Standard Manual Wheelchair Research Articles

Reinventing the wheel for a manual wheelchair

Purpose Standard manual wheelchairs (MWCs) are inefficient and pushrim propulsion may cause progressive damage and pain to the user’s arms. We describe a wheel for a MWC with a novel propulsion mechanism. Methods The wheel has two modes of operation called “Standard” mode and “Run” mode. In Run mode, the wheelchair is propelled forward by pushing a compliant handle forward and then pulling it back, both strokes contributing to forward propulsion. We report the propulsive force and preliminary testing on a rough outdoor circuit by three able-bodied participants. Results In Run mode, the peak applied force is reduced to 30% and the maximum force gradient is reduced to 10% of that for standard pushrim propulsion, for the same work output. The travel time for the 1.06 km outdoor circuit is about 60% of that for a brisk walk and about 40% of that for pushrim propulsion. At a propulsion speed of 1 m/s, the cardiovascular effort in Run mode is 56% of that for pushrim propulsion. Automatic hill-hold in Run mode improves safety when ascending slopes. The mechanism has three gears so that it can be used by people with widely varying strength and fitness. Folding the handle away converts the operation to Standard mode with the conventional pushrim propulsion, supplemented by three gears. Conclusions Despite the increased weight, width and friction, the bimodal geared wheels facilitate wheelchair travel on challenging paths. This may bring significant improvement to the quality of life of MWC users.

Effect of power-assistance on upper limb biomechanical and physiological variables during a 6-minute, manual wheelchair propulsion test: a randomised, cross-over study

Purpose Use of a power-assistance wheelchair could reduce the risk of musculoskeletal disorders (MSDs), however, a comprehensive biomechanical evaluation of these systems has not been carried out. This study aimed to evaluate and compare biomechanical UL propulsion variables, and physiological exercise-related variables during the use of a wheelchair with rear drive power assist device (RD-PAD) and a standard manual wheelchair (MW). Materials and methods Twenty-two adults with spinal cord injury were recruited. RD-PAD (SmartDrive system) was fitted to their own MW. An instrumented wheel was used to measure handrim forces, and gas exchange and heart rate were monitored. Participants performed repeated out and back runs for 6 min on a straight outdoor course. Results Distance covered was significantly greater with the RD-PAD (538 ± 104 m versus 470 ± 124 m). Peak mechanical effort during the propulsion phase was significantly lower with the RD-PAD (p < 0.001). Heart rate, metabolic equivalent of task (MET), tidal volume, minute volume, oxygen consumption, and peak oxygen consumption were all significantly lower with the RD-PAD (p < 0.001). Conclusions The results showed that use of RD-PAD increased the distance covered by MW users and reduced the energy costs of propulsion. The biomechanical results indirectly suggest that RD-PAD may reduce the risk of MSD. Implications for Rehabilitation Using the SmartDrive system as propulsion assistance increases the travel autonomy. The SmartDrive system reduces the biomechanical constraints propelling the wheelchair on a slope and low slope. SmartDrive the system reduces the physiological solicitation related to the propulsion of wheelchair.

A Dynamic Wheelchair Armrest for Promoting Arm Exercise and Mobility After Stroke.

Arm movement recovery after stroke can improve with sufficient exercise. However, rehabilitation therapy sessions are typically not enough. To address the need for effective methods of increasing arm exercise outside therapy sessions we developed a novel armrest, called Boost. It easily attaches to a standard manual wheelchair just like a conventional armrest and enables users to exercise their arm in a linear forward-back motion. This paper provides a detailed design description of Boost, the biomechanical analysis method to evaluate the joint torques required to operate it, and the results of pilot testing with five stroke patients. Biomechanics results show the required shoulder flexion and elbow extension torques range from −25% to +36% of the torques required to propel a standard pushrim wheelchair, depending on the direction of applied force. In pilot testing, all five participants were able to exercise the arm with Boost in stationary mode (with lower physical demand). Three achieved overground ambulation (with higher physical demand) exceeding 2 m/s after 2–5 practice trials; two of these could not propel their wheelchair with the pushrim. This simple to use, dynamic armrest provides people with hemiparesis a way to access repetitive arm exercise outside of therapy sessions, independently right in their wheelchair. Significantly, Boost removes the requirements to reach, grip, and release the pushrim to propel a wheelchair, an action many individuals with stroke cannot complete.

Assessment of wheeled mobility devices provided to a commercially insured population in 2017

ABSTRACT In the United States, wheeled mobility devices (WMD) are classified as durable medical equipment (DME). Consistent with the definition of DME, wheeled mobility devices are typically covered by health insurance when deemed medically necessary. Despite the number of persons using wheelchairs, little knowledge is available about the types of wheelchairs provided, user’s specific diagnoses and the costs associated with WMD provision. The objective of this analysis was to define the number and types of wheelchairs and associated seating and mobility (S&M) accessories provided in the calendar year 2017. The analysis focused on user demographics, categories of WMDs and associated S&M equipment as well as cost accounting according to the type of insurance and contributions by beneficiaries. Analysis of over 81,000 wheelchair acquisitions found that manual wheelchairs accounted for nearly 90% with standard manual wheelchairs accounting for 86% of all wheelchairs provided. Wheelchair recipients tended to be older with the majority being female. Based upon ICD-10 diagnostic categories over 50% of captured ICD-10 codes came from three classifications, musculoskeletal (M), circulatory (I) and a general category of not otherwise classified disorders (R). Costs associated with seating and mobility equipment were fairly large, exceeding $79 million over a single calendar year.

A novel ergonomic wheelchair reduces bacterial hand contamination

Objective To determine whether bacterial contamination of rider’s hands is less with a novel ergonomic wheelchair (EW) than a standard wheelchair (SW). Experimental design After wheelchair hand rims were disinfected, volunteers wearing nitrile gloves propelled each wheelchair through a standardised “run” in hospital. Post-run cultures were obtained from riders' gloved hands. Bacterial hand counts were compared between runs matched by rider (same rider, different chairs) or time (different riders in each chair, running concurrently), and overall. Setting Minneapolis Veterans Affairs Health Care System (MVAHCS), a large tertiary care facility. Participants Eleven employee volunteers. Intervention EW, as compared with SW. With SW, co-location of hand rims and tyres potentially exposes the user’s hands to tyres, which risks contaminating the user’s hands with ground-source bacteria. Our novel ergonomic wheelchair (EW) separates drive wheel and hand rims, potentially reducing hand contamination. Main outcome measure Bacterial hand counts. Results Post-run bacterial hand counts were over 10-fold lower with the EW than the SW. This was true (i) when the same rider tested both chairs sequentially (n = 8 pairs) (median counts, 40 vs. 1030; p = 0.008), (ii) when different riders tested the two chairs concurrently (n = 9 pairs) (median counts, 40 vs. 660; p = 0.004), and (iii) overall (median counts, 40 [n = 9 runs] vs. 550 [n = 10 runs]; p < 0.001). Conclusion Separation of wheelchair hand rims from tyres significantly reduces bacterial hand contamination. Reduced hand contamination could decrease bacterial infections and dissemination of resistant bacteria, warranting further study. Implications for rehabilitation The novel design of the ergonomic wheelchair, removing the push rim from proximity to the wheelchair tyre, keeps the hands of wheelchair users cleaner. The re-design of the standard manual wheelchair was implemented initially to improve shoulder ergonomics during manual wheelchair propulsion and has the added benefit of reduction in the transfer of bacteria from floors to hands for manual wheelchair users. Since the ergonomic wheelchair has the potential to decrease rates of bacterial infection in manual wheelchair users, further testing is warranted.

A pair of step-climbing units for a manual wheelchair user: Passing over several steps using a pair of portable slopes

We have developed a pair of step-climbing units that can be installed on a standard manual wheelchair. Many wheelchair users hope to lead an independent life without assistance. The target users of these units are those who can independently lift the front casters of their wheelchairs. The units are installed on the back frames of a wheelchair. Each unit comprises two actuators and has 2 degrees of freedom: telescopic motion and rotational motion. They are lightweight and do not prevent the wheelchair from being folded. Therefore, it is still relatively easy to load a wheelchair fixed with these units into a car. In our earlier project, these units addressed the problem of climbing a single step. In this article, we primarily discuss a strategy that enables wheelchair users to climb stairs comprising multiple steps. We additionally use a pair of portable slopes to achieve this task. Results of experiments where users traveled on a pair of slopes that covered a height of 30 cm over two steps confirm the effectiveness of the design.

Evaluation of shoulder joint kinematics and muscle activity during geared and standard manual wheelchair mobility.

Manual wheelchairs often lead to reduced independent function and an increase in shoulder pain and injuries. Geared manual wheelchairs may be a promising alternative that reduces the biomechanical demands of the shoulder needed for tasks such as propulsion on ramps and carpeted floors, while maximizing function and participation. To investigate the effects of geared manual wheelchair mobility during demanding tasks such as ramp ascent, six able-bodied subjects were evaluated in this study. Subjects were asked to propel both standard and geared manual wheelchairs on a tiled level floor and on a wheelchair ADA ramp. Shoulder muscle activity and glenohumeral joint kinematics were investigated. The results indicated that using geared manual wheelchair wheels did not alter the shoulder joint kinematics, but notably affected peak and integrated shoulder muscle activity. Muscle activity results normalized by stroke distance, indicated that using geared manual wheelchairs could decrease anterior deltoid, pectoralis major and infraspinatus muscle activity during ramp ascending, but on level floor infraspinatus muscle activity may increase. These results could have clinical implications for determining the types of functional mobility tasks for which geared manual wheelchairs are beneficial.

Development and evaluation of one-hand drivable manual wheelchair device for hemiplegic patients

This study was conducted for one-hand users including hemiplegic clients currently using standard manual wheelchairs, so as to analyze their specific problems and recommend solutions regarding usage. Thirty hemiplegic clients who were admitted to rehabilitation and convalescent hospitals participated as subjects. The research tools were standard manual wheelchairs commonly used by people with impaired gait and a “one-hand drivable manual wheelchair,” which was developed for this study. The Wheelchair Skills Test (WST) was adopted for the objective assessment tool, while drivability, convenience, difference, and acceptability were developed for the subjective evaluation tools. The assessment procedures comprise two phases of pre-assessment and post-assessment. In the pre-assessment phase, the WST and subjective evaluation (drivability, convenience) were conducted using the existing standard manual wheelchair and with/without use of a foot to control the wheelchair. In the post-assessment phase, the WST and subjective evaluation (drivability, convenience, difference, acceptability) were also carried out using the developed one-hand drivable manual wheelchair. The results showed that the highest pass rate recorded for the WST items was 3.3% when the participants drove standard manual wheelchairs without the use of either foot and 96.7% when using the manual wheelchairs equipped with developed device. As compared to the existing wheelchair, statistical results showed significant effects on the WST, drivability, convenience, difference and acceptability when the participants drove wheelchairs equipped with the developed device. These findings imply that the one-hand drivable wheelchair equipped with the developed device can be an active and effective solution for hemiplegic clients using existing manual wheelchairs to increase their mobility and occupational performance.

Analysis of a Lever-Driven Wheelchair Prototype and the Correlation between Static Push Force and Wheelchair Performance

In this experimental study a lever-driven wheelchair prototype was compared with a manual wheelchair. The push force of 13 able-bodied human participants was measured over the range of motion required to propel the lever-driven wheelchair prototype and the standard manual wheelchair. The push force that is required to propel each wheelchair was measured statically using strain gauges and dynamically using a purpose built dynamometer to quantify high and low force areas and to determine if correlation exists to wheelchair performance. The force exerted, simulated peak wheelchair velocity, acceleration, torque and power, were examined. The 13 human participants completed five maximal effort tests in the lever-driven wheelchair and three maximal effort tests in a manual wheelchair on the dynamometer. A multiple regression and a Pearson's product-moment correlation coefficient analysis were performed on the acquired data and a p-value of less than 0.05 level of significance was found; suggesting a correlation does exist between the static and dynamic force measurement methods.

自走用車椅子使用者のための段差移動補助機の開発

Many people with lower limb disabilities use wheelchairs, but their degrees of physical impairment vary greatly. We direct our investigation to manual wheelchair users who are able to lift the front wheelchair casters independently. They hope to establish an independent life without assistance to the greatest extent possible. We developed a pair of step-climbing units that can be installed in a standard manual wheelchair. This mechanism is simpler than any other because it uses the remaining capabilities of the wheelchair user. Each unit comprises two actuators and has two degrees of freedom: a telescopic motion and a rotational motion. We mainly discuss the step-climbing motion using this system. Experimental results obtained when ascending and descending a step of 15 cm height confirm the design's effectiveness.

512 自走用車椅子使用者のための段差移動補助装置の開発 : 携帯スロープを用いた段差踏破の検討(OS5 オーガナイズドセッション《ライフサポートにおける工学技術》)

In this paper, we propose a pair of step-climbing units that can be set on a standard manual wheelchair. The user is such a person who has no disabled upper limbs and is able to raise casters attached in front of the wheelchair by him/herself. This system can support the independent life of the user. Each step-climbing unit comprises two actuators and has two degrees of freedom: a prismatic joint and a rotational joint. We mainly discuss the motion of walking up a slope using this system, and experimental results of climbing a 30 cm step with a pair of mobile slopes confirmed effectiveness of the design.

Basic studies on life circumstances and stress in persons with congenital physical disabilities using always wheelchairs

Many studies about the health problems of persons with physical disabilities have been performed, however few studies have focused on the life circumstances of persons with physical disabilities. This study aimed to clarify the relationship between stress and the life circumstances of persons with congenital physical disabilities who must use wheelchairs. The participants were 70 individuals who used the services of care workers employed by welfare service business offices. Participants used wheelchairs. In addition, those participants who used a standard manual wheelchair were not able to operate it alone. Participants were required to answer a two-part questionnaire with questions about factors related to basic lifestyle and stress, and about life factors related to the stress of individuals with physical disabilities. No significant relationship between lifestyle and stress was found in either males or females. Most persons with congenital physical disabilities using wheelchairs had some kind of stress in daily life. In particular, significantly more level of stress was found in females (90%) than that in males (65%). Levels of stress according to life factor differed between males and females. The most dramatic gender difference was that the level of stress caused by the mental or mind factor in females was significantly higher than that in males (p < 0.05). Most persons who must use wheelchairs have stress resulting from daily life, and in particular, females experience more mental stress than males.

Demographic and Clinical Variation in Veterans Health Administration Provision of Assistive Technology Devices to Veterans Poststroke

Hubbard Winkler SL, Cowper Ripley DC, Wu S, Reker DM, Vogel B, Fitzgerald SG, Mann WC, Hoenig H. Demographic and clinical variation in Veterans Health Administration provision of assistive technology devices to veterans poststroke. Objectives To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region. Design Retrospective population-based study. Setting VHA. Participants Veterans poststroke in fiscal years 2001 and 2002 (N=12,046). Interventions Not applicable. Main Outcome Measure Provision of 8 categories of AT devices. Results There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic regression, with only demographic variables as predictors of standard manual wheelchair provision, the c statistic was .62, and the pseudo R 2 was 2.5%. Adding disease severity increased the c statistic to .67 and the pseudo R 2 to 6.2%, and adding Veteran Integrated Network System further increased the c statistic to .72 and pseudo R 2 to 9.8%. Conclusions Our research showed significant variation in the provision of AT devices to veterans poststroke, and it showed that patient characteristics accounted for only 6.2% of the variation. VHA administrative region and disability severity accounted for equivalent amounts of the variation. Our findings suggest the need for improvements in the process for providing AT and/or provider education concerning device provision.

Comparison of Shoulder Muscle Electromyographic Activity During Standard Manual Wheelchair and Push-Rim Activated Power Assisted Wheelchair Propulsion in Persons With Complete Tetraplegia

Lighthall-Haubert L, Requejo PS, Mulroy SJ, Newsam CJ, Bontrager E, Gronley JK, Perry J. Comparison of shoulder muscle electromyographic activity during standard manual wheelchair and push-rim activated power assisted wheelchair propulsion in persons with complete tetraplegia. Objectives To compare spatio-temporal propulsion characteristics and shoulder muscle electromyographic activity in persons with cervical spinal cord injury propelling a standard pushrim wheelchair (WC) and a commercially available pushrim-activated power assisted wheelchair (PAPAW) design on a stationary ergometer. Design Repeated measures. Setting Motion analysis laboratory within a rehabilitation hospital. Participants Men (N=14) with complete (American Spinal Injury Association grade A or B) tetraplegia (C6=5; C7=9). Intervention Participants propelled a standard pushrim WC and PAPAW during 3 propulsion conditions: self-selected free and fast and simulated 4% or 8% graded resistance propulsion. Main Outcome Measures Median speed, cycle length, cadence, median and peak electromyographic activity intensity, and duration of electromyographic activity in pectoralis major, anterior deltoid, supraspinatus, and infraspinatus muscles were compared between standard pushrim WC and PAPAW propulsion. Results A significant ( P<.05) decrease in electromyographic activity intensity and duration of pectoralis major, anterior deltoid, and infraspinatus muscles and significantly reduced intensity and push phase duration of supraspinatus electromyographic activity at faster speeds and with increased resistance were seen during PAPAW propulsion. Conclusions For participants with complete tetraplegia, push phase shoulder muscle activity was decreased in the PAPAW compared with standard pushrim WC, indicating a reduction in demands when propelling a PAPAW.

Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies.

Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury

Hunt PC, Boninger ML, Cooper RA, Zafonte RD, Fitzgerald SG, Schmeler MR. Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury. Arch Phys Med Rehabil 2004;85:1859–64. Objectives To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample. Design Convenience sample survey. Setting Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education. Participants A total of 412 people with SCI who use wheelchairs over 40 hours a week. Intervention Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source. Main outcome measures Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls). Results Ninety-seven percent of manual wheelchair users and 54% of power wheelchair users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs. Conclusions The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs.

The Bush Wheelchair: A Manual Transporter for Adults Living in Rural Communities

A four year project to design and develop an appropriate mobility device for people with disabilities living in rural communities in the Northern Territory has resulted in the successful field testing of a manual transporter. This device, designed and developed by the Seating Equipment And Technical Service (SEAT) for the Northern Territory, is based on a rickshaw style configuration to enable an attendant to pull the occupant over rough terrain more easily than using a standard manual wheelchair. This Bush Wheelchair is more robust and has fewer moving parts. It therefore requires less maintenance and is a more appropriate form of transporting people with disabilities within their communities. The design is discussed.