Wheelchair Transportation Safety Research Articles

A Literature Review of Wheelchair Transportation Safety Relevant to Automated Vehicles.

This literature review summarizes wheelchair transportation safety, focusing on areas pertinent to designing automated vehicles (AVs) so they can accommodate people who remain seated in their wheelchairs for travel. In these situations, it is necessary to secure the wheelchair to the vehicle and provide occupant protection with a Wheelchair Tiedown and Occupant Restraint System (WTORS). For this population to use AVs, a WTORS must be crashworthy for use in smaller vehicles, able to be used independently, and adaptable for a wide range of wheelchair types. Currently available WTORS do not have these characteristics, but a universal docking interface geometry and prototype automatic seatbelt donning systems have been developed. In the absence of government regulations that address this situation, RESNA and ISO have developed voluntary industry standards to define design and performance criteria to achieve occupant protection levels for wheelchair-seated passengers that are similar to those provided by conventional vehicle seats.

Identifying Challenges to Securing Wheeled Mobility Devices Using Tiedowns and Occupant Restraint Systems From the User Perspective

OCCUPATIONAL APPLICATIONS Wheeled mobility device passengers rely upon bus operators for proper securement of the wheelchair tiedown and occupant restraint system during transit. Yet, wheeled mobility devices are rarely properly secured, and passengers are often unrestrained during transit. This study investigated the usability of wheelchair tiedown and occupant restraint systems aboard transit systems to identify challenges resulting in improper securement or non-use of the wheelchair tiedown and occupant restraint system system. The task demands and bus operator's functional limitations appeared mismatched, jeopardizing the wheeled mobility device user's safety during transit. The current findings suggest the need to incorporate the bus operator's role during subsequent design or redesign of the wheelchair tiedown and occupant restraint system task.TECHNICAL ABSTRACT Rationale: Public transportation buses are required to be equipped with wheelchair tiedowns and occupant restraint systems to ensure safe transit of wheeled mobility device users. Wheeled mobility device users rely upon bus operators for wheeled mobility device securement, yet proper wheelchair tiedown and occupant restraint system implementation is often not performed. Prior research efforts in wheelchair transportation safety have not considered the bus operator's physical health as a challenge to securing a wheeled mobility device passenger. Purpose: The current study characterized musculoskeletal pain and discomfort, along with functional limitations, among bus drivers in the context of assisting wheeled mobility device passengers. Findings from this study were then synthesized with a previously reported ergonomic analysis to provide a more comprehensive understanding of factors that may pose challenges to bus operators securing a wheeled mobility device passenger. Methods: Musculoskeletal pain and functional limitations were determined by self-reports using a customized and standardized questionnaire. Previously reported task demands were quantified by ergonomic analyses of the wheelchair tiedown and occupant restraint system task. Results: Eighty-three percent of the operators reported musculoskeletal pain/discomfort in at least one body region, and 60% reported experiencing pain across multiple regions of the body. The highest number of prevalent reports of pain and functional limitations identified by the operators were at the knees, low back, neck, and shoulders. Ergonomic analyses revealed higher demands for these same four body regions, suggesting limited ability of the operators to perform the wheelchair tiedown and occupant restraint system task properly. Conclusions: The mismatch between the wheelchair tiedown and occupant restraint system work-related factors and the bus operator's functional limitations may contribute to the observed improper securement. These findings suggest a redesign of the wheelchair tiedown and occupant restraint system is warranted, which should incorporate the role of bus operators during the process.

RESNA's Position on Wheelchairs Used as Seats in Motor Vehicles

ABSTRACT This position paper is based on the premise that those who ride seated in wheelchairs are entitled to equivalent occupant safety when they are traveling in motor vehicles. The document summarizes research and best practice for safety and selection of crashworthy wheelchairs with the requisite features required by the WC19 safety standard when it is necessary for individuals to use a wheelchair as a seat in a motor vehicle. Recommendations are based on data from accident and injury databases, prior research and a synopsis of the design, testing, performance and labeling requirements of ANSI and ISO voluntary industry standards for wheelchair transportation safety. This paper is intended for an audience of consumers, rehabilitation and health care professionals, manufacturers of wheelchairs and wheelchair transportation equipment and those who make reimbursement and public policy decisions. Content reviewed by the RESNA SIG on Wheeled Mobility and modified in accordance with SIG reviewers comments—January 2010. Approved by the RESNA Board of Directors—April 2010.

Wheeled Mobility Device Transportation Safety in Fixed Route and Demand-Responsive Public Transit Vehicles within the United States

ABSTRACT An overview of the current status of wheelchair transportation safety in fixed route and demand-responsive, non-rail, public transportation vehicles within the US is presented. A description of each mode of transportation is provided, followed by a discussion of the primary issues affecting safety, accessibility, and usability. Technologies such as lifts, ramps, securement systems, and occupant restraint systems, along with regulations and voluntary industry standards have been implemented with the intent of improving safety and accessibility for individuals who travel while seated in their wheeled mobility device (e.g., wheelchair or scooter). However, across both fixed route and demand-responsive transit systems a myriad of factors such as nonuse and misuse of safety systems, oversized wheeled mobility devices, vehicle space constraints, and inadequate vehicle operator training may place wheeled mobility device (WhMD) users at risk of injury even under non-impact driving conditions. Since WhMD-related incidents also often occur during the boarding and alighting process, the frequency of these events, along with factors associated with these events are described for each transit mode. Recommendations for improving WhMD transportation are discussed given the current state of knowledge.

Applying basic principles of child passenger safety to improving transportation safety for children who travel while seated in wheelchairs

Occupant restraint systems are designed based on knowledge of crash dynamics and the application of proven occupant-protection principles. For ambulatory children or children who use wheelchairs but can transfer out of their wheelchair when traveling in motor vehicles, there is a range of child safety seats that comply with federal safety standards and that therefore offer high levels of crash protection. For children who remain seated in wheelchairs for travel, the use of wheelchairs and wheelchair tiedown and occupant restraint systems (WTORS) that comply with voluntary industry standards significantly enhances safety. Revisions to the initial versions of these standards will further improve safety for smaller children who travel seated in wheelchairs by requiring wheelchairs for children between 13 and 22 kg (18 and 50 lb) to provide a five-point, wheelchair-integrated crash-tested harness similar to that used in forward-facing child safety seats. While wheelchair and tiedown/restraint manufacturers, van modifiers, transportation personnel, clinicians, and others involved with children who use wheelchairs have clearly defined responsibilities relative to providing these children with safe transportation, parents and caregivers should be knowledgeable about best-practice in wheelchair transportation safety and should use this knowledge to advocate for the safest transportation possible.

Wheelchair transportation safety on school buses: Stakeholder recommendations for priority issues and actions

This paper presents results from and provides discussion of a state-of-the-science workshop in which highly informed stakeholders in wheelchair transportation safety for students on school buses were participants. The Nominal Group Technique was used to create a process in which the main issues preventing safe transportation of wheelchair-seated students and key strategies to overcome these issues were identified and ranked. These results, along with a synthesis of group discussion and recommendations for action, are presented along with consideration of current policies, regulations, and political realities. Critical safety shortcomings exist in this highly specialized enterprise that varies from state to state. Recommended strategies include implementing wheelchair requirements in federal transportation safety standards, creation of a clearinghouse for wheelchair transportation best practices and education, creation of national standards for training, practices, and monitoring, and increased "buy-in" to voluntary wheelchair standards by wheelchair manufacturers.

School bus transportation for students seated in wheelchairs

For children with Individualized Education Plans (IEPs), transportation is considered a related service and a part of their education. This paper presents an overview of the current status of wheelchair transportation for students on school buses within the United States. The review includes the school transportation environment for wheelchair-seated students, applicable regulations and voluntary standards, primary safety issues for wheelchair-seated students, and key stakeholders roles in improving wheelchair transportation safety. Future actions to improve wheelchair transportation safety in school transportation are discussed, including the need to improve data collection, mandate payment for and use of RESNA WC19-compliant wheelchairs, improve training for bus operators and attendants, and require specialty certification for school bus operators who transport wheelchair-seated students.

WC19: A wheelchair transportation safety standard—Experience to date and future directions

ANSI/RESNA WC19 (i.e., WC19) is a voluntary standard that specifies design and performance requirements for wheelchairs that are suitable for use as seats in motor vehicles. The guiding principles for the standard originate from automotive crash-protection principles that are effective in reducing occupant injuries and fatalities. In addition to frontal-impact testing of wheelchairs, the standard includes tests for securement-point accessibility, tiedown-strap clear paths, lateral stability, and accommodation of vehicle-anchored belt restraints. Results from testing wheelchairs to WC19 reveal that the most common wheelchair problems include: a lack of structural integrity during frontal-impact loading; sharp rigid edges; and wheelchair structures that interfere with achieving proper positioning of vehicle-anchored belt restraints. Data from 8 years of experience with WC19 indicate where changes are needed to further improve transportation safety for wheelchair-seated travelers. These include expanding WC19 to include wheelchairs for smaller children who require a five-point harness restraint, and requiring wheelchairs to achieve a minimal rating for the ease of achieving proper positioning of vehicle-anchored belt restraints.

State of the Science Workshop on Wheelchair Transportation Safety

ABSTRACT The Rehabilitation Engineering Research Center on Wheelchair Transportation Safety held a state-of-the-science workshop on wheelchair transportation. The workshop had three purposes: reviewing and documenting the status of wheelchair transportation safety, identifying deficiencies, and formulating, discussing, and prioritizing recommendations for future action. The final goal was to disseminate the workshop outcomes for utilization in formatting future research priorities. A nominal group technique was used to facilitate focused open discussion by knowledgeable persons, resulting in the identification and ranking of existing deficiencies according to priority. Participants then formulated potential short-term solutions and speculated what wheelchair transportation safety should be in the future. This document presents four white papers, prepared prior to the workshop and modified according to participant feedback, and summarizes the outcomes of the workshop. The results identify and prioritize recommendations for future action.

Patients' and Health Care Providers' Knowledge of Wheelchair Transportation Issues

ABSTRACT The objective of this study was to determine the level of knowledge about wheelchair transportation safety practices among wheelchair users (WCUs) and caregivers, therapists, physicians, and other professionals (CTPs). Two 10-question surveys were designed. One was administered to a convenience sample of 107 WCUs, average age 31 years (range: 4 to 86). Diagnoses included cerebral palsy (39%), spinal cord injury (19%), and others. The second was given to a convenience sample of 87 caregivers (33%), therapists (27%), physicians (18%), and others. Results indicated that most WCUs (67%) and about half of the CTPs had not received education about best transportation practices. Less than 20% in either group had heard of the transit option or a transit wheelchair, and less than 7% were aware of SAE J2249 and ANSI-RESNA WC/19 standards for wheelchairs and transportation. Sixty-seven percent of WCUs and 46% of CTPs felt lack of knowledge restricted their use of best transportation practices, followed by cost and vehicle space. Education about best practices was related to increased knowledge as well as increased use of occupant and wheelchair restraints. We concluded that there is a poor level of knowledge about wheelchair transportation safety practices among WCUs, caregivers, and professionals who prescribe wheelchairs. This knowledge deficit leads to a lack of standardized transport and a potential compromise of safety. Education can be beneficial, and should be pursued.

Characterization of pediatric wheelchair kinematics and wheelchair tiedown and occupant restraint system loading during rear impact

This study characterizes pediatric wheelchair kinematic responses and wheelchair tiedown and occupant restraint system (WTORS) loading during rear impact. It also examines the kinematic and loading effects of wheelchair headrest inclusion in rear impact. In two separate rear-impact test scenarios, identical WC19-compliant manual pediatric wheelchairs were tested using a seated Hybrid III 6-year-old anthropomorphic test device (ATD) to evaluate wheelchair kinematics and WTORS loading. Three wheelchairs included no headrests, and three were equipped with slightly modified wheelchair-mounted headrests. Surrogate WTORS properly secured the wheelchairs; three-point occupant restraints properly restrained the ATD. All tests used a 26 km/h, 11 g rear-impact test pulse. Headrest presence affected wheelchair kinematics and WTORS loading; headrest-equipped wheelchairs had greater mean seatback deflections, mean peak front and rear tiedown loads and decreased mean lap belt loads. Rear-impact tiedown loads differed from previously measured loads in frontal impact, with comparable tiedown load levels reversed in frontal and rear impacts. The front tiedowns in rear impact had the highest mean peak loads despite lower rear-impact severity. These outcomes have implications for wheelchair and tiedown design, highlighting the need for all four tiedowns to have an equally robust design, and have implications in the development of rear-impact wheelchair transportation safety standards.