドを複製し、続く各節の最初で該当する箇条書きを強調しながら再映する ことを検討せよ。 内容 • 変革とは、えてして何か恐ろしい、あるいは疑わしいものと見なされがちであることを強調せよ。 受講者へ、われわれの反応しだいで変革はよいものにも悪いものになり、変革そのものは中立で あることを念押しせよ。 • この節にはそれほど時間がないので、必要ならばいくつかの質問は省いてよい。 b. 第 1 節：変革プロセスを先導する管理者の役割 • 「教習員用指導書」では、この授業をそれまでの授業に結び付けるよう指示している。ここまで で話し合った、適正な車椅子供与とそこでの事業管理者の役割、例えばよく機能するサービスを 開発し、じゅうぶんに教習を受けた職員のやる気を引き出す責任などを強調せよ。 c. 第 4 節：職員とリソースを配置する • p.38 の「教習員への注記」を指摘し、受講者が資金調達に関する話のみに時間を費やすべきでは ないことを強調せよ。資金調達はサービス事業のあらゆる側面に影響する課題だが、必要な人的・ 物的リソースを管理者がどうやってまとめ上げられるか、を案出することの方が重要である。 d. 第 6 節：管理者が取り組むこと • 「教習員用指導書」p.42 の活動では、受講者に、各授業の終わりに自分の考えを 4 枚のフリップ チャート紙に記入するよう指示している。時間が少なく、また教習プログラムの終わりまで再び 言及する機会もないため、受講者には、毎回の授業の終わりにこれを行なうよう念押しせよ。 16 [原文] Managers Who Lead [訳注] 本書の日本語訳作成時点 (2023.8.17) では、この資料の日本語訳はない. 17 [原文] Supplementary Resources [訳注] 英語版のみ 83 B.1: サービスへのアクセス この授業を教えるための主な留意点 a. 第 2 節：公正なサービスとは何か？ • 「教習員用指導書」p.43 では、「公正なサービス」のスライドを映す前に質問が入る。教科名の 「公正なサービス」を入れるかこの質問を表示した、新規スライドの追加を検討せよ。 b. 第 3 節：紹介・相談および面接予約 • この節の活動にはそれほど時間がない。 • この活動は、紹介・相談ネットワークの提携先がフォームへの記入に消極的であることについて、 多くの議論をまき起こすかもしれない。議論を、どうすれば事業管理者が、提携先に紹介・相談 フォームの利用を促せるかに集中せよ。例えば、記入用に白紙のフォームを配布する、フォーム をなるべく簡潔にする、定期的なフォームの回収を手配する、サービスを利用するようになった 車椅子ユーザーについてのフィードバックを返す（と紹介・相談者にその有益さが分かる）など。 c. 第 4 節：管理者は、公正なサービス実現のために何ができるか？ • サービスの公正さを確保することの重要性を強調せよ。受講者に CRPD（障害者の権利に関する 条約）の、女性、子ども、高齢者、貧しい人びと、農村地域に住む人びとのニーズを強調した 諸条文を再認識させよ。事業管理者は、こうした集団が疎外されず対応されるように、必ず働き かけねばならない。 d. 授業のおわりに • 授業のおわりに、受講者へ、取り組むことを各自のワークブックに記録するよう指示し、また、 前の授業で掲示したフリップチャート紙 4 枚に書き込むよう念押しせよ。 84 B.2: 施設および設備 この授業を教えるための主な留意点 a. 第 2 節：施設およびサービスの流れ • 教習プログラムがサービスセンター内で行われる場合は、この授業にはサービス所内を歩き通す ことが含まれる。全体グループに、車椅子ユーザーを尊重すること、および邪魔にならないため に声を低めるよう指示せよ。 • この節にはそれほど時間がないため、経路は予め詳細に計画せよ。進度を上げるには、受講者を 小グループに分けて別々の場所からスタートさせることを検討せよ。各スペースへの訪問許可を 得ていることを確認し、職員が、訪問があることを分かっているようにせよ。 • サービスセンターを拠点としていなければ、スライド「サービスの「流れ」の一例」(B2.3) を より時間をかけて詳しく説明せよ。代替として、実際に歩き通したビデオか写真を撮り、それを 見せることを検討せよ。 • 各サービススペースの名前カードをつくって教室か隣の廊下にぐるりと掲示し、受講者がカード を並べ替えてサービスの流れを改善できるようにするとよい。これは、サービス事業を計画する 際に何を考慮すべきかの話し合いを盛り上げる。 • 「参考書＆ワークブック」p.22 を参照し、以下を強調せよ： o サービス所内のあらゆるスペースは、出入り口も含め、必ず車椅子で完全にアクセスできなけ ればならない。 o サービス所に到着した人には、受付および待合のスペースが絶対に必要である。 o 待合スペースには、ポスター、リーフレット、ビデオ資料、また子ども用のおもちゃを揃えて おくと役に立つ。 o 長距離移動したため、例えば体重がかかる身体部位に褥瘡があるなどの理由で、横にならなけ ればならない人もいる。 o だれにでも到着しだい水が用意されるべきで、また軽食をとれる場所の情報も提供されるべき である。 o アクセスしやすいトイレは、受付スペースの近くにも必要である。 o 事前評価スペースは受付/待合スペースに近くなければならない。静かで人目に触れず、事前 評価に必要な設備を備えていること。例えば評価用のベッドまたはベンチ、目隠しの仕切り、 足乗せブロック、巻尺、事前評価とフィッティングの主要な段階を記録するカメラなどである。 85 o 床面および作業台のエリアを備えた技工スペースが、車椅子の下準備・メンテナンス・修理の ために必要である。事前評価スペースの近くが理想的だが、騒音がじゅうぶん抑えられる程度 に離れていることが望ましい。スペースはじゅうぶん明るく、換気がよく、防水で、作業に適 した温度でなければならない。最終の組み立てと製品の調整のため、穴あけ、ペーパーがけ、 塗装の区域とは別に清潔なスペースが必要である。技工的活動は、サービスの他の部面に都合 のよい場所とは分けて、離れた他の場所に置いても、さらには外注してもよい。 o 移動練習エリアは、事前評価とフィッティングのスペース近くに置くべきである。スペースは 屋内でも屋外でもよく、さまざまな路面や障害物を備えるべきである。 o 安全な収納スペースが必要で、これは技工スペースの近くに設けるべきである。 o 事務スペースは、記録の作成や保管、職員会議などサービス事業の管理業務に必要である。 b. 第 4 節：施設の整理整頓 • 政府の施設では、破損した設備や古い書類も、政府の目録から正式に削除されるまで保管を義務 づけられる場合が多いことを説明せよ。これは、しばしば工房が不要な設備や書類でいっぱいに なることを意味する。作業スペースを整頓して保つため、事業管理者に、こうした物品は収納し、 スペースが狭ければコンテナも活用するよう勧めよ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 86 B.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 環境・機能・姿勢支持について特色が異なるさまざまな車椅子を用意し、また、この授業の要点 を解説するため、除圧クッションを 1・2 枚用意しておけ。 内容 • この授業は、管理者向け WSTP の中で最も重要なものの一つである。関係者の多くは、車椅子や 適正な車椅子がもたらす違いについて、ほとんど知らない。 • 絶対にこの授業は、事業管理者が適正な車椅子の効果を理解するような、心を動かし、説得力に あふれた18ものでなければならない。 • 現地の状況に即した写真やケーススタディを追加すると、効果が高まる。 a. 第 2 節：適正な車椅子およびクッションとは何か? 19 • 事業管理者は、適正な車椅子とは何を意味するのかしっかりと理解し、また、ある人には適正な ものでも、他の人には適正でないことを分かっている必要がある。車椅子が不適正になるのは、 ただユーザーのニーズとの関連においてのみである。 • 個別ニーズおよび環境や機能の多様性から、サービス事業は、ただ一種類の車椅子を供与する だけであってはならない。車椅子ユーザーの多様なニーズを完全に満たすには、さまざまな型式 が必要である。 • クッションは任意のオプション20ではなく、適正な車椅子の不可欠な構成要素であると強調せよ。 b. 第 3 節：適切にフィットし姿勢を支える • 車椅子にしっかりと座るために必要な支えは、一人ひとり異なる。追加の支えを一個の製品だけ で設けることはできず、個々人にフィットするように、調整や改造ができるか選択幅がある複数 の製品が必要である。サービス事業所は、車椅子に付加してさまざまな種類およびレベルの姿勢 支持を設けられる、座位保持専用シート21またはオプションの姿勢支持具（PSDs）を持っておく 18 [原文] inspirational and persuasive 19 [訳注] これ以下の小見出しのアルファベットは原文のまま. 20 [原文] optional 21 [原文] dedicated supportive seat 87 ことになろう。用意できれば、この授業中にいくつか姿勢支持具の見本を見せるか、多様な レベルの姿勢支持ニーズがある、さまざまな車椅子ユーザーの写真をスライドに追加せよ。 c. 第 4 節：ユーザーのニーズおよび環境に合う • この節では、車椅子ユーザーのニーズは、都市と農村のどちらの環境で暮らしているかによって 異なることを説明せよ。例えば、ひんぱんに公共交通機関や車で移動する人には、折りたたみや 分解ができる軽量な車椅子が有益である。農村に住んで移動しない人には、そうした機能はそれ ほど重要ではなく、荒地での安定性が高くなるリジッドフレームと長いホイールベースが有益で あろう。 d. 第 5 節：安全で耐久性がある製品の重要性 • 「参考書＆ワークブック」p.34 のコラムの内容は、さらに深く掘り下げよ。事業管理者は、提示 された車椅子を何でも引き受け、または数量が最大になるよう最も安価な型式を選択する誘惑に 駆られうる。事業管理者は、候補となる寄付者や供給者に尋ねるべき質問を心得ていなければ ならない。例えば、その車椅子が、ISO（国際標準化機構）規格や現地規格など、性能や耐久性 への認証規格について試験を経ているかどうかは考慮すべきである。 • 寄付者や資金供与者が、事業管理者やチームに、最も安価な車椅子を選ぶよう圧力をかける場合 もある。月/年当たり費用を考慮するよう強調することが重要で、なぜなら安物の車椅子はすぐ 壊れることが多い一方、品質のよい車椅子は、定期的にメンテナンスすれば最低 3〜5 年は持つ からである。 車椅子のモデル 購入費用 使用年数 費用/使用年数 車椅子 A 80 米ドル 0.5 160 米ドル 車椅子 B 150 米ドル 1 150 米ドル 車椅子 C 300 米ドル 3 100 米ドル 車椅子 D 300 米ドル 5 60 米ドル e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 88 B.4: 職員の配置 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 5 節：サービス容量を査定する • 授業で計算機を使えるようにしておけ。このことを「教習員用指導書」の授業計画22「教材」欄 に追加せよ。 この授業を教えるための主な留意点 a. 第 2 節：車椅子サービス事業内の業務 • 地域に中級レベルのサービスがない場合、基礎レベルサービス事業の管理者は、将来に向けて、 それをどのように計画できるか検討し、職員や関係者と話し合うべきであると説明せよ b. 第 2 節：車椅子サービス事業内の業務 準備のコツ • 数値の計算に自信がなければ、準備万端だと思えるまで練習せよ。 内容 • スクリーン上の表に記入したい場合は、スライド B.4.11 になったら「スライドショー」モードを 終了せよ。スライドに数字を入力するには、PPT の表の端をクリックすることが必要。代替手段 としては、事前に表をフリップチャートに描いておき、授業中に数字を書き加えよ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 • スライド B.4.11 に授業中追加したデータは、すべて削除せよ。 22 [訳注] p.72 89 活動 この活動は、ひとりで作業せよ。計算機が必要。 下の表で自分に割り当てられたデータを計算し、A〜F 列下部のグレー欄を埋めよ。末尾の数字は 四捨五入してよい。 選択肢１ 週間作業計画 シナリオ A B C D E F 週間勤務日数 4 2 5 4 2 5 年間勤務週数 40 42 46 40 42 46 サービス容量見積もり 基礎 中級 １日当たり作業時間 6.5 5 7 6.5 5 7 ユーザー当たり推定作業時間 2.5 3 3.5 5 5 5.5 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 90 選択肢２ 週間作業計画 シナリオ A B C D E F 週間勤務日数 3 2.5 5 3 2.5 5 年間勤務週数 44 46 42 44 46 42 サービス容量見積もり 基礎 中級 １日当たり作業時間 7 6 8 7 6 8 ユーザー当たり推定作業時間 3 2.5 3 7 5 6 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 91 B.5: 車椅子サービスはどうお金がかかるのか? この授業を教えるための主な留意点 a. 全般 • この授業の目的は、事業管理者に、車椅子サービス事業のさまざまな費用分野について考える よう促すことである。予算枠についてあまり議論しすぎないようにせよ。 • この授業は、概略は知っておく必要があるにせよ、詳細は会計士が詰めてくれる事業管理者には、 詳しすぎるかもしれない。はじめに受講者へ、自分のサービス事業で細かい予算編成に携わって いるかどうかを尋ねよ。そうでなければ、活動をグループ全体での話し合いに切り替え、時間を 節約することを検討せよ。 b. 第 2 節：予算目安 • 模擬授業では、時間を節約するため、1 グループとなって短時間で活動を進めよ。 • 「立ち上げ費用」と「運転費用」の予算項目は、ホワイトボードに書いておくこと。受講者に、 各見出しの下にどんな種類の費用が入るか考えてもらうことを明確にせよ。 • 事業管理者とチームは、各サービスステップに必要な人員と設備について、またサービス事業所 と地域の、どちらでそれを行なうのか明確にすべきだと強調せよ。 c. 第 3 節：サービス統合からの益 • この節にも財務方面の活動があるが省略してよい。特に、ここでの概念は「第 4 節：提携による 費用分担からの益」で説明するからである。 d. 第 4 節：提携による費用分担からの益 準備のコツ • この授業の冒頭に「費用分担とは何でしょうか？費用分担が有益な点には何があるでしょうか？」 と問うスライドの追加を検討せよ。 e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 92 C.1: サービス事業が機能しているか判るには？ この授業を教えるための主な留意点 a. 第 2 節：モニタリングと評価とは何か? • この授業で時間が尽きてきたら、活動を行なう代わりにモニタリングと評価の有益さについての 全般的な話し合いを持て。 b. 第 3 節：効率よく効果的なサービス • 話し合いにより多く時間を割けるよう、これを全体グループの活動として進めることを検討せよ。 「参考書＆ワークブック」p.100-101 の表に記入しながら、発問して話し合いを活性化せよ。例 として、第 2 行 2 列目の最初の空欄について： o 受講者に質問：実績目標として妥当な時間はどれくらいでしょうか？ o だれかが答えを示したら、他の人に賛成かどうか尋ねよ。これは話し合いを活性化する。 o やるべきことの例として、あらかじめ表の記入済みの部分を説明しておけ。 o 受講者に第 2 行 3 列目の欄「ユーザーファイルに、紹介・相談を受けた日付および事前評価日 を記録」を見るよう指示し、各自のサービス事業では、だれがこの情報を記入し、目標を達成 したかどうか見極めるために、どうデータを照合しているのか尋ねよ。 o 目標に届かないことが続いた場合、どんな取り組みができるか尋ねよ。 o 表の第 3 行「車椅子を受け取ったユーザー数」の実績目標である月 20 台に対する「情報収集」 の下の空欄を参照させよ。 o 質問：車椅子を受け取った人に関する情報は、どこに保管すればよいでしょうか？ o これはユーザーファイルに記録する。しかし総数をモニターするには、事業管理者は供給した 車椅子の基本帳簿もまとめておく必要がある。 o 質問：これは、どう管理すればよいでしょうか？ o この活動の目的は、受講者に、各自のサービス事業に関する情報を記録および評価するための 方策を考えてみるよう促すことである。表への作業を続けながら、各項目についての話し合い を促せ。 93 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 94 C.2: 需要管理 この授業を教えるための主な留意点 a. 第 2 節：需要創出 準備のコツ • この授業では、教習員にバングラデシュの成功事例23を読み上げるよう指示している。WSTP 用 USB メモリに収めた24スライドをプレゼンテーションファイルに追加するかコピーを配布して、 受講者が話し合うあいだ参照できるようにせよ。 • 「教習員用指導書」p.98 の二つ目の「最も重要な答え」欄の、なぜ需要が少ないのかの理由に、 「サービス提供に問題がある」「サービスへの不満」「サービスへの悪評」を追加せよ。サービス 事業が、低品質か高価な製品を供与する、または待ち時間が長い場合、サービスユーザーは他を 当たるか、車椅子なしでやって行くことを選ぶであろう。この情報を、各自の「教習員用指導書」 の表に追加するよう、受講者に提案せよ。 b. 第 4 節：子どもを早期紹介する重要さ 準備のコツ • 以下にまとめたような、早期紹介の有益さを示すスライドの追加を検討せよ。 内容 • 親が、子どもを車椅子事前評価へ連れて来るのを渋ることには、多くの理由がある（「教習員用 指導書」p.103 の「最も重要な答え」を参照）。親たちは子どもが歩こうとしなくなるか、怠惰に なることを恐れているのかもしれない。適切な支えを備えた適正な車椅子があると、遠くまで 行かなくて済むため、子どもの歩行は改善することが多いと強調せよ。それは体力を節約して、 他のことへ使えるようにする。機能が改善すれば車椅子を降り、床の上や立位で活動できるよう になる。 23 [訳注]「教習員用指導書」p.99 24 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 95 c. 第 5 節：効率よく効果的なサービス運営 • 各ステップの所要時間に関する議論は、これはサービス事業によって異なるため、限定的なもの にとどめよ。この節は、事業管理者に、各自のサービス事業についての現実的な目標を算定する 方法を理解してもらうために活用せよ。 • スライド C.2 13 に示した時間設定は、平均値であると強調せよ。これらは、手に入る車椅子と 姿勢支持具の種類やサービス職員の技能により、サービス事業で違ってくる。状況によっては、 ここに示した倍の時間を要するサービスユーザーも出てくる。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 96 C.3: フォローアップ計画 この授業を教えるための主な留意点 a. 第 2 節：フォローアップの重要性 • この授業で経験を分かち合う車椅子ユーザーを見定めるさい、適正なフォローアップの経験者で あることを確かめよ。事前に各自の経験について話し合い、重要な側面を強調できるようにせよ。 b. 第 4 節：フォローアップ計画 準備のコツ • スライド C.3.7 と C.3.8 は分かりにくい。既存のスライドを、WSTP 用 USB メモリに収めた 新版25に差し替えよ。 内容 • スライドが示す通り、フォローアップ提供のために、サービス事業が提供できる車椅子は、人的 リソースが増えない限り 2 年目から少なくなる。 • サービス事業の有効性は、単なる車椅子の供給数以上のものとして測るべきであると強調せよ。 c. 第 6 節：地域へのインクルージョンおよび参加 準備のコツ • 「教習員用指導書」p.122 のスリランカの事例について、米ドルでの金額を、米ドルになじみが 薄い人のために現地通貨に換算26せよ。 内容 • 実際の米ドル額ではなく、帰宅できないための長期入院によって、どれほどの費用負担が生じる かに集中せよ。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 25 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 26 [訳注] この注記は, 同書 p.120 のインドネシアの事例にも該当するであろう. 97 C.4: 持続可能な財政計画 この授業を教えるための主な留意点 a. 第 3 節：財政的持続可能性に向けた計画 • 自分自身が、非金銭的支援の概念を理解しているようにせよ。 • 現物供与は寄付金より確保しやすい場合もあり、サービス事業の全分野で検討されるべきである。 しかし寄付品によって、例えば乗り物などはメンテナンスが必要になるため、それを予算に含め ておくようにせよ。 b. 第 4 節：初期財源27を特定する • 受講者に、アプローチ先を検討する際には、資金供与の調達期間28を考慮するよう念押しせよ。 信託、財団、政府の審査プロセスは時間がかかりうる一方、法人寄付者や個人の対応はもっと 素早い。広範な財源へのアプローチを盛り込むのが、理想的な方策である。 c. 第 5 節：資金集め方策を計画する • 資金集めの話題は、受講者に大きな議論を巻きおこしうる。グループが脱線しないようにせよ。 • 受講者は、受けられそうな寄付金額について、非現実的であることが多い。資金集めが成功する にはたいへんな努力が必要で、寄付者に実績を示すまでは少額しか受けられないのが普通である ことを強調せよ。 • 可能性のある寄付者が知りたいのは、そのサービス事業が、適切な計画と予算を立て、財務への 説明責任を全うしていることだと強調せよ。 • 寄付者への、質が高くタイミングのよい報告の必要性を強調せよ。定期的に進捗状況を更新せよ。 寄付者が、くり返し寄付しないという方針を定めていない限り、関係を築き、じゅうぶんに情報 提供している財源からは、2 度目の寄付を得られる可能性が高くなる。 • 受講者に、現実的な予想を立てるよう勧めよ。例えば、車椅子供給能力が月間 30 台のところで、 3 か月にわたる車椅子 200 台への資金供与を寄付者へ求めてはならない。 27 [原文] initial funding source [訳注] 日本語版管理者向け WSTP 教習員用指導書では「可能性のある財源」と なっているが, 誤訳である. 28 [原文] lead times 98 総まとめ この授業を教えるための主な留意点 a. 第 2 節：変革を導く取り組み • この授業のねらいは、国内の車椅子供与改善への取り組みに合意することである。グループメン バーからの意見を集約する29ことに注力せよ。 • 管理者向け WSTP を実施する際には、授業「A.3: 変革を導く管理者」で導入した「変革ファシ リテーター」を活用せよ。受講者には、考えを壁のフリップチャート 4 枚に追加し続けるよう、 2 日間を通して念押しせよ。その一覧が話し合いの土台となるからである。以下に例を掲げる： 適正な車椅子供与に関する共有ビジョンをつくり出すために管理者ができること • 全チームメンバーの参画を得てサービス事業の全体目標を決め、ビジョンとミッションの宣言 をつくり上げる30。 • 共有ビジョンを定期的に見直し、全チームメンバーが、その達成に向けて貢献していることを 確かめる。 • 共有ビジョン全体をユーザーに根ざしたものにする。すなわち、車椅子ユーザーの参画を得て 策定すべきである。 適正な車椅子供与の重要性を伝達するために管理者ができること • 車椅子の後援者や寄付者にプレゼン31を行なう。 • 政府の省庁・部局、非政府組織（NGO）、障害者団体、リハビリテーション専門職に対して、 「車椅子ガイドライン」への認識を高める。 • 他の関係者との合同意識啓発イベント・活動を、特に「国際障害者デー32」に開催する。 • 「障害者の権利に関する条約（CRPD）」の、支援機器に関連する条項への認識を高める。 • 「持続可能な開発目標（SDGs）」のうち、支援機器を適正に供与することの重要性を奨励する 目標を強調する。 • 「車椅子ガイドライン」への認識を高め、それを推進するため、リハビリテーション教育機関 や地域に根ざしたリハビリテーション訓練校との会合を開く。 • 車椅子サービスユーザーについてのケーススタディおよびビフォーアフターの写真を集めて 共有し、専門的サービスの有益さを強調する。 29 [原文] gathering inputs 30 [原文] creating a vision and mission statement 31 [原文] presentations [訳注] 文脈から, 日本語の「プレゼン」に近い内容の活動として訳した. 32 [訳注] 12 月 3 日. 日本では「障害者の日」が 12 月 9 日で, 12 月 3-9 日が「障害者週間」. 99 職員とリソースを配置するために管理者ができること • 車椅子サービスの全ステップに、それをやり遂げる技能と作業時間を持つ人材が配置される ようにする。 • 可能な限りサービス、とくにユーザー教習とフォローアップで車椅子ユーザーの参画を得る。 • 臨床、技術、教習の各業務を果たす職員が、必ず適正な教習を受けているようにする。 • サービス目標が、利用可能な人員とリソースに基づいて現実的であるようにする。 • 定期的にサービスをモニターし、職員の業務、責任、作業負荷が適正であるようにする。 職員を動機付け・惹き込み・注力させるために管理者ができること • 全チームメンバーによるチーム会議を開いて、目標に合意し、それを理解する。 • 車椅子ユーザーに体験談を共有してもらうことで、チームの全メンバーが、専門的サービスの 有益さ、および劣悪なサービスの危険性を分かるようにする。 • ボーナス、休暇、抜きん出た仕事に対する「今月の人」表彰など、職員に動機を与える。 • チームづくり33イベントを開催して、チームワークを強化し意欲を高める。 • 職員が、立派に仕事をし、サービスの重要目標を達成したら感謝する。 この授業で最も重要な部分は、教習プログラムの後に何が始まるのか話し合うことである。それが 単なるフォローアップの会議で、詳細な計画は後に作成される予定であっても、集まっている間に 次のステップについて合意する必要があることを強調せよ。受講者に、事をさらに推し進める役を 指名し、教習プログラム後も互いに連絡を取り合う方法について合意するよう勧めよ。 教習員の役割は、受講者が、会議後に進展と成功を果たすための、具体的取り組みの設定を手伝う ことである。 「教習員用指導書」では、次を問いかけるよう提案している：「次のステップは何でしょうか？」 「提案された取り組みに着手するための作業部会は編成しますか？」「だれが、これらの取り組み をさらに進めて行くのですか？」「また皆さんで集まる予定はありますか？いつ？」。 受講者には、答えが具体的になるよう勧めよ。受講者が作業部会を編成する、と述べたら「責任者 はだれですか？」「だれが参加するのですか？」「メンバーは何人ですか？」「どんな権限が委託 されますか？」「会議費用はかかりますか？だれが支払うのですか？」「何が次の段階へ進む妨げに なるでしょうか？どうその障壁を克服しますか？」「どうやってグループ全体へフィードバック しますか？」などを尋ねよ。 33 [原文] team building [訳注]「チームビルディング」としてビジネス用語にもなっている. 100 受講者に、個人または組織として取り組むよう勧めよ。例えば、次の会議を企画または主催する、 地元の新聞に教習プログラムに関する記事を執筆し、車椅子サービスへの認識を向上させるなど。 101 WSTPtot 関係者向け参考資料 102 WSTPtot 関係者向け教習プログラムのはじめに 関係者向け WSTPtot の実施計画 WSTPtot の「必須教習技能」および WSTPtot 管理者向け教習で論じた教材の多くは、関係者向け 教習にも該当する。例えば「CRPD（障害者の権利に関する条約）」、「車椅子ガイドライン」、教習 プログラムを実施する国や地域の法律や政策に関する徹底した知識は、関係者向け WSTP のファ シリテーターにも必須である。 管理者向け WSTP と同じく関係者向け WSTP も、きっちり時間割例通りに実施されることはまれ である。内容は、現地の状況や望む成果によって変わる。例えば、調整団体がすでにある場合は、 行動への参加（政策提言や意識啓発への取り組みおよび/またはリソース動員34など）を指導・監督 できるだろう。 そうしたしくみがない場合は、このワークショップは、関係者が一堂に会して知識を共有し、関係 を築くために役立てられる。この場合は共有ビジョンをつくり出すことが非常に重要になり、それ によって関係者が協働し、国内の適正な車椅子供与に向けて前進する。これはフィリピンで起きた ことで、関係者向け WSTP ワークショップに続いて協会が設立された。 重要なことは、合意された行動のフォローアップに率先して当たる人の確立である。これはワーク ショップから生まれた勢いを維持し、参加者の期待に応える役に立つ。この役割を果たす適任者は、 ワークショップ主催団体の代表の場合が多い。決定を推し進めるためにワークショップで作業部会 や委員会を選出する場合もあるが、こうした代表者は、全受講者に進捗状況を知らせ続ける役割を 担うことができる。 関係者向け WSTP プログラムは、特に現地の状況に合うよう計画した授業35や活動と結合させる と、より当を得たものになることが多い。関係者向け WSTP は最短 240 分（4 時間）で実施でき、 半日のワークショップに当たる。これは、政府の高職位者が参加できる時間としては最長であろう。 しかし、1 日のワークショップか、できれば現地に特有のニーズを満たせるよう、2 日間の日程を 組むよう強く推奨する。 34 [原文] mobilizing resources 35 [原文] sessions [原文] 他の WSTP や本書の他の部分に合わせて session にはすべて「授業」の訳語を宛ててい るが, 本文でも後述する関係者向け WSTP の性格から, 日本語でも「セッション」のイメージに近いものとなろう. 103 開会式に、例えば大臣など政府高官を含め、イベントをメディアが報道する可能性を高めることを 検討せよ。また、政府高官を開会式と閉会式に招待することも検討せよ。これは、管轄部門の課題 に対する認識を高めてもらい、ワークショップの成果を共有し、具体的なやり方で支援に加わって もらうよう要請するためである。 「関係者向け WSTP 教習員用指導書」では、関係者向け WSTP の実施準備のあらゆる面にわたる 情報を示している。以下の各節では、計画および実施の参考となる追加情報を与える。 関係者向け WSTP および教材の紹介 「教習員用指導書」が関係者向け WSTP の主教材で、受講者用マニュアルはない。受講者には主要 教材、例えば「車椅子ガイドライン」「障害者の権利に関する条約（CRPD）」、WSTP ロゴなどを DVD か USB メモリで配布するのが望ましい。ポスター「車椅子サービスのステップ」を受講者へ 配布することも勧める。これは、WSTP 用 USB メモリから印刷できる。 関係者向け WSTP の対象者 「教習員用指導書」p.2 には、関係者向けワークショップへ参加するとよい人びとを列記している。 この一覧表には、つねに障害問題を担当する政府部局（通常は、保健、社会福祉、退役軍人援護、 時として都市開発、交通、住宅）、NGO（非政府組織）、DPO（障害者団体）、リハビリテーション 専門職、車椅子の生産者と供給者、外部の寄付者、宗教団体（寄付者、供給者、リハビリテーショ ン専門職でもありうる）、リハビリテーション分野で活動する国際機関を含むべきである。準備と して、当該地域の招待すべき団体を、現地の事情を知る人に尋ねよ。車椅子ユーザーのジェンダー 比率が適正で、特定の集団、できれば脊髄損傷（対麻痺や四肢麻痺）、下肢切断、脳性麻痺がある 人、高齢者、変性疾患患者などが、じゅうぶんに代表されるようにせよ。また、親の会が含まれる ようにし、人権団体を招くことを検討せよ。 104 関係者向け WSTP の目的および対象範囲 関係者向け WSTP の目的は、自分の国や地域において適正な車椅子供与の確立に参画するすべて の人びと（関係者）の意識を啓発し、知識を高めることである。 関係者向け WSTP は 4 つの授業からなり、各々に PPT プレゼンテーションおよび授業計画が付属 している。上映すべき動画が 4 本あり、それらが PPT に埋め込まれているか事前に確認せよ。そ のやり方に関する情報は「必須教習技能」モジュールを参照。 関係者向けワークショップは、あらゆる WSTP（車椅子サービス教習パッケージ）の中で最も状況 に依存し、受講者のレベル、期待する成果、使える時間に合わせた柔軟な運用が必要である。 関係者向け WSTP の教習員および受講者 WSTP 全体を通して「教習員36」の語を用いているものの、関係者向け WSTP に求められるのは、 教習員よりもファシリテーターである。受講者が幅広く多様なため、全員に貢献の機会を保証する には、優れたファシリテーションが必要である。 受講者 8〜10 名ごとに教習員１名の比率を推奨する。受講者数は範囲とする地域や求める成果など 多くの要因によって変わる。人数は 12〜40 名、あるいはそれ以上もありうる。全国集会の場合は、 国のすべての地域から代表を得よ。さらに、移動に障害のある女性、若者、子どもが、公平に代表 されるようにせよ。 関係者向け WSTP のダウンロード 関係者向け WSTP は、以下の WHO ウェブサイトからダウンロードできる37： http://www.who.int/disabilities/technology/wheelchairpackage/wstpmanagers/en/ 36 [原文] trainer 37 [訳注] 本文 URL はリンク切れ (2023.8.17) のため (https://apps.who.int/iris/handle/10665/246227) を参照. 105 関係者向け WSTP：教習運営実務と準備 計画 関係者向けワークショップ準備の主な要件の一つに、対象の国あるいは地域での車椅子供与の現況 を知ることがある。それに必要な情報の主なものは「教習員用指導書」p.8 に列記している。 この資料を集めるには、幅広い団体や個人に相談する必要がある。下のコラムはだれに連絡を取る べきかの提案である。だれをワークショップに招くべきかの決定は、こうした相談の後で下すべき である。 「管理者/関係者向け WSTP 計画ツール」は、教習員が、計画段階において現在の概況を把握し、 達成すべき成果を決定するのに役立つよう作成された。このツールは、本書の「付録」および WSTP 用 USB メモリに載っている。 連絡すべき団体/個人の候補： • 障害を管轄する主要な政府省庁、例えば保健、社会福祉、障害問題、児童福祉など • 障害分野のネットワーキングNGO38、例えば全国連盟や全国協会など • 車椅子または義肢装具に携わるリハビリテーションセンター職員 • 障害者およびその家族/介助者 • 地域に根ざしたリハビリテーション組織 • 障害プログラムを実施している学術機関 • 世界保健機関および現地で活動しているリハビリテーション分野の国際 NGO（非政府組織） • リハビリテーション機器の生産者および供給者 • 障害関連の取り組みを支援する資金援助団体 • 脳性麻痺、脊髄損傷、下肢切断、退役軍人などに特化した、障害別の組織 • 人権団体 • 主流をなす開発組織39 • CRPD（障害者の権利に関する条約）の報告に携わる団体 38 [原文] Umbrella disability NGOs 39 [原文] Mainstream development organizations 106 受講者を見定める 関係者向けワークショップの成否は、明確な目的や望まれる成果を設定すること、またそれと並行 して最適な関係者が招かれるようにすることにかかっている。 出席者数は、ワークショップが範囲とする地域、使える予算、求める成果によって変わる。普通は、 受講者 12〜40 名からなる。ワークショップが全国的なものである場合は、必ず国のすべての地域 あるいは国の機関からの、じゅうぶんな出席が得られるようにせよ。これは予算に影響しようが、 どんな計画でも、信頼性と首尾よく実行されるために重要である。あらゆる関連部門や地域からの 出席がうまく得られなかった場合、以下のようになる恐れがある： • 話し合いが、すべての利害関係者を代表したものにならない。 • 話し合いが、考慮すべき重要な視点を欠いたまま行なわれる。 • 受講者が、重要な意見が表明されていないために、現状に対する不完全な図式を持ち帰る。 • 受講者が、ワークショップがその部門を代表しないために、不満をつのらせる。 • 合意された計画が、すべての関係者グループの支持を欠くため、信頼されないか実行できない。 見定めた関係者全員に招待が送られ、続いて出席確認が行なわれたことを確認せよ。 招待講演者を見定め準備する 「教習員用指導書」p.10・11 では、招待講演者を見定め、準備するやり方について助言している。 招待講演者は場の雰囲気づくり40と、適正な車椅子供与の重要性の強調に役立つ。 講演者は、じゅうぶん前もって確定し、その発表の重点、スライドを用いるかどうか、および持ち 時間を話し合っておくこと。招待講演者が PPT プレゼンテーションを用いる予定であれば事前に 頂いて、関係者向けワークショップの間に使うノート PC に読み込んでおくこと。 以下のコラムは、招待講演者についてアプローチする部門についての提案である： 40 [原文] set the scene 107 招待講演者の候補： • 関係省庁（保健、社会福祉、退役軍人）の大臣あるいは次官 • 障害問題に関わる機関、部局、総局の長 • 国の障害部門の、技術的専門家 招聘する人が、効果的でポジティブな影響力があると広く受けとめられていることを確かめよ。 「教習員用指導書」の付録 1（p.49）では、政府代表者とその講演についてどう打ち合わせるかに ついての情報を与えている。そこで重要なことは、車椅子サービス供与に関連する最も重要な話題 （講演者の部局の管轄、車椅子供与の現状、関連する法律の地位など）を押さえることである。 車椅子ユーザー代表者の候補： • 適正な車椅子供与の重要性を分かっている • 実体験から適正な車椅子の価値を説明できる • 現地の車椅子供与に関する知識と経験 • 大勢の前で熱く語る41自信 • CRPD（障害者の権利に関する条約）の知識 • 車椅子ユーザーが直面する課題を強調するために自分の体験談を共有しようという意志 障害者の権利の提唱者で、課題に対して権利に基づいたアプローチをとり、また現地の政治力学 や事情を分かっている人を見出すよう試みよ。CRPDについて知識豊富な可能性は高いにせよ、 「車椅子ガイドライン」を必ず知っているとは限らない。これについては、準備の一環として 打ち合わせるとよい。 「教習員用指導書」p.51 では、車椅子ユーザー代表者に、講演では何を押さえるべきかについての 助言を与えている。講演者と話し合い、車椅子ユーザーであるとはどういうことか、また将来達成 したい希望は何か、生き生きと伝えて頂くようにせよ。 「教習員用指導書」p.53（付録 3）では、講演者や教習員が発表で参照するとよい引用および統計 を与えている。講演者には、自身の組織の活動に絞り込まず、車椅子供与をめぐる大状況について 語って頂くよう促せ。車椅子サービス供与部門内の強み、弱点、機会、脅威42を強調してもらうの は、討論を刺激するために有効である。 41 [原文] speak passionately 42 [原文] threats 108 教習員の役割 関係者向け WSTP は、教習プログラムではなくワークショップであるため、教習員には、よりファ シリテーター役を身につけることが求められる。教習員には、車椅子と障害部門、ならびに現地の 事情への徹底した理解が必要で、これによって授業を最も効果的に計画し運営できるようになる。 関係者向け WSTP 教習員には適正な車椅子供与の重要性への深い理解、およびそれに対する強い 熱意が必要である。保健政策と政府の機能を熟知した教習員は、教習チームの貴重な財産である。 教習員の一人が車椅子ユーザーで、上記の技能や知識を一部、あるいはすべて持ち、さらに教習 パッケージも分かっている人であれば、とりわけ有益である。教習員が全員、現地以外の地域から 来る場合は、ワークショップ前に追加時間を取り、現地の関係者と会って現地の事情について話し 合ってもらうとよい。 109 関係者向け WSTP 模擬授業 110 S.1: はじめに この授業を教えるための主な留意点 a. 参加者紹介 • 進行させるワークショップが半日で、グループが大きい場合、5 分の時間配分では一人ひとりを 紹介するには足りない。かわりに、分野名（例えば、療法士、政府、障害者団体（DPO）、非政 府組織（NGO）、寄付者、メディアなど）で呼び、当該分野の各メンバーに、立ち上がるか手を 挙げて確認してもらうことが可能。 • 集まる主目的が関係づくりであれば、自己紹介が重要になる。数分取って各テーブルで自己紹介 してもらい、その後の授業で違うテーブルに席替えして、より多く関係がつくられるようにせよ。 • 受講者に、以後の授業で発言する際には、名前と所属を示すよう勧めよ。 b. 招待講演者および基調講演：車椅子ユーザー/代表者 準備のコツ • 「教習員用指導書」では、この部の招待講演者は 3 人までと述べている。時間配分は合計 20 分 しかなく、しかも招待講演者は予定時間をオーバーして話すことがしばしばである。 • 時間に余裕があれば、この授業を延長することを検討せよ。招待講演者の人選が適切で、じゅう ぶんに打ち合わせてあれば、その証言は極めて強力になり、ワークショップのよい土台を築くで あろう。 講演者が適切で時間を守るようになるコツ： • PPT は避けるか、スライド 3〜4枚に制限する。 • 現地の窓口に、招待講演者について聞いておく。時間をオーバーしがちな人なら、講演者数を 減らす。 • 招待講演者に、時間に余裕がないことを予め説明しておく。残り時間 2分になったら、時間に 間に合うよう合図を掲げることを伝えておく。PPT のプレゼンテーションは事前に求め、確認 してコンピューターにアップロードできるようにする。 111 c. 質疑応答 • 招待講演者との質疑応答には 5 分しか取っていない。質問数を制限し、講演者には簡潔に答える よう促せ。招待講演者がワークショップ全体に参加する場合、受講者には、休憩時間に追加質問 するよう勧めよ。 112 S.2: 政策から実践へ この授業を教えるための主な留意点 a. 全般 • 「教習員用指導書」に、この授業への法的枠組みの配布資料を作成するための、主要資料の確認 表が載っている。政府代表、非政府組織（NGO）、障害者団体（DPO）その他の関係者と話し、 またインターネットを検索して、この情報を収集せよ。 • 当該国の、より包括的な概況を知るには「管理者/関係者向け WSTP 計画ツール」を完成せよ。 これは本書の「付録」および WSTP 用 USB メモリ43に載っている。 b. 第 2 節：ニーズ、および満たされざるニーズとは何か？ 準備のコツ • 国の人口統計値を最初のスライドに追加し、さらにこの数字の 1 %を計算して、車椅子が必要な 人口の WHO（世界保健機関）に従った推計値(44)を示せ。教習員仲間に計算が正しいか確認して もらうこと。最新の国勢調査情報をインターネットで検索するか、さらに直近の推計値を政府の 統計局あるいはその他の信頼できる情報源で調べよ。 43 [訳注] USB メモリは英語版のみ. 日本語版は右 URL よりダウンロード可能 (https://j-aws.jp/who/). 44 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/が i/item/9789241547482). [日本語版: 手動車椅子供与の世 界ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.w ho.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 113 内容 • WHO は、どこでも人口の約 15 %は障害者で(45)、1 %に車椅子が必要と推定している。国勢調査 の情報46からの障害者の合計割合は、通常 WHO の推計よりずっと低く、また国によりばらつき がある（通常 2〜5 %前後）。したがって WHO の推計に疑問を抱く受講者も出よう。いっぱんに 障害は、多くの理由から過少に報告されることを説明せよ： o 障害を持つ家族は家の中に隠され、国勢調査で数えられない場合がある。 o 自分の障害を、国勢調査の調査票上で認めているとは限らない。 o 国勢調査の調査票が適切な情報を捉えるとは限らず、そのため障害者が特定されていない。 c. 第 3 節：車椅子供与の重要性 準備のコツ • 授業開始前に、動画が WSTP 用 USB メモリに埋め込み済みか簡単に見つかることを確かめよ。 • この節への時間配分は 3 分で、うち 2 分半が動画のため、「インドのショバの例話」は授業時間 を延長しないかぎり盛り込めない。別のインドでの例話が後に出ている（p.27）。 d. 第 5 節：権利は万人のもの • 「障害者の権利に関する条約（CRPD）」は、紹介された条文だけでなく、全文を読んでおけ。 そうすることで、それらの条文の文脈が整理され、同条約がうたう諸権利に関して、より包括的 な理解が得られる。 e. 第 6 節：政策はサービスを通して個人に届く • この節には、車椅子サービスのステップを示すスライドが盛り込まれている。そのポスターを、 壁に貼って参照させよ。 • 関係者向け WSTP では、ここで初めて「車椅子ガイドライン」に触れている。ガイドラインの 認知度が低く、それに関する別の授業も行なわれない場合は、この機会にガイドライン、および 車椅子供与の 8 ステップの重要性を強調せよ。 45 https://www.who.int/en/news-room/fact-sheets/detail/disability-and-health 46 [原文] Census information 114 f. 第 7 節：国の計画によって権利を現実に • 第 7 節の活動は、完結するにはあまり時間がない。この演習をグループ全体で行なうか演習時間 を多く取って、フィードバックの時間を少なくせよ。4 グループから別べつにではなく、全体で フィードバックしてもらえ。 g. 第 9 節：要点のまとめ • この授業のおわりに、適正な車椅子供与の実現において、政府の全部門に果たすべき役割がある ことを強調せよ。国内および国際的な政策・条約・法律は、さまざまな関係者が実行した場合に のみ意味があり、これは政策提言とロビー活動を経なければ実現しない場合もある。全関係者の 順守、参画、説明責任47がたいへん重要である。 • 全関係者に、車椅子供与システム（車椅子の設計、生産、供給、サービス提供など）の改善への 差し迫った必要に対処し、サービス提供が第 6 節で取り上げた 8 ステップに沿うようにするうえ で、担うべき役割がある。 47 [原文] The compliance, commitment and accountability 115 S.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業計画の「教材」欄に「さまざまな種類の車椅子」と「クッション」を追加せよ。さまざまな 特色や設計を強調して質問を促し、受講者を惹きつけるために活用せよ。 • 授業開始前に動画 2 本を、WSTP 用 USB メモリに埋め込み済みか簡単に見つかるようにせよ。 b. 第 2 節：適正な車椅子とクッションの重要性 準備のコツ • スライド 3.5：米ドルの数字を現地通貨に換算し、だれにでも金額が分かるようにせよ。 • この節の焦点は、適正な車椅子とクッションの重要性である。時間があれば、不適正な車椅子と クッションが及ぼす影響を示す、自分のケーススタディを追加せよ。 内容 • 褥瘡はたちどころに発生・悪化し、命に関わることもあるため、クッションが車椅子の不可分な 構成要素であることを強調せよ。車椅子ユーザーは、褥瘡が治るまで何か月や何年も寝たきりを 余儀なくされる場合がある。 • 話を適正な車椅子の供与方法に集中させよ。すなわちユーザーのニーズと、さまざまな車椅子の 中から選べることの重要性に焦点を絞れ。車椅子の生産や特定のブランドについての詳細には、 それが重要なトピックだと判明していない限り、拘泥するのを避けよ。 116 c. 第 4 節：ユーザーのニーズおよび環境に合う • 受講者には、さまざまな車椅子が、動画に登場する人びとが活動をやり遂げるのをどう支援して いるか観察してもらえ。取り上げているさまざまな環境を強調せよ。教材用車椅子を活用して、 動画でやって見せている、はね上げ式足台や折りたたみ機構を示せ。 d. 第 5 節：安全で耐久性がある製品の重要性 • サービス事業所で新製品を検討する際には、安全性と耐久性を調べることが重要だと強調せよ。 例えば、その車椅子には除圧クッションが付属しているか？その車椅子は認証検査（ISO（国際 標準化機構）検査などの）に合格しているか？その設計は、よそで同様の環境で使われたことが あるか？交換用部品は付属しているか？フレームは現地で修理できるか？ 117 S.4: 変革に向け協働を WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 6 節：どうやって支援を与え、障壁を取り除くか • この節の最後のスライドはサムネイルの見出しが誤っている。PPT スライドの「要点のまとめ」 が正しい見出しである。「教習員用指導書」を修正せよ48。 この授業を教えるための主な留意点 a. 全般 • 関係者向けワークショップ受講者は、変革の創出と推進の両面において重要であると強調せよ。 これら各節の内容を、受講者に関連づけよ。例えば、適正な車椅子供与を支持する先行受容者を 見極める必要を強調するなど。最も変革を望み、車椅子供与の原動力となりうる組織を見極める 必要性を強調せよ。 b. 第 1 節：はじめに • 「はじめに」では、この授業を、満たされざるニーズや適正な車椅子の有益さに関する、以前の 同様な授業に結びつけるよう提案している。国際的あるいは国内や現地の政策などの指針文書を 再度掲げよ。 c. 第 2 節：どうやって緊迫感を伝えるか • 受講者が、統計が手に入らないため、車椅子へのニーズが分からないとコメントすることは多い。 かれらに、それが不作為の言い訳49にならないことを納得させよ。WHO 統計の「1 %」は信頼性 が高い統計値で、推計や計画の目的で使用できる。 d. 第 6 節：どうやって支援を与え、障壁を取り除くか • スライド 4.12：スライドを編集して教習実施国の人口を加え、車椅子が必要な人口の 1 %を計算 せよ。このデータは、すでに授業 S.2 のスライドで得ているはずである。 48 [訳注] 関係者向け WSTP 教習員用指導書 p.46. 日本語版サムネイルは翻訳した PPT から生成したため修正済み. 49 [原文] a reason for inaction 118 e. 第 7 節：変革プロセスを支援する方策 • 「次のステップは何でしょうか？」(p.47)：可能であれば、フリップチャート紙に列記した取り 組みを議論するため、時間配分を増やせ。ワークショップ解散前に、どのように前進すべきか 合意していることが重要である。例えば、受講者が振り返り、同僚と協議する時間を置いた後の フォローアップ会議を計画するなど。 • 時間を節約するため、第 7 節の活動をグループ全体か 3 グループに分けるかのどちらかで進める よう検討せよ。各グループに、答えを直接フリップチャート紙に、あるいは付箋紙を介して記録 するやり方を示せ。 f. 授業のおわりに • 最後のスライド 2 枚は「閉会のことば」に用いる。その初めのスライドの前に空白のスライドを 1 枚挿入し、誤って閉会のことばへ移らないようにすることを検討せよ。 119 閉会のことば この授業を教えるための主な留意点 a. 全般 • 「閉会のことば」用のスライド 2 枚は、授業 S.4「変革に向け協働を」用 PPT の最後にある。 b. 閉会のことばおよびロゴ • WSTP（車椅子サービス教習パッケージ）のロゴは、WSTP 用 USB メモリに載っていることを 強調せよ。 c. 事後評価および WHO へのフィードバック • 事後評価およびフィードバックは、WHO にとり、WSTP 教材の継続的な改善および発展を可能 にするため極めて重要である。受講者に、このプロセスへの参加を奨励せよ。 120 付録 付録１：WSTPtot 必須授業時間割 第 1 日 第 2 日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 121 付録２：WSTPtot 管理者/関係者向け教習時間割 第 1 日 第 2 日 第 3 日 8:30 WSTPtot 管理者向け教習の はじめに(85 分) B.5: 車椅子サービスは どうお金がかかるのか？ (60 分) WSTPtot 関係者向け教習の はじめに(35 分) 8:45 9:00 S.2: 政策から実践へ(45 分) 9:15 9:30 B.5: 車椅子サービスは どうお金がかかるのか？ フィードバック(30 分) 9:45 S.2: 政策から実践へ： フィードバック(25 分) 10:00 午前の休憩 午前の休憩 10:15 あいさつ・自己紹介・概略 (10 分) C.2: 需要管理(85 分) 午前の休憩 10:30 あいさつ・自己紹介・概略： フィードバック(15 分) S.3: 適正な車椅子を 取り揃える(30 分) 10:45 A.1: 適正な車椅子供与とは 何か？(50 分) 11:00 S.3: 適正な車椅子を取り揃え る：フィードバック(30 分) 11:15 S.4: 変革に向け協働を (パート 1)(57 分) 11:30 A.1: 適正な車椅子供与とは 何か？フィードバック(25 分) 11:45 C.2: 需要管理： フィードバック(35 分) 12:00 昼休み 12:15 昼休み 昼休み 12:30 12:45 1:00 A.2: サービス提供(40 分) 1:15 C.4: 持続可能な財政計画 (70 分) S.4: 変革に向け協働を (パート 2)(43 分) 1:30 1:45 A.2: サービス提供： フィードバック(20 分) 2:00 A.3: 変革を導く管理者 (45 分) S.4: 変革に向け協働を： フィードバック(30 分) 2:15 2:30 C.4: 持続可能な財政計画： フィードバック(30 分) 管理者/関係者向けWSTPの 教習運営実務と準備 (30 分) 2:45 A.3: 変革を導く管理者： フィードバック(30 分) 3:00 午後の休憩 午後の休憩 122 3:15 午後の休憩 管理者向けWSTPの模擬 授業範囲外の授業(105 分) 管理者/関係者向けWSTP 時間割の選択肢 (45 分) 3:30 B.1: サービスへのアクセス (45 分) 3:45 4:00 「保留スペース」 4:15 B.1: サービスへのアクセス： フィードバック(25 分) ToT 教習員の個別フィード バック(65 分) 4:30 4:45 「保留スペース」 5:00 授業準備・ToT 教習員の個別 フィードバック(30 分) 授業準備・ToT 教習員の個別 フィードバック(30 分) 5:15 WSTPtot 管理者・関係者 向け教習への評価と閉講式 (10 分) 123 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot 実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2 つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP 教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 124 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 125 ToT 教習員への指示：WSTPtot の終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 126 付録 4：管理者/関係者向け WSTP 計画ツール 国：________________________________ 記入者：_____________________________________ 連絡先：____________________________ 日付：______________________________________ 1. このツールの使い方 このツールは、当該国の一般的状況を収集し、教習やワークショップの望ましい成果を設定できる ように設計された。関係者と協力して、下表を次の手順で記入するよう推奨する。 当該国の状況に最も近い内容が述べられている欄を、マルで囲むかマーカーで強調する。 左端の列、白地の「要約」欄に、当該地域の状況の詳細を手短に記入する。 現地への知識、「追加を検討する授業」の行、可能な成果のページを利用し、現地の状況と 持ち時間に基づいて、自分の教習にどの授業を盛り込むか検討する。 2. 調査と計画への参画を得る国内の主な関係者の概要 関係者向け WSTP で挙げた、以下の関係者に相談し/参加を得よ： • 政策の企画者および実施者（例えば政府部局の、特に車椅子供与を担当するところ） • 障害分野のネットワーキング組織 • 障害者団体（ODP） • 影響力のある指導者や政治家 • 車椅子ユーザー、およびその家族/介助者 • 慈善家/資金供与者/寄付者 • メディア（電子および印刷） • 車椅子の製造者および供給者 • 専門家集団（理学療法士、作業療法士、CBR（地域に根ざしたリハビリテーション）専門職、 義肢/装具士その他） 経験を共有できる、海外の関係者を招待することも検討せよ。 1 2 7 3. 管理者/関係者向け WSTP 計画ツール 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 下の白地要約欄に記入 10 分野の各々について、最もよく当てはまる白地欄をマルで囲む/強調する 1. 政策および政策策定：政策/国家障害者計画/車椅子サービス提供に関連する法律 要約： 支援機器供与に、具体的に 言及した政策/計画が存在 しない。 国としての方策はない。 一般的な政策/計画はある が、CRPD（障害者の権利に 関する条約）や車椅子ガイ ドラインに沿っていないか 関係者に知られていない。 それらは実行されておらず また時代遅れである。 政策/計画があり、ほとんど の関係者に知られている。 それらは、CRPD や車椅子 ガイドラインにある程度は 沿っているが実行されてい ない。 政策/計画があり、CRPDと 車椅子ガイドラインに沿 っている。それらは定期的 に見直され、あらゆる関係 者によく知られており、広 く実行されている。 追加を検討する授業： CRPD/WHO ガイドライン に沿って政策/国家障害者 計画/国の基準を策定/起草 する。 CRPD/車椅子ガイドライ ンを基準に政策を見直す。 適正な車椅子サービスを 提唱する政策を運用可能 にする方法。 政策を活用して車椅子提供 を強化する。 他国が政策を開発/実施 するのを支援する方法。 1 2 8 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 2. 政策および政策策定：障害者の権利に関する条約（CRPD） 要約： CRPD に署名しておらず、 政府も同条約に関する国内 での取り組みを行なってい ない。 CRPDには署名しているが 批准していない。国内では よく知られておらず、推進 もされていない。 CRPDに署名しそれを批准 しているが、同条約に対す る認知やモニタリングは 弱い。 国は CRPD に署名し批准 しており、その進捗を評価 するための、強力なモニタ リングのしくみを備えて いる。 追加を検討する授業： CRPD およびその車椅子 サービス提供との関連へ の認識を高める。 CRPD およびその車椅子 サービス提供との関連を 宣伝する方法。 車椅子サービスに関する モニタリングのしくみ/ 組織を見直す/開発する。 モニタリングのデータを 見直し、CRPDに関する車 椅子サービス事業の強み と弱点を明確にする。 3. 政策および政策策定：WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて（車椅子ガイドライン）」に関する知識 要約： 同ガイドラインについては 車椅子サービス提供に携わ る関係者の間でもほとんど あるいはまったく知られて いない。 同ガイドラインについて、 限られた人数の関係者は 知っているが、その普及は 非常に限られている。 同ガイドラインは、主要な 車椅子関係者間ではよく 知られているが、政府や 主流の障害/開発関係者の 間では知られていない。 同ガイドラインはよく知 られており、政府その他の 関係者の間で、車椅子サー ビス事業を計画・実施する ための主要な指針資料と して活用されている。 追加を検討する授業： 同ガイドラインの内容およ び背景に関する提示。 同ガイドラインを推進 するための、一般的方策を 策定する。 特定部門に対して同ガイ ドラインを普及するため の方策。 同ガイドラインの達成状 況に関する国内の/国際的 なケーススタディ。 1 2 9 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 4. 政策および政策策定：国の社会基盤および車椅子供与への取り組みの調和 要約： 国が状況不安定/緊急事態 で、公的社会基盤がほとん ど存在しない。 リハビリテーションへの取 り組みは最低限度で、その ほとんどは国際 NGO/国内 NGO部門が運営している。 国の組織化と資金力が貧弱 で、構造が脆弱である。リハ ビリテーションは優先され ておらず取り組みも調和さ れていない。国の熟練した 人材は希少である。 社会基盤が整備され、リハ ビリテーションのサービス 事業と職員は存在するが、 各サービスの調和が取れて いないか資金力が乏しく、 その品質・量・普及範囲に は制約がある。 国のあらゆる地域に、確立 して調和されたリハビリテ ーションサービスがあるな ど、国に堅実な社会基盤が ある。 追加を検討する授業： 国際 NGO/NGO のリハビ リテーション関係者の間 の、適正な車椅子提供への 認識を高める。 国内の車椅子サービス提供 への取り組みを調和させる 方法。 作業部会または全国協会 を編成する。 国内の車椅子サービス提供 の取り組みを、調和させる 方法。 持続可能性の確保と将来、 すなわち人口高齢化に伴う 車椅子サービスへのニーズ の変化に対する計画： 5. 政策および政策策定：障害者運動の力量および障害者のインクルージョンの水準 要約： OPD（障害者団体）が弱いか 存在しない。障害者は、のけ 者にされ、差別・偏見にさら され敬遠されている。 OPD や NGO が障害分野で 活動する弱い障害者運動は あるが、活動が調和されて おらず、影響力に欠ける。 障害者はほとんど排除され ている。 OPD の力量が増すにつれ 障害者運動が成長中。生活 場面によっては、障害者の インクルージョンがあり、 CRPD に沿う障害者の権利 への認識も高まっている。 活発な障害者運動と強力な OPDの組織がある。障害者 は車椅子サービス提供に参 画しCRPDに沿った障害者 の権利もほとんどの場所で 認識されている。 追加を検討する授業： 車椅子ユーザーの権利と車 椅子サービス提供における 車椅子ユーザーおよびその 組織の役割。 車椅子提供における、自助 グループの役割の可能性： ケーススタディと共に。 どうやって車椅子サービス 提供における OPD の役割 を向上させるか。 国内の、および国際的な、 適正な車椅子サービス提供 推進におけるOPDの役割。 1 3 0 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 6. 製品：適正な車椅子および座位保持装置の入手可能性 要約： どんな車椅子も完全に不足 しており、手に入るものは 大半の人のニーズに対して 適正ではない。 1・2種類の適正な車椅子は あるが広く普及しておらず ニーズに対応できていな い。座位保持装置は、ほとん ど、あるいはまったくない。 じゅうぶんな/限られた種 類の適正な車椅子および/ または座位保持装置がある が、数量/品質/全地域への 普及には制約がある。 国のあらゆる地域に適正な 車椅子および座位保持装置 が包括的に取り揃えられて いる。 追加を検討する授業： 適正な車椅子を取り揃える。 上記ガイドラインを基準に 現地で手に入る製品を評価 する。 適正な車椅子の普及範囲 と種類の拡張、および座位 保持装置の導入。 適正な車椅子と座位保持 装置の、普及範囲と種類を 拡張する。 包括的な種類を揃えて おくことの重要性を強調 する成功談の発表。 7. サービス：車椅子サービスの状況 要約： 政府のサービスはない。 NGO による散発的な大量 配布に依存し、上記ガイド ラインに従った事前評価や 処方サービスはない。 政府やNGOの運営による、 バラついた水準の基礎的な サービス。中級レベルのサ ービスはない。紹介・相談と フォローアップは乏しい。 基礎と中級のサービスを、 車椅子ガイドラインの基準 に沿って運用しているが、 ニーズに対して不十分で、 政府のリハビリテーション サービスに統合されておら ず、ユーザーの参画やフォ ローアップは最低限度。 良質な基礎と中級レベルの サービスネットワークが、 政府の全国的サービスに統 合され、地方・国レベルで ニーズを満たしユーザーが 全面的に参画している。 追加を検討する授業： 車椅子サービスを開始する 車椅子サービス事業を 運営する 全国的ニーズに応えるため にサービス提供のポジティ ブな側面を拡大する方法。 サービスの継続的発展への 方途。 他国のサービス開発を支援 する方法。 1 3 1 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 8. サービス：リハビリテーション専門職/地域に根ざしたリハビリテーション(CBR)サービス/車椅子提供技能教習を受けた職員の利用可能性 要約： 理学/作業療法士や、CBR 専門職はほとんどいない。 車椅子提供の関連技能を持 つ人は、国内にまったく、 あるいはほとんどいない。 限られた人数の有資格専 門職と教習を受けた CBR ワーカーがいる。しかし、 車椅子提供の専門技能を 持つ人はほとんどいない。 有資格専門職がほとんど の地域に、CBRワーカーが ほとんどの地区に配置さ れている。地方によって は、車椅子提供の専門技能 教習を受けた人がいる。 全国かほとんどの地方を、 教習を受けたリハビリテー ションとCBR専門職の ネットワークが覆い車椅子 提供の技能教習を受けた人 が多数いる。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ガイドラインと、 WSTPモジュールへの認識 WSTPモジュールをリハビ リテーション教程に統合 する方法。 WSTPモジュールをリハビ リテーション教程に統合 する方法。 9. サービス：資金供与の利用可能性 要約： リハビリテーションのため に国内で利用できる資金は ほとんどあるいはまったく ない。ほとんどのリハビリ テーション資金は、国際 NGO/国際機関が供与。 サービスには最低限度の資 金を利用できるが、車椅子 供与に関与する資金供与は ない。 サービスと製品の両方で、 そこそこの水準の資金は 利用できるが、ニーズには 不十分である。 サービスにじゅうぶん資金 力があり、すべて/ほとんど の車椅子と座位保持装置は 国の制度を通して資金供与 される。 追加を検討する授業： 国際 NGO/NGO 関係者の 間の、適正な車椅子供与へ の認識を高める。 適正な車椅子供与と障害者 のインクルージョンによる 保健医療費用節減を示す、 ケーススタディの発表。 多様なニーズに合う、さま ざまなコストでさまざまな 種類の適正な車椅子が揃う ことの重要性。 効果的なサービスの有益さ に関するケーススタディ で、それらが維持されるた め、また教訓として他者と 共有されるためのもの。 1 3 2 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 10. 教習：車椅子ユーザーを含む、車椅子サービス職員が受けられる教習 要約： 車椅子提供教習が国内では まったく受けられない。国 のリハビリテーション訓練 学校がない。 限定的な車椅子提供教習が CBR/その他の教習コース に含まれているが、車椅子 ガイドラインに沿ったもの ではない。車椅子ユーザー の技能教習はない。 さまざまな幹部職員には 教習が提供され、WSTPか 同等のパッケージの教習 を実施できる限られた数 の人がいる。若干の車椅子 ユーザー教習がある。 車椅子ガイドラインに沿っ た基礎および中級レベルの 車椅子提供技能教習コース が定期的に実施され、他の リハビリテーション専門職 教程に統合されている。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 さまざまな部門に対する、 教習ニーズの分析。 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ユーザーに対する、 ピア教習への認識。 リハビリテーション専門職 および車椅子ユーザーの、 車椅子提供技能を向上させ る方策を開発する。 車椅子専門職の技能を、 中級/上級レベルへ発展 させる方策。 133 4. 車椅子サービス管理者向け教習や関係者向けワークショップの設定可能な成果 最も適切かつ達成可能な成果を見定め、それを押さえるためにはどれくらい時間が必要か検討せよ。 適切であれば、授業時間または授業範囲を拡張せよ。 教習パッケージで特定した、以下の領域を考慮せよ： 管理者向け WSTP • 車椅子サービス提供の 8 ステップへの認識を高める。 • 車椅子サービス事業を開始する方法への知識と技能を高める。 • 車椅子サービス事業を運営する方法への知識と技能を高める。 • 車椅子供与を持続可能にする方法への認識を高める。 • 車椅子サービス提供の質を高める。 関係者向け WSTP • 適正な車椅子へのニーズおよびその有益さについての理解を深める。 • 関係者に、適正な車椅子サービス提供を発展させるうえでの各自の役割を伝える。 • バリアフリー環境への理解を深める。 • 予算支援を見出す/提供することへのより深い関与を得る。 • 車椅子サービス提供の持続可能性を高める。 現地の状況およびニーズに基づき、以下の可能な追加的成果を検討するか、独自の成果を特定せよ。 • 車椅子サービス提供のための国の政策を策定/起草する。 • 車椅子サービス提供のための国の方策を策定/起草する。 • 車椅子問題を調整し推進する作業部会を任命する。 • 車椅子/支援製品協会あるいは研究会を設立する。 • 車椅子サービス提供のための国の基準に合意する。 • 既存の車椅子と座位保持の種類を、WHO 車椅子ガイドラインに照らし評価する • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」への認識を高める。 • CRPD その他の国際的法律文書と、それらと車椅子サービス提供との関連への認識を高める。 • 車椅子サービス提供をよりよく調整する。 • 車椅子サービス事業管理に携わる職員の技能を向上させる。 134 • 車椅子サービス提供の、世界/地域/国内における状況に対する理解を深める。 • 車椅子サービス提供教習へのニーズ分析を完成する。 車椅子サービス教習員養成教習パッケージ 管理者/関係者向け教習ハンドブック 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

車椅子サービス 教習員養成教習パッケージ 管理者/関係者向け 教習員指導書 車椅子サービス教習員養成教習パッケージ・管理者/関係者向け教習員指導書 © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: Trainer’s manual managers and stakeholders. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: Trainer’s manual managers and stakeholders. ジュネーブ: 世界保健機関; 2017. ライセ ンス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワール ド・ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: Trainer’s Manual Intermediate Level” の全訳である。序章の「はじめに」で述べている通り、本書を含む この 車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings” （訳訳 動車車椅子与 の世界ガイドライン 低リソース 状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたものである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移車支援機器与 に関する共同方針提言書：個人的移車性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子与 ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬授業実習からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳と校閲では以下の方々のご協力をいただきました。ここにお名前を 記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: Trainer’s Manual Intermediate Level, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 1. ToT 教習員への手引き xiii 2. 教習パッケージ実施準備のやり方 xvii 必須教習技能モジュール xxiv ToT.1 車椅子サービス教習員養成教習パッケージ紹介 1 ToT.2 車椅子サービス教習パッケージについて 12 ToT.3 模擬授業について 25 ToT.4 多様性に備える 36 ToT.5 成人学習 43 ToT.6 準備時間について 55 ToT.7 プレゼンテーションとファシリテーション 58 ToT.8 コミュニケーションスキル 67 ToT.9 指針文書の知識 75 ToT.10 視聴覚ツールおよび機材 92 ToT.11 フィードバックについて 103 ToT.12 グループダイナミクスを取り仕切る 109 管理者/関係者向け教習モジュール 117 WSTPtot 管理者向け教習のはじめに 118 あいさつ・自己紹介・概略 133 A.1: 適正な車椅子供与とは何か? 134 A.2: サービス提供 136 A.3: 変革を導く管理者 137 B.1: サービスへのアクセス 138 B.2: 施設および設備 139 B.3: 適正な車椅子を取り揃える 141 B.4: 職員の配置 143 B.5: 車椅子サービスはどうお金がかかるのか? 145 C.1: サービス事業が機能しているか判るには？ 146 C.2: 需要管理 147 C.3: フォローアップ計画 149 C.4: 持続可能な財政計画 150 総まとめ 151 管理者向け WSTP 模擬授業範囲外の授業 153 WSTPtot 関係者向け教習のはじめに 164 S.1: はじめに 172 S.2: 政策から実践へ 174 S.3: 適正な車椅子を取り揃える 177 S.4: 変革に向け協働を 179 閉会のことば 181 管理者/関係者向け WSTP の教習運営実務と準備 182 管理者/関係者向け WSTP 時間割の選択肢 191 WSTPtot 管理者/関係者向け教習への評価と閉講式 201 付録 203 付録１：WSTPtot 必須授業時間割 203 付録２：WSTPtot 管理者/関係者向け教習時間割 204 付録 3：WSTPtot 模擬授業フィードバックシート 206 付録 4：管理者/関係者向け WSTP 計画ツール 209 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008 年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4 種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHO は、WSTPtot の発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtot は、単一の「必須教習技能」モジュール3、および既成の 4 教習パッケージ（2012 年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013 年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015 年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtot では、WSTPm と WSTPs は、一つの教習パッケージ別モジュールと して統合されている。 WSTPtot は 40 時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtot の修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した授 業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi 対象者 WSTPtot は、以下 4 つのモジュールからなる： • 必須教習技能5：2 日間 • 基礎教習（WSTPb）：3 日間 • 中級教習（WSTPi）：3 日間 • 管理者/関係者向け教習（WSTPm/s）：3 日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールの一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向けおよび関係者向け WSTP の実施を計 画している教習員が対象である。実習生が WSTPtot 管理者/関係者向け教習から最大限の成果を 得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業の 必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習6 の機会を得る必要がある。 5 [原文] Core Training Skills 6 [原文] co-training xii 教習員 技能：このパッケージを実施する ToT 教習員には、以下が求められる： • 管理者/関係者向け WSTP 教習を実施し、またその実施のために他の人を指導した豊富な経験 • WSTPtot を実施するところの状況に対する深い理解 • さまざまな国/状況における車椅子サービス事業管理の幅広い知識または経験 • 車椅子供与に関連する、国際的指針文書7に関する知識 • 車椅子供与に関する議論に関係者を惹き込んだ経験およびその能力 車椅子ユーザー：他の WSTP［車椅子サービス教習パッケージ］と同様、車椅子ユーザーを教習 チームに含めるよう強く推奨する。車椅子ユーザーは自身の経験をもとに、適正な車椅子供与が、 自分のインクルージョンの実感8や QOL へどう影響したかについて、貴重な見解を示せる。また、 車椅子ユーザーが自身の車椅子を選択するうえで果たす、中心的役割についても語ることができる。 ToT教習員の人数：実習生は注意深く支援する必要があるため、基礎または中級モジュールでは 実習生 4〜5 名ごと、管理者/関係者向けモジュールでは実習生 6 名ごとに ToT 教習員 1 名を置く よう推奨する。 開始までの流れ ToT プログラム実施に先立ち、WSTP 用 USB メモリ9から WSTPtot フォルダーをコンピューター のハードドライブにコピー10する。 • 次ページの「1. ToT 教習員への手引き」を読む。xviii-xxiv ページの表にある資材を準備する。 • 「教習パッケージ実施準備のやり方」の章が示す通りに、必要な段取りをすべてやっておく。 • 各受講者に、本書 xviii-xx ページに挙げた教習教材一式を配布する。 7 [原文] international guiding documents 8 [原文] their feeling of inclusion 9 [原文] WSTP Pen Drive [訳注] 英語版のみが WHO より配布されている. 10 [訳注] 英語版のみ. 日本語版は教習パッケージフォルダーをダウンロードして使用. 以下同じ. xiii 1. ToT 教習員への動引き 教習の概略 必須教習技能モジュール 分 日 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 75 第 １ 日 ToT.2 車椅子サービス教習パッケージとは 90 ToT.3 模擬授業について 60 ToT.4 多様性に備える 60 ToT.5 成人学習 85 ToT.6 準備時間について 15 準備時間 45 ToT.7 プレゼンテーションとファシリテーション 60 第 ２ 日 ToT.8 コミュニケーションスキル 90 ToT.9 指針文書の知識 75 ToT.10 視聴覚ツールおよび機材 45 ToT.11 フィードバックについて 45 ToT.12 グループダイナミクスを取り仕切る 40 準備時間 75 管理者/関係者向け教習モジュール WSTPtot 管理者向け教習のはじめに 85 第 ３ 日 あいさつ・自己紹介・概略 25 A.1: 適正な車椅子供与とは何か？ 75 A.2: サービス提供 60 A.3: 変革を導く管理者 75 B.1: サービスへのアクセス 70 保留スペース・授業準備・ToT 教習員の個別フィードバック 60 第 ４ 日 B.5: 車椅子サービスはどうお金がかかるのか？ 90 C.2: 需要管理 120 C.4: 持続可能な財政計画 100 管理者向けWSTP模擬授業範囲外の授業 105 授業準備・ToT 教習員の個別フィードバック 30 xiv WSTPtot 関係者向け教習のはじめに 35 第 ５ 日 S.2: 政策から実践へ 70 S.3: 適正な車椅子を取り揃える 50 S.4: 変革に向け協働を 130 管理者/関係者向けWSTPの教習運営実務と準備 30 管理者/関係者向けWSTP時間割の選択肢 45 保留スペース・授業準備・ToT 教習員の個別フィードバック 80 WSTPtot 管理者/関係者向け教習への評価と閉講式 10 教習時間計 2205 教習パッケージの時間割および期間 WSTPtot「必須教習技能」および「管理者/関係者向け教習」モジュールは連続した数日間で、ある いは一定期間に数ブロックに分けて実施できる。連続した 5 日間での時間割の一例を、WSTP 用 USB メモリ内の WSTPtot フォルダーに載せている11。 ToT 教習員には、現地の事情および受講者の学習ニーズに合わせ、この時間割を調整し、修正する よう奨励する。 必須教習技能」の授業計画 「必須教習技能」モジュールは 12 教科からなり、各々の詳しい授業計画から始まる。計画は以下 の要点を押さえ、ToT 教習員が、各授業を計画し実施するのに役立つよう設計されている12。 • ねらい13：その授業のねらいは何か • 学習目標14：実習生は、その授業が終わるまでに何を達成するのか • 教材：その授業にはどんな教材が必要か • 準備15：ToT 教習員がその授業を準備するのに役立つ確認表 • あらすじ16：時間配分を含む、その授業の主な内容 ToT 教習員には、授業に自分自身の知識・技能・スタイルを取り入れ、また WSTPtot 教習全体を 通して実習生の経験を引き出すよう奨励する。 11 [訳注] WSTP 用 USB メモリは英語版のみ. 時間割例の日本語版は本書の付録 1 を参照. 12 [訳注] 分かりやすさのため、受講者への語りは ですます調」、教習員への指示は である調」で区別した。 13 [原文] Aim 14 [原文] Learning objectives 15 [原文] To prepare 16 [原文] Outline xv 管理者/関係者向けWSTPの授業計画 「必須教習技能」モジュール修了後、実習生は WSTPtot の第 2 部へと進んで、管理者向け WSTP および関係者向け WSTP からの授業を実施することによって学んだ教習技能を実践する。実習生 には [模擬] 授業を割り振り、授業実施に続いてフィードバックと討論を行なう。模擬授業の時間17 は、ToT 教習員に実習生の技能を観察し、評価する機会を与える。 • 模擬授業18 ：各模擬授業の内容は、実習生による割り振られた授業項目のプレゼンテーション19 などである。 • ToT教習員のデモ20 ：ToT 教習員が、優れた実践21の例22として教授する項目を含む授業もある。 • フィードバック：授業後、ToT 教習員は、実習生および模擬受講者からのフィードバックでは ファシリテーターを務める。フィードバックを与える際の詳しい指導内容は、本マニュアルの xxii-xxiii ページ「模擬授業のファシリテーション要領」を参照。 実習生に模擬授業を準備させる 実習生が WSTPtot のためにじゅうぶん準備できるように、管理者向け WSTP および関係者向け WSTP の資料を事前に渡しておくことが重要である。これは、教習パッケージの紙コピーでも電子 コピーでもダウンロードリンクでもよい。実習生は、どの授業でも実施できるように準備しておく べきである。 実習生に WSTPtot への準備をさせるための指示書の見本は、WSTP 用 USB メモリ内の WSTPtot フォルダーに載せている。 模擬授業の割り振り 模擬授業割り振りの例は、WSTPtot フォルダー内の「WSTPtot 管理者/関係者向け教習割り振り」 ファイルを参照。ToT 教習員は、これを自分の教習状況および実習生数に合わせて修正すること。 模擬授業は、「必須教習技能」モジュール第 1 日の授業「ToT. 3 模擬授業について」で割り振りを 決める。 注記：実習生が「必須技能教習」モジュール履修済みで、いきなり管理者/関係者向け教習モジュ ールから始める場合は、各々の模擬授業について 2・3日前に23通知しておくべきである。 17 [原文] practice delivery sessions 18 [原文] practice delivery 19 [原文] presentations [訳注] この語の本書での意味は授業 ToT.7 を参照. 20 [原文] demonstrations [訳注]「やって見せること・実演すること」という意味での「デモ」. 21 [原文] good practice [訳注] 以下同じ, 頻出. セミナー等では「グッドプラクティス」と訳される場合もある. 22 [原文] an example 23 [原文] two-to-three days in advance xvi メンター24およびピアサポート25 ToT 教習員には、メンター26という重要な役割がある。教習プログラムの最初に、各実習生には、 メンター21 の ToT 教習員を必ず割り当てよ。実習生は、ToT 教習員で均等に分け合うべきである。 メンターの ToT 教習員は、自分の実習生から模擬授業に関する質問を受け、また実習生の進歩に 対してフィードバックも与える、主要な接点27である。 ToT 教習員には、WSTPtot 教習後も、実習生に対するメンターを継続するよう勧める。 実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各々の技能と自信とを養うために 役立つ。実習生がソーシャルメディア上のグループに参加するかグループを立ち上げ、質問したり 学習経験を共有したりできると有益であろう。 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員に付いて見習い教習を実施し、自らの技能を育成し 続けなければならない。ToT 教習員は、実習生が WSTPtot 修了後に見習い教習を経験することを、 自らの教習技能を育成し続けるための最良の方途として奨励しなければならない。 見習い教習では、教習指導員 1 名に対して実習生 2〜4 名の割合を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、模擬授業からのフィードバックで記録し、実習生と共有すべきである。 実施ごとに ToT プログラムを事後評価する 教習プログラムを一つひとつ実施後に評価するのは優れた実践である。ToT 教習員は、実習生から 定期的にフィードバックを集め、ToT プログラムの間に自分が考察したことを記録しておくべきで ある。これは、ToT 教習員が WSTPtot および自分自身の教習技能の両方を改善するために役立つ。 例えば、以下のフィードバックおよびデータを提供できると、たいへん有用である： • 受講者の登録および評価フォーム • WSTPtot に関する自分自身の考察やコメント 教習プログラム評価フォームは WSTP 用 USB メモリ内の WSTPtot フォルダーに収めており、 ToT 教習員は、これを各自のニーズに合わせて修正してよい。 24 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 25 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 26 [原文] mentor [訳注] 本書では助言指導 mentor, その行為 mentoring と指導者 mentor は「メンター」に一括. 27 [原文] main point of contact xvii 2. 教習パッケージ実施準備のやり方 各実習生の経歴28を知る 各実習生の経歴を熟知することは重要である。例えば： • 車椅子供与において、実習生がすでにどんな経験を有しているのか把握する。 • 実習生がすでに履修あるいは実施したことがある教習プログラムをすべて分かっている。 • 実習生が、自分が管理者向け WSTP および関係者向け WSTP を実施する機会が将来あるかどう か知っている。 車椅子サービス提供が、実習生の勤務先での業務全体にどう組み込まれているのか見極めよ。 教習施設を準備する WSTPtot を実行するために必要な施設： • 広い教室（またはスペース）1 室：実習生が小グループに分かれて作業できるくらいじゅうぶん 広く、また実習生が集中できるくらいじゅうぶん静かであること。 • 昼食/軽食のための独立したスペース • 清潔なトイレ トイレをはじめあらゆるエリアは、絶対に車椅子でアクセスしやすくなければならない。 28 [原文] background xviii 下の確認表を、教習施設の下調べと準備に用いるとよい。 教習施設確認表 教室 講義エリア □ 各実習生用の椅子：折りたたみテーブルなど実習生がノートを取れる設備があるもの □ 実習生が 2〜4人ずつの小グループに分かれられるスペース □ 最低 3台の車椅子を展示し、動かして回れるスペース □ じゅうぶんな照明および換気 □ 施錠可能/安全なスペース □ 昼食/軽食エリア 清潔な食事エリア □ テーブルと椅子 □ 近くの手洗い場：清潔なタオルおよび石けん □ トイレ 水場、トイレットペーパー、手洗い設備、ゴミ入れを備えた清潔なトイレ □ 教材および設備を準備する WSTPtot の印刷教材 教材 数量 X 注/備考 マニュアル類 ToT 教習員用指導書 ToT 教習員 1人に（教授する モジュールにつき）1冊 □ 印刷して製本。 ToT ハンドブック 実習生 1人に（教授する モジュールにつき）1冊、 ToT 教習員 1人に 1冊 □ 印刷して製本。 WHO「手動車椅子供与の世界 ガイドライン 低リソース状況 の克服に向けて」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 国際連合「障害者の権利に 関する条約（CRPD）」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 教習パッケージ別モジュール （管理者向けWSTPと関係者 向けWSTP）用印刷教材セット 実習生・ToT 教習員 1 人に 1セット □ マニュアル類、ワークブ ック、ポスター、フォー ムと確認表など。詳しく は以下の表を参照。 xix 教習プログラム用各種フォーム 受講者登録フォーム 1 プログラムに 1部 □ 受講者の参加記録に、この フォームを使用。 名札 実習生・ToT 教習員 1 人に 1枚 □ ― 時間割表（必須教習技能および 教習パッケージ別モジュール） 実習生 1人に該当する モジュールを 1部ずつ □ 各モジュールの見本を、 WSTP用 USB メモリに収載。 現地の事情に合わせて調整。 写真撮影同意フォーム 1 部 □ 主催/教習実施団体向けに修正 し、現地語に翻訳して、写真 を撮られる人には、必ずこの フォームへ署名してもらう。 実習修了証 実習生 1人に 1部 □ 実習修了証は、準備するか WSTP用 USB メモリに所収 のひな形を調整。 教習プログラム評価フォーム • 必須教習技能 • 教習パッケージ別モジュール 実習生 1人に 1部 □ 実施後に情報を集約し、 WHOと共有。 WSTPtot 模擬授業フィード バックシート ToT 教習員には実習生 1人につき 1部必要 □ 実習生 1人につき最低 1部を 印刷。このシートは 3回まで の模擬授業に対するフィード バックに使用可能。 xx 管理者向けWSTPおよび関係者向けWSTPの印刷教材 教材 数量 X 注/備考 マニュアル類、ワークブック、ポスター 管理者向けWSTP教習員用指導書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 管理者向けWSTP参考書＆ワーク ブック 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 管理者向けWSTP補足資料 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 関係者向けWSTP教習員用指導書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 ポスターセット 内容： • 車椅子サービスのステップ • 車椅子の移動技能 • 褥瘡 • 家庭での車椅子の手入れ方法 • 子どもと車椅子 • さまざまな体位 • 姿勢支持具（PSD）一覧表 • 中級車椅子ユーザー教習確認表 実習生・ToT 教習員 1 人に 1セット □ ― 「低リソース状況での移動支援機器 供与に関する共同方針提言書」 見本版を最低 1部 □ WSTP用 USB メモリ内資料 「CBRガイドライン：導入ブック レットおよび保健コンポーネント」 見本版を最低 1部 □ WSTP用 USB メモリ内資料 「先導する管理者」 見本版を最低 1部 □ WSTP用 USB メモリ内資料 「アクセシビリティのための デザインの留意事項」 見本版を最低 1部 □ WSTP用 USB メモリ内資料 xxi 設備 一般的な教習設備 物品 数量 X 注/備考 大きなホワイトボード 1 □ ― ホワイトボードマーカー 3〜4本 □ さまざまな色のもの プロジェクター 1 台 □ ― コンピューター 1 台 □ ― ポータブルスピーカー 1 セット □ 動画の音質向上用 ポインター/リモコン 1 □ ― フリップチャート用イーゼル および用紙 イーゼル 1〜2架 および用紙 1包 □ フリップチャート用マーカーペン 3〜4本 □ さまざまな色のもの 付箋紙 3〜4冊 □ さまざまな色のもの マスキングテープか類似品 1 巻 □ フリップチャート紙やポスターを 壁に貼るため 延長コード 最低 1つ □ ― 電源タップ/アダプター 必要に応じて ― xxii 教習教材について知る ToT 教習員は、管理者向け WSTP および関係者向け WSTP 教材すべてを包括的に知っている必要 がある。これには教習パッケージ別の「教習員用指導書」ならびに「受講者用参考書」「受講者用 ワークブック」そして WSTP 用 USB メモリ内のその他の教材の、あらゆる面に精通することが含 まれる。 また「ToT 教習員用指導書」と「ToT ハンドブック」の全項目を熟知していることも必要である。 WSTPtot 教習は他の ToT 教習員と共同で実施してもよいが、その場合でも自分がすべての授業を 熟知していることは重要である。例えば、WSTPtot で教わる「必須教習技能」はすべてじゅうぶん に理解し、自分の授業において優れた実践としてお手本を示せるべきである。 模擬授業のファシリテーション要領 • 授業時間をモニターし、予定時間を過ぎたら、完了していなくても実習生を停止させよ。 • 授業を複数の実習生で分け持つ場合は、流れを止めないよう授業全体を実行した後で、各実習生 に対するフィードバックのファシリテーションを順番に行なえ（WSTPtot の時間配分により、 休憩が必要な授業を除く）。 • 「ToT 教習員用指導書」中の「WSTP 教材の誤り」と「この授業を教えるための主な留意点」を 熟知し、実習生がそれらを取り上げたか確認せよ。 • 授業は「WSTP 教習員用指導書」および「ToT 教習員用指導書」に沿って進めよ。 • 授業中、WSTP 用 USB メモリ内の「WSTPtot 模擬授業フィードバックシート」を記入せよ。 • 模擬授業中、授業がスムーズに進まないからといって早まって介入しないこと29。実習生に自力 で状況を軌道修正し30受講者を方向転換させる31時間を与えよ。介入するのは、安全上の懸念が 生じたか、実習生が自力で授業を軌道に戻せなくなった32場合だけにせよ。 29 [原文] don’t step in foo quickly 30 [原文] rectify the situation 31 [原文] redirect participants 32 [原文] unable to bring the session back on track themselves xxiii 模擬授業後のフィードバックでファシリテーションを行なう ToT 教習員の役割は、フィードバック時間にファシリテーションを行ない、それを簡潔で建設的、 かつ的確な33ものにすることである。 模擬授業が完了したら、以下のプロセスをたどること。 *「WSTPtot 模擬授業フィードバックシート」内に収載。 フィードバックが建設的になるよう、注意深くモニターせよ。受講者がネガティブまたは傷つける ような34フィードバックを発したら介入せよ。フィードバックを建設的に言い換える見本を示せ。 個別フィードバック ToT 教習員へのメンターの割り振りに基づいて、ToT 教習員は、各実習生と「WSTPtot 模擬授業 フィードバックシート」を指針に用いながらフィードバックを交わす時間を設定する。この時間は、 追加の、またはデリケートなコメント35をフィードバックするためにも活用せよ。 33 [原文] brief, constructive and relevant 34 [原文] hurtful 35 [原文] sensitive comments xxiv 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 ね ら い WSTPtot（車椅子サービス教習員養成教習パッケージ）を実習生に紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  ToT［教習員養成教習］プログラムのねらいおよび目標を詳述する。  ToT プログラム時間割およびWSTPtot の課程を説明する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.1：WSTPtot 紹介」  各 ToT 教習員の名札 各実習生に：  さまざまな色の付箋紙（A5くらいのサイズ）：3〜4枚  「ToT ハンドブック」  モジュール別WSTP［車椅子サービス教習パッケージ］の教習員用指導書、受講者用 参考書およびワークブック、ポスター、WSTP用 USB メモリ  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」および 「障害者の権利に関する条約（CRPD）」  「必須教習技能」モジュールおよび教習パッケージ別モジュールの時間割表  白紙の名札 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  現地に適した短いWSTPtot 開講式を段取る。  庶務連絡1を準備。  「基本ルール2」および「保留スペース3」のフリップチャート紙を準備。  教室を設営：テーブルと椅子、プロジェクター、コンピューターとスクリーン、 ホワイトボード、フリップチャート用イーゼルと用紙、マーカーペン。  教材を受講者ごとのセットに仕分けして取り置く。混乱を避けるため、この日は最初 実習生に「ToT ハンドブック」、各自の教習パッケージ別「WSTP教習員用指導書」と ToT 時間割表のみを配布する。残りの教材は、この日の終わりに配布。  「経験の壁4」を準備。 5節に示した見出しを大きい付箋紙か A5用紙に印刷するか 記入するかし、壁に「経験の壁」の見出しを付けて、その下に貼っておく。 1 [原文] housekeeping information 2 [原文] Ground Rules 3 [原文] Car Park 4 [原文] Wall of Experience 2 あ ら す じ 1. 開講式 2. 歓迎あいさつ・自己紹介5 3. この授業のはじめに 4. 庶務連絡および「基本ルール」 5. 経験の壁 6. WSTPtotの概略 7. 要点のまとめ 10 10 1 10 15 27 2 授業時間計 75 開講式（10分） 主催団体と共同で、現地に適した WSTPtot 開講式を挙行せよ。 歓迎あいさつ・自己紹介（10分） ToT 教習員へ：全員を歓迎して自己紹介せよ。自 分の経歴および車椅子供与と教習の経験に関し て、概略を簡潔に伝えよ。 実習生に、自分の名前、役職、所属組織を明らかに しながら自己紹介するよう求めよ。 名札を配り、自分の名前を記入するよう実習生に 指示せよ。 この授業のはじめに（1分） この授業のねらいと学習目標を説明せよ。 5 [原文] Welcome and introductions 3 庶務連絡および 基本ルール」（10分） 必要に応じて以下を説明せよ： • トイレの場所 • 軽食および昼食の段取り • アクセシビリティに関すること • 緊急時にはどうしたらよいか • その他運営に関すること このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 説明：これから、この教習での「基本ルール」を定めましょう。 実習生に、この一週間について定めておきたい「基本ルール」を簡潔に話し 合うよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 2分、フィードバックに 9分見込んでおけ。 フィードバック： 各ペアに、各自のリストから 1 項目ずつ挙げてはフリップチャートに記録 し、それをアイデアが出尽くすまで続けるよう指示せよ。 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 これらのルールを破る人に、グループとしてはどう対処したいか尋ねよ。 「基本ルール」は、ToTプログラム全体を通して参照用に壁に掲示せよ。 4 ToT 教習員への注記： • 「基本ルール」の施行には、ToT教習員だけでなく、全員が有責であると説明せよ。 • 実習生には、「基本ルール」が破られるたびにこの表を参照させよ。 基本ルール」の例： • 携帯電話：サイレントモードにする • 私語を慎み、話の途中で割り込まない • 他者のものの見方を尊重する • どの授業にも遅刻しない • 教習スペースを整理整頓し清潔に保つ • 話し合いに貢献する • 適切な障害用語6を用いる 説明7： • WSTP では障害者に関してポジティブな用語の 使用を推進しています。 • 教習員は優れた実践の模範を示し、WSTP およ び CRPD（障害者の権利に関する条約）が定める 言語指針に従わなければなりません。 • 「the disabled」「disabled people」「special people」などは不適切な用語で、用いるべきでは ありません。 • 「persons with disabilities」または「people with disabilities」をつねに用いなさい。 • 障害がない人を指す場合に、「normal people」 の語を用いるのは避けなさい。 「基本ルール」に列挙していなければ「適切な障害 用語を用いる」を追加せよ。実習生は、ToT 全体を 通してポジティブな用語を使っているかモニター するよう提案せよ。 ToT 教習員への注記： • ここで「disabled people」の語の使用は避けるよう推奨しているものの、「Disabled People’s Organization［障害者団体］」および「DPO［左の略称］」は依然広く用いられ、また広く受 容されている。一般的になりつつある「Organization of Persons/People with Disabilities (OPD)［障害者団体］」の語を用いるよう奨励せよ。 6 [原文] disability terminology 7 [訳注] 本節では, 英語版での議論をなるべく原文通りに伝えるよう努めた. 5 説明： • 教習中、教習員が即答できないか、後の授業で取 り上げる内容の質問を受けることもあります。 • これらの質問は「保留スペース」に置き、あとで 適切な時に話し合うようにします。 「保留スペース」のフリップチャートを壁に貼り 出せ。 経験の壁（15分） このスライドは活動の間じゅう映しておけ。 6 活車２ グループ： 実習生に単独8で作業するよう指示せよ。 指導内容： 「経験の壁」の見出しを壁に貼り出せ。例えば： • 教えたか受けたWSTP教習 • 支援機器供与に関連する経験年数およびその種類 • 職歴 • 話す言語 説明：この教習に来ている私たちは、さまざまな経験、知識、技能を持って います。いっしょに「経験の壁」をつくりましょう。 それぞれの見出しごとに違う色の付箋紙を（必要なら複数枚）使い、自分の 答えを書き出して下さい。 実習生に、分かりやすく書き、壁の各見出しの下に各自の付箋紙を貼り出す よう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 実習生が付箋紙/カードごとに 1項目ずつ、分かりやすく書いていることを 確かめよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 教室内が豊富な知識、技能、経験に満ちていることへの注意を喚起せよ。 実習生はここへ至るまでにすでに長い道のりを歩んでおり、ここからさらに 経験を積み重ねて行くのだ、と強調せよ。 ToT 教習員への注記： • この「経験の壁」は、プログラムの間じゅう参照し、適宜、教習の他のパートと関連づけよ。 8 [原文] alone 7 WSTPtotの概略（27分） WSTPtot のねらい、および目標を説明せよ。 実習生に各自の ToT 時間割表を見るよう指示 せよ。 説明：ToT は次の 2 部に分かれています： • 「必須教習技能」モジュール • 教習パッケージ別モジュール。この中で実習生 は、WSTP の授業を仲間と実習します。 ToT 教習員への注記： • 「車椅子サービス教習パッケージ」には 4種あるが、うち「管理者向け」と「関係者向け」は 一つのモジュールとして取り扱うため、教習パッケージ別モジュールは 3種のみである。 各実習生に配布される教材を紹介せよ。それぞれの教材を簡潔に説明して示せ。資料によっては、 この日の終わりに配られるものもあることを説明せよ。 8 説明：WSTPtot から最大限の成果を得るには、 教習員には次のことが必要です： • 一つ以上の WSTP を修了していること • 車椅子サービス提供や障害領域9での経験がある こと • ToT プログラムを教授する、言語の読み書きが できること • 教習やファシリテーションを行なった経験が あること • ToT プログラム後に、教習パッケージを実施す る機会があること 説明： • 見習い教習は ToT プログラムの後、実習生が 独立して教習を実施する前に行なわれます。 見習い教習を経験することが、WSTPtot 修了後 も教習技能を伸ばして行く最良の道です。 • ToT プログラム修了後、実習生はみな最低 1 回 の見習い教習を経験しなければなりません。 • 経験豊富な教習員との見習い教習は、次のよう な教習技能を強化するために役立ちます： o WSTP 実施の計画と準備 o プレゼンテーションとファシリテーション o 受講者へのメンター o 教習運営実務10の調整 9 [原文] disability sector 10 [原文] logistics [訳注] 以下同じ. 9 説明：経験豊富な教習員と見習い教習を行なえな い場合は、必要とする支援を受けられる他のやり 方を検討しなさい。例えば： • 経験豊富な教習員に連絡を取り、電子メールや 電話による、遠隔メンターを依頼する • 他の ToT 実習生と連携し、助け合って WSTP の 計画、準備、実施を行なう。 説明： • 見習い教習の実行回数は、実習生によって変わ ります。 • 教習員となるまでの期間も、いつ見習い教習 ができ、何回見習い教習をやり遂げたかによ って変わります。 • ToT 教習員と、見習い教習中の実習生のメン ター教習員は、実習生が、ひとり立ちして教習を 実施するまでに見習い教習を何回完了すべき か、決めるのを手伝います。 10 実習生に、各自の「ToT ハンドブック」p.132-134 の「WSTPtot 模擬授業フィードバックシート」を 見るよう指示せよ。 説明： • 自分が上手にできたことと改善の余地があるこ とについて振り返り考察することは、よりよい 教習員になるために役立ちます。 • 「WSTPtot 模擬授業フィードバックシート」に は、この教習で育成することが目的の、実習生の 技能一覧表が載っています。 • フィードバックシートは各模擬授業後の教習員 によるフィードバックで指針に用います。 • ToT 教習員は、一日の終わりにリーダー役実習 生へフィードバックを、また、ToT プログラムの 最後に書面のフィードバックを与えるために も、これを用います。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 11 経験の壁 支援機器与 に関連する経験年数およびその種類 教えたか受けたWSTP教習 職歴 話す言語 12 ToT.2 車椅子サービス教習パッケージについて ね ら い WSTP［車椅子サービス教習パッケージ］の構成と方法論を紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  4 種のWSTPを列挙する。  WSTPの指針原則を列挙する。  各教習パッケージの教習員用指導書の構成を詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.2：車椅子サービス教習パッケージについて」  各実習生に、教習員用指導書（「必須教習技能」モジュールの後に各々が受講する教習 パッケージ別モジュールによって基礎WSTP、中級WSTP、あるいは管理者向けWSTP および関係者向けWSTP）の紙コピー 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  できれば、WSTP 用 USB メモリに PPT スライド p.20 へのリンクを、その使い方の 説明のために埋め込んでおく。 あ ら す じ 1. はじめに 2. WSTP 4種の沿革と存在理由 3. 各WSTPの構成 4. 「教習員用指導書」を理解する 5. WSTPの使い方 6. 要点のまとめ 2 15 5 30 35 3 授業時間計 90 13 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 WSTP 4種の背景と存在理由（15分） 説明： • WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(11)」は、2006 年 11 月にインド・バンガロールで開催された「開 発途上国への車椅子に関する合意形成会議(12)」 が土台になっています。 • 「車椅子ガイドライン」では教習機会の必要を 指摘しており、それが基礎・中級・管理者向け・ 関係者向けの各 WSTP［車椅子サービス教習パ ッケージ］開発につながりました。 11 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 12 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブ ス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006 年 11 月 6〜11 日. インド, バン ガロール: 世界保健機関, 2006]. 14 説明： • 基礎 WSTP(13)は、移動に障害があるものの、 付加姿勢支持なしでまっすぐに座れる男女の 子どもや大人に、適正な手動車椅子および クッションを供与する職員への教習用です。 • 中級 WSTP(14)は、まっすぐに座るには付加姿勢 支持が必要な男女の子どもや大人に、適正な 手動車椅子およびクッションを供与する職員へ の教習用です。 説明： • 基礎 WSTP と中級 WSTP ともに、最短 5 日間で 実施できるように設計されています。 • 教習プログラムには、次の目的で時間を追加 することも可能です： o 授業計画に教材資料を追加する o 授業を追加する o 車椅子ユーザーとの実習回数を増やす o 教習で使用する製品に対して、さらに下準備 の時間を取る o 通訳するゆとりを設ける o 教習日数を短縮する o 重要な概念を学ぶための時間を追加する 13 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版: 基礎車椅子サービス教習パッ ケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 14 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版: 中級車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 15 説明： • 基礎 WSTP および中級 WSTP の目的は、車椅子 サービス提供における教習を受けた職員の数を 増やすことです。 • しかし、高職位の参画なしに、教習を受けた職員 だけで適正な車椅子供与を確立することはでき ません。 • サービス事業の発展を支援するために WHO が 開発したのが： o 管理者向け WSTP(15)：事業管理者が、適正な 車椅子供与を効果的に支援するための指針と なるように設計されています。これには、適正 な車椅子供与の確立に向けて、事業管理者や 関係者の参画を推進することも含まれます。 管理者向け WSTP は最短 2 日で実施でき ます。 o 関係者向け WSTP(16)：国/地域における適正な 車椅子供与の確立に向けて、全関係者の意識 を啓発し、技能や知識を育成するために設計 されています。最短 4 時間で実施できます。 • どちらの教習パッケージも、通訳、より詳細な 討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るため に、期間を延長して実施できます。 15 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 16 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 16 説明：WSTP は、以下の一群の指針原則17に従って 作成されました： • 車椅子ユーザーを車椅子サービスの中心に置く ユーザー中心で人権に根ざしたアプローチ18。 • 手に入るエビデンスに基づく19、国際的な最良の 実践例20にならう。 • 低リソース状況21に重点を置く。 • 全教習パッケージにおける教習員や教習対象者 としての、車椅子ユーザーのインクルージョン。 説明：WSTP では、取っ付きやすい非医療的なことばづかいと用語22を用い、それによって： • 臨床や技術の資格を持たない受講者も教習を受けられ、 • サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになります。 各WSTP の構成（5分） ToT 教習員への注記： • この項は簡潔に済ませよ。詳細は ToTプログラムの「必須教習技能」に続く教習パッケージ別 モジュールで教わるからである。実習生が教習パッケージ別モジュールで教授する種類の WSTPに重点を置け。 説明：それぞれのパッケージに、さまざまな教材が 含まれており： • 教習員用指導書、PPT プレゼンテーションス ライド、動画、ポスター、 • 基礎・中級・管理者向け WSTP には受講者用 参考書があり、 • 基礎・中級 WSTP はサービスフォーム、確認表、 別冊の受講者用ワークブックも含んでいます。 17 [原文] guiding principles 18 [原文] user-centered and rights-based approach 19 [原文] available evidence-based 20 [原文] best practice 21 [原文] less-resourced settings 22 [原文] accessible, non-medical language and terminology 17 説明：WSTP の資料はすべて、実習生の教材に含まれている WSTP 用 USB メモリに載っていま す。またこれらは、WHO のウェブサイトからもダウンロードできます。 説明：WSTP 用 USB メモリにさらに含まれている ものとしては： • 修了証 • 教習員用観察確認表 • 各種評価フォーム これら23は ToT では使いませんが、WSTP 実施中 に使うことになります。 教習員用指導書」をよく知る（30分） 説明：4 種の WSTP で取り上げる主題はそれぞれ 異なりますが、構成とアプローチはみな同じです。 活動を通して、その構成に詳しくなりましょう。 このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。実習生によって異なる教習パッケージ別モジュール を「必須教習技能」モジュール後に履修する場合は、同じパッケージの教習 を受ける実習生どうしをペアにせよ。 指導内容： ペアごとに最低、基礎・中級・管理者向けWSTP「教習員用指導書」のうち どれか 1冊が必要。 この活動のねらいは、実習生に、教習員用指導書を熟知させることであると 説明せよ。 各ペアに、協力して「ToTハンドブック」の問いに答えるよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 回答に 15分、フィードバックに 10分見込んでおけ。 23 [訳注] 日本語版:「中級車椅子サービス教習パッケージ_フォーム・確認表冊子」を https://j-aws.jp/who/に収載. 18 フィードバック： 問い 正解 1. 「教習員用指導書」の全内容の 一覧はどこで見つかりますか？ 指導書の冒頭で「もくじ」に列記。 2. グループ活動は授業の中でどう 示されていますか？ それぞれの活動について、「活動」表 にグループ分け、指導内容、モニタ ー、時間配分、フィードバックが詳述 されている。 3. 教習パッケージ全体のねらいや 目的は、どこで分かりますか？ p.2の「目的」の見出しが付いた項目。 4. 授業計画で、教習員が PPTスラ イドを映写すべきタイミングは どこに示されていますか？ 各スライドの画像が授業計画ページ の左側に、映す順番で、該当する本文 の横に載っている。 5. 教習授業の実行に必要な施設、 教材、設備はどこで分かります か？ 「教習員用指導書」の 2 部「教習 パッケージ実施準備のやり方」に 一覧表が載っている： • 基礎および中級WSTPでは p.14 • 管理者向けWSTPでは p.9 WSTPの使い方（35分） 受講者に「教習員用指導書」の第 1 部「車椅子サービス教習パッケージについて」を開くよう指示 せよ。 説明：各「教習員用指導書」の最初には、教習員に役立つ注記や指示が載っています。 受講者のひとりに、「教習員用指導書」のこの部の見出しを読み上げるよう指示せよ。 最も重要な答え： • はじめに • 対象者 • 目的 • 対象範囲 • 教習員 • 開始までの流れ 19 説明： • WSTP 用 USB メモリ内に「Read Me First」と いうファイルが見つかるでしょう24。これは重要 な文書です。 • これには、WHO からの要請として、実施した WSTP 教習プログラムについてフィードバック および以下のようなデータを提供してほしい旨 が含まれています： o 受講者登録フォームおよび評価フォーム o 教習に関する教習員の考察またはコメント 説明：「教習員用指導書」の第 2 部は「教習パッケージ実施準備のやり方」（関係者向け WSTP で は「関係者向けワークショップ実施準備のやり方」）です。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生を前の活動と同じペアに分けよ。 指導内容： 実習生に「教習パッケージ実施準備のやり方」の部にパートナーと目を通し、 そこのさまざまな項目を読んで話し合うよう指示せよ。 実習生に、質問があれば書き出すよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、各自の教習パッケージに関して、何か質問がないか尋ねよ。 教習に関する範囲を超えた質問は、取り上げる時間がないか後の授業で取り 上げるのであれば「保留スペース」に置いておくことができる。 24 [訳注] 英語版のみ. 20 ToT 教習員への注記： • 教習パッケージによって、見出し語には異同がある。 説明：授業計画は、授業を通して教習員を導く、 レシピ25のような働きをします。 授業計画に従うのは次の面で有効です： • 学習目標への集中を保つ • 時間を守る • 関連トピックについてのフォーカスグループ 活動、話し合い、質問 このスライドは活動の間じゅう映しておけ。 活車３ グループ： 実習生を前の活動と同じペアに分けよ。 指導内容： 実習生に、「授業計画の詳細」をパートナーと読んで話し合い、グループで 話し合うための質問があれば書き出すよう指示せよ。 授業は各ペアが ToT でどのパッケージを履修するかによって以下のリスト から割り当てよ： • 基礎WSTP：「教習員用指導書」の p.99「A.8: 移乗」 • 中級WSTP：「教習員用指導書」の p.52「B.1: 事前評価の概略・事前 評価インタビュー」 • 管理者向けWSTP：「教習員用指導書」の p.15「A.1: 適正な車椅子供与 とは何か？」 モニター： グループをモニターし、必要に応じて支援せよ。 25 [原文] recipe 21 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、何か質問や説明があるか尋ねよ。 パワーポイントスライドの変更に関する質問は、「保留スペース」に置いて おけ。これは「ToT.10 視聴覚ツールおよび機材」で取り扱う。 説明：各授業計画の最初に、授業概要表が載っています。 ペアの一つに尋ねよ：授業概要はどんな項目に分かれていますか？ 最も重要な答え： • 目的：授業のねらいを説明。 • 教材：授業に必要なあらゆる教材。 • 状況（中級WSTPでは 事前学習と状況」）：現地の状況/国/サービス事業に合わせる調整 への提案。 • 準備：授業が始まる前に準備しておくべきこと。 • あらすじ：時間配分を入れた、授業各項目の要約。 別のペアに尋ねよ：「状況」あるいは「事前学習と状況」のコラムの目的は何でしょうか？ 最も重要な答え： • 教習員に、現地の状況や教習を受ける受講者の種類に対して、授業計画をどう適合できるか についての指針を与える。 また別のペアに尋ねよ：教習の状況に影響を及ぼしそうなものには何があるでしょうか？ 応答を受けとめ承認せよ26。 説明：授業に影響するさまざまなものとしては： • サービス提供モデル • 受講者の経験度合い • 組織、地域または国の方針 • 処方に使える製品 26 [原文] Acknowledge responses [訳注] 以下同じ. 22 また別のペアに尋ねよ：授業計画では、動画の上映をどのように指示していますか？ 最も重要な答え： • 動画アイコンの付いた、動画のコラムで示している。 説明： • 実習生は、すべての動画の内容、関連性、タイミ ングを熟知しておくことが重要です。 • 動画の使い方についての詳細は、ToT の後の ほうで説明します。 説明：「教習員用指導書」では、教習員への手引き27として、さまざまな太字の語を用いています。 例えば：尋ねよ [指示せよ、依頼せよ]28、説明せよ、示せ [映写せよ、上映せよ]28 などです。 説明：「教習員用指導書」には、教習員への指針 として役立つ追加情報が載っています。例えば： • 教習員が受講者からの質問に答えるのに役立つ 補足情報。 • 質問への最も重要な答え • グループダイナミクスに関する助言 27 [訳注] 受講者への語り (「ですます」調) と区別しやすいよう, 訳文では「である」調・命令口調を用いている. 28 [訳注] 文脈によって[ ]内の訳語も用いている. 23 また別のペアに尋ねよ：授業計画の「活動」コラムはどんな情報を与えていますか？ 最も重要な答え： • グループ：活動のために、どうグループ全体を分けるか。 • 指導内容：活動をどのように実施すべきか、受講者に何を話すべきか。 • モニター：活動中、どのようにグループをモニターして正しい作業を行なうようにするか。 • 時間：活動時間および最後のフィードバック時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき要点、受講者の思考や感覚を引き出す方法。 説明：WSTP の電子コピーは、コンピューターのハードドライブ上でも外部ストレージ（DVD や WSTP 用 USB メモリ）上でも実行できます。 スライドショーを終了せよ。WSTP 用メモリのフォルダーを、WSTP 用 USB メモリあるいはコン ピューター上のファイルから引き出せ29。 「START.pdf」ファイルを開いてプロジェクターで映写せよ。 説明：教材には、WSTP 用メモリの一般的メニューからでも、「START」上のメニューをクリック してもアクセスできます。 リンクを示せ。授業を一つか二つクリックし、PPT を上映せよ。 説明： • 動画は、これらのファイルの PDF 版プレゼンテーションファイルには埋め込まれています30。 • 個別の PPT 形式プレゼンテーションファイルもすべて用意されており、必要なら改変可能です。 PPT ファイルの改変については、後の授業で話し合います。 ToT 教習員への注記： • アップル（Mac）コンピューターの場合、Adobe Proか類似のソフトで開かない限り、「START」 ファイルを開いても「START」メニューからリンク先には飛べない。 説明：どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」(管理者向け WSTP のみ) です。 29 [訳注] この下 4 行 (「START.pdf」ファイルを開いて…PPT を上映せよ。) の操作は, 英語版でのみ可能. 30 [訳注] 英語版のみ. 24 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 25 ToT.3 模擬授業について ね ら い 教習パッケージ別モジュールと模擬受講者および教習員の役割について、詳細を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPtot における、模擬授業のねらいと構成を詳述する。  リーダー役実習生と補助役実習生の役割と担当を詳述する。  自分が担当するのはどの模擬授業かがわかる。  模擬授業をどうやって準備するのかがわかる。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.3：模擬授業について」  WSTPtot 教習パッケージ別モジュール割り振り表（実習生用）：実習生 1人に 1部  実習生の番号を記入した紙片  実習生の番号を記入したフリップチャート紙 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  このマニュアルの最初にある用語一覧を参照しておく。  教習パッケージ別モジュールのWSTPtot割り振りを実習生の人数に合わせて仕上げ、 コピーしておく。  最終決定した人数に基づき、実習生の番号くじをバケツ/帽子に準備しておく。  実習生の番号を記入し、番号を選んだ受講者名の記入欄を設けたフリップチャート紙 を準備しておく。  同僚の教習員と31、メンターする実習生をどう割り振るか話し合っておく。実習生に は、その情報をこの授業の間か「ToT.6 準備時間について」の初めに伝えておく。 あ ら す じ 1. はじめに 2. 教習パッケージ別モジュールの構成とねらい 3. 模擬授業の進め方 4. リーダー役・補助役実習生および模擬受講者の役割 5. 振り返りとフィードバック 6. 模擬授業の準備 7. 要点のまとめ 4 3 2 15 5 30 1 授業時間計 60 31 [原文] with their co-trainer [訳注] 文脈から, ToT 教習をいっしょに実施する他の ToT 教習員のことであろう. 26 はじめに（4分） 質問：ここで学ぶ、WSTP パッケージを実施する ことへの自信は、1〜10 点で採点すると、どれく らいありますか？ • 1 点はまったく自信がない、 • 10 点はたいへん自信がある、です。 説明： • 採点を自分の「ToT ハンドブック」p.10 に記録 しなさい。 • ToT プログラムの最後に、その時点での自信が どれくらいか記録するよう指示します。 • その両方の採点を、自分自身への ToT 評価 フォームに記入しなさい。 授業のねらいおよび学習目標を説明せよ。 教習パッケージ別モジュールの構成とねらい（3分） 説明： • 「必須教習技能」の授業のあと、各自の教習 パッケージ別モジュールが始まります。 • 教習パッケージ別モジュールの内容は： o 習得を選択した WSTP の授業を実施する機会、 o ToT 教習員が指導する話し合いやデモ、 o または、これら二つの組み合わせです。 27 模擬授業の進め方（2分） 説明： • 模擬授業の割り当ては、この授業の終わりに、 くじ引き（ラッキーディップ32）で決めます。 • 実習生ひとりが受け持つ授業時間は、ほぼ同じ 長さです。 • リーダー役実習生と補助役実習生の役割が両方 割り当てられます。 • 一授業にリーダー役実習生が複数割り当てられ た場合、プレゼンテーション33を行なっていない 人は、自動的に補助役実習生を務める想定です。 リーダー役・補助役実習生および模擬受講者の役割（15分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、リーダー役実習生と補助役実習生の主な役割とは何だと思うか、 パートナーと話し合うよう指示せよ。 実習生に、考察を「ToTハンドブック」p.10に記録するよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 3分、フィードバックに 5分見込んでおけ。 フィードバック： 質問：リーダー役実習生と補助役実習生の主な役割とは何でしょうか？ 答えを話し合って明確にし、最も重要な答えをホワイトボードに記録せよ。 実習生に、正しい情報を各自「ToTハンドブック」に記録するよう指示せよ。 32 [原文] Lucky Dip [訳注] 手を突っ込んで福引きやくじ引きを行なう箱や袋. 33 [原文] presenting [訳注] この語の本書での意味は授業 ToT.7 を参照. 28 最も重要な答え： リーダー役実習生の役割の例： • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役実習生を調整する。 補助役実習生の役割の例： • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー役実習生にもたらす。 • 授業実施に関する全体的フィードバック/振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消しやブラインドの開閉を行なう。 質問：模擬授業中、実習生はチームとして協力しな ければなりません。例えば、以下について助け合う ことなどです： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 授業の進行、例えば： o 時間管理 o 誤りの指摘 o 受講者からの質問に答える o 妨害や割り込みへの対処 29 説明： • 教習員は、プロとしての行動と実践のポジティ ブなお手本34を示すべきです。 • 受講者に求める行動は、その模範を示しなさい。 例えば： o 時間を守り、じゅうぶん準備しなさい。 o 困難な状況で、問題を解決し解決策を見出し なさい。 o ポジティブなフィードバック、および建設的 なフィードバックを与えなさい。 o 上手に自己管理しなさい：例えば、ストレス 管理のため、授業準備とじゅうぶんな睡眠・ よい食事とのバランスを取るなどです。 説明：優れた教習員のお手本になるとは、常に質問 への答えを知っていなければならないということ ではありません。 質問：質問を受けたが、答えを知らない場合には どうしますか？ 最も重要な答え： • 補助役実習生に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 答えを知っているふりをしない。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 34 [原文] a role model [訳注] そのまま「ロールモデル」と呼ばれることも多い. 30 説明： • 実習生仲間が担当授業を実施している間、自分 は WSTP 受講者役を演じることになります。 • これに含まれることは： o ケーススタディや実習に参加する。 o 質問し、また質問に答える。 o 話し合いに参加する。 • 「現実味のある」教習状況をつくり出すために 積極的に参加することは重要ですが、挑発的な 行動をわざと取っては35なりません。 • 模擬授業のあいだ、「WSTPtot 教習員用指導書」 や「ToT ハンドブック」はしまっておきなさい。 振り返りとフィードバック（5分） 説明： • 教習員にとり、自分自身の教習技能を振り返る ことを学ぶのは重要です。 • また教習員には教習受講者へ建設的なフィード バックを与えられることも重要です。 • これらの技能は両方とも ToT プログラムに組み 込まれています。 35 [原文] act in a challenging manner 31 説明： • 各模擬授業の終わりに、リーダー役実習生は、 次を振り返るよう求められます： o 何がよかったか、また何がうまく行ったか o 何に改善の余地があるか • 模擬受講者は、リーダー役実習生に簡潔なフィ ードバックを与えます。この詳細は授業「ToT.11 フィードバックについて」で話し合います。 • ToT 教習員がフィードバックを与え、リーダー役 実習生や模擬受講者が挙げていなかった点が あれば付け加えます。 模擬授業の準備（30分） 説明： • 「教習員用指導書」の授業計画を読み、授業内容 をすべて理解していることを確かめなさい。 • 「受講者用参考書」と「受講者用ワークブック」 (関係者向け以外の WSTP で使う) の該当箇所を 読みなさい。 • PPT に適切な変更/補足を加えなさい。 • 適切ならば自分自身の知識や経験を組み込み、 自分のケーススタディを活用しなさい。 • 授業実施を、時間配分を含め予行演習しなさい。 • 補助役実習生と、チームとして協力しなさい。 • 授業に必要な教材を準備しなさい。 説明：授業が ToT 教習員によるデモを含む場合は、 ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせなさい。 32 説明： • WSTP の「教習員用指導書」「受講者用参考書」 「受講者用ワークブック」および PPT の中に、 いくつかの誤りが判明しています。 • 判明している誤りは「ToT ハンドブック」の中で 挙げています。 • 授業を準備するさい、担当授業に誤りがないか 確かめ、必要な変更を加えなさい。 • 模擬受講者と誤りについては話さず、授業のプレ ゼンテーションは、通常の WSTP 教習と同様に 行ないなさい。 ToT 教習員への注記： • WSTP にはいくつか誤りが判明しているが、 2 版発行まで訂正されない。それらの誤りは 「ToTハンドブック」に挙げ、実習生が教材を訂正できるようにしている。 このスライドは活動の間じゅう映しておけ。 33 活車２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の「教習員用指導書」で以下の授業に目を通し、自分の「ToT ハンドブック」の中でその授業に該当する注記を見つけるよう指示せよ。 実習生にはその両方を読み通すことで、それらがどう関連し合っているか、 また授業の実施準備でそれらをどう活用できるかを把握するよう指示せよ。 • 基礎WSTP：授業 A.6: 適正な車椅子 • 中級WSTP：授業 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる • 管理者向けWSTP：授業 A.1: 適正な車椅子供与とは何か？ また実習生に、「ToTハンドブック」の序章から「模擬授業準備の手引き36」 を探し、手短に確認しておくよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 以下を強調せよ： • 実習生は、模擬授業および将来のすべての見習い教習において、「教習員 用指導書」および「ToTハンドブック」の指示に従うべきです。 • 実習生は、以下に対処するための指示に従うための、じゅうぶんな時間を 見込んでおく必要があります：WSTP教材の誤りの取り扱いへの指示、 ジェンダーおよび文化への配慮に関する注意、進行や時間配分を改善する ための授業準備、プレゼンテーション、教習運営実務に関する助言。 • 模擬授業中、実習生は必要に応じて教習スペースの設営を担当します。 何か質問があるかどうか尋ねよ。 36 [訳注] ページ xiii. 34 説明： • 各教習日の終わりには、後日の模擬授業を準備 する時間があります。詳しくは授業 ToT.6 で話 し合います。 • ToT 教習員は、休憩中および一日の終わりに 時間を取れます。質問や懸念があれば、支援を 求めなさい。 • 教習仲間や ToT 教習員を前に授業する時には、 アガる方が普通です37。 • さらに授業を実施すれば、技能と自信がついて きます。 • これは競争ではないこと、教習スタイルは一人 ひとり違うことを忘れないで下さい。 • これから 2 日間、グループ活動からのフィード バック発表を求められます。その機会を活かし、 仲間へのプレゼンテーションを練習しなさい。 説明： • 実習生への扱いを平等にするため、模擬授業の あいだ、時間は厳しくモニターされます。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止 させて次の教習員に移るか、授業を終了します。 • 時間を守る方法を学んで下さい。これは重要な 技能で、練習によって上達します。 説明： • 各授業の標準版 PPT は、動画を埋め込んだもの が教習用ノート PC で使用可能です。 • 自分の PPT に変更を加えた場合は、模擬授業前 に教習用ノート PC へそれをアップロードして おく必要があります。 37 [原文] It is normal to feel nervous 35 ToT 教習員への注記： • 実習生には、PPTをコンピューターへ読み込む必要がある場合は、例えば教習開始の 30分前 か授業前の休憩時間にするよう伝えよ。 説明：では、これから授業を割り当てます。 実習生に、一人ひとり番号を引くよう指示せよ。 各実習生に、自分の名前を、各自の WSTPtot 教習 パッケージ別モジュール割り振り表（実習生用）に 記入するよう指示せよ。 各実習生に、全体グループに自分の番号を伝え、 それを表に記録するよう指示せよ。 実習生の名前を、フリップチャート紙に準備した表の該当する番号の横に記録せよ。 説明：各実習生に一人、ToT 教習員がそのメンターとして割り当てられます。メンターは： • 実習生の準備を支援します • 実習生のプレゼンテーションスキルについて、個別にフィードバックを与えます。 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 36 ToT.4 多様性に備える38 ね ら い 文化39、多様性40、文化的能力41およびこれらの概念の重要性を、WSTP［車椅子サービス 教習パッケージ］の教習実施に関連づけて理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  「文化」と「多様性」の違いを理解する。  「文化的能力」の重要性を理解する。  異文化間コミュニケーション42の課題を話し合う。  車椅子ユーザーを教習や業務環境へ統合する43うえでの課題を特定する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.4：多様性に備える」  マスキングテープか同様のもの 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  現地の状況や実習生グループの性格を基に、最初の活動のための適切な「区別」を 案出しておく。  最初の活動用に、教室の空いたスペースの中央にマスキングテープを貼って線を一本 引いておく。 あ ら す じ 1. はじめに 2. 文化と多様性 3. 文化的能力 4. 多様性を推進する44：車椅子ユーザーはじめ障害者のインクルージョン 5. 要点のまとめ 20 5 20 14 1 授業時間計 60 38 [原文] Preparing for diversity 39 [原文] culture 40 [原文] diversity 41 [原文] cultural competence [訳注] 国際保健分野では「文化能力」とも訳される. 42 [原文] cross cultural communication 43 [原文] integrating 44 [原文] Encouraging diversity 37 はじめに（20分） 活車１ グループ： 全体で。 指導内容： 床の中央を横切るマスキングテープの線に注目させよ。 全員、教室の片方へ移動するよう指示せよ。 男性は全員線の片側に、女性全員が反対側に立つよう指示せよ。 説明：男性と女性、これはさまざまなグループ分けの最初のものです。これ から、多様性をさまざまな面から見て行きます。 子どものいる人は線の片側に、いない人は反対側に立つよう指示せよ。 年齢が 50 歳超の人は線の片側に立つよう指示せよ。他の人は反対側に立つ よう指示せよ。 この活動を最低 6回続けよ。 区別の例： • 話す言語 • 出身地/国 • 障害の有無 • 職歴 モニター： 受講者が困惑したり、不快を感じたりしていないことを確かめよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 区別についての感想を尋ねよ。 質問：大きい方のグループにいると、どんな感じがしますか？ 質問：ひとり、あるいは少数派になると、どんな感じがしますか？ ネガティブな経験だった人がいるかもしれませんが、それは他の人にとって はポジティブだったかもしれません、と説明せよ。 説明：多数派の中にいると、人はえてして力強さや自信を感じるものです。少数派の中にいると、 人は孤立や疎外を感じることがあります。集団は、文化や多様性によって分かれたりまとまったり するので、この二つの概念について詳しく見ていくことにしましょう。 38 授業のねらいおよび学習目標を説明せよ。 文化と多様性（5分） ホワイトボードかフリップチャートの中央に縦線を引き、「文化」「多様性」と片側ずつ書き込め。 質問：「文化」と「多様性」という語は、どういう意味だと理解していますか？ 励まして応答を促し、それを板書せよ。 最も重要な答え： 文化：人びとを同じにするもの • 共有あるいは共通の、価値観45、意識46、道徳、伝統、信念47などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団48、ジェンダー、性自認49、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 説明：文化と多様性に対しては、さまざまな捉え方ができます。 • それらは強みで、奨励すべきものだと思いますか？ • あるいは紛争や不和の元だと思いますか？ • それらは邪魔なものでしょうか？ 全体に、先の活動で体験した、自分たちの中にある多様性や文化について振り返るよう指示せよ。 質問：この全体グループは多様でしょうか？ 45 [原文] values 46 [原文] attitudes 47 [原文] beliefs 48 [原文] ethnicity 49 [原文] gender identity 39 質問：この全体グループの中には、どんな種類の多様性があるでしょうか？ 質問：私たちはどんな文化を共有しているでしょうか？ 応答を受けとめ承認せよ。 説明：私たちは、だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを 忘れないようにしましょう。 文化的能力（20分） 質問：「文化的能力」とは何でしょうか？ 応答を受けとめ承認せよ。 説明： • 文化的能力とは、個々人が、自分の文化とは 異なる文化への、効果的かつ敬意をもった50 関わり方を学ぶ、能動的プロセスです。 • それは、文化の違いに対してポジティブな姿勢 で臨み、受容することです。 • それは、文化が人びとの交流に及ぼす影響を 意識することです。 説明：文化の違いは、誤解、失望、混乱、困惑、怒り、侮蔑などを引き起こすことがあります。 例えば、攻撃する意図のないコメントが、文化が異なる人からは侮辱と取られる場合などです。 説明：WSTP の教習は、さまざまな文化の教習員によって文化の異なる受講者へ教授されることも あります。さまざまな文化的配慮が教習へどう影響するのか、その例を「ToT ハンドブック」p.16 に挙げています。 50 [原文] effectively and respectfully 40 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の文化とは異なる文化を経験した実例について考え、それは どういったもので、自分がどう感じ、何を学んだかを書き出すよう指示せよ。 実習生に、その経験についてパートナーと話し合うよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 8分、フィードバックに 5分見込んでおけ。 フィードバック： 4〜5名に、各自の経験を全体で共有してもらうよう依頼せよ。 多様性を推進する：車椅子ユーザーはじめ障害者のインクルージョン（20分） 説明： • 障害とは多様性の一面です。 • WSTP では教習チームへの、また受講者として の、車椅子ユーザーはじめ障害者のインクルー ジョンを推進しています。 質問：なぜそれが重要なのでしょうか？ 41 最も重要な答え： • 車椅子ユーザーは、自分の体験や視点を活かしてWSTPの学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子サービスでの車椅子ユーザーの中心的役割を 強化する。 • 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、 差別・偏見とたたかい51、CRPD（障害者の権利に関する条約）の原則を強調するのに役立つ。 スライドを読み上げよ。 質問：車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁となるものには、 何があるでしょうか？ 最も重要な答え： • 意識の障壁52 • 環境の障壁：アクセスできない家屋、学校、公共建築物 • 支援機器の不足 • 障害をネガティブにとらえる文化的信条 • 障害者の権利を支援する法令の欠如 • サービスや支援に対する財源の不足 51 [原文] combat stigma [訳注] stigma は本来「烙印」を意味し, 社会がおしつける不名誉を指して用いられる. 52 [原文] Attitudinal barriers 42 説明： • 意識の障壁とは、例えば： o 障害者ができることに関する予断 o 障害者は自己決定ができないとする偏見 o 障害者を慈善の対象として扱う o 文化によっては、障害者は祟られていると信 じ、そのけっか地域や家族から閉め出される • 環境の障壁とは、例えば： o 自然環境：岩場や急傾斜地など o 建造環境：アクセスできない家屋、学校、 公共建築物など o 支援機器の不足 • 制度の障壁とは、例えば： o 障害者の権利を支援する、政府の法令や政策 の欠如 o 入学基準に関する学校・大学の規則や規制 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 43 ToT.5 成人学習 ね ら い 「成人学習53」の概念およびさまざまな学び方を紹介し、これらのアプローチによって WSTP［車椅子サービス教習パッケージ］実施をどのように改善できるか理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  大人はどのように学ぶのか詳述する。  自分自身にとってのそれも含め、4つの選好学習スタイル54を詳述する。  なぜ学習スタイルを理解すると、WSTPの教授が効果的になるのか説明する。  教習員が、受講者の問題解決をどのように支援できるか詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.5：成人学習」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. 選好学習スタイル 3. 学習経験サイクル55 4. 成人学習を支援する 5. 受講者の問題解決を助ける 6. 要点のまとめ 2 25 30 10 15 3 授業時間計 85 53 [原文] adult learning 54 [原文] preferred learning style [訳注]「選好する/好む学習スタイル」の意. 55 [原文] Experiential learning cycle 44 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 選好学習スタイル（25分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に以下を行なうよう指示せよ： • これまでの、自分のポジティブな学習経験について考える。 • それはどのようにポジティブだったのか書き出す。 • その経験をパートナーと共有する。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 個々人での考察とペアでの話し合いに 5分、フィードバックに 5分見込んで おけ。 フィードバック： 各ペアが自分たちのリストから 1項目ずつ読み上げ、経験がすべてホワイト ボードに書き出されるまで、それを教室内で持ち回るよう指示せよ。 簡単に話し合わせよ。 45 説明：前の活動で話し合ったポジティブな学習経験から、選好される学び方にはさまざまなものが あることが分かります。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生に単独で作業するよう指示せよ。 指導内容： 実習生に、「ToTハンドブック」p.21を開くよう指示せよ。 「ToTハンドブック」に載っているのは、学習に関して述べた文の一覧表で あることを説明せよ。 実習生に、自分の選好に合うすべての記号にマルを付け、それを次ページの 集計表に転記するよう指示せよ。 実習生に、各列のマルの数を合計して、どの列のマルが最も多かったか確認 するよう指示せよ。マルの最も多い列が、自分の選好学習スタイルである。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 3分見込んでおけ。 フィードバック： 各実習生に、自分の選好学習スタイルを、となりの実習生と共有するよう 指示せよ。 複数のスタイルが同じくらいの数だった場合、それは強いこだわりがなく、 複数のやり方で抵抗なく学べるということだと説明せよ。 実習生に、自分の学習スタイルへの選好がポジティブな学習経験と一致する かどうか尋ねよ。 46 学習経験サイクル（30分） 説明： • めいめいの人に、一つかそれ以上の選好学習スタイルがあります。 • しかし、新しい情報や技能を学ぶ際に最も効果的なのは、情報を複数の経路で学ぶことです。 説明： • 学習経験サイクルの各段階は、学習スタイルの 4 種類と一致しています。 • スタイルは人によってさまざまですが、新しい 知識や技能を学ぶには、この 4 段階のそれぞれ を経るのが最も効果的です。 • WSTP に学びの 4 段階/種類がそれぞれ含まれて いるのは、そうした理由からです。 • このサイクルは「経験によって」「観察/感受 によって」「理論や概念の定義/説明によって」 「実行によって」のどれから始めてもかまい ません。 説明：WSTP の開発に当たり、「選好学習スタイ ル」と「成人学習」の概念は、個々の授業計画の構 成や教習の時間割全体に組み込まれています。 47 説明：WSTP では、こうした４段階を経ることで、確実に学びが生まれるようにしています。 • 基礎 WSTP では、受講者は車椅子に乗りさまざまな移動技能を試みます。これは「経験」です。 • 中級 WSTP では、受講者は車椅子ユーザーやその家族が姿勢支持具のポジティブな影響を語る 動画を視聴します。これは「観察」あるいは「感受」です。 • 管理者向け WSTP では、受講者は車椅子サービス提供に関連する概念や原則を学びます。これ は「思考」あるいは「理解」です。 • 基礎および中級 WSTP では、受講者は車椅子ユーザーと作業し、適正な車椅子とクッションを そのユーザーに供与します。これは「実行」あるいは「適用」です。 質問：「経験」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学びが実生活との接点を失い、受講者個人の経験に根を下ろさない、抽象的なものになる。 質問：「観察」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者が、自分の個人的経験がより広い抽象的な概念や枠組みとどう結びついているのか、 探求したり、確かめたりできなくなる。 質問：「思考」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、ある経験から別の経験へ、それらどうしの関連を分からないまま進むことになる。 そうした人は、経験を有意義なやり方で整理するのに役立つ枠組みから得るものがない。 質問：「実行（練習）」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、理論や枠組みを職場や自分の生活に適用するやり方を見出すことがない。 48 説明：教習員は、自分が選好するものだけでなく、あらゆる学習スタイルを支えることが重要です。 説明：ここまで「学習スタイル」と「学習経験サイ クル」の概念を見てきたので、これらを「実践」に 移し、「実行」によって学ぶことにしましょう。 このスライドは活動の間じゅう映しておけ。 活車３ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、「ToTハンドブック」p.24の「活動・選好学習マッチング表」を 見るよう指示せよ。 説明： • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解する56ことによって最もよく学びます。 実習生に、この教習活動はこの人の学習スタイルに最も効果的、と考える人 の名前の下に「X」を付けるよう指示せよ。 授業後に各実習生で、最後の列に自分自身の選好について記入してみるよう 提案せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 以下のように、全体で答えを確認せよ： 希望する実習生に、回答するよう依頼せよ。 全員が同意するか確認せよ。 反対がなければ、その答えを（正しければ）受けとめ承認し、次の行に移れ。 皆の答えが同じでなければ、正解を示し説明せよ。 短い話し合いのみ許可せよ。 56 [原文] understanding the big picture 49 ToT 教習員への注記： • 下記の解答欄について、Xは最適解、(X)は同様に正しい別解を示す。 上の印がないものを回答した実習生には、理由を説明するよう依頼し全体で話し合え。理由づけ が適切で学習スタイル間の違いを理解していると認められれば、答えを訂正する必要はない。 この課題からの重要な学びは、皆が同じように学ぶわけではないことへの気づきである。 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 1. 車椅子ユーザー教習の練習として ロールプレイングを行なう X (X) 2. 教習員が新規車椅子ユーザーへの 身体計測のやり方を示すところを 観察する X 3. 自国の車椅子サービスに関する、 法律や規制についての政府職員の 発表に出席する X 4. 車椅子に乗っている人がやりたい ことを実行しているのを観察する X 5. 車椅子サービスに関連する重要 文書について学習する X 6. 他の受講者と、フォローアップを ユーザーの家で行なうことの長所 と短所について話し合う X 50 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 7. CRPD（障害者の権利に関する 条約）の最も重要な条文に関する、 教習員の説明を聴く X 8. 除圧クッションをつくる X (X) 9. 車椅子で走り、車椅子ユーザーが 経験するであろう障壁を体感する X 10. 教習員が事前評価を実施する様子 を観察する X 11. 新規車椅子ユーザーに対する事前 評価インタビューを実施する (X) X 12. 車椅子サービス事業を既存のリハ ビリテーションサービスに追加す ることによる費用節減を算定する X (X) 51 成人学習を支援する（10分） 説明：だれにも選好学習スタイルがある一方、あらゆる大人の学習者についての共通項もあります。 説明： • 大人の学習者は主体的57で、自分の学習に責任を 持ちます。 • つまり、次のようになる方向で支援するという ことです： o 積極的参加者 o 話し合いやグループ活動に取り組む 説明： • 大人の学習者は、学習活動に自分自身の知識や 経験をもたらします。例えば： o 仕事に関連する経験 o 受けてきた教育 o 人生や家族の経験 説明： • 大人の学習者は、関連が明らかで実践的な58学び を求めます。 • 大人が新しい情報を学ぶには、必ずその理由が 分かり、自分の状況に当てはめられる必要が あります。 • 教習に必要なことは： o 明確な学習目標 o 目に見える実際への適用 57 [原文] self-directed 58 [原文] relevant and practical 52 説明：大人の学習者は、学んだことを適用しようと 求めます。 • 学習者が、教習で学んだことと教習プログラム 終了後にやることとの関連を理解できるような 実例を活用しなさい。 • 問題解決活動を活用しなさい。 • 学習〜行動計画59を立てなさい。 受講者の問題解決60を助ける（15分） 説明：「問題解決」とは何でしょうか？ 最も重要な答え： • 問題に対して最適解を見出すプロセスのこと。 成人学習の重要部分である。 説明：なぜ問題解決は、生活技能として重要なので しょうか？ 最も重要な答え： • だれもがゴールを設定し、課題に直面しながら それを達成するから。 • 遭遇する障壁を克服するには、その方法を見出 す必要があるから。 説明： • 問題解決は、問題への解決が一筋縄では行かない車椅子サービス供与での重要技能です。 • 教習員は、受講者の問題解決能力を育成し、仕事で遭遇する困難に対する解決を見出せるように する重要な役割を担っています。 59 [原文] learning-action plans 60 [原文] problem solving 53 このスライドは活動の間じゅう映しておけ。 活車４ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、受講者の問題解決をどう手伝えるかについてのブレインストー ミングを行ない61、自分なりの解決策を見出すよう指示せよ。 2分間それを個々人62で考察し、自分のグループ内で共有して、アイデアの リストをつくるよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： この活動には 12分見込んでおけ。 フィードバック： 各グループで順番に、受講者 の問題解決を手伝う方法を 説明するよう指示せよ。新し いアイデアが出なくなるまで 続けるよう指示せよ。 新しいアイデアをそれぞれ、 キーワード 2〜3 語だけで63 ホワイトボードに記録せよ。 考慮すべき事項のよい例が 出たら、受けとめ承認せよ。 誤解があれば訂正/説明せよ。 まとめとして左のスライドを 映せ。 61 [原文] to brainstorm [訳注] 批判・判断・結論を交えず自由に意見を出し合う会議手法. ブレストとも呼ばれる. 62 [原文] individually 63 [原文] using only a few words 54 最も重要な答え： • オープンクエスチョン64（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ65：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のため に教習を訪れた個々のユーザーについて話せ。 • 分かりません」で答えを終わらせるな66：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ67：課題を個別のステップに分解し、ステップバイステップに68質問 し、問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的69に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 64 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 65 [原文] Ask rather than tell 66 [原文] Don’t take ‘I don’t know’ for an answer 67 [原文] One step at a time 68 [原文] step-by-step 69 [原文] laterally 55 ToT.6 準備時間について ね ら い 実習生が、毎日の終わりの準備時間を有効利用できるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  毎日の終わりの準備時間の目的を理解する。  各自の模擬授業に関連する疑問を話し合う。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.6：準備時間について」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  「保留スペース」を点検し、どの質問にも答える準備をしておく。 あ ら す じ 1. 「保留スペース」の点検 2. 準備時間の目的 10 5 授業時間計 15 56 保留スペース」の点検（10分） 実習生と「保留スペース」を点検せよ。翌日の前に明確にしておくべき項目があれば、必要に応じ て回答なり説明をせよ。 準備時間の目的（5分） 説明：この第 1 日の後に取っておいた時間で： • 「保留スペース」に残った項目を点検します。 • 実習生はフィードバックのため ToT 教習員と 面談します。 • 模擬授業を準備します。 説明： • ToT 教習員はリーダー役実習生との短い一対一 の面談を設定して、フィードバックを与え模擬 授業について話し合います。 • これは実習生にとって、そのフィードバックを これからの模擬授業にどう活かせるか質問する 機会です。 • フィードバックの与え方と受け取り方について は、授業 ToT.11 で詳しく話し合います。 57 説明：ToT 教習員とフィードバックを話し合う 面談がない場合、この時間の使い方は： • 自分が組む実習生70を調整します。 • 授業に必要な、デモ用資材や視聴覚機器を準備 します。 • 自分の授業内容で理解できない点があれば、 ToT 教習員と明確にします。 • 自分の PPT プレゼンテーションファイルが、正 しく動作することを確認します。 何か質問がないか尋ねよ。 実習生に、明日の授業開始までに思い出すべき教習運営実務の項目があれば再確認せよ。 ToT 教習員への注記： • WSTPtot の初日終了後、残るプログラムでの模擬授業に関連する教習運営実務の調整にこの 時間を活用せよ。例えば、実習生は現場に早めに来て授業の設営をできるか？または、実習生 は、翌日の授業で使う修正済み PPTをいつアップロードするのか？ 70 [原文] co-trainers 58 ToT.7 プレゼンテーションとファシリテーション ね ら い 優れた教習員の条件を明らかにし、プレゼンテーション71とファシリテーション72の違い を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  優れた教習員としてのふるまい73を列挙する。  プレゼンテーションとファシリテーションとの違いを説明する。  プレゼンター74とファシリテーター75の優れた実践例を列挙する。  時間を守れるようにする方策を 3つ詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.7：プレゼンテーションとファシリテーション」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. 教習員の技能 3. プレゼンテーションとファシリテーション 4. プレゼンテーションとファシリテーションの優れた実践 5. 時間管理 6. 要点のまとめ 3 15 5 15 20 2 授業時間計 60 71 [原文] presenting [訳注] 意味は p.62 本文を参照. 72 [原文] facilitating [訳注] 一般的で適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 73 [原文] behaviour 74 [原文] presenters 75 [原文] facilitators 59 はじめに（3分） 授業のねらいおよび学習目標を説明せよ。 教習員の技能（15分） 説明：教習プログラム実施を成功に導くには、さまざまな技能を養う必要があります。 この授業では、教習員の技能を、情報プレゼンターおよび学びのファシリテーターという両面から 見て行きます。教習員としての効果的ふるまいは、受講者の学びを喚起し、ポジティブな学習環境 をつくり上げるうえで決定的に重要です。 このスライドは活動の間じゅう映しておけ。 60 活車１ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、過去に自分が教習を受けた人を思い出し、だれが効果的な教習員 だったと考えられるか特定するよう指示せよ。それはつまり、学ぶべきこと を学べるようにし、ポジティブで価値のある経験をもたらした人である。 実習生に、数分間その効果的な教習員のふるまい方を振り返り、考えたこと を「ToTハンドブック」p.28の「その人のふるまいのどんな点が効果的でし たか？」の見出しがついた欄に書き出すよう指示せよ。 実習生に、考えたことを他のグループメンバーと共有するよう指示せよ。 各グループに、以前の教習員のふるまい方についてあらゆる面から考察する よう指示せよ： • どう自分を紹介したか。 • どう受講者と関わり合ったか。 • どう教習を運営したか。 • どうやってポジティブな環境をつくり出したか。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、各々考えたことを一つずつ、それらがすべて出揃うまで報告 するよう指示せよ： ホワイトボードに考えたことを記録せよ。 実習生に、各自の「ToTハンドブック」に載っている情報を紹介せよ。 実習生に、ふるまい方の練習機会が週の後半にあることを念押しせよ。 実習生に、取り組むべきふるまい方を確認するため、「ToTハンドブック」 p.29の「プレゼンテーションとファシリテーションの優れた実践」の一覧を 活用するよう勧めよ。この一覧は、必要ならば自己評価にも活用できると 説明せよ。 61 プレゼンテーションとファシリテーション（5分） 説明：WSTP［車椅子サービス教習パッケージ］で の教習員の役割は、プレゼンテーションとファシ リテーションとの間をひんぱんに交替します。 質問：プレゼンテーションとファシリテーション との違いは何だと思いますか？ 実習生に 2〜3 分これについて考える時間を え、 グループ全体から回答を募れ。 次のスライドを映し、すでに答えられているもの があれば受けとめ承認せよ。 スライドの内容を読み、必要なら拡張せよ。 スライドの内容を読み、必要なら拡張せよ。 WSTP では、プレゼンテーションとファシリテーションの組み合わせを活用していると説明せよ。 「教習員用指導書」では、いつプレゼンテーションを行ない、いつファシリテーションを行なうか 指示している。 62 プレゼンテーションとファシリテーションの優れた実践（15分） 実習生にプレゼンテーションを行なう際の優れた 実践とは何だと思うか熟考するよう指示し、グル ープ全体から回答を募れ。 ToT 教習員への注記： • ToT教習員は ToTを通して、とりわけこの授業中は、優れた実践のお手本となるべきである。 言ったことは必ず実行せよ。 スライドを読み、すでに回答で実習生が挙げた例 があれば、受けとめ承認せよ。 63 質問：「エナジャイザー76」とはどういう意味か、知っている人はいますか？ 応答を受けとめ承認せよ。 説明： • 「エナジャイザー」とは、グループを元気づけ、再活性化させる目的の短い活動です。 • いつもそうとは限りませんが、たいてい「エナジャイザー」は授業内容には関係しません。 • 「ToT ハンドブック」の p.30-31 に、「エナジャイザー」の項目が事例付きで載っています。 実習生にひとり、率先してグループへ短い「エナジャイザー」を行なうよう依頼せよ。 実習生たちに、その「エナジャイザー」はグループへどう効いたか尋ねよ。 ToT 教習員への注記： • たいていの実習生は、前に経験した教習を通して「エナジャイザー」を何か知っているだろう。 だれも率先しない場合のために、実施例を準備しておけ。 説明： • スライドは合図77として、また主要メッセージを 示すために使いなさい • スライドごとに受講者が内容を消化する時間を 取りなさい。外国語で受講している場合は、より 長く取りなさい。 • 受講者に、スライドの内容を音読してもらい、 変化を付けなさい。 • 映したスライドが話の内容と一致していること を確かめなさい。 • スライドは「教習員用指導書」とつねに同期させ なさい。 • スクリーンを読み上げるのは避けなさい。 • あえてスクリーンを読む場合は、それを肩越し に見たり聴衆に背を向けたりしないように。 • プロジェクター光を遮断してはなりません。 上記のうち最後の 3 か条を、教室の端に寄ったり、 受講者の背後に回ったりできることを示しながら やって見せよ。 76 [原文] energizer 77 [原文] prompt 64 質問：視覚障害のある人が受講者に含まれる場合、プレゼンテーションのやり方や授業計画はどう 変更しますか？ 回答を受けとめ承認せよ。 最も重要な答え： • スライドの情報を読み上げ、視力障害のある受講者がすべての情報を得られるようにする。 • 弱視の受講者には、プレゼンテーションスライドのフォントを大きく、またスクリーンをなる べく大きいものにする。 • 教習前に受講者に会い、そのニーズを理解する。 • 受講者が音声読み上げソフト78を使用する場合は、文書やプレゼンテーションスライドを事前 に渡しておき、教習開始前に確認できるようにする。 • 適切ならば、点字化した文書を提供する。 スライドを読め。 実習生に、「ToT ハンドブック」の要点を紹介せよ。 必要に応じて拡張せよ 質問：これまで、教習員が授業のどこで「プレゼン テーション」を行ない、「ファシリテーション」を 行なっていたか、例を挙げられる人はいますか？ 質問：実習生として、これら 2 つの方法はどう違っ て感じられますか？ 応答を受けとめ承認せよ。 実習生に、ToT が進むにつれ、プレゼンテーションとファシリテーションの両方について、観察や 練習の機会があることを念押しせよ79。 78 [原文] screen reader 79 [原文] remind 65 時間管理（20分） 説明： • 教習員と受講者には、教習プログラムが確実に時間通り進むようにする必要があります。 • 数多くの授業や活動がある一方、それらを完了するための時間は限られているからです。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 質問：教習が時間通り進むようにするには、どうしたらよいでしょうか？ 実習生に、思いついたことを各自「ToTハンドブック」p.31に書き出すよう 指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 全体でフィードバックし、各ペアに順番に提案を出してもらえ。 応答を受けとめ承認し、下記「ToT教習員への注記」を用いて補足せよ。 66 ToT 教習員への注記： • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者 を待たせて不利益を負わせるな80。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTPに資料やあまりにも多くの 実例を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留81」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば「15分休憩、10:45には戻って下さい」 「自分のグループでの話し合いに 10分、フィードバックに 5分使えます」 • 教習員仲間と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には、予備計画82を立てておけ。例えば、雨で車椅子の移動 技能の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 80 [原文] avoid penalizing 81 [原文] Park 82 [原文] back-up plan 67 ToT.8 コミュニケーションスキル ね ら い コミュニケーションスキルについて話し合い、プレゼンテーションスキルを実践に移す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  コミュニケーションスキルの重要性を説明し、プレゼンテーションスキルを実践に 移す。  優れたデモの示し方を説明する。  通訳者とうまく協力するやり方を詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.8：コミュニケーションスキル」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. コミュニケーションの種類 3. デモ・動画・通訳について 4. 要点のまとめ 2 55 30 3 授業時間計 90 68 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 コミュニケーションの種類（55分） 説明： • コミュニケーションスキルは、優れた教習員となるためのカギです。 • この活動は、自分のコミュニケーションスキルを練習する機会です。 • 実習生は教習員役を務め、自分のトピックの学習の要点を自分で発表します。 • これは、「プレゼンテーションとファシリテーション」の授業で話し合った技能を、実践に移す 機会です。 このスライドは活動の間じゅう映しておけ。 69 活車１ グループ： 実習生を 4グループに分けよ。 指導内容： それぞれのグループに、下の「ToT教習員への注記」に列記されているトピ ックを一つずつ割り当て、続いて実習生に「ToTハンドブック」の p.33-35 を開かせよ。 各グループは、各自のトピックの下に列記された情報をプレゼンテーション すること。 創造性を発揮するようグループを励まし、小道具、フリップチャート、ホワ イトボードなどは自由に用いるよう奨めよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 課題の準備に 20分、グループごとのプレゼンテーションに各 5分、それ ぞれのプレゼンテーションの後に話し合いを 2分ずつ、ToT教習員による、 最後のフィードバックおよび取りまとめに 5分見込んでおけ。 フィードバック： 実習生に各自の「ToTハンドブック」を参照させ、すべての情報が、上の プレゼンテーションで伝えられたか確認させよ。 フィードバックは、授業内容とさまざまなコミュニケーションスキルに重点 を置け。ToT教習員は、グループが明確にプレゼンテーションしていない 要点を簡潔に要約すること。 ToT 教習員への注記： グループ１：言語的技能 • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語83や「無意味な語84」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な85ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 83 [原文] slang 84 [原文] ‘non-speak’ 85 [原文] simple and non-medical 70 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 己れのボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える86な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室の中から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン87（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 86 [原文] jump to answer 87 [原文] closed questions 71 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ88（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば「あなたはどう思いま すか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論89 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな90。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴91：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・車画・通訳について（30分） 説明：これから、コミュニケーションをさらに 3 つ の面から見て行きます。 スライドを読み上げよ。 88 [原文] challenge 89 [原文] clinical reasoning 90 [原文] Never make up an answer if you do not know. 91 [原文] Listen 72 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生を 2グループに分けよ。 指導内容： 実習生に、「ToTハンドブック」を閉じるよう（本の中に答えが載っている ため）指示せよ。 それぞれのグループに、トピックを割り当てよ。 • グループ１に検討を指示せよ：デモを行ない、動画を上映する際の優れた 実践について • グループ２に検討を指示せよ：外国語や手話の通訳者との協働について 実習生に、教習を実施するさい、各自のトピックに関して何を考慮すべきか 話し合い、もう片方のグループへプレゼンテーションするためフリップチャ ートに書き出すよう指示せよ。 実習生に、PPTスライドの活動への手引きを参照させよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： グループでの表づくりに 10分、グループごとのプレゼンテーションに 5分 ずつ、それぞれのプレゼンテーション後の要点追加に 5 分ずつ見込んでお け。 フィードバック： グループ１に、所見をグループ２へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 グループ２に、所見をグループ１へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 実習生に、「ToTハンドブック」の参考資料を参照させよ。 73 ToT 教習員への注記： デモによって示す： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎WSTPと中級 WSTPのデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 車画を用いる： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や動話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2倍時間を要する。 74 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 75 ToT.9 指針文書の知識 ね ら い 実習生にWSTP［車椅子サービス教習パッケージ］の指針文書92を紹介し、それらの関連 性を説明する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPの指針文書を列挙する。  WSTPの教習員および受講者に対する、それらの重要性を説明する。 教 材 この授業には93：  PPT スライド「必須教習技能 ToT.9：指針文書の知識」  動画：「持続可能な開発目標（SDGs）」 以下の資料を 1部ずつ：  「国際連合 障害者の権利に関する条約（CRPD）」  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」  WHO「低リソース状況での移動支援機器供与に関する共同方針提言書」  WHO「CBRガイドライン」：導入ブックレットおよび保健コンポーネント  「アクセシビリティのためのデザインの留意事項」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  すべての指針文書について、徹底的に知っておく。  国際連合のウェブサイト（https://www.un.org/development/desa/disabilities/）を 検索し、教習プログラムの時点で CRPDに署名した国の総数を調べておく。このこと について触れ、質問に答えられるよう、実習生の国がCRPDに署名し批准しているか 調べておく。 あ ら す じ 1. はじめに 2. CRPDと車椅子サービス供与の関連 3. 「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」 4. 「CBRガイドライン」 5. その他の指針文書 6. 要点のまとめ 8 20 5 25 15 2 授業時間計 75 92 [原文] guiding documents 93 [訳注] 資料の英語原題, 書誌, インターネット上のリンク等は次ページからの授業計画本文を参照. 76 はじめに（8分） 授業のねらいおよび学習目標を説明せよ。 質問：「指針文書」とはどういう意味でしょうか？ 回答を受けとめ承認せよ。 最も重要な答え： • 出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、規則を与え るもの • 車椅子サービス供与関係者の指針となる資料 質問：これらの文書に精通していることは、なぜ 重要なのでしょうか？ 回答を受けとめ承認せよ。 77 最も重要な答え： • 多くの政府、国際機関、資金供与者94その他の関係者は、これらの国際的枠組みに沿って開発 事業を計画し、資金を供与するから。 • より強い立ち位置から、車椅子サービス供与に向けた啓発や政策提言を行なうため。 説明： • WSTP 教習プログラムを運営するさい、これらの 指針文書に精通することは、車椅子供与に向けた 啓発や政策提言に役立つので重要です。 • 受講者は国内の文書を参照する場合が多いため、 教習員もこれらをよく理解しているべきです。 説明：これらの資料へのしっかりした理解は、教習授業の質に貢献します。「ToT ハンドブック」 には、すべての指針文書についてさらに詳しい情報が載っています。 質問：車椅子供与に関係する、最も重要な二大指針文書は何でしょうか？ 最も重要な答え： • 「国際連合 障害者の権利に関する条約（CRPD）」 • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて95」 94 [原文] donors 95 [訳注] これに加え, 2023 年 6 月に WHO から「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024 年に発行予定. 78 CRPDと車椅子サービス与 の関連（20分） 説明： • まず「国際連合 障害者の権利に関する条約(96)」、 通称「CRPD」97から見て行きます。 • CRPD は、障害者に関する最も重要な国際条約だ と広く考えられています。 • CRPD は、2008 年に発効しました。 説明： • 発効日には 82 か国が CRPD に署名、その選択議定書に 44 か国が署名しました。これは国連の 条約中、発効日での署名国数では史上最多です。 • CRPD は、障害者への社会の見方と処遇のあり方を変革するために、国際社会の代表者によって 策定されました。 • 代表者とは障害者、政府当局者、非政府組織（NGO）の代表などです。 • CRPD が重要である理由は、障害者が、他のあらゆる人びとと同じ権利と機会へアクセスできる ようになるためのツールだからです。 ToT 教習員への注記： • 教習プログラムの時点で CRPD に署名した国の総数を調べ、また実習生の国が CRPDに署名 し批准しているか調べておけ。 96 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). [訳注] 日本政府外務省仮訳: https://www.mofa.go.jp/mofaj/fp/hr_ha/page22_000899.html 97 [訳注] 日本では「障害者権利条約」と略されることも多い. 79 質問：なぜ WSTP 受講者には、CRPD に精通して いることが重要なのでしょうか？ 応答を受けとめ承認せよ。 最も重要な答え： • CRPDの人権に基づくアプローチを、障害者への車椅子サービス供与の開発に役立つように 活用するため。 • CRPDの条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえ で役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 説明：CRPD には車椅子サービス供与に関連する いくつもの条文があります。 質問：「ToT ハンドブック」を見ないで、最も深い 関わりがあるのはどの条文か、思い出せる98人はい ますか？ 応答を受けとめ承認せよ。 最も重要な答え： • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション99およびリハビリテーション • 32条：国際協力 98 [訳注] この内容は基礎および管理者向け WSTP で取り上げており, WSTPtot 実習生は既習が前提のため. 99 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 80 他のありうる答え： • 19条：自立生活および地域社会へのインクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30条：文化的生活・レクリエーション・余暇・スポーツへの参加 説明： • CRPD 第 20 条は、車椅子サービス供与に最も 関わりがある条文です。 • ここでは締約国へ、最大限に自立した個人的移動 を障害者へ保証するための実効ある施策を講じる よう求めています。 説明：第 4 条では一般的義務を取り扱い、この文言 を含んでいます。 説明： • これらの条文も、例えば支援機器の重要性、合理 的配慮100、移動技能教習に言及しており、関わり があります。 • 第 26 条は、ハビリテーションおよびリハビリテ ーションを扱っているため、特に重要です。 100 [原文] reasonable accommodation 81 説明：CRPD の他の多くの条文が、間接的に車椅子サービス供与と関わっています。例えば第 6 条 は女性障害者の具体的なインクルージョン、第 7 条は子どもの平等に関わるものです。 質問：子どもや女性が車椅子サービスへアクセス するさい、さらにぶつかりうる障壁には何がある でしょうか？ 実習生に、隣どうしで 1〜2 分、これについて話し 合い、フィードバックを集めるよう指示せよ。 応答を受けとめ承認し、指摘がなかった重要事項 はすべて補足せよ。 最も重要な答え： • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持101を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉102を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 説明：CRPD の第 6・7 条を満たすには、必ず車椅子 供与サービスは、特に女性や子どものニーズが考慮 されるようにしなければなりません。 101 [原文] supportive seating 102 [原文] stigma 82 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて」(5分) 説明： WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて（車椅子 ガイドライン）」は、車椅子供与に焦点を置いた、最も重要な国際的文書です。 ほとんどの実習生は「車椅子ガイドライン」をよくご存知ですよね、と確認せよ103。 説明： • 「車椅子ガイドライン」は、現在、世界的に理解 されている適正な車椅子供与枠組みをまとめたも のです。 • 「車椅子ガイドライン」の発行以前、車椅子供与 に関わる諸組織は、考慮すべき重要事項は何か、 共通理解を持っていませんでした。 説明： • 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画によって作成されました。 • これは、合意された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子 サービスの政策提言に役立つ、強力なツールをもたらします。 • 「車椅子ガイドライン」は低・中・高リソース状況で普遍的に達成可能な基準を反映しています。 質問：「適正な車椅子」の定義を覚えていますか？ 回答を受けとめ承認せよ。 103 [原文] Acknowledge [訳注] 各 WSTP で参考資料として取り上げており, WSTPtot 実習生は既習が前提のため. 83 スライドの要点を読み上げよ。 説明：「車椅子ガイドライン」では車椅子に関する 以下の項目も取り上げています： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 質問：この 1 年間に「車椅子ガイドライン」を読んだ人はいますか？ 全実習生に、「車椅子ガイドライン」はとことん読み込むよう勧めよ。WSTP 教習員の「車椅子 ガイドライン」に関する知識は包括的なものでなければならない。ToT 教習員は機会あるごとに その意識を喚起しなければならない。 説明：「車椅子ガイドライン」は、WHO のウェブサイトで各言語版(104)を入手できます。 104 https://www.who.int/publications/i/item/9789241547482 [訳注] フランス語・スペイン語を含む. https://apps.who.int/iris/handle/10665/43960 [訳注] 日本語・ベトナム語を含む. 84 CBRガイドライン」（25分） 説明：WSTP 用 USB メモリの補足資料フォルダに、他の指針文書がいくつか収められています。 実習生はそれらを熟知し、重要性と関連性を説明できるようになっておくべきです。 説明：「地域に根ざしたリハビリテーション (CBR)105」は、WSTP の中で話題に上る可能性が高い ものです。そのため教習員は「CBR ガイドライン(106)」、特にその保健コンポーネントをしっかり と理解しておくことが重要です。 説明： • CBR は、「地域に根ざしたインクルーシブ開発 (CBID) 107」とも呼ばれることも多く、CRPD を 履行するために最も効果的な方法の一つである と、ますます考えられるようになっています。 • CBR の多くの側面が車椅子サービス供与に関連 します。例えば紹介・相談ネットワーク、地域の 保健センター、CBR ワーカーなどです。 説明：CBR マトリックス(108)は、「CBR ガイド ライン」の土台の一つです。 質問：CBR マトリックスの 5 つの主要な領域109と は何でしょうか？ 回答を受けとめ承認せよ。 105 [原文] community-based rehabilitation 106 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBR ガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 107 [原文] community-based inclusive development 108 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr/matrix/en/). 109 [原文] components 85 説明： • 5 つの領域とは保健、教育、生計110、社会、能力 強化 (エンパワーメント)111です。 • マトリックスの各領域には 5 つずつの要素112が 含まれるため、合計で 25 の要素があります。 このスライドは活動の間じゅう映しておけ。 110 [原文] Livelihood 111 [原文] Empowerment [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_security/human_security_approach/) の訳語.「エンパワーメント」 も広く使われ, こちらが分かりやすい読者も多いと考え併記した. 112 [原文] elements 86 活車１ グループ： 実習生を 5 グループに分けよ。各グループでジェンダー、経験/知識、技能 がさまざま混在するようにせよ。 指導内容： 実習生に「ToTハンドブック」p.45の「CBRマトリックス」を参照させよ。 各グループに CBRマトリックスの領域を一つずつ割り当て、話し合わせよ。 実習生に、車椅子サービス供与が担当領域にどう関連するか、その仕方を 考え、うち二通りにつき全体へのフィードバックを準備するよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、自分たちの答えの一つ目を順番に尋ねよ。それから同様に して、各グループに二つ目を尋ねよ。 ありうる答えの例： 保健 • リハビリテーション：長期および短期の • 健康増進や二次障害予防。例えば早期発見と早期介入による側弯や褥瘡の 予防 • 保健医療サービスへのアクセス 教育 • 学校、教育プログラム、職業訓練プログラムへのアクセスを可能にする。 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス 社会 • 社会およびレクリエーション活動へのアクセス増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 能力強化（エンパワーメント） • 自己イメージや自信の向上 • ピアサポート（当事者支援） 87 説明： • このスライドは、CBR マトリックスに分類され た生活の主要側面を、適正な車椅子供与がどう 改善するかをまとめたものです。 • さらに詳しい情報は、「CBR ガイドライン」お よび「ToT ハンドブック」の CBR マトリックス に載っています。 その他の指針文書（15分） 説明： • WHO の「低リソース状況での移動支援機器供与 に関する共同方針提言書(113)」は、各国が CRPD の移動支援機器供与に関連する条文を履行でき るよう、2011 年に刊行されました。 • その内容は移動支援機器へのアクセスにおける 障壁、移動支援機器へのアクセスを増やすため の要件、各国と国際的な関係者への提言などの 情報です。 113 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URL および https://j-aws.jp/who/). 88 説明： • WSTP 用 USB メモリに収めている、指針文書の 最後は「アクセシビリティのためのデザインの 留意事項(114)」です。 • この文書は、車椅子サービスを訪れる場合と、 その他の環境の両方とで、アクセスのあらゆる 面が考慮されるようにする方法に関する有益 な情報をもたらします。 説明：WSTP 教習員として、精通しておくべき指針文書は他にも数多くあります。 質問：別の主要な国際文書で、WSTP の開発が始まったあとに発表されたものがあります。それが 何か分かる人はいますか？ 回答を受けとめ承認せよ。 最も重要な答え： 「持続可能な開発目標 (SDGs)(115)」。 説明： • SDGs は「ミレニアム開発目標（MDGs）116」を 継承するものです。 • 2015 年 9 月に発表され、2015〜2030 年を達成 期間としています。 114 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 115 The sustainable development goals [website]. New York: United Nations (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 116 [原文] Millennium Development Goals [訳注] 2015 年までに 8 目標・21 ターゲットの達成を掲げた. 89 車画を紹介せよ：「持続可能な開発目標（SDGs）」。 実習生に 17 ある SDGs に関する、この国際連合の 動画を視聴するよう指示せよ。 動画を上映せよ。 説明： • 障害について具体的に言及している SDGs は、 ゴール 4・8・10・11・17 の 5 つです。 • その世界的指標117のうち、9 つが障害に関連 します。 説明： • SDGs のねらいは、最もそこなわれやすい人びと に手を差し伸べ118、最後に取り残されたものへ 最初に手を差し伸べる119よう尽力すること です。 • 多くの関係者が SDGs に取り組むようになる ため、適正な車椅子供与が、そのゴール達成に どう貢献できるか検討することは重要です。 117 [原文] global indicators 118 [原文] reach the most vulnerable 119 [原文] reach the furthest behind first 90 説明： • WHO の 「 支 援 技 術 に 関 す る 世 界 的 協 力 (GATE)(120)」の取り組みは、もう一つの重要な 前進の一歩です。 • GATE は、支援技術へのアクセスを全世界で向上 させるためにつくられました。 • GATE の最初の成果が 2016 年 5 月に発表された WHO「優先的支援製品リスト (APL)(121)」です。 • APL では、政府が無理のない価格で利用可能に すべき 50 の優先度の高い支援製品/機器を取り 挙げており、そこに 4 種類のさまざまな車椅子 が含まれています。 説明：その他の関連文書で、「ToT ハンドブック」 で詳しく述べているものは： • WHO「障害に関する世界報告書(122)」 • WHO「世界障害者行動計画(123)」 • 国連「障害に関する高級事務レベル会合(124)」 120 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 121 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/implementation/assistive_technology/global_survey-apl/en/). 122 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 123 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 124 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 91 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 92 ToT.10 視聴覚ツールおよび機材 ね ら い 実習生が、パワーポイント (PPT) によるプレゼンテーションおよび視聴覚機材を効果的 に使えるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPに使える各形式の PPT ファイルの、利点および難点を説明する。  各種 PPT に変更を加え、動画を埋め込む。  視聴覚機材を用いる際の優れた実践を詳述する。  視覚教材としてホワイトボードやフリップチャートを効果的に用いる。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.10：視聴覚ツールおよび機材」  あればスライド転換用リモコンおよびレーザーポインター 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  機材および PPT の使い方（動画の埋め込みを含む）に自分が慣れておく。そうすれば 質問に答え、デモを上手に行ない、実習生がどんな問題にぶつかるかが分かる。 あ ら す じ 1. はじめに 2. WSTPのパワーポイント 3. ホワイトボードやフリップチャートを視覚教材に用いる 4. 要点のまとめ 4 20 20 1 授業時間計 45 93 はじめに（4分） 授業のねらいおよび学習目標を説明せよ。 質問：ここまでの教習で、どんな種類の視聴覚機材を使ってきましたか？ 最も重要な答え： • PPTおよび動画用にプロジェクター • ホワイトボード • フリップチャート • 壁の付箋紙 質問：それらの機材は、どういう点で役に立ちましたか？ 最も重要な答え： フリップチャートやホワイトボード： • 授業中および授業後の参照用に重要な、情報/学習の要点の強調（例えば「基本ルール」） • すでに与えられた答えの視覚的リマインダー • 技術的な説明の補助 PPTや動画 • 概念を説明する図表を示す機会 • 話すとともに画像/メッセージを示すことで、学びを補強 • 注意を集中させるために有効 94 WSTPのパワーポイント（4分） 説明： • WSTP の PPT は二つの仕様が使え、編集不可能 な PDF 版と編集可能な PPT 版があります。 • PDF 版は： o ファイルサイズが小さく、動画が埋め込まれ ています。 o 編集は不可能125です。 o 箇条書きが一つずつ現れる「ビルド」あるいは 「表示」といった効果はありません。 • PPT 版は： o ファイルサイズは大きいです。 o 編集可能です。 o 出荷状態では動画は埋め込まれていません。 o アニメーション効果が入っています。 125 [訳注] 日本語版は PDF 編集ソフトがあればある程度可能. 95 説明：教習員は、次の内容のスライドを追加しても よいでしょう： • 重要な質問： o 「教習員用指導書」には、教習員から受講者へ 尋ねるべき質問が載っています。 o スライドに質問を追加しておけば、その質問 をすることや、いきなり解答に移らないこと を覚えておけます。 • 要点： o 「教習員用指導書」には、長い本文がリマイン ダー用スライドなしで載っている項目もあり ます。 o 要点スライドを追加しておけば、授業計画の すべての面を押さえることを忘れないように できます。 • 活動への指示： o 活動に関連する重要な質問や重要な指示を、 スライドに追加できます。 説明：教習員は、次の目的でスライドを変更しても よいでしょう： • 現地の事情/状況に適合させる。 • 翻訳または現地で適切な用語を入れる。 • 本文を減らすか、内容を複数スライドに分割。 説明：内容の意味や WSTP の方法論は変えないこ とが重要です。 96 説明：スライドを修正あるいは追加する場合、必ず 守るべきことは： • PPT 原版と同じスタイルに従って下さい。 • WSTP の意味および核心的内容は、変えないで 下さい。 • WHO のロゴを（WHO の著作権規定に従い） 削除して下さい。 説明：スタイル、フォント、色を変更したり、複雑 なアニメーションを追加したりしないで下さい 97 スライドの追加 スライドショー」モードを終了し、その次のスライドを用いて以下のデモを行なえ。 説明： • 既存のプレゼンテーションファイルにスライ ドを追加する最も簡単な方法は、別のスライド を複製し、その見出しと本文の文字を削除し、 フッターのスライド番号を変更することです。 • 追加したスライドから、WHO のロゴを削除する ことを忘れないで下さい。 • これの詳しいやり方は、「ToT ハンドブック」に 載っています。 車画の挿入（Office 2013を使用） 説明： • 動画ファイルは、すべて mp4 と wmv の二形式 が用意されています。使うコンピューターに 合うものを選んで下さい。 • 動画によっては字幕入りも用意されています。 次のような目的のため字幕入りを推奨します： o 方言126を理解する困難を取り除く o 音質の悪さや外部の騒音を乗りきる o 聴覚障害者にも利用可能にする 説明： • 動画の埋め込みを推奨します。 • 埋め込むことで動画を PPT ファイルに内蔵でき ます。 • それによって、ファイルサイズは増えますが、 ファイルを他のコンピューターにコピーして も動画が失われることはありません。 126 [原文] regional accents 98 以下をやって見せよ： PPT 2010 以降の127ソフトで動画を埋め込む には、次の手順に従います： • 「Presentations」＞「PowerPoint」フォルダー を開きます。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入 • 変更を保存 • これで動画が PPT の一部になりました 説明： • 動画がつねにフルスクリーンで表示される ようにも設定可能です。 • ウィンドウズコンピュータ ：ー「ビデオツール」 の「再生」タブから「全画面表示の再生」チェ ックボックスをオンにする。 • アップルコンピューター：「ビデオ形式」タブ から「再生オプション」をクリック、ドロップ ダウンリストから「全画面再生」を選択。 「スライドショー」モードに戻り、動画再生のやり方を示せ。最初の数秒間だけ再生したら、次の スライドへ移れ。 ToT 教習員への注記： • 実習生には、これらの技能は一日の終わりの準備時間に練習できることを伝えよ。 • 現地の写真やイラストを、状況を示すために追加してもよい。 • スライドの翻訳は現地で行なってよい：すでにスライドの現地語訳128があるかどうか、 WHOに必ず確認せよ。 127 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 128 [訳注] 日本語版 PDF は全 WSTP について右ウェブページよりダウンロードが可能 (https://www.j-aws.jp/). 99 説明： • PPT の授業を練習する時は、「スライドショー」 モードを用いなさい。それによってトランジシ ョン、アニメーション、フローなどの問題を発見 できます。 • 教習で使う「スライドショー」モードのコンピュ ーターおよびプロジェクターを用い、スライド および動画を通しで実行しなさい。 • 自分のコンピューターを用いない場合、設定が 異なる別のコンピューターではプレゼンテーシ ョンスライドを予定通りに実行しないことがあ るため、これは重要です。 • 教習中のプレゼンテーションは、すべて一台の コンピューターで行なうことを検討しなさい。 これでプレゼンターごとの切り替え時間が省け ます。 説明： • できれば、予備のプロジェクターかプロジェク ター用ランプを用意しておきなさい。 • 休憩時間や実習中は、プロジェクターの電源を 切ってランプの使用を節約しなさい。 • 黒色あるいは白色のスクリーンに映写する必要 がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キー を打つと黒いスクリーンになります。 白または黒のスクリーンにする方法を実演せよ。 100 説明： • リモコンを用い、クリックしてスライドを切り 替えると、教習員はプレゼンテーションの間に コンピューターの横に立たなくて済みます。 • レーザーポインターは、スライドの個別の項目 について受講者の注意を引くために使えます。 • スピーカーは、接続が正しいか毎朝テストして おきなさい。 リモコンとレーザーポインタ （ーあれば）の使い方 をやって見せよ。 ホワイトボードやフリップチャートを視覚教材に用いる（4分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生を 5グループに分けよ。 指導内容： 実習生に「ToTハンドブック」p.60の「ホワイトボード/フリップチャート を視覚教材に用いる」に関する表を参照させよ。 各グループに表のトピックを一つずつ割り当てよ。与えられた情報を通読 し、それを他のグループへ、ホワイトボード/フリップチャートを活用して 伝達する方法を計画するよう実習生に指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 準備に 10分、各グループのプレゼンテーションに 2分ずつ見込んでおけ。 フィードバック： プレゼンテーションで抜けていた情報があれば補足せよ。 101 ホワイトボード/フリップチャートを視覚教材に用いる 1. スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 2. ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 3. ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正129に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 4. 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 5. ホワイトボードの動入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間130」で 姿勢を描くなど）。 129 [原文] neat 130 [原文] ‘stick-draw’ 102 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 103 ToT.11 フィードバックについて ね ら い 有益なフィードバックを与える、教習員の役割および技能を探求する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  有益なフィードバックを与えるやり方を詳述する。  各模擬授業の終わりにフィードバックを与えるプロセスを詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.11：フィードバックについて」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  フリップチャート紙 1枚にフィードバックの 4ステップを書いて用意しておく： 1. 実習生の自己省察 2. 模擬受講者のフィードバック 3. ToT教習員のフィードバック 4. ToT教習員が要点を話し合う あ ら す じ 1. はじめに 2. フィードバックを与える 3. 模擬授業後のフィードバックプロセス 4. 要点のまとめ 2 35 7 1 授業時間計 45 104 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 フィードバックを える（35分） 質問：フィードバックとは何でしょうか？ 最も重要な答え： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 説明：教習員が、上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を 支援できることは重要です。 このスライドは活動の間じゅう映しておけ。 105 活車１a グループ： 実習生をペアに分けよ。 指導内容： 質問：フィードバックをもらうことについて、どんな経験がありますか？ 自分の学びに役立ったフィードバック、また自分が身構える131か動転して132 役に立たなかったフィードバックを思い出しなさい 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 実習生に、その考察を「ToTハンドブック」p.61に記録するよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、全体へのフィードバックに 5分を 見込んでおけ。 フィードバック： 実習生に、事例を提供するよう依頼せよ。 キーワードをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 131 [原文] defensive 132 [原文] upset 106 活車１b グループ： 実習生を同じペアに分けよ。 指導内容： 質問：教習員は、フィードバックを与える際に何を考慮すべきでしょうか？ 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、フィードバックに 10分を見込んで おけ。 フィードバック： 各ペアに順番で、フィードバックを与える際の重要な留意事項を一つか二つ 述べるよう指示せよ。 検討すべきよい例を受けとめ承認せよ。 誤解があれば訂正/説明せよ。 下の注記を用い、適切な答えが全体で話し合われるようにせよ。 ToT 教習員への注記： 望ましいフィードバック： • タイムリーに133：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。これは受講者 が、フィードバックを直近の学びや経験と結びつけるうえで有効である。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 行動に絞り込め：建設的なフィードバックを与える時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に公開で与えよ。意識、 行動、規律に関わる問題には、非公開で対処せよ134。 • 受講者の視点に立って：まず受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者を支援せよ、みんな違ってみんないい135：建設的なフィードバックを与える前に、受講 者が完了した活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。 サービス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 133 [原文] Be timely 134 [原文] deal with them in private 135 [原文] we are all different [訳注] 文脈と用例から, 文意に対してはこの詩句の引用が最適と判断した. 107 模擬授業後のフィードバックプロセス（7分） 説明：ToT 教習員は、授業は教室の後ろから観察しますが、フィードバックのファシリテーション を行なうには教室前方に移動します。 フィードバックの 4 ステップを示す、作成済みの フリップチャート紙を掲示せよ。参照のため、これ は教習の残りの期間、壁に貼ったままにしておけ。 説明：模擬授業の後には、4 つのフィードバックの ステップがあります。 1. 実習生自身の振り返り136：リーダー役実習生が 自分たちの出来ばえを振り返ります。内容は： • 何がうまく行ったか？ • 何に改善の余地があるか？ 2. 模擬受講者のフィードバック：リーダー役実習 生へ、次に関するコメント 1 つを含む、簡潔で 具体的なフィードバックを与えます： • 何がうまく行ったか？ • 何に改善の余地があるか？ 3. ToT教習員のフィードバック：ToT 教習員が、 実習グループが全体として学べる部分に絞り、 「必須教習技能」授業の学びを補強する追加の フィードバックを与えます。 4. ToT教習員が要点を話し合う：ToT 教習員と、 全実習生に関係がある、その授業の要点を話し 合います。 136 [原文] self-reflection 108 説明：フィードバックをもたらすさい、重要なことは： • 話題になっている人を見ながら、その人に直接語りかけなさい。 • 具体的に。例えば「それは本当によい」と言うより「あなたのグループ分けのやり方と、明確な 指示の出し方がよかった」と言うべきです。 • 受講者からのフィードバックは、つねに建設的であるべきです。 • フィードバックが実習生を傷つけるか無神経なものであれば介入し、フィードバックを言い直し て建設的なものにしなさい。 • フィードバックのプロセスは、この授業で学んだことを実践に移す機会になります。 より正式な実習生と１対 1 でのフィードバックは、各教習日の終わりの準備時間に行ないます。 何か質問がないか尋ねよ。 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 109 ToT.12 グループダイナミクスを取り仕切る137 ね ら い グループで効率よく効果的に作業する要領、およびグループ内で個々人が示すさまざま な行動を取り仕切るやり方を考究する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  多彩な方法を活用して、技能、専門性、経験を考慮した、活動のための小グループを 編成する。  グループでの妨害行動138に対処する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.12：グループダイナミクスを取り仕切る」  「妨害行動カード」を準備：この授業計画の最後に収録しているカードを、印刷して 切り分けるか手書きする。帽子かバケツを用意しておく。 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. グループ活動を組織し取り仕切る 3. 妨害行動に対処する 4. 要点のまとめ 3 10 25 2 授業時間計 40 137 [原文] Managing group dynamics 138 [原文] disruptive behaviour 110 はじめに（3分） 授業のねらいおよび学習目標を説明せよ。 質問：なぜ WSTP にはグループ活動が盛り込まれ ているのでしょうか？ 回答を受けとめ承認せよ。 回答をホワイトボードに記録せよ。 説明： • 教室内にはつねに、さまざまなレベルの経験と 専門性を持つ人がいます。 • グループ作業によって可能になることは： o 教習員は、すでにどのくらいのことが知られ ているのかを見出せます。 o より多くの経験や専門知識を持つ人が、他と それを共有できます。 o 受講者は、自分が経験を通してすでに多くの ことを知っているとわかり自信がつきます。 o 内気な、または年若い受講者も小グループの 中では気後れせず発言できます。 111 グループ活車を組織し取り仕切る（10分） 質問：受講者をグループ分けする際の重要な留意 事項は何でしょうか？ 回答を受けとめ承認せよ。 実習生に、「ToT ハンドブック」p.63-65 を開き、 実習生が挙げなかった内容を指摘しながら、一覧 に沿って話し合うよう指示せよ。 ToT 教習員への注記： グループのサイズを決定する要因 • 時間グループが多いほど、フィードバックにも時間が必要になる。持ち時間が少なければ、大 きいグループをつくれ。ただし、1グループの人数は 6名を超えないようにせよ。 • プライバシー/内密さ139：気をつかうトピック、内気な人、言語の壁がある場合の話し合いに はペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な機材/消耗品の分量。例えば、作業場が 3か所あれば、3グループ まで対応が可能になる。 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や経歴を持った人を同じグループにする（臨床職全員が 協働するように配置する、あるいは技術者全員が同じグループにいるなど）か、逆に、わざと 同じグループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、かれらをグループ にする方が適切な場合と、分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混合：これはお互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混合：作業への文化・宗教・社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が協力し合って作業し、学び合いの機会140が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 139 [原文] confidentiality 140 [原文] peer learning opportunities 112 グループづくりの動法 各WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与え ている。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ 分けの手法をいくつか掲げる： • フルーツサラダ法141：同じ果物カードを 3、4枚ずつ、さまざまな種類の果物で受講者の人数 分になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ (1人 1種類の)」でいっしょになる、などを指定する。 • 番号点呼142：必要なグループ数の番号を点呼する。例えば 3グループに分ける必要があれば、 最初の人が「一」、次の人が「二」、それから「三」、また「一」に戻って数を点呼するよう 指示し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分け ておく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3人、次の 3人 とまとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1人または 2人、自分が組んだことがない人を選んでもらう。ただし 3人を超える と、自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4人ずつのグループに有効。 妨害行車に対処する（25分） このスライドは活動の間じゅう映しておけ。 141 [原文] The fruit salad method 142 [原文] Count off 113 活車１ グループ： 実習生をペアに分けよ。 指導内容： どんな受講者の集団も、幅広い個性、技能、経験、学習スタイルの集まりで あり、また、ある種の行動が授業を妨害する場合のみ教習員は対処すべきで あることを説明せよ。 実習生に、あちこちの教習でどんな種類の妨害行動を目にしたことがある か、パートナーと話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 話し合いに 2分、フィードバックに 3分見込んでおけ。 フィードバック： 各ペアからの答えを、新しい考えが出なくなるまで一つずつ集めよ。 答えをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 各ペアに、順番に帽子/バケツからカードを 1枚ずつ引くよう指示せよ。 各ペアに、そこで述べられている行動にどう対処するか、パートナーと話し 合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 各ペアに、各自のアイデアを共有するよう指示せよ：グループでのそうした 問題にどう対処する？何が有効/無効か？ 各ペアからのフィードバックの後で、他に共有するアイデアがあるか実習生 に尋ねよ。 114 ToT 教習員への注記： いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、前向きだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 地位が高い/年長の受講者 • 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいは その人に反対するのをためらうかもしれない。 • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話す よう呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 場を仕切る受講者 • 自分が仕切り、大声で、または長時間しゃべり、他の受講者に、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っている かのように振る舞う。 • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える 機会を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく特定の受講者に、質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は、最有力な受講者とのペアあるいはグループに入れ、 内気な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 寡黙な受講者 • もともと寡黙あるいは内気で、大人数の前でしゃべり、グループ活動へ貢献することに気が 進まない受講者。 • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3名の）を活用せよ。 攻撃的な受講者 • 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。 • または教習員の技能・知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとっては本当ですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 115 ToT 教習員への注記： 注意散漫な受講者 • 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習の妨げになるのか話せ。規則を念押しせよ。 ふざける受講者 • 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動 中のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 ネガティブな受講者 • ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれ が住む地域ではうまく行きっこない」とコメントするかもしれない。 • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由 を説明する機会を与えよ。他の受講者に、それに同意するか尋ねよ。他の受講者も同意すれば、 「どうすればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 116 妨害行車カード：コピーするか動書きして切り分けよ 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた 場合、受講者たちは話し、質問に答え、または その人に反対するのをためらうかもしれない。 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、 他の受講者には、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受 講者。こうした人は、自分はすでに何でも知っ ているかのように振る舞う。 寡黙な受講者 寡黙あるいは内気で、大人数の前でしゃべり、 グループ活動に貢献することに気が進まない 受講者。 攻撃的な受講者 異論を唱え、自分が信じられない概念を問い ただし、トピックや論点について議論を吹っ かけ、グループの他の受講者がどれくらい強く そう思っているか試す受講者。または教習員の 技能・知識程度を試し、自分の方が優れている と示そうとするかもしれない。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入った り、電話を手に取ったり放したりする受講者。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談 を飛ばし、時には他をからかう受講者。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 117 管理者/関係者向け教習モジュール 118 WSTPtot 管理者向け教習のはじめに ね ら い 実習生を、管理者向け車椅子サービス教習パッケージ（管理者向けWSTP）、および このパッケージの教習員養成教習（ToT）プログラムのねらいと構成に習熟させる。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  管理者向けWSTPの対象者、対象範囲、目的を詳述する。  教習チームの構成と、教習員に対する受講者の理想的な人数比を詳述する。  管理者向けWSTPのねらいおよび時間割を説明する。  管理者向けWSTPを現地のニーズに適合させる。  管理者向けWSTPの教材を列挙する。 教 材 この授業には：  PPT スライド「1. WSTPtot 管理者向け教習のはじめに」  ポスター「車椅子サービスのステップ」 各実習生に必要な、管理者向けWSTP教材：  「教習員用指導書」  「参考者＆ワークブック」  「補足資料」  WSTPポスターのセット 各実習生に必要な、WSTPtot 管理者/関係者向け教習教材：  「ToT ハンドブック」  「WSTPtot 管理者/関係者向け教習時間割」  WSTP用 USB メモリ 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  教室を設営し、設備を確認する。  WHO のウェブサイトに当たり、どれの翻訳版が手に入るか把握し、教習パッケージ 教材の最新の参考資料を確認する。  名札と実習生用教材が未配布であれば、参加登録時に配布できるよう手配する。 119 あ ら す じ 1. ToT 教習員および実習生の自己紹介 2. 庶務連絡および基本ルール 3. 教習モジュール紹介 4. WSTPtot 管理者向け教習の時間割とねらい 5. 管理者向けWSTPの対象者と目的 6. 管理者向けWSTPを現地のニーズに適合させる 7. 管理者向けWSTPの教習員と受講者 8. 管理者向けWSTPの教材 9. 要点のまとめ 15 2 2 8 10 30 3 10 5 授業時間計 85 ToT 教習員および実習生の自己紹介（15 分） ToT 教習員への注記： • 1および 2節は、「必須教習技能」モジュールを履修していない実習生がいる場合にのみ 必要である。 ToT 教習員へ：自己紹介せよ。自分の経歴および 車椅子供与の経験に関して、概略を簡潔に伝えよ。 実習生に、所属する組織の名称、車椅子サービス 供与の経験、および WSTPtot モジュールを含む、 これまでに履修した教習を明らかにしながら自己 紹介するよう求めよ。 アイスブレーキング1を盛り込め。 1 [原文] icebreaker [訳注] 場の緊張をほぐし, コミュニケーションを円滑にするための, ゲームなどの短い活動. 120 庶務連絡および 基本ルール」（2分） 説明せよ： • トイレの場所 • 軽食および昼食の段取り • アクセシビリティに関すること • 緊急時にはどうしたらよいか • その他運営に関すること 以下の基本ルールを実習生に説明せよ： • どの授業も時間通りに始めるよう準備すること • 授業中は携帯電話をオフにすること • 質問は奨励されること 教習モジュール紹介（2分） 説明：これは 3 日間のモジュールです。はじめの 2 日は管理者向け WSTP に重点を置き、3 日目で 関係者向け WSTP を、また管理者向けと関係者向け両方の WSTP に関連する授業を押さえます。 授業のねらい、および学習目標を説明せよ。 121 WSTPtot 管理者向け教習の時間割とねらい（8分） 実習生に、各自の「WSTPtot 管理者/関係者向け教習時間割表」を参照するよう指示せよ。 説明： 1 日目と 2 日目には、以下のための 3 種類の授業 が含まれます： • 実習生を管理者向け WSTP に習熟させる。 • 授業実施を練習する。 • 判明した課題を明確にし、模擬授業には含まれ ない授業のコツを教える。 説明： WSTPtot 管理者向け教習のねらいは、実習生に、 次を行なうための技能と知識を授けることです： • 管理者向け WSTP を実施する。 • 管理者向け WSTP を、現地のニーズと合うよう に調整する。 説明：管理者向け WSTP を、どうやってさまざまな状況に適合させられるか話し合いましょう。 例えば、演習の数は受講者の熱意の度合いに応じて増減できます。演習は、実習生の意欲があまり 高くない場合には重要ですが、熱心な場合にはそれほど重要ではありません。 学習スタイルは人それぞれなので、多様な教習およびファシリテーションの技法を活用することを 忘れないようにしなさい。 122 管理者向けWSTPの対象者と目的（10 分） スライドを読み上げよ。 質問：WHO によれば、どこでも人口の何%の人に車椅子が必要か、覚えている人はいますか？ 最も重要な答え： • どこでも人口の 1 %に車椅子が必要(2)。 説明： • 推計では、どこでも人口の 1 %に車椅子が必要で すが、いまだに多くの場所で車椅子サービスは 利用できないか、たいへん立ち遅れています。 • 管理者向け WSTP は、車椅子サービス事業の 実施、管理、評価を担当する人材を対象として います。 • 管理者向け WSTP の受講者は、日ごろリハビリ テーションサービスの経営や管理に携わってい るが車椅子サービス管理は直接経験していない 人でしょう。管理者向 WSTP に、適正な車椅子 サービス管理に関する基本情報を盛り込んでい るのはそのためです。 2 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 123 質問：どんな事情によって、車椅子サービス管理の経験がない事業管理者が、管理者向け WSTP 教習プログラムに参加するのでしょうか？ 答えを受けとめ承認せよ。 説明：考えられる理由としては： • 新しいサービス事業を立ち上げ中か検討中の 場合。 • 義肢装具サービスなどのサービス事業が車椅子 供与に事業を拡大中の場合。 • 事業管理者が、既存の車椅子供与サービス事業 に着任して間もない場合。 • 車椅子生産者が自社による車椅子供与サービス 事業の展開を検討中の場合。 • 例えば政府部局の管理職などが、適正な車椅子 供与について、さらに学ぼうとしている場合。 質問：車椅子サービス事業管理の経験がある事業管理者が、管理者向け WSTP 教習プログラムに 参加するとしたら、それはなぜでしょうか？ 答えを受けとめ承認せよ。 124 説明：ありうる理由としては： • 直面している課題への答えを見出すため。 • 車椅子供与関連の国際的な方針・ガイドライン・ 条約について深く学ぶため。 • 「車椅子ガイドライン(3)」に沿った適正な車椅子 供与と、車椅子サービス提供の 8 ステップにつ いての理解を深めるため。 • さまざまなサービス提供モデルへの理解を深め るため。 • 事業管理技能を改善する、新しいやり方を学ぶ ため。 • 基礎や中級の WSTP モジュール教習を受けた 職員を、管理・支援できるようになるため。 • 車椅子供与を改善する変革を先導するために、 事業管理者が果たしうる役割を理解するため。 説明： • 管理者向け WSTP は、基礎 WSTP と中級 WSTP の開発に続くものです。 • このパッケージは、事業管理者が、車椅子サービ ス提供の 8 ステップを満たす、適正で効果的な 車椅子サービスを提供するために役立ちます。 • 管理者向け WSTP は、WSTP［車椅子サービス 教習パッケージ］の第 3 部です。 3 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 125 質問：車椅子サービス提供の 8 つのステップには何があるでしょうか？ 答えを、8 つのステップがすべて正しく出揃うまでホワイトボードに書き出せ。実習生がステップ を飛ばしたら、スペースを空けておいて最後に戻ること。 「車椅子サービスのステップ」ポスターを掲示し、教習プログラム期間中、貼り出しておけ。 車椅子サービス提与の 8ステップ： 紹介・相談および面接予約 事前評価 処方（選択） 資金調達および発注 製品の下準備 フィッティング ユーザー教習 フォローアップ・メンテナンス・修理 説明： • 車椅子サービス提供の 8 ステップについては、 WHO の「車椅子ガイドライン」でさらに詳しく 説明しています。この文書については「必須教習 技能」の授業「指針文書の知識」で話し合います。 皆さんは、これをよく知らなければなりません。 説明： • 管理者向け WSTP には、8 ステップのすべてを 果たすために必要なリソースについての情報を 盛り込んでいます。 • 管理者向け WSTP から得た知識は、事業管理者 の、さまざまな分野での業務に役立ちます。 126 実習生に質問し、車椅子の臨床職と技術者の業務を支援できるよう、事業管理者が実施する活動を 列挙させよ。 答えを受けとめ承認せよ。 最も重要な答え： • 適正な車椅子および資材の在庫確認。 • 車椅子のために利用できる資金を確保する。 • サービスユーザー数を計画し、職員が忙しすぎず、しかし仕事はじゅうぶんあるようにする。 • サービスユーザーが、適正かつ整備された機器や施設を使えるようにする。 • サービス事業を円滑に運営できるよう、管理上の支援を提供する。 • サービス事業の予算を立て、やりくりする4。 • 専門的サービスの普及を支援する。 • 職員の地位に支持を与えるよう、政府に提言する。 • 政府と、地域に根ざしたリハビリテーション（CBR）事業はじめ、その他の関係者との協働を 支援する。 管理者向けWSTPを現地のニーズに適合させる（30 分） 説明： • 管理者向け WSTP は 13〜14 時間で実施でき、 また、例えば通訳の時間を追加するなど、現地の ニーズに適合させることも可能です。 • 時間を削ってはなりません。 • 時間割の例は、WSTP 用 USB メモリに収載した ものが利用できます。 • 管理者向け WSTP の授業は、現地に特有の状況 や目的に応じた、他の活動と組み合わせること も可能です。 4 [原文] Prepare and manage the budget 127 • 実習生に、各自の「ToT ハンドブック」を開き、 「付録」の「管理者/関係者向け WSTP 計画 ツール」を参照させよ。 説明： • 「管理者/関係者向け WSTP 計画ツール」を、 教習を行なう国/地域で、どの授業を組み込み、 どんな成果の達成が期待できるか、見定める ために役立てることをお勧めします。 • このツールは、「車椅子ガイドライン」に沿った 政策・製品・サービス・教習に関する 10 分野 を対象としています。 • そこでは 10 分野の各々について、「初期段階5」 から「成長中6」「成熟中7」「じゅうぶんに機能8」 までの状況の例を示しています。 • 計画作業は教習に先立ってなるべく早く始め、 必要な情報を集める時間をじゅうぶん確保し なさい。 このスライドは活動の間じゅう映しておけ。 5 [原文] early stages 6 [原文] developing 7 [原文] maturing 8 [原文] well-functioning 128 活車１ グループ： 実習生を、同じ出身国の人どうしでグループに分けよ。実習生の出身国が皆 同じであれば、2〜3名のグループに分けよ。 指導内容： 活動のねらいは、実習生が「管理者/関係者向けWSTP計画ツール」に習熟 することであると説明せよ。 グループに、「管理者/関係者向けWSTP計画ツール」を通読し、白地の欄の うち（「初期段階」「成長中」「成熟中」「じゅうぶんに機能」のどれか）、各自 の状況に最も当てはまる内容のものをマルで囲むよう指示せよ。 実習生に自分の答えについて、左端の「概況」欄に 1〜2 文でさらに詳しい 説明を加えるよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 15分、フィードバックに 10分見込んでおけ。 フィードバック： 1のグループに分野 1について自分たちの答えをフィードバックし、マル で囲んだ段階と追加コメントを報告するよう指示せよ。次に 2のグループ に分野 2について答えをフィードバックするよう指示し…と、分野 10 まで 同様に続けよ。 WSTPtot 関係者向け教習の最後に「管理者/関係者向けWSTP計画ツール」 によって集めた情報を活用する演習を行なうことを説明せよ。 管理者向けWSTPの教習員と受講者（3分） 説明： • 教習員の比率は、受講者 8〜10 名ごとに教習員 １名を推奨します。 • 管理者向け WSTP は、一般には受講者 5〜15 名 で実施します。 • 経験豊富な車椅子ユーザーで、理想的にはこの テーマと教習パッケージをよく知っている人が 教習チームにいると、強みになります。 • 教習員のうち最低 1 名には現地での車椅子供与 の経験と知識が必要です。それによって話し合 いが豊かになり、当を得た教習になります。 • 教習員の一人には車椅子供与、および関連する 国際的ガイドライン、条約、目標に関する国際的 な知識が必要です。 129 管理者向けWSTPの教材（10 分） 説明：管理者向け WSTP には、3 冊のマニュアル があります。 • 教習員用指導書 • 参考書＆ワークブック • 補足資料 実習生に「教習員用指導書」を開くよう指示せよ。 説明：最初の節、p.1-4「管理者向け車椅子サービス教習パッケージについて」では、その対象者、 目的、対象範囲、教習員を選ぶ際に考慮すべき技能と人数、開始までの流れを述べています。 説明：p.5 の「教習員への手引き」の内容は教習プログラムの概略、授業計画に関する簡潔な情報、 付属のパワーポイントのプレゼンテーション（PPTs）の説明、よい教習を実施するコツなどです。 このプログラムを、実施のたびに事後評価するよう推奨しています。 説明：p.8 からの「教習パッケージ実施準備のやり方」では、教習実施地での車椅子供与の現状や 背景を知る必要性を強調しています。 説明： • 詳しい授業計画は、次の節 p.12 からです。12 の 授業が 3 部に分けられています。 130 実習生に「参考書＆ワークブック」を見るよう指示 せよ。 • 参考書は、授業を補足して各トピックについて の詳細を提供します。 • ワークブックには、受講者が、授業での活動の 一環として記入するフォームおよび資料が 載っています。 実習生に、3 つ目のマニュアル「補足資料」を見る よう指示せよ。 • これを、「参考書＆ワークブック」といっしょに 印刷・製本することがあります。 • ここには、役立つフォームや参考文書が載って います。例えば、対象者と作業するための評価 ボックスや評価ベッドのつくり方、移動練習 エリアの設営方法などです。 実習生に、3 つのマニュアルすべてを熟知するよう奨励せよ。 マニュアルに関して質問がないか尋ねよ。 131 説明： • パワーポイント（PPT）のプレゼンテーションに は次の 5 種類があります： o はじめに o 必須知識 o 車椅子サービスを開始する o 車椅子サービス事業を運営する o 総まとめ：ここですべての情報を要約します • 管理者向け WSTP パッケージに「ねらいと目標」 のスライドはありませんが、各授業計画に示す 目標を用い、自分で追加しても構いません。 • また活動を説明し、追加の指導を与えるための スライドをつくって追加してもよいでしょう。 WSTP 用 USB メモリには、6 本の動画が用意されています9。これらは PPT の中で参照されて いますが、埋め込まれていません。必ず事前に、動画が PPT 内に準備できているか、自分のデスク トップにアップロードされて再生できるようになっていることを確かめてください。 説明：WSTP のポスターも必要で、これは WSTP 用 USB メモリに載っています10。 説明：補助教材は WSTP 用 USB メモリに収められており11、「必須教習技能」モジュールで、その 大半は説明しました。注目すべきものは「先導する管理者12」で、組織変革を先導し、そこに影響 を与えることについての情報を与えるもので、特に授業「A.3: 変革を導く管理者」に関連します。 教材に関して質問がないか尋ねよ。 9 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) から動画の YouTube チャンネルにアクセス可能. 10 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (同上) からダウンロード可能. 11 [訳注] 同上. 12 [原文] Managers Who Lead [訳注] 未訳. 英語原本は (https://msh.org/wp-content/uploads/2015/07/mwl- 2008-edition-2.pdf ) にて閲覧・ダウンロード可能. 132 説明： • 最新版の管理者向け WSTP 教材、および既成の あらゆる翻訳版は、WHO のウェブサイト上(13)で 見つかります。 • そのリンクは ToT ハンドブックに載っています。 説明： • ToT ハンドブックでは、教習パッケージを実施 した教習員の経験に基づく補足情報を提供して います。また、公開済みの教材の中の誤りも指摘 しています。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 13 https://apps.who.int/iris/handle/10665/246227 133 あいさつ・自己紹介・概略 この授業を教えるための主な留意点 a. 全般 • 第 3 節と第 4 節を入れ替え、庶務連絡等を済ませてからワークショップの概略に入ってもよい。 b. 第 1節：開講式 • 時間割では、例えば教習プログラム実施機関の長による歓迎あいさつなど簡潔な開講式のために 10 分を見込んでいる。もっと大がかりな儀式が必要であれば、それに応じて時間割を修正せよ。 c. 第 3節：ワークショップ概略 準備のコツ • WSTP 用 USB メモリの PPT に、動画「車椅子サービス提供」が埋め込まれているか確認せよ。 なければ埋め込むか、デスクトップ上の開きやすい場所に置いておけ。 内容 • この動画の上映前に、受講者へ、車椅子サービス提供のさまざまなステップに注目しながら視聴 するよう指示せよ。動画を上映後、ポスター「車椅子サービスのステップ」を示し、車椅子サー ビス提供の 8 つのステップを列挙せよ。教習プログラムの残りの期間中、このポスターは話題に 上ったらいつでも参照せよ。 d. 第 4節：教習プログラム時間割・庶務連絡・諸注意 準備のコツ • 安全に関する説明のさい、車椅子を用意しておくと便利。 内容 • 車椅子のさまざまな部材（例えば、スポーク、ブレーキ、足台など）を、説明しながら指示せよ。 受講者は背後に助手が付いている場合も、坂を登る際は前にかがみ、坂を下りる際は後ろにもた れるべきことを説明せよ。 134 A.1: 適正な車椅子与 とは何か? WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 4節：適正な車椅子与 を支える • 「教習員用指導書」p.22 の活動について、「教習員用指導書」では国の政策の実例を 1 つ示して いるが「参考書＆ワークブック」には 2 つ載っている。両方とも取り上げるには時間が足りない ので、より状況に適する実例を選べ。 • 「参考書＆ワークブック」の本文は、「教習員用指導書」のものと異なっている。受講者に分かり やすいよう「参考書」の方を読み上げよ。 この授業を教えるための主な留意点 a. 全般 • この授業の時間割り振りは、第３節では余裕があるが第 4 節には短めで、全体としては間に合う はずである。残り時間が尽きてきたら、受講者の応答を絞れ。 135 b. 第 2節：車椅子へのニーズおよび満たされざるニーズとは何か? 準備のコツ • スライド A.1.4 を、適切な国勢調査データと国全体の車椅子ニーズ計算により、個別設定せよ。 複数国からの受講者に教習を実施する場合は、すべての国を列記せよ。 • 国勢調査が古すぎる場合は、国家統計局その他の政府機関による、より最近の推計を探してみよ。 • 1 %を計算するには、総人口を 100 で割ればよい。以下に例を示す。 人口 人口の 1 % 45 060 436 450 604 14 538 933 145 389 3 785 566 378 55614 c. 第 3節：個人的移車への権利 • 「国際連合 障害者者の権利に関する条約（CRPD）」をじゅうぶんに理解し、教習プログラムを 実施している国が、すでに署名し批准しているかどうか確かめよ。 d. 第 4節：適正な車椅子与 を支える 準備のコツ • 仁川方策（インチョン戦略）は教材に含まれていないが、教習を「アジア太平洋障害者の十年15」 の構成国で実施している場合は、以下からダウンロードしておくとよい：http://www.unescap. org/resources/incheon-strategy-“make-right-real”-persons-disabilities-asia-and-pacific 内容 • この活動へのフィードバックとして、国の政策が存在しない場合、受講者に、それを立ち上げる ための指針として「WHO 世界障害者行動計画 2014-2021(16)」を参照するよう提案してもよい。 14 [訳注] 原文のまま. 37 856 あるいは 37 855 とすべきであろう. 15 [原文] Strategy in Asia and Pacific 16 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 136 A.2: サービス提与 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 4節：管理者のより広範な任務 準備のコツ • スライド A.2.12 の文が、「参考書＆ワークブック」の同じ図とは一部異なっている。スライドを WSTP 用 USB メモリに収めた17新版に差し替え、自分の「教習員用指導書」に、PPT スライド がマニュアルに載っているサムネイルのものから更新されている旨を注記せよ。 この授業を教えるための主な留意点 a. 第 2節：サービス提与のレベル • サービスのレベルは車椅子ユーザーの年齢や障害には関係しないことを強調せよ。多くの地域や 国には（あっても）基礎レベルのサービスしかないが、目標は各々の国や地域で両方のレベルを 利用できることである。中級レベルのサービスでは、基礎レベルサービスとは異なるリソースや 職員の技能が求められる。現地の状況に関する知識は、あると既存の基礎および中級レベル対応 の施設の例を示せるようになるため有用である。 b. 第 3節：サービス提与モデル • この節の活動にはそれほど時間がない。各グループに「車椅子サービスのステップ」ポスターの 近くに座るか立つかして答えを話し合い、付箋を書いて該当するサービスステップの隣に貼って もらえ。これによってフィードバックがより迅速になる。 c. 第 4節：管理者のより広範な任務 • 「管理者の任務」スライドを映す代わりに、その図のポスターを用いてもよい。受講者は付箋を ポスターに貼ることができ、それを教習プログラムの期間を通して壁に貼っておける。 d. 第 5節：車椅子ユーザーのサービス提与への積極的参画 • ルーマニアでのケーススタディを示す追加スライドを、WSTP 用 USB メモリに収載しており18、 この授業の PPT に追加してもよい。 17 [訳注] 日本語版は, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 18 [訳注] 同上. 137 A.3: 変革を導く管理者 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「先導する管理者19」第 6 章を資料として配布することを検討せよ。これは WSTP 用 USB メモ リの「補足資料20」フォルダに用意されている。 • スライド A.3.3 では成功への要因を 4 つ挙げ、続いてそれぞれの詳細を説明している。分かりや すいよう、このスライドを複製し、続く各節の最初で該当する箇条書きを強調しながら再映する ことを検討せよ。 内容 • 変革とは、えてして何か恐ろしい、あるいは疑わしいものと見なされがちであることを強調せよ。 受講者へ、われわれの反応しだいで変革はよいものにも悪いものになり、変革そのものは中立で あることを念押しせよ。 • この節にはそれほど時間がないので、必要ならばいくつかの質問は省いてよい。 b. 第 1節：変革プロセスを先導する管理者の役割 • 「教習員用指導書」では、この授業をそれまでの授業に結び付けるよう指示している。ここまで で話し合った、適正な車椅子供与とそこでの事業管理者の役割、例えばよく機能するサービスを 開発し、じゅうぶんに教習を受けた職員のやる気を引き出す責任などを強調せよ。 c. 第 4節：職員とリソースを配置する • p.38 の「教習員への注記」を指摘し、受講者が資金調達に関する話のみに時間を費やすべきでは ないことを強調せよ。資金調達はサービス事業のあらゆる側面に影響する課題だが、必要な人的・ 物的リソースを管理者がどうやってまとめ上げられるか、を案出することの方が重要である。 d. 第 6節：管理者が取り組むこと • 「教習員用指導書」p.42 の活動では、受講者に、各授業の終わりに自分の考えを 4 枚のフリップ チャート紙に記入するよう指示している。時間が少なく、また教習プログラムの終わりまで再び 言及する機会もないため、受講者には、毎回の授業の終わりにこれを行なうよう念押しせよ。 19 [原文] Managers Who Lead [訳注] 本邦未訳. 英語原本は (https://msh.org/wp-content/uploads/2015/07/mwl- 2008-edition-2.pdf ) にて閲覧・ダウンロード可能. 20 [原文] Supplementary Resources [訳注] 英語版のみ. 英語版の入手方法は上記を参照. 138 B.1: サービスへのアクセス この授業を教えるための主な留意点 a. 第 2節：公正なサービスとは何か？ • 「教習員用指導書」p.43 では、「公正なサービス」のスライドを映す前に質問が入る。教科名の 「公正なサービス」を入れるかこの質問を表示した、新規スライドの追加を検討せよ。 b. 第 3節：紹介・相談および面接予約 • この節の活動にはそれほど時間がない。 • この活動は、紹介・相談ネットワークの提携先がフォームへの記入に消極的であることについて、 多くの議論をまき起こすかもしれない。議論を、どうすれば事業管理者が、提携先に紹介・相談 フォームの利用を促せるかに集中せよ。例えば、記入用に白紙のフォームを配布する、フォーム をなるべく簡潔にする、定期的なフォームの回収を手配する、サービスを利用するようになった 車椅子ユーザーについてのフィードバックを返す（と紹介・相談者にその有益さが分かる）など。 c. 第 4節：管理者は、公正なサービス実現のために何ができるか？ • サービスの公正さを確保することの重要性を強調せよ。受講者に CRPD（障害者の権利に関する 条約）の、女性、子ども、高齢者、貧しい人びと、農村地域に住む人びとのニーズを強調した 諸条文を再認識させよ。事業管理者は、こうした集団が疎外されず対応されるように、必ず働き かけねばならない。 d. 授業のおわりに • 授業のおわりに、受講者へ、取り組むことを各自のワークブックに記録するよう指示し、また、 前の授業で掲示したフリップチャート紙 4 枚に書き込むよう念押しせよ。 139 B.2: 施設および設備 この授業を教えるための主な留意点 a. 第 2節：施設およびサービスの流れ • 教習プログラムがサービスセンター内で行われる場合は、この授業にはサービス所内を歩き通す ことが含まれる。全体グループに、車椅子ユーザーを尊重すること、および邪魔にならないため に声を低めるよう指示せよ。 • この節にはそれほど時間がないため、経路は予め詳細に計画せよ。進度を上げるには、受講者を 小グループに分けて別々の場所からスタートさせることを検討せよ。各スペースへの訪問許可を 得ていることを確認し、職員が、訪問があることを分かっているようにせよ。 • サービスセンターを拠点としていなければ、スライド「サービスの「流れ」の一例」(B2.3) を より時間をかけて詳しく説明せよ。代替として、実際に歩き通したビデオか写真を撮り、それを 見せることを検討せよ。 • 各サービススペースの名前カードをつくって教室か隣の廊下にぐるりと掲示し、受講者がカード を並べ替えてサービスの流れを改善できるようにするとよい。これは、サービス事業を計画する 際に何を考慮すべきかの話し合いを盛り上げる。 • 「参考書＆ワークブック」p.22 を参照し、以下を強調せよ： o サービス所内のあらゆるスペースは、出入り口も含め、必ず車椅子で完全にアクセスできなけ ればならない。 o サービス所に到着した人には、受付および待合のスペースが絶対に必要である。 o 待合スペースには、ポスター、リーフレット、ビデオ資料、また子ども用のおもちゃを揃えて おくと役に立つ。 o 長距離移動したため、例えば体重がかかる身体部位に褥瘡があるなどの理由で、横にならなけ ればならない人もいる。 o だれにでも到着しだい水が用意されるべきで、また軽食をとれる場所の情報も提供されるべき である。 o アクセスしやすいトイレは、受付スペースの近くにも必要である。 o 事前評価スペースは受付/待合スペースに近くなければならない。静かで人目に触れず、事前 評価に必要な設備を備えていること。例えば評価用のベッドまたはベンチ、目隠しの仕切り、 足乗せブロック、巻尺、事前評価とフィッティングの主要な段階を記録するカメラなどである。 140 o 床面および作業台のエリアを備えた技工スペースが、車椅子の下準備・メンテナンス・修理の ために必要である。事前評価スペースの近くが理想的だが、騒音がじゅうぶん抑えられる程度 に離れていることが望ましい。スペースはじゅうぶん明るく、換気がよく、防水で、作業に適 した温度でなければならない。最終の組み立てと製品の調整のため、穴あけ、ペーパーがけ、 塗装の区域とは別に清潔なスペースが必要である。技工的活動は、サービスの他の部面に都合 のよい場所とは分けて、離れた他の場所に置いても、さらには外注してもよい。 o 移動練習エリアは、事前評価とフィッティングのスペース近くに置くべきである。スペースは 屋内でも屋外でもよく、さまざまな路面や障害物を備えるべきである。 o 安全な収納スペースが必要で、これは技工スペースの近くに設けるべきである。 o 事務スペースは、記録の作成や保管、職員会議などサービス事業の管理業務に必要である。 b. 第 4節：施設の整理整頓 • 政府の施設では、破損した設備や古い書類も、政府の目録から正式に削除されるまで保管を義務 づけられる場合が多いことを説明せよ。これは、しばしば工房が不要な設備や書類でいっぱいに なることを意味する。作業スペースを整頓して保つため、事業管理者に、こうした物品は収納し、 スペースが狭ければコンテナも活用するよう勧めよ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 141 B.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 環境、機能、姿勢支持について特色が異なるさまざまな車椅子を用意し、また、この授業の要点 を解説するため、除圧クッションを 1・2 枚用意しておけ。 内容 • この授業は、管理者向け WSTP の中で最も重要なものの一つである。関係者の多くは、車椅子や 適正な車椅子がもたらす違いについて、ほとんど知らない。 • 絶対にこの授業は、事業管理者が適正な車椅子の効果を理解するような、心を動かし、説得力に あふれた21ものでなければならない。 • 現地の状況に即した写真やケーススタディを追加すると、効果が高まる。 a. 第 2節：適正な車椅子およびクッションとは何か? 22 • 事業管理者は、適正な車椅子とは何を意味するのかしっかりと理解し、また、ある人には適正な ものでも、他の人には適正でないことを分かっている必要がある。車椅子が不適正になるのは、 ただユーザーのニーズとの関連においてのみである。 • 個別ニーズおよび環境や機能の多様性から、サービス事業は、ただ一種類の車椅子を供与する だけであってはならない。車椅子ユーザーの多様なニーズを完全に満たすには、さまざまな型式 が必要である。 • クッションは任意のオプション23ではなく、適正な車椅子の不可欠な構成要素であると強調せよ。 b. 第 3節：適切にフィットし姿勢を支える • 車椅子にしっかりと座るために必要な支えは、一人ひとり異なる。追加の支えを一個の製品だけ で設けることはできず、個々人にフィットするように、調整や改造ができるか選択幅がある複数 の製品が必要である。サービス事業所は、車椅子に付加してさまざまな種類およびレベルの姿勢 支持を設けられる、座位保持専用シート24またはオプションの姿勢支持具（PSDs）を持っておく 21 [原文] inspirational and persuasive 22 [訳注] 小見出しのアルファベットは, これ以下も原文のまま. 23 [原文] optional 24 [原文] dedicated supportive seat 142 ことになろう。用意できれば、この授業中にいくつかの姿勢支持具の見本を見せるか、多様な レベルの姿勢支持ニーズがある、さまざまな車椅子ユーザーの写真をスライドに追加せよ。 c. 第 4節：ユーザーのニーズおよび環境に合う • この節では、車椅子ユーザーのニーズは、都市と農村のどちらの環境で暮らしているかによって 異なることを説明せよ。例えば、ひんぱんに公共交通機関や車で移動する人には、折りたたみや 分解ができる軽量な車椅子が有益である。農村に住んで移動しない人には、そうした機能はそれ ほど重要ではなく、荒地での安定性が高くなるリジッドフレームと長いホイールベースが有益で あろう。 d. 第 5節：安全で耐久性がある製品の重要性 • 「参考書＆ワークブック」p.34 のコラムの内容は、さらに深く掘り下げよ。事業管理者は、提示 された車椅子を何でも引き受け、または数量が最大になるよう最も安価な型式を選択する誘惑に 駆られうる。事業管理者は、候補となる寄付者や供給者に尋ねるべき質問を心得ていなければ ならない。例えば、その車椅子が、ISO（国際標準化機構）規格や現地規格など、性能や耐久性 への認証規格について試験を経ているかどうかは考慮すべきである。 • 寄付者や資金供与者が、事業管理者やチームに、最も安価な車椅子を選ぶよう圧力をかける場合 もある。月/年当たり費用を考慮するよう強調することが重要で、なぜなら安物の車椅子はすぐ 壊れることが多い一方、品質のよい車椅子は、定期的にメンテナンスすれば最低 3〜5 年は持つ からである。 車椅子のモデル 購入費用 使用年数 費用/使用年数 車椅子 A 80 米ドル 0.5 160 米ドル 車椅子 B 150 米ドル 1 150 米ドル 車椅子 C 300 米ドル 3 100 米ドル 車椅子 D 300 米ドル 5 60 米ドル e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 143 B.4: 職員の配置 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 5節：サービス容量を査定する • 授業で計算機を使えるようにしておけ。このことを「教習員用指導書」の授業計画25「教材」欄 に追加せよ。 この授業を教えるための主な留意点 a. 第 2節：車椅子サービス事業内の業務 • 地域に中級レベルのサービスがない場合、基礎レベルサービス事業の管理者は、将来に向けて、 それをどのように計画できるか検討し、職員や関係者と話し合うべきであると説明せよ b. 第 2節：車椅子サービス事業内の業務 準備のコツ • 数値の計算に自信がなければ、準備万端だと思えるまで練習せよ。 内容 • スクリーン上の表に記入したい場合は、スライド B.4.11 になったら「スライドショー」モードを 終了せよ。スライドに数字を入力するには、PPT の表の端をクリックすることが必要。代替手段 としては、事前に表をフリップチャートに描いておき、授業中に数字を書き込む。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 • スライド B.4.11 に授業中追加したデータは、すべて削除せよ。 25 [訳注] p.72 144 活車 この活動は、ひとりで作業せよ。計算機が必要。 下の表で自分に割り当てられたデータを計算し、A〜F 列下部のグレー欄を埋めよ。末尾の数字は 四捨五入してよい。 選択肢１ 週間作業計画 シナリオ A B C D E F 週間勤務日数 4 2 5 4 2 5 年間勤務週数 40 42 46 40 42 46 サービス容量見積もり 基礎 中級 １日当たり作業時間 6.5 5 7 6.5 5 7 ユーザー当たり推定作業時間 2.5 3 3.5 5 5 5.5 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 選択肢２ 週間作業計画 シナリオ A B C D E F 週間勤務日数 3 2.5 5 3 2.5 5 年間勤務週数 44 46 42 44 46 42 サービス容量見積もり 基礎 中級 １日当たり作業時間 7 6 8 7 6 8 ユーザー当たり推定作業時間 3 2.5 3 7 5 6 １日当たりサービスユーザー数 週間サービスユーザー数 年間サービスユーザー数 15 % 差し引き（想定外のできごとへの予備費） 年間サービスユーザー数見積もり 145 B.5: 車椅子サービスはどうお金がかかるのか? この授業を教えるための主な留意点 a. 全般 • この授業の目的は、事業管理者に、車椅子サービス事業のさまざまな費用分野について考える よう促すことである。予算枠についてあまり議論しすぎないようにせよ。 • この授業は、概略は知っておく必要があるにせよ、詳細は会計士が詰めてくれる事業管理者には、 詳しすぎるかもしれない。はじめに受講者へ、自分のサービス事業で細かい予算編成に携わって いるかどうかを尋ねよ。そうでなければ、活動をグループ全体での話し合いに切り替え、時間を 節約することを検討せよ。 b. 第 2節：予算目安 • 模擬授業では、時間を節約するため、1 グループとなって短時間で活動を進めよ。 • 「立ち上げ費用」と「運転費用」の予算項目は、ホワイトボードに書いておくこと。受講者に、 各見出しの下にどんな種類の費用が入るか考えてもらうことを明確にせよ。 • 事業管理者とチームは、各サービスステップに必要な人員と設備について、またサービス事業所 と地域の、どちらでそれを行なうのか明確にすべきだと強調せよ。 c. 第 3節：サービス統合からの益 • この節にも財務方面の活動があるが省略してよい。特に、ここでの概念は「第 4 節：提携による 費用分担からの益」で説明するからである。 d. 第 4節：提携による費用分担からの益 準備のコツ • この授業の冒頭に「費用分担とは何でしょうか？費用分担が有益な点には何があるでしょうか？」 と問うスライドの追加を検討せよ。 e. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 146 C.1: サービス事業が機能しているか判るには？ この授業を教えるための主な留意点 a. 第 2節：モニタリングと評価とは何か? • この授業で時間が尽きてきたら、活動を行なう代わりにモニタリングと評価の有益さについての 全般的な話し合いを持て。 b. 第 3節：効率よく効果的なサービス • 話し合いにより多く時間を割けるよう、これを全体グループの活動として進めることを検討せよ。 「参考書＆ワークブック」p.100-101 の表に記入しながら、発問して話し合いを活性化せよ。 例として、第 2 行 2 列目の最初の空欄について： o 受講者に質問：実績目標として妥当な時間はどれくらいでしょうか？ o だれかが答えを示したら、他の人に賛成かどうか尋ねよ。これは話し合いを活性化する。 o やるべきことの例として、あらかじめ表の記入済みの部分を説明しておけ。 o 受講者に第 2 行 3 列目の欄「ユーザーファイルに、紹介・相談を受けた日付および事前評価日 を記録」を見るよう指示し、各自のサービス事業では、だれがこの情報を記入し、目標を達成 したかどうか見極めるために、どうデータを照合しているのか尋ねよ。 o 目標に届かないことが続いた場合、どんな取り組みができるか尋ねよ。 o 表の第 3 行「車椅子を受け取ったユーザー数」の実績目標である月 20 台に対する「情報収集」 の下の空欄を参照させよ。 o 質問：車椅子を受け取った人に関する情報は、どこに保管すればよいでしょうか？ o これはユーザーファイルに記録する。しかし総数をモニターするには、事業管理者は供給した 車椅子の基本帳簿もまとめておく必要がある。 o 質問：これは、どう管理すればよいでしょうか？ o この活動の目的は、受講者に、各自のサービス事業に関する情報を記録および評価するための 方策を考えてみるよう促すことである。表への作業を続けながら、各項目についての話し合い を促せ。 c. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 147 C.2: 需要管理 この授業を教えるための主な留意点 a. 第 2節：需要創出 準備のコツ • この授業では、教習員にバングラデシュの成功事例26を読み上げるよう指示している。WSTP 用 USB メモリに収めた27スライドをプレゼンテーションファイルに追加するかコピーを配布して、 受講者が話し合うあいだ参照できるようにせよ。 • 「教習員用指導書」p.98 の二つ目の「最も重要な答え」欄の、なぜ需要が少ないのかの理由に、 「サービス提供に問題がある」「サービスへの不満」「サービスへの悪評」を追加せよ。サービス 事業が、低品質か高価な製品を供与する、または待ち時間が長い場合、サービスユーザーは他を 当たるか、車椅子なしでやって行くことを選ぶであろう。この情報を、各自の「教習員用指導書」 の表に追加するよう、受講者に提案せよ。 b. 第 4節：子どもを早期紹介する重要さ 準備のコツ • 以下にまとめたような、早期紹介の有益さを示すスライドの追加を検討せよ。 内容 • 親が、子どもを車椅子事前評価へ連れて来るのを渋ることには、多くの理由がある（「教習員用 指導書」p.103 の「最も重要な答え」を参照）。親たちは子どもが歩こうとしなくなるか、怠惰に なることを恐れているのかもしれない。適切な支えを備えた適正な車椅子があると、遠くまで 行かなくて済むため、子どもの歩行は改善することが多いと強調せよ。それは体力を節約して、 他のことへ使えるようにする。機能が改善すれば車椅子を降り、床の上や立位で活動できるよう になる。 26 [訳注]「教習員用指導書」p.99 27 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 148 c. 第 5節：効率よく効果的なサービス運営 • 各ステップの所要時間に関する議論は、これはサービス事業によって異なるため、限定的なもの にとどめよ。この節は、事業管理者に、各自のサービス事業についての現実的な目標を算定する 方法を理解してもらうために活用せよ。 • スライド C.2 13 に示した時間設定は、平均値であると強調せよ。これらは、手に入る車椅子と 姿勢支持具の種類やサービス職員の技能により、サービス事業で違ってくる。状況によっては、 ここに示した倍の時間を要するサービスユーザーも出てくる。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 149 C.3: フォローアップ計画 この授業を教えるための主な留意点 a. 第 2節：フォローアップの重要性 • この授業で経験を分かち合う車椅子ユーザーを見定めるさい、適正なフォローアップの経験者で あることを確かめよ。事前に各自の経験について話し合い、重要な側面を強調できるようにせよ。 b. 第 4節：フォローアップ計画 準備のコツ • スライド C.3.7 と C.3.8 は分かりにくい。既存のスライドを、WSTP 用 USB メモリに収めた 新版28に差し替えよ。 内容 • スライドが示す通り、フォローアップ提供のために、サービス事業が提供できる車椅子は、人的 リソースが増えない限り 2 年目から少なくなる。 • サービス事業の有効性は、単なる車椅子の供給数以上のものとして測るべきであると強調せよ。 c. 第 6節：地域へのインクルージョンおよび参加 準備のコツ • 「教習員用指導書」p.122 のスリランカの事例について、米ドルでの金額を、米ドルになじみが 薄い人のために現地通貨に換算29せよ。 内容 • 実際の米ドル額ではなく、帰宅できないための長期入院によって、どれほどの費用負担が生じる かに集中せよ。 d. 授業のおわりに • 授業のおわりに、受講者へ、考えを壁のフリップチャート 4 枚に追加し続けるよう念押しせよ。 その内容を確認し、必要であれば指示を反復して全員に思い出させよ。 28 [訳注] 英語版のみ. 日本語版は日本車椅子シーティング協会のウェブサイト (https://j-aws.jp/who/) からダウン ロード可能. 29 [訳注] この注記は, 同書 p.120 のインドネシアの事例にも該当するであろう. 150 C.4: 持続可能な財政計画 この授業を教えるための主な留意点 a. 第 3節：財政的持続可能性に向けた計画 • 自分自身が、非金銭的支援の概念を理解しているようにせよ。 • 現物供与は寄付金より確保しやすい場合もあり、サービス事業の全分野で検討されるべきである。 しかし寄付品によって、例えば乗り物などはメンテナンスが必要になるため、それを予算に含め ておくようにせよ。 b. 第 4節：初期財源30を特定する • 受講者に、アプローチ先を検討する際には、資金供与の調達期間31を考慮するよう念押しせよ。 信託、財団、政府の審査プロセスは時間がかかりうる一方、法人寄付者や個人の対応はもっと 素早い。広範な財源へのアプローチを盛り込むのが、理想的な方策である。 c. 第 5節：資金集め方策を計画する • 資金集めの話題は、受講者に大きな議論を巻きおこしうる。グループが脱線しないようにせよ。 • 受講者は、受けられそうな寄付金額について、非現実的であることが多い。資金集めが成功する にはたいへんな努力が必要で、寄付者に実績を示すまでは少額しか受けられないのが普通である ことを強調せよ。 • 可能性のある寄付者が知りたいのは、そのサービス事業が、適切な計画と予算を立て、財務への 説明責任を全うしていることだと強調せよ。 • 寄付者への、質が高くタイミングのよい報告の必要性を強調せよ。定期的に進捗状況を更新せよ。 寄付者が、くり返し寄付しないという方針を定めていない限り、関係を築き、じゅうぶんに情報 提供している財源からは、2 度目の寄付を得られる可能性が高くなる。 • 受講者に、現実的な予想を立てるよう勧めよ。例えば、車椅子供給能力が月間 30 台のところで、 3 か月にわたる車椅子 200 台への資金供与を寄付者へ求めてはならない。 30 [原文] initial funding source [訳注] 日本語版管理者向け WSTP 教習員用指導書では「可能性のある財源」と なっているが, 誤訳である. 31 [原文] lead times 151 総まとめ この授業を教えるための主な留意点 a. 第 2節：変革を導く取り組み • この授業のねらいは、国内の車椅子供与改善への取り組みに合意することである。グループメン バーからの意見を集約する32ことに注力せよ。 • 管理者向け WSTP を実施する際には、授業「A.3: 変革を導く管理者」で導入した「変革ファシ リテーター」を活用せよ。受講者には、考えを壁のフリップチャート 4 枚に追加し続けるよう、 2 日間を通して念押しせよ。その一覧が話し合いの土台となるからである。以下に例を掲げる： 適正な車椅子与 に関する共有ビジョンをつくり出すために管理者ができること • 全チームメンバーの参画を得てサービス事業の全体目標を決め、ビジョンとミッションの宣言 をつくり上げる33。 • 共有ビジョンを定期的に見直し、全チームメンバーが、その達成に向けて貢献していることを 確かめる。 • 共有ビジョン全体をユーザーに根ざしたものにする。すなわち、車椅子ユーザーの参画を得て 策定すべきである。 適正な車椅子与 の重要性を伝達するために管理者ができること • 車椅子の後援者や寄付者にプレゼン34を行なう。 • 政府の省庁・部局、非政府組織（NGO）、障害者団体、リハビリテーション専門職に対して、 「車椅子ガイドライン」への認識を高める。 • 他の関係者との合同意識啓発イベント・活動を、特に「国際障害者デー35」に開催する。 • 「障害者の権利に関する条約（CRPD）」の、支援機器に関連する条項への認識を高める。 • 「持続可能な開発目標（SDGs）」のうち、支援機器を適正に供与することの重要性を奨励する 目標を強調する。 • 「車椅子ガイドライン」への認識を高め、それを推進するため、リハビリテーション教育機関 や地域に根ざしたリハビリテーション訓練校との会合を開く。 • 車椅子サービスユーザーについてのケーススタディおよびビフォーアフターの写真を集めて 共有し、専門的サービスの有益さを強調する。 32 [原文] gathering inputs 33 [原文] creating a vision and mission statement 34 [原文] presentations [訳注] 文脈から, 日本語の「プレゼン」に近い内容の活動として訳した. 35 [訳注] 12 月 3 日. 日本では「障害者の日」が 12 月 9 日で, 12 月 3-9 日が「障害者週間」. 152 職員とリソースを配置するために管理者ができること • 車椅子サービスの全ステップに、それをやり遂げる技能と作業時間を持つ人材が配置される ようにする。 • 可能な限りサービス、とくにユーザー教習とフォローアップで車椅子ユーザーの参画を得る。 • 臨床、技術、教習の各業務を果たす職員が、必ず適正な教習を受けているようにする。 • サービス目標が、利用可能な人員とリソースに基づいて現実的であるようにする。 • 定期的にサービスをモニターし、職員の業務、責任、作業負荷が適正であるようにする。 職員を車機付け・惹き込み・注力させるために管理者ができること • 全チームメンバーによるチーム会議を開いて、目標に合意し、それを理解する。 • 車椅子ユーザーに体験談を共有してもらうことで、チームの全メンバーが、専門的サービスの 有益さ、および劣悪なサービスの危険性を分かるようにする。 • ボーナス、休暇、抜きん出た仕事に対する「今月の人」表彰など、職員に動機を与える。 • チームづくり36イベントを開催して、チームワークを強化し意欲を高める。 • 職員が、立派に仕事をし、サービスの重要目標を達成したら感謝する。 この授業で最も重要な部分は、教習プログラムの後に何が始まるのか話し合うことである。それが 単なるフォローアップの会議で、詳細な計画は後に作成される予定であっても、集まっている間に 次のステップについて合意する必要があることを強調せよ。受講者に、事をさらに推し進める役を 指名し、教習プログラム後も互いに連絡を取り合う方法について合意するよう勧めよ。 教習員の役割は、受講者が、会議後に進展と成功を果たすための、具体的取り組みの設定を手伝う ことである。 「教習員用指導書」では、次を問いかけるよう提案している：「次のステップは何でしょうか？」 「提案された取り組みに着手するための作業部会は編成しますか？」「だれが、これらの取り組み をさらに進めて行くのですか？」「また皆さんで集まる予定はありますか？いつ？」。 受講者には、答えが具体的になるよう勧めよ。受講者が作業部会を編成する、と述べたら「責任者 はだれですか？」「だれが参加するのですか？」「メンバーは何人ですか？」「どんな権限が委託 されますか？」「会議費用はかかりますか？だれが支払うのですか？」「何が次の段階へ進む妨げに なるでしょうか？どうその障壁を克服しますか？」「どうやってグループ全体へフィードバック しますか？」などを尋ねよ。 受講者に、個人または組織として取り組むよう勧めよ。例えば、次の会議を企画または主催する、 地元の新聞に教習プログラムに関する記事を執筆し、車椅子サービスへの認識を向上させるなど。 36 [原文] team building [訳注]「チームビルディング」としてビジネス用語にもなっている. 153 管理者向けWSTP模擬授業範囲外の授業 ね ら い 模擬授業範囲外の、WSTPの授業に関する情報を提供する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  授業における課題を説明し、それらに対処する。 教 材 この授業には：  PPT スライド「WSTPtot 管理者向け：模擬授業範囲外の授業」  色紙のカードか付箋紙：各受講者につき 6枚前後  「変革ファシリテーター」4枚の見本  「活動１」では各受講者に計算機が必要。なければ受講者で共有しグループで作業 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  フリップチャート紙と付箋紙で、この授業の最後に載せた「変革ファシリテーター」 4枚の見本を作成する。 あ ら す じ 1. はじめに 2. 授業B.2: 施設および設備 3. 授業B.3: 適正な車椅子を取り揃える 4. 授業B.4: 職員の配置 5. 授業C.1: サービス事業が機能しているか判るには？ 6. 授業C.3: フォローアップ計画 7. 要点のまとめ 2 15 10 30 20 27 1 授業時間計 105 154 はじめに（2分） 授業のねらい、および学習目標を説明せよ。 説明：「ToT ハンドブック」には、各々の授業についての手引きとなる注記が載っています。ここで は、それらのいくつかの面についてより詳しく話し合います。 授業B.2: 施設および設備（15 分） 実習生に「教習員用指導書」p.52 および「参考書＆ワークブック」p.22 を開けるよう指示せよ。 p.22-29 の内容のあらましを話せ。管理者向け WSTP 教習を実行する前に、基礎および中級レベル のサービスに求められる施設と設備を熟知しておく必要性を強調せよ。 説明： • サービスは、ユーザー中心で人権に根ざすもの でなければなりません。 • 待合スペースには、子ども用のおもちゃと共に 情報ポスター、リーフレット、動画資料を備え なさい。例えば「車椅子サービスのステップ」の ポスターやサービスの働きについての情報など です。 実習生に「教習員用指導書」p.53 を開けるよう指示せよ 155 説明： • p.53 の活動の内容には、サービスセンター内を 歩き通すことが含まれます。これには、必ず時間 の追加が必要です。 • 経路は授業前に詳細に計画しなさい。 • 教習プログラムが、サービスセンターを拠点と していない場合は、スライド B.2.3 を用い、より 時間をかけてサービスの流れを説明しなさい。 詳細は「ToT ハンドブック」を参照しなさい。 • 代替として、実際に歩き通してビデオあるいは 写真を撮り、上映することを検討しなさい。 • サービス所の各サービススペースの名前カード をつくって教室か隣の廊下にぐるりと掲示し、 受講者がカードを並べ替えてサービスの流れを 改善できるようにしなさい。これは、サービス 事業を計画する際に何を考慮すべきかの話し合 いを盛り上げます。 授業B.3: 適正な車椅子を取り揃える（10 分） 実習生に「教習員用指導書」p.57 を開けるよう指示せよ 説明： • この授業は、管理者向け WSTP の中で最も重要 なものの一つです。関係者の多くは、車椅子や 適正な車椅子がもたらす違いについてほとんど 知りません。 • 絶対にこの授業は、事業管理者に適正な車椅子 の効果を伝える、心を動かし説得力にあふれた ものでなければなりません。 • 現地の状況に即した、写真やケーススタディを 追加すると、効果が高まります。 156 説明： • 事業管理者は、「適正な車椅子」が何を意味する のか、また、ある人には適正なものも他の人には そうではないことを、しっかりと理解している 必要があります。車椅子が不適正であるとは、 ユーザーのニーズに照らして不適正ということ 以外にないのです。 • ユーザーの個別ニーズそして環境や機能の多様 性から、必ずサービス事業は、ただ一種類だけで なく、多彩なモデルの車椅子を供与しなければ なりません。 • クッションは任意のオプションではなく、適正 な車椅子の不可欠な構成要素です。 実習生に「参考書＆ワークブック」p.34 を開けるよう指示せよ。 説明： • 事業管理者は、提示された車椅子を何でも引き 受け、または数量が最大になるよう最も安価な 型式を選ぶ誘惑に駆られる可能性があります。 • 事業管理者は、可能性がある寄付者や供給者へ 発すべき質問を心得ているべきです。「参考書＆ ワークブック」p.34 を参照しなさい。 • 寄付者は、事業管理者に、もっと多く供与される ため最も安価な車椅子を選ぶよう圧力をかける 可能性があります。 • 寄付者に、月/年当たり費用を検討するよう強調 しなさい。すなわち安物の車椅子はすぐ壊れる ことが多い一方で、品質のよい車椅子は定期的 にメンテナンスを行なえば 3〜5 年持ちます。 • 買うには高い車椅子も、年当たり費用で考える とたいてい安くつきます。それはこの表の通り です。 157 授業B.4: 職員の配置（30 分） 実習生に「管理者向け WSTP 教習員用指導書」p.57 を開けるよう指示せよ このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生に、ひとりで取り組むよう指示せよ。 指導内容： 説明：これから、 5節「サービス容量を査定する」の表に記入する練習を しましょう。 1 日当たりの作業時間を少なく感じるかもしれないが、ほとんどの人は臨床 業務のかたわら管理その他の業務も負っているのだと強調せよ。 実習生に、「ToT ハンドブック」から選択肢 1 または 2 を割り当て、3 つの シナリオそれぞれについて、チームが対応できる基礎レベルと中級レベルの ユーザー数を推計させよ。 末尾の数字は四捨五入してよいことを説明せよ。 モニター： グループをモニターし、必要に応じて手助けせよ。 教室を巡回し、実習生の計算を確認せよ。 予備費 15 %を差し引くよう念押しせよ。 時間： 活動に 20分、計算をやって見せるのに 5分見込んでおけ。 フィードバック： 活動の最後に、各選択肢について以下の計算をゆっくり書き出せ： • 選択肢 1について Aの下を • 選択肢 2について Dの下を 選択肢 1は直接スライドに、選択肢 2はホワイトボードに書き込め。これに よって、計算方法と二通りの提示方法を示せる。 実習生に、この数字に対して各自の答えを確かめ訂正があればしておくよう 勧めよ。あとで答え合わせに用いることになるからである。 他 4つのシナリオについて、最終行の答えを出せた人がいるか尋ねよ。 自信がない人は、この授業を進める前に、準備万端だと思えるまで練習する よう強調せよ。 158 選択肢１ 週間勤務時間計画 シナリオ A B C D E F 勤務日数/週 4 2 5 4 2 5 勤務週数/年 40 42 46 40 42 46 サービス容量見積もり 基礎 中級 １日当たり勤務時間 6.5 5 7 6.5 5 7 ユーザー当たり時間数推計 2.5 3 3.5 5 5 5.5 サービスユーザー数/日 2.6 1.67 2 1.08 1 1.27 サービスユーザー数/週 10.4 3.33 10 4.33 2 6.36 サービスユーザー数/年 416 140 460 173 84 293 15 % 差し引き（想定外のできごとへの予備費） 62.4 21 69 26 13 44 ユーザー数見積もり/年 354 199 391 147 71 249 選択肢２ 週間勤務時間計画 シナリオ A B C D E F 勤務日数/週 3 2.5 5 3 2.5 5 勤務週数/年 44 46 42 44 46 42 サービス容量見積もり 基礎 中級 １日当たり勤務時間 7 6 8 7 6 8 ユーザー当たり時間数推計 3 2.5 3 7 5 6 サービスユーザー数/日 2.3 2.4 2.67 1 1.2 1.33 サービスユーザー数/週 7 6 13.33 3 3 6.67 サービスユーザー数/年 308 276 560 132 138 280 15 % 差し引き（想定外のできごとへの予備費） 46 41 84 20 21 42 ユーザー数見積もり/年 262 235 476 112 117 238 159 授業C.1: サービス事業が機能しているか判るには？（20 分） 実習生に、この節では「教習員用指導書」と「ToT ハンドブック」を閉じ「参考書＆ワークブック」 p.100 を開けるよう指示せよ。 説明：この授業で明確にするのは、サービス事業のモニターできる分野、可能な実績目標、情報の 収集方法です。この活動は実習生自身が行なうことで、モニタリングの概念への習熟に役立ちます。 このスライドは活動の間じゅう映しておけ。 ToT 教習員への注記： • 「管理者向けWSTP 教習員用指導書」p.90 の活動を進め、 3節の最後までの残りの情報を 押さえよ。「ToT ハンドブック」の追加情報を参照し、そこの提案を活動に組み入れよ。 160 授業C.3: フォローアップ計画（27 分） 説明： • フォローアップは、車椅子サービス供与の中で 軽視されがちです。職員が、実施許可を得られな かったり、旅費を精算してもらえなかったり することもあります。 • この授業は、フォローアップの重要性を事業 管理者へ強調するために役立ちます。 • 車椅子ユーザーに授業へ参加してもらい経験を 共有する場合は、その人へのフォローアップが 適正であったか確かめなさい。事前に話し合い、 重要な側面を強調してもらうようにしなさい。 説明：パッケージ初版のスライド C.3.7 と C.3.8 は、 不明確だったため差し替えてあります。これらの 改訂版スライドは、WSTP 用 USB メモリに収めて あります。「教習員用指導書」に注記しなさい。 説明： • スライドが示す通り、「フォローアップの打撃」 とは、サービス事業が 2 年目以降、人的リソース が増えない限り、より少ない車椅子しか供給 できなくなることをいいます。 • 車椅子の供給数だけがサービス事業の有効性を 測る方法であってはならない、と強調しなさい。 161 このスライドは活動の間じゅう映しておけ。 活車２ グループ： グループをペアに分けよ。 指導内容： ４枚の「変革ファシリテーター」を、この授業の最後に載せているアイデア を提案する付箋紙と共に壁に貼り出せ。 各ペアに、教室内を巡回してその４枚に挙げられた内容を読み返し、付箋紙 （か色紙のカード）を用いてさらにアイデアを追加するよう指示せよ。 モニター： グループの間を巡回し、必要に応じて手助けせよ。 時間： 活動に 12分、話し合いに 10分見込んでおけ。 フィードバック： グループに各 4枚の周りに順番に集まり、内容を議論するよう指示せよ。 話し合いを通して浮かんだアイデアがあれば追加せよ。 この活動は、受講者が教習全体を通してアイデアを追加し続けた場合にのみ 効果が出ることを強調せよ。そうでなければ、実習生は、各分野について、 その場で考える時間を取るとよい。 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 説明：翌日のプログラムでは関係者向け WSTP を 取り上げますが、授業には教習運営実務や時間割 の 選択肢など、管理者向け WSTP に関わる詳細な 内容を含むものがあります。 162 変革ファシリテーター」見本版の作成 4 つの見出しを別べつのフリップチャート紙に書き、以下列記した項目を一つずつ付箋紙に書いて 追加せよ。現地の状況に対して適切な、他の取り組みを追加してもよい。 適正な車椅子与 に関する共有ビジョンをつくり出すために管理者ができること • 全チームメンバーの参画を得てサービス事業の全体目標を決め、ビジョンとミッションの宣言 をつくり上げる。 • 共有ビジョンを定期的に見直し、全チームメンバーが、その達成に向けて貢献していることを 確かめる。 • 共有ビジョン全体をユーザーに根ざしたものにする。すなわち、車椅子ユーザーの参画を得て 作成すべきである。 適正な車椅子与 の重要性を伝達するために管理者ができること • 車椅子の後援者や寄付者にプレゼンを行なう。 • 政府の省庁・部局、非政府組織（NGO）、障害者団体、リハビリテーション専門職に対して、 「車椅子ガイドライン」への認識を高める。 • 他の関係者との合同意識啓発イベント・活動を、特に「国際障害者デー」に開催する。 • 「障害者の権利に関する条約（CRPD）」の、支援機器に関連する条項への認識を高める。 • 「持続可能な開発目標（SDGs）」のうち、支援機器を適正に供与することの重要性を奨励する 目標を強調する。 • 「車椅子ガイドライン」への認識を高め、それを推進するため、リハビリテーション教育機関 や地域に根ざしたリハビリテーション訓練校との会合を開く。 • 車椅子サービスユーザーについてのケーススタディおよびビフォーアフターの写真を集めて 共有し、専門的サービスの有益さを強調する。 163 職員とリソースを配置するために管理者ができること • 車椅子サービスの全ステップに、それをやり遂げる技能と作業時間を持つ人材が配置される ようにする。 • 可能な限りサービス、とくにユーザー教習とフォローアップで車椅子ユーザーの参画を得る。 • 臨床・技術・教習の各業務を果たす職員が、必ず適正な教習を受けているようにする。 • サービス目標が、利用可能な人員とリソースに基づいて現実的であるようにする。 • 定期的にサービスをモニターし、職員の業務、責任、作業負荷が適正であるようにする。 職員を車機付け・惹き込み・注力させるために管理者ができること • 全チームメンバーによるチーム会議を開いて、目標に合意し、それを理解する。 • 車椅子ユーザーに体験談を共有してもらうことで、チームの全メンバーが、専門的サービスの 有益さ、および劣悪なサービスの危険性を分かるようにする。 • ボーナス、休暇、抜きん出た仕事に対する「今月の人」表彰など、職員に動機を与える。 • チームづくりイベントを開催して、チームワークを強化し意欲を高める。 • 職員が、立派に仕事をし、サービスの重要目標を達成したら感謝する。 164 WSTPtot 関係者向け教習のはじめに ね ら い 実習生を、関係者向け車椅子サービス教習パッケージ（関係者向けWSTP）、および、 関係者向け教習の教習員養成教習（ToT）プログラムのねらいと構成に習熟させる。 学 習 目 標 この授業が終わるまでに、実習生が以下を詳述できるようになること：  関係者向けWSTPの対象者、対象範囲、目的  関係者向けWSTPの、教習員と受講者の理想的な人数および比率  関係者向けWSTPの構成および時間割  WSTPtot 関係者向け教習プログラムのねらいと目標  関係者向けWSTPの教材およびその使い方 教 材 この授業には：  PPT スライド「3. WSTPtot 関係者向け教習のはじめに」 各実習生に必要な、関係者向けWSTP教材：  「教習員用指導書」  WSTPポスターのセット 各実習生に必要な、WSTPtot 管理者/関係者向け教習教材：  「ToT ハンドブック」  「WSTPtot 管理者/関係者向け教習時間割」  WSTP用 USB メモリ 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  教室を設営し、設備を確認する。 あ ら す じ 1. WSTPtot 関係者向け教習の概略 2. ToT（教習員養成教習）１日プログラムの時間割 3. 関係者向けWSTPおよび教材の紹介 4. 対象者 5. 目的および対象範囲 6. 教習員および受講者 7. 開会式および招待講演者 8. 要点のまとめ 5 3 3 5 6 3 8 2 授業時間計 35 165 WSTPtot 関係者向け教習の概略（5分） 説明：WSTPtot 管理者向け教習で話し合った教材の多くは、WSTPtot 関係者向け教習にも該当 します。 授業のねらい、および学習目標を説明せよ。 説明： • 関係者向け WSTP は、適正な車椅子サービスに 関心を持つ関係者の、認識を高め知識を増やす ために作成されました。 • 内容は、現地の状況や期待される成果によって 変わります。 • しくみがすでに出来上がっているところでは、 その集まりは、将来の取り組みやさらなる支援 への深い関与を生むかもしれません。 • しくみがないところでは、知識共有や作業部会 設置のために、この集まりを活用できます。共有 ビジョンをつくり出すことは、関係者に正当性 を与えるために重要です。 • 必要に応じて、現地の状況にあつらえた授業37や 活動を追加しなさい。 • 関係者向け WSTP は、最短 4 時間で実施でき、 時間があれば 1〜2 日に延長も可能です。 37 [原文] sessions [原文] 他の WSTP や本書の他の部分に合わせて session にはすべて「授業」の訳語を宛てている が, 本文でも後述する関係者向け WSTP の性格から, 日本語でも「セッション」のイメージに近いものとなろう. 166 説明： • 関係者向け WSTP のすべての授業を順々に取り上げ、それを広範な関係者向けワークショップ の一部として活用する方法について話し合いましょう。 • 関係者向け WSTP は教習プログラムというよりは集会なので、演習や活動よりもグループでの 話し合い、ブレインストーミング、ビジョンづくりを行なう方が適切です。 ToT（教習員養成教習）１日プログラムの時間割38（3分） 実習生に、各自の「WSTPtot 管理者/関係者向け教習時間割表」を見るよう指示せよ。 説明：WSTPtot 関係者向け教習プログラムは、WSTPtot 管理者向け教習と同じ構成で進めます。 関係者向けWSTPおよび教材の紹介（3分） 説明： • 関係者向け WSTP の主教材は「教習員用指導書」 です。受講者用マニュアルはありません。主要な 教習パッケージ教材は、DVD や WSTP 用 USB メモリで配布します。 • 可能であれば、「車椅子サービスのステップ」の ポスターを受講者へ配布しなさい。これは、 WSTP 用 USB メモリから印刷できます。 • 関係者向け WSTP は WHO のウェブサイトから ダウンロードできます(39)。 実習生に「教習員用指導書」p.1 を開けるよう指示せよ 38 [訳注] 授業用 PPT にはこの節に対応する 4 枚目のスライド (下掲) が入っているが, 原著では省かれている. 39 https://apps.who.int/iris/handle/10665/246227 167 説明：最初の節では、パッケージ作成の背景を紹介しています。教習プログラムの対象者、目的、 対象範囲を説明し、関係者向け WSTP 教習員の人数と技能に関して推奨事項を与え、開始までの 流れを教えています。 説明： • 関係者向け WSTP では授業 4 コマがあり、それ に PPT と授業計画が付属しています。 • 4 本の動画があります。 • 閉会のことばには、WSTP ロゴの紹介（受講者に 活用を勧める）と動画「お土産のメッセージ」も 含まれます。 対象者（5分） 質問：「教習員用指導書」を見ないで、このワークショップに招待すべき関係者はだれか提案して もらえますか？ ほとんど、あるいはすべて出揃うまで、応答をホワイトボードに書きとめよ。 実習生に「教習員用指導書」p.2 を開け、自分の回答と「対象者」の一覧を見比べるよう指示せよ。 現地の事情を知る人に、どの団体を招待すべきか尋ねよ。人権団体を含めよ。 目的および対象範囲（6分） 説明： • 教習を受けた職員のみで、適正な車椅子供与を 確保するのは困難です。車椅子供与の確立や改 善には、高職位から職員への支援が必要です。 • 関係者向け WSTP の目的は、適正な車椅子供与 の確立に参画するすべての人の意識を啓発し、 技能と知識を育成することです。 168 関係者向け WSTP の対象範囲を説明せよ。 説明： • 関係者向けワークショップには、期待する成果、 受講者のレベル、使える時間に合わせた、柔軟な 運用が必要です。 • 半日が最低必要な時間です。高職位の関係者40 は、長時間の出席が難しい場合もあります。 • 重要な関係者による基調講演41を盛り込み、 メディアの注意を引くことを考慮しなさい。 • 政府高官42を開会式と閉会式に招いて管轄部門 での課題に対する認識を高めてもらい、ワーク ショップの成果を共有し、支援を要請すること を検討しなさい。 • 半日以上時間が取れれば、「管理者/関係者向け WSTP 計画ツール」を関係者向け WSTP の設計 に活用しなさい。達成したい成果を明確にし、 ただし使える時間および出席者の責任範囲に 対して現実的になりなさい。 40 [原文] Senior stakeholders 41 [原文] opening presentations 42 [原文] high-level officials 169 教習員および受講者（3分） 説明： • WSTP 全体を通して「教習員43」の語を用いてい るものの、関係者向け WSTP に求められるのは 教習員よりもファシリテーターです。受講者が 幅広く多様なため、ファシリテーションが優れ ていることで、全員の意見が耳を傾けられるよ うになります。 • 関係者向け WSTP では、最低 2 名の教習員が ファシリテーションを行なうよう推奨します。 グループが大きければ (40 名超)、教習員が 3 名 いるとより柔軟になります（2 名は小グループで の話し合いの席に入る、また車椅子サービスに ついての情報で欠落しているものを補うなど）。 • 関係者向け WSTP 教習員には、以下を備えた人 を推奨します： o 適切な水準で、教習を実施するかファシリ テーションを行なった経験。 o さまざまな関係者や、さまざまなレベルの 聴衆を相手にした経験。 o 適正な車椅子供与の導入は車椅子ユーザーに とって有益なのだ、という強い信念。 o 異なる意見を傾聴し歓迎しながらも、同時に 適正な車椅子供与の基本原則を保ち、ワーク ショップの目的を堅持する能力。 43 [原文] trainer 170 開会式および招待講演者（8分） 実習生に「教習員用指導書」p.16 を開けるよう指示せよ 説明：進行させるワークショップが半日で、かつグループが大きい場合、5 分の時間配分では一人 ひとりを紹介するには足りません。かわりに分野名（例えば療法士、政府、障害者団体（DPO）、 非政府組織（NGO）、寄付者、メディアなど）で呼び、その分野の各メンバーに立ち上がるか手を 挙げて確認してもらうことが可能です。 説明： • 関係づくりはワークショップの主要目的の一つ なので、自己紹介は重要です。可能ならば、この 時間を延長し、またグループ作業中に自己紹介 の時間を設けるとよいでしょう。 • 受講者に、この後の授業で発言する時には、名前 と所属を言ってもらうよう勧めなさい。 171 説明： • 「教習員用指導書」では、招待講演者は 3 人まで としています。時間配分は合計 20 分しかなく、 しかも、招待講演者は予定時間をオーバーして 話すことがしばしばです。 • 講演者が適切44で時間を守るようになるコツは： o PPT は避けるか、前もって提供される場合は スライド 3〜4 枚に制限しなさい。 o 講演者に、残り時間が 2 分になったら合図を 出すことを伝えなさい。 o 講演者ごとの質問数に制限を設けなさい。 o 講演者に、簡潔に答えるよう促しなさい。招待 講演者が、ワークショップ全体にも参加する 場合、受講者は休憩時間に追加質問できます。 • もっと時間があれば、この授業を延長すること を検討しなさい。招待講演者の人選が適切で、 事前打ち合わせがじゅうぶんに行なわれれば、 その証言は極めて強力になり、ワークショップ のよい土台を築くでしょう。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 44 [原文] relevant 172 S.1: はじめに この授業を教えるための主な留意点 a. 参加者紹介 • 進行させるワークショップが半日で、グループが大きい場合、5 分の時間配分では一人ひとりを 紹介するには足りない。かわりに、分野名（例えば、療法士、政府、障害者団体（DPO）、非政 府組織（NGO）、寄付者、メディアなど）で呼び、当該分野の各メンバーに、立ち上がるか手を 挙げて確認してもらうことが可能。 • 集まる主目的が関係づくりであれば、自己紹介が重要になる。数分取って各テーブルで自己紹介 してもらい、その後の授業で違うテーブルに席替えして、より多く関係がつくられるようにせよ。 • 受講者に、以後の授業で発言する際には、名前と所属を示すよう勧めよ。 b. 招待講演者および基調講演：車椅子ユーザー/代表者 準備のコツ • 「教習員用指導書」では、この部の招待講演者は 3 人までと述べている。時間配分は合計 20 分 しかなく、しかも招待講演者は予定時間をオーバーして話すことがしばしばである。 • 時間に余裕があれば、この授業を延長することを検討せよ。招待講演者の人選が適切で、じゅう ぶんに打ち合わせてあれば、その証言は極めて強力になり、ワークショップのよい土台を築くで あろう。 講演者が適切で時間を守るようになるコツ： • PPT は避けるか、スライド 3〜4枚に制限する。 • 現地の窓口に、招待講演者について聞いておく。時間をオーバーしがちな人なら、講演者数を 減らす。 • 招待講演者に、時間に余裕がないことを予め説明しておく。残り時間 2分になったら、時間に 間に合うよう合図を掲げることを伝えておく。PPT のプレゼンテーションは事前に求め、確認 してコンピューターにアップロードできるようにする。 173 c. 質疑応答 • 招待講演者との質疑応答には 5 分しか取っていない。質問数を制限し、講演者には簡潔に答える よう促せ。招待講演者がワークショップ全体に参加する場合、受講者には、休憩時間に追加質問 するよう勧めよ。 174 S.2: 政策から実践へ この授業を教えるための主な留意点 a. 全般 • 「教習員用指導書」に、この授業への法的枠組みの配布資料を作成するための、主要資料の確認 表が載っている。政府代表、非政府組織（NGO）、障害者団体（DPO）その他の関係者と話し、 またインターネットを検索して、この情報を収集せよ。 • 当該国の、より包括的な概況を知るには「管理者/関係者向け WSTP 計画ツール」を完成せよ。 これは本書の「付録」および WSTP 用 USB メモリ45に載っている。 b. 第 2節：ニーズ、および満たされざるニーズとは何か？ 準備のコツ • 国の人口統計値を最初のスライドに追加し、さらにこの数字の 1 %を計算して、車椅子が必要な 人口の WHO（世界保健機関）に従った推計値(46)を示せ。補助役教習員に、計算が正しいか確認 してもらうこと。最新の国勢調査情報をインターネットで検索するか、さらに直近の推計値を 政府の統計局あるいはその他の信頼できる情報源で調べよ。 45 [訳注] USB メモリは英語版のみ. 日本語版は右 URL よりダウンロード可能 (https://j-aws.jp/who/). 46 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/が i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガ イドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 175 内容 • WHO は、どこでも人口の約 15 %は障害者で(47)、1 %に車椅子が必要と推定している。国勢調査 の情報48からの障害者の合計割合は、通常 WHO の推計よりずっと低く、また国によりばらつき がある（通常 2〜5 %前後）。したがって WHO の推計に疑問を抱く受講者も出よう。いっぱんに 障害は、多くの理由から過少に報告されることを説明せよ： o 障害を持つ家族は家の中に隠され、国勢調査で数えられない場合がある。 o 自分の障害を、国勢調査の調査票上で認めているとは限らない。 o 国勢調査の調査票が適切な情報を捉えるとは限らず、そのため障害者が特定されていない。 c. 第 3節：車椅子与 の重要性 準備のコツ • 授業開始前に、動画が WSTP 用 USB メモリに埋め込み済みか簡単に見つかることを確かめよ。 • この節への時間配分は 3 分で、うち 2 分半が動画のため、「インドのショバの例話」は授業時間 を延長しないかぎり盛り込めない。別のインドでの例話が後に出ている（p.27）。 d. 第 5節：権利は万人のもの • 「障害者の権利に関する条約（CRPD）」は、紹介された条文だけでなく、全文を読んでおけ。 そうすることで、それらの条文の文脈が整理され、同条約がうたう諸権利に関して、より包括的 な理解が得られる。 e. 第 6節：政策はサービスを通して個人に届く • この節には、車椅子サービスのステップを示すスライドが盛り込まれている。そのポスターを、 壁に貼って参照させよ。 • 関係者向け WSTP では、ここで初めて「車椅子ガイドライン」に触れている。ガイドラインの 認知度が低く、それに関する別の授業も行なわれない場合は、この機会にガイドライン、および 車椅子供与の 8 ステップの重要性を強調せよ。 47 https://www.who.int/en/news-room/fact-sheets/detail/disability-and-health 48 [原文] Census information 176 f. 第 7節：国の計画によって権利を現実に • 第 7 節の活動は、完結するにはあまり時間がない。この演習をグループ全体で行なうか演習時間 を多く取って、フィードバックの時間を少なくせよ。4 グループから別べつにではなく、全体で フィードバックしてもらえ。 g. 第 9節：要点のまとめ • この授業のおわりに、適正な車椅子供与の実現において、政府の全部門に果たすべき役割がある ことを強調せよ。国内および国際的な政策・条約・法律は、さまざまな関係者が実行した場合に のみ意味があり、これは政策提言とロビー活動を経なければ実現しない場合もある。全関係者の 順守、参画、説明責任49がたいへん重要である。 • 全関係者に、車椅子供与システム（車椅子の設計、生産、供給、サービス提供など）の改善への 差し迫った必要に対処し、サービス提供が第 6 節で取り上げた 8 ステップに沿うようにするうえ で、担うべき役割がある。 49 [原文] The compliance, commitment and accountability 177 S.3: 適正な車椅子を取り揃える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業計画の「教材」欄に「さまざまな種類の車椅子」と「クッション」を追加せよ。さまざまな 特色や設計を強調して質問を促し、受講者を惹きつけるために活用せよ。 • 授業開始前に動画 2 本を、WSTP 用 USB メモリに埋め込み済みか簡単に見つかるようにせよ。 b. 第 2節：適正な車椅子とクッションの重要性 準備のコツ • スライド 3.5：米ドルの数字を現地通貨に換算し、だれにでも金額が分かるようにせよ。 • この節の焦点は、適正な車椅子とクッションの重要性である。時間があれば、不適正な車椅子と クッションが及ぼす影響を示す、自分のケーススタディを追加せよ。 内容 • 褥瘡はたちどころに発生・悪化し、命に関わることもあるため、クッションが車椅子の不可分な 構成要素であることを強調せよ。車椅子ユーザーは、褥瘡が治るまで何か月や何年も寝たきりを 余儀なくされる場合がある。 • 話を適正な車椅子の供与方法に集中させよ。すなわちユーザーのニーズと、さまざまな車椅子の 中から選べることの重要性に焦点を絞れ。車椅子の生産や特定のブランドについての詳細には、 それが重要なトピックだと判明していない限り、拘泥するのを避けよ。 178 c. 第 4節：ユーザーのニーズおよび環境に合う • 受講者には、さまざまな車椅子が、動画に登場する人びとが活動をやり遂げるのをどう支援して いるか観察してもらえ。取り上げているさまざまな環境を強調せよ。教材用車椅子を活用して、 動画でやって見せている、はね上げ式足台や折りたたみ機構を示せ。 d. 第 5節：安全で耐久性がある製品の重要性 • サービス事業所で新製品を検討する際には、安全性と耐久性を調べることが重要だと強調せよ。 例えば、その車椅子には除圧クッションが付属しているか？その車椅子は認証検査（ISO（国際 標準化機構）検査などの）に合格しているか？その設計は、よそで同様の環境で使われたことが あるか？交換用部品は付属しているか？フレームは現地で修理できるか？ 179 S.4: 変革に向け協働を WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 6節：どうやって支援を え、障壁を取り除くか • この節の最後のスライドはサムネイルの見出しが誤っている。PPT スライドの「要点のまとめ」 が正しい見出しである。「教習員用指導書」を修正せよ50。 この授業を教えるための主な留意点 a. 全般 • 関係者向けワークショップ受講者は、変革の創出と推進の両面において重要であると強調せよ。 これら各節の内容を、受講者に関連づけよ。例えば、適正な車椅子供与を支持する先行受容者を 見極める必要を強調するなど。最も変革を望み、車椅子供与の原動力となりうる組織を見極める 必要性を強調せよ。 b. 第 1節：はじめに • 「はじめに」では、この授業を、満たされざるニーズや適正な車椅子の有益さに関する、以前の 同様な授業に結びつけるよう提案している。国際的あるいは国内や現地の政策などの指針文書を 再度掲げよ。 c. 第 2節：どうやって緊迫感を伝えるか • 受講者が、統計が手に入らないため、車椅子へのニーズが分からないとコメントすることは多い。 かれらに、それが不作為の言い訳51にならないことを納得させよ。WHO 統計の「1 %」は信頼性 が高い統計値で、推計や計画の目的で使用できる。 d. 第 6節：どうやって支援を え、障壁を取り除くか • スライド 4.12：スライドを編集して教習実施国の人口を加え、車椅子が必要な人口の 1 %を計算 せよ。このデータは、すでに授業 S.2 のスライドで得ているはずである。 50 [訳注] 関係者向け WSTP 教習員用指導書 p.46. 日本語版サムネイルは翻訳した PPT から生成したため修正済み. 51 [原文] a reason for inaction 180 e. 第 7節：変革プロセスを支援する方策 • 「次のステップは何でしょうか？」(p.47)：可能であれば、フリップチャート紙に列記した取り 組みを議論するため、時間配分を増やせ。ワークショップ解散前に、どのように前進すべきか 合意していることが重要である。例えば、受講者が振り返り、同僚と協議する時間を置いた後の フォローアップ会議を計画するなど。 • 時間を節約するため、第 7 節の活動をグループ全体か 3 グループに分けるかのどちらかで進める よう検討せよ。各グループに、答えを直接フリップチャート紙に、あるいは付箋紙を介して記録 するやり方を示せ。 f. 授業のおわりに • 最後のスライド 2 枚は「閉会のことば」に用いる。その初めのスライドの前に空白のスライドを 1 枚挿入し、誤って閉会のことばへ移らないようにすることを検討せよ。 181 閉会のことば この授業を教えるための主な留意点 a. 全般 • 「閉会のことば」用のスライド 2 枚は、授業 S.4「変革に向け協働を」用 PPT の最後にある。 b. 閉会のことばおよびロゴ • WSTP［車椅子サービス教習パッケージ］のロゴは、WSTP 用 USB メモリに載っていることを 強調せよ。 c. 事後評価およびWHOへのフィードバック • 事後評価およびフィードバックは、WHO にとり、WSTP 教材の継続的な改善および発展を可能 にするため極めて重要である。受講者に、このプロセスへの参加を奨励せよ。 182 管理者/関係者向けWSTPの教習運営実務と準備 ね ら い 実習生に、管理者向け WSTP および関係者向け WSTP の実施に必要な、教習運営実務と 準備を紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  車椅子供与の現状を知ることの重要性を説明する  管理者向け/関係者向けWSTPの授業を適切に用いて教習プログラムを計画する  関係者向けWSTPの適切な招待講演者および受講者を見定めて準備する 教 材 この授業には：  PPT スライド「4. 管理者向け／関係者向けWSTP の教習運営実務と準備52」  「管理者向けWSTP教習員用指導書」  「関係者向けWSTP教習員用指導書」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  現地の車椅子サービス提供に関する基本情報を集める。 あ ら す じ 1. はじめに 2. 現地の状況に基づく管理者/関係者向けWSTP実施計画 3. 関係者向けWSTPの受講者を見定める 4. 関係者向けWSTPの招待講演者を見定める 5. 関係者向けWSTPにおける教習員の役割 6. 要点のまとめ 2 5 8 8 5 2 授業時間計 30 52 [訳注] 日本語プレゼンテーションスライドのファイル名のみ, スラッシュ ( / ) に全角を用いている. 183 はじめに（2分） 授業のねらい、および学習目標を説明せよ。 説明： • 管理者向け WSTP および関係者向け WSTP の 「教習員用指導書」は、教習パッケージの実施に 関する詳細な手引書で、教習員のよい出発点と なるものです。 • 「ToT ハンドブック」は、追加情報を与えます。 現地の状況に基づく管理者/関係者向けWSTP実施計画（5分） 説明： • 現地の状況を知ることは非常に重要です • 授業を調整して現地の状況に当てはまり、期待 通りの成果を達成するものにしなさい。 184 説明： • これらのパッケージを時間配分通りに実施する のは困難というのが、教習員のこれまでの感想 です。 • 大半のトピックは貴重な話し合いを生み出すた め、教習の価値を最大にするには、それに合わせ るべきです。話し合わせ、活動を減らす方がよい でしょう。 • 授業内容が、あらゆる学習スタイルに応える ものであることを確かめなさい。 • 「管理者/関係者向け WSTP 計画ツール」を活用 して、現状の概略を知り、どの授業を盛り込む べきか見極めるのに役立てなさい。 説明：管理者向け WSTP は、2 日間の教習として 設計されていますが、延長して時間を増やしたり、 トピックを追加したりも可能です。 説明： • 関係者向け WSTP は、半日のワークショップと して設計されています。授業をすべて押さえる か、その一部を現地の状況から適切な他の活動 と結合させて活用します。 • 関係者向け WSTP に含まれる４つの授業には、 最低 4 時間必要です。 185 説明：時間の要素は重要です。事業管理者が教習に参加するには通常 2 日間が現実的で、他方、 高職位の関係者は、関係者向け WSTP に半日か 1 日、時間を割けるはずです。 持ち時間が少ない場合は、どの授業を盛り込むべきか、優先順位を付けなさい。例えば、車椅子 サービス事業がすでに整っている地域では「車椅子サービスを開始する」の授業は一部を省くか 減らすのが合理的です。同様にサービス事業が確立していない地域では、「車椅子サービス事業 を運営する」を減らしてもよいでしょう。 関係者向けWSTPの受講者を見定める（8分） 質問：自分の国でのワークショップにはどんな種類の関係者団体を招きたいですか？また、それは なぜですか？ 回答を受けとめ承認せよ。 最も重要な答え： 以下は、過去に関係者向けWSTPへ参加した関係者の一覧である。 • 障害を管轄する主要な政府省庁、例えば保健、社会福祉、障害問題、児童福祉など • 障害分野のネットワーキングNGO53、例えば全国連盟や全国協会など • 車椅子または義肢装具に携わるリハビリテーションセンター職員 • 障害者およびその家族/介助者 • 地域に根ざしたリハビリテーション組織 • 障害プログラムを実施している学術機関 • 世界保健機関および現地で活動しているリハビリテーション分野の国際 NGO（非政府組織） • リハビリテーション機器の生産者および供給者 • 障害関連の取り組みを支援する資金援助団体 • 脳性麻痺、脊髄損傷、下肢切断、退役軍人などに特化した、障害別の組織 • 人権団体 • 主流をなす開発組織54 • CRPD（障害者の権利に関する条約）の報告に携わる団体 53 [原文] Umbrella disability NGOs 54 [原文] Mainstream development organizations 186 最も重要な答え： 最適な出席者に関する決定は、じゅうぶん協議したうえで下すべきである。 関係者に出席してもらう理由： • 車椅子ユーザーのニーズが満たされるよう、政府の政策や計画に影響を及ぼしてもらうため。 • 車椅子ユーザーのニーズを理解し、自分の業務において表明するよう促すため。 • 国際的および国内の政策や条約と、車椅子ユーザーのニーズの関連を理解してもらうため。 • 「車椅子ガイドライン」および適正な車椅子供与を紹介するため。 説明： • 必ず、全員をじゅうぶん前もって招待し、ワーク ショップの目的をはっきりと説明しなさい。 • ワークショップの成否は次にかかっています： 目的の明確さ、望まれる成果の現実性、適切な 人が一堂に会すること。 説明：招く関係者の人数と分野は、範囲とする地域、使える予算、達成したい成果によって変わり ます。12〜40 名の受講者を目標にしなさい。 ワークショップが全国的なものであれば、必ずすべての地域および団体から、じゅうぶんな出席を 得られるようにしなさい。これは予算に影響するかもしれませんが、どんな計画であれ、信頼性と 実施内容のために重要です。 質問：出席しない関係者がいた場合、どうなる恐れがあるでしょうか？ 回答を受けとめ承認せよ。 最も重要な答え： • 話し合いが、すべての利害関係者を代表したものにならない。 • 話し合いが、考慮すべき重要な視点を欠いたまま行なわれる。 • 受講者が、重要な意見が表明されていないために、現状に対する不完全な図式を持ち帰る。 • 受講者が、ワークショップがその部門を代表しないために、不満をつのらせる。 • 合意された計画が、すべての関係者グループの支持を欠くため、信頼されないか実行できない。 説明：招待がすべて送られ、それに続いて出席確認が行なわれたことを確認しなさい。 187 関係者向けWSTPの招待講演者を見定める（8分） 説明： • ワークショップは、1〜2 名の招待講演者による 簡潔な発表から始めなさい。これは場の雰囲気 づくり55と、適正な車椅子供与の重要性の強調に 役立ちます。 • 講演者はじゅうぶん前もって確定し、その発表 の重点、スライドを用いるかどうか、および持ち 時間を話し合っておきなさい。招待講演者が PPT プレゼンテーションを用いる予定であれば 事前に頂き、関係者向けワークショップの間に 使うノート PC に読み込んでおきなさい。 説明：「教習員用指導書」は、付録 1・2 で最初の発表に関する助言を与え、付録 3 で障害一般に 関する有用な統計および引用を提供しています。現地の統計を追加すると役に立つでしょう。 55 [原文] set the scene 188 発表は、現実的で、しかし変革は可能だという希望にあふれたものでなければなりません。その ねらいは、状況へ対処することへの課題とその緊急性とが認識された環境をつくり出し、同時に、 今こそ共同行動を起こす時だと示すことです。 可能であれば、政府代表者を一人と、車椅子ユーザーを一人含めるようにしなさい。 質問：政府代表者には、どんな人が適当でしょうか？ 回答を受けとめ承認せよ。 最も重要な答え： • 関係省庁（保健、社会福祉、退役軍人）の大臣［長官］あるいは次官 • 障害問題に関わる機関、部局、総局の長 • 国の障害部門の、技術的専門家 注記： • 著名な56省庁代表者を招聘できればメディアで報道される可能性が増し、車椅子供与問題への 注目度を高める57ために役立つ。それは従って、集会での公約をフォローアップしやすくなる ことでもある。高職位者がワークショップ全体に参加できない場合、もう一人の講演の間は 残るよう促し、かれら（とメディア）が、車椅子ユーザーが直面する課題を聴けるようにせよ。 • 講演者を選ぶ際は、現地の政治力学58に気をつけよ。招待する人が、効果的でポジティブな 影響力があると評価されていることを確かめよ。この重要な集会の雰囲気をつくるうえで、 物議を醸すような人物59は望ましくなかろう。 質問：車椅子ユーザー代表者については、どんな面に注目すべきでしょうか？ 回答を受けとめ承認せよ。 56 [原文] high-profile 57 [原文] raise the profile 58 [原文] local politics 59 [原文] controversial figure 189 最も重要な答え： • 適正な車椅子供与の重要性を分かっている • 実体験から適正な車椅子の価値を説明できる • 現地の車椅子供与に関する知識と経験 • 大勢の前で熱く語る60自信 • CRPD（障害者の権利に関する条約）に関する知識 • 車椅子ユーザーが直面する課題を強調するために自分の体験談を共有しようという意志 注記：障害者の権利の提唱者で、課題に対して権利に基づいたアプローチをとり、また現地の 政治力学や事情を分かっている人を見出すよう試みよ。CRPDについて知識豊富な可能性は 高いにせよ、「車椅子ガイドライン」を必ず知っているとは限らない。 実習生に「教習員用指導書」p.49 の「付録 1：政府代表者への摘要」を開けるよう指示せよ。 説明：これは、政府代表者が車椅子サービス供与に関連する最も重要な話題（自分の部局の管轄、 車椅子供与の現状、関連するあらゆる制度など）を押さえるための助言です。 実習生に「教習員用指導書」p.51 の「付録 2：車椅子ユーザー代表者への摘要」を開けるよう指示 せよ。 説明：ここでの肝は、車椅子ユーザーに、実体験に即して自らの人生および将来達成したい希望に ついて語っていただくことです。 説明：「付録 3（p.53）」では、講演者や教習員が発表で用いるための、一般的な引用および統計を 提供しています。講演者には車椅子供与をめぐる大状況について語り、車椅子サービス供与部門内 の強み、弱点、機会、脅威61を強調するよう促しなさい。 60 [原文] speak passionately 61 [原文] threats 190 関係者向けWSTPにおける教習員の役割（5分） 説明： • 関係者向け WSTP は（教習プログラムではなく） ワークショップなので、求められるのは教習員 というよりファシリテーターです。 • 教習員には、授業の効果的な計画と運営のため に、車椅子と障害部門ならびに現地の事情への 徹底した理解が必要です。 • 関係者向け WSTP 教習員には、適正な車椅子供 与の重要性への深い理解、およびそれに対する 強い熱意が必要です。 • 保健政策および政府の機能を熟知した教習員 は、教習チームの貴重な財産です。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 191 管理者/関係者向けWSTP時間割の選択肢 ね ら い 実習生を、管理者向け WSTP および関係者向け WSTP の時間割を作成できるようにし、 「管理者/関係者向けWSTP計画ツール」に精通させる。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  「管理者/関係者向けWSTP計画ツール」を活用する  管理者向けWSTPや関係者向けWSTPの時間割を作成する 教 材 この授業には：  PPT スライド「5. 管理者／関係者向けWSTP時間割の選択肢62」  授業計画の最後に載っている、4セットある授業カード 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  授業カード 4セットを、指導内容に沿って色紙に印刷する。可能であれば切り分ける 前にラミネート加工する。空欄のカードも含めること。 あ ら す じ 1. はじめに 2. 時間割を作成する 3. 要点のまとめ 2 40 3 授業時間計 45 62 [訳注] 日本語プレゼンテーションスライドのファイル名のみ, スラッシュ ( / ) に全角を用いている. 192 はじめに（2分） 授業のねらい、および学習目標を説明せよ。 時間割を作成する（40 分） 説明：管理者向け WSTP および関係者向け WSTP は、きっちり教習パッケージ通りに実施しても よいですが、以下のように現地の状況にあつらえると、さらに当を得たものになります。 活動の前半についてのスライドを映せ。 • 活動の後半についてのスライドを映せ。 193 活車１ グループ： 実習生を 2グループに分けよ。適切であれば、国や地域で分けよ。 指導内容： 両方のグループに同じシナリオを配布せよ。 「授業カード」一式を配布せよ。管理者向けWSTP用カードはすべて同じ色 で、関係者向けWSTP用カードはすべて別の同じ色であること、および他の トピックと空欄のカードは 三の色であることを説明せよ。 両グループに、2日間の管理者向けWSTPプログラムを、自分のシナリオの 情報に基づき、カードセットを活用して設計するよう指示せよ。追加授業を 空欄カードに記入してもよい。 両グループに、管理者向け WSTP プログラムは 2 日間にわたるため、授業 を追加したければ、他を減らすか削るほかないことを念押しせよ。 15 分取れ。 スライドを、関係者向けWSTPの指導内容を示すものに転換せよ。 両グループに 2つ目のカード一式を渡し、同じシナリオに対して 1日の関係 者向けWSTPプログラムを選択するよう指示せよ。 15 分取れ。 両グループに、完全な関係者向けWSTPプログラムは半日で終わるため、 残る半日には授業を追加し、標準の関係者向けWSTP63の授業の一部または 全部を活用することを選択してもよいと念押しせよ。 モニター： グループをモニターし、話し合って決定したら、その理由づけに耳を傾けよ。 補助役教習員が、もう片方のグループを支援するようにせよ。 必要に応じて情報提供せよ。 時間： グループでの話し合いに 30分、このプロセスに関するフィードバックに 5分見込んでおけ。 フィードバック： 説明：決まった正解や誤答はありませんが、重要なのは、達成しようとする 目標や成果について計画段階からよく検討し、自分の教習プログラムを計画 する際にそれを考慮に入れることです。 各グループの実習生 1〜2名に、このプロセスを振り返るよう指示せよ。 注記：この活動の主目的は、実習生が、現地の状況に基づいて時間割を計画 するよう促すことである。 63 [訳注]「管理者向け WSTP」の誤りか. 194 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 シナリオ： その国のインフラは、脆弱だが安定している。1992 年には「国家障害者計画」が策定された ものの、更新されていない。CRPD（障害者の権利に関する条約）には署名し批准している。 関係者の間での「車椅子ガイドライン」に関する知識は乏しい。 障害者は社会からのけ者にされており、非常にしばしば重荷だと見なされる。国内には強力な 障害者団体がなく、車椅子ユーザーのほとんどは移動技能がたいへん低い。 品質が悪い車椅子の現地生産はあるが少量にすぎない。数年前、大量の車椅子が寄付されたが ほとんどの人のニーズを満たさず、すぐに壊れてしまった。車椅子が必要な人のほとんどは、 一台も持っていない。 国の人口は 150万人で、国内にリハビリテーション専門職訓練校がない。資金供与は多少ある が、ほとんどは国際NGOからのものである。これまでに、車椅子供与技能の教習を受けた者は いない。教習に参加する人の大多数は、適正な車椅子供与に関する知識がほとんど、あるいは まったくない。車椅子ユーザーは非常に無力化されている。 195 活車１用授業カード 色A: 管理者向けWSTP 授業用 管 理 者 向 け W S T P あいさつ・自己紹介・概略 管 理 者 向 け W S T P 適正な車椅子与 とは何か？ 管 理 者 向 け W S T P サービス提与 管 理 者 向 け W S T P 変革を導く管理者 管 理 者 向 け W S T P サービスへのアクセス 管 理 者 向 け W S T P 施設および設備 管 理 者 向 け W S T P 適正な車椅子を取り揃える 196 管 理 者 向 け W S T P 職員の配置 管 理 者 向 け W S T P 車椅子サービスはどうお金がかかるのか？ 管 理 者 向 け W S T P サービス事業が機能しているか判るには？ 管 理 者 向 け W S T P 需要管理 管 理 者 向 け W S T P フォローアップ計画 管 理 者 向 け W S T P 持続可能な財政計画 管 理 者 向 け W S T P 総まとめ 197 活車１用授業カード 色B: 関係者向けWSTP 授業用 関 係 者 向 け W S T P はじめに 関 係 者 向 け W S T P 政策から実践へ 関 係 者 向 け W S T P 適正な車椅子を取り揃える 関 係 者 向 け W S T P 変革に向け協働を 198 活車１用授業カード 色C: その他のトピック。ページ全体を印刷し、最下段は空欄カードとして 受講者独自のトピックに使用。 そ の 他 の ト ピ ッ ク 車椅子サービス提与のための 国の政策を起草する そ の 他 の ト ピ ッ ク 車椅子サービス提与のための 国の方策を起草する そ の 他 の ト ピ ッ ク 車椅子問題を調整し推進する 作業部会を任命する そ の 他 の ト ピ ッ ク 車椅子/支援製品協会を設立する そ の 他 の ト ピ ッ ク 車椅子サービス提与のための 国の基準に合意する そ の 他 の ト ピ ッ ク 199 そ の 他 の ト ピ ッ ク WHO車椅子ガイドラインに照らし既存の 車椅子と座位保持の品揃えを評価する そ の 他 の ト ピ ッ ク WHO車椅子ガイドラインへの 認識を高める そ の 他 の ト ピ ッ ク 車椅子サービス提与をよりよく調整する そ の 他 の ト ピ ッ ク CRPDその他の国際的法律文書と、 それらの車椅子サービス提与に対する 関係への認識を高める そ の 他 の ト ピ ッ ク 車椅子サービス事業管理に携わる職員の 技能を向上させる そ の 他 の ト ピ ッ ク 200 そ の 他 の ト ピ ッ ク 車椅子サービス提与の世界、地域、国内に おける状況に対する理解を深める そ の 他 の ト ピ ッ ク 車椅子サービス提与教習への ニーズを分析する そ の 他 の ト ピ ッ ク そ の 他 の ト ピ ッ ク そ の 他 の ト ピ ッ ク そ の 他 の ト ピ ッ ク 201 WSTPtot 管理者/関係者向け教習への評価と閉講式 ね ら い 実習生からの最後の質問に対応し、実習生が記入した評価フォームを回収する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  管理者向けWSTPおよび関係者向けWSTPを、見習い教習員として実施する 教 材 この授業には：  PPT スライド「6. WSTPtot 管理者／関係者向け教習のおわりに64」  評価フォーム 準 備  教材を取りまとめ、授業計画を読み通す。 あ ら す じ 1. 最後の質問とコメントおよび評価フォーム記入 10 授業時間計 10 64 [訳注] 日本語プレゼンテーションスライドのファイル名のみ, スラッシュ ( / ) に全角を用いている. 202 最後の質問とコメントおよび評価フォーム記入（10 分） 実習生に、管理者向け WSTP および関係者向け WSTP の見習い教習への準備ができたと感じるか どうか尋ねよ。 評価フォームを配布せよ。 「ToT 教習前に、管理者向け WSTP や関係者向け WSTP を実施することにはどれくらい自信があり ましたか？」を問うた項目を指摘せよ。 実習生に、フォームのコメント欄に記入するよう 促せ。 何か質問がないか尋ねよ。 説明：管理者向け WSTP あるいは関係者向け WSTP の実施を計画する際には、教習指導員に 助言や指導を求めることができます。 実習生に、かれらの貢献に感謝し、将来の見習い 教習経験での幸運を祈願せよ。 ToT 教習プログラムを閉講せよ。 203 付録 付録１：WSTPtot必須授業時間割 第 1日 第 2日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 204 付録２：WSTPtot 管理者/関係者向け教習時間割 第 1日 第 2日 第 3日 8:30 WSTPtot 管理者向け教習の はじめに(85 分) B.5: 車椅子サービスは どうお金がかかるのか？ (60 分) WSTPtot 関係者向け教習の はじめに(35 分) 8:45 9:00 S.2: 政策から実践へ(45 分) 9:15 9:30 B.5: 車椅子サービスは どうお金がかかるのか？ フィードバック(30 分) 9:45 S.2: 政策から実践へ： フィードバック(25 分) 10:00 午前の休憩 午前の休憩 10:15 あいさつ・自己紹介・概略 (10 分) C.2: 需要管理(85 分) 午前の休憩 10:30 あいさつ・自己紹介・概略： フィードバック(15 分) S.3: 適正な車椅子を 取り揃える(30 分) 10:45 A.1: 適正な車椅子供与とは 何か？(50 分) 11:00 S.3: 適正な車椅子を取り揃え る：フィードバック(30 分) 11:15 S.4: 変革に向け協働を (パート 1)(57 分) 11:30 A.1: 適正な車椅子供与とは 何か？フィードバック(25 分) 11:45 C.2: 需要管理： フィードバック(35 分) 12:00 昼休み 12:15 昼休み 昼休み 12:30 12:45 1:00 A.2: サービス提供(40 分) 1:15 C.4: 持続可能な財政計画 (70 分) S.4: 変革に向け協働を (パート 2)(43 分) 1:30 1:45 A.2: サービス提供： フィードバック(20 分) 2:00 A.3: 変革を導く管理者 (45 分) S.4: 変革に向け協働を： フィードバック(30 分) 2:15 2:30 C.4: 持続可能な財政計画： フィードバック(30 分) 管理者/関係者向けWSTPの 教習運営実務と準備 (30 分) 2:45 A.3: 変革を導く管理者： フィードバック(30 分) 3:00 午後の休憩 午後の休憩 205 3:15 午後の休憩 管理者向けWSTPの模擬 授業範囲外の授業(105 分) 管理者/関係者向けWSTP 時間割の選択肢 (45 分) 3:30 B.1: サービスへのアクセス (45 分) 3:45 4:00 「保留スペース」 4:15 B.1: サービスへのアクセス： フィードバック(25 分) ToT 教習員の個別フィード バック(65 分) 4:30 4:45 「保留スペース」 5:00 授業準備・ToT 教習員の個別 フィードバック(30 分) 授業準備・ToT 教習員の個別 フィードバック(30 分) 5:15 WSTPtot 管理者・関係者 向け教習への評価と閉講式 (10 分) 206 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot 実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2 つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP 教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 207 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 208 ToT教習員への指示：WSTPtot の終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 209 付録 4：管理者/関係者向けWSTP計画ツール 国：________________________________ 記入者：_____________________________________ 連絡先：____________________________ 日付：______________________________________ 1. このツールの使い方 このツールは、当該国の一般的状況を収集し、教習やワークショップの望ましい成果を設定できる ように設計された。関係者と協力して、下表を次の手順で記入するよう推奨する。 当該国の状況に最も近い内容が述べられている欄を、マルで囲むかマーカーで強調する。 左端の列、白地の「要約」欄に、当該地域の状況の詳細を手短に記入する。 現地への知識、「追加を検討する授業」の行、可能な成果のページを利用し、現地の状況と 持ち時間に基づいて、自分の教習にどの授業を盛り込むか検討する。 2. 調査と計画への参画を得る国内の主な関係者の概要 関係者向け WSTP で挙げた、以下の関係者に相談し/参加を得よ： • 政策の企画者および実施者（例えば政府部局の、特に車椅子供与を担当するところ） • 障害分野のネットワーキング組織 • 障害者団体（ODP） • 影響力のある指導者や政治家 • 車椅子ユーザー、およびその家族/介助者 • 慈善家/資金供与者/寄付者 • メディア（電子および印刷） • 車椅子の製造者および供給者 • 専門家集団（理学療法士、作業療法士、CBR（地域に根ざしたリハビリテーション）専門職、 義肢/装具士その他） 経験を共有できる、海外の関係者を招待することも検討せよ。 2 1 0 3. 管理者/関係者向けWSTP計画ツール 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 下の白地要約欄に記入 10 分野の各々について、最もよく当てはまる白地欄をマルで囲む/強調する 1. 政策および政策策定：政策/国家障害者計画/車椅子サービス提与に関連する法律 要約： 支援機器供与に、具体的に 言及した政策/計画が存在 しない。 国としての方策はない。 一般的な政策/計画はある が、CRPD（障害者の権利に 関する条約）や車椅子ガイ ドラインに沿っていないか 関係者に知られていない。 それらは実行されておらず また時代遅れである。 政策/計画があり、ほとんど の関係者に知られている。 それらは、CRPD や車椅子 ガイドラインにある程度は 沿っているが実行されてい ない。 政策/計画があり、CRPDと 車椅子ガイドラインに沿 っている。それらは定期的 に見直され、あらゆる関係 者によく知られており、広 く実行されている。 追加を検討する授業： CRPD/WHO ガイドライン に沿って政策/国家障害者 計画/国の基準を策定/起草 する。 CRPD/車椅子ガイドライ ンを基準に政策を見直す。 適正な車椅子サービスを 提唱する政策を運用可能 にする方法。 政策を活用して車椅子提供 を強化する。 他国が政策を開発/実施 するのを支援する方法。 2 1 1 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 2. 政策および政策策定：障害者の権利に関する条約（CRPD） 要約： CRPD に署名しておらず、 政府も同条約に関する国内 での取り組みを行なってい ない。 CRPDには署名しているが 批准していない。国内では よく知られておらず、推進 もされていない。 CRPDに署名しそれを批准 しているが、同条約に対す る認知やモニタリングは 弱い。 国は CRPD に署名し批准 しており、その進捗を評価 するための、強力なモニタ リングのしくみを備えて いる。 追加を検討する授業： CRPD およびその車椅子 サービス提供との関連へ の認識を高める。 CRPD およびその車椅子 サービス提供との関連を 宣伝する方法。 車椅子サービスに関する モニタリングのしくみ/ 組織を見直す/開発する。 モニタリングのデータを 見直し、CRPDに関する車 椅子サービス事業の強み と弱点を明確にする。 3. 政策および政策策定：WHO 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて（車椅子ガイドライン）」に関する知識 要約： 同ガイドラインについては 車椅子サービス提供に携わ る関係者の間でもほとんど あるいはまったく知られて いない。 同ガイドラインについて、 限られた人数の関係者は 知っているが、その普及は 非常に限られている。 同ガイドラインは、主要な 車椅子関係者間ではよく 知られているが、政府や 主流の障害/開発関係者の 間では知られていない。 同ガイドラインはよく知 られており、政府その他の 関係者の間で、車椅子サー ビス事業を計画・実施する ための主要な指針資料と して活用されている。 追加を検討する授業： 同ガイドラインの内容およ び背景に関する提示。 同ガイドラインを推進 するための、一般的方策を 策定する。 特定部門に対して同ガイ ドラインを普及するため の方策。 同ガイドラインの達成状 況に関する国内の/国際的 なケーススタディ。 2 1 2 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 4. 政策および政策策定：国の社会基盤および車椅子与 への取り組みの調和 要約： 国が状況不安定/緊急事態 で、公的社会基盤がほとん ど存在しない。 リハビリテーションへの取 り組みは最低限度で、その ほとんどは国際 NGO/国内 NGO部門が運営している。 国の組織化と資金力が貧弱 で、構造が脆弱である。リハ ビリテーションは優先され ておらず取り組みも調和さ れていない。国の熟練した 人材は希少である。 社会基盤が整備され、リハ ビリテーションのサービス 事業と職員は存在するが、 各サービスの調和が取れて いないか資金力が乏しく、 その品質・量・普及範囲に は制約がある。 国のあらゆる地域に、確立 して調和されたリハビリテ ーションサービスがあるな ど、国に堅実な社会基盤が ある。 追加を検討する授業： 国際 NGO/NGO のリハビ リテーション関係者の間 の、適正な車椅子提供への 認識を高める。 国内の車椅子サービス提供 への取り組みを調和させる 方法。 作業部会または全国協会 を編成する。 国内の車椅子サービス提供 の取り組みを、調和させる 方法。 持続可能性の確保と将来、 すなわち人口高齢化に伴う 車椅子サービスへのニーズ の変化に対する計画： 5. 政策および政策策定：障害者運車の力量および障害者のインクルージョンの水準 要約： OPD（障害者団体）が弱いか 存在しない。障害者は、のけ 者にされ、差別・偏見にさら され敬遠されている。 OPD や NGO が障害分野で 活動する弱い障害者運動は あるが、活動が調和されて おらず、影響力に欠ける。 障害者はほとんど排除され ている。 OPD の力量が増すにつれ 障害者運動が成長中。生活 場面によっては、障害者の インクルージョンがあり、 CRPD に沿う障害者の権利 への認識も高まっている。 活発な障害者運動と強力な OPDの組織がある。障害者 は車椅子サービス提供に参 画しCRPDに沿った障害者 の権利もほとんどの場所で 認識されている。 追加を検討する授業： 車椅子ユーザーの権利と車 椅子サービス提供における 車椅子ユーザーおよびその 組織の役割。 車椅子提供における、自助 グループの役割の可能性： ケーススタディと共に。 どうやって車椅子サービス 提供における OPD の役割 を向上させるか。 国内の、および国際的な、 適正な車椅子サービス提供 推進におけるOPDの役割。 2 1 3 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 6. 製品：適正な車椅子および座位保持装置の入動可能性 要約： どんな車椅子も完全に不足 しており、手に入るものは 大半の人のニーズに対して 適正ではない。 1・2種類の適正な車椅子は あるが広く普及しておらず ニーズに対応できていな い。座位保持装置は、ほとん ど、あるいはまったくない。 じゅうぶんな/限られた種 類の適正な車椅子および/ または座位保持装置がある が、数量/品質/全地域への 普及には制約がある。 国のあらゆる地域に適正な 車椅子および座位保持装置 が包括的に取り揃えられて いる。 追加を検討する授業： 適正な車椅子を取り揃える。 上記ガイドラインを基準に 現地で手に入る製品を評価 する。 適正な車椅子の普及範囲 と種類の拡張、および座位 保持装置の導入。 適正な車椅子と座位保持 装置の、普及範囲と種類を 拡張する。 包括的な種類を揃えて おくことの重要性を強調 する成功談の発表。 7. サービス：車椅子サービスの状況 要約： 政府のサービスはない。 NGO による散発的な大量 配布に依存し、上記ガイド ラインに従った事前評価や 処方サービスはない。 政府やNGOの運営による、 バラついた水準の基礎的な サービス。中級レベルのサ ービスはない。紹介・相談と フォローアップは乏しい。 基礎と中級のサービスを、 車椅子ガイドラインの基準 に沿って運用しているが、 ニーズに対して不十分で、 政府のリハビリテーション サービスに統合されておら ず、ユーザーの参画やフォ ローアップは最低限度。 良質な基礎と中級レベルの サービスネットワークが、 政府の全国的サービスに統 合され、地方・国レベルで ニーズを満たしユーザーが 全面的に参画している。 追加を検討する授業： 車椅子サービスを開始する 車椅子サービス事業を 運営する 全国的ニーズに応えるため にサービス提供のポジティ ブな側面を拡大する方法。 サービスの継続的発展への 方途。 他国のサービス開発を支援 する方法。 2 1 4 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 8. サービス：リハビリテーション専門職/地域に根ざしたリハビリテーション(CBR)サービス/車椅子提与技能教習を受けた職員の利用可能性 要約： 理学/作業療法士や、CBR 専門職はほとんどいない。 車椅子提供の関連技能を持 つ人は、国内にまったく、 あるいはほとんどいない。 限られた人数の有資格専 門職と教習を受けた CBR ワーカーがいる。しかし、 車椅子提供の専門技能を 持つ人はほとんどいない。 有資格専門職がほとんど の地域に、CBRワーカーが ほとんどの地区に配置さ れている。地方によって は、車椅子提供の専門技能 教習を受けた人がいる。 全国かほとんどの地方を、 教習を受けたリハビリテー ションとCBR専門職の ネットワークが覆い車椅子 提供の技能教習を受けた人 が多数いる。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ガイドラインと、 WSTPモジュールへの認識 WSTPモジュールをリハビ リテーション教程に統合 する方法。 WSTPモジュールをリハビ リテーション教程に統合 する方法。 9. サービス：資金与 の利用可能性 要約： リハビリテーションのため に国内で利用できる資金は ほとんどあるいはまったく ない。ほとんどのリハビリ テーション資金は、国際 NGO/国際機関が供与。 サービスには最低限度の資 金を利用できるが、車椅子 供与に関与する資金供与は ない。 サービスと製品の両方で、 そこそこの水準の資金は 利用できるが、ニーズには 不十分である。 サービスにじゅうぶん資金 力があり、すべて/ほとんど の車椅子と座位保持装置は 国の制度を通して資金供与 される。 追加を検討する授業： 国際 NGO/NGO 関係者の 間の、適正な車椅子供与へ の認識を高める。 適正な車椅子供与と障害者 のインクルージョンによる 保健医療費用節減を示す、 ケーススタディの発表。 多様なニーズに合う、さま ざまなコストでさまざまな 種類の適正な車椅子が揃う ことの重要性。 効果的なサービスの有益さ に関するケーススタディ で、それらが維持されるた め、また教訓として他者と 共有されるためのもの。 2 1 5 段階を説明する 簡潔な情報 初期段階 成長中 成熟中 じゅうぶんに機能 10. 教習：車椅子ユーザーを含む、車椅子サービス職員が受けられる教習 要約： 車椅子提供教習が国内では まったく受けられない。国 のリハビリテーション訓練 学校がない。 限定的な車椅子提供教習が CBR/その他の教習コース に含まれているが、車椅子 ガイドラインに沿ったもの ではない。車椅子ユーザー の技能教習はない。 さまざまな幹部職員には 教習が提供され、WSTPか 同等のパッケージの教習 を実施できる限られた数 の人がいる。若干の車椅子 ユーザー教習がある。 車椅子ガイドラインに沿っ た基礎および中級レベルの 車椅子提供技能教習コース が定期的に実施され、他の リハビリテーション専門職 教程に統合されている。 追加を検討する授業： 車椅子ガイドラインと、 WSTPモジュールへの認識 さまざまな部門に対する、 教習ニーズの分析。 車椅子ガイドラインと、 WSTPモジュールへの認識 車椅子ユーザーに対する、 ピア教習への認識。 リハビリテーション専門職 および車椅子ユーザーの、 車椅子提供技能を向上させ る方策を開発する。 車椅子専門職の技能を、 中級/上級レベルへ発展 させる方策。 216 4. 車椅子サービス管理者向け教習や関係者向けワークショップの設定可能な成果 最も適切かつ達成可能な成果を見定め、それを押さえるためにはどれくらい時間が必要か検討せよ。 適切であれば、授業時間または授業範囲を拡張せよ。 教習パッケージで特定した、以下の領域を考慮せよ： 管理者向けWSTP • 車椅子サービス提供の 8 ステップへの認識を高める。 • 車椅子サービス事業を開始する方法への知識と技能を高める。 • 車椅子サービス事業を運営する方法への知識と技能を高める。 • 車椅子供与を持続可能にする方法への認識を高める。 • 車椅子サービス提供の質を高める。 関係者向けWSTP • 適正な車椅子へのニーズおよびその有益さについての理解を深める。 • 関係者に、適正な車椅子サービス提供を発展させるうえでの各自の役割を伝える。 • バリアフリー環境への理解を深める。 • 予算支援を見出す/提供することへのより深い関与を得る。 • 車椅子サービス提供の持続可能性を高める。 現地の状況およびニーズに基づき、以下の可能な追加的成果を検討するか、独自の成果を特定せよ。 • 車椅子サービス提供のための国の政策を策定/起草する。 • 車椅子サービス提供のための国の方策を策定/起草する。 • 車椅子問題を調整し推進する作業部会を任命する。 • 車椅子/支援製品協会あるいは研究会を設立する。 • 車椅子サービス提供のための国の基準に合意する。 • 既存の車椅子と座位保持の種類を、WHO 車椅子ガイドラインに照らし評価する • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」への認識を高める。 • CRPD その他の国際的法律文書と、それらと車椅子サービス提供との関連への認識を高める。 • 車椅子サービス提供をよりよく調整する。 • 車椅子サービス事業管理に携わる職員の技能を向上させる。 217 • 車椅子サービス提供の、世界/地域/国内における状況に対する理解を深める。 • 車椅子サービス提供教習へのニーズ分析を完成する。 車椅子サービス教習員養成教習パッケージ 管理者/関係者向け教習員指導書 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

車椅子サービス 教習員養成教習パッケージ j 中級教習員指導書 車椅子サービス教習員養成教習パッケージ・中級教習員指導書 © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: Trainer’s manual intermediate level. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: Trainer’s manual intermediate level. ジュネーブ: 世界保健機関; 2017. ライセンス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャ hリテ ィーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インデ ィア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーシ ョン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医 学研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人 道のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワール ド・ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: Trainer’s Manual Intermediate Level” の全訳である。序章の 「はめめに」で述べている通り、本書を含む この 車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings” （訳訳 動車車椅子与 の世界ガイドライン 低リソース 状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたものである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移車支援機器与 に関する共同方針提言書：個人的移車性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子与 ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬授業実習からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同めで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳と校閲では以下の方々のご協力をいただきました。ここにお名前を 記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: Trainer’s Manual Intermediate Level, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひめ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 1. ToT 教習員への手引き xiii 2. 教習パッケージ実施準備のやり方 xvii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 13 ToT.3 模擬授業について 26 ToT.4 多様性に備える 37 ToT.5 成人学習 44 ToT.6 準備時間について 56 ToT.7 プレゼンテーションとファシリテーション 59 ToT.8 コミュニケーションスキル 68 ToT.9 指針文書の知識 76 ToT.10 視聴覚ツールおよび機材 93 ToT.11 フィードバックについて 104 ToT.12 グループダイナミクスを取り仕切る 110 中級教習モジュール 118 A.1: 付加姿勢支持が有益な車椅子ユーザー 119 A.2: 障害児 121 B.1: 事前評価の概略・事前評価インタビュー 123 B.2: 身体的事前評価−支えなしの座位姿勢 125 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック 128 B.4: 身体的事前評価−ハンド・シミュレーション 131 B.5: 身体的事前評価−身体計測 135 B.6: 車椅子およびクッションの選択 138 B.7: 姿勢支持具の処方（選択）−はじめに 141 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる 143 B.9: 姿勢支持具の処方（選択）−股関節を支える 150 B.10: 姿勢支持具の処方（選択）−体幹を支える 151 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を支える 155 B.12: 製品（車椅子）の下準備 157 B.13: フィッティング 158 B.14: ユーザー教習 159 B.16: メンテナンス・修理・フォローアップ 160 実習 1〜4 162 B.15&17: 総まとめ&教習員からのフィードバック・討論・閉講式 165 教習運営実務と準備 166 付録 171 付録１：WSTPtot 必須授業時間割 171 付録２：WSTPtot 中級教習時間割 172 付録 3：WSTPtot 模擬授業フィードバックシート 174 付録 4：技術に関する付録：中級 WSTP 向け 177 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008 年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4 種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHO は、WSTPtot の発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtot は、単一の「必須教習技能」モジュール3、および既成の 4 教習パッケージ（2012 年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013 年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015 年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtot では、WSTPm と WSTPs は、一つの教習パッケージ別モジュールと して統合されている。 WSTPtot は 40 時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtot の修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi 対象者 WSTPtot は、以下 4 つのモジュールからなる： • 必須教習技能5：2 日間 • 基礎教習（WSTPb）：3 日間 • 中級教習（WSTPi）：3 日間 • 管理者/関係者向け教習（WSTPm/s）：3 日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向け、または関係者向け WSTP の実施を 計画している教習員が対象である。実習生が WSTPtot 管理者/関係者向け教習から最大限の成果 を得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業 の必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習6 の機会を得る必要がある。 5 [原文] Core Training Skills 6 [原文] co-training xii 教習員 技能：このパッケージを実施する ToT 教習員には、以下が求められる： • 中級 WSTP 教習を実施し、またその実施のために他の人を指導した豊富な経験 • WSTPtot を実施するところの状況に対する深い理解 • 車椅子供与に関連する、国際的指針文書7に関する知識 • 車椅子供与に関する議論に関係者を惹き込んだ経験およびその能力 車椅子ユーザー：他の WSTP［車椅子サービス教習パッケージ］と同様、車椅子ユーザーを教習 チームに含めるよう強く推奨する。車椅子ユーザーは自身の経験をもとに、適正な車椅子供与が、 自分のインクルージョンの実感8や QOL へどう影響したかについて、貴重な見解を示せる。また、 車椅子ユーザーが自身の車椅子を選択するうえで果たす、中心的役割についても語ることができる。 ToT教習員の人数：実習生は注意深く支援する必要があるため、基礎または中級モジュールでは 実習生 4〜5 名ごと、管理者/関係者向けモジュールでは実習生 6 名ごとに ToT 教習員 1 名を置く よう推奨する。 開始までの流れ ToT プログラム実施に先立ち、WSTP 用 USB メモリ9から WSTPtot フォルダーをコンピューター のハードドライブにコピー10する。 • 次ページの「1. ToT 教習員への手引き」を読む。xviii-xxiv ページの表にある資材を準備する。 • 「教習パッケージ実施準備のやり方」の章が示す通りに、必要な段取りをすべてやっておく。 • 各受講者に、本書 xviii-xx ページに挙げた教習教材一式を配布する。 7 [原文] international guiding documents 8 [原文] their feeling of inclusion 9 [原文] WSTP Pen Drive [訳注] 英語版のみが WHO より配布されている. 10 [訳注] 英語版のみ. 日本語版は教習パッケージフォルダーをダウンロードして使用. 以下同じ. xiii 1. ToT 教習員への動引き 教習の概略 必須教習技能モジュール 分 日 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 75 第 １ 日 ToT.2 車椅子サービス教習パッケージとは 90 ToT.3 模擬授業について 60 ToT.4 多様性に備える 60 ToT.5 成人学習 85 ToT.6 準備時間について 15 準備時間 45 ToT.7 プレゼンテーションとファシリテーション 60 第 ２ 日 ToT.8 コミュニケーションスキル 90 ToT.9 指針文書の知識 75 ToT.10 視聴覚ツールおよび機材 45 ToT.11 フィードバックについて 45 ToT.12 グループダイナミクスを取り仕切る 40 準備時間 75 中級教習モジュール B.2: 身体的事前評価−支えなしの座位姿勢 120 第 ３ 日 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック 120 B.4: 身体的事前評価−ハンド・シミュレーション 75 授業準備・ToT 教習員の個別フィードバック 75 B.5: 身体的事前評価−身体計測 47 B.6: 車椅子およびクッションの選択 75 B.7: 車椅子の処方（選択）−はめめに 75 第 ４ 日 B.8: 車椅子の処方（選択）−骨盤を安定させる 135 B.9: 車椅子の処方（選択）−股関節を支える 60 B.10: 車椅子の処方（選択）−体幹を支える（パート１） 135 授業準備・ToT 教習員の個別フィードバック 75 B.11: 車椅子の処方（選択）−頭・大腿・下腿を支える 135 第 ５ 日 B.12: 製品の下準備 75 B.13: フィッティング 75 B.14: ユーザー教習 75 ToT 教習員の個別フィードバック 30 閉講式 15 教習時間計 2257 xiv 教習パッケージの時間割および期間 WSTPtot 「必須教習技能」および 「中級教習」モジュールは連続した数日間で、あるいは一定期間 に数ブロックに分けて実施できる。連続した 5 日間での時間割の一例を、WSTP 用 USB メモリ内 の WSTPtot フォルダーに載せている11。 ToT 教習員には、現地の事情および受講者の学習ニーズに合わせ、この時間割を調整し、修正する よう奨励する。 必須教習技能」の授業計画 「必須教習技能」モジュールは 12 教科からなり、各々の詳しい授業計画から始まる。計画は以下 の要点を押さえ、ToT 教習員が、各授業を計画し実施するのに役立つよう設計されている12。 • ねらい13：その授業のねらいは何か • 学習目標14：実習生は、その授業が終わるまでに何を達成するのか • 教材：その授業にはどんな教材が必要か • 準備15：ToT 教習員がその授業を準備するのに役立つ確認表 • あらすじ16：時間配分を含む、その授業の主な内容 ToT 教習員には、授業に自分自身の知識、技能、スタイルを取り入れ、また WSTPtot 教習全体を 通して実習生の経験を引き出すよう奨励する。 中級WSTPの授業計画 「必須教習技能」モジュール修了後、実習生は WSTPtot の第 2 部へと進み、中級 WSTP からの 授業を実施することにより学んだ教習技能を実践する。実習生には [模擬] 授業を割り振り、授業 実施に続いてフィードバックと討論を行なう。模擬授業の時間17は、ToT 教習員に実習生の技能を 観察し、評価する機会を与える。 11 [訳注] WSTP 用 USB メモリは英語版のみ. 時間割の日本語版は本書の付録 1 を参照. 12 [訳注] 分かりやすさのため、受講者への語りは ですます調」、教習員への指示は である調」で区別した。 13 [原文] Aim 14 [原文] Learning objectives 15 [原文] To prepare 16 [原文] Outline 17 [原文] practice delivery sessions xv • 模擬授業18 ：各模擬授業の内容は、実習生による割り振られた授業項目のプレゼンテーション19 などである。 • ToT教習員のデモ20 ：ToT 教習員が、優れた実践21の例22として教授する項目を含む授業もある。 • フィードバック：授業後、ToT 教習員は、実習生および模擬受講者からのフィードバックでは ファシリテーターを務める。フィードバックを与える際の詳しい指導内容は、本マニュアルの xxv-xxvi ページ「模擬授業のファシリテーション要領」を参照。 実習生に模擬授業を準備させる 実習生が WSTPtot のためにじゅうぶん準備できるように、中級 WSTP の資料を事前に渡しておく ことが重要である。これは教習パッケージの紙コピーでも電子コピーでもダウンロードリンクでも よい。実習生は、どの授業でも実施できるように準備しておくべきである。 実習生に WSTPtot への準備をさせるための指示書の見本は、WSTP 用 USB メモリ内の WSTPtot フォルダーに載せている。 模擬授業の割り振り 模擬授業割り振りの例は、WSTPtot フォルダー内「WSTPtot 中級教習割り振り」ファイルを参照。 ToT 教習員は、これを各自の教習状況および実習生数に合わせて修正すること。模擬授業は 「必須 教習技能」モジュール第 1 日の授業「ToT. 3 模擬授業について」で割り振りを決める。 注記：実習生が「必須技能教習」モジュール履修済みで、いきなり中級教習モジュールから始める 場合は、各々の模擬授業について 2・3 日前に23通知しておくべきである。 18 [原文] practice delivery 19 [原文] presentations [訳注] この語の本書での意味は授業 ToT.7 を参照. 20 [原文] demonstrations [訳注]「やって見せること・実演すること」という意味での「デモ」. 21 [原文] good practice [訳注] 以下同じ, 頻出. セミナー等では「グッドプラクティス」と訳される場合もある. 22 [原文] an example 23 [原文] two-to-three days in advance xvi メンター24およびピアサポート25 ToT 教習員には、メンター26という重要な役割がある。教習プログラムの最初に、各実習生には、 メンター21 の ToT 教習員を必ず割り当てよ。実習生は、ToT 教習員で均等に分け合うべきである。 メンターの ToT 教習員は、自分の実習生から模擬授業に関する質問を受け、また実習生の進歩に 対してフィードバックも与える、主要な接点27である。 ToT 教習員には、WSTPtot 教習後も、実習生に対するメンターを継続するよう勧める。 実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各々の技能と自信とを養うために 役立つ。実習生がソーシャルメディア上のグループに参加するかグループを立ち上げ、質問したり 学習経験を共有したりできると有益であろう。 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員に付いて見習い教習を実施し、自らの技能を育成し 続けなければならない。ToT 教習員は、実習生が WSTPtot 修了後に見習い教習を経験することを、 自らの教習技能を育成し続けるための最良の方途として奨励しなければならない。 見習い教習では、教習指導員 1 名に対して実習生 2〜4 名の割合を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、模擬授業からのフィードバックで記録し、実習生と共有すべきである。 実施ごとに ToT プログラムを事後評価する 教習プログラムを一つひとつ実施後に評価するのは優れた実践である。ToT 教習員は、実習生から 定期的にフィードバックを集め、ToT プログラムの間に自分が考察したことを記録しておくべきで ある。これは、ToT 教習員が WSTPtot および自分自身の教習技能の両方を改善するために役立つ。 例えば、以下のフィードバックおよびデータを提供できると、たいへん有用である： • 受講者の登録および評価フォーム • WSTPtot に関する自分自身の考察やコメント 教習プログラム評価フォームは WSTP 用 USB メモリ内の WSTPtot フォルダーに収めており、 ToT 教習員は、これを各自のニーズに合わせて修正してよい。 24 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 25 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 26 [原文] mentor [訳注] 本書では助言指導 mentor, その行為 mentoring と指導者 mentor は「メンター」に一括. 27 [原文] main point of contact xvii 2. 教習パッケージ実施準備のやり方 各実習生の経歴28を知る 各実習生の経歴を熟知することは重要である。例えば： • 車椅子供与において、実習生がすでにどんな経験を有しているのか把握する。 • 実習生がすでに履修あるいは実施したことがある教習プログラムをすべて分かっている。 • 実習生が、自分が中級 WSTP を実施する機会が将来あるかどうか知っている。 車椅子サービス提供が、実習生の勤務先での業務全体にどう組み込まれているのか見極めよ。 教習施設を準備する WSTPtot を実行するために必要な施設： • 広い教室（またはスペース）1 室：実習生が小グループに分かれて作業できるくらいじゅうぶん 広く、また実習生が集中できるくらいじゅうぶん静かであること • 昼食/軽食のための独立したスペース • 清潔なトイレ トイレをはじめあらゆるエリアは、絶対に車椅子でアクセスしやすくなければならない。 28 [原文] background xviii 下の確認表を、教習施設の下調べと準備に用いるとよい。 教習施設確認表 教室 講義エリア □ 各実習生用の椅子：折りたたみテーブルなど実習生がノートを取れる設備があるもの □ 実習生が 2〜4人ずつの小グループに分かれられるスペース □ 最低 3台の車椅子を展示し、動かして回れるスペース □ めゅうぶんな照明および換気 □ 施錠可能/安全なスペース □ 昼食/軽食エリア 清潔な食事エリア □ テーブルと椅子 □ 近くの手洗い場：清潔なタオルおよび石けん □ トイレ 水場、トイレットペーパー、手洗い設備、ゴミ入れを備えた清潔なトイレ □ 教材および設備を準備する WSTPtot の印刷教材 教材 数量 X 注/備考 マニュアル類 ToT 教習員用指導書 ToT 教習員 1人に（教授する モジュールにつき）1冊 □ 印刷して製本。 ToT ハンドブック 実習生 1人に（教授する モジュールにつき）1冊、 ToT 教習員 1人に 1冊 □ 印刷して製本。 WHO「手動車椅子供与の世界 ガイドライン 低リソース状況 の克服に向けて」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 国際連合「障害者の権利に 関する条約（CRPD）」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 教習パッケージ別モジュール （中級WSTP）用印刷教材 セット 実習生・ToT 教習員 1 人に 1セット □ マニュアル類、ワークブ ック、ポスター、フォー ムと確認表など。詳しく は以下の表を参照。 xix 教習プログラム用フォーム類 受講者登録フォーム 1 プログラムに 1部 □ 受講者の参加記録にこの フォームを使用。 名札 実習生・ToT 教習員 1 人に 1枚 □ ― 時間割表（必須教習技能および 教習パッケージ別モジュール） 実習生 1人に該当する モジュールを 1部ずつ □ 各モジュールの見本を、 WSTP用 USB メモリに収載。 現地の事情に合わせて調整。 写真撮影同意フォーム 1 部 □ 主催/教習実施団体向けに修正 し、現地語に翻訳して、写真 を撮られる人には、必ずこの フォームに署名してもらう。 実習修了証 実習生 1人に 1部 □ 実習修了証は、準備するか WSTP用 USB メモリに所収 のひな形を改変。 教習プログラム評価フォーム • 必須教習技能 • 教習パッケージ別モジュール 実習生 1人に 1部 □ 実施後に情報を集約し、 WHOと共有。 WSTPtot 模擬授業フィード バックシート ToT 教習員には実習生 1人につき 1部必要 □ 実習生 1人につき最低 1部を 印刷。このシートは 3回まで の模擬授業に対するフィード バックに使用可能。 xx 中級WSTPの印刷教材 教材 数量 X 注/備考 マニュアル類、ワークブック、ポスター 教習員用指導書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 参考書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 受講者用ワークブック 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 ポスターセット 内容： • 子どもと車椅子 • さまざまな体位 • 姿勢支持具（PSD）一覧表 • 中級車椅子ユーザー教習確認表 実習生・ToT 教習員 1 人に 1セット □ ― 車椅子サービスフォーム・確認表 中級車椅子事前評価フォーム □ ― 中級車椅子処方フォーム □ ― 中級車椅子フィッティング確認表 □ 印刷してラミネート加工。 確認表は中級WSTP教材 「各種フォーム＆確認表」 に収載。 中級車椅子ユーザー教習確認表 □ 中級車椅子の安全・準備完了確認表 □ 姿勢支持具（PSD）一覧表 □ xxi 設備 一般的な教習設備 物品 数量 X 注/備考 大きなホワイトボード 1 □ ― ホワイトボードマーカー 3〜4本 □ さまざまな色のもの プロジェクター 1 台 □ ― コンピューター 1 台 □ ― ポータブルスピーカー 1 セット □ 動画の音質向上用 ポインター/リモコン 1 □ ― フリップチャート用イーゼル および用紙 イーゼル 1〜2架 および用紙 1包 □ フリップチャート用マーカーペン 3〜4本 □ さまざまな色のもの 付箋紙 3〜4冊 □ さまざまな色のもの マスキングテープか類似品 1 巻 □ フリップチャート紙やポスターを 壁に貼るため 延長コード 最低 1つ □ ― 電源タップ/アダプター 必要に応めて ― xxii 中級教習用設備 物品 数量 X 注/備考 硬いウレタンフォームのブロック 30 x 150 x 300 mm 9 □ ― 硬いウレタンフォームのウェッジ 30 x 150 x 300 mm 9 □ 中級WSTP教習員用指導書・ 付録２の図を参照 ボール紙/プラスチック製の角度計 （ゴニオメーター） 3 □ ― 巻尺 3 巻 □ 硬い巻き取り式巻尺（裁縫用巻 尺ではなく）でmm単位のもの クリップボード 6 枚 □ ― 評価ベッド29 3 台 □ ― 足乗せブロックのセット30 3 セット □ ― 車椅子：現地で動に入る車椅子および座位保持シートを最低各 1台/個。どの車椅子も、正常に 車作しクッションが付いていること。 座位保持付き車椅子 2〜3台 □ ― 折りたたみフレームで基本的また は調節可能な 4輪の手動車椅子 広く使われている ものを 2〜3台 ひめ掛けがないもの /さまざまなひめ掛 けのものを揃える □ ― リジッドフレームで 4輪の手動 車椅子 □ ― 座面が固定したもの 広く使われている ものを 1〜2台 □ ― 座面と背もたれがスリングの手動 車椅子（授業 B.10 用） 1 台 □ ― 29 [原文] assessment bed [訳注]「管理者向け車椅子サービス教習パッケージ補足資料」p.8 を参照. 30 [原文] set of foot blocks [訳注]「管理者向け車椅子サービス教習パッケージ補足資料」p.9 を参照. xxiii ホイールベースが長い、できれば ソリッドな座面と背もたれの手動 車椅子（授業B.10 用） 1 台 □ ― 折りたたみフレームで子ども用サ イズ、座面と背もたれがスリング の手動車椅子（授業 B.10 用） 1 台 □ ― 基本的な工具箱：教習中の車椅子 調節用 1 箱 □ ― クッション 水平でないまま固まった骨盤を 支えるために改造したクッション 1 枚 □ ― 片側がニュートラルな座位姿勢ま で屈曲しない（体幹〜大腿の角度 が 90度超の）股関節を支える ために改造したクッション 1 枚 □ ― 両側がニュートラルな座位姿勢ま で屈曲しない（体幹〜大腿の角度 が 90度超の）股関節に形を合わ せるやり方のデモ用に、大きな （高さ 20 cm 以上の）ウェッジ が付いた（標準的）クッション 1 枚 □ ― 片側または両側がニュートラルな 座位姿勢まで伸展しない（体幹〜 大腿の角度が 90度未満の） 股関節を支えるために改造した クッション 1 枚 □ ― 改造して、骨盤前傾用ウェッジを 設けたクッション 1 枚 □ ― 上記の車椅子の、各々に合った クッション 上記の車椅子用の クッション □ ― xxiv 姿勢支持具（PSD）キット：以下の姿勢支持具の現地で使える見本。教習プログラムで学習す るさまざまな支えをやって見せるために役立つ。教習員は既製品の姿勢支持具で広く手に入る ものについて、あらゆる見本を揃えておくよう心がけること。 骨盤側方パッド 2 個 □ ― 大腿外側パッド 2 個 □ ― 膝分離パッド 1 個 □ ― 張り調整背もたれ 1 個 □ ― 体幹側方パッド 2 個 □ ― ヘッドレスト 1 個 □ ― 骨盤ベルト 各グループに 1本 □ ― 下腿ベルト 1 本 □ ― 足ベルト 2 本 □ ― 肩ハーネス 1 本 □ ― 現地で使われている以下の素材の見本：授業 B.12「製品の下準備」のデモのみに使用。 ソリッド座面・背もたれ用の木/ 金属/プラスチック 現地で手に入るも のを各種 1枚ずつ □ ― 硬いウレタンフォーム（チップ ウレタン） 5 枚 □ 50 x 400 x 400 mm 柔らかいウレタンフォーム 5 枚 □ 50 x 400 x 400 mm EVA フォーム 5 枚 □ 50 x 400 x 400 mm クッションカバー生地の見本 現地で手に入るもの を各種 1枚ずつ □ 伸縮性があり、丈夫で耐水性の もの ナイロンベルト地 現地で手に入るもの を各種 1枚ずつ □ ― バックル付き面ファスナー 現地で手に入るもの を各種 1本ずつ □ ― ファスナー 現地で手に入るもの を各種 1本ずつ □ ― ボルトとナット 現地で手に入るもの を各種 1個ずつ □ ― xxv 教習教材について知る ToT 教習員は、中級 WSTP 教材すべてを包括的に知っている必要がある。これには教習パッケージ 別の「教習員用指導書」ならびに「受講者用参考書」「受講者用ワークブック」そして WSTP 用 USB メモリ内のその他の教材の、あらゆる面に精通することが含まれる。 また「ToT 教習員用指導書」と「ToT ハンドブック」の全項目を熟知していることも必要である。 WSTPtot 教習は他の ToT 教習員と共同で実施してもよいが、その場合でも自分がすべての授業を 熟知していることは重要である。例えば、WSTPtot で教わる「必須教習技能」はすべてじゅうぶん に理解し、自分の授業において優れた実践としてお手本を示せるべきである。 模擬授業のファシリテーション要領 • 授業時間をモニターし、予定時間を過ぎたら、完了していなくても実習生を停止させよ。 • 授業を複数の実習生で分け持つ場合は、流れを止めないよう授業全体を実行した後で、各実習生 に対するフィードバックのファシリテーションを順番に行なえ（WSTPtot の時間配分により、 休憩が必要な授業を除く）。 • 「ToT 教習員用指導書」中の「WSTP 教材の誤り」と「この授業を教えるための主な留意点」を 熟知し、実習生がそれらを取り上げたか確認せよ。 • 授業は「WSTP 教習員用指導書」および「ToT 教習員用指導書」に沿って進めよ。 • 授業中、WSTP 用 USB メモリ内の「WSTPtot 模擬授業フィードバックシート」を記入せよ。 • 模擬授業中、授業がスムーズに進まないからといって早まって介入しないこと31。実習生に自力 で状況を軌道修正し32受講者を方向転換させる33時間を与えよ。介入するのは、安全上の懸念が 生じたか、実習生が自力で授業を軌道に戻せなくなった34場合だけにせよ。 31 [原文] don’t step in foo quickly 32 [原文] rectify the situation 33 [原文] redirect participants 34 [原文] unable to bring the session back on track themselves xxvi 模擬授業後のフィードバックでファシリテーションを行なう ToT 教習員の役割は、フィードバック時間にファシリテーションを行ない、それを簡潔で建設的、 かつ的確な35ものにすることである。 模擬授業が完了したら、以下のプロセスをたどること。 *「WSTPtot 模擬授業フィードバックシート」内に収載。 フィードバックが建設的になるよう、注意深くモニターせよ。受講者がネガティブまたは傷つける ような36フィードバックを発したら介入せよ。フィードバックを建設的に言い換える見本を示せ。 個別フィードバック ToT 教習員へのメンターの割り振りに基づいて、ToT 教習員は、各実習生と「WSTPtot 模擬授業 フィードバックシート」を指針に用いながらフィードバックを交わす時間を設定する。この時間は、 追加の、またはデリケートなコメント37をフィードバックするためにも活用せよ。 35 [原文] brief, constructive and relevant 36 [原文] hurtful 37 [原文] sensitive comments 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 ね ら い WSTPtot（車椅子サービス教習員養成教習パッケージ）を実習生に紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  ToT［教習員養成教習］プログラムのねらいおよび目標を詳述する。  ToTプログラム時間割およびWSTPtotの課程を説明する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.1：WSTPtot紹介」  各 ToT教習員の名札 各実習生に：  さまざまな色の付箋紙（A5くらいのサイズ）：3〜4枚  「ToTハンドブック」  モジュール別WSTP［車椅子サービス教習パッケージ］の教習員用指導書、受講者用 参考書およびワークブック、ポスター、WSTP用 USBメモリ  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」および 「障害者の権利に関する条約（CRPD）」  「必須教習技能」モジュールおよび教習パッケージ別モジュールの時間割表  白紙の名札 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  現地に適した短いWSTPtot開講式を段取る。  庶務連絡1を準備。  「基本ルール2」および「保留スペース3」のフリップチャート紙を準備。  教室を設営：テーブルと椅子、プロジェクター、コンピューターとスクリーン、 ホワイトボード、フリップチャート用イーゼルと用紙、マーカーペン。  教材を受講者ごとのセットに仕分けして取り置く。混乱を避けるため、この日は最初 実習生に「ToTハンドブック」、各自の教習パッケージ別「WSTP教習員用指導書」 と ToT時間割表のみを配布する。残りの教材は、この日の終わりに配布。  「経験の壁4」を準備。 5節に示した見出しを大きい付箋紙か A5用紙に印刷するか 記入するかし、壁に「経験の壁」の見出しを付けて、その下に貼っておく。 1 [原文] housekeeping information 2 [原文] Ground Rules 3 [原文] Car Park 4 [原文] Wall of Experience 3 あ ら す じ 1. 開講式 2. 歓迎あいさつ・自己紹介5 3. この授業のはめめに 4. 庶務連絡および「基本ルール」 5. 経験の壁 6. WSTPtotの概略 7. 要点のまとめ 10 10 1 10 15 27 2 授業時間計 75 開講式（10分） 主催団体と共同で、現地に適した WSTPtot 開講式を挙行せよ。 歓迎あいさつ・自己紹介（10分） ToT 教習員へ：全員を歓迎して自己紹介せよ。自 分の経歴および車椅子供与と教習の経験に関し て、概略を簡潔に伝えよ。 実習生に、自分の名前、役職、所属組織を明らかに しながら自己紹介するよう求めよ。 名札を配り、自分の名前を記入するよう実習生に 指示せよ。 この授業のはじめに（1分） この授業のねらいと学習目標を説明せよ。 5 [原文] Welcome and introductions 4 庶務連絡および 基本ルール」（10分） 必要に応じて以下を説明せよ： • トイレの場所 • 軽食および昼食の段取り • アクセシビリティに関すること • 緊急時にはどうしたらよいか • その他運営に関すること このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 説明：これから、この教習での「基本ルール」を定めましょう。 実習生に、この一週間について定めておきたい「基本ルール」を簡潔に話し 合うよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 2分、フィードバックに 9分見込んでおけ。 フィードバック： 各ペアに、各自のリストから 1 項目ずつ挙げてはフリップチャートに記録 し、それをアイデアが出尽くすまで続けるよう指示せよ。 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 これらのルールを破る人に、グループとしてはどう対処したいか尋ねよ。 「基本ルール」は、ToTプログラム全体を通して参照用に壁に掲示せよ。 5 ToT 教習員への注記： • 「基本ルール」の施行には、ToT教習員だけでなく、全員が有責であると説明せよ。 • 実習生には、「基本ルール」が破られるたびにこの表を参照させよ。 基本ルール」の例： • 携帯電話：サイレントモードにする • 私語を慎み、話の途中で割り込まない • 他者のものの見方を尊重する • どの授業にも遅刻しない • 教習スペースを整理整頓し清潔に保つ • 話し合いに貢献する • 適切な障害用語6を用いる 説明7： • WSTP では障害者に関してポジティブな用語の 使用を推進しています。 • 教習員は優れた実践の模範を示し、WSTP およ び CRPD（障害者の権利に関する条約）が定める 言語指針に従わなければなりません。 • 「the disabled」「disabled people」「special people」などは不適切な用語で、用いるべきでは ありません。 • 「persons with disabilities」または「people with disabilities」をつねに用いなさい。 • 障害がない人を指す場合に、「normal people」 の語を用いるのは避けなさい。 「基本ルール」に列挙していなければ「適切な障害 用語を用いる」を追加せよ。実習生は、ToT 全体を 通してポジティブな用語を使っているかモニター するよう提案せよ。 ToT 教習員への注記： • ここで「disabled people」の語の使用は避けるよう推奨しているものの、「Disabled People’s Organization［障害者団体］」および「DPO［左の略称］」は依然広く用いられ、また広く受 容されている。一般的になりつつある「Organization of Persons/People with Disabilities (OPD)［障害者団体］」の語を用いるよう奨励せよ。 6 [原文] disability terminology 7 [訳注] 本節では, 英語版での議論をなるべく原文通りに伝えるよう努めた. 6 説明： • 教習中、教習員が即答できないか、後の授業で取 り上げる内容の質問を受けることもあります。 • これらの質問は「保留スペース」に置き、あとで 適切な時に話し合うようにします。 「保留スペース」のフリップチャートを壁に貼り 出せ。 経験の壁（15分） このスライドは活動の間じゅう映しておけ。 7 活車２ グループ： 実習生に単独8で作業するよう指示せよ。 指導内容： 「経験の壁」の見出しを壁に貼り出せ。例えば： • 教えたか受けたWSTP教習 • 支援機器供与に関連する経験年数およびその種類 • 職歴 • 話す言語 説明：この教習に来ている私たちは、さまざまな経験、知識、技能を持って います。いっしょに「経験の壁」をつくりましょう。 それぞれの見出しごとに違う色の付箋紙を（必要なら複数枚）使い、自分の 答えを書き出して下さい。 実習生に、分かりやすく書き、壁の各見出しの下に各自の付箋紙を貼り出す よう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 実習生が付箋紙/カードごとに 1項目ずつ、分かりやすく書いていることを 確かめよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 教室内が豊富な知識、技能、経験に満ちていることへの注意を喚起せよ。 実習生はここへ至るまでにすでに長い道のりを歩んでおり、ここからさらに 経験を積み重ねて行くのだ、と強調せよ。 ToT 教習員への注記： • この「経験の壁」は、プログラムの間めゅう参照し、適宜、教習の他のパートと関連づけよ。 8 [原文] alone 8 WSTPtotの概略（27分） WSTPtot のねらい、および目標を説明せよ。 実習生に各自の ToT 時間割表を見るよう指示 せよ。 説明：ToT は次の 2 部に分かれています： • 「必須教習技能」モジュール • 教習パッケージ別モジュール。この中で実習生 は、WSTP の授業を仲間と実習します。 ToT 教習員への注記： • 「車椅子サービス教習パッケージ」には 4種あるが、うち「管理者向け」と「関係者向け」は 一つのモジュールとして取り扱うため、教習パッケージ別モジュールは 3種のみである。 各実習生に配布される教材を紹介せよ。それぞれの教材を簡潔に説明して示せ。資料によっては、 この日の終わりに配られるものもあることを説明せよ。 9 説明：WSTPtot から最大限の成果を得るには、 教習員には次のことが必要です： • 一つ以上の WSTP を修了していること • 車椅子サービス提供や障害領域9での経験がある こと • ToT プログラムを教授する、言語の読み書きが できること • 教習やファシリテーションを行なった経験が あること • ToT プログラム後に、教習パッケージを実施す る機会があること 説明： • 見習い教習は ToT プログラムの後、実習生が 独立して教習を実施する前に行なわれます。 見習い教習を経験することが、WSTPtot 修了後 も教習技能を伸ばして行く最良の道です。 • ToT プログラム修了後、実習生はみな最低 1 回 の見習い教習を経験しなければなりません。 • 経験豊富な教習員との見習い教習は、次のよう な教習技能を強化するために役立ちます： o WSTP 実施の計画と準備 o プレゼンテーションとファシリテーション o 受講者へのメンター o 教習運営実務10の調整 9 [原文] disability sector 10 [原文] logistics [訳注] 以下同じ. 10 説明：経験豊富な教習員と見習い教習を行なえな い場合は、必要とする支援を受けられる他のやり 方を検討しなさい。例えば： • 経験豊富な教習員に連絡を取り、電子メールや 電話による、遠隔メンターを依頼する • 他の ToT 実習生と連携し、助け合って WSTP の 計画、準備、実施を行なう。 説明： • 見習い教習の実行回数は、実習生によって変わ ります。 • 教習員となるまでの期間も、いつ見習い教習 ができ、何回見習い教習をやり遂げたかによ って変わります。 • ToT 教習員と、見習い教習中の実習生のメン ター教習員は、実習生が、ひとり立ちして教習を 実施するまでに見習い教習を何回完了すべき か、決めるのを手伝います。 11 実習生に、各自の「ToT ハンドブック」p.132-134 の「WSTPtot 模擬授業フィードバックシート」を 見るよう指示せよ。 説明： • 自分が上手にできたことと改善の余地があるこ とについて振り返り考察することは、よりよい 教習員になるために役立ちます。 • 「WSTPtot 模擬授業フィードバックシート」に は、この教習で育成することが目的の、実習生の 技能一覧表が載っています。 • フィードバックシートは各模擬授業後の教習員 によるフィードバックで指針に用います。 • ToT 教習員は、一日の終わりにリーダー役実習 生へフィードバックを、また、ToT プログラムの 最後に書面のフィードバックを与えるために も、これを用います。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 12 経験の壁 支援機器与 に関連する経験年数およびその種類 教えたか受けたWSTP教習 職歴 話す言語 13 ToT.2 車椅子サービス教習パッケージについて ね ら い WSTP［車椅子サービス教習パッケージ］の構成と方法論を紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  4種のWSTPを列挙する。  WSTPの指針原則を列挙する。  各教習パッケージの教習員用指導書の構成を詳述する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.2：車椅子サービス教習パッケージについて」  各実習生に、教習員用指導書（「必須教習技能」モジュールの後に各々が受講する教 習パッケージ別モジュールによって基礎 WSTP、中級 WSTP、あるいは管理者向け WSTPおよび関係者向けWSTP）の紙コピー 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  できれば、WSTP 用 USB メモリに PPT スライド p.20 へのリンクを、その使い方の 説明のために埋め込んでおく。 あ ら す じ 1. はめめに 2. WSTP 4種の沿革と存在理由 3. 各WSTPの構成 4. 「教習員用指導書」を理解する 5. WSTPの使い方 6. 要点のまとめ 2 15 5 30 35 3 授業時間計 90 14 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 WSTP 4種の背景と存在理由（15分） 説明： • WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(11)」は、2006 年 11 月にインド・バンガロールで開催された「開 発途上国への車椅子に関する合意形成会議(12)」 が土台になっています。 • 「車椅子ガイドライン」では教習機会の必要を 指摘しており、それが基礎・中級・管理者向け・ 関係者向けの各 WSTP［車椅子サービス教習パ ッケージ］開発につながりました。 11 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.wh o.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 12 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Develo ping Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブ ス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006 年 11 月 6〜11 日. インド, バン ガロール: 世界保健機関, 2006]. 15 説明： • 基礎 WSTP(13)は、移動に障害があるものの、 付加姿勢支持なしでまっすぐに座れる男女の 子どもや大人に、適正な手動車椅子および クッションを供与する職員への教習用です。 • 中級 WSTP(14)は、まっすぐに座るには付加姿勢 支持が必要な男女の子どもや大人に、適正な 手動車椅子およびクッションを供与する職員へ の教習用です。 説明： • 基礎 WSTP と中級 WSTP ともに、最短 5 日間で 実施できるように設計されています。 • 教習プログラムには、次の目的で時間を追加 することも可能です： o 授業計画に教材資料を追加する o 授業を追加する o 車椅子ユーザーとの実習回数を増やす o 教習で使用する製品に対して、さらに下準備 の時間を取る o 通訳するゆとりを設ける o 教習日数を短縮する o 重要な概念を学ぶための時間を追加する 13 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版: 基礎車椅子サービス教習パッ ケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 14 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版: 中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 16 説明： • 基礎 WSTP および中級 WSTP の目的は、車椅子 サービス提供における教習を受けた職員の数を 増やすことです。 • しかし、高職位の参画なしに、教習を受けた職員 だけで適正な車椅子供与を確立することはでき ません。 • サービス事業の発展を支援するために WHO が 開発したのが： o 管理者向け WSTP(15)：事業管理者が、適正な 車椅子供与を効果的に支援するための指針と なるように設計されています。これには、適正 な車椅子供与の確立に向けて、事業管理者や 関係者の参画を推進することも含まれます。 管理者向け WSTP は最短 2 日で実施でき ます。 o 関係者向け WSTP(16)：国/地域における適正な 車椅子供与の確立に向けて、全関係者の意識 を啓発し、技能や知識を育成するために設計 されています。最短 4 時間で実施できます。 • どちらの教習パッケージも、通訳、より詳細な 討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るため に、期間を延長して実施できます。 15 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 16 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 20 15 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 17 説明：WSTP は、以下の一群の指針原則17に従って 作成されました： • 車椅子ユーザーを車椅子サービスの中心に置く ユーザー中心で人権に根ざしたアプローチ18。 • 手に入るエビデンスに基づく19、国際的な最良の 実践例20にならう。 • 低リソース状況21に重点を置く。 • 全教習パッケージにおける教習員や教習対象者 としての、車椅子ユーザーのインクルージョン。 説明：WSTP では、取っ付きやすい非医療的なことばづかいと用語22を用い、それによって： • 臨床や技術の資格を持たない受講者も教習を受けられ、 • サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになります。 各WSTP の構成（5分） ToT 教習員への注記： • この項は簡潔に済ませよ。詳細は ToTプログラムの「必須教習技能」に続く教習パッケージ別 モジュールで教わるからである。実習生が教習パッケージ別モジュールで教授する種類の WSTPに重点を置け。 説明：それぞれのパッケージに、さまざまな教材が 含まれており： • 教習員用指導書、PPT プレゼンテーションフ ァイル、動画、ポスター、 • 基礎・中級・管理者向け WSTP には受講者用 参考書があり、 • 基礎・中級 WSTP はサービスフォーム、確認表、 別冊の受講者用ワークブックも含んでいます。 17 [原文] guiding principles 18 [原文] user-centered and rights-based approach 19 [原文] available evidence-based 20 [原文] best practice 21 [原文] less-resourced settings 22 [原文] accessible, non-medical language and terminology 18 説明：WSTP の資料はすべて、実習生の教材に含まれている WSTP 用 USB メモリに載っていま す。またこれらは、WHO のウェブサイトからもダウンロードできます。 説明：WSTP 用 USB メモリにさらに含まれている ものとしては： • 修了証 • 教習員用観察確認表 • 各種評価フォーム これら23は ToT では使いませんが、WSTP 実施中 に使うことになります。 教習員用指導書」をよく知る（30分） 説明：4 種の WSTP で取り上げる主題はそれぞれ 異なりますが、構成とアプローチはみな同じです。 活動を通して、その構成に詳しくなりましょう。 このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。実習生によって異なる教習パッケージ別モジュール を「必須教習技能」モジュール後に履修する場合は、同めパッケージの教習 を受ける実習生どうしをペアにせよ。 指導内容： ペアごとに最低、基礎・中級・管理者向けWSTP「教習員用指導書」のうち どれか 1冊が必要。 この活動のねらいは、実習生に、教習員用指導書を熟知させることであると 説明せよ。 各ペアに、協力して「ToTハンドブック」の問いに答えるよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 回答に 15分、フィードバックに 10分見込んでおけ。 23 [訳注] 日本語版:「中級車椅子サービス教習パッケージ_フォーム・確認表冊子」を https://j-aws.jp/who/に収載. 19 フィードバック： 問い 正解 1. 「教習員用指導書」の全内容の 一覧はどこで見つかりますか？ 指導書の冒頭で「もくめ」に列記。 2. グループ活動は授業の中でどう 示されていますか？ それぞれの活動について、「活動」表 にグループ分け、指導内容、モニタ ー、時間配分、フィードバックが詳述 されている。 3. 教習パッケージ全体のねらいや 目的は、どこで分かりますか？ p.2の「目的」の見出しが付いた項目。 4. 授業計画で、教習員が PPTスラ イドを映写すべきタイミングは どこに示されていますか？ 各スライドの画像が授業計画ページ の左側に、映す順番で、該当する本文 の横に載っている。 5. 教習授業の実行に必要な施設、 教材、設備はどこで分かります か？ 「教習員用指導書」の 2 部「教習 パッケージ実施準備のやり方」に 一覧表が載っている： • 基礎および中級WSTPでは p.14 • 管理者向けWSTPでは p.9 WSTPの使い方（35分） 受講者に「教習員用指導書」の第 1 部「車椅子サービス教習パッケージについて」を開くよう指示 せよ。 説明：各「教習員用指導書」の最初には、教習員に役立つ注記や指示が載っています。 受講者のひとりに、「教習員用指導書」のこの部の見出しを読み上げるよう指示せよ。 最も重要な答え： • はめめに • 対象者 • 目的 • 対象範囲 • 教習員 • 開始までの流れ 20 説明： • WSTP 用 USB メモリ内に「Read Me First」と いうファイルが見つかるでしょう24。これは重要 な文書です。 • これには、WHO からの要請として、実施した WSTP 教習プログラムについてフィードバック および以下のようなデータを提供してほしい旨 が含まれています： o 受講者登録フォームおよび評価フォーム o 教習に関する教習員の考察またはコメント 説明：「教習員用指導書」の第 2 部は「教習パッケージ実施準備のやり方」（関係者向け WSTP で は「関係者向けワークショップ実施準備のやり方」）です。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生を前の活動と同めペアに分けよ。 指導内容： 実習生に「教習パッケージ実施準備のやり方」の部にパートナーと目を通し、 そこのさまざまな項目を読んで話し合うよう指示せよ。 実習生に、質問があれば書き出すよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、各自の教習パッケージに関して、何か質問がないか尋ねよ。 教習に関する範囲を超えた質問は、取り上げる時間がないか後の授業で取り 上げるのであれば「保留スペース」に置いておくことができる。 24 [訳注] 英語版のみ. 21 ToT 教習員への注記： • 教習パッケージによって、見出し語には異同がある。 説明：授業計画は、授業を通して教習員を導く、 レシピ25のような働きをします。 授業計画に従うのは次の面で有効です： • 学習目標への集中を保つ • 時間を守る • 関連トピックについてのフォーカスグループ 活動、話し合い、質問 このスライドは活動の間じゅう映しておけ。 活車３ グループ： 実習生を前の活動と同めペアに分けよ。 指導内容： 実習生に、「授業計画の詳細」をパートナーと読んで話し合い、グループで 話し合うための質問があれば書き出すよう指示せよ。 授業は各ペアが ToT でどのパッケージを履修するかによって以下のリスト から割り当てよ： • 基礎WSTP：「教習員用指導書」の p.99「A.8: 移乗」 • 中級WSTP：「教習員用指導書」の p.52「B.1: 事前評価の概略・事前 評価インタビュー」 • 管理者向けWSTP：「教習員用指導書」の p.15「A.1: 適正な車椅子供与 とは何か？」 モニター： グループをモニターし、必要に応めて支援せよ。 25 [原文] recipe 22 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、何か質問や説明があるか尋ねよ。 パワーポイントスライドの変更に関する質問は、「保留スペース」に置いて おけ。これは「ToT.10 視聴覚ツールおよび機材」で取り扱う。 説明：各授業計画の最初に、授業概要表が載っています。 ペアの一つに尋ねよ：授業概要はどんな項目に分かれていますか？ 最も重要な答え： • 目的：授業のねらいを説明。 • 教材：授業に必要なあらゆる教材。 • 状況（中級WSTPでは 事前学習と状況」）：現地の状況/国/サービス事業に合わせる調整 への提案。 • 準備：授業が始まる前に準備しておくべきこと。 • あらすじ：時間配分を入れた、授業各項目の要約。 別のペアに尋ねよ：「状況」あるいは「事前学習と状況」のコラムの目的は何でしょうか？ 最も重要な答え： • 教習員に、現地の状況や教習を受ける受講者の種類に対して、授業計画をどう適合できるか についての指針を与える。 また別のペアに尋ねよ：教習の状況に影響を及ぼしそうなものには何があるでしょうか？ 応答を受けとめ承認せよ26。 説明：授業に影響するさまざまなものとしては： • サービス提供モデル • 受講者の経験度合い • 組織、地域または国の方針 • 処方に使える製品 26 [原文] Acknowledge responses [訳注] 以下同じ. 23 また別のペアに尋ねよ：授業計画では、動画の上映をどのように指示していますか？ 最も重要な答え： • 動画アイコンの付いた、動画のコラムで示している。 説明： • 実習生は、すべての動画の内容、関連性、タイミ ングを熟知しておくことが重要です。 • 動画の使い方についての詳細は、ToT の後の ほうで説明します。 説明：「教習員用指導書」では、教習員への手引き27として、さまざまな太字の語を用いています。 例えば：尋ねよ [指示せよ、依頼せよ]28、説明せよ、示せ [映写せよ、上映せよ]28 などです。 説明：「教習員用指導書」には、教習員への指針 として役立つ追加情報が載っています。例えば： • 教習員が受講者からの質問に答えるのに役立つ 補足情報。 • 質問への最も重要な答え • グループダイナミクスに関する助言 27 [訳注] 受講者への語り (「ですます」調) と区別しやすいよう, 訳文では「である」調・命令口調を用いている. 28 [訳注] 文脈によって[ ]内の訳語も用いている. 24 また別のペアに尋ねよ：授業計画の「活動」コラムはどんな情報を与えていますか？ 最も重要な答え： • グループ：活動のために、どうグループ全体を分けるか。 • 指導内容：活動をどのように実施すべきか、受講者に何を話すべきか。 • モニター：活動中、どのようにグループをモニターして正しい作業を行なうようにするか。 • 時間：活動時間および最後のフィードバック時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき要点、受講者の思考や感覚を引き出す方法。 説明：WSTP の電子コピーは、コンピューターのハードドライブ上でも外部ストレージ（DVD や WSTP 用 USB メモリ）上でも実行できます。 スライドショーを終了せよ。WSTP 用メモリのフォルダーを、WSTP 用 USB メモリあるいはコン ピューター上のファイルから引き出せ29。 「START.pdf」ファイルを開いてプロジェクターで映写せよ。 説明：教材には、WSTP 用メモリの一般的メニューからでも、「START」上のメニューをクリッ クしてもアクセスできます。 リンクを示せ。授業を一つか二つクリックし、PPT を上映せよ。 説明： • 動画は、これらのファイルの PDF 版プレゼンテーションファイルには埋め込まれています30。 • 個別の PPT 形式プレゼンテーションファイルもすべて用意されており、必要なら改変可能です。 PPT ファイルの改変については、後の授業で話し合います。 ToT 教習員への注記： • アップル（Mac）コンピューターの場合、Adobe Proか類似のソフトで開かない限り、「START」 ファイルを開いても「START」メニューからリンク先には飛べない。 説明：どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」(管理者向け WSTP のみ) です。 29 [訳注] この下 4 行 (「START.pdf」ファイルを開いて…PPT を上映せよ。) の操作は, 英語版でのみ可能. 30 [訳注] 英語版のみ. 25 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 26 ToT.3 模擬授業について ね ら い 教習パッケージ別モジュールと模擬受講者および教習員の役割について、詳細を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPtotにおける、模擬授業のねらいと構成を詳述する。  リーダー役実習生と補助役実習生の役割と担当を詳述する。  自分が担当するのはどの模擬授業かがわかる。  模擬授業をどうやって準備するのかがわかる。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.3：模擬授業について」  WSTPtot教習パッケージ別モジュール割り振り表（実習生用）：実習生 1人に 1部  実習生の番号を記入した紙片  実習生の番号を記入したフリップチャート紙 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  このマニュアルの最初にある用語一覧を参照しておく。  教習パッケージ別モジュールのWSTPtot割り振りを実習生の人数に合わせて仕上げ、 コピーしておく。  最終決定した人数に基づき、実習生の番号くめをバケツ/帽子に準備しておく。  実習生の番号を記入し、番号を選んだ受講者名の記入欄を設けたフリップチャート紙 を準備しておく。  同僚の教習員と31、メンターする実習生をどう割り振るか話し合っておく。実習生に は、その情報をこの授業の間か「ToT.6 準備時間について」の初めに伝えておく。 あ ら す じ 1. はめめに 2. 教習パッケージ別モジュールの構成とねらい 3. 模擬授業の進め方 4. リーダー役・補助役実習生および模擬受講者の役割 5. 振り返りとフィードバック 6. 模擬授業の準備 7. 要点のまとめ 4 3 2 15 5 30 1 授業時間計 60 31 [原文] with their co-trainer [訳注] 文脈から, ToT 教習をいっしょに実施する他の ToT 教習員のことであろう. 27 はじめに（4分） 質問：ここで学ぶ、WSTP パッケージを実施する ことへの自信は、1〜10 点で採点すると、どれく らいありますか？ • 1 点はまったく自信がない、 • 10 点はたいへん自信がある、です。 説明： • 採点を自分の「ToT ハンドブック」p.10 に記録 しなさい。 • ToT プログラムの最後に、その時点での自信が どれくらいか記録するよう指示します。 • その両方の採点を、自分自身への ToT 評価 フォームに記入しなさい。 授業のねらいおよび学習目標を説明せよ。 教習パッケージ別モジュールの構成とねらい（3分） 説明： • 「必須教習技能」の授業のあと、各自の教習 パッケージ別モジュールが始まります。 • 教習パッケージ別モジュールの内容は： o 習得を選択した WSTP の授業を実施する機会、 o ToT 教習員が指導する話し合いやデモ、 o または、これら二つの組み合わせです。 28 模擬授業の進め方（2分） 説明： • 模擬授業の割り当ては、この授業の終わりに、 くじ引き（ラッキーディップ32）で決めます。 • 実習生ひとりが受け持つ授業時間は、ほぼ同じ 長さです。 • リーダー役実習生と補助役実習生の役割が両方 割り当てられます。 • 一授業にリーダー役実習生が複数割り当てられ た場合、プレゼンテーション33を行なっていない 人は、自動的に補助役実習生を務める想定です。 リーダー役・補助役実習生および模擬受講者の役割（15分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、リーダー役実習生と補助役実習生の主な役割とは何だと思うか、 パートナーと話し合うよう指示せよ。 実習生に、考察を「ToTハンドブック」p.10に記録するよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 3分、フィードバックに 5分見込んでおけ。 フィードバック： 質問：リーダー役実習生と補助役実習生の主な役割とは何でしょうか？ 答えを話し合って明確にし、最も重要な答えをホワイトボードに記録せよ。 実習生に、正しい情報を各自「ToTハンドブック」に記録するよう指示せよ。 32 [原文] Lucky Dip [訳注] 手を突っ込んで福引きやくじ引きを行なう箱や袋. 33 [原文] presenting [訳注] この語の本書での意味は授業 ToT.7 を参照. 29 最も重要な答え： リーダー役実習生の役割の例： • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役実習生を調整する。 補助役実習生の役割の例： • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー役実習生にもたらす。 • 授業実施に関する全体的フィードバック/振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応めて照明の点け消しやブラインドの開閉を行なう。 質問：模擬授業中、実習生はチームとして協力しな ければなりません。例えば、以下について助け合う ことなどです： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 授業の進行、例えば： o 時間管理 o 誤りの指摘 o 受講者からの質問に答える o 妨害や割り込みへの対処 30 説明： • 教習員は、プロとしての行動と実践のポジティ ブなお手本34を示すべきです。 • 受講者に求める行動は、その模範を示しなさい。 例えば： o 時間を守り、じゅうぶん準備しなさい。 o 困難な状況で、問題を解決し解決策を見出し なさい。 o ポジティブなフィードバック、および建設的 なフィードバックを与えなさい。 o 上手に自己管理しなさい：例えば、ストレス 管理のため、授業準備とじゅうぶんな睡眠・ よい食事とのバランスを取るなどです。 説明：優れた教習員のお手本になるとは、常に質問 への答えを知っていなければならないということ ではありません。 質問：質問を受けたが、答えを知らない場合には どうしますか？ 最も重要な答え： • 補助役実習生に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 答えを知っているふりをしない。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 34 [原文] a role model [訳注] そのまま「ロールモデル」と呼ばれることも多い. 31 説明： • 実習生仲間が担当授業を実施している間、自分 は WSTP 受講者役を演じることになります。 • これに含まれることは： o ケーススタディや実習に参加する。 o 質問し、また質問に答える。 o 話し合いに参加する。 • 「現実味のある」教習状況をつくり出すために 積極的に参加することは重要ですが、挑発的な 行動をわざと取っては35なりません。 • 模擬授業のあいだ、「WSTPtot 教習員用指導書」 や「ToT ハンドブック」はしまっておきなさい。 振り返りとフィードバック（5分） 説明： • 教習員にとり、自分自身の教習技能を振り返る ことを学ぶのは重要です。 • また教習員には教習受講者へ建設的なフィード バックを与えられることも重要です。 • これらの技能は両方とも ToT プログラムに組み 込まれています。 35 [原文] act in a challenging manner 32 説明： • 各模擬授業の終わりに、リーダー役実習生は、 次を振り返るよう求められます： o 何がよかったか、また何がうまく行ったか o 何に改善の余地があるか • 模擬受講者は、リーダー役実習生に簡潔なフィ ードバックを与えます。この詳細は授業「ToT.11 フィードバックについて」で話し合います。 • ToT 教習員がフィードバックを与え、リーダー役 実習生や模擬受講者が挙げていなかった点が あれば付け加えます。 模擬授業の準備（30分） 説明： • 「教習員用指導書」の授業計画を読み、授業内容 をすべて理解していることを確かめなさい。 • 「受講者用参考書」と「受講者用ワークブック」 (関係者向け以外の WSTP で使う) の該当箇所を 読みなさい。 • PPT に適切な変更/補足を加えなさい。 • 適切ならば自分自身の知識や経験を組み込み、 自分のケーススタディを活用しなさい。 • 授業実施を、時間配分を含め予行演習しなさい。 • 補助役実習生と、チームとして協力しなさい。 • 授業に必要な教材を準備しなさい。 説明：授業が ToT 教習員によるデモを含む場合は、 ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせなさい。 33 説明： • WSTP の「教習員用指導書」「受講者用参考書」 「受講者用ワークブック」および PPT の中に、 いくつかの誤りが判明しています。 • 判明している誤りは「ToT ハンドブック」の中で 挙げています。 • 授業を準備するさい、担当授業に誤りがないか 確かめ、必要な変更を加えなさい。 • 模擬受講者と誤りについては話さず、授業のプレ ゼンテーションは、通常の WSTP 教習と同様に 行ないなさい。 ToT 教習員への注記： • WSTP にはいくつか誤りが判明しているが、 2 版発行まで訂正されない。それらの誤りは 「ToTハンドブック」に挙げ、実習生が教材を訂正できるようにしている。 このスライドは活動の間じゅう映しておけ。 34 活車２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の「教習員用指導書」で以下の授業に目を通し、自分の「ToT ハンドブック」の中でその授業に該当する注記を見つけるよう指示せよ。 実習生にはその両方を読み通すことで、それらがどう関連し合っているか、 また授業の実施準備でそれらをどう活用できるかを把握するよう指示せよ。 • 基礎WSTP：授業 A.6: 適正な車椅子 • 中級WSTP：授業 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる • 管理者向けWSTP：授業 A.1: 適正な車椅子供与とは何か？ また実習生に、「ToTハンドブック」の序章から「模擬授業準備の手引き36」 を探し、手短に確認しておくよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 以下を強調せよ： • 実習生は、模擬授業および将来のすべての見習い教習において、「教習員 用指導書」および「ToTハンドブック」の指示に従うべきです。 • 実習生は、以下に対処するための指示に従うための、めゅうぶんな時間を 見込んでおく必要があります：WSTP教材の誤りの取り扱いへの指示、 ジェンダーおよび文化への配慮に関する注意、進行や時間配分を改善する ための授業準備、プレゼンテーション、教習運営実務に関する助言。 • 模擬授業中、実習生は必要に応めて教習スペースの設営を担当します。 何か質問があるかどうか尋ねよ。 36 [訳注] ページ xiii. 35 説明： • 各教習日の終わりには、後日の模擬授業を準備 する時間があります。詳しくは授業 ToT.6 で話 し合います。 • ToT 教習員は、休憩中および一日の終わりに 時間を取れます。質問や懸念があれば、支援を 求めなさい。 • 教習仲間や ToT 教習員を前に授業する時には、 アガる方が普通です37。 • さらに授業を実施すれば、技能と自信がついて きます。 • これは競争ではないこと、教習スタイルは一人 ひとり違うことを忘れないで下さい。 • これから 2 日間、グループ活動からのフィード バック発表を求められます。その機会を活かし、 仲間へのプレゼンテーションを練習しなさい。 説明： • 実習生への扱いを平等にするため、模擬授業の あいだ、時間は厳しくモニターされます。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止 させて次の教習員に移るか、授業を終了します。 • 時間を守る方法を学んで下さい。これは重要な 技能で、練習によって上達します。 説明： • 各授業の標準版 PPT は、動画を埋め込んだもの が教習用ノート PC で使用可能です。 • 自分の PPT に変更を加えた場合は、模擬授業前 に教習用ノート PC へそれをアップロードして おく必要があります。 37 [原文] It is normal to feel nervous 36 ToT 教習員への注記： • 実習生には、PPTをコンピューターへ読み込む必要がある場合は、例えば教習開始の 30分前 か授業前の休憩時間にするよう伝えよ。 説明：では、これから授業を割り当てます。 実習生に、一人ひとり番号を引くよう指示せよ。 各実習生に、自分の名前を、各自の WSTPtot 教習 パッケージ別モジュール割り振り表（実習生用）に 記入するよう指示せよ。 各実習生に、全体グループに自分の番号を伝え、 それを表に記録するよう指示せよ。 実習生の名前を、フリップチャート紙に準備した表の該当する番号の横に記録せよ。 説明：各実習生に一人、ToT 教習員がそのメンターとして割り当てられます。メンターは： • 実習生の準備を支援します • 実習生のプレゼンテーションスキルについて、個別にフィードバックを与えます。 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 37 ToT.4 多様性に備える38 ね ら い 文化39、多様性40、文化的能力41およびこれらの概念の重要性を、WSTP［車椅子サービス 教習パッケージ］の教習実施に関連づけて理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  「文化」と「多様性」の違いを理解する。  「文化的能力」の重要性を理解する。  異文化間コミュニケーション42の課題を話し合う。  車椅子ユーザーを教習や業務環境へ統合する43うえでの課題を特定する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.4：多様性に備える」  マスキングテープか同様のもの 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  現地の状況や実習生グループの性格を基に、最初の活動のための適切な「区別」を 案出しておく。  最初の活動用に、教室の空いたスペースの中央にマスキングテープを貼って線を一本 引いておく。 あ ら す じ 1. はめめに 2. 文化と多様性 3. 文化的能力 4. 多様性を推進する44：車椅子ユーザーはめめ障害者のインクルージョン 5. 要点のまとめ 20 5 20 14 1 授業時間計 60 38 [原文] Preparing for diversity 39 [原文] culture 40 [原文] diversity 41 [原文] cultural competence [訳注] 国際保健分野では「文化能力」とも訳される. 42 [原文] cross cultural communication 43 [原文] integrating 44 [原文] Encouraging diversity 38 はじめに（20分） 活車１ グループ： 全体で。 指導内容： 床の中央を横切るマスキングテープの線に注目させよ。 全員、教室の片方へ移動するよう指示せよ。 男性は全員線の片側に、女性全員が反対側に立つよう指示せよ。 説明：男性と女性、これはさまざまなグループ分けの最初のものです。これ から、多様性をさまざまな面から見て行きます。 子どものいる人は線の片側に、いない人は反対側に立つよう指示せよ。 年齢が 50 歳超の人は線の片側に立つよう指示せよ。他の人は反対側に立つ よう指示せよ。 この活動を最低 6回続けよ。 区別の例： • 話す言語 • 出身地/国 • 障害の有無 • 職歴 モニター： 受講者が困惑したり、不快を感めたりしていないことを確かめよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 区別についての感想を尋ねよ。 質問：大きい方のグループにいると、どんな感めがしますか？ 質問：ひとり、あるいは少数派になると、どんな感めがしますか？ ネガティブな経験だった人がいるかもしれませんが、それは他の人にとって はポジティブだったかもしれません、と説明せよ。 説明：多数派の中にいると、人はえてして力強さや自信を感じるものです。少数派の中にいると、 人は孤立や疎外を感じることがあります。集団は、文化や多様性によって分かれたりまとまったり するので、この二つの概念について詳しく見ていくことにしましょう。 39 授業のねらいおよび学習目標を説明せよ。 文化と多様性（5分） ホワイトボードかフリップチャートの中央に縦線を引き、「文化」「多様性」と片側ずつ書き込め。 質問：「文化」と「多様性」という語は、どういう意味だと理解していますか？ 励まして応答を促し、それを板書せよ。 最も重要な答え： 文化：人びとを同じにするもの • 共有あるいは共通の、価値観45、意識46、道徳、伝統、信念47などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団48、ジェンダー、性自認49、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 説明：文化と多様性に対しては、さまざまな捉え方ができます。 • それらは強みで、奨励すべきものだと思いますか？ • あるいは紛争や不和の元だと思いますか？ • それらは邪魔なものでしょうか？ 全体に、先の活動で体験した、自分たちの中にある多様性や文化について振り返るよう指示せよ。 質問：この全体グループは多様でしょうか？ 45 [原文] values 46 [原文] attitudes 47 [原文] beliefs 48 [原文] ethnicity 49 [原文] gender identity 40 質問：この全体グループの中には、どんな種類の多様性があるでしょうか？ 質問：私たちはどんな文化を共有しているでしょうか？ 応答を受けとめ承認せよ。 説明：私たちは、だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを 忘れないようにしましょう。 文化的能力（20分） 質問：「文化的能力」とは何でしょうか？ 応答を受けとめ承認せよ。 説明： • 文化的能力とは、個々人が、自分の文化とは 異なる文化への、効果的かつ敬意をもった50 関わり方を学ぶ、能動的プロセスです。 • それは、文化の違いに対してポジティブな姿勢 で臨み、受容することです。 • それは、文化が人びとの交流に及ぼす影響を 意識することです。 説明：文化の違いは、誤解、失望、混乱、困惑、怒り、侮蔑などを引き起こすことがあります。 例えば、攻撃する意図のないコメントが、文化が異なる人からは侮辱と取られる場合などです。 説明：WSTP の教習は、さまざまな文化の教習員によって文化の異なる受講者へ教授されることも あります。さまざまな文化的配慮が教習へどう影響するのか、その例を「ToT ハンドブック」p.16 に挙げています。 50 [原文] effectively and respectfully 41 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の文化とは異なる文化を経験した実例について考え、それは どういったもので、自分がどう感め、何を学んだかを書き出すよう指示せよ。 実習生に、その経験についてパートナーと話し合うよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 話し合いに 8分、フィードバックに 5分見込んでおけ。 フィードバック： 4〜5名に、各自の経験を全体で共有してもらうよう依頼せよ。 多様性を推進する：車椅子ユーザーはじめ障害者のインクルージョン（20分） 説明： • 障害とは多様性の一面です。 • WSTP では教習チームへの、また受講者として の、車椅子ユーザーはじめ障害者のインクルー ジョンを推進しています。 質問：なぜそれが重要なのでしょうか？ 42 最も重要な答え： • 車椅子ユーザーは、自分の体験や視点を活かしてWSTPの学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子サービスでの車椅子ユーザーの中心的役割を 強化する。 • 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、 差別・偏見とたたかい51、CRPD（障害者の権利に関する条約）の原則を強調するのに役立つ。 スライドを読み上げよ。 質問：車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁となるものには、 何があるでしょうか？ 最も重要な答え： • 意識の障壁52 • 環境の障壁：アクセスできない家屋、学校、公共建築物 • 支援機器の不足 • 障害をネガティブにとらえる文化的信条 • 障害者の権利を支援する法令の欠如 • サービスや支援に対する財源の不足 51 [原文] combat stigma [訳注] stigma は本来「烙印」を意味し, 社会がおしつける不名誉を指して用いられる. 52 [原文] Attitudinal barriers 43 説明： • 意識の障壁とは、例えば： o 障害者ができることに関する予断 o 障害者は自己決定ができないとする偏見 o 障害者を慈善の対象として扱う o 文化によっては、障害者は祟られていると信 じ、そのけっか地域や家族から閉め出される • 環境の障壁とは、例えば： o 自然環境：岩場や急傾斜地など o 建造環境：アクセスできない家屋、学校、 公共建築物など o 支援機器の不足 • 制度の障壁とは、例えば： o 障害者の権利を支援する、政府の法令や政策 の欠如 o 入学基準に関する学校・大学の規則や規制 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 44 ToT.5 成人学習 ね ら い 「成人学習53」の概念およびさまざまな学び方を紹介し、これらのアプローチによって WSTP［車椅子サービス教習パッケージ］実施をどのように改善できるか理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  大人はどのように学ぶのか詳述する。  自分自身にとってのそれも含め、4つの選好学習スタイル54を詳述する。  なぜ学習スタイルを理解すると、WSTPの教授が効果的になるのか説明する。  教習員が、受講者の問題解決をどのように支援できるか詳述する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.5：成人学習」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はめめに 2. 選好学習スタイル 3. 学習経験サイクル55 4. 成人学習を支援する 5. 受講者の問題解決を助ける 6. 要点のまとめ 2 25 30 10 15 3 授業時間計 85 53 [原文] adult learning 54 [原文] preferred learning style [訳注]「選好する/好む学習スタイル」の意. 55 [原文] Experiential learning cycle 45 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 選好学習スタイル（25分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に以下を行なうよう指示せよ： • これまでの、自分のポジティブな学習経験について考える。 • それはどのようにポジティブだったのか書き出す。 • その経験をパートナーと共有する。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 個々人での考察とペアでの話し合いに 5分、フィードバックに 5分見込んで おけ。 フィードバック： 各ペアが自分たちのリストから 1項目ずつ読み上げ、経験がすべてホワイト ボードに書き出されるまで、それを教室内で持ち回るよう指示せよ。 簡単に話し合わせよ。 46 説明：前の活動で話し合ったポジティブな学習経験から、選好される学び方にはさまざまなものが あることが分かります。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生に単独で作業するよう指示せよ。 指導内容： 実習生に、「ToTハンドブック」p.21を開くよう指示せよ。 「ToTハンドブック」に載っているのは、学習に関して述べた文の一覧表で あることを説明せよ。 実習生に、自分の選好に合うすべての記号にマルを付け、それを次ページの 集計表に転記するよう指示せよ。 実習生に、各列のマルの数を合計して、どの列のマルが最も多かったか確認 するよう指示せよ。マルの最も多い列が、自分の選好学習スタイルである。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 10分、フィードバックに 3分見込んでおけ。 フィードバック： 各実習生に、自分の選好学習スタイルを、となりの実習生と共有するよう 指示せよ。 複数のスタイルが同めくらいの数だった場合、それは強いこだわりがなく、 複数のやり方で抵抗なく学べるということだと説明せよ。 実習生に、自分の学習スタイルへの選好がポジティブな学習経験と一致する かどうか尋ねよ。 47 学習経験サイクル（30分） 説明： • めいめいの人に、一つかそれ以上の選好学習スタイルがあります。 • しかし、新しい情報や技能を学ぶ際に最も効果的なのは、情報を複数の経路で学ぶことです。 説明： • 学習経験サイクルの各段階は、学習スタイルの 4 種類と一致しています。 • スタイルは人によってさまざまですが、新しい 知識や技能を学ぶには、この 4 段階のそれぞれ を経るのが最も効果的です。 • WSTP に学びの 4 段階/種類がそれぞれ含まれて いるのは、そうした理由からです。 • このサイクルは「経験によって」「観察/感受 によって」「理論や概念の定義/説明によって」 「実行によって」のどれから始めてもかまい ません。 説明：WSTP の開発に当たり、「選好学習スタイ ル」と「成人学習」の概念は、個々の授業計画の構 成や教習の時間割全体に組み込まれています。 48 説明：WSTP では、こうした４段階を経ることで、確実に学びが生まれるようにしています。 • 基礎 WSTP では、受講者は車椅子に乗りさまざまな移動技能を試みます。これは「経験」です。 • 中級 WSTP では、受講者は車椅子ユーザーやその家族が姿勢支持具のポジティブな影響を語る 動画を視聴します。これは「観察」あるいは「感受」です。 • 管理者向け WSTP では、受講者は車椅子サービス提供に関連する概念や原則を学びます。これ は「思考」あるいは「理解」です。 • 基礎および中級 WSTP では、受講者は車椅子ユーザーと作業し、適正な車椅子とクッションを そのユーザーに供与します。これは「実行」あるいは「適用」です。 質問：「経験」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学びが実生活との接点を失い、受講者個人の経験に根を下ろさない、抽象的なものになる。 質問：「観察」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者が、自分の個人的経験がより広い抽象的な概念や枠組みとどう結びついているのか、 探求したり、確かめたりできなくなる。 質問：「思考」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、ある経験から別の経験へ、それらどうしの関連を分からないまま進むことになる。 そうした人は、経験を有意義なやり方で整理するのに役立つ枠組みから得るものがない。 質問：「実行（練習）」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、理論や枠組みを職場や自分の生活に適用するやり方を見出すことがない。 49 説明：教習員は、自分が選好するものだけでなく、あらゆる学習スタイルを支えることが重要です。 説明：ここまで「学習スタイル」と「学習経験サイ クル」の概念を見てきたので、これらを「実践」に 移し、「実行」によって学ぶことにしましょう。 このスライドは活動の間じゅう映しておけ。 活車３ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、「ToTハンドブック」p.24の「活動・選好学習マッチング表」を 見るよう指示せよ。 説明： • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解する56ことによって最もよく学びます。 実習生に、この教習活動はこの人の学習スタイルに最も効果的、と考える人 の名前の下に「X」を付けるよう指示せよ。 授業後に各実習生で、最後の列に自分自身の選好について記入してみるよう 提案せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 以下のように、全体で答えを確認せよ： 希望する実習生に、回答するよう依頼せよ。 全員が同意するか確認せよ。 反対がなければ、その答えを（正しければ）受けとめ承認し、次の行に移れ。 皆の答えが同めでなければ、正解を示し説明せよ。 短い話し合いのみ許可せよ。 56 [原文] understanding the big picture 50 ToT 教習員への注記： • 下記の解答欄について、Xは最適解、(X)は同様に正しい別解を示す。 上の印がないものを回答した実習生には、理由を説明するよう依頼し全体で話し合え。理由づけ が適切で学習スタイル間の違いを理解していると認められれば、答えを訂正する必要はない。 この課題からの重要な学びは、皆が同めように学ぶわけではないことへの気づきである。 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 1. 車椅子ユーザー教習の練習として ロールプレイングを行なう X (X) 2. 教習員が新規車椅子ユーザーへの 身体計測のやり方を示すところを 観察する X 3. 自国の車椅子サービスに関する、 法律や規制についての政府職員の 発表に出席する X 4. 車椅子に乗っている人がやりたい ことを実行しているのを観察する X 5. 車椅子サービスに関連する重要 文書について学習する X 6. 他の受講者と、フォローアップを ユーザーの家で行なうことの長所 と短所について話し合う X 51 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 7. CRPD（障害者の権利に関する 条約）の最も重要な条文に関する、 教習員の説明を聴く X 8. 除圧クッションをつくる X (X) 9. 車椅子で走り、車椅子ユーザーが 経験するであろう障壁を体感する X 10. 教習員が事前評価を実施する様子 を観察する X 11. 新規車椅子ユーザーに対する事前 評価インタビューを実施する (X) X 12. 車椅子サービス事業を既存のリハ ビリテーションサービスに追加す ることによる費用節減を算定する X (X) 52 成人学習を支援する（10分） 説明：だれにも選好学習スタイルがある一方、あらゆる大人の学習者についての共通項もあります。 説明： • 大人の学習者は主体的57で、自分の学習に責任を 持ちます。 • つまり、次のようになる方向で支援するという ことです： o 積極的参加者 o 話し合いやグループ活動に取り組む 説明： • 大人の学習者は、学習活動に自分自身の知識や 経験をもたらします。例えば： o 仕事に関連する経験 o 受けてきた教育 o 人生や家族の経験 説明： • 大人の学習者は、関連が明らかで実践的な58学び を求めます。 • 大人が新しい情報を学ぶには、必ずその理由が 分かり、自分の状況に当てはめられる必要が あります。 • 教習に必要なことは： o 明確な学習目標 o 目に見える実際への適用 57 [原文] self-directed 58 [原文] relevant and practical 53 説明：大人の学習者は、学んだことを適用しようと 求めます。 • 学習者が、教習で学んだことと教習プログラム 終了後にやることとの関連を理解できるような 実例を活用しなさい。 • 問題解決活動を活用しなさい。 • 学習〜行動計画59を立てなさい。 受講者の問題解決60を助ける（15分） 説明：「問題解決」とは何でしょうか？ 最も重要な答え： • 問題に対して最適解を見出すプロセスのこと。 成人学習の重要部分である。 説明：なぜ問題解決は、生活技能として重要なので しょうか？ 最も重要な答え： • だれもがゴールを設定し、課題に直面しながら それを達成するから。 • 遭遇する障壁を克服するには、その方法を見出 す必要があるから。 説明： • 問題解決は、問題への解決が一筋縄では行かない車椅子サービス供与での重要技能です。 • 教習員は、受講者の問題解決能力を育成し、仕事で遭遇する困難に対する解決を見出せるように する重要な役割を担っています。 59 [原文] learning-action plans 60 [原文] problem solving 54 このスライドは活動の間じゅう映しておけ。 活車４ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、受講者の問題解決をどう手伝えるかについてのブレインストー ミングを行ない61、自分なりの解決策を見出すよう指示せよ。 2分間それを個々人62で考察し、自分のグループ内で共有して、アイデアの リストをつくるよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： この活動には 12分見込んでおけ。 フィードバック： 各グループで順番に、受講者 の問題解決を手伝う方法を 説明するよう指示せよ。新し いアイデアが出なくなるまで 続けるよう指示せよ。 新しいアイデアをそれぞれ、 キーワード 2〜3 語だけで63 ホワイトボードに記録せよ。 考慮すべき事項のよい例が 出たら、受けとめ承認せよ。 誤解があれば訂正/説明せよ。 まとめとして左のスライドを 映せ。 61 [原文] to brainstorm [訳注] 批判・判断・結論を交えず自由に意見を出し合う会議手法. ブレストとも呼ばれる. 62 [原文] individually 63 [原文] using only a few words 55 最も重要な答え： • オープンクエスチョン64（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ65：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のため に教習を訪れた個々のユーザーについて話せ。 • 分かりません」で答えを終わらせるな66：受講者が、主題について自分が知っていることを めっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ67：課題を個別のステップに分解し、ステップバイステップに68質問 し、問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的69に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 64 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 65 [原文] Ask rather than tell 66 [原文] Don’t take ‘I don’t know’ for an answer 67 [原文] One step at a time 68 [原文] step-by-step 69 [原文] laterally 56 ToT.6 準備時間について ね ら い 実習生が、毎日の終わりの準備時間を有効利用できるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  毎日の終わりの準備時間の目的を理解する。  各自の模擬授業に関連する疑問を話し合う。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.6：準備時間について」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  「保留スペース」を点検し、どの質問にも答える準備をしておく。 あ ら す じ 1. 「保留スペース」の点検 2. 準備時間の目的 10 5 授業時間計 15 57 保留スペース」の点検（10分） 実習生と「保留スペース」を点検せよ。翌日の前に明確にしておくべき項目があれば、必要に応じ て回答なり説明をせよ。 準備時間の目的（5分） 説明：この第 1 日の後に取っておいた時間で： • 「保留スペース」に残った項目を点検します。 • 実習生はフィードバックのため ToT 教習員と 面談します。 • 模擬授業を準備します。 説明： • ToT 教習員はリーダー役実習生との短い一対一 の面談を設定して、フィードバックを与え模擬 授業について話し合います。 • これは実習生にとって、そのフィードバックを これからの模擬授業にどう活かせるか質問する 機会です。 • フィードバックの与え方と受け取り方について は、授業 ToT.11 で詳しく話し合います。 58 説明：ToT 教習員とフィードバックを話し合う 面談がない場合、この時間の使い方は： • 自分が組む実習生70を調整します。 • 授業に必要な、デモ用資材や視聴覚機器を準備 します。 • 自分の授業内容で理解できない点があれば、 ToT 教習員と明確にします。 • 自分の PPT プレゼンテーションファイルが、正 しく動作することを確認します。 何か質問がないか尋ねよ。 実習生に、明日の授業開始までに思い出すべき教習運営実務の項目があれば再確認せよ。 ToT 教習員への注記： • WSTPtot の初日終了後、残るプログラムでの模擬授業に関連する教習運営実務の調整にこの 時間を活用せよ。例えば、実習生は現場に早めに来て授業の設営をできるか？または、実習生 は、翌日の授業で使う修正済み PPTをいつアップロードするのか？ 70 [原文] co-trainers 59 ToT.7 プレゼンテーションとファシリテーション ね ら い 優れた教習員の条件を明らかにし、プレゼンテーション71とファシリテーション72の違い を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  優れた教習員としてのふるまい73を列挙する。  プレゼンテーションとファシリテーションとの違いを説明する。  プレゼンター74とファシリテーター75の優れた実践例を列挙する。  時間を守れるようにする方策を 3つ詳述する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.7：プレゼンテーションとファシリテーション」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はめめに 2. 教習員の技能 3. プレゼンテーションとファシリテーション 4. プレゼンテーションとファシリテーションの優れた実践 5. 時間管理 6. 要点のまとめ 3 15 5 15 20 2 授業時間計 60 71 [原文] presenting [訳注] 意味は p.62 本文を参照. 72 [原文] facilitating [訳注] 一般的で適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 73 [原文] behaviour 74 [原文] presenters 75 [原文] facilitators 60 はじめに（3分） 授業のねらいおよび学習目標を説明せよ。 教習員の技能（15分） 説明：教習プログラム実施を成功に導くには、さまざまな技能を養う必要があります。 この授業では、教習員の技能を、情報プレゼンターおよび学びのファシリテーターという両面から 見て行きます。教習員としての効果的ふるまいは、受講者の学びを喚起し、ポジティブな学習環境 をつくり上げるうえで決定的に重要です。 このスライドは活動の間じゅう映しておけ。 61 活車１ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、過去に自分が教習を受けた人を思い出し、だれが効果的な教習員 だったと考えられるか特定するよう指示せよ。それはつまり、学ぶべきこと を学べるようにし、ポジティブで価値のある経験をもたらした人である。 実習生に、数分間その効果的な教習員のふるまい方を振り返り、考えたこと を「ToTハンドブック」p.28の「その人のふるまいのどんな点が効果的でし たか？」の見出しがついた欄に書き出すよう指示せよ。 実習生に、考えたことを他のグループメンバーと共有するよう指示せよ。 各グループに、以前の教習員のふるまい方についてあらゆる面から考察する よう指示せよ： • どう自分を紹介したか。 • どう受講者と関わり合ったか。 • どう教習を運営したか。 • どうやってポジティブな環境をつくり出したか。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 話し合いに 5分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、各々考えたことを一つずつ、それらがすべて出揃うまで報告 するよう指示せよ： ホワイトボードに考えたことを記録せよ。 実習生に、各自の「ToTハンドブック」に載っている情報を紹介せよ。 実習生に、ふるまい方の練習機会が週の後半にあることを念押しせよ。 実習生に、取り組むべきふるまい方を確認するため、「ToTハンドブック」 p.29の「プレゼンテーションとファシリテーションの優れた実践」の一覧を 活用するよう勧めよ。この一覧は、必要ならば自己評価にも活用できると 説明せよ。 62 プレゼンテーションとファシリテーション（5分） 説明：WSTP［車椅子サービス教習パッケージ］で の教習員の役割は、プレゼンテーションとファシ リテーションとの間をひんぱんに交替します。 質問：プレゼンテーションとファシリテーション との違いは何だと思いますか？ 実習生に 2〜3 分これについて考える時間を え、 グループ全体から回答を募れ。 次のスライドを映し、すでに答えられているもの があれば受けとめ承認せよ。 スライドの内容を読み、必要なら拡張せよ。 スライドの内容を読み、必要なら拡張せよ。 WSTP では、プレゼンテーションとファシリテーションの組み合わせを活用していると説明せよ。 「教習員用指導書」では、いつプレゼンテーションを行ない、いつファシリテーションを行なうか 指示している。 63 プレゼンテーションとファシリテーションの優れた実践（15分） 実習生にプレゼンテーションを行なう際の優れた 実践とは何だと思うか熟考するよう指示し、グル ープ全体から回答を募れ。 ToT 教習員への注記： • ToT教習員は ToTを通して、とりわけこの授業中は、優れた実践のお手本となるべきである。 言ったことは必ず実行せよ。 スライドを読み、すでに回答で実習生が挙げた例 があれば、受けとめ承認せよ。 64 質問：「エナジャイザー76」とはどういう意味か、知っている人はいますか？ 応答を受けとめ承認せよ。 説明： • 「エナジャイザー」とは、グループを元気づけ、再活性化させる目的の短い活動です。 • いつもそうとは限りませんが、たいてい「エナジャイザー」は授業内容には関係しません。 • 「ToT ハンドブック」の p.30-31 に、「エナジャイザー」の項目が事例付きで載っています。 実習生にひとり、率先してグループへ短い「エナジャイザー」を行なうよう依頼せよ。 実習生たちに、その「エナジャイザー」はグループへどう効いたか尋ねよ。 ToT 教習員への注記： • たいていの実習生は、前に経験した教習を通して「エナジャイザー」を何か知っているだろう。 だれも率先しない場合のために、実施例を準備しておけ。 説明： • スライドは合図77として、また主要メッセージを 示すために使いなさい • スライドごとに受講者が内容を消化する時間を 取りなさい。外国語で受講している場合は、より 長く取りなさい。 • 受講者に、スライドの内容を音読してもらい、 変化を付けなさい。 • 映したスライドが話の内容と一致していること を確かめなさい。 • スライドは「教習員用指導書」とつねに同期させ なさい。 • スクリーンを読み上げるのは避けなさい。 • あえてスクリーンを読む場合は、それを肩越し に見たり聴衆に背を向けたりしないように。 • プロジェクター光を遮断してはなりません。 上記のうち最後の 3 か条を、教室の端に寄ったり、 受講者の背後に回ったりできることを示しながら やって見せよ。 76 [原文] energizer 77 [原文] prompt 65 質問：視覚障害のある人が受講者に含まれる場合、プレゼンテーションのやり方や授業計画はどう 変更しますか？ 回答を受けとめ承認せよ。 最も重要な答え： • スライドの情報を読み上げ、視力障害のある受講者がすべての情報を得られるようにする。 • 弱視の受講者には、プレゼンテーションファイルのフォントを大きく、またスクリーンをなる べく大きいものにする。 • 教習前に受講者に会い、そのニーズを理解する。 • 受講者が音声読み上げソフト78を使用する場合は、文書やプレゼンテーションファイルを事前 に渡しておき、教習開始前に確認できるようにする。 • 適切ならば、点字化した文書を提供する。 スライドを読め。 実習生に、「ToT ハンドブック」の要点を紹介せよ。 必要に応じて拡張せよ 質問：これまで、教習員が授業のどこで「プレゼン テーション」を行ない、「ファシリテーション」を 行なっていたか、例を挙げられる人はいますか？ 質問：実習生として、これら 2 つの方法はどう違っ て感じられますか？ 応答を受けとめ承認せよ。 実習生に、ToT が進むにつれ、プレゼンテーションとファシリテーションの両方について、観察や 練習の機会があることを念押しせよ79。 78 [原文] screen reader 79 [原文] remind 66 時間管理（20分） 説明： • 教習員と受講者には、教習プログラムが確実に時間通り進むようにする必要があります。 • 数多くの授業や活動がある一方、それらを完了するための時間は限られているからです。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 質問：教習が時間通り進むようにするには、どうしたらよいでしょうか？ 実習生に、思いついたことを各自「ToTハンドブック」p.31に書き出すよう 指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 全体でフィードバックし、各ペアに順番に提案を出してもらえ。 応答を受けとめ承認し、下記「ToT教習員への注記」を用いて補足せよ。 67 ToT 教習員への注記： • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者 を待たせて不利益を負わせるな80。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTPに資料やあまりにも多くの 実例を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留81」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば「15分休憩、10:45には戻って下さい」 「自分のグループでの話し合いに 10分、フィードバックに 5分使えます」 • 教習員仲間82と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には、予備計画83を立てておけ。例えば、雨で車椅子の移動 技能の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 80 [原文] avoid penalizing 81 [原文] Park 82 [原文] co-trainers 83 [原文] back-up plan 68 ToT.8 コミュニケーションスキル ね ら い コミュニケーションスキルについて話し合い、プレゼンテーションスキルを実践に移す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  コミュニケーションスキルの重要性を説明し、プレゼンテーションスキルを実践に 移す。  優れたデモの示し方を説明する。  通訳者とうまく協力するやり方を詳述する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.8：コミュニケーションスキル」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はめめに 2. コミュニケーションの種類 3. デモ・動画・通訳について 4. 要点のまとめ 2 55 30 3 授業時間計 90 69 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 コミュニケーションの種類（55分） 説明： • コミュニケーションスキルは、優れた教習員となるためのカギです。 • この活動は、自分のコミュニケーションスキルを練習する機会です。 • 実習生は教習員役を務め、自分のトピックの学習の要点を自分で発表します。 • これは、「プレゼンテーションとファシリテーション」の授業で話し合った技能を、実践に移す 機会です。 このスライドは活動の間じゅう映しておけ。 70 活車１ グループ： 実習生を 4グループに分けよ。 指導内容： それぞれのグループに、下の「ToT教習員への注記」に列記されているトピ ックを一つずつ割り当て、続いて実習生に「ToTハンドブック」の p.33-35 を開かせよ。 各グループは、各自のトピックの下に列記された情報をプレゼンテーション すること。 創造性を発揮するようグループを励まし、小道具、フリップチャート、ホワ イトボードなどは自由に用いるよう奨めよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 課題の準備に 20分、グループごとのプレゼンテーションに各 5分、それ ぞれのプレゼンテーションの後に話し合いを 2分ずつ、ToT教習員による、 最後のフィードバックおよび取りまとめに 5分見込んでおけ。 フィードバック： 実習生に各自の「ToTハンドブック」を参照させ、すべての情報が、上の プレゼンテーションで伝えられたか確認させよ。 フィードバックは、授業内容とさまざまなコミュニケーションスキルに重点 を置け。ToT教習員は、グループが明確にプレゼンテーションしていない 要点を簡潔に要約すること。 ToT 教習員への注記： グループ１：言語的技能 • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語84や「無意味な語85」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な86ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 84 [原文] slang 85 [原文] ‘non-speak’ 86 [原文] simple and non-medical 71 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 己れのボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える87な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室の中から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン88（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同め質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 87 [原文] jump to answer 88 [原文] closed questions 72 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ89（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば「あなたはどう思いま すか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論90 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな91。 • 尋ねられた時点で質問に答える時間がめゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感めているかどうか確かめよ。 • 傾聴92：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・車画・通訳について（30分） 説明：これから、コミュニケーションをさらに 3 つ の面から見て行きます。 スライドを読み上げよ。 89 [原文] challenge 90 [原文] clinical reasoning 91 [原文] Never make up an answer if you do not know. 92 [原文] Listen 73 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生を 2グループに分けよ。 指導内容： 実習生に、「ToTハンドブック」を閉めるよう（本の中に答えが載っている ため）指示せよ。 それぞれのグループに、トピックを割り当てよ。 • グループ１に検討を指示せよ：デモを行ない、動画を上映する際の優れた 実践について • グループ２に検討を指示せよ：外国語や手話の通訳者との協働について 実習生に、教習を実施するさい、各自のトピックに関して何を考慮すべきか 話し合い、もう片方のグループへプレゼンテーションするためフリップチャ ートに書き出すよう指示せよ。 実習生に、PPTスライドの活動への手引きを参照させよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： グループでの表づくりに 10分、グループごとのプレゼンテーションに 5分 ずつ、それぞれのプレゼンテーション後の要点追加に 5 分ずつ見込んでお け。 フィードバック： グループ１に、所見をグループ２へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 グループ２に、所見をグループ１へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 実習生に、「ToTハンドブック」の参考資料を参照させよ。 74 ToT 教習員への注記： デモによって示す： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 • 受講者をモニターし、必要に応めて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎WSTPと中級 WSTPのデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 車画を用いる： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や動話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2倍時間を要する。 75 要点のまとめ（3分） 要点を読み上げよ。 何か質問がないか尋ねよ。 76 ToT.9 指針文書の知識 ね ら い 実習生にWSTP［車椅子サービス教習パッケージ］の指針文書93を紹介し、それらの関連 性を説明する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPの指針文書を列挙する。  WSTPの教習員および受講者に対する、それらの重要性を説明する。 教 材 この授業には94：  PPTスライド「必須教習技能 ToT.9：指針文書の知識」  動画：「持続可能な開発目標（SDGs）」 以下の資料を 1部ずつ：  「国際連合 障害者の権利に関する条約（CRPD）」  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」  WHO「低リソース状況での移動支援機器供与に関する共同方針提言書」  WHO「CBRガイドライン」：導入ブックレットおよび保健コンポーネント  「アクセシビリティのためのデザインの留意事項」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  すべての指針文書について、徹底的に知っておく。  国際連合のウェブサイト（https://www.un.org/development/desa/disabilities/）を 検索し、教習プログラムの時点で CRPDに署名した国の総数を調べておく。このこと について触れ、質問に答えられるよう、実習生の国が CRPDに署名し批准しているか 調べておく。 あ ら す じ 1. はめめに 2. CRPDと車椅子サービス供与の関連 3. 「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」 4. 「CBRガイドライン」 5. その他の指針文書 6. 要点のまとめ 8 20 5 25 15 2 授業時間計 75 93 [原文] guiding documents 94 [訳注] 資料の英語原題, 書誌, インターネット上のリンク等は次ページからの授業計画本文を参照. 77 はじめに（8分） 授業のねらいおよび学習目標を説明せよ。 質問：「指針文書」とはどういう意味でしょうか？ 回答を受けとめ承認せよ。 最も重要な答え： • 出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、規則を与え るもの • 車椅子サービス供与関係者の指針となる資料 質問：これらの文書に精通していることは、なぜ 重要なのでしょうか？ 回答を受けとめ承認せよ。 78 最も重要な答え： • 多くの政府、国際機関、資金供与者95その他の関係者は、これらの国際的枠組みに沿って開発 事業を計画し、資金を供与するから。 • より強い立ち位置から、車椅子サービス供与に向けた啓発や政策提言を行なうため。 説明： • WSTP 教習プログラムを運営するさい、これらの 指針文書に精通することは、車椅子供与に向けた 啓発や政策提言に役立つので重要です。 • 受講者は国内の文書を参照する場合が多いため、 教習員もこれらをよく理解しているべきです。 説明：これらの資料へのしっかりした理解は、教習授業の質に貢献します。「ToT ハンドブック」 には、すべての指針文書についてさらに詳しい情報が載っています。 質問：車椅子供与に関係する、最も重要な二大指針文書は何でしょうか？ 最も重要な答え： • 「国際連合 障害者の権利に関する条約（CRPD）」 • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて96」 95 [原文] donors 96 [訳注] これに加え, 2023 年 6 月に WHO から「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024 年に発行予定. 79 CRPDと車椅子サービス与 の関連（20分） 説明： • まず「国際連合 障害者の権利に関する条約(97)」、 通称「CRPD」98から見て行きます。 • CRPD は、障害者に関する最も重要な国際条約だ と広く考えられています。 • CRPD は、2008 年に発効しました。 説明： • 発効日には 82 か国が CRPD に署名、その選択議定書に 44 か国が署名しました。これは国連の 条約中、発効日での署名国数では史上最多です。 • CRPD は、障害者への社会の見方と処遇のあり方を変革するために、国際社会の代表者によって 策定されました。 • 代表者とは障害者、政府当局者、非政府組織（NGO）の代表などです。 • CRPD が重要である理由は、障害者が、他のあらゆる人びとと同じ権利と機会へアクセスできる ようになるためのツールだからです。 ToT 教習員への注記： • 教習プログラムの時点で CRPD に署名した国の総数を調べ、また実習生の国が CRPDに署名 し批准しているか調べておけ。 97 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations G eneral Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/6 11) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). [訳注] 日本政府外務省仮訳: https: //www.mofa.go.jp/mofaj/fp/hr_ha/page22_000899.html 98 [訳注] 日本では「障害者権利条約」と略されることも多い. 80 質問：なぜ WSTP 受講者には、CRPD に精通して いることが重要なのでしょうか？ 応答を受けとめ承認せよ。 最も重要な答え： • CRPDの人権に基づくアプローチを、障害者への車椅子サービス供与の開発に役立つように 活用するため。 • CRPDの条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえ で役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 説明：CRPD には車椅子サービス供与に関連する いくつもの条文があります。 質問：「ToT ハンドブック」を見ないで、最も深い 関わりがあるのはどの条文か、思い出せる99人はい ますか？ 応答を受けとめ承認せよ。 最も重要な答え： • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション100およびリハビリテーション • 32条：国際協力 99 [訳注] この内容は基礎および管理者向け WSTP で取り上げており, WSTPtot 実習生は既習が前提のため. 100 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 81 他のありうる答え： • 19条：自立生活および地域社会へのインクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30条：文化的生活・レクリエーション・余暇・スポーツへの参加 説明： • CRPD 第 20 条は、車椅子サービス供与に最も 関わりがある条文です。 • ここでは締約国へ、最大限に自立した個人的移動 を障害者へ保証するための実効ある施策を講じる よう求めています。 説明：第 4 条では一般的義務を取り扱い、この文言 を含んでいます。 説明： • これらの条文も、例えば支援機器の重要性、合理 的配慮101、移動技能教習に言及しており、関わり があります。 • 第 26 条は、ハビリテーションおよびリハビリテ ーションを扱っているため、特に重要です。 101 [原文] reasonable accommodation 82 説明：CRPD の他の多くの条文が、間接的に車椅子サービス供与と関わっています。例えば第 6 条 は女性障害者の具体的なインクルージョン、第 7 条は子どもの平等に関わるものです。 質問：子どもや女性が車椅子サービスへアクセス するさい、さらにぶつかりうる障壁には何がある でしょうか？ 実習生に、隣どうしで 1〜2 分、これについて話し 合い、フィードバックを集めるよう指示せよ。 応答を受けとめ承認し、指摘がなかった重要事項 はすべて補足せよ。 最も重要な答え： • 文化や地域によっては、女性や子どもは男性と同め価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持102を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉103を感めないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 説明：CRPD の第 6・7 条を満たすには、必ず車椅子 供与サービスは、特に女性や子どものニーズが考慮 されるようにしなければなりません。 102 [原文] supportive seating 103 [原文] stigma 83 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて」(5分) 説明： WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて（車椅子 ガイドライン）」は、車椅子供与に焦点を置いた、最も重要な国際的文書です。 ほとんどの実習生は「車椅子ガイドライン」をよくご存知ですよね、と確認せよ104。 説明： • 「車椅子ガイドライン」は、現在、世界的に理解 されている適正な車椅子供与枠組みをまとめたも のです。 • 「車椅子ガイドライン」の発行以前、車椅子供与 に関わる諸組織は、考慮すべき重要事項は何か、 共通理解を持っていませんでした。 説明： • 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画によって作成されました。 • これは、合意された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子 サービスの政策提言に役立つ、強力なツールをもたらします。 • 「車椅子ガイドライン」は低・中・高リソース状況で普遍的に達成可能な基準を反映しています。 質問：「適正な車椅子」の定義を覚えていますか？ 回答を受けとめ承認せよ。 104 [原文] Acknowledge [訳注] 各 WSTP で参考資料として取り上げており, WSTPtot 実習生は既習が前提のため. 84 スライドの要点を読み上げよ。 説明：「車椅子ガイドライン」では車椅子に関する 以下の項目も取り上げています： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 質問：この 1 年間に「車椅子ガイドライン」を読んだ人はいますか？ 全実習生に、「車椅子ガイドライン」はとことん読み込むよう勧めよ。WSTP 教習員の「車椅子 ガイドライン」に関する知識は包括的なものでなければならない。ToT 教習員は機会あるごとに その意識を喚起しなければならない。 説明：「車椅子ガイドライン」は、WHO のウェブサイトで各言語版(105)を入手できます。 105 https://www.who.int/publications/i/item/9789241547482 [訳注] フランス語・スペイン語を含む. https://apps.who.int/iris/handle/10665/43960 [訳注] 日本語・ベトナム語を含む. 85 CBRガイドライン」（25分） 説明：WSTP 用 USB メモリの補足資料フォルダに、他の指針文書がいくつか収められています。 実習生はそれらを熟知し、重要性と関連性を説明できるようになっておくべきです。 説明：「地域に根ざしたリハビリテーション (CBR)106」は、WSTP の中で話題に上る可能性が高い ものです。そのため教習員は「CBR ガイドライン(107)」、特にその保健コンポーネントをしっかり と理解しておくことが重要です。 説明： • CBR は、「地域に根ざしたインクルーシブ開発 (CBID) 108」とも呼ばれることも多く、CRPD を 履行するために最も効果的な方法の一つである と、ますます考えられるようになっています。 • CBR の多くの側面が車椅子サービス供与に関連 します。例えば紹介・相談ネットワーク、地域の 保健センター、CBR ワーカーなどです。 説明：CBR マトリックス(109)は、「CBR ガイド ライン」の土台の一つです。 質問：CBR マトリックスの 5 つの主要な領域110と は何でしょうか？ 回答を受けとめ承認せよ。 106 [原文] community-based rehabilitation 107 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 20 10 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBR ガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 108 [原文] community-based inclusive development 109 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 110 [原文] components 86 説明： • 5 つの領域とは保健、教育、生計111、社会、能力 強化 (エンパワーメント)112です。 • マトリックスの各領域には 5 つずつの要素113が 含まれるため、合計で 25 の要素があります。 このスライドは活動の間じゅう映しておけ。 111 [原文] Livelihood 112 [原文] Empowerment [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_securi ty/human_security_approach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと 考え併記した. 113 [原文] elements 87 活車１ グループ： 実習生を 5 グループに分けよ。各グループでジェンダー、経験/知識、技能 がさまざま混在するようにせよ。 指導内容： 実習生に「ToTハンドブック」p.45の「CBRマトリックス」を参照させよ。 各グループに CBRマトリックスの領域を一つずつ割り当て、話し合わせよ。 実習生に、車椅子サービス供与が担当領域にどう関連するか、その仕方を 考え、うち二通りにつき全体へのフィードバックを準備するよう指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、自分たちの答えの一つ目を順番に尋ねよ。それから同様に して、各グループに二つ目を尋ねよ。 ありうる答えの例： 保健 • リハビリテーション：長期および短期の • 健康増進や二次障害予防。例えば早期発見と早期介入による側弯や褥瘡の 予防 • 保健医療サービスへのアクセス 教育 • 学校、教育プログラム、職業訓練プログラムへのアクセスを可能にする。 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス 社会 • 社会およびレクリエーション活動へのアクセス増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 能力強化（エンパワーメント） • 自己イメージや自信の向上 • ピアサポート（当事者支援） 88 説明： • このスライドは、CBR マトリックスに分類され た生活の主要側面を、適正な車椅子供与がどう 改善するかをまとめたものです。 • さらに詳しい情報は、「CBR ガイドライン」お よび「ToT ハンドブック」の CBR マトリックス に載っています。 その他の指針文書（15分） 説明： • WHO の「低リソース状況での移動支援機器供与 に関する共同方針提言書(114)」は、各国が CRPD の移動支援機器供与に関連する条文を履行でき るよう、2011 年に刊行されました。 • その内容は移動支援機器へのアクセスにおける 障壁、移動支援機器へのアクセスを増やすため の要件、各国と国際的な関係者への提言などの 情報です。 114 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) re lated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URL および https://j-aws.jp/who/). 89 説明： • WSTP 用 USB メモリに収めている、指針文書の 最後は「アクセシビリティのためのデザインの 留意事項(115)」です。 • この文書は、車椅子サービスを訪れる場合と、 その他の環境の両方とで、アクセスのあらゆる 面が考慮されるようにする方法に関する有益 な情報をもたらします。 説明：WSTP 教習員として、精通しておくべき指針文書は他にも数多くあります。 質問：別の主要な国際文書で、WSTP の開発が始まったあとに発表されたものがあります。それが 何か分かる人はいますか？ 回答を受けとめ承認せよ。 最も重要な答え： 「持続可能な開発目標 (SDGs)(116)」。 説明： • SDGs は「ミレニアム開発目標（MDGs）117」を 継承するものです。 • 2015 年 9 月に発表され、2015〜2030 年を達成 期間としています。 115 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled P eople; 2006 (http://ascon.info/publications/accessibility.pdf). 116 The sustainable development goals [website]. New York: United Nations (http://www.un.org/s ustainabledevelopment/sustainable-development-goals/). 117 [原文] Millennium Development Goals [訳注] 2015 年までに 8 目標・21 ターゲットの達成を掲げた. 90 車画を紹介せよ：「持続可能な開発目標（SDGs）」。 実習生に 17 ある SDGs に関する、この国際連合の 動画を視聴するよう指示せよ。 動画を上映せよ。 説明： • 障害について具体的に言及している SDGs は、 ゴール 4・8・10・11・17 の 5 つです。 • その世界的指標118のうち、9 つが障害に関連 します。 説明： • SDGs のねらいは、最もそこなわれやすい人びと に手を差し伸べ119、最後に取り残されたものへ 最初に手を差し伸べる120よう尽力すること です。 • 多くの関係者が SDGs に取り組むようになる ため、適正な車椅子供与が、そのゴール達成に どう貢献できるか検討することは重要です。 118 [原文] global indicators 119 [原文] reach the most vulnerable 120 [原文] reach the furthest behind first 91 説明： • WHO の 「 支 援 技 術 に 関 す る 世 界 的 協 力 (GATE)(121)」の取り組みは、もう一つの重要な 前進の一歩です。 • GATE は、支援技術へのアクセスを全世界で向上 させるためにつくられました。 • GATE の最初の成果が 2016 年 5 月に発表された WHO「優先的支援製品リスト (APL)(122)」です。 • APL では、政府が無理のない価格で利用可能に すべき 50 の優先度の高い支援製品/機器を取り 挙げており、そこに 4 種類のさまざまな車椅子 が含まれています。 説明：その他の関連文書で、「ToT ハンドブック」 で詳しく述べているものは： • WHO「障害に関する世界報告書(123)」 • WHO「世界障害者行動計画(124)」 • 国連「障害に関する高級事務レベル会合(125)」 121 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 122 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.w ho.int/phi/implementation/assistive_technology/global_survey-apl/en/). 123 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabi lities/ world_report/2011/en/). 124 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 125 Outcome document of the High-level Meeting of the General Assembly on the realization of t he Millennium Development Goals and other internationally agreed development goals for pers ons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.a sp?symbol=A/68/L.1). 92 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 93 ToT.10 視聴覚ツールおよび機材 ね ら い 実習生が、パワーポイント (PPT) によるプレゼンテーションおよび視聴覚機材を効果的 に使えるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPに使える各形式の PPTファイルの、利点および難点を説明する。  各種 PPTに変更を加え、動画を埋め込む。  視聴覚機材を用いる際の優れた実践を詳述する。  視覚教材としてホワイトボードやフリップチャートを効果的に用いる。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.10：視聴覚ツールおよび機材」  あればスライド転換用リモコンおよびレーザーポインター 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  機材および PPTの使い方（動画の埋め込みを含む）に自分が慣れておく。そうすれば 質問に答え、デモを上手に行ない、実習生がどんな問題にぶつかるかが分かる。 あ ら す じ 1. はめめに 2. WSTPのパワーポイント 3. ホワイトボードやフリップチャートを視覚教材に用いる 4. 要点のまとめ 4 20 20 1 授業時間計 45 94 はじめに（4分） 授業のねらいおよび学習目標を説明せよ。 質問：ここまでの教習で、どんな種類の視聴覚機材を使ってきましたか？ 最も重要な答え： • PPTおよび動画用にプロジェクター • ホワイトボード • フリップチャート • 壁の付箋紙 質問：それらの機材は、どういう点で役に立ちましたか？ 最も重要な答え： フリップチャートやホワイトボード： • 授業中および授業後の参照用に重要な、情報/学習の要点の強調（例えば「基本ルール」） • すでに与えられた答えの視覚的リマインダー • 技術的な説明の補助 PPTや動画 • 概念を説明する図表を示す機会 • 話すとともに画像/メッセージを示すことで、学びを補強 • 注意を集中させるために有効 95 WSTPのパワーポイント（4分） 説明： • WSTP の PPT は二つの仕様が使え、編集不可能 な PDF 版と編集可能な PPT 版があります。 • PDF 版は： o ファイルサイズが小さく、動画が埋め込まれ ています。 o 編集は不可能126です。 o 箇条書きが一つずつ現れる「ビルド」あるいは 「表示」といった効果はありません。 • PPT 版は： o ファイルサイズは大きいです。 o 編集可能です。 o 出荷状態では動画は埋め込まれていません。 o アニメーション効果が入っています。 126 [訳注] 日本語版は PDF 編集ソフトがあればある程度可能. 96 説明：教習員は、次の内容のスライドを追加しても よいでしょう： • 重要な質問： o 「教習員用指導書」には、教習員から受講者へ 尋ねるべき質問が載っています。 o スライドに質問を追加しておけば、その質問 をすることや、いきなり解答に移らないこと を覚えておけます。 • 要点： o 「教習員用指導書」には、長い本文がリマイン ダー用スライドなしで載っている項目もあり ます。 o 要点スライドを追加しておけば、授業計画の すべての面を押さえることを忘れないように できます。 • 活動への指示： o 活動に関連する重要な質問や重要な指示を、 スライドに追加できます。 説明：教習員は、次の目的でスライドを変更しても よいでしょう： • 現地の事情/状況に適合させる。 • 翻訳または現地で適切な用語を入れる。 • 本文を減らすか、内容を複数スライドに分割。 説明：内容の意味や WSTP の方法論は変えないこ とが重要です。 97 説明：スライドを修正あるいは追加する場合、必ず 守るべきことは： • PPT 原版と同じスタイルに従って下さい。 • WSTP の意味および核心的内容は、変えないで 下さい。 • WHO のロゴを（WHO の著作権規定に従い） 削除して下さい。 説明：スタイル、フォント、色を変更したり、複雑 なアニメーションを追加したりしないで下さい 98 スライドの追加 スライドショー」モードを終了し、その次のスライドを用いて以下のデモを行なえ。 説明： • 既存のプレゼンテーションファイルにスライ ドを追加する最も簡単な方法は、別のスライド を複製し、その見出しと本文の文字を削除し、 フッターのスライド番号を変更することです。 • 追加したスライドから、WHO のロゴを削除する ことを忘れないで下さい。 • これの詳しいやり方は、「ToT ハンドブック」に 載っています。 車画の挿入（Office 2013を使用） 説明： • 動画ファイルは、すべて mp4 と wmv の二形式 が用意されています。使うコンピューターに 合うものを選んで下さい。 • 動画によっては字幕入りも用意されています。 次のような目的のため字幕入りを推奨します： o 方言127を理解する困難を取り除く o 音質の悪さや外部の騒音を乗りきる o 聴覚障害者にも利用可能にする 説明： • 動画の埋め込みを推奨します。 • 埋め込むことで動画を PPT ファイルに内蔵でき ます。 • それによって、ファイルサイズは増えますが、 ファイルを他のコンピューターにコピーして も動画が失われることはありません。 127 [原文] regional accents 99 以下をやって見せよ： PPT 2010 以降の128ソフトで動画を埋め込む には、次の手順に従います： • 「Presentations」＞「PowerPoint」フォルダー を開きます。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入 • 変更を保存 • これで動画が PPT の一部になりました 説明： • 動画がつねにフルスクリーンで表示される ようにも設定可能です。 • ウィンドウズコンピュータ ：ー「ビデオツール」 の「再生」タブから「全画面表示の再生」チェ ックボックスをオンにする。 • アップルコンピューター：「ビデオ形式」タブ から「再生オプション」をクリック、ドロップ ダウンリストから「全画面再生」を選択。 「スライドショー」モードに戻り、動画再生のやり方を示せ。最初の数秒間だけ再生したら、次の スライドへ移れ。 ToT 教習員への注記： • 実習生には、これらの技能は一日の終わりの準備時間に練習できることを伝えよ。 • 現地の写真やイラストを、状況を示すために追加してもよい。 • スライドの翻訳は現地で行なってよい：すでにスライドの現地語訳129があるかどうか、 WHOに必ず確認せよ。 128 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 129 [訳注] 日本語版 PDF は全 WSTP について右ウェブページよりダウンロードが可能 (https://www.j-aws.jp/). 100 説明： • PPT の授業を練習する時は、「スライドショー」 モードを用いなさい。それによってトランジシ ョン、アニメーション、フローなどの問題を発見 できます。 • 教習で使う「スライドショー」モードのコンピュ ーターおよびプロジェクターを用い、スライド および動画を通しで実行しなさい。 • 自分のコンピューターを用いない場合、設定が 異なる別のコンピューターではプレゼンテーシ ョンファイルを予定通りに実行しないことがあ るため、これは重要です。 • 教習中のプレゼンテーションは、すべて一台の コンピューターで行なうことを検討しなさい。 これでプレゼンターごとの切り替え時間が省け ます。 説明： • できれば、予備のプロジェクターかプロジェク ター用ランプを用意しておきなさい。 • 休憩時間や実習中は、プロジェクターの電源を 切ってランプの使用を節約しなさい。 • 黒色あるいは白色のスクリーンに映写する必要 がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キー を打つと黒いスクリーンになります。 白または黒のスクリーンにする方法を実演せよ。 101 説明： • リモコンを用い、クリックしてスライドを切り 替えると、教習員はプレゼンテーションの間に コンピューターの横に立たなくて済みます。 • レーザーポインターは、スライドの個別の項目 について受講者の注意を引くために使えます。 • スピーカーは、接続が正しいか毎朝テストして おきなさい。 リモコンとレーザーポインタ （ーあれば）の使い方 をやって見せよ。 ホワイトボードやフリップチャートを視覚教材に用いる（4分） このスライドは活動の間じゅう映しておけ。 活車１ グループ： 実習生を 5グループに分けよ。 指導内容： 実習生に「ToTハンドブック」p.60の「ホワイトボード/フリップチャート を視覚教材に用いる」に関する表を参照させよ。 各グループに表のトピックを一つずつ割り当てよ。与えられた情報を通読 し、それを他のグループへ、ホワイトボード/フリップチャートを活用して 伝達する方法を計画するよう実習生に指示せよ。 モニター： グループをモニターし、必要に応めて支援せよ。 時間： 準備に 10分、各グループのプレゼンテーションに 2分ずつ見込んでおけ。 フィードバック： プレゼンテーションで抜けていた情報があれば補足せよ。 102 ホワイトボード/フリップチャートを視覚教材に用いる 1. スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかめめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 2. ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 3. ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正130に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 4. 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 5. ホワイトボードの動入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間131」で 姿勢を描くなど）。 130 [原文] neat 131 [原文] ‘stick-draw’ 103 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 104 ToT.11 フィードバックについて ね ら い 有益なフィードバックを与える、教習員の役割および技能を探求する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  有益なフィードバックを与えるやり方を詳述する。  各模擬授業の終わりにフィードバックを与えるプロセスを詳述する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.11：フィードバックについて」 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。  フリップチャート紙 1枚にフィードバックの 4ステップを書いて用意しておく： 1. 実習生の自己省察 2. 模擬受講者のフィードバック 3. ToT教習員のフィードバック 4. ToT教習員が要点を話し合う あ ら す じ 1. はめめに 2. フィードバックを与える 3. 模擬授業後のフィードバックプロセス 4. 要点のまとめ 2 35 7 1 授業時間計 45 105 はじめに（2分） 授業のねらいおよび学習目標を説明せよ。 フィードバックを える（35分） 質問：フィードバックとは何でしょうか？ 最も重要な答え： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 説明：教習員が、上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を 支援できることは重要です。 このスライドは活動の間じゅう映しておけ。 106 活車１a グループ： 実習生をペアに分けよ。 指導内容： 質問：フィードバックをもらうことについて、どんな経験がありますか？ 自分の学びに役立ったフィードバック、また自分が身構える132か動転して133 役に立たなかったフィードバックを思い出しなさい 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 実習生に、その考察を「ToTハンドブック」p.61に記録するよう指示せよ。 モニター： 各ペアをモニターし、必要に応めて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、全体へのフィードバックに 5分を 見込んでおけ。 フィードバック： 実習生に、事例を提供するよう依頼せよ。 キーワードをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 132 [原文] defensive 133 [原文] upset 107 活車１b グループ： 実習生を同めペアに分けよ。 指導内容： 質問：教習員は、フィードバックを与える際に何を考慮すべきでしょうか？ 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応めて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、フィードバックに 10分を見込んで おけ。 フィードバック： 各ペアに順番で、フィードバックを与える際の重要な留意事項を一つか二つ 述べるよう指示せよ。 検討すべきよい例を受けとめ承認せよ。 誤解があれば訂正/説明せよ。 下の注記を用い、適切な答えが全体で話し合われるようにせよ。 ToT 教習員への注記： 望ましいフィードバック： • タイムリーに134：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。これは受講者 が、フィードバックを直近の学びや経験と結びつけるうえで有効である。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 行動に絞り込め：建設的なフィードバックを与える時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に公開で与えよ。意識、 行動、規律に関わる問題には、非公開で対処せよ135。 • 受講者の視点に立って：まず受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者を支援せよ、みんな違ってみんないい136：建設的なフィードバックを与える前に、受講 者が完了した活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。 サービス提供の取り組み方は十人十色である。受講者が自分と同めように動くと期待するな。 134 [原文] Be timely 135 [原文] deal with them in private 136 [原文] we are all different [訳注] 文脈と用例から, 文意に対してはこの詩句の引用が最適と判断した. 108 模擬授業後のフィードバックプロセス（7分） 説明：ToT 教習員は、授業は教室の後ろから観察しますが、フィードバックのファシリテーション を行なうには教室前方に移動します。 フィードバックの 4 ステップを示す、作成済みの フリップチャート紙を掲示せよ。参照のため、これ は教習の残りの期間、壁に貼ったままにしておけ。 説明：模擬授業の後には、4 つのフィードバックの ステップがあります。 1. 実習生自身の振り返り137：リーダー役実習生が 自分たちの出来ばえを振り返ります。内容は： • 何がうまく行ったか？ • 何に改善の余地があるか？ 2. 模擬受講者のフィードバック：リーダー役実習 生へ、次に関するコメント 1 つを含む、簡潔で 具体的なフィードバックを与えます： • 何がうまく行ったか？ • 何に改善の余地があるか？ 3. ToT教習員のフィードバック：ToT 教習員が、 実習グループが全体として学べる部分に絞り、 「必須教習技能」授業の学びを補強する追加の フィードバックを与えます。 4. ToT教習員が要点を話し合う：ToT 教習員と、 全実習生に関係がある、その授業の要点を話し 合います。 137 [原文] self-reflection 109 説明：フィードバックをもたらすさい、重要なことは： • 話題になっている人を見ながら、その人に直接語りかけなさい。 • 具体的に。例えば「それは本当によい」と言うより「あなたのグループ分けのやり方と、明確な 指示の出し方がよかった」と言うべきです。 • 受講者からのフィードバックは、つねに建設的であるべきです。 • フィードバックが実習生を傷つけるか無神経なものであれば介入し、フィードバックを言い直し て建設的なものにしなさい。 • フィードバックのプロセスは、この授業で学んだことを実践に移す機会になります。 より正式な実習生と１対 1 でのフィードバックは、各教習日の終わりの準備時間に行ないます。 何か質問がないか尋ねよ。 要点のまとめ（1分） 要点を読み上げよ。 何か質問がないか尋ねよ。 110 ToT.12 グループダイナミクスを取り仕切る138 ね ら い グループで効率よく効果的に作業する要領、およびグループ内で個々人が示すさまざま な行動を取り仕切るやり方を考究する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  多彩な方法を活用して、技能、専門性、経験を考慮した、活動のための小グループを 編成する。  グループでの妨害行動139に対処する。 教 材 この授業には：  PPTスライド「必須教習技能 ToT.12：グループダイナミクスを取り仕切る」  「妨害行動カード」を準備：この授業計画の最後に収録しているカードを、印刷して 切り分けるか手書きする。帽子かバケツを用意しておく。 準 備  教材を取りまとめ、PPTスライドを見通し、授業計画を読み通す。  「ToTハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はめめに 2. グループ活動を組織し取り仕切る 3. 妨害行動に対処する 4. 要点のまとめ 3 10 25 2 授業時間計 40 138 [原文] Managing group dynamics 139 [原文] disruptive behaviour 111 はじめに（3分） 授業のねらいおよび学習目標を説明せよ。 質問：なぜ WSTP にはグループ活動が盛り込まれ ているのでしょうか？ 回答を受けとめ承認せよ。 回答をホワイトボードに記録せよ。 説明： • 教室内にはつねに、さまざまなレベルの経験と 専門性を持つ人がいます。 • グループ作業によって可能になることは： o 教習員は、すでにどのくらいのことが知られ ているのかを見出せます。 o より多くの経験や専門知識を持つ人が、他と それを共有できます。 o 受講者は、自分が経験を通してすでに多くの ことを知っているとわかり自信がつきます。 o 内気な、または年若い受講者も小グループの 中では気後れせず発言できます。 112 グループ活車を組織し取り仕切る（10分） 質問：受講者をグループ分けする際の重要な留意 事項は何でしょうか？ 回答を受けとめ承認せよ。 実習生に、「ToT ハンドブック」p.63-65 を開き、 実習生が挙げなかった内容を指摘しながら、一覧 に沿って話し合うよう指示せよ。 ToT 教習員への注記： グループのサイズを決定する要因 • 時間グループが多いほど、フィードバックにも時間が必要になる。持ち時間が少なければ、大 きいグループをつくれ。ただし、1グループの人数は 6名を超えないようにせよ。 • プライバシー/内密さ140：気をつかうトピック、内気な人、言語の壁がある場合の話し合いに はペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な機材/消耗品の分量。例えば、作業場が 3か所あれば、3グループ まで対応が可能になる。 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や経歴を持った人を同めグループにする（臨床職全員が 協働するように配置する、あるいは技術者全員が同めグループにいるなど）か、逆に、わざと 同めグループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、かれらをグループ にする方が適切な場合と、分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混合：これはお互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混合：作業への文化・宗教・社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が協力し合って作業し、学び合いの機会141が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 140 [原文] confidentiality 141 [原文] peer learning opportunities 113 グループづくりの動法 各WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与え ている。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ 分けの手法をいくつか掲げる： • フルーツサラダ法142：同め果物カードを 3、4枚ずつ、さまざまな種類の果物で受講者の人数 分になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ (1人 1種類の)」でいっしょになる、などを指定する。 • 番号点呼143：必要なグループ数の番号を点呼する。例えば 3グループに分ける必要があれば、 最初の人が「一」、次の人が「二」、それから「三」、また「一」に戻って数を点呼するよう 指示し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分け ておく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3人、次の 3人 とまとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1人または 2人、自分が組んだことがない人を選んでもらう。ただし 3人を超える と、自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4人ずつのグループに有効。 妨害行車に対処する（25分） このスライドは活動の間じゅう映しておけ。 142 [原文] The fruit salad method 143 [原文] Count off 114 活車１ グループ： 実習生をペアに分けよ。 指導内容： どんな受講者の集団も、幅広い個性、技能、経験、学習スタイルの集まりで あり、また、ある種の行動が授業を妨害する場合のみ教習員は対処すべきで あることを説明せよ。 実習生に、あちこちの教習でどんな種類の妨害行動を目にしたことがある か、パートナーと話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応めて支援せよ。 時間： 話し合いに 2分、フィードバックに 3分見込んでおけ。 フィードバック： 各ペアからの答えを、新しい考えが出なくなるまで一つずつ集めよ。 答えをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 活車２ グループ： 実習生をペアに分けよ。 指導内容： 各ペアに、順番に帽子/バケツからカードを 1枚ずつ引くよう指示せよ。 各ペアに、そこで述べられている行動にどう対処するか、パートナーと話し 合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応めて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 各ペアに、各自のアイデアを共有するよう指示せよ：グループでのそうした 問題にどう対処する？何が有効/無効か？ 各ペアからのフィードバックの後で、他に共有するアイデアがあるか実習生 に尋ねよ。 115 ToT 教習員への注記： いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、前向きだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 地位が高い/年長の受講者 • 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいは その人に反対するのをためらうかもしれない。 • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話す よう呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 場を仕切る受講者 • 自分が仕切り、大声で、または長時間しゃべり、他の受講者に、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っている かのように振る舞う。 • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える 機会を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく特定の受講者に、質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は、最有力な受講者とのペアあるいはグループに入れ、 内気な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 寡黙な受講者 • もともと寡黙あるいは内気で、大人数の前でしゃべり、グループ活動へ貢献することに気が 進まない受講者。 • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3名の）を活用せよ。 攻撃的な受講者 • 異論を唱え、自分が信められない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。 • または教習員の技能・知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとっては本当ですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 116 ToT 教習員への注記： 注意散漫な受講者 • 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習の妨げになるのか話せ。規則を念押しせよ。 ふざける受講者 • 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動 中のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 ネガティブな受講者 • ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれ が住む地域ではうまく行きっこない」とコメントするかもしれない。 • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由 を説明する機会を与えよ。他の受講者に、それに同意するか尋ねよ。他の受講者も同意すれば、 「どうすればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 要点のまとめ（2分） 要点を読み上げよ。 何か質問がないか尋ねよ。 117 妨害行車カード：コピーするか動書きして切り分けよ 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた 場合、受講者たちは話し、質問に答え、または その人に反対するのをためらうかもしれない。 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、 他の受講者には、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受 講者。こうした人は、自分はすでに何でも知っ ているかのように振る舞う。 寡黙な受講者 寡黙あるいは内気で、大人数の前でしゃべり、 グループ活動に貢献することに気が進まない 受講者。 攻撃的な受講者 異論を唱え、自分が信められない概念を問い ただし、トピックや論点について議論を吹っ かけ、グループの他の受講者がどれくらい強く そう思っているか試す受講者。または教習員の 技能・知識程度を試し、自分の方が優れている と示そうとするかもしれない。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入った り、電話を手に取ったり放したりする受講者。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談 を飛ばし、時には他をからかう受講者。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 118 中級教習モジュール 119 A.1: 付加姿勢支持が有益な車椅子ユーザー この授業を教えるための主な留意点 a. 全般 • グループでの話し合いは、教習員が受講者の既有の知識・経験の程度を理解するために役立つ。 • 個々の姿勢支持具（PSDs）に関する細かい議論は避けよ。それらは後の授業で取り上げる。 b. 第 3節：いつ付加姿勢支持が必要なのか？ 準備のコツ • 活動：中級 WSTP「教習員用指導書」p.34-35 のキャッチボールおよび水飲みの活動について、 椅子がじゅうぶん丈夫なことを確かめよ。適当な椅子がなければ、車椅子を使ってもよい。 内容 • 多くの中級レベル適応の車椅子ユーザーは、褥瘡発生の危険が大きい。その理由は： 圧力 − 非対称な（不均等な）姿勢1 − 不動性2（動けないこと） − 虚弱さ3 − バランスの乏しさ − 姿位4を変えられない、あるいは除圧動作を実行できない。 剪断 − 虚弱さの結果としての不安定な姿勢 − 緊張（固さ）の増大5 − 制御できない運動6 − 関節の拘縮7 − 対処されていない脚長の左右差 1 [原文] asymmetrical (uneven) posture 2 [原文] immobility 3 [原文] weakness 4 [原文] position [訳注] 本書では posture の訳語に「姿勢」, position の訳語 (の一つ) に「姿位」を用いている. 5 [原文] increased tone (stiffness) 6 [原文] uncontrolled movement 7 [原文] joint contractures 120 摩擦 − 姿勢支持が足りないと、車椅子ユーザーの身体の一部が車椅子や姿勢支持具と 擦れる。 − 制御できない運動や筋攣縮 [きんれんしゅく]8 − 移乗中に起こる負傷：例えば車椅子ユーザーの臀部が、持ち上げても9車椅子から 離れなかった場合、皮膚が引きずられて摩擦を生じる。 • 中級レベル適応の車椅子ユーザーは、除圧クッションだけでは褥瘡の予防に不十分な場合がある。 • 車椅子ユーザーを安定させ、適切な姿勢支持具で姿勢を支え、ユーザーおよび/またはその介助 者を教育することが、褥瘡の発生・悪化10を予防するために役立つ。 • 褥瘡は、車椅子ユーザーの身体と車椅子、クッション、姿勢支持具との、あらゆる接点で発生・ 悪化しうることに留意せよ。 c. 第 4節：車いすユーザーは何を望んでいるのか？ • 「教習員用指導書」p.38 に列記した「車椅子ユーザーが付加姿勢支持を備えた車椅子を拒否する 理由」に追加するとよい答えの例： o 費用：付加姿勢支持を備えた車椅子には、ユーザーに追加費用が生じる場合がある。 o サイズ：多くの姿勢支持付き車椅子は折りたたみできず、より大きくまた重い。 o 姿勢支持車椅子には決まった種類の姿勢支持具一式が付属しているが、その中には当該車椅子 ユーザーには必要ないものもある。 o 車椅子に付加した姿勢支持具への余分なメンテナンス。 8 [原文] spasms 9 [原文] when lifting 10 [原文] developing 121 A.2: 障害児 この授業を教えるための主な留意点 a. 第 3節：さまざまな体位 • 6 歳まで子どもの股関節は、大きい子どもや成人のように完全にまっすぐに（伸展）したり内転 したりできない。これが、子どもの立位や座位の姿勢が異なる理由である。 • 小さい子どもは、そのため股関節がわずかに屈曲し、両膝が開いてわずかに外向きになるように 立つ。その股関節を無理にまっすぐにしては絶対にならず、足を真正面に向けさせてはならない。 うつ伏せに寝る時には、股関節がわずかに屈曲し、膝と足が外を向いているようにすること。 • ポスタ 「ーさまざまな体位」のイラストは、股関節がすでにまっすぐになって（伸展して）いる、 大きい子どものそれである。 立位 • 立つことが重要な理由に関する注記（「教習員用指導書」p.44）に「骨折の予防」を追加せよ。 これは重要な点である。 • 他の立つことの有益な点で、挙げられていなかったものとしては： o 痙縮 [けいしゅく] (筋肉の硬直)11の制御を助ける。 o 消化を助ける。 o 排便・排尿を助ける。 o 座骨からの圧力を緩和する。 o 骨の発達を助け、骨密度（強度）の低下を抑える。 • 「教習員用指導書」p.45・スライド 8：小さい子どもの立位に関する注意への追加項目として、 立位台の膝への支えは決して膝蓋に直接ではなく、その下に設けなければならない。その理由： o 膝蓋は敏感なため、そこへの圧力は痛みや不快感を生じる。 o 膝の、体重が自然にかかる部位は膝蓋のすぐ下である。ここは下腿義足12が体重を支える部位 でもある。 11 [原文] spasticity (muscle stiffness) 12 [原文] below-knee prostheses 122 b. 第 4節：子どもを早期紹介する重要さ • 車椅子の供与が、子どもの歩くことへの欲求や歩行能力を奪うことはない。 • 子どもへの車椅子供与は、子どもが以下を行なうために役立つ： o 友だちと遊ぶ。 o 学校へ通う。 o 自分のことをやる。 o 家の手伝いをする。 • 車椅子を使うと、歩行器に比べてエネルギー消費が少なく、子どもは行動半径を広げ、より完全 に参加できるようになる。 • 子どもの歩行は、車椅子を使用することで改善する場合があり、それは子どもがより少なく歩き、 費やす労力も少なくなることが、歩行の質的向上を助けるためである。 c. 第 5節：子どもと働く • この授業で述べる子どもの安全のための慣行は、子どもと関わって働くために最低限必要なもの である。 • 受講者には、各自のサービスにおける、子どもの安全に関する行動規範を策定するよう勧めよ。 行動規範は、職員が子どもとの安全な関わり方を理解するのを助ける。児童保護に関する資料と しては： o 児童保護に関する、現地の国や機関の法令や政策 o オーストラリア国際開発評議会：「児童保護政策策定のための行動規範ガイドライン(13)」 o 国際児童基金（UNICEF）ウェブサイト(14)の「児童保護」 13 ACFID Code of conduct guidelines for the development of a child protection policy. Canberra: Australian Council for International Development; 2016 (https://acfid.asn.au/resources). 14 Child protection. In: Disabilities in programmes, UNICEF [website]. New York: UNICEF; Sept 2015 (http://www.unicef.org/disabilities/index_65309.html). [2023 年 8 月 17 日：リンク切れ] 123 B.1: 事前評価の概略・事前評価インタビュー WSTP［車椅子サービス教習パッケージ］教材の誤り a. 全般 • 「教習員用指導書」に記した 1〜3 節への時間配分は、下記のように修正すべきである： o 第 1 節15 2 分 o 第 2 節16 3 分 o 第 3 節17 65 分 「教習員用指導書」p.53 の授業計画の「あらすじ」、および同書 p.53 ・54 の各節への時間配分を 変更せよ。合計の授業時間に変更はない。 b. 第 3節：事前評価インタビュー（実習を含む） • 「教習員用指導書」p.56 の活動への指導内容に、一点誤りがある。指導内容では「各グループに 番号（1〜5）を付与し」となっているが、これは「1〜4」とすべきである。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 事前評価フォームに現地のサービス供与者が加えたどんな変更も、授業に組み込むよう考慮せよ。 • グループ活動に盛り込まれた障害や疾患の種類を、状況に応じて調整せよ。 内容 • 受講者は基礎 WSTP の事前評価インタビューには精通しているはずである。したがって、中級 レベル適応の車椅子ユーザー向けの新しい内容に集中せよ。 15 [訳注] 日本語版の「1. はじめに」 16 [訳注] 日本語版の「2. 事前評価」 17 [訳注] 日本語版の「3. 事前評価インタビュー」 124 b. 第 3節：事前評価インタビュー • この節の合計時間は 65 分である（上記、誤記訂正の項を参照）。内容は活動への指導・説明18を 含む授業への導入を 5 分、および 60 分の活動である。 • 活動では、さまざまな障害についてより詳しい受講者に、他のグループメンバーを支援するよう 励ませ。 • 単一の疾患/身体的問題について、長々と話し合うのは避けよ。 • 車椅子ユーザーによっては診断を受けていないか、誤診を受けている場合がある。したがって、 ユーザーが受けた診断は貴重な情報をもたらすが、重要なのは事前評価を完全に実施することで ある。そのあらゆる情報が、最適な車椅子の選択に必要となる。 18 [原文] instruction 125 B.2: 身体的事前評価−支えなしの座位姿勢 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 5節：小さい子どものまっすぐな座位姿勢 • 「教習員用指導書」p.68 のスライド 10 の最初の箇条は「背中は 平らで腰椎のカーブがなく」とすべきである。PPT スライドおよ びスライドへの注記から「や胸郭19」を削除し、語句を訂正せよ。 • イラスト（図 1）から判る通り、胸椎には前方へのカーブがあり、 その結果、子どもの肩は耳や股関節よりもわずかに前方に出る。 ここの重要なメッセージは、5 歳未満の子どもの「まっすぐな」 姿勢は大人のそれとは異なる、ということである。 図 1 小さい子どもの まっすぐな姿勢 b. 第 7節：座位姿勢を観察する • スライド 18 が PPT と 「教習員用指導書」とで異なっている。「教習員用指導書」では肩の右側 が低いと述べているが、スライドの図は肩の左側が低くなっている。「教習員用指導書」p.72 の 語句を「両肩が水平でない（左側が低い）」に訂正せよ。 19 [訳注] 日本語版ではこのスライドの thoracic curve を「胸郭のカーブ」と訳している. これは「胸椎のカーブ」 とすべきであったが, いずれにせよこの訂正により上記の通り削除することとなった. 126 c. 第 8節：姿勢を記録する • 「教習員用指導書」の活動（p.76）には線画が欠落している20。それらを図 2 に示す： 教習員向けの線画の見本 図 2 線画の見本21 この授業を教えるための主な留意点 a. 第 4節：まっすぐな座位姿勢 • 「固まった姿勢」、「ニュートラル姿勢になる柔軟さ」、「ニュートラル姿勢途中の柔軟さ」などの 用語は、車椅子ユーザーの全身姿勢にではなく、個々の関節に対して用いるべきである。例えば、 左股関節が「固まって」いても、右股関節には「ニュートラル姿勢途中の柔軟さ」がありうる。 b. 第 5節：小さい子どものまっすぐな座位姿勢 • 子どもの腰椎と胸椎のカーブは、立つことによって発達する。立ったことがまったくない子ども は、長じてもこれらのカーブが発達することはない。 20 [訳注] 教習員用指導書の「教習員用の線画の例題」の下に位置するべき解答である. 21 [訳注] いちばん左のイラストは、例題とは左右が逆になっている. 127 c. 第 6節：骨盤は座位姿勢の基礎 • 受講者全員が、座骨（ITs）、上前腸骨棘（ASIS）、上後腸骨棘（PSIS）の位置を見出せることを 確かめてから次へ進むこと。 • 拘縮や変形、肥満のため骨の指標部位22を見つけるのが難しい場合もある。受講者に、肥満した 車椅子ユーザーでも、正中線に対する ITs・ASIS・PSIS の位置は変わらないのだと念押しせよ。 受講者は、触診（指標部位を感じ取る）を始める前に、解剖学の知識を駆使して骨の指標部位が どこか見当をつけておくべきである。 • 骨盤に関する「まっすぐ/ニュートラル」の語について： o 「水平な骨盤」とは、前方/正面から見た骨盤に関わる。水平な骨盤は、正面から見て左右に 傾いておらず、左右の ASIS が横一直線上にある。 o 「まっすぐな/ニュートラルな骨盤」とは、側方/横から見た骨盤に関わる。まっすぐな骨盤は、 横からみて前傾も後傾もしておらず、座骨の上でバランスが取れている。 d. 第 7節：座位姿勢を観察する • 車椅子ユーザーの姿勢を観察するさい、評価ベッドなり椅子の脇に座れるよう、ユーザーに多少 支えが必要になることもある。ただし、この支えがユーザーの姿勢を矯正してはならない。 • 「教習員用指導書」p.72 のスライド 19 への注記のうち「体幹がやや（左側が後方へ）回旋して いる」および「左脚が内旋している」については、納得しない受講者もあろう。その場合は： o 受講者に主要な偏り、すなわち骨盤の回旋と右脚の外旋に注目するよう求めよ。 o 一方向からだけの観察で、姿勢の微妙な変化を見定めるのは難しいことを認めよ。人の姿勢を 十全に理解するには、必ず正面、横、背後から、主要な解剖学的/骨の指標部位を確かめつつ 観察しなければならない。 e. 第 8節：姿勢を記録する 姿勢を描くコツ • 姿勢を描くのが受講者には難しいようなら、まず姿勢の線を人体イラストに描き込み、それから フリーハンドで指定欄に描き取るよう勧めよ。 • 骨盤の小丸と点/角は、骨盤の ASIS・PSIS・ITs など骨の指標部位を表している。 • 骨盤に付ける小丸は不可欠ではないが、骨盤の姿位を強調するために有効である。 • 教習員は、大腿の描き方は一通りを選択し、ずっとそれで通すことが重要である23。 22 [原文] bony landmarks 23 [訳注] 大腿の描き方が複数紹介されているための注記. 詳細は教習員用指導書 p.75「教習員への注記」を参照. 128 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 2節：骨盤と股関節の姿勢チェック • PPT ファイルからスライド 6 が欠落している24。PDF 版は正しい。 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役実習生と補助役実習生は、この授業をいっしょに準備し、実技の教え方に統一性を 持たせよ。例えば、正しい手の位置、角度計 ［ゴニオメーター］の使い方、モデルの車椅子ユー ザーの正しい姿位など。 • 一時的支持部は予め準備しておく必要があり、現地の、最も広く使われているクッション基層の 材料でつくるべきである。 • 脊椎および短く大腿骨が付いた骨盤の人体骨格模型や子どもの体格の人形（あれば）は、一時的 支持の適用法をやって見せるために役立つ。 ToT 教習員によるデモ/説明 中級 WSTP「教習員用指導書」p.79 の指導・説明に従って骨盤と股関節の姿勢チェックへ導入し、 活動を進めよ。 b. 第 2節：骨盤と股関節の姿勢チェック 以下を強調せよ： • 車椅子ユーザーの周囲を移動するようにし、その上に身を乗り出さないなど、敬意のこもった 立ち位置を取れ25。 • 腰を痛めないために： o 身を乗り出さないで済むよう、車椅子ユーザーの位置は評価ベッドの端の方にする。 o かがまないでひざまずく。 24 [訳注] この日本語版作成の時点で, WHO の配布教材ではすでに修正されていた. 25 [原文] Be respectful in how you position yourself 129 • 最初に車椅子ユーザーの姿勢を臥位で確認してから、骨盤と股関節の姿勢チェックを始めよ26。 その内容は： o 肩を水平にせよ：ベッドの前後辺を基準点に用いよ。 o 頭・首・体幹上部を、ベッドの側辺を基準点に用いて揃えよ27。 • 車椅子ユーザーの四肢および身体の上手な扱い方28をやって見せよ。強くつかみすぎると不快感 を生じる。 • 股関節の緊張をゆるめるため、骨盤と股関節の姿勢チェックは車椅子ユーザーの膝を支えながら 実施せよ。股関節周りの緊張が非常に強いと、車椅子ユーザーの骨盤が、ニュートラルでない 姿勢へ引かれかねない。 • 車椅子ユーザーの衣服が、股関節の動きの自由を妨げないようにせよ。 • 評価者と助手両方の、手の位置を（「教習員用指導書」p.84 で詳述している通りに）強調せよ。 助手からのフィードバックは、精確なチェックの要諦である。 o 評価者の手は、脚の重さを支える。膝裏の緊張 （固いハムストリングス）によって骨盤が動く ことで膝が曲がる（屈曲する）のを、評価者の手が制限してはならない。 • 角度計の正しい使い方をやって見せよ。 • 受講者が ［動きの］制限を真似てみることがある。これは通常、混乱のもとである。受講者には 手順と技法の習得に集中するよう戒めよ。そうすれば、実習中に本物の制限を感じることになる。 まとめとして動画を上映せよ。 ジェンダー/文化への配慮 • 骨盤と股関節の姿勢チェックをやって見せ、また受講者に実施してもらう際には、ジェンダーに 基づいて受講者をグループ分けせよ。 26 [訳注] 日本でのいわゆる「マット評価」で, WSTPtot で追加された内容である. 27 [原文] line up 28 [原文] good handling [訳注] 文意から, 療法技術としての「ハンドリング」との混同を避けた. 130 この授業を教えるための主な留意点 a. 第 4節：固まった水平でない骨盤への一時的支持のデモ • 受講者が、骨盤を水平にするため、低い側に支えを付加してはと提案した場合の説明： o 骨盤姿勢は、矯正しても水平でニュートラルな骨盤にはできない。 o 水平でない骨盤の座骨を圧迫すると強い圧力を生じ、褥瘡につながる。 • 骨盤と股関節の姿勢チェックからの所見を強調せよ。受講者が臥位で骨盤を水平にできなかった 場合、座位でも骨盤は水平でないままである。 • この姿勢支持具は、単独では使われない。固まった水平でない骨盤の車椅子ユーザーには、姿勢 を支えるために他の姿勢支持具がいくつか必要になる。 b. 第 5節：ニュートラルな座位姿勢まで屈曲しない股関節への一時的支持 のデモ • 希望者を募る前に、人体骨格模型か人形 を用いてやって見せることを検討せよ。 • 臥位で、股関節がニュートラル姿勢まで 曲がらないところをやって見せよ。 • 膝裏から評価ベッドに下ろした垂線 ［図中の点線］がつくる、三角形の空間 を強調せよ（図 3）。 図 3 一時的支持 • 垂線から座骨までの距離が、大腿が骨盤を押して後傾させるのを止めるために必要な、一時的 支持部の高さである。 • 体幹〜大腿の角度を測れ。 • 人形/モデルを一時的支持部に座らせよ。 • 体幹〜大腿の角度が同じであることを示せ。 • 大腿の下の三角形のすき間は、ニュートラル姿勢まで曲がらない股関節に形を合わせる側の、 クッション前部に必ず設けるべきものの形状である。 • 受講者が、この大腿の下の三角スペースをウェッジで埋めてはと提案する場合もあろう。これは 可能ではあるが不必要で、なぜなら骨盤の最終姿勢には変化を及ぼさないからである。 131 B.4: 身体的事前評価−ハンド・シミュレーション WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 3節：ハンド・シミュレーションの結果を記録する • 「教習員用指導書」p.101 の活動への「答え」欄に、エニスの股関節姿勢がニュートラルとして 記録されている。これは誤りなので、左右の股関節へのチェック印✔︎を「いいえ」に変更。 • 注記の「体幹〜大腿の角度が 90 度超」は正しい。 ToT 教習員によるデモ/説明 a. 第 2節：ハンド・シミュレーションのやり方 この授業を教えるための主な留意点 • 身体的にはもっとまっすぐに座れるものの、その姿位では維持できない車椅子ユーザーもいる。 そうしたユーザーには、車椅子を一日じゅう使えるように、あまり起こしすぎない、骨盤後傾の 姿位での支えが必要な場合もある。より起こした姿位から、ユーザーの頭と体幹のバランスが 取れる最適な姿位のところまで、徐々に車椅子ユーザーの骨盤を後ろへ傾けさせよ。 • 助手が複数いても、手だけでは与えられない強い支えが必要な場合があり、ハンド・シミュレー ションが常に実施できるとは限らない。そうした場合は、以下の使用を検討せよ： o より安定して支えるための、カバーが付いた板、フォーム材、セラピー用ブロック29 o 姿勢支持部を仮設した模擬 [仮合わせ]30の車椅子 • 小さい子どもへのハンド・シミュレーションは、その子が怖がっている間は実施が困難である。 以下を検討せよ： o 子どもを親/介助者の膝の上に横向きに座らせる。 o ちょくちょく休憩を取る。 o 親/介助者を事前評価に、例えば子どもの足や肩を支えて参加してもらう。どれくらいの強さ で支える必要があるか、適切な指示を出すようにせよ。 • ハンド・シミュレーションでとれた最終姿勢を、骨盤と股関節の姿勢チェックの結果と比較する ことは重要である。骨盤と股関節の最終姿位は通常同じになる。違いが生じた場合の理由： o 骨盤と股関節の姿勢チェックで力を加えすぎていた。 o 座位での支えが不十分。 29 [原文] upholstered boards, foam or therapy blocks 30 [原文] mocked-up with temporary postural supports 132 この授業を教えるための主な留意点 a. 全般 • 受講者が、ハンド・シミュレーションや車椅子ユーザーの姿勢分析に慣れていなければ、さらに 時間が必要になる。 • 動画でのケーススタディすべてを通して、段階を踏んで取り組むことを強調せよ： o 助手に明確な指示を与える。 o 最初に骨盤の姿位を決めてから、他の部位への支えに移る。 • ハンド・シミュレーションでとれた最終姿勢は、必要な支えと併せて、絶対に文書化しなければ ならないことを、受講者が理解するようにせよ。文書化は、描画、ことばによる説明、事前評価 フォームに載っている身体の各部位についての確認表記入などによる。 • 写真がサービス文書の標準内容とされている場合は、だれかに姿勢を変えるごとに写真を撮って もらえ。 o サービス職員は、それぞれの写真を見直して、車椅子ユーザーへ設ける支えをどう変更するか 判断できる。 o 身体への操作を最小限にできる31ため、時間の節約になる。 • 教習プログラム中に写真を用いる場合は、受講者に、最終写真を指針に用いて、自分が担当する 車椅子ユーザーへのハンド・シミュレーションの結果を記録するよう指示せよ。 • 車椅子ユーザーの資料作成には最終写真のみを用い、他の写真はすべて削除せよ。 31 [原文] can minimize handling 133 b. 第 3節：ハンド・シミュレーションの結果を記録する 内容 • 姿勢全体が目に見えない場合は、「教習員用指導書」の「教習員への注記」を用いて明確にせよ。 • 全受講者が最後のハンド・シミュレーション、姿勢の描画・説明の記録を練習する時間を取れ。 • ニュートラルな姿勢だと記録するには、必ず正面と横から見てニュートラルでなければならない。 • 「はい」にチェックを付ける身体部位は、ハンド・シミュレーションで、付加姿勢支持の有無に かかわらずニュートラルな姿勢をとれた部位である。 • ニュートラルでない姿勢（固まった姿勢、あるいはニュートラル姿勢途中の柔軟さ）の場合は、 すべて「いいえ」に印を付けること。 • 骨盤の水平およびニュートラルな股関節可動域は骨盤と股関節の姿勢チェックで識別されるが、 最終姿勢の決定はハンド・シミュレーションによる。骨盤の最終姿位が（ニュートラルでない） 前傾/後傾の場合、その結果、股関節はニュートラル姿勢より伸びる/曲がる32。骨盤がニュート ラルでも、安定性をもたらすために座面前方のかさ上げを付加した場合、股関節は曲がる。 エニス • エニスへの骨盤と股関節の姿勢チェックからは、両股関節がニュートラルな座位姿勢まで曲がる ことが判っている。 • エニスの両股関節は臥位では 90 度になるが、骨盤が後傾したまま固まっているため、その体位 では座れない。 • ハンド・シミュレーションの結果を記録する際には、最終的にとれた姿勢を精確に記録せよ。 • 体幹〜大腿の角度を狭めるため、姿勢支持具として、座面前方のかさ上げを提案する受講者もあ ろう。それが可能であることは受けとめ承認せよ。しかし受講者には、決定は車椅子ユーザーの ニーズの全体像に基づくことを念押しせよ。座面前方のかさ上げを最終処方に盛り込んだ場合、 移乗や机・テーブルの下へ入り込むことなど、他の要素に影響を及ぼす可能性がある。 • 「教習員用指導書」ではエニスとバハティの最終姿勢を詳述している。以下を最終姿勢の描画に 用いよ。 32 [原文] open/closed [訳注] 語順としては, 骨盤前傾/後傾に対して股関節が曲がる/伸びる場合が一般的であろう. 134 エニス 各身体部位が、動の支えでニュートラルな座位姿勢になれば はい」、ならなければ いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 □ ✔︎ 体幹 □ ✔︎ 頭 ✔︎ □ 左股関節 □ ✔︎ 右股関節 □ ✔︎ 大腿 □ ✔︎ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ バハティ 各身体部位が、動の支えでニュートラルな座位姿勢になれば はい」、ならなければ いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 ✔︎ □ 体幹 ✔︎ □ 頭 ✔︎ □ 左股関節 ✔︎ □ 右股関節 ✔︎ □ 大腿 ✔︎ □ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ 135 B.5: 身体的事前評価−身体計測 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 全般 • 以下は教材リストに挙げられていないため、追加すべきものである： o 3 人ひと組の各グループに、クリップボードを 2 枚ずつ o さまざまな高さ（厚さ）の足乗せブロックを 1 セット b. 第 2 節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.112 の、スライド 6 のマダヴィの姿勢の線画には誤りがある。線画では、 腰椎がニュートラルなカーブを描いている。しかしユーザーが骨盤を後傾/後ろに倒して座ると、 腰椎がカーブせず33、体幹が円背になり34、それが「崩れた35」姿勢を引き起こす。 • 「受講者用参考書」p.67 にも同じ誤りがある。受講者に、それを各自の参考書について訂正する よう指示せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「教習員用指導書」の身体計測への注記を読み直し、身体計測をやって見せる練習を、統一性を 持たせるために全教習員とやっておけ。 • ありがちな誤りで、活動のあいだ目を配るべきものの例： o 車椅子ユーザーの姿勢/支え o 不精確な計測技法、例えばクリップボードを斜めに当てる、巻尺で測り始める端を間違える、 巻尺を読み取る頭の高さが不適切 • 受講者をデモに用いるのは避け、受講者が観察できるようにせよ。 • 状況に合わせて調整せよ (寒冷な気候で厚着している場合など)。 • 時間が許せば、この授業は延長して、各受講者が中級レベルの身体計測をすべて練習できるよう にすることを検討せよ。 33 [原文] flattens 34 [原文] the trunk will be rounded 35 [原文] slumped 136 b. 第 2節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.110 の項目 I は「座面〜骨盤上端（PSIS36）」と題されている。しかし、 PSIS は骨盤の上端ではない。骨盤の上端は腸骨稜37である。 • 教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある： o 選択肢１：この語句から「骨盤上端」を削除し、PSIS のみに言及する。したがって「受講者用 参考書」p.70 も変更が必要になる。 o 選択肢 2： 「骨盤上端」を一般的な呼び名として用いる。この選択肢を採用した場合、受講者 が、PSIS は骨盤の「上端」より下に位置することを理解するのが重要である。 • この節を通して、以下の点を常に強調せよ： o 身体計測は、車椅子ユーザーを、最終姿勢（ハンド・シミュレーションで決定した）で支えて いる状態で行なうこと。 o 選択した車椅子の種類および必要な姿勢支持具が、どの身体寸法が必要かを決める。例えば、 背中全体の高さの背もたれが必要な車椅子ユーザーには身体寸法 F: 座面〜肩上端［の高さ］ を選ぶ。身体寸法 D: 座面〜胸郭下端［の高さ］や身体寸法 E: 座面〜肩甲骨下端［の高さ］は 不要になる。 • 車椅子ユーザーが、骨盤が後傾したまま固まっている、あるいは 体幹が円背のまま固まっている場合、受講者は、これが車椅子に どう収まるか考える必要がある。このため座面奥行きの測り方を 変更することもある。 • 背もたれをリクライニングできる場合：骨盤背面の下端から膝裏 までの直線距離を測る（図 4）。 図 4 リクライニングした 背もたれの計測 36 [訳注] 上後腸骨棘. 37 [原文] iliac crest [訳注] IC とも略される. 137 • 背もたれがリクライニングせず「座面〜背もたれ角度を開ける」 が処方された場合は、車椅子の座面奥行き内で収まる必要がある。 • 「座面〜背もたれ角度を開ける」ための身体計測で必ず含むべき 項目： o C 字カーブ38の頂点から座面上端までの距離（Z） o C 字カーブの頂点から座面上端へ下ろした垂線と、骨盤背面の 下端との間の距離（X）（図 5） 図 5 座面〜背もたれ角度を 開ける」ための身体計測 • 図 6 を使い「座面〜背もたれ角度を開ける」姿勢支持を用いる際の座面奥行きの計算法を示せ。 図 6 座面奥行きの計算 • 身体計測のあいだ、車椅子ユーザーを最終姿勢で支えておくのが難しい場合もある。これに対処 する方策としては： o ちょくちょく休憩を取る。 o 姿勢を支えたり、身体計測を行なったりする助手を、さらに手配する。 38 [原文] c-shaped curve [訳注] ここでは身体を横から見た場合の, 円背になった脊柱の形状を指す. 車椅子および姿勢支持具 寸法（mm） （Z）三角形の高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 座面〜背もたれ 角度を開ける： 138 B.6: 車椅子およびクッションの選択 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 全般 • この授業に 60 分では不十分である。第２節に 60 分取り、授業時間を合計 70 分にせよ。 b. 第 2節：車椅子およびクッションの種類 • 「教習員用指導書」p.119 のスライド 12・13 のリクライニング背もたれのイラストに、腰椎や 骨盤の支持部の形状を入れるべきではなかった。処方の適応（スライドへの注記で挙げている） から考えて、この車椅子ユーザーは骨盤が後傾しており、その結果、腰椎がカーブしていないか 屈曲して39いる。 • この背もたれ下部は、以下のように表すべきである： o 平らに、あるいは o 「座面〜背もたれ角度を開ける」ウェッジ（これは列挙した状況から想定される姿勢支持具） を付けて • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 • 「教習員用指導書」p.119 の、スライド 13 の横の最初の箇条「股関節や膝の屈曲に拘縮を伴う、 後傾したまま固まった骨盤」は正しくない。ティルトインスペースは、股関節や膝の屈曲に拘縮 を伴う、後傾したまま固まった骨盤への適応ではない。この最初の箇条を削除し、以下の箇条を 追加せよ： o 頭の位置およびコントロールを改善するため o バランスを改善するため • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 39 [原文] flat or flexed lumbar spine 139 この授業を教えるための主な留意点 a. 全般 準備のコツ • 現地で手に入る車椅子および姿勢支持具の部材を熟知していることを確かめよ： o 製造者からの情報を研究せよ。 o 手に入るサイズの範囲を知れ。 o 調節可能部分/機能の範囲を調べ、これらを説明できるか、やって見せられるようにしておけ。 o 手に入るあらゆる付属品を含め、何をカスタマイズできるか40見定めよ。 • この授業の実施前に、現地での処方フォームへの変更を熟知しているか確かめ、適切であれば、 それを授業に取り入れよ。 • 現地の処方フォームは、以下の内容を含んでいるべきである： o 車椅子およびクッションの、種類およびサイズの指定 o 身体および理想的な車椅子の、詳細な寸法 o 姿勢支持具についての詳細説明 o 車椅子ユーザーの合意署名 b. 第 1節：はじめに • 受講者に、適正な車椅子の定義は「車椅子ガイドライン」に従うことと、支えを追加した車椅子 と座位保持専用シート41のどちらが最適か、常に検討が必要であることを念押しせよ。 c. 第 2節：車椅子およびクッションの種類 準備のコツ • 環境、機能、フィッティング、姿勢支持に関係する、さまざまな機能をやって見せられるだけの 多様な車椅子が揃っているようにせよ。 • 車椅子は、姿勢支持専用のものと、姿勢支持具を付加できるものの両方を揃えよ。 40 [原文] what can be customized [訳注]「カスタマイズ」の方がむしろ一般的かもしれない. 41 [原文] dedicated supportive seat [訳注] ここでは以下の「姿勢支持専用車椅子」と同義であろう. 140 内容 • 姿勢支持具付き手動車椅子だけあればよいユーザーには、姿勢支持専用車椅子42から生じる以下 の制約を考慮せよ： o 姿勢支持車椅子43は、手に入る設計やサイズの種類が限られる場合がある。 o 不必要な機能が盛り込まれ、重量や費用がかさむ場合がある。 o 姿勢支持車椅子は、運搬が難しい場合がある。 • 座角44が「固定」される車椅子：車椅子ユーザーを支える最適な角度を、必ず処方時に選択しな ければならない。 • 「クイックリリース」あるいは 「調節可能な」ティルトを備えた車椅子：傾き度合いを、一日の 間に容易に調節でき、必要に応じて多く、あるいは少なく支えられる。これは重傷からの回復中、 あるいは頭のコントロールなどの技能を習得中で、一日中まっすぐに座れない車椅子ユーザーに は助かる。こうした機能を備えた車椅子を指摘せよ。 • 受講者に、必要な車椅子および姿勢支持具が、必要となる車椅子のサイズを決めることを念押し せよ。例えば、体幹側方サポートと背もたれパイプの間でリクライニングする背もたれが必要な 場合、車椅子の幅を決めるのは： o 身体寸法 G の「体幹幅」足す； o 両側の体幹側方サポートの厚さ (B x 2)（以上は背もたれ パイプ内側の間隔に等しい）足す； o 両側の背もたれパイプの幅 (A x 2)（図 7） • 背もたれを背もたれパイプの前に組み付ける場合は、車椅子 ユーザーの体幹幅 足す 両側の体幹側方サポートの厚さ、 または骨盤/大腿の幅（どちらか広い方）が車椅子の幅 （車椅子各部の寸法の 1 か 2）を決める。 図 7 車椅子の幅 42 [原文] dedicated posture support wheelchair 43 [原文] posture support wheelchairs 44 [原文] tilt. 141 B.7: 姿勢支持具の処方（選択）−はじめに この授業を教えるための主な留意点 a. 全般 準備のコツ • 個々の姿勢支持具に関する質問は 「保留スペース」に置いておけ。これらは、次の授業から取り 上げる。 • この授業の実施前に、現地での処方フォームへの変更を熟知し、適切であれば現地のフォームを 授業へ組み込むようにせよ。 • デモ用に、現地の姿勢支持具の見本を調達せよ。 • 費用や供給者に関する情報は予め作成し、別個に配布資料としてまとめよ。これは授業の一部と して話し合うべきではない。 b. 第 2節：姿勢支持具とは何か？ • 姿勢支持具の選択は、ハンド・シミュレーションで見定めた必要な支えによって違ってくる。 o 要求されるサイズ（高さと奥行き）は、必要な支えの量に関係する。必要な支えが多いほど、 姿勢支持具の表面積は広くなる。 o 素材の選択は、支えの強固さによって違ってくる。例えば、軽い支えが必要な場合は体幹側方 ウェッジ（硬いウレタンフォームでつくり柔らかいウレタンフォームの下に置く）を処方でき よう。強固な支えが必要ならば硬い構造材（木、金属、プラスチックなど）でつくり柔らかい 素材（ウレタンフォーム、EVA など）を貼った、体幹側方サポートを処方するとよい。 o 支えの形状は、身体のどの部分を支えるかによって異なる。例えばひじ掛けが手こぎの邪魔に なるなど、身体の他の部分の動きを制限するようであってはならない。骨ばった部位、例えば 体幹の弯曲に形を合わせた際の肋骨の上などに、高い圧力が集中する形状であってはならない。 支えの成形しだいで、圧力を広い面積に分散させる（褥瘡の危険を減らす）ことができる。 o 圧力は非常に重要である。姿勢支持具の、身体に近く褥瘡を引き起こしうるほど硬いあらゆる 部分は、適切な形状にして、柔らかい適切な素材（ウレタンフォーム、EVA、ネオプレンなど） のクッションを入れるべきである。 142 c. 第 3節：中級車椅子処方（選択）フォームに姿勢支持具を記録する • 「教習員用指導書」p.130 のスライド 8・9 に処方フォームに姿勢支持具を描いた見本が載って おり、寸法線と記号で計測が必要なところを表している。 • 処方フォーム上に描画するさい、受講者は硬いウレタンフォームの形状とサイズに集中すべきで ある。どの部分も柔らかいウレタンフォーム層で覆う必要はあるが、それまで描く必要はないと 説明せよ。 • 補助線45は、姿勢支持具を描きやすくする目安で ある。必ず用いるべきサイズや形状を示している わけではない。 • 描画の目的は、必要な姿勢支持具の種類、形状、サイズ を伝達することなので、明確に描くことが重要である。 • 背もたれと足台に補助線を追加すると、姿勢支持具を スケッチしやすくなる。 • この補助線を PPT および各自の処方フォームに追加 するとよい。この図は WSTP 用 USB メモリに収載46 している。 図 8 姿勢支持具の描画 に用いる補助線 45 [原文] shadow lines 46 [訳注] 日本車椅子シーティング協会のダウンロードサイトでは「補足資料」フォルダに収載. 143 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 2節：問題：骨盤が後傾および/または前滑りする • 「教習員用指導書」p.136 のスライド 8 は、座骨 前方（アンカー）サポートが付いたクッションを 示している。 • このイラストは、誤解を招く恐れがある。以下を 説明せよ： o クッション基層は硬いウレタンフォームである こと o 柔らかいウレタンフォームの表層は、座骨前方 （アンカー）サポートに、必ずしっかりと接着 すること • スライド 8 のイラストを、WSTP 用 USB メモリ に収めた新しいもの（図 9）に差し替えよ47。 図 9 座骨前方（アンカー）サポート が付いたクッション • 「教習員用指導書」p.137 のスライド 11 のイラストは、マリアンの姿勢支持具の寸法を示して いる。この図では 2 つの寸法を示しているが、骨盤後方パッドの寸法線が、誤って座面上端から 骨盤後方パッドの下端へ引かれている。この線は、座面上端から骨盤後方パッドの中央高さまで でなければならない。 • 中級 WSTP パッケージには、その版によって PPT（スライド 11）にもこの誤りがみられる。 • 「教習員用指導書」および（必要ならば）PPT について、これを差し替えよ48。 • 「受講者用ワークブック」p.26 では、この寸法線が誤って座面上端から骨盤後方パッドの上端へ 引かれている。受講者に、ここを訂正49するよう指示せよ。 47 [訳注] 日本語版でも修正が必要. 48 [訳注] 日本語版は, 作成段階で PPT を修正済みで, 従ってそのスライドを用いた教習員用指導書も修正済み. 49 [訳注] ここは日本語版でも修正が必要. 144 この授業を教えるための主な留意点 a. 全般 準備のコツ • 人体骨格/脊椎/骨盤/股関節模型は、授業ツールとしてたいへん有用である。教習員は、模型を 以下のことに活用できる： o 骨の指標部位を特定する。 o どこに支えを設けるべきか、やって見せる。 o 骨盤と股関節の姿勢チェック、一時的支持（適切であれば）、ハンド・シミュレーションから の所見を関連づける。 • 適切なサイズのウレタンフォーム製のブロックおよびウェッジを用意しておけば、クッションの 解決策の見本を素早く組み立てられる。例えば、第 2 節の座面前方のかさ上げや、積み増しして 第 3 節の座骨前方（アンカー）サポート付きクッションにするなど50。 内容 クッション • あらゆる中級レベル適応の車椅子ユーザーに、骨盤を 支える適切なクッションを供与すべきである。 • 中級レベル適応の車椅子ユーザーのほとんどには骨盤 の前滑りを止める、座骨前方（アンカー）サポートの 付いたクッションが必要である。座骨前方（アンカー） サポートには、座骨からの圧力を逃がす51 （除圧する） 効果もある。 • 座骨前方（アンカー）サポートが必要で、さらに褥瘡 発生の危険がある中級レベル適応の車椅子ユーザーに は、骨盤井 [こつばんせい]52を設けたクッションを 処方するとよい（図 10）。 図 10 骨盤井を設けたクッション • 骨盤井は、座骨前方（アンカー）サポートと同じように姿勢を支え、さらに体重を分散して大腿 上部（転子部）の下に加重することで、さらに除圧をもたらす。 50 [訳注] 本書の付録 4 (p.183-187) にその例が図示されている. 51 [原文] move some pressure away from their seat bones 52 [原文] pelvic well [訳注] 基礎・中級 WSTP 教材でいう seat bones well (座骨井) と同じもの. 145 大腿内側ウェッジ付きの骨盤井クッション：基層 大腿内側ウェッジ付きの骨盤井クッション b. 第 2節：問題：骨盤が後傾および/または前滑りする 準備のコツ • 「教習員用指導書」p.136 のスライド 9 には「骨盤後方パッドは、骨盤を上端（上後腸骨棘（PSIS） の高さ）で支え」と注記されている。しかし、PSIS は骨盤の上端ではない。骨盤の上端は腸骨稜 である。教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある53。 • 選択肢１：この文から「骨盤上端」の語を削除し、PSIS のみに言及する。この変更を行なう場合 は、以下も変更する必要がある。 o 「受講者用ワークブック」p.25 の身体計測表 o 「受講者用参考書」p. 95（後ろから 3 段落目） o 中級車椅子事前評価フォームの寸法 I • 選択肢 2： 「骨盤上端」を、骨盤背面の上端を指す一般的な呼び名として用いる。この選択肢を 採用した場合、受講者が PSIS は骨盤の「上端」より下に位置することを理解するのが重要。 53 [訳注] 同じ用語の問題を扱っている, 本書 p.136 も参照. 146 PSIS を見つける • 両手を骨盤上縁に当て、両手を優しく絞り込みながら 柔らかい部位を見つける。それから、親指を（親指の 水かきを張り広げながら）他の指より下に移動する。 親指は骨盤上縁より下の、PSIS に近い位置に来る （図 11）。 図 11 PSISを見つける 内容 • 骨盤ベルトを配置する適切な角度は、45 度と 90 度の 間である（図 12）。 • しかし 45 度のベルトは、特に強い支えが必要な場合、 車椅子ユーザーが座った時に骨盤後傾を助長する。 • 座面上で前滑りする傾向がある車椅子ユーザーに は、60〜90 度が効果的な角度である。 図 12 骨盤ベルトの配置 脊柱に自然なカーブがある大人への骨盤後方の支え • 骨盤後方パッドは、腰椎/胸椎に通常のカーブがある車椅子ユーザーに対して、骨盤をまっすぐ に起こして保ち、骨盤後傾を防ぐように設計されている。 • これは、背もたれが平らな車椅子での骨盤〜胸郭前後差54 （骨盤背面と胸椎背面の位置の前後差） を埋め合わせるように設計されている。 • 骨盤をニュートラル姿勢まで矯正できないか、車椅子ユーザーの脊柱にニュートラルなカーブが ない場合、骨盤後方パッドは用いるべきでない。 54 [原文] pelvic-trunk offset [原文] 訳語はシーティングエンジニアの講習等で一般的な名称. 西方倫彰氏の教示に よる. 147 骨盤〜胸郭前後差 骨盤後方パッドを垂直な背もたれと併用 • 後方に曲げた背もたれや張り調整背もたれは、骨盤をまっすぐに起こして支えられる（さらに 脊柱の自然なカーブに形を合わせられる）ため、骨盤後方パッドが不要な場合もある。 • さらに支えが必要な場合、骨盤後方パッドを上記のような背もたれに付加してもよい。 後方に曲げた背もたれ 張り調整背もたれ • 骨盤を矯正し過ぎてはならない。車椅子ユーザーがまっすぐか、まっすぐに近い姿勢に耐えられ ない場合は、支えを減らして、ユーザーが骨盤を後傾させて座れるようにせよ。そうした車椅子 ユーザーには座面〜背もたれ角度を開け、それほどまっすぐでない姿勢で支えるのが有益な場合 もある。 148 脊柱に自然なカーブがある子どもへの骨盤後方の支え • 骨盤後方パッドは、小さい子どもには使用禁止55である。 • 小さい子どもは、ニュートラルな姿勢では腰椎のカーブが なく、胸椎は前に曲がる56（図 13）。 • 骨盤後方パッドを用いると、骨盤を前へ押し出して前傾させ、 かつ/または車椅子ユーザーを背もたれから押し出す。これは 不快感、苦痛、姿勢の問題の原因となる。 図 13 小さい子どもの まっすぐな姿勢 c. 第 3節：問題：骨盤が側傾している（固まった水平でない骨盤） 固まった水平でない骨盤 • 骨盤下の積み増しの高さは、ハンド・シミュレーションで用いた一時的支持部と同じ高さになる。 • 一時的支持部の高さは、最も矯正された（骨盤と股関節の姿勢チェックで決定した）骨盤姿勢で の、左右の ASIS の高さの差と同じになる。 水平でない骨盤：ニュートラル姿勢になる柔軟さがある • 車椅子ユーザーの骨盤にニュートラル姿勢になる柔軟さがある時、受講者が、低い側の骨盤下を 積み増しして矯正してはと提案する場合がある。これは、低い側の座骨下の圧力を増すため安全 ではない。 • 骨盤側方パッドとしっかりした骨盤ベルトを設けて骨盤を支えると、配置が適切で57バランスが 取れた姿勢になる。車椅子ユーザーの体幹にも支えが必要な場合がある。 55 [原文] must not be used 56 [原文] forward bend 57 [原文] aligned 149 d. 第 4節：問題：骨盤が片側に寄る 準備のコツ • 「教習員用指導書」p.143 のスライド 22 への注記に、以下を追加： o 「骨盤を両肩との垂直線上まで矯正できなければ、骨盤側方パッドを中心からずらし58ます。」 • 受講者に、上の一文を「受講者用参考書」(p.96 のいちばん下) に追加するよう指示せよ。 内容 • 骨盤側方パッドは座面、ひじ掛け、背もたれ、背もたれパイプに固定できる。 • 骨盤パッドをひじ掛けや座面に固定する場合、形状が適切でなければ大腿部に干渉しやすい。 • 背もたれあるいは背もたれパイプに取り付けると干渉しにくい。これらは骨盤上端から大腿上端 のすぐ上までの形状にするとよい。 • 骨盤側方パッドを中心からずらして配置したい場合、以下の方法が可能： o 片方の骨盤側方パッドを、反対側より厚くする。 o パッドを非対称に/中心からずらして取り付ける。 e. 第 6節：要点のまとめ • 受講者に、実習および自分のサービス事業で車椅子ユーザーと協働するさい、車椅子ユーザーと さまざまな選択肢やアプローチを試みるよう奨励せよ。 58 [原文] off-centre 150 B.9: 姿勢支持具の処方（選択）−股関節を支える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業を通して、骨盤と股関節の姿勢チェック、必要な一時的支持、ハンド・シミュレーションの 結果と、姿勢とを関連づけよ。 b. 第 2節：股関節を支える 準備のコツ • 人体骨格模型があれば、さまざまな姿勢をやって見せるために役立つ。 内容 • ニュートラル姿勢まで屈曲しない股関節に対する一時的支持部の高さの決め方のコツは、授業 「B.3: 身体的事前評価−骨盤と股関節の姿勢チェック」の注記を参照せよ。 • 両側の座骨を一時的支持部に乗せて座ると、股関節の可動域制限（拘縮）から影響を受けること なく、脊柱を事前評価できる。 • 脊柱を事前評価したら、一時的支持部を取り除き、骨盤を後傾した位置にせよ。 151 B.10: 姿勢支持具の処方（選択）−体幹を支える WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 2節：体幹を支える ケーススタディ：ジョセフィン • 「受講者用ワークブック」(p.34-35) のジョセフィンのケーススタディで、彼女は長いホイール ベースの車椅子を使っていると書かれているが、イラストには、短いホイールベースの車椅子に 乗っているジョセフィンが描かれている。 • ジョセフィンのケーススタディに取り組むグループには、長いホイールベースの車椅子を与えて ワークブックのその誤りに注記しておくよう助言せよ。 • ジョセフィンへのハンド・シミュレーション結果に、左股関節がニュートラル姿勢になると記録 されている。これは誤りで、骨盤がニュートラル姿勢でないのに左股関節がニュートラル姿勢に なるはずがない。 • 受講者に、「受講者用ワークブック」p.34-35 のコラム内のケーススタディへの情報について、 上記の情報を変更するよう指示せよ。 • 「教習員用指導書」p.160 に、上記の変更について注記せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • この授業には、予め準備が必要なたくさんの教材が要求される。将来の教習プログラムで再使用 できる、教習教材キットの作成を検討せよ。 • 受講者が、姿勢支持具を成形し、切断する必要がある場合は、「教習員用指導書」の教材リストに 必要な工具を追加せよ。 • 受講者が姿勢支持具の実物大模型をつくるための、接着テープ数巻を教材リストに追加せよ。 この資材およびその取り付け方法は、教習のみを目的としていることを強調せよ。 • 姿勢支持具キットおよび姿勢支持具の材料を準備する際には、受講者が自分の職場で使うことに なる姿勢支持具および資材を用いるようにせよ。それらが手に入らなければ、低コストの代用品 ［下記］を用いてもよい。受講者には、それが教習のみを目的としていることを説明せよ： 152 o ソリッド座面/背もたれ、体幹/骨盤の側方支持具について、段ボールを木材の代用にする。 o 発泡スチロール、梱包材廃棄物の合成樹脂フォーム、草を編んだマットをウレタンフォームの 代用にする。 • 模擬品 [仮合わせの車椅子]59を完成するための資材がじゅうぶんない場合は、受講者に、加え ようとする変化、およびその作り方を詳述してもらえ。 • ケーススタディでは各ユーザー用車椅子の種類を詳述しているが： o その種類の車椅子が手に入らなければ、現地で手に入る代替品を提供し、 o その車椅子には、いかなる姿勢支持具も取り付けられていないようにして、 o その車椅子について受講グループで話し合え：提供した車椅子とケーススタディで述べている 車椅子との、主な変更点をすべて特定せよ • シアン（ケーススタディ 3）用に子ども用サイズの車椅子が用意できなければ、受講者には、 異なるサイズのものを用い、必要となる姿勢支持に集中するよう助言せよ。 b. 第 2節：体幹を支える 準備のコツ 受講者全体での活動（「教習員用指導書」p.156）について： • 受講者が座る、ベンチあるいはテーブルの幅が広すぎないことを確かめよ。さもなければ受講者 の脚が伸びてしまうからである。座面が平らで水平な椅子があれば、壁に横向きに当てて置くと 代用になる。 内容 活動のケーススタディについて： • 受講者に、活動の中心は問題解決で、あらゆる可能な解決策を検討すべきだと念押しせよ。 • 受講者に、まず骨盤と股関節への支えを含む座面60から始め、続いてハンド・シミュレーション と同じ順序に沿って行くよう指示せよ。 • 受講者が適切でない解決策を選んだ場合は、その理由を説明するよう求めよ。受講者の解決策が 引き起こしうる臨床的または機能的な問題に関する話し合いを先導し、その克服のためには何が できるかを問え。 59 [原文] mock-ups 60 [原文] seat base 153 よくある誤解の修正：ケーススタディ 1：マーク • 高すぎる背もたれ：受講者に、ハンド・シミュレーションの所見は、車椅子ユーザーに肩甲骨の 背面に支えが必要であることを示していると念押しせよ。これは、背中への支えに必要な高さは 肩の上端ではなく胸郭の中ほどであることを示している。肩甲骨の高さの背もたれは、腕の機能 に影響を及ぼす。 • 背もたれは、ハンド・シミュレーションで判明した支えの高さにすべきである。 • 背もたれが低いと、車椅子ユーザーが不安定になる可能性がある。 • 肩甲骨背面への支えは、通常、肩の機能には影響しない。 よくある誤解の修正：ケーススタディ 2：ジョセフィン • 骨盤後方パッドを、「座面〜背もたれ角度を開ける」の代わりに選択：授業「B.8: 姿勢支持具の 処方（選択）−骨盤を安定させる：第 2 節：問題：骨盤が後傾および/または前滑りする」 （「教習員用指導書」p.134）の、骨盤への支えに関する解説を参照。 • 座骨前方サポートが処方されない。 • 片側の座面前方下げの角度が不適切：ニュートラル姿勢まで屈曲しない側の股関節に対する片側 の座面前方下げの傾斜は、座骨前方サポートのすぐ前方から始まる必要がある。 • リクライニングしすぎ：背もたれを、背もたれパイプの間でリクライニングさせる場合、車椅子 ユーザーの肩が背もたれパイプに触れる直前でリクライニングは止めるべきである。 • 座面＆背もたれティルト61を用いる：受講者はまず骨盤と股関節、続いて体幹への姿勢支持具に 集中し、ティルトさせる必要を調べるのはそれからにすべきである。 • ジョセフィンの骨盤後傾による体幹〜大腿の角度が、股関節がニュートラル姿勢にならないこと による体幹〜大腿の角度と同じ、あるいはより大きければ、クッションの改造は不要。 よくある誤解の修正：ケーススタディ 3：シアン • 骨盤の低い側を積み増し：授業「B.8: 姿勢支持具の処方（選択）−骨盤を安定させる：第 3 節： 問題：骨盤が側傾している62」の、骨盤への支えに関する解説を参照。 • 座面前方のかさ上げの位置：座面前方のかさ上げの傾斜は、座骨前方サポートのすぐ前方から 始まり、クッション前端まで続く必要がある。 • 骨盤後方パッドを付加：シアンは 3 歳なので腰椎のカーブは発達していない。この年齢の子ども には、平らな背もたれ63が適切である。 61 [原文] seat and back rest tilt [訳注] 座面と背もたれが一体化して傾く, 日本語のいわゆる「ティルト」を指す. 本書には, 同じ機能を tilt in space「ティルトインスペース」と呼んでいる箇所 (p.154) もある. 62 [訳注] 中級 WSTP「教習員用指導書」p.141. 63 [原文] flat backrest [訳注] いわゆる腰椎 (ランバー) サポートのない背もたれ, と解すべきであろう. 154 体幹と頭のコントロールに乏しい子ども： • 子どもは、ニュートラルな姿勢では、骨盤がまっすぐに 起き、腰部のカーブがなく、胸椎がわずかに屈曲し、 体幹上部がわずかに前傾する（図 14）。 • つまり子どもの体幹上部は、平らな背もたれには密着 しないのである。 • いっぱんに、筋力が弱い/体幹のコントロールに乏しい 子どもは、体幹上部と頭をまっすぐに起こして保つのが 困難である。 • 子どもによっては、さらに支えが必要である。 図 14 子どものニュートラルな姿勢 子どもをよりまっすぐに座らせるには： 座骨前方サポートを付加し、座面〜背もたれ角度を 開け、骨盤ベルトを付加して、評価せよ： • この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合： • テーブルを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ • 肩ハーネスを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合：座面および背のティルト （ティルトインスペース）を付加せよ（図 16）。 図 15 座面〜背もたれ角度を開ける 図 16 ティルトインスペース 155 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を 支える WSTP［車椅子サービス教習パッケージ］教材の誤り a. 受講者用参考書 • 「受講者用参考書」p.106 の見出し「問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢 よりも小さい角度のまま固まっている」に続く（ ）内の語「大腿〜下腿の角度が 90 度超」を 「大腿〜下腿の角度が 90 度未満」に差し替えよ64。受講者に、各自の参考書にこの変更を加える よう指示せよ。 この授業を教えるための主な留意点 a. 第 3節：大腿を支える 内容 活動のケーススタディに対するよくある誤り： • まず車椅子および/またはクッションの問題に対処するより先に姿勢支持具を付加する：姿勢の しっかりした土台を構築するうえで、基礎レベルの車椅子の原則が重要であることを強調せよ。 • 車椅子ユーザーの大腿へじゅうぶんな支えを設けない：ハンド・シミュレーションの結果から、 どこを支える必要があり、どの程度支えが必要なのかが示される。これには姿勢支持具のサイズ、 形状、強固さなどが含まれる。 • 車椅子および/またはクッションへ付加する姿勢支持具が機能（例えば車椅子の移乗や推進）に 及ぼす影響へ対処していない：。 • 「教習員用指導書」p.169 のスライド 11 のイラストは、骨盤井があるクッション上の大腿外側 ウェッジを示している。これは一つのクッションに複数の姿勢支持具を組み合わせた一例である。 大腿外側ウェッジを組み付けたクッションには必ず骨盤井が必要、ということではない。 • 上記は「教習員用指導書」p.170 のスライド 15 にも当てはまり、こちらは、骨盤井クッションに 設けた大腿内側ウェッジを示している。骨盤井の詳細は、本書「B.8: 姿勢支持具の処方（選択） −骨盤を安定させる」の「この授業を教えるための主な留意点」を参照。 • 「教習員用指導書」p.169 のスライド 13 の膝分離パッド：座骨前方サポートや座面前方のかさ 上げを付加した場合、クッション前部は高さが増す。これは、膝分離パッドの設計によっては、 車椅子ユーザーの膝に対するパッド位置に影響を及ぼす。 64 [訳注] 日本語版では注記済み. 156 b. 第 4節：下腿と足を支える 問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢より小さい角度のまま固まって いる（ 教習員用指導書」p.173） • 追加の（列挙されていない）解決策として座面前方のかさ上げがある。これは股関節を屈曲させ （体幹〜大腿の角度を狭め）、足を座面の真下から前方へ持っていく。 • 股関節をニュートラル姿勢より屈曲させて座っても、ニュートラル姿勢で座るより拘縮が発生・ 悪化する危険が増すことはない。しかし、車椅子ユーザーへの以下の助言は優れた実践である： o 毎日、車椅子を降りてうつ伏せになって休憩し、股関節を伸ばしなさい。 o 毎日、立位台で過ごす時間を設けなさい。 157 B.12: 製品（車椅子）の下準備 この授業を教えるための主な留意点 a. 全般 準備のコツ • 教習員は、現地で手に入る車椅子と資材を熟知している必要がある。教習プログラムの計画段階 で、しっかりと把握しておけ。教習員が現地を拠点としていない場合、これは以下のようにして 行なうとよい： o 現地のサービス事業者に、手に入る資材の情報と写真を送ってもらうよう依頼する。 o プログラム開始前に到着し、用意された資材を確認し、必要ならば代替品を探すためのじゅう ぶんな時間を確保する。 • 教習プログラムに必要なリソースは、実施地ごとに、以下の条件に従い変わってくる： o 現地で服、靴、バックパックを製造していれば、さまざまな種類の布地、ベルト地、バックル、 面ファスナー、EVA が手に入る可能性が高くなる。 o 現地に家具製造業や建設業があれば、木材、合板、留め具、鋼管などさまざまな種類の材料が 手に入る可能性が高くなる。 • 姿勢支持具の部材は、国際的ドナーからの寄付によることも可能である。例えば、ベルト、頭部 支持具、ハーネス、体幹側方サポートなど。 • 「受講者用参考書」p.110 の初めに載っている情報を、資材と工具に関する一般的情報について 読み直し、話し合いの場で参照できるようにしておけ。 • この授業には、技術的専門知識が豊富な教習員がおり、製品の下準備に関する技術的支援を得ら れると助かる。 b. 第 1節：はじめに • どの車椅子が、その車椅子ユーザーの環境および機能的ニーズに対して最適な特色をもたらすか、 また必要な姿勢支持具の付加によって、ユーザーのフィッティングおよび姿勢支持へのニーズが じゅうぶんに満たされるかどうか検討せよ。必要な姿勢支持機能のみをもたらすよう、ハンド・ シミュレーションで設けた支えに基づいて姿勢支持具を選択することが、最良の解決策となる。 • 姿勢支持専用車椅子は、車椅子ユーザーが必要とするよりも多くの機能を提供する場合がある。 可能であれば、不必要な機能は取り除くこと。 158 B.13: フィッティング この授業を教えるための主な留意点 a. 全般 • 受講者は、基礎 WSTP のフィッティング手順を熟知していなければならない。 • 基礎レベルのサービス供与は、単線的プロセス（順々にステップを踏む）である。中級レベルの サービス供与は、循環を経て完結する。受講者は、車椅子と姿勢支持具が最初の処方から調整や 改造を経るに従い、フィッティング確認表を繰り返し用いる必要がある（「教習員用指導書」p.183 のスライド 3 を参照）。 • 時間が許せば、教習員はこの授業をより対話的にするとよい。例えば： o 志願者を募り、受講者に、基礎レベルで学んだ確認で確認表に載っている項目をやって見せて もらう。 • ほとんどの基礎レベル適応の車椅子ユーザーは、フィッティング手順の終わりにはまっすぐに/ ニュートラルな姿勢で座れるようになる。中級レベルでは、多くの車椅子ユーザーはまっすぐに /ニュートラルな姿勢では座れない。受講者は、ユーザーが可能な限り最良の姿勢になったのか 確信が持てないかもしれない。そうした場合には： o 骨盤と股関節の姿勢チェックおよびハンド・シミュレーションからの所見を、フィッティング 手順の終わりにとれた最終姿勢と関連づけよ。 • 最終姿勢が、ハンド・シミュレーションの終わりに到達した姿勢とぴったり一致しない場合は、 以下のような理由による： o 骨盤と股関節の姿勢チェックでの評価を誤った。 o ハンド・シミュレーションで、姿勢の問題を矯正しすぎている。この場合は、新しい姿勢での 快適さ、バランス、耐久性65を向上させるため、最終処方を調整する必要がある。 o 事前評価から最終フィッティングまでに時間が空き、車椅子ユーザーの姿勢が事前評価の時点 から変化した。この場合は、骨盤と股関節の姿勢チェックおよびハンド・シミュレーションの やり直しが必要かもしれない。 65 [原文] tolerance 159 B.14: ユーザー教習 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役教習員と補助役教習員とで、車椅子での移動と移乗に関する技能を復習し、練習して やり方に統一性を持たせるべきである。 • 車椅子が正常に動作し、すべての部品が取り付けられていることを確認せよ。 • 選んだ車椅子は、各々の例話に登場する製品と、なるべくぴったり合致させよ。 o ジョシュア：ティルトインスペースと転倒防止の機能を備えた製品 o サンギータ：クイックリリース車輪、骨盤ベルト、骨盤パッドを備えた（できれば）子ども用 の製品 o キム・ソム：クッションと背もたれに姿勢支持具を備えた、標準的な車椅子 b. 第 2節：ユーザー教習：車椅子ユーザーの例話 • 車椅子サービス職員役を割り当てられるのは各グループに一人だけだが、グループには、教えら れるべきそれぞれの技能、およびその正しい教え方を、協力して見定めるよう指示せよ。 • この配役は、車椅子ユーザー教習のさまざまな側面を強調することを意図しており、この活動を 一人だけで完結することは想定していない。 • 技能をどう教えているか注意深くモニターせよ。受講者は説明し、やって見せ、練習するところ を観察し、フィードバックを伝えるべきである。 • 例えば折りたたみ、駆動輪やテーブルなど着脱式部品の取り外し/取り付けをはじめ、車椅子の あらゆる機能を、分かりやすく車椅子ユーザーとその家族にやって見せていることを確認せよ。 • 中級 WSTP 受講者にはそうした機能を理解し、それをユーザーおよび/またはその家族に上手に やって見せられる能力が不可欠である。 160 B.16: メンテナンス・修理・フォローアップ この授業を教えるための主な留意点 a. フォローアップ実習 準備のコツ • 教習時間割に、フォローアップ実習は含まれていない。時間が許せば、教習員は、現地の車椅子 ユーザーとの、サービス施設あるいは在宅環境でのフォローアップ面接予約を段取るとよい。 • 学習の要点を強調し、受講者からの質問に答えるため、現地で手に入る車椅子を用意しておけ。 • 一般的な手入れ・メンテナンス・修理用工具一式を用意し、受講者に見せられるようにしておけ。 b. 第 2節：フォローアップの概略 • あらゆる中級レベル適応の車椅子ユーザーにとって、定期的フォローアップは有益である。 • よりひんぱん（3〜6 か月ごと）なフォローアップが必要な車椅子ユーザーの例： o 子ども：成長による、または機能（例えば頭や腕のコントロール）や姿勢における変化に形を 合わせるため、姿勢支持具の調整が必ず必要 o 進行性疾患がある、または機能的能力や体重が変化しそうな車椅子ユーザー • フォローアップは車椅子サービス供与の最も難しい側面で、特に車椅子ユーザーの家でフォロー アップを行なう場合がそうである。その原因は移動のリソースに制約がある、都合がつく職員に 限りがある、サービスセンターから車椅子ユーザーの家までが遠いことなどによる。 • フォローアップ面接はたいへん重要である。そこでサービス供与者ができること： o 車椅子ユーザーが、自分の車椅子を安全に使えていることを確かめる。 o 車椅子が、適切に動作していることを確かめる。 o タイヤの空気入れ、ブレーキの調整など基本的なメンテナンスを実施する。 o 追加の車椅子ユーザー教習を提供する。 o サービスの出来ばえに関するフィードバックをもらう。 o サービスの必要性を立証する、車椅子ユーザーの体験談を集める。 o 製品の使われ方、および製品が使用環境や期待された機能に対して適切かどうかを把握する。 161 • フォローアップに障壁があるところでは、教習員は、現地での解決策を見出すための話し合いを （時間が許せば）先導してもよい。その内容として考えられること： o フォローアップ実施のために、地域に根ざした組織を活用する。 o 車椅子ユーザーがフォローアップに出かけられるよう、移動への支援を提供する。 o 地域ごとのフォローアップ日程を決め、職員が一地域で数件の家庭訪問を行なう。 o 車椅子ユーザーがすでに他の予約、例えば医師との面接などでその地域にいる時に合わせて、 フォローアップの面接予約を入れる。 c. 第 3節：車椅子フォローアップフォーム • 受講者に、中級レベル適応の車椅子ユーザーには、メンテナンスや修理がより多く必要になると 念押しせよ。なぜなら： o 通常、車椅子に、摩耗したりゆるんだりしがちな部品が多くなるため。 o 中級レベル適応の車椅子ユーザーの場合、激しい筋攣縮［きんれんしゅく］や、座り方の パターン66のために、姿勢支持具に通常以上の圧力が加わることがあるため。 66 [原文] patterns of sitting 162 実習 1〜4 この授業を教えるための主な留意点 a. 全般 準備のコツ 注意義務67 • 教習員は、教習プログラムに参加した車椅子ユーザーに適正な車椅子、クッション、姿勢支持具 が供与されたことを確かめる、注意義務を負っている。 • ユーザーやその家族にとって安全でない、または機能的ではないと教習員が感じるような製品の ままで、車椅子ユーザーを教習プログラムから去らせてはならない。車椅子を供与できなかった 場合は、ユーザーの地元のサービス事業者との面接予約を別に取り、処方、フィッティング、 ユーザー教習が完結するようにせよ。 • 教習員は、車椅子ユーザーへのフォローアップを担当するサービス事業者またはサービス職員を、 必ず確定しなければならない。そのサービス供与者には、事前評価フォームや処方フォームなど 関連書類をすべて提供しなければならない。 • 教習員は、車椅子ユーザーに、支援、修理、フォローアップを提供できる地元のサービス供与者 の連絡先を、必ず伝えなければならない。 車椅子ユーザー • 主催団体または教習チームから、連絡担当者を指名せよ。その役割は： o 車椅子ユーザーが実習に到着したら出迎える。 o 実習に到着していない車椅子ユーザーへの対応を行なう。 o サービス事業と教習チームとの間の連絡をとる。 o 車椅子ユーザーおよびその家族が自分の面接が始まるまで待機する、適切な場所を指定する。 o 食事や軽食を提供する場合、全員の希望を前日までにはケータリング68業者に確認する。 o 写真撮影許可が完了していることを、写真を撮る前に確認する。 67 [原文] Duty of care 68 [原文] catering 163 グループ分け • 優れた学習経験ができるためには、受講者をどうグループ分けするのがよいか、よく考えよ： o 同じサービス事業所からの受講者をいっしょのグループにしたり、臨床職と技術職の受講者の 混成グループにしたりすると有効な場合がある。 o 自信満々の/饒舌な69受講者と、自信のない/寡黙な受講者をいっしょのグループにし、揃った ペースで作業できるようにすることを検討せよ。 o ことばや、事前評価をジェンダー混合のグループで行なうかどうかなど、文化的配慮を考えよ。 実習中のグループへの教育指導70 • 各グループに、個別の教習員を配置して実習の調整を手伝わせよ。 • できれば、リーダー役教習員が教育指導するグループ数は減らし、補助役教習員との確認作業に じゅうぶん時間を取れるようにせよ。 • 「教習員用指導書」に沿って、受講者にステップごとの時間を予告せよ。 • 時間経過に気をつけ、受講者へ定期的に残り時間を知らせよ。 • 実習を通して、各グループに同じ教習員が付くようにせよ。 b. 実習 1: 事前評価および処方（選択） 準備のコツ • 各グループに、事前評価を人目に触れないように71実施するじゅうぶんなスペースがあるように、 実習エリアを設営せよ。 • 個室を用意できない場合は、間仕切りを活用するとよい（例えば、褥瘡を観察するため）。 • 各グループに、事前評価と処方に必要な器材を支給せよ。グループの一人を、「実習 3」終了後 に器材を返却する責任者に任命せよ。 • 事前評価と処方の各パートで、別のチームメンバーがリーダーを務めるように配置し、グループ メンバー間でその経験を共有するようにせよ。 • 受講者には、事前評価プロセスが円滑に流れ、焦点を車椅子ユーザーに置き続けられるように、 同僚が各々の項目を終えるまで待ってから追加の質問をするよう勧めよ。 69 [原文] talkative 70 [原文] Supervision 71 [原文] privately 164 内容 • 身体的事前評価を注意深くモニターし、グループが、処方に影響を及ぼしうる誤りはすべて修正 するよう手助けせよ （例えば、骨盤と股関節の姿勢チェックやハンド・シミュレーションの誤り、 正しくない計測技法など）。 • 教習員は、受講者の所見を検証するため、骨盤と股関節の姿勢チェックを独自にやるとよい。 • 受講者が、事前評価フォームの順序に従うようにせよ。例えば、身体寸法は、車椅子処方を決定 する前に車椅子寸法に換算されている必要がある。 • 車椅子ユーザーは、処方プロセスへの積極的参加者であるべき。車椅子の選択肢や特色について、 受講者が車椅子ユーザーと話し合ったうえで最終処方をつくり上げるようにせよ。 • 車椅子ユーザーや家族に、見本の車椅子を示せるように用意し、じゅうぶんに情報を得たうえで 決定できるようにせよ。 • 受講者の各グループに、処方フォームへの署名前に、処方の臨床推論72を説明してもらえ。 c. 実習 2: 製品（車椅子）の下準備 準備のコツ • 製品の下準備用に教室を設営するやり方の詳細は、本書「技術に関する付録」を参照。 d. 実習 3: フィッティングおよびユーザー教習 • ユーザー教習にはじゅうぶん時間をかけられるようにし、慌ただしくならないようにせよ。 e. 実習 4: 事前評価・処方（選択）・製品（車椅子）の下準備・ フィッティング・ユーザー教習 • 学習成果を高めるため、受講者を異なるグループに編成することを検討せよ。 • 受講者へ、車椅子サービス提供の最初の 5 ステップを所定の時間内に完了するために、計画的に 作業するよう念押しせよ。 • 受講者は、必ずグループ全員で作業を分担すること。例えば製品の下準備では、一人が車椅子の 調整をやり上げ、他の一人がクッションを下準備し、もう一人が姿勢支持具を下準備するなど。 • 上手に作業を分担すると、すべてのステップが所定の時間内に完了するようになる。 72 [原文] clinical reasoning 165 B.15&17: 総まとめ&教習員からのフィードバック・ 討論・閉講式 この授業を教えるための主な留意点 準備のコツ • 教習員の一人に、発表での説明に必要な、ビフォーアフター73の写真をダウンロードして整理 する役を割り当てよ。この作業は休憩時間に行なうこと。 • ビフォーアフターの写真を並べて表示せよ。これは、フィッティングの効果と成果とを示す、 効果的な方法である。 内容 • グループの準備を手伝う補助役教習員を配置せよ。 • 受講者へ、各発表が制限時間 10 分に収まるよう、残り 5 分と 1 分で合図することを伝えよ。 • 発表に盛り込む情報を選ぶために、支援が必要な受講者もあろう。「受講者用ワークブック」p.49 の「総まとめ」の項目を指針に用いよ。 • 発表およびファシリテーションでは、教習員は以下を強調せよ： o 骨盤と股関節の姿勢チェック、ハンド・シミュレーション、最終的にとれた姿勢の関連 o ハンド・シミュレーションで見定めた支えと、最終的に選択した姿勢支持具との関連 o 選択した車椅子の特色が、環境および機能に対するユーザーのニーズをどのように満たすか • 発表のケーススタディに関する討論を促し、グループからの質問やフィードバックを、バランス が取れ、重要な事前評価での所見および介入に焦点を当てたものにせよ。 • 低リソース状況では、手に入る車椅子や姿勢支持具の範囲には限りがある。 • 妥協は常に必要である。問題は、車椅子ユーザーにとって最善の成果と、常にユーザーの安全を 確保することとの、適切なバランスを見出すことである。 73 [原文] before and after 166 教習運営実務と準備 ToT 教習員への注記： • この章はプレゼンテーションや話し合いのためのものではない。以下は「ToT ハンドブック」 に実習生向けの参考資料として載っているものである。実習生は、見習い教習を経験する中で 教習運営実務と準備の問題に直面し、そこで教習員に問いを発せるようになる。 「教習員用指導書」には、中級 WSTP 教習プログラムの企画を成功させるのに必要な、施設、印刷 教材、資材、器材の包括的一覧表が載っている。教習プログラム調整役の教習員は、通常、現地の 主催者と連絡を取り合い、だれが教習運営実務と準備の各部面での責任を負うか決定する。 実習生は見習い教習を通して、教習運営実務および準備における任務を処理する経験と技能を獲得 する。教習員の調整者は、これらの活動を教習員に分担させ、さらに教習員をモニターし支援する。 施設およびサービス 必要な施設の完全な確認表は、「教習員用指導書」p.14 に収載。 中級 WSTP 教習員が、受講者と同じことばを話さない場合は、通訳サービスが必要になる。通常、 こうしたサービスは需要が大きいため、じゅうぶん前もって予約しておくべきである。費用を教習 予算に追加する必要があろう。 印刷教材 資料は、必ずすべて現地で印刷すべきである。中級 WSTP に必要な印刷教材の完全な一覧は、中級 WSTP 「教習員用指導書」p.15-16 を参照。「教習員用指導書」の確認表を用い、正しい数量の資料 が印刷されていることを確認せよ。 資材および器材 中級 WSTP に必要な資材および器材の一覧は、中級 WSTP「教習員用指導書」p.17-18 を参照。 167 車椅子 「教習員用指導書」p.18 の最初で、現地で手に入る車椅子とクッションについて述べている。多種 多様な車椅子が手に入る場合は最もよく使われる種類を選択し、できれば幼児用座椅子74を含めよ。 電動車椅子は含めないこと。それは中級 WSTP の範囲ではないため。 どの車椅子も正常に動作し（タイヤに空気が入り、ボルトが締まっており）、クッションが付いて いることを確かめよ。 実習に参加する各車椅子ユーザーについて車椅子、クッション、姿勢支持具、あるいはクッション と姿勢支持具をつくるための資材が必要である。 技工作業エリア 改造に必要な種々の工具と資材を備えた、技工作業エリアを利用できるようにするか設置すべきで ある。これは教習予算に影響しうる。 電力与給 電源が不安定な地域では、非常用として無停電電源装置内蔵の発電機を手配すべきである。これは 「教習員用指導書」p.17 の「器材」一覧表にも追加する必要がある。 教習に向けた計画 中級 WSTP 教習プログラムの計画について、以下、最も重要な活動とおおよその日程を列記する： 8〜12 か月前 • 教習プログラムの予算を立てる。 • 複数のパートナーが参画する場合は、各パートナーの責任について合意する。 • 日程、会場、教習員、受講者の概要、現地事情に関する情報（現地の、車椅子に関する活動や サービスの指針となる一般的な方針や手続き、手に入る車椅子、クッション、その他手に入る 資材の種類、現地の文化や受講者の多様性に関する情報、参画する組織など）を確定する。 • 教習に必要な日数を算定し、毎日の開始と終了時刻、および通訳が必要かどうかを確定する。 74 [原文] a floor seat for infants 168 4〜6 か月前 • 各受講者に、教習プログラムの詳細（日程、会場、運営に関する情報）が載った招待状を送付し、 記入して返送してもらう。 • 受講者の職歴や技能に関する情報を集め、それに従って授業計画を適合できるようにする。 • 教習器材を予約する。 • 模擬授業に必要な、デモ用器材やその他のリソースを調達する。例えば処置用ベッド、足置き、 スライディングボードなど。 • 消耗品を調達する。 • ユーザー用の器材を調達する（ユーザー用器材を、寄付金および/または教習予算の一部に依る 場合、器材調達はもっと早く始める必要がある）。 • 状況と受講者についての概要を各教習員に伝え、授業と役割の分担について合意する。 • ケータリングサービスを予約する。 • 必要ならば、通訳および翻訳設備を手配する。 4〜6 週間前 • すべての必要な資料について、現地での印刷を手配する。 • 車椅子ユーザーを選んで招聘する。 • 登録の詳細を最終決定。例えば、名札と登録簿の手配、登録作業に当たる人への連絡など。 • 参加確認/事前情報を参加者、車椅子ユーザー、教習員に送付する。 • ケータリング業者、会場、その他の教習運営実務を確定する 1〜2 週間前 • 注文品が配達済みか確認する。 • 会場のトイレ、および水道と電気が通っているのを確認する。 • 清掃スケジュールを確認する。 教習チームの地元でない場合は、プログラム開始の 2〜3 日前に到着し、設備と会場の確認、教習 プログラムを支援する車椅子ユーザーとの打ち合わせ、必要な残り資材の購入ができれば最善。 調整役の教習員と他の教習員、主催団体、他の関係機関との間には、定期的なコミュニケーション が必要である。 169 車椅子ユーザー 中級 WSTP の間に実習が 4 回あり、そこに 2 グループの車椅子ユーザーが参加する。最初のグル ープは、2 つ別の日に参加する。 教習員は教習プログラムの前に、実習に参加する意思があり、また参加が可能な車椅子ユーザーを 見定めて招く必要がある。「教習員用指導書」p.11 の確認表は、車椅子ユーザーを見極めるために 役立つ。 主催団体および教習企画者と、車椅子ユーザーのために使える予算と施設について連絡を取り合え。 車椅子ユーザーに移動手段が提供されるか、または交通費が支払われるかどうか確かめよ。 車椅子ユーザーの参加が 1 日だけの場合、プログラムを再編成し、ユーザーグループ 1 に対する 「実習 1」と「実習 2」を同じ日に収めよ。時間割を調整する際には、サービスステップ 2〜7 を 必ず「実習 3」より前に完了せよ。 可能ならば、教習員が直接車椅子ユーザーを審査すべきである。教習員が現地を拠点にしていない 場合は地元のサービス供与者に、可能性がある車椅子ユーザーを見定め、教習レベルに適合するか 教習員が判断するための写真と情報を事前に送ってもらうよう依頼するとよい。 車椅子ユーザーへの招聘状 車椅子ユーザーへの招聘状を作成する際には、以下の項目を考慮せよ（WSTP 用 USB メモリ内に ひな形を用意している75）： • 何が、実習へ参加すると起こるのかの詳細。 • 授業の日時および期間 • だれかといっしょに来てもよいのか？ • 授業で車椅子を受け取れるのか？車椅子にフォローアップが必要になったり、問題が起きたり した場合はどうなるのか？ • 教習後、どこでフォローアップサービスを受けられるのか？ • 会場にはどうやって行くのか？交通費は支払われるのか？ • 軽食や昼食は持参しなければならないのか？ • 参加に対して報酬は出るのか？ 75 [訳注] 英語版のみ. 170 各車椅子ユーザーが、これらの情報を記載した書面の招聘状を受け取るようにすべきである。ユー ザーは、参加や写真を撮られることへの意向を示すため、同意フォームにも署名する必要がある。 写真は、小グループが他の受講グループへ発表を行なう際に用いる。 注意深い計画にもかかわらず、車椅子ユーザーが、到着してみると褥瘡があったり授業日に体調を 崩したりする場合もある。これらの可能性は事前に主催団体と話し合い、こうした事態が発生した 場合に対処する準備を整え、また交替の車椅子ユーザーの参加を手配できるようにしておけ。 車椅子ユーザーが授業中、膀胱や腸のアクシデントに遭った場合に、ユーザーと設備を清潔にする 物品を準備せよ。また小さい応急処置キットを、受講者と車椅子ユーザー両方の打撲やすり傷に 備えて用意しておくこと。 171 付録 付録１：WSTPtot必須授業時間割 第 1日 第 2日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 172 付録２：WSTPtot 中級教習時間割1 第 1日 第 2日 第 3日 8:30 はめめに B.5: 身体的事前評価− 身体計測 B.10: 車椅子の処方（選択） −体幹を支える (パート 2)2 8:45 9:00 B.2: 身体的事前評価− 支えなしの座位姿勢 B.10: フィードバック （パート 2） 9:15 B.11: 車椅子の処方（選択） −頭・大腿・下腿を支える 9:30 B.5: フィードバック 9:45 B.8: 車椅子の処方（選択） −骨盤を安定させる 10:00 午前の休憩 10:15 B.2: 身体的事前評価− 支えなしの座位姿勢 (続き) 午前の休憩 午前の休憩 10:30 B.8: 車椅子の処方（選択） −骨盤を安定させる（続き） B.11: 車椅子の処方（選択） −頭・大腿・下腿を支える （続き） 10:45 B.2: フィードバック 11:00 11:15 B.3: 身体的事前評価− 骨盤と股関節の姿勢チェック （ToT 訓練員のデモ授業） 11:30 B.8: フィードバック B.11: フィードバック 11:45 B.9: 車椅子の処方（選択） −股関節を支える B.12: 製品の下準備 12:00 12:15 12:30 昼休み B.9: フィードバック 12:45 昼休み B.12: フィードバック 1:00 昼休み 1:15 1:30 B.3: 身体的事前評価− 骨盤と股関節の姿勢チェック （続き） 1:45 B.10: 車椅子の処方（選択） −体幹を支える（パート１） 2:00 B.13: フィッティング 2:15 B.4: 身体的事前評価− ハンド・シミュレーション 1 [訳注] この時間割表の内容および時間配分は, ページ xiii「教習の概略」の表とは異なっている. 2 [訳注] ページ xiii「教習の概略」には存在しない授業. 173 2:30 午後の休憩 2:45 午後の休憩 B.10: 車椅子の処方（選択） −体幹を支える（パート１） （続き） 3:00 B.4: 身体的事前評価− ハンド・シミュレーション （続き） B.13: フィードバック 3:15 午後の休憩 3:30 B.4: フィードバック ToT 教習員の個別フィード バック 3:45 「保留スペース」 4:00 授業準備 ToT 教習員の個別フィード バック B.10: フィードバック （パート１） 4:15 「保留スペース」 4:30 授業準備 ToT 教習員の個別フィード バック 閉講式 4:45 5:00 注3 5:15 3 [訳注] ページ xiii「教習の概略」では, ここに授業 B.5 と B.8 (B.6 あるいは B.7 の誤記か) の一部が入る. 174 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot 実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2 つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP 教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 175 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 176 ToT教習員への指示：WSTPtot の終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 177 付録 4：技術に関する付録：中級WSTP向け この付録は、教習員の中級 WSTP での実習準備に役立つことが目的である。中級レベルでは、適正 な車椅子の組み立てがもっと複雑で、実地訓練での要求がさらに厳しくなり、技術者の役割の重要 性への理解が大切になる。計画段階で、教習員は、教習授業での工具と資材および経験豊富な技術 的支援を確保する方法について考えておく必要がある。また、より多くの技術者に、サービス事業 を支援するために中級教習を受けるよう奨励することも重要である。 中級サービス与 における技術職 一連の教習プログラムの一環として、WHO は、幅広い種類の車椅子に適用されることを意図した 座位保持の原理を教え、また姿勢支持具（PSDs）の例を示している。ユーザーを事前評価し、どの 姿勢支持具が必要か処方（選択）し伝達するのは臨床職の役割である。技術職の役割は、最終的に 必要な姿勢支持を達成する、なるべく実用的で、安全で、耐久性があり、取り扱いが楽な車椅子を、 手に入る工具、設備、資材、部品を用いてつくり上げる方法を把握することである。 基礎レベルでの技術者の役割は、ユーザーに合わせて車椅子を組み立てて調節することだと明確に 定義され、そのプロセスは単線的で、役割はより単純である。中級レベルに取り組む技術者には、 車椅子の組み立てのみならず、以下が求められる： • プロセス全体を通じて、ユーザーと臨床職により深く関わる。 • より独立して問題を解決できる。 • 容易に、立体形状をイメージして方向を定められる4。 • さまざまな材料や部品から、適正な姿勢支持具をつくる技工的技能を有する。 臨床職とのチームワークおよび優れたコミュニケーションは、非常に重要である。技術者の役割は、 工房での安全な作業環境を維持することや、工具と設備の手入れにも及ぶ。 臨床職/技術者チームは経験を積み、さらに複雑な姿勢支持ニーズを持つ車椅子ユーザーと関わる 中で自らの技能に挑戦し、それを高めて行く。経験豊富な技術者は、利用できるリソースを用いて 安全に達成できることは何か、その限界を把握することを学ぶ。複雑な姿勢支持具をつくれても、 それがユーザーとその家族にとって、適正、安全、あるいは長持ちする解決策である保証はない。 例えば、ユーザーをうまく支える姿勢支持具であっても、材料に耐久性がないか取り付けが不安定 であれば短期間しか持たず、したがって適正な解決策とはならない。 4 [原文] imagine and orientate 178 もっと多くの技術者に教習を 基礎 WSTP と中級 WSTP は、低リソース状況において車椅子を供与する実務家の量と質を高める ことが目的である。組み立てと調整［の方法］は車椅子の種類によって非常に特殊化しているため、 こうした情報は教習プログラムには盛り込まず、教習実施団体から別途提供することが多い。 中級 WSTP 受講者として技術者の参画を得ることは非常に有益である。技術者の車椅子サービス の 8 ステップへの理解が深まるほど、よりよい技術的支援ができるようになる。組織によっては、 教習は技術と臨床の職員へ同時に行なうが、サービス供与での継続的役割に応じて、技術レベルで 到達すべき能力への要求を違えている。 各サービス供与者や教習実施団体は、より複雑なニーズを満たすために、技術者が中級レベルの 力量を養うのを支援する最良の方法を見定める必要がある。 中級WSTP教習における技術者の役割 教習員には、中級 WSTP の実習中に支援を与える経験豊富な中級レベルの車椅子技術者を最低 1 名手配しておくよう勧める。これは、在庫品や既製品を用いないで姿勢支持具をつくる予定の場合、 特に重要である。 車椅子と姿勢支持具に関する技術的な内容を教授し、技術関連の質問に答えるために、経験豊富な 中級レベルの技術者および/または技術教習員を、教習全体を通じて教習チームに加えよ。 実習用の教室設営 姿勢支持具づくりには注意深さと時間が要求されるため、教習員 と技術者は、時間割を守れるようにきちんと計画しておくことが 絶対に必要である。一般的に使われる姿勢支持具のいくつかは、 予めつくっておくことを検討してもよい。 179 以下は、安全で整理整頓された教習用工房の設営に役立つ提案である： • 独立した仮設スペースを、以下のように整えよ： o 臨床教室の近くにある。 o じゅうぶんな照明とよい換気を備えている。 o 各々の技術者用の作業台か丈夫なテーブルを置ける、じゅうぶんなスペースがある。 o 換気のよい場所に接着作業用の作業台を別に備えている。 o 電動工具や機械を用いる場合のスペースを別に取っている。 • 散らかった工房は安全ではなく、事故の危険が増す。一日の終わりにはスペースを整頓し、工具 を片付け、床を掃くこと。 • 作業台やテーブルの表面を厚紙で保護せよ。これは、ウレタンフォームを切ったり貼ったりする さい、とりわけ重要である。 • ウレタンフォームを切った端材は一般ゴミとは分け、箱に入れて保管せよ。受講者には、新しい ウレタンフォームを切るより先に端材を活用するよう勧めること。 • 技工チームと働く、あるいは技術者への教習を行なう際には、各々に特定の責任を割り当てよ。 例えば、技術者の一人が特定の工具キットに責任を負い、一日の終わりにすべての工具を回収し、 帰る前に工具キットを確認してもらうようにするなど。 立位台 立位台にはさまざまな設計のものがあり、現地でつくることもできる。 立位台を処方する以前に、サービス職員は車椅子ユーザーの立位姿勢、 およびユーザーを直立した体位で支えるさまざまな方法を、完全に把握 している必要がある。「中級 WSTP 教習員用指導書」p.45 の指針に従う ことは重要である。 考慮すべき主な技術的課題として、以下の三つがある： • 強度：立位台には、ユーザーの体重を安全に支える、じゅうぶんな強度が必要である。立位台を 構成する材料の接合部と長い部品5にはじゅうぶん強度があり、しっかり接合されていることが 絶対に必要である。ユーザーは動くこともあるので、それによって立位台に加わる力を考慮せよ。 新しい機器は、使用前に強度と安定性を試験せよ。 5 [原文] The joints and lengths of material 180 • 安定性：立位台は、ユーザーが体勢を整える時や立ち上がる時を含め、使用中は完全に安定して いることが重要である。これは通常、接地して支える基底面を広く取ることで達成される。 • 支持面の安定性と快適さ：膝へ圧力が直接かからないことを確かめよ。立位台が身体と接触する 支持面には、除圧クッションと同様にクッションを効かせること。 さらに考慮すべき点： • 立位台は、車椅子に乗って近づいても簡単に使える設計であること。 • さまざまな身長や年齢のユーザーに対応するには、股関節、膝、骨盤、体幹への支えにある程度 高さ調節が必要になる。 • 立ちながら活動ができる平面を、トレイやテーブルなどで設けること。 ウレタンフォーム ポリウレタン（PU）フォームの品質を評価するには、以下の二通りの尺度が用いられる： • 硬度：支えの程度。硬度は密度と混同されがちだが、別の属性である。硬度は完成したウレタン フォームの物理的属性で、生産工程でウレタンフォームの化学反応により調節される。ウレタン フォームは硬くなればなるほど圧縮しにくい。ウレタンフォーム硬度は、それを圧縮するために 要する力を記録して測定できる。 • 密度：立方メートル当たりキログラム （kg/㎥）で表わす単位体積当たり質量（重さ）の測定値。 密度はウレタンフォーム生産に用いる化学物質と添加剤の関数で、ウレタンフォームの耐久性に 影響を与える。通常ウレタンフォームは、密度が高くなればなるほどより長期にわたって性質を 保ち、支えと快適さをもたらす。 181 ウレタンフォーム試験装置 下記のウレタンフォーム試験装置（図 1）を用い、簡便な圧縮試験を実施して、ウレタンフォーム 標本の硬度を算出せよ。キログラム単位で測定すると、その結果を比較基準および他の入手できる ウレタンフォームと比較できる。 ウレタンフォーム試験装置は金属部品 2 個からなり、下に異なる角度から見たところを示す： 図 1 ウレタンフォーム試験装置 これらの部品は、計量器やばねばかりから吊り下げる（図 2） 182 図 2 圧縮試験の動順 50 %圧縮試験の手順は以下の通り： 手順 3：計量器 1. ウレタンフォームを、なるべく 正確に 50 x 50 x 50 mm の標本 に切り、直径 6.5〜7.5 mmの穴 を中央に貫通させる。 2. 計量器/ばねばかりを掛ける。 手に下げないこと。 3. 標本を試験装置に通し、計量器 /ばねばかりから吊り下げる。 4. はかりの表示をゼロに調整。 5. 上側の板だけ均等に押し下げ、 標本を 50 %まで圧縮。試験装置 に付いた25 mmの刻みを注目。 6. 重さをキログラム単位で記録。 手順 1 ：試験用に調製した ウレタンフォーム標本 手順 5 ：上側の板だけ押し下げる 183 試験での注意事項 • 最低 3 回測定し、結果の平均をとること。誤差を最小限に抑えるため、すべての測定を同じ人が 実施すること。 • 成形ウレタンフォームから切り取った標本の場合、ウレタンフォームの外皮部分は含めないこと。 各種ウレタンフォームの使用目安 以下の数値は、あくまで目安とするのが目的である。ウレタンフォームを用いた新しい姿勢支持具 や除圧クッションは、すべて試作してユーザー試用を経るよう推奨する。硬度試験の結果は前述の 試験手順で得られたものである。 名称 用途 密度 50 %圧縮試験 (kg) 中くらいの PUフォーム 心地よい層：クッションの表層・外層 30〜60 kg/㎥ 2.2〜3.5 kg* 硬い PUフォーム 支える層：(心地よい層の下の) 基層**、 起伏、クッションのウェッジ 30〜60 kg/㎥ 3.5〜5.8 kg PU：ポリウレタン *この kg の許容範囲は±0.3 kg のばらつき6を含む。 **チップ/複合/再生/接着ウレタンも使用可能であるが、産業廃棄物からの製品であるため、硬度 にはばらつきがありうる。 一時的支持部および模擬姿勢支持具用ウレタンフォームの形状 教習には、さまざまな硬いウレタンフォームのブロックとウェッジが役立つ。一時的支持部に使う 基本的なブロックに加え他の形状のものも用いると、車椅子ユーザーの座部のさまざまな選択肢を 模擬するために役立つ。例えば： • 座面〜背もたれ角度を開ける」を模擬するため、背もたれ前面にウレタンフォームウェッジを 付加する。 • より狭めた座幅を模擬するため、骨盤側方パッドにさらにウレタンフォームを付加する。 • 大腿外側ウェッジを模擬するため、座面にウレタンフォームを付加する。 • 片側の座面前方下げ」のさまざまな角度を模擬するため、ウレタンフォームブロックを組み 合わせて付加する。 6 [原文] variation 184 ユーザーの姿勢支持ニーズが非常に複雑な場合、状況によっては、まず姿勢支持具のサイズ、形状、 位置を、より安価な材料でつくったもので最終決定することが必要になる。姿勢支持具の最終的な 処方（選択）が合意されたら、それらをもっと質のよいウレタンフォームでつくるとよい。 広く動に入るウレタンフォームの厚さは 25 mm か 35 mm である。もっと薄いウレタンフォーム （10 mm や 15 mm 厚など）は、たいへん小さい子どもや、例えば「骨盤下の積み増し」のように ほんの少しだけ変更が必要な場合に便利である。薄いウレタンフォームは、厚いウレタンフォーム から切り出さなければならない場合もある。この場合は、できる限り高品質のウレタンフォームと、 非常に鋭利な刃物を用いることが重要である。 下のイラスト（図 3）に基本的なウレタンフォーム形状の例を示す。寸法は状況に応じて調整可能。 例として、大人用の一時的支持部の一般的サイズは 200 x 200 mm で、子ども用は 200 x 100 mm である。 図 3 一時的支持部用の基本的ウレタンフォーム形状の寸法案（単位：mm） 185 ウェッジは、さまざまな寸法や厚さのものがあると、教習用にたいへん便利である。下のイラスト （図 4〜8）にウレタンフォームウェッジの例を示す。寸法は状況に合わせて調整してよい。一般的 な厚さは 35 mm と 50 mm、奥行きの範囲は 100 から 200 mm の間である。 図 4 ウレタンフォームウェッジの例 186 図 5 一時的支持部の使用例 図 6 片側の座面前方下げ」の模擬でのウェッジの使用例 図 7 大腿外側ウェッジの使用例 187 図 8 座面〜背もたれ角度を開ける」および座骨前方サポートの例 188 座位保持シミュレーター7の利点と難点 座位保持シミュレーターとは、臨床職や技術者が最終の車椅子を下準備する前に、車椅子ユーザー がとる姿勢を「模擬8」するために使用することがある装置のこと。この装置は、ユーザーを支える ために必要なあらゆる調節方法ができるよう、特別に設計されている。シミュレーターは事前評価 プロセスの終わりに、ハンド・シミュレーションの後で使用し、車椅子処方への情報をもたらす。 座位保持シミュレーターの使用には利点と難点とがある： 利点 • ムダを省く：座位保持シミュレーターは、車椅子と姿勢支持具の下準備がユーザーの最終姿勢を シミュレーター上でとれてからだけでよくなるため、廃棄物を（したがってサービスの反復費用 も）最小にすることが可能。 • 時間を節約：座位保持シミュレーターは、車椅子を下準備する前に最終姿勢を把握できるため、 経験豊富な臨床職や技術者には、車椅子と姿勢支持具をフィッティングする時間の節約になる。 難点 • 抜け道：経験が浅い職員は、事前評価とハンド・シミュレーションのプロセスを完全に行なって から必要な姿勢支持を決める代わりに、座位保持シミュレーターを抜け道に使うかもしれない。 そのため、検討する姿勢支持の種類が、座位保持シミュレーターに付いていたものに限定される ことがありうる。その結果、ユーザーが、自分の姿勢の可能性を、最終の車椅子上で完全に発揮 できない可能性がある。 • 熟達した技術者：安全で耐久性がある座位保持シミュレーターの設計には、技工的技能が必要で ある。また、座位保持シミュレーターが与えた支えを最終の車椅子と姿勢支持具に翻訳するにも、 技能が必要である。これはサービス事業が、いろいろなやり方で姿勢を支えるさまざまな種類の 車椅子を使用する場合、とりわけ難題となる。 • 費用：座位保持シミュレーターを購入する単発の初期費用は高く付くかもしれないが、サービス の反復費用が後のち節約されることで相殺されうる。費用節減のため、サービス事業で一般的に 使用する車椅子（および姿勢支持具）を改造して調節機能を追加し、座位保持シミュレーターに 転用することも可能である。 • 重くて大きい：座位保持シミュレーターは、たいてい最終の車椅子より大きくて重い。このため、 シミュレーターを持ってサービスセンターの外へ移動するのは難しい。 7 [原文] seating simulator [訳注] 日本では「計測椅子」の名称で呼ばれることもある. ビーズ等を封入したいわゆ る「シミュレーター」とは別物. 8 [原文] simulate [訳注] 斜字になっている. 189 合計座面奥行き」ツール紹介 骨盤の後ろに置く姿勢支持具（PSDs）には 2 種類ある。それが車椅子上で占めるスペースを把握 したうえで、ユーザーが快適に収まるかどうか、あるいは別の車椅子が必要なのか判断することが 重要である。以下は、中級車椅子事前評価フォームの寸法を用いて、合計の座面奥行き（「座面〜 背もたれ角度を開ける」ための三角形あるいは骨盤後方パッドの前後厚さを含む）を割り出すのに 役立つ、簡便なツールである： 図 9 合計座面奥行き」の計算 選択した車椅子がじゅうぶん大きく「合計座面奥行き」を収められれば、ユーザーの座底長に合い、 また姿勢支持具を座面に収められる。 車椅子および姿勢支持具 寸法（mm） 骨盤後方の支え： （Z）三角形の高さ あるいは（9）中央までの高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 骨盤後方パッド：□ 座面〜背もたれ 角度を開ける：□ 190 製品の下準備 中級レベルの製品下準備は、中級対応の車椅子の 組み立てと姿勢支持具の製作とを含む。車椅子の 組み立てプロセスが単線的な基礎レベルよりも、 問題解決がより多く必要とされる。 ユーザーの姿勢を支えるのに必要な形状を把握 して適正な姿勢支持具をつくるには、立体形状を イメージし方向を定める9 ことがたいてい必要に なる。このプロセスは中級車椅子処方フォームの 「補助線」が付いた描画ツールを用いると容易に なる (図 10)。 図 10 中級車椅子処方フォームの 描画ツール 提案された姿勢支持具のサイズと形状を明確にしたあと、技術者はそれをどうやってつくり、どの 資材を用いるかを決める。最終的な姿勢支持具は、実用的で、安全で、耐久性があり、可能な限り 使いやすいことが重要である。 技術者の仕事は、ユーザーが小柄で姿勢の問題が少ない場合、また多様な姿勢支持具を組み込んだ 調整可能な座位保持製品を用いる場合は容易になる。一方、ユーザーが大柄で複雑な姿勢の問題と 激しい制御できない運動とをあわせ持っている場合、作業はより困難になる。そうしたユーザーに 適正な姿勢支持具を製作するには技能、技術的知識、時間、資材と部品、問題解決能力が、はるか に多く必要である。 技術者は、利用できる車椅子の種類ごとの組み立て方を熟知している必要がある。車椅子の種類が 違えば、姿勢支持具をつくり、取り付けるやり方も違う。技術的業務は、調節可能な姿勢支持具が 組み込まれた姿勢支持専用車椅子が手に入る場合、 「病院型」車椅子10やその他の手動車椅子で作業 する場合と比べ違ってくる。 9 [原文] orthopaedic style wheelchair 10 [原文] imagining and orientating 191 車椅子どうしの違い、姿勢支持具のつくり方の違い、ユーザーの座り方の個別性11にもかかわらず、 製品の下準備には一般的順序がある： 1. 座面奥行き：臨床職が骨盤から始めて遠位部へと作業する12よう教わるのと同様、技術者も、 骨盤を支える姿勢支持具から始めるべきである。「合計座面奥行き」ツールを用いると車椅子 や座面の最適なサイズの処方（選択）が容易になる。次に技術者は座骨前方サポート（および その他の座面の姿勢支持具、例えば「片側の座面前方下げ」や「座面前方のかさ上げ」など） をつくるとよい。座面の姿勢支持具をウレタンフォームでつくる場合、接着剤は、初回フィッ ティングで姿勢支持具を定位置へ固定するのに必要最小限だけ用いよ。姿勢支持具のサイズや 位置は変化しうる（特に教習中）からである。 2. 骨盤ベルト：出発点として13、骨盤ベルトは座面に対し 60〜90 度の角度で座骨前方サポート とほぼ同じ位置に取り付けるべきである。 3. 骨盤側方パッドまたは座幅：座面がユーザーの臀部をどう支えれば、その横滑りを防げるかを 割り出すことが重要である。多くの場合、受け具とパッドを用いる。 4. その他の座面の姿勢支持具：車椅子によっては、座面に付加するその他の姿勢支持具、例えば 膝分離パッドを装着するための金具などをすべて取り付けてから、車椅子の他の部分へと移る 必要がある。 座面が完成してから、技術者は、頭と足へ作業を広げて行く14とよい： 5. 背もたれ：背もたれ高を設定してから、背もたれに装着する姿勢支持具を取り付けること。 6. 頭の支持具：頭の支持具が必要な場合は、それを設置してから他の必要な調整をせよ。 7. 足台：足台の高さ、角度、位置を設定する必要がある。足台ウェッジ、足台の積み増し、足首 や足ベルトなどの姿勢支持具は、たいてい初回フィッティングで再配置が必要になる。 8. 肩ハーネス：ハーネスが必要な場合、最上端はユーザーの肩と同じ高さかその上に取り付ける こと。ハーネスを肩上端より下に取り付けると、ユーザーの肩を引き下げがちになる。 11 [原文] individual natures of each user’s seat 12 [原文] work outwards 13 [原文] As a starting point 14 [原文] work outwards towards the head and feet 192 どの車椅子にも、フィッティングのたびにユーザーが安全に座れることは重要である。これに関し、 技術者と臨床職は、褥瘡の危険がある部位、または使用中だが未完成の姿勢支持具へ、特に注意を 払いながら判断する必要がある。 「安全・準備完了確認表」は活用すべきだが、車椅子部材には、初回フィッティングで 100 %完成 していなくてよいものもある。例えば： • 布製カバーは外しておいてもよい。 • ウレタンフォーム製部材は、変更が必要な場合に簡単にはがせるよう、接着剤を全面にではなく 「点々と15」塗って貼り付けよ。 • 例えば体幹側方パッドや肩ハーネスなど、特別な姿勢支持具の要不要についてチームでも確信が 持てない場合、それは付けないでおいて、初回フィッティングで判断してもかまわない16。 • 足台は、計測した身体寸法に従って取り付けよ。ただし、足首や足ベルトは、ユーザーが車椅子 に座ってフットプレートの最終位置が決まるまで付けないでおけ。 • テーブルのフィッティングを行なう場合、ユーザーが最終姿勢で車椅子に座ってから調整せよ。 安全ではないため、以下は禁止： • フレームのボルトがゆるんだまま。 • 駆動輪、キャスター輪、手押しハンドル、座面、背もたれ、ブレーキ、姿勢支持具を取り付ける ボルトがゆるんだまま。 • 鋭い角が始末されていないか、露出したまま。 最終フィッティングの後、教習員の一人が車椅子と姿勢支持具を確認してその署名をすべきである。 これは、チームが（「点々と」接着した残りのウレタンフォームすべての）全面的な接着、カバーの 完成、部材の塗装/ニスがけなどの最終仕上げを完了する前に行なうべきである。 包括的な 「安全・準備完了」確認は、ユーザーとその家族が、車椅子を持ち帰る前に完了している べきである。 15 [訳注] フィッティング前に受注見積もりを確定しなければならない等の事情がある場合は別だが, 一般論として. 16 [原文] ‘spots’ 193 技術に関する補足資料 資料 内容/参照ページ 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて • 製品試験を含む、車椅子の設計および生産の 関連情報、p.37-65 基礎車椅子サービス教習パッケージ 受講者用参考書 • 除圧クッションづくり、p.57-60 中級車椅子サービス教習パッケージ 受講者用参考書 • 姿勢支持具のつくり方、p.112-128 管理者向け車椅子サービス教習パッケージ 補足資料 • 事業管理者がサービスを育成するのを支援 する情報、技術リソースの運用に関する情報 を含む 車椅子サービス教習員養成教習パッケージ 中級教習員指導書 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

車椅子サービス 教習員養成教習パッケージ 基礎教習員指導書 車椅子サービス教習員養成教習パッケージ・基礎教習員指導書 © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: Trainer’s manual basic level. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: Trainer’s manual basic level. ジュネーブ: 世界保健機関; 2017. ライセンス: CC BY-NC- SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワールド・ ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017年に発行した ”Wheelchair Service Training of Trainers Package: Trainer’s Manual Basic Level” の全訳である。序章の「はじめに」で述べている通り、本書を含むこの「車 椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings”（邦訳「手動車椅子供与の世界ガイドライン 低リソース 状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたものである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移動支援機器供与に関する共同方針提言書：個人的移動性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子供与ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬授業実習からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳と校閲では以下の方々のご協力をいただきました。ここにお名前を 記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: Trainer’s Manual Basic Level, WHO, 2017 の 全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに従い翻訳手続きを行なっている。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称・住所・URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設によ って付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を含むevaluationと区別するため］ backrest 背もたれ［ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート］ calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 1. ToT 教習員への手引き xiii 2. 教習パッケージ実施準備のやり方 xvii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 13 ToT.3 模擬授業について 26 ToT.4 多様性に備える 37 ToT.5 成人学習 44 ToT.6 準備時間について 56 ToT.7 プレゼンテーションとファシリテーション 59 ToT.8 コミュニケーションスキル 68 ToT.9 指針文書の知識 76 ToT.10 視聴覚ツールおよび機材 93 ToT.11 フィードバックについて 104 ToT.12 グループダイナミクスを取り仕切る 110 基礎教習モジュール 118 A.1: 車椅子ユーザー 119 A.2: 車椅子サービス 120 A.3: 車椅子による移動 121 A.4: まっすぐに座る 125 A.5: 褥瘡 127 A.6: 適正な車椅子 129 A.7: クッション 132 A.8: 移乗 137 B.1: 紹介・相談および面接予約 141 B.2: 事前評価 142 B.3: 事前評価インタビュー 143 B.4: 身体的事前評価 144 B.5: 処方（選択） 151 B.6: 資金調達および発注 153 B.7: 製品（車椅子）の下準備 154 B.8: クッションづくり 156 B.9: フィッティング 158 B.10: 問題解決 159 B.11: ユーザー教習 164 B.12: メンテナンスおよび修理 165 B.13: フォローアップ 167 B.14a: 実習 1〜4 168 B.14: 総まとめ 172 教習運営実務と準備 174 付録 179 付録１：WSTPtot 必須授業時間割 179 付録２：WSTPtot 基礎教習時間割 180 付録 3：WSTPtot 模擬授業フィードバックシート 182 付録 4：クッションに関する付録 185 付録 5：改訂版車椅子事前評価フォーム 190 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008 年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4 種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHO は、WSTPtot の発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtot は、単一の「必須教習技能」モジュール3、および既成の 4 教習パッケージ（2012 年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013 年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015 年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者向け 車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち一つ で構成される。WSTPtot では、WSTPm と WSTPs は、一つの教習パッケージ別モジュールとして 統合されている。 WSTPtot は 40 時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtot の修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi 対象者 WSTPtot は、以下 4 つのモジュールからなる： • 必須教習技能5：2 日間 • 基礎教習（WSTPb）：3 日間 • 中級教習（WSTPi）：3 日間 • 管理者/関係者向け教習（WSTPm/s）：3 日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向け、または関係者向け WSTP の実施を 計画している教習員が対象である。実習生が WSTPtot 管理者/関係者向け教習から最大限の成果 を得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業 の必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習6 の機会を得る必要がある。 5 [原文] Core Training Skills 6 [原文] co-training xii 教習員 技能：このパッケージを実施する ToT 教習員には、以下が求められる： • 基礎 WSTP 教習を実施し、またその実施のために他の人を指導した豊富な経験 • WSTPtot を実施するところの状況に対する深い理解 • 車椅子供与に関連する、国際的指針文書7に関する知識 • 車椅子供与に関する議論に関係者を惹き込んだ経験およびその能力 車椅子ユーザー：他の WSTP［車椅子サービス教習パッケージ］と同様、車椅子ユーザーを教習 チームに含めるよう強く推奨する。車椅子ユーザーは自身の経験をもとに、適正な車椅子供与が、 自分のインクルージョンの実感8や QOL へどう影響したかについて、貴重な見解を示せる。また、 車椅子ユーザーが自身の車椅子を選択するうえで果たす、中心的役割についても語ることができる。 ToT 教習員の人数：実習生は注意深く支援する必要があるため、基礎または中級モジュールでは 実習生 4〜5 名ごと、管理者/関係者向けモジュールでは実習生 6 名ごとに ToT 教習員 1 名を置く よう推奨する。 開始までの流れ ToT プログラム実施に先立ち、WSTP 用 USB メモリ9から WSTPtot フォルダーをコンピューター のハードドライブにコピー10する。 • 次ページの「1. ToT 教習員への手引き」を読む。xviii-xxiv ページの表にある資材を準備する。 • 「教習パッケージ実施準備のやり方」の章が示す通りに、必要な段取りをすべてやっておく。 • 各受講者に、本書 xviii-xxii ページに挙げた教習教材一式を配布する。 7 [原文] international guiding documents 8 [原文] their feeling of inclusion 9 [原文] WSTP Pen Drive [訳注] 英語版のみが WHO より配布されている. 10 [訳注] 英語版のみ. 日本語版は教習パッケージフォルダーをダウンロードして使用. 以下同じ. xiii 1. ToT 教習員への手引き 教習の概略 必須教習技能モジュール 分 日 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 75 第 １ 日 ToT.2 車椅子サービス教習パッケージとは 90 ToT.3 模擬授業について 60 ToT.4 多様性に備える 60 ToT.5 成人学習 85 ToT.6 準備時間について 15 準備時間 45 ToT.7 プレゼンテーションとファシリテーション 60 第 ２ 日 ToT.8 コミュニケーションスキル 90 ToT.9 指針文書の知識 75 ToT.10 視聴覚ツールおよび機材 45 ToT.11 フィードバックについて 45 ToT.12 グループダイナミクスを取り仕切る 40 準備時間 75 基礎教習モジュール A.1: 車椅子ユーザー 35 第 ３ 日 A.3: 車椅子による移動 120 A.4: まっすぐに座る 55 A.5: 褥瘡 70 A.6: 適正な車椅子（パート 1） 45 授業準備・ToT 教習員の個別フィードバック 75 A.6: 適正な車椅子（パート 2） 88 第 ４ 日 A.7: クッション 85 A.8: 移乗 90 B.3: 事前評価インタビュー 100 授業準備・ToT 教習員の個別フィードバック 60 xiv 基礎教習モジュール B.4: 身体的事前評価 95 第 ５ 日 B.5: 処方 135 B.7: 製品の下準備 45 B.9: フィッティング 70 B.13: フォローアップ 40 講評 15 閉講式 15 教習時間計 2100 教習パッケージの時間割および期間 WSTPtot「必須教習技能」および「基礎教習」モジュールは連続した数日間で、あるいは一定期間 に数ブロックに分けて実施できる。連続した 5 日間での時間割の一例を、WSTP 用 USB メモリ内 の WSTPtot フォルダーに載せている11。 ToT 教習員には、現地の事情および受講者の学習ニーズに合わせ、この時間割を調整し、修正する よう奨励する。 「必須教習技能」の授業計画 「必須教習技能」モジュールは 12 教科からなり、各々の詳しい授業計画から始まる。計画は以下 の要点を押さえ、ToT 教習員が、各授業を計画し実施するのに役立つよう設計されている12。 • ねらい13：その授業のねらいは何か • 学習目標14：実習生は、その授業が終わるまでに何を達成するのか • 教材：その授業にはどんな教材が必要か • 準備15：ToT 教習員がその授業を準備するのに役立つ確認表 • あらすじ16：時間配分を含む、その授業の主な内容 ToT 教習員には、授業に自分自身の知識、技能、スタイルを取り入れ、また WSTPtot 教習全体を 通して実習生の経験を引き出すよう奨励する。 11 [訳注] WSTP 用 USB メモリは英語版のみ. 時間割例の日本語版は本書の付録 1 を参照. 12 [訳注] 分かりやすさのため、受講者への語りは「ですます調」、教習員への指示は「である調」で区別した。 13 [原文] Aim 14 [原文] Learning objectives 15 [原文] To prepare 16 [原文] Outline xv 基礎 WSTP の授業計画 「必須教習技能」モジュール修了後、実習生は WSTPtot の第 2 部へと進み、基礎 WSTP からの 授業を実施することにより学んだ教習技能を実践する。実習生には [模擬] 授業を割り振り、授業 実施に続いてフィードバックと討論を行なう。模擬授業の時間17は、ToT 教習員に実習生の技能を 観察し、評価する機会を与える。 • 模擬授業18 ：各模擬授業の内容は、実習生による割り振られた授業項目のプレゼンテーション19 などである。 • ToT 教習員のデモ20：ToT 教習員が、優れた実践21のお手本22として教授する節を含む授業もあ る。 • フィードバック：授業後、ToT 教習員は、実習生および模擬受講者からのフィードバックでは ファシリテーターを務める。フィードバックを与える際の詳しい指導内容は、本マニュアルの xxiii-xxiv ページ「模擬授業のファシリテーション要領」を参照。 実習生に模擬授業を準備させる 実習生が WSTPtot のためにじゅうぶん準備できるように、基礎 WSTP の資料を事前に渡しておく ことが重要である。これは教習パッケージの紙コピーでも電子コピーでもダウンロードリンクでも よい。実習生は、どの授業でも実施できるように準備しておくべきである。 実習生に WSTPtot への準備をさせるための指示書の見本は、WSTP 用 USB メモリ内の WSTPtot フォルダーに載せている。 模擬授業の割り振り 模擬授業割り振りの例は、WSTPtot フォルダー内「WSTPtot 基礎教習割り振り」ファイルを参照。 ToT 教習員は、これを各自の教習状況および実習生数に合わせて修正すること。模擬授業は「必須 教習技能」モジュール第 1 日の授業「ToT. 3 模擬授業について」で割り振りを決める。 注記：実習生が「必須技能教習」モジュール履修済みで、いきなり基礎教習モジュールから始める 場合は、各々の模擬授業について 2・3 日前に23通知しておくべきである。 17 [原文] practice delivery sessions 18 [原文] practice delivery 19 [原文] presentations [訳注] この語の本書での意味は授業 ToT.7 を参照. 20 [原文] demonstrations [訳注]「やって見せること・実演すること」という意味での「デモ」. 21 [原文] good practice [訳注] 以下同じ, 頻出. セミナー等では「グッドプラクティス」と訳される場合もある. 22 [原文] an example 23 [原文] two-to-three days in advance xvi メンター24およびピアサポート25 ToT 教習員には、メンター26という重要な役割がある。教習プログラムの最初に、各実習生には、 メンター21 の ToT 教習員を必ず割り当てよ。実習生は、ToT 教習員で均等に分け合うべきである。 メンターの ToT 教習員は、自分の実習生から模擬授業に関する質問を受け、また実習生の進歩に 対してフィードバックも与える、主要な接点27である。 ToT 教習員には、WSTPtot 教習後も、実習生に対するメンターを継続するよう勧める。 実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各々の技能と自信とを養うために 役立つ。実習生がソーシャルメディア上のグループに参加するかグループを立ち上げ、質問したり 学習経験を共有したりできると有益であろう。 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員に付いて見習い教習を実施し、自らの技能を育成し続 けなければならない。ToT 教習員は、実習生が WSTPtot 修了後に見習い教習を経験することを、 自らの教習技能を育成し続けるための最良の方途として奨励しなければならない。 見習い教習では、教習指導員 1 名に対して実習生 2〜4 名の割合を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、模擬授業からのフィードバックで記録し、実習生と共有すべきである。 実施ごとに ToT プログラムを事後評価する 教習プログラムを一つひとつ実施後に評価するのは優れた実践である。ToT 教習員は、実習生から 定期的にフィードバックを集め、ToT プログラムの間に自分が考察したことを記録しておくべきで ある。これは、ToT 教習員が WSTPtot および自分自身の教習技能の両方を改善するために役立つ。 例えば、以下のフィードバックおよびデータを提供できると、たいへん有用である： • 受講者の登録および評価フォーム • WSTPtot に関する自分自身の考察やコメント 教習プログラム評価フォームは WSTP 用 USB メモリ内の WSTPtot フォルダーに収めており、 ToT 教習員は、これを各自のニーズに合わせて修正してよい。 24 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 25 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 26 [原文] mentor [訳注] 本書では助言指導 mentor, その行為 mentoring と指導者 mentor は「メンター」に一括. 27 [原文] main point of contact xvii 2. 教習パッケージ実施準備のやり方 各実習生の経歴28を知る 各実習生の経歴を熟知することは重要である。例えば： • 車椅子供与において、実習生がすでにどんな経験を有しているのか把握する。 • 実習生がすでに履修あるいは実施したことがある教習プログラムをすべて分かっている。 • 実習生が、自分が基礎 WSTP を実施する機会が将来あるかどうか知っている。 車椅子サービス提供が、実習生の勤務先での業務全体にどう組み込まれているのか見極めよ。 教習施設を準備する WSTPtot を実行するために必要な施設： • 広い教室（またはスペース）1 室：実習生が小グループに分かれて作業できるくらいじゅうぶん 広く、また実習生が集中できるくらいじゅうぶん静かであること • 昼食/軽食のための独立したスペース • 清潔なトイレ トイレをはじめあらゆるエリアは、絶対に車椅子でアクセスしやすくなければならない。 28 [原文] background xviii 下の確認表を、教習施設の下調べと準備に用いるとよい。 教習施設確認表 教室 講義エリア □ 各実習生用の椅子：折りたたみテーブルなど実習生がノートを取れる設備があるもの □ 実習生が 2〜4人ずつの小グループに分かれられるスペース □ 最低 3台の車椅子を展示し、動かして回れるスペース □ じゅうぶんな照明および換気 □ 施錠可能/安全なスペース □ 昼食/軽食エリア 清潔な食事エリア □ テーブルと椅子 □ 近くの手洗い場：清潔なタオルおよび石けん □ トイレ 水場、トイレットペーパー、手洗い設備、ゴミ入れを備えた清潔なトイレ □ 教材および設備を準備する WSTPtot の印刷教材 教材 数量 X 注/備考 マニュアル類 ToT 教習員用指導書 ToT 教習員 1人に（教授する モジュールにつき）1冊 □ 印刷して製本。 ToT ハンドブック 実習生 1人に（教授する モジュールにつき）1冊、 ToT 教習員 1人に 1冊 □ 印刷して製本。 WHO「手動車椅子供与の世界 ガイドライン 低リソース状況 の克服に向けて」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 国際連合「障害者の権利に 関する条約（CRPD）」 実習生 1人に 1冊 □ 印刷して製本するか電子 コピーを配布。 教習パッケージ別モジュール （基礎WSTP）用印刷教材 セット 実習生・ToT 教習員 1 人に 1セット □ マニュアル類、ワークブ ック、ポスター、フォーム と確認表など。詳しくは 以下の表を参照。 xix 教習プログラム用フォーム類 受講者登録フォーム 1 プログラムに 1部 □ 受講者の参加記録に、この フォームを使用。 名札 実習生・ToT 教習員 1 人に 1枚 □ ― 時間割表（必須教習技能および 教習パッケージ別モジュール） 実習生 1人に該当する モジュールを 1部ずつ □ 各モジュールの見本を、 WSTP用 USB メモリに収載。 現地の事情に合わせて調整。 写真撮影同意フォーム 1 部 □ 主催/教習実施団体向けに修正 し、現地語に翻訳して、写真 を撮られる人には、必ずこの フォームに署名してもらう。 実習修了証 実習生 1人に 1部 □ 実習修了証は、準備するか WSTP 用 USB メモリに所収 のひな形を改変。 教習プログラム評価フォーム • 必須教習技能 • 教習パッケージ別モジュール 実習生 1人に 1部 □ 実施後に情報を集約し、 WHOと共有。 WSTPtot 模擬授業フィード バックシート ToT 教習員には実習生 1人につき 1部必要 □ 実習生 1人につき最低 1部を 印刷。このシートは 3 回まで の模擬授業に対するフィード バックに使用可能。 xx 基礎 WSTP の印刷教材 教材 数量 X 注/備考 マニュアル類、ワークブック、ポスター 教習員用指導書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 受講者用参考書 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 受講者用ワークブック 実習生・ToT 教習員 1 人に 1冊 □ 印刷して製本。 ポスターセット 内容： • 車椅子サービスのステップ • 車椅子の移動技能 • 褥瘡 • 家庭での車椅子の手入れ方法 実習生・ToT 教習員 1 人に 1セット □ ― 車椅子サービスフォーム・確認表 車椅子サービス紹介・相談フォーム 実習生・ToT 教習員 1 人に 1部 □ ― 車椅子事前評価フォーム □ WSTP 用 USB メモリから 改訂版29を印刷。 車椅子処方（選択）フォーム □ ― 車椅子概要フォーム □ ― 車椅子フォローアップフォーム □ ― 車椅子フィッティング確認表 □ 印刷してラミネート加工。 確認表は基礎 WSTP 教材 「各種フォーム＆確認表」 に収載。 車椅子ユーザー教習確認表 □ 車椅子の安全・準備完了確認表 □ 29 [訳注] 変更箇所および詳細については、本書の授業「B.4 身体的事前評価」を参照. WSTP 用 USB メモリは英語 版のみで, 日本語版は本書の付録 5 を参照. xxi 設備 一般的な教習設備 物品 数量 X 注/備考 大きなホワイトボード 1 □ ― ホワイトボードマーカー 3〜4本 □ さまざまな色のもの プロジェクター 1 台 □ ― コンピューター 1 台 □ ― ポータブルスピーカー 1 セット □ 動画の音質向上用 ポインター/リモコン 1 □ ― フリップチャート用イーゼル および用紙 イーゼル 1〜2架 および用紙 1包 □ フリップチャート用マーカーペン 3〜4本 □ さまざまな色のもの 付箋紙 3〜4冊 □ さまざまな色のもの マスキングテープか類似品 1 巻 □ フリップチャート紙やポスターを 壁に貼るため 延長コード 最低 1つ □ ― 電源タップ/アダプター 必要に応じて ― xxii 基礎教習用設備 物品 数量 X 注/備考 評価ベッド30 3 台 □ ― 足乗せブロックのセット31 2 セット □ ― スライディングボード 3 枚 □ ― 巻尺 4 巻 □ 硬い巻き取り式巻尺（裁縫用巻 尺ではなく）でmm単位のもの 脊柱と骨盤の解剖模型 1 セット □ 短く大腿骨が付いているものが 望ましい（手に入れば） 以下を含む車椅子とクッション： • リジッドフレームの 3輪車椅子 • リジッドフレームの 4輪車椅子 • 調整機能付き折りたたみフレーム 車椅子 • 単純な折りたたみフレーム車椅子 （例：病院用や移送用のもの） 現地で手に入る ものを最低 1台 ずつ □ どの車椅子も正常に動作し、ク ッションが付いているように。 除圧クッションのよい見本を、 最低一つ含むように。 見本はホイールベースの長いも のと短いもの、さまざまなひじ 掛けと足台のものが混在するよ うに。 成形ウレタンフォーム除圧クッ ション32およびカバーの見本 1 組 □ ― クッションのかさ上げ33の見本 1 枚 □ ― 弓ノコ刃34か刃渡りの長いナイフ 1 本 □ ― 黒の油性マーカー 受講者 1〜3名 に 1本 □ ― 硬い (チップ) ウレタンフォーム □ 50 x 400 x 400 mmのシート5枚 柔らかいウレタンフォーム 50 x 400 x 400 mmのシート5枚 クッションカバー生地見本 現地で手に入る ものを各種 1枚 ― 30 [原文] assessment bed [訳注]「管理者向け車椅子サービス教習パッケージ補足資料」p.8 を参照. 31 [原文] set of foot blocks [訳注]「管理者向け車椅子サービス教習パッケージ補足資料」p.9 を参照. 32 [訳注]「基礎車椅子サービス教習パッケージ教習員用指導書」p.169-177「B.8: クッションづくり」も参照. 33 [訳注]「基礎車椅子サービス教習パッケージ教習員用指導書」p.172 を参照. 34 [原文] Hacksaw blades [訳注]「管理者向け車椅子サービス教習パッケージ補足資料」p.18 も参照. xxiii 教習教材について知る ToT 教習員は、基礎 WSTP 教材すべてを包括的に知っている必要がある。これには教習パッケージ 別の「教習員用指導書」ならびに「受講者用参考書」「受講者用ワークブック」そして WSTP 用 USB メモリ内のその他の教材の、あらゆる面に精通することが含まれる。 また「ToT 教習員用指導書」と「ToT ハンドブック」の全項目を熟知していることも必要である。 WSTPtot 教習は他の ToT 教習員と共同で実施してもよいが、その場合でも自分がすべての授業を 熟知していることは重要である。例えば、WSTPtot で教わる「必須教習技能」はすべてじゅうぶん に理解し、自分の授業において優れた実践としてお手本を示せるべきである。 模擬授業のファシリテーション要領 • 授業時間をモニターし、予定時間を過ぎたら、完了していなくても実習生を停止させよ。 • 授業を複数の実習生で分け持つ場合は、流れを止めないよう授業全体を実行した後で、各実習生 に対するフィードバックのファシリテーションを順番に行なえ（WSTPtot の時間配分により、 休憩が必要な授業を除く）。 • 「ToT 教習員用指導書」中の「WSTP 教材の誤り」と「この授業を教えるための主な留意点」を 熟知し、実習生がそれらを取り上げたか確認せよ。 • 授業は「WSTP 教習員用指導書」および「ToT 教習員用指導書」に沿って進めよ。 • 授業中、WSTP 用 USB メモリ内の「WSTPtot 模擬授業フィードバックシート」を記入せよ。 • 模擬授業中、授業がスムーズに進まないからといって早まって介入しないこと35。実習生に自力 で状況を軌道修正し36受講者を方向転換させる37時間を与えよ。介入するのは、安全上の懸念が 生じたか、実習生が自力で授業を軌道に戻せなくなった38場合だけにせよ。 35 [原文] don’t step in foo quickly 36 [原文] rectify the situation 37 [原文] redirect participants 38 [原文] unable to bring the session back on track themselves xxiv 模擬授業後のフィードバックでファシリテーションを行なう ToT 教習員の役割は、フィードバック時間にファシリテーションを行ない、それを簡潔で建設的、 かつ的確な39ものにすることである。 模擬授業が完了したら、以下のプロセスをたどること。 *「WSTPtot 模擬授業フィードバックシート」内に収載。 フィードバックが建設的になるよう、注意深くモニターせよ。受講者がネガティブまたは傷つける ような40フィードバックを発したら介入せよ。フィードバックを建設的に言い換える見本を示せ。 個別フィードバック ToT 教習員へのメンターの割り振りに基づいて、ToT 教習員は、各実習生と「WSTPtot 模擬授業 フィードバックシート」を指針に用いながらフィードバックを交わす時間を設定する。この時間は、 追加の、またはデリケートなコメント41をフィードバックするためにも活用せよ。 39 [原文] brief, constructive and relevant 40 [原文] hurtful 41 [原文] sensitive comments 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 ね ら い WSTPtot（車椅子サービス教習員養成教習パッケージ）を実習生に紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  ToT［教習員養成教習］プログラムのねらいおよび目標を詳述する。  ToT プログラム時間割およびWSTPtot の課程を説明する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.1：WSTPtot 紹介」  各 ToT 教習員の名札 各実習生に：  さまざまな色の付箋紙（A5くらいのサイズ）：3〜4枚  「ToT ハンドブック」  モジュール別WSTP［車椅子サービス教習パッケージ］の教習員用指導書、受講者用 参考書およびワークブック、ポスター、WSTP用 USB メモリ  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」および 「障害者の権利に関する条約（CRPD）」  「必須教習技能」モジュールおよび教習パッケージ別モジュールの時間割表  白紙の名札 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  現地に適した短いWSTPtot 開講式を段取る。  庶務連絡1を準備。  「基本ルール2」および「保留スペース3」のフリップチャート紙を準備。  教室を設営：テーブルと椅子、プロジェクター、コンピューターとスクリーン、 ホワイトボード、フリップチャート用イーゼルと用紙、マーカーペン。  教材を受講者ごとのセットに仕分けして取り置く。混乱を避けるため、この日は最初 実習生に「ToT ハンドブック」、各自の教習パッケージ別「WSTP教習員用指導書」と ToT 時間割表のみを配布する。残りの教材は、この日の終わりに配布。  「経験の壁4」を準備。 5節に示した見出しを大きい付箋紙か A5用紙に印刷するか 記入するかし、壁に「経験の壁」の見出しを付けて、その下に貼っておく。 1 [原文] housekeeping information 2 [原文] Ground Rules 3 [原文] Car Park 4 [原文] Wall of Experience 3 あ ら す じ 1. 開講式 2. 歓迎あいさつ・自己紹介5 3. この授業のはじめに 4. 庶務連絡および「基本ルール」 5. 経験の壁 6. WSTPtot の概略 7. 要点のまとめ 10 10 1 10 15 27 2 授業時間計 75 開講式（10 分） 主催団体と共同で、現地に適した WSTPtot 開講式を挙行せよ。 歓迎あいさつ・自己紹介（10 分） ToT 教習員へ：全員を歓迎して自己紹介せよ。自分 の経歴および車椅子供与と教習の経験に関して、 概略を簡潔に伝えよ。 実習生に、自分の名前、役職、所属組織を明らかに しながら自己紹介するよう求めよ。 名札を配り、自分の名前を記入するよう実習生に 指示せよ。 この授業のはじめに（1 分） この授業のねらいと学習目標を説明せよ。 5 [原文] Welcome and introductions 4 庶務連絡および「基本ルール」（10 分） 必要に応じて以下を説明せよ： • トイレの場所 • 軽食および昼食の段取り • アクセシビリティに関すること • 緊急時にはどうしたらよいか • その他運営に関すること このスライドは活動の間じゅう映しておけ。 活動１ グループ： 実習生をペアに分けよ。 指導内容： 説明：これから、この教習での「基本ルール」を定めましょう。 実習生に、この一週間について定めておきたい「基本ルール」を簡潔に話し 合うよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 2分、フィードバックに 9分見込んでおけ。 フィードバック： 各ペアに、各自のリストから 1 項目ずつ挙げてはフリップチャートに記録 し、それをアイデアが出尽くすまで続けるよう指示せよ。 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 これらのルールを破る人に、グループとしてはどう対処したいか尋ねよ。 「基本ルール」は、ToT プログラム全体を通して参照用に壁に掲示せよ。 5 ToT 教習員への注記： • 「基本ルール」の施行には、ToT 教習員だけでなく、全員が有責であると説明せよ。 • 実習生には、「基本ルール」が破られるたびにこの表を参照させよ。 「基本ルール」の例： • 携帯電話：サイレントモードにする • 私語を慎み、話の途中で割り込まない • 他者のものの見方を尊重する • どの授業にも遅刻しない • 教習スペースを整理整頓し清潔に保つ • 話し合いに貢献する • 適切な障害用語6を用いる 説明7： • WSTP では障害者に関してポジティブな用語の 使用を推進しています。 • 教習員は優れた実践の模範を示し、WSTP およ び CRPD（障害者の権利に関する条約）が定める 言語指針に従わなければなりません。 • 「the disabled」「disabled people」「special people」などは不適切な用語で、用いるべきでは ありません。 • 「persons with disabilities」または「people with disabilities」をつねに用いなさい。 • 障害がない人を指す場合に、「normal people」の 語を用いるのは避けなさい。 「基本ルール」に列挙していなければ「適切な障害 用語を用いる」を追加せよ。実習生は、ToT 全体を 通してポジティブな用語を使っているかモニター するよう提案せよ。 ToT 教習員への注記： • ここで「disabled people」の語の使用は避けるよう推奨しているものの、「Disabled People’s Organization［障害者団体］」および「DPO［左の略称］」は依然広く用いられ、また広く受容 されている。一般的になりつつある「Organization of Persons/People with Disabilities (OPD) ［障害者団体］」の語を用いるよう奨励せよ。 6 [原文] disability terminology 7 [訳注] 本節では, 英語版での議論をなるべく原文通りに伝えるよう努めた. 6 説明： • 教習中、教習員が即答できないか、後の授業で取 り上げる内容の質問を受けることもあります。 • これらの質問は「保留スペース」に置き、あとで 適切な時に話し合うようにします。 「保留スペース」のフリップチャートを壁に貼り 出せ。 経験の壁（15 分） このスライドは活動の間じゅう映しておけ。 7 活動２ グループ： 実習生に単独8で作業するよう指示せよ。 指導内容： 「経験の壁」の見出しを壁に貼り出せ。例えば： • 教えたか受けたWSTP教習 • 支援機器供与に関連する経験年数およびその種類 • 職歴 • 話す言語 説明：この教習に来ている私たちは、さまざまな経験、知識、技能を持って います。いっしょに「経験の壁」をつくりましょう。 それぞれの見出しごとに違う色の付箋紙を（必要なら複数枚）使い、自分の 答えを書き出して下さい。 実習生に、分かりやすく書き、壁の各見出しの下に各自の付箋紙を貼り出す よう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 実習生が付箋紙/カードごとに 1 項目ずつ、分かりやすく書いていることを 確かめよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 実習生からフィードバックを集め、ルールに同意してもらうようにせよ。 教室内が豊富な知識、技能、経験に満ちていることへの注意を喚起せよ。 実習生はここへ至るまでにすでに長い道のりを歩んでおり、ここからさらに 経験を積み重ねて行くのだ、と強調せよ。 ToT 教習員への注記： • この「経験の壁」は、プログラムの間じゅう参照し、適宜、教習の他のパートと関連づけよ。 8 [原文] alone 8 WSTPtot の概略（27 分） WSTPtot のねらい、および目標を説明せよ。 実習生に各自の ToT 時間割表を見るよう指示 せよ。 説明：ToT は次の 2 部に分かれています： • 「必須教習技能」モジュール • 教習パッケージ別モジュール。この中で実習生 は、WSTP の授業を仲間と実習します。 ToT 教習員への注記： • 「車椅子サービス教習パッケージ」には 4種あるが、うち「管理者向け」と「関係者向け」は 一つのモジュールとして取り扱うため、教習パッケージ別モジュールは 3種のみである。 各実習生に配布される教材を紹介せよ。それぞれの教材を簡潔に説明して示せ。資料によっては、 この日の終わりに配られるものもあることを説明せよ。 9 説明：WSTPtot から最大限の成果を得るには、 教習員には次のことが必要です： • 一つ以上の WSTP を修了していること • 車椅子サービス提供や障害領域9での経験がある こと • ToT プログラムを教授する、言語の読み書きが できること • 教習やファシリテーションを行なった経験が あること • ToT プログラム後に、教習パッケージを実施する 機会があること 説明： • 見習い教習は ToT プログラムの後、実習生が 独立して教習を実施する前に行なわれます。 見習い教習を経験することが、WSTPtot 修了後 も教習技能を伸ばして行く最良の道です。 • ToT プログラム修了後、実習生はみな最低 1 回 の見習い教習を経験しなければなりません。 • 経験豊富な教習員との見習い教習は、次のよう な教習技能を強化するために役立ちます： o WSTP 実施の計画と準備 o プレゼンテーションとファシリテーション o 受講者へのメンター o 教習運営実務10の調整 9 [原文] disability sector 10 [原文] logistics [訳注] 以下同じ. 10 説明：経験豊富な教習員と見習い教習を行なえな い場合は、必要とする支援を受けられる他のやり 方を検討しなさい。例えば： • 経験豊富な教習員に連絡を取り、電子メールや 電話による、遠隔メンターを依頼する • 他の ToT 実習生と連携し、助け合って WSTP の 計画、準備、実施を行なう。 説明： • 見習い教習の実行回数は、実習生によって変わ ります。 • 教習員となるまでの期間も、いつ見習い教習 ができ、何回見習い教習をやり遂げたかによ って変わります。 • ToT 教習員と、見習い教習中の実習生のメン ター教習員は、実習生が、ひとり立ちして教習を 実施するまでに見習い教習を何回完了すべき か、決めるのを手伝います。 11 実習生に、各自の「ToT ハンドブック」p.132-134 の「WSTPtot 模擬授業フィードバックシート」を 見るよう指示せよ。 説明： • 自分が上手にできたことと改善の余地があるこ とについて振り返り考察することは、よりよい 教習員になるために役立ちます。 • 「WSTPtot 模擬授業フィードバックシート」に は、この教習で育成することが目的の、実習生の 技能一覧表が載っています。 • フィードバックシートは各模擬授業後の教習員 によるフィードバックで指針に用います。 • ToT 教習員は、一日の終わりにリーダー役実習生 へフィードバックを、また、ToT プログラムの最 後に書面のフィードバックを与えるためにも、 これを用います。 要点のまとめ（2 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 12 経験の壁 支援機器供与に関連する経験年数およびその種類 教えたか受けた WSTP 教習 職歴 話す言語 13 ToT.2 車椅子サービス教習パッケージについて ね ら い WSTP［車椅子サービス教習パッケージ］の構成と方法論を紹介する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  4 種のWSTPを列挙する。  WSTPの指針原則を列挙する。  各教習パッケージの教習員用指導書の構成を詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.2：車椅子サービス教習パッケージについて」  各実習生に、教習員用指導書（「必須教習技能」モジュールの後に各々が受講する教習 パッケージ別モジュールによって基礎WSTP、中級WSTP、あるいは管理者向けWSTP および関係者向けWSTP）の紙コピー 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  できれば、WSTP 用 USB メモリに PPT スライド p.20 へのリンクを、その使い方の 説明のために埋め込んでおく。 あ ら す じ 1. はじめに 2. WSTP 4 種の沿革と存在理由 3. 各WSTPの構成 4. 「教習員用指導書」を理解する 5. WSTPの使い方 6. 要点のまとめ 2 15 5 30 35 3 授業時間計 90 14 はじめに（2 分） 授業のねらいおよび学習目標を説明せよ。 WSTP 4 種の背景と存在理由（15 分） 説明： • WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(11)」は、2006 年 11 月にインド・バンガロールで開催された「開 発途上国への車椅子に関する合意形成会議(12)」 が土台になっています。 • 「車椅子ガイドライン」では教習機会の必要を 指摘しており、それが基礎・中級・管理者向け・ 関係者向けの各 WSTP［車椅子サービス教習パ ッケージ］開発につながりました。 11 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.wh o.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 12 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Develo ping Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブ ス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006 年 11 月 6〜11 日. インド, バン ガロール: 世界保健機関, 2006]. 15 説明： • 基礎 WSTP(13)は、移動に障害があるものの、 付加姿勢支持なしでまっすぐに座れる男女の 子どもや大人に、適正な手動車椅子および クッションを供与する職員への教習用です。 • 中級 WSTP(14)は、まっすぐに座るには付加姿勢 支持が必要な男女の子どもや大人に、適正な 手動車椅子およびクッションを供与する職員へ の教習用です。 説明： • 基礎 WSTP と中級 WSTP ともに、最短 5 日間で 実施できるように設計されています。 • 教習プログラムには、次の目的で時間を追加 することも可能です： o 授業計画に教材資料を追加する o 授業を追加する o 車椅子ユーザーとの実習回数を増やす o 教習で使用する製品に対して、さらに下準備 の時間を取る o 通訳するゆとりを設ける o 教習日数を短縮する o 重要な概念を学ぶための時間を追加する 13 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版: 基礎車椅子サービス教習パッ ケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 14 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版: 中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 16 説明： • 基礎 WSTP および中級 WSTP の目的は、車椅子 サービス提供における教習を受けた職員の数を 増やすことです。 • しかし、高職位の参画なしに、教習を受けた職員 だけで適正な車椅子供与を確立することはでき ません。 • サービス事業の発展を支援するために WHO が 開発したのが： o 管理者向け WSTP(15)：事業管理者が、適正な 車椅子供与を効果的に支援するための指針と なるように設計されています。これには、適正 な車椅子供与の確立に向けて、事業管理者や 関係者の参画を推進することも含まれます。 管理者向け WSTP は最短 2 日で実施でき ます。 o 関係者向け WSTP(16)：国/地域における適正な 車椅子供与の確立に向けて、全関係者の意識 を啓発し、技能や知識を育成するために設計 されています。最短 4 時間で実施できます。 • どちらの教習パッケージも、通訳、より詳細な 討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るため に、期間を延長して実施できます。 15 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 16 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 201 5 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 17 説明：WSTP は、以下の一群の指針原則17に従って 作成されました： • 車椅子ユーザーを車椅子サービスの中心に置く ユーザー中心で人権に根ざしたアプローチ18。 • 手に入るエビデンスに基づく19、国際的な最良の 実践例20にならう。 • 低リソース状況21に重点を置く。 • 全教習パッケージにおける教習員や教習対象者 としての、車椅子ユーザーのインクルージョン。 説明：WSTP では、取っ付きやすい非医療的なことばづかいと用語22を用い、それによって： • 臨床や技術の資格を持たない受講者も教習を受けられ、 • サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになります。 各 WSTP の構成（5 分） ToT 教習員への注記： • この項は簡潔に済ませよ。詳細は ToT プログラムの「必須教習技能」に続く教習パッケージ別 モジュールで教わるからである。実習生が教習パッケージ別モジュールで教授する種類の WSTPに重点を置け。 説明：それぞれのパッケージに、さまざまな教材が 含まれており： • 教習員用指導書、PPT プレゼンテーションフ ァイル、動画、ポスター、 • 基礎・中級・管理者向け WSTP には受講者用 参考書があり、 • 基礎・中級 WSTP はサービスフォーム、確認表、 別冊の受講者用ワークブックも含んでいます。 17 [原文] guiding principles 18 [原文] user-centered and rights-based approach 19 [原文] available evidence-based 20 [原文] best practice 21 [原文] less-resourced settings 22 [原文] accessible, non-medical language and terminology 18 説明：WSTP の資料はすべて、実習生の教材に含まれている WSTP 用 USB メモリに載っています。 またこれらは、WHO のウェブサイトからもダウンロードできます。 説明：WSTP 用 USB メモリにさらに含まれている ものとしては： • 修了証 • 教習員用観察確認表 • 各種評価フォーム これら23は ToT では使いませんが、WSTP 実施中 に使うことになります。 「教習員用指導書」をよく知る（30 分） 説明：4 種の WSTP で取り上げる主題はそれぞれ 異なりますが、構成とアプローチはみな同じです。 活動を通して、その構成に詳しくなりましょう。 このスライドは活動の間じゅう映しておけ。 活動１ グループ： 実習生をペアに分けよ。実習生によって異なる教習パッケージ別モジュール を「必須教習技能」モジュール後に履修する場合は、同じパッケージの教習 を受ける実習生どうしをペアにせよ。 指導内容： ペアごとに最低、基礎・中級・管理者向けWSTP「教習員用指導書」のうち どれか 1冊が必要。 この活動のねらいは、実習生に、教習員用指導書を熟知させることであると 説明せよ。 各ペアに、協力して「ToT ハンドブック」の問いに答えるよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 回答に 15分、フィードバックに 10分見込んでおけ。 23 [訳注] 日本語版:「中級車椅子サービス教習パッケージ_フォーム・確認表冊子」を https://j-aws.jp/who/に収載. 19 フィードバック： 問い 正解 1. 「教習員用指導書」の全内容の 一覧はどこで見つかりますか？ 指導書の冒頭で「もくじ」に列記。 2. グループ活動は授業の中でどう 示されていますか？ それぞれの活動について、「活動」表 にグループ分け、指導内容、モニタ ー、時間配分、フィードバックが詳述 されている。 3. 教習パッケージ全体のねらいや 目的は、どこで分かりますか？ p.2 の「目的」の見出しが付いた項目。 4. 授業計画で、教習員が PPT スラ イドを映写すべきタイミングは どこに示されていますか？ 各スライドの画像が授業計画ページ の左側に、映す順番で、該当する本文 の横に載っている。 5. 教習授業の実行に必要な施設、 教材、設備はどこで分かります か？ 「教習員用指導書」の 2 部「教習 パッケージ実施準備のやり方」に 一覧表が載っている： • 基礎および中級WSTPでは p.14 • 管理者向けWSTPでは p.9 WSTP の使い方（35 分） 受講者に「教習員用指導書」の第 1 部「車椅子サービス教習パッケージについて」を開くよう指示 せよ。 説明：各「教習員用指導書」の最初には、教習員に役立つ注記や指示が載っています。 受講者のひとりに、「教習員用指導書」のこの部の見出しを読み上げるよう指示せよ。 最も重要な答え： • はじめに • 対象者 • 目的 • 対象範囲 • 教習員 • 開始までの流れ 20 説明： • WSTP 用 USB メモリ内に「Read Me First」と いうファイルが見つかるでしょう24。これは重要 な文書です。 • これには、WHO からの要請として、実施した WSTP 教習プログラムについてフィードバック および以下のようなデータを提供してほしい旨 が含まれています： o 受講者登録フォームおよび評価フォーム o 教習に関する教習員の考察またはコメント 説明：「教習員用指導書」の第 2 部は「教習パッケージ実施準備のやり方」（関係者向け WSTP では 「関係者向けワークショップ実施準備のやり方」）です。 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生を前の活動と同じペアに分けよ。 指導内容： 実習生に「教習パッケージ実施準備のやり方」の部にパートナーと目を通し、 そこのさまざまな項目を読んで話し合うよう指示せよ。 実習生に、質問があれば書き出すよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、各自の教習パッケージに関して、何か質問がないか尋ねよ。 教習に関する範囲を超えた質問は、取り上げる時間がないか後の授業で取り 上げるのであれば「保留スペース」に置いておくことができる。 24 [訳注] 英語版のみ. 21 ToT 教習員への注記： • 教習パッケージによって、見出し語には異同がある。 説明：授業計画は、授業を通して教習員を導く、 レシピ25のような働きをします。 授業計画に従うのは次の面で有効です： • 学習目標への集中を保つ • 時間を守る • 関連トピックについてのフォーカスグループ 活動、話し合い、質問 このスライドは活動の間じゅう映しておけ。 活動３ グループ： 実習生を前の活動と同じペアに分けよ。 指導内容： 実習生に、「授業計画の詳細」をパートナーと読んで話し合い、グループで 話し合うための質問があれば書き出すよう指示せよ。 授業は各ペアが ToT でどのパッケージを履修するかによって以下のリスト から割り当てよ： • 基礎 WSTP：「教習員用指導書」の p.99「A.8: 移乗」 • 中級 WSTP：「教習員用指導書」の p.52「B.1: 事前評価の概略・事前 評価インタビュー」 • 管理者向け WSTP：「教習員用指導書」の p.15「A.1: 適正な車椅子供与 とは何か？」 モニター： グループをモニターし、必要に応じて支援せよ。 25 [原文] recipe 22 時間： 話し合いに 7分、質問への回答に 5分見込んでおけ。 フィードバック： グループ全体に、何か質問や説明があるか尋ねよ。 パワーポイントスライドの変更に関する質問は、「保留スペース」に置いて おけ。これは「ToT.10 視聴覚ツールおよび機材」で取り扱う。 説明：各授業計画の最初に、授業概要表が載っています。 ペアの一つに尋ねよ：授業概要はどんな項目に分かれていますか？ 最も重要な答え： • 目的：授業のねらいを説明。 • 教材：授業に必要なあらゆる教材。 • 状況（中級 WSTP では「事前学習と状況」）：現地の状況/国/サービス事業に合わせる調整へ の提案。 • 準備：授業が始まる前に準備しておくべきこと。 • あらすじ：時間配分を入れた、授業各項目の要約。 別のペアに尋ねよ：「状況」あるいは「事前学習と状況」のコラムの目的は何でしょうか？ 最も重要な答え： • 教習員に、現地の状況や教習を受ける受講者の種類に対して、授業計画をどう適合できるか についての指針を与える。 また別のペアに尋ねよ：教習の状況に影響を及ぼしそうなものには何があるでしょうか？ 応答を受けとめ承認せよ26。 説明：授業に影響するさまざまなものとしては： • サービス提供モデル • 受講者の経験度合い • 組織、地域または国の方針 • 処方に使える製品 26 [原文] Acknowledge responses [訳注] 以下同じ. 23 また別のペアに尋ねよ：授業計画では、動画の上映をどのように指示していますか？ 最も重要な答え： • 動画アイコンの付いた、動画のコラムで示している。 説明： • 実習生は、すべての動画の内容、関連性、タイミ ングを熟知しておくことが重要です。 • 動画の使い方についての詳細は、ToT の後の ほうで説明します。 説明：「教習員用指導書」では、教習員への手引き27として、さまざまな太字の語を用いています。 例えば：尋ねよ [指示せよ、依頼せよ]28、説明せよ、示せ [映写せよ、上映せよ]28 などです。 説明：「教習員用指導書」には、教習員への指針と して役立つ追加情報が載っています。例えば： • 教習員が受講者からの質問に答えるのに役立つ 補足情報。 • 質問への最も重要な答え • グループダイナミクスに関する助言 27 [訳注] 受講者への語り (「ですます」調) と区別しやすいよう, 訳文では「である」調・命令口調を用いている. 28 [訳注] 文脈によって[ ]内の訳語も用いている. 24 また別のペアに尋ねよ：授業計画の「活動」コラムはどんな情報を与えていますか？ 最も重要な答え： • グループ：活動のために、どうグループ全体を分けるか。 • 指導内容：活動をどのように実施すべきか、受講者に何を話すべきか。 • モニター：活動中、どのようにグループをモニターして正しい作業を行なうようにするか。 • 時間：活動時間および最後のフィードバック時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき要点、受講者の思考や感覚を引き出す方法。 説明：WSTP の電子コピーは、コンピューターのハードドライブ上でも外部ストレージ（DVD や WSTP 用 USB メモリ）上でも実行できます。 スライドショーを終了せよ。WSTP 用メモリのフォルダーを、WSTP 用 USB メモリあるいはコン ピューター上のファイルから引き出せ29。 「START.pdf」ファイルを開いてプロジェクターで映写せよ。 説明：教材には、WSTP 用メモリの一般的メニューからでも、「START」上のメニューをクリック してもアクセスできます。 リンクを示せ。授業を一つか二つクリックし、PPT を上映せよ。 説明： • 動画は、これらのファイルの PDF 版プレゼンテーションファイルには埋め込まれています30。 • 個別の PPT 形式プレゼンテーションファイルもすべて用意されており、必要なら改変可能です。 PPT ファイルの改変については、後の授業で話し合います。 ToT 教習員への注記： • アップル（Mac）コンピューターの場合、Adobe Pro か類似のソフトで開かない限り、「START」 ファイルを開いても「START」メニューからリンク先には飛べない。 説明：どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」(管理者向け WSTP のみ) です。 29 [訳注] この下 4 行 (「START.pdf」ファイルを開いて…PPT を上映せよ。) の操作は, 英語版でのみ可能. 30 [訳注] 英語版のみ. 25 要点のまとめ（3 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 26 ToT.3 模擬授業について ね ら い 教習パッケージ別モジュールと模擬受講者および教習員の役割について、詳細を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPtot における、模擬授業のねらいと構成を詳述する。  リーダー役実習生と補助役実習生の役割と担当を詳述する。  自分が担当するのはどの模擬授業かがわかる。  模擬授業をどうやって準備するのかがわかる。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.3：模擬授業について」  WSTPtot 教習パッケージ別モジュール割り振り表（実習生用）：実習生 1人に 1部  実習生の番号を記入した紙片  実習生の番号を記入したフリップチャート紙 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  このマニュアルの最初にある用語一覧を参照しておく。  教習パッケージ別モジュールのWSTPtot割り振りを実習生の人数に合わせて仕上げ、 コピーしておく。  最終決定した人数に基づき、実習生の番号くじをバケツ/帽子に準備しておく。  実習生の番号を記入し、番号を選んだ受講者名の記入欄を設けたフリップチャート紙 を準備しておく。  同僚の教習員と31、メンターする実習生をどう割り振るか話し合っておく。実習生 には、その情報をこの授業の間か「ToT.6 準備時間について」の初めに伝えておく。 あ ら す じ 1. はじめに 2. 教習パッケージ別モジュールの構成とねらい 3. 模擬授業の進め方 4. リーダー役・補助役実習生および模擬受講者の役割 5. 振り返りとフィードバック 6. 模擬授業の準備 7. 要点のまとめ 4 3 2 15 5 30 1 授業時間計 60 31 [原文] with their co-trainer [訳注] 文脈から, ToT 教習をいっしょに実施する他の ToT 教習員のことであろう. 27 はじめに（4 分） 質問：ここで学ぶ、WSTP パッケージを実施する ことへの自信は、1〜10 点で採点すると、どれく らいありますか？ • 1 点はまったく自信がない、 • 10 点はたいへん自信がある、です。 説明： • 採点を自分の「ToT ハンドブック」p.10 に記録 しなさい。 • ToT プログラムの最後に、その時点での自信が どれくらいか記録するよう指示します。 • その両方の採点を、自分自身への ToT 評価 フォームに記入しなさい。 授業のねらいおよび学習目標を説明せよ。 教習パッケージ別モジュールの構成とねらい（3 分） 説明： • 「必須教習技能」の授業のあと、各自の教習 パッケージ別モジュールが始まります。 • 教習パッケージ別モジュールの内容は： o 習得を選択した WSTP の授業を実施する機会、 o ToT 教習員が指導する話し合いやデモ、 o または、これら二つの組み合わせです。 28 模擬授業の進め方（2 分） 説明： • 模擬授業の割り当ては、この授業の終わりに、 くじ引き（ラッキーディップ32）で決めます。 • 実習生ひとりが受け持つ授業時間は、ほぼ同じ 長さです。 • リーダー役実習生と補助役実習生の役割が両方 割り当てられます。 • 一授業にリーダー役実習生が複数割り当てられ た場合、プレゼンテーション33を行なっていない 人は、自動的に補助役実習生を務める想定です。 リーダー役・補助役実習生および模擬受講者の役割（15 分） このスライドは活動の間じゅう映しておけ。 活動１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、リーダー役実習生と補助役実習生の主な役割とは何だと思うか、 パートナーと話し合うよう指示せよ。 実習生に、考察を「ToT ハンドブック」p.10 に記録するよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 3分、フィードバックに 5分見込んでおけ。 フィードバック： 質問：リーダー役実習生と補助役実習生の主な役割とは何でしょうか？ 答えを話し合って明確にし、最も重要な答えをホワイトボードに記録せよ。 実習生に、正しい情報を各自「ToT ハンドブック」に記録するよう指示せよ。 32 [原文] Lucky Dip [訳注] 手を突っ込んで福引きやくじ引きを行なう箱や袋. 33 [原文] presenting [訳注] この語の本書での意味は授業 ToT.7 を参照. 29 最も重要な答え： リーダー役実習生の役割の例： • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役実習生を調整する。 補助役実習生の役割の例： • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー役実習生にもたらす。 • 授業実施に関する全体的フィードバック/振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消しやブラインドの開閉を行なう。 質問：模擬授業中、実習生はチームとして協力しな ければなりません。例えば、以下について助け合う ことなどです： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 授業の進行、例えば： o 時間管理 o 誤りの指摘 o 受講者からの質問に答える o 妨害や割り込みへの対処 30 説明： • 教習員は、プロとしての行動と実践のポジティ ブなお手本34を示すべきです。 • 受講者に求める行動は、その模範を示しなさい。 例えば： o 時間を守り、じゅうぶん準備しなさい。 o 困難な状況で、問題を解決し解決策を見出し なさい。 o ポジティブなフィードバック、および建設的 なフィードバックを与えなさい。 o 上手に自己管理しなさい：例えば、ストレス 管理のため、授業準備とじゅうぶんな睡眠・ よい食事とのバランスを取るなどです。 説明：優れた教習員のお手本になるとは、常に質問 への答えを知っていなければならないということ ではありません。 質問：質問を受けたが、答えを知らない場合には どうしますか？ 最も重要な答え： • 補助役実習生に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 答えを知っているふりをしない。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 34 [原文] a role model [訳注] そのまま「ロールモデル」と呼ばれることも多い. 31 説明： • 実習生仲間が担当授業を実施している間、自分 は WSTP 受講者役を演じることになります。 • これに含まれることは： o ケーススタディや実習に参加する。 o 質問し、また質問に答える。 o 話し合いに参加する。 • 「現実味のある」教習状況をつくり出すために 積極的に参加することは重要ですが、挑発的な 行動をわざと取っては35なりません。 • 模擬授業のあいだ、「WSTPtot 教習員用指導書」 や「ToT ハンドブック」はしまっておきなさい。 振り返りとフィードバック（5 分） 説明： • 教習員にとり、自分自身の教習技能を振り返る ことを学ぶのは重要です。 • また教習員には教習受講者へ建設的なフィード バックを与えられることも重要です。 • これらの技能は両方とも ToT プログラムに組み 込まれています。 35 [原文] act in a challenging manner 32 説明： • 各模擬授業の終わりに、リーダー役実習生は、 次を振り返るよう求められます： o 何がよかったか、また何がうまく行ったか o 何に改善の余地があるか • 模擬受講者は、リーダー役実習生に簡潔なフィ ードバックを与えます。この詳細は授業「ToT.11 フィードバックについて」で話し合います。 • ToT 教習員がフィードバックを与え、リーダー役 実習生や模擬受講者が挙げていなかった点が あれば付け加えます。 模擬授業の準備（30 分） 説明： • 「教習員用指導書」の授業計画を読み、授業内容 をすべて理解していることを確かめなさい。 • 「受講者用参考書」と「受講者用ワークブック」 (関係者向け以外の WSTP で使う) の該当箇所を 読みなさい。 • PPT に適切な変更/補足を加えなさい。 • 適切ならば自分自身の知識や経験を組み込み、 自分のケーススタディを活用しなさい。 • 授業実施を、時間配分を含め予行演習しなさい。 • 補助役実習生と、チームとして協力しなさい。 • 授業に必要な教材を準備しなさい。 説明：授業が ToT 教習員によるデモを含む場合は、 ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせなさい。 33 説明： • WSTP の「教習員用指導書」「受講者用参考書」 「受講者用ワークブック」および PPT の中に、 いくつかの誤りが判明しています。 • 判明している誤りは「ToT ハンドブック」の中で 挙げています。 • 授業を準備するさい、担当授業に誤りがないか 確かめ、必要な変更を加えなさい。 • 模擬受講者と誤りについては話さず、授業のプレ ゼンテーションは、通常の WSTP 教習と同様に 行ないなさい。 ToT 教習員への注記： • WSTP にはいくつか誤りが判明しているが、 2 版発行まで訂正されない。それらの誤りは 「ToT ハンドブック」に挙げ、実習生が教材を訂正できるようにしている。 このスライドは活動の間じゅう映しておけ。 34 活動２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の「教習員用指導書」で以下の授業に目を通し、自分の「ToT ハンドブック」の中でその授業に該当する注記を見つけるよう指示せよ。 実習生にはその両方を読み通すことで、それらがどう関連し合っているか、 また授業の実施準備でそれらをどう活用できるかを把握するよう指示せよ。 • 基礎WSTP：授業 A.6: 適正な車椅子 • 中級WSTP：授業 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる • 管理者向けWSTP：授業 A.1: 適正な車椅子供与とは何か？ また実習生に、「ToT ハンドブック」の序章から「模擬授業準備の手引き36」 を探し、手短に確認しておくよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 5分見込んでおけ。 フィードバック： 以下を強調せよ： • 実習生は、模擬授業および将来のすべての見習い教習において、「教習員 用指導書」および「ToT ハンドブック」の指示に従うべきです。 • 実習生は、以下に対処するための指示に従うための、じゅうぶんな時間を 見込んでおく必要があります：WSTP教材の誤りの取り扱いへの指示、 ジェンダーおよび文化への配慮に関する注意、進行や時間配分を改善する ための授業準備、プレゼンテーション、教習運営実務に関する助言。 • 模擬授業中、実習生は必要に応じて教習スペースの設営を担当します。 何か質問があるかどうか尋ねよ。 36 [訳注] ページ xiii. 35 説明： • 各教習日の終わりには、後日の模擬授業を準備 する時間があります。詳しくは授業 ToT.6 で話し 合います。 • ToT 教習員は、休憩中および一日の終わりに 時間を取れます。質問や懸念があれば、支援を 求めなさい。 • 教習仲間や ToT 教習員を前に授業する時には、 アガる方が普通です37。 • さらに授業を実施すれば、技能と自信がついて きます。 • これは競争ではないこと、教習スタイルは一人 ひとり違うことを忘れないで下さい。 • これから 2 日間、グループ活動からのフィード バック発表を求められます。その機会を活かし、 仲間へのプレゼンテーションを練習しなさい。 説明： • 実習生への扱いを平等にするため、模擬授業の あいだ、時間は厳しくモニターされます。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止 させて次の教習員に移るか、授業を終了します。 • 時間を守る方法を学んで下さい。これは重要な 技能で、練習によって上達します。 説明： • 各授業の標準版 PPT は、動画を埋め込んだもの が教習用ノート PC で使用可能です。 • 自分の PPT に変更を加えた場合は、模擬授業前 に教習用ノート PC へそれをアップロードして おく必要があります。 37 [原文] It is normal to feel nervous 36 ToT 教習員への注記： • 実習生には、PPT をコンピューターへ読み込む必要がある場合は、例えば教習開始の 30分前 か授業前の休憩時間にするよう伝えよ。 説明：では、これから授業を割り当てます。 実習生に、一人ひとり番号を引くよう指示せよ。 各実習生に、自分の名前を、各自の WSTPtot 教習 パッケージ別モジュール割り振り表（実習生用）に 記入するよう指示せよ。 各実習生に、全体グループに自分の番号を伝え、 それを表に記録するよう指示せよ。 実習生の名前を、フリップチャート紙に準備した表の該当する番号の横に記録せよ。 説明：各実習生に一人、ToT 教習員がそのメンターとして割り当てられます。メンターは： • 実習生の準備を支援します • 実習生のプレゼンテーションスキルについて、個別にフィードバックを与えます。 要点のまとめ（1 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 37 ToT.4 多様性に備える38 ね ら い 文化39、多様性40、文化的能力41およびこれらの概念の重要性を、WSTP［車椅子サービス教 習パッケージ］の教習実施に関連づけて理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  「文化」と「多様性」の違いを理解する。  「文化的能力」の重要性を理解する。  異文化間コミュニケーション42の課題を話し合う。  車椅子ユーザーを教習や業務環境へ統合する43うえでの課題を特定する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.4：多様性に備える」  マスキングテープか同様のもの 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  現地の状況や実習生グループの性格を基に、最初の活動のための適切な「区別」を 案出しておく。  最初の活動用に、教室の空いたスペースの中央にマスキングテープを貼って線を一本 引いておく。 あ ら す じ 1. はじめに 2. 文化と多様性 3. 文化的能力 4. 多様性を推進する44：車椅子ユーザーはじめ障害者のインクルージョン 5. 要点のまとめ 20 5 20 14 1 授業時間計 60 38 [原文] Preparing for diversity 39 [原文] culture 40 [原文] diversity 41 [原文] cultural competence [訳注] 国際保健分野では「文化能力」とも訳される. 42 [原文] cross cultural communication 43 [原文] integrating 44 [原文] Encouraging diversity 38 はじめに（20 分） 活動１ グループ： 全体で。 指導内容： 床の中央を横切るマスキングテープの線に注目させよ。 全員、教室の片方へ移動するよう指示せよ。 男性は全員線の片側に、女性全員が反対側に立つよう指示せよ。 説明：男性と女性、これはさまざまなグループ分けの最初のものです。これ から、多様性をさまざまな面から見て行きます。 子どものいる人は線の片側に、いない人は反対側に立つよう指示せよ。 年齢が 50 歳超の人は線の片側に立つよう指示せよ。他の人は反対側に立つ よう指示せよ。 この活動を最低 6回続けよ。 区別の例： • 話す言語 • 出身地/国 • 障害の有無 • 職歴 モニター： 受講者が困惑したり、不快を感じたりしていないことを確かめよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 区別についての感想を尋ねよ。 質問：大きい方のグループにいると、どんな感じがしますか？ 質問：ひとり、あるいは少数派になると、どんな感じがしますか？ ネガティブな経験だった人がいるかもしれませんが、それは他の人にとって はポジティブだったかもしれません、と説明せよ。 説明：多数派の中にいると、人はえてして力強さや自信を感じるものです。少数派の中にいると、 人は孤立や疎外を感じることがあります。集団は、文化や多様性によって分かれたりまとまったり するので、この二つの概念について詳しく見ていくことにしましょう。 39 授業のねらいおよび学習目標を説明せよ。 文化と多様性（5 分） ホワイトボードかフリップチャートの中央に縦線を引き、「文化」「多様性」と片側ずつ書き込め。 質問：「文化」と「多様性」という語は、どういう意味だと理解していますか？ 励まして応答を促し、それを板書せよ。 最も重要な答え： 文化：人びとを同じにするもの • 共有あるいは共通の、価値観45、意識46、道徳、伝統、信念47などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団48、ジェンダー、性自認49、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 説明：文化と多様性に対しては、さまざまな捉え方ができます。 • それらは強みで、奨励すべきものだと思いますか？ • あるいは紛争や不和の元だと思いますか？ • それらは邪魔なものでしょうか？ 全体に、先の活動で体験した、自分たちの中にある多様性や文化について振り返るよう指示せよ。 質問：この全体グループは多様でしょうか？ 45 [原文] values 46 [原文] attitudes 47 [原文] beliefs 48 [原文] ethnicity 49 [原文] gender identity 40 質問：この全体グループの中には、どんな種類の多様性があるでしょうか？ 質問：私たちはどんな文化を共有しているでしょうか？ 応答を受けとめ承認せよ。 説明：私たちは、だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを 忘れないようにしましょう。 文化的能力（20 分） 質問：「文化的能力」とは何でしょうか？ 応答を受けとめ承認せよ。 説明： • 文化的能力とは、個々人が、自分の文化とは 異なる文化への、効果的かつ敬意をもった50 関わり方を学ぶ、能動的プロセスです。 • それは、文化の違いに対してポジティブな姿勢 で臨み、受容することです。 • それは、文化が人びとの交流に及ぼす影響を 意識することです。 説明：文化の違いは、誤解、失望、混乱、困惑、怒り、侮蔑などを引き起こすことがあります。 例えば、攻撃する意図のないコメントが、文化が異なる人からは侮辱と取られる場合などです。 説明：WSTP の教習は、さまざまな文化の教習員によって文化の異なる受講者へ教授されることも あります。さまざまな文化的配慮が教習へどう影響するのか、その例を「ToT ハンドブック」p.16 に挙げています。 50 [原文] effectively and respectfully 41 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生をペアに分けよ。 指導内容： 実習生に、自分の文化とは異なる文化を経験した実例について考え、それは どういったもので、自分がどう感じ、何を学んだかを書き出すよう指示せよ。 実習生に、その経験についてパートナーと話し合うよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 8分、フィードバックに 5分見込んでおけ。 フィードバック： 4〜5名に、各自の経験を全体で共有してもらうよう依頼せよ。 多様性を推進する：車椅子ユーザーはじめ障害者のインクルージョン（20 分） 説明： • 障害とは多様性の一面です。 • WSTP では教習チームへの、また受講者として の、車椅子ユーザーはじめ障害者のインクルー ジョンを推進しています。 質問：なぜそれが重要なのでしょうか？ 42 最も重要な答え： • 車椅子ユーザーは、自分の体験や視点を活かしてWSTPの学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子サービスでの車椅子ユーザーの中心的役割を 強化する。 • 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、 差別・偏見とたたかい51、CRPD（障害者の権利に関する条約）の原則を強調するのに役立つ。 スライドを読み上げよ。 質問：車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁となるものには、 何があるでしょうか？ 最も重要な答え： • 意識の障壁52 • 環境の障壁：アクセスできない家屋、学校、公共建築物 • 支援機器の不足 • 障害をネガティブにとらえる文化的信条 • 障害者の権利を支援する法令の欠如 • サービスや支援に対する財源の不足 51 [原文] combat stigma [訳注] stigma は本来「烙印」を意味し, 社会がおしつける不名誉を指して用いられる. 52 [原文] Attitudinal barriers 43 説明： • 意識の障壁とは、例えば： o 障害者ができることに関する予断 o 障害者は自己決定ができないとする偏見 o 障害者を慈善の対象として扱う o 文化によっては、障害者は祟られていると信 じ、そのけっか地域や家族から閉め出される • 環境の障壁とは、例えば： o 自然環境：岩場や急傾斜地など o 建造環境：アクセスできない家屋、学校、 公共建築物など o 支援機器の不足 • 制度の障壁とは、例えば： o 障害者の権利を支援する、政府の法令や政策 の欠如 o 入学基準に関する学校・大学の規則や規制 要点のまとめ（1 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 44 ToT.5 成人学習 ね ら い 「成人学習53」の概念およびさまざまな学び方を紹介し、これらのアプローチによって WSTP［車椅子サービス教習パッケージ］実施をどのように改善できるか理解する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  大人はどのように学ぶのか詳述する。  自分自身にとってのそれも含め、4つの選好学習スタイル54を詳述する。  なぜ学習スタイルを理解すると、WSTPの教授が効果的になるのか説明する。  教習員が、受講者の問題解決をどのように支援できるか詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.5：成人学習」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. 選好学習スタイル 3. 学習経験サイクル55 4. 成人学習を支援する 5. 受講者の問題解決を助ける 6. 要点のまとめ 2 25 30 10 15 3 授業時間計 85 53 [原文] adult learning 54 [原文] preferred learning style [訳注]「選好する/好む学習スタイル」の意. 55 [原文] Experiential learning cycle 45 はじめに（2 分） 授業のねらいおよび学習目標を説明せよ。 選好学習スタイル（25 分） このスライドは活動の間じゅう映しておけ。 活動１ グループ： 実習生をペアに分けよ。 指導内容： 実習生に以下を行なうよう指示せよ： • これまでの、自分のポジティブな学習経験について考える。 • それはどのようにポジティブだったのか書き出す。 • その経験をパートナーと共有する。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 個々人での考察とペアでの話し合いに 5分、フィードバックに 5分見込んで おけ。 フィードバック： 各ペアが自分たちのリストから 1項目ずつ読み上げ、経験がすべてホワイト ボードに書き出されるまで、それを教室内で持ち回るよう指示せよ。 簡単に話し合わせよ。 46 説明：前の活動で話し合ったポジティブな学習経験から、選好される学び方にはさまざまなものが あることが分かります。 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生に単独で作業するよう指示せよ。 指導内容： 実習生に、「ToT ハンドブック」p.21 を開くよう指示せよ。 「ToT ハンドブック」に載っているのは、学習に関して述べた文の一覧表で あることを説明せよ。 実習生に、自分の選好に合うすべての記号にマルを付け、それを次ページの 集計表に転記するよう指示せよ。 実習生に、各列のマルの数を合計して、どの列のマルが最も多かったか確認 するよう指示せよ。マルの最も多い列が、自分の選好学習スタイルである。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 3分見込んでおけ。 フィードバック： 各実習生に、自分の選好学習スタイルを、となりの実習生と共有するよう 指示せよ。 複数のスタイルが同じくらいの数だった場合、それは強いこだわりがなく、 複数のやり方で抵抗なく学べるということだと説明せよ。 実習生に、自分の学習スタイルへの選好がポジティブな学習経験と一致する かどうか尋ねよ。 47 学習経験サイクル（30 分） 説明： • めいめいの人に、一つかそれ以上の選好学習スタイルがあります。 • しかし、新しい情報や技能を学ぶ際に最も効果的なのは、情報を複数の経路で学ぶことです。 説明： • 学習経験サイクルの各段階は、学習スタイルの 4 種類と一致しています。 • スタイルは人によってさまざまですが、新しい 知識や技能を学ぶには、この 4 段階のそれぞれ を経るのが最も効果的です。 • WSTP に学びの 4 段階/種類がそれぞれ含まれて いるのは、そうした理由からです。 • このサイクルは「経験によって」「観察/感受 によって」「理論や概念の定義/説明によって」 「実行によって」のどれから始めてもかまい ません。 説明：WSTP の開発に当たり、「選好学習スタイル」 と「成人学習」の概念は、個々の授業計画の構成や 教習の時間割全体に組み込まれています。 48 説明：WSTP では、こうした４段階を経ることで、確実に学びが生まれるようにしています。 • 基礎 WSTP では、受講者は車椅子に乗りさまざまな移動技能を試みます。これは「経験」です。 • 中級 WSTP では、受講者は車椅子ユーザーやその家族が姿勢支持具のポジティブな影響を語る 動画を視聴します。これは「観察」あるいは「感受」です。 • 管理者向け WSTP では、受講者は車椅子サービス提供に関連する概念や原則を学びます。これ は「思考」あるいは「理解」です。 • 基礎および中級 WSTP では、受講者は車椅子ユーザーと作業し、適正な車椅子とクッションを そのユーザーに供与します。これは「実行」あるいは「適用」です。 質問：「経験」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学びが実生活との接点を失い、受講者個人の経験に根を下ろさない、抽象的なものになる。 質問：「観察」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者が、自分の個人的経験がより広い抽象的な概念や枠組みとどう結びついているのか、 探求したり、確かめたりできなくなる。 質問：「思考」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、ある経験から別の経験へ、それらどうしの関連を分からないまま進むことになる。 そうした人は、経験を有意義なやり方で整理するのに役立つ枠組みから得るものがない。 質問：「実行（練習）」の部分が欠けると、何が起こるでしょうか？ 最も重要な答え： • 学習者は、理論や枠組みを職場や自分の生活に適用するやり方を見出すことがない。 49 説明：教習員は、自分が選好するものだけでなく、あらゆる学習スタイルを支えることが重要です。 説明：ここまで「学習スタイル」と「学習経験サイ クル」の概念を見てきたので、これらを「実践」に 移し、「実行」によって学ぶことにしましょう。 このスライドは活動の間じゅう映しておけ。 活動３ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、「ToT ハンドブック」p.24 の「活動・選好学習マッチング表」を 見るよう指示せよ。 説明： • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解する56ことによって最もよく学びます。 実習生に、この教習活動はこの人の学習スタイルに最も効果的、と考える人 の名前の下に「X」を付けるよう指示せよ。 授業後に各実習生で、最後の列に自分自身の選好について記入してみるよう 提案せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 以下のように、全体で答えを確認せよ： 希望する実習生に、回答するよう依頼せよ。 全員が同意するか確認せよ。 反対がなければ、その答えを（正しければ）受けとめ承認し、次の行に移れ。 皆の答えが同じでなければ、正解を示し説明せよ。 短い話し合いのみ許可せよ。 56 [原文] understanding the big picture 50 ToT 教習員への注記： • 下記の解答欄について、Xは最適解、(X)は同様に正しい別解を示す。 上の印がないものを回答した実習生には、理由を説明するよう依頼し全体で話し合え。理由づけ が適切で学習スタイル間の違いを理解していると認められれば、答えを訂正する必要はない。 この課題からの重要な学びは、皆が同じように学ぶわけではないことへの気づきである。 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 1. 車椅子ユーザー教習の練習として ロールプレイングを行なう X (X) 2. 教習員が新規車椅子ユーザーへの 身体計測のやり方を示すところを 観察する X 3. 自国の車椅子サービスに関する、 法律や規制についての政府職員の 発表に出席する X 4. 車椅子に乗っている人がやりたい ことを実行しているのを観察する X 5. 車椅子サービスに関連する重要 文書について学習する X 6. 他の受講者と、フォローアップを ユーザーの家で行なうことの長所 と短所について話し合う X 51 解答 実行 観察 経験 理解 カルロス ミリアム シータ アフマド 7. CRPD（障害者の権利に関する 条約）の最も重要な条文に関する、 教習員の説明を聴く X 8. 除圧クッションをつくる X (X) 9. 車椅子で走り、車椅子ユーザーが 経験するであろう障壁を体感する X 10. 教習員が事前評価を実施する様子 を観察する X 11. 新規車椅子ユーザーに対する事前 評価インタビューを実施する (X) X 12. 車椅子サービス事業を既存のリハ ビリテーションサービスに追加す ることによる費用節減を算定する X (X) 52 成人学習を支援する（10 分） 説明：だれにも選好学習スタイルがある一方、あらゆる大人の学習者についての共通項もあります。 説明： • 大人の学習者は主体的57で、自分の学習に責任を 持ちます。 • つまり、次のようになる方向で支援するという ことです： o 積極的参加者 o 話し合いやグループ活動に取り組む 説明： • 大人の学習者は、学習活動に自分自身の知識や 経験をもたらします。例えば： o 仕事に関連する経験 o 受けてきた教育 o 人生や家族の経験 説明： • 大人の学習者は、関連が明らかで実践的な58学び を求めます。 • 大人が新しい情報を学ぶには、必ずその理由が 分かり、自分の状況に当てはめられる必要が あります。 • 教習に必要なことは： o 明確な学習目標 o 目に見える実際への適用 57 [原文] self-directed 58 [原文] relevant and practical 53 説明：大人の学習者は、学んだことを適用しようと 求めます。 • 学習者が、教習で学んだことと教習プログラム 終了後にやることとの関連を理解できるような 実例を活用しなさい。 • 問題解決活動を活用しなさい。 • 学習〜行動計画59を立てなさい。 受講者の問題解決60を助ける（15 分） 説明：「問題解決」とは何でしょうか？ 最も重要な答え： • 問題に対して最適解を見出すプロセスのこと。 成人学習の重要部分である。 説明：なぜ問題解決は、生活技能として重要なので しょうか？ 最も重要な答え： • だれもがゴールを設定し、課題に直面しながら それを達成するから。 • 遭遇する障壁を克服するには、その方法を見出 す必要があるから。 説明： • 問題解決は、問題への解決が一筋縄では行かない車椅子サービス供与での重要技能です。 • 教習員は、受講者の問題解決能力を育成し、仕事で遭遇する困難に対する解決を見出せるように する重要な役割を担っています。 59 [原文] learning-action plans 60 [原文] problem solving 54 このスライドは活動の間じゅう映しておけ。 活動４ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、受講者の問題解決をどう手伝えるかについてのブレインストー ミングを行ない61、自分なりの解決策を見出すよう指示せよ。 2 分間それを個々人62で考察し、自分のグループ内で共有して、アイデアの リストをつくるよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： この活動には 12分見込んでおけ。 フィードバック： 各グループで順番に、受講者 の問題解決を手伝う方法を 説明するよう指示せよ。新し いアイデアが出なくなるまで 続けるよう指示せよ。 新しいアイデアをそれぞれ、 キーワード 2〜3 語だけで63 ホワイトボードに記録せよ。 考慮すべき事項のよい例が 出たら、受けとめ承認せよ。 誤解があれば訂正/説明せよ。 まとめとして左のスライドを 映せ。 61 [原文] to brainstorm [訳注] 批判・判断・結論を交えず自由に意見を出し合う会議手法. ブレストとも呼ばれる. 62 [原文] individually 63 [原文] using only a few words 55 最も重要な答え： • オープンクエスチョン64（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ65：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のため に教習を訪れた個々のユーザーについて話せ。 • 「分かりません」で答えを終わらせるな66：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ67：課題を個別のステップに分解し、ステップバイステップに68質問 し、問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的69に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 要点のまとめ（3 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 64 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 65 [原文] Ask rather than tell 66 [原文] Don’t take ‘I don’t know’ for an answer 67 [原文] One step at a time 68 [原文] step-by-step 69 [原文] laterally 56 ToT.6 準備時間について ね ら い 実習生が、毎日の終わりの準備時間を有効利用できるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  毎日の終わりの準備時間の目的を理解する。  各自の模擬授業に関連する疑問を話し合う。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.6：準備時間について」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  「保留スペース」を点検し、どの質問にも答える準備をしておく。 あ ら す じ 1. 「保留スペース」の点検 2. 準備時間の目的 10 5 授業時間計 15 57 「保留スペース」の点検（10 分） 実習生と「保留スペース」を点検せよ。翌日の前に明確にしておくべき項目があれば、必要に応じ て回答なり説明をせよ。 準備時間の目的（5 分） 説明：この第 1 日の後に取っておいた時間で： • 「保留スペース」に残った項目を点検します。 • 実習生はフィードバックのため ToT 教習員と 面談します。 • 模擬授業を準備します。 説明： • ToT 教習員はリーダー役実習生との短い一対一 の面談を設定して、フィードバックを与え模擬 授業について話し合います。 • これは実習生にとって、そのフィードバックを これからの模擬授業にどう活かせるか質問する 機会です。 • フィードバックの与え方と受け取り方について は、授業 ToT.11 で詳しく話し合います。 58 説明：ToT 教習員とフィードバックを話し合う 面談がない場合、この時間の使い方は： • 自分が組む実習生70を調整します。 • 授業に必要な、デモ用資材や視聴覚機器を準備 します。 • 自分の授業内容で理解できない点があれば、 ToT 教習員と明確にします。 • 自分の PPT プレゼンテーションファイルが、正 しく動作することを確認します。 何か質問がないか尋ねよ。 実習生に、明日の授業開始までに思い出すべき教習運営実務の項目があれば再確認せよ。 ToT 教習員への注記： • WSTPtot の初日終了後、残るプログラムでの模擬授業に関連する教習運営実務の調整にこの 時間を活用せよ。例えば、実習生は現場に早めに来て授業の設営をできるか？または、実習生 は、翌日の授業で使う修正済み PPT をいつアップロードするのか？ 70 [原文] co-trainers 59 ToT.7 プレゼンテーションとファシリテーション ね ら い 優れた教習員の条件を明らかにし、プレゼンテーション71とファシリテーション72の違い を示す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  優れた教習員としてのふるまい73を列挙する。  プレゼンテーションとファシリテーションとの違いを説明する。  プレゼンター74とファシリテーター75の優れた実践例を列挙する。  時間を守れるようにする方策を 3つ詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.7：プレゼンテーションとファシリテーション」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. 教習員の技能 3. プレゼンテーションとファシリテーション 4. プレゼンテーションとファシリテーションの優れた実践 5. 時間管理 6. 要点のまとめ 3 15 5 15 20 2 授業時間計 60 71 [原文] presenting [訳注] 意味は p.62 本文を参照. 72 [原文] facilitating [訳注] 一般的で適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 73 [原文] behaviour 74 [原文] presenters 75 [原文] facilitators 60 はじめに（3 分） 授業のねらいおよび学習目標を説明せよ。 教習員の技能（15 分） 説明：教習プログラム実施を成功に導くには、さまざまな技能を養う必要があります。 この授業では、教習員の技能を、情報プレゼンターおよび学びのファシリテーターという両面から 見て行きます。教習員としての効果的ふるまいは、受講者の学びを喚起し、ポジティブな学習環境 をつくり上げるうえで決定的に重要です。 このスライドは活動の間じゅう映しておけ。 61 活動１ グループ： 実習生を 2〜3名のグループに分けよ。 指導内容： 実習生に、過去に自分が教習を受けた人を思い出し、だれが効果的な教習員 だったと考えられるか特定するよう指示せよ。それはつまり、学ぶべきこと を学べるようにし、ポジティブで価値のある経験をもたらした人である。 実習生に、数分間その効果的な教習員のふるまい方を振り返り、考えたこと を「ToT ハンドブック」p.28 の「その人のふるまいのどんな点が効果的でし たか？」の見出しがついた欄に書き出すよう指示せよ。 実習生に、考えたことを他のグループメンバーと共有するよう指示せよ。 各グループに、以前の教習員のふるまい方についてあらゆる面から考察する よう指示せよ： • どう自分を紹介したか。 • どう受講者と関わり合ったか。 • どう教習を運営したか。 • どうやってポジティブな環境をつくり出したか。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、各々考えたことを一つずつ、それらがすべて出揃うまで報告 するよう指示せよ： ホワイトボードに考えたことを記録せよ。 実習生に、各自の「ToT ハンドブック」に載っている情報を紹介せよ。 実習生に、ふるまい方の練習機会が週の後半にあることを念押しせよ。 実習生に、取り組むべきふるまい方を確認するため、「ToT ハンドブック」 p.29 の「プレゼンテーションとファシリテーションの優れた実践」の一覧を 活用するよう勧めよ。この一覧は、必要ならば自己評価にも活用できると 説明せよ。 62 プレゼンテーションとファシリテーション（5 分） 説明：WSTP［車椅子サービス教習パッケージ］で の教習員の役割は、プレゼンテーションとファシ リテーションとの間をひんぱんに交替します。 質問：プレゼンテーションとファシリテーション との違いは何だと思いますか？ 実習生に 2〜3 分これについて考える時間を与え、 グループ全体から回答を募れ。 次のスライドを映し、すでに答えられているもの があれば受けとめ承認せよ。 スライドの内容を読み、必要なら拡張せよ。 スライドの内容を読み、必要なら拡張せよ。 WSTP では、プレゼンテーションとファシリテーションの組み合わせを活用していると説明せよ。 「教習員用指導書」では、いつプレゼンテーションを行ない、いつファシリテーションを行なうか 指示している。 63 プレゼンテーションとファシリテーションの優れた実践（15 分） 実習生にプレゼンテーションを行なう際の優れた 実践とは何だと思うか熟考するよう指示し、グル ープ全体から回答を募れ。 ToT 教習員への注記： • ToT 教習員は ToT を通して、とりわけこの授業中は、優れた実践のお手本となるべきである。 言ったことは必ず実行せよ。 スライドを読み、すでに回答で実習生が挙げた例 があれば、受けとめ承認せよ。 64 質問：「エナジャイザー76」とはどういう意味か、知っている人はいますか？ 応答を受けとめ承認せよ。 説明： • 「エナジャイザー」とは、グループを元気づけ、再活性化させる目的の短い活動です。 • いつもそうとは限りませんが、たいてい「エナジャイザー」は授業内容には関係しません。 • 「ToT ハンドブック」の p.30-31 に、「エナジャイザー」の項目が事例付きで載っています。 実習生にひとり、率先してグループへ短い「エナジャイザー」を行なうよう依頼せよ。 実習生たちに、その「エナジャイザー」はグループへどう効いたか尋ねよ。 ToT 教習員への注記： • たいていの実習生は、前に経験した教習を通して「エナジャイザー」を何か知っているだろう。 だれも率先しない場合のために、実施例を準備しておけ。 説明： • スライドは合図77として、また主要メッセージを 示すために使いなさい • スライドごとに受講者が内容を消化する時間を 取りなさい。外国語で受講している場合は、より 長く取りなさい。 • 受講者に、スライドの内容を音読してもらい、 変化を付けなさい。 • 映したスライドが話の内容と一致していること を確かめなさい。 • スライドは「教習員用指導書」とつねに同期させ なさい。 • スクリーンを読み上げるのは避けなさい。 • あえてスクリーンを読む場合は、それを肩越し に見たり聴衆に背を向けたりしないように。 • プロジェクター光を遮断してはなりません。 上記のうち最後の 3 か条を、教室の端に寄ったり、 受講者の背後に回ったりできることを示しながら やって見せよ。 76 [原文] energizer 77 [原文] prompt 65 質問：視覚障害のある人が受講者に含まれる場合、プレゼンテーションのやり方や授業計画はどう 変更しますか？ 回答を受けとめ承認せよ。 最も重要な答え： • スライドの情報を読み上げ、視力障害のある受講者がすべての情報を得られるようにする。 • 弱視の受講者には、プレゼンテーションファイルのフォントを大きく、またスクリーンをなる べく大きいものにする。 • 教習前に受講者に会い、そのニーズを理解する。 • 受講者が音声読み上げソフト78を使用する場合は、文書やプレゼンテーションファイルを事前 に渡しておき、教習開始前に確認できるようにする。 • 適切ならば、点字化した文書を提供する。 スライドを読め。 実習生に、「ToT ハンドブック」の要点を紹介せよ。 必要に応じて拡張せよ 質問：これまで、教習員が授業のどこで「プレゼン テーション」を行ない、「ファシリテーション」を 行なっていたか、例を挙げられる人はいますか？ 質問：実習生として、これら 2 つの方法はどう違っ て感じられますか？ 応答を受けとめ承認せよ。 実習生に、ToT が進むにつれ、プレゼンテーションとファシリテーションの両方について、観察や 練習の機会があることを念押しせよ79。 78 [原文] screen reader 79 [原文] remind 66 時間管理（20 分） 説明： • 教習員と受講者には、教習プログラムが確実に時間通り進むようにする必要があります。 • 数多くの授業や活動がある一方、それらを完了するための時間は限られているからです。 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生をペアに分けよ。 指導内容： 質問：教習が時間通り進むようにするには、どうしたらよいでしょうか？ 実習生に、思いついたことを各自「ToT ハンドブック」p.31 に書き出すよう 指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 全体でフィードバックし、各ペアに順番に提案を出してもらえ。 応答を受けとめ承認し、下記「ToT 教習員への注記」を用いて補足せよ。 67 ToT 教習員への注記： • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者 を待たせて不利益を負わせるな80。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTPに資料やあまりにも多くの 実例を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留81」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば「15分休憩、10:45 には戻って下さい」 「自分のグループでの話し合いに 10分、フィードバックに 5分使えます」 • 教習員仲間82と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には、予備計画83を立てておけ。例えば、雨で車椅子の移動 技能の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 要点のまとめ（2 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 80 [原文] avoid penalizing 81 [原文] Park 82 [原文] co-trainers 83 [原文] back-up plan 68 ToT.8 コミュニケーションスキル ね ら い コミュニケーションスキルについて話し合い、プレゼンテーションスキルを実践に移す。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  コミュニケーションスキルの重要性を説明し、プレゼンテーションスキルを実践に 移す。  優れたデモの示し方を説明する。  通訳者とうまく協力するやり方を詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.8：コミュニケーションスキル」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. コミュニケーションの種類 3. デモ・動画・通訳について 4. 要点のまとめ 2 55 30 3 授業時間計 90 69 はじめに（2 分） 授業のねらいおよび学習目標を説明せよ。 コミュニケーションの種類（55 分） 説明： • コミュニケーションスキルは、優れた教習員となるためのカギです。 • この活動は、自分のコミュニケーションスキルを練習する機会です。 • 実習生は教習員役を務め、自分のトピックの学習の要点を自分で発表します。 • これは、「プレゼンテーションとファシリテーション」の授業で話し合った技能を、実践に移す 機会です。 このスライドは活動の間じゅう映しておけ。 70 活動１ グループ： 実習生を 4グループに分けよ。 指導内容： それぞれのグループに、下の「ToT 教習員への注記」に列記されているトピ ックを一つずつ割り当て、続いて実習生に「ToT ハンドブック」の p.33-35 を開かせよ。 各グループは、各自のトピックの下に列記された情報をプレゼンテーション すること。 創造性を発揮するようグループを励まし、小道具、フリップチャート、ホワ イトボードなどは自由に用いるよう奨めよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 課題の準備に 20分、グループごとのプレゼンテーションに各 5分、それ ぞれのプレゼンテーションの後に話し合いを 2分ずつ、ToT 教習員による、 最後のフィードバックおよび取りまとめに 5分見込んでおけ。 フィードバック： 実習生に各自の「ToT ハンドブック」を参照させ、すべての情報が、上の プレゼンテーションで伝えられたか確認させよ。 フィードバックは、授業内容とさまざまなコミュニケーションスキルに重点 を置け。ToT 教習員は、グループが明確にプレゼンテーションしていない 要点を簡潔に要約すること。 ToT 教習員への注記： グループ１：言語的技能 • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語84や「無意味な語85」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な86ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 84 [原文] slang 85 [原文] ‘non-speak’ 86 [原文] simple and non-medical 71 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 己れのボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える87な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室の中から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン88（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 87 [原文] jump to answer 88 [原文] closed questions 72 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ89（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば「あなたはどう思いま すか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論90や 問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな91。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に対 応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴92：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・動画・通訳について（30 分） 説明：これから、コミュニケーションをさらに 3 つ の面から見て行きます。 スライドを読み上げよ。 89 [原文] challenge 90 [原文] clinical reasoning 91 [原文] Never make up an answer if you do not know. 92 [原文] Listen 73 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生を 2グループに分けよ。 指導内容： 実習生に、「ToT ハンドブック」を閉じるよう（本の中に答えが載っている ため）指示せよ。 それぞれのグループに、トピックを割り当てよ。 • グループ１に検討を指示せよ：デモを行ない、動画を上映する際の優れた 実践について • グループ２に検討を指示せよ：外国語や手話の通訳者との協働について 実習生に、教習を実施するさい、各自のトピックに関して何を考慮すべきか 話し合い、もう片方のグループへプレゼンテーションするためフリップチャ ートに書き出すよう指示せよ。 実習生に、PPT スライドの活動への手引きを参照させよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： グループでの表づくりに 10 分、グループごとのプレゼンテーションに 5分 ずつ、それぞれのプレゼンテーション後の要点追加に 5 分ずつ見込んでお け。 フィードバック： グループ１に、所見をグループ２へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 グループ２に、所見をグループ１へプレゼンテーションするよう指示せよ。 下の「教習員への注記」から、抜けていた要点を追加せよ。 実習生に、「ToT ハンドブック」の参考資料を参照させよ。 74 ToT 教習員への注記： デモによって示す： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎WSTPと中級 WSTPのデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 動画を用いる： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や手話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2倍時間を要する。 75 要点のまとめ（3 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 76 ToT.9 指針文書の知識 ね ら い 実習生に WSTP［車椅子サービス教習パッケージ］の指針文書93を紹介し、それらの関連 性を説明する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPの指針文書を列挙する。  WSTPの教習員および受講者に対する、それらの重要性を説明する。 教 材 この授業には94：  PPT スライド「必須教習技能 ToT.9：指針文書の知識」  動画：「持続可能な開発目標（SDGs）」 以下の資料を 1部ずつ：  「国際連合 障害者の権利に関する条約（CRPD）」  WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」  WHO「低リソース状況での移動支援機器供与に関する共同方針提言書」  WHO「CBRガイドライン」：導入ブックレットおよび保健コンポーネント  「アクセシビリティのためのデザインの留意事項」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  すべての指針文書について、徹底的に知っておく。  国際連合のウェブサイト（https://www.un.org/development/desa/disabilities/）を 検索し、教習プログラムの時点で CRPDに署名した国の総数を調べておく。このこと について触れ、質問に答えられるよう、実習生の国がCRPDに署名し批准しているか 調べておく。 あ ら す じ 1. はじめに 2. CRPDと車椅子サービス供与の関連 3. 「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」 4. 「CBRガイドライン」 5. その他の指針文書 6. 要点のまとめ 8 20 5 25 15 2 授業時間計 75 93 [原文] guiding documents 94 [訳注] 資料の英語原題, 書誌, インターネット上のリンク等は次ページからの授業計画本文を参照. 77 はじめに（8 分） 授業のねらいおよび学習目標を説明せよ。 質問：「指針文書」とはどういう意味でしょうか？ 回答を受けとめ承認せよ。 最も重要な答え： • 出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、規則を与え るもの • 車椅子サービス供与関係者の指針となる資料 質問：これらの文書に精通していることは、なぜ 重要なのでしょうか？ 回答を受けとめ承認せよ。 78 最も重要な答え： • 多くの政府、国際機関、資金供与者95その他の関係者は、これらの国際的枠組みに沿って開発 事業を計画し、資金を供与するから。 • より強い立ち位置から、車椅子サービス供与に向けた啓発や政策提言を行なうため。 説明： • WSTP 教習プログラムを運営するさい、これらの 指針文書に精通することは、車椅子供与に向けた 啓発や政策提言に役立つので重要です。 • 受講者は国内の文書を参照する場合が多いため、 教習員もこれらをよく理解しているべきです。 説明：これらの資料へのしっかりした理解は、教習授業の質に貢献します。「ToT ハンドブック」に は、すべての指針文書についてさらに詳しい情報が載っています。 質問：車椅子供与に関係する、最も重要な二大指針文書は何でしょうか？ 最も重要な答え： • 「国際連合 障害者の権利に関する条約（CRPD）」 • WHO「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて96」 95 [原文] donors 96 [訳注] これに加え, 2023 年 6 月に WHO から「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024 年に発行予定. 79 CRPD と車椅子サービス供与の関連（20 分） 説明： • まず「国際連合 障害者の権利に関する条約(97)」、 通称「CRPD」98から見て行きます。 • CRPD は、障害者に関する最も重要な国際条約だ と広く考えられています。 • CRPD は、2008 年に発効しました。 説明： • 発効日には 82 か国が CRPD に署名、その選択議定書に 44 か国が署名しました。これは国連の 条約中、発効日での署名国数では史上最多です。 • CRPD は、障害者への社会の見方と処遇のあり方を変革するために、国際社会の代表者によって 策定されました。 • 代表者とは障害者、政府当局者、非政府組織（NGO）の代表などです。 • CRPD が重要である理由は、障害者が、他のあらゆる人びとと同じ権利と機会へアクセスできる ようになるためのツールだからです。 ToT 教習員への注記： • 教習プログラムの時点で CRPD に署名した国の総数を調べ、また実習生の国が CRPD に署名 し批准しているか調べておけ。 97 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations G eneral Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/6 11) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). [訳注] 日本政府外務省仮訳: https:/ /www.mofa.go.jp/mofaj/fp/hr_ha/page22_000899.html 98 [訳注] 日本では「障害者権利条約」と略されることも多い. 80 質問：なぜ WSTP 受講者には、CRPD に精通して いることが重要なのでしょうか？ 応答を受けとめ承認せよ。 最も重要な答え： • CRPDの人権に基づくアプローチを、障害者への車椅子サービス供与の開発に役立つように 活用するため。 • CRPDの条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえ で役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 説明：CRPD には車椅子サービス供与に関連する いくつもの条文があります。 質問：「ToT ハンドブック」を見ないで、最も深い 関わりがあるのはどの条文か、思い出せる99人はい ますか？ 応答を受けとめ承認せよ。 最も重要な答え： • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション100およびリハビリテーション • 32条：国際協力 99 [訳注] この内容は基礎および管理者向け WSTP で取り上げており, WSTPtot 実習生は既習が前提のため. 100 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 81 他のありうる答え： • 19条：自立生活および地域社会へのインクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30条：文化的生活・レクリエーション・余暇・スポーツへの参加 説明： • CRPD 第 20 条は、車椅子サービス供与に最も 関わりがある条文です。 • ここでは締約国へ、最大限に自立した個人的移動 を障害者へ保証するための実効ある施策を講じる よう求めています。 説明：第 4 条では一般的義務を取り扱い、この文言 を含んでいます。 説明： • これらの条文も、例えば支援機器の重要性、合理 的配慮101、移動技能教習に言及しており、関わり があります。 • 第 26 条は、ハビリテーションおよびリハビリテ ーションを扱っているため、特に重要です。 101 [原文] reasonable accommodation 82 説明：CRPD の他の多くの条文が、間接的に車椅子サービス供与と関わっています。例えば第 6 条 は女性障害者の具体的なインクルージョン、第 7 条は子どもの平等に関わるものです。 質問：子どもや女性が車椅子サービスへアクセス するさい、さらにぶつかりうる障壁には何がある でしょうか？ 実習生に、隣どうしで 1〜2 分、これについて話し 合い、フィードバックを集めるよう指示せよ。 応答を受けとめ承認し、指摘がなかった重要事項 はすべて補足せよ。 最も重要な答え： • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持102を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉103を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 説明：CRPD の第 6・7 条を満たすには、必ず車椅子 供与サービスは、特に女性や子どものニーズが考慮 されるようにしなければなりません。 102 [原文] supportive seating 103 [原文] stigma 83 「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて」(5 分) 説明： WHO の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて（車椅子 ガイドライン）」は、車椅子供与に焦点を置いた、最も重要な国際的文書です。 ほとんどの実習生は「車椅子ガイドライン」をよくご存知ですよね、と確認せよ104。 説明： • 「車椅子ガイドライン」は、現在、世界的に理解 されている適正な車椅子供与枠組みをまとめたも のです。 • 「車椅子ガイドライン」の発行以前、車椅子供与 に関わる諸組織は、考慮すべき重要事項は何か、 共通理解を持っていませんでした。 説明： • 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画によって作成されました。 • これは、合意された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子 サービスの政策提言に役立つ、強力なツールをもたらします。 • 「車椅子ガイドライン」は低・中・高リソース状況で普遍的に達成可能な基準を反映しています。 質問：「適正な車椅子」の定義を覚えていますか？ 回答を受けとめ承認せよ。 104 [原文] Acknowledge [訳注] 各 WSTP で参考資料として取り上げており, WSTPtot 実習生は既習が前提のため. 84 スライドの要点を読み上げよ。 説明：「車椅子ガイドライン」では車椅子に関する 以下の項目も取り上げています： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 質問：この 1 年間に「車椅子ガイドライン」を読んだ人はいますか？ 全実習生に、「車椅子ガイドライン」はとことん読み込むよう勧めよ。WSTP 教習員の「車椅子ガ イドライン」に関する知識は包括的なものでなければならない。ToT 教習員は機会あるごとにそ の意識を喚起しなければならない。 説明：「車椅子ガイドライン」は、WHO のウェブサイトで各言語版(105)を入手できます。 105 https://www.who.int/publications/i/item/9789241547482 [訳注] フランス語・スペイン語を含む. https://apps.who.int/iris/handle/10665/43960 [訳注] 日本語・ベトナム語を含む. 85 「CBR ガイドライン」（25 分） 説明：WSTP 用 USB メモリの補足資料フォルダに、他の指針文書がいくつか収められています。 実習生はそれらを熟知し、重要性と関連性を説明できるようになっておくべきです。 説明：「地域に根ざしたリハビリテーション (CBR)106」は、WSTP の中で話題に上る可能性が高い ものです。そのため教習員は「CBR ガイドライン(107)」、特にその保健コンポーネントをしっかりと 理解しておくことが重要です。 説明： • CBR は、「地域に根ざしたインクルーシブ開発 (CBID) 108」とも呼ばれることも多く、CRPD を 履行するために最も効果的な方法の一つである と、ますます考えられるようになっています。 • CBR の多くの側面が車椅子サービス供与に関連 します。例えば紹介・相談ネットワーク、地域の 保健センター、CBR ワーカーなどです。 説明：CBR マトリックス(109)は、「CBR ガイド ライン」の土台の一つです。 質問：CBR マトリックスの 5 つの主要な領域110と は何でしょうか？ 回答を受けとめ承認せよ。 106 [原文] community-based rehabilitation 107 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 20 10 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBR ガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 108 [原文] community-based inclusive development 109 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 110 [原文] components 86 説明： • 5 つの領域とは保健、教育、生計111、社会、能力 強化 (エンパワーメント)112です。 • マトリックスの各領域には 5 つずつの要素113が 含まれるため、合計で 25 の要素があります。 このスライドは活動の間じゅう映しておけ。 111 [原文] Livelihood 112 [原文] Empowerment [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_securi ty/human_security_approach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと 考え併記した. 113 [原文] elements 87 活動１ グループ： 実習生を 5 グループに分けよ。各グループでジェンダー、経験/知識、技能 がさまざま混在するようにせよ。 指導内容： 実習生に「ToT ハンドブック」p.45 の「CBRマトリックス」を参照させよ。 各グループにCBRマトリックスの領域を一つずつ割り当て、話し合わせよ。 実習生に、車椅子サービス供与が担当領域にどう関連するか、その仕方を 考え、うち二通りにつき全体へのフィードバックを準備するよう指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 活動に 10分、フィードバックに 10分見込んでおけ。 フィードバック： 各グループに、自分たちの答えの一つ目を順番に尋ねよ。それから同様に して、各グループに二つ目を尋ねよ。 ありうる答えの例： 保健 • リハビリテーション：長期および短期の • 健康増進や二次障害予防。例えば早期発見と早期介入による側弯や褥瘡の 予防 • 保健医療サービスへのアクセス 教育 • 学校、教育プログラム、職業訓練プログラムへのアクセスを可能にする。 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス 社会 • 社会およびレクリエーション活動へのアクセス増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 能力強化（エンパワーメント） • 自己イメージや自信の向上 • ピアサポート（当事者支援） 88 説明： • このスライドは、CBR マトリックスに分類され た生活の主要側面を、適正な車椅子供与がどう 改善するかをまとめたものです。 • さらに詳しい情報は、「CBR ガイドライン」およ び「ToT ハンドブック」の CBR マトリックスに 載っています。 その他の指針文書（15 分） 説明： • WHO の「低リソース状況での移動支援機器供与 に関する共同方針提言書(114)」は、各国が CRPD の移動支援機器供与に関連する条文を履行でき るよう、2011 年に刊行されました。 • その内容は移動支援機器へのアクセスにおける 障壁、移動支援機器へのアクセスを増やすため の要件、各国と国際的な関係者への提言などの 情報です。 114 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) rel ated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/h andle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URL および https://j-aws.jp/who/). 89 説明： • WSTP 用 USB メモリに収めている、指針文書の 最後は「アクセシビリティのためのデザインの 留意事項(115)」です。 • この文書は、車椅子サービスを訪れる場合と、 その他の環境の両方とで、アクセスのあらゆる 面が考慮されるようにする方法に関する有益 な情報をもたらします。 説明：WSTP 教習員として、精通しておくべき指針文書は他にも数多くあります。 質問：別の主要な国際文書で、WSTP の開発が始まったあとに発表されたものがあります。それが 何か分かる人はいますか？ 回答を受けとめ承認せよ。 最も重要な答え： 「持続可能な開発目標 (SDGs)(116)」。 説明： • SDGs は「ミレニアム開発目標（MDGs）117」を 継承するものです。 • 2015 年 9 月に発表され、2015〜2030 年を達成 期間としています。 115 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled P eople; 2006 (http://ascon.info/publications/accessibility.pdf). 116 The sustainable development goals [website]. New York: United Nations (http://www.un.org/s ustainabledevelopment/sustainable-development-goals/). 117 [原文] Millennium Development Goals [訳注] 2015 年までに 8 目標・21 ターゲットの達成を掲げた. 90 動画を紹介せよ：「持続可能な開発目標（SDGs）」。 実習生に 17 ある SDGs に関する、この国際連合の 動画を視聴するよう指示せよ。 動画を上映せよ。 説明： • 障害について具体的に言及している SDGs は、 ゴール 4・8・10・11・17 の 5 つです。 • その世界的指標118のうち、9 つが障害に関連 します。 説明： • SDGs のねらいは、最もそこなわれやすい人びと に手を差し伸べ119、最後に取り残されたものへ 最初に手を差し伸べる120よう尽力すること です。 • 多くの関係者が SDGs に取り組むようになる ため、適正な車椅子供与が、そのゴール達成に どう貢献できるか検討することは重要です。 118 [原文] global indicators 119 [原文] reach the most vulnerable 120 [原文] reach the furthest behind first 91 説明： • WHO の 「 支 援 技 術 に 関 す る 世 界 的 協 力 (GATE)(121)」の取り組みは、もう一つの重要な 前進の一歩です。 • GATE は、支援技術へのアクセスを全世界で向上 させるためにつくられました。 • GATE の最初の成果が 2016 年 5 月に発表された WHO「優先的支援製品リスト (APL)(122)」です。 • APL では、政府が無理のない価格で利用可能に すべき 50 の優先度の高い支援製品/機器を取り 挙げており、そこに 4 種類のさまざまな車椅子 が含まれています。 説明：その他の関連文書で、「ToT ハンドブック」 で詳しく述べているものは： • WHO「障害に関する世界報告書(123)」 • WHO「世界障害者行動計画(124)」 • 国連「障害に関する高級事務レベル会合(125)」 121 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 122 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.w ho.int/phi/implementation/assistive_technology/global_survey-apl/en/). 123 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabi lities/ world_report/2011/en/). 124 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 125 Outcome document of the High-level Meeting of the General Assembly on the realization of t he Millennium Development Goals and other internationally agreed development goals for pers ons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.a sp?symbol=A/68/L.1). 92 要点のまとめ（2 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 93 ToT.10 視聴覚ツールおよび機材 ね ら い 実習生が、パワーポイント (PPT) によるプレゼンテーションおよび視聴覚機材を効果的に 使えるようにする。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  WSTPに使える各形式の PPT ファイルの、利点および難点を説明する。  各種 PPT に変更を加え、動画を埋め込む。  視聴覚機材を用いる際の優れた実践を詳述する。  視覚教材としてホワイトボードやフリップチャートを効果的に用いる。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.10：視聴覚ツールおよび機材」  あればスライド転換用リモコンおよびレーザーポインター 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  機材および PPT の使い方（動画の埋め込みを含む）に自分が慣れておく。そうすれば 質問に答え、デモを上手に行ない、実習生がどんな問題にぶつかるかが分かる。 あ ら す じ 1. はじめに 2. WSTPのパワーポイント 3. ホワイトボードやフリップチャートを視覚教材に用いる 4. 要点のまとめ 4 20 20 1 授業時間計 45 94 はじめに（4 分） 授業のねらいおよび学習目標を説明せよ。 質問：ここまでの教習で、どんな種類の視聴覚機材を使ってきましたか？ 最も重要な答え： • PPT および動画用にプロジェクター • ホワイトボード • フリップチャート • 壁の付箋紙 質問：それらの機材は、どういう点で役に立ちましたか？ 最も重要な答え： フリップチャートやホワイトボード： • 授業中および授業後の参照用に重要な、情報/学習の要点の強調（例えば「基本ルール」） • すでに与えられた答えの視覚的リマインダー • 技術的な説明の補助 PPT や動画 • 概念を説明する図表を示す機会 • 話すとともに画像/メッセージを示すことで、学びを補強 • 注意を集中させるために有効 95 WSTP のパワーポイント（4 分） 説明： • WSTP の PPT は二つの仕様が使え、編集不可能 な PDF 版と編集可能な PPT 版があります。 • PDF 版は： o ファイルサイズが小さく、動画が埋め込まれ ています。 o 編集は不可能126です。 o 箇条書きが一つずつ現れる「ビルド」あるいは 「表示」といった効果はありません。 • PPT 版は： o ファイルサイズは大きいです。 o 編集可能です。 o 出荷状態では動画は埋め込まれていません。 o アニメーション効果が入っています。 126 [訳注] 日本語版は PDF 編集ソフトがあればある程度可能. 96 説明：教習員は、次の内容のスライドを追加しても よいでしょう： • 重要な質問： o 「教習員用指導書」には、教習員から受講者へ 尋ねるべき質問が載っています。 o スライドに質問を追加しておけば、その質問 をすることや、いきなり解答に移らないこと を覚えておけます。 • 要点： o 「教習員用指導書」には、長い本文がリマイン ダー用スライドなしで載っている項目もあり ます。 o 要点スライドを追加しておけば、授業計画の すべての面を押さえることを忘れないように できます。 • 活動への指示： o 活動に関連する重要な質問や重要な指示を、 スライドに追加できます。 説明：教習員は、次の目的でスライドを変更しても よいでしょう： • 現地の事情/状況に適合させる。 • 翻訳または現地で適切な用語を入れる。 • 本文を減らすか、内容を複数スライドに分割。 説明：内容の意味や WSTP の方法論は変えないこ とが重要です。 97 説明：スライドを修正あるいは追加する場合、必ず 守るべきことは： • PPT 原版と同じスタイルに従って下さい。 • WSTP の意味および核心的内容は、変えないで 下さい。 • WHO のロゴを（WHO の著作権規定に従い） 削除して下さい。 説明：スタイル、フォント、色を変更したり、複雑 なアニメーションを追加したりしないで下さい 98 スライドの追加 「スライドショー」モードを終了し、その次のスライドを用いて以下のデモを行なえ。 説明： • 既存のプレゼンテーションファイルにスライ ドを追加する最も簡単な方法は、別のスライド を複製し、その見出しと本文の文字を削除し、 フッターのスライド番号を変更することです。 • 追加したスライドから、WHO のロゴを削除する ことを忘れないで下さい。 • これの詳しいやり方は、「ToT ハンドブック」に 載っています。 動画の挿入（Office 2013 を使用） 説明： • 動画ファイルは、すべて mp4 と wmv の二形式 が用意されています。使うコンピューターに 合うものを選んで下さい。 • 動画によっては字幕入りも用意されています。 次のような目的のため字幕入りを推奨します： o 方言127を理解する困難を取り除く o 音質の悪さや外部の騒音を乗りきる o 聴覚障害者にも利用可能にする 説明： • 動画の埋め込みを推奨します。 • 埋め込むことで動画を PPT ファイルに内蔵でき ます。 • それによって、ファイルサイズは増えますが、 ファイルを他のコンピューターにコピーして も動画が失われることはありません。 127 [原文] regional accents 99 以下をやって見せよ： PPT 2010 以降の128ソフトで動画を埋め込む には、次の手順に従います： • 「Presentations」＞「PowerPoint」フォルダー を開きます。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入 • 変更を保存 • これで動画が PPT の一部になりました 説明： • 動画がつねにフルスクリーンで表示される ようにも設定可能です。 • ウィンドウズコンピューター：「ビデオツール」 の「再生」タブから「全画面表示の再生」チェ ックボックスをオンにする。 • アップルコンピューター：「ビデオ形式」タブ から「再生オプション」をクリック、ドロップ ダウンリストから「全画面再生」を選択。 「スライドショー」モードに戻り、動画再生のやり方を示せ。最初の数秒間だけ再生したら、次の スライドへ移れ。 ToT 教習員への注記： • 実習生には、これらの技能は一日の終わりの準備時間に練習できることを伝えよ。 • 現地の写真やイラストを、状況を示すために追加してもよい。 • スライドの翻訳は現地で行なってよい：すでにスライドの現地語訳129があるかどうか、 WHOに必ず確認せよ。 128 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 129 [訳注] 日本語版 PDF は全 WSTP について右ウェブページよりダウンロードが可能 (https://www.j-aws.jp/). 100 説明： • PPT の授業を練習する時は、「スライドショー」 モードを用いなさい。それによってトランジシ ョン、アニメーション、フローなどの問題を発見 できます。 • 教習で使う「スライドショー」モードのコンピュ ーターおよびプロジェクターを用い、スライド および動画を通しで実行しなさい。 • 自分のコンピューターを用いない場合、設定が 異なる別のコンピューターではプレゼンテーシ ョンファイルを予定通りに実行しないことがあ るため、これは重要です。 • 教習中のプレゼンテーションは、すべて一台の コンピューターで行なうことを検討しなさい。 これでプレゼンターごとの切り替え時間が省け ます。 説明： • できれば、予備のプロジェクターかプロジェク ター用ランプを用意しておきなさい。 • 休憩時間や実習中は、プロジェクターの電源を 切ってランプの使用を節約しなさい。 • 黒色あるいは白色のスクリーンに映写する必要 がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キーを 打つと黒いスクリーンになります。 白または黒のスクリーンにする方法を実演せよ。 101 説明： • リモコンを用い、クリックしてスライドを切り 替えると、教習員はプレゼンテーションの間に コンピューターの横に立たなくて済みます。 • レーザーポインターは、スライドの個別の項目 について受講者の注意を引くために使えます。 • スピーカーは、接続が正しいか毎朝テストして おきなさい。 リモコンとレーザーポインタ （ーあれば）の使い方 をやって見せよ。 ホワイトボードやフリップチャートを視覚教材に用いる（4 分） このスライドは活動の間じゅう映しておけ。 活動１ グループ： 実習生を 5グループに分けよ。 指導内容： 実習生に「ToT ハンドブック」p.60 の「ホワイトボード/フリップチャート を視覚教材に用いる」に関する表を参照させよ。 各グループに表のトピックを一つずつ割り当てよ。与えられた情報を通読 し、それを他のグループへ、ホワイトボード/フリップチャートを活用して 伝達する方法を計画するよう実習生に指示せよ。 モニター： グループをモニターし、必要に応じて支援せよ。 時間： 準備に 10分、各グループのプレゼンテーションに 2分ずつ見込んでおけ。 フィードバック： プレゼンテーションで抜けていた情報があれば補足せよ。 102 ホワイトボード/フリップチャートを視覚教材に用いる 1. スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 2. ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 3. ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正130に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 4. 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 5. ホワイトボードの手入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間131」で 姿勢を描くなど）。 130 [原文] neat 131 [原文] ‘stick-draw’ 103 要点のまとめ（1 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 104 ToT.11 フィードバックについて ね ら い 有益なフィードバックを与える、教習員の役割および技能を探求する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  有益なフィードバックを与えるやり方を詳述する。  各模擬授業の終わりにフィードバックを与えるプロセスを詳述する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.11：フィードバックについて」 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。  フリップチャート紙 1枚にフィードバックの 4ステップを書いて用意しておく： 1. 実習生の自己省察 2. 模擬受講者のフィードバック 3. ToT 教習員のフィードバック 4. ToT 教習員が要点を話し合う あ ら す じ 1. はじめに 2. フィードバックを与える 3. 模擬授業後のフィードバックプロセス 4. 要点のまとめ 2 35 7 1 授業時間計 45 105 はじめに（2 分） 授業のねらいおよび学習目標を説明せよ。 フィードバックを与える（35 分） 質問：フィードバックとは何でしょうか？ 最も重要な答え： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 説明：教習員が、上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を 支援できることは重要です。 このスライドは活動の間じゅう映しておけ。 106 活動１a グループ： 実習生をペアに分けよ。 指導内容： 質問：フィードバックをもらうことについて、どんな経験がありますか？ 自分の学びに役立ったフィードバック、また自分が身構える132か動転して133 役に立たなかったフィードバックを思い出しなさい 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 実習生に、その考察を「ToT ハンドブック」p.61 に記録するよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、全体へのフィードバックに 5分を 見込んでおけ。 フィードバック： 実習生に、事例を提供するよう依頼せよ。 キーワードをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 132 [原文] defensive 133 [原文] upset 107 活動１b グループ： 実習生を同じペアに分けよ。 指導内容： 質問：教習員は、フィードバックを与える際に何を考慮すべきでしょうか？ 実習生に、この問いについて個々人で手短に振り返り、続いてパートナーと 共有して話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 振り返りに 2分、ペアでの作業に 3分、フィードバックに 10分を見込んで おけ。 フィードバック： 各ペアに順番で、フィードバックを与える際の重要な留意事項を一つか二つ 述べるよう指示せよ。 検討すべきよい例を受けとめ承認せよ。 誤解があれば訂正/説明せよ。 下の注記を用い、適切な答えが全体で話し合われるようにせよ。 ToT 教習員への注記： 望ましいフィードバック： • タイムリーに134：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。これは受講者 が、フィードバックを直近の学びや経験と結びつけるうえで有効である。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 行動に絞り込め：建設的なフィードバックを与える時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に公開で与えよ。意識、 行動、規律に関わる問題には、非公開で対処せよ135。 • 受講者の視点に立って：まず受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者を支援せよ、みんな違ってみんないい136：建設的なフィードバックを与える前に、受講 者が完了した活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。 サービス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 134 [原文] Be timely 135 [原文] deal with them in private 136 [原文] we are all different [訳注] 文脈と用例から, 文意に対してはこの詩句の引用が最適と判断した. 108 模擬授業後のフィードバックプロセス（7 分） 説明：ToT 教習員は、授業は教室の後ろから観察しますが、フィードバックのファシリテーション を行なうには教室前方に移動します。 フィードバックの 4 ステップを示す、作成済みの フリップチャート紙を掲示せよ。参照のため、これ は教習の残りの期間、壁に貼ったままにしておけ。 説明：模擬授業の後には、4 つのフィードバックの ステップがあります。 1. 実習生自身の振り返り137：リーダー役実習生が 自分たちの出来ばえを振り返ります。内容は： • 何がうまく行ったか？ • 何に改善の余地があるか？ 2. 模擬受講者のフィードバック：リーダー役実習 生へ、次に関するコメント 1 つを含む、簡潔で 具体的なフィードバックを与えます： • 何がうまく行ったか？ • 何に改善の余地があるか？ 3. ToT 教習員のフィードバック：ToT 教習員が、 実習グループが全体として学べる部分に絞り、 「必須教習技能」授業の学びを補強する追加の フィードバックを与えます。 4. ToT 教習員が要点を話し合う：ToT 教習員と、 全実習生に関係がある、その授業の要点を話し 合います。 137 [原文] self-reflection 109 説明：フィードバックをもたらすさい、重要なことは： • 話題になっている人を見ながら、その人に直接語りかけなさい。 • 具体的に。例えば「それは本当によい」と言うより「あなたのグループ分けのやり方と、明確な 指示の出し方がよかった」と言うべきです。 • 受講者からのフィードバックは、つねに建設的であるべきです。 • フィードバックが実習生を傷つけるか無神経なものであれば介入し、フィードバックを言い直し て建設的なものにしなさい。 • フィードバックのプロセスは、この授業で学んだことを実践に移す機会になります。 より正式な実習生と１対 1 でのフィードバックは、各教習日の終わりの準備時間に行ないます。 何か質問がないか尋ねよ。 要点のまとめ（1 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 110 ToT.12 グループダイナミクスを取り仕切る138 ね ら い グループで効率よく効果的に作業する要領、およびグループ内で個々人が示すさまざまな 行動を取り仕切るやり方を考究する。 学 習 目 標 この授業が終わるまでに、実習生が以下をできるようになること：  多彩な方法を活用して、技能、専門性、経験を考慮した、活動のための小グループを 編成する。  グループでの妨害行動139に対処する。 教 材 この授業には：  PPT スライド「必須教習技能 ToT.12：グループダイナミクスを取り仕切る」  「妨害行動カード」を準備：この授業計画の最後に収録しているカードを、印刷して 切り分けるか手書きする。帽子かバケツを用意しておく。 準 備  教材を取りまとめ、PPT スライドを見通し、授業計画を読み通す。  「ToT ハンドブック」の関連する注記を読み通す。 あ ら す じ 1. はじめに 2. グループ活動を組織し取り仕切る 3. 妨害行動に対処する 4. 要点のまとめ 3 10 25 2 授業時間計 40 138 [原文] Managing group dynamics 139 [原文] disruptive behaviour 111 はじめに（3 分） 授業のねらいおよび学習目標を説明せよ。 質問：なぜ WSTP にはグループ活動が盛り込まれ ているのでしょうか？ 回答を受けとめ承認せよ。 回答をホワイトボードに記録せよ。 説明： • 教室内にはつねに、さまざまなレベルの経験と 専門性を持つ人がいます。 • グループ作業によって可能になることは： o 教習員は、すでにどのくらいのことが知られ ているのかを見出せます。 o より多くの経験や専門知識を持つ人が、他と それを共有できます。 o 受講者は、自分が経験を通してすでに多くの ことを知っているとわかり自信がつきます。 o 内気な、または年若い受講者も小グループの 中では気後れせず発言できます。 112 グループ活動を組織し取り仕切る（10 分） 質問：受講者をグループ分けする際の重要な留意 事項は何でしょうか？ 回答を受けとめ承認せよ。 実習生に、「ToT ハンドブック」p.63-65 を開き、 実習生が挙げなかった内容を指摘しながら、一覧 に沿って話し合うよう指示せよ。 ToT 教習員への注記： グループのサイズを決定する要因 • 時間グループが多いほど、フィードバックにも時間が必要になる。持ち時間が少なければ、大 きいグループをつくれ。ただし、1グループの人数は 6名を超えないようにせよ。 • プライバシー/内密さ140：気をつかうトピック、内気な人、言語の壁がある場合の話し合いに はペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な機材/消耗品の分量。例えば、作業場が 3か所あれば、3グループ まで対応が可能になる。 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や経歴を持った人を同じグループにする（臨床職全員が 協働するように配置する、あるいは技術者全員が同じグループにいるなど）か、逆に、わざと 同じグループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、かれらをグループ にする方が適切な場合と、分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混合：これはお互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混合：作業への文化・宗教・社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が協力し合って作業し、学び合いの機会141が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 140 [原文] confidentiality 141 [原文] peer learning opportunities 113 グループづくりの手法 各WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与え ている。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ 分けの手法をいくつか掲げる： • フルーツサラダ法142：同じ果物カードを 3、4 枚ずつ、さまざまな種類の果物で受講者の人数 分になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ (1人 1種類の)」でいっしょになる、などを指定する。 • 番号点呼143：必要なグループ数の番号を点呼する。例えば 3グループに分ける必要があれば、 最初の人が「一」、次の人が「二」、それから「三」、また「一」に戻って数を点呼するよう指示 し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分け ておく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3人、次の 3人 とまとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1人または 2人、自分が組んだことがない人を選んでもらう。ただし 3人を超える と、自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4人ずつのグループに有効。 妨害行動に対処する（25 分） このスライドは活動の間じゅう映しておけ。 142 [原文] The fruit salad method 143 [原文] Count off 114 活動１ グループ： 実習生をペアに分けよ。 指導内容： どんな受講者の集団も、幅広い個性、技能、経験、学習スタイルの集まりで あり、また、ある種の行動が授業を妨害する場合のみ教習員は対処すべきで あることを説明せよ。 実習生に、あちこちの教習でどんな種類の妨害行動を目にしたことがある か、パートナーと話し合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 話し合いに 2分、フィードバックに 3分見込んでおけ。 フィードバック： 各ペアからの答えを、新しい考えが出なくなるまで一つずつ集めよ。 答えをホワイトボードに記録せよ。 このスライドは活動の間じゅう映しておけ。 活動２ グループ： 実習生をペアに分けよ。 指導内容： 各ペアに、順番に帽子/バケツからカードを 1枚ずつ引くよう指示せよ。 各ペアに、そこで述べられている行動にどう対処するか、パートナーと話し 合うよう指示せよ。 モニター： 各ペアをモニターし、必要に応じて支援せよ。 時間： 話し合いに 5分、フィードバックに 15分見込んでおけ。 フィードバック： 各ペアに、各自のアイデアを共有するよう指示せよ：グループでのそうした 問題にどう対処する？何が有効/無効か？ 各ペアからのフィードバックの後で、他に共有するアイデアがあるか実習生 に尋ねよ。 115 ToT 教習員への注記： いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、前向きだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 地位が高い/年長の受講者 • 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいは その人に反対するのをためらうかもしれない。 • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話す よう呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 場を仕切る受講者 • 自分が仕切り、大声で、または長時間しゃべり、他の受講者に、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っている かのように振る舞う。 • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える 機会を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく特定の受講者に、質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は、最有力な受講者とのペアあるいはグループに入れ、 内気な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 寡黙な受講者 • もともと寡黙あるいは内気で、大人数の前でしゃべり、グループ活動へ貢献することに気が 進まない受講者。 • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3名の）を活用せよ。 攻撃的な受講者 • 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。 • または教習員の技能・知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとっては本当ですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 116 ToT 教習員への注記： 注意散漫な受講者 • 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習の妨げになるのか話せ。規則を念押しせよ。 ふざける受講者 • 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動 中のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 ネガティブな受講者 • ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれ が住む地域ではうまく行きっこない」とコメントするかもしれない。 • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由 を説明する機会を与えよ。他の受講者に、それに同意するか尋ねよ。他の受講者も同意すれば、 「どうすればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 要点のまとめ（2 分） 要点を読み上げよ。 何か質問がないか尋ねよ。 117 妨害行動カード：コピーするか手書きして切り分けよ 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた 場合、受講者たちは話し、質問に答え、または その人に反対するのをためらうかもしれない。 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、 他の受講者には、知識を共有し、質問に答え、 グループ活動の主役になる機会を与えない受 講者。こうした人は、自分はすでに何でも知っ ているかのように振る舞う。 寡黙な受講者 寡黙あるいは内気で、大人数の前でしゃべり、 グループ活動に貢献することに気が進まない 受講者。 攻撃的な受講者 異論を唱え、自分が信じられない概念を問い ただし、トピックや論点について議論を吹っ かけ、グループの他の受講者がどれくらい強く そう思っているか試す受講者。または教習員の 技能・知識程度を試し、自分の方が優れている と示そうとするかもしれない。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入った り、電話を手に取ったり放したりする受講者。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談 を飛ばし、時には他をからかう受講者。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 118 基礎教習モジュール 119 A.1: 車椅子ユーザー この授業を教えるための主な留意点 a. 全般 準備のコツ • CRPD（障害者の権利に関する条約）のコピーを、受講者が休憩中に目を通せるように用意して おけ。できれば、各受講者へ印刷版を配布せよ。 b. 第 4 節：国際連合「障害者の権利に関する条約」 • 基礎 WSTP［車椅子サービス教習パッケージ］「教習員用指導書」第 4 節（p.26-28）の焦点は、 個人的移動への権利（CRPD 第 20 条）である。受講者どうしの話し合いを促し、受講者が CRPD および人権に根ざしたアプローチを包括する原則を理解し、またそれらに同意するようにせよ。 第 20 条に加えて強調すること： o 第 1 条：CRPD の目的：人権はすべての人のもので、障害者もあらゆる他者と同じ権利をもつ。 o 第 3 条：CRPD の一般原則：われわれはみな平等で、何人も尊厳と敬意をもって遇されねば ならない。 o CRPD が基づく原則：尊厳の尊重、無差別、参加とインクルージョン、違いの尊重、機会の 平等、アクセシビリティ、男女平等、子どもの尊重。 c. 第 5 節：車いすユーザーは車椅子サービス提供における対等なパートナー • 「教習員用指導書」p.28 の活動は、「受講者用ワークブック」にワークシートがないため、導入 および説明はていねいに行なう必要がある。 120 A.2: 車椅子サービス この授業を教えるための主な留意点 a. 第 2 節：車椅子サービス 準備のコツ • 本節は、PPT スライドがないため忘れられがちである。本節の各質問に関する、スライドの追加 を検討せよ。 b. 第 3 節：車椅子サービス職員の役割 • サービスステップに関する詳細は追加するな。各ステップは、あとの授業でさらに詳しく取り 上げる。詳しい説明を要する質問は、「保留スペース」に置いておけ。 • あらゆる車椅子ユーザーに、8 ステップのサービス提供へのアクセスが必要である。これらは、 単独の組織が提供してもさまざまな組織が提携して行なってもよい。重要なことは、受講者が 各サービスステップに関わるあらゆる人の役割を理解し、それによって効果的に協働できること である。 121 A.3: 車椅子による移動 この授業を教えるための主な留意点 a. 全般 • 追加時間が取れれば、この授業を延長してさらに練習時間を確保するか、追加の車椅子移動技能 を教えてもよい。授業が複数日にわたってもよい。 b. 第 4 節：車椅子の移動技能：デモと練習 準備のコツ • 「教習員用指導書」では、この活動に必要な車椅子の種類は指定していない。可能であれば、 以下のものをすべて含めよ： o 「病院型」車椅子1 o 駆動輪が活動的な2位置にあるアクティブユーザー向け 2 車椅子 o ホイールベースが長い車椅子 o 3 輪車椅子 • 適切なサイズの車椅子が用意されていることを確認しておき、受講者がみな移動技能の練習機会 を得られるようにせよ。 • リーダー役実習生と補助役実習生とが、あらゆる技能を同じようにやって見せることは重要。 授業前に当該技能をいっしょに復習・練習して統一を図れ。「教習員用指導書」を指針に用いよ。 • 「手こぎ」と「転回」項目の準備として、リーダー役実習生と補助役実習生が、どこを 10 時3と 2 時の手の位置とするか、見方が一致していることを確かめよ。これは車輪を左右どちら側から 見るかによって変わるからである。 移動練習エリア • 事前に適切なエリアを見定めよ。 • 行き来の時間を節約するため、互いに近いエリアを選べ。 • ローテーションのやり方を計画せよ。例えば：教習員が付くか付かないか？車椅子は、受講者と いっしょに移動するのか、あるいは移動練習エリアに置いておくのか？ • 練習エリアが屋外で屋根もない場合、現地の天候をみながら計画し、授業を一日で最も乾燥した、 暖かいまたは涼しいといった時間帯に実施せよ。 1 [原文] orthopaedic-style wheelchairs 2 [原文] active 3 [訳注] 以下,「〜時の位置」は 12 時間時計の文字盤上の針の方向を表す. 12 時が垂直上向き, 3 時と 9 時が水平. 122 内容 • さまざまな移動技能の紹介に動画を活用せよ。動画の技能シーンの字幕を読み上げ、学習の要点 を強調せよ。 • 動画を 2 分 39 秒のシーン（真横から見た構図）で停止し、坂を登る時に頭と肩がどれくらい前 に出ているか指摘せよ。 • 移動技能によっては、活動中に再度やって見せる必要が出てくるものもあろう。 • 受講者には、実習活動ではさまざまな車椅子に試乗して違いを体験するよう求めよ： o 荒地および坂道：受講者に、用意されているあらゆる種類の車椅子をこいでみるよう促せ。 o 一時ウィリー4：受講者に「病院型」車椅子と、駆動輪が活動的な位置にあるアクティブ車椅子 とを用いて比較するよう提案せよ。 • 駆動輪の位置は、車椅子をこぎ、ウィリーを行なうための労力に影響する。駆動輪がユーザーに 対して後ろにあるほど、車椅子をこぎ、ウィリーを行なうのが困難になる。 • 長いホイールベースの車椅子は短いホイールベースのものより重く、そのためウィリーを行なう のが難しいと思い込んではならない。駆動輪位置こそが、ウィリーを行なう難しさに影響する。 • 重要技能を「教習員用指導書」p.42 の解説通り正確に練習するよう強調せよ。以下を追加せよ： o 登り坂：前にかがむ。受講者や新規ユーザーは通常、前へのかがみ方が足りない。 o 下り坂：減速にブレーキを使ってはならない。 o 介助により階段を昇る：決して前向きに昇ってはならない5。 o 介助により階段を降りる：決して後ろ向きに降りてはならない。 • この活動中、受講者が負傷する場合もある。グループを注意深くモニターし、必要に応じて介入 せよ。 • グループの管理と安全について、明確な指示を与えよ。 • 見まもりベルト6は、車椅子ユーザーの後方転倒防止に用いる車椅子技能教習に便利なツールで ある。また助手は、これによって車椅子ユーザーとつながりを保ちながら、習得中の技能に干渉 しないでいられる（図 1・2）。 4 [原文] partial wheelies 5 [訳注] 日本では, 前向きに昇る介助手法が標準とされる場合もある. 6 [原文] spotter strap 123 図 1 見まもりベルトの使い方 図 2 見まもりベルト(7) ジェンダー/文化への配慮 • 授業開始前に、グループのどの車椅子ユーザーにも、練習用車椅子を試乗したいかどうか尋ねよ。 もし希望があれば、車椅子間の移乗に介助や器具が必要かどうか尋ね、それに従い段取りせよ。 必要に応じて、介助する補助役実習生を指名せよ。 • 受講者はこの活動ではペアを組み、一人は転倒や転落を防ぐ介助ができるようにしておく。機能 障害や身体障害のある受講者がいる場合は、他の人を介助することに不安がないか、授業開始前 に尋ねておけ。活動中は違う姿位8をとる必要があるかもしれない。 • この活動に加われない受講者がいる場合は、その人が代わりに果たせる役割を見出せ。例えば、 他の受講者を観察してフィードバックをもたらすなど。 7 Wheelchair skills assessment and training 2015. Canada: Dalhousie University; 2015 (http://www.wheelchairskillsprogram.ca/eng/manual.php). 8 [原文] position [訳注] 本書では「姿勢」は posture,「姿位」は position の訳語 (の一つ) である. 124 ToT 教習員によるデモ/説明 a. 第 4 節：車椅子の移動技能：デモと練習 一時ウィリーのデモ 「教習員用指導書」p.43 の解説に従うこと。以下の点を強調せよ： • 駆動輪が安全な位置にある車椅子で、ウィリーを行なうのはより困難である。「教習員用指導書」 で詳説している以下の技法を用いれば、ウィリーを行なうのが容易になる： o 両手を駆動輪の 1 時の位置に置く。 o 手が 10 時の位置に来るまで駆動輪を後ろへ回し、止めずに向きを変えて素早く前にこぐ。 • 駆動輪が活動的位置にあれば、後ろへ回さず前にこぐだけで一時ウィリーができる場合もある。 • 受講者が一時ウィリーで越えるための、まっすぐに張ったロープを地面に置くと効果的である。 • 練習では、受講者を 3 名ずつのグループに分けよ。よくある間違いの例： o 始めの手の位置が、1 時の位置よりも遠すぎる。 o 手をじゅうぶん後ろへ回していない。 o 向きを変える時に止まってしまっているか、方向転換に素早さが足りない。 o じゅうぶん前へこいでいないか、こぐ強さが足りない。 125 A.4: まっすぐに座る WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 2 節：まっすぐに座る/ニュートラルな座位姿勢 • スライド 5 で、正面から見た、まっすぐに座った姿勢の要点を列記したさい、体幹が抜けており、 頭が正しい順番になかった。正しい順序は以下の通り： o 骨盤（が水平） o 体幹（がまっすぐに起きて左右対称） o 両肩（が水平） o 頭（が上体の上の中央でバランスが取れている） o 大腿（がわずかに開いている/外転している） この授業を教えるための主な留意点 a. 全般 • 姿勢を詳述する際の正しい順序をつねに強調せよ。骨盤から始めて上へと移動し、次に股関節に 飛んで下へと移動せよ。 b. 第 2 節：まっすぐに座る/ニュートラルな座位姿勢 準備のコツ • 希望者が座るためのスツールまたは評価ベッドを用意しておけ。 • 希望者が椅子9に座った場合、背もたれにもたれかかると姿勢が変化してしまう。椅子しか使える ものがない場合には、座面が水平であることを確かめ、希望者には椅子に横向きに（背もたれが 脇に来るように）座ってもらい、もたれかかれないようにせよ。 9 [原文] chairr [訳注] 英語の chair は通常背もたれがあるものを指す. 126 c. 第 3 節：骨盤は座り方にどう影響するか • 受講者が、基礎 WSTP［車椅子サービス教習パッケージ］で使われる用語（例：前〜10、後〜11、 上前腸骨棘12）を熟知していると決めてかかるな。 • あれば、人体骨格模型を用いて重要な骨部位を示し、骨盤の動きをやって見せよ。 • 受講者に、自分の身体の上で骨部位を見つけ、感じる時間を与えよ。 • 受講者に、過体重のユーザーに対して骨部位を見つける際には、つねに典型的サイズの成人骨格 を頭に置くよう念押しせよ。 • 受講者と骨盤の動きを実演する際には、それぞれの動きに対して、骨盤の上では脊柱に、骨盤の 下では股関節に何が起こるのか強調せよ。これによって受講者は、姿勢と、骨盤の姿位とを関連 づけられる。 10 [原文] anterior [訳注] 本節の訳語でいえば「骨盤前傾」など. 用語法についての WSTP の方針は p.17 を参照. 11 [原文] posterior [訳注] 本節の訳語でいえば「骨盤後傾」など. 用語法についての WSTP の方針は p.17 を参照. 12 [原文] ASIS [訳注] 日本の専門職にも, ASIS の方が一般的かもしれない. 127 A.5: 褥瘡 この授業を教えるための主な留意点 a. 全般 • 除圧クッションおよびその設計上の特徴、それを湿気から保護する方法に関する質問には、何で あれ「保留スペース」を活用せよ。これらの情報は「A.7: クッション」で詳しく取り上げる。 b. 第 3 節：いつ、どこで支援を受けるか • 褥瘡への医療的処置や包帯類（創傷被覆材）に関する助言は与えないこと。それは授業の焦点で はなく、また基礎 WSTP の範囲外である。 • 民間療法13は、創傷管理に関わる保健医療専門家が推奨または承認したものでないかぎり行なわ ないよう、ユーザーに警告せよ。 c. 第 4 節：褥瘡の原因は何か？ • 剪断 [せんだん]14は、受講者にとっては新しい概念かもしれない。摩擦との混同を避けるため、 じゅうぶんに説明すべきである。剪断を説明するには受講者に自分でこぶしを握り、じゅうぶん 圧力を加えてテーブル天板に押し当ててもらえ。すると、握りこぶしを前後に動かしても皮膚は 静止したままで、骨だけがその上を動く。 • 車椅子ユーザーが、車椅子上で［姿勢が］崩れ15たり滑ったりするのを防ぐことが、剪断および 褥瘡の危険を減らす。 d. 第 8 節：除圧動作 • 本節は、10 分間に説明と活動の両方を含んでいる。 • 各受講者は、練習では車椅子ユーザーと介助者、両方の役を務めるべきである。 • 受講者は、除圧動作はどれくらいの頻度で、どれくらいの時間行なうべきか質問するであろう。 通常の目安では 30 分おきに 2 分間、当該部位に血流が回復するまでである。 • プッシュアップ法（両腕でプッシュアップして持ち上がる）は、以下の理由から基礎 WSTP では 教えていない： 13 [原文] home remedies 14 [原文] shear 15 [原文] slump 128 o 肩への緊張および損傷を与える可能性。 o 血流が完全に回復するまでに必要な 2 分間、その姿勢を維持できる人はほとんどいない。 o ユーザーがコントロールを失い、激しく落下した場合に皮膚を損傷する可能性。 • 左右へ傾く方法では、骨盤が傾斜して座骨に圧力がかからなくなる、必要最小限だけ傾くように する。この技法を車椅子ユーザーへ教える際には自分の手をユーザーの座骨の下に置き、圧力が 緩和されたらフィードバックを与えよ。 129 A.6: 適正な車椅子 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 3 節：車椅子ユーザーのニーズを満たす • 「教習員用指導書」p.76-77 の表では、ロジャー、ダーヴィド、ピンキーの欄で「短いホイール ベース」に触れている。ホイールベース長には、この箇所で初めて言及している。車椅子の全長 も、狭い場所での転回や移動の能力に影響することに留意せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 可能であれば、特色を説明するためのデモ用車椅子を用意せよ。授業開始前に下準備し、必要に 応じて以下の調節方法を示せるようにしておけ： o 折りたたみフレームおよびリジッドフレームの車椅子（3 輪と 4 輪どちらも） o 着脱式および固定式のひじ掛け o 固定式足台、およびはね上げ式と開き式の足台 o 短い、および長いホイールベースの車椅子 o 足台の最高位置および最低位置、あるいは前後への設定 o 背もたれの最高位置および最低位置への設定 o 安全な、および活動的な駆動輪位置 • デモ用車椅子が全受講者から見えるように、授業エリアを設営せよ。 b. 第 3 節：車椅子ユーザーのニーズを満たす 3.2 節：車椅子をこぐ • 軽量な車椅子が特に重要なのは、子ども、進行性疾患がある人、筋力に制約がある人（例えば 高位脊髄障害16）、ひんぱんに長距離をこぐ人、車椅子を押す介助者などにとってである。 16 [原文] high spinal cord lesion 130 • 座面に対する駆動輪の位置は、車椅子がどれくらい軽く感じられるかに影響する。駆動輪の車軸 は、車椅子ユーザーの下に配置すべきである。 • 駆動輪が活動的な位置にある車椅子は、自走する車椅子ユーザーと車椅子を押す介助者、両者に とって推進し17やすくキャスター上げ18もやりやすい。 • 高齢の車椅子ユーザーや下肢切断した（車椅子上での体重の配分が異なる）人だからといって、 自動的に「安全な」駆動輪位置が必要というわけではない。駆動輪位置に影響する要因の例： o ユーザーの全般的機能：筋力、バランス、移乗技能 o 車椅子のこぎ方 o 車椅子に乗って行なう活動 o 理解力および認識力19の水準 o その他の条件、例えば筋攣縮 [きんれんしゅく]20や制御できない運動21 • より活動的になる可能性があるユーザーには、一時的な安定性の付加を検討するとよい。例えば、 ユーザーがバランスの取り方やこぎ方を学ぶ間は、車椅子の前部に重量を付加しておき、時間を かけて徐々に減らして行く、あるいは転倒防止装置を用いることが可能である。 3.3 節：車椅子の折りたたみ • 交通機関を利用する場合に可能な選択肢は、折りたたみフレームだけではない。軽量なリジッド フレームで、着脱式車輪の 4 輪車椅子を、どうやって運搬できるかやって見せよ。その場合は、 駆動輪を取り外し、車両が満員で車椅子ユーザーが運転しない場合、フレームを車椅子ユーザー の膝に乗せる。駆動輪のみ、車両の別の場所に収める必要がある。 c. 第 4 節：車椅子ユーザーの環境に合う • スライド 23 でホイールベースを紹介している。このイラストはホイールベースが短い車椅子で ある。この点について話し合う時は、車椅子が 2 台、ホイールベースが短いものと長いものとが 1 台ずつあると便利。 • ホイールベース長は、キャスター輪が後ろ側に来た位置 (トレーリングポジション)22で測ること を忘れないように。 • 「病院型」車椅子が、自動的にアクティブユーザー向け車椅子より安定するわけではない。 「病院型」車椅子の一般的特徴は以下の通り： 17 [原文] push [訳注] ユーザーが自走する場合と介助者が押す場合を両方指すため, ここでは上の訳語を用いた. 18 [原文] wheelie [訳注] 自操による場合と介助者が行なう場合を両方含むため, ここでは上の訳語を用いた. 19 [原文] insight 20 [原文] spasms 21 [原文] uncontrolled movements 22 [原文] rear (trail) position 131 o 短いホイールベース：その結果、前方キャスターに大きく荷重がかかり、車椅子が容易に前方 に転倒する。 o 座面が駆動輪車軸よりかなり高い：側方・後方・前方へ不安定になる。 o 駆動輪が後方（座面の背後）に設置されている：これが短いホイールベースと組み合わされる と、前方キャスターへ荷重がかかる結果になり、車椅子をこぎ、転回するのが難しくなる。 • 「病院型」車椅子は、屋外の荒地での活動的使用には向かない。受講者には、「病院型」車椅子を 荒地でこぐのがどれほど大変だったか、他の種類の車椅子に比べて一時ウィリーを行なうのがど れほど難しかったか思い出させよ。 d. 第 5 節：適切にフィットし姿勢を支える • 入手できる車椅子が一種類しかなく、使用環境に対して適切な製品を処方できない場合もある。 つねに最適なサイズを選択し、最高のフィットと姿勢支持をもたらすステップを踏め。 132 A.7: クッション この授業を教えるための主な留意点 a. 全般 • この授業は「A.5: 褥瘡」と連結している。必要ならば A.5 に戻り、以下の要点に絞って参照せよ。 o 褥瘡発生の危険が最も高い身体部位 o 褥瘡の主な原因（圧力、摩擦、剪断 [せんだん]） • これらの学習要点を踏まえることで、除圧クッションの井戸穴の機能23を強調し説明できる。 • 座骨井 [ざこつせい]24の寸法は「B.8: クッションづくり」で話し合い、練習を行なう。 準備のコツ • この授業の準備として、現地で手に入るクッション、素材、生地を集めておけ。用意できれば、 以下を含めよ： o 成形クッション25（座骨井があるもの） o 平面クッション26（2 層以上の構造で、座骨井がなく基層が平らなもの） o 単層のウレタンフォーム o 他に現地で手に入るクッションで、広く使われているもの • 指を用いた圧力検査の活動に備え、クッションの付いた車椅子を準備しておけ。 • この授業のためにクッションをつくる必要がある場合は、本書 p.185「クッションに関する付録」 の詳細情報を参照。 b. 第 4 節：除圧クッション 準備のコツ • スライド 6 に対する「受講者用参考書」の箇条書きの第 2 条に、以下のような語句を追加せよ： 「これがクッションを、形状を保ち、ユーザーをしっかりと支えてユーザーの体動に対して動か ないようにします。」 23 [原文] the well feature [訳注] the well (直訳すると「井戸」) は次行の「座骨井」と同じものを指す. 24 [原文] seat bone well 25 [原文] a contoured cushion 26 [原文] a flat cushion 133 内容 • スライド 5：座骨井は、除圧と姿勢保持の両方をもたらす。座骨井は座骨の下の圧力を減らし、 座骨前方の棚状段差27で骨盤をまっすぐに起こして保ち、前方に滑るのを防ぐ。これは滑りから 生じる剪断を減らす。 • この棚状段差28が正しい位置にあるか、圧力検査を完了して確かめることが重要である。 どのクッションを用いるべきか？ • 優れた除圧、姿勢支持、圧力分散は、クッションの、形状と素材の組み合わせで達成される。 • ユーザーに最適なクッションを選択する際に考慮することは： o 形状：滑りを防ぎ骨盤をまっすぐに起こしておく、座骨前方サポートまたは座骨井があるか？ 大腿が据わる凹みあるいは溝29があるか？ o 素材：しっかりと支えるためにじゅうぶん硬く、また快適なくらいじゅうぶん柔らかいか？ o 圧力分散：ユーザーが車椅子上でそのクッションに座った時、圧力検査をパスするか？ o 快適さ：これは主観的なものである。どんなクッションも、除圧と姿勢支持をもたらすことに よって快適でなければならない。空気/液体/ゲルクッションが、自動的にウレタンフォームの ものより快適なわけではない。 • クッションの形状や品質は、さまざまであることに留意せよ： o 形状：設計がよい成形（立体形状）ウレタンフォームクッション30は、設計がまずい空気/液体 /ゲルクッションより、除圧効果に優れている。 o 素材：設計がよい空気/液体/ゲルクッションは、設計がよいウレタンフォームクッションでも じゅうぶん防護できない、褥瘡の危険が非常に高い人への最適解となりうる。 o ウレタンフォームクッションの寿命は、車椅子よりずっと短い。現地でサポートするサービス 事業者は、必要に応じてクッションを交換できることが絶対に必要である。 クッションカバー • 湿気および失禁の管理における留意事項（「教習員用指導書」p.94）への追加情報を、本書 p.185 「クッションに関する付録」に収録している。 27 [原文] pre seat bone shelf [訳注] 同じ語で姿勢支持具の「座骨前方サポート」を指している場合もある. 28 [原文] the shelf [訳注] 前注の pre seat bone shelf を指す. 29 [原文] grooves or gutters 30 [原文] contoured (shaped) foam cushion 134 c. 第 5 節：除圧クッションが効いているかどうかの検査法 準備のコツ • 各受講者が、自分にフィットする車椅子を得られるようにせよ。 内容 受講者が圧力検査の練習に入る前に、以下の点 を強調せよ： • 始める前に手のアクセサリー31は外しておく。 • 車椅子の背後から座骨に手が届きにくい場合 は： o 車椅子の後ろの隅に立ち、手を座骨の下に 置く（図 3）。 o ユーザーを前方へ押し出してしまうので、 腕を背もたれとユーザーの間に置いてはな らない。車椅子ユーザーが左右対称に座り、 背中が背もたれに当たっていることを確か めよ。 図 3 座骨への圧力を検査する 31 [原文] jewellery 135 • 受講者が、座骨を見つけるのに苦労している 場合： o 人体骨格模型を用い、座骨がどのくらい前 方に位置し、左右の座骨がどのくらい近接 しているか再認識させよ（図 4）。 o 座骨の下への指の置き方をやって見せよ。 人体骨格模型がなければ、握りこぶしの底 を座骨になぞらえよ。 o 受講者に、座った状態で自分自身の座骨を 見つけ、その位置と左右の間隔に注目する よう指示せよ。 図 4 座骨の模式図 • 車椅子ユーザーの圧力がレベル 3（危険）の場合、指を座骨の下から無理やり引き抜いてはなら ない。ユーザーに前へかがむか横に傾いてもらって、指を滑り出せるようにせよ。 • 座骨には、左右で異なる圧力がかかっている場合がある。左右別べつに評価せよ。 • 圧力検査に関する研究や妥当性について質問を受けた場合、その目的は個々の車椅子ユーザーの 安全確保であることを強調せよ。手は、人体と車椅子の間の圧力を測定する精確な手段である。 手は非常に敏感なので、この検査をひんぱんに実践することによって、圧力評価の感度をさらに 高めて行くことができる。 136 d. 第 6 節：減圧のためにやるべきことは何か？ • 図 5 を見ながら、「かさ上げ」32に関する以下 の点を強調せよ： o 形状は U 字形でなければならない。座面の 角度が変化するため、「かさ上げ」を大腿の 下だけに入れてはならない。 o 「かさ上げ」の厚さは 20 mm 前後にする。 o 座骨井の寸法は「B.8: クッションづくり」 の授業で取り上げる。 図 5 安全でない圧力を低減する • 「かさ上げ」の目的は、体重を座骨から大腿の上部および遠位部33へ移すことである。 • 多層構造クッション34では「かさ上げ」を層と層の間に置ける。一体成形モールドクッション35の 場合、「かさ上げ」はクッションの下に置く。 • ウレタンフォームクッションの除圧効果を改善するその他の方法で、「教習員用指導書」で説明 していないもの： o 表層が非常に柔らかいか薄い場合は、その硬さまたは厚みを増す。 o 基層が柔らかく、車椅子ユーザーが座った状態でその形状や起伏36を維持できていない場合は、 基層をもっと硬い素材のものに交換する。 32 [原文] lift 33 [原文] distal parts [訳注] この場合, 大腿のより膝に近い方. 34 [原文] layered cushion 35 [原文] one-piece moulded cushion 36 [原文] its shape or contours 137 A.8: 移乗 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 4 節：3 通りの車椅子の乗り降りと個別フィードバック • 資料動画：座っての自力移乗（車椅子からベッドへ）：車椅子ユーザーが移乗中に背のスリング37 を押し下げていることに注意。これは推奨しない。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 実習活動用機材を準備しておけ。横方向の移乗に、固定式で前後にいっぱいの長いひじ掛け38が 付いた車椅子を用いるな。 • リーダー役教習員と各補助役教習員が何を担当するか、授業前に決めておけ。移乗の実施方法と 教え方に、教習チーム内で統一性を持たせよ。 b. 第 4 節：3 通りの車椅子の乗り降りと個別フィードバック これらの移乗のやり方について、すでに別の技法を習得し、または代わりの方法を開発していて、 代替案を出してくる受講者もあろう。受講者による提案は認めて受けとめよ。ただし動画のデモが 基本的で安全な技法であることは念押しせよ。 • 受講者は、基礎 WSTP の間はこれらの技法に従うべきである。個々の体型、例えば身長、体重、 筋力などに合わせた多少のバリエーションは許容される。 • 介助者が背中を回旋させる（ひねる）必要がある、あるいは車椅子ユーザーが介助者の肩や首に しがみつく技法は、介助者に負傷する危険を負わせるため推奨しない。 • 移乗のための車椅子の安定性を高めるには、キャスター輪を前方に設定する。 • 動画の中の要点は、スクリーンからそれらを読み上げて強調せよ。 37 [原文] back upholstery 38 [原文] fixed, full depth armrests 138 座っての自力移乗（車椅子からベッドへ） • 車椅子ユーザーが、なぜ車椅子の前部へ移動する必要があるのか説明せよ。これは、移乗の間に 駆動輪に触れたりぶつかったりしないためで、それで皮膚を傷め、褥瘡につながりかねないから である。 スライディングボードを用いた、介助による座っての移乗（車椅子からベッドへ） • 字幕「3. 車椅子とベッドの間に渡す」が消えたら一時停止せよ。 • 車椅子ユーザーは、横に傾き、またスライディングボード39を置くために必ず介助が必要である ことを強調せよ。 • スライディングボードの片端は車椅子ユーザーの片方の臀部の下に置く。スライディングボード は車椅子座面とベッドの間に斜めに渡すことで、駆動輪40をかわせる。 • 動画を再開せよ。 • 次の字幕「4. 介助者はユーザーの背後に立つ」のところで一時停止せよ。 • この移乗の間の、車椅子ユーザーの背後という介助者の立ち位置を強調せよ。この位置であれば、 介助者は、車椅子ユーザーの頭部や体幹の前への動きを妨げることがない。また介助者は、移乗 中の前滑りをしっかりと制御できる。車椅子ユーザーが前滑りへの不安を抱いていれば、介助者 がもうひとり、その前方に立つとよい。 • 介助者の体勢を強調せよ。介助者は片脚でベッド上に膝をつく。反対側の脚はベッドと車椅子の 間に置く。 • 動画を再開せよ。 • 次の字幕「5. ユーザーはできるかぎりプッシュアップ」の、ユーザーがプッシュアップする直前 で一時停止せよ。 • 介助者が車椅子ユーザーの骨盤まわりを、ベッドへの横移動を介助するために保持するやり方 （介助者は、ズボンの上端やベルトをつかんではならない）を説明せよ。 • 強調せよ：ユーザーの手はスライディングボードの上面に置き、その指をスライディングボード の縁にかけてはなりません。移乗を始めて体重がスライディングボードに乗った時、負傷につな がる恐れがあるためです。 • 「5. ユーザーはできるかぎりプッシュアップ」の字幕を強調せよ。ユーザーは、小さいプッシュ アップを何回かくり返して移乗することも可能だと付け加えよ。 • 動画のあと、「教習員用指導書」p.104 の要点をくり返せ。 • 受講者に、練習前に再度動画を上映してもらいたいか尋ねよ。 39 [原文] transfer board 40 [原文] the arch of the rear wheel 139 介助による立ち上がっての移乗（ベッドから車椅子へ） • 字幕「4. ユーザーがベッド上で前へ移るのを介助し」のところで一時停止せよ。 • 説明：介助者は、脚で車椅子ユーザーの膝を横から支えます（ユーザーの膝を前方からブロック してはなりません）。 • 説明：ユーザーは、手を介助者の肩（手は肩の上に置き、首まわりをつかんではなりません）か 臀部/骨盤部に置きます。 • 動画を再開せよ。 • 字幕「もっと上（肩甲骨）を支えてもよい」のところで一時停止せよ。 • 説明：介助者は、車椅子ユーザーの骨盤を支えても、体幹を肩甲骨のすぐ下で支えてもよいです。 介助者は、ユーザーに、頭や肩を足よりも前方へ出せるスペースを確保するよう注意しなければ なりません。 • 動画を再開せよ。 • 次の字幕「5. ユーザーを車椅子の方へ回旋させ、」のところで一時停止せよ。 • 説明：車椅子ユーザーが、完全に直立するようにしなさい。そのうえでベッドの端41へ回旋させ、 ユーザーが再び座れるようにしなさい。 • 動画を再開せよ。 • 動画のあと、「教習員用指導書」p.104 の要点をくり返せ。 • 受講者に、練習前に再度動画を上映してもらいたいか尋ねよ。 41 [原文] to the side of the bed [訳注] これは「車椅子の方」の誤りの可能性がある. 140 ToT 教習員によるデモ/説明 a. 第 5 節：床から車椅子への自力移乗 • 車椅子ユーザーが、床から車椅子座面へ移乗する筋力やバランスに乏しい場合もある。ユーザー は、以下の 2 段階での移乗が可能である： o 床からステップ42へ。ステップには、例えば 3 輪車椅子のフレーム、木箱、重ねた新聞紙、 低いスツールなどが可能。 o ステップから車椅子座面へ。 • ステップ/車椅子は、必ず安定しており、安全な位置にあること。 • 車椅子ユーザーは、移乗のための片手を、座面に代えてレッグパイプ上部やフレームの他の部分 に置いてもよい。 • 褥瘡発生の危険が非常に高い車椅子ユーザーは、車椅子のどの部分にもぶつからないよう、注意 する必要がある。 • 正しい技法を身につけ、この移乗を自力でやれるようになるには、教育指導の下で43たくさん 練習する必要があることを強調せよ。安全な移乗方法の開発には、車椅子ユーザーおよびその 家族と共に問題解決を図ることが重要である。 • グループ内にこの移乗をやって見せられる人がいれば、最後にやってもらえ。 42 [原文] step 43 [原文] under supervision 141 B.1: 紹介・相談および面接予約 この授業を教えるための主な留意点 a. 全般 準備のコツ • 受講者に、自分のサービス事業所で車椅子紹介・相談フォームを使用していれば、そのコピーを 持参してもらい、授業で共有せよ。それによって、授業がより対話的44になる。 b. 第 2 節：紹介・相談 • 受講者に、各自のサービス事業体制について共有するよう奨励せよ。例えば： o 既存の紹介・相談システム（車椅子に特化した紹介・相談システムがなければ、他の紹介・ 相談システムについて話し合え） o 紹介・相談システムがうまく働いているか。 o システムをどのように改善できるか。 o 紹介・相談の方法（例：電話、紹介状、電子メール）、紹介・相談に含まれる情報 o 受講者がもたらした車椅子サービス紹介・相談フォーム、または「教習員用指導書」の付録に 載っている車椅子紹介・相談フォームの見本 • 受講者の職場に紹介・相談システムが存在しない場合は、例えば実習生自身の仕事の経験を共有 せよ。これには、紹介・相談システムをどのように構築したか、また車椅子サービス事業にどう 有益だったか、あるいはどんな変化があったか、といったことが含まれよう。 • 受講者に、この話題を各自のサービス事業管理者に上げるよう奨励し、以下を支援せよ： o 紹介・相談元へ案内を出すために必要な情報を集める。 o 紹介状を作成する。 o 紹介・相談元を見定め、連絡を取る。 o 車椅子サービス事業所のオープンデイを開催するなど、サービス事業への関心を喚起する取り 組みを起こす。 o 紹介・相談を、サービス事業の力量と見合うように増大させる。 44 [原文] interactive 142 B.2: 事前評価 この授業を教えるための主な留意点 a. 全般 • これは、受講者へ基礎 WSTP の事前評価プロセスを紹介することが目的の、短い授業である。 • 事前評価インタビューや身体的事前評価に関する質問は、続く授業 2 コマで取り上げるため、 「保留スペース」に置いておけ。 b. 第 2 節：だれに車椅子が必要なのか？ • 車椅子の使用によって「怠け者」になったり、歩かなくなったりすることはない、と強調せよ。 運動機能障害を抱えながら歩くのは、運動機能障害なしで歩くより多くのエネルギーを要する。 そのため、車椅子と歩行補助具を組み合わせて使うのが最善であることが多い。 • 車椅子によって可能になることは： o 地域社会への参加および統合 o 自分の移動距離が広がる。 o より凸凹な地面45を往ける。 o 歩行よりも早いペースが可能 o 立ってバランスを保つために松葉杖・クラッチを使う人の場合、車椅子に座ると両手が自由に なるため、より多くのことができる。 c. 第 3 節：なぜ事前評価が必要なのか？ • 基礎 WSTP の事前評価フォームに含まれるのは、基礎レベルの車椅子事前評価に必要不可欠な 情報のみである。 • サービス供与者には、他種のサービスを提供するため追加情報の収集が必要な場合もある。それ は基礎 WSTP 教習では取り上げない。 d. 第 4 節：どこで事前評価を行うべきか？ • 受講者へ、事前評価を地域や車椅子ユーザーの家で実施する場合は、創造性を発揮するよう奨励 せよ。例えば、身体計測はベンチあるいは椅子に横向きに座った状態で可能、車椅子ユーザーの 足を支えるためにブロック類46を積んで足乗せにすることが可能など。 45 [原文] rougher terrain 46 [原文] bricks 143 B.3: 事前評価インタビュー この授業を教えるための主な留意点 a. 全般 準備のコツ • 多くの受講者は、車椅子事前評価フォームを見たことも使ったこともないかもしれない。受講者 には、「受講者用参考書」p.42 のフォームを活用して授業をこなすよう奨励せよ。 b. 第 2 節：車椅子ユーザーに関する情報 • 受講者は、習得途中ではフォームに頼ろうとするだろう。受講者へ、事前評価は余裕が出てくる に従い、対話として取り組むよう奨励せよ。 • 受講者には、集めている情報は、車椅子に関する決定にどう関連するのか考えるよう促せ。 c. 第 3 節：身体条件 • この節の授業がより対話的47になるよう、受講者の経験から知見48やアイデアを引き出せ。 • 「教習員用指導書」p.121 の本文「車椅子ユーザーの身体条件を知っておくと、(つねに必要とは 限りませんが) 役に立ちます49」を参照せよ。これについて全体で話し合え。車椅子事前評価に おいて、医学的診断を知ることは有用だが不可欠ではない、と強調せよ。よい車椅子処方に必須 の要素とは、徹底した事前評価インタビューと身体的事前評価である。 d. 第 6 節：事前評価インタビュー演習 • 教習員は受講者をモニターし、事前評価では受講者が話し合い、質問表にチェック印を付ける だけにならないようにせよ。 47 [原文] interactive 48 [原文] input 49 [訳注] 上記ページ第 2 行の箇条書き. 144 B.4: 身体的事前評価 WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 6 節：身体寸法の取り扱い50 • 本節の「教習員用指導書」p.140 の見出しは混乱を招く。本節は、身体寸法がどう車椅子寸法と 関係するかが内容である。上の見出しは、「身体寸法が車椅子寸法にどう関係するか51」に変更。 • 次の項目を、「教習員用指導書」p.131 の授業計画表の「教材」欄に追加52：「改訂版基礎車椅子 事前評価フォーム：各受講者につき 1 部」。 • 改訂版事前評価フォームは本書の付録に収載しており、また WSTP 用 USB メモリからもダウン ロード可能53。 • 事前評価フォーム「身体計測」の「身体寸法を理想的な車椅子寸法へ換算」列で、寸法 C・D に いくつか誤り54がある。 • 「教習員用指導書」および PPT の以下のスライドには、次ページの改訂版「身体計測表」(表 1) の情報と合わせて修正が必要である： o スライド 10：「教習員用指導書」p.138 o スライド 12：「教習員用指導書」p.140 o スライド 19：「教習員用指導書」p.143 • 受講者に、同様の修正を「受講者用参考書」p.48 および「受講者用ワークブック」p.18・19 へ 施す55よう指示せよ。 50 [原文] How to take body measurements [訳注] 原文通りだと「身体寸法の計測方法」等の訳になるが, 本書で 指摘されている問題点には訳者も基礎 WSTP の翻訳段階で気づき, 弥縫策として上の訳語を採っている. 51 [原文] How body measurements relate to wheelchair measurements 52 [原文] Add [訳注] 英語原著は配布部数も誤っていた可能性があり, この欄第 7 行の「差し替え」が適切であろう. 53 [訳注] 英語版のみ. 日本語の修正版は右 URL より閲覧・ダウンロード可能 (https://drive.google.com/open?id= 1zhhlGFDQkNb_zRbBc_VEZuvnevJcmaMU&usp=drive_fs). 54 [訳注] 修正内容は次ページ表 1 を参照. 55 [訳注]「教習員用指導書」付録 3, 別冊の「各種フォーム＆確認表」の同じフォームについても必要であろう. 145 表 1 身体寸法を車椅子へ換算 身体計測 身体寸法 (mm) 身体寸法を理想的な車椅子寸法へ換算 車椅子寸法 (mm) A 座位臀幅 座位臀幅＝座幅 B 座底長 右 B 引く 30〜50 mm＝座面奥行き56 （長さが異なる場合は、短い方を採用） 左 C 座位下腿長 右 (C 引く クッション厚さ*)57 C 引く クッション厚さ* ＝座面〜フットプレート58上端 または 座面〜床面 〈ユーザーのニーズによる〉 左 D 座面〜胸郭下端 (〈ユーザーのニーズにより〉D か E 足す クッション厚さ*)59 〈ユーザーのニーズにより〉D か E 足す クッション厚さ*＝座面〜背もたれ上端 E 座面〜肩甲骨下端 *車椅子ユーザーが使うクッションの厚さを確認。 この授業を教えるための主な留意点 a. 第 3 節：褥瘡の有無・危険・既往歴 • この節は「A.5: 褥瘡」と結びつけよ。［褥瘡の］危険因子を簡潔に復習し、どんな場合に除圧 クッションを指定するか再確認せよ。 b. 第 4 節：車椅子のこぎ方 準備のコツ • 事前に実習エリアを特定し、動線を塞がない足台60が付いた車椅子を用意しておけ。 56 [訳注] 2012 年発行の初版では「30〜50 mm」が「30〜60 mm」となっていた. 57 [訳注] 2012 年発行の初版では, *の注記のみでクッションの厚さ分を差し引く計算は示されていなかった. 58 [原文] footplate 59 [訳注] 2012 年発行の初版では, *の注記のみでクッションの厚さ分を加える計算は示されていなかった. 60 [原文] footrests that move out of the way [訳注] ユーザーの動線から外せる, 着脱式・開き式などの足台. 146 内容 「教習員用指導書」p.136 の足こぎ活動 • いっぱんに 3 輪車椅子は、ビーム61が足こぎの邪魔になるため不適当。 • 車椅子ユーザーには、後ろ向きにこぐ/進むのは、行き先が見えないため避けるよう助言せよ。 また、それにより座位姿勢が崩れる。しかし登り坂で、あるいは軟らかい地面や小さい障害物を 越えて行く場合には、後ろ向きにこぐ方が容易である。受講者には後ろ向きにこいで坂を登り、 違いを体感するよう勧めよ。 o ほとんどの人にとり、車椅子の標準的な座面高は、効果的に足こぎで前進するには高すぎる。 o ユーザーにとり、座面がじゅうぶん低くなければ、よい姿勢を保って前へこぐのは困難。 o ユーザーのかかとは楽に床面に届き、こぐために力を入れても、しっかりと床に着いたままで あることが必要。 • 座面が低い車椅子は広く出回っていないため、ユーザーの足を楽に床へ届かせるには改造が必須。 例えば： o クッション全体の高さ62 [厚さ] を減らす。 o 元の座面より低いソリッド座面63を取り付ける。板をシートパイプにフックでつり下げるよう にすると、必要ならば折りたたみのために取り外せる（図 6）。折りたたみフレームの車椅子の 場合は、クロスバーの上端をかわせるよう切り込む。この板は、クロスバーにも乗る。 図 6 フック付きの座板 • 座面およびクッションを改造。 • 以上はたいてい組み合わせが必要で、本書 p.185「クッションに関する付録」で詳述している。 61 [原文] the beam [訳注] 中央から前に突き出た前輪フレーム部分のことであろう. 62 [原文] the overall height of the cushion 63 [原文] solid seat 147 c. 第 5 節：身体計測 準備のコツ • 受講者 3 名からなる各グループに対して、身体計測活動に必要な機材（巻尺、クリップボード 2 枚、足乗せブロック 1 セットなど）を用意しておけ。 • 補助役教習員と、動画「身体計測のデモ：背もたれ高」のところ64で胸骨下端および肩甲骨下端 を見つけるデモのリハーサルをやって65おけ。 内容 • 動画を以下述べるように用い、学習の要点を強調せよ。 • 字幕はすべて読み上げよ。 「準備」の部 o 字幕「車椅子ユーザーがまっすぐに座っているか確認」のところで、評価者が助手を呼んだら 一時停止せよ。 o 説明：車椅子ユーザーが介助なしではまっすぐに座れない場合、助手が必要になります。 o 動画を再開せよ。 o 助手が車椅子ユーザーの側に座り、評価者が姿勢の確認を始めたら一時停止せよ。 o 説明：評価者は、助手に指示を出しながら姿勢を確認します。骨盤・体幹・頭・首が垂直線上 に並んでいなければなりません。 o 動画を再開せよ。 o 動画を続けながら説明：股関節・膝・足首は 90 度に屈曲していますね。 「身体計測」の部 o 字幕「座幅：臀部または大腿の最大幅」で一時停止せよ。 o 強調：クリップボードが平行で直立していることを確かめなさい。 o 動画を再開せよ。 • 字幕「かがんで巻尺を読み取る」で一時停止せよ。 • 以下を強調： o 2 枚のクリップボードの内幅を測りなさい。 o かがんで巻尺を読み取りなさい。さもなければ、読み取りが不精確になります。 • 動画を再開せよ。 64 [訳注] 1 分 52 秒〜2 分 24 秒の部分. 65 [原文] prepare to demonstrate 148 • 字幕「座底長：骨盤背面から膝裏まで」で一時停止せよ。 • 以下を強調： o クリップボードは直立させ、ベッド前端と同じ高さに保ちなさい。 o クリップボードの前端から膝裏までを測りなさい。 o 左右両側を測りなさい。 • 動画を再開せよ。 • 字幕「座底長66：座位下腿長：膝裏からかかとの底まで」で一時停止せよ。 • 以下を強調： o 最も精確に測るには、かかとから膝裏までを測ります。これは「教習員用指導書」p.140 の文 とは違います67。 o かがんで巻尺を読み取りなさい。 • 動画を再開せよ。 • 字幕「背もたれ高：座面から胸郭下端まで」で一時停止せよ。 • デモ：胸郭下端を見つけるやり方には、二通りあります。 o 両手を肋骨の両側へ当て、両手をいっしょに優しく絞り込みながら、胸郭の下へ滑らせます。 柔らかい部位に来たと感じたら、そこが胸郭下端です。 o または、両手を骨盤の上縁に当て、両手を優しく絞り込みながら柔らかい部位を見つけます。 徐々に正中線に向かいながら上へ移動し、肋骨を感じたところが胸郭下端です。 • 動画を再開せよ。 • 上の計測を行なっているところで一時停止せよ。 • 以下を強調： o 座面から胸郭下端へと測りなさい。 o かがんで巻尺を読み取りなさい。 • 動画を再開せよ。 • 次の字幕「高い背もたれの場合は、座面から肩甲骨下端まで」を強調せよ。ストップモーション68 になるので、ここで動画を一時停止する必要はない。 • 説明：肩甲骨を見つけるには、計測される人に肩をすくめて69もらいなさい。 • 動画を一時停止なしで再度上映せよ。 • 何か質問がないか尋ねよ。 66 [訳注] 原文では Seat depth: となっているが, この語は動画字幕にもなく余計 (削除し忘れ？) であろう. 67 [訳注] 基礎 WSTP 各教材の該当部分は「膝裏からかかとの底まで」で, 巻尺を当てる始点と終点が逆である. 68 [原文] frozen frame 69 [原文] shrug 149 d. 第 6 節：身体寸法の取り扱い (訂正70後の授業名：身体寸法が車椅子寸法にどう関係するか) • この節は、特に背もたれ高とフットプレート〜座 面71高の身体計測について、混乱を生じる場合が ある。 • ベッド上で身体計測を行なう場合、ベッド上面が 基準点となり、車椅子座面に相当する。 • 車椅子は、つねにクッションを付けて処方される ため、身体寸法を車椅子寸法へと換算するには、 クッション分の補正が必ず必要である（図 7）。 図 7 評価ベッドの上面を基準に測った 身体寸法 足台 • 身体寸法 C は、車椅子寸法では、座面クッション 上端からフットプレート上端までに等しくなる （図 8）。 • フットプレート〜座面高72、すなわち 車椅子座面〜フットプレート上端の計算式： 身体寸法 C 引く クッション高［厚さ］ 足こぎ用 • クッションは、ユーザーの位置を、車椅子座面に 対して高くする。 • 足でこげるためには、ユーザーが、クッションに 腰を下ろした状態で足が床面に届く必要がある。 • 床面〜座面高73の計算式： 身体寸法 C 引く クッション高［厚さ］。 • この車椅子寸法は、足こぎ用ではつねに身体寸法 より短くなる。 図 8 身体寸法 C は、車椅子寸法ではクッ ション上端〜フットプレート上端/床面 に等しい 70 [訳注] 訂正理由は p.144 を参照. 71 [訳注] ここから次ページの「座面」および「車椅子座面」はクッションを除いた状態の車椅子の座面を指す. 72 [原文] footplate height [訳注] 直訳は「フットプレート高」だが, 床からフットプレート上面までの高さとの混 同を避けるため. 73 [原文] seat height [訳注] 直訳は「座面高」だが, フットプレート上面から座面までの高さとの混同を避けた. 150 背もたれ • 身体寸法 D および E＝座面クッション上端から 背もたれ上端までの寸法74。 • どの寸法を用いるかは、ユーザーのニーズによる。 • つねにクッションを置いて座る以上、クッション を見込んで計算するのが当然である。 • 車椅子寸法（座面〜背もたれ上端）を算出するに は、クッション高［厚さ］を身体寸法 （D または E）に加えなければならない。 • 車椅子寸法 (座面〜背もたれ上端)＝ 身体寸法 D または E＋クッション高［厚さ］ • たいへん厚いクッションだが、柔らかいウレタン フォームでできているものもある。この場合は、 クッション高［厚さ］を半分として計算するのが、 座った時にそれくらい圧縮されるため、より精確 であろう。 図 9 身体寸法 D/E は、車椅子寸法の 座クッション〜背もたれ上端に等しい 74 [訳注] 指定はないが, 図 9 はこの内容を指すとみてよい. また図 8 のようにクッション上端から背もたれ上端まで の破線矢印があると親切. 151 B.5: 処方（選択） WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 5 節：正しい車椅子サイズを選ぶ • 「教習員用指導書」p.153-154 の表の「身体寸法を理想的な車椅子寸法へ換算」列を、本指導書 「B.4: 身体的事前評価」の p.145 表 1 に揃えて訂正せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • デモ用車椅子を座学エリアに置き、テーブルや箱の上に載せてよく見えるようにしておけ。 • 記入済みの「車椅子概要フォーム」および「車椅子処方フォーム」のコピーを揃え、受講者へ 配布できる状態にしておけ。これらは、教習プログラムの後も重要な参考資料になる。 • 受講者は、処方とは車椅子のサイズ決めに過ぎない、と考えがちなので気をつけよ。受講者に、 適正な車椅子の定義の主要素、すなわち環境、機能（日常活動および生活様式）、フィッティング (サイズ)、姿勢支持のニーズを再認識させよ。まず、これらのニーズに合致する車椅子の特色を 判断せよ。それから、その特色を備え適切なサイズの車椅子のメーカーおよびモデルを見定めよ。 • 工具は各グループに 1 セットずつ渡るよう努めよ。共有するよりも作業が早く進むからである。 b. 第 3 節：現地で手に入る車椅子とクッション • 可能であれば、各グループに技術職の受講者を入れよ。技術職の受講者は、車椅子のさまざまな 特色に、より精通しているだろう。 • 車椅子の背もたれ高75の寸法は、車椅子座面から背もたれ上端までを、クッションなしで測る。 • 受講者は、車椅子概要表76をサービス提供にどう活用したらよいか分からずにいることが多い。 これは、既存の製品や新製品を同じ評価基準で比較するための優れたツールであることを説明 せよ。特に、車椅子に複雑な調節が必要なユーザーへの処方を選択するために役立つ。 75 [原文] back height [訳注] 背もたれ高 backrest height とは訳語も区別した. 76 [原文] wheelchair summary sheet [訳注] メーカー等が作成したものも含むため, WSTP に付属している車椅子 概要フォーム wheelchair summary form とは訳語でも区別した. 152 c. 第 5 節：正しい車椅子サイズを選ぶ • 「教習員用指導書」p.152 の活動では、「B.4: 身体的事前評価」で取り上げた、クッションに 関する計算を明確に理解している必要がある。 • 受講者は、用意された車椅子は、どれも「受講者用ワークブック」の 2 つのケーススタディの ために適切なサイズではないと判断するかもしれない。この問題は「B.10: 問題解決」で取り 扱う。その見識を受けとめ承認し、問題は「保留スペース」に置いておけ。 d. 第 6 節：処方を記録する • 「車椅子処方フォーム」のスライドを映すさい、受講者に「受講者用参考書」p.51 を確かめて 行くよう指示せよ。受講者は、そのプレゼンテーションや話し合いのあいだ、フォームにメモ を取れる。 • 処方プロセスへ車椅子ユーザーが参画することの重要性を強調せよ。 153 B.6: 資金調達および発注 この授業を教えるための主な留意点 a. 全般 準備のコツ • この授業の内容は、各々の国/状況での車椅子の資金調達と発注のプロセスから影響を受ける。 • 授業準備では、どんな資金調達の選択肢があり、どの発注プロセス（あれば）に従うのか確かめ ておけ。 • 各々の状況に応じた情報や話し合いがあると、この授業が受講者によりぴったり来るものになる。 • 教習員は、自分自身の経験から得たモデルを、例として共有してもよい。 内容 • 多くの低リソース状況では公式の資金調達や発注のプロセスがなく、寄付のみが頼りであること に留意せよ。 • 最適な車椅子は、入手できるものから選択される。可能であれば、最適な車椅子の中から車椅子 ユーザーが選べるようにせよ。このシステムの課題および管理方法を、受講者と話し合え。 • 受講者には、車椅子ユーザーのデータベースを構築するよう奨励せよ。それによって、可能性が ある寄付者や資金供与者と、受講者のサービス事業を利用する車椅子ユーザーのニーズに関して 交渉できる。また、データベースには各ユーザーに対する車椅子の仕様が記録されるため、発注 プロセスが容易になる。 o データベースを構築するさい、サービス供与者は、ユーザーの個人情報のプライバシーおよび セキュリティを考慮すべきである。これには絶対に、何を共有するか、いつ共有するか、だれ と共有してよいかに関するガイドラインを含めよ。 • 受講者は、車椅子概要フォームは、各ユーザーへの適正な車椅子を発注する際の目安に使えると 助言せよ。これは時間を節約し、特に複数の選択肢があるメーカーやモデルの場合に有用である。 154 B.7: 製品（車椅子）の下準備 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「車椅子の安全・準備完了確認表」をラミネート加工しておくと、受講者が再使用できる。 • 授業の前に、処方フォームに目を通しておけ。どのグループにより複雑な技術的調整や改造が 必要になるかに注目し、そうしたグループへの資材や追加工具を用意しておけ。 • 多くの、または複雑な調整や改造が必要な場合には、授業を支援する追加の技工スタッフを 手配せよ。授業に先立ち、その技工スタッフとの打ち合わせや教習が必要かどうか検討せよ。 b. 第 2 節：車椅子の下準備 準備のコツ • 受講者全員が、工具の扱いおよび工房で守るべき基本的注意事項に習熟しているか確かめよ。 そうでない受講者がいれば、授業の最初にあらゆる疑問/懸念について話し合い、以下の、工房 での安全の基本的注意点77を復習せよ： o 工具を使って作業する時は、足を覆う靴を履く。 o 作業区域を整理整頓し、清潔に保つ。 o 決して、自分自身や他人に向かって切らない。 o 電動工具に慣れていない場合は、補助を頼む。 o 電動工具や鋭利な工具を使う時は、安全メガネをかける。 o 切断や穴開けをする時は、部材をしっかり固定する。 • 授業の最初に、使用する工具を紹介せよ。 • 用意された車椅子が、受講者が処方したものと寸法が大きく異なる（幅が広すぎる、足台が低す ぎるなど）ものしかない場合もある。この場合、授業を支援して受講者が活動を所定の時間内で 完結できるよう、追加の技工スタッフが必要である。授業後、技工スタッフはさらに大幅な改造 を加えてもよいが「実習 2: フィッティングおよびユーザー教習」の前に完了すべきである。 77 [原文] basic workshop safety points [訳注] この説明は基礎 WSTP 教材中にはない. 中級 WSTP で取り上げて おり, 類似の説明が同教習員用指導書 p.192, 受講者用参考書 p.109 に載っている. 155 • 車椅子に複数の調整が必要な場合は、この授業により多く時間を割り振るか、特定の調整（駆動 輪位置や、その他高度な技術的調整）は技工スタッフが行なうようにせよ。 • 車椅子ユーザーが 2 日間にわたって参加できない場合、この授業はユーザーへの処方を完了する 前に実施する。その場合は「教習員用指導書」の「2. 車椅子の下準備」(p.165) の活動を割愛し、 車椅子ユーザーが参加する日に実習の一部として行なうにとどめる。 内容 • PPT では、製品の下準備を明確な段階を踏んだプロセスとして述べている。「教習員用指導書」 p.165 の活動では、このプロセスを強調せよ。 • 受講グループが安全に作業し、所定の時間内に終了できるようにせよ。 c. 第 3 節：車椅子の安全・準備完了確認表 準備のコツ • 車椅子ユーザーが 2 日間にわたって参加できない場合、この授業はユーザーへの処方が完了する 前に実施する。その場合、教習員は、小さい不具合のある車椅子を各受講者グループへ用意する とよい。例えば、クッションを上下/前後逆にクッションカバーに収める、いくつかのボルトを ゆるめる、片方の足台を下げる、タイヤの空気を抜くなど。 内容 • 動画上映前に確認表を 1 部ずつ各受講者へ配布し、視聴しながらそれに目を通せるようにせよ。 156 B.8: クッションづくり この授業を教えるための主な留意点 a. 全般 準備のコツ • 提示中に回覧するため、「かさ上げ」の付いた除圧クッション（表層と基層）を用意しておけ。 • この授業への準備は、状況によって変わる。クッション基層から製作が必要ならば、2 日前まで には開始せよ。詳細は本書 p.185「クッションに関する付録」を参照。 • この授業では、「A.7: クッション」で取り上げた情報を復習する。そのプレゼンテーションを、 スライドにまとめられた原則を説明させて、受講者の理解度を評価する機会として活用せよ。 b. 第 2 節：クッションの特徴および寸法 • 「教習員用指導書」p.173 に示した座骨井の寸法は、正しい用語と基準点を用いながら、明確に 説明する必要がある。これはたいてい、受講者にとって新しい概念だからである。 • 受講者へ、フィッティングの過程で、圧力検査を用い座骨が井戸穴78へ正しくフィットしている ことを必ず確認するよう念押しせよ。必要ならば、座骨井 24 は調整しなければならない。 c. 第 4 節：クッション基層のつくり方：練習 • 現地生産のクッションが手に入らない場合は、この授業時間を「実習 1」で事前評価した車椅子 ユーザーへのクッション製作に充ててよい。受講者には実習 1 と同じグループで作業し、処方の 授業で計算した寸法を用いるよう指示せよ。 • 表層と基層を接着することを選択した場合は、基層の起伏に表層の形を合わせるよう注意せよ （起伏の上でぴんと張ってしまうと、クッションの除圧特性が失われる）。 • 可能ならば技術教習員をこの授業に参加させ、また各グループに技術職の参加者を 1 名ずつ配置 して、活動のあいだ同輩の受講者たちを指導してもらえ。 • 受講者に、各自ウレタンフォームに寸法線を引き終えたら、クッションの寸法を再確認するよう 促せ。 • けがき [寸法付け・加工線引き]79作業には、10〜12 分見込んでおけ。 • すばやく、手際よくやり終えた受講者には、遅いグループを手助けしてもらうとよい。 78 [原文] the well [訳注] seat-bone well の切り取り穴部分. 79 [原文] marking and drawing 157 d. 第 6 節：ウレタンフォーム除圧クッションに関する、よくある質問 • 「このクッションは、あらゆる車椅子ユーザーに有効だろうか？」どんなユーザーにも有効な クッションはない。 • 「除圧クッションは、あらゆる車椅子ユーザーに必要だろうか？」受講者に以下を念押しせよ： o 感覚異常があるか感覚がない80車椅子ユーザーには、必ず除圧クッションを供与すべき。 o 感覚はあるが褥瘡の危険因子が 3 つ以上ある車椅子ユーザーにも、除圧クッションが必要。 o 褥瘡の危険因子がない車椅子ユーザーには、快適なクッション81や姿勢支持クッションが必要 である。除圧クッションは、座骨前方の棚状段差 (座骨井の前縁)82が、車椅子ユーザーが崩れ る/滑る83のを防ぐため、姿勢の改善や姿勢支持のために活用できる。 80 [原文] with altered or no sensation 81 [原文] comfort cushion [訳注] 材質や形状により快適さを高めたクッションの総称として訳した. 82 [原文] pre-seat bone well (front of the well) 83 [原文] slumping/sliding 158 B.9: フィッティング この授業を教えるための主な留意点 a. 全般 準備のコツ • 提示中にフィッティング確認の手技をやって見せる計画であれば、車椅子を 1 台、座学エリアに 置け。どの受講者からも見えるようにせよ。 ジェンダー/文化への考慮 • グループ分けのさい、受講者をジェンダーによってグループ分けすべきか検討せよ。 b. 第 2 節：フィッティングの優れた実践 • フィッティング手順の動画を視聴したあと（「教習員用指導書」p.183）「車椅子フィッティング 確認表」の手順を踏むことがどれほど重要か強調せよ。 c. 第 3 節：フィッティング演習 準備のコツ • グループの受講者が、自分にフィットする車椅子を得られるようにせよ。 内容 • 座幅の確認：大腿は、車椅子の側面/ひじ掛けに接触してよい。座幅は、評価者が大腿と車椅子と の間でスムーズに指を滑らせられるだけあればじゅうぶんである。大腿とひじ掛け/側面の間に 圧力が生じるのは避けよ。 • 座面奥行きの確認：クッションとふくらはぎ後面は接触してよい84が、圧力が生じてはならない。 • 足台〜座面高：足台と地面の間には 5 cm 程度すき間が必要である。つまり足台の長さ調整には 限度がある。 • 足こぎ：座面が高すぎると、車椅子ユーザーは足を地面にべったり着けられないため、「技術に 関する付録」85で述べている改造を（クッションまたは車椅子に）加えよ。 84 [訳注] 基礎 WSTP の教習員用指導書 p.180. 受講者用参考書 p.63 では, ふくらはぎ後面が「座面にもクッション にも触れないことを確かめ」る, とされており, やや修正されている. 85 [訳注] この見出しは原著に存在しないが「クッションに関する付録」p.188-189 にこの条に関する解説がある. 159 B.10: 問題解決 WSTP［車椅子サービス教習パッケージ］教材の誤り • 第 1 節「はじめに」：スライド 2 の箇条書きの最終条の階層を変更し、レベル 1 の条（最初の条 と同じビュレット［・］付き）にせよ86。 • 第 2 節「短すぎる、あるいは長すぎる座面奥行き」：この節に第 1 節［1.］と表記されているが、 誤りである87。 この授業を教えるための主な留意点 a. 全般 準備のコツ • この授業には、技術担当の補助役教習員がいると助かる。 • 5 通りの問題解決の授業に必要な資材を準備せよ： o 適正な車椅子を選び、座面奥行きを延長するデモを行なえるよう布地とベルトを準備せよ。 o 見本の車椅子に合わせて、木板をあらかじめ切っておけ。これは、車椅子のシートパイプ88に それを取り付ける方法をやって見せるため。 • 授業は、提示するだけでなく自分のファシリテーション技能を活用し、受講者が解決策を見出す よう促せ。例えば問題解決のためにどの資材を用い、それを車椅子のどこへどのように取り付け るのか、受講者に質問せよ。その解決策が、移乗や車椅子の折りたたみなどの機能を決して妨げ てはならないことを強調せよ。 • 受講者が経験豊富であれば、受講者をグループに分けて 1 台ずつ車椅子を与え、いくつか課題を 与えてブレインストーミングさせることを検討せよ。 86 [訳注] 日本語版は翻訳段階で修正済み. 87 [訳注] 日本語版は翻訳段階で修正済み. 88 [原文] seat rails 160 b. 第 2 節：短すぎる、あるいは長すぎる座面奥行き 問題：短すぎる座面奥行き • この解決策が、車椅子の折りたたみ機構に差し支えてはならない。 • 座面奥行きを延長する場合は、木かその他の固い 素材を用い、その板をフックでシートパイプから つり下げる。そうすると、必要な時に取り外して 折りたためる（図 10）。 • 折りたたみフレーム車椅子の場合、クロスバーの 上端をかわせるよう切り込む89。この板はクロス バーにも乗る。この座面をシートパイプ上に固定 すると実質的に座面が持ち上がり、駆動輪、足台、 背もたれへの距離に影響することに留意せよ。 図 10 座面奥行きを延長する • 替わりの選択肢として、ハードボード［硬質繊維板］など薄い板を用い、シートパイプの間隔に 合わせて裁断し、座面前端をはみ出させて延長する方法がある。軽量であれば、それを延長した 車椅子クッションの底に貼り付けてもよい。 • 既存のクッションを延長する場合は、前方を延長せよ。クッション後方を延長すると、接着剤の 盛り上がりが、ユーザーの褥瘡発生の危険を高める。シートパイプを延長して、新しい張り布を 取り付ける方法を実演し、どうやってやるのか受講者が判るようにせよ。 問題：長すぎる座面奥行き • 張り布90座面の短縮：通常、座面の脇には補強として細い金属板91が付いている。張り布を切って 縫い直す場合、この板も短縮しなければならない。あるいは張り布前部に脇のさや部分92を残し、 金属板を付け戻せるようにしてもよい。こうすれば張り布の延長が必要になった（例えば子ども の成長により）場合も、金属板は完全なままである。 • 座面奥行きを短縮しながら、子どもの成長にも対応できる別のやり方は、張り布上面の金属板を 収めるさや部分93に、小さな切り込みを入れておくことである。金属板をこの切り込みから突き 出させ、張り布はこの位置で折り返す。折り返し部分は、貼り合わせても、かがり縫いして固定 してもよい。付け戻す前に、補強ベルトを座面の前部（座面と折り返しの間）に付加しておく。 補強ベルトは直接シートパイプに取り付けるか、シートパイプを巻いてベルト自体に接合する。 89 [原文] cut reliefs for the top of the cross brace 90 [原文] upholstery [訳注] ここの問題に関しては, この語は「スリング」とほぼ同義で使われている. 91 [原文] metal strip 92 [原文] slot 93 [原文] sleeve 161 • 背もたれにクッションを付加しても解決にはならない。理由は： o 自操するための、駆動輪への手の届きやすさを制限する。 o 車椅子ユーザーの体重が前方へ移動して前方キャスターに負荷がかかるため、車椅子が前方へ 転倒する危険が増す。 c. 第 3 節：低すぎる、あるいは高すぎる足台 準備のコツ 問題：低すぎる足台 • ウレタンフォームブロックを切り、見本の車椅子の、はね上げ式フットプレートの一つに合わせ ておけ。ブロックはフットプレートがうまくはね上がらない程度にじゅうぶん厚くせよ。見本を もう一つつくり、レッグパイプが妨げにならないように溝を切っておけ。 問題：高すぎる足台 • 硬いウレタンフォームを切り、既存の車椅子座面の一つに合わせておけ。可能であれば、それが クッションカバーの内側へどのように収まるかやって見せよ。 内容 問題：低すぎる足台 • 足台にかさ上げ94が必要な場合、ゴム/EVA/木や同様の硬い素材が好適。かさ上げは、足台上に 接着する。フットプレートに接着できない場合は、木板を切って用いる。木板をフットプレート にボルト止めし、その木板にウレタンフォームを接着する。 • 改造が、足台をはね上げたり開いたりする機構を妨げてはならない。上記「準備のコツ」で説明 した 2 種類の見本をつくっておき、この問題および解決方法をやって見せよ。 問題：高すぎる足台 • 足台の底と地面の間には、必ず最低 5 cm のすき間が必要である。 • クッションの高さを上げることは、足台が高い問題への解決策として授業計画に示されている。 クッションを上げることが、背もたれ高、ひじ掛け高、駆動輪への手の届きやすさに及ぼす影響 を強調せよ。実践では、受講者は上の 3 点をすべて勘案し、クッションを上げることが機能的な 解決策かどうか、個々の車椅子ユーザーについて判断すべきである。 94 [原文] building up 162 d. 第 4 節：脚が内転、あるいは外転しがち 準備のコツ • 硬いウレタンフォームのウェッジ95を切り、見本の車椅子クッションの一つに合わせておけ。 内容 • ウェッジをクッション基層に接着し、それからクッション表層をかぶせる方法をやって見せよ。 このことは「教習員用指導書」p.191 のスライド 12 を映した際に強調せよ。受講者によっては、 このイラストを、クッション表層の上にウェッジを接着していると受け取るからである。 • 車椅子クッションに着脱できる表層のウレタンフォームがない場合は、クッションの側面を切り 込み、ウェッジを置いて接着するやり方を受講者に示せ。 • ウェッジは、移乗を妨げてはならない。 • ウェッジに使える素材の、サイズと種類について話し合え（通常はクッション基層と同じ素材）。 • 座面が中央でたるみ、設計上、座面の張りを直す のが難しければ、スリング補正パッド96を用いて 脚が内側に閉じるのを止めてもよい（図 11）。 図 11 スリング補正パッド e. 第 5 節：足が足台から滑り落ちがち • 下腿/足首ベルトの、さまざまな位置/取り付け方について話し合え。 • ベルトは、足台の機構（例えばはね上げ機能）を妨げてはならないため、着脱可能にすることが 必要な場合もある。 95 [原文] wedges [訳注] くさび, あるいはくさび形のもの. 中級 WSTP 教習員用指導書 p.253 などを参照. 96 [原文] sling-filler pad 163 f. 第 6 節：幅が広すぎる車椅子 準備のコツ • EVA かその他の硬いウレタンフォームから見本を切り出し、「外層97」の素材をいくつか用意 して、布、革や EVA フォームでウレタンフォームにカバーをかけるやり方を示せ。 内容 • どんな素材（カバーをかけた EVA/ゴム/チップウレタン）でパッドをつくれるか話し合え。 • パッドをどこへどのように取り付けるか（車椅子あるいはクッションに；着脱式あるいは固定式 で）話し合え。いろいろな解決策の長所と短所、またそれらが、車椅子の折りたたみ機構などの 機能や移乗にどう差し支えるかを話し合え。 • クッションは、車椅子座面と同じサイズのままでなければならない。パッドはクッションより上、 あるいはクッション上に設置。 97 [原文] outer layer 164 B.11: ユーザー教習 この授業を教えるための主な留意点 a. 全般 • 車椅子のメンテナンスに関する質問は「保留スペース」に置いておけ。これらは「B.12: メンテ ナンスおよび修理」で取り上げる。 • 確認表に収めたユーザー教習の技能は、「A.3: 車椅子による移動」「A.5: 褥瘡」「A.8: 移乗」で 取り上げている。 • 教習員やサービス供与者にとり、あらゆる車椅子技能について、教える前に自分自身がそれらに 自信を持っていることは重要である。 • ユーザー教習にじゅうぶん時間をかけられるよう、授業を段取れ。 • ユーザー教習は車椅子サービス供与に不可欠のステップであることを強調し、教習プログラムで は絶対にその時間を取れ。ユーザーが適正でうまくフィットする車椅子を持っていても、移乗や 移動の技能に自信がないばかりに家から出られない場合もある。 b. 第 2 節：車椅子ユーザーの役に立つ技能とは？ • あらゆる車椅子ユーザーに、6 つの技能すべてを教える必要はない。受講者は車椅子事前評価で 集めた情報に基づき、どの技能がそのユーザーに該当するか見極める必要がある。 c. 第 3 節：車椅子ユーザー教習の演習 • 受講者に、優れた教え方の 3 ステップ、説明・デモ・練習に沿って進むよう促せ。 • 車椅子ユーザーに関わる人（家族・介助者）も、皆その技能を学ぶ必要がある理由を説明せよ。 • ピア教習98の有益さを強調せよ。特に新しいユーザーにとって、他の車椅子ユーザーと語り合い、 かれらに学ぶことは非常に有益である。既存の車椅子ユーザーは、自分の体験や個別状況への理 解に基づいて、仲間たちへ技能をやって見せ、教えるために最適な立場にある。 98 [原文] peer training [訳注] 同様の問題を抱える仲間 (当事者) どうしで行なう教習. 165 B.12: メンテナンスおよび修理 この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業開始前に、現地でどの潤滑剤が手に入るか、また現地の車椅子のどの部材に潤滑剤が必要か を見出しておけ。家庭でのメンテナンス用工具キットを、各グループに一式ずつ（あるいは複数 グループで共有してもらう）まとめておけ。キットの内容：スパナ、六角レンチ、ドライバー、 タイヤの空気入れポンプ、パンク修理セット、潤滑油、バケツ、石けん、布、サンドペーパー。 • 可能であれば、技工的経験のある受講者を、支援と指導のため各グループに 1 名配置せよ。 内容 • 受講者が、メンテナンスと修理の違いを理解しているか確かめよ： o メンテナンスとは、破損や故障を防ぐための日常的手入れのこと。 o 修理とは、破損して補修や交換が必要な部材に関わること。 b. 第 2 節：修理を予防する：家庭でのメンテナンス 準備のコツ • 石鹸と水で車椅子を清掃する場所を決めよ。これは「教習員用指導書」p.205 のメンテナンス 活動のため。 内容 • 現地の車椅子のメンテナンス要件を明確にせよ。例えば、潤滑剤が不要の密封型ベアリング99が 付いているかもしれない。受講者に適切な潤滑油の目安を示せ。ミシン油などサラサラした油100 を勧めよ。エンジンオイルなど粘っこい油101は不適。有機質の天然油（ココナッツ油やオリーブ 油）は、代替品がない場合は使用可能だが、ありがたくないことに虫を誘引しがち。合成潤滑油 は、より効果的で長持ちする。 99 [原文] sealed bearings 100 [原文] light oil 101 [原文] heavy oil 166 • 資料動画の「可動部への注油」の部分には 2 点、混乱を招きそうな箇所がある： o キャスター受け具の密封型ベアリングに潤滑剤は不要。しかし、動画を撮った島嶼部の気候は 湿度と塩分が多いため、キャスター受け具の上面に少量の油を施してサビを抑えている。 o 前方キャスター車軸のナットは可動部ではないので、注油は不要。ここでも、島嶼部の気候の ため、少量の油を施してサビを抑えてもよい。 • 1 本か、飛び離れた 2 本のスポークがゆるんでいる場合は、家庭でのメンテナンス作業として、 スポークレンチで締めなければならない。スポークは、張りすぎないように注意。これは、その 両隣の（車輪のリムに付いている）スポークニップル［を回すため］にどれくらい力が必要かを 確かめ、ゆるんだスポークにも同じ力を要する程度にする。スポークが非常にゆるんでいたり、 外れたりしている場合は、車輪を自転車修理店へ持って行く。 c. 第 3 節：車椅子およびクッションの一般的な修理 • 「教習員用指導書」p.206 の活動で、受講者は各自の車椅子に必要な修理を特定し、どこでその 修理を行なえるか判断できなければならない。自分で修理を行なう必要はない。 • 問題がある中古車椅子を用意できない場合は、手持ちの車椅子に何か問題をつくり出せ。例えば、 車軸やブレーキ、キャスターフォークのボルトとナットをゆるめる、タイヤの空気を抜く、張り 布のボルトとナットをゆるめるなど。これらの問題点は、授業の終わりに忘れずに修復すること： 「車椅子の安全・準備完了確認表」を活用せよ。 • 修理には、曲がった部材の再調整102（正しい形状に曲げ戻すこと）や交換も含まれる。 102 [原文] re-aligning 167 B.13: フォローアップ この授業を教えるための主な留意点 a. 第 2 節：フォローアップとは何か、またどのように行なうのか？ • 「教習員用指導書」p.214 の箇所で、フォローアップをどれくらいひんぱんに行なうべきか話し 合う場合、以下の点を目安に用いるとよい： o 初めて自分の車椅子を受け取った車椅子ユーザーは、その 4〜8 週間後にフォローアップを 受けるべきである。 o 子どもや進行性疾患のある車椅子ユーザーは、ニーズが急激に変化しうるため 4〜6 か月おき にフォローアップすべきである。 o 状態が安定しており長い間車椅子を使っている車椅子ユーザーには、フォローアップは年 1 回 でもよい。 o フォローアップ日を設定する際には、個々人のニーズをよく考えよ。 b. 第 5 節：要点のまとめ • フォローアップとは、単に確認表を埋めることにとどまるものではないと強調せよ。 • 受講者には各設問を批判的に考察し、車椅子ユーザーの応答がさらにやるべきことへどのように 影響するか、考えるよう促せ。 • フォローアップでの車椅子ユーザーからのフィードバックは、ユーザーの体験103への洞察を与え、 サービス供与者に貴重なフィードバックをもたらす。 103 [原文] lived experience 168 B.14a: 実習 1〜4 この授業を教えるための主な留意点 a. 全般 準備のコツ 教習エリアおよび設営 • 実習エリアを、インタビューと身体的事前評価を人目に触れないで104実施できる、じゅうぶんな スペースを各グループが持てるように設営せよ。 グループ分け • 同じサービス事業所からの受講者をいっしょのグループにする、および/または臨床職と技術職 の受講者で混成グループにすることを検討せよ。自信満々の/饒舌な105受講者と、寡黙な/自信の ない受講者とをグループにまとめ、他のグループと揃ったペースで作業できるようにせよ。 教育指導 • 各グループに教育指導役の教習員を配置せよ。リーダー役教習員は、補助役教習員と確認を取り 授業を順調に進行させるためにじゅうぶんな時間を必要とするため、教育指導するグループ数を より少なくすべきである。 車椅子ユーザー • サービス事業と教習プログラムとを繋ぐ、主催団体の連絡担当者を決めておけ。その役割は、 車椅子ユーザーの応接、遅刻者のフォローアップ、教習プログラム後のユーザーへのフォロー アップの調整など。 • 代理の車椅子ユーザーを、だれかが参加できなくなった場合には頼めるようにしておけ。 • 到着した時点で自分の車椅子を持ってない車椅子ユーザーには、一時的な車椅子とクッションを 用意しておくこと。 • 車椅子ユーザーへの、食事と飲み物が用意されていることを確認せよ。 104 [原文] privately 105 [原文] talkative 169 写真撮影 • 車椅子ユーザーおよび受講者が写真を撮られることに同意し、写真撮影同意フォームに署名して いることを確認せよ。 • クッションに施したあらゆる改造は、カバーをする前に写真に撮っておくこと。 • 実習中、ビフォーアフター106の姿や、改造部分の拡大写真を撮っておけ。「B.14: 総まとめ」での 受講者による発表が、これにより、学習実践としてより有益なものになる。 • 教習員を 1 名、写真係に任命せよ。これによって受講者は実習により集中でき、事後に写真を ダウンロードしたり、整理したりも楽になる。 b. 実習 1: 事前評価および処方（選択） • 開始前に、受講者は、だれがどの作業（インタビュー、身体的事前評価、身体計測、フィッティ ング、ユーザー教習）を担当するのか、決めておく必要がある。受講者は互いに口を挟まず、 同僚が終えるのを待ってコメントを加え、次の作業へ移るべきである。 • 受講者に、事前評価インタビューは 20〜25 分で完了するよう指示せよ。 • 身体的事前評価を注意深くモニターし、処方に影響を及ぼしうる誤りはすべて訂正せよ（例えば、 正しくない計測技法）。 • 身体寸法は、車椅子処方の作成前に、車椅子寸法に換算されていること。 • 車椅子ユーザーは、処方プロセスへの積極的参加者であるべき。受講者は、車椅子の選択肢や 特色について車椅子ユーザーと話し合ったうえで最終処方をつくること。デモ用車椅子が使える 場合は、それを用いて車椅子の個々の特色をユーザーに説明し、質問に答えるとよい。 • 受講者の各グループに、各自が選択した処方についての臨床推論107を説明してもらえ。 c. 実習 2: フィッティングおよびユーザー教習 • 各教習員は、実習 1 と同じグループの教育指導を務めること。 • 受講者は最初の確認を、ユーザーが車椅子に座った状態で、座幅、座面奥行き、足台〜座面高に ついて行なうべきである。続いて他の受講者に注意深く観察してもらいながら、車椅子ユーザー に適切な走行面でこいで（腕か足で）もらう。これは、例えば駆動輪位置の変更や背もたれ高の 引き上げといった大きい調整が必要かどうかを判断するために役立つ。受講者が「車椅子フィッ ティング確認表」を完成し、すべての調整を完了する作業に入ってよいのはそれからである。 106 [原文] before and after [訳注]「ビフォーアフター」の方が通りがよいかもしれない. 107 [原文] clinical reasoning 170 • あらゆる調整や改造について、受講者がそれらを所定の位置に接着/固定する前に確認せよ。 • 最終のフィッティング確認を、受講者がユーザー教習を始める前に確認せよ。 • 車椅子ユーザーが去ってしまう前に、ユーザーに車椅子についての問題や疑問が出た場合、助け になる人の名前と連絡先を伝えよ。車椅子ユーザーへのフォローアップについて、アクセスが 容易なサービス事業所での面接予約を段取れ。 • 適切かつ時間が許せば、終わりは短いフィードバックの話し合いで締めよ。 d. 実習 3: フォローアップ 準備のコツ • 状況によっては、修理や調整をすべて完了することへの大きいプレッシャーがかかる。しかし、 フォローアップの重点は教習であって、そうした追加要請には同時に対応できないことが多い。 車椅子ユーザーへ十全な情報を与えることによって、ユーザーの期待を現実的なものにすること が重要である。 内容 • 受講者を新しいグループへ配置せよ。 • グループをモニターし質問して、受講者が得た情報を理解し適切な行動を取れるか確かめよ。 • 改造や変更の必要が生じたら、すべて文書化して教習員と話し合うべきである。単純かつ所定の 時間に収まるものであれば実行してよい。 e. 実習 4: 事前評価・処方（選択）・製品（車椅子）の下準備・ フィッティング・ユーザー教習 • 受講者を新しいグループへ配置せよ。導入では、各ステップにどれだけ時間を割り当てているか （「教習員用指導書」p.224 に列記）説明せよ。受講者が時間を守れるよう、この情報をホワイト ボードに書き出せ。受講者はステップの完了ごとにチェック印を付け、要した時間を示せる。 • 作業が捗るように、技工スタッフを、その経験と都合に応じて各グループに 1 名ずつ配置する ことを検討せよ。 171 • 全ステップを完了する時間がないグループが出た場合は、車椅子ユーザーが容易にアクセスでき るサービス事業所で作業が完了されるよう、予約を段取れ。 • 受講者には、グループ内で作業を分担すべきであると説明せよ。例えば製品の下準備では、一人 がフットプレートを調整し、別の一人がクッションの座骨井を切り、もう一人が車椅子を狭める パッドを切り出すなど。上手に作業を分担すると、すべてのステップを所定の時間内に完了でき るようになると説明せよ。 172 B.14: 総まとめ WSTP［車椅子サービス教習パッケージ］教材の誤り a. 第 2 節：受講者からの質問 • 「教習員用指導書」p.225 の活動時間は「合計 5 分取っておけ」とすること（10 分ではなく）。 この授業を教えるための主な留意点 a. 第 3 節：受講者の準備 準備のコツ • 教習員の一人に、発表での説明に必要な、ビフォーアフター108の写真をダウンロードして整理 する役を割り当てよ。この作業は休憩時間に行なうこと。 • ビフォーアフターの写真を並べて表示せよ。これは、フィッティングの効果と成果とを示す、 効果的な方法である。 内容 • グループの準備を手伝う補助役教習員を配置せよ。 • 受講者へ、各発表が制限時間 10 分に収まるよう、残り 5 分と 1 分で合図することを伝えよ。 b. 第 4 節：受講者による発表 • 発表に対してファシリテーションを行ない、受講者の集中を保ち、学習の要点を明確に説明でき るようにせよ。 • 発表とファシリテーションでは、環境、機能、および姿勢支持とフィッティングへのユーザーの ニーズを、車椅子とクッションの特色がどのように満たしているのか関連づけよ。 • 車椅子のオプションや選択肢が限られていた場合、どこで妥協したのかを明らかにせよ。どんな 妥協であれ、車椅子ユーザーと話し合って合意する必要があることを強調せよ。 108 [原文] before and after 173 c. 第 5 節：質疑応答 • 受講者に、継続的な専門能力開発への支援ネットワーク109を構築し、また基調として、お互いを 支援し、学び合い続けるよう勧めよ。 • 上記は対面でも、オンラインでソーシャルメディアのプラットフォームを用いて行なってもよい。 • 支援ネットワークとしては、例えば臨床的な質問を投稿して話し合い、情報や最新の研究を共有 するフォーラムや、ケーススタディを討議するより公式な会合などがある。 • サービスユーザーに関する内密情報は、書面による許可がない限り、決して共有してはならない。 d. 第 6 節：要点 • 受講者に、この教習プログラムを通して得たあらゆる技能や知識を実践し、適用するよう勧めよ （練習が完璧をもたらす！110）。 109 [原文] a support network for continuing professional development 110 [原文] practice makes perfect! [訳注] 日本語では「練習は熟達の道」「継続は力なり」「習うより慣れよ」等々, さまざまな訳があることわざ. ここでは直訳調ではあるが教習および教材の趣旨に沿った訳を試みた. 174 教習運営実務と準備 ToT 教習員への注記： • この章はプレゼンテーションや話し合いのためのものではない。以下は「ToT ハンドブック」 に実習生向けの参考資料として載っているものである。実習生は、見習い教習を経験する中で 教習運営実務と準備の問題に直面し、そこで教習員に問いを発せるようになる。 「教習員用指導書」には、基礎 WSTP 教習プログラムの企画を成功させるのに必要な、施設、印刷 教材、資材、器材の包括的一覧表が載っている。教習プログラム調整役の教習員は、通常、現地の 主催者と連絡を取り合い、だれが教習運営実務と準備の各部面での責任を負うか決定する。 実習生は見習い教習を通して、教習運営実務および準備における任務を処理する経験と技能を獲得 する。教習員の調整者は、これらの活動を教習員に分担させ、さらに教習員をモニターし支援する。 施設およびサービス 施設の確認表は、「教習員用指導書」p.14 に収載。 基礎 WSTP 教習員が受講者と同じことばを話さない場合には、通訳サービスが必要になる。通常、 こうしたサービスは需要が大きいため、じゅうぶん前もって予約しておくべきである。費用を教習 予算に追加する必要があろう。 印刷教材 資料は、必ずすべて現地で印刷すべきである。基礎 WSTP に必要な印刷教材の完全な一覧は、基礎 WSTP「教習員用指導書」p.14-16 を参照。「教習員用指導書」の確認表を用い、正しい数量の資料 が印刷されていることを確認せよ。 資材および器材 基礎 WSTP に必要な資材および器材の一覧は、基礎 WSTP「教習員用指導書」p.17-18 を参照。 175 車椅子 「教習員用指導書」p.17 の最終行で、現地で入手できる車椅子とクッションについて述べている。 多種多様な車椅子が手に入る場合は、以下の車椅子/特色が含まれるようにしながら最もひんぱん に使われるモデルを選択せよ。 • リジッドフレーム 3 輪車椅子 • リジッドフレーム 4 輪車椅子 • 調節機能が付いた、折りたたみフレーム車椅子 • 基本的な折りたたみフレーム（「病院型」）車椅子 • ホイールベースが短い車椅子（4 輪車椅子） • ホイールベースが長いもの（3 輪および 4 輪車椅子） 低リソース状況で、ホイールベースが長い 3 輪車椅子も 4 輪車椅子も手に入らない場合、受講者に 見本を紹介することを検討せよ。低リソース状況におけるホイールベースが長い車椅子の利点は、 文書によるじゅうぶんな裏付けがあり、車椅子のアクティブユーザーにとって最適な設計であるこ とが多い。これらの見本を購入する資金は、教習予算に含めるべきである。 電動車椅子や、座位保持具/付加姿勢支持具付きの車椅子は含めないこと。それらは基礎 WSTP の 範囲ではないからである。 どの車椅子も正常に動作し（タイヤに空気が入り、ボルトが締まっており）、クッションが付いて いることを確かめよ。 実習に参加する車椅子ユーザーごとに、車椅子、クッションまたはクッションをつくるための資材、 足首ベルトや下腿ベルトなどの基本的物品が必要である。 消耗品 「教習員用指導書」p.18 に、クッションづくりの練習に必要なウレタンフォームを列記している。 車椅子に基本的な改造を加えるには、追加のウレタンフォーム、接着剤、張り布、ボルト/ナット、 その他の部材や交換用部品が必要である。それらは、「教習員用指導書」p.17 の「資材」一覧表に 追加すること。必要になるリソースの完全な一覧は、状況により違ってくる。利用できるリソース によっては、改造への技術的支援を手配してもよい（例えば、座面やレッグパイプの短縮/延長）。 176 技工作業エリア 改造に必要な種々の工具と資材を備えた、技工作業エリアを利用できるようにするか設置すべきで ある。これは教習予算に影響しうる。 電力供給 電源が不安定な地域では、非常用として無停電電源装置内蔵の発電機を手配すべきである。これは 「教習員用指導書」p.17 の「器材」一覧表にも追加する必要がある。 教習に向けた計画 基礎 WSTP 教習プログラムの計画について、以下、最も重要な活動とおおよその日程を列記する： 8〜12 か月前 • 教習プログラムの予算を立てる。 • 複数のパートナーが参画する場合は、各パートナーの責任について合意する。 • 日程、会場、教習員、受講者の概要、現地事情に関する情報（現地の、車椅子に関する活動や サービスの指針となる一般的な方針や手続き、手に入る車椅子、クッション、その他手に入る 資材の種類、現地の文化や受講者の多様性に関する情報、参画する組織など）を確定する。 • 教習の必要日数を算定し、毎日の開始と終了時刻、および通訳が必要かどうかを確定する。 4〜6 か月前 • 各受講者に、教習プログラムの詳細（日程、会場、運営に関する情報）が載った招待状を送付し、 記入して返送してもらう。 • 受講者の職歴や技能に関する情報を集め、それに従って授業計画を適合できるようにする。 • 教習器材を予約する。 • 模擬授業に必要な、デモ用器材やその他のリソースを調達する。例えば処置用ベッド、足置き、 スライディングボードなど。 • 消耗品を調達する。 • ユーザー用の器材を調達する（ユーザー用器材を、寄付金および/または教習予算の一部に依る 場合、器材調達はもっと早く始める必要がある）。 • 状況と受講者についての概要を各教習員に伝え、授業と役割の分担について合意する。 • ケータリングサービスを予約する。 • 必要ならば、通訳および翻訳設備を手配する。 177 4〜6 週間前 • すべての必要な資料について、現地での印刷を手配する。 • 車椅子ユーザーを選んで招待する。 • 登録の詳細を最終決定。例えば、名札と登録簿の手配、登録作業に当たる人への連絡など。 • 参加確認/事前情報を参加者、車椅子ユーザー、教習員に送付する。 • 飲食サービス業者、会場、その他の教習運営実務を確定する 1〜2 週間前 • 注文品が配達済みか確認する。 • 会場のトイレ、および水道と電気が通っているのを確認する。 • 清掃スケジュールを確認する。 教習チームの地元でない場合は、プログラム開始の 2〜3 日前に到着し、設備と会場の確認、教習 プログラムを支援する車椅子ユーザーとの打ち合わせ、必要な残り資材の購入ができれば最善。 調整役の教習員と他の教習員、主催団体、他の関係機関との間には、定期的なコミュニケーション が必要である。 車椅子ユーザー 基礎 WSTP の間に模擬授業が 4 回あり、そこに 3 グループの車椅子ユーザーが参加する。最初の グループは、2 つ別の日に参加する。教習員は教習プログラムの前に、模擬授業に参加する意欲が あり、また参加できる車椅子ユーザーを見定めて招く必要がある。「教習員用指導書」p.11 の確認 表は、車椅子ユーザーを見極めるために役立つ。 主催団体および教習企画者と、車椅子ユーザーのために使える予算と施設について連絡を取り合え。 車椅子ユーザーに移動手段が提供されるか、または交通費が支払われるかどうか確かめよ。 車椅子ユーザーが 1 日だけ参加可能な場合は、プログラムを再編成し、ユーザーグループ 1 との 「実習 1」と「実習 2」を同じ日に収めよ。時間割を調整する際には、サービスステップ 2〜7 を 必ず「実習 3」より前に完了せよ。 可能ならば、教習員が直接車椅子ユーザーを審査すべきである。教習員が現地を拠点にしていない 場合は地元のサービス供与者に、可能性がある車椅子ユーザーを見定め、教習レベルに適合するか 教習員が判断するために、写真と情報を事前に送ってもらうよう依頼するとよい。 178 車椅子ユーザーへの招聘状 車椅子ユーザーへの招聘状を作成する際には、以下の項目を考慮せよ（WSTP 用 USB メモリ内に ひな形を用意している111）： • 何が、実習へ参加すると起こるのかの詳細。 • 授業の日時および期間 • だれかといっしょに来てもよいのか？ • 授業で車椅子を受け取れるのか？車椅子にフォローアップが必要になったり、問題が起きたり した場合はどうなるのか？ • 教習後、どこでフォローアップサービスを受けられるのか？ • 会場にはどうやって行くのか？交通費は支払われるのか？ • 軽食や昼食は持参しなければならないのか？ • 参加に対して報酬は出るのか？ 各車椅子ユーザーが、これらの情報を記載した書面の招聘状を受け取るようにすべきである。ユー ザーは、参加や写真を撮られることへの意向を示すため、同意フォームにも署名する必要がある。 写真は、小グループが他の受講グループへ発表を行なう際に用いる。 注意深い計画にもかかわらず、車椅子ユーザーが、到着してみると褥瘡があったり授業日に体調を 崩したりする場合もある。これらの可能性は事前に主催団体と話し合い、こうした事態が発生した 場合に対処する準備を整え、また補欠の車椅子ユーザーの参加を手配できるようにしておけ。 車椅子ユーザーが授業中、膀胱や腸のアクシデントに遭った場合に、ユーザーと設備を清潔にする 物品を準備せよ。また小さい応急処置キットを、受講者と車椅子ユーザー両方の打撲やすり傷に 備えて用意しておくこと。 111 [訳注] 英語版のみ. 179 付録 付録１：WSTPtot 必須授業時間割 第 1 日 第 2 日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 180 付録２：WSTPtot 基礎教習時間割 第 1 日 第 2 日 第 3 日 8:30 はじめに 30 分 A.6 適正な車椅子 「パート 2」（78分） B.4 身体的事前評価（85 分） 8:45 9:00 A.1 車椅子ユーザー 25 分 9:15 9:30 A.1 のフィードバック 10 分 9:45 A.3 車椅子による移動 90 分 10:00 A.3 車椅子による移動 「パート 1」（37分） A.6 のフィードバック 5+5 分 B.4 のフィードバック 5+5 分 10:15 午前の休憩 午前の休憩 午前の休憩 10:30 A.3 車椅子による移動 （43分） A.7 クッション 75 分 B.5 処方 120 分 10:45 11:00 11:15 A.3「一時ウィリー」10分 11:30 A.3 のフィードバック 20 分 11:45 A.4 まっすぐに座る 45 分 A.7 のフィードバック 5+5 分 12:00 A.8 移乗 65 分 12:15 12:30 A.4 のフィードバック 10 分 昼休み B.5 のフィードバック 5+5+5 分 12:45 昼休み 昼休み 1:00 1:15 1:30 A.8 移乗 1:45 A.5 褥瘡 60 分 B.7 製品の下準備 40 分 2:00 2:15 A.8 のフィードバック 5+5+5 分 2:30 A.8「床から車椅子への移乗」 10分 B.7のフィードバック 5分 181 2:45 A.5 のフィードバック 10 分 B.3 事前評価インタビュー 90 分 「パート 1」（47分） B.9 フィッティング 60 分 3:00 午後の休憩 3:15 A.6 適正な車椅子 120 分 「パート 1」（42分） 3:30 午後の休憩 B.9 のフィードバック 5+5 分 3:45 A.6 のフィードバック 5分 B.3 事前評価インタビュー 「パート 2」（43分） 午後の休憩 4:00 「保留スペース」15分 B.13 フォローアップ 35 分 4:15 授業準備 ToT 教習員の個別フィード バック B.3 のフィードバック 5+5 分 4:30 授業準備 ToT 教習員の個別フィード バック B.13 のフィードバック 5 分 4:45 「保留スペース」15分 5:00 講評 15 分 5:15 閉講式 15 分 182 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot 実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2 つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP 教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 183 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 184 ToT 教習員への指示：WSTPtot の終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 185 付録 4：クッションに関する付録 準備 「A.7: クッション」と「B.8: クッションづくり」の 授業に使えるリソースは教習コースの状況によって 変わってくる。教習後も受講者が手に入れやすく、 価格に無理がない資材や布地を使うよう心がけよ。 状況によっては、既製品のクッションが入手できる 場合もある。そうでなければ適切な資材を調達する か購入するかして、教習開始前に見本のクッション をつくれ。 接着剤を使う場合は、じゅうぶんな時間だけ置いて 乾燥させよ。これは必要な厚さを出すために何層も 貼り重ねる場合、特に重要である。 図 1 除圧クッション クッションおよびクッションカバーをつくる 現地の市場を調べ、ウレタンフォーム、靴、マットレス、家具工場を訪ねて、現地で入手できる ウレタンフォームを探せ。 適切な硬さのウレタンフォームを確保せよ： • 基層の素材には、ユーザーの体重を受けて形状を保てるだけのじゅうぶんな硬さが必要である。 クッション基層に適した素材は、調達困難なことが多い。リソースが希少なところでの代替には エチレン酢酸ビニル（EVA）、チップウレタン、ゴム（例えばヨガマット）などがある。 • 表層は座骨が沈み込む程度に柔らかくなければならないが、座骨が完全に底まで沈み、堅い基層 や車椅子座面を打って止まるほど柔らかくてはならない。 ウレタンフォームの硬さを試験するやり方の詳細は、「技術に関する付録1」を参照せよ。 車椅子ユーザーへデモを行ない、また供与するために、さまざまな厚さ（30〜50 mm）のウレタン フォームを用意しておくよう心がけよ。 1 [訳注] WSTPtot 中級教習員指導書 p.180-183 または WSTPtot 中級教習ハンドブック p.130-133 を参照. 186 クッションカバーについて： • クッションの形状に沿って縦横に伸縮する布地、例えば T シャツ素材やライクラなどを選べ。 • 伸縮性のある布地が手に入らない場合、クッションの起伏に形が合うようカバーにはじゅうぶん ゆとりを設けよ。クッションカバーには、折りひだ2を入れるとクッションの形状に合わせやすく なる（特に座骨井の部分）。 • 皮膚に痕を付ける、分厚い折り目は避けよ。布地は、折り目の上に座った場合もその盛り上がり の痕が残らない程度に、じゅうぶん薄くなければならない。 受講者への見本 基層、表層、クッションカバーに適当な、および不適当な素材（ウレタンフォーム、ゴム、布地） の見本を持っておけ。 素材見本は、最小で 50 x 50 mm、布地の場合は 100 x 100 mm 必要。 これは受講者が、どの素材が許容でき、どれがそうでないのか理解する助けになる。可能ならば、 受講者が持ち帰れるよう、よい見本を小さい標本セットにまとめよ。 湿気と失禁の管理 失禁があるユーザーに対して、耐水性あるいは防水性のクッションカバーが調達困難な場合もある。 選択肢としては： • 予備のクッションを供与する。そうすれば 1 枚を使っている間にもう 1 枚を洗って乾かせる。 • クッションを薄いビニール袋で覆う。 クッションをたいへん薄いビニール袋で覆う場合は： • 車椅子ユーザーがクッションの柔らかい表層に沈み込む、じゅうぶんなゆとりを設けよ。これに よってユーザーは、姿勢支持と除圧の面でクッションからの益を得られ続ける。 複数層からなるクッションを供与する場合、基層のみビニール袋で覆うことを検討せよ。 • 表層は、必要に応じて取り外して交換できる。 • ユーザーへ表層を複数供与しておくと、ユーザーは、表層が濡れたり汚れたりするたびに洗って 乾かせる。 2 [原文] pleats [訳注] 日本語でも「プリーツ」の方が一般的か. 187 クッションをビニール袋で覆うと、ユーザーに熱を生じ汗/湿気を引き起こすが、これらは褥瘡の 危険因子である。 • ユーザーと、褥瘡発生の危険が増える旨を話し合え。 • ユーザーに、定期的に皮膚を点検するよう促せ。 車椅子ユーザーは決してビニールに直接座ってはならず、クッションは常にカバーをかけて用いる ことを忘れないように。 クッションづくりの工具 クッションづくりを初めて経験する受講者もあろう。使用する工具および資材について、実践的な コツを伝えよ。例えば： 弓ノコ刃の一端にマスキングテープを巻いて柄に すると、より容易に、かつ効果的に切れる（図 2）。 ノコ刃の歯は、ウレタンフォームを切るためには、 研ぎ落としておく必要がある。 切削用弓ノコ刃の調製に関する詳細は「管理者向け WSTP 補足資料」を参照。 図 2 弓ノコ刃 クッションづくりの際にガイドをつくる 視覚的ガイドは、ボール紙か木板でつくれる。 ガイドは、クッションへ切る前に目印を付ける際に 便利である。例えば、座骨井のふちを小さく面取り する場合など（図 3）。 図 3 切削の際にガイドを用いる 188 ガイドは、一定の形や直線を切削する際にも便利 （図 4）。 図 4 直線を切る 足でこげるようにするための座面およびクッションの改造 車椅子を、ユーザーの足が容易に床へ届くように改造する（授業「B.4 身体的事前評価」）際には、 以下の選択肢を検討せよ。 クッション全体の高さを減らす • クッションに、より薄いウレタンフォームの基層あるいは表層を用いる。 • ユーザーに褥瘡の危険があれば、指による圧力検査を用い、クッションがじゅうぶんに除圧を もたらしていることを確かめよ。 折りたたみフレーム車椅子の座面を、ソリッド座面を取り付けて低くする • 座板をシートパイプからフックでつり下げると、簡単 に取り外せる（図 5）。 • クロスバーの上端をかわせるよう切り込む。 図 5 フック付きのソリッド座面 189 「座面の前方下げ3」を付加してクッションを改造 「座面の前方下げ」を床面へ届く必要がある脚の側の クッションに付加する（図 6）。 • 座面前方を下げる前後幅は、棚状段差4から始まり、 クッション前縁まで下りて行く。 • 座面前方を下げる左右幅は、クッション全体の幅の 半分にする。 • ユーザーの座骨および大腿の下に、均等に接触しな ければならない。 図 6 座面の前方下げ 座面とクッションを両方とも改造 こぐ脚の側の座面とクッションを切り詰める（図 7）。 • ソリッド座面：床面へ届く必要がある側の座面と クッションとを、必要な奥行きまで切り詰める。 これは、「座面の前方下げ」と組み合わせること。 • 布製スリング座面：座面全体を、望みの奥行きまで 切り詰める。クッションと同形で、縁が座面よりも 前にはみ出る板を付加する。布製座面は、低くした ソリッド座面へ交換が必要になる場合もある。 図 7 短く詰めた座面とクッション 3 [原文] lowered seat front [訳注] 中級 WSTP で付加姿勢支持の一種として「座面前方を下げる」と呼ぶもの. 4 [原文] shelf 190 付録 5：改訂版車椅子事前評価フォーム 容易にまっすぐに座れる、車椅子ユーザーの事前評価に使用。まっすぐに座るのが容易ではない 車椅子ユーザーには、「中級」レベルの教習を受けた者による事前評価が必要。このフォームは、 車椅子ユーザーのファイルで保管。 事前評価者名： 事前評価年月日： 1. 事前評価インタビュー 車椅子ユーザーに関する情報 名前： 番号： 年齢： 男性□ 女性□ 電話番号： 住所： ゴール： 身体条件 脳性麻痺□ ポリオ□ 脊髄損傷□ 脳血管障害□ 虚弱□ 筋攣縮5/制御できない運動6□ 下肢切断：右膝上□ 右膝下□ 左膝上□ 左膝下□ 膀胱の問題□ 腸の問題□ 膀胱や腸の問題がある車椅子ユーザーについて、管理できているかどうか。はい□ いいえ□ その他： 生活様式および環境 車椅子ユーザーが、どこで車椅子を使うかの詳細： １日の移動距離： 1 km 以内□ 1〜5 km□ 5 km 超□ 5 [原文] spasms 6 [原文] uncontrolled movements 191 １日に車椅子を使う時間数： 1 時間未満□ 1〜3□ 3〜5□ ５〜８□ ８時間超□ 車椅子に座らない時、車椅子ユーザーがどこにどう座り、または寝そべるか（姿勢および接触面）： 移乗： 自力で□ 介助して□ 立って□ 立たないで□ 抱え上げて□ その他□ トイレの種類（トイレへ移る場合）： しゃがみ式□ 洋式□ 適合済み7□ 車椅子ユーザーが公共の/私的な交通機関をひんぱんに使うかどうか： はい□ いいえ□ 「はい」の場合、種類： 自動車□ タクシー□ バス□ その他□ 既存の車椅子（車椅子をすでに持っている場合） 車椅子は、ユーザーのニーズを満たしているか？ はい□ いいえ□ 車椅子は、ユーザーの環境条件に合っているか？ はい□ いいえ□ 車椅子は、適切にフィットして姿勢を支えているか？ はい□ いいえ□ 車椅子は安全で耐久性があるか（クッションがあるかどうかも考慮せよ）？ はい□ いいえ□ クッションは適切に除圧しているか（褥瘡の危険があるユーザーの場合）？ はい□ いいえ□ 注記： すべての問いについて「はい」であれば、ユーザーに新しい車椅子は必要ない。もし「いいえ」が 一つでもあれば、そのユーザーには別の車椅子またはクッションが必要、あるいは既存の車椅子ま たはクッションに修理ないし改造が必要である。 7 [原文] adapted 192 2. 身体的事前評価 褥瘡の有無・危険・既往歴 /// ＝感覚がない ◯ ＝過去の褥瘡 ● ＝現存する褥瘡 普通に感覚があるか？ はい □ いいえ □ 過去に褥瘡があったか？ はい □ いいえ □ 現在、褥瘡があるか？ はい □ いいえ □ あれば、傷が開いているか？ （ステージ 1〜４のどれか？） はい □ いいえ □ 期間および原因：______________________________ _____________________________________________ 褥瘡の危険*がある人か？*褥瘡の危険があるのは、感覚がない、あるいは 以下の、褥瘡の危険因子を３つ以上抱える人。褥瘡の危険因子：動けない、 湿気、不良姿勢、過去/現在の褥瘡、栄養不良、高齢化、低体重や過体重。 はい □ いいえ □ 車椅子のこぎ方 車椅子ユーザーはどうやって車椅子をこぐのか？ 両腕で□ 左腕で□ 右腕で□ 両脚で□ 左脚で□ 右脚で□ 介助者が押して□ 注記： 193 身体計測表 身体計測 身体寸法 (mm) 身体寸法を理想的な車椅子寸法へ換算 車椅子寸法 (mm) A 座位臀幅 座位臀幅＝座幅 B 座底長 右 B 引く 30〜50 mm＝座面奥行き （長さが異なる場合は、短い方を採用） 左 C 座位下腿長 右 (C 引く クッション厚さ*) C 引く クッション厚さ* ＝座面〜フットプレート上端 または 座面〜床面 〈ユーザーのニーズによる〉 左 D 座面〜胸郭下端 (〈ユーザーのニーズにより〉Dか E 足す クッション厚さ*) 〈ユーザーのニーズにより〉Dか E 足す クッション厚さ*＝座面〜背もたれ上端 E 座面〜肩甲骨下端 *車椅子ユーザーが使うクッションの厚さを確認。 車椅子サービス教習員養成教習パッケージ 基礎教習員指導書 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

車椅子サービス 教習員養成教習パッケージ 中級教習ハンドブック 車椅子サービス教習員養成教習パッケージ・中級教習ハンドブック © Japan Association of Wheelchair and Seating (JAWS) 2023 This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition Wheelchair service training of trainers package: ToT handbook intermediate level. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO shall be the binding and authentic edition. This translated work is available under the CC BY-NC-SA 3.0 この翻訳は、世界保健機関 (WHO) の手になるものではない。WHO はこの翻訳の内容および精確 さに関するいっさいの責任を有しない。英語版原著 (Wheelchair service training of trainers package: ToT handbook intermediate level. ジュネーブ: 世界保健機関; 2017. ライセンス: CC BY-NC-SA 3.0 IGO) が、拘束力を有する正版である。 この翻訳物は、クリエイティブ・コモンズ CC BY-NC-SA 3.0 のもとで利用可能である。 原著者： 世界保健機関 (WHO) 翻訳・制作： 日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト (ASAP) 発行日： 2023 年 10 月 4日 発行所： 一般社団法人 日本車椅子シーティング協会 (JAWS) 〒105-0013 東京都港区浜松町 2-7-15 三電舎ビル 2階 電話 03-6435-0365 FAX 03-6435-0365 URL http://www.j-aws.jp ＊本書の作成には公益財団法人日本社会福祉弘済会より研究助成（2023 年度）をいただきました。 英語版原著者・制作者・協力者一覧 執筆者・編集者: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson 査読者: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier 校正者: Amanda Milligan 写真著作権者: Chapal Khasnabis, Jesse Moss ビデオ著作権者: Global Goals Organization http://www.globalgoals.org/ 実施試験実習生: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa 実施試験教習員: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier 実施試験観察者: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp 提携団体: ケニア身体障害者協会 (APDK), 国際車椅子専門家学会 (ISWP), 末日聖徒チャリティ ーズリーダーシップ・マネジメント・ガバナンスプロジェクト, モビリティ・インディ ア, モティベーション・オーストラリア, モティベーション慈善基金, モティベーショ ン・ルーマニア財団, サンパウロ大学医学部総合病院物理療法リハビリテーション医学 研究所, シリントーン国立医療リハビリテーション研究所, 脳性麻痺連合 (UCP)/人道 のための車輪, ピッツバーグ大学, 西ケープ州リハビリテーションセンター, ワールド・ ビジョン 資金協力: 米国国際開発庁 (USAID) 用語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いることばを下記の通り定義する。 ToT 教習員 [ToT trainer] WSTPtot［車椅子サービス教習員養成教習パッケージ］を教授する人 実習生 [Trainees] WSTPtot の受講者すべて リーダー役実習生 [Lead trainees] 指定された基礎/中級/管理者向け/関係者向けWSTPtot の 模擬授業を教授するに当たり、リーダー役を務める実習生 補助役実習生 [Support trainees] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 リーダー役実習生を補助するよう指定された実習生 模擬受講者 [ToT participants] 基礎/中級/管理者向け/関係者向けWSTPtot の模擬授業で、 受講者役を務める実習生 受講者 [Participants] 基礎/中級/管理者向け/関係者向けWSTPを受講する人 ToT ハンドブック [ToT Handbook] ToT［教習員養成教習］実習生用に参考書とワークブックを一体化 したもの 略語 以下、車椅子サービス教習員養成教習パッケージ全体を通して用いる略語を下記の通り定義する。 ASIS 上前腸骨棘 [Anterior Superior Iliac Spine] AV equipment 視聴覚機器 [Audio-visual equipment] CBR 地域に根ざしたリハビリテーション [Community-based Rehabilitation] CRPD 障害者の権利に関する条約 [障害者権利条約, Convention of the Rights of Persons with Disabilities] DPO 障害者団体 [Disabled People’s Organization] INGO 国際NGO [非政府組織] ISO standards ISO [国際標準化機構, International Organization for Standardization] 規格 ISPO 国際義肢装具学会 [International Society of Prosthetic and Orthotics] ISWP 国際車椅子専門家学会 [International Society of Wheelchair Professionals] ITs 座骨/坐骨 [Ischial Tuberosities, seat bones] [訳注: 本文では「座骨」に統一] NGO 非政府組織 [Non-governmental Organization] OPD 障害者団体 [Organization of People with Disabilities] PPT/s パワーポイントのプレゼンテーションファイルないしスライド PSD 姿勢支持具 [Postural Support Device] PSIS 上後腸骨棘 [Posterior Superior Iliac Spine] PWDs 障害者 [Persons with Disabilities] SDGs 持続可能な開発目標 [Sustainable Development Goals] ToT 教習員養成教習 [Training of Trainers] USAID 米国国際開発庁 [United States Agency for International Development] WHO 世界保健機関 [World Health Organization] WSTP 車椅子サービス教習パッケージ [Wheelchair Service Training Package] WSTPb 基礎車椅子サービス教習パッケージ, 基礎WSTP [WSTP basic level] WSTPi 中級車椅子サービス教習パッケージ, 中級WSTP [WSTP intermediate level] WSTPm 管理者向け車椅子サービス教習パッケージ, 管理者向けWSTP [WSTP for managers] WSTPs 関係者向け車椅子サービス教習パッケージ, 関係者向けWSTP [WSTP for stakeholders] WSTPtot 車椅子サービス教習員養成教習パッケージ [WSTP training of trainers Package] 訳者解説 本書は、世界保健機関（WHO）が 2017 年に発行した ”Wheelchair Service Training of Trainers Package: ToT Handbook Intermediate Level” の全訳である。序章の「はじめに」で述べている通り、本書を含むこ の「車椅子サービス教習員養成教習パッケージ」は、2008 年刊 ”Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings” （訳訳 「動車車椅子与 の世界ガイドライン 低リソース 状況の克服に向けて」、日本車椅子シーティング協会刊、以下「ガイドライン」と略）を受けたものである。 「ガイドライン」はその一章 （ 4章「教習/人材育成」）を割き、現場で車椅子サービス提供に携わる職員、 および車椅子ユーザーの掘り起こしや見極め、車椅子サービスへの紹介・相談、さらには車椅子供与政策の 開発や推進に当たる、さまざまな関係者向けの教習の重要さを強調している。本書を含む「車椅子サービス 教習員養成教習パッケージ」、とそれに先立つ車椅子サービス教習パッケージ群は、その問題提起に対する WHO自身からの実践的回答であり、上記「ガイドライン」のいわば各論をなすものである。 したがって、本書を読み活用するに当たっては、まず「ガイドライン」を一読して WHO が提起する車椅子 供与の概念や世界観を把握することを強く推奨する。また各教習パッケージでも、「ガイドライン」は必須の 参考資料として挙げられている。 関連する出版物 車椅子や姿勢保持に関連して、WHOからは、米国国際開発庁（USAID）などの協力のもとで以下の出版物が 刊行されており、すべて日本車椅子シーティング協会による日本語訳が公開（8のみ予定）されている： 1. 動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて (Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, 2008) 2. 低リソース状況での移車支援機器与 に関する共同方針提言書：個人的移車性に関する障害者の権利に 関する条約（CRPD）履行に向けた一歩 (Joint position paper on the provision of mobility devices in less-resourced settings : a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility, 2011) 3. 基礎車椅子サービス教習パッケージ (Wheelchair Service Training Package – Basic level, 2012) 4. 中級車椅子サービス教習パッケージ (Wheelchair Service Training Package – Intermediate level, 2013) 5. 管理者向け・関係者向け車椅子サービス教習パッケージ (Wheelchair Service Training Package for Managers and Stakeholders, 2015) 6. 車椅子サービス教習員養成教習パッケージ (Wheelchair Service Training of Trainers package, 2017) 7. 支援技術に関する世界報告書 (Global Report on Assistive Technology, 2022) 8. 車椅子与 ガイドライン (Wheelchair Provision Guidelines, 2023) 1. は、主に低・中所得国向けに作成された車椅子供与事業・政策策定指針であるが、先進工業国にとっても 極めて重要な内容を含むグローバルな文献である。WHOの上記文献の底流をなす、参加とインクルージョン のための車椅子、ユーザー中心、人権ベース、供与サービスの可視化と構造化、供与への包括的アプローチ といったコンセプトは、本書ですべて出揃っている。 2. はいわば 1. の三年目のフォローアップで、1. の提起にもかかわらず、低リソース状況での移動支援機器 普及が遅々として進まない現状報告や改善を阻む問題点の指摘、その克服に向けた政策提言からなる。 3-6. は 1-2. が強調する人材育成のための、異なる受講者層に向けた教習パッケージである。 3. と 4. は車椅子の供与や適合に携わる現場職員への、実践的・総合的な技能教習パッケージで、WHO が 「車椅子サービス提供の 8 ステップ」として整理した、車椅子サービス提供の全プロセスについて、人権、 国際法、コミュニケーション、身体評価の座学から、車椅子の移動技能、処方、適合、改造、メンテナンス などの演習・実習を網羅した、包括的プログラムである。資料も受講者用参考書・ワークブックのみならず 教習員用指導書（講習準備の手引きや必要機材リスト、授業の計画 ・シナリオも含む）、プレゼンテーション スライド、動画、受講者および教習員の評価表、意識啓発用ポスターなどの教材から各種書式（参加登録簿 から当事者の写真撮影許可書など）、実施、運営、評価方法のマニュアルまでを網羅している。 3. は、車椅子の基礎技能教習教材として、途上国のみならず世界に広く普及しており、例えば米国では国際 車椅子専門家学会（ISWP）がその教習を実施し、追加教材などを発行している。 4. は、3. 修了ののち現場経験を積んだ職員向けの教習パッケージで、姿勢保持ニーズのある車椅子ユーザー、 特に子どもへの対応に重点を置き、途上国を含む世界で広く実施可能な、普通型車椅子に改造を加え、姿勢 支持具を付加する範囲での座位保持を取り上げている。 5. は 2 部に分かれ、車椅子供与に携わる事業体の管理職向けの教習パッケージ、および車椅子供与関係者 （当事者や実務家のみならず行政担当者、政治家、企業家、資金供与者、メディアなども含む）に向けた、 意識啓発ワークショップの実施パッケージからなる。 6. （本書を含む）は、3-5. を教授する人材への力量育成、いわば「教育者を教育する」ためのパッケージで、 指導方法・原理などの基礎技能教習、上記パッケージへの追加情報・訂正、模擬授業実習からなる。 これら教習パッケージは、内容のみならず研修設計の点でも優れて現代的であり、訳者は車椅子、姿勢保持、 国際協力のみならず、広く教育や研修に関わる方々にも読まれることを期待している。 7. は車椅子・姿勢保持のみならず、眼鏡から移動支援機器、コミュニケーション装置、認知支援製品などの 支援技術全般に関する、現在のニーズとその充足状況、制度的準備状況に関する世界大の見取り図、および 問題点の指摘や政策提言からなる初の報告書で、この分野に関する今後の世界的指針を示すものである。 8. は 1. の全世界に向けた 15年目の新版であるが、改訂版というより、7. に合わせたコンセプトの再整理、 エビデンスの追加など補遺・補足の色合いが強く、1. に取って代わるのではなく併読されるべき文書である。 7., 8. とも、支援技術や車椅子へのアクセスを明確に「人権」であると規定し、その保証を各国政府の責務と している点では同じで、今後「障害者の権利に関する条約（障害者権利条約）」等を解釈する指針となろう。 おわりに、本書の翻訳には、公益財団法人日本社会福祉弘済会より研究助成（2023年度）をいただきました。 ここに心より御礼を申し上げます。翻訳と校閲では以下の方々のご協力をいただきました。ここにお名前を 記し、謝辞に代えさせていただきます。 浦川純二、沖ちなみ、尾崎充希、鷹野真利、西方倫彰、山崎雅幸（敬称略） 2023年10月4日 一般社団法人日本車椅子シーティング協会国際委員会・アジア姿勢保持プロジェクト（担当：松本和志） 訳注： • 本書は Wheelchair Service Training of Trainers Package: ToT handbook Intermediate Level, WHO, 2017 の全訳である。底本には英語版（https://apps.who.int/iris/handle/10665/258701）を用いた。 • 本書の翻訳出版は、一般社団法人日本車椅子シーティング協会の、資料作成事業の一環である。 • 本書は、WHOよりクリエイティブ・コモンズCC BY-NC-SA 3.0 IGOに基づく翻訳許可を取得している。 • 日本語版翻訳に関する著作権および文責は、すべて一般社団法人日本車椅子シーティング協会に帰属する。 • 翻訳および編集作業は、同協会国際委員会・アジア姿勢保持プロジェクト（ASAP）で行なった。 • 本書を転載する際は日本車椅子シーティング協会までご連絡（連絡先は見返しを参照）頂きたい。 • 英語原文と日本語訳文の間に内容の齟齬がある場合は英語版を正とするが、誤記、団体の名称、住所、URL で変更されているものなどは、WHOに確認のうえ訳者で一部修正している。 • 国際連合の条約など政策文書で複数言語の正文が定められているものは、英語版の参照先を記した。 • 政策文書の日本語訳は、既存の訳を参考にしつつ、訳者で独自に訳出したものである。 • インターネット上の参考文献のURL閲覧日は、すべて2023年8月17日である。 • 本文中、原文にない訳者による補足は［ ］に入れて示している。 • 文中の脚注番号がカッコ（）入りのものは原注（巻末）、（）なしのものは訳注（ページ下）を示す。 • 原文の主な用語と本書での訳語は、原則として下表の通り対照させている。なるべく原著に忠実に、かつ 既存の用語との紛らわしさを避け、簡明さを失わないよう努めた。 英語用語 日本語訳語 additional postural support 付加姿勢支持［基本的な車椅子にもともと備わっている以上の、改造や増設に よって付加された姿勢支持（力）。中級車椅子サービス教習で扱う内容］ armrest ひじ掛け［ISO7176-26:2007: arm support, JIS T9201:2016: アームサポート］ assessment 事前評価［事後評価を主とするevaluationと区別するため］ backrest 背もたれ [ISO7176-26: 2007: back support, JIS T9201: 2016: バックサポート] calf 下腿、［特にその部位を指す場合］ふくらはぎ community-based 地域に根ざした footrest 足台［ISO7176-26:2007: foot support, JIS T9201: 2016: フットサポート］ neutral sitting posture ニュートラルな座位姿勢 personal mobility ［主に行為を指して］個人的移動、［主に機能を指して］個人的移動性 postural support 姿勢支持 product preparation 製品の下準備 referral 紹介・相談 seat 座面［ISO7176-26:2007: seat, JIS T9201: 2016: シート］ seating 座位保持 service delivery サービス提供 sitting upright まっすぐに座る training 教習、［引用や条約などで定訳がある場合］研修 upholstery 張り布 user ［指示内容が明白な場合］車椅子ユーザー、ユーザー wheelchair provision 車椅子供与 wheelchair services ［行為］車椅子サービス、［事業・事業組織］車椅子サービス事業、 ［施設・所在地］車椅子サービス事業所 もくじ 車椅子サービス教習員養成教習パッケージについて x 模擬授業準備の手引き xiii 必須教習技能モジュール 1 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 2 ToT.2 車椅子サービス教習パッケージについて 3 ToT.3 模擬授業について 10 ToT.4 多様性に備える 15 ToT.5 成人学習 20 ToT.6 準備時間について 27 ToT.7 プレゼンテーションとファシリテーション 28 ToT.8 コミュニケーションスキル 33 ToT.9 指針文書の知識 37 ToT.10 視聴覚ツールおよび機材 55 ToT.11 フィードバック 61 ToT.12 グループダイナミクスを取り仕切る 63 中級教習モジュール 68 A.1: 付加姿勢支持が有益な車椅子ユーザー 69 A.2: 障害児 71 B.1: 事前評価の概略・事前評価インタビュー 73 B.2: 身体的事前評価−支えなしの座位姿勢 75 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック 78 B.4: 身体的事前評価−ハンド・シミュレーション 81 B.5: 身体的事前評価−身体計測 85 B.6: 車椅子およびクッションの選択 88 B.7: 姿勢支持具の処方（選択）−はじめに 91 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる 93 B.9: 姿勢支持具の処方（選択）−股関節を支える 100 B.10: 姿勢支持具の処方（選択）−体幹を支える 101 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を支える 105 B.12: 製品（車椅子）の下準備 107 B.13: フィッティング 108 B.14: ユーザー教習 109 B.16: メンテナンス・修理・フォローアップ 110 実習 1〜4 112 B.15&17: 総まとめ&教習員からのフィードバック・討論・閉講式 115 教習運営実務と準備 116 付録 121 付録１：WSTPtot必須授業時間割 121 付録２：WSTPtot 中級教習時間割 122 付録 3：WSTPtot 模擬授業フィードバックシート 124 付録 4：技術に関する付録：中級WSTP向け 127 x 車椅子サービス教習員養成教習パッケージに ついて はじめに 2008年の「手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて(1)」2 発行を受け、 世界保健機関（WHO）は、米国国際開発庁（USAID）との提携のもと、開発途上国における車椅子 利用を増大するために、一連の教習パッケージ 4種を作成してきた。この「車椅子サービス教習員 養成教習パッケージ (WSTPtot)」はその中でも最新のもので、既成のパッケージを実施する教習員 の育成に主眼を置いている。 車椅子供与に関わる人材と、したがってそうした人材への教習員は、世界中あまねく必要とされて いる。WHOは、WSTPtotの発行によって教習を受けた車椅子人材が飛躍的に増加し、より多くの 人びとが適正な車椅子を利用してその可能性を発揮できるようになることを期待している。 WSTPtotは、単一の「必須教習技能」モジュール3、および既成の 4教習パッケージ（2012年発行 の「基礎車椅子サービス教習パッケージ (WSTPb)」、2013年の「中級車椅子サービス教習パッケ ージ (WSTPi）」、2015年の「管理者向け車椅子サービス教習パッケージ (WSTPm)」・「関係者 向け車椅子サービス教習パッケージ (WSTPs)」）に基づく、教習パッケージ別モジュール4のうち 一つで構成される。WSTPtotでは、WSTPmとWSTPsは、一つの教習パッケージ別モジュールと して統合されている。 WSTPtotは 40時間で履修できるが、この期間は各々の状況に特有のニーズや利用できるリソース に応じて伸縮させてよい。WSTPtotの修了に続いて、実習生は、その教習パッケージを経験豊富な 教習員に付いて実施し、その中で技能と経験を積み、独立して教習を実施できるようになる。 1 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2 008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 2 [訳注] 以下「車椅子ガイドライン」と略. 3 [原文] Core Training Skills module [訳注] ここでの「モジュール」とは, 教習パッケージ内で目的別に区分した 授業単元や実習のまとまり (科目群) を指す. 4 [原文] package-specific module xi ToT ハンドブックの使い方 この ToT ハンドブックは、教習パッケージ別モジュールの教授法に関する情報を含む、WSTPtot へのステップバイステップの手引き書である。本書は、実習生5が WSTPtot プログラム中に使い、 また将来、WSTPを計画し、実施する際の参考資料として持っておくために開発された。 対象者 WSTPtot は、以下 4つのモジュールからなる： • 必須教習技能6：2日間 • 基礎教習（WSTPb）：3日間 • 中級教習（WSTPi）：3日間 • 管理者/関係者向け教習（WSTPm/s）：3日間 全実習生が修了すべきものは、「必須教習技能」モジュールとそれに続く以下の教習パッケージ別 モジュールから一つである： • WSTPtot 基礎教習モジュール：基礎 WSTP の実施を計画している教習員が対象である。基礎 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が基礎 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 中級教習モジュール：中級 WSTP の実施を計画している教習員が対象である。中級 レベルの車椅子供与経験が不可欠で、この WSTPtot は、実習生が中級 WSTP で教わった能力 を発揮できることを前提に設計されている。 • WSTPtot 管理者/関係者向け教習モジュール：管理者向けおよび関係者向け WSTP の実施を計 画している教習員が対象である。実習生がWSTPtot 管理者/関係者向け教習から最大限の成果を 得るには、車椅子サービス事業を実施、管理または評価した経験、または車椅子サービス事業の 必要性、有益さまたはその育成に対する関係者の意識を啓発した経験が不可欠である。 実習生は、WSTPtot 修了から 3 か月以内に、新たに獲得した技能の定着・実践のため見習い教習7 の機会を得る必要がある。 5 [原文] you [訳注] この教習パッケージ（WSTPtot）を受講する実習生 (模擬授業では教習員). 以下同様. 6 [原文] Core Training Skills 7 [原文] co-training xii 模擬授業8の割り当て 「必須教習技能」モジュールを修了後、実習生はWSTPtot の第 2 部に進み、そこで各自のWSTP 授業を実施することで学んだ技能を実践する。 実習生には、「必須教習技能」モジュール初日に「ToT.3 模擬授業について9」で担当授業が割り振 られる。その際、各実習生にメンター10として ToT 教習員ひとりが割り振られる。教習プログラム には授業を準備し、またメンターの ToT 教習員と相談する時間が盛り込まれている。模擬授業の後 にフィードバックと話し合いが持たれ、このプロセス全体を通して ToT 教習員が実習生の技能を 観察し、評価できるようになっている。 WSTPtot への準備をじゅうぶん行なえるよう、実習生には予め教習パッケージ別教材資料が送付 される。実習生は、どの授業でも実施できるよう準備万端で臨むべきである。 注記： 模擬授業の中には、WSTPtot に合わせて時間配分を短縮するか、授業の一部を割愛するよう 改変したものもある。これらの改変はWSTPtot の目的に合わせただけのもので、WSTP 実施の 際にまねてはならない。 8 [原文] practice delivery 9 [原文] practice delivery sessions 10 [原文] mentor [訳注] 本書では助言指導 mentor, その行為mentoringと指導者mentorは「メンター」に一括. xiii 模擬授業準備の動引き リーダー役実習生 • 担当する授業についてWSTP「教習員用指導書」の授業計画を読み、授業内容をすべて理解して いることを確かめよ。活動は自分でやってみて、受講者に何をやることが期待されているのか、 自分が理解していることを確かめよ。自分が担当する節/授業のみ準備せよ。 • 基礎/中級/管理者向け WSTP「受講者用参考書」と「受講者用ワークブック」（これらは関係者 向けWSTPにはない）の、該当箇所を読め。 • 担当授業について、「ToT ハンドブック」の「この授業を教えるための主な留意点」など関係する 節を読め。 • WSTPの教材にはいくつかの誤りが判明しており、それはこのハンドブックに挙げている。担当 授業について誤りがあるか調べ、あれば推奨されている変更を加えよ。 • 必要に応じて、PPT スライドを編集せよ。 • 適切ならば、ケーススタディなど自分の知識や経験を盛り込め。 • 授業実施を、時間配分も含め予行演習せよ。 • 補助役実習生と話し合い、チームとしてどう作業するか計画せよ： o 役割を割り振る。例えばタイムキーパーや板書など。 o 実技を含むグループ活動については、いっしょに予行演習し、どの誤りに注意が必要で、どう やってそれを訂正するか話し合う。 補助役実習生 • 自分の「教習員用指導書」の授業計画を読め。 • 指示に応じて、リーダー役実習生を補助せよ。 授業開始の前に • 自分の PPT スライドを、当該教習日の開始前に、教習用ノート PCへアップロードせよ。 • 必要に応じて、教室を設営し教習資材を設定せよ。 • 視聴覚機材が設定され、正常に動作することを確認せよ。 xiv 見習い教習 WSTPtot 修了後、実習生は経験豊富な教習員といっしょに見習い教習を実施し、自らの技能を育成 し続けなければならない。見習い教習では、教習指導員 1名に対して見習い教習員 2〜4 名の割合 を推奨する。 見習い教習前に、ToT 教習員が実習生に、臨床や技術の知識を深めておくよう推奨する場合もある。 この情報は、「WSTPtot 模擬授業フィードバックシート」に記録して、実習生と共有される。 メンター11およびピアサポート12 実習生にはWSTPtot 教習後も自分の ToT 教習員と連絡を取り合い、進境を報告し、相談して助言 をもらうよう勧める。実習生は、実習生仲間からも貴重な継続的支援を得られ、それは各自の技能 と自信とを養うために役立つ。実習生がソーシャルメディア上のグループに参加するかグループを 立ち上げ、質問したり学習経験を共有したりできると有益であろう。 11 [原文] mentoring [訳注] 比較的身近な, 先輩格くらいの指導者が助言指導を行なうこと. 12 [原文] peer support [訳注] 同様の課題に取り組む仲間 (当事者) どうしの支援のこと. 1 必須教習技能モジュール 2 ToT.1 車椅子サービス教習員養成教習パッケージ紹介 車椅子サービス教習員養成教習パッケージ (WSTPtot) の構成 WSTPtot プログラムは2日間の「必須教習技能」モジュールと、続く基礎（WSTPb）、中級（WSTPi）、 管理者向け（WSTPm）・関係者向け（WSTPs）から一つ選択する、3日間のモジュールとからなる。 この教習パッケージ別モジュールでは、実習機会を与えて実習生の WSTP 教習員としての技能と 自信を育てる。ここではWSTP実施の際に起こりがちな課題も明らかにし、解決策を提示する。 WSTPtot 課程の概観 ToT プログラム修了後、実習生は、自立した教習員としての自信と能力が備わるまで、見習い教習 を行なわねばならない。見習い教習の回数は、人によって異なる。ToT 教習員と、見習い教習中に 実習生のメンターを務める教習員は、実習生が見習い教習を継続すべきか、ひとり立ちして教習を 実施すべきか、決めるのを手伝う。 必須教習技能 教習パッケージ別 見習い教習員 教習員 実習生が、対面でのToT教習後に経験豊富な教習員との見習い教習を行なえない場合、WHOでは、 実習生にバーチャルな支援やコーチを探し、また他の ToT 実習生と連携し、助け合って、WSTPの 計画、準備、実施を行なうよう奨励している。 フィードバックおよび自己評価 教習パッケージ別モジュールの模擬授業中、実習生は、実習生の技能一覧表を含む「WSTPtot 模擬 授業フィードバックシート」を用いて自分の出来ばえを評価する。ToT 教習員は ToT プログラムの 最後に、このフォームに書面でのフィードバックを与える。これは、実習生が教習技能を向上させ 続けるために役立つ。このフォームは、本書の付録に載っている。 3 ToT.2 車椅子サービス教習パッケージについて 沿革 WSTP（車椅子サービス教習パッケージ）は、2006 年 11 月に インド・バンガロールで開かれた、「開発途上国への車椅子に 関する合意形成会議(1)」に端を発している。 この合意形成会議が基礎となり、WHO「手動車椅子供与の世界 ガイドライン 低リソース状況の克服に向けて(2)」が作成され、 国際義肢装具学会（ISPO）及び米国国際開発庁（USAID）との 提携のもと、2008 年にWHOから発行された。 車椅子は、個人的移動を可能にするために最もよく使われる支援機器の一つであるが、サービス 供与者には、車椅子ユーザーが最大限に自立した個人的移動を達成し、生産的で高い生活の質を 享受できるようにするための教習を受ける機会がほとんどなかった。 基礎・中級 WSTP の開発目的は、低リソース状況の車椅子サービス職員に包括的車椅子サービス 供与教習を行なうことにより、より多くの大人や子どもが自分のニーズを満たす車椅子を手に入れ られるようになることによって「車椅子ガイドライン」が実行されることである。 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/) [シェルドン, S, ジェイコブス, N.A.編. 開発途上国への車椅子に関する合意形成会議報告書, 2006年 11月 6〜11日. インド, バンガロール: 世界保健機関, 2006]. 2 Guidelines on the Provision of Manual Wheelchair Service in Less-resourced Settings, WHO, 2008 (https://www.who.int/publications/i/item/9789241547482). [日本語版: 手動車椅子供与の世界ガイ ドライン 低リソース状況の克服に向けて, 日本車椅子シーティング協会, 2022 (https://apps.who.int/iris/handle/10665/43960), (https://j-aws.jp/who/).] 4 4 つのWSTP 基礎車椅子サービス教習パッケージ (基礎WSTP、WSTPb)(3)は、 移動に障害があるものの、付加姿勢支持なしでまっすぐに座れる 男女の子どもや大人に、適正な手動車椅子およびクッションを 供与する職員への教習を助ける。 中級車椅子サービス教習パッケージ (中級WSTP、WSTPi)(4)は、 まっすぐに座るには付加姿勢支持が必要な男女の子どもや大人 に、適正な手動車椅子およびクッションを供与する職員への教習 を助ける。 基礎 WSTP、中級 WSTP とも最短 5 日間で実施できるように設計されている。しかし、各授業に 要する実際の時間はさまざまである。以下のような場合は、追加時間が必要になる： • 授業計画に教材資料を追加する。 • 状況や受講者の技能レベルに対して適切な、追加授業を盛り込む。 • 車椅子ユーザーとの実習回数を増やす。 • 通訳が必要。 • 教習で使用する製品に対して、さらに下準備の時間を取る。 • 現地の事情に合わせて、教習日数を短縮する。 • 教えている受講者に、経験や公式の資格といった面で制約がある。 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (https://www.who.int/publications/i/item/9789241503471) [日本語版：基礎車椅子サービス教習パ ッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (https://www.who.int/publications/i/item/9789241505765) [日本語版：中級車椅子サービス 教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/)]. 5 教習時間割に授業を追加したい場合、国際車椅子専門家学会（ISWP）のウェブサイトに追加教材 が載っている。以下を参照：http://wheelchairnet.org/resources5 管理者向け車椅子サービス教習パッケージ (管理者向け WSTP、 WSTPm)(6)は、事業管理者が、適正な車椅子供与を効果的に支援 する指針となるように設計されている。これには、適正な車椅子 供与の確立に向けて事業管理者や関係者の参画を推進すること も含まれる。管理者向けWSTPは最短 2日で実施できる。 関係者向け車椅子サービス教習パッケージ (関係者向け WSTP、 WSTPi)(7)は、国/地域における適正な車椅子供与の確立に向けて、 全関係者の意識を啓発し、技能や知識を育成するために設計され ている。最短 4時間で実施できる。 • どちらの教習パッケージも、通訳、より詳細な討論や計画、関係者の行動計画会議など現地の 事情から適切な集会と併催する時間を取るために、期間を延長して実施できる。 5 [訳注] 2022年 10月 28日現在, リンク切れ. 6 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 管理者向け車椅子サービス教 習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 7 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 20 15 (https://www.who.int/publications/i/item/9789241549080) [日本語版: 関係者向け車椅子サービ ス教習パッケージ, 日本車椅子シーティング協会, 2022 (https://j-aws.jp/who/))]. 6 指針原則 WSTPは、以下の一群の指針原則8に従って作成された： • 車椅子ユーザーを車椅子サービスの中心に置く、ユーザー中心で人権に根ざしたアプローチ9。 • 手に入るエビデンスに基づく10、国際的な最良の実践例11にならう。 • 低リソース状況12に重点を置き、状況に対して適正な製品と教習を採用する。 • 全教習パッケージにおける、教習員や教習対象者としての車椅子ユーザーのインクルージョン。 • 取っ付きやすい非医療的なことばづかいと用語13を用い、それによって： o 臨床や技術の資格を持たない受講者も教習を受けられ、 o サービス職員が、車椅子ユーザーも理解しやすい用語を使えるようになる。 WSTP の構成要素 各教習パッケージは、さまざまな教材からなっている。 基礎WSTP 中級WSTP 管理者向け WSTP 関係者向け WSTP 教習員用指導書 ✔︎ ✔︎ ✔︎ パワーポイントのプレゼンテーション ✔︎ ✔︎ ✔︎ 動画 ✔︎ ✔︎ ✔︎ ポスターセット ✔︎ 選択した ポスター 選択した ポスター 補助資料：車椅子ガイドライン、障害者権利条約 ✔︎ ✔︎ ✔︎ 受講者用参考書 ✔︎ 合本 受講者用ワークブック ✔︎ 各種フォーム＆確認表 ✔︎ － 補助教材：工具、器材、各種フォームなど － ✔︎ 8 [原文] guiding principles 9 [原文] user-centered and rights-based approach 10 [原文] available evidence-based 11 [原文] best practice 12 [原文] less-resourced settings 13 [原文] accessible, non-medical language and terminology 7 活車１：「教習員用指導書」をよく知る グループで協力し、「教習員用指導書」を用いながら以下の問いに答えなさい。答えは各問いの横 に書きなさい。 問い 答え 1. 「教習員用指導書」全内容の一覧は、 どこで見つかりますか？ 2. グループ活動は授業の中でどう示され ていますか？ 3. 教習パッケージ全体のねらいや目的 は、どこで分かりますか？ 4. 授業計画で、教習員が PPTスライド を映写すべきタイミングはどこに示さ れていますか？ 5. 教習授業の実行に必要な施設、教材、 設備はどこで分かりますか？ 8 WSTP「教習員用指導書」の使い方 マニュアル 各「教習員用指導書」は教習員に当該パッケージの概観をもたらし、その具体的な手引き書となる ものである。各項目は、WSTPの実施準備前に注意深く読み返すべきである。 付録 補足情報を与える付録は基礎・中級・関係者向けの「教習員用指導書」の末尾に載っており、各種 フォームや確認表も含んでいる。 授業計画 授業計画は、授業を通して教習員を導くレシピのように働く。授業計画に従うのは以下の面で有効： • 学習目標への集中を保つ • 時間を守る • 関連トピックについての、フォーカスグループ活動、話し合い、質問 車画コラム 動画を上映すべきところには、右の動画アイコンのどちら かが付いた動画コラムが「教習員用指導書」に載っている。 • すべての動画の内容、関連性、タイミングを熟知して おくことが重要。 教習員への注記 教習員への注記は、「教習員用指導書」全体に盛り込まれており、内容は： • 質問に対する最も重要な答え • グループ活動への手引き • 教習員が受講者からの質問に答えるのを支援する補足情報 9 活車コラム 活動コラムは、下記の情報を提供する教習員の手引き である： • グループ：活動のために、どうグループ全体を分け るか。 • 指導内容：活動をどのように実施すべきか、受講者 に何を話すべきか。 • モニター：活動中、どのようにグループをモニター して正しい作業を行なうようにするか。 • 時間：活動時間の長さおよび最後のフィードバック 時間を指定。 • フィードバック：尋ねるべき質問、押さえるべき 要点、受講者の思考や感覚を引き出すやり方。 要点のまとめ どの授業計画も、最後は「要点のまとめ」あるいは「管理者が取り組むこと」（管理者向け WSTP の場合）である。 10 ToT.3 模擬授業について はじめに ここで学ぶ、WSTPパッケージを教授することへどれくらい自信を感じるか 1〜10点で記録せよ： 1 2 3 4 5 6 7 8 9 10 自信がない たいへん自信がある 教習パッケージ別モジュールの構成とねらい 教習パッケージ別モジュールには、習得を選択したWSTPの授業を実施する機会が含まれる。 これは実習生14が、以下ができることをねらいとしている： • WSTPの教習教材を使う練習をする。 • 教習仲間を相手に授業を実施する練習をする。 • WSTPの理論、原則、技能、方法論への自分の理解を明確にする。 • 教習時に発生する、よくある問題について学び、それに対処するやり方を見出す。 • 自分の、実習生としての技能（各自の「ToT ハンドブック」付録の「WSTPtot 模擬授業フィード バックシート」の一覧表を参照）を育成する。 リーダー役・補助役教習員および模擬受講者の役割 • 実習生には、リーダー役教習員15と補助役教習員16の両方になる機会がある。 • 同じ授業にリーダー役教習員が複数割り当てられた場合、プレゼンテーションを行なっていない 人はそのあいだ自動的に補助役教習員役に回る。 • 一つの授業にリーダー役教習員が一人だけの場合、その人は他の模擬受講者に補助を頼んでよい。 • 模擬授業では、補助役教習員に特定の役割が割り当てられる場合もある。 14 [原文] you [訳注] 原著では, 本書の対象者で ToT教習を受ける実習生 traineeを, 模擬授業で教える役割にある 場合のみ教習員 trainer, それ以外では youと呼びかけているが, 二人称は日本語的でないため「実習生」の訳語を 充てた. ToT教習員は, WSTPtot教習員用指導書でも ToTハンドブックでも「ToT教習員 ToT trainer」である. 15 [原文] lead trainer [訳注] 実習生 traineeが, 模擬授業で教える際に務める役割の一つ. 16 [原文] support trainer [訳注] 同上. 11 活車１：リーダー役教習員と補助役教習員 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ 12 リーダー役教習員の主な役割は何でしょうか？ 補助役教習員の主な役割は何でしょうか？ • 授業を実施する。 • デモおよび実習の設備を準備する。 • 時間を守る。 • 補助役教習員を調整する。 • 参加型の授業中、答えを板書する。 • 欠落情報や補足情報を追加する。 • 時間を守るのを手伝う。 • グループ活動を促進する。 • 受講者に関するフィードバックをリーダー 役実習生にもたらす。 • 授業実施に関する全体的フィードバック/ 振り返りに貢献する。 • 授業中、デモ用機器の手伝いをする。 • 動画上映時、必要に応じて照明の点け消し やブラインドの開閉を行なう。 チームワーク 実習生はチームとして、協力して授業を実施すべきである。例えば、以下を助け合うことなど： • 授業準備 • 教室設営 • デモ用機器の準備 • 教習スペースの整理整頓 • 時間管理 • 授業実施中の誤りの指摘 • 受講者からの質問に答える • 妨害や割り込みへの対処 お動本17としての教習員 教習員は、プロとしての行動と実践のポジティブな手本を示すべきである。受講者に求める行動に は、その模範を示せ。例えば： • 時間を守り、じゅうぶん準備する。 • 困難な状況で、問題を解決し解決策を見出す。 • ポジティブなフィードバック、および建設的なフィードバックを与える。 • 上手に自己管理する：例えばストレス管理のため、授業準備とじゅうぶんな睡眠・よい食事との バランスを取るなど。 17 [原文] role models [訳注] そのまま「ロールモデル」と呼ばれることも多い. 13 留意事項：優れた教習員であり、動本であるとは、常に質問への答えを知っていなければならない ということではない。 質問を受けたが答えを知らない場合に、答えを知っているふりをしてはならない。代わりにできる ことは： • 補助役教習員に答えを知らないか聞く。 • 受講者に答えを知らないか聞く。 • 教習プログラム終了までに答えを見出すことを承諾（して「保留スペース」に追加）する。 振り返り18とフィードバック 自分自身の教えぶりを振り返ることを学ぶのは、教習員にとって重要な技能である。教習員には、 教習受講者に、建設的な指針となるフィードバックを与えられることも重要である。 これが、振り返りとフィードバックの技能が ToT プログラムに組み込まれている理由である。 各模擬授業の終わりに、リーダー役教習員は次を振り返るよう求められる： • 何がよかったか、また何がうまく行ったか。 • 何に改善の余地があるか。 ToT 教習員は模擬受講者からの簡潔なフィードバックを促し、リーダー役教習員や模擬受講者が挙 げていなかった点があれば、最後に ToT 教習員から付け加える。 模擬授業の準備 模擬授業の準備には、以下が含まれるべきである： • 「教習員用指導書」の授業計画を読み、授業内容をすべて理解していることを確かめる。 • 「受講者用参考書」と「受講者用ワークブック」（関係者向け以外のWSTPで使う）の該当箇所 を読む。 • PPT に適切な変更/補足を加える。 • 適切ならば自分自身の知識や経験を組み込み、自分のケーススタディを活用する。 • 授業実施を、時間配分を含め予行演習する。 • 補助役教習員と、チームとして協力する。 • 授業に必要な教材を準備する。 授業が ToT 教習員によるデモを含む場合は、ToT 教習員に授業の担当部分をどのようにやって もらうか、本人と打ち合わせよ。 18 [原文] Reflection 14 判明している誤り WSTP の「教習員用指導書」「受講者用参考書」「受講者用ワークブック」および PPT の中には、 いくつかの誤りが判明している。 • 判明している誤りは各自の「ToT ハンドブック」で挙げている。 • 授業を準備するさい、担当授業に誤りがないか確かめ、必要な変更を加えよ。 • 模擬受講者と誤りについては話さず、授業のプレゼンテーションは通常の WSTP 教習と同様に 行なえ。 授業プレゼンテーションにおける自信 • 最初の模擬授業では、教習仲間や ToT 教習員を前にしてアガるかもしれない。それが普通だ19！ • さらに授業を実施するにつれ、技能と自信がついてくる。 • 「必須教習技能」モジュールのあいだ、グループ活動からのフィードバックを発表するよう求め られる。その機会を活かし、仲間へのプレゼンテーションを練習せよ。 PPT（パワーポイント）のプレゼンテーション • 各授業の標準版 PPT は、動画を埋め込んだものが教習用ノート PCで使用可能。 • 自分の PPT に、スライドの追加などの変更を加えた場合は、模擬授業前に教習用ノート PC へ それをアップロードしておく必要がある。 模擬授業の制限時間 • 模擬授業のあいだ、時間は厳しくモニターされる。 • 持ち時間を過ぎたら、ToT 教習員は授業を停止させて次の教習員に移るか、授業を終了する。 19 [原文] This is normal! 15 ToT.4 多様性に備える20 WSTP教習員はしばしば多様性21に遭遇するため、多様な受講者集団を取り仕切るやり方を、必ず 把握しているべきである。多数派の中にいると、人はえてして力強さや自信を感じる。少数派の中 にいると、人は孤立や疎外を感じることがある。集団は文化22や多様性によって分かれ、あるいは まとまる。 文化と多様性 文化：人びとを同じにするもの • 共有あるいは共通の、価値観23、意識24、道徳、伝統、信念25などの体系 • 何が適切な行動かの共通理解 多様性：人びとに違いを生むもの • 民族集団26、ジェンダー、性自認27、年齢、身体的能力 • 宗教的または精神的信仰、政治的信条 • 職業 だれもが複数の文化的集団に属し、だれもがさまざまな面で多様であることを忘れないように。 文化的能力28 文化的能力とは、個々人が自分の文化とは異なる文化との効果的かつ敬意をもった関わり方を学ぶ、 能動的プロセスである。 それは個人や集団、組織に関係するものであり、また学ぶことができるものである。 文化的能力に通常含まれること： • 自分の文化的慣行への自覚 • 異なる文化的慣行に関する知識 • 文化の違いに対するポジティブな姿勢 • 文化が人的交流へどのように影響を及ぼすかの理解 20 [原文] Preparing for diversity 21 [原文] diversity 22 [原文] culture 23 [原文] values 24 [原文] attitudes 25 [原文] beliefs 26 [原文] ethnicity 27 [原文] gender identity 28 [原文] cultural competence [訳注] 国際保健用語では「文化能力」とも訳される. 16 教習員の文化的能力 教習員は文化の違いを理解し、よさを分かるために必要な知識、技能、意識を必ず持つように せよ。これには他者の文化的な信念、ふるまい、ニーズを尊重し、受容することが含まれる。 WSTP 教習員が文化の違いを理解あるいは尊重しなければ、こうした違いは、誤解、失望、混乱、 困惑、怒り、侮蔑などを引き起こすことがある。 ありうる文化的留意事項 • 身体的接触：女性教習員が男性車椅子ユーザーを事前評価する、または男性教習員が女性車椅子 ユーザーを事前評価することは、文化的に不適切な場合がある。 • 服装：服装は、必ず文化的に適切であるようにせよ。 • コミュニケーション：文化によっては、直接聞かれない限り受講者が質問に答えない場合がある。 • アイコンタクト29：直接相手を見ながら話しかけることが、失礼に当たる場合がある。 • フィードバック：受講者が、人前で建設的な批判/フィードバックを与えたり受けたりする際に、 どこまでそれを受容できるか、よく気をつけよ。 • ジェンダー：文化によっては、男女がペアを組んで活動したり、いっしょに食事をしたりするの は不適切な場合がある。これは、グループ作業や休憩時間の組み方に影響しよう。 • 宗教的信念：現地の宗教的慣行、例えば祭礼、断食、礼拝などに合わせて、休憩時間の延長や、 開始/終了時間の変更が必要になる場合がある。 活車２：文化的能力 自分の文化とは違う文化を経験したときの例について考え、書き出しなさい。 それはどういうものでしたか？ 29 [原文] Eye contact 17 どう感じましたか？ その経験から何を学びましたか？ 車椅子ユーザーはじめ障害者のWSTP へのインクルージョン WSTP（車椅子サービス教習パッケージ）は、教習 チームへの、また受講者としての、車椅子ユーザー はじめ障害者のインクルージョンを推進している。 これが重要な理由は： • 車椅子ユーザーは、自分の体験や視点を活かして WSTPの学習目標を伝えられる。 • 車椅子ユーザーから教習を受けることは、車椅子 サービスにおける車椅子ユーザーの中心的役割 を強化する。 車椅子ユーザーのインクルージョンと参加は、車椅子ユーザーの可能性に対する見方を変え、差別・ 偏見とたたかい30、CRPD（障害者の権利に関する条約）の原則を強調するために役立つ。 30 [原文] combat stigma 18 車椅子ユーザーはじめ障害者の社会への完全なインクルージョンを阻む障壁 車椅子ユーザーはじめ障害者の WSTP へのインクルージョンのために、WSTP 教習員は、障害者 の社会へのインクルージョンを阻むものは何か、必ず理解しておくべきである。 認識 人びとは障害についてよく知らないことが多いため、障害者に対して誤った思い込みを抱く。 • 多くの人は、障害者は家族、仕事、余暇、社会生活、個人生活に関して同じゴールや夢を持って いないか、それらを達成する能力がないと考える。 • 身体障害があることから、この人には認知障害もあると考え、その人を子ども扱いし、ゆっくり と、あるいは大声で話し、あるいは障害者に付き添っている人に話しかける。 意識31 障害者に対するネガティブな意識の例 • 障害者は、その機能障害ゆえに社会での価値は低いとする見方。 • 障害者を慈善の対象として恩を着せる32。 • 障害者を、よく知らないために、あるいは失言をやらかすのを恐れて忌避する。 • 家族、地域リーダー、学校などの機関が、障害児教育に低い価値を置く。障害者は、教育抜きに は機会が限られる。 信念 信念は意識と密接に関係し、また障壁もつくり上げる。例えば、機能障害がある人は、そのために 任務を達成できないと、実際はできるにもかかわらず信じることなど。 31 [原文] Attitudes 32 [原文] Patronizing 19 文化 文化的信念、規範、価値観も障壁をつくり上げる。文化によっては、障害者は祟られていると信じ、 そのけっか障害者が地域や家族から閉め出され、引きこもり隠れてしまう場合もある。 ステレオタイプ33 これらは障害者を、自分自身の関心や技能を持ち社会に貢献する個人として認識しないネガティブ な見方である。 法令および政策 障害者の権利を保護する法令や政策は、あっても執行されないことが多い。例えば、国によっては 一定枠の障害者を雇用することを要件とするか、被雇用者への合理的配慮を規定した雇用法制を 持っている。強制力を伴わなければ、こうした法律や政策は効果を発揮しない。 環境の障壁 物理的な障壁は障害者の参加や統合への制約になる。屋外生活でのそうした例は傾斜、砂、草、川 などで、また屋内での移動や自立には階段、狭い戸口、家具、カーペットなどが妨げになる。 支援機器の欠如 これはインクルージョンへの大きな障壁の一つで、WSTP（車椅子サービス教習パッケージ）は、 CRPD（障害者の権利に関する条約）に沿って適正な車椅子の入手しやすさを改善する取り組みの 一つである。 33 [原文] Stereotypes 20 ToT.5 成人学習34 効果的な教習員となるためには、大人にとって最良の学び方を理解し、さまざまな学習スタイルに ついて知ることが重要である。 活車１：成人学習の原則 これまでの、自分のポジティブな学習経験について考え、その経験がどのようにポジティブだった のか書き出しなさい。 下欄を用い、活動中に考えたことを書き出しなさい。 ポジティブな学習経験 34 [原文] adult learning 21 活車２：自分の選好学習スタイル35を判定する 自分の学び方を反映している文にマルを付けなさい A. ステップバイステップの指導に従って B. 新しいものごとを経験することによって C. 間違えることによって D. 推論によって E. 教わった内容の理論を理解することによって F. 学んだことを適用することによって G. 自分の経験を当てはめることによって H. 動画を視聴することによって I. 選択肢を評価することによって J. 自分の感覚に依拠することによって K. 人と交流することによって L. 人がやって見せるのを見まもることによって M. 感受することによって N. 大局を分かる36ことによって O. そばに付いて見まもることによって P. やり方の説明を傾聴することによって Q. そのトピックについて書かれたものを調べることによって R. 人と関わり合うことによって S. 学んでいる内容を試してみることによって T. ものごとの一般的原理を理解することによって U. 講義に参加することによって V. 実体験を通して W. 自分の観察に頼ることによって X. ものごとに個人的に関わることによって Y. ものごとに対する自分の感じ方を探ることによって Z. 活動的になることによって AA. 教習員を観察することによって BB. 実験によって 35 [原文] preferred learning style [訳注]「選好する/好みの学習スタイル」の意. 36 [原文] seeing the big picture 22 選好学習スタイル集計表 質問表に付けたものと同じ記号をマルで囲みなさい。マルで囲んだ記号が最も多い列が、自分の 選好学習スタイルになります。 複数列が同数だった場合、それは強いこだわりがないということです。 経験によって 観察によって 思考によって 実行によって B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB 合計： 合計： 合計： 合計： 学習経験サイクル37 選好される学びの 4つのスタイル： 1. 経験による学び 2. 観察/感受による学び 3. 思考/理解による学び 4. 実行/適用による学び 4 つの学習スタイルは、学習経験サイクルと一致する。 スタイルは人によってさまざまでも、新しい知識や技能を学ぶには、この 4つの段階のそれぞれを 経るのが最も効果的である。 37 [原文] Experiential learning cycle 23 WSTPには、全受講者の参加を得るため、学びの 4段階/種類をそれぞれ含めている。 • ロールプレイングやシミュレーションは、経験から最もよく学ぶ人に最適である。 • 観察から最もよく学ぶ人には、デモ、動画、教習員や車椅子ユーザーを視るのが最も有益である。 • 概念を論じ、枠組みや定義、理論をもたらす発表や読み物は、大局的に考え、理解することから 最もよく学ぶ人に役立つ。 • 車椅子ユーザーとの実習（基礎WSTPや中級WSTPなどの）は、理論的な説明を適用するので、 実行によって学ぶ人に最適である。 グループの話し合い、ケーススタディ、質疑応答、ワークブックの課題、フィードバック時間は すべて、異なる学習スタイルにアピールする授業方法なので、それらの目的、および各場面に適合 する活用方法をよく考える必要がある。 教習員自身にも、自分の選好スタイルがある。重要なことは、それを認識していることと、特定の アプローチをおろそかにしないよう気をつけることである。 どの段階も飛ばさないように！ 「経験」の部分が欠けると何が起こるか？学びが実生活との接点を失い、受講者個人の経験に根を 下ろさない、抽象的なものになる。 「観察」の部分が欠けると何が起こるか？学習者が、自分の個人的経験がより広い抽象的な概念や 枠組みとどう結びついているのか、探求したり確かめたりできなくなる。 「思考」の部分が欠けると何が起こるか？学習者はある経験から別の経験へ、それらどうしの関連 を分からないまま進むことになる。そうした人は、経験を有意義なやり方で整理するために役立つ 枠組みから得るものがない。 「実行（練習）」の部分が欠けると何が起こるか？学習者は、理論や枠組みを職場や自分の生活に 適用するやり方を見出すことがない。 24 活車３：学習への選好と活車をマッチさせる この教習活動はこの人の学習スタイルに最も効果的、と思う人の名前の下に「X」を付けなさい。 最後の列には、比較として自分自身のスタイルについて記入しなさい。 • カルロスは、実行によって最もよく学びます。 • ミリアムは、観察によって最もよく学びます。 • シータは、経験によって最もよく学びます。 • アフマドは、大局を理解することによって最もよく学びます。 カ ル ロ ス ミ リ ア ム シ ー タ ア フ マ ド 自 分 自 身 1. 車椅子ユーザー教習の練習としてロールプレイングを 行なう 2. 教習員が新規車椅子ユーザーへの身体計測のやり方を 示すところを観察する 3. 自国の車椅子サービスに関する、法律や規制についての 政府職員の発表に出席する 4. 車椅子に乗っている人がやりたいことを実行している のを観察する 5. 車椅子サービスに関連する重要文書について学習する 6. 他の受講者と、フォローアップをユーザーの家で行なう ことの長所と短所について話し合う 7. CRPD（障害者の権利に関する条約）の最も重要な条文 に関する、教習員の説明を聴く 8. 除圧クッションをつくる 9. 車椅子で走り、車椅子ユーザーが経験する障壁を体感 する 10. 教習員が事前評価を実施する様子を観察する 11. 新規車椅子ユーザーに対する事前評価インタビューを 実施する 12. 車椅子サービス事業を既存のリハビリテーション サービスに追加することによる費用節減を算定する 25 成人学習を支援する だれにも選好学習スタイルがある一方、あらゆる大人の学習者に ついての共通項もある。 大人の学習者は主体的38で自分の学習に責任を持つため、積極的 参加を促すことで支援せよ。 大人の学習者は、学びに自分自身の知識や経験をもたらすため、 その経験を他者と共有し、また他者から学ぶよう奨励せよ。 大人の学習者は、関連が明らかで実践的な39学びを求め、学んだことを適用したいと望む。業務へ 実際に適用できる、明確な学習目標を置くことで支援せよ。 活車４：問題解決40 「問題解決」とは、問題に対して最適解を見出すプロセスのことです。 これは成人学習の重要部分で、車椅子サービス供与における重要技能です。 受講者が問題解決を行ない、自分自身の解決策を見出すには、どう動伝えばよいでしょうか？ 38 [原文] self-directed 39 [原文] relevant and practical 40 [原文] problem solving 26 受講者の問題解決を助ける • オープンクエスチョン41（単純に「はい」か「いいえ」で答えられない）で問え：オープン クエスチョンは、受講者に教習員が期待する答えを推測するのではなく、ものごとについて より深く考える、あるいは自分の経験をたどり自分自身で考えるよう要求する。 • 教えるより問いかけよ42：受講者に、どんな解決策が必要あるいは可能か、教えるのではなく 尋ねよ。受講者が自分自身でそれを導き出す手助けをせよ。 • グループの他の人にも答えを考えてもらえ：「どなたか違う考えはありませんか？」 • 事例ごとの話し合いを奨励せよ：受講者へ、事前評価、フィッティング、ユーザー教習のために 教習を訪れた、個々のユーザーについて話せ。 • 「分かりません」で答えを終わらせるな43：受講者が、主題について自分が知っていることを じっくり考え、可能な答えを検討するように支援せよ。 • 辛抱強くあれ：問題解決能力の育成には時間を要する。 • いちどに１ステップずつ44：課題を個別のステップに分解し、ステップバイステップに45質問し、 問題解決を促すことによって受講者を支援せよ。 • 受講者に、創造的で多面的46に考えることを奨励せよ。 • 受講者に協働を奨励せよ：チームワークとよいコミュニケーションは問題解決を助ける。 留意事項 • 車椅子供与教習（基礎WSTP・中級WSTP）の受講者には、単純な答えがない場合もある。 • 臨床場面では、処方や改造、姿勢支持具が、技術的にはよい解決策であっても、機能的な障壁や 制約をこしらえてしまう場合もある。 • 完璧な解決策は、たいてい一つではないことを認識せよ。車椅子サービス供与には、顧客ニーズ と手に入る製品の範囲との間での妥協が求められる。 41 [原文] open-ended questions [訳注] 自由回答形式, 拡大質問とも呼ばれる. 42 [原文] Ask rather than tell 43 [原文] Don’t take ‘I don’t know’ for an answer 44 [原文] One step at a time 45 [原文] step-by-step 46 [原文] laterally 27 ToT.6 準備時間について 準備時間は、ToT の時間割に盛り込まれている。この時間は、以下のことに活用できる： • 「保留スペース」の質問に答える。 • ToT 教習員と面談し： o 質問する。 o フィードバックをもらう。 • 自分の模擬授業を準備する： o 教習員仲間を調整する。 o デモ用資材や視聴覚機器を準備する。 28 ToT.7 プレゼンテーション47とファシリテーション48 活車１：教習員のふるまい49 過去に自分が教習を受けた人を思い出し、だれが効果的な教習員だったと思われるか特定しなさい。 それは、学ぶべきことを学べるようにし、ポジティブで価値ある経験をもたらした人です。 下欄に自分の経験を振り返りなさい。 その人のどんなふるまいが効果的でしたか？ 47 [原文] presenting [訳注] 意味は p.29本文を参照. 48 [原文] facilitating [訳注] 適切な和語がないため, 外来語として定着している名詞形を訳語に用いた. 49 [原文] behaviour 29 プレゼンテーションとファシリテーション プレゼンテーションとは、受講者が情報を与えら れる、一方通行のプロセスである。プレゼンテー ションでは情報、事実、数字を提供し、誤情報を 訂正する。 事実、理論、枠組みのプレゼンテーションを行な う際には、対象者がその情報を知らないか、思い 出す必要があるという前提でのぞむ。したがって 全受講者は、たとえその情報をすでに知っている 人がいても同様に扱われる。 ファシリテーションとは「ものごとを容易にする」という意味である。ファシリテーションを 行なうのは、受講者にとり、以下が容易になる場合である： • 理論的概念と現実の課題や任務との結びつきを理解する。 • 自分自身の経験を振り返る。 • 自分自身の経験や見方を、新しい情報と結びつける。 プレゼンテーションとファシリテーションの優れた実践 プレゼンテーション： • 話のペースやトーンに変化をつけよ。 • 教室内の自分の立ち位置に注意し、変化をつけよ。 • 質問し、励ましてグループに貢献を促せ。 • 試験済みで時間が設定されている、WSTP「教習員用指導書」の指示にならうこと。 • 映しているスライドが、話している内容と一致していることを確かめよ。スライドは「教習員用 指導書」と同期させよ。 • スライドを読む時、グループに背を向けてはならない。 ファシリテーション： • 活動は授業前にやってみること。そうすると活動の目的がわかる。 • 自分で考える間 [ま]50を与えよ。沈黙をおそれるな。 • 受講者からの質問は、自分で答える前にグループへ問いかけよ。 • 受講者には明確な指示を出し、自分自身がその指示を理解しているか授業前に確かめておけ。 • 受講者をモニターし、授業の要点を学んでいるか確かめよ。 50 [原文] time and space to think 30 エナジャイザー(51) どんな教習の中でも、活力レベルが落ちてくる時間はあるものだ。暑い気候、空気のよどんだ部屋、 豪華な昼食、教習の長い一日からの疲れは、注意を散漫にし、グループの活力を落ち込ませる。 これに対処する最善策は、みなが気軽に動いて交流する機会を設けることにより、教室へ活発さや 楽しさを注入することである。 これは活気をもたらすための、教習の一環としても、単独の活動によっても達成できる。以下は、 いくつかのアイデアである。 教習の一環として： • グループ全体へひんぱんに質問し、一人を指名して答えてもらう。 • 受講者に、隣どうし顔を合わせて質問やトピックへの答えを話し合ったり、出たばかりの意見に 対して異なる意見を探ったりしてもらう。 • 受講者に、立ち上がって何か（車椅子やポスター、フリップチャート、デモ）を見に来てもらう。 • 可能であれば、気分転換や運動をもたらすため、授業を他の部屋や屋外へ移動して行なう。 単独の活車として： • いっしょに歌う。 • 立ち上がって簡単なストレッチ体操を行なう。 • 「サイモンが言った52」で遊ぶ：指示を出し（「跳び上がれ」、「つま先に触れ」、「空を指させ」、 「振り返れ」など）、受講者は、指示が「サイモンが言った」で始まった時だけ、それに従わねば ならない。 • 3 分間ストレッチを行ない、休憩する。 • 受講者のひとり、あるいはグループをよび、2〜3 分、エナジャイザー活動を指揮してもらう。 かれらは、グループ全体で共有できる、別の現地に合った活動を知っているだろう。 51 With thanks to Robert Chambers for some of them [感謝: このいくつかはロバート・チェンバースに 負っている]. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 (https://www.routledge.com/Participatory-Workshops-A- Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). [原文] Energizers 52 [原文] Simon says [訳注] 日本の「船長さんの命令」と同じルールで行なわれるゲーム. 詳細は例えば (https:// yamatoco.theblog.me/posts/4946847/, 2023年 7月 1日アクセス済) などを参照. 31 留意事項： • 文化、ジェンダー、障害による違いを認識し、また敏感であれ。 • 受講者ができない、あるいはやりたくないことは、いっさい強制するな。 • ゆっくりと始め、より元気のある活動へと盛り上げよ。 • 可能な時は、自分も参加せよ。 • 楽しんで！ 時間管理 教習員は、必ず教習が時間通り進むようにすべきである。数多くの授業や活動がある一方、それら を完了するための時間は限られている。持てる時間を最大限に利用するには、行動や活動の修正が しばしば必要になる。 活車２：時間管理 ペアを組んで話し合いなさい：教習が時間通り進むためには、どうしたらよいでしょうか？ 思いついたことを書き出しなさい： 32 教習を予定通りに保つための提案 • 時間を守ることは全員の責任である：受講者には、各自が時間を守る責任を果たすよう促せ。 • 授業は毎回、時間通りに（一日の始まりおよび休憩後に）始めよ：時間通り来た人に、遅刻者を 待たせて不利益を負わせるな53。 • 機材と教材は、前もって準備せよ：それらをどう使い、どこに置くか計画しておけ。 • きっちり授業計画に沿って進めよ。追加時間がない限り、WSTPに資料やあまりにも多くの実例 を追加するな。 • 話し合いを授業のねらいと学習目標に集中させ続けよ。話し合いでの、目下の授業に関係ない、 あるいはすぐに答えられない話題は「保留54」しておけ。 • 受講者には時間の区切りをはっきり知らせよ：例えば、「15 分休憩、10:45 には戻って下さい」 「自分のグループでの話し合いに 10分、フィードバックに 5分使えます」 • 教習員仲間55と、授業時間がどれくらい残っているか知らせる合図を決めておけ。 • 特定の実施条件が要求される授業には予備計画56を立てておけ。例えば、雨で車椅子の移動技能 の授業が中断になった場合どうするか？ • 電源が不安定な地域では、UPS（無停電電源装置）内蔵の発電機を備えるよう検討せよ。 • 軽食の準備が整っているか確かめよ：食事の到着が遅れると、休憩後の授業開始が遅れる。 53 [原文] avoid penalizing 54 [原文] Park 55 [原文] co-trainers 56 [原文] back-up plan [訳注]「プラン B」とも呼ばれる. 33 ToT.8 コミュニケーションスキル 活車１：コミュニケーションスキル 下表のうち、自分のグループに割り当てられた情報を読みなさい。続いて他の実習生がその要点を 把握できる発表を作成しなさい。 グループで作業し、情報をどのようにプレゼンテーションし、だれがどの部分をプレゼンテーション するか決めなさい。発表には、グループ全員が参加しなさい。フリップチャートやホワイトボード などの小道具は、自由に用いてかまいません。発表では、創造性を発揮しなさい。 準備には 20分使えます。皆への発表時間は 5分あります。 グループ１：言語的技能： • プレゼンテーションを行なう時は、声の速さ、大きさ、抑揚（イントネーション）を意識せよ。 • 社会的に不適切なことば、例えば、卑語俗語57や「無意味な語58」（「あー」「うん」「そのー」 「ええと」など）の使用を避けよ。 • 受講者全員に、はっきり聞こえるようにせよ。 • 受講者が、教習員が言ったことを理解しているか、してしないか気づけ。 • 教習プログラムを受講者の 二言語で行なう場合や通訳を介して実施する場合も、必ず全員が 理解できるようにせよ。 • 受講者全員が理解できる用語を用いよ（特に身体の解剖学的部位について話し合う場合）。 • 教習で用いる用語は平易で非医療的な59ものにし、臨床教育や高等教育を受けていない車椅子 サービスユーザーや受講者も内容を理解できるようにせよ。 57 [原文] slang 58 [原文] ‘non-speak’ 59 [原文] simple and non-medical 34 グループ２：非言語コミュニケーション • アイコンタクトを保て。 • 自分のボディランゲージを自覚せよ。 • 適切ならばユーモアを交えよ。ユーモアとは軽妙さのこと、また自分自身や自分の意見を深刻 に扱いすぎないことである。 • ユーモアとは、ジョークを飛ばすことではない。ジョークの多くは文化に依存するため、意図 した通りには効かないこともある。 • 車椅子ユーザーとのコミュニケーションでは、目の高さに身をかがめるなど適切に動作せよ。 • 教室での、自分と受講者の位置： o プレゼンテーションを行なう時、教習員は前か横に立つこと。 o 受講者から教習員が見え、聞こえなければならない。 o 半円をつくると、だれも後列にならなくてよく、受講者全員からお互いが見える。 o 受講者の背後に立つのも状況によっては適切である。例えば、教習員がプレゼンテーション を行ないながらパワーポイントのスライドを読み上げる必要がある場合など。 o 流れによっては、時おり教習員が座るのも適切である。これは、リラックスして打ちとけた 雰囲気をつくり出す。 グループ３：質問する • 受講者みなが質問について考え、応答するための時間を取れ：最初に反応した人から、つねに 答えをもらう必要はない。特に教習を受講者の 一言語で実施していない場合、考えるために 受講者が時間を要することもある。 • 受講者の質問に、一足飛びに答える60な。なるべく答えを言わないで、受講者が着想や概念、 答えを思いつくよう促せ。教室から答えを引き出せ。 • 必要なら、質問をわかりやすく言い換えよ。受講者の反応が沈黙や混乱、誤答である場合は、 質問を言い換える必要があろう。 • オープンクエスチョンを活用して理解を確かめよ（例えば「褥瘡の 3つの原因とは？」）。 • クローズドクエスチョン61（応答が「はい」か「いいえ」になる質問）を用いるのは避けよ。 • 正しい答えが発されたら、受けとめ承認せよ。 • 誤答が返ってきたら、まず他の受講者またはグループメンバーに同じ質問をせよ。グループが だれも答えられなかった場合にのみ、正解を示せ。 • 質問に対して誤答がくり返されるのは、何か問題ありのしるしだ。ありうる問題としては： o 受講者が学んでいない。説明を言い換えるか、よく理解していないことが判明した、教習の 以前の部分まで戻る必要があるかもしれない。 o 受講者の知識レベルに対して、質問が不適切。 o 質問がうまく言い表されていない。 o 質問に、受講者が分からないことばを用いている。 60 [原文] jump to answer 61 [原文] closed questions 35 グループ４：質問に答える • 受講者が、自分でよく考えずに質問を発する場合もある。こうした場合は、答えを自分で導き 出すよう逆質問せよ62（授業「ToT.5: 成人学習」の最後の課題を参照）。 • 受講者に問いかけることで、かれらが答えを見出すのを助けよ。例えば、「あなたはどう思い ますか？」「…について判断するさい、考慮すべき重要な要素は何でしょうか？」。臨床推論63 や問題解決能力を育成しながら、正しい着想を受講者から引き出せ。 • 自分が答えを知らない質問を受けたら、まず受講者か教習員仲間に答えられないか尋ねよ。 • だれも答えられない場合は、その質問を「保留スペース」に追加し、教習が終わるまでに調べ て全体で共有すると申し出よ。 • 決して、知らないのに答えをでっち上げるな64。 • 尋ねられた時点で質問に答える時間がじゅうぶんない場合は「保留スペース」を利用して控え ておき、後ほど教習プログラムの中で取り上げよ。 • 授業のねらいや学習目標から外れた質問に時間を費やすな。休憩中に、質問者とそれについて 話し合う機会を設けよ。 • 後の授業に関連する質問は、「保留スペース」に置くことが可能。「保留スペース」の質問に 対応したら、自分の質問が答えられたと受講者が感じているかどうか確かめよ。 • 傾聴65：どんな質問なのか判ったつもりになる前に、必ず質問全体を傾聴せよ。これは、話の 途中で口を挟んだり付け足したりしないことである。 • 正誤がある質問(特に基礎WSTPや中級WSTPに当てはまる)と、管理者向けWSTPや関係者 向けWSTPによくある、正解や誤答がない質問との違いを意識せよ。 デモ・車画・通訳について 以下は教習でデモを行ない、動画を上映し、外国語と手話、両方の通訳を用いる場合の優れた実践 である。 デモを行なう： デモを行なう際には： • だれからも見えるようにせよ。 • 小道具や機材は前もって準備せよ。 • はっきりと説明し、やって見せ、くり返せ。 • 聴衆を知れ。 • 受講者が、やって見せたことを練習できるようにせよ。 62 [原文] challenge 63 [原文] clinical reasoning 64 [原文] Never make up an answer if you do not know. 65 [原文] Listen 36 • 受講者をモニターし、必要に応じて介入しフィードバックを与えよ（特に安全に関して）。 • 基礎WSTPと中級 WSTPのデモでは、ジェンダーに配慮せよ：特に接触が必要な場合。 車画を用いる： WSTPでは、ほとんどの実技のデモに動画を用いている。動画を上映する前に： • 内容を熟知せよ。 • 文化やジェンダーに触れないか確認せよ。 • 上映の前に、どういったものか説明せよ。 • おおよその長さを知らせよ。 • 授業に結びつけよ。 • わかりやすいよう、字幕付きの動画を上映せよ。 • 受講者に、考えてほしいことがらについて質問し、観察すべき点を強調せよ。 • 時間が許せば、重要場面を繰り返し、あるいは重要ポイントで一時停止して強調せよ。 外国語や動話の通訳者と協働する： 通訳者と教習開始前に会って打ち合わせるべきこと： • 話のペース • 重要語彙、例えば障害者に関する用語 • 車椅子ユーザーとのコミュニケーション方法 • 通訳者の実習中の役割 • 教習内容：通訳者に「教習員用指導書」を 1部渡しておけ。 • 通訳者に、すべて翻訳し、要約したり、言われたことを変えたりしないよう指示せよ。 • 通訳者は、決して自分の代わりに質問に答えてはならない。 • 通訳者を二人手配し、休憩を取れるようにせよ。 教習中、自分自身について確認すること： • ゆっくり、はっきりと話せ。 • 自分の身体言語に注意を払え。 • 読唇する人のために、手は顔から離せ。 • つねに本人や受け手と直接やり取りせよ。 • 関心を示し、アイコンタクトを保ち、集中力を維持せよ。 • 時間を計画せよ：通訳を介して話すと、会話に 2倍時間を要する。 37 ToT.9 指針文書66の知識 「指針文書」とは何か？ 指針文書とは、出版物、政策、条約、法律などで、車椅子サービス供与に関連する枠組み、指針、 規則を与え、また車椅子サービス供与関係者の指針となるものである。 多くの政府、国際機関、資金供与者67その他の関係者は、これらの国際的枠組みに沿って開発事業 を計画し、資金を供与する。 これらについての知識があれば、より強い立ち位置から、車椅子サービス供与に向けた啓発や政策 提言を行なえる。 国や地域の法令および政策は、現地の車椅子サービス供与に影響を及ぼす。話し合いを導くうえで、 そうした文書は熟知しておく必要がある。 次節からは、車椅子サービス供与に関係するさまざまな指針文書を概観する。そのいくつかは WSTP用 USB メモリ68に収めており、その他はインターネット上でアクセスできる。 「国際連合 障害者の権利に関する条約 (CRPD)」 「国際連合 障害者の権利に関する条約」は一般に「CRPD」、 時に「UNCRPD」とも呼ばれる69。CRPDは障害者に関する最も 重要な国際条約だと広く考えられている。 2008 年に発効し、発効日には 82か国が CRPDに署名、その選択 議定書に 44か国が署名した。 これは国連の条約中、発効日の署名国数では史上最多である。 CRPDは、障害者への社会の見方と処遇のあり方を変革するため、国際社会の代表者によって策定 された。 この条約の策定に参画した代表者は障害者、政府当局者、非政府組織（NGO）の代表などである。 66 [原文] guiding documents 67 [原文] donors 68 [原文] WSTP Pen Drive [訳注] 英語版のみがWHOより配布されている. 各資料の日本語版入手先は訳注を参照. 特に指定していないものは, 日本車椅子シーティング協会のウェブサイトよりダウンロード可能. 69 [訳注] 日本では「障害者権利条約」と略されることも多い. 38 CRPDが重要である理由は、障害者が他のあらゆる人びとと同じ権利と機会へアクセスできるよう になるためのツールだからである。 年々、ますます多くの国ぐにが CRPDに署名している。CRPDおよびその選択議定書への署名国に 関する最新情報は、国際連合のウェブサイト(70)上で確認できる。 CRPDには車椅子サービス与 に関連するいくつもの条文がある： 最も関連がある こちらも関連がある • 20条：個人的移動性 • 4条：一般的義務 • 26条：ハビリテーション71および リハビリテーション • 32条：国際協力 • 19条：自立生活および地域社会への インクルージョン • 24条：教育 • 25条：健康 • 27条：仕事および雇用 • 30 条：文化的生活・レクリエーション・ 余暇・スポーツへの参加 CRPDの他の多くの条文が、間接的に車椅子サービス供与と関連している。例えば、第 6条は女性 障害者の具体的なインクルージョン、第 7条は子どもの平等に関わる。 70 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/enable/rights/convtexte.htm). 71 [原文] Habilitation [訳注] 機能を回復する「リハビリテーション」に対して, 新規に機能を構築すること. 39 子どもや女性がさらにぶつかる障壁には何があるだろうか？ • 文化や地域によっては、女性や子どもは男性と同じ価値があると見なされない。 • 車椅子を購入する必要がある場合に、文化によっては女性や子どもへの出費が優先されない。 • 早期発見や早期介入のサービスを利用できないところでは、子どもが紹介・相談されない。 • 子どもに合うサイズの車椅子が手に入らない。 • 子どもに必要なことが多い、座位保持72を利用できない。親や介助者が、さまざまな理由から 障害児を抱えることを選択する。例えば、子どもが小さいうちはその方が楽、わが子が車椅子 に乗っているところを見られる不名誉73を感じないで済む、車椅子で公共交通機関を利用する のが非常に困難、他の選択肢を知らないなど。 WSTP受講者がCRPDを熟知していることは重要： • CRPDの人権に基づくアプローチを、障害者への車椅子サービス供与の発展に役立つように活用 するため。 • CRPDの条文を、車椅子サービス提供のゴールを設定する際の指針として活用するため。 • 政府やその他の関係者へ、条文の目的を達成するために協働するよう、政策提言を行なううえで 役立つため。 • CRPD を支持する寄付者に、自国での車椅子サービス供与を支援するよう促すため。 72 [原文] supportive seating 73 [原文] stigma 40 主要条文の詳細： 第 4条 第 4条 一般的義務 によると締約国は： 障害に基づくいかなる種類の差別もない、すべての障害者のあらゆる人権および基本的自由の完 全な実現を保証し、また促進することを約束する。 第 4条 (g)項によると： 障害者に適した、情報通信技術、移動補助具、支援機器、支援技術などの新技術について、研究 開発を実行または推進し、またその入手しやすさと利用とを増進し、そこでは価格に無理のない 技術を優先する。 同 (h)項によると： 障害者へ、新技術を含む移動補助具、支援機器、支援技術についての利用しやすい情報を、他の 形態の支援、支援サービス、施設と並んで供する。 同 (i)項によると： この条約が認める権利について障害者と協働する専門家および職員への研修を推進し、それらの 諸権利が保証する支援およびサービスが、よりよく供されるようにする。 第 20条 第 20条 個人的移動性 は車椅子サービス供与に最も関連する条文である。これの要件は： 締約国は、最大限に自立した個人的移動を障害者へ保証するための実効ある施策を講じ、以下の ことなどを行なう： (a) 障害者の、自分が選んだ方法で、自分が選んだ時に、無理のない費用で行なう個人的移動を 容易にする。 (b) 質の高い移動補助具、補装具、支援技術、人や動物による支援、仲介サービスを、障害者が 利用しやすくなるようにし、とりわけ無理のない費用でこれらが手に入るようにする。 (c) 障害者、および障害者と協働する専門職員に対して、移動技能の教習を提供する。 (d) 移動補助具、補装具、支援技術の生産に当たる事業体が、障害者の移動についてのあらゆる 側面を考慮するよう奨励する。 41 第 26条 第 26条 ハビリテーションおよびリハビリテーション に含まれる要件： 締約国は、障害者のために設計された支援機器および支援技術について、ハビリテーション およびリハビリテーションと連携するので、それらの入手しやすさ、知識、利用を増進する。 「ハビリテーション」と「リハビリテーション 」の定義： • リハビリテーションの言葉はよく知られているが、ハビリテーションはあまり使われない。 • リハビリテーションの重点は能力を回復することで、いっぽうハビリテーションは新規に能力 を習得し、構築することに関わる。 第 32条 第 32 条は、例えば支援技術の利用促進などの国際協力を推進することから、広い意味で車椅子 サービス供与に関連する。 42 WHO「動車車椅子与 の世界ガイドライン 低リソース状況の克服に向けて」 WHOの「手動車椅子供与の世界ガイドライン 低リソース状況の 克服に向けて (車椅子ガイドライン)74」は、車椅子供与に焦点を 置いた、最も重要な国際的文書である。 「車椅子ガイドライン」は、現在世界的に理解されている適正な 車椅子供与枠組みをまとめたものである。「車椅子ガイドライン」 の発行以前、車椅子供与に関わる諸組織は、車椅子の設計や生産； サービス提供システムの確立；職員教習；車椅子供与に関連する 政策策定に当たり考慮すべき重要事項は何か、共通理解を持って いなかった。 「車椅子ガイドライン」は、全世界の多分野にわたる関係者の参画により作成された。これは合意 された基準に沿ったサービス事業開発や、政府やその他の関係者への適正な車椅子サービスの政策 提言のために役立つ、強力なツールとなる。「車椅子ガイドライン」は、低・中・高リソース状況で 普遍的に達成可能な基準を反映している。 車椅子が適正であるとは： ✓ ユーザーのニーズおよび環境条件に合い、 ✓ 適切にフィットして姿勢を支え、 ✓ 安全で耐久性があり、 ✓ 国内に用意され、 ✓ 入手・メンテナンス・継続したサービスが国内で、無理のない価格で可能であること。 これは、教習員およびWSTP受講者が知っておくべき重要な定義である。 74 [訳注] これに加え, 2023年 6月にWHOから「車椅子供与ガイドライン」(Wheelchair Provision Guidelines) が 発行された (https://www.who.int/publications/i/item/9789240074521). 日本語訳は 2024年に発行予定. 43 「車椅子ガイドライン」では、車椅子に関する以下の項目も 取り上げている： • 設計および生産 • サービス提供 • 教習/人材育成 • 政策および計画策定 WSTP教習員の、「車椅子ガイドライン」に関する知識は、 包括的でなければならない。教習員として、機会あるごとに その意識を喚起すること。 「車椅子ガイドライン」は、WHOのウェブサイトで各言語版75を入手できる。 「低リソース状況での移車支援機器与 に関する共同方針提言書」 WHO の「低リソース状況での移動支援機器供与に関する共同 方針提言書(76)」は、各国が CRPD の移動支援機器供与関連の 条文を履行できるよう、2011 年に発行された。 この文書は、移動支援機器へのアクセスに対する障壁、移動支援 機器へのアクセスを増やすための要件、各国および国際的な関係 者への提言などの貴重な情報を提供する。 75 (https://www.who.int/publications/i/item/9789241547482). [訳注] フランス語・スペイン語を含む. (https://apps.who.int/iris/handle/10665/43960). [訳注] 日本語・ベトナム語を含む. 76 Joint position paper on the provision of mobility devices in less-resourced settings: a step to wards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) re lated to personal mobility. Geneva: World Health Organization; 2011 (https://apps.who.int/iris/ handle/10665/44780). [日本語版] 日本車椅子シーティング協会訳. 2022 (上記 URLおよび https://j-aws.jp/who/). 44 「地域に根ざしたリハビリテーション：CBRガイドライン」 WHOの「地域に根ざしたリハビリテーション：CBR ガイドライ ン(77)」は 2010 年に発表され、CBR78への世界共通の理解および 取り組みを提示したものである。 CBR は、低リソース状況における障害者のリハビリテーションへ のアクセスを、地域リソースの最適な活用によって改善するため の方策である。「CBR ガイドライン」は行動への枠組みを提供し、 実施への実践的な提案を示している。 「CBR ガイドライン」の導入ブックレットと保健コンポーネント はWSTP用 USB メモリに資料として収められている79が、WSTP で特に触れてはいない。 CBR は 90超の国ぐにで実施され、CRPDの条文を実現する最も 効果的な方法の一つだと、ますます考えられるようになっている ため、「CBR ガイドライン」についてよく知るよう推奨する。 CBR はしばしば「地域に根ざしたインクルーシブ開発 (CBID)80」とも呼ばれ、WSTP でも話題に 上る可能性が高い。CBR の多くの側面が車椅子サービス供与に関連しており、例えば、紹介・相談 ネットワーク、地域の保健センター、CBR ワーカーなどがある。 77 WHO Community-based rehabilitation: CBR Guidelines. Geneva: World Health Organization; 2010 (http://www.who.int/disabilities/cbr/guidelines/en/). [日本語版] CBRガイドライン日本語訳: 上野悦子監修. 公益財団法人日本障害者リハビリテーション協会. 2010 (https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html). 78 [訳注] Community-based rehabilitationの略称. 79 [訳注] 英語版のみ. ウェブ上で入手する場合は例えば: 日本語版 (公益財団法人日本障害者リハビリテーション協 会訳) https://www.dinf.ne.jp/doc/japanese/intl/un/CBR_guide/index.html その他各言語版：https://www.wh o.int/publications/i/item/9789241548052 80 [原文] community-based inclusive development 45 CBRマトリックス CBR マトリックス(81)は「CBR ガイドライン」の土台の一つである。その 5つの領域82として保健、 教育、生計83、社会、能力強化 (エンパワーメント)84があり、さらにマトリックスの各領域は５つ ずつの要素85を含むため、合計で 25要素がある。 81 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr /matrix/en/). 82 [原文] components 83 [原文] Livelihood 84 [訳注]「能力強化」は国連広報センター (https://www.unic.or.jp/activities/human_security/human_security_ap proach/) の訳語.「エンパワーメント」も広く使われ, こちらが分かりやすい読者も多いと考え併記した. 85 [原文] elements 46 活車１：CBRマトリックス グループで作業し、車椅子サービス与 が CBR マトリックスの自分たちに割り当てられた領域 （保健、教育、生計、社会、能力強化（エンパワーメント））に、どう関連するか列記しなさい。 さらに詳しい情報および「CBRガイドライン」全文は、WHOのウェブサイト(86)を参照。 86 (http://www.who.int/disabilities/cbr/guidelines/en/). 47 車椅子サービス与 とCBRの 5領域 保健 教育 • リハビリテーション：長期および短期の • 健康増進や二次障害予防：例えば早期発見 と早期介入による側弯や褥瘡の予防 • 保健医療サービスへのアクセス • 学校、教育プログラム、職業訓練プログラムへ のアクセスを可能にする 社会 • 社会およびレクリエーション活動へのアクセス 増進 • 仲間との、スポーツや文化プログラムへの参加 • 人間関係をつくり、育てる機会 生計 • 生計活動を遂行することへのアクセス • 収益力 • 金融サービスへのアクセス エンパワーメント • 自己イメージや自信の向上 • ピアサポート（当事者支援） 「アクセシビリティのためのデザインの留意事項」 「アクセシビリティのためのデザインの留意事項(87)」は、車椅子 サービスを訪れる場合およびその他の環境の両方で、アクセスが あらゆる面について考慮されるようにする方法に関する、有益な 情報をもたらす。ここで取り上げているのは： • 障害者用保留スペース • 切り下げ縁石 • 通り道 • スロープ • 階段 • 手すり • ドアおよび戸口 • 廊下 • トイレ 87 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled Pe ople; 2006 (http://ascon.info/publications/accessibility.pdf). 48 「持続可能な開発目標（SDGs）」 「持続可能な開発目標 (SDGs)(88)」は、2015 年 9 月、歴史的な 「国連サミット」で世界の指導者たちが採択し、2016 年 1月 1日 に発効した。続く 15 年にわたり、各国は持続可能な開発の 3 つ の側面（環境、経済、社会）すべてに努力を結集し、17のゴール を達成すべく尽力する。 SDGs は、2015 年に最終報告書を出した「ミレニアム開発目標 (MDGs)89」を継承するもので、2012 年の「国連持続可能な開発 会議 (リオ+20)」で始まった共同開発プロセスの成果である。 WSTP モジュールの開発は SDGs の発表前だったため、教習パッケージではそれに触れていない。 しかし、政府、開発・援助機関の多くが SDGs への取り組みに集中するため、実習生や受講者が、 それを意識して適正な車椅子サービス供与が SDG の課題90にどう適合するか見極めることは重要 である。 SDGs は 17 のゴールと関連する 169 のターゲットからなる。 SDGs 宣言の第 4パラグラフでは、重要な誓約がなされている： この偉大なる共同の旅へ乗り出すにあたって、我われはだれひとり取り残さないことを誓う。 我われは、人間の尊厳は根本をなすものであると認識し、この目標とターゲットとがあらゆる 国ぐにと人びと、そして社会のあらゆる部分で満たされるよう希願する。そして我われは、 その最後に取り残されたものへ、最初に手を差し伸べるべく尽力する。 障害者への言及は、そこなわれやすい91人びとに関する第 23パラグラフにも盛り込まれている： そこなわれやすい人びとは、必ず力づけられるべきである。そのニーズが課題に反映されている 人びとには、すべての子ども、若者、（その 80%超が貧困のうちに暮らしている）障害者、 HIV/AIDS と共に生きる人びと、高齢者、先住民、難民および国内避難民、移民などがある。 我われは、複合的な人道的危機に見舞われた地域や、テロリズムに襲われた地域に住む人びとの 障壁や束縛を取り除き、支援を強化し、特別なニーズを満たすべく、国際法にのっとり、さらに 効果的な措置と行動をとることを決意する。 88 The sustainable development goals [website]. New York: United Nations (http://www.un.org/su stainabledevelopment/sustainable-development-goals/). 89 [原文] Millennium Development Goals [訳注] 2015年までに 8目標・21ターゲットの達成を掲げた. 90 [原文] agenda [訳注] 日本語でも, そのまま「アジェンダ」と呼ばれることも多い. 91 [原文] vulnerable populations 49 障害と SDGs ゴール 4：すべての人に、インクルーシブで公正な質の高い教育と 生涯学習機会を保証するため、教育におけるジェンダー格差を取りの ぞき、障害者などそこなわれやすい人びとへの、あらゆる水準の教育 と職業訓練への平等なアクセスを保証することに重点を置く。さらに 提案書では、子ども、障害、ジェンダーに配慮して教育施設を建設ま たは改装し、すべての人に安全で、非暴力的で、インクルーシブかつ 効果的な学習環境をもたらすよう求めている。 ゴール 8：継続的でインクルーシブかつ持続可能な経済成長、および、 すべての人の完全かつ生産的な雇用と真っ当な仕事92を促進するため、 国際社会は障害者を含むすべての男女の完全かつ生産的な雇用および 真っ当な仕事、および等価値の仕事への平等な賃金93の達成をめざす。 ゴール 10：障害者を含むすべての人の能力強化（エンパワーメント） および社会・経済・政治的インクルージョンの推進により、各国内 および各国間の不平等を縮小すべく尽力する。 92 [原文] decent work 93 [原文] equal pay for work of equal value 50 ゴール 11：インクルーシブ、安全、強靭94で持続可能な、まちと住み 場づくりをめざす。このゴールの実現のため締約国に求められること は、とりわけ障害者などそこなわれやすい人びとのニーズに特に配慮 した公共交通の拡大を通じた交通安全の向上により、安全で、料金に 無理がなく、利用しやすい、持続可能な交通システムへのアクセスを すべての人にもたらすことである。加えて提案書では、特に障害者に とり、安全かつインクルーシブで利用しやすい緑地と公共スペースへ のユニバーサルアクセスを求めている。 ゴール 17：持続可能な開発に向けた実施手段を強化し、グローバルな 連携を活性化するには、SDGs に関するデータ収集、モニタリングと 説明責任が極めて重要だと強調している。締約国には後発開発途上国95 や小島嶼開発途上国96など開発途上国への力量構築97支援が求められ、 それは質が高くタイムリーで信頼でき、さらに障害別にも分類された データの入手可能性を、著しく向上させる。 SDGsに関するさらに詳しい情報は、国際連合のウェブサイト(98)を参照。 「支援技術に関する世界協力（GATE）」 WHO の推計では現在 10 億超の人が 1 つ以上の支援製品、例えば 車椅子、補聴器、歩行器、眼鏡、ピルケース、コミュニケーション ボード99などを必要としている。 世界的な人口高齢化および非感染性疾患の増加に伴い、WHOの 予測では、この数は 2050 年までに 20 億人を超え、多くの高齢者 には、加齢に伴い複数の製品が必要になる。 94 [原文] resilient 95 [原文] least developed countries 96 [原文] small island developing states 97 [原文] capacity-building 98 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 99 [原文] communication board 51 支援製品には、教育や生計手段へのアクセスを可能にし、自立を維持し、世界とつながるうえで 極めて重要な役割がある。しかし現在、製品を必要とする人のうち、アクセスできるのは 10人に ひとりに過ぎず、製品がなければ社会参加から排除され、孤立し、貧困のうちに閉じ込められる。 WHO は、この巨大で満たされざる世界規模のニーズ100に応え、CRPD 第 32 条を実現するため、 GATE の取り組みを調整している。GATE が取り組むゴールは一つだけである。それは、高品質で 価格に無理のない支援製品へのアクセスを、全世界で向上させることである。これを達成するため、 GATE は、製品、人材、供与、政策という 4つの相互連関する行動領域に重点を置いている。 「WHO 必須医薬品範例リスト101」の先例にならい、GATE が最優先で作成したのが「WHO 優先 的支援製品リスト (APL)(102)」である。APL には、世界中で最も必要とされる 50 の支援製品を収 めている。そこには、4 種類の車椅子、除圧クッション、可搬式スロープ、またその他の移動性、 聴覚、認知、コミュニケーション、視覚を向上させる製品が含まれる。 APLは制約を与えるリストではなく、締約国が、現地のニーズと利用可能なリソースに沿った国内 向け APLを作成するたたき台103の提供が目的である。そこに込められた期待は、現地の関係者が、 アクセス増大への努力を相乗させるための結集点となることである。 GATE が現在取り組んでいるのは、APL実施の支援ツール、例えばニーズ評価ツールキット、教習 パッケージ、政策枠組み、サービス供与モデルなどの開発である。 GATEに関するさらに詳しい情報は、WHOのウェブサイト(104)を参照。 100 [原文] huge and unmet global need 101 [原文] WHO Model List of Essential Medicines 102 Priority Assistive Products List. Geneva: GATE World Health Organization; 2016 (http://www.who.int/phi/implementation/assistive_technology/global_survey-apl/en/). 103 [原文] blueprint 104 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 52 「障害に関する世界報告書」 2011 年、WHOと世界銀行が共同作成した、初の「障害に関する 世界報告書(105)」が発行された。 報告書によれば、障害者は障害がない人に比べ、総じて健康状態 が悪く、教育水準が低く、経済的機会に乏しく、貧困率が高い。 これは障害者が利用できるサービスの欠如と、障害者が日常生活 でぶつかる多くの障壁によるところが大きい。 この報告書は、保健医療・リハビリテーション・教育・雇用・支援サービスへの障壁を克服する 方途に関する、エビデンスに基づく提言を与えている。また、障害者が活躍できる支援的な環境を つくり出すうえで、何が有効かを明らかにしている。 「障害に関する世界報告書」は以下の障壁を強調している： • 不適切な政策や基準 • ネガティブな意識 • サービス供与の欠如 • サービス提供における問題 • 不十分な資金 • アクセスの欠如 • 協議と参画の欠如 • データとエビデンスの欠如 これらはすべて車椅子サービス供与に関連するため、本書は有用な背景文書106である。この報告書 の提言 2「障害者のための特別なプログラムやサービスに投資すること」では、車椅子の重要性に 言及している： 車椅子や補聴器などの支援技術を含むリハビリテーションは、機能と自立を向上させる。地域の さまざまな調整が行き届いた補助および支援サービスはケアへのニーズを満たし、人びとが自立 して暮らし、経済・社会・文化的生活に参加できるようにする。 105 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/world_report/2011/en/). 106 [原文] background document 53 本報告書の、要約および提言はWHOのウェブサイト(107)を参照。 「WHO世界障害者行車計画」 「WHO世界障害者行動計画 2014-2021(108)」は、「障害に関する 世界報告書」の提言に基づき、また CRPDに沿ったものである。 これは締約国、国連諸機関、障害者団体などの国内および国際的 パートナーとの協議を経て作成された。 この計画は、障害者と障害がない人との格差への対処を目指して いる。これによると、世界中で障害者は、障害がない人に比べて 必要とする保健医療を受けておらず、健康状態が悪い。障害者は、 2 倍超の確率で技能や施設が不十分な保健医療供与者に当たり、 3 倍近くの確率で保健医療を拒絶され、4 倍の確率で劣悪な処置 を受ける。 行車計画の 3つの目標： • 障壁を取り除き、保健サービス・プログラムへのアクセスを向上させる • リハビリテーション、ハビリテーション、支援技術、援助および支援サービス、地域に根ざした リハビリテーションを強化し拡張する • 障害に関する、妥当かつ国際的に比較可能なデータ収集を強化し、障害や関連サービスの研究を 支援する。 締約国は、提案された行動を国の優先事項および状況に合わせて調整し、実施するよう要請されて いる。 全文は、WHOのウェブサイト(109)を参照。 107 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.wh o.int/iris/bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) [日本語訳 (概要): 障害に関する世界報告書, 国立障害者リハビリテーションセンター訳 (https://ww w.dinf.ne.jp/doc/japanese/intl/un/wrod_sum_jp.html)]. 108 WHO Global disability action plan 2014–2021: Better health for all people with disability. Gene va: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/978924 1509619_eng.pdf?ua=1). 109 (http://www.who.int/disabilities/actionplan/en/). 54 「障害と開発に関する国連総会高級事務レベル会合」 2013 年 9 月 23 日、国連総会高級事務レベル会合(110)が障害に関して 「前進への道：2015 年以降に向けた障害インクルーシブな開発実施 計画」という主題のもとに、一日開催された。 参加者は、締約国、オブザーバー、国連の代表者、また市民社会、 障害者団体、民間セクターの代表者などであった。 この会合の「成果文書」では、(a)から(q)までの誓約を列記している。 誓約(h)： ユニバーサルデザインの手法に従い、物理的環境、交通、雇用、教育、保健、サービス、情報、 情報通信技術はじめ支援機器に対する障壁を取り除き、遠隔地や農村地域においても、障害者が その全生涯にわたって最大限の可能性を実現するための、アクセスしやすさを保証する。 この会合の背景および成果を伝える冊子は、国際連合のウェブサイト(111)を参照。 110 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http://www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 111 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 55 ToT.10 視聴覚ツールおよび機材 教習員が、さまざまな視聴覚機材の使用に精通し自信を持つことは、教習授業を円滑に進めるうえ で重要である。 パワーポイント (PPT) と PDF WSTP のプレゼンテーションは、パワーポイントと PDF 両方の形式が用意されている。各形式の 利点と難点を下表にまとめた。 利点 難点 PPT • パワーポイントは個々のプレゼンテー ションスタイルに合わせて、また現地 の状況に当てはまるように変更可能。 • テキストの削減/簡略化が可能。 • 新しい内容や話し合いでの質問を押さ えたスライドの追加が可能。これは、 グループが異なる言語や方言を話す、 あるいは教習員の訛りを聞き取れない 場合に有効。 • コンピューターのスクリーンセーバー は、プレゼンテーションが「スライド ショー」モードであれば起動しない。 • 動画は自分で読み込む必要がある。 • ファイル全体のサイズは大きくなる。 • パワーポイントのファイル編集には、 時間を要する。 PDF • この PDF は、4種の動画形式すべて にリンクしている。望む形式をクリッ クすれば、動画を再生する。 • フォーマットや互換性について、問題 ないことが確認済み。 • ファイルサイズは、編集可能なものに 比べ小さい。 • 内容は固定され、現地事情や、自分の プレゼンテーションスタイルに合わせ た修正は不可能。 • 各スライドのテキストは、全部いちど に表示され（編集可能版にあるような スライドの「ビルド」効果がない）、 学習の要点を一つひとつ紹介すること はできない。 • 内容が多いスライドについてテキスト の簡略化や削減はできない。 • PDF なのでコンピューターのスクリ ーンセーバーが起動するため、それを プレゼンテーション開始前に機能停止 しておく必要がある（コンピューター の「システム環境設定」で可能）。 56 PPTにスライドを追加する スライドを追加する場合、その目的は「教習員用指導書」に沿うことであって、主題からそれては ならない。以下の理由であれば、PPT にスライドを追加してもよい： • スライドがない節に対して。 • 話し合いのための大事な質問で、いきおい解答に移らないことを覚えておくため。 • これから始まる活動のリマインダーとして、また指示を盛り込むため。 以下の理由であれば、PPTに変更を加えてもよい： • スライドを現地の事情/状況に適合させる。 • 翻訳を提供する。 • スライドの本文を減らすか、内容が多いスライド一枚を複数スライドに分割する。 • 教習授業を拡張するか増やす場合に、資料を追加する。 授業内容を追加する場合は、授業時間にも追加が必要であることに留意せよ。 PPTの統一性を保つ • すべての新規スライドおよび既成スライドへの変更について、必ず PPT 原版と同じ形式、 スタイル、フォントに従うこと。 • 追加あるいは変更したスライドから、WHO および WSTP のロゴを忘れずに削除せよ。既成の WSTP プレゼンテーションに同じ形式を維持しながらスライドを追加する最も簡便なやり方は、 既成のスライドを複製して、その本文を変更することである。 • 複雑なアニメーションを追加してはならない。 • PPT マスターを利用してスライドを追加してもよい。 • 動画ファイルは、すべて mp4 と wmv の二形式が用意されている。mp4 形式はアップルコンピ ューター用、wmv 形式はウィンドウズコンピューター用である。ウィンドウズコンピューター でQuickTime Player を搭載したものであれば、mp4動画を使用できる。 • 動画によっては字幕入りも用意されており、そちらの使用を推奨する。音質が悪い、外の騒音が ある、きつい方言が話されている、といった場合に受講者の理解を助ける。 • 動画は埋め込むことも、リンクを張ることも可能である。埋め込みを推奨するが、その理由は、 ファイルサイズは増えるが動画を PPT ファイルに内蔵でき、ファイルを他のコンピューターに コピーしても動画が失われないからである。 57 PPTに車画を埋め込む PPT 2010 以降の112ソフトで動画を埋め込むには、 次の手順に従う： • 「Presentations」＞「PowerPoint」フォルダー を開く。編集したいスライドを開き、 • 「挿入」タブをクリック • 「ビデオ」アイコンのドロップダウンマークを クリック • 「ファイルからムービー…」をクリック • フォルダーを参照して、必要な動画ファイルを 選択し挿入する。 • 動画フレームがスクリーンいっぱいに表示され ない場合は、サイズ調整する。 112 [訳注] この種の操作はソフトのバージョンによって変わってくるので, 自分の機種での確認は必要であろう. 58 • 変更を保存。 • 以上で、動画が PPT の一部になった。 動画を自動的にフルスクリーン表示するには (Windows)： • 「ビデオツール」の「再生」タブの「全画面表示 の再生」チェックボックスをオンにする。 動画を自動的にフルスクリーン表示するには (Mac)： • 「ビデオ形式」タブの「再生オプション」をクリ ックし、ドロップダウンリストの「全画面再生」 を選択 困難があれば、PPT のヘルプメニューで質問せよ。 59 視聴覚機材を用いる際の優れた実践 「スライドショー」で実行して確認 • PPT の授業を練習する時は、「スライドショー」モードを用いよ。それによってトランジション、 アニメーション、フローなどの問題を発見できる。 • 教習で使用する「スライドショー」モードのコンピューターおよびプロジェクターを用い、スラ イドおよび動画を通しで実行せよ。自分のコンピューターを用いない場合に、設定が異なる別の コンピューターではプレゼンテーションを予定通りに実行しないことがあるため、これは重要。 • 教習中のプレゼンテーションは、すべて一台のコンピューターで行なうことを検討せよ。これで、 プレゼンターごとの切り替え時間が省ける。 プロジェクター・リモコン・レーザーポインター • できれば、予備のプロジェクターまたはプロジェクター用ランプを用意せよ。 • 休憩時間や実習中は、プロジェクターの電源を切ってランプの使用を節約せよ。 • 黒色あるいは白色のスクリーンに映写する必要がある場合、通常、「スライドショー」モードで 「W」キーを打つと白いスクリーン、「B」キーを打つと黒いスクリーンになる。 • リモコンを用い、クリックしてスライドを切り替えるようにすると、プレゼンテーションの間に コンピューターの横に立たなくて済む。 • レーザーポインターはスライドの個別の項目について、受講者の注意を引くために使える。 スピーカー • スピーカーは、毎日のはじめに接続し、テストしてから接続したままにしておけ。 • 携帯電話その他の電子信号を拾うため、スピーカーの電源は、動画再生時だけ入れよ。 ケーブルおよびアダプター • 必要なケーブルが、ノートパソコン、プロジェクター、スピーカーについて、すべて揃っている ことを確かめよ。 • プラグアダプター類が、予備 2、3個も含め揃っていることを再確認せよ。 • ケーブルが電源まで届かない場合に備え、予備の延長コードを持参せよ。 60 活車１：ホワイトボード/フリップチャートを視覚教材に用いる 自分のグループに割り当てられた情報を通読し、ホワイトボード/フリップチャートを活用して、 他のグループへの発表を作成せよ。 スケッチや図表を描く 説明の補助としてスケッチ/図面/図表/グラフを使いたい場合は、自分自身で描け： • 薄く鉛筆で下絵を描いておくか、あらかじめ図面を作成しておくことを検討せよ。 • 前もって計画しておけ。そうすればホワイトボードに収まり、見やすくなる。 • はっきり、楽らくと描けるようになるまで練習せよ。 ホワイトボードかフリップチャートか：筆記スタイルとマーカーの選択 • もし両方使える場合は、ホワイトボードは授業後に残しておく必要がない情報を書き出すため に使い、フリップチャートは壁に貼り出す情報、または教習のメモとして書き留めておきたい 情報を記録するために用いよ。 • はっきりと書け。自分が書いたものが、教室の後ろからでも読めるかどうか確かめよ。 • 太くて濃色の、例えば黒と青のマーカーを用いよ。赤は、遠くからは読みにくいので避けよ。 下線に用いるとよい。 ホワイトボード/フリップチャートの位置と端正さ • だれからも見えることを確かめよ。 • ホワイトボードやフリップチャートに書く場合、その脇に立ち、顔は聴衆に向けよ。難しけれ ば、素早く書いて脇に退くか教習員仲間に書いてもらえ。 • メモや図表は、端正113に保て。 • まっすぐに書く練習をせよ。初めは鉛筆の薄い罫線を用いよ（練習すれば必要なくなる）。 何を書くべきか • 一文や一句まるまるではなく、キーワードを書け。 • 必要ならば、ページを予め準備しておくか、どこへ何を書く予定か薄い鉛筆で下書きせよ。 • 授業の後に、重要な詳細情報がホワイトボード上に残った場合（例えば事前評価からの所見、 小グループの進捗状況、実習のグループ分けなど）、写真を撮っておけば後で参照できる。 ホワイトボードの動入れと使い方 • ホワイトボード上で油性マーカーを使わないように注意せよ。うっかり油性マーカーを使って しまった場合は、適切なクリーナーを用いるかホワイトボード用マーカーでなぞり書きすれば （その溶剤が油性マーカーのインクを溶かすため）字を消せる。油性マーカーは、乾くと除去 しにくくなるため、間違ったらこれをその直後に行なうこと。 • ホワイトボードは、必要であれば映写スクリーンとして、例えばスライドの表に記入したり、 絵や写真に上書きしたりするために使用できる（例えば、写真や絵の人の上に「棒人間114」で 姿勢を描くなど）。 113 [原文] neat 114 [原文] ‘stick-draw’ 61 ToT.11 フィードバック フィードバックとは何か？ フィードバックとは、だれかに提供する以下についての情報である： • 何を上手にやれているか：ポジティブなフィードバック • 何を改善する必要があるか：建設的なフィードバック 上手にフィードバックを与える技能を持ち、受講者のポジティブな学習成果を支援できることは 重要。 通常、よい出来ばえにフィードバックを与えることに、だれも問題はない。間違いや改善が必要な 出来ばえの場合には、必ず自信をもって建設的なフィードバックを与えなければならない。 活車１：フィードバックをもらう 自分の学びに役立ったフィードバック、また自分が身構えるか動転して役に立たなかったフィード バックについて考えなさい。 下欄に自分の振り返りを記録しなさい フィードバックを えるさい、教習員が考慮すべきことは何でしょうか？ 62 望ましいフィードバック： • タイムリーに115：フィードバックはなるべく早く、経験が新鮮なうちに与えよ。 • 具体的に：なるべく明確に、ポジティブな、あるいは注意すべき行動について述べよ。 • 建設的なフィードバックをもたらす時は、その人格ではなく行動に絞り込め。 • ポジティブに始めよ：うまくできたことを指摘した後で、改善が必要なことについて話せ。 できれば、ポジティブな講評で締めくくれ。 • さまざまな伝え方で：賞賛や建設的なフィードバックは、できれば全体に与えよ。意識、行動、 規律に関わる問題には、非公開で対処せよ116。 • 受講者の視点に立って：まず、受講者に自分の出来ばえを振り返ってもらえ。受講者は、何が うまく行って何を改善すべきか、すでに理解しているかもしれない。 • 受講者の違う取り組み方を支援せよ：建設的なフィードバックを与える前に、受講者が完了した 活動について、不正確にやったのか、あるいは単に違う流儀でやったのか考えよ。受講者のサー ビス提供の取り組み方は十人十色である。受講者が自分と同じように動くと期待するな。 115 [原文] Be timely 116 [原文] deal with them in private 63 ToT.12 グループダイナミクスを取り仕切る117 WSTP 教習員が、グループで、効率よく効果的に作業するやり方を知っていることは重要である。 この授業では小グループ活動を促進し、時間を管理し、妨害行動へ対処するやり方を見て行く。 なぜグループ活車を用いるのか？ 教習においてグループ作業は重要である。なぜなら： • 受講者が、考察、知識、経験を共有できる。これによって教習員は、受講者がすでに持っている 専門性をよりよく知ることができ、どこにギャップがあり、授業をどう調節すべきかが分かる。 • 教室内にすでにある智慧、経験、技能が尊重される。これによって、経験や専門知識をより多く 持つ人が、他とそれを共有できる。 • 教習員が関心から外れる。受講者が経験を共有し、自分たちがすでに何を知っているか見出す ことが、自信の構築に役立つ。 • 全受講者が語り出し、貢献できる環境をつくり出す。内気な、または年若い受講者も小グループ の中では気後れせず発言できる。これは、自分の考えが評価されていると気づくことで、自信を つくり上げる。 グループ活車を組織し取り仕切る 受講者をグループ分けする際の重要な留意事項 • グループのサイズを決める。 • 各グループに、だれが入るか決める。 • グループづくりの手法。 グループのサイズを決定する要因 • 時間：グループが多いほど、フィードバックにもより時間が必要になる。持ち時間が少なければ 大きいグループをつくれ。ただし、1グループの人数は 6名を超えないようにせよ。 • プライバシー/内密さ118：気をつかうトピック、内気な人、言語の壁がある場合の話し合いには ペアが最善である。 • 参画：グループが小さいほど、どのグループメンバーも参加しないでいることが難しくなる。 • 活動：グループ活動に必要な、機材/消耗品の分量。例えば、作業場が 3か所あれば、3グループ まで対応が可能になる。 117 [原文] Managing group dynamics 118 [原文] confidentiality 64 各グループの編成を決定する要因 • 活動の目的をよく考えて、同様の技能や来歴を持った人を同じグループに入れる（臨床家全員が 協働するように配置する、あるいは技工職全員が同じグループにいるなど）か、逆にわざと同じ グループに技能の種類や経験を混在させるか、どちらが望ましいかを判断せよ。 • いっしょに働いている受講者どうしのグループ化：活動や関係性しだいで、グループにする方が 適切な場合と分ける方が適切な場合とがある。 • 強力な/非力な（経験が多い/少ない）受講者を混成：これは、お互いからの学びを促すが、皆が 平等な発言機会を持つようにしたければ、有力な受講者どうし、内気な受講者どうしのグループ 分けを検討せよ。 • 性別を混成：作業への文化、宗教、社会的規範（特に接触とプライバシーに関して）に注意。 • 言語的技能：受講者と車椅子ユーザーのコミュニケーションのために。 • 全受講者が互いに協力して作業し、学び合いの機会119が最大になるようにせよ。 • ランダムなグループ分けが最善の場合もある。 グループづくりの動法 各WSTP「教習員用指導書」では、各々の活動に必要なグループのサイズや数を参考として与えて いる。これは従前の活動経験に基づき、各自の状況に合わせて調整してよい。以下、グループ分け の手法をいくつか掲げる： • フルーツサラダ法120：同じ果物カードを 3、4 枚ずつ、さまざまな種類の果物で受講者の人数分 になるよう準備する。それから「バナナの皆さん」で協働する、あるいは「フルーツサラダ （1人 1種類の）」でいっしょになる、など指定する。 • 番号点呼121：必要なグループ数の番号を点呼する。例えば、3 グループに分ける必要があれば、 最初の人が「一」、次が「二」、その次が「三」、そして再び「一」に戻って数を点呼するよう指示 し、教室を一周する。「一」「二」「三」のそれぞれ全員がいっしょに組む。 • パズルピース合わせ：必要なグループ数に合わせた写真や雑誌グラビアを 2、3 片に切り分けて おく。各自、自分と合う者を見つける。 • 誕生月で整列：誕生月の順に一列に並び、そこからグループをつくる（最初の 3人、次の 3人と まとめ、全員がグループになるまで続ける）。あるいは身長や名前の頭文字の順に並ぶ。 • 自己選択：1人または 2人、自分が組んだことがない人を選んでもらう。ただし 3人を超えると、 自力でまとまるのは時間がかかることに注意せよ。 • ペアを、隣の人、あるいは横列に並んで座っていれば前列の人が椅子を反転させて背後の人と 組む。これはペアまたは 4人ずつのグループに有効。 119 [原文] peer learning opportunities 120 [原文] The fruit salad method 121 [原文] Count off 65 受講者をグループ分けする際には明確な指示を えよ • だれがどのグループに入るか。 • 何をグループにやってほしいのか（その課題は何か）。 • どこへグループに行ってほしいのか（各部屋へ分かれるのか、大部屋のスペースか）。 • いつグループは報告を返す用意ができているべきなのか。 • どうやってグループに報告してほしいのか（フリップチャートで、全体グループへ口頭で、各自 の席にいるグループへ非公式に、グループ自身が選んで創造的に発表、など）。 • どれくらいの時間、報告しなければならないか。 小グループ活動はつねにモニターし、受講者が各自のワークブックの正しいページを用い予定した 課題に取り組んでいることを確かめよ。必要なら促しや誘導的な質問によって助け、解決策を教え たり、自分が長々としゃべったりするな。気をつけて時間を守るよう念押しせよ。 妨害行車に対処する いっぱんに、教習へ関心を持ち、参画するよう受講者を惹きつけておくために： • 受講生みなを惹きつけるため、授業計画で示されたさまざまな教習方法を用いよ。 • 質問し、受講者に答えを考えるよう促せ。 • 受講者がうまくできたらほめ、ポジティブだが率直なフィードバックを与えよ。 • 学びを、受講者が関連づけられる実例に結びつけよ。 • 教習をつねに楽しく。 66 場を仕切る受講者 自分が仕切り、大声でまたは長時間しゃべり、他の受講者には、知識を共有し、質問に答え、グル ープ活動の主役になる機会を与えない受講者。こうした人は、自分がすべてを知っているかのよう に振る舞う。 場を仕切る受講者への対処： • 休憩中にその人に話しかけ、その経験を受けとめ承認せよ。その人に、学び、質問に答える機会 を他の人にも与えてもらうよう依頼せよ。 • 全体にではなく、特定の受講者に質問に答えてもらうように問いかけることを考慮せよ。 • グループ活動では、場を仕切る受講者は最有力な受講者とのペアあるいはグループに入れ、内気 な、あるいは寡黙な受講者も各自のグループに貢献できるようにせよ。 ふざける受講者 教習に真剣に取り組む様子がなく、いつも冗談を飛ばし、時には他をからかう受講者。 ふざける受講者への対処： • 休憩中にその受講者と、その行動がどう教習の妨げになるか話せ。冗談は休憩かグループ活動中 のしかるべき時間まで取っておくよう、協力を依頼せよ。 • 授業中、冗談には、真剣な発言に対するように応答せよ。 攻撃的な受講者 異論を唱え、自分が信じられない概念は問いただし、トピックや論点について議論を吹っかけ、 グループの他の受講者がどれくらい強くそう思っているか試す受講者。または教習員の技能・ 知識の程度を試し、自分の方が優れていると示そうとするかもしれない。 攻撃的な受講者への対処： • 自分自身の信条や経験についてのみ話すよう要請せよ。 • 異論を唱えたら、その受講者に「それはあなたにとって本当なのですか？」と問え。もし答えが 「いいえ」でも、他の人には本当であるようなら、他の受講者にも意見を求めよ。 ネガティブな受講者 ネガティブまたは他を落ち込ませる受講者。教習の一環として教わった取り組みに「われわれが 住む地域ではうまく行きっこない」とコメントするかもしれない。 ネガティブな受講者への対処： • ネガティブな受講者が、教習のアプローチではうまく行かないと思っている場合は、その理由を 説明する機会を与えよ。他の受講者に賛成するか尋ねよ。他の受講者も同意見であれば、「どう すればその状況でもうまく行くようにできるでしょうか？」と尋ね、問題解決を助けよ。 67 寡黙な受講者 もともと寡黙あるいは内気で、大人数の前でしゃべりグループ活動へ貢献することには気が進まな い受講者。 寡黙な受講者への対処： • 答えられそうな、直接的な質問を投げかけてみることを検討せよ。 • ほめ、承認することによって、もっと参加するよう促せ。 • グループでの活動や話し合いに、小グループ（ペアか 3名の）を活用せよ。 地位が高い/年長の受講者 受講者の中に他より権威ある地位の人がいた場合、受講者たちは話し、質問に答え、あるいはその 人に反対するのをためらうかもしれない。 年長の受講者への対処： • 休憩中に、その受講者と全体の中で果たす役割について話せ。その人から皆へ、自由に話すよう 呼びかけ、居心地のよい雰囲気づくりを助けてもらうよう依頼せよ。 • その受講者に、独壇場にならないよう、教室の後方に座ってもらえないか依頼してもよい。 注意散漫な受講者 簡単に注意がそれ、つねに教室を出たり入ったり、電話を手に取ったり放したりする受講者。 注意散漫な受講者への対処： • 理由を探ってみよ：教習以外のことで、気にかかる問題があるのだろうか？ • 教科内容や教習スタイルが退屈なのだろうか？ • 休憩中にその受講者と、その行動がどう教習を妨げるのか話せ。規則を念押しせよ。 68 中級教習モジュール 69 A.1: 付加姿勢支持が有益な車椅子ユーザー この授業を教えるための主な留意点 a. 全般 • グループでの話し合いは、教習員が、受講者の既有の知識・経験の程度を理解するために役立つ。 • 個々の姿勢支持具（PSDs）に関する細かい議論は避けよ。それらは以後の授業で取り上げる。 b. 第 3節：いつ付加姿勢支持が必要なのか？ 準備のコツ • 活動：中級 WSTP「教習員用指導書」p.34-35 のキャッチボールおよび水飲みの活動について、 椅子がじゅうぶん丈夫なことを確かめよ。適当な椅子がなければ、車椅子を使ってもよい。 内容 • 多くの中級レベル適応の車椅子ユーザーは、褥瘡発生の危険が大きい。その理由は： 圧力 − 非対称な（不均等な）姿勢1 − 不動性2（動けないこと） − 虚弱さ3 − バランスの乏しさ − 姿位4を変えられない、あるいは除圧動作を実行できない。 剪断 − 虚弱さの結果としての不安定な姿勢 − 緊張（固さ）の増大5 − 制御できない運動6 − 関節の拘縮7 − 対処されていない脚長の左右差 1 [原文] asymmetrical (uneven) posture 2 [原文] immobility 3 [原文] weakness 4 [原文] position [訳注] 本書では postureの訳語に「姿勢」, positionの訳語 (の一つ) に「姿位」を用いている. 5 [原文] increased tone (stiffness) 6 [原文] uncontrolled movement 7 [原文] joint contractures 70 摩擦 − 姿勢支持が足りないと、車椅子ユーザーの身体の一部が車椅子や姿勢支持具と 擦れる。 − 制御できない運動や筋攣縮 [きんれんしゅく]8 − 移乗中に起こる負傷：例えば車椅子ユーザーの臀部が、持ち上げても9車椅子から 離れなかった場合、皮膚が引きずられて摩擦を生じる。 • 中級レベル適応の車椅子ユーザーは、除圧クッションだけでは褥瘡の予防に不十分な場合がある。 • 車椅子ユーザーを安定させ、適切な姿勢支持具で姿勢を支え、ユーザーおよび/またはその介助 者を教育することが、褥瘡の発生・悪化10を予防するために役立つ。 • 褥瘡は、車椅子ユーザーの身体と車椅子、クッション、姿勢支持具との、あらゆる接点で発生・ 悪化しうることに留意せよ。 c. 第 4節：車いすユーザーは何を望んでいるのか？ • 「教習員用指導書」p.38に列記した「車椅子ユーザーが付加姿勢支持を備えた車椅子を拒否する 理由」に追加するとよい答えの例： o 費用：ユーザーが、付加姿勢支持を備えた車椅子には追加料金を払う必要がある。 o サイズ：多くの姿勢支持付き車椅子は折りたたみできず、より大きくまた重い。 o 姿勢支持車椅子には決まった種類の姿勢支持具一式が付属しているが、その中には当該車椅子 ユーザーには必要ないものもある。 o 車椅子に付加した姿勢支持具への余分なメンテナンス。 8 [原文] spasms 9 [原文] when lifting 10 [原文] developing 71 A.2: 障害児 この授業を教えるための主な留意点 a. 第 3節：さまざまな体位 • 6歳まで子どもの股関節は、大きい子どもや成人のように完全にまっすぐに（伸展）したり内転 したりできない。これが、子どもの立位や座位の姿勢が異なる理由である。 • 小さい子どもは、したがって股関節がわずかに屈曲し両膝が開いてわずかに外向きになるように 立つ。その股関節を無理にまっすぐにしては絶対にならず、足を真正面に向けさせてはならない。 うつ伏せに寝る時には、股関節がわずかに屈曲し、膝が外を向いているようにすること。 • ポスタ 「ーさまざまな体位」のイラストは、股関節がすでにまっすぐになって（伸展して）いる、 大きい子どものそれである。 立位 • 立つことが重要な理由に関する注記（「教習員用指導書」p.44）に「骨折の予防」を追加せよ。 これは重要な点である。 • 他の立つことの有益な点で、挙げられていなかったものとしては： o 痙縮 [けいしゅく] (筋肉の硬直)11の制御を助ける。 o 消化を助ける。 o 排便・排尿を助ける。 o 座骨からの圧力を緩和する。 o 骨の発達を助け、骨密度（強度）の低下を抑える。 • 「教習員用指導書」p.45・スライド 8：小さい子どもの立位に関する注意への追加項目として、 立位台の膝への支えは決して膝蓋に直接ではなく、その下に設けなければならない。その理由： o 膝蓋は敏感なため、そこへの圧力は痛みや不快感を生じる。 o 膝の、体重が自然にかかる部位は膝蓋のすぐ下である。ここは下腿義足12が体重を支える部位 でもある。 11 [原文] spasticity (muscle stiffness) 12 [原文] below-knee prostheses 72 b. 第 4節：子どもを早期紹介する重要さ • 車椅子の供与が、子どもの歩くことへの欲求や歩行能力を奪うことはない。 • 子どもへの車椅子供与は、子どもが以下を行なうために役立つ： o 友だちと遊ぶ。 o 学校へ通う。 o 自分のことをやる。 o 家の手伝いをする。 • 車椅子を使うと、歩行器に比べてエネルギー消費が少なく、子どもは行動半径を広げ、より完全 に参加できるようになる。 • 子どもの歩行は、車椅子を使用することで改善する場合があり、それは子どもがより少なく歩き、 費やす労力も少なくなることが、歩行の質的向上を助けるためである。 c. 第 5節：子どもと働く • この授業で述べる子どもの安全のための慣行は、子どもと働くために最低限必要なものである。 • 受講者には、各自のサービスにおける、子どもの安全に関する行動規範を策定するよう勧めよ。 行動規範は、職員が子どもとの安全な関わり方を理解するのを助ける。児童保護に関する資料と しては： o 児童保護に関する、現地の国や機関の法令や政策 o オーストラリア国際開発評議会：「児童保護政策策定のための行動規範ガイドライン(13)」 o 国際児童基金（UNICEF）ウェブサイト(14)の「児童保護」 13 ACFID Code of conduct guidelines for the development of a child protection policy. Canberra: Australian Council for International Development; 2016 (https://acfid.asn.au/resources). 14 Child protection. In: Disabilities in programmes, UNICEF [website]. New York: UNICEF; Sept 2015 (http://www.unicef.org/disabilities/index_65309.html). [2023年 8月 17日：リンク切れ] 73 B.1: 事前評価の概略・事前評価インタビュー WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • 「教習員用指導書」に記した 1〜3節への時間配分は、下記のように修正すべきである： o 第 1節15 2分 o 第 2節16 3分 o 第 3節17 65分 「教習員用指導書」p.53 の授業計画の「あらすじ」、および同書 p.53・54の各節への時間配分を 変更せよ。合計の授業時間に変更はない。 b. 第 3節：事前評価インタビュー（実習活車を含む） • 「教習員用指導書」p.56の活動への指導内容に、一点誤りがある。指導内容では「各グループに 番号（1〜5）を付与し」となっているが、これは「1〜4」とすべきである。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 事前評価フォームに現地のサービス供与者が加えたどんな変更も、授業に組み込むよう考慮せよ。 • グループ活動に盛り込まれた障害や疾患の種類を、状況に応じて調整せよ。 内容 • 受講者は基礎 WSTP の事前評価インタビューには精通しているはずである。したがって、中級 レベル適応の車椅子ユーザー向けの新しい内容に集中せよ。 15 [訳注] 日本語版の「1. はじめに」 16 [訳注] 日本語版の「2. 事前評価」 17 [訳注] 日本語版の「3. 事前評価インタビュー」 74 b. 第 3節：事前評価インタビュー • この節の合計時間は 65分である（上記、誤記訂正の項を参照）。内容は活動への指導・説明18を 含む授業紹介を 5分と、60分の活動である。 • 活動では、さまざまな障害の知識をより多く持つ受講者に他のグループメンバーを支援するよう 励ませ。 • 単一の疾患/身体的問題について、長々と話し合うのは避けよ。 • 車椅子ユーザーによっては診断を受けていないか、誤診を受けている場合がある。したがって、 ユーザーが受けた診断は貴重な情報をもたらすが、重要なのは事前評価を完全に実施することで ある。そのあらゆる情報が、最適な車椅子の選択に必要となる。 18 [原文] instruction 75 B.2: 身体的事前評価−支えなしの座位姿勢 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 5節：小さい子どものまっすぐな座位姿勢 • 「教習員用指導書」p.68のスライド 10の最初の箇条は「背中は 平らで腰椎のカーブがなく」とすべきである。PPTスライドおよ びスライドへの注記から「や胸郭19」を削除し、語句を訂正せよ。 • イラスト（図 1）から判る通り胸椎には前方へのカーブがあり、 その結果、子どもの肩は耳や股関節よりもわずかに前方に出る。 ここの重要なメッセージは、5歳未満の子どもの「まっすぐな」 姿勢は大人のそれとは異なる、ということである。 図 1 小さい子どもの まっすぐな姿勢 b. 第 7節：座位姿勢を観察する • スライド 18 が PPTと「教習員用指導書」とで異なっている。「教習員用指導書」では肩の右側 が低いと述べているが、スライドの図は肩の左側が低くなっている。「教習員用指導書」p.72の 語句を「両肩が水平でない（左側が低い）」に訂正せよ。 19 [訳注] 日本語版ではこのスライドの thoracic curveを「胸郭のカーブ」と訳している. これは「胸椎のカーブ」 とすべきであったが, いずれにせよこの訂正により上記の通り削除することとなった. 76 c. 第 8節：姿勢を記録する • 「教習員用指導書」の活動（p.76）には線画が欠落している20。それらを図 2に示す： 教習員向けの線画の見本 図 2 線画の見本21 この授業を教えるための主な留意点 a. 第 4節：まっすぐな座位姿勢 • 「固まった姿勢」、「ニュートラル姿勢になる柔軟さ」、「ニュートラル姿勢途中の柔軟さ」の 用語は、車椅子ユーザーの全身姿勢にではなく、個々の関節に対して用いるべきである。例えば、 左股関節が「固まって」いても、右股関節には「ニュートラル姿勢途中の柔軟さ」がありうる。 b. 第 5節：小さい子どものまっすぐな座位姿勢 • 子どもの腰椎と胸椎のカーブは、立つことによって発達する。立ったことがまったくない子ども は、長じてもこれらのカーブが発達することはない。 20 [訳注] 教習員用指導書の「教習員用の線画の例題」の下に位置するべき解答である. 21 [訳注] いちばん左のイラストは、例題とは左右が逆になっている. 77 c. 第 6節：骨盤は座位姿勢の基礎 • 受講者全員が、座骨（ITs）、上前腸骨棘（ASIS）、上後腸骨棘（PSIS）の位置を見出せることを 確かめてから次へ進むこと。 • 拘縮や変形、肥満のため骨の指標部位22を見つけるのが難しい場合もある。受講者に、肥満した 車椅子ユーザーでも、正中線に対する ITs・ASIS・PSIS の位置は変わらないのだと念押しせよ。 受講者は、触診（指標部位を感じ取る）を始める前に、解剖学の知識を駆使して骨の指標部位が どこか見当をつけておくべきである。 • 骨盤に関する「まっすぐ/ニュートラル」の語について： o 「水平な骨盤」とは、前方/正面から見た骨盤に関わる。水平な骨盤は、正面から見て左右に 傾いておらず、左右の ASIS が横一直線上にある。 o 「まっすぐな/ニュートラルな骨盤」とは、側方/横から見た骨盤に関わる。まっすぐな骨盤は、 横からみて前傾も後傾もしておらず、座骨の上でバランスが取れている。 d. 第 7節：座位姿勢を観察する • 車椅子ユーザーの姿勢を観察するさい、評価ベッドなり椅子の脇に座れるよう、ユーザーに多少 支えが必要になることもある。ただし、この支えがユーザーの姿勢を矯正してはならない。 • 「教習員用指導書」p.72 のスライド 19への注記のうち「体幹がやや（左側が後方へ）回旋して いる」および「左脚が内旋している」については、納得しない受講者もあろう。その場合は： o 受講者に主要な偏り、すなわち骨盤の回旋と右脚の外旋に注目するよう求めよ。 o 一方向からだけの観察で、姿勢の微妙な変化を見定めるのは難しいことを認めよ。人の姿勢を 十全に理解するには、必ず正面、横、背後から、主要な解剖学的/骨の指標部位を確かめつつ 観察しなければならない。 e. 第 8節：姿勢を記録する 姿勢を描くコツ • 姿勢を描くのが受講者には難しいようなら、まず姿勢の線を人体イラストに描き込み、それから フリーハンドで指定欄に描き取るよう勧めよ。 • 骨盤の小丸と点/角は、骨盤の ASIS・PSIS ・ITs など骨の指標部位を表している。 • 骨盤に付ける小丸は不可欠ではないが、骨盤の位置を強調するために有効である。 • 教習員は、大腿の描き方は一通りを選択し、ずっとそれで通すことが重要である23。 22 [原文] bony landmarks 23 [訳注] 大腿の描き方が複数紹介されているための注記. 詳細は教習員用指導書 p.75「教習員への注記」を参照. 78 B.3: 身体的事前評価−骨盤と股関節の姿勢チェック WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：骨盤と股関節の姿勢チェック • PPTファイルからスライド 6が欠落している24。PDF版は正しい。 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役実習生と補助役実習生は、この授業をいっしょに準備し、実技の教え方に統一性を 持たせよ。例えば、正しい手の位置、角度計 ゴニオメーター］の使い方、モデルの車椅子ユー ザーの正しい姿位など。 • 一時的支持部は予め準備しておく必要があり、現地の、最も広く使われているクッション基層の 材料でつくるべきである。 • 脊椎および短く大腿骨が付いた骨盤の人体骨格模型や子どもの体格の人形（あれば）は、一時的 支持の適用法をやって見せるために役立つ。 b. 第 2節：骨盤と股関節の姿勢チェック • 車椅子ユーザーの周囲を移動するようにし、その上に身を乗り出さないなど、敬意のこもった 立ち位置を取れ25。 • 腰を痛めないために： o 身を乗り出さないで済むよう、車椅子ユーザーの位置は評価ベッドの端の方にする。 o かがまないでひざまずく。 24 [訳注] この日本語版作成の時点で, WHOの配布教材ではすでに修正されていた. 25 [原文] Be respectful in how you position yourself 79 • 最初に車椅子ユーザーの姿勢を臥位で確認してから、骨盤と股関節の姿勢チェックを始めよ26。 その内容は： o 肩を水平にせよ：ベッドの前後辺を基準点に用いよ。 o 頭・首・体幹上部を、ベッドの側辺を基準点に用いて配列せよ27。 • 車椅子ユーザーの四肢および身体の上手な扱い方28をやって見せよ。強くつかみすぎると不快感 を生じる。 • 股関節の緊張をゆるめるため、骨盤と股関節の姿勢チェックは車椅子ユーザーの膝を支えながら 実施せよ。股関節周りの緊張が非常に強いと、車椅子ユーザーの骨盤が、ニュートラルでない 姿勢へ引かれかねない。 • 車椅子ユーザーの衣服が、股関節の動きの自由を妨げないようにせよ。 • 評価者と助手両方の、手の位置を（「教習員用指導書」p.84で詳述している通りに）強調せよ。 助手からのフィードバックは、精確なチェックの要諦である。 o 評価者の手は、脚の重さを支える。膝裏の緊張（固いハムストリングス）によって骨盤が動く ことで膝が曲がる（屈曲する）のを、評価者の手が制限してはならない。 • 角度計の正しい使い方をやって見せよ。 • 受講者が 動きの］制限を真似てみることがある。これは通常、混乱のもとである。受講者には 手順と技法の習得に集中するよう戒めよ。そうすれば、実習中に本物の制限を感じることになる。 まとめとして動画を上映せよ。 ジェンダー/文化への配慮 • 骨盤と股関節の姿勢チェックをやって見せ、また受講者に実施してもらう際には、ジェンダーに 基づいて受講者をグループ分けせよ。 26 [訳注] 日本でのいわゆる「マット評価」で, WSTPtotで追加された内容である. 27 [原文] line up 28 [原文] good handling [訳注] 文意から, 療法技術としての「ハンドリング」との混同を避けた. 80 c. 第 4節：固まった水平でない骨盤への一時的支持のデモ • 受講者が、骨盤を水平にするため、低い側に支えを付加してはと提案した場合の説明： o 骨盤姿勢は、矯正しても水平でニュートラルな骨盤にはできない。 o 水平でない骨盤の座骨を圧迫すると強い圧力を生じ、褥瘡につながる。 • 骨盤と股関節の姿勢チェックからの所見を強調せよ。受講者が臥位で骨盤を水平にできなかった 場合、座位でも骨盤は水平でないままである。 • この姿勢支持具は、単独では使われない。固まった水平でない骨盤の車椅子ユーザーには、姿勢 を支えるために他の姿勢支持具がいくつか必要になる。 d. 第 5節：ニュートラルな座位姿勢まで屈曲しない股関節への一時的支持 のデモ • 希望者を募る前に、人体骨格模型か人形 を用いてやって見せることを検討せよ。 • 臥位で、股関節がニュートラル姿勢まで 曲がらないところをやって見せよ。 • 膝裏から評価ベッドに下ろした垂線 図中の点線］がつくる、三角形の空間 を強調せよ（図 3）。 図 3 一時的支持 • 垂線から座骨までの距離が、大腿が骨盤を押して後傾させるのを止めるために必要な、一時的 支持部の高さである。 • 体幹〜大腿の角度を測れ。 • 人形/モデルを一時的支持部に座らせよ。 • 体幹〜大腿の角度が同じであることを示せ。 • 大腿下の三角形のすき間は、ニュートラル姿勢まで曲がらない股関節に形を合わせる側の、 クッション前部に必ず設けるべきものの形状である。 • 受講者が、この大腿下の三角スペースをウェッジで埋めてはと提案する場合もある。これは可能 ではあるが不必要で、なぜなら骨盤の最終姿勢には変化を及ぼさないからである。 81 B.4: 身体的事前評価−ハンド・シミュレーション WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 3節：ハンド・シミュレーションの結果を記録する • 「教習員用指導書」p.101の活動への「答え」欄に、エニスの股関節姿勢がニュートラルとして 記録されている。これは誤りなので、左右の股関節へのチェック印✔︎を「いいえ」に変更。 • 注記の「体幹〜大腿の角度が 90度超」は正しい。 この授業を教えるための主な留意点 a. 全般 • 受講者が、ハンド・シミュレーションやユーザーの姿勢分析に慣れていなければ、さらに時間が 必要になる。 • 動画でのケーススタディすべてを通して、段階を踏んで取り組むことを強調せよ： o 助手に明確な指示を与える。 o 最初に骨盤の姿位を決めてから、他の部位への支えに移る。 • ハンド・シミュレーションでとれた最終姿勢は、必要な支えと併せて、絶対に文書化しなければ ならないことを、受講者が理解するようにせよ。文書化は、描画、ことばによる説明、事前評価 フォームに載っている身体の各部位についての確認表記入などによる。 • 写真がサービス文書の標準項目となっている場合は、だれかに姿勢を変えるごとに写真を撮って もらえ。 o サービス職員は、それぞれの写真を見直して、車椅子ユーザーへ設ける支えをどう変更するか 判断できる。 o 身体への操作を最小限にできる29ため、時間を節約できる。 • 教習プログラム中に写真を用いる場合は、受講者に、最終写真を指針に用いて、自分が担当する 車椅子ユーザーへのハンド・シミュレーションの結果を記録するよう指示せよ。 • 車椅子ユーザーの資料作成には最終写真のみを用い、他の写真はすべて削除せよ。 29 [原文] can minimize handling 82 b. 第 2節：ハンド・シミュレーションのやり方 • 身体的にはもっとまっすぐに座れるものの、その姿位では維持できない車椅子ユーザーもいる。 そうしたユーザーには、車椅子を一日じゅう使えるように、あまり起こしすぎない、骨盤後傾の 姿位での支えが必要な場合もある。より起こした姿位から、ユーザーの頭と体幹のバランスが 取れる最適な姿位のところまで、徐々に車椅子ユーザーの骨盤を後ろへ傾けさせよ。 • 助手が複数いても、手だけでは与えられない強い支えが必要な場合があり、ハンド・シミュレー ションが常に実施できるとは限らない。そうした場合は、以下の使用を検討せよ： o より安定して支えるための、カバーが付いた板、フォーム材、セラピー用ブロック30 o 姿勢支持部を仮設した模擬 [仮合わせ]31の車椅子 • 小さい子どもへのハンド・シミュレーションは、その子が怖がっている間は実施が困難である。 以下を検討せよ： o 子どもを親/介助者の膝の上に横向きに座らせる。 o ちょくちょく休憩を取る。 o 親/介助者を事前評価に、例えば子どもの足や肩を支えて参加してもらう。どれくらいの強さ で支える必要があるか、適切な指示を出すようにせよ。 • ハンド・シミュレーションでとれた最終姿勢を、骨盤と股関節の姿勢チェックの結果と比較する ことは重要である。骨盤と股関節の最終姿位は通常同じになる。違いが生じた場合の理由： o 骨盤と股関節の姿勢チェックで力を加えすぎていた。 o 座位での支えが不十分。 30 [原文] foam or therapy blocks 31 [原文] mocked-up with temporary postural supports 83 c. 第 3節：ハンド・シミュレーションの結果を記録する 内容 • 姿勢全体が目に見えない場合は、「教習員用指導書」の「教習員への注記」を用いて明確にせよ。 • 全受講者が最後のハンド・シミュレーション、姿勢の描画・説明の記録を練習する時間を取れ。 • ニュートラルな姿勢だと記録するには、必ず正面と横から見てニュートラルでなければならない。 • 「はい」にチェックを付ける身体部位は、ハンド・シミュレーションで、付加姿勢支持の有無に かかわらずニュートラルな姿勢をとれた部位である。 • ニュートラルでない姿勢（固まった姿勢、あるいはニュートラル姿勢途中の柔軟さ）の場合は、 すべて「いいえ」に印を付けること。 • 骨盤の水平およびニュートラルな股関節可動域は骨盤と股関節の姿勢チェックで識別されるが、 最終姿勢の決定はハンド・シミュレーションによる。骨盤の最終姿位が（ニュートラルでない） 前傾/後傾の場合、その結果、股関節はニュートラル姿勢より伸びる/曲がる32。骨盤がニュート ラルでも、安定性をもたらすために座面前方のかさ上げを付加した場合、股関節は曲がる。 エニス • エニスへの骨盤と股関節の姿勢チェックからは、両股関節がニュートラルな座位姿勢まで曲がる ことが判っている。 • エニスの両股関節は臥位では 90 度になるが、骨盤が後傾したまま固まっているため、その体位 では座れない。 • ハンド・シミュレーションの結果を記録する際には、最終的にとれた姿勢を精確に記録せよ。 • 体幹〜大腿の角度を狭めるため、姿勢支持具として、座面前方のかさ上げを提案する受講者もあ ろう。それが可能であることは受けとめ承認せよ。しかし受講者には、決定は車椅子ユーザーの ニーズの全体像に基づくことを念押しせよ。座面前方のかさ上げを最終処方に盛り込んだ場合、 移乗や机・テーブルの下へ入り込むことなど、他の要素に影響を及ぼす可能性がある。 • 「教習員用指導書」ではエニスとバハティの最終姿勢を詳述している。以下を最終姿勢の描画に 用いよ。 32 [原文] open/closed [訳注] 語順としては, 骨盤前傾/後傾に対して股関節が曲がる/伸びる場合が一般的であろう. 84 エニス 各身体部位が、動の支えでニュートラルな座位姿勢になれば「はい」、ならなければ「いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 □ ✔︎ 体幹 □ ✔︎ 頭 ✔︎ □ 左股関節 □ ✔︎ 右股関節 □ ✔︎ 大腿 □ ✔︎ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ バハティ 各身体部位が、動の支えでニュートラルな座位姿勢になれば「はい」、ならなければ「いいえ」に印。 部位 はい いいえ 手の支えで、車椅子ユーザーがとれた最終的な座位姿勢を記述するか 線画で描き、なおかつ、その座位姿勢がとれるように設けた支えを、 記述するか線画で描く。 骨盤 ✔︎ □ 体幹 ✔︎ □ 頭 ✔︎ □ 左股関節 ✔︎ □ 右股関節 ✔︎ □ 大腿 ✔︎ □ 左膝 ✔︎ □ 右膝 ✔︎ □ 左足首 ✔︎ □ 右足首 ✔︎ □ 85 B.5: 身体的事前評価−身体計測 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • 以下は教材リストに挙げられていないため、追加すべきものである： o 3人ひと組の各グループに、クリップボードを 2枚ずつ o さまざまな高さ（厚さ）の足乗せブロックを 1セット b. 第 2節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.112 の、スライド 6 のマダヴィの姿勢の線画には誤りがある。線画では、 腰椎がニュートラルなカーブを描いている。しかしユーザーが骨盤を後傾/後ろに倒して座ると、 腰椎がカーブせず33、体幹が円背になり34、それが「崩れた35」姿勢を引き起こす。 • 「受講者用参考書」p.67にも同じ誤りがある。受講者に、それを各自の参考書について訂正する よう指示せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • 「教習員用指導書」の身体計測への注記を読み直し、身体計測をやって見せる練習を、統一性を 持たせるために全教習員とやっておけ。 • ありがちな誤りで、活動のあいだ目を配るべきものの例： o 車椅子ユーザーの姿勢/支え o 不精確な計測技法、例えばクリップボードを斜めに当てる、巻尺で測り始める端を間違える、 巻尺を読み取る頭の高さが不適切 • 受講者をデモに用いるのは避け、受講者が観察できるようにせよ。 • 状況に合わせて調整せよ (寒冷な気候で厚着している場合など)。 • 時間が許せば、この授業は延長して、各受講者が中級レベルの身体計測をすべて練習できるよう にすることを検討せよ。 33 [原文] flattens 34 [原文] the trunk will be rounded 35 [原文] slumped 86 b. 第 2節：適切な車椅子サイズと姿勢支持具の配置を選ぶための車椅子 ユーザーへの身体計測 • 「教習員用指導書」p.110 の項目 I は「座面〜骨盤上端（PSIS36）」と題されている。しかし、 PSISは骨盤の上端ではない。骨盤の上端は腸骨稜37である。 • 教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある： o 選択肢１：この語句から「骨盤上端」を削除し、PSISのみに言及する。したがって「受講者用 参考書」p.70も変更が必要になる。 o 選択肢 2：「骨盤上端」を一般的な呼び名として用いる。この選択肢を採用した場合、受講者 が、PSISは骨盤の「上端」より下に位置することを理解するのが重要である。 • この節を通して、以下の点を常に強調せよ： o 身体計測は、車椅子ユーザーを、最終姿勢（ハンド・シミュレーションで決定した）で支えて いる状態で行なうこと。 o 選択した車椅子の種類および必要な姿勢支持具が、どの身体寸法が必要かを決める。例えば、 背中全体の高さの背もたれが必要な車椅子ユーザーには身体寸法 F: 座面〜肩上端 の高さ］ を選ぶ。身体寸法 D: 座面〜胸郭下端 の高さ］や身体寸法 E: 座面〜肩甲骨下端 の高さ］は 不要になる。 • 車椅子ユーザーが、骨盤が後傾したまま固まっている、あるいは 体幹が円背のまま固まっている場合、受講者は、これが車椅子に どう収まるか考える必要がある。このため、座面奥行きの測り方 を変更することもある。 • 背もたれをリクライニングできる場合：骨盤背面の下端から膝裏 までの直線距離を測る（図 4）。 図 4 リクライニングした 背もたれの計測 36 [訳注] 上後腸骨棘. 37 [原文] iliac crest [訳注] ICとも略される. 87 • 背もたれがリクライニングせず「座面〜背もたれ角度を開ける」 が処方された場合は、車椅子の座面奥行き内で収まる必要がある。 • 「座面〜背もたれ角度を開ける」ための身体計測で必ず含むべき 項目： o C字カーブ38の頂点から座面上端までの距離（Z） o C 字カーブの頂点から座面上端へ下ろした垂線と、骨盤背面の 下端との間の距離（X）（図 5） 図 5 「座面〜背もたれ角度を 開ける」ための身体計測 • 図 6 を使い「座面〜背もたれ角度を開ける」姿勢支持を用いる際の座面奥行きの計算法を示せ。 図 6 座面奥行きの計算 • 身体計測のあいだ、車椅子ユーザーを最終姿勢で支えておくのが難しい場合もある。これに対処 する方策としては： o ちょくちょく休憩を取る。 o 姿勢を支えたり、身体計測を行なったりする助手を、さらに手配する。 38 [原文] c-shaped curve [訳注] ここでは身体を横から見た場合の, 円背になった脊柱の形状を指す. 車椅子および姿勢支持具 寸法（mm） （Z）三角形の高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 座面〜背もたれ 角度を開ける： 88 B.6: 車椅子およびクッションの選択 WSTP（車椅子サービス教習パッケージ）教材の誤り a. 全般 • この授業に 60分では不十分である。第２節に 60分取り、授業時間を合計 70分にせよ。 b. 第 2節：車椅子およびクッションの種類 • 「教習員用指導書」p.119 のスライド 12・13 のリクライニング背もたれのイラストに、腰椎や 骨盤の支持部の形状を含めるべきではなかった。処方の適応（スライドへの注記で挙げている） から考えて、この車椅子ユーザーは骨盤が後傾しており、その結果、腰椎がカーブしていないか 屈曲して39いる。 • この背もたれ下部は、以下のように表すべきである： o 平らに、あるいは o 「座面〜背もたれ角度を開ける」ウェッジ（これは列挙した状況から想定される姿勢支持具） を付けて • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 • 「教習員用指導書」p.119 の、スライド 13の横の最初の箇条「股関節や膝の屈曲に拘縮を伴う、 後傾したまま固まった骨盤」は正しくない。ティルトインスペースは、股関節や膝の屈曲に拘縮 を伴う、後傾したまま固まった骨盤への適応ではない。この最初の箇条を削除し、以下の箇条を 追加せよ： o 頭の位置およびコントロールを改善するため o バランスを改善するため • 受講者に「受講者用参考書」p.74 の同じ誤りを訂正するよう指示せよ。 39 [原文] flat or flexed lumbar spine 89 この授業を教えるための主な留意点 a. 全般 準備のコツ • 現地で手に入る車椅子および姿勢支持具の部材を熟知していることを確かめよ： o 製造者からの情報を研究せよ。 o 手に入るサイズの範囲を知れ。 o 調節可能部分/機能の範囲を調べ、これらを説明できるか、やって見せられるようにしておけ。 o 手に入るあらゆる付属品を含め、何をカスタマイズできるか40見定めよ。 • この授業の実施前に、現地での処方フォームへの変更を熟知しているか確かめ、適切であれば、 それを授業に取り入れよ。 • 現地の処方フォームは、以下の内容を含んでいるべきである： o 車椅子およびクッションの、種類およびサイズの指定 o 身体および理想的な車椅子の、詳細な寸法 o 姿勢支持具についての詳細説明 o 車椅子ユーザーの合意署名 b. 第 1節：はじめに • 受講者に、適正な車椅子の定義は「車椅子ガイドライン」に従うことと、支えを追加した車椅子 と座位保持専用シート41のどちらが最適か、常に検討が必要であることを念押しせよ。 c. 第 2節：車椅子およびクッションの種類 準備のコツ • 環境、機能、フィッティング、姿勢支持に関係する、さまざまな機能をやって見せられるだけの 多様な車椅子が揃っているようにせよ。 • 車椅子は、姿勢支持機能専用のものと、姿勢支持具を付加できるものの両方を揃えよ。 40 [原文] what can be customized [訳注]「カスタマイズ」の方がむしろ一般的かもしれない. 41 [原文] dedicated supportive seat [訳注] ここでは以下の「姿勢支持専用車椅子」と同義であろう. 90 内容 • 姿勢支持具付き手動車椅子だけあればよいユーザーには、姿勢支持専用車椅子42から生じる以下 の制約を考慮せよ： o 姿勢支持車椅子43は、手に入る設計やサイズの種類が限られる場合がある。 o 不必要な機能が盛り込まれ、重量や費用がかさむ場合がある。 o 姿勢支持車椅子は、運搬が難しい場合がある。 • 座角44が「固定」される車椅子：車椅子ユーザーを支える最適な角度を、必ず処方時に選択しな ければならない。 • 「クイックリリース」あるいは 「調節可能な」ティルトを備えた車椅子：傾き度合いを、一日の 間に容易に調節でき、必要に応じて多く、あるいは少なく支えられる。これは重傷からの回復中、 あるいは頭のコントロールなどの技能を習得中で、一日中まっすぐに座れない車椅子ユーザーに は助かる。こうした機能を備えた車椅子を指摘せよ。 • 受講者に、必要な車椅子および姿勢支持具が、必要となる車椅子のサイズを決めることを念押し せよ。例えば、体幹側方サポートと背もたれパイプの間でリクライニングする背もたれが必要な 場合、車椅子の幅を決めるのは： o 身体寸法 Gの「体幹幅」足す； o 両側の体幹側方サポートの厚さ (B x 2)（以上は背もたれ パイプ内側の間隔に等しい）足す； o 両側の背もたれパイプの幅 (A x 2)（図 7） • 背もたれを背もたれパイプの前に組み付ける場合は、車椅子 ユーザーの体幹幅 足す 両側の体幹側方サポートの厚さ、 または骨盤/大腿の幅（どちらか広い方）が車椅子の幅 （車椅子各部の寸法の 1か 2）を決める。 図 7 車椅子の幅 42 [原文] dedicated posture support wheelchair 43 [原文] posture support wheelchairs 44 [原文] tilt. 91 B.7: 姿勢支持具の処方（選択）−はじめに この授業を教えるための主な留意点 a. 全般 準備のコツ • 個々の姿勢支持具に関する質問は「保留スペース」に停めておけ。これらは、次の授業から取り 上げる。 • この授業の実施前に、現地での処方フォームへの変更を熟知し、適切であれば現地のフォームを 授業へ組み込むようにせよ。 • デモ用に、現地の姿勢支持具の見本を調達せよ。 • 費用や供給者に関する情報は予め作成し、別個に配布資料としてまとめよ。これは授業の一部と して話し合うべきではない。 b. 第 2節：姿勢支持具とは何か？ • 姿勢支持具の選択は、ハンド・シミュレーションで見定めた必要な支えによって違ってくる。 o 要求されるサイズ（高さと奥行き）は、必要な支えの量に関係する。必要な支えが多いほど、 姿勢支持具の表面積は広くなる。 o 素材の選択は、支えの強固さによって違ってくる。例えば、軽い支えが必要な場合は体幹側方 ウェッジ（硬いウレタンフォームでつくり柔らかいウレタンフォームの下に置く）を処方でき よう。強固な支えが必要ならば硬い構造材（木、金属、プラスチックなど）でつくり柔らかい 素材（ウレタンフォーム、EVAなど）を貼った、体幹側方サポートを処方するとよい。 o 支えの形状は、身体のどの部分を支えるかによって異なる。例えばひじ掛けが手こぎの邪魔に なるなど、身体の他の部分の動きを制限するようであってはならない。骨ばった部位、例えば 体幹の弯曲に形を合わせた際の肋骨の上などに、高い圧力が集中する形状であってはならない。 支えの成形しだいで、圧力を広い面積に分散させる（褥瘡の危険を減らす）ことができる。 o 圧力は非常に重要である。姿勢支持具の、身体に近く褥瘡を引き起こしうるほど硬いあらゆる 部分は、適切な形状にして、柔らかい適切な素材（ウレタンフォーム、EVA、ネオプレンなど） のクッションを入れるべきである。 92 c. 第 3節：中級車椅子処方（選択）フォームに姿勢支持具を記録する • 「教習員用指導書」p.130 のスライド 8・9 に処方フォームに姿勢支持具を描いた見本が載って おり、寸法線と記号で計測が必要なところを表している。 • 処方フォーム上に描画するさい、受講者は硬いウレタンフォームの形状とサイズに集中すべきで ある。どの部分も柔らかいウレタンフォーム層で覆う必要はあるが、それまで描く必要はないと 説明せよ。 • 補助線45は、姿勢支持具を描きやすくする目安で ある。必ず用いるべきサイズや形状を示している わけではない。 • 描画の目的は、必要な姿勢支持具の種類、形状、サイズ を伝達することなので、明確に描くことが重要である。 • 背もたれと足台に補助線を追加すると、姿勢支持具を スケッチしやすくなる。 • この補助線を PPT および各自の処方フォームに追加 するとよい。この図はWSTP用 USB メモリに収載46 している。 図 8 姿勢支持具の描画 に用いる補助線 45 [原文] shadow lines 46 [訳注] 日本車椅子シーティング協会のダウンロードサイトでは「補足資料」フォルダに収載. 93 B.8: 姿勢支持具の処方（選択）−骨盤を安定させる WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：問題：骨盤が後傾および/または横滑りする • 「教習員用指導書」p.136 のスライド 8 は、座骨 前方（アンカー）サポートが付いたクッションを 示している。 • このイラストは、誤解を招く恐れがある。以下を 説明せよ： o クッション基層は硬いウレタンフォームである こと o 柔らかいウレタンフォームの表層は、座骨前方 （アンカー）サポートに、必ずしっかりと接着 すること • スライド 8 のイラストを、WSTP 用 USB メモリ に収めた新しいもの（図 9）に差し替えよ47。 図 9 座骨前方（アンカー）サポート が付いたクッション • 「教習員用指導書」p.137 のスライド 11 のイラストは、マリアンの姿勢支持具の寸法を示して いる。この図では 2つの寸法を示しているが、骨盤後方パッドの寸法線が、誤って座面上端から 骨盤後方パッドの下端へ引かれている。この線は、座面上端から骨盤後方パッドの中央高さまで でなければならない。 • 中級WSTPパッケージには、その版によって PPT（スライド 11）にもこの誤りがみられる。 • 「教習員用指導書」および（必要ならば）PPTについて、これを差し替えよ48。 • 「受講者用ワークブック」p.26では、この寸法線が誤って座面上端から骨盤後方パッドの上端へ 引かれている。受講者に、ここを訂正49するよう指示せよ。 47 [訳注] 日本語版でも修正が必要. 48 [訳注] 日本語版の作成段階で PPTは修正済みで, そのスライドを用いた日本語版教習員用指導書も修正済み. 49 [訳注] ここは日本語版でも修正が必要. 94 この授業を教えるための主な留意点 a. 全般 準備のコツ • 人体骨格/脊椎/骨盤/股関節模型は、授業ツールとしてたいへん有用である。教習員は、模型を 以下のことに活用できる： o 骨の指標部位を特定する。 o どこに支えを設けるべきか、やって見せる。 o 骨盤と股関節の姿勢チェック、（適切であれば）一時的支持、ハンド・シミュレーションから の所見を関連づける。 • 適切なサイズのウレタンフォーム製のブロックおよびウェッジを用意しておけば、クッションの 解決策の見本を素早く組み立てられる。例えば、第 2節の座面前方のかさ上げや、積み増しして 第 3節の座骨前方（アンカー）サポート付きクッションにするなど50。 内容 クッション • あらゆる中級レベル適応の車椅子ユーザーに、骨盤を 支える適切なクッションを供与すべきである。 • 中級レベル適応の車椅子ユーザーのほとんどには骨盤 の前滑りを止める、座骨前方（アンカー）サポートの 付いたクッションが必要である。座骨前方（アンカー） サポートには、座骨からの圧力を逃がす51（除圧する） 効果もある。 • 座骨前方（アンカー）サポートが必要で、さらに褥瘡 発生の危険がある中級レベル適応の車椅子ユーザーに は、骨盤井 [こつばんせい]52を設けたクッションを 処方するとよい（図 10）。 図 10 骨盤井を設けたクッション • 骨盤井は、座骨前方（アンカー）サポートと同じように姿勢を支え、さらに体重を分散して大腿 上部（転子部）の下に加重することで、さらに除圧をもたらす。 50 [訳注] 本書の付録 4 (p.133-137) にその例が図示されている. 51 [原文] move some pressure away from their seat bones 52 [原文] pelvic well [訳注] 基礎・中級WSTP教材でいう seat bones well (座骨井) と同じもの. 95 大腿内側ウェッジ付きの骨盤井クッション：基層 大腿内側ウェッジ付きの骨盤井クッション b. 第 2節：問題：骨盤が後傾および/または横滑りする 準備のコツ • 「教習員用指導書」p.136のスライド 9には「骨盤後方パッドは、骨盤を上端（上後腸骨棘（PSIS） の高さ）で支え」と注記されている。しかし、PSISは骨盤の上端ではない。骨盤の上端は腸骨稜 である。教習員は、これを受講者に対してどう取り扱うのが最善か、判断する必要がある53。 • 選択肢１：この文から「骨盤上端」の語を削除し、PSISのみに言及する。この変更を行なう場合 は、以下も変更する必要がある。 o 「受講者用ワークブック」p.25の身体計測表 o 「受講者用参考書」p. 95（後ろから 3段落目） o 中級車椅子事前評価フォームの寸法 I • 選択肢 2：「骨盤上端」を、骨盤背面の上端を指す一般的な呼び名として用いる。この選択肢を 採用した場合、受講者が PSISは骨盤の「上端」より下に位置することを理解するのが重要。 53 [訳注] 同じ用語の問題を扱っている, 本書 p.86も参照. 96 PSISを見つける • 両手を骨盤上縁に当て、両手を優しく絞り込みながら 柔らかい部位を見つける。それから、親指を（親指の 水かきを張り広げながら）他の指より下に移動する。 親指は骨盤上縁より下の、PSIS に近い位置に来る （図 11）。 図 11 PSISを見つける 内容 • 骨盤ベルトを配置する適切な角度は、45度と 90度の 間である（図 12）。 • しかし 45度のベルトは、特に強い支えが必要な場合、 車椅子ユーザーが座った時に骨盤後傾を助長する。 • 座面上で前滑りする傾向がある車椅子ユーザーには、 60〜90度が効果的な角度である。 図 12 骨盤ベルトの配置 脊柱に自然なカーブがある大人への骨盤後方の支え • 骨盤後方パッドは、腰椎/胸椎に通常のカーブがある車椅子ユーザーに対して、骨盤をまっすぐ に起こして保ち、骨盤後傾を防ぐように設計されている。 • これは、背もたれが平らな車椅子での骨盤〜胸郭前後差54 （骨盤背面と胸椎背面の位置の前後差） を埋め合わせるように設計されている。 • 骨盤をニュートラル姿勢まで矯正できないか、車椅子ユーザーの脊柱にニュートラルなカーブが ない場合、骨盤後方パッドは用いるべきでない。 54 [原文] pelvic-trunk offset [原文] 訳語はシーティングエンジニアの講習等で一般的な名称. 西方倫彰氏の教示に よる. 97 骨盤〜胸郭前後差 骨盤後方パッドを垂直な背もたれと併用 • 後方に曲げた背もたれや張り調整背もたれは、骨盤をまっすぐに起こして支えられる（さらに 脊柱の自然なカーブに形を合わせられる）ため、骨盤後方パッドが不要な場合もある。 • さらに支えが必要な場合、骨盤後方パッドを上記のような背もたれに付加してもよい。 後方に曲げた背もたれ 張り調整背もたれ • 骨盤を矯正し過ぎてはならない。車椅子ユーザーがまっすぐか、まっすぐに近い姿勢に耐えられ ない場合は、支えを減らして、ユーザーが骨盤を後傾させて座れるようにせよ。そうした車椅子 ユーザーには座面〜背もたれ角度を開け、それほどまっすぐでない姿勢で支えるのが有益な場合 もある。 98 脊柱に自然なカーブがある子どもへの骨盤後方の支え • 骨盤後方パッドは、小さい子どもには使用禁止55である。 • 小さい子どもは、ニュートラルな姿勢では腰椎のカーブが なく、胸椎は前に曲がる56（図 13）。 • 骨盤後方パッドを用いると、骨盤を前へ押し出して前傾させ、 かつ/または車椅子ユーザーを背もたれから押し出す。これは 不快感、苦痛、姿勢の問題の原因となる。 図 13 小さい子どもの まっすぐな姿勢 c. 第 3節：問題：骨盤が側傾している（固まった水平でない骨盤） 固まった水平でない骨盤 • 骨盤下の積み増しの高さは、ハンド・シミュレーションで用いた一時的支持部と同じ高さになる。 • 一時的支持部の高さは、最も矯正された（骨盤と股関節の姿勢チェックで決定した）骨盤姿勢で の、左右の ASISの高さの差と同じになる。 水平でない骨盤：ニュートラル姿勢になる柔軟さがある • 車椅子ユーザーの骨盤にニュートラル姿勢になる柔軟さがある時、受講者が、低い側の骨盤下を 積み増しして矯正してはと提案する場合がある。これは、低い側の座骨下の圧力を増すため安全 ではない。 • 骨盤側方パッドとしっかりした骨盤ベルトを設けて骨盤を支えると、配置が適切で57バランスが 取れた姿勢になる。車椅子ユーザーの体幹にも支えが必要な場合がある。 55 [原文] must not be used 56 [原文] forward bend 57 [原文] aligned 99 d. 第 4節：問題：骨盤が片側に寄る 準備のコツ • 「教習員用指導書」p.143のスライド 22への注記に、以下を追加： o 「骨盤を両肩との垂直線上まで矯正できなければ、骨盤側方パッドを中心からずらし58ます。」 • 受講者に、上の一文を「受講者用参考書」(p.96のいちばん下) に追加するよう指示せよ。 内容 • 骨盤側方パッドは座面、ひじ掛け、背もたれ、背もたれパイプに固定できる。 • 骨盤パッドをひじ掛けや座面に固定する場合、形状が適切でなければ大腿部に干渉しやすい。 • 背もたれあるいは背もたれパイプに取り付けると干渉しにくい。これらは骨盤上端から大腿上端 のすぐ上までの形状にするとよい。 • 骨盤側方パッドを中心からずらして配置したい場合、以下の方法が可能： o 片方の骨盤側方パッドを、反対側より厚くする。 o パッドを非対称に/中心からずらして取り付ける。 e. 第 6節：要点のまとめ • 受講者に、実習および自分のサービス事業で車椅子ユーザーと協働するさい、車椅子ユーザーと さまざまな選択肢やアプローチを試みるよう奨励せよ。 58 [原文] off-centre 100 B.9: 姿勢支持具の処方（選択）−股関節を支える この授業を教えるための主な留意点 a. 全般 準備のコツ • 授業を通して、骨盤と股関節の姿勢チェック、必要な一時的支持、ハンド・シミュレーションの 結果と、姿勢とを関連づけよ。 b. 第 2節：股関節を支える 準備のコツ • 人体骨格模型があれば、さまざまな姿勢をやって見せるために役立つ。 内容 • ニュートラル姿勢まで屈曲しない股関節に対する一時的支持部の高さの決め方のコツは、授業 「B.3: 身体的事前評価−骨盤と股関節の姿勢チェック」の注記を参照せよ。 • 両側の座骨を一時的支持部に乗せて座ると、股関節の可動域制限（拘縮）から影響を受けること なく、脊柱を事前評価できる。 • 脊柱を事前評価したら、一時的支持部を取り除き、骨盤を後傾した位置にせよ。 101 B.10: 姿勢支持具の処方（選択）−体幹を支える WSTP（車椅子サービス教習パッケージ）教材の誤り a. 第 2節：体幹を支える ケーススタディ：ジョセフィン • 「受講者用ワークブック」(p.34-35) のジョセフィンのケーススタディで、彼女は長いホイール ベースの車椅子を使っていると述べているが、イラストには、短いホイールベースの車椅子に 乗っているジョセフィンが描かれている。 • ジョセフィンのケーススタディに取り組むグループには、長いホイールベースの車椅子を与えて ワークブックのその誤りに注記しておくよう助言せよ。 • ジョセフィンへのハンド・シミュレーション結果に、左股関節がニュートラル姿勢になると記録 されている。これは誤りで、骨盤がニュートラル姿勢でないのに左股関節がニュートラル姿勢に なるはずがない。 • 受講者に、「受講者用ワークブック」p.34-35 のコラム内のケーススタディへの情報について、 上記の情報を変更するよう指示せよ。 • 「教習員用指導書」p.160に、上記の変更について注記せよ。 この授業を教えるための主な留意点 a. 全般 準備のコツ • この授業には、予め準備が必要なたくさんの教材が要求される。将来の教習プログラムで再使用 できる、教習教材キットの作成を検討せよ。 • 受講者が、姿勢支持具を成形し切断する必要がある場合は、「教習員用指導書」の教材リストに 必要な工具を追加せよ。 • 受講者が姿勢支持具の実物大模型をつくるための、接着テープ数巻を教材リストに追加せよ。 この資材およびその取り付け方法は、教習のみを目的としていることを強調せよ。 • 姿勢支持具キットおよび姿勢支持具の材料を準備する際には、受講者が自分の職場で使うことに なる姿勢支持具および資材を用いるようにせよ。それらが手に入らなければ、低コストの代用品 下記］を用いてもよい。受講者には、それが教習のみを目的としていることを説明せよ： 102 o ソリッド座面/背もたれ、体幹/骨盤の側方支持具について、段ボールを木材の代用にする。 o 発泡スチロール、梱包材廃棄物の合成樹脂フォーム、草を編んだマットをウレタンフォームの 代用にする。 • 模擬品 [仮合わせの車椅子]59を完成するための資材がじゅうぶんない場合は、受講者に、加え ようとする変化、およびその作り方を詳述してもらえ。 • ケーススタディでは各ユーザー用車椅子の種類を詳述しているが： o その種類の車椅子が手に入らなければ、現地で手に入る代替品を提供し、 o その車椅子には、いかなる姿勢支持具も取り付けられていないようにして、 o その車椅子について受講グループで話し合え：提供した車椅子とケーススタディで述べている 車椅子との、主な変更点をすべて特定せよ • シアン（ケーススタディ 3）用に、子ども用サイズの車椅子が用意できなければ、受講者には、 異なるサイズのものを用い、必要となる姿勢支持に集中するよう助言せよ。 b. 第 2節：体幹を支える 準備のコツ 受講者全体での活動（「教習員用指導書」p.156）について： • 受講者が座る、ベンチあるいはテーブルの幅が広すぎないことを確かめよ。さもなければ受講者 の脚が伸びてしまうからである。座面が平らで水平な椅子があれば、壁に横向きに当てて置くと 代用になる。 内容 活動のケーススタディについて： • 受講者に、活動の中心は問題解決で、あらゆる可能な解決策を検討すべきだと念押しせよ。 • 受講者に、まず骨盤と股関節への支えを含む座面60から始め、続いてハンド・シミュレーション と同じ順序に沿って行くよう指示せよ。 • 受講者が適切でない解決策を選んだ場合は、その理由を説明するよう求めよ。受講者の解決策が 引き起こしうる臨床的または機能的な問題に関する話し合いを先導し、その克服のためには何が できるかを問え。 59 [原文] mock-ups 60 [原文] seat base 103 よくある誤解の修正：ケーススタディ 1：マーク • 高すぎる背もたれ：受講者に、ハンド・シミュレーションの所見は、車椅子ユーザーに肩甲骨の 背面に支えが必要であることを示していると念押しせよ。これは、背中への支えに必要な高さは 肩の上端ではなく胸郭の中ほどであることを示している。肩甲骨の高さの背もたれは、腕の機能 に影響を及ぼす。 • 背もたれは、ハンド・シミュレーションで判明した支えの高さにすべきである。 • 背もたれが低いと、車椅子ユーザーが不安定になる可能性がある。 • 肩甲骨背面への支えは、通常、肩の機能には影響しない。 よくある誤解の修正：ケーススタディ 2：ジョセフィン • 骨盤後方パッドを、「座面〜背もたれ角度を開ける」の代わりに選択：授業「B.8: 姿勢支持具の 処方（選択）−骨盤を安定させる：第 2節：問題：骨盤が後傾および/または前滑りする」 （「教習員用指導書」p.134）の、骨盤への支えに関する解説を参照。 • 座骨前方サポートが処方されない。 • 片側の座面前方下げの角度が不適切：ニュートラル姿勢まで屈曲しない側の股関節に対する片側 の座面前方下げの傾斜は、座骨前方サポートのすぐ前方から始まる必要がある。 • リクライニングしすぎ：背もたれを、背もたれパイプの間でリクライニングさせる場合、車椅子 ユーザーの肩が背もたれパイプに触れる直前でリクライニングは止めるべきである。 • 座面＆背もたれティルト61を用いる：受講者はまず骨盤と股関節、続いて体幹への姿勢支持具に 集中し、ティルトさせる必要を調べるのはそれからにすべきである。 • ジョセフィンの骨盤後傾による体幹〜大腿の角度が、股関節がニュートラル姿勢にならないこと による体幹〜大腿の角度と同じ、あるいはより大きければ、クッションの改造は不要。 よくある誤解の修正：ケーススタディ 3：シアン • 骨盤の低い側を積み増し：授業「B.8: 姿勢支持具の処方（選択）−骨盤を安定させる：第 3節： 問題：骨盤が側傾している62」の、骨盤への支えに関する解説を参照。 • 座面前方のかさ上げの位置：座面前方のかさ上げの傾斜は、座骨前方サポートのすぐ前方から 始まり、クッション前端まで続く必要がある。 • 骨盤後方パッドを付加：シアンは 3歳なので腰椎のカーブは発達していない。この年齢の子ども には、平らな背もたれ63が適切である。 61 [原文] seat and back rest tilt [訳注] 座面と背もたれが一体化して傾く, 日本語のいわゆる「ティルト」を指す. 本書には, 同じ機能を tilt in space「ティルトインスペース」と呼んでいる箇所 (p.104) もある. 62 [訳注] 中級WSTP「教習員用指導書」p.141. 63 [原文] flat backrest [訳注] いわゆる腰椎 (ランバー) サポートのない背もたれ, と解すべきであろう. 104 体幹と頭のコントロールに乏しい子ども： • 子どもは、ニュートラルな姿勢では、骨盤がまっすぐに 起き、腰部のカーブがなく、胸椎がわずかに屈曲し、 体幹上部がわずかに前傾する（図 14）。 • つまり子どもの体幹上部は、平らな背もたれには密着 しないのである。 • いっぱんに、筋力が弱い/体幹のコントロールに乏しい 子どもは、体幹上部と頭をまっすぐに起こして保つのが 困難である。 • 子どもによっては、さらに支えが必要である。 図 14 子どものニュートラルな姿勢 子どもをよりまっすぐに座らせるには： 座骨前方サポートを付加し、座面〜背もたれ角度を 開け、骨盤ベルトを付加して、評価せよ： • この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合： • テーブルを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ • 肩ハーネスを付加して、評価せよ： o この姿勢を維持できるか？ さらに支えが必要か？ さらに支えが必要な場合：座面および背のティルト （ティルトインスペース）を付加せよ（図 16）。 図 15 座面〜背もたれ角度を開ける 図 16 ティルトインスペース 105 B.11: 姿勢支持具の処方（選択）−頭・大腿・下腿を 支える WSTP（車椅子サービス教習パッケージ）教材の誤り a. 受講者用参考書 • 「受講者用参考書」p.106の見出し「問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢 よりも小さい角度のまま固まっている」に続く（ ）内の語「大腿〜下腿の角度が 90 度超」を 「大腿〜下腿の角度が 90度未満」に差し替えよ64。受講者に、自分の参考書にこの変更を加える よう指示せよ。 この授業を教えるための主な留意点 a. 第 3節：大腿を支える 内容 活動のケーススタディに対するよくある誤り： • まず車椅子および/またはクッションの問題に対処するより先に姿勢支持具を付加する：姿勢の しっかりした土台を構築するうえで、基礎レベルの車椅子の原則が重要であることを強調せよ。 • 車椅子ユーザーの大腿へじゅうぶんな支えを設けない：ハンド・シミュレーションの結果から、 どこを支える必要があり、どの程度支えが必要なのかが示される。これには姿勢支持具のサイズ、 形状、強固さなどが含まれる。 • 車椅子および/またはクッションへ付加する姿勢支持具が機能（例えば車椅子の移乗や推進）に 及ぼす影響へ対処していない：。 • 「教習員用指導書」p.169 のスライド 11 のイラストは、骨盤井があるクッション上の大腿外側 ウェッジを示している。これは一つのクッションに複数の姿勢支持具を組み合わせた一例である。 大腿外側ウェッジを組み付けたクッションには必ず骨盤井が必要、という意味ではない。 • 上記は「教習員用指導書」p.170のスライド 15にも当てはまり、こちらは、骨盤井クッションに 設けた大腿内側ウェッジを示している。骨盤井の詳細は、本書「B.8: 姿勢支持具の処方（選択） −骨盤を安定させる」の「この授業を教えるための主な留意点」を参照。 • 「教習員用指導書」p.169 のスライド 13 の膝分離パッド：座骨前方サポートや座面前方のかさ 上げを付加した場合、クッション前部は高さが増す。これは、膝分離パッドの設計によっては、 車椅子ユーザーの膝に対するパッド位置に影響を及ぼす。 64 [訳注] 日本語版では注記済み. 106 b. 第 4節：下腿と足を支える 問題：片膝または両膝が屈曲し、ニュートラルな座位姿勢より小さい角度のまま固まって いる（「教習員用指導書」p.173） • 追加の（列挙されていない）解決策として座面前方のかさ上げがある。これは股関節を屈曲させ （体幹〜大腿の角度を狭め）、足を座面の真下から前方へ持っていく。 • 股関節をニュートラル姿勢より屈曲させて座っても、ニュートラル姿勢で座るより拘縮が発生・ 悪化する危険が増すことはない。しかし、車椅子ユーザーへの以下の助言は優れた実践である： o 毎日、車椅子を降りてうつ伏せになって休憩し、股関節を伸ばしなさい。 o 毎日、立位台で過ごす時間を設けなさい。 107 B.12: 製品（車椅子）の下準備 この授業を教えるための主な留意点 a. 全般 準備のコツ • 教習員は、現地で手に入る車椅子と資材を熟知している必要がある。教習プログラムの計画段階 で、しっかりと把握しておけ。教習員が現地を拠点としていない場合、これは以下のようにして 行なうとよい： o 現地のサービス事業者に、手に入る資材の情報と写真を送ってもらうよう依頼する。 o プログラム開始前に到着し、用意された資材を確認し、必要ならば代替品を探すためのじゅう ぶんな時間を確保する。 • 教習プログラムに必要なリソースは、実施地ごとに、以下の条件に従い変わってくる： o 現地で服、靴、バックパックを製造していれば、さまざまな種類の布地、ベルト地、バックル、 面ファスナー、EVAが手に入る可能性が高くなる。 o 現地に家具製造業や建設業があれば、木材、合板、留め具、鋼管などさまざまな種類の材料が 手に入る可能性が高くなる。 • 姿勢支持具の部材は、国際的ドナーからの寄付によることも可能である。例えば、ベルト、頭部 支持具、ハーネス、体幹側方サポートなど。 • 「受講者用参考書」p.110の初めに載っている情報を、資材と工具に関する一般的情報について 読み直し、話し合いの場で参照できるようにしておけ。 • この授業には、技術的専門知識が豊富な教習員がおり、製品の下準備に関する技術的支援を得ら れると助かる。 b. 第 1節：はじめに • どの車椅子が、その車椅子ユーザーの環境および機能的ニーズに対して最適な特色をもたらすか、 また必要な姿勢支持具の付加によって、ユーザーのフィッティングおよび姿勢支持へのニーズが じゅうぶんに満たされるかどうか検討せよ。必要な姿勢支持機能のみをもたらすよう、ハンド・ シミュレーションで設けた支えに基づいて姿勢支持具を選択することが、最良の解決策となる。 • 姿勢支持専用車椅子は、車椅子ユーザーが必要とするよりも多くの機能を提供する場合がある。 可能であれば、不必要な機能は取り除くこと。 108 B.13: フィッティング この授業を教えるための主な留意点 a. 全般 • 受講者は、基礎WSTPのフィッティング手順を熟知していなければならない。 • 基礎レベルのサービス供与は、単線的プロセス（順々にステップを踏む）である。中級レベルの サービス供与は、循環を経て完結する。受講者は、車椅子と姿勢支持具が最初の処方から調整や 改造を経るに従い、フィッティング確認表を繰り返し用いる必要がある（「教習員用指導書」p.183 のスライド 3を参照）。 • 時間が許せば、教習員はこの授業をより対話的にするとよい。例えば： o 志願者を募り、受講者に、基礎レベルで学んだ確認で確認表に載っている項目をやって見せて もらう。 • ほとんどの基礎レベル適応の車椅子ユーザーは、フィッティング手順の終わりにはまっすぐに/ ニュートラルな姿勢で座れるようになる。中級レベルでは、多くの車椅子ユーザーはまっすぐに /ニュートラルな姿勢では座れない。受講者は、ユーザーが可能な限り最良の姿勢になったのか 確信が持てないかもしれない。そうした場合には： o 骨盤と股関節の姿勢チェックおよびハンド・シミュレーションからの所見を、フィッティング 手順の終わりにとれた最終姿勢と関連づけよ。 • 最終姿勢が、ハンド・シミュレーションの終わりに到達した姿勢とぴったり一致しない場合は、 以下のような理由による： o 骨盤と股関節の姿勢チェックでの評価を誤った。 o ハンド・シミュレーションで、姿勢の問題を矯正しすぎている。この場合は、新しい姿勢での 快適さ、バランス、耐久性65を向上させるため、最終処方を調整する必要がある。 o 事前評価から最終フィッティングまでに時間が空き、車椅子ユーザーの姿勢が事前評価の時点 から変化した。この場合は、骨盤と股関節の姿勢チェックおよびハンド・シミュレーションの やり直しが必要かもしれない。 65 [原文] tolerance 109 B.14: ユーザー教習 この授業を教えるための主な留意点 a. 全般 準備のコツ • リーダー役教習員と補助役教習員とで、車椅子での移動と移乗に関する技能を復習し、練習して やり方に統一性を持たせるべきである。 • 車椅子が正常に動作し、すべての部品が取り付けられていることを確認せよ。 • 選んだ車椅子は、各々の例話に登場する製品と、なるべくぴったり合致させよ。 o ジョシュア：ティルトインスペースと転倒防止の機能を備えた製品 o サンギータ：クイックリリース車輪、骨盤ベルト、骨盤パッドを備えた（できれば）子ども用 の製品 o キム・ソム：クッションと背もたれに姿勢支持具を備えた、標準的な車椅子 b. 第 2節：ユーザー教習：車椅子ユーザーの例話 • 車椅子サービス職員役を割り当てられるのは各グループに一人だけだが、グループには、教えら れるべきそれぞれの技能、およびその正しい教え方を、協力して見定めるよう指示せよ。 • この配役は、車椅子ユーザー教習のさまざまな側面を強調することを意図しており、この活動を 一人だけで完結することは想定していない。 • 技能をどう教えているか注意深くモニターせよ。受講者は説明し、やって見せ、練習するところ を観察し、フィードバックを伝えるべきである。 • 例えば折りたたみ、駆動輪やテーブルなど着脱式部品の取り外し/取り付けをはじめ、車椅子の あらゆる機能を、分かりやすく車椅子ユーザーとその家族にやって見せていることを確認せよ。 • 中級WSTP受講者にはそうした機能を理解し、それをユーザーおよび/またはその家族に上手に やって見せられる能力が不可欠である。 110 B.16: メンテナンス・修理・フォローアップ この授業を教えるための主な留意点 a. フォローアップ実習 準備のコツ • 教習時間割に、フォローアップ実習は含まれていない。時間が許せば、教習員は、現地の車椅子 ユーザーとの、サービス施設あるいは在宅環境でのフォローアップ面接予約を段取るとよい。 • 学習の要点を強調し、受講者からの質問に答えるため、現地で手に入る車椅子を用意しておけ。 • 一般的な手入れ・メンテナンス・修理用工具一式を用意し、受講者に見せられるようにしておけ。 b. 第 2節：フォローアップの概略 • あらゆる中級レベル適応の車椅子ユーザーにとって、定期的フォローアップは有益である。 • よりひんぱん（3〜6か月ごと）なフォローアップが必要な車椅子ユーザーの例： o 子ども：成長による、または機能（例えば頭や腕のコントロール）や姿勢における変化に形を 合わせるため、姿勢支持具の調整が必ず必要 o 進行性疾患がある、または機能的能力や体重が変化しそうな車椅子ユーザー • フォローアップは車椅子サービス供与の最も難しい側面で、特に車椅子ユーザーの家でフォロー アップを行なう場合がそうである。その原因は移動のリソースに制約がある、都合がつく職員に 限りがある、サービスセンターから車椅子ユーザーの家までが遠いことなどによる。 • フォローアップ面接はたいへん重要である。そこでサービス供与者ができること： o 車椅子ユーザーが、自分の車椅子を安全に使えていることを確かめる。 o 車椅子が、適切に動作していることを確かめる。 o タイヤの空気入れ、ブレーキの調整など基本的なメンテナンスを実施する。 o 追加の車椅子ユーザー教習を提供する。 o サービスの出来ばえに関するフィードバックをもらう。 o サービスの必要性を立証する、車椅子ユーザーの体験談を集める。 o 製品の使われ方、および製品が使用環境や期待された機能に対して適切かどうかを把握する。 111 • フォローアップに障壁があるところでは、教習員は、現地での解決策を見出すための話し合いを （時間が許せば）先導してもよい。その内容として考えられること： o フォローアップ実施のために、地域に根ざした組織を活用する。 o 車椅子ユーザーがフォローアップに出かけられるよう、移動への支援を提供する。 o 地域ごとのフォローアップ日程を決め、職員が一地域で数件の家庭訪問を行なう。 o 車椅子ユーザーがすでに他の予約、例えば医師との面接などでその地域にいる時に合わせて、 フォローアップの面接予約を入れる。 c. 第 3節：車椅子フォローアップフォーム • 受講者に、中級レベル適応の車椅子ユーザーには、メンテナンスや修理がより多く必要になると 念押しせよ。なぜなら： o 通常、車椅子に、摩耗したりゆるんだりしがちな部品が多くなるため。 o 中級レベル適応の車椅子ユーザーの場合、激しい筋攣縮 きんれんしゅく］や、座り方の パターン66のために、姿勢支持具に通常以上の圧力が加わることがあるため。 66 [原文] patterns of sitting 112 実習 1〜4 この授業を教えるための主な留意点 a. 全般 準備のコツ 注意義務67 • 教習員は、教習プログラムに参加した車椅子ユーザーに適正な車椅子、クッション、姿勢支持具 が供与されたことを確かめる、注意義務を負っている。 • ユーザーやその家族にとって安全でない、または機能的ではないと教習員が感じるような製品の ままで、車椅子ユーザーを教習プログラムから去らせてはならない。車椅子を供与できなかった 場合は、ユーザーの地元のサービス事業者との面接予約を別に取り、処方、フィッティング、 ユーザー教習が完結するようにせよ。 • 教習員は、車椅子ユーザーへのフォローアップを担当するサービス事業者またはサービス職員を、 必ず確定しなければならない。そのサービス供与者には、事前評価フォームや処方フォームなど 関連書類をすべて提供しなければならない。 • 教習員は、車椅子ユーザーに、支援、修理、フォローアップを提供できる地元のサービス供与者 の連絡先を、必ず伝えなければならない。 車椅子ユーザー • 主催団体または教習チームから、連絡担当者を指名せよ。その役割は： o 車椅子ユーザーが実習に到着したら出迎える。 o 実習に到着していない車椅子ユーザーへの対応を行なう。 o サービス事業と教習チームとの間の連絡をとる。 o 車椅子ユーザーおよびその家族が自分の面接が始まるまで待機する、適切な場所を指定する。 o 食事や軽食を提供する場合、全員の希望を前日までにはケータリング68業者に確認する。 o 写真撮影許可が完了していることを、写真を撮る前に確認する。 67 [原文] Duty of care 68 [原文] catering 113 グループ分け • 優れた学習経験ができるためには、受講者をどうグループ分けするのがよいかよく考えよ： o 同じサービス事業所からの受講者をいっしょのグループにしたり、臨床職と技術職の受講者の 混成グループにしたりすると有効な場合がある。 o 自信満々の/饒舌な69受講者と、自信のない/寡黙な受講者をいっしょのグループにし、揃った ペースで作業できるようにすることを検討せよ。 o ことばや、事前評価をジェンダー混合のグループで行なうかどうかなど、文化的配慮を考えよ。 実習中のグループへの教育指導70 • 各グループに、個別の教習員を配置して実習の調整を手伝わせよ。 • できれば、リーダー役教習員が教育指導するグループ数は減らし、補助役教習員との確認作業に じゅうぶん時間を取れるようにせよ。 • 「教習員用指導書」に沿って、受講者にステップごとの時間を予告せよ。 • 時間経過に気をつけ、受講者へ定期的に残り時間を知らせよ。 • 実習を通して、各グループに同じ教習員が付くようにせよ。 b. 実習 1: 事前評価および処方（選択） 準備のコツ • 各グループに、事前評価を人目に触れないように71実施するじゅうぶんなスペースがあるように、 実習エリアを設営せよ。 • 個室を用意できない場合は、間仕切りを活用するとよい（例えば、褥瘡を観察するため）。 • 各グループに、事前評価と処方に必要な器材を支給せよ。グループの一人を、「実習 3」終了後 に器材を返却する責任者に任命せよ。 • 事前評価と処方の各パートで、別のチームメンバーがリーダーを務めるように配置し、グループ メンバー間でその経験を共有するようにせよ。 • 受講者には、事前評価プロセスが円滑に流れ、焦点を車椅子ユーザーに置き続けられるように、 同僚が各々の項目を終えるまで待ってから追加の質問をするよう勧めよ。 69 [原文] talkative 70 [原文] Supervision 71 [原文] privately 114 内容 • 身体的事前評価を注意深くモニターし、グループが、処方に影響を及ぼしうる誤りはすべて修正 するよう手助けせよ （例えば、骨盤と股関節の姿勢チェックやハンド・シミュレーションの誤り、 正しくない計測技法など）。 • 教習員は、受講者の所見を検証するため、骨盤と股関節の姿勢チェックを独自にやるとよい。 • 受講者が、事前評価フォームの順序に従うようにせよ。例えば、身体寸法は、車椅子処方を決定 する前に車椅子寸法に換算されている必要がある。 • 車椅子ユーザーは、処方プロセスへの積極的参加者であるべき。車椅子の選択肢や特色について、 受講者が車椅子ユーザーと話し合ったうえで最終処方をつくり上げるようにせよ。 • 車椅子ユーザーや家族に、見本の車椅子を示せるように用意し、じゅうぶんに情報を得たうえで 決定できるようにせよ。 • 受講者の各グループに、処方フォームへの署名前に、処方の臨床推論72を説明してもらえ。 c. 実習 2: 製品（車椅子）の下準備 準備のコツ • 製品の下準備用に教室を設営するやり方の詳細は、本書「技術に関する付録」を参照。 d. 実習 3: フィッティングおよびユーザー教習 • ユーザー教習にはじゅうぶん時間をかけられるようにし、慌ただしくならないようにせよ。 e. 実習 4: 事前評価・処方（選択）・製品（車椅子）の下準備・ フィッティング・ユーザー教習 • 学習成果を高めるため、受講者を異なるグループに編成することを検討せよ。 • 受講者へ、車椅子サービス提供の最初の 5ステップを所定の時間内に完了できるよう、計画的に 作業するよう念押しせよ。 • 受講者は、必ずグループ全員で作業を分担すること。例えば製品の下準備では、一人が車椅子の 調整をやり上げ、他の一人がクッションを下準備し、もう一人が姿勢支持具を下準備するなど。 • 上手に作業を分担すると、すべてのステップが所定の時間内に完了するようになる。 72 [原文] clinical reasoning 115 B.15&17: 総まとめ&教習員からのフィードバック・ 討論・閉講式 この授業を教えるための主な留意点 準備のコツ • 教習員の一人に、各発表の説明に必要な、ビフォーアフター73の写真をダウンロードして整理 する役を割り当てよ。この作業は休憩時間に行なうこと。 • ビフォーアフターの写真を並べて表示せよ。これは、フィッティングの効果と成果とを示す、 効果的な方法である。 内容 • グループの準備を手伝う補助役教習員を配置せよ。 • 受講者へ、各発表が制限時間 10分に収まるよう、残り 5分と 1分で合図することを伝えよ。 • 発表に盛り込む情報を選ぶために、支援が必要な受講者もあろう。「受講者用ワークブック」p.49 の「総まとめ」の項目を指針に用いよ。 • 発表およびファシリテーションでは、教習員は以下を強調せよ： o 骨盤と股関節の姿勢チェック、ハンド・シミュレーション、最終的にとれた姿勢の関連 o ハンド・シミュレーションで見定めた支えと、最終的に選択した姿勢支持具との関連 o 選択した車椅子の特色が、環境および機能に対するユーザーのニーズをどのように満たすか • 発表のケーススタディに関する討論を促し、グループからの質問やフィードバックを、バランス が取れ、重要な事前評価の所見および介入に焦点を当てたものにせよ。 • 低リソース状況では、手に入る車椅子や姿勢支持具の範囲には限りがある。 • 妥協は常に必要である。問題は、車椅子ユーザーにとって最善の成果と、常にユーザーの安全を 確保することとの、適切なバランスを見出すことである。 73 [原文] before and after 116 教習運営実務と準備 「教習員用指導書」には、中級WSTP教習プログラムがうまく行くために必要な施設、印刷教材、 資材、器材の包括的一覧表が載っている。教習プログラム調整役の教習員は通常、現地の主催者と 連絡を取り合い、教習運営実務と準備の各部面の責任者を決定する。 実習生は見習い教習を通して、教習運営実務と準備における任務を処理する、経験と技能とを獲得 する。教習員の調整役は、これらの活動を実習生に分担させ、さらに実習生をモニターし支援する。 施設74 必要な施設の完全な確認表は、「教習員用指導書」p.14 に収載。 中級WSTP教習員が、受講者と同じことばを話さない場合は、通訳サービスが必要になる。通常、 こうしたサービスは需要が大きいため、じゅうぶん前もって予約しておくべきである。費用を教習 予算に追加する必要があろう。 印刷教材 資料は、必ずすべて現地で印刷すべきである。中級WSTPに必要な印刷教材の完全な一覧は、中級 WSTP 「教習員用指導書」p.15-16 を参照。「教習員用指導書」の確認表を用い、正しい数量の資料 が印刷されていることを確認せよ。 資材および器材 中級WSTPに必要な資材および器材の一覧は、中級WSTP「教習員用指導書」p.17-18 を参照。 74 [訳注]「中級教習員指導書」の対応する見出しは「施設およびサービス」. 117 車椅子 「教習員用指導書」p.18 の最初で、現地で手に入る車椅子とクッションについて述べている。多種 多様な車椅子が手に入る場合は最もよく使われる種類を選択し、できれば幼児用座椅子75を含めよ。 電動車椅子は含めないこと。それは中級WSTPの範囲ではないため。 どの車椅子も正常に動作し（タイヤに空気が入り、ボルトが締まっており）、クッションが付いて いることを確かめよ。 実習に参加する各車椅子ユーザーについて車椅子、クッション、姿勢支持具、あるいはクッション と姿勢支持具をつくるための資材が必要である。 技工作業エリア 改造に必要な種々の工具と資材を備えた、技工作業エリアを利用できるようにするか設置すべきで ある。これは教習予算に影響しうる。 電力与給 電源が不安定な地域では、非常用として無停電電源装置内蔵の発電機を手配すべきである。これは 「教習員用指導書」p.17 の「器材」一覧表にも追加する必要がある。 教習に向けた計画 中級WSTP教習プログラムの計画について、以下、最も重要な活動とおおよその日程を列記する： 8〜12 か月前 • 教習プログラムの予算を立てる。 • 複数のパートナーが参画する場合は、各パートナーの責任について合意する。 • 日程、会場、教習員、受講者の概要、現地事情に関する情報（現地の、車椅子に関する活動や サービスの指針となる一般的な方針や手続き、手に入る車椅子、クッション、その他手に入る 資材の種類、現地の文化や受講者の多様性に関する情報、参画する組織など）を確定する。 • 教習に必要な日数を算定し、毎日の開始と終了時刻、および通訳が必要かどうかを確定する。 75 [原文] a floor seat for infants 118 4〜6 か月前 • 各受講者に、教習プログラムの詳細（日程、会場、運営に関する情報）が載った招待状を送付し、 記入して返送してもらう。 • 受講者の職歴や技能に関する情報を集め、それに従って授業計画を適合できるようにする。 • 教習器材を予約する。 • 模擬授業に必要な、デモ用器材やその他のリソースを調達する。例えば処置用ベッド、足置き、 スライディングボードなど。 • 消耗品を調達する。 • ユーザー用の器材を調達する（ユーザー用器材を、寄付金および/または教習予算の一部に依る 場合、器材調達はもっと早く始める必要がある）。 • 状況と受講者についての概要を各教習員に伝え、授業と役割の分担について合意する。 • ケータリングサービスを予約する。 • 必要ならば、通訳および翻訳設備を手配する。 4〜6 週間前 • すべての必要な資料について、現地での印刷を手配する。 • 車椅子ユーザーを選んで招聘する。 • 登録の詳細を最終決定。例えば、名札と登録簿の手配、登録作業に当たる人への連絡など。 • 参加確認/事前情報を参加者、車椅子ユーザー、教習員に送付する。 • ケータリング業者、会場、その他の教習運営実務を確定する 1〜2 週間前 • 注文品が配達済みか確認する。 • 会場のトイレ、および水道と電気が通っているのを確認する。 • 清掃スケジュールを確認する。 教習チームの地元でない場合は、プログラム開始の 2〜3 日前に到着し、設備と会場の確認、教習 プログラムを支援する車椅子ユーザーとの打ち合わせ、必要な残り資材の購入ができれば最善。 調整役の教習員と他の教習員、主催団体、他の関係機関との間には、定期的なコミュニケーション が必要である。 119 車椅子ユーザー 中級 WSTP の間に実習が 4 回あり、そこに 2 グループの車椅子ユーザーが参加する。最初のグル ープは、2つ別の日に参加する。 教習員は教習プログラムの前に、実習に参加する意思があり、また参加が可能な車椅子ユーザーを 見定めて招く必要がある。「教習員用指導書」p.11 の確認表は、車椅子ユーザーを見極めるために 役立つ。 主催団体および教習企画者と、車椅子ユーザーのために使える予算と施設について連絡を取り合え。 車椅子ユーザーに移動手段が提供されるか、または交通費が支払われるかどうか確かめよ。 車椅子ユーザーの参加が 1 日だけの場合、プログラムを再編成し、ユーザーグループ 1 に対する 「実習 1」と「実習 2」を同じ日に収めよ。時間割を調整する際には、サービスステップ 2〜7 を 必ず「実習 3」より前に完了せよ。 可能ならば、教習員が直接車椅子ユーザーを審査すべきである。教習員が現地を拠点にしていない 場合は地元のサービス供与者に、可能性がある車椅子ユーザーを見定め、教習レベルに適合するか 教習員が判断するための写真と情報を事前に送ってもらうよう依頼するとよい。 車椅子ユーザーへの招聘状 車椅子ユーザーへの招聘状を作成する際には、以下の項目を考慮せよ（WSTP 用 USB メモリ内に ひな形を用意している76）： • 何が、実習へ参加すると起こるのかの詳細。 • 授業の日時および期間 • だれかといっしょに来てもよいのか？ • 授業で車椅子を受け取れるのか？車椅子にフォローアップが必要になったり、問題が起きたり した場合はどうなるのか？ • 教習後、どこでフォローアップサービスを受けられるのか？ • 会場にはどうやって行くのか？交通費は支払われるのか？ • 軽食や昼食は持参しなければならないのか？ • 参加に対して報酬は出るのか？ 76 [訳注] 英語版のみ. 120 各車椅子ユーザーが、これらの情報を記載した書面の招聘状を受け取るようにすべきである。ユー ザーは、参加や写真を撮られることへの意向を示すため、同意フォームにも署名する必要がある。 写真は、小グループが他の受講グループへ発表を行なう際に用いる。 注意深い計画にもかかわらず、車椅子ユーザーが、到着してみると褥瘡があったり授業日に体調を 崩したりする場合もある。これらの可能性は事前に主催団体と話し合い、こうした事態が発生した 場合に対処する準備を整え、また交替の車椅子ユーザーの参加を手配できるようにしておけ。 車椅子ユーザーが授業中、膀胱や腸のアクシデントに遭った場合に、ユーザーと設備を清潔にする 物品を準備せよ。また小さい応急処置キットを、受講者と車椅子ユーザー両方の打撲やすり傷に 備えて用意しておくこと。 121 付録 付録１：WSTPtot必須授業時間割 第 1日 第 2日 8:30 ToT.1 車椅子サービス教習員養成教習 パッケージ紹介（75分） ToT.7 プレゼンテーションと ファシリテーション（60分） 8:45 9:00 9:15 9:30 ToT.8 コミュニケーションスキル（90分） 9:45 ToT.2 車椅子サービス教習パッケージ とは（90分） 10:00 10:15 10:30 10:45 11:00〜11:15：午前の休憩（時間は現地の事情および授業計画に合わせる） 11:15 ToT.2 車椅子サービス教習パッケージ とは ToT.9 指針文書の知識（75分） 11:30 ToT.3 模擬授業について（60分） 11:45 12:00 12:15〜1:15：昼食（時間は現地の事情および授業計画に合わせる） 1:15 ToT.3 模擬授業について ToT.9 指針文書の知識 1:30 ToT.4 多様性に備える（60分） ToT.10 視聴覚ツールおよび機材（45分） 1:45 2:00 2:15 ToT.11 フィードバックについて（45分） 2:30 ToT.5 成人学習（80分） 2:45〜3:00：休憩（時間は現地の事情および授業計画に合わせる） 3:00 ToT.5 成人学習 ToT.11 フィードバックについて 3:15 ToT.12 グループダイナミクスを取り 仕切る（45分） 3:30 3:45 4:00 ToT.6 準備時間について（15分） 準備時間（60分） 4:15 準備時間（45分） 4:30 4:45 122 付録２：WSTPtot 中級教習時間割1 第 1日 第 2日 第 3日 8:30 はじめに B.5: 身体的事前評価－ 身体計測 B.10: 車椅子の処方（選択）－ 体幹を支える (パート 2)2 8:45 9:00 B.2: 身体的事前評価－ 支えなしの座位姿勢 B.10: フィードバック （パート 2） 9:15 B.11: 車椅子の処方（選択） －頭・大腿・下腿を支える 9:30 B.5: フィードバック 9:45 B.8: 車椅子の処方（選択） －骨盤を安定させる 10:00 午前の休憩 10:15 B.2: 身体的事前評価－ 支えなしの座位姿勢 (続き) 午前の休憩 午前の休憩 10:30 B.8: 車椅子の処方（選択） －骨盤を安定させる（続き） B.11: 車椅子の処方（選択） －頭・大腿・下腿を支える （続き） 10:45 B.2: フィードバック 11:00 11:15 B.3: 身体的事前評価－ 骨盤と股関節の姿勢チェック （ToT 訓練員のデモ授業） 11:30 B.8: フィードバック B.11: フィードバック 11:45 B.9: 車椅子の処方（選択） －股関節を支える B.12: 製品の下準備 12:00 12:15 12:30 昼休み B.9: フィードバック 12:45 昼休み B.12: フィードバック 1:00 昼休み 1:15 1:30 B.3: 身体的事前評価－ 骨盤と股関節の姿勢チェック （続き） 1:45 B.10: 車椅子の処方（選択） －体幹を支える（パート１） 2:00 B.13: フィッティング 2:15 B.4: 身体的事前評価－ ハンド・シミュレーション 1 [訳注] この時間割表の内容および時間配分は, ページ xiii「教習の概略」の表とは異なっている. 2 [訳注] ページ xiii「教習の概略」には存在しない授業. 123 2:30 午後の休憩 2:45 午後の休憩 B.10: 車椅子の処方（選択）－ 体幹を支える（パート１）（続 き） 3:00 B.4: 身体的事前評価－ ハンド・シミュレーション （続き） B.13: フィードバック 3:15 午後の休憩 3:30 B.4: フィードバック ToT 教習員の個別フィード バック 3:45 「保留スペース」 4:00 授業準備 ToT 教習員の個別フィード バック B.10: フィードバック （パート１） 4:15 「保留スペース」 4:30 授業準備 ToT 教習員の個別フィード バック 閉講式 4:45 5:00 注3 5:15 3 [訳注] ページ xiii「教習の概略」では, ここに授業 B.5と B.8 (B.6あるいは B.7の誤記か) の一部が入る. 124 付録 3：WSTPtot 模擬授業フィードバックシート 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ このフィードバックシートは、WSTPtot実習生の自信と教習技能とを育成するためのものである。 このシートは以下のために活用できる： • 実習生が、自身の教習技能を振り返るため • ToT 教習員が、実習生へフィードバックを与えるため ToT 教習員への指示：毎回の模擬授業の後、下記「WSTPtot 実習生技能一覧表」を用い、下の欄 2つを記入せよ。WSTPtot の終わりに、最終ページの推奨事項と要約を記入せよ。 WSTPtot 実習生技能一覧表 • 準備 • 時間管理 • WSTP教材資料の教授 • プレゼンテーション • ファシリテーション • コミュニケーション • グループ作業を取り仕切る • フィードバックを与える 模擬授業 第 1 回 よかった点 改善の余地がある点 125 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 2 回 よかった点 改善の余地がある点 実習生：________________________________ ToT 教習員：_______________________________ 授業名/番号：______________________________ 担当した項目 ：______________________________ 日付：________________ 持ち時間：________________ 実際に要した時間：_________________ すべての項目を終えたか？ はい□ いいえ□ 模擬授業 第 3 回 よかった点 改善の余地がある点 126 ToT教習員への指示：WSTPtotの終わりに、下記の推奨事項を選択し、実習生の強みおよび 改善すべき分野に関する簡潔な要約を記せ。 推奨事項と要約 ToT 教習員の推奨事項： □ 見習い教習を継続しなさい □ 見習い教習を継続する前に、知識および/または技能を養いなさい（詳細は下記） 要約 127 付録 4：技術に関する付録：中級WSTP向け この付録は、教習員の中級WSTPでの実習準備に役立つことが目的である。中級レベルでは、適正 な車椅子の組み立てがもっと複雑で、実地訓練での要求がさらに厳しくなり、技術者の役割の重要 性への理解が大切になる。計画段階で、教習員は、教習授業での工具と資材および経験豊富な技術 的支援を確保する方法について考えておく必要がある。また、より多くの技術者に、サービス事業 を支援するために中級教習を受けるよう奨励することも重要である。 中級サービス与 における技術職 一連の教習プログラムの一環として、WHO は、幅広い種類の車椅子に適用されることを意図した 座位保持の原理を教え、また姿勢支持具（PSDs）の例を示している。ユーザーを事前評価し、どの 姿勢支持具が必要か処方（選択）し伝達するのは臨床職の役割である。技術職の役割は、最終的に 必要な姿勢支持を達成する、なるべく実用的で、安全で、耐久性があり、取り扱いが楽な車椅子を、 手に入る工具、設備、資材、部品を用いてつくり上げる方法を把握することである。 基礎レベルでの技術者の役割は、ユーザーに合わせて車椅子を組み立てて調節することだと明確に 定義され、そのプロセスは単線的で、役割はより単純である。中級レベルに取り組む技術者には、 車椅子の組み立てのみならず、以下が求められる： • プロセス全体を通じて、ユーザーと臨床職により深く関わる。 • より独立して問題を解決できる。 • 容易に、立体形状をイメージして方向を定められる4。 • さまざまな材料や部品から、適正な姿勢支持具をつくる技工的技能を有する。 臨床職とのチームワークおよび優れたコミュニケーションは、非常に重要である。技術者の役割は、 工房での安全な作業環境を維持することや、工具と設備の手入れにも及ぶ。 臨床職/技術者チームは経験を積み、さらに複雑な姿勢支持ニーズを持つ車椅子ユーザーと関わる 中で自らの技能に挑戦し、それを高めて行く。経験豊富な技術者は、利用できるリソースを用いて 安全に達成できることは何か、その限界を把握することを学ぶ。複雑な姿勢支持具をつくれても、 それがユーザーとその家族にとって、適正、安全、あるいは長持ちする解決策である保証はない。 例えば、ユーザーをうまく支える姿勢支持具であっても、材料に耐久性がないか取り付けが不安定 であれば短期間しか持たず、したがって適正な解決策とはならない。 4 [原文] imagine and orientate 128 もっと多くの技術者に教習を 基礎WSTPと中級WSTPは、低リソース状況において車椅子を供与する実務家の量と質を高める ことが目的である。組み立てと調整 の方法］は車椅子の種類によって非常に特殊化しているため、 こうした情報は教習プログラムには盛り込まず、教習実施団体から別途提供することが多い。 中級 WSTP 受講者として技術者の参画を得ることは非常に有益である。技術者の車椅子サービス の 8 ステップへの理解が深まるほど、よりよい技術的支援ができるようになる。組織によっては、 教習は技術と臨床の職員へ同時に行なうが、サービス供与での継続的役割に応じて、技術レベルで 到達すべき能力への要求を違えている。 各サービス供与者や教習実施団体は、より複雑なニーズを満たすために、技術者が中級レベルの 力量を養うのを支援する最良の方法を見定める必要がある。 中級WSTP教習における技術者の役割 教習員には、中級 WSTP の実習中に支援を与える経験豊富な中級レベルの車椅子技術者を最低 1 名手配しておくよう勧める。これは、在庫品や既製品を用いないで姿勢支持具をつくる予定の場合、 特に重要である。 車椅子と姿勢支持具に関する技術的な内容を教授し、技術関連の質問に答えるために、経験豊富な 中級レベルの技術者および/または技術教習員を、教習全体を通じて教習チームに加えよ。 実習用の教室設営 姿勢支持具づくりには注意深さと時間が要求されるため、教習員 と技術者は、時間割を守れるようにきちんと計画しておくことが 絶対に必要である。一般的に使われる姿勢支持具のいくつかは、 予めつくっておくことを検討してもよい。 129 以下は、安全で整理整頓された教習用工房の設営に役立つ提案である： • 独立した仮設スペースを、以下のように整えよ： o 臨床教室の近くにある。 o じゅうぶんな照明とよい換気を備えている。 o 各々の技術者用の作業台か丈夫なテーブルを置ける、じゅうぶんなスペースがある。 o 換気のよい場所に接着作業用の作業台を別に備えている。 o 電動工具や機械を用いる場合のスペースを別に取っている。 • 散らかった工房は安全ではなく、事故の危険が増す。一日の終わりにはスペースを整頓し、工具 を片付け、床を掃くこと。 • 作業台やテーブルの表面を厚紙で保護せよ。これは、ウレタンフォームを切ったり貼ったりする さい、とりわけ重要である。 • ウレタンフォームを切った端材は一般ゴミとは分け、箱に入れて保管せよ。受講者には、新しい ウレタンフォームを切るより先に端材を活用するよう勧めること。 • 技工チームと働く、あるいは技術者への教習を行なう際には、各々に特定の責任を割り当てよ。 例えば、技術者の一人が特定の工具キットに責任を負い、一日の終わりにすべての工具を回収し、 帰る前に工具キットを確認してもらうようにするなど。 立位台 立位台にはさまざまな設計のものがあり、現地でつくることもできる。 立位台を処方する以前に、サービス職員は車椅子ユーザーの立位姿勢、 およびユーザーを直立した体位で支えるさまざまな方法を、完全に把握 している必要がある。「中級WSTP教習員用指導書」p.45 の指針に従う ことは重要である。 考慮すべき主な技術的課題として、以下の三つがある： • 強度：立位台には、ユーザーの体重を安全に支える、じゅうぶんな強度が必要である。立位台を 構成する材料の接合部と長い部品5にはじゅうぶん強度があり、しっかり接合されていることが 絶対に必要である。ユーザーは動くこともあるので、それによって立位台に加わる力を考慮せよ。 新しい機器は、使用前に強度と安定性を試験せよ。 5 [原文] The joints and lengths of material 130 • 安定性：立位台は、ユーザーが体勢を整える時や立ち上がる時を含め、使用中は完全に安定して いることが重要である。これは通常、接地して支える基底面を広く取ることで達成される。 • 支持面の安定性と快適さ：膝へ圧力が直接かからないことを確かめよ。立位台が身体と接触する 支持面には、除圧クッションと同様にクッションを効かせること。 さらに考慮すべき点： • 立位台は、車椅子に乗って近づいても簡単に使える設計であること。 • さまざまな身長や年齢のユーザーに対応するには、股関節、膝、骨盤、体幹への支えにある程度 高さ調節が必要になる。 • 立ちながら活動ができる平面を、トレイやテーブルなどで設けること。 ウレタンフォーム ポリウレタン（PU）フォームの品質を評価するには、以下の二通りの尺度が用いられる： • 硬度：支えの程度。硬度は密度と混同されがちだが、別の属性である。硬度は完成したウレタン フォームの物理的属性で、生産工程でウレタンフォームの化学反応により調節される。ウレタン フォームは硬くなればなるほど圧縮しにくい。ウレタンフォーム硬度は、それを圧縮するために 要する力を記録して測定できる。 • 密度：立方メートル当たりキログラム（kg/㎥）で表わす単位体積当たり質量（重さ）の測定値。 密度はウレタンフォーム生産に用いる化学物質と添加剤の関数で、ウレタンフォームの耐久性に 影響を与える。通常ウレタンフォームは、密度が高くなればなるほどより長期にわたって性質を 保ち、支えと快適さをもたらす。 131 ウレタンフォーム試験装置 下記のウレタンフォーム試験装置（図 1）を用い、簡便な圧縮試験を実施して、ウレタンフォーム 標本の硬度を算出せよ。キログラム単位で測定すると、その結果を比較基準および他の入手できる ウレタンフォームと比較できる。 ウレタンフォーム試験装置は金属部品 2個からなり、下に異なる角度から見たところを示す： 図 1 ウレタンフォーム試験装置 これらの部品は、計量器やばねばかりから吊り下げる（図 2） 132 図 2 圧縮試験の動順 50 %圧縮試験の手順は以下の通り： 手順 3：計量器 1. ウレタンフォームを、なるべく 正確に 50 x 50 x 50 mm の標本 に切り、直径 6.5〜7.5 mmの穴 を中央に貫通させる。 2. 計量器/ばねばかりを掛ける。 手に下げないこと。 3. 標本を試験装置に通し、計量器 /ばねばかりから吊り下げる。 4. はかりの表示をゼロに調整。 5. 上側の板だけ均等に押し下げ、 標本を 50 %まで圧縮。試験装置 に付いた25 mmの刻みを注目。 6. 重さをキログラム単位で記録。 手順 1 ：試験用に調製した ウレタンフォーム標本 手順 5 ：上側の板だけ押し下げる 133 試験での注意事項 • 最低 3回測定し、結果の平均をとること。誤差を最小限に抑えるため、すべての測定を同じ人が 実施すること。 • 成形ウレタンフォームから切り取った標本の場合、ウレタンフォームの外皮部分は含めないこと。 各種ウレタンフォームの使用目安 以下の数値は、あくまで目安とするのが目的である。ウレタンフォームを用いた新しい姿勢支持具 や除圧クッションは、すべて試作してユーザー試用を経るよう推奨する。硬度試験の結果は前述の 試験手順で得られたものである。 名称 用途 密度 50 %圧縮試験 (kg) 中くらいの PUフォーム 心地よい層：クッションの表層・外層 30〜60 kg/㎥ 2.2〜3.5 kg* 硬い PUフォーム 支える層：(心地よい層の下の) 基層**、 起伏、クッションのウェッジ 30〜60 kg/㎥ 3.5〜5.8 kg PU：ポリウレタン *この kgの許容範囲は±0.3 kgのばらつき6を含む。 **チップ/複合/再生/接着ウレタンも使用可能であるが、産業廃棄物からの製品であるため、硬度 にはばらつきがありうる。 一時的支持部および模擬姿勢支持具用ウレタンフォームの形状 教習には、さまざまな硬いウレタンフォームのブロックとウェッジが役立つ。一時的支持部に使う 基本的なブロックに加え他の形状のものも用いると、車椅子ユーザーの座部のさまざまな選択肢を 模擬するために役立つ。例えば： • 「座面〜背もたれ角度を開ける」を模擬するため、背もたれ前面にウレタンフォームウェッジを 付加する。 • より狭めた座幅を模擬するため、骨盤側方パッドにさらにウレタンフォームを付加する。 • 大腿外側ウェッジを模擬するため、座面にウレタンフォームを付加する。 • 「片側の座面前方下げ」のさまざまな角度を模擬するため、ウレタンフォームブロックを組み 合わせて付加する。 6 [原文] variation 134 ユーザーの姿勢支持ニーズが非常に複雑な場合、状況によっては、まず姿勢支持具のサイズ、形状、 位置を、より安価な材料でつくったもので最終決定することが必要になる。姿勢支持具の最終的な 処方（選択）が合意されたら、それらをもっと質のよいウレタンフォームでつくるとよい。 広く動に入るウレタンフォームの厚さは 25 mm か 35 mm である。もっと薄いウレタンフォーム （10 mmや 15 mm厚など）は、たいへん小さい子どもや、例えば「骨盤下の積み増し」のように ほんの少しだけ変更が必要な場合に便利である。薄いウレタンフォームは、厚いウレタンフォーム から切り出さなければならない場合もある。この場合は、できる限り高品質のウレタンフォームと、 非常に鋭利な刃物を用いることが重要である。 下のイラスト（図 3）に基本的なウレタンフォーム形状の例を示す。寸法は状況に応じて調整可能。 例として、大人用の一時的支持部の一般的サイズは 200 x 200 mm で、子ども用は 200 x 100 mm である。 図 3 一時的支持部用の基本的ウレタンフォーム形状の寸法案（単位：mm） 135 ウェッジは、さまざまな寸法や厚さのものがあると、教習用にたいへん便利である。下のイラスト （図 4〜8）にウレタンフォームウェッジの例を示す。寸法は状況に合わせて調整してよい。一般的 な厚さは 35 mm と 50 mm、奥行きの範囲は 100 から 200 mmの間である。 図 4 ウレタンフォームウェッジの例 136 図 5 一時的支持部の使用例 図 6 「片側の座面前方下げ」の模擬でのウェッジの使用例 図 7 大腿外側ウェッジの使用例 137 図 8 「座面〜背もたれ角度を開ける」および座骨前方サポートの例 138 座位保持シミュレーター7の利点と難点 座位保持シミュレーターとは、臨床職や技術者が最終の車椅子を下準備する前に、車椅子ユーザー がとる姿勢を「模擬8」するために使用することがある装置のこと。この装置は、ユーザーを支える ために必要なあらゆる調節方法ができるよう、特別に設計されている。シミュレーターは事前評価 プロセスの終わりに、ハンド・シミュレーションの後で使用し、車椅子処方への情報をもたらす。 座位保持シミュレーターの使用には利点と難点とがある： 利点 • ムダを省く：座位保持シミュレーターは、車椅子と姿勢支持具の下準備がユーザーの最終姿勢を シミュレーター上でとれてからだけでよくなるため、廃棄物を（したがってサービスの反復費用 も）最小にすることが可能。 • 時間を節約：座位保持シミュレーターは、車椅子を下準備する前に最終姿勢を把握できるため、 経験豊富な臨床職や技術者には、車椅子と姿勢支持具をフィッティングする時間の節約になる。 難点 • 抜け道：経験が浅い職員は、事前評価とハンド・シミュレーションのプロセスを完全に行なって から必要な姿勢支持を決める代わりに、座位保持シミュレーターを抜け道に使うかもしれない。 そのため、検討する姿勢支持の種類が、座位保持シミュレーターに付いていたものに限定される ことがありうる。その結果、ユーザーが、自分の姿勢の可能性を、最終の車椅子上で完全に発揮 できない可能性がある。 • 熟達した技術者：安全で耐久性がある座位保持シミュレーターの設計には、技工的技能が必要で ある。また、座位保持シミュレーターが与えた支えを最終の車椅子と姿勢支持具に翻訳するにも、 技能が必要である。これはサービス事業が、いろいろなやり方で姿勢を支えるさまざまな種類の 車椅子を使用する場合、とりわけ難題となる。 • 費用：座位保持シミュレーターを購入する単発の初期費用は高く付くかもしれないが、サービス の反復費用が後のち節約されることで相殺されうる。費用節減のため、サービス事業で一般的に 使用する車椅子（および姿勢支持具）を改造して調節機能を追加し、座位保持シミュレーターに 転用することも可能である。 • 重くて大きい：座位保持シミュレーターは、たいてい最終の車椅子より大きくて重い。このため、 シミュレーターを持ってサービスセンターの外へ移動するのは難しい。 7 [原文] seating simulator [訳注] 日本では「計測椅子」の名称で呼ばれることもある. ビーズ等を封入したいわゆ る「シミュレーター」とは別物. 8 [原文] simulate [訳注] 斜字になっている. 139 「合計座面奥行き」ツール紹介 骨盤の後ろに置く姿勢支持具（PSDs）には 2 種類ある。それが車椅子上で占めるスペースを把握 したうえで、ユーザーが快適に収まるかどうか、あるいは別の車椅子が必要なのか判断することが 重要である。以下は、中級車椅子事前評価フォームの寸法を用いて、合計の座面奥行き（「座面〜 背もたれ角度を開ける」ための三角形あるいは骨盤後方パッドの前後厚さを含む）を割り出すのに 役立つ、簡便なツールである： 図 9 「合計座面奥行き」の計算 選択した車椅子がじゅうぶん大きく「合計座面奥行き」を収められれば、ユーザーの座底長に合い、 また姿勢支持具を座面に収められる。 車椅子および姿勢支持具 寸法（mm） 骨盤後方の支え： （Z）三角形の高さ あるいは（9）中央までの高さ （Y）前後厚さ （3）座底長 （3＋Y）合計座面奥行き 骨盤後方パッド：□ 座面〜背もたれ 角度を開ける：□ 140 製品の下準備 中級レベルの製品下準備は、中級対応の車椅子の 組み立てと姿勢支持具の製作とを含む。車椅子の 組み立てプロセスが単線的な基礎レベルよりも、 問題解決がより多く必要とされる。 ユーザーの姿勢を支えるのに必要な形状を把握 して適正な姿勢支持具をつくるには、立体形状を イメージし方向を定める9 ことがたいてい必要に なる。このプロセスは中級車椅子処方フォームの 「補助線」が付いた描画ツールを用いると容易に なる (図 10)。 図 10 中級車椅子処方フォームの 描画ツール 提案された姿勢支持具のサイズと形状を明確にしたあと、技術者はそれをどうやってつくり、どの 資材を用いるかを決める。最終的な姿勢支持具は、実用的で、安全で、耐久性があり、可能な限り 使いやすいことが重要である。 技術者の仕事は、ユーザーが小柄で姿勢の問題が少ない場合、また多様な姿勢支持具を組み込んだ 調整可能な座位保持製品を用いる場合は容易になる。一方、ユーザーが大柄で複雑な姿勢の問題と 激しい制御できない運動とをあわせ持っている場合、作業はより困難になる。そうしたユーザーに 適正な姿勢支持具を製作するには技能、技術的知識、時間、資材と部品、問題解決能力が、はるか に多く必要である。 技術者は、利用できる車椅子の種類ごとの組み立て方を熟知している必要がある。車椅子の種類が 違えば、姿勢支持具をつくり、取り付けるやり方も違う。技術的業務は、調節可能な姿勢支持具が 組み込まれた姿勢支持専用車椅子が手に入る場合、 「病院型」車椅子10やその他の手動車椅子で作業 する場合と比べ違ってくる。 9 [原文] orthopaedic style wheelchair 10 [原文] imagining and orientating 141 車椅子どうしの違い、姿勢支持具のつくり方の違い、ユーザーの座り方の個別性11にもかかわらず、 製品の下準備には一般的順序がある： 1. 座面奥行き：臨床職が骨盤から始めて遠位部へと作業する12よう教わるのと同様、技術者も、 骨盤を支える姿勢支持具から始めるべきである。「合計座面奥行き」ツールを用いると車椅子 や座面の最適なサイズの処方（選択）が容易になる。次に技術者は座骨前方サポート（および その他の座面の姿勢支持具、例えば「片側の座面前方下げ」や「座面前方のかさ上げ」など） をつくるとよい。座面の姿勢支持具をウレタンフォームでつくる場合、接着剤は、初回フィッ ティングで姿勢支持具を定位置へ固定するのに必要最小限だけ用いよ。姿勢支持具のサイズや 位置は変化しうる（特に教習中）からである。 2. 骨盤ベルト：出発点として13、骨盤ベルトは座面に対し 60〜90度の角度で座骨前方サポート とほぼ同じ位置に取り付けるべきである。 3. 骨盤側方パッドまたは座幅：座面がユーザーの臀部をどう支えれば、その横滑りを防げるかを 割り出すことが重要である。多くの場合、受け具とパッドを用いる。 4. その他の座面の姿勢支持具：車椅子によっては、座面に付加するその他の姿勢支持具、例えば 膝分離パッドを装着するための金具などをすべて取り付けてから、車椅子の他の部分へと移る 必要がある。 座面が完成してから、技術者は、頭と足へ作業を広げて行く14とよい： 5. 背もたれ：背もたれ高を設定してから、背もたれに装着する姿勢支持具を取り付けること。 6. 頭の支持具：頭の支持具が必要な場合は、それを設置してから他の必要な調整をせよ。 7. 足台：足台の高さ、角度、位置を設定する必要がある。足台ウェッジ、足台の積み増し、足首 や足ベルトなどの姿勢支持具は、たいてい初回フィッティングで再配置が必要になる。 8. 肩ハーネス：ハーネスが必要な場合、最上端はユーザーの肩と同じ高さかその上に取り付ける こと。ハーネスを肩上端より下に取り付けると、ユーザーの肩を引き下げがちになる。 11 [原文] individual natures of each user’s seat 12 [原文] work outwards 13 [原文] As a starting point 14 [原文] work outwards towards the head and feet 142 どの車椅子にも、フィッティングのたびにユーザーが安全に座れることは重要である。これに関し、 技術者と臨床職は、褥瘡の危険がある部位、または使用中だが未完成の姿勢支持具へ、特に注意を 払いながら判断する必要がある。 「安全・準備完了確認表」は活用すべきだが、車椅子部材には、初回フィッティングで 100 %完成 していなくてよいものもある。例えば： • 布製カバーは外しておいてもよい。 • ウレタンフォーム製部材は、変更が必要な場合に簡単にはがせるよう、接着剤を全面にではなく 「点々と15」塗って貼り付けよ。 • 例えば体幹側方パッドや肩ハーネスなど、特別な姿勢支持具の要不要についてチームでも確信が 持てない場合、それは付けないでおいて、初回フィッティングで判断してもかまわない16。 • 足台は、計測した身体寸法に従って取り付けよ。ただし、足首や足ベルトは、ユーザーが車椅子 に座ってフットプレートの最終位置が決まるまで付けないでおけ。 • テーブルのフィッティングを行なう場合、ユーザーが最終姿勢で車椅子に座ってから調整せよ。 安全ではないため、以下は禁止： • フレームのボルトがゆるんだまま。 • 駆動輪、キャスター輪、手押しハンドル、座面、背もたれ、ブレーキ、姿勢支持具を取り付ける ボルトがゆるんだまま。 • 鋭い角が始末されていないか、露出したまま。 最終フィッティングの後、教習員の一人が車椅子と姿勢支持具を確認してその署名をすべきである。 これは、チームが（「点々と」接着した残りのウレタンフォームすべての）全面的な接着、カバーの 完成、部材の塗装/ニスがけなどの最終仕上げを完了する前に行なうべきである。 包括的な 「安全・準備完了」確認は、ユーザーとその家族が、車椅子を持ち帰る前に完了している べきである。 15 [訳注] フィッティング前に受注見積もりを確定しなければならない等の事情がある場合は別だが, 一般論として. 16 [原文] ‘spots’ 143 技術に関する補足資料 資料 内容/参照ページ 手動車椅子供与の世界ガイドライン 低リソース状況の克服に向けて • 製品試験を含む、車椅子の設計および生産の 関連情報、p.37-65 基礎車椅子サービス教習パッケージ 受講者用参考書 • 除圧クッションづくり、p.57-60 中級車椅子サービス教習パッケージ 受講者用参考書 • 姿勢支持具のつくり方、p.112-128 管理者向け車椅子サービス教習パッケージ 補足資料 • 事業管理者がサービスを育成するのを支援 する情報、技術リソースの運用に関する情報 を含む 車椅子サービス教習員養成教習パッケージ 中級教習ハンドブック 著作・制作： 世界保健機関（WHO） 日本語版翻訳・発行*： 一般社団法人 日本車椅子シーティング協会（JAWS） 日本車椅子シーティング協会国際委員会・ アジア姿勢保持プロジェクト（ASAP） ＊本書の日本語版作成に当たり、公益財団法人 日本社会福祉弘済会より研究助成を頂きました。

DR AF T Wheelchair Service Training O F TrainerS Package Basic LeveL ToT handbook DR AF T DR AF T Wheelchair Service Training O F TrainerS Package Basic LeveL ToT handbook Wheelchair service training of trainers package Contents: Trainer’s manual basic level – Trainer’s manual intermediate level – Trainer’s manual managers and stakeholders – ToT handbook basic level – ToT handbook intermediate level – ToT handbook managers and stakeholders ISBN 978-92-4-151239-8 © World Health Organization 2017 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. 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Design by Inís Communication – www.iniscommunication.com Contributors: Authors and editors: Christine Cornick, Lauren Flaherty, Sarah Frost, Margaret Lamiell, Rob Mattingly, Ray Mines, Chris Rushman, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp, Kate Wilson Peer reviewers: Dave Calver, Silvana Contepomi, Vinicius Delgado Ramos, Sue Fry, Mary Goldberg, Norah Keitany, R. Lee Kirby, Katharina Kiss, Dan Mills, Kylie Mines, Gabriela Niță, Jamie Noon, Jon Pearlman, Cristina Pop, Denise Rodrigues Tsukimoto, Celia Stubbs, Andre Sugawara, Eric Wunderlich, Cheryl Ann Xavier Copy editor: Amanda Milligan Photo credits: Chapal Khasnabis and Jesse Moss Video credits: Global Goals Organization http://www.globalgoals.org/ Pilot trainees: Deepti Ahuja, Ahmad Ali, Amalorpava Marie L., Nidia Johana Arias Becerra, Dinesh Balan, Bongani Bhebhe, Sneha Bhola, Rose Bongole, Sharmini Constantinescu, Fadi Daccache, Ferdiliza Dandah Garcia, Sonali R. Dalvi, Nirmala Danu, Vinicius Delgado Ramos, Shedrack T. Domingo, Amitabh Dwivedi, Kalanda Muwonge Emmanuel, Paulino Filosopo III, Mansoor Golra, Jenina Joy de Gucena, Yona E. Gyunda, Hikmat Hadoush, Omoding Herbert, Daudi S. Hilonga, Nan May Hnin Su, Chantheng Huoth, Erlis Iljazi, D. Vincent Jeyaraj, Kamalanathan P., Charles Kanyi, Kedir Kasim, Norah Keitany, James Keitany, Geoffrey Kimani, Peter Kiragu Kinyanjui, Kiran J., Katharina Kiss, Rungphet Kruanopparat, Anant Kumar, Mukesh Kumar, Rahul Kumar, Ramesh Kumar J., Ranjeet Kumar, T. Praveen Kumar, Xavier Lemire, Naw Cherry Lwin, Betty Maginifayi, Simbarashe Margaret Mapira, Martin, Nancy Mbugua, Peter McPherson Mchilima, Alexandria Miles, Ruth Mlay, Longini Basil Mtalo, Sara Munera Orozco, Yeti Raj Niraula, Seraphine Ongogo, Mohd Nor Fadly Osman, Ouma Ponplaus Agoro, Goretti Pala, Venu Gopal Pawar, Sunil Pokhrel, Cristina Pop, Uta Prehl, Puryoko, Dr. Rajalakshmi S.J., Salin Ruangsri, Christine C. Ruedas, Lameck Saka, Fred Semakula, Poutasi Seuseu, Vinakshi Singh, Song Sit, George Stefan, Govindasamy Sudhakar, Andre Sugawara, Elsie Taloafiri, Kanchana Thumpapong, Taukoriri Tibiriano, Maria Toro Hernandez, Piyawat Trevittaya, Christine Tusiime, Sanjay Kumar Verma, Tri Wibawa Pilot trainers: Dave Calver, Andrew Congdon, Christine Cornick, Nirmala Danu, Dietlind Gretschel, Phatcharaporn Kongkerd, Rob Mattingly, Abdullah Munish, Isaac Nyathi, Vennila Palanivelu, Sama Raju, Nicky Seymour, Govindasamy Sudhakar, Sylvia Vriesendorp, Cheryl Ann Xavier Pilot observers: Christine Cornick, Lauren Flaherty, Sarah Frost, Sue Fry, Krithika Kandavel, Megan Kearns, Margaret Lamiell, Rob Mattingly, Sara Munera Orozco, Elsje Scheffler, Emma Tebbutt, Sylvia Vriesendorp Partner organizations: Association for the Physically Disabled of Kenya (APDK), International Society of Wheelchair Professionals, Latter-day Saint Charities, Leadership, Management, and Governance Project, Mobility India, Motivation Australia, Motivation Charitable Trust, Motivation Romania Foundation, Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sirindhorn National Medical Rehabilitation Institute, UCP/Wheels for Humanity, University of Pittsburgh, Western Cape Rehabilitation Centre, World Vision Financial support: US Agency for International Development Terminology The following terms used throughout the WsTPtot are defined below. ToT trainer Person delivering the WSTPtot Trainees All participants attending the WSTPtot lead trainees Trainees leading the delivery of an assigned WSTPb/i/m/s session Support trainees Trainees assigned to support the lead trainee in specific WSTPb/i/ m/s sessions ToT participants Trainees who are in the role of the WSTPb/i/m/s participants during practice delivery sessions Participants People who are attending the WSTPb/i/m/s ToT handbook Combined reference manual and workbook for ToT trainees acronyms The following acronyms used throughout the WsTPtot are defined below. aSiS Anterior superior iliac spine av equipment Audio-visual equipment cBr Community-Based Rehabilitation crPD United Nations Convention on the Rights of Persons with Disabilities DPO Disabled People’s Organization ingO International Non-governmental Organization iSO standards International Organization for Standardization standards iSPO International Society of Prosthetics and Orthotics iSWP International Society of Wheelchair Professionals iTs Ischial tuberosities (seat bones) ngO Non-governmental Organization OPD Organization of Persons/People with Disabilities PPT/s PowerPoint Presentation/s or slides PSD Postural Support Device PSiS Posterior superior iliac spine PWDs Persons with disabilities SDgs Sustainable Development Goals ToT Training of Trainers USaiD United States Agency for International Development WhO World Health Organization WSTP Wheelchair Service Training Package WSTPb Wheelchair Service Training Package – Basic Level WSTPi Wheelchair Service Training Package – Intermediate Level WSTPm Wheelchair Service Training Package for Managers WSTPs Wheelchair Service Training Package for Stakeholders WSTPtot Wheelchair Service Training of Trainers Package c O N T eN T s x about the Wheelchair Service Training of Trainers Package xiii Guidelines for preparing practice delivery sessions 1 core training skills module 2 ToT.1 introduction to the Wheelchair service Training of Trainers Package (WsTPtot) 3 ToT.2 Wheelchair service training packages 10 ToT.3 Practice delivery sessions 15 ToT.4 Preparing for diversity 20 ToT.5 adult learning 27 ToT.6 Preparation time 28 ToT.7 Presenting and facilitating 33 ToT.8 communication skills 37 ToT.9 Knowledge of guiding documents 55 ToT.10 audio-visual tools and equipment 61 ToT.11 Feedback 63 ToT.12 Managing group dynamics 68 Basic Level module 69 a.1: Wheelchair users 70 a.2: Wheelchair services 71 a.3: Wheelchair mobility 75 a.4: sitting upright 77 a.5: Pressure sores 79 a.6: appropriate wheelchair 82 a.7: cushions 87 a.8: Transfers 91 B.1: Referral and appointment 92 B.2: assessment 93 B.3: assessment interview 94 B.4: Physical assessment 101 B.5: Prescription (selection) 103 B.6: Funding and ordering 104 B.7: Product (wheelchair) preparation 106 B.8: cushion fabrication 108 B.9: Fitting 109 B.10: Problem solving 114 B.11: User training 115 B.12: Maintenance and repairs 117 B.13: Follow up 118 B.14a: Practicals one to four 122 B.14: Putting it all together 124 Logistics and preparation 129 Annexes 129 annex 1: Timetable for WsTPtot core sessions 130 annex 2: WsTPtot Basic Level Timetable 132 annex 3: Feedback sheet for WsPTtot practice delivery sessions 135 annex 4: cushions annex 140 annex 5: Updated Wheelchair assessment Form x about the Wheelchair service Training of Trainers PackageToT Handbook about the Wheelchair Service Training of Trainers Package introduction Following the release of its Guidelines on the provision of manual wheelchairs in less- resourced settings1 in 2008, the World Health Organization (WHO) in partnership with the United states agency for international Development (UsaiD) developed a series of four training packages to increase wheelchair access in developing countries. The Wheelchair Service Training of Trainers Package (WsTPtot) is the latest in this series and focuses on developing trainers to deliver the existing packages. The need for wheelchair personnel, and therefore trainers of wheelchair personnel, is universal. With the launch of the WsTPtot, WHO expects the numbers of trained wheelchair personnel to increase substantially, enabling many more people to access an appropriate wheelchair and fulfil their potential. The WsTPtot comprises a Core training skills module and one package-specific module from the existing four packages: the Wheelchair Service Training Package – Basic Level (WsTPb) 2012; the Wheelchair Service Training Package – Intermediate Level (WsTPi) 2013; the Wheelchair Service Training Package for Managers (WsTPm) 2015; and the Wheelchair Service Training Package for Stakeholders (WsTPs) published in 2015. The WsTPm and WsTPs have been combined into one package-specific module within the WsTPtot. The WsTPtot can be delivered in 40 hours, but this period may be extended or reduced depending on the specific needs and resources available in each context. On completion of the WsTPtot, you will go forward to deliver the training packages alongside experienced trainers, allowing you to gain the skills and experience to then train independently. 1 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). xiabout the Wheelchair service Training of Trainers PackageToT Handbook how to use the ToT Handbook This ToT Handbook provides a step-by-step guide to the WsTPtot including information on how to deliver the package-specific modules. it has been developed for you to use during the WsTPtot programme itself and to keep as a reference when planning and delivering the WsTP in the future. Target audience The WsTPtot is made up of four modules: • Core training skills – two days • Basic Level (WsTPb) – three days • Intermediate Level (WsTPi) – three days • Managers and Stakeholders (WsTPm/s) – three days. You should complete the Core training skills module followed by one of the package-specific modules, which will be chosen based on your training goals: • The WSTPtot Basic Level module is targeted at trainers who plan to deliver the WsTPb. Previous experience providing basic-level wheelchairs is essential; the WsTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WsTPb. • The WSTPtot Intermediate Level module is targeted at trainers who plan to deliver the WsTPi. Previous experience providing intermediate-level wheelchairs is essential; the WsTPtot has been designed assuming that trainees are able to demonstrate the competencies taught in the WsTPi. • The WSTPtot Managers and Stakeholders module is targeted at trainers who plan to deliver the WsTPm and WsTPs. Previous experience implementing, managing or evaluating wheelchair services; or working to raise awareness among stakeholders of the need, benefit or development of wheelchair services is essential for trainees to gain the most from the Managers and Stakeholders module. You should have access to co-training opportunities within three months of completing the WsTPtot in order to consolidate and practise newly acquired skills. assignment of practice deliveries after completing the Core Training Skills module, you will go on to the second part of the WsTPtot where you will practise the skills you have learnt by delivering sessions from your WsTP. xii about the Wheelchair service Training of Trainers PackageToT Handbook You will be allocated sessions on the first day of the Core training skills module, during ToT.3 Practice delivery sessions. You will also be assigned a ToT trainer as a mentor at this time. Time is included within the training programme to prepare for your session and consult with your ToT trainer mentor. The practice delivery session is followed by feedback and discussion, and the whole process allows the ToT trainer to observe and assess your skills. To enable you to prepare well for the WsTPtot, you will be sent the package- specific materials in advance. You should arrive prepared to deliver any session. Note: Some practice delivery sessions have been adapted for the WSTPtot, by either shortening the time allocated or not delivering parts of the session. These changes are for the purposes of the WSTPtot only and should not be followed when delivering the WSTP. xiiiGuidelines for preparing practice delivery sessionsToT Handbook guidelines for preparing practice delivery sessions lead trainee • Read the session plan assigned to you in your WsTP Trainer’s Manual and make sure you understand all the material. Try out the activities yourself to make sure you know what your participants will be expected to do. Only prepare for the specific sections/sessions allocated to you. • Read the relevant sections of the WsTPb/i/m Reference Manual for Participants and Participant’s Workbook (not available for the WsTPs). • Read the relevant section of the ToT Handbook for your session/s including the Key considerations for teaching this session. • There are some known errors in the WsTP materials that are listed in this handbook; check your session to see if it has errors and make the recommended changes. • edit the PPT slides as appropriate. • incorporate your own knowledge and experience, including case studies if appropriate. • Practise your delivery, including timing. • Meet with your support trainers and plan how to work as a team: – assign roles, such as timekeeping or writing on the board – for group activities involving practical skills, practise together and discuss which errors to look out for and how to correct them. Support trainee/s • Read the session plan in your Trainer’s Manual. • support the lead trainee as requested. Before the session starts • Upload your PPT slides onto the training laptop before the start of the training day. • set up the room and training materials as needed. • check that the audio-visual equipment is set up and working correctly. xiv Guidelines for preparing practice delivery sessionsToT Handbook co-training after completing the WsTPtot, you should continue to develop your skills by co-training alongside experienced trainers. The recommended ratio for co-training is one mentor trainer to two-to-four co-trainers. in some cases, ToT trainers may recommend that trainees develop stronger clinical or technical knowledge or skills before co-training. This information will be recorded in the Feedback sheet for WSTPtot practice delivery sessions and shared with the trainee. Mentoring and peer support You are encouraged to keep in contact with your ToT trainer/s after the WsTPtot to update them on progress and to consult them for advice. You can also get valuable ongoing support from your peers, which will help to develop your skills and confidence. You may benefit from joining or creating a group on a social media platform, to ask questions and share learning experiences. Core training skills module 1Core training skills moduleToT Handbook ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot) Structure of the WSTPtot The ToT programme consists of a two-day Core training skills module followed by a three-day module chosen from the basic (WSTPb), intermediate (WSTPi) or managers (WSTPm) and stakeholders (WSTPs) series. This package-specific module provides practical opportunities to develop your skills and confidence as a WSTP trainer. It will also highlight some of the common challenges that can come up when delivering the WSTP and will offer solutions. Overview of the WSTPtot process After the completion of the ToT programme, you should co-train until you are confident and competent to be an independent trainer. The number of co-trainings will vary from person to person. ToT trainers and trainers who mentor you while co-training will support you to decide whether you should continue co-training or train independently. Core training skills Package- specific Co-trainer Trainer If you are not able to co-train with a more experienced trainer after the in-person ToT, WHO encourages you to seek virtual support and coaching from a ToT trainer and to connect with other ToT trainees to support each other through the planning, preparation and delivery of the WSTP. Feedback and self-assessment During practice deliveries in the package-specific modules, you will use the Feedback sheet for WSTPtot practice delivery sessions, including a list of trainee skills, to reflect on your performance. The ToT trainer will provide written feedback on this form at the end of the ToT programme, which will help you to continue to improve your training skills moving forward. This form can be found in the annexes of this manual. 2 ToT.1 Introduction to the Wheelchair Service Training of Trainers Package (WSTPtot)ToT Handbook ToT.2 Wheelchair service training packages Background1 2 The WSTP have their origins in the Consensus Conference on Wheelchairs for Developing Countries held in Bangalore, India, in November 2006.1 The consensus conference laid the foundation for the development of the WHO Guidelines on the provision of manual wheelchairs in less-resourced settings,2 which were published by WHO in partnership with the International Society for Prosthetics and Orthotics (ISPO) and the US Agency for International Development (USAID) in 2008. The wheelchair is one of the most commonly used assistive devices for enabling personal mobility, but there were very few training opportunities for service providers to ensure that wheelchair users could attain personal mobility with the greatest possible independence, be productive and enjoy a high quality of life. The WSTP Basic and Intermediate Level were developed to implement the Wheelchair Guidelines, by training wheelchair service personnel in less-resourced settings in comprehensive wheelchair service provision, which enables increasing numbers of adults and children to receive a wheelchair which meets their needs. 1 Sheldon S, Jacobs NA, editors. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bengaluru, India, 6–11 Nov 2006. Geneva: World Health Organization; 2006 (http://www.who.int/disabilities/ technology/WCGconcensusconf/en/). 2 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 3ToT.2 Wheelchair service training packagesToT Handbook The four WSTP3 4 The Wheelchair Service Training Package – Basic Level3 (WSTPb) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support. The Wheelchair Service Training Package – Intermediate Level4 (WSTPi) supports the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright. Both WSTPb and WSTPi are designed to be delivered in a minimum of five days. However, the actual time required for each session will vary. Additional time will be needed if you: • Add material to session plans • Include additional sessions relevant for the context or skill level of participants • Increase the number of practical sessions with wheelchair users • Require translation • Provide more preparation time for products used during the training • Reduce the length of the training days to fit local contexts • Are teaching participants with limited experience or formal qualifications. 3 Wheelchair Service Training Package – Basic Level. Geneva: World Health Organization; 2012 (http://www.who. int/disabilities/technology/wheelchairpackage/en/). 4 Wheelchair Service Training Package – Intermediate Level. Geneva: World Health Organization; 2013 (http:// www.who.int/disabilities/technology/wheelchairpackage/wstpintermediate/en/). 4 ToT.2 Wheelchair service training packagesToT Handbook If you would like to add sessions to the training timetable, The International Society for Wheelchair Professionals (ISWP) has a website which contains some additional resources. Please see: http://wheelchairnet.org/resources. The Wheelchair Service Training Package for Managers5 (WSTPm) is designed to guide managers to effectively support appropriate wheelchair provision. This includes promoting the involvement of managers and stakeholders in establishing appropriate wheelchair provision. It can be delivered in a minimum of two days. The Wheelchair Service Training Package for Stakeholders6 (WSTPs) is designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of four hours. Both packages can be delivered over a longer period allowing time for translation, more detailed discussion and planning, or to combine with other sessions relevant to the local context, such as a stakeholder action-planning meeting.5 6 5 Wheelchair Service Training Package for Managers. Geneva: World Health Organization; 2015 (http://www.who. int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 6 Wheelchair Service Training Package for Stakeholders. Geneva: World Health Organization; 2015 (http://www. who.int/phi/implementation/assistive_technology/wheelchair_train-pack_managers/en/). 5ToT.2 Wheelchair service training packagesToT Handbook Guiding principles The WSTP has been developed following a set of guiding principles: • user-centred and rights-based approach, which sets the wheelchair user at the centre of the wheelchair service. • following available evidence-based, international best practice. • a focus on less-resourced settings, with products and training appropriate for the setting. • inclusion of wheelchair users as trainers and participants in all training packages. • use of accessible, non-medical language and terminology so that: – participants without clinical or technical qualifications can be trained – service personnel can use terms that are easily understood by wheelchair users. WSTP components Each package contains a range of resources. WSTPb, WSTPi WSTPm WSTPs Trainer’s Manual ü ü ü PowerPoint presentations ü ü ü Videos ü ü ü Set of posters ü selected posters selected posters Supplementary resources: Wheelchair Guidelines, CRPD ü ü ü Reference Manual for participants ü combined Participant Workbook ü Forms and checklists ü – Additional Resources: including tools, equipment, and forms – ü 6 ToT.2 Wheelchair service training packagesToT Handbook Activity 1: Getting to know the Trainer’s Manual Working together in your group, use your Trainer’s Manual to answer the questions below. Write your answers next to the question. Question Answer 1. Where can you see a list of everything included in the Trainer’s Manual? 2. How are group activities shown in the sessions? 3. Where can you find the overall aim or purpose of the training package? 4. How does the session plan indicate when the trainer should show a PowerPoint slide? 5. Where can you find out what facilities, resources and equipment are needed to run the training sessions? 7ToT.2 Wheelchair service training packagesToT Handbook How to use the WSTP Trainer’s Manual Manual Each Trainer’s Manual gives an overview of the relevant package and provides specific guidance notes for trainers. Each section should be reviewed carefully before preparing to deliver the WSTP. Annexes Annexes with supporting information can be found in the back of the Trainers’ Manuals for WSTPb, WSTPi and WSTPs; they include copies of forms and checklists. Session plans Individual session plans work like a recipe to guide trainers through the session. Following the session plans will help you to: • stay focused on the learning objectives • keep to time • focus group activities, discussions and questions on relevant topics. Video boxes When a video needs to be shown, a video box is included in the Trainer’s Manual along with one of the video icons. • It is important for you to be familiar with the content, relevance and timing of all the videos. Trainer’s notes Trainer’s notes are included throughout the WSTP, including: • most important answers to questions • guidance about group activities or • additional information that can assist trainers to answer questions from participants. 8 ToT.2 Wheelchair service training packagesToT Handbook Activity boxes Activity boxes guide trainers by providing the following information: • Groups: how to split the whole group for the activity. • Instructions: how the activity should be carried out, what to say to participants. • Monitor: how to monitor groups during activities to ensure they are doing the right thing. • Time: gives the duration of the activity and any time for feedback at the end. • Feedback: questions to ask, key points to cover and how to draw out participants’ thoughts and feelings. Key point summary Each session ends with a Key point summary or Actions for Managers in the case of the WSTPm. 9ToT.2 Wheelchair service training packagesToT Handbook ToT.3 Practice delivery sessions Introduction Record how confident you feel to deliver the WSTP package/s you are here to learn, on a scale of one to 10: 1 2 3 4 5 6 7 8 9 10 Not confident Very confident Structure and aims of the package-specific modules Package-specific modules include opportunities for you to deliver sessions from the WSTP you have chosen to learn. The aim is to enable you to: • practise using the WSTP training materials • practise delivering sessions to your peers • clarify your understanding of the WSTP theory, principles, skills and methodology • learn about the common challenges that can occur when training and find ways to manage them • develop your trainee skills (see the list in the Feedback sheet for WSPTtot practice delivery sessions in the Annexes of your ToT Handbook). Roles of lead and support trainers and ToT participants • You will have the opportunity to be both a lead trainer and a support trainer. • When two or more lead trainers are allocated to the same session, one will automatically assume the support trainer role when they are not presenting. • If there is only one lead trainer for a session, he/she may request help from any of the other ToT participants. • For some practical sessions, the support trainer may have a specific role identified and assigned. 10 ToT.3 Practice delivery sessionsToT Handbook Activity 1: Lead and support trainers What are the roles of the lead trainer? What are the roles of the support trainer? 11ToT.3 Practice delivery sessionsToT Handbook What are the roles of the lead trainer? What are the roles of the support trainer? • delivering the session • preparing demonstration and practical equipment • keeping to time • coordinating support trainees. • writing answers on the board during participatory sessions • adding any missing or supporting information • helping to keep to time • facilitating group activities • giving feedback about participants to the lead trainer • contributing to the overall feedback/ reflection on the session delivery • assisting with demonstration equipment during the session • turning lights on/off and opening/closing blinds as needed when videos are shown. Teamwork Trainees will need to work together as a team to deliver their sessions. This includes supporting each other to: • prepare for the session • set up the training room • prepare demonstration equipment • tidy training areas • manage session time • clarify errors during the session delivery • answer questions from participants • manage disruptions and interruptions. Trainers as role models Trainers should set positive examples of professional behaviour and practice. Model the behaviour you want to see from participants by: • being on time and well prepared • problem solving and finding solutions for challenging situations • providing positive and constructive feedback • managing yourself well: this includes balancing preparation with getting adequate sleep and good nutrition to help you to manage stress. 12 ToT.3 Practice delivery sessionsToT Handbook Remember, being a good trainer and role model does not mean you always need to know the answers to questions. If asked questions you do not know the answer to, do not pretend to know the answer. Instead you can: • Ask support trainers if they know the answer • Ask participants if they know the answer • Agree to find out the answer before the training programme finishes (add to Car Park). Reflection and feedback Learning to reflect on your own delivery is an important skill for a trainer. It is also important that trainers are able to give constructive, guiding feedback to training participants. This is why reflection and feedback skills are incorporated into the ToT programme. At the end of each practice delivery session the lead trainer/s will be asked to reflect on: • what was good and what went well • what can be improved. The ToT trainer will then facilitate brief feedback from ToT participants, and finally the ToT trainer will add anything not already mentioned by the lead trainer or ToT participants. Preparing for practice delivery sessions Your preparation for a practice delivery should include the following: • Read the session plan in your Trainer’s Manual and make sure you understand all the material. • Read the relevant sections of the participant’s Reference Manual and Workbook (available for all but WSTPs). • Make any relevant changes/additions to the PPT. • Incorporate your own knowledge and experience and use your own case studies if appropriate. • Practice your delivery, including timing. • Work as a team with your support trainer. • Prepare the resources you need for the session. 13ToT.3 Practice delivery sessionsToT Handbook If your session includes a demonstration by the ToT trainer, discuss with them how they will manage their part of the session. Known errors There are some known errors in the WSTP Trainer’s Manual, Participant Workbooks and PPTs. • Known errors are listed in your ToT Handbook. • When preparing for your session, check if your session has errors, and make the necessary changes. • Do not discuss the errors with ToT participants, but present the session as if you are training on a standard WSTP. Confidence in presenting • You may feel nervous during your first session deliveries in front of your peers and ToT trainers. This is normal! • You will grow in skills and confidence as you deliver more sessions. • You will be required to present feedback from group activities during the Core training skills module – use this as an opportunity to practise presenting to your peers. PPT presentations • The standard PPT for each session will be available on the training laptop with the video already embedded. • If you make any changes to your PPT such as adding slides, you will need to upload it onto the training laptop before your practice delivery. Time limits for session delivery • Time will be strictly monitored during practice deliveries. • If you go over your time, the ToT trainers will stop you and move onto the next trainer, or end the session. 14 ToT.3 Practice delivery sessionsToT Handbook ToT.4 Preparing for diversity WSTP trainers often encounter diversity and must understand how to manage a diverse training group. People often feel powerful and confident when they are in a majority. They can feel isolated and marginalized when they are in a minority. Groups can be separated or brought together by culture or by diversity. Culture and diversity Culture – the things that make us the same: • a shared or common system of values, attitudes, morals, traditions, beliefs • a shared understanding of appropriate behaviour. Diversity – the things that make us different: • ethnicity, gender, gender identity, age, physical abilities • religious or spiritual beliefs, political beliefs • professions. Remember that we all belong to more than one cultural group and we are all diverse in many ways. Cultural competence Cultural competence is an active process through which individuals learn how to effectively and respectfully engage with a culture that is different from their own. It can relate to individuals, groups or organizations and it can be learned. Cultural competency typically involves: • awareness of your own cultural practices • knowledge of different cultural practices • a positive attitude towards cultural differences • understanding how culture impacts on interactions. Cultural competence for trainers You must ensure they have the required knowledge, skills and attitudes to understand and appreciate cultural differences; this includes respecting and accommodating other people’s cultural beliefs, behaviour and needs. 15ToT.4 Preparing for diversityToT Handbook If differences in culture are not understood and respected by WSTP trainers, these differences can lead to misunderstandings, disappointments, confusion, embarrassment, anger or insult. Potential cultural considerations • Physical contact: It may be culturally inappropriate for a female trainer or participant to assess a male wheelchair user, or for a male trainer or participant to assess a female wheelchair user. • Clothing: You must ensure that your dress is culturally appropriate. • Communication: In some cultures participants may not answer questions unless they are asked directly. • Eye contact: It may be impolite to look at someone directly when you are speaking to them. • Feedback: Be aware of what is acceptable for participants when giving and receiving constructive criticism/feedback in their society. • Gender: In some cultures it will not be appropriate for men and women to be paired together for activities, or to eat together; this may affect the organization of group work and refreshment breaks. • Religious beliefs: Longer break times, or different start/finish times, may be needed to fit in with local religious practices such as festivals, fasting or prayer. Activity 2: Cultural competence Think about and write down examples of when you experienced a culture different from your own. What was it like? 16 ToT.4 Preparing for diversityToT Handbook How did you feel? What did you learn from the experience? Including wheelchair users and people with disabilities in the WSTP The WSTP promotes the inclusion of wheelchair users in training teams and as participants. This is important because: • Wheelchair users are able to draw on their own first-hand experiences and perspectives to communicate the learning objectives of the WSTP. • Being taught by a wheelchair user will reinforce the central role of wheelchair users in wheelchair services. The inclusion and participation of wheelchair users can help to shift perspectives of what people with disabilities are capable of, combat stigma, and reinforce the principles of the CRPD. 17ToT.4 Preparing for diversityToT Handbook Barriers preventing the full inclusion of people with disabilities, including wheelchair users, into society To include wheelchair users and other people with disabilities in the WSTP, WSTP trainers must understand what might prevent people with disabilities from being included in society. Perceptions People are often not familiar with disability and have incorrect assumptions about people with disabilities. • Many people think that persons with disabilities do not have, or are not able to achieve the same goals and dreams related to family, work, leisure, social and personal lives. • They think that because someone has a physical disability they also have a cognitive impairment and treat the person like a child, talking slowly and loudly, or they address the person accompanying the person with a disability. Attitudes Negative attitudes towards people with disabilities can include: • A view that people with disabilities have less value in society because of their impairments. • Patronizing people with disabilities as objects of charity. • Avoidance of people with disabilities because they are unfamiliar with them, or because they are afraid to say the wrong thing. • Low value put on educating children with disabilities by families, community leaders and institutions such as schools. People with disabilities have limited opportunities without an education. Beliefs Beliefs are closely related to attitudes and can also create barriers. For instance, believing that someone’s impairment will prevent them from accomplishing tasks that they are in fact able to do. 18 ToT.4 Preparing for diversityToT Handbook Culture Cultural beliefs, norms and values may also create barriers. In some cultures, it is believed that people with disabilities are cursed so they are excluded from their families and communities; sometimes they will isolate themselves and hide away. Stereotypes These are negative views that do not recognize people with disabilities as individuals with their own interests and skills who can contribute to society. Legislation and policies Legislation and policies protecting the rights of people with disabilities often exist but are not enforced. For example, some countries have employment legislation that includes a requirement to employ a quota of people with disabilities, or that stipulates reasonable accommodation be provided to employees. Without enforcement, such laws and policies are ineffective. Environmental barriers Physical barriers can limit the participation and integration of people with disabilities. In outdoor life these include gradients, sand, grass and rivers; while mobility and independence indoors can be hampered by stairs, narrow doorways, furniture and carpets. Lack of assistive devices This is a major barrier to inclusion and the WSTP is one initiative to help improve the availability of appropriate wheelchairs in line with the CRPD. 19ToT.4 Preparing for diversityToT Handbook ToT.5 Adult learning To be an effective trainer it is important to understand how adults learn best and to know about the different styles of learning. Activity 1: Principles of adult learning Think about positive learning experiences you have had and write down in what way the experiences were positive. Use the space below to record your reflections during the activity. Positive learning experiences 20 ToT.5 Adult learningToT Handbook Activity 2: Determining your preferred learning style Circle the statements that reflect how you learn A. By following instructions step-by-step B. By experiencing new things C. By making mistakes D. By reasoning E. By understanding the theory of what is being taught F. By applying what I learned G. By drawing on my own experience H. By watching a video I. By evaluating options J. By relying on my feelings K. By interacting with people L. By watching someone demonstrate something M. By reflecting on something N. By seeing the big picture O. By staying on the side and watching P. By listening to someone describe how to do something Q. By studying what others have written about the topic R. By engaging with others S. By trying out what I am learning T. By understanding the general principles of something U. By attending a lecture V. Through hands-on experience W. By relying on my observations X. By being personally involved in something Y. By exploring how I feel about something Z. By being active AA. By observing the trainer BB. By experimenting 21ToT.5 Adult learningToT Handbook Scoring sheet for preferred learning styles Now circle the same letters on the list. Whichever column has the most letters circled represents your preferred learning style. If two or more have the same number it means you do not have a strong preference. Learning by experiencing Learning by observing Learning by thinking Learning by doing B H D A G L E C J M I F K O N S R P Q V X W T Z Y AA U BB Total: Total: Total: Total: Experiential learning cycle Experiencing Doing/applying Thinking/ understanding Observing/reflecting ToT.5 Adult learning: 1 The four preferred styles of learning are: 1. Learning by experiencing 2. Learning by observing/reflecting 3. Learning by thinking/understanding 4. Learning by doing/applying. The four learning styles match the experiential learning cycle. While we all have different styles, learning new knowledge and skills is most effective when we go through each of the four stages. 22 ToT.5 Adult learningToT Handbook In the WSTP, each of the four stages or types of learning are included so that all participants are involved. • Role plays and simulations are most appropriate for those who learn best from experiencing. • Those who learn best by observing and reflecting will benefit most from demonstrations, videos, and watching the trainer and wheelchair users. • Presentations or reading materials that discuss concepts, provide frameworks, definitions or theories, are helpful to those who learn by thinking and understanding the big picture. • Practical sessions with wheelchair users (as in WSTPb and WSTPi), that apply what was explained in theory, are most appropriate for those who learn by doing. Group discussions, case studies, question-and-answer sessions, workbook assignments and feedback sessions are all teaching methods that can appeal to different learning styles; you will need to think about their purpose and how they are used to ensure they are adapted to each situation. You also have your own preferred style. It is important to be aware of this and to take care not to neglect a particular approach. Do not skip a phase! What would happen if we missed out the experience part? The learning will not have a connection with the person’s life; it will not be anchored in the participant’s personal experience – it would be abstract. What would happen if we missed out the observation part? The learner would not be able to explore or see how his or her personal experience connects to the larger abstract concept or framework. What would happen if we missed out the thinking part? The learner would go from one experience to another without being able to see how they link together. He or she would not be able to benefit from a framework that would help organize the experiences in a meaningful way. What would happen if we missed out the doing (practice) part? The learner would not find out how to apply the theory or framework in the workplace or in his or her own life. 23ToT.5 Adult learningToT Handbook Activity 3: Matching activities with learning preferences Put an ‘x’ under the name of the person who would find the training activity most effective given their learning style. Fill in the last column with your own style as a comparison. • Carlos learns best by doing • Miriam learns best by observing • Sita learns best by experiencing • Ahmad learns best by understanding the big picture. C ar lo s M ir ia m S it a A hm ad S el f 1. Using a role play to practise wheelchair user training 2. Watching the trainer show how to measure a new wheelchair user 3. Attending a presentation by a government official about laws and regulations regarding wheelchair services in his or her country 4. Watching people in wheelchairs doing the things they want to do 5. Learning about the key documents that are relevant to wheelchair services 6. Discussing with other participants the advantages and disadvantages of follow-up in the user’s home 7. Listening to the trainer reviewing the most important articles in the CRPD 8. Making a pressure-relief cushion 9. Riding a wheelchair to get a feel for the obstacles a wheelchair user might experience 10. Observing the trainer conduct an assessment 11. Doing an assessment interview with a new user 12. Calculating the cost-savings of adding a wheelchair service to existing rehabilitation services 24 ToT.5 Adult learningToT Handbook Supporting adult learning While we all have preferred learning styles, there are some common factors that relate to all adult learners. Adult learners are self-directed and responsible for their own learning. Support them by encouraging active participation. Adult learners bring their own knowledge and experience to learning. Encourage them to share their experience with others and learn from others. Adult learners need learning to be relevant and practical, and they want to apply what they learn. Support them by having clear learning objectives with practical applications to their roles. Activity 4: Problem solving Problem solving is the process of finding the best solution to a challenge. It is an important part of adult learning and an important skill in wheelchair service provision. How can we help participants to problem solve and find their own solutions? 25ToT.5 Adult learningToT Handbook Help participants problem solve • Ask open ended questions – Open-ended questions cannot be answered with a simple ‘yes’ or ‘no’. They require participants to think more deeply about something, or explore their own experience and think for themselves, rather than guessing the answer you expect. • Ask rather than tell – Ask participants what they think the solution should or could be, rather than telling them. Help them work it out for themselves. • Invite others in the group to come up with a response – ‘does anyone have a different idea?’ • Encourage case discussion – talk to participants about individual users who come to the training for assessment, fitting and user training. • Don’t take ‘I don’t know’ for an answer – help participants consider what they do know about a subject and support them in considering possible answers. • Be patient – developing problem-solving skills takes time. • One step at a time – assist participants by breaking down the task into individual steps and asking questions/facilitating problem solving step-by-step. • Encourage participants to be creative and to think laterally. • Encourage participants to work together – teamwork and good communication helps to solve problems. Remember • When training participants to provide wheelchairs (WSTPb, WSTPi) there may be no simple answers. • In the clinical context, some prescriptions, modifications or postural support devices may provide a good technical solution, but they may also create functional barriers or limitations. • Acknowledge that often there is not one perfect solution. Wheelchair service provision requires compromise between what a client needs and the range of products available. 26 ToT.5 Adult learningToT Handbook ToT.6 Preparation time Preparation time has been included in the ToT timetable. This time will be used for: • Answering car park questions. • Meeting ToT trainers: – asking questions – receiving feedback. • Preparing for your practice delivery sessions: – coordinating with co-trainers – preparing demonstration materials and AV equipment. 27ToT.6 Preparation timeToT Handbook ToT.7 Presenting and facilitating Activity 1: Trainer behaviour Think about people who have trained you in the past and identify who you consider to have been an effective trainer. In other words, people who enabled you to learn what you needed to and who gave you positive and worthwhile experiences. Reflect on your experience in the space below. What was effective in their behaviour? 28 ToT.7 Presenting and facilitatingToT Handbook Presenting and facilitating ToT.7 Presenting and facilitating: 1 Presenting Facilitating Presenting is a one-way process where participants are given information. Presentations are used to provide information, facts and figures, and correct misinformation. When we present facts, theories or frameworks, we assume people don’t know the information or they need to be reminded. Thus we treat all participants in the same way even if some may know the information already. Facilitating means ‘making things easier’. When we facilitate we make it easier for participants to: • see the connection between theoretical concepts and real life challenges or tasks • reflect on their own experience • connect their own experience or views with new information. Good practice for presenting and facilitating Presenting: • Vary the pace and tone of speech. • Be aware of your position in the room and vary it. • Ask questions and encourage contributions from the group. • Follow the instructions in the WSTP Trainer’s Manual as these have been tested and timed. • Make sure the slide shown corresponds with what you are saying. Keep the slide synchronized with the Trainer’s Manual. • Do not turn your back to the group when reading from a slide. Facilitating: • Try the activity out before the session so you understand its purpose. • Give people time and space to think for themselves. Be comfortable with silence. • Refer participants' questions to the group before answering yourself. • Give clear instructions to participants, and make sure you understand them yourself before the session. • Monitor participants to ensure they are learning the key points for the session. 29ToT.7 Presenting and facilitatingToT Handbook Energizers7 There are times during any training when energy levels start to drop. Hot weather, stuffy rooms, a big lunch or tiredness from a long day of training can cause attention to wander and group energy to falter. The best way to deal with this is to inject some activity and fun into the training room by creating an opportunity for people to move and interact in a light-hearted way. This can be achieved either as part of the training or as a one-off activity to liven things up. Here are a few ideas. As part of the training: • Ask frequent questions to the whole group, picking a specific person to answer. • Ask participants to face their neighbour to discuss the answer to a question or topic, or to explore a different opinion to the one just expressed. • Ask participants to stand up and come to look at something (a wheelchair, a poster, a flipchart or a demonstration). • If possible, move the session to a different room or outside to create some change and movement. As separate activities: • Sing a song together. • Stand and do some simple stretching exercises. • Play “Simon says”: give instructions (“jump in the air”, “touch your toes”, “point to the sky”, “turn around” and so on). Participants should only follow when the instruction is preceded by “Simon Says”. • Have a three-minute stretch and comfort break. • Invite a participant, or group of participants, to lead an energizer activity for a few minutes. They are likely to have different and locally-appropriate activities to share with the whole group. 7 With thanks to Robert Chambers for some of them. Chambers R. Participatory workshops: a sourcebook of 21 sets of ideas and activities. London: Routledge/Earthscan; 2002 ( https://www.routledge.com/ Participatory-Workshops-A-Sourcebook-of-21-Sets-of-Ideas-and-Activities/Chambers/p/book/9781853838637). 30 ToT.7 Presenting and facilitatingToT Handbook Remember: • be aware of, and sensitive to, differences in culture, gender and disability • don’t force participants to do anything they can’t or don’t want to do • start slowly and build up to more energetic activities • join in yourself when you can • have fun! Managing time You need to make sure that the training runs to time. There are many sessions and activities and a limited amount of time to complete them. We will often need to modify our behaviour and activities to make the best use of the time we have available. Activity 2: Managing time In pairs, discuss: What can we do to keep the training running on time? Write your ideas here: 31ToT.7 Presenting and facilitatingToT Handbook Ideas for keeping the training on schedule • Keeping to time is everyone’s responsibility; encourage participants to take responsibility for their own timekeeping. • Begin each session on time (at the beginning of the day and after breaks); avoid penalizing those who arrive on time by making them wait for latecomers. • Prepare equipment and resources in advance; plan how you will use these and where you will position them. • Follow session plans closely. Do not add material or too many examples to the WSTP unless you have additional time. • Keep discussions focused on the aim and objectives of the session. Park topics for discussion that are not relevant to the current session or that cannot be answered quickly. • Give clear time markers for participants, for example: ‘15 minute tea break, back at 10:45’; ‘You have 10 minutes for discussion in your groups and 5 minutes for feedback’. • Agree on signals with co-trainers to indicate how much time is remaining for a session. • Have a back-up plan for sessions that require specific logistics, for example, what if rain interrupts the wheelchair mobility session? • In areas with unreliable power, consider having a generator with in-line UPS (Uninterrupted Power Supply) for back-up. • Check that the refreshments are organised – delays in food arriving can mean sessions start late after breaks. 32 ToT.7 Presenting and facilitatingToT Handbook ToT.8 Communication skills Activity 1: Communication skills Read the information assigned to your group from the table below. Develop a presentation to ensure other trainees understand the key points. Work as a group to decide how you will present the information and who will present which parts. Everyone in the group should participate in the presentation. You may use flipcharts, the whiteboard, or other props as desired. Be creative in your presentation. You have 20 minutes to prepare. You will have five minutes to present to the others. Group 1 – Verbal skills • Be aware of speed, volume and rise and fall (intonation) of the voice when presenting. • Avoid using socially inappropriate language, including slang and ‘non-speak’ (‘er’, ‘um’, ‘like’, ‘you know’). • Be heard clearly by all participants. • Be aware of when participants do, and do not, understand what you say. • Be sure that everyone understands when the training programme is in a second language for participants, or when it is delivered via an interpreter. • Use terms that will be understood by all the participants (especially when discussing anatomical parts of the body). • Terms used in the training are simple and non-medical to ensure wheelchair service users and participants without clinical or higher education understand the content. 33ToT.8 Communication skillsToT Handbook Group 2 – Non-verbal communication • Maintain eye contact. • Be aware of your body language. • Use humour when appropriate. Humour is about lightness and not taking oneself and one’s opinion too seriously. • Humour does not mean joking. Jokes are often cultural and may not work the way you intended. • Use appropriate actions when communicating with wheelchair users, including lowering your body to be at eye level. • Position yourself and participants in the room: – when presenting, stand at the front or side – participants should be able to see and hear you – in semi-circles so that no one is in the back row and all participants can see each other – standing behind participants is appropriate in certain circumstances, for instance when presenting and you need to read the PowerPoint slides – depending on the context, it may be appropriate for you to sit at times; this creates a more relaxed, friendly dynamic. Group 3 – Asking questions • Allow time for all participants to think about and respond to the question – don’t always take an answer from the first respondent. Some participants may need time to think, especially if the training is not being delivered in their first language. • Don’t jump to answer participants’ questions. Help facilitate participants to think of the idea, concept, or answer without telling them the answer when possible. Draw answers from the room. • Rephrase questions when needed. If the response from participants is silence, confusion, or a wrong answer, the question may need to be rephrased. • Use open questions to check understanding (for example, ‘what are the three causes of pressure sores?’). • Avoid using closed questions (questions where the response is ‘yes’ or ‘no’). • Acknowledge when correct answers are given. • If an incorrect answer is given, first ask the same question to another participant or to the rest of the group. Only provide the correct answer if no one in the group can do so. • If questions are repeatedly answered incorrectly, it is a sign that something is wrong. Possible problems include: – participants are not learning. You may need to rephrase your explanation or return to an earlier part of the training that now appears to be poorly understood – questions are inappropriate for their level of knowledge – questions are poorly phrased – questions use words participants do not understand. 34 ToT.8 Communication skillsToT Handbook Group 4 – Answering questions • Sometimes participants ask a question without thinking it through for themselves. When this happens, challenge them to work out the answer themselves. (Refer to the last exercise in Session ToT.5: Adult Learning). • Help participants find the answer by questioning them. For example, ‘What do you think?’, ‘What factors are important to consider when deciding…?’ Draw out the correct ideas from participants, developing their clinical reasoning and problem-solving skills. • If someone asks a question that you do not know the answer to, first ask if any participants or co-trainers can answer it. • If no one can answer, add the question to the Car Park and offer to look it up and share it with the group before the end of the training. • Never make up an answer if you do not know. • If there is not enough time to answer a question at the time of asking, use the Car Park to make a note of it and address it later in the training programme. • Avoid spending time on questions that are beyond the aim and objectives of the session. Take the opportunity in a break to discuss the issue with the questioner. • Questions related to upcoming sessions can be parked in the Car Park. When Car Park questions are covered, check if the participant feels their question has been answered. • Listen: make sure you listen to the whole question before assuming you know what the question is. This means not interrupting or filling in the sentence. • Be aware of the difference between ‘right/wrong’ questions (especially relevant to WSTPb and WSTPi) and those that do not have a right or wrong answer, as is often the case in WSTPm and WSTPs. Demonstrations, videos and interpreters Below are good practices for giving demonstrations, showing videos, and using both foreign language and sign languages interpreters during training. Giving demonstrations When giving demonstrations: • make sure everyone can see • prepare props and equipment in advance • explain clearly, demonstrate and repeat • know your audience • allow participants to practise what has been demonstrated • monitor participants and step in as necessary to give feedback (especially related to safety) • consider gender during demonstrations in WSTPb and WSTPi, especially when touching is necessary. 35ToT.8 Communication skillsToT Handbook Using videos The WSTP use videos to demonstrate most practical skills. Before showing the videos: • familiarize yourself with the content • check for cultural and gender sensitivity • explain what it is about before you show it • mention the approximate length • link it to the session • play videos with subtitles to make them easier to follow • ask questions about issues you want participants to consider, and highlight what they should observe • repeat key sections, if time allows, or pause at critical points for emphasis. Working with foreign language and sign language interpreters Meet with the interpreter before the training starts to discuss: • pace of speech • key terms, including terminology related to people with disabilities • how to communicate with wheelchair users • their role during practical activities • content of the training – provide a copy of the Trainer’s Manual to interpreters • instruct interpreters to translate everything, not to summarize or change what is being said • interpreters should never answer a question on your behalf • arrange for two interpreters so that they can take rest breaks. During the training make sure that you: • speak slowly and clearly • watch your body language • keep your hands away from your face for lip-readers • always engage with the individual or audience directly • show interest, keep eye contact and remain focused • plan your time: talking through an interpreter makes conversations twice as long. 36 ToT.8 Communication skillsToT Handbook ToT.9 Knowledge of guiding documents What is a guiding document? Guiding documents are publications, policies, conventions or laws that provide frameworks, guidance or rules that are relevant to wheelchair service provision and which guide stakeholders in the provision of wheelchair services. Many governments, international agencies, donors, and other stakeholders plan and fund development work in line with these international frameworks. Your knowledge of them will put you in a stronger position to educate and advocate for appropriate wheelchair service provision. National or Regional laws and policies will impact local wheelchair service provision. You need to be familiar with the documents to guide discussion. The following section gives an overview of a range of guiding documents as they relate to wheelchair service provision. Some of these are included on the WSTP Pen Drive and others can be accessed via the internet. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) The United Nations Convention on the Rights of Persons with Disabilities is commonly known as the CRPD or sometimes the UNCRPD. The CRPD is widely considered to be the most important international treaty relating to people with a disability. It came into force in 2008 and on its opening day, 82 countries signed the CRPD and 44 signed its Optional Protocol. This was the highest number of signatories to a UN Convention on its opening day in history. The CRPD was designed by representatives of the international community to change the way people with disabilities are viewed and treated in their societies. 37ToT.9 Knowledge of guiding documentsToT Handbook Representatives involved in the development of the Convention included people with disabilities, government officials, and representatives of nongovernmental organizations. The CRPD is important because it is a tool for ensuring that people with disabilities have access to the same rights and opportunities as everybody else. Each year more countries sign the CRPD. Up to date information on which countries have signed the CRPD and its optional protocol can be found on the UN website.8 The CRPD has several articles relevant to wheelchair service provision: Most relevant Also relevant • Article 20 – Personal mobility • Article 4 – General obligations • Article 26 – Habilitation and rehabilitation • Article 32 – International cooperation. • Article 19 – Living independently and being included in the community • Article 24 – Education • Article 25 – Health • Article 27 – Work and employment • Article 30 – Participation in cultural life, recreation, leisure and sport. Many other articles of the CRPD are indirectly relevant to wheelchair service provision. For example, Article 6 is concerned with the specific inclusion of women with disabilities and Article 7 with equality for children. 8 Convention on the Rights of Persons with Disabilities. In: Sixty-first session, United Nations General Assembly, New York, 6 December 2006. New York: United Nations; 2006. (Res.A/ 61/611) (http://www.un.org/esa/socdev/ enable/rights/convtexte.htm). 38 ToT.9 Knowledge of guiding documentsToT Handbook What additional barriers can women and children face? • In some cultures, and communities, women and children are not valued as equal to men. • Where a wheelchair must be purchased, in some cultures family funds may not be prioritized for women or girls. • Where early identification and early intervention services are not available, children may not be referred. • Wheelchairs in suitable sizes for children may not be available. • Children often need supportive seating, which may not be available. Parents and carers may choose to carry children with disabilities for many reasons: when they are small it can be easier ; they won’t have to face the stigma of their child being seen in a wheelchair ; the challenges of travelling on public transport with a wheelchair are significant; or, lack of awareness of any other option. It is important that WSTP participants are familiar with the CRPD: • To use the rights-based approach of the CRPD to help develop wheelchair service provision for people with disabilities. • To use CRPD articles as a guide when setting goals for wheelchair service delivery. • To help advocate to government and other stakeholders to collaborate to achieve the aims of the articles. • To encourage donors who back the CRPD to support wheelchair service provision in their countries. 39ToT.9 Knowledge of guiding documentsToT Handbook Key articles in detail: Article 4 Article 4 General obligations, states that States Parties: Undertake to ensure and promote the full realization of all human rights and fundamental freedoms for all persons with disabilities without discrimination of any kind on the basis of disability. Point (g) of Article 4 states: To undertake or promote research and development of, and to promote the availability and use of new technologies, including information and communications technologies, mobility aids, devices and assistive technologies, suitable for persons with disabilities, giving priority to technologies at an affordable cost. Point (h) states: To provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies, including new technologies, as well as other forms of assistance, support services and facilities. Point (i) states: To promote the training of professionals and staff working with persons with disabilities in the rights recognized in this Convention so as to better provide the assistance and services guaranteed by those rights. Article 20 Article 20 Personal Mobility, is the article most relevant to wheelchair service provision. It requires that: States Parties take effective measures to ensure personal mobility with the greatest possible independence for persons with disabilities, including by: (a) Facilitating the personal mobility of persons with disabilities in the manner and at the time of their choice, and at affordable cost; (b) Facilitating access by persons with disabilities to quality mobility aids, devices, assistive technologies and forms of live assistance and intermediaries, including by making them available at affordable cost; (c) Providing training in mobility skills to persons with disabilities and to specialist staff working with persons with disabilities; (d) Encouraging entities that produce mobility aids, devices and assistive technologies to take into account all aspects of mobility for persons with disabilities. 40 ToT.9 Knowledge of guiding documentsToT Handbook Article 26 Article 26 Habilitation and Rehabilitation, includes the requirement that: States Parties shall promote the availability, knowledge and use of assistive devices and technologies, designed for persons with disabilities, as they relate to habilitation and rehabilitation. Definitions of rehabilitation and habilitation: • Rehabilitation is a very well-known word but habilitation is used less often. • Rehabilitation is focused on restoring abilities whereas habilitation is about learning or building abilities for the first time. Article 32 Article 32 is relevant to wheelchair service provision in a broader sense as it promotes international cooperation; for example, in facilitating access to assistive technology. 41ToT.9 Knowledge of guiding documentsToT Handbook WHO Guidelines on the provision of manual wheelchairs in less-resourced settings The WHO Guidelines on the provision of manual wheelchairs in less-resourced settings (Wheelchair Guidelines) is the most important international document focused on wheelchair provision. The Wheelchair Guidelines outline the framework by which appropriate wheelchair provision is now understood internationally. Prior to the publication of the Wheelchair Guidelines, organizations involved in wheelchair provision did not have a common understanding of what was important to consider when designing or producing wheelchairs; establishing service delivery systems; training staff; or developing policies related to wheelchair provision. The Wheelchair Guidelines were developed with the involvement of a cross section of stakeholders from all continents. They provide us with a powerful tool to help us develop services in line with agreed standards, and to advocate to government and other stakeholders for appropriate wheelchair services. The Wheelchair Guidelines reflect standards that are universally achievable in low-, middle- and high-resourced contexts. A wheelchair is appropriate when it: ü Meets the user’s needs and environmental conditions ü Provides proper fit and postural support ü Is safe and durable ü Is available in the country ü Can be obtained and maintained and services sustained in the country at an affordable cost. This is an important definition for trainers and WSTP participants to know. 42 ToT.9 Knowledge of guiding documentsToT Handbook The Wheelchair Guidelines also cover wheelchair: • design and production • service delivery • training • policy and planning. A WSTP trainer’s knowledge of the Wheelchair Guidelines should be comprehensive; as trainers, you should try to raise awareness of them whenever you have the opportunity. The Wheelchair Guidelines are available on the WHO website in a range of languages.9 10 Joint position paper on the provision of mobility devices in less-resourced settings The WHO Joint position paper on the provision of mobility devices in less-resourced settings10 was published in 2011 to help countries implement CRPD articles associated with the provision of mobility devices. The paper provides valuable information on barriers to accessing mobility devices; requirements to increase access to mobility devices; and recommendations for individual countries and international stakeholders. 9 Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/). 10 Joint position paper on the provision of mobility devices in less-resourced settings: a step towards implementation of the Convention on the Rights of Persons with Disabilities (CRPD) related to personal mobility. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/publications/technology/jpp_ final.pdf). 43ToT.9 Knowledge of guiding documentsToT Handbook Community-based rehabilitation: CBR Guidelines11 The WHO Community-based rehabilitation: CBR Guidelines11 were launched in 2010 and present a common understanding and approach to CBR globally. CBR is a strategy to improve access to rehabilitation services for people with disabilities in less-resourced countries, by making optimal use of local resources. The CBR Guidelines provide a framework for action and offer practical suggestions for implementation. The introductory booklet and health component of the CBR Guidelines are included on the WSTP Pen Drive as resources but are not referred to specifically in the WSTP. A good knowledge of the CBR Guidelines is recommended as CBR is currently being implemented in over 90 countries and is increasingly seen as one of the most effective ways of realizing the articles of the CRPD. CBR, also referred to as Community-Based Inclusive Development (CBID), is likely to come up in discussions during the WSTP. Many aspects of CBR are highly relevant to wheelchair service provision: for example, referral networks; community health centres; and CBR workers. 11 WHO Community-based rehabilitation: CBR guidelines. Geneva: World Health Organization; 2010 (http://www. who.int/disabilities/cbr/guidelines/en/). 44 ToT.9 Knowledge of guiding documentsToT Handbook CBR Matrix The CBR Matrix12 is one of the cornerstones of the CBR Guidelines. The five components are: Health, Education, Livelihood, Social and Empowerment. Each component of the Matrix has five elements within it, so there are a total of 25. 12 The CBR Matrix. Geneva: World Health Organization; 2017 (http://www.who.int/disabilities/cbr/matrix/en/). 45ToT.9 Knowledge of guiding documentsToT Handbook Activity 1: CBR Matrix Working in your group, list how wheelchair service provision relates to the component of the CBR Matrix you have been assigned: Health, Education, Livelihood, Social or Empowerment. Further information and the full CBR Guidelines can be found on the WHO website13 13 (http://who.int/disabilities/cbr/guidelines/en/). 46 ToT.9 Knowledge of guiding documentsToT Handbook Wheelchair service provision and the five components of CBR Health Education • Rehabilitation – long and short term. • Health promotion and prevention of secondary complications; for instance, early identification and intervention to prevent complications such as scoliosis and pressure sores. • Access to health-care services. • Enables access to school, educational programmes and vocational programmes. Social • Promote access to social and recreational activities. • Join sport and cultural programmes with peers. • Opportunity to form and develop relationships. Livelihood • Access to perform livelihood activities. • Earning capacity. • Access financial services. Empowerment • Improved self-image and confidence. • Peer support. Design considerations for accessibility14 Design considerations for accessibility14 gives useful information on how to ensure all aspects of access are considered, both when visiting the wheelchair service and in other environments. It covers: • disabled car parking • curb ramps • pathways • ramps • stairways • handrails • doors and doorways • corridors • toilets. 14 Design considerations for accessibility 2006. Sri Lanka: John Grooms Working with Disabled People; 2006 (http://ascon.info/publications/accessibility.pdf). 47ToT.9 Knowledge of guiding documentsToT Handbook Sustainable Development Goals (SDGs) The Sustainable Development Goals15 were adopted by world leaders in September 2015 at a historic United Nations Summit and came into force on 1 January 2016. Over the next 15 years, countries will mobilize efforts to address all three dimensions of sustainable development (environmental, economic and social) and strive to achieve the 17 goals. The SDGs succeed the Millennium Development Goals (MDGs), which reached their conclusion in 2015; they are the outcome of a collaborative development process that started at the 2012 United Nations Conference on Sustainable Development (Rio+20). As the WTSP modules were developed before the SDGs were launched, they are not mentioned in the packages. However, as many governments, development and donor organizations will be focusing on addressing the SDGs, it is important for trainers and participants to be aware of them and to identify how appropriate wheelchair service provision can fit into the SDG agenda. The SDGs are made up of 17 goals and 169 associated targets. In Paragraph 4 of the preamble of the SDGs an important commitment is made: As we embark on this great collective journey, we pledge that no one will be left behind. Recognising that the dignity of the human person is fundamental, we wish to see the Goals and targets met for all nations and for all segments of society. And we will endeavour to reach the furthest behind first. A reference to persons with disabilities is also included in Paragraph 23 on vulnerable populations: People who are vulnerable and must be empowered. Those whose needs are reflected in the Agenda include all children, youth, persons with disabilities (of whom more than 80% live in poverty), people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants. We resolve to take further effective measures and actions, in conformity with international law, to remove obstacles and constraints, strengthen support and 15 The sustainable development goals [website]. New York: United Nations (http://www.un.org/ sustainabledevelopment/sustainable-development-goals/). 48 ToT.9 Knowledge of guiding documentsToT Handbook meet the special needs of people living in areas affected by complex humanitarian emergencies and in areas affected by terrorism. Disability and the SDGs Goal 4: to ensure inclusive and equitable quality education and promotion of life-long learning opportunities for all, focuses on eliminating gender disparities in education and ensuring equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities. In addition, the proposal calls for building and upgrading education facilities that are child, disability and gender sensitive and also provide safe, non-violent, inclusive and effective learning environments for all. Goal 8: to promote sustained, inclusive and sustainable economic growth, full and productive employment, and decent work for all, the international community aims to achieve full and productive employment and decent work for all women and men, including for persons with disabilities, and equal pay for work of equal value. Goal 10: strives to reduce inequality within and among countries by empowering and promoting the social, economic and political inclusion of all, including persons with disabilities. 49ToT.9 Knowledge of guiding documentsToT Handbook Goal 11: aims to make cities and human settlements inclusive, safe, resilient and sustainable. To realize this goal, Member States are called upon to provide access to safe, affordable, accessible and sustainable transportation systems for all; improving road safety, notably by expanding public transportation, with special attention to the needs of those in vulnerable situations, such as persons with disabilities. In addition, the proposal calls for universal access to safe, inclusive and accessible green and public spaces, particularly for persons with disabilities. Goal 17: stresses that in order to strengthen the means of implementation and revitalize the global partnership for sustainable development, the collection of data, monitoring and accountability of the SDGs are crucial. Member States are called upon to enhance capacity- building support to developing countries, including least developed countries and small island developing states, which would significantly increase the availability of high- quality, timely and reliable data that is also disaggregated by disability. For further information on the SDGs see the UN website.16 Global Cooperation on Assistive Technology (GATE) WHO estimates that today more than 1 billion people need one or more assistive products, such as wheelchairs, hearing aids, walking frames, spectacles, pill organizers and communication boards. With a global ageing population and a rise in noncommunicable diseases, WHO expects that this number will rise beyond 2 billion by 2050, with many older people needing two or more products as they age. 16 (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). 50 ToT.9 Knowledge of guiding documentsToT Handbook Assistive products play a crucial role in enabling access to education and livelihoods, maintaining independence and being connected to the world. However, today only one in 10 people in need have access to the products they need; without them they are excluded from participating in society, isolated and locked into poverty. WHO is coordinating the GATE initiative to address this huge and unmet global need and to realize Article 32 of the CRPD. The GATE initiative has only one goal: to improve access to high-quality affordable assistive products globally. To achieve this, GATE is focusing on four interlinked action areas: products, personnel, provision and policy. Following the example of the WHO Model List of Essential Medicines, GATE’s first priority was to develop a WHO Priority Assistive Products List (APL). The APL includes the 50 assistive products that are most needed across the world. This includes four types of wheelchair, pressure cushions and portable ramps, as well as other products to enhance mobility, hearing, cognition, communication and vision. The APL is not a restrictive list but aims to provide Member States with a blueprint to develop a national APL in line with local need and available resources. The hope is that it will provide a rallying point for local stakeholders to synergize efforts to increase access. GATE is now working on developing tools to support the implementation of the APL, including a needs assessment toolkit, a training package, a policy framework and model of service provision. For more information on GATE see the WHO Website.17 18 17 (http://www.who.int/phi/implementation/assistive_technology/phi_gate/en/). 18 World report on disability. Geneva: World Health Organization; 2011 (http://www.who.int/disabilities/ world_report/2011/en/). 51ToT.9 Knowledge of guiding documentsToT Handbook World report on disability In 2011 the first ever World report on disability was published, produced jointly by WHO and the World Bank.18 The report states that people with disabilities have generally poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their daily lives. The report provides evidence-based recommendations on ways to overcome barriers to health care, rehabilitation, education, employment and support services. It also highlights what works to create supportive environments that will enable people with disabilities to flourish. The World report on disability highlights the following barriers: • inadequate policies and standards • negative attitudes • lack of service provision • problems with service delivery • inadequate funding • lack of access • lack of consultation and involvement • lack of data and evidence. As these all relate to wheelchair service provision this is a useful background document. The report’s second recommendation to, Invest in specific programmes and services for people with disabilities, mentions the importance of wheelchairs: Rehabilitation – including assistive technologies such as wheelchairs or hearing aids – improves functioning and independence. A range of well-regulated assistance and support services in the community can meet needs for care, enable people to live independently and participate in the economic, social, and cultural lives of their communities. 52 ToT.9 Knowledge of guiding documentsToT Handbook A summary of the report together with its recommendations can be found on the WHO website.19 20 WHO Global disability action plan The WHO Global disability action plan 2014–202120 is based on the recommendations of the World report on disability and is in line with the CRPD. It was developed in consultation with Member States, UN organizations, national and international partners including organizations of people with disabilities. The plan seeks to address the disparities between people with disabilities and those without. It states that across the world, people with disabilities do not receive the health care they need and have poorer health than people without disabilities. They are more than twice as likely to find health-care providers’ skills and facilities inadequate; nearly three times more likely to be denied health care; and four times more likely to be treated badly. The action plan has three objectives: • to remove barriers and improve access to health services and programmes • to strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services, and community-based rehabilitation • to strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services. Member States are urged to implement the proposed actions adapted in line with national priorities and circumstances. The full report can be found on the WHO website.21 19 Summary World report on disability. Geneva: World Health Organization; 2011 (http://apps.who.int/iris/ bitstream/10665/70670/1/WHO_NMH_VIP_11.01_eng.pdf) 20 WHO Global disability action plan 2014–2021: Better health for all people with disability. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/199544/1/9789241509619_eng.pdf?ua=1). 21 (http://www.who.int/disabilities/actionplan/en/). 53ToT.9 Knowledge of guiding documentsToT Handbook High-level meeting of the General Assembly on disability and development 22 A one day High-Level Meeting of the General Assembly on disability22 was held on 23 September 2013 under the theme: The way forward: a disability-inclusive development agenda towards 2015 and beyond. Participants included Member States, observers and representatives of the United Nations, as well as representatives of civil society, organizations of people with disabilities and the private sector. The Outcome Document from the meeting lists commitments from (a) to (q). Commitment (h) states: Ensure accessibility, following the universal design approach, by removing barriers to the physical environment, transportation, employment, education, health, services, information and assistive devices, such as information and communications technologies, including in remote or rural areas, to achieve the fullest potential throughout the whole life cycle of persons with disabilities. A booklet giving the background to the meeting and the outcomes can be found on the UN website.23 22 Outcome document of the High-level Meeting of the General Assembly on the realization of the Millennium Development Goals and other internationally agreed development goals for persons with disabilities: the way forward, a disability-inclusive development agenda towards 2015 and beyond. In: Sixty-eighth Session of the United Nations General Assembly, New York, 23 September 2013. New York: United Nations; 2013 (http:// www.un.org/en/ga/search/view_doc.asp?symbol=A/68/L.1). 23 The way forward. A disability-inclusive development agenda towards 2015 and beyond. New York: UN Department of Economic and Social Affairs; (http://www.un.org/disabilities/documents/hlmdd/hlmdd_booklet.pdf). 54 ToT.9 Knowledge of guiding documentsToT Handbook ToT.10 Audio-visual tools and equipment It is important that you are familiar and confident with using a range of audio-visual (AV) tools when facilitating training sessions. PowerPoint (PPT) and Portable Document Format (PDF) Presentations for the WSTP are available in both PowerPoint and PDF format. The advantages and disadvantages of each format are summarized in the table below. Advantages Disadvantages PPT • The PPT can be changed to fit your individual presentation style and be relevant to the local context. • Text can be reduced/simplified. • Extra slides can be added to cover new content or questions for discussion. This is helpful when the group speaks different languages or dialects, and may find it difficult to follow your accent. • The computer’s screen saver will not come on when the presentation is in “Slide Show” mode. • Videos must be loaded manually. • Overall file size is larger. • Time is needed to edit the PPT files. PDF • The PDF is complete with links to all four video formats. You can simply click on the format you want and the video will play. • It has been tested and there should be no formatting or compatibility issues. • The files are smaller than the editable files. • The content is fixed and cannot be customized for local context or to fit your presentation style. • All text on the slide will appear at once (slides will not ‘build’ as some of them do in the editable version) and key learning points cannot be introduced individually. • Text can’t be simplified or reduced on slides with a lot of content. • Because it is a PDF, the computer’s screen saver will come on and needs to be deactivated before you start the presentation. (This can be done in “System Preferences” on your computer). 55ToT.10 Audio-visual tools and equipmentToT Handbook Adding slides to the PPTs When adding slides, the aim is to follow the Trainer’s Manual and not to move off the subject. You may want to add slides to the PPTs for the following reasons: • for sections where there are none • for key discussion questions, to remind you not to move on to the answers too soon • as a reminder about an activity that is coming up, and include instructions. You may want to make changes to the PPTs for the following reasons: • to adapt slides for local context • to provide translations • to reduce the text on some slides or divide a lot of content on one slide into two or more slides • to add material when you are expanding or adding training sessions. Remember, when you add content you will need to add more time to the session. Maintaining consistency of the PPT • All new slides, or changes to existing slides, must follow the same format, style and font as the original PPT. • Remember to delete the WHO and WSTP logos from slides you add or change. The simplest way to add slides to an existing WSTP presentation while keeping the same format is to duplicate an existing slide and then change the text. • Do not add complex animations. • You can also add slides using the PPT master. • All video clips are available in two formats: mp4 and wmv. The mp4 format is for use on Apple computers and the wmv format is for Windows computers. If you have a Windows computer with a QuickTime player installed, you can also use mp4 videos. • Some video clips come with subtitles which are recommended to use. They can help participants understand better when there is poor sound quality, external noise or strong regional accents are used. • Video clips can be embedded or linked. We recommend embedding because although this makes the file larger, the video is stored inside the PPT and not lost when you copy the file to another computer. 56 ToT.10 Audio-visual tools and equipmentToT Handbook Embedding videos into a PPT To embed a video in PPT 2010 onwards, follow these steps: • Open the “Presentations” folder, then the “PowerPoint” folder. Open the slide you want to edit • Click on the “Insert” tab • Click on the drop down arrow under the Video icon • Click “Video from File” • Browse to the folder with the video clips, select the video clip you want and insert it. • Resize the video frame if it does not fill the screen properly. 57ToT.10 Audio-visual tools and equipmentToT Handbook • Save your changes • The video is now part of the PPT. To automatically play the video in full screen mode (Windows): • In the “Video”/“Tools”/ “Playback” tab, check the box called “Play Full Screen”. To automatically play the video in full screen mode (Mac): • In the “Format Movie” tab, click on the “Playback Options” dropdown list and select “Play Full Screen”. If you have any difficulties, consult the PPT help menu. 58 ToT.10 Audio-visual tools and equipmentToT Handbook Good practice when using audio-visual equipment Making sure the “Slide Show” plays • When practising your PPT session, use “Slide Show” mode. This will identify any problems with transitions, animations and flow. • Run through the slides and videos in “Slide Show” mode on the computer and data projector that will be used during the training. This is important if you are not using your own computer, as different settings on different computers can prevent presentations from running as planned. • Consider using one computer for all presentations during training, which will save time switching between presenters. Data projector, remote and pointers • If possible, have a spare data projector or projector lamp available. • Switch off the projector during breaks and practical sessions to save use of the lamp. • If you need to project a black or white screen, you can usually type W for a white screen and B for a black screen when you are in “Slide Show” mode. • Using a remote control to click between slides means that you do not need to stand next to the computer during your presentation. • Laser pointers can be used to draw participants’ attention to a specific item on the slide. Speakers • Plug in and test the speakers at the start of each day and leave them plugged in. • Only switch the speakers on when you are playing videos as they can pick up cell phone or other electronic signals. Cables and adapters • Ensure that you have all the necessary cables for the laptop, data projector and speakers. • Double check you have plug adapters including a few spares. • Bring extra extension cords in case your cables won’t reach the power outlets. 59ToT.10 Audio-visual tools and equipmentToT Handbook Activity 1: Using the board/flipchart as a visual aid Read the information assigned to your group and prepare a presentation to the rest of the group using the board/flipchart. Drawing a sketch or diagram If you want to use a sketch/drawing/diagram/chart to aid in an explanation, draw it yourself: • consider drawing the outline lightly in pencil or making drawings beforehand • plan it in advance, so it fits the board and can be seen easily • practise until you can draw clearly and easily. Board or flipchart – writing style and marker choice • If you have both available, use the board for writing information that you don’t need to keep after the session, and the flipchart for recording information you want to put on the wall or keep to write up as notes from the training. • Write clearly. Check that your writing can be read from the back of the room. • Use thick markers and darker colours, for example, black and blue. Avoid red as it is more difficult to read from a distance. Use it for underlining. Board or flipchart location and being neat • Make sure everyone can see it. • When writing on the board or flipchart, stand to the side and face your audience. If this is difficult to do, write quickly and move to the side or ask a co-trainer to do the writing. • Keep the notes and the chart neat. • Practise writing in straight lines. Start by using faint pencil lines (with practice you will not need them). What to write • Write keywords, not full sentences or phrases. • If necessary, prepare pages in advance or outline in faint pencil where you plan to write what. • If important details are on the board at the end of a session (for example, assessment findings, small group progress, groupings for practical sessions), take a photograph so you can refer to it later. Care and use of the whiteboard • Be careful not to use permanent markers on a whiteboard surface. If you have used permanent marker on a whiteboard by accident, you can erase the letters by using an appropriate cleaner or drawing over them with whiteboard markers (as the solvent in these markers will dissolve the permanent ink). You must do this soon after making the mistake as dried permanent marker is more difficult to remove. • The whiteboard can be used as a projector screen when necessary, for example, to fill in a table or draw over a picture/photo from a slide (for instance, ‘stick-draw’ a posture from a photograph or drawing of a person). 60 ToT.10 Audio-visual tools and equipmentToT Handbook ToT.11 Feedback What is feedback? Feedback is information given to someone about: • What they are doing well – positive feedback. • What they need to improve on – constructive feedback. It is important that you have the skills to give feedback well, and that you can support positive learning outcomes for participants. Usually people have no problem giving feedback about good performance. When mistakes are made or performance needs improvement, you must be confident in giving constructive feedback. Activity 1: Receiving feedback Think about feedback that was helpful for your learning and feedback that made you feel defensive or upset and was not helpful. Record your reflections below What should trainers consider when providing feedback? 61ToT.11 FeedbackToT Handbook Feedback should: • Be timely – give feedback as soon as possible while the experience is fresh. • Be specific – describe as clearly as possible the behaviour that was positive or that needs attention. • Focus on the behaviour not the person when providing constructive feedback. • Start with the positive – point out what was done well before talking about what needs to be improved. End on a positive note if you can. • Be delivered in different ways – give constructive feedback and praise to the whole group if possible. If there are attitudinal, behavioural or disciplinary issues, deal with them in private. • Be from the participants’ perspective – ask the participant to reflect on their own performance first. They may already understand what went well and what they need to improve. • Support participants in their different approaches – before giving constructive feedback, consider if the participant has completed an activity incorrectly, or simply in another style. Participants will all approach service provision differently. Do not expect participants to act in the same way as you. 62 ToT.11 FeedbackToT Handbook ToT.12 Managing group dynamics It is important that the WSTP trainer knows how to work effectively and efficiently with groups. This session looks at facilitating small group activities, managing time and dealing with disruptive behaviour. Why use groups? Group work is important in training because it: • Allows participants to share ideas, knowledge and experience. This allows you to find out more about the participants’ existing expertise so that you know where the gaps are and how to pitch the session. • Honours the existing wisdom, experience and skills in the room. This allows those with more experience and expertise to share it with others. • Takes the focus off the trainer. As the participants share experiences and find out what they already know, this helps to build their confidence. • Creates an environment that enables everyone to speak and contribute. Shy or more junior participants will be more comfortable speaking out in a small group. This builds confidence as they discover their ideas are valued. Organizing and managing group activities What to consider when dividing a large group into smaller groups • Determine group size • Determine who is in each group • Methods to create groups. Factors to determine the size of the groups • Time: the more groups there are the more time is needed for the feedback session. If you have less time, create larger groups, but no more than six people in a group. • Privacy/confidentiality: pairs are best for discussing topics that are sensitive, when people are shy or there are language barriers. • Involvement: the smaller the group the more difficult it will be for any group member not to participate. 63ToT.12 Managing group dynamicsToT Handbook • The activity: the amount of equipment/supplies that are needed for the group activity. For example, if you have three work stations then you will be able to accommodate three groups. Factors to determine the make-up of each group • Think of the purpose of the activity to determine whether you want people with similar skills and background in the same group, (by placing all clinicians working together or all technicians in the same group), or the opposite by deliberately mixing skill sets and experience in the same group. • Grouping of participants who work together: depending on the activity or relationships, it may be appropriate to group them together or apart. • Mixing stronger/weaker (more experienced/less experienced) participants: this facilitates learning from each other, However, if you want people to have equal opportunity to express themselves consider grouping dominant participants together and shy ones together. • Mixing the sexes: be aware of cultural, religious or social norms of working (especially regarding touch and privacy). • Language skills: for communication between participants and wheelchair users. • Ensure that all participants have the opportunity to work with each other to maximize peer learning opportunities. • Sometimes, random group selection is best. Methods to create groups The Trainer’s Manual for each WSTP gives guidance about the size or number of groups required for each activity. You can adjust this to your situation, based on your experience in previous activities. Here are some methods to divide up a group: • The fruit salad method: prepare three or four of the same fruit cards and different kinds of fruits, enough for each participant. You can then assign ‘all bananas’ to work together, or have a fruit salad (one of each) together. • Count off. Count off to the number of groups you want, for example if you need three groups of three, go around the room asking the first person to count ‘one’, the next ‘two’, then ‘three’ and back to ‘one’. All the ones, twos and threes go together. • Matching puzzle pieces: cut photos or magazine pictures into two or three pieces according to how many groups you want. People find their match. 64 ToT.12 Managing group dynamicsToT Handbook • Organize by birthday month: line people up by the month in which they were born and then form groups (first three together, next three, and continue until everyone is in a group). Or line up by height or by first name initial letter. • Self-select: instruct people to select one or two people they have not worked with yet, but beware that self-organising with more than three people can take more time. • Work in pairs with the person next to them, or if sitting in rows the people in the front row can turn their chairs around and work with the person behind them. This will work for pairs or groups of four. Give clear directions when dividing participants into groups: • who goes into which group • what you want groups to do (what is their task) • where you want groups to go (break-out rooms, or areas of a large room) • when the group should be ready to report back • how you want groups to report (using a flipchart; verbal presentation to the whole group; informal report to the group sitting in their seat; creative presentation chosen by the group itself) • how much time will they have to report back. Always monitor small group activities to ensure participants are working on the intended task and using the correct page in their workbook. Help them if necessary, by prompting and asking leading questions; don’t provide the solutions or take too much time talking yourself. Remind them to keep an eye on the time. Managing disruptive behaviour In general, to help engage and keep participants interested and involved in the training: • use the different training methods given in the session plans to engage all the participants • ask questions to encourage participants to come up with answers • praise good work from participants and give positive but honest feedback • link learning to real examples the participants can relate to • keep the training fun. 65ToT.12 Managing group dynamicsToT Handbook The dominant participant The participant who does not give other participants an opportunity to share knowledge, answer questions or lead a group activity because they dominate, talk loudly or for a long time. This person behaves like they know everything already. Managing a dominant participant: • During a break, approach the person and acknowledge their experience. Ask them to help you by giving others a chance to learn and respond to questions. • Consider asking specific participants to answer questions rather than asking the whole group. • Pair or group the dominant participant with the strongest participants during group activities, to provide an opportunity for shy or quiet participants to contribute to their group. The joking participant The participant who appears not to take the training seriously, making jokes all the time and sometimes making fun of others. Managing ‘the joking’ participant: • During a break, talk to the participant about how their behaviour is disrupting the training. Ask them to help you by keeping jokes for breaks or for appropriate times during group activities. • During sessions, respond to the joke as if it was a serious remark. The argumentative participant The participant who likes to raise objections or question concepts that they do not believe, to start an argument or test how strongly other members of the group feel about a topic or issue. Or, they may wish to test your skills and knowledge – and demonstrate that they are superior. Managing an argumentative participant: • Request that people only speak about their own beliefs and experiences. • After an objection is raised, ask the participant ‘is this true for you?’ If the person says no, but that it may be for others, ask other participants for their opinion. The negative participant The participant that tends to be negative or discourage others. They may comment that the approach taught as part of the training ‘won’t work where we live’. 66 ToT.12 Managing group dynamicsToT Handbook Managing a negative participant: • If a negative participant feels that approaches in the training will not work, give them an opportunity to explain why. Ask other participants if they agree. If other participants agree, help them problem solve by asking: how can we make it work even in those situations? The quiet participant The participant who is naturally quiet or shy and feels uncomfortable speaking in front of a large group, or contributing to group activities. Managing a quiet participant: • Consider asking them direct questions that they are likely to be able to answer. • Use praise and recognition to encourage more participation. • Use small groups (pairs or three people) for group activities and discussions. The higher status/senior participant If there is a participant who is in a position of authority over others in the group, it can lead to participants being reluctant to speak, answer questions or to disagree with them. Managing a senior participant: • During a break, talk to the participant about their role in the group. Ask the person to help you create a comfortable atmosphere by requesting that people speak freely. • You may also ask the participant to sit at the back of the group, to be less dominant in the room. The distracted participant The participant who is easily distracted, always in and out of the training room or on the phone. Managing a distracted participant: • Try to find out why: is there a problem away from the training that is worrying them? • Is he/she bored because of the subject matter or training style? • During a break, talk to the participant about how their behaviour is disrupting the training. Remind him/her of any house rules. 67ToT.12 Managing group dynamicsToT Handbook Basic Level module 68 Basic Level moduleToT Handbook A.1: Wheelchair users Key considerations for teaching this session a. General Tips for preparation • Make copies of the CRPD available for participants to look at during breaks. If possible, provide each participant with a printed copy. b. Section 4. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) • Section 4 of the WSTPb Trainer’s Manual (pages 26–28) focuses on the right to personal mobility (CRPD Article 20). Facilitate a discussion between participants, to ensure that they understand and agree with the overarching principles of the CRPD and of a rights-based approach. In addition to Article 20, highlight: – Article 1: Purpose of CRPD: everyone has rights and people with disabilities should have the same rights as everyone else. – Article 3: General principles of CRPD: that we are all equal and everyone should be treated with dignity and respect. – The CRPD is based on the principles of respect for dignity; non- discrimination; participation and inclusion; respect for difference; equality of opportunity; accessibility; equality between men and women; and respect for children. c. Section 5. Wheelchair users are equal partners in service delivery • The activity on page 28 of the Trainer’s Manual needs to be introduced and explained well as it does not have a worksheet in the Participant’s Workbook. 69A.1: Wheelchair users ToT Handbook A.2: Wheelchair services Key considerations for teaching this session a. Section 2. Wheelchair services Tips for preparation • This section does not have any PPT slides and can easily be forgotten. Consider adding a slide for each of the questions within this section. b. Section 3. Wheelchair service personnel roles • Do not add detail to the service steps. Each step will be covered in more detail in later sessions. Park any questions requiring a more detailed explanation in the Car Park. • All wheelchair users need access to the eight steps of service delivery. These can be delivered by one organization or by different organizations working in partnership. It is important that participants understand the role of everyone involved in each service step so that they can work together effectively. 70 A.2: Wheelchair services ToT Handbook A.3: Wheelchair mobility Key considerations for teaching this session a. General • If you have additional time available, this session can be extended to allow for more practice time, or for teaching additional wheelchair mobility skills. It can also be delivered over multiple days. b. Section 4. Wheelchair mobility skills – demonstration and practice Tips for preparation • The Trainer’s Manual does not specify the type of wheelchair required for this activity. If possible, include all of the following: – orthopaedic-style wheelchairs – active wheelchairs with the rear wheel in the active position – long-wheelbase wheelchairs – three-wheel wheelchairs. • Check there are appropriate sizes of wheelchairs available so all participants have an opportunity to practise the mobility skills. • It is important that lead and support trainees demonstrate all skills in the same way. Before the session, review and practise the skills together to ensure consistency. Use the Trainer’s Manual for guidance. • In preparation for the pushing and turning section, check that lead and support trainees agree where 10 and 2 o’clock hand positions are as this varies depending from which side you are looking at the wheel. Mobility training areas • Identify appropriate areas in advance. • Choose areas that are close together to save time moving. • Plan how the rotations will be done, for example: with or without trainers? Do wheelchairs stay with participants or at the mobility training areas? • If training areas are outside and not covered, plan around local weather condi- tions and run the session during the driest, warmest or coolest part of the day. 71A.3: Wheelchair mobility ToT Handbook Content • Use the video to introduce the different mobility skills. Read out the captions in the skills sections of the video to emphasize the key learning points. • Pause the video at 2’39” (straight side on view) and point out how far forward the head and shoulders are when going up slopes. • It may be necessary to demonstrate some of the mobility skills again during the activity. • Ask participants to try a range of wheelchairs during the practical activity to experience the differences: – Over rough ground and slopes: encourage participants to try pushing with all types of wheelchairs available. – For partial wheelies: suggest participants use an orthopaedic-style wheelchair and an active-style wheelchair with the rear wheel in the more active position for comparison. • The position of the rear wheel affects the effort needed to propel the wheelchair or do a wheelie. The further back the rear wheel is, relative to the user, the harder it will be to push the wheelchair or do a wheelie. • Do not assume that a long-wheelbase wheelchair is heavier than a short- wheelbase wheelchair and therefore harder to wheelie. It is the position of the rear wheel that affects how difficult it is to do a wheelie. • Emphasize correct practice of key skills as described on page 42 of the Trainer’s Manual. Add these points: – Up slopes: lean forward. Participants and new wheelchair users usually do not lean forward enough. – Down slopes: do not use the brakes to slow down. – Up a series of steps with assistance: never go up forwards. – Down a series of steps with assistance: never go down backwards. • Participants can injure themselves during this activity. Closely monitor the groups and step in as needed. • Give clear instructions on group management and safety. • A spotter strap is used to prevent the wheelchair user from tipping backwards and is a useful tool in wheelchair skills training. It also enables the assistant to be in contact with the wheelchair user, without interfering with the skill being learnt (Figures 1 & 2). 72 A.3: Wheelchair mobility ToT Handbook Figure 1. Using a spotter strap Figure 2. spotter straps24 Teaching the partial wheelie24 Emphasize the following points: • It is harder to do a wheelie in wheelchairs where the rear wheel is in a safe position. The technique described in the Trainer’s Manual makes it easier to do a wheelie: – place hands on the 1 o’clock position on the rear wheel – roll the wheel backwards until the hands are at the 10 o’clock position. Without stopping, change direction and push forward quickly. • If the rear wheel is in a more active position, it may be possible to do a partial wheelie by pushing forwards without rolling backwards first. • It can be helpful to stretch out a rope on the ground so participants can do a partial wheelie over it. • Common errors include: – starting with the hands too far from the 1 o’clock position – not going far enough back with the hands – stopping when changing direction or not changing direction quickly enough – not pushing forward far enough or hard enough. 24 Wheelchair skills assessment and training 2015. Canada: Dalhousie University; 2015 (http://www. wheelchairskillsprogram.ca/eng/manual.php). 73A.3: Wheelchair mobility ToT Handbook Considerations for gender/culture • Before the session begins ask any wheelchair users in the group if they want to try out the practice wheelchairs. If they do, ask if they need assistance or equipment to transfer between the wheelchairs and make arrangements accordingly. Appoint a support trainee to assist them as required. • Participants work in pairs for this activity, with one person ready to assist to prevent tips or falls. If any participant has an impairment or physical disability, ask them before the session begins if they feel comfortable to assist others. They may need to position themselves differently during the activity. • If any participants are unable to participate in this activity, identify a role they can perform instead, for example observing other participants and providing feedback. 74 A.3: Wheelchair mobility ToT Handbook A.4: Sitting upright Errors in the WSTP materials a. Section 2. Sitting upright/neutral sitting posture • On slide 5, when listing the key points for sitting upright as seen from the front, the trunk has been omitted and the head is not listed in the correct order. The correct order is: – pelvis (level) – trunk (upright and symmetrical) – shoulders (level) – head (balanced centrally over the body) – thighs (thighs slightly open/abducted). Key considerations for teaching this session a. General • Keep emphasizing the correct order when describing posture. Start at the pelvis and move up, then go to the hips and move down. b. Section 2. Sitting upright/neutral sitting posture Tips for preparation • Have a stool or an assessment bed available for the volunteer to sit on. • If the volunteer sits on a chair, their posture will change if they lean against the backrest. If you only have access to a chair, make sure that the seat is level and ask the volunteer to sit sideways on the chair (with the backrest on one side) so they cannot lean on it. c. Section 3. How the pelvis affects the way we sit • Do not assume that participants are familiar with the terminology used in the WSTPb (for example: anterior, posterior, ASIS). • If available, use a model skeleton to demonstrate the important bony landmarks and movements of the pelvis. • Allow time for participants to locate and feel bony landmarks on their own body. 75A.4: Sitting upright ToT Handbook • Remind participants to keep the typical size of the adult skeleton in mind when locating bony landmarks on users who are overweight (relate to model pelvis if available). • When demonstrating the movements of the pelvis with participants, emphasize what is happening above the pelvis in the spine and below pelvis in the hips with each movement. This will help participants to link posture with the position of the pelvis. 76 A.4: Sitting upright ToT Handbook A.5: Pressure sores Key considerations for teaching this session a. General • Use the Car Park for any questions about pressure relief cushions, their design features and how to protect the cushion from moisture. This information is explained in detail in A.7: Cushions. b. Section 3. When and where to get help • Do not offer advice about medical treatment or dressings used for pressure sores. This is not the focus of the session and is outside the scope of the WSTPb. • Warn users against any home remedies unless recommended or approved by the health care professional who is managing the wound. c. Section 4. What causes pressure sores? • Shear may be a new concept for participants. It needs to be explained well to avoid confusion with friction. To explain shear, ask participants to place their knuckle against the table top with enough pressure so that when the knuckle is moved forward and back only the bone moves over the stationary skin. • Preventing the wheelchair user from slumping or sliding in the wheelchair will reduce shear and the risk of pressure sores. d. Section 8. Pressure relief techniques • This section is 10 minutes long and includes both the explanation and the activity. • Each participant should practise being both the wheelchair user and the assistant. • Participants are likely to ask how often, and for how long, pressure relief should be done. The usual guideline is every 30 minutes, for 2 minutes, to allow blood flow to return to the area. • The push-up technique (lifting by pushing up on both arms) is not taught in the WSTPb for the following reasons: 77A.5: Pressure soresToT Handbook – the strain and potential injury to the shoulders – few people can sustain the position for the 2 minutes needed to fully restore blood flow – the possibility of injury to the skin if the user loses control and drops down too hard. • When leaning to the side, lean only as far as necessary for the pelvis to tilt and free the seat bone of pressure. When teaching this technique to a wheelchair user, place your hand under the user’s seat bone and give them feedback once the pressure is relieved. 78 A.5: Pressure sores ToT Handbook A.6: Appropriate wheelchair Errors in the WSTP materials a. Section 3. Meeting the wheelchair user’s needs • In the table on pages 76–77 of the Trainer’s Manual the entries for Roger, Dawid and Pinky mention a short wheelbase. This is the first time the wheelbase length is mentioned. Note that the overall length of the wheelchair will also affect the ability to turn and move in small spaces. Key considerations for teaching this session a. General Tips for preparation • If possible, have demonstration wheelchairs available to explain the features. Prepare before the session starts so that you can show how to make adjustments where appropriate to: – a folding frame and a rigid frame wheelchair (both 3-wheel and 4-wheel) – removable and fixed armrests – fixed footrest hangers and footrest hangers that flip up and swing away – short and long wheelbase wheelchairs – footrests set in highest and lowest, or forward and back, positions – backrests set in highest and lowest positions – rear wheels in safe and active positions. • Set up the area so that all the participants can see the demonstration wheelchairs. b. Section 3. Meeting the wheelchair user’s needs Section 3.2: Pushing the wheelchair • Lightweight wheelchairs are particularly important for children; those with progressive conditions; wheelchair users with limited strength (for example a high spinal cord lesion); those who frequently push long distances; and caregivers who push the wheelchair user. 79A.6: Appropriate wheelchair ToT Handbook • The position of the rear wheel in relation to the seat impacts on how light the wheelchair feels. The rear wheel axle should be positioned under the wheelchair user. • With the rear wheel in an active position, the wheelchair is easier to push and wheelie both for wheelchair users who self-propel and caregivers who push the wheelchair. • Older wheelchair users and people with leg amputation (whose weight is distributed differently in the wheelchair) do not automatically require a ‘safe’ rear wheel position. Factors that will influence the rear wheel position include: – the user’s overall function: strength, balance and transfer skills – how they push their wheelchair – activities they do in their wheelchair – their level of understanding and insight – other conditions, for example spasms or uncontrolled movements. • You can consider providing temporary additional stability to users who may become more active. For example, you can add weight to the front of the wheelchair and gradually reduce it over time or use anti-tip bars while they learn to balance and propel. Section 3.3. Folding the wheelchair • Folding-frame wheelchairs are not the only option available when using transportation. Demonstrate how a lightweight 4-wheel rigid-frame wheelchair with removable wheels can be transported, by removing the rear wheels and then positioning the frame on the wheelchair user’s lap, when the vehicle is full and the wheelchair user is a passenger. Only the rear wheels have to be stored elsewhere in the vehicle. c. Section 4. Meeting the wheelchair user’s environment • Slide 23 introduces the wheelbase. The picture is of a wheelchair with a short wheelbase. When discussing this point, it is helpful to have two wheelchairs, one with a short and another with a long wheelbase. • Remember that the length of the wheelbase is measured with the castor wheel in the rear (trail) position. • An orthopaedic-style wheelchair is not automatically more stable than an active wheelchair. Orthopaedic-style wheelchairs generally have these features: 80 A.6: Appropriate wheelchair ToT Handbook – short wheelbase: resulting in the front castors being heavily loaded so the wheelchair can tip forward easily – seat is high above the rear wheel axle: resulting in instability to the side, back and front – rear wheel is set back (behind the seat): when combined with a short wheelbase this results in the front castors being loaded and makes the wheelchair more difficult to push and turn. • The orthopaedic-style wheelchair is not suitable for active and outdoor use on rough terrain. Remind participants how hard it was to push the orthopaedic- style wheelchair on uneven ground and how difficult it was to do a partial wheelie compared to other types of wheelchairs. d. Section 5. Providing proper fit and postural support • Sometimes there is only one type of wheelchair available and it is not possible to prescribe a product appropriate for the environment. Always select the most appropriate size and take steps to ensure the best fit and postural support. 81A.6: Appropriate wheelchair ToT Handbook A.7: Cushions Key considerations for teaching this session a. General • This session links with A.5: Pressure sores. Refer back to A.5 if necessary, focusing on the following key points: – the areas of the body that are most at risk of developing pressure sores – the main causes of pressure sores (pressure, friction and shear). • These key learning points will allow you to highlight and explain the well feature of the pressure relief cushion. • The dimensions of the seat bone well will be discussed and practised during B.8: Cushion fabrication. Tips for preparation • To prepare for the session, gather locally available cushions, materials and fabrics. If available, include the following: – a contoured cushion (with a seat bone well) – a flat cushion (at least two layers, with no seat bone well and a flat base) – a single layer of foam – any other locally available cushions that are commonly used. • Set out wheelchairs, with cushions, for the finger pressure test activity. • If you need to make cushions for this session, further information is available in the Cushions Annex on page 135. b. Section 4. Pressure relief cushions Tips for preparation • Slide 6: Add to the text of the second bullet in the Trainer’s Manual: “This will make sure the cushion keeps its shape, provides good support for the user and does not move when the user moves”. 82 A.7: Cushions ToT Handbook Content • Slide 5: A seat bone well can provide both pressure relief and postural support. The well reduces the pressure under the seat bones and the seat bone shelf helps to keep the pelvis more upright and prevent it from sliding forward. This reduces shear caused by sliding. • It is important to check that the shelf is in the correct place by completing a pressure test. Which cushion to use? • Good pressure relief, postural support and pressure redistribution are achieved by a combination of the shape of the cushion and its material. • When selecting the most appropriate cushion for a user, consider: – The shape. Is there a pre-seat bone shelf or a seat bone well to prevent sliding and help to keep the pelvis upright? Are there grooves or gutters to rest the thighs in? – The material. Is it sufficiently firm to provide good support and soft enough to be comfortable? – Pressure redistribution. Does it pass the pressure test when the user is sitting on it in their wheelchair? – Comfort. This is subjective. All cushions should be comfortable because they provide pressure relief and postural support. An air/fluid/gel cushion is not automatically more comfortable than foam. • Remember, cushions vary in shape and quality: – Shape. A well-designed contoured (shaped) foam cushion can provide better pressure relief than a poorly designed air/fluid/gel cushion. – Material. A well-designed air/fluid/gel cushion may be the most appropriate solution for someone with very high risk of pressure sores, where a well- designed foam cushion does not offer adequate protection. – As the lifespan of a foam cushion is much shorter than the lifespan of the wheelchair, local support services must be able to replace the cushions as needed. Cushion covers • Additional considerations for moisture or incontinence management (on page 94 of the Trainer’s Manual) are covered in the Cushions Annex (page 135). 83A.7: Cushions ToT Handbook c. Section 5. How to test if a pressure relief cushion is working Tips for preparation • Ensure that group participants have access to a wheelchair that fits them. Content Before participants practise the pressure test, highlight the following points: • Remove jewellery from hands before starting. • If it is difficult to get to the seat bones from behind the wheelchair: – Stand at the back corner of the wheelchair and place your hand underneath the seat bone (Figure 3). – Do not place your arm between the backrest and the user as this will push them forward. Check that the wheelchair user is sitting symmetrically and has their back against the backrest. Figure 3. Checking pressure on the seat bones 84 A.7: Cushions ToT Handbook • If participants have difficulty finding the seat bones: – Use the skeleton to remind participants how far forward and close together the seat bones are (Figure 4). – Demonstrate how fingers should be positioned underneath the seat bone. If you do not have a skeleton, use the bottom of your fist to represent the seat bone. – Ask participants to find their own seat bones when sitting; to pay attention to where they are located as well as the distance between them. Figure 4. Diagram of seat bones • If the wheelchair user’s pressure is grade 3 (unsafe), do not force your fingers out from underneath their seat bones; ask them to lean forward or to the side so that you can slide your fingers out. • The seat bones could have different pressure going through them. Assess each side separately. • If questioned on the research and validity of the pressure test, emphasize that its purpose is to ensure the safety of individual wheelchair users. Our hands are an accurate way to measure the pressure between a person’s body and the wheelchair. Our hands are very sensitive and by practising this test frequently, we will continue to develop further sensitivity to evaluate pressure. 85A.7: Cushions ToT Handbook d. Section 6. What action can be taken to reduce pressure? • See Figure 5 and highlight the following points about the lift: – It must be a U-shape. Do not use a lift under the thighs only as this will change the angle of the seat. – The thickness of the lift should be approximately 20 mm. – Dimensions of the seat bone well are covered in session B.8: Cushion fabrication. • To reduce unsafe pressure add a ‘lift’ on top of the base layer and under the comfort foam layer. A.7. Cushions:12 Figure 5. Reducing unsafe pressure • The aim of the lift is to move weight off the seat bones and on to the upper and distal parts of the thigh. • A layered cushion allows the lift to be positioned between the layers. With a one-piece moulded cushion, the lift is positioned underneath. • There are some other ways to improve the pressure relief qualities of a foam cushion that are not described in the Trainer’s Manual: – if the top layer is very soft or thin, increase its firmness and thickness – if the base layer is soft, and does not maintain its shape or contours when the wheelchair user is on it, replace the base layer with a firmer material. 86 A.7: Cushions ToT Handbook A.8: Transfers Errors in the WSTP materials a. Section 4. Three ways to get in and out of a wheelchair and individual feedback • In the video clip: Independent transfer through sitting (wheelchair to bed): note that the wheelchair user pushes down on the back upholstery during the transfer. This is not recommended. Key considerations for teaching this session a. General Tips for preparation • Set out the equipment for the practical activity. For sideways transfers, do not use wheelchairs with fixed, full depth armrests. • Decide what the lead trainer and each of the support trainers will be responsible for before the session. Ensure the training team is consistent in its approach to carrying out and teaching the transfers. b. Section 4. Three ways to get in and out of a wheelchair and individual feedback Participants may suggest alternative ways to do these transfers – they may have learnt different techniques or developed alternative methods. Acknowledge suggestions by participants but remind them that the video demonstrates basic, safe techniques. • Participants should follow these techniques during the WSTPb. Some variations are acceptable to accommodate individual body shape, such as height, weight and strength. • Techniques that require rotation (twisting) of the assistant’s back, or where the wheelchair user holds on to the assistant’s shoulders or neck are not acceptable as they pose a risk of injury to the assistant. • To increase the stability of the wheelchair for transfers, position the castor wheel forward. • Highlight the key points during the video by reading them from the screen. 87A.8: Transfers ToT Handbook 1. Independent transfer through sitting (wheelchair to bed) • Explain why the wheelchair user needs to move to the front of the wheelchair. This is to ensure that they don’t make contact with or bump the rear wheel during the transfer as this might damage their skin and lead to a pressure sore. 2. Assisted transfer through sitting with a transfer board (wheelchair to bed) • Pause when the following subtitle disappears: 3. Place transfer board under buttocks across the wheelchair and bed. • Emphasize that the wheelchair user must be assisted to lean sideways and to place the transfer board. • One end of the board is placed under one side of the wheelchair user’s buttocks. The board is placed at an angle between the wheelchair seat and the bed so that it misses the arch of the rear wheel. • Continue the video. • Pause at the next subtitle: 4. Assistant stands behind the user. • Emphasize the assistant’s position behind the wheelchair user during this transfer. In this position the assistant does not block the forward movement of the wheelchair user’s head and trunk. The assistant also has good control of any forward sliding during the transfer. If the wheelchair user is worried about falling forward, a second helper can stand in front of them. • Emphasize the assistant’s position. The assistant kneels with one knee on the bed. The other leg is placed between the bed and wheelchair. • Continue the video. • Pause at the next subtitle just before the user lifts: 5. User lifts as much as they are able. • Explain how the assistant grips around the wheelchair user’s pelvis to assist with the sideways movement to the bed (the assistant should not grip the top of the user’s trousers or belt). • Emphasize: The user’s hands are placed on top of the transfer board and his/ her fingers should not curl around the edge of the board as this may lead to injury when transfer commences and weight is placed on the board. • Emphasize the text: 5. User lifts as much as they are able. Add that the user can do the transfer using multiple small lifts. • Repeat the key points on page 104 of the Trainer’s Manual after the video. • Ask the participants if they would like you to play the video again before they practise. 88 A.8: Transfers ToT Handbook 3. Assisted standing transfer (bed to wheelchair) • Pause at the subtitle: 4. Assist user to move forward on the bed, place user’s feet on the floor. • Explain: The assistant uses his/her legs to support the user’s knees from the side (do not block the user’s knees from the front). • Explain: The user rests their hands either on the assistant’s shoulders (hand resting on the shoulders, not gripping around the neck) or the assistant’s hips/ pelvis. • Continue the video. • Pause at the next subtitle: For taller and heavier clients, support may be given higher (shoulder blades). • Explain: the assistant can support the wheelchair user at the pelvis or on the trunk just below the shoulder blades. The assistant should take care to allow the user enough space to bring their head and shoulders forward over their feet. • Continue the video. • Pause at the next subtitle: 5. Twist the user toward the wheelchair and help her sit down gently. • Explain: Ensure the wheelchair user comes to a fully upright standing position. Only then twist to the side of the bed and allow the user to sit down again. • Continue the video. • Repeat the key points on page 104 of the Trainer’s Manual after the video. • Ask the participants if they would like you to play the video again before they practise.· c. Section 5. Independent transfer from floor to wheelchair • Some wheelchair users may not have the strength or balance to transfer from the floor to their wheelchair seat. Users can transfer in two stages: – From the floor to a step. For example, the step could be the frame of a three- wheel wheelchair, a wooden box, a stack of newspapers, or a low stool. – From the step to their wheelchair seat. • Note that the step/wheelchair must be stable and positioned safely. • Instead of the seat, wheelchair users may be able to place one hand on the top of the footrest hanger or other part of the frame for transfers. 89A.8: Transfers ToT Handbook • Wheelchair users who are at a high risk of developing pressure sores need to take care not to bump any wheelchair parts. • Emphasize that developing the correct technique and being able to perform this transfer independently may require a lot of practice under supervision. It is important to problem solve with the wheelchair user and their family to develop a safe transfer method. • If someone in the group is able to demonstrate the transfer, ask them to do it at the end. 90 A.8: Transfers ToT Handbook B.1: Referral and appointment Key considerations for teaching this session a. General Tips for preparation • Ask participants to bring a copy of the wheelchair referral form used by their service, if one is used, to share during the session. This will make it more interactive. b. Section 2. Referral • Encourage participants to share experiences about their service settings, including: – existing referral systems (if wheelchair-specific referral systems are not in place, discuss other referral systems) – whether their referral systems are working – how the systems could be improved – how referrals are made (for example: by telephone, referral letter, email) and what information is included in a referral – wheelchair service referral forms brought by participants or the sample wheelchair referral form in the WSTP Additional Resources manual. • If no referral systems exist in the participants’ workplaces, share experiences from your own work as an example. This may include how your referral system was established and how the wheelchair service has benefited or changed. • Encourage participants to take this issue up with their service managers and to assist in: – putting together information needed to guide referral sources – developing a referral letter – identifying and contacting referral sources – holding a wheelchair service open day and other initiatives to raise awareness about the service – building up referrals in line with the capacity of the service. 91B.1: Referral and appointment ToT Handbook B.2: Assessment Key considerations for teaching this session a. General • This is a short session designed to introduce participants to the WSTPb assessment process. • Park questions about the assessment interview and the physical assessment in the Car Park as these are covered in the following two sessions. b. Section 2. Who needs a wheelchair? • Emphasize that using a wheelchair will not make a person ‘lazy’ or cause the person to stop walking. Walking with a mobility impairment uses more energy than walking without a mobility impairment. That is why using a combination of wheelchair and walking aids is often best. • Wheelchairs enable: – community participation and integration – individuals to cover longer distances – access to rougher terrain – a faster pace than walking would allow – a person who uses crutches to stand and balance can do more when sitting down in a wheelchair with their hands free. c. Section 3. Why do you need an assessment? • The WSTPb assessment form only covers the essential information needed for a basic level wheelchair assessment. • Service providers may need to collect additional information for other types of services they offer. This will not be covered during the WSTPb. d. Section 4. Where to carry out assessment • Encourage participants to be creative when carrying out assessments in the community or at the wheelchair user’s home. For example: measurements can be taken with the person sitting on a bench or sideways on a chair; bricks can be used to build a foot support to ensure that the wheelchair user’s feet are supported. 92 B.2: Assessment ToT Handbook B.3: Assessment interview Key considerations for teaching this session a. General Tips for preparation • Many participants may not have seen or used a wheelchair assessment form before. Encourage participants to follow the session using the form on page 42 of the Reference Manual for Participants. b. Section 2. Information about the wheelchair user • While participants are learning, they may prefer to rely on the form. As they become more comfortable, encourage them to approach the assessment as a discussion. • Encourage participants to think about how the information being gathered relates back to decisions about the wheelchair. c. Section 3. Physical condition • Draw input and ideas from the experiences of participants to make this section more interactive. • Look at this statement on page 121 of the Trainer’s Manual: “It is helpful (although not always necessary) to know which condition a wheelchair user has”. Discuss this with the whole group. Emphasize that knowing the medical diagnosis is helpful but not essential for a wheelchair assessment. A thorough assessment interview and physical assessment are the essential elements of a good wheelchair prescription. d. Section 6. Assessment interview practice • Trainers should monitor participants to ensure they are discussing the assessment and not just ticking the list of questions. 93B.3: Assessment interview ToT Handbook B.4: Physical assessment Errors in the WSTP materials a. Section 6. How to take body measurements • This heading in the Trainer’s Manual is confusing. This section covers how body measurements relate to wheelchair measurements. Change the heading to How body measurements relate to wheelchair measurements. • Add the following to the list of resources on pg. 131: A copy of the amended Basic wheelchair assessment form for each participant. • An amended version of the assessment form is included in the annexes of this manual and can be downloaded from the WSTP Pen Drive. • There are some errors in the Measurement Table in the assessment form in the column Change body measurement to ideal wheelchair size for measurements C, D and E. • The following slides in the Trainer’s Manual and PPT need correcting with the information in the amended Measurement Table (Table 1) below: – Slide 10: page 138 – Slide 12: page 140 – Slide 19: page 143. • Ask participants to make the same correction on page 48 of the Reference Manual for Participants and on pages 18 and 19 of the Participant’s Workbook. 94 B.4: Physical assessment ToT Handbook Table 1. Body measurements for wheelchair conversion Body Measurement Measurement (mm) Change body measurement to ideal wheelchair size Wheelchair measurement A Hip width Hip width = seat width B Seat depth L B less 30–50 mm = seat depth (if length is different, use shorter one) R C Calf length L (C less cushion height*) C less cushion height* = seat to top of footplate or seat to floor, depending on user’s needs R D Bottom of rib cage (D or E [depending on user’s needs] + cushion height*) D or E (depending on user’s needs) + cushion height* = seat to top of backrest E Bottom of shoulder blade L: left; R: right. *Check the height of the wheelchair user’s cushion. Key considerations for teaching this session a. Section 3. Presence, risk of, or history of, pressure sores • Link this section to A.5: Pressure sores. Briefly review risk factors and remind participants when a pressure relief cushion is indicated. b. Section 4. Method of pushing Tips for preparation • Identify the practical area beforehand and set out wheelchairs with footrests that move out of the way. 95B.4: Physical assessment ToT Handbook Content Pushing with feet activity on page 136 of the Trainer’s Manual • Three-wheel wheelchairs are generally not suitable, as the beam will interfere with foot propelling. • Advise wheelchair users to avoid pushing/propelling backwards as they are unable to see where they are going. It can also result in poor sitting posture. However, pushing backwards is easier when going uphill or over soft terrain or small obstacles. Encourage participants to experience the difference of pushing backwards up a slope. – For most people, the standard seat height of a wheelchair is too high to effectively foot propel forwards. – It will be difficult for the user to maintain good posture and propel forwards if the seat is not low enough. – The user’s heel should comfortably reach the floor and remain firmly on the floor as they apply force to propel. • Wheelchairs with lower seats are not widely available so modifications must be made to allow the user to reach the floor with ease, for instance: – Reduce the overall height of the cushion. – Attach a solid seat lower than the original seat. Suspend the board from the seat rail on hooks so that it can be removed for folding if necessary (Figure 6). On folding-frame wheelchairs, cut reliefs for the top of the cross brace. The board will also rest on the cross brace. Figure 6. Seat board with hooks • Modify the seat and cushion • Combinations of the above are often required and are described in the Cushions Annex on page 135. 96 B.4: Physical assessment ToT Handbook c. Section 5. Taking measurements Tips for preparation • Set out the equipment needed for the measurement activity for each group of three participants, including: tape measure, two clipboards and one set of foot blocks. • With a support trainer, prepare to demonstrate finding the lower ribs and bottom of the shoulder blade during the video: measurement demonstration: back height. Content • Use the video as described below to emphasize key learning points. • Read all the subtitles. • Prepare – Pause where the assessor calls the helper at the subtitle: Make sure the wheelchair user is sitting upright. – Explain: If the wheelchair user is unable to sit upright without assistance, a helper is needed. – Continue the video. – Pause where the helper is sitting next to the wheelchair user and the assessor starts to check the posture. – Explain: The assessor guides the helper and then checks the posture. The pelvis, trunk, head and neck should be upright and in line. – Continue the video. – Explain as the video continues: The hips, knees and ankles are flexed to 90 degrees. Take measurements – Pause at the subtitle: Hip width: hips or widest part of thighs. – Emphasize: Ensure that the clipboards are parallel and upright. – Continue the video. • Pause at the subtitle: Bend down to read the tape measure. • Emphasize the following: – measure the inside distance between the two clipboards – bend down to read the tape measure otherwise readings will be inaccurate. • Continue the video. • Pause at the subtitle: Seat depth: back of pelvis to back of knee. 97B.4: Physical assessment ToT Handbook • Emphasize the following: – keep the clipboard upright and level with the front of the bed – measure from the front of the clipboard to the back of the knee – measure both sides. • Continue the video. • Pause at the subtitle: Seat depth: Calf length: back of knee to base of heel. • Emphasize the following: – For best accuracy, measure from the heel to the back of the knee. This is different from the text on page 140 of the Trainer’s Manual – Bend down to read the tape measure. • Continue the video. • Pause at the subtitle: Back height: seat to bottom of rib cage. • Demonstrate: There are two ways to locate the lower ribs. – Place the hands on the sides of the ribs and gently squeeze them together as you slide down the rib cage until you find the soft area and the bottom of the rib cage. – Alternatively, place hands on top of the pelvis and gently squeeze in to find the soft area. Gradually move up and in towards the centre until you feel the ribs. • Continue the video. • Pause where the measurement is taken. • Emphasize the following: – measure from the seat to the bottom of the rib cage – bend down to read the tape measure • Continue the video. • Emphasize the next subtitle: For a higher backrest, measure from seat to bottom of shoulder blades. As this is a frozen frame, there is no need to pause the video. • Explain: To help locate the shoulder blades ask the person being measured to shrug their shoulders. • Repeat the video without pausing. • Ask whether there are any questions. 98 B.4: Physical assessment ToT Handbook d. Section 6. How to take body measurements (Corrected session title: How body measurements relate to wheelchair measurements) • This section sometimes causes confusion, particularly measuring the backrest and footplate height. • When we take measurements on the bed the reference point is the bed surface, which represents the seat of the wheelchair. • Because wheelchairs should always be prescribed with a cushion, when we convert the body measurement to the wheelchair measurement we must adjust for the cushion (Figure 7). Figure 7. Body measurement are taken from the top of the assessment bed Footrest • The body measurement C equals the wheelchair measurement from the top of the seat cushion to top of the footplate or floor (Figure 8). • To calculate the footplate height: wheelchair seat to top of the footplate: Body measurement C less cushion height. For foot propellers • The cushion raises the user up and away from the seat. • To be able to foot propel, the user’s foot should reach the floor when sitting on the cushion. • To calculate the seat height: Body measurement C less cushion height. • The wheelchair measurement for foot propelling is always shorter than the body measurement. Figure 8. Body measurement C: wheelchair measurements: seat cushion to top of footplate or seat cushion to floor 99B.4: Physical assessment ToT Handbook Backrest • The body measurements D and E = measurement from the top of seat cushion to top of backrest. • The measurement you will use depends on a user’s needs. • Because a person should always sit on a cushion, a calculation must be made to include the cushion. • To calculate the wheelchair measurement (seat to top of backrest) the cushion height must be added to the body measurement (D or E). • Wheelchair measurement (seat to top of backrest) = Body measurement D or E + cushion height. • Sometimes cushions are quite thick but made from soft foam. In this situation, it may be more accurate to halve the height of the cushion for calculations, as it will compress approximately this much when a person sits on it. Figure 9. Body measurement D/E: wheelchair measurement: seat cushion to top of backrest 100 B.4: Physical assessment ToT Handbook B.5: Prescription (selection) Errors in the WSTP materials a. Section 5. Selecting the right wheelchair size • In the table on pages 153–154 of the Trainer’s Manual, correct the information in the column Change body measurement to ideal wheelchair size in line with Table 1 in B.4: Physical assessment on page 95 of this ToT Handbook. Key considerations for teaching this session a. General Tips for preparation • Place a demonstration wheelchair in the theory area, raise it on a table or box if this gives a better view. • Organize photocopies of the completed Wheelchair summary forms and the Wheelchair prescription forms, ready to hand out to participants. These are also an important reference for after the training programme. • Keep in mind that participants often think of prescription as determining the size of the wheelchair only. Remind participants of the key elements in the definition of an appropriate wheelchair; environment, function (daily activities and lifestyle), fit (size) and posture support needs. First determine the wheelchair features that match these needs. Second, makes and models of wheelchairs that have these features and are the right size can be identified. • Try to give each group a set of hand tools as this will be quicker than if they have to share. b. Section 3. Locally available wheelchairs and cushions • If possible, have one technical participant in each group. Technical participants may be more familiar with the various features of the wheelchair. • Wheelchair back height dimensions are measured from the wheelchair seat to the top of the backrest without a cushion. • Participants are often unsure about how to use the wheelchair summary sheet in service delivery. Explain that it is a good tool for comparing existing and new 101B.5: Prescription (selection) ToT Handbook products against the same criteria. It can also help with prescription choices particularly for users who need more complex wheelchair adjustments. c. Section 5. Selecting the right wheelchair size • The activity on page 152 of the Trainer’s Manual requires a clear understanding of the cushion calculations covered in B.4 Physical assessment. • Participants may decide that none of the available wheelchairs are the correct size for the two case studies in the Participant’s Workbook. This issue will be addressed in B.10: Problem solving. Acknowledge the observation and park it in the Car Park. d. Section 6. Recording the prescription (selection) • Ask participants to follow on page 51 of the Reference Manual for Participants when showing the slides of the Wheelchair prescription form. Participants can make notes on the form during the presentation and discussion. • Highlight the importance of wheelchair user involvement in the prescription process. 102 B.5: Prescription (selection) ToT Handbook B.6: Funding and ordering Key considerations for teaching this session a. General Tips for preparation • The content of this session is influenced by the wheelchair funding and ordering process in each country/context. • To prepare for the session, find out what funding options are available and which, if any, ordering processes are followed. • Context-specific information and discussions will make this session more relevant to participants. • The trainers can also share examples of models from their own experiences. Content • Keep in mind that many less-resourced settings rely solely on donations, with no formal funding and ordering processes. • The most appropriate wheelchair is selected from what is available. Where possible, give wheelchair users a choice between the most appropriate wheelchairs. Discuss the challenges of using this system, and how to manage them, with participants. • Recommend that participants establish a database of wheelchair users. This will enable them to engage with potential donors or funders regarding the needs of wheelchair users at their service. A database can also make the ordering process easier as the wheelchair specifications for each user are recorded. – When setting up a database, service providers will need to consider the privacy and security of users’ personal information. This must include guidelines about what is shared, when it is shared, and who it can be shared with. • Advise that participants may use the wheelchair summary form as a guide when ordering an appropriate wheelchair for each user. This will save time and is particularly useful for makes and models that offer multiple options. 103B.6: Funding and ordering ToT Handbook B.7: Product (wheelchair) preparation Key considerations for teaching this session a. General Tips for preparation • Laminating the Wheelchair safe and ready checklist will allow participants to reuse it. • Go through the prescription forms before the session. Highlight which groups might need more complex technical adjustments and modifications and have materials and extra tools ready for those groups. • Arrange for additional technical staff to support the session if many or complex adjustments and modifications will be needed. Consider whether the technical staff need briefing or training prior to the session. b. Section 2. Preparing the wheelchair Tips for preparation • Find out if all participants are familiar with handling the tools and the basic precautions to take in the workshop. For any participants who are not, discuss any questions/concerns at the beginning of the session and review the following basic workshop safety points: – wear covered shoes when working with tools – keep the work area neat and clean – never cut towards yourself or others – ask for help if you are not familiar with power tools – use safety glasses when using power tools or sharp tools – secure your work piece when cutting or drilling. • Introduce the tools that are going to be used at the beginning of the session. • The only available wheelchairs may have very different dimensions (such as too wide, or footrests too low) to those prescribed by participants. In this case, extra technical staff will be needed to support the session and to ensure the participants complete the activity in the allocated time. Technical staff can make more substantial modifications after the session, but these need to be completed before Practical Two: Fitting and user training. 104 B.7: Product (wheelchair) preparation ToT Handbook • In settings where wheelchairs require multiple adjustments, either allocate more time to the session or ensure that technical staff are available to make certain adjustments (such as to the rear wheel position, or advanced technical adjustments). • Where wheelchair users are not able to attend over two days, this session will take place before the user prescriptions have been done. In this case, exclude the activity on page 165 of the Trainer’s Manual under Section 2. Preparing the wheelchair. Only do this on the day the wheelchair users attend, as part of the practical. Content • The PPT describes a clear step-by- step process for product preparation. Reinforce this process during the activity on page 165 of the Trainer’s Manual. • Ensure that groups are working safely and able to finish in the allocated time. c. Section 3. Wheelchair safe and ready checklist Tips for preparation • Where wheelchair users are not able to attend over two days, this session will take place before the user prescriptions are done. In this case, trainers can prepare one wheelchair with minor problems for each group of participants. This could include placing the cushion upside down/back-to-front in the cover and on the wheelchair; loosening a few bolts; lowering one foot plate; and/or deflating a tyre. Content • Before showing the video, provide each participant with a copy of the checklist to follow while watching. 105B.7: Product (wheelchair) preparation ToT Handbook B.8: Cushion fabrication Key considerations for teaching this session a. General Tips for preparation • Have one pressure relief cushion (top layer and base) with a lift available, to be passed around during the presentation. • Preparation for this session will vary depending on the context. If materials for the cushion base need to be fabricated, start at least two days in advance. More details are covered in the Cushions Annex on page 135. • This session reviews information covered in A.7: Cushions. Use the presentation as an opportunity to evaluate participants’ understanding by asking them to explain the principles summarized in the slides. b. Section 2. Cushion features and dimensions • The seat bone-well dimensions shown on page 173 of the Trainer’s Manual need to be clearly explained, using the correct terminology and reference points, as this is often a new concept to participants. • Remind participants they must check that the seat bones fit correctly into the well during the fitting process, using the pressure test. The well should be adjusted if necessary. c. Section 4. How to make a cushion base – practice • If no locally made cushions are available, this session can be used to make a cushion for the wheelchair users assessed in Practical One. Ask participants to work in the same groups as for Practical One and to use the dimensions calculated during the prescription session. • If choosing to glue the top and base layers together, take care to mould the top layer to the contours created by the base layer (if it is pulled tight over the contours, the pressure relief qualities of the cushion will be lost). • Where possible, include a technical trainer for this session and allocate one technical participant to each group to guide fellow participants during the activity. • Encourage participants to double check the cushion measurements once they have finished drawing the dimensions on to their piece of foam. 106 B.8: Cushion fabrication ToT Handbook • Allow 10 to 12 minutes for marking and drawing. • Participants who finish quickly and neatly can support the slower groups. d. Section 6. Frequently asked questions about foam pressure relief cushions • “Does this cushion work for all users?” No cushion works for all users. • “Do all wheelchair users need a pressure relief cushion?” Remind participants of the following: – A wheelchair user with altered or no sensation, must be provided with a pressure relief cushion. – Wheelchair users with sensation, and who have three or more risk factors, also require a pressure relief cushion. – Wheelchair users who do not have any pressure-sore risk factors require either a comfort cushion or a postural support cushion. A pressure relief cushion can be used to provide postural support, as the pre-seat bone shelf (front of the well) prevents the wheelchair user from slumping/sliding and improves posture. 107B.8: Cushion fabrication ToT Handbook B.9: Fitting Key considerations for teaching this session a. General Tips for preparation • Place a wheelchair in the theory area if you plan to demonstrate any of the fitting check activities during the presentation. Ensure that the wheelchair is visible to all participants. Considerations for gender/culture • When dividing the groups, consider whether participants should be grouped according to gender. b. Section 2. Good practice in fitting • After showing the video on the fitting sequence (page 183 of the Trainer’s Manual), highlight how important it is to follow the sequence in the Wheelchair fitting checklist. c. Section 3. Fitting practice Tips for preparation • Ensure group participants have access to a wheelchair that fits them. Content • Checking seat width: the thigh can make contact with the side/armrest of the wheelchair. The seat width is adequate if the assessor can slide their fingers in between the thigh and the wheelchair smoothly. Pressure between the thigh and the armrest/side should be avoided. • Checking seat depth: there may be contact between the cushion and the back of the calf, but there should be no pressure. • Footrest height: about 5 cm clearance is required between the footrest and the ground, which means there is a limit to the length adjustment of the footrest. • Foot propelling: if the seat is too high and the wheelchair user cannot put their foot flat on the ground, make the modifications (to the cushion or the wheelchair) as described in the Technical Annex. 108 B.9: Fitting ToT Handbook B.10: Problem solving Errors in the WSTP materials • Section 1. Introduction: In slide 2 modify the last bullet to be a level one bullet (the same as the first bullet point). • Section 2. Seat depth too short or too long. This section is incorrectly marked as Section 1. Key considerations for teaching this session a. General Tips for preparation • It would help to have a technical co-trainer for this session. • Prepare materials to use in the five problem-solving sessions: – Select appropriate wheelchairs and have some fabric and straps ready to demonstrate how to lengthen the seat – Pre-cut a wood board to fit one of the sample wheelchairs, and demonstrate how to attach it to the seat rails on the wheelchair. • As well as presenting the session, use your facilitation skills to encourage participants to find solutions. For example, ask them which materials they would use to resolve a problem, and how and where they would attach it to the wheelchair. Highlight that solutions must not interfere with functions such as transfers, or folding the wheelchair. • If the participants are experienced, consider dividing them into groups with a wheelchair each and giving them a few problems to brainstorm. 109B.10: Problem solving ToT Handbook b. Section 2. Seat depth too short or too long Problem: Seat depth too short • The solution should not interfere with the folding mechanism of the wheelchair. • When lengthening the seat, using wood or other solid material, suspend the board from the seat rail on hooks so that it can be removed for folding if necessary (Figure 10). • On folding-frame wheelchairs, cut reliefs for the top of the cross brace. The board will also rest on the cross brace. If fixing the seat to the top of the seat rails, keep in mind that it will effectively raise the seat and may affect reach to the back wheel, foot support and back support. Figure 10. Lengthening seat depth • An alternative option is to use a thin board, such as hardboard, cut to fit between the seat rails and extending over the edge of the seat. If light, it can also be attached to the bottom of the extended wheelchair cushion. • If extending the existing cushion, do so at the front. Do not extend from the back of the cushion because any ridges from the glue will increase the user’s risk of developing pressure sores. Demonstrate how to extend seat rails and attach new upholstery to help participants see how this would be done. Problem: Seat depth too long • Shortening an upholstery seat: there is usually a metal strip that reinforces the sides of the seat. The strip will also have to be shortened when the upholstery is cut and re-stitched. Alternatively, a slot can be left in the front of the upholstery to allow the metal strip to be reattached. This allows the metal strips to remain intact when the upholstery needs to be lengthened (for example with growing children). • Another way to shorten the seat, but to allow for a child’s growth, is to cut a small slot in the sleeve that the metal strip fits into on the top side of the upholstery. The metal strip is pushed through this slot and the upholstery folded over at that level. The folded part can be glued together, or stabilized with a few overhand stitches. A reinforcement strap is added to the front of the seat (in between the folded part of the seat) before it is reattached. The reinforcement 110 B.10: Problem solving ToT Handbook strap must be attached directly to the seat rails or looped around the seat rails and attached back to itself. • Adding a cushion to the backrest is not a solution because: – it limits access to the rear wheel for self-propelling – the wheelchair user’s weight is shifted forwards, loading the front castors and increasing the risk of the wheelchair tipping forwards. c. Section 3. Footrests height too low or too high Tips for preparation Problem: Footrests’ height is too low • Cut a foam block to fit one of the flip-up footplates on the sample wheelchairs. Make the block thick enough, so that the footplate does not flip-up properly. Make another sample with a channel cut out to remove the interference with the frame tube. Problem: Footrests’ height is too high • Cut a piece of firm foam to fit an existing wheelchair seat. If possible, demonstrate how it fits inside the cushion cover. Content Problem: Footrests’ height is too low • Rubber/EVA/wood or similar solid materials work well if the footrest needs building up. The build-up can be glued on to the footrest. If it is not possible to glue on to the footplate, then use a wood cut-out, bolt the wood to the footplate, and glue the foam to the wood. • Modifications should not interfere with the flip-up or swing-away mechanism of the footrest. Use the two pre-made samples discussed in the Tips for preparation section, to demonstrate this point, and how to solve it. Problem: Footrests’ height is too high • There must be at least 5 cm clearance between the bottom of the footrest and the ground. • Raising the height of the cushion is provided as a solution to a high footrest problem in the session plan. Highlight the effect of raising the cushion on: 111B.10: Problem solving ToT Handbook backrest height, armrest height and access to the rear wheel. In practice, participants need to consider all three and then decide if raising the cushion is a functional solution for each individual wheelchair user. d. Section 4. Legs tend to roll inwards or outwards Tips for preparation • Cut firm foam wedges to fit one of the sample wheelchair cushions. Content • Demonstrate how wedges are glued on to the base of the cushion and are then covered by the top layer of the cushion. Reinforce this point, when showing slide 12 on page 191 of the Trainer’s Manual, as participants sometimes think that the illustrations are showing the wedges glued on to the top layer of the cushion. • If a wheelchair cushion does not have a removable top layer of foam, show participants how the cushion can be cut on the side and the wedges placed and glued in. • Wedges should not interfere with transfers. • Discuss size and types of material that can be used for wedges (usually the same material as the base of the cushion). • If the seat sags in the middle and the design makes it difficult to tighten the seat tension, a sling-filler pad can also be used to stop the legs rolling inwards (Figure 11). Figure 11. Sling-filler pad e. Section 5. Feet tend to slide off the footrests • Discuss different positions/attachments for a calf/ankle strap. • Straps should not interfere with the mechanism of the footrests (for example their swing-away action) and therefore may need to be detachable. 112 B.10: Problem solving ToT Handbook f. Section 6. Wheelchair is too wide Tips for preparation • Cut samples from EVA or other firm foam and have some ‘outer layer’ materials to show how the foam can be covered with fabric, leather or EVA foam. Content • Discuss which materials the pad could be made from (EVA/rubber/chip foam, with a cover). • Discuss how and where the pad should be attached (on the wheelchair or the cushion; removable or fixed). Discuss advantages and disadvantages of the various solutions and how these might interfere with functions such as the folding mechanism of the wheelchair or transfers. • The cushion should remain the same size as the wheelchair seat. Pads are placed above or on top of the cushion. 113B.10: Problem solving ToT Handbook B.11: User training Key considerations for teaching this session a. General • Park questions about wheelchair maintenance in the Car Park. These will be covered in B12: Maintenance and repairs. • User training skills included in the checklist are covered in sessions A.3: Wheelchair mobility, A.5: Pressure sores, and A.8: Transfers. • As trainers or service providers, it is important to be confident in all the wheelchair skills yourself before teaching them. • Organize the session to ensure that there is sufficient time for user training. • Emphasize that user training is an essential step in wheelchair service provision and time must always be allowed for it in the training programme. A user could have an appropriate and well-fitting wheelchair but not be able to leave their home because they lack confidence in transfer and mobility skills. b. Section 2. What are helpful skills for wheelchair users? • Not all six skills need to be taught to every wheelchair user. Participants need to identify which skills are relevant to the user, based on the information gathered during the wheelchair assessment. c. Section 3. Wheelchair user training practice • Encourage participants to follow the three steps of good teaching: explain, demonstrate, practise. • Explain why everyone involved with the wheelchair user (family member, caregiver) needs to learn the skills too. • Highlight the benefits of peer training. Talking with other wheelchair users and learning from them can be very helpful, especially for new users. Based on their first-hand experience and understanding of particular situations, existing wheelchair users are best placed to demonstrate and teach skills to their peers. 114 B.11: User training ToT Handbook B.12: Maintenance and repairs Key considerations for teaching this session a. General Tips for preparation • Before the session starts, find out which lubricants are available locally and which components need to be lubricated on local wheelchairs. Put together one home maintenance tool kit per group (or ask groups to share items). The kit should include: a spanner, allen keys, screwdriver, tyre pump, puncture repair kit, lubricating oil, bucket, soap, cloth and sandpaper. • If possible, allocate one participant with technical experience to assist and guide each group. Content • Check that participants understand the difference between maintenance and repair: – maintenance refers to regular care that helps to prevent of damage and breakdowns – repairs refer to components that are broken and need to be repaired or replaced. b. Section 2. Prevent repairs: home maintenance Tips for preparation • Identify an area that is suitable for washing wheelchairs with soap and water. This is for the maintenance activity on page 205 of the Trainer’s Manual. Content • Be clear on the maintenance requirements of local wheelchairs. For example, some may have sealed bearings that do not need any lubrication. Give participants a guide on appropriate lubricating oils. Recommend a light oil such as sewing machine oil; heavy oils, such as engine oil, are not suitable. Organic natural oils, (coconut or olive oil), can be used if there is no alternative but tend 115B.12: Maintenance and repairs ToT Handbook to attract unwanted attention from insects. Synthetic oils are more effective and will last longer. • Video clip. In the section on Oil moving parts, there are two points that often cause confusion: – The sealed bearing in the castor barrel does not require lubrication. However, the island climate featured in the video is one of high humidity and salt, so a small amount of oil is used on top of the castor barrel to help reduce rust. – The nut on the front castor axle is not a moving part and does not need to be oiled. Again, due to the example of an island climate, a small amount of oil can be used to reduce rust. • If one or two isolated spokes come loose, these should be tightened as a home maintenance activity using a spoke key. Take care not to over-tighten the spoke. You can check this by seeing how much force is needed on the spoke nipples next to it (located at the wheel rim), and use the same force on the loose spoke. If the spokes are very loose or fall out, take the wheel to a bicycle repair shop. c. Section 3. Common wheelchair and cushion repairs • For the activity on page 206 of the Trainer’s Manual, participants must identify the repairs that their wheelchair needs and decide where these repairs will be done. They do not need to carry out the repairs themselves. • If there are no used wheelchairs with problems available, create some problems in the wheelchairs that you do have. For example, loosen the axle, brake or castor fork bolts and nuts; deflate a tyre; loosen the upholstery bolts and nuts. Remember to fix these problems again at the end of the session – use the Wheelchair safe and ready checklist. • Repairs also include re-aligning (bending back into the correct shape) or replacement of bent components. 116 B.12: Maintenance and repairs ToT Handbook B.13: Follow up Key considerations for teaching this session a. Section 2. What is follow up and how does it happen? • When discussing how often follow up should happen, on page 214 of the Trainer’s Manual, the following points can be used for guidance: – A wheelchair user should be followed up four to eight weeks after receiving their first wheelchair. – Children and wheelchair users with progressive illnesses should be followed up every four to six months as their needs may change very quickly. – Wheelchair users who have a stable condition and have been using a wheelchair for a long time can be followed up annually. – Look at an individual’s needs when setting a follow-up date. b. Section 5. Key point summary • Emphasize that follow up should be more than simply completing a checklist. • Encourage participants to think critically about each question and how wheelchair user responses will influence the actions that need to be taken. • The wheelchair user’s feedback at follow up provides insight into their lived experience and gives invaluable feedback to service providers. 117B.13: Follow up ToT Handbook B.14a: Practicals one to four Key considerations for teaching this session a. General Tips for preparation Training area and set up • Set up the practical area so that each group has enough space to carry out their interview and physical assessments privately. Group allocations • Consider grouping participants from the same service together and/or to mixing clinical and technical participants. Group more confident/talkative participants and quieter/less sure participants so they can work with others at a similar pace. Supervision • Allocate a supervising trainer to each group. The lead trainer should supervise fewer groups as they need enough time to check in with the support trainers and keep the session on track. Wheelchair users • Identify a link person from the host organization to liaise between the service and the training programme. Their role will include: receiving wheelchair users; following up on latecomers; and coordinating user follow up after the training programme. • Have a back-up wheelchair user available in case someone is no longer able to attend. • Temporary wheelchairs and cushions should be available for those wheelchair users who do not have their own wheelchairs when they arrive. • Ensure that food and drinks are available for wheelchair users. 118 B.14a: Practicals one to four ToT Handbook Taking photographs • Check that wheelchair users and participants have agreed to be photographed and have signed the consent forms. • Any modifications made to the cushion should be photographed before the cover is put on. • During the practical sessions take before and after images, as well as close-ups of modifications; this will make the participant presentations in B.14 Putting it all together more useful as a learning exercise. • Allocate one trainer to take photographs. This allows participants to focus on the practical and makes it easier to download and organize photos afterwards. b. Practical One: Assessment and prescription (selection) • Before starting, participants need to decide who will be responsible for which part (interview, physical assessment, measurement, fitting and training). Participants should not interrupt each other but wait for a colleague to finish before adding a comment and moving on to the next part. • Ask participants to complete the assessment interview in 20 to 25 minutes. • Closely monitor the physical assessment and correct any errors (for example, incorrect measuring technique) that would influence the prescription. • Body measurements need to be converted to wheelchair measurements before preparing the wheelchair prescription. • The wheelchair user should be an active participant during the prescription process. Ensure that participants have discussed wheelchair options and features with the wheelchair user before the final prescription is made. If demonstration wheelchairs are available, these can be used to explain specific wheelchair features to the user and to answer any questions. • Ask each group of participants to explain the clinical reasoning for the prescription they have chosen. c. Practical Two: Fitting and user training • Trainers should supervise the same groups as for Practical One. • Participants should do an initial check of the seat width and depth, and the footrest height with the user in the wheelchair. Then ask the wheelchair user to propel (with arms or feet) over relevant surfaces while another participant watches closely. This helps determine if any major adjustments need to be done, for instance moving the position of the rear wheel or increasing backrest height. 119B.14a: Practicals one to four ToT Handbook Participants can then complete the Wheelchair fitting checklist and prepare to finalize all adjustments. • Check all adjustments and modifications before participants glue/fix them in place. • Review the final fitting check before participants begin user training. • Before wheelchair users depart, give them the name and contact details of someone to help if they have any problems or questions about the wheelchair. Organize a follow-up appointment for the wheelchair user at a service that is easily accessible. • If applicable and time allows, finish with a short feedback session. d. Practical Three: Follow up Tips for preparation • In some situations, there is a lot of pressure to complete all repairs and adjustments. However, follow up is the focus of the training and these additional requests often cannot be accommodated at the same time. It is important that wheelchair users are fully informed so their expectations are realistic. Content • Allocate participants to new groups. • Monitor the groups and ask questions to see whether participants understand the information they are getting and can take appropriate action. • Any modifications or changes that are needed should be documented and discussed with the trainers. They can only be done if they are simple and fit into the allotted time. e. Practical Four: Assessment, prescription (selection), product (wheelchair) preparation, fitting and user training • Allocate participants to new groups. During the introduction, explain how much time is allocated for each step (listed on page 224 of the Trainer’s Manual). Write this information on the board to help participants keep to time. Participants can tick as they complete each step and indicate how much time it took. • Depending on the experience and availability of technical staff, consider allocating one of them to each group as this will speed things up. 120 B.14a: Practicals one to four ToT Handbook • If any groups do not have time to complete all the steps, organize an appointment for the work to be completed at a service accessible to the wheelchair user. • Explain to participants that they should allocate tasks within their group. For example, during product preparation one person can adjust the footplate; another cuts the cushion well and a third cuts pads to narrow the wheelchair. Explain that good task allocation will ensure that all steps are completed within the allocated time. 121B.14a: Practicals one to four ToT Handbook B.14: Putting it all together Errors in the WSTP materials a. Section 2. Participants’ questions • The time section in the activity on page 225 of the Trainer’s Manual should say ‘Allow 5 minutes in total’ instead of 10 minutes. Key considerations for teaching this session a. Section 3. Participants’ preparation Tips for preparation • Allocate a trainer to download and organize the before and after photographs needed to illustrate each presentation. This task should be done during a break. • Display before and after photographs side by side as an effective way of showing the impact and outcome of the fitting. Content • Allocate support trainers to help the groups prepare. • Tell participants that you will give them 5 and 1 minute warnings to ensure that each presentation is limited to 10 minutes. b. Section 4. Participants’ presentations • Facilitate the presentations to ensure that they remain focused and that participants explain key learning points clearly. • During the presentation and facilitation, link how the wheelchair and cushion features meet the user’s environmental, functional and postural support and fitting needs. • Where wheelchair options and choices are limited, highlight where compromises have been made. Emphasize that any compromise needs to be discussed and agreed with the wheelchair user. 122 B.14: Putting it all together ToT Handbook c. Section 5. Question-and-answer session • Encourage participants to set up a support network for continuing professional development and generally to keep supporting and learning from each other. • This could be done in-person or online using a social media platform. • A support network may include a forum to post and discuss clinical questions; to share information and latest research; or more formal meetings to present and discuss case studies. • Confidential information about service users should never be shared without written permission. d. Section 6. Key points • Encourage participants to practise and apply all the skills and knowledge they have gained during the programme (practice makes perfect!). 123B.14: Putting it all together ToT Handbook Logistics and preparation The Trainer’s Manual includes a comprehensive list of facilities, printed resources, materials and equipment needed to successfully organize a WSTPb training programme. The trainer coordinating the training programme will usually liaise with the local host to decide who takes responsibility for each aspect of the logistics and preparation. The trainees will gain experience and skills in handling logistics and preparation tasks during their co-training. The trainer coordinator will divide up these activities among trainees and then monitor and support them. Facilities and services A facilities checklist is included on page 14 of the Trainer’s Manual. Translation services may be needed if the WSTPb trainers do not speak the same language as participants. These services are usually in high demand and should be booked well in advance. Costs will need to be added to the training budget. Printed resources Materials must all be printed locally. A full list of the printed resources needed for the WSTPb can be found on pages 14 – 16 of the Trainer’s Manual. Use the checklist in the Trainer’s Manual to ensure that you have printed the correct number of materials. Materials and equipment A list of materials and equipment needed for the WSTPb can be found on pages 17–18 of the WSTPb Trainer’s Manual. 124 Logistics and preparation ToT Handbook Wheelchairs The last row on page 17 of the Trainer’s Manual refers to locally available wheelchairs and cushions. If there are many different wheelchairs available, select the models that are used most often ensuring that the following wheelchairs/ features are included: • rigid frame 3-wheel wheelchair • rigid frame 4-wheel wheelchair • folding-frame wheelchair with adjustment options • basic folding-frame (orthopaedic-style) wheelchair • short-wheelbase wheelchair (4-wheel wheelchair) • long-wheelbase (3- and 4-wheel wheelchairs). In less-resourced settings where there are no long-wheelbase four-wheel or three- wheel wheelchairs available, consider introducing examples to participants. The benefits of long-wheelbase wheelchairs in less-resourced settings have been well documented and they are often the most appropriate design for active wheelchair users. Funds to purchase these samples should be included in the training budget. Do not include motorized wheelchairs or wheelchairs that have supportive seating/additional postural support devices as these are not covered in the WSTPb. Ensure that all wheelchairs are in good working order (tyres pumped up and bolts tightened) and have a cushion. There should be a wheelchair and cushion – or materials to make a cushion – for each wheelchair user who attends the practical sessions, as well as basic items like ankle and calf straps. Consumables Page 18 of the Trainer’s Manual lists the foam needed for the cushion fabrication practical. Additional foam, glue, upholstery, nuts/bolts and other components and spares may be needed to make basic modifications to wheelchairs. These should be added to the Materials table at the top of page 17 in the Trainer’s Manual. The complete list of resources needed will depend on the context. Depending on the resources available, technical assistance may be arranged for modifications (for example shortening/extending seats or footrest hangers). 125Logistics and preparation ToT Handbook Technical work area A technical work area with a variety of tools and materials needed for modifications should be made available or created. This may have budget implications for the training. Power supply Where there is unreliable electricity, a generator with an in-line uninterruptible power supply should be arranged for back-up. This also needs to be added to the equipment list on page 17 of the Trainer’s Manual. Planning for training The most important activities and approximate timelines for planning a WSTPb training programme are listed here. 8 to 12 months in advance • Develop a budget for the training programme. • When multiple partners are involved, agree on the responsibilities of different partners. • Identify dates, a venue, trainers, participant profiles and information on the local context such as: general policies and procedures that guide local wheelchair practice and services; types of wheelchairs, cushions and other materials available; information on local culture and diversity of the participants; and organizations involved. • To work out how many days are required for the training, confirm start and finish times for each day and whether translation will be required. 4 to 6 months in advance • Send invitation letters to each participant with details of the training programme (dates, venue, logistical information) to complete and return. • Gather information on the professional background and skills of participants so that you can adapt session plans accordingly. • Book training equipment. • Source demonstration equipment and other resources needed for the practical sessions, such as treatment beds, foot supports, and transfer boards. • Source consumables. • Source equipment for users (if user equipment is dependent on donor funds and/ or part of the training budget, sourcing equipment may need to start earlier). 126 Logistics and preparation ToT Handbook • Brief trainers on the context and participants, and agree on the division of sessions and roles. • Book catering services. • Arrange for translators and translation facilities if needed. 4 to 6 weeks in advance • Arrange for local printing of all necessary materials. • Screen and invite wheelchair users. • Finalize registration details: for example, arrange for name tags and registers; and liaise with whoever will carry out the registration. • Send final written confirmation/pre-course information to participants, wheelchair users and trainers. • Confirm caterers, venue and other logistics. 1 to 2 weeks in advance • Confirm that any ordered items have been delivered. • Check toilets, water and electricity supply at venue. • Confirm cleaning schedules. If the training team is not local, it is best to arrive a few days before the programme begins to check the equipment and the venue; meet with wheelchair users supporting the training programme; and to buy any remaining materials required. Regular communication will be needed between the coordinating trainer and other trainers, the host organization and other organizations involved. Wheelchair users During the WSTPb, there are four practical sessions in which three groups of wheelchair users participate. The first group attends on two different days. Before the training programme, trainers need to identify and invite wheelchair users who are willing and able to attend the practical sessions. There is a checklist on page 11 of the Trainer’s Manual that helps to identify wheelchair users. Liaise with the host organization and training organizers regarding budgets and facilities available for wheelchair users. Find out if transport will be provided for wheelchair users or whether they will be reimbursed for costs. If wheelchair users are only able to attend on one day, the programme can be rearranged to accommodate Practical One and Practical Two for user group one on 127Logistics and preparation ToT Handbook the same day. When adjusting the timetable, make sure service steps 2–7 have been covered before Practical Three. Where possible, trainers should screen wheelchair users in person. If trainers are not based locally, a local service provider can be asked to identify potential wheelchair users and send photos and information in advance for trainers to confirm their suitability for the training level. Invitations to wheelchair users When drafting invitations to wheelchair users think about the following issues (a template is available on the WSTP Pen Drive): • A description of what will happen when they attend the session. • The time, date and the duration of the session. • Can they bring someone with them? • Will they receive a wheelchair at the session? What happens if they need follow up or have any problems with the wheelchair? • Where will they receive follow-up services after the training? • How will they get to the venue? Will their transportation costs be reimbursed? • Do they have to bring refreshments and lunch? • Will they receive payment for attending? Each wheelchair user should receive an invitation letter with this information in writing. They should also sign a consent form to indicate their willingness to take part and to be photographed. The photographs are used when the small groups present back to the rest of the group. Despite careful planning, a wheelchair user may arrive with a pressure sore or fall ill on the day of the session. Discuss this possibility in advance with the host organization so that they are ready to manage the situation if it arises, and can arrange for a back-up wheelchair user to attend. If a wheelchair user has a bladder or bowel accident during the session, have supplies ready to clean the user and the equipment. Also, a small first aid kit should be available in case of bumps and scrapes to both participants and wheelchair users. 128 Logistics and preparation ToT Handbook 129AnnexesToT Handbook Annexes Annex 1: Timetable for WSTPtot core sessions Day One Day Two 8:30 ToT.1 Introduction to the WSTPtot (75) ToT.7 Presenting and Facilitating (60) 8:45 9:00 9:15 9:30 ToT.8 Communication skills (90) 9:45 ToT.2 Wheelchair Service Training Packages (90) 10:00 10:15 10:30 10:45 11:00 – 11.15 Morning break (adjust time to suit local context and session plan) 11:15 ToT.2 Wheelchair Service Training Packages ToT.9 Guiding documents (75) 11:30 ToT.3 Practice deliveries (60) 11:45 12:00 12:15 – 1.15 Lunch (adjust time to suit local context and session plan) 1:15 ToT.3 Practice deliveries ToT.9 Guiding documents 1:30 ToT.4 Preparing for diversity (60) ToT.10 Audio-visual tools and equip- ment (45)1:45 2:00 2:15 ToT.11 Feedback (45) 2:30 ToT.5 Adult learning (80) 2:45 – 3.00 Break (adjust time to suit local context and session plan) 3:00 ToT.5 Adult learning ToT.11 Feedback 3:15 ToT.12 Managing group dynamics (45) 3:30 3:45 4:00 ToT.6 Preparation time (15) Preparation (60) 4:15 Preparation (45) 4:30 4:45 130 AnnexesToT Handbook Annex 2: WSTPtot Basic Level Timetable Day one Day two Day three 8:30 Introduction 30 A.6 Appropriate wheelchairs Part 2 (78) B.4 Physical assessment 85 8:45 9:00 A.1: Wheelchair users 25 9:15 9:30 A.1: Feedback 10 9:45 A.3 Wheelchair mobility 90 10:00 Part I (37) A.6 Feedback 5+5 B.4 Feedback 5+5 10:15 Morning break Morning break Morning break 10:30 A.3 Wheelchair mobility (43) A.7 Cushions 75 B.5 Prescription 120 10:45 11:00 11:15 A.3 Partial wheelie 10 11:30 A.3 Feedback 20 11:45 A.4 Sitting upright 45 A.7 Feedback 5+5 12:00 A.8 Transfers 65 12:15 12:30 A.4 Feedback 10 Lunch break B.5 Feedback 5+5+5 12:45 Lunch break Lunch break 1:00 1:15 1:30 A.8 Transfers 1:45 A.5 pressure sores 60 B.7 Product preparation 40 2:00 2:15 A.8 Feedback 5+5+5 2:30 A.8 Floor to chair 10 B.7 Feedback 5 131AnnexesToT Handbook 2:45 A.5 Feedback 10 B.3 Assessment interview 90 Part 1 (47) B.9 Fitting 60 3:00 Afternoon break 3:15 A.6 Appropriate wheelchairs 120 Part 1 (42)3:30 Afternoon break B.9 Feedback 5+5 3:45 A.6 Feedback 5 B.3 Assessment interview Part 2 (43) Afternoon break 4:00 Car park 15 B.13 Follow-up 35 4:15 Session preparation ToT Trainer individual feedback B.3 Feedback 5+5 4:30 Session preparation ToT Trainer individual feedback B.13 Follow-up 5 4:45 Car park 15 5:00 Evaluation 15 5:15 Closing ceremony 15 132 AnnexesToT Handbook Annex 3: Feedback sheet for WSPTtot practice delivery sessions Trainee: ________________________ ToT trainer: _______________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No This feedback sheet is a tool to help to develop the confidence and training skills of WSTPtot trainees. This sheet can be used by: • trainees, to reflect on their training skills • ToT trainers, to give feedback to trainees. Instructions to ToT trainers: After each practice delivery, write in the two columns below, using the WSTPtot trainee skills list below for guidiance. At the end of the WSTPtot, complete the recommendation and summary at the end of page 2. WSTPtot trainee skills: • preparation • time management • delivery of WSTP materials • presenting • facilitating • communication • managing group work • giving feedback. First practice delivery What was good What can be improved 133AnnexesToT Handbook Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved Trainee: ________________________ ToT trainer: ________________________ Session name/number: _________________ Sections: ______________________ Date: __________ Allocated time: ___________ Actual time taken: ___________ Finished all sections? Yes No Second practice delivery What was good What can be improved 134 AnnexesToT Handbook Instructions to ToT Trainers: At the end of the WSTPtot, select your recommendation below and write a brief summary of the trainee’s strengths and areas for improvement. Recommendation and summary ToT trainer recommendation: Continue to co-training Develop knowledge and/or skills before continuing to co-training (details below) Summary 135AnnexesToT Handbook Annex 4: Cushions Annex Preparations The resources available for sessions A.7: Cushions and B.8: Cushion Fabrication will vary depending on the context of the training course. Aim to use materials and fabric that will be accessible and affordable for participants after the training. In some contexts ready-made cushions may be available. If not, source or buy appropriate materials and make sample cushions before the training starts. When using glue, ensure that you leave enough time for it to dry. This is particularly important if you are glueing several layers together to create the required thickness. Fabricating cushions and cushion covers Look in the local market and visit foam, shoe, mattress and furniture factories to find locally-available foam. Ensure that you have the correct firmness of foam: • The base layer materials must be firm enough to maintain their shape under the weight of the user. Suitable materials for the cushion base are often hard to source. Where resources are scarce, alternatives can include layered ethyl vinyl acetate (EVA), chip foam or rubber (such as a yoga mat). • The top layer should be soft enough to allow the seat bones to sink into it, but should not be so soft that the seat bones can sink all to the bottom to rest on the solid base of the wheelchair seat. See the Technical Annex for more information about how to test foam firmness. Aim to have different thicknesses of foam available (30−50 mm) for demonstration and provision to wheelchair users. Figure 1. Pressure relief cushion 136 AnnexesToT Handbook For the cushion cover: • Choose a fabric with two-way stretch that follows the shape of the cushion, such as T-shirt material or lycra. • If stretchy fabric is not available, ensure there is enough room in the cover to fit into the contours of the cushion. Pleats in the cushion cover may also allow it to fit the shape of the cushion better (especially in the well area). • Avoid thick folds that mark the skin. The fabric should be thin enough to avoid causing ridge marks when sitting on a fold. Samples for participants Have examples of suitable and unsuitable materials (foams, rubbers, fabrics) for the base layer, the top layer and cushion cover. Samples of materials should be a minimum of a 50 x 50 mm and fabric 100 x 100 mm. This will help participants to understand which materials are acceptable and which are not. If possible, put together a small sample kit of good examples for each participant to take home. Moisture and incontinence management Water-resistant or waterproof cushion covers for users who are incontinent can be difficult to source. Options include: • Providing two cushions so that one can be used, while the other is being washed and dried. • Covering the cushion with a thin plastic bag. When covering a cushion with a very thin plastic bag: • Ensure it is loose enough to allow the wheelchair user to sink into the soft top layer of the cushion. This will ensure the user continues to benefit from posture support and pressure relief aspects of the cushion. If providing a cushion with more than one layer, consider only covering the base layer with a plastic bag. • The top layer can then be removed and replaced as necessary. • Providing more than one layer to the user will help them to wash and dry the top layers each time they get wet or soiled. 137AnnexesToT Handbook Covering the cushion with a plastic bag may create heat and cause sweating/ moisture for the user, which are risk factors for pressure sores. • Talk with users about the increased risk of developing a pressure sore. • Encourage them to check their skin regularly. Remember that wheelchair users should never sit directly on the plastic; the cushion should always be used with a cover. Tools for cushion fabrication For some participants, it may be their first experience of making a cushion. Give them some practical tips on the tools and materials they will be using, for example: Apply masking tape to one end of the hacksaw blade to create a grip, to make cutting easier and more effective (Figure 2). The tooth edge of the saw blade should be ground down for foam cutting. For more details on preparing a hacksaw blade for cutting, refer to the WSTPm additional resources. Figure 2. Hacksaw blade Create a guide when fabricating a cushion A visual guide can be made out of cardboard or wood. A guide is helpful for marking up a cushion before cutting, for example when removing a small bevel from the edges of the well (Figure 3). Figure 3. Using a guide when cutting 138 AnnexesToT Handbook A guide can also be useful when cutting a consistent shape or straight line (Figure 4). Figure 4. Cutting a straight line Seat and cushion modifications to enable foot propelling When modifying a wheelchair to allow the user’s foot to comfortably reach the floor (session B.4: Physical assessment) consider the following options. Reduce the overall height of the cushion • Use a thinner base layer or top layer of foam on the cushion. • If the user is at risk for pressure sores, use the finger pressure test to ensure that the cushion provides enough pressure relief. Lower the seat of folding-frame wheelchairs by attaching a solid seat • Suspend the seat board from the seat rail on hooks, then it can be removed easily (Figure 5). • Cut reliefs for the top of the cross brace. Figure 5. Solid seat with hooks 139AnnexesToT Handbook Modify the cushion by adding a lowered seat front Add a lowered seat front to the cushion on the side of the leg that needs to reach the floor (Figure 6). • The length of the lowered seat front starts from the shelf and extends down to the front edge of the cushion. • The width of the lowered seat front is half of the overall width of the cushion. • There should be even contact under the user’s seat bones and thighs. Figure 6. Lowered seat front Modify both the seat and cushion Shorten the seat and cushion on the side of the propelling leg (Figure 7). • Solid seat: Shorten the seat and the cushion to the required length on the side which needs to reach the floor. This should be combined with a lowered seat front. • Fabric slung seat: Shorten the entire seat to the desired length. Add a board the same shape as the cushion, extending over the edge of the seat. It may be necessary to replace the fabric seat with a lowered solid seat. Figure 7. Shortened seat and cushion 140 AnnexesToT Handbook Annex 5: Updated Wheelchair Assessment Form For assessment of wheelchair users who can sit upright easily. Wheelchair users who cannot sit upright easily may need assessment by a person with ‘intermediate’ level training. Keep this form in the wheelchair user’s file. Assessor’s name: Date of assessment: 1: Interview Assessment Information about the wheelchair user Name: Number: Age: Male Female Phone no.: Address: Goals: Physical condition Cerebral palsy Polio Spinal cord injury Stroke Frail Spasms or uncontrolled movements Amputation: R above knee R below knee L above knee L below knee Bladder problems Bowel problems If the wheelchair user has bladder or bowel problems, is this managed? Yes No Others: __________________________________________________________________ Lifestyle and environment Describe where the wheelchair user will use their wheelchair: ___________________________________________________________________ Distance travelled per day: Up to 1 km 1– 5 km More than 5 km 141AnnexesToT Handbook Hours per day using wheelchair? Less than 1 1-3 3-5 5-8 more than 8 hours When out of the wheelchair, where does the user sit or lie down and how (posture and the surface? ___________________________________________________________________ Transfer: Independent Assisted Standing Non-Standing Lifted Other Type of toilet (if transferring to a toilet): Squat Western Adapted Does the wheelchair user often use public/private transport? Yes No If yes, then what kind: Car Taxi Bus Other _________________________ Existing wheelchair (if a person already has a wheelchair) Does the wheelchair meet the user’s needs? Yes No Does the wheelchair meet the user’s environmental conditions? Yes No Does the wheelchair provide proper fit and postural support? Yes No Is the wheelchair safe and durable? (Consider whether there is a cushion) Yes No Does the cushion provide proper pressure relief (if user has pressure sore risk)? Yes No Comments: _________________________________________________________ If yes to all questions, the user may not need a new wheelchair. If no to any of these questions, the user needs a different wheelchair or cushion; or the existing wheelchair or cushion needs repair or modifications. 142 AnnexesToT Handbook 2: Physical Assessment Presence, risk of or history of pressure sores /// = does not feel O = previous pressure sore l = existing pressure sore Can feel normally? Yes No Previous pressure sore? Yes No Current pressure sore? Yes No If yes, is it an open sore (stage 1– 4)? Yes No Duration and cause: ________________________ ______________________________________ Is this person at risk* of a pressure sore? *A person who cannot feel or has 3 or more risk factors is at risk. Risk factors: cannot move, moisture, poor posture, previous / current pressure sore, poor diet, ageing, under or over weight. Yes No Method of pushing How will the wheelchair user push their wheelchair? Both arms Left arm Right arm Both legs Left leg Right leg Pushed by a helper Comment: __________________________________________________________ 143AnnexesToT Handbook Measurements Body Measurement Measurement (mm) Change body meas- urement to ideal wheelchair size Wheelchair measurement A Hip width Hip width = seat width B Seat depth L B less 30 – 50 mm = seat depth (if length is different, use shorter one) R C Calf length L (C less cushion height*) C less cushion height* = seat to top of footplate or seat to floor depending on user’s needs R D Bottom of rib cage (D or E [depending on user’s needs] + cushion height*) D or E (depending on user’s needs) + cushion height* = seat to top of backrest E Bottom of shoulder blade *check the height of the cushion that the wheelchair user will use.

146 AnnexesToT Handbook For more information, contact: World Health Organization 20, Avenue Appia CH-1211 Geneva 27 Switzerland Tel.: (+ 41 22) 791-2715 Fax: (+ 41 22) 791-4874 www.who.int/disabilities/en/