Wheelchair Maintenance Research Articles

Ultralight wheelchair part failures are associated with sensor-monitored road shocks: A pilot study

ABSTRACT Wheelchair part failures and repairs have significantly increased over the last decade, leading to severe consequences for wheelchair users. Servicing these devices by wheelchair repair technicians has reduced part failures. However, no tools or technologies have been developed to support servicing in practice. To inform servicing events, risk factors affecting wheelchair quality and reliability need to be identified. This pilot study tracks wheelchair usage for a week in the community for eight ultralight manual wheelchair users and assesses the relationship between usage variables and user-reported part failures over 20 months. The participants’ preferences for using smart technology for wheelchair servicing were evaluated. At least 73 wheelchair part failures and two adverse consequences were reported. Data analysis indicated associations between part failure frequency, usage variable of road shocks, wheelchair maintenance frequency, and the user’s demographic characteristics of training status and transportation. Six participants favored using smart technology for wheelchair servicing. This study’s findings encourage the development of usage monitoring technology and failure prediction models to support technician-led servicing and prevent wheelchair failures and user consequences.

Wheelchair user’s perceived access to maintenance and repair services: a qualitative study

Purpose Wheelchairs and associated seating and positioning systems require maintenance and repair services to sustain essential functions for wheelchair users. This study aims to amplify wheelchair users’ opinions and experiences related to their perceived access to crucial wheelchair maintenance and repair services. Methods We conducted semi-structured interviews with four full-time wheelchair users using five semi-structured interview questions. The collected data was analyzed using a reflexive thematic analysis approach. Six interconnected themes were inductively, reflexively, and collaboratively constructed through critical discussions and mind-mapping techniques. Results These themes are as follows: “improving accessibility and efficiency: service delivery,” “access challenges: diversifying repair options and locations,” “systemic challenges: the role of policy,” “design, durability, and dependability: meeting the user’s needs,” “empowering accessibility: bridging the knowledge gap,” and “The system Itself: a call for change.” Conclusions Our findings suggest that wheelchair users prioritize not only the revision of existing barriers to access but also the implementation of preventative measures to minimize repair needs. Stakeholders are encouraged to collaborate to critically analyze existing wheelchair service delivery processes and associated policies. Practical implications include adjusting current policies, establishing best practice guidelines, and enacting preventative measures to facilitate improved user access to maintenance and repair services and optimize related outcomes.

VocalVision: Smart Wheelchair Maintenance with Pressure Sensors and Machine Learning

The Vocal Vision system introduces an innovative approach to enhancing electric wheelchair maintenance and control. It utilizes a network of sensors embedded within the wheelchair's wheels to gather real-time data on tire pressure, temperature, tread wear, and alignment. This data is wirelessly transmitted to a central control unit. Advanced algorithms, incorporating machine learning and predictive analytics, analyze the data to detect irregularities and predict maintenance needs. Users can control direction, speed, and perform complex maneuvers with precision using voice commands and eye gestures. The wheelchair integrates OpenCV for eye gesture recognition and Google Speech Recognition API for voice commands, enabling intuitive control methods. This proposed method introduces a new assistive technology for individuals with disabilities, leveraging cutting-edge technologies.

Wheeled repair alliance: Rolling out wheelchair repair and maintenance in community bicycle shops

ABSTRACT The increasing population of wheelchair users in the United States highlights the importance of access to reliable and affordable wheelchair maintenance and repair. Having a well-maintained mobility device is essential to living a safe, healthy, and social life as a wheelchair user. Unfortunately, access to these services is limited. This study aims to address this need by developing and evaluating a workshop program designed to teach basic wheelchair maintenance skills to bike shop employees, allied health professionals, and wheelchair users themselves. The workshops covered key wheelchair maintenance tasks. Pre and post workshop surveys assessed participants’ confidence in basic maintenance and repair skills and overall satisfaction with the workshop. Workshop participants reported increased confidence in all maintenance skills following the workshops and bike shop employees expressed increased confidence in their ability to work with and provide resources for wheelchair users. This study highlights that community-based workshops may help to enhance confidence in wheelchair maintenance skills, potentially aiding in bridging the gap in affordable and accessible repair services. The Wheeled Repair Alliance has the potential to empower wheelchair users and improve their quality of life. Further research should consider increasing the precision of measurements and assessing long-term outcomes related to wheelchair maintenance and repair.

Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study.

Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults' interaction experience with the app and their perceived barriers to and facilitators of maintenance. Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Interviews with power and manual wheelchair users (37/57, 65%), wheelchair service providers (15/57, 26%), manufacturers (2/57, 4%), seating and mobility researchers (1/57, 2%), and insurance plan providers (2/57, 4%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83% women; and n=2, 17% men) participated in the usability testing study. Of the 12 participants, 9 (75%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future.

Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial

ObjectiveTo assess the effectiveness of group wheelchair maintenance training and investigate participant characteristics associated with responsiveness to training. DesignRandomized controlled trial with an immediate group and a waitlist control group (WLCG) who received the intervention after a 6-month delay. SettingFour Spinal Cord Injury Model Systems Centers. ParticipantsManual (MWC; n=80) and power wheelchair (PWC; n=67) users with spinal cord injury (N=147). InterventionsTwo 90-minute structured wheelchair maintenance training program classes with 12-20 people per class and separate classes for MWC and PWC users. Each class included in-person hands-on demonstrations and practice of wheelchair maintenance. Main Outcome MeasuresSeparate analysis was completed for MWC and PWC users using the Wheelchair Maintenance Training Questionnaire (WMT-Q) capacity (ability to complete), performance (frequency of completion) and knowledge at baseline, 1 month, 6 months, 6 months pretraining (WLCG only), and 1 year (immediate only). ResultsAfter the intervention, participants in both the immediate and WLCG improved in maintenance capacity (MWC and PWC, P<.001) and performance (MWC and PWC, P<.001) with training. Only PWC users improved knowledge of wheelchair maintenance (P<.001). For both WLCGs (MWC and PWC), there was no difference between the 6-month pretraining time point and baseline. MWC users who responded to training had lower WMT-Q scores for all domains, whereas this was only the case for knowledge for PWC users. ConclusionsGroup wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even in a cohort of experienced wheelchair users. For MWC users, improvements were tied to lower WMT-Q scores at baseline, whereas PWC users improved in capacity and performance independent of baseline score. Delivering this training in a structured group format has a lower cost, which might improve adoption into clinical practice.

Factors Influencing Incidence of Wheelchair Repairs and Consequences Among Individuals with Spinal Cord Injury

ObjectiveTo investigate the frequency and consequences of wheelchair repairs, looking at the relationship to usage, components, out-of-pocket costs, number of days affecting the user, and factors associated with the need for repairs or consequences. DesignSurvey, cross-sectional. SettingNine spinal cord injury (SCI) Model Systems centers. ParticipantsWheelchair users with SCI (N=533). InterventionsNot applicable. Main Outcome MeasuresCost and incidence of wheelchair repairs and consequences and wheelchair usage within the past 6 months. ResultsA total of 310 participants (56%) reported repairs, 127 (42%) of whom experienced at least 1 adverse consequence lasting a median of 5 days (interquartile range [IQR], 2-17.3 days). Repair rates were highest for the seating system, electronics, and tires. Participants were most often stranded at home or forced to use a backup chair. Median out-of-pocket costs were $150 (IQR, $50-$620). Active users, based on type of mobility and terrain, experienced more repairs and consequences than less active users. Repairs were more common among those who were Black (odds ratio [OR], 2.42) or power wheelchair (PWC) users (OR, 1.84), whereas consequences were more common among those who were Black (OR, 2.27), PWC (OR, 2.08) or power assist users (OR, 2.76), and those who had public insurance (OR, 1.70). ConclusionsWheelchair repairs continue to affect more than 50% of wheelchair users with significant financial and personal cost. High repair rates limited participation inside and outside of the home. Consequences lasted longer than 2 weeks for many and may be minimized by a working backup chair. Disparities exist based on participant and wheelchair factors; repairs and adverse consequences appear to hit those most vulnerable with the least financial resources. Costs may be a barrier to repair completion for some individuals. This ongoing problem of high repair rates and their associated effects requires action such as higher standards, access to quicker service, and better training of users on wheelchair maintenance and repair.

Feasibility of a peer-led, manual wheelchair maintenance skills training programme to improve wheelchair efficiency, and knowledge and confidence about wheelchair maintenance: a pre–post study

Background Wheelchair users typically receive little training about wheelchair maintenance. Therefore, we developed a peer-led, manual wheelchair skills maintenance training programme, with the intention of evaluating its efficacy in a future experimental study. Purpose The purpose of this feasibility study was to examine how well we were able to implement the training programme and to evaluate the feasibility of conducting a larger scale clinical trial. Setting Spinal cord injury research centre. Participants Five mentors and fifteen mentees were recruited to complete this feasibility study. Method We collected information about recruitment capability and sample characteristics, data collection procedure, acceptability of the training programme, resources required, and participants’ responses to the intervention. Participants completed all the items and we had little missing data. Participants did not face any difficulty answering the questionnaires or performing the tests. Therefore, we could conclude data collection was feasible moving forward to perform larger efficacy trials. The acceptability of the wheelchair maintenance programme was more than 90%. There was a statistically significant improvement in wheelchair maintenance knowledge test and total rolling resistance. Confidence of mentees increased significantly after the training. Improvements in the 3-cone test and the 6-min push test results were not significant. Conclusions If recruitment and scheduling challenges can be overcome, our data suggested that it is feasible to conduct a larger experimental study to test the efficacy of the programme. Implications for Rehabilitation Wheelchair maintenance skills are important to help wheelchair users keep their wheelchairs working safely and efficiently. The findings from this study suggest that a peer-led wheelchair maintenance training programme may improve participants’ wheelchair maintenance knowledge and maintenance self-confidence. The study also suggests that a peer-led wheelchair maintenance training programme may decrease the rolling resistance of participants’ wheelchairs. A larger clinical trial is needed to demonstrate the efficacy of this intervention authoritatively.

Christianity and the Art of Wheelchair Maintenance: A Dialectical Inquiry at the End of the World by Stephen Faller

Stephen Faller, Christianity and the Art of Wheelchair Maintenance: A Dialectical Inquiry at the End of the World. Oregon: Cascade Books, 2018, 198 pp. (Pbk). ISBN: 978-1532634666, £20.00.

Development and efficacy of an online wheelchair maintenance training program for wheelchair personnel

ABSTRACT Objectives: To develop an online version of the wheelchair maintenance training program (WMTP) and compare learning outcomes from the in-person and online programs using the wheelchair maintenance training questionnaire (WMT-Q), administered before and after the intervention. Design: Iterative development of an online version of the WMTP and implementation. Setting: Online. Participants: 26 graduate and undergraduate students. Intervention: Web-based training. These results are compared with those from another study of the in-person WMTP with 10 participants. Main outcome measures: Feedback survey and WMT-Q. Results: The training program was well-received and valued by all 26 participants. A significant increase in all scores after the online training program was found, based on pre-/post-intervention scores. In manual wheelchair open-ended questions, knowledge increased from 16% to 21%, p < .05; in power wheelchair open-ended questions, from 9% to 31%, p < .05; in multiple-choice questions related to knowledge, from 27% to 59%, p < .05; confidence increased from 8% to 80%, p < .05; and capacity from 12% to 88%, p < .05. There was no statistical difference in WMT-Q scores between individuals who participated in the in-person and online programs. Conclusion: This study indicates that there was a similar-increased knowledge for participants, indicating that web-based training may be a viable approach for delivering maintenance training.

Wheelchair Maintenance Training Program

Wheelchair Maintenance Training Program

We describe the development and validation of an online wheelchair maintenance training program (WMTP) for clinicians that is freely available for use

It is well known that wheelchairs which are well maintained suffer breakdowns less frequently, and their users are less likely to be injured. But until recently, there was no widely known wheelchair maintenance training program. Our team recently developed the wheelchair maintenance training program (WMTP) that we used to train clinicians on how to train wheelchair users in an in-person format, but was difficult to scale due to the in-person nature of the training. This manuscript presents the development of the online version of the WMTP program and compares learning results from the in-person and online program using the wheelchair maintenance training questionnaire (WMT-Q). The training program was well received and valued by participants all 22 participants. A significant increase in all scores after online training program was found: manual wheelchair open-ended questions, t(25) = −3.367, P < 0.05; power wheelchair open-ended questions, t(25) = −5.360, P < 0.05; multiple choice questions related to knowledge, t(25) = −6.368, P < 0.05; confidence, t(25) = −13.521, P < 0.05; and capacity, t(25) = −10.735, P < 0.05. There were no statistical difference in WMT-Q scores between individuals who participated in the in-person and online participants: knowledge: t(34) = 0.371, P = 0.185, capacity: t(34) = 0.540, P = 0.793. Our results suggest that there was a similar trend of increased knowledge for participants in both training programs indicating that web-based training is a viable avenue for delivering maintenance training.

Preliminary inter-rater reliability of the wheelchair components questionnaire for condition

Purpose: The Wheelchair Components Questionnaire for Condition (WCQ-C) enables the collection of data on wheelchair maintenance condition and durability in resource-limited environments. It can be used in large studies to indicate typical patterns of wear at a location, or for a type of wheelchair. It can also be used in clinical settings as an evidence based indication that a wheelchair may need repair or replacement. This type of data can enable effective use of limited funds by wheelchair providers, manufacturers and users. The goal of this study was to investigate the inter-rater reliability of the WCQ-C.Methods: Two therapists from North America who have worked extensively in low-resource areas used the WCQ-C to independently evaluate 46 wheelchairs at a primary school for children with disabilities in Kenya.Results: Mean scores of ratings for each wheelchair by the two raters were used to calculate a two-way random interclass correlation coefficient. A value of 0.82 with a 95% confidence interval of 0.67–0.89 indicated good preliminary reliability.Conclusion: Preliminary results indicate that the WCQ-C is a reliable method of assessment. Additional studies are needed with larger and more diverse groups of raters. Because WCQ-C findings are specific to wheelchair wear and maintenance at each location, studies at other locations are also needed.Implications for rehabilitationThe importance of inter-rater reliability testing in confirming the reliability of an assessment tool such as the WCQ-C.The use of the WCQ-C to monitor wheelchair condition in low-resource settings and other field settings. If used at regular interval can produce data that can be used to describe typical changes over time at each individual setting. This could enable proactive planning at that setting to avoid typical breakdowns and the injuries or clinical complications that could result.The use of the WCQ-C to monitor the condition of groups of wheelchairs of the same type. It can describe typical patterns of wear and failure in a way that enables responsive change by manufacturers and designers. This enables more effective use of limited funds.On an individual basis, the use of the WCQ-C to alert users and health professionals of a need for repair or replacement. This could minimize the clinical problems and accidents that can result from wheelchair breakdown.Assessment of a wheelchair using the WCQ-C could provide evidence based data to insurance companies or wheelchair providers which indicates a need for wheelchair repair or replacement.

Development of a Classification System for Wheelchair Maintenance and Seat Positioning

Development of a Classification System for Wheelchair Maintenance and Seat Positioning

A longitudinal study assessing the maintenance condition of cadres of four types of wheelchairs provided in low-resource areas

Wheelchair breakdowns increase the risk of injury and limit the mobility of wheelchair users. In the endeavour to meet the enormous global need for wheelchairs, manufacturers of wheelchairs for low-resource settings face a cost–benefit tension between affordability and durability. Field studies are needed to provide feedback on durability. Four manufacturers provided cadres of wheelchairs to the organization providing rehabilitation to students at a boarding school for children with disabilities in a low-resource area. The Wheelchair Components Questionnaire for Condition was used to evaluate wheelchair maintenance condition at several time intervals after fitting. Because the maintenance regime was not identical for the four wheelchair types, wheelchair types were not compared. Analysis of variance indicated differences in condition across time and between wheelchair components. Tukey’s simultaneous comparison of means indicated that across the entire group, brakes, seats, casters and foot rests received lower ratings than frame. Preliminary data after each iteration of this study were provided to manufactures and resulted in responsive design changes.Implications for RehabilitationLongitudinal studies with the Wheelchair Components Questionnaire for Condition (WCQc) have enabled manufacturers to make responsive design improvements. Additional studies could be done with other wheelchair types to result in responsive positive design changes for those wheelchairs as well.The WCQc can be used in studies on wheelchair condition even when records of repair history are not reliably available, a situation which is not uncommon in low-resource areas.Data sets collected at an individual clinic uses the WCQc could focus attention on wheelchair components needing regular repair. With that data in mind, the maintenance regime could be modified to respond and in so doing improve wheelchair condition and reduce loss of mobility or risk of injury.Organizations involved in funding wheelchairs for a particular location could use data from longitudinal studies done with the WCQc at that location to inform purchasing decisions.

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users.Methods: The WMTP and WMT-Q were developed through an iterative process.Results: A convenience sample of clinicians (n = 17), manual wheelchair (n ∞ 5), power wheelchair users (n = 4) and caregivers (n = 4) provided feedback on the training programme. A convenience sample of clinicians (n = 38), manual wheelchair (n = 25), and power wheelchair users (n = 30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1) = 0.48 to ICC(3,1) = 0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p < 0.007).Conclusion: The WMTP will continue to be revised as it is further implemented. The WMT-Q is an acceptable instrument to measure pre- and post-training maintenance knowledge.Implications for RehabilitationThe Wheelchair Maintenance Training Program can be used to educate rehabilitation clinicians and technicians to improve wheelchair service and delivery to end users.This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers.This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown.This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

Preliminary reliability and internal consistency of the Wheelchair Components Questionnaire for Condition

Wheelchair durability and maintenance condition are key factors of wheelchair function. Durability studies done with double drum and drop testers, although valuable, do not perfectly imitate conditions of use. Durability may be harvested from clinical records; however, these may be inconsistent because protocols for recording information differ from place to place. Wheelchair professionals with several years of experience often develop a good eye for wheelchair maintenance condition. The Wheelchair Components Questionnaire for Condition (WCQc) was developed as a professional report questionnaire to provide data specifically on the maintenance condition of a wheelchair. The goal of this study was to obtain preliminary test–retest reliability and internal consistency for the WCQc. Participants were a convenience sample of wheelchair professionals who self-reported more than two years’ of wheelchair experience, and completed the WCQc on the same wheelchair twice. Results indicated preliminary reliability and internal consistency for domain related questions and the entire questionnaire.Implications for rehabilitationThe WCQc, if administered routinely at regular intervals, can be used to monitor wheelchair condition and alert users and health professionals about the need for repair or replacement.The WCQc is not difficult to use, making early monitoring for wear or damage more feasible. The earlier a tool can detect need for maintenance, the higher likelihood that appropriate measures may be employed in a timely fashion to maximize the overall durability of wheelchairs and minimize clinical complications.Keeping wheelchairs appropriately maintained allows users to minimize effort expended when using them, and maximize their function. It also lowers the risk of injury due to component failure.When assessing groups of similar wheelchairs, organizations involved in funding wheelchairs can use data from the WCQc to make purchase decisions based on durability, and manufacturers can use WCQc data for responsive design change

Clinician Competency with Wheelchair Maintenance and the Efficacy of a Wheelchair Maintenance Training Program

Clinician Competency with Wheelchair Maintenance and the Efficacy of a Wheelchair Maintenance Training Program

Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers.

The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veteran's nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.

Weather, disability, vulnerability, and resilience: exploring how youth with physical disabilities experience winter

Purpose: Having a mobility-related disability can create numerous challenges in navigating the physical and built environment, especially during winter. Such weather-related challenges can be a significant barrier to participation in everyday activities and are linked with increased physical and psychological morbidities. Unfortunately, mobility research – especially among youth – has often overlooked the effects of winter weather. Methods: This study explores the experiences of daily activities during Canadian winter among a purposive sample of youth, aged 15–22, who have a physical disability requiring the use of a mobility device. The researchers applied a qualitative design, including 12 in-depth interviews. Results: Our findings show that youth encounter several vulnerabilities to participating in social and recreational activities in winter, including: (1) physical barriers and social spatial exclusion; (2) health and safety concerns; and (3) psychosocial issues (i.e. worry, isolation and dependence). Youth also discussed several strategies for adapting to barriers and enhancing their participation during winter, including: (1) wheelchair maintenance; (2) awareness of surroundings; (3) practice using mobility devices and planning; and (4) keeping busy and active. Conclusions: Youth who use a mobility device are vulnerable to health and safety risks and isolation during the winter, but they also display signs of resilience.Implications for RehabilitationClinicians should ensure that youth who are new to using their mobility device are properly trained in how to use it.Service providers should offer a winter survival guide to youth who use a mobility device.Clinicians should be taught to recognize signs of loneliness, isolation and depression, and provide a list of local resources and activities during the winter.Rehabilitation engineers should focus their efforts on adapting mobility devices to enhance the safety of youth.