Evaluation Of Wheelchair Research Articles

Falls in people with mobility limitations: a cross-sectional analysis of a US registry of assistive device users

Purpose of the Article: To (1) summarise the personal and clinical characteristics of persons with disabilities (PwDs) in the US who were evaluated for mobility assistive equipment (MAE) in the functional mobility assessment and uniform dataset (FMA/UDS) and (2) stratify subpopulations of PwD who reported falling versus those who do not report a fall. Materials and Methods: This study was a retrospective, descriptive cohort analysis of adults with disabilities using the FMA/UDS. Data are collected during a user’s initial evaluation for a new mobility device. The sample is intentionally general to be inclusive of all mobility device users. The primary variable of interest was a patient-reported fall within the 3 months leading up to their evaluation for a new mobility device. Subpopulation characteristics were stratified by this binary fall variable. Results and Conclusions: This study provides descriptions of PwDs being evaluated for a new mobility device. There were 11,084 PwDs with 31 different primary diagnoses. During their new mobility device evaluation, 52.2% of PwDs reported at least one fall in the last 3 months. For those who reported a fall, 46.6% of PwDs were using a walking aid or no device at all before the new mobility device evaluation. Additionally, persons with progressively acquired disabilities (i.e., Parkinson’s disease, osteoarthritis and cardiopulmonary disease) reported higher rates of falls than those with congenital disabilities (i.e., cerebral palsy and spina bifida). These findings will influence future studies comparing different types of devices and their influence on falls and user satisfaction.

Telerehabilitation for New Wheelchair Evaluations: A Retrospective Study of Patient Characteristics.

The purpose of this paper was to describe the clinical and personal factors of persons with disabilities (PwD) seeking a new wheelchair evaluation via telerehabilitation compared to in-person appointments. This retrospective cohort analysis used the Functional Mobility Assessment and Uniform Dataset, which is a nationwide registry with ongoing enrollment at 31 clinical sites of PwD seeking a new wheelchair evaluation. PwD were stratified into either a Telerehabilitation Group or In-Person Group. There were 1,669 PwD in the Telerehabilitation Group and 10,284 in the In-Person Group. The Telerehabilitation Group had a higher mean age and higher percentage of Progressively Acquired Disabilities than the In-Person Group. This project lays the groundwork for future comparative effectiveness studies, which may influence telerehabilitation reimbursement policies for wheelchair services.

Clinically Relevant Outcomes in Manual Wheelchair Evaluation: A Systematic Review of the Literature

To determine the clinically relevant and objective wheelchair-use outcomes in manual wheelchair skill and use evaluations.

A Primary Care Provider's Guide to Wheelchair Prescription for Persons With Spinal Cord Injury.

The wheelchair is an essential tool for individuals with spinal cord injury (SCI). When the capacity and fit of a wheelchair is matched to the needs and abilities of an individual with SCI, health, function, community participation, and quality of life are maximized. Throughout an individual's life, function and health status can decline (or improve), necessitating a new wheelchair and/or seating components (eg, cushions and backrests). Additionally, a patient's current wheelchair may be identified as a factor contributing to a health concern or functional deficit, again necessitating wheelchair adjustments. Primary care physicians often manage the complex and lifelong medical needs of individuals with SCI and play a key role in wheelchair evaluation and prescription. This article provides a broad overview of indicators that a new wheelchair is needed, describes the wheelchair prescription process, identifies important team members, reviews the major wheelchair components, and provides guidance to match components to patients' needs and abilities.

PENGEMBANGAN ALAT UKUR EVALUASI DAN PERANCANGAN PRODUK KURSI RODA

A wheelchair is one of the mobility aids for people with disabilities. Availability of wheelchair type is very decisive for users based on the limitations they have. The problem felt by users in Indonesia today, especially in Yogyakarta, is that users have not got the right kind of wheelchairs with the needs, with certain limitations. This study aims to develop a wheelchair evaluation and to know the user's expectation of the wheelchair design. This study shows that there are problems due to the users not getting a wheelchair that suits their needs. The wheelchair design that the users want are the wheelchair with 3 wheels and have new feature.

Toward community-based wheelchair evaluation with machine learning methods.

IntroductionUpper extremity pain among manual wheelchair users induces functional decline and reduces quality of life. Research has identified chronic overuse due to wheelchair propulsion as one of the factors associated with upper limb injuries. Lack of a feasible tool to track wheelchair propulsion in the community precludes testing validity of wheelchair propulsion performed in the laboratory. Recent studies have shown that wheelchair propulsion can be tracked through machine learning methods and wearable accelerometers. Better results were found in subject-specific machine learning method. To further develop this technique, we conducted a pilot study examining the feasibility of measuring wheelchair propulsion patterns.MethodsTwo participants, an experienced manual wheelchair user and an able-bodied individual, wore two accelerometers on their arms. The manual wheelchair user performed wheelchair propulsion patterns on a wheelchair roller system and overground. The able-bodied participant performed common daily activities such as cooking, cleaning, and eating.ResultsThe support vector machine built from the wrist and arm acceleration of wheelchair propulsion pattern recorded on the wheelchair roller system predicted the wheelchair propulsion patterns performed overground with 99.7% accuracy. The support vector machine built from additional rotation data recorded overground predicted wheelchair propulsion patterns (F1 = 0.968).ConclusionsThese results further demonstrate the possibility of tracking wheelchair propulsion in the community.

Evaluation of wheelchair with a function to drive straight by one-hand operation in driving it on a bike roller

Evaluation of wheelchair with a function to drive straight by one-hand operation in driving it on a bike roller

Development and initial validation of the Seated Posture Scale.

Literature shows that some health outcomes (e.g., eating, breathing, and speaking) are directly related to posture. Evidence of outcomes mediated by wheelchair seated posture is limited to interface pressure, physical function, and wheelchair skills and safety. This study's purpose was to develop and validate a rapid, low-burden, paper-pencil assessment of wheelchair seated posture for research use and to test feasibility of its use with a sample of older adults. We used a prospective design and a convenience sample of older adults who were receiving rehabilitation services in a community living center. Forty-nine older wheelchair users participated. Main measures were the Seated Posture Scale (SPS), Modified Ashworth Scale, Barthel Index, Visual Descriptor Scale, scale-content validity index (S-CVI), Cronbach alpha, and test-retest reliability. Rating by six experts yielded the overall content validity score (S-CVI) of 0.744. Total SPS score correlated positively with physical function (Barthel Index, r = 0.46, p < 0.001) and negatively with muscle tone (Modified Ashworth Scale, r = -0.44, p = 0.001), supporting SPS construct validity. Internal consistency was 0.66 (Cronbach alpha). Test-retest reliability yielded Pearson product-moment correlations of 0.89 to 0.99. We conclude that the SPS has sufficient preliminary validity and reliability to support its use as an evaluation of wheelchair seated posture in outcomes research.

Outcome Measures for Wheelchair and Seating Provision: A Critical Appraisal

Introduction: Every aspect of the wheelchair and seating provision process has an impact on overall outcomes for service users. This critical appraisal sought to identify outcome measures suitable for evaluation of wheelchair and seating provision, considering activity, participation, and impact of the service delivery on quality of life. Method: Outcome measures were identified using databases: Medline, CINHAL, PsychInfo, and Google Scholar. An evaluation was conducted to establish those that were particularly useful and a critical appraisal was completed. Findings: Five outcome measures identified as relevant for critical appraisal included: Wheelchair Outcome Measure; Functioning Every day in a Wheelchair; Goal Attainment Scale; Psychosocial Impact of Assistive Devices Scales; and the Quebec User Evaluation of Satisfaction with Assistive Technology. The strengths and limitations of each were identified. Conclusion: No single outcome measure captures all necessary information; trade-offs are inevitable. When choosing an outcome measure, the specific goals of the service evaluation and the resources available need to be considered within context. Critical appraisal of five outcome measures deemed appropriate for the evaluation highlighted some areas for consideration to inform decision making. A move towards sustainability indicators is suggested to monitor, measure, and respond to the provision processes and outcomes required to meet this primary need.

The Positive Effects of Early Powered Mobility on Children's Psychosocial and Play Skills

Powered mobility can have an important cognitive and psychosocial impact on young children who are unable to move independently. Twenty-three children with physical disabilities between the ages of 18 months and 6 years participated in this study. Data evaluating social skills, frequency of mobility play activities, frequency of interaction with toys/objects, and play/verbal developmental levels were collected at wheelchair evaluation, wheelchair delivery, and approximately 6 months later. Significant increases were found in parental perceptions of positive social skills for younger children after receiving a wheelchair; slightly older children showed improvements in social skills before the wheelchair was received; no changes were found in negative social skills. Parental ratings also indicated a significantly greater difficulty remaining engaged in tasks after receiving a wheelchair. A significant increase was noted in the number of mobility activities during indoor free play but no difference was seen in interaction with toys or objects. Improvement in the qualitative level of outdoor interactive free play was reported but there was no change in verbal interactions. This article discusses the potential positive impact of early powered mobility. These findings may be helpful in justifying the recommendation of powered mobility to young children and in justifying medical necessity of powered mobility for reimbursement by third party payers.

Remote decision support for wheeled mobility and seating devices

Current wheelchair selection and evaluation processes are time-consuming, often requiring cumbersome review and re-review of frequently changing wheelchair products and manufacturers. Telerehabilitation (TR) is an emerging field that complements the current in-person assessment for selecting an appropriate wheeled mobility and seating device in underserved areas. One of TR’s core functions is remote wheelchair selection (RWS), which requires detailed information on wheelchair characteristics and specifications, policy knowledge, and patient medical conditions including mobility limitation. Stakeholders currently have limited means to access comprehensive, reliable, monitored, and up-to-date information relative to wheeled mobility and seating devices, including performance, coverage criteria, or research evidence as to their benefits and short-comings. Centers for Medicare and Medicaid Services (CMS) implemented significant changes to the Healthcare Common Procedures Coding System (HCPCS) for wheeled mobility devices (WMDs) that includes expansion from 4 to 64 unique codes to identify different types of physical mobility devices (PMDs). This 16-fold increase can make it difficult to fully understand where a given product falls within the new structure. In our work we review the current TR research, wheelchair coverage policy issues, and the modern remote wheelchair selection paradigm. We introduce a framework for a web-based decision support system for remote wheelchair selection. These outcomes improve the wheelchair selection and evaluation processes through the capabilities of remote investigation of in-person assessment process, appropriated wheelchair alternatives, advanced wheelchair query and selection, a reusable wheelchair information repository, and systematic wheelchair evaluation. We also discuss lessons learned from a focus group study regarding the user acceptance of RWS-Advisor and the future direction of research on remote wheelchair selection.

The Extraordinary in the Ordinary

As I meet with many of our colleagues in different parts of the country, I hear accounts about their clinical practice, their research, their teaching, and their learning. Although these colleagues often express their joy in the science and art of what we do and the hope that we can provide to those we care for, I sometimes hear comments about how elements of what they do seem ordinary. One such comment came after an account of a colleague's work with a patient with a rare protein receptor deficiency resulting in serious myopathy. The patient's muscle wasting was severe—estimated at 25 pounds of muscle in one month—and the patient's creatine kinase levels were consistently above 60,000 units per liter, far above what we know to be the norm of predictably under 200 units per liter. While working on the root cause of the pathology, the patient's neurologist was in a quandary about how to manage the myopathy. In consulting with the physical therapist, the neurologist said simply, “Will you see this patient? I am not sure what you can do, but you are our best option right now.” The physical therapist explained to me that the examination seemed routine, and there was nothing particularly unusual about the interventions of strengthening, aerobic conditioning, and functional activities that she chose to use with the patient. This physical therapist further described to me the need for her to take charge of a bigger picture of care and how that action led to a wheelchair evaluation and fitting, a nutrition consult, and the call for some additional nursing care. What was the result of this colleague's action? The patient is now out of the power chair, is walking, and is back to work at about 85% of pre-episode levels. This physical therapist told me …

The Impact of Early Powered Mobility on Parental Stress, Negative Emotions, and Family Social Interactions

ABSTRACTPowered mobility has been found to have positive effects on young children with severe physical disabilities, but the impact on the family has been less well documented. We evaluated the impact of early powered mobility on parental stress, negative emotions, perceived social interactions, and parental satisfaction with wheelchair characteristics such as size and durability. The participants were parents of 23 children with disabilities—10 with orthopedic disabilities (average age 30.1 months) and 13 with cerebral palsy (average age 47.0 months). Pretest assessments were completed two times: at initial wheelchair evaluation and at wheelchair delivery. A posttest assessment was completed after each child had used the wheelchair for 4–6 months. Parents reported a lower perceived level of stress at the time of wheelchair delivery, although the magnitude of this effect was fairly small, standardized mean difference (δ) = .27. They also reported an increased satisfaction with their child's social and play skills (δ = .38), ability to go where desired (δ = .86), sleep/wake pattern (δ = .61), and belief that the general public accepts their child (δ = .39) after several months using the wheelchair. Parents reported an increase in interactions within the family at the time of wheelchair delivery (δ = .66). There was no decrease in negative emotions. Parents were satisfied with most factors relating to the wheelchair itself, with areas of concern being wheelchair size and difficulty adjusting the wheelchair. The findings suggest that self-initiated powered mobility for a young child had a positive impact on the family.

Power Wheelchair Prescription, Utilization, Satisfaction, and Cost for Patients With Amyotrophic Lateral Sclerosis: Preliminary Data for Evidence-Based Guidelines

Ward AL, Sanjak M, Duffy K, Bravver E, Williams N, Nichols M, Brooks BR. Power wheelchair prescription, utilization, satisfaction, and cost for patients with amyotrophic lateral sclerosis: preliminary data for evidence-based guidelines. Objectives To determine the features most frequently selected in a power wheelchair (PWC), level of satisfaction with the selections, and how often the PWC features are used by patients diagnosed with amyotrophic lateral sclerosis (ALS)/motor neuron disease (MND). Design Internally generated questionnaire. Setting An ALS/Muscular Dystrophy Association center. Participants Convenience sample of current patients (N=45) of our clinic with ALS/MND who are PWC users (men, n=27; women, n=18; age range, 27–85y). Intervention Self-administered survey. Main Outcome Measure Thirty-two patients completed a 31-question survey investigating patients' patterns of selection, satisfaction, and frequency of PWC use; technical and psychometric influences; and other aspects of decision-making processes that patients experience before, during, and after acquiring a PWC. Results Ninety percent of respondents received their evaluations at a multidisciplinary ALS clinic, 1 via the Department of Veterans Affairs, and 1 was unknown. Sixty-six percent of patients thought the chair evaluation was timed correctly, and 19% wished they had started sooner. Forty-five percent of people were able to walk a few steps, and 55% were able to stand when their chairs arrived. When they first received the chair, 79% were satisfied with the overall comfort of the chair, and 86% were satisfied with the ease of use; currently, 69% are satisfied with the overall comfort, and 72% are satisfied with ease of use. There was a statistically significant difference in how patients used their wheelchair features initially and currently in terms of seat elevate and attendant control, but not tilt, recline, and elevating leg rests. The average cost for the power chairs was $26,404 (range, $19,376–$34,311), and the average cost a month is $917. Overall, 88% of respondents said they would get the same type of chair with the same features again, and 81% felt that the chair was a good value for the cost. Conclusions We obtained first-hand knowledge from 32 patients with ALS/MND who are current PWC users on their use and satisfaction with their PWCs from initial to current use. Based on this survey, patients with ALS/MND seen for their wheelchair evaluation with experienced clinicians exhibit high use and satisfaction with their PWCs.

The Clinical Decision-Making Process of Prescribing Power Mobility for a Child with Cerebral Palsy

Powered mobility has been shown to be an effective method for children with disabilities to achieve independent mobility. The purpose of this case report is to describe the physical therapist's clinical decision making related to power mobility for a child with multiple disabilities. Power wheelchair evaluation for a nine-year-old child was conducted using Furumasu's tasks for wheelchair readiness moving through a doorway, maneuvering through three cones, and driving in a hallway. Ongoing team assessment with family consultation informed clinical decision-making. A mid-wheel-drive chair afforded improved performance on Furumasu's tasks compared with a rear-wheel-drive chair. This case describes the clinician's role in prescribing power wheelchairs to affect the user's functional skills, as well as how, in the absence of evidence, clinical experience and patients' needs can guide clinical decision-making.

1021 人間・車椅子系のモデル化と運動挙動の解析

As the population ages and fewer babies are born, both care-givers and persons who have necessity for being cared are currently ageing. Since it's important for both of them to be concerned with a local community, as one of the transfer aids, power assist wheelchairs are developed to help them to move. It is required that adjustment of the assist power is given due consideration in their safety and reducing burden to their body. Human adjusts assist power depending on walking velocity, so that we regard human, wheelchair as a prime motor, a load, and identify human-wheelchair's modeling system. In this paper, we describe the influence on assist power to human's behavior and an evaluation of wheelchair's driving performance.

8B13 上肢運動特性の空間表現を用いた車いす操作性評価

8B13 上肢運動特性の空間表現を用いた車いす操作性評価

Thin flexible pressure sensors

This article gives an overview on the currently available techniques for the measurement of interface pressure or force between (soft) objects. These techniques make use of single sensor elements as well as integrated arrays of sensors to obtain pressure maps. Most of these devices originate from biomedical applications such as the evaluation of wheelchairs and the prevention of pressure ulcers in hospital beds. Today, these technologies are used in a wide range of applications such as computer peripherals, robotics, automotive systems and consumer electronics. These typical applications are considered in the first section. Next, the sensor technologies (and their suppliers) are briefly described and compared. The list of suppliers and technologies is intended as an overview and may not be complete. Finally, new developments in this field are discussed.

Reliability of Measurements of Static Weight Distribution of Manual Wheelchairs

The purpose of this study was to evaluate the reliability of measurements of weight distribution among the wheels of wheelchairs using a commercial balance testing system. Reliable data may be useful in the wheelchair evaluation and adjustment process. Three male full-time manual wheelchair users aged 30, 26, and 27 years with cervical spinal cord injuries 7.5, 6.5, and 10 years in duration participated. Calibration weights, unoccupied wheelchairs, and occupied wheelchairs were repeatedly placed on the force transducers of the balance testing system to obtain measurements of weight distribution. The intraclass correlation coefficients of the measurements were .99 for calibration weights, .96 for unoccupied wheelchairs and .98 for wheelchairs occupied by the subjects. The described use of this instrumentation appears to generate reliable measurements of static weight distribution. With further testing, this system may provide useful information related to manual wheelchair prescription and adjustment.

Living aids: wheelchair evaluation and prescription.

This article reviews the assessment procedure for patients who require a wheelchair. The author, a medical specialist in prosthetics and orthotics, describes the important physical and social factors which must be considered, and defines what equipment is available from the National Health Service and elsewhere.