Manual Wheelchair Research Articles

Challenges with mobility devices for female Veterans with spinal cord injuries

Context The growing number of females entering the armed forces has led to an increase in the number of female Veterans with spinal cord injury and diseases (SCI/D) requiring mobility devices. Limited research exists that explores whether mobility devices meet their needs in terms of comfort, fit and design. Objective To characterize respondents with SCI/D who use mobility devices and determine if these devices are meeting their daily needs. Design Online survey. Settings Veterans Health Administration. Participants Female Veterans with SCI/D who received mobility devices in the past five years. Interventions: Participants completed an online survey regarding their challenges in obtaining and using mobility devices for their daily needs. Results 101 women with SCI/D participated in a nation-wide online survey. Respondents were mainly in their 50s and 59% were not currently employed due to their disability. Most used manual (35%) or power wheelchairs (34%). Many female Veterans felt their devices were not made with female users in mind and some felt they did not meet their needs. Opportunities to improve the assessment, follow-up, maintenance and repair processes were identified. Conclusions Given that some female Veterans with SCI/D felt their devices did not meet all their needs, it is important for researchers to engage women in user-centered design of mobility devices and for providers to be mindful of Veterans’ daily needs within all steps of the provision process in order for mobility devices to support overall function and usability.

The Effect of Wheelchair Skills Training on Increasing Participation among Manual Wheelchair Users Compared to the Standard of Care: An RSR

Abstract Date Presented 03/22/24 The purpose of this rapid systematic review was to appraise literature related to the question: What is the effect of wheelchair skills training on increasing participation in occupations among wheelchair users as compared to standard of care? Primary Author and Speaker: Brynn Seigel Additional Authors and Speakers: Samantha Murtiff, Zoe Brubaker, Morgan Meier, Sarah McCoy Contributing Authors: Tony Chase

Design Considerations Concerning an Innovative Drive System for a Manual Wheelchair

Manual wheelchairs, which are the basic means of transport for people with disabilities, are usually characterized by an inefficient adaptation to the physical capabilities of their users. For this reason, it is advisable to search for solutions that will allow us to change the parameters of the mechanical power generated by human muscles. For this purpose, mechanical gearing known from other solutions, for example, from bicycles, can be used. The paper describes the design methodology and a number of issues related to the construction of an innovative wheelchair prototype using a chain transmission in its drive system. This solution allows for the implementation of a variable ratio between the wheels and the pushrims. Thus, it effectively allows for matching the demand for driving torque to the movement conditions and the physical capabilities of its user. The use of such a system provides the basis for increasing the efficiency of the manual propulsion process. Initial studies show that changing the gear ratio allows for different speeds of the wheelchair wheel. In the tests conducted, the root mean square of this value varied from 15.2 RPM to 35.5 RPM, which resulted in a change in power from 15.8 W to 40.1 W. Of course, the values of rotational speed and torque show a cyclically changing character, which results from the intermittent nature of generating drive by the wheelchair user. The average peak values of rotational speed were 31.4 ± 1.7 RPM, 44.3 ± 3.4 RPM and 57.9 ± 3.4 RPM, while the torque was 12.1 ± 0.5 Nm, 12.4 ± 0.4 Nm and 14.1 ± 0.6 Nm for Gears 1, 4 and 6, respectively.

How university students view disabled people: The role of wheelchairs, canes, and unspecified mobility aids.

Mobility aids are important to disabled people as a functional tool that can enhance their participation in leisure activities and work; however, mobility aids may also have implications for how disabled people are viewed by others. Using theories from social psychology, this study aimed to understand how mobility aids contribute to the perception of mobility aid users. A total of 259 participants without disabilities, who were primarily young, Caucasian, female-identifying university students, completed the questionnaires. The primary questionnaires of interest included the Multidimensional Attitudes Scale Toward Persons with Disabilities and the Stereotype Content Model. Every participant completed three conditions of the questionnaires to examine their attitudes and stereotypes associated with three mobility aid conditions: a wheelchair, a cane, and a control condition without a specified mobility aid. Affective attitudes toward the unspecified mobility aid condition and the manual wheelchair condition were more negative than the cane condition. Perceived warmth was higher for the manual wheelchair condition compared to the unspecified mobility aid condition and perceived competence was higher for the cane and manual wheelchair conditions compared to the unspecified mobility aid condition. This study explored how young women without disabilities, and potentially nondisabled people more generally, may hold a range of attitudes and stereotypes about the use of mobility aids by disabled people. These findings have implications for the design of effective attitudinal change programs and for rehabilitation professionals who work with individuals as they adopt mobility aids following the onset of disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Driving Assistance System with Obstacle Avoidance for Electric Wheelchairs.

A system has been developed to convert manual wheelchairs into electric wheelchairs, providing assistance to users through the implemented algorithm, which ensures safe driving and obstacle avoidance. While manual wheelchairs are typically controlled indoors based on user preferences, they do not guarantee safe driving in areas outside the user's field of vision. The proposed model utilizes the dynamic window approach specifically designed for wheelchair use, allowing for obstacle avoidance. This method evaluates potential movements within a defined velocity space to calculate the optimal path, providing seamless and safe driving assistance in real time. This innovative approach enhances user assistance and safety by integrating state-of-the-art algorithms developed using the dynamic window approach alongside advanced sensor technology. With the assistance of LiDAR sensors, the system perceives the wheelchair's surroundings, generating real-time speed values within the algorithm framework to ensure secure driving. The model's ability to adapt to indoor environments and its robust performance in real-world scenarios underscore its potential for widespread application. This study has undergone various tests, conclusively proving that the system aids users in avoidance obstacles and ensures safe driving. These tests demonstrate significant improvements in maneuverability and user safety, highlighting a noteworthy advancement in assistive technology for individuals with limited mobility.

Calibration to Differentiate Power Output by the Manual Wheelchair User from the Pushrim-Activated Power-Assisted Wheel on a Force-Instrumented Computer-Controlled Wheelchair Ergometer

To examine the biomechanical demands of manual wheelchair propulsion, it is crucial to determine the wheelchair user’s (WCU) force for propulsion technique parameter calculation. When using a pushrim-activated power-assisted wheelchair (PAPAW) on a wheelchair ergometer, a combined propulsion force from the WCU and PAPAW is exerted. To understand PAPAW’s assistance and distinguish the WCU’s force application from the force exerted by the PAPAW, both propulsion components must be assessed separately. In this study, a calibration of the PAPAW on an ergometer was developed to achieve this separation. The calibration consists of five steps: (I) Collecting data on force and velocity measured from the ergometer, along with electrical current and velocity from the PAPAW. (II) Synchronizing the velocity signals of the wheelchair ergometer and PAPAW using cross-correlation. (III) Calibrating the PAPAW’s electromotors to convert electrical current (mA) to force (N). A product-specific motor constant of 0.30, provided an average ICC of 0.563, indicating a moderate agreement between the raw ergometer data (N) and the motor constant-converted drive-rim (PAPAW) data (from mA to N). (IV) Subtracting the PAPAW’s force signal from the ergometer’s measured force to isolate forces generated by the WCU. (V) Using markerless motion capture to determine and validate the phase of hand contact with the handrim. This technical note provides an example of PAPAW calibration for researchers and clinicians. It emphasizes the importance of integrating this calibration into the development of PAPAW devices to reveal the complex interaction between PAPAW and WCU during wheelchair propulsion.

Preliminary field validity of ActiGraph-based energy expenditure estimation in wheelchair users with spinal cord injury.

Cross-sectional validation study. To develop a raw acceleration signal-based random forest (RF) model for predicting total energy expenditure (TEE) in manual wheelchair users (MWUs) and evaluate the preliminary field validity of this new model, along with four existing models published in prior literature, using the Doubly Labeled Water (DLW) method. General community and research institution in Pittsburgh, USA. A total of 78 participants' data from two previous studies were used to develop the new RF model. A seven-day cross-sectional study was conducted to collect participants' free-living physical activity and TEE data, resting metabolic rate, demographics, and anthropometrics. Ten MWUs with spinal cord injury (SCI) completed the study, with seven participants having valid data for evaluating the preliminary field validity of the five models. The RF model achieved a mean absolute error (MAE) of 0.59 ± 0.60 kcal/min and a mean absolute percentage error (MAPE) of 23.6% ± 24.3% on the validation set. For preliminary field validation, the five assessed models yielded MAE from 136 kcal/day to 1141 kcal/day and MAPE from 6.1% to 50.2%. The model developed by Nightingale et al. in 2015 achieved the best performance (MAE: 136 ± 96 kcal/day, MAPE: 6.1% ± 4.7%), while the RF model achieved comparable performance (MAE: 167 ± 99 kcal/day, MAPE: 7.4% ± 5.1%). Two existing models and our newly developed RF model showed good preliminary field validity for assessing TEE in MWUs with SCI and the potential to detect lifestyle change in this population. Future large-scale field validation studies and model iteration are recommended.

Comparison of rolling resistance, propulsion technique and physiological demands between a rigid, folding and hybrid manual wheelchair frame

Background When selecting a manual wheelchair frame, the choice between rigid and folding frames carries significant implications. Traditional folding frames are expected to have more rolling resistance and power dissipation caused by frame deformation, while they are more convenient for transportation, such as in a car. A new hybrid frame, designed to be more rigid, aims to minimize power dissipation while still retaining foldability. Aim This study aimed to assess rolling resistance, power output, propulsion technique and physiological demands of handrim wheelchair propulsion across three different frames: a rigid frame, a hybrid frame and a conventional folding frame. Materials and Methods Forty-eight able-bodied participants performed coast-down tests using inertial measurement units to determine rolling resistance. Subsequently, four-minute submaximal exercise block under steady-state conditions at 1.11 m/s were performed on a wheelchair ergometer (n = 24) or treadmill (n = 24) to determine power output, propulsion technique and physiological demands. Results Repeated measures ANOVA revealed that the hybrid frame exhibited the lowest rolling resistance (7.0 ± 1.5N, p ≤ 0.001) and required less power output (8.3 ± 1.0W, p ≤ 0.001) at a given speed, compared to both the folding (9.3 ± 2.2N, 10.8 ± 1.4W) and rigid frame (8.0 ± 1.9N, 9.4 ± 1.6W). Subsequently, this resulted in significantly lower applied forces and push frequency for the hybrid frame. The folding frame had the highest energy expenditure (hybrid: 223 ± 44 W, rigid: 234 ± 51 W, folding: 240 ± 46 W, p ≤ 0.001). Conclusion The hybrid frame demonstrated to be a biomechanically and physiologically beneficial solution compared to the folding frame, exhibiting lower rolling resistance, reduced power output, and consequently minimizing force application and push frequency, all while retaining its folding mechanism.

Evaluation of the bilateral symmetry assumption in manual wheelchair propulsion: a systematic review of literature in daily-life and sports contexts.

This systematic review aimed to 1) verify bilateral symmetry assumption in manual wheelchair (MWC) propulsion in daily-life and sports, and its relationship with injury risk and sports performance; 2) evaluate methods for assessing bilateral symmetry. Scopus, Web-Of-Science, PubMed, and EBSCO databases were searched for articles published before January 2024 investigating bilateral symmetry in MWC users and/or healthy participants during MWC propulsion. Two independent reviewers screened, extracted data, and assessed methodological quality of retrieved papers. Twenty-five studies were included. In daily ground-level propulsion, minimal asymmetries were observed in kinematic, kinetic, and temporal parameters when averaging ≥3 push cycles. In the sports context, diverse findings emerged, ranging from up to 27% side-to-side differences in propulsion kinetics and kinematics during sprinting, to descriptions of both symmetrical and asymmetrical upper extremity motions. Limited evidence exists regarding the role of asymmetry in MWC propulsion as a risk factor for injury and pain, as well as the association between sprinting performance and symmetry. In conclusion, bilateral symmetry assumption in MWC propulsion is valid only under specific conditions (i.e., slow/moderate speed, averaging ≥3 push cycles, smooth level ground). The wheeling environment and inter-individual variability impact symmetry research outcome and require consideration in future studies.

Inhibitory Control of Downhill Turning Using Friction Brakes for Manual Wheelchair

Inhibitory Control of Downhill Turning Using Friction Brakes for Manual Wheelchair

Inertial Measurement Unit and Heart Rate Monitoring to Assess Cardiovascular Fitness of Manual Wheelchair Users during the Six-Minute Push Test.

Manual wheelchair users (MWUs) are prone to a sedentary life that can negatively affect their physical and cardiovascular health, making regular assessment important to identify appropriate interventions and lifestyle modifications. One mean of assessing MWUs' physical health is the 6 min push test (6MPT), where the user propels themselves as far as they can in six minutes. However, reliance on observer input introduces subjectivity, while limited quantitative data inhibit comprehensive assessment. Incorporating sensors into the 6MPT can address these limitations. Here, ten MWUs performed the 6MPT with additional sensors: two inertial measurement units (IMUs)-one on the wheelchair and one on the wrist together with a heart rate wristwatch. The conventional measurements of distance and laps were recorded by the observer, and the IMU data were used to calculate laps, distance, speed, and cadence. The results demonstrated that the IMU can provide the metrics of the traditional 6MPT with strong significant correlations between calculated laps and observer lap counts (r = 0.947, p < 0.001) and distances (r = 0.970, p < 0.001). Moreover, heart rate during the final minute was significantly correlated with calculated distance (r = 0.762, p = 0.017). Enhanced 6MPT assessment can provide objective, quantitative, and comprehensive data for clinicians to effectively inform interventions in rehabilitation.

TransKinect: a computer vision and machine learning clinical decision support system for automatic independent wheelchair transfer technique assessment

Background Physical and occupational therapists provide routine care for manual wheelchair users and are responsible for training and assessing the quality of transfers. These transfers can produce large loads on the upper extremity joints if improper sitting-pivot-technique is used. Methods to assess quality of transfers include the Transfer Assessment Instrument, a clinically validated tool derived from quantitative biomechanical features; however, adoption of this tool is low due to the complex usage requirements and speed of typical transfers. Objective The objective of this study is to develop and validate a computer vison and machine learning solution to better implement the Transfer Assessment Instrument in clinical settings. Methods The prototype system, TransKinect, consists of an infrared depth sensor and a custom software application; usability testing was carried out with fifteen therapists who performed two transfer assessments with the TransKinect. Proficiency in using features, usability, acceptability and satisfaction were analysed with validated surveys and themes were extracted from the qualitative feedback. Results The therapists were able to successfully complete the transfer quality assessments with 86.7 ± 5.4% proficiency. Total scores for System Usability Scale (77.6 ± 14.7%) and Questionnaire for User Interface Satisfaction (83.5 ± 8.7%) indicated that the system was usable and satisfactory. Qualitative feedback indicated that TransKinect was user-friendly, easy to learn, and had high potential. Discussion The results support TransKinect as a potential clinical decision support system for therapists for the comprehensive assessment of independent transfer technique. Future research is needed to investigate the utility and acceptance of TransKinect in real clinical environments. Implications for Rehabilitation Machine learning and computer vision can be used to analyze transfer technique TransKinect is a usable and user-friendly means for therapists to automate analysis Summary reports and videos of transfers show high potential for clinical use Adoption of TransKinect can increase quality of care for manual wheelchair users

Frequency of Neck Disability Among Manual Wheelchair Users Having Injury of Spinal Cord; A Cross Sectional Study

Frequency of Neck Disability Among Manual Wheelchair Users Having Injury of Spinal Cord; A Cross Sectional Study

A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL).

Mixed-method approach. To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL). SCIR-Group (UDESC)/Brazil. Developing the WC-MAL comprised five steps: (1) defining the construct-based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items - activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated. From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of "Mobility (d4)" and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96. The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.

Adaptive neuro-fuzzy sliding mode control of the human upper limb during manual wheelchair propulsion: estimation of continuous joint movements using synergy-based extended Kalman filter

Adaptive neuro-fuzzy sliding mode control of the human upper limb during manual wheelchair propulsion: estimation of continuous joint movements using synergy-based extended Kalman filter

Wheelchair satisfaction and recommended improvements of manual wheelchairs in the UK

Purpose of the article The aim of this study was to determine user satisfaction with manual wheelchairs in the United Kingdom and to determine areas that could be improved to help drive future design and development. Materials and Methods Manual wheelchair users, aged 18-65 years old living in the United Kingdom, were invited, to complete an online cross-sectional questionnaire. The link to the questionnaire was distributed using a range of methods to charities, organisations and wheelchair user groups via invitation by email and social media. Responses were gathered from 122 respondents and analysed using descriptive statistics, cross-tabulation and content analysis. Results Respondents felt comfort (39.3%), weight (35.4%), manoeuvrability (34.3%) and durability (30.7%) were the most important features of a wheelchair. Seventy percent of respondents that were “not at all satisfied” with their current wheelchair were fitted by the National Health Service (NHS, X2 = 42.39, p < 0.001). Ninety percent of respondents who were “not at all satisfied” with their current wheelchair experienced issues with comfort (X2 = 17.82, p = 0.001). Sixty percent who were “not satisfied at all” with their wheelchair had not chosen their wheelchair (X2 = 25.15, p < 0.001). Conclusion Wheelchair satisfaction was largely determined by comfort, location of the users’ wheelchair fitting (for example the NHS) and users choosing their own wheelchair. Future wheelchair designs should utilise a user centred and inclusive design approach to cater for a wider range of individual needs and requirements.

Care for children and youth with cerebral palsy (GMFCS levels III to V).

Cerebral palsy (CP) is the most common physical disability in Canadian children. The comprehensive care of ambulatory children with CP functioning at Gross Motor Function Classification System (GMFCS) level I and II was covered in a previous practice point. This companion document focuses on the care of children with CP functioning at GMFCS levels III to V. Children functioning at GMFCS level III and IV mobilize using devices such as a walker, canes, or powered mobility, while those functioning at GMFCS level V require assisted mobility, such as a manual wheelchair. An overview of key concepts in early detection, rehabilitation services, and therapeutic options for children with CP at these levels is provided, along with practical resources to assist health surveillance for paediatricians caring for this population.

“I think it was helpful but not as helpful as it could have been” - a qualitative study of the experiences and perspectives of using fitness apps among manual wheelchair users with spinal cord injury

Purpose To gain knowledge of the experiences and perceptions of using fitness apps by full-time wheelchair users with spinal cord injury (SCI) and to explore experiences and perceptions of using these apps in relation to barriers to and facilitators of physical activity (PA). Materials and Methods A qualitative design was employed. Semi-structured interviews were conducted with ten manual wheelchair users with SCI. Data were analysed using reflexive thematic analysis. Results Four themes were developed: 1) App functionality and experience, 2) Enhancing motivation, 3) Precursors to engagement and 4) Knowledge gaps. Experience and perception were strongly influenced by app design, particularly the presence or absence of features tailored for wheelchair users. Many apps incorporated the use wearable or mountable sensors. Fitness apps were perceived to increase motivation, although, this had its limitations. Conversely, apps were reported to have limited influence on commonly reported barriers to PA. Furthermore, the data highlighted gaps in knowledge which created barriers to effective app use. Conclusions Fitness apps were perceived to increase motivation to engage in PA in manual wheelchair users with SCI. However, more needs to be done to further develop app features for wheelchair users with SCI and to address remaining barriers to engagement.

The Effect of Arm Movements on the Dynamics of the Wheelchair Frame during Manual Wheelchair Actuation and Propulsion

Wheelchair propulsion and actuation are influenced by the moving masses of the wheelchair user; however, the extent of this effect is still unclear. The main evidence of this effect is that the speed of the wheelchair frame continues to increase after the end of the push phase. The wheelchair’s speed was measured using IMUs and the duration of the push period was recorded using miniaturised pressure sensors attached to the driver’s middle fingers. The velocity and acceleration were determined for various average stroke cycle speeds to determine the speed dependency of the acceleration. The wheelchair was then mounted on a force plate to measure the inertial forces of the hands moving back and forth. The aerodynamic drag and rolling resistance forces were determined from coast-down experiments. Based on the measured forces, the behaviour of the force and velocity profiles was finally modelled by gradually reducing the mass of the arms and thus their inertial force. The results showed that the wheelchair is accelerated throughout the push phase (except for a temporary deceleration in the middle of the push phase at higher velocities), and that this acceleration continues well after the push phase. In the second half of the recovery phase, the wheelchair decelerates. The horizontal inertial forces measured on the force plate are predominantly negative in the push phase and in the second half of the recovery phase, and positive in the first half of the push phase, and their impulse is zero due to the conservation of momentum. Modelling the wheelchair with moving masses showed that reducing the horizontal inertial forces has no effect on the driver’s propulsive force but reduces the velocity fluctuations. The main conclusion of this research is that the wheelchair user’s power should be calculated only from the pure propulsive force that is required in the push phase to overcome the dissipative forces and that enables the gain or loss in speed per stroke cycle, but not directly from the measured velocity.

Development of the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course.

Manual wheelchairs (MWC) users have limited mobility during winter months as they encounter many environmental barriers that restrict their community participation. This paper outlines the creation and standardization of an outdoor environment designed to simulate the real-life conditions and obstacles experienced by MWC users in winter. This study consisted of four phases. In Phase 1, researchers used a qualitative ethnographic approach to document the specific challenges and adaptive strategies used by MWC users in winter conditions. In Phase 2, key informants with expertise in MWC winter mobility were invited to co-design the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course. Participants reviewed draft design solutions and offered their input and suggestions to expand upon the initial design. A second co-design workshop included additional key informants, including service providers, policymakers, and professionals with expertise in landscape architecture and engineering, to validate the design solution. The workshops resulted in a detailed illustration of the SNOWMAN course, including five sections: platforms with side slopes, a miniature ice rink, curbs and curb cuts, a path with uneven winter surfaces, and modular ramps at various slopes. Phases 3 and 4 marked the conclusion of the study and involved fabrication of the SNOWMAN course and establishment of a standardized protocol for course setup and maintenance. The project aimed to offer several additional potential benefits, supported by the various stakeholders across the study phases, that extend beyond creation of a controlled and safe environment for wheelchair users to develop their winter mobility skills. Practicing wheelchair skills in this area may assist wheelchair users in gaining confidence which may ultimately translate to increased participation in the community.