Manual Wheelchair Research Articles

Investigation of traffic accidents involving seated pedestrians using a finite element simulation-based approach

Pedestrians who use wheelchairs (seated pedestrians) report 36% - 75% higher mortality rates than standing pedestrians in car-to-pedestrian collisions but the cause of this mortality is unknown. This is the first study to investigate the cause of seated pedestrian mortality in vehicle impacts using finite element simulations. In this study a manual wheelchair model was developed using geometry taken from publicly available CAD data, and was tested to meet ISO standards. The GHBMC 50th percentile male simplified occupant model was used as the seated pedestrian and the EuroNCAP family car and sports utility vehicle models were used as the impacting vehicles. The seated pedestrian was impacted by the two vehicles at three different locations on the vehicle and at 30 and 40 km/h. In 75% of the impacts the pedestrian was ejected from the wheelchair. In the rest of the impacts, the pedestrian and wheelchair were pinned to the vehicle and the pedestrian was not ejected. The underlying causes of seated pedestrian mortality in these impacts were head and brain injury. Life-threatening head injury risks (0.0% - 100%) were caused by the ground-pedestrian contact, and life-threatening brain injury risks (0.0 - 97.9%) were caused by the initial vehicle-wheelchair contact and ground-pedestrian contact. Thoracic and abdominal compression reported no risks of life-threatening injuries, but may do so in faster impacts or with different wheelchair designs. Protective equipment such as the wheelchair seatbelt or personal airbag may be useful in reducing injury risks but future research is required to investigate their efficacy.

Progression of rotator cuff tendon pathology in manual wheelchair users with spinal cord injury: A 1-year longitudinal study

Objective To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology. Design Longitudinal cohort study, 1-year follow-up. Setting Outpatient clinic at a tertiary medical center. Participants Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals. Interventions Not applicable. Main outcome measure(s) Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant. Results Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort. Conclusion MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Association between individual wheelchair skills and fitness in community-dwelling manual wheelchair users with spinal cord injuries

Purpose Wheelchair skills are a key component to promotion of community participation among persons with spinal cord injury (SCI). The objective of this secondary analysis was to examine the association between individual wheelchair skills from the Wheelchair Skills Test Questionnaire (WST-Q) and fitness among community-dwelling adults with SCI. Materials and methods Twenty-six adults were recruited to complete the WST-Q and a standard graded aerobic wheelchair exercise test on a motorized treadmill for assessing peak power output (POpeak). Results Spearman Rho rank-order correlation (ρ) analyses indicated statistically significant correlations between POpeak and six basic (ρ = 0.41–0.57), eight intermediate (ρ = 0.44–0.59), and nine advanced (ρ = 0.42–0.80) WST-Q skill scores. After controlling for sex and injury level (Partial Spearman Rho rank order) significant correlations persisted for four advanced skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position; ρ = 0.46–0.59) and one additional skill (i.e., ascends high curb ρ = 0.51). Conclusions More advanced wheelchair skills are significantly associated with fitness in persons with SCI. The directionality of the skills-fitness relationship, specifically whether wheelchair skills facilitate greater fitness or fitness is a prerequisite for certain wheelchair skills needs to be determined in future, larger studies. However, results from this study provide a comprehensive list of wheelchair skills that are associated with fitness that can be directly applied to guide further research and practice promoting community participation among persons with SCI. Implications for Rehabilitation Significant positive associations exist between advanced wheelchair skills (i.e., descends high curb, turns in place in wheelie position, descends steep incline in wheelie position, descends high curb in wheelie position and ascends high curb) and fitness in manual wheelchair users with spinal cord injury (SCI). This study provides a list of skills associated with fitness to guide clinical practice and areas for further rehabilitation research assessing the directionality of the relationship between fitness and wheelchair skills.

Physical activity levels and shoulder pain in wheelchair users during COVID-19 restrictions

BackgroundManual wheelchair users are at high risk of developing shoulder pain. However, it is not known if restrictions to limit the spread of the COVID-19 virus affected physical activity, wheelchair use and shoulder pain. ObjectiveThe aim of the study is to determine whether COVID-19 related restrictions caused changes in physical activity levels and the presence of shoulder pain in persons who use a wheelchair. MethodsManual wheelchair users completed a survey about the presence and severity of shoulder pain in a cross-sectional study design. Participants completed the Leisure Time Physical Activity Questionnaire and were asked about daily wheelchair activity before and during lockdown. A logistic regression examined the relationship between increase in shoulder pain severity and change in activity levels. ResultsSixty respondents were included for analysis. There was no significant change in physical activity during lockdown. There was a significant reduction in number of hours of daily wheelchair use and number of chair transfers during lockdown. Of the respondents, 67% reported having shoulder pain and 22% reported their shoulder pain becoming more severe during lockdown. No significant relationship was observed between the change in activity levels and increasing severity of shoulder pain. ConclusionRestrictions to reduce the spread of the COVID-19 virus resulted in no changes in physical activity levels in a sample of adult manual wheelchair users; however, there was a reduced time using a wheelchair each day and fewer chair transfers. The changes in wheelchair activities were not related to the worsening of shoulder pain.

Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults

Purpose To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults. Methods The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses. Results Fifty older adults, aged 65–85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%. Conclusions Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults. Implication for rehabilitation Given the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills. Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills. Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.

Effect of Haptic Training During Manual Wheelchair Propulsion on Shoulder Joint Reaction Moments.

BackgroundManual wheelchair propulsion remains a very ineffective means of locomotion in terms of energy cost and mechanical efficiency, as more than half of the forces applied to the pushrim do not contribute to move the wheelchair forward. Manual wheelchair propulsion training using the haptic biofeedback has shown an increase in mechanical efficiency at the handrim level. However, no information is available about the impact of this training on the load at the shoulders. We hypothesized that increasing propulsion mechanical efficiency by 10% during propulsion would not yield clinically significant augmentation of the load sustained at the shoulders.MethodsEighteen long-term manual wheelchair users with a spinal cord injury propelled a manual wheelchair over a wheelchair simulator offering the haptic biofeedback. Participants were asked to propel without the Haptic Biofeedback (HB) and, thereafter, they were subjected to five training blocks BL1–BL5 of 3 min in a random order with the haptic biofeedback targeting a 10% increase in force effectiveness. The training blocs such as BL1, BL2 BL3, BL4, and BL5 correspond, respectively, to a resistant moment of 5, 10, 15, 20, and 25%. Pushrim kinetics, shoulder joint moments, and forces during the propulsive cycle of wheelchair propulsion were assessed for each condition.ResultsThe tangential force component increases significantly by 74 and 87%, whereas value for the mechanical effective force increases by 9% between the pretraining and training blocks BL3. The haptic biofeedback resulted in a significant increase of the shoulder moments with 1–7 Nm.ConclusionIncreases in shoulder loads were found for the corresponding training blocks but even though the percentage of the increase seems high, the amplitude of the joint moment remains under the values of wheelchair propulsion found in the literature. The use of the HB simulator is considered here as a safe approach to increase mechanical effectiveness. However, the longitudinal impact of this enhancement remains unknown for the impact on the shoulder joint. Future studies will be focused on this impact in terms of shoulder risk injury during manual wheelchair propulsion.

User experience study of an affordable manual standing wheelchair

Purpose The manual user-operated Arise Standing Wheelchair (SWC) is the end-result of multiple design iterations based on comments from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customizability. This paper describes a user experience study of the Arise SWC’s pre-commercial version. Methods Thirty participants (N = 30, 25 Male, 5 Female) were recruited for the study. All the participants were people with spinal cord injury. The study was conducted over a period of six weeks (five participants per week) within the hospital premises under the supervision of clinical personnel. A 30 min interactive training session involved thirteen activities. During the trial period, the participants were trained to perform twenty-two activities to familiarize themselves with the SWC. The participants were also trained to perform four functional usage activities with the SWC. At the end of the study, participant responses to ten outcome measures were captured using a smiley-based Likert-scale questionnaire. Results A majority of the participants (93.3%) felt happy when they stood in the SWC. The majority participants (83.3%) preferred the Arise SWC over their current wheelchair. Also, 80% participants anticipated that they could get more work done at home using the standing function of the wheelchair. Conclusions A one-time fitting and training ensured optimal effort for the SWC operation, correct posture, and comfortable user experience. With proper dissemination and awareness, it is believed that the Arise SWC will benefit eligible users and improve their quality of life. IMPLICATIONS FOR REHABILITATION The Arise wheelchair provides standing functionality, outdoor mobility, affordability, and customizability. Study confirms that incorporating standing functionality can improve the quality of life for wheelchair users. The majority of users were happy, felt safe and expected to do more with the standing functionality. Study results support further testing in real world conditions beyond the hospital setting.

Dutch-Flemish translation and cross-cultural adaption of the Spinal Cord Injury-Quality of Life (SCI-QOL) short forms

PurposeA spinal cord injury (SCI) has a large impact on a person’s physical, psychological, and social health. Previous studies focused on physical recovery in patients with SCI and assessed their health-related quality of life (HRQOL) with general questionnaires, which often contain irrelevant questions. The SCI-QOL questionnaire was developed to specifically assess the HRQOL of the SCI population. A comprehensive translation and cross-cultural adaptation are required to use this questionnaire in the Netherlands and Flanders, Belgium.MethodsAll 23 short forms of the SCI-QOL for adults were translated from English into Dutch-Flemish using the Functional Assessment of Chronic Illness Therapy translation methodology, with a cognitive debriefing being performed with 10 patients with SCI and 10 persons from the general population.ResultsThe Dutch-Flemish PROMIS group previously translated 46 of the 207 items in the 23 short forms. Here, we achieved an acceptable translation of the other 161 items. A single Dutch-Flemish translation was obtained for 20 short forms, while separate Dutch and Flemish translations were necessary for the short forms Ambulation, Manual Wheelchair, and Stigma.ConclusionThe Dutch-Flemish translation of the SCI-QOL is now available for clinical and research purposes. Future studies should focus on the psychometric properties of this cross-culturally adapted version.

A descriptive analysis of wheelchair repair registry data

ABSTRACT Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability.

Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study

Purpose The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would be the strongest predictor of cycle time. Materials and methods Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted. Results The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro [p < .001], Great Lakes [p = .016], and Northeast area [p < .001]), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and “other” (p = .028)) were associated with lower cycle time. Conclusions Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities. Implications for rehabilitation The national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source. Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times. Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times. As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.

Training Program to Modify Manual Wheelchairs to Simplified Power Wheelchairs for Community Dwelling Elderly People and Caregivers.

Mobility aids, particularly power wheelchairs, are necessary for elderly individuals who have health problems and disabilities. However, there is a limitation in providing power wheelchairs for such people in the community. The objectives of this study were to develop a prototype for a simplified power wheelchair and develop and evaluate a training program that has the potential to encourage evaluation and modification of the wheelchair for the elderly and their caregivers in the community. Twenty-four participants consist of elderly people and caregivers who were interested in the training program that comprised two sessions: theory and fieldwork experience. Results showed that the elderly people and caregivers, who had no knowledge or experience of wheelchair modification, were able to learn and provide suggestions for wheelchair users in their community. Two themes emerged from evaluating the training program, which included “benefits from the training program” and “improvement of the training program in the future.” Key concepts were elicited and considered in six categories: sufficient knowledge and practical learning to build confidence, values of fieldwork experiences, team support, organizational support, expansion of various contexts, and system of continued connection and services after training.

Concrete Paving Slabs for Comfort of Movement of Mobility-Impaired Pedestrians-A Survey.

People with locomotion difficulties encounter many barriers in a pedestrian environment. Pavement quality has been shown to substantially affect pedestrian satisfaction in general, and its optimal design may contribute to reducing the stigma put on people with impairments. Our research involved a survey assessing perception and attitudes towards pavement quality and characteristics for pedestrian comfort. The classic correlation of the variables based on contingency tables was used to analyse data and to test whether respondents’ perceptions depended on certain profile features. The completion of the statistical inference was the use of advanced algorithms of the correspondence analysis method. The relationships between the variables were assessed optionally using the chi2 test. The study results revealed desirable parameters and features of paving surfaces. People who use manual wheelchairs and declare limb loss prefer medium- and large-format concrete pavers with smooth finishing and no bevelling. People with skeletal abnormalities or peripheral neuropathy prefer concrete slabs and surfaces made of small- or medium-sized panels arranged in a regular pattern, made of smooth non-slip concrete with narrow joints. Further laboratory tests are necessary to investigate whether increased water permeability of pavements constructed on eco-friendly base layers can curb damage to the pavement surface and provide long-term durability.

Performance of Impedance Control-Based Strategies in Power-Assisted Wheelchairs: A Predictive Simulation Study.

Manual wheelchair propulsion is known to be inefficient and causes upper extremity pain, fatigue, and injury. Power-assisted wheelchairs can mitigate these effects through motors that reduce users' effort and load during propulsion. Among the different control strategies proposed to govern the user-wheelchair interaction, impedance control-based ones appear to be the most natural and effective. It can change the apparent dynamical properties of the wheelchair, particularly mass and friction, and automatically compensate for external disturbances such as terrain conditions. This study investigates the advantages and disadvantages of this control strategy employing predictive simulations of locomotion with power-assisted wheelchairs in different scenarios. The simulations are generated using a biomechanically realistic model of the upper extremities and their interaction with the power-assisted wheelchair by solving an optimal control problem. Investigated scenarios include steady-state locomotion vs. a transient maneuver starting from rest, movement on a ramp vs. a level surface, and different choices of reference model parameters. The results reveal that the investigated impedance control-based strategy can effectively reproduce the reference model and reduce the user's effort, with a more significant effect of inertia in the transient maneuver and of friction in steady-state locomotion. However, the simulations also show that imposing a first-order, linear reference model with constant parameters can produce disadvantageous locomotion patterns, particularly in the recovery phase, leading to unnecessary energy dissipation and consequent increase in energy consumption from the batteries. These observations indicate there is room for improvement, for instance, by exploring energy regeneration in the recovery phase or by switching reference model nature or parameters along the cycle. To the best of our knowledge, this is the first investigation of impedance control-based strategies for power-assisted wheelchairs using predictive simulations and a realistic, nonlinear model of the user-wheelchair system.

Effects of Wheel and Tire Selection on High-Strength Lightweight Manual Wheelchair Propulsion Cost Using Robotic Propulsion

<h3>Research Objectives</h3> To investigate the effects of wheel and tire selections on the propulsion characteristics of a high-strength lightweight manual wheelchair, a robotic propulsion device was deployed across a cohort of wheelchair configurations. <h3>Design</h3> This experimental study compared the mechanical behaviors of four wheelchair configurations with differing drive wheels and casters. <h3>Setting</h3> This study was conducted in a laboratory setting. Test surfaces (linoleum tile, low-pile carpet) represented common environments where high-strength lightweight wheelchairs are used. <h3>Participants</h3> No human subjects were used in this study. One high-strength lightweight wheelchair frame (Viper Plus GT, Drive Medical) was used for all four configurations. The baseline configuration reflected the default manufacturer configuration, comprising a solid mag drive wheel and solid 8"x1" caster. The other three configurations included Primo 6"x1.5" caster wheels and solid 24"x1-3/8" Primo XPress drive tires. <h3>Interventions</h3> The Anatomical Model Propulsion System (AMPS) robotic wheelchair tester propelled the chair using pre-generated straight and curvilinear maneuvers using repeatable and reliable cyclic torque profiles across tile and carpet. <h3>Main Outcome Measures</h3> The main outcome measure was propulsion cost, defined as the ratio of mechanical energy required to propel the wheelchair to the total distance traveled over-ground, reported in Joules per meter. In addition, the metric of 'value' – the retail cost of components in comparison to their relative impact on the energetic propulsion cost – was proposed for the first time in relation to high-strength lightweight wheelchair components. <h3>Results</h3> Results indicate significant reduction in propulsion cost across all maneuvers and surfaces with upgraded casters (<24%), drive wheel tires (<23%), or both (<41%). The total retail cost differential between the full sets of default components and upgraded components was $33 (USD). <h3>Conclusions</h3> This study demonstrated that better casters and drive wheel tires can improve the performance of high-strength lightweight wheelchairs and better meet the mobility needs of users. Furthermore, gaining knowledge of component-level energy losses could inform users, clinicians, and manufacturers on 'better' components that are available in each context of use. <h3>Author(s) Disclosures</h3> The authors do not have any conflicts to disclose.

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury.

BackgroundPain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity.ObjectiveTo determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users.MethodThis quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance.ResultsThe pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%).ConclusionsPain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI.Clinical implicationsIn-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Wheelchair Skills Education and Training for Children with Spina Bifida and/or Hydrocephalus and Their Parents: A Pilot Study

Background: Many children with spina bifida and/or hydrocephalus use manual wheelchairs. However, training to ensure appropriate wheelchair use is limited and informal, and this negatively impacts daily activity and participation. Evidence suggests formal training can increase children’s confidence and independence, with early intervention being critical for healthy development. In Ireland, like in many other regions internationally, such interventions are not readily available to families. Aim and objectives: The overall aim of the study was to pilot wheelchair skills training for children aged 3–8 years with spina bifida and/or hydrocephalus and their parents, to develop a sustainable program. The objectives were: (1) to develop and evaluate a wheelchair skills information pack; (2) to investigate the impact of training on children’s performance of wheelchair skills; (3) to explore parents’ perspectives on how training influenced their children’s daily participation; (4) to identify beneficial aspects of program delivery for children and parents. Methods: We applied a mixed-methods study design that included three stages: (1) evaluation of the use of a bespoke wheelchair skills information pack; (2) within-subject pre-post analysis of the wheelchair skills test (WST) and individual training goals; (3) qualitative thematic analysis of Photovoice documentary narratives from focus groups with parents. Results: Four children and their parents participated in the study. Parents reported the wheelchair skills information pack to be useful, recommending more child-friendly images, and the provision of the pack when children first receive their wheelchairs. Analysis of the pre/post-WST showed an increase in the performance of skills. Parents’ perspectives and experiences are captured in two Photovoice themes: (1) children developing their skills, (2) supporting parents to support their children. Conclusion: The pilot program was a success for these families, highlighting potential gaps in Irish wheelchair provision services and the need for wheelchair skills education and training to support parents and children.

Design refinement and evaluation of a mobile manual standing wheelchair

Purpose There are no manually propelled wheelchairs on the market that are mobile in both seated and standing positions. In response to this product gap, our group formerly designed a mobile manual standing wheelchair (MMSW) and gathered stakeholder feedback. The purpose of this study was to refine the MMSW based on feedback, including weight and width reduction, and evaluate its performance. Materials and methods The MMSW was subjected to ANSI/RESNA stability testing, and three male participants completed a subset of the wheelchair skills test, including a 100-m roll test in the MMSW (seated and standing) and in their ultralight wheelchair. Results The MMSW met ANSI/RESNA stability safety standards. During the 100-m roll test, participants reached speeds with the MMSW in both the standing and sitting postures similar or greater than those typical of moving in the home environment (1.11 m/s seated; 0.79 m/s standing). Mobility speeds in the MMSW in the standing position were about three times faster than average walking speeds in exoskeletons (0.26 m/s exoskeletons). With the addition of chain drive bracing to the MMSW, one user was able to reach speeds in the standing position similar to average neurotypical walking speeds indicating the possibility for wheelchair users to be able to move in pace with family and friends. Conclusion All participants expressed interest in the MMSW to facilitate improved quality of life. Further work is needed to test the utility of the MMSW in home and community settings, and its potential effects on standing time and health outcomes. Implications for rehabilitation Manual standing wheelchairs with standing mobility may increase functional utility and length of standing time for manual wheelchair users Increased standing time may lead to several health benefits for manual wheelchair users

Turning in Circles: Understanding Manual Wheelchair Use Towards Developing User-Friendly Steering Systems

For people with physical disabilities, manual wheelchairs are essential enablers of mobility, participation in society, and a healthy lifestyle. Their most general design offers great flexibility and direct feedback, but has been described to be inefficient and demands good coordination of the upper extremities while critically influencing users’ actions. Multiple research groups have used Inertial Measurement Units (IMUs) to quantify physical activities in wheelchairs arguing that knowledge over behavioural patterns in manual wheelchair usage can guide technological development and improved designs. The present study investigates turning behaviour among fulltime wheelchair users, laying the foundation of the development of novel steering systems that allow directing kinetic energy by means other than braking. Three wearable sensors were installed on the wheelchairs of 14 individuals for tracking movement over an entire week. During detected “moving windows”, phases where the velocities of the two rear wheels differed by more than 0.05 m/s were considered as turns. Kinematic characteristics for both turns-on-the-spot as well as for moving turns were then derived from the previously reconstructed wheeled path. For the grand total of 334 km of recorded wheelchair movement, a turn was detected every 3.6 m, which equates to about 900 turns per day on average and shows that changing and adjusting direction is fundamental in wheelchair practice. For moving turns, a median turning radius of 1.09 m and a median turning angle of 39° were found. With a median of 89°, typical turning angles were considerably larger for turns-on-the-spot, which accounted for roughly a quarter of the recognised turns and often started from a standstill. These results suggest that a frequent pattern in daily wheelchair usage is to initiate movement with an orienting turn-on-the-spot, and cover distances with short, straightforward sections while adjusting direction in small and tight moving turns. As large bends often require simultaneous pushing and breaking, this is, perhaps, the result of users intuitively optimising energy efficiency, but more research is needed to understand how the design of the assistive devices implicitly directs users’ movement.

Usability of a virtual reality manual wheelchair simulator

Purpose: Individuals with impaired mobility often require assistance for getting around. The skilled use of a manual wheelchair (MW) is required in order to gain independence while preventing injuries. Training in a virtual reality (VR) setting allows for safe practice of MW skills in a wide range of environments. We developed a low-cost MW simulator which includes visual and haptic feedback. Our objectives were to assess the usability and fidelity of the VR simulator, by clinicians and expert MW users, and to determine whether the addition of haptic feedback would positively improve the user’s experience. Materials and Methods: This mixed method study investigated the sense of presence, overall experience and ease of use of the experience in six MW users, as well as five clinicians (wheeled mobility experts) who practiced in the simulator. Results: Participants reported a positive perception of usefulness, sense of presence, and immersion during the MiWe simulator experience. The addition of haptic feedback to the simulator significantly enhanced fidelity of the overall experience, compared to the no-feedback condition. Conclusion: Our low-cost simulator was well perceived by clinicians and MW users and was considered as a potentially useful tool to complement MW skill training. IMPLICATIONS FOR REHABILITATION We developed a low-cost, virtual reality simulator with visual and haptic feedback, for the practice of manual wheelchair skills. Expert clinicians and wheelchair users reported a positive experience after practicing in the wheelchair simulator, in terms of presence, realism and usability. Participants highlighted the potential usefulness of our low-cost simulator in the training of manual wheelchair skills.

Detecting clinical practice guideline-recommended wheelchair propulsion patterns with wearable devices following a wheelchair propulsion intervention

ABSTRACT Wheelchair propulsion interventions typically teach manual wheelchair users to perform wheelchair propulsion biomechanics as recommended by the Clinical Practice Guidelines (CPG). Outcome measures for these interventions are primarily laboratory based. Discrepancies remain between manual wheelchair propulsion (MWP) in laboratory-based examinations and propulsion in the real-world. Current developments in machine learning (ML) allow for monitoring of MWP in the real world. In this study, we collected data from participants enrolled in two wheelchair propulsion interventions, then built an ML algorithm to distinguish CPG recommended MWP patterns from non-CPG-recommended patterns. Eight primary manual wheelchair users did not initially follow CPG recommendations but learned and performed CPG propulsion after the interventions. Participants each wore two inertial measurement units as they propelled their wheelchairs on a roller system, indoors overground, and outdoors. ML models were trained to classify propulsion patterns as following the CPG or not following the CPG. Video recordings were used for reference. For indoor detection, we found that a subject-independent model was able to achieve 85% accuracy. For outdoor detection, we found that the subject-independent model achieved 75.4% accuracy. These results provide further evidence that CPG and non-CPG-recommended MWP patterns can be predicted with wearable sensors using an ML algorithm.