The impact of mHealth on physical activity in wheelchair users: A scoping review.

Balance and balance confidence are often impaired in ambulatory individuals with incomplete spinal cord injury (iSCI) and can increase the risk for falls. The Berg Balance Scale (BBS) and the Activities-specific Balance Confidence (ABC) Scale assess balance and balance confidence, respectively, although clinically significant changes in these outcomes are uncertain. Accordingly, the goal of this study was to determine the minimal detectable change (MDC) for the BBS and ABC Scale in individuals after iSCI. Individuals >6 months after C1-T10 iSCI with walking speeds <1.0 m/s were recruited and self-identified as community ambulators or community wheelchair users. Using a population-specific standardization protocol, the BBS and ABC Scale were administered twice by varied assessors. Test-retest reliability was assessed using the intraclass correlation coefficient with absolute agreement. The MDC was calculated with 95% confidence and stratified by the primary means of community mobility. Of the 50 individuals included, 52% identified as community ambulators. Both the BBS and ABC Scale demonstrated excellent test-retest reliability. Overall, the MDC 95 for the BBS was 8.0 points and lower for self-identified community ambulators (5.4 points) than for community wheelchair users (10.3 points). Observed MDC 95 for the ABC Scale was 16.6% and was similar for community ambulators (15.6%) and community wheelchair users (17.5%). Using a population-specific standardization protocol, the BBS and ABC Scale demonstrated excellent test-retest reliability in iSCI. The obtained MDC for the BBS is slightly higher than those reported in other neurologic populations, although the MDC for the ABC Scale is similar.

Greater mobility independence after spinal cord injury is thought to lead to better long-term outcomes. However, evidence is inconclusive for ambulation compared with wheelchair dependency. This study aimed to describe and compare long-term outcomes across mobility levels in individuals with spinal cord injury. Cross-sectional survey. Community-dwelling individuals with spinal cord injury in the Netherlands. Data were collected via the Dutch arm of the International Spinal Cord Injury (InSCI-NL) Survey (2018). Mobility level was assessed using the modified Spinal Cord Independence Measure-Self-Report. Long-term outcomes were compared across mobility levels, using generalised linear models. 253 participants were included with a mean (standard deviation) age of 58.7 (13.6) years and median [interquartile range] time since injury of 10 [5.0-22.0] years. Electric wheelchair users reported lower functional independence, and more participation problems and secondary health conditions compared with manual wheelchair users (p < 0.001). Ambulatory individuals using walking aids reported no better outcomes than manual wheelchair users, except for functional independence (p < 0.001). Ambulatory individuals without walking aids reported more paid work than those with walking aids (62.7% vs 34.3%, p < 0.001). In general, electric wheelchair users reported the least favourable long-term outcomes. Remarkably, ambulatory individuals using walking aids generally did not report better outcomes than manual wheelchair users.

ABSTRACT Objective To characterize the clinical and functional profile of adult patients with spina bifida attending a statewide spina bifida service in New South Wales, Australia. Setting public spina bifida service in NSW, Australia. Participants all adult patients (≥18 years) attending the spina bifida service as of January 2025. Outcome Measures continence status, mobility, skin integrity, psychosocial functioning, and ventriculoperitoneal shunt status. Methods A retrospective audit was conducted of clinical records for all adult patients (≥18 years) attending the NSW statewide spina bifida service as of January 2025. Variables assessed included continence status, mobility, skin integrity, psychosocial functioning, and ventriculoperitoneal shunt status. Results 143 patients were included (median age 37 years, 62% female). Urinary incontinence affected 42% of patients in the preceding 12 months, with 56% managing their bladder via intermittent catheterization. Bowel incontinence was reported by 20% of patients. Half of all patients (51%) were wheelchair users. A quarter (25%) reported a history of pressure injuries in the preceding 12 months. Despite these challenges, most patients (75%) lived either independently or with family support. Of patients with available data, 72% were engaged in work or study. Conclusions Adults with spina bifida continue to experience high rates of bladder and bowel dysfunction, mobility impairment, and pressure injuries. However, with appropriate multidisciplinary support, most individuals achieve employment and functional independence. These findings highlight the ongoing need for comprehensive spina bifida services and provide baseline data about this population in a large quaternary hospital.

Purpose: Wheelchairs should support not only safe and intuitive navigation but also positive social presence without reinforcing disability-related stereotypes. This study introduces a user-centred external communication framework (ECF) to guide the design of wheelchair external human–machine interfaces and their perceptual dimensions. Materials and methods: A two-phase mixed-methods approach was employed. In phase 1, focus groups with wheelchair users (WUs) and domain experts identified four key themes through thematic analysis. In phase 2, WUs evaluated multiple wheelchair designs, and their socio-emotional responses were analysed using principal component (PC) analysis. Results: In developing the ECF, phase 1 identified four themes – Streamlined Information in Interaction; User-Centric Safety Feedback; Harmonious & Minimalist Interaction Design; and Effortless Integration & Production – which form the foundational layer addressing functional and interactional requirements. In phase 2, PCs were positioned as second-layer perceptual elements, with the first three explaining over 70% of the variance. Manual wheelchairs were associated with Safety, Stability and Comfort, whereas powered designs emphasised Independence, Trustworthiness and Futuristic design; Communicative and Stylish qualities were valued across both. Conclusion: Although not mechanically functional, these PCs exert a circular influence by shaping user perceptions before interaction. Applying the ECF in wheelchair development can potentially improve wheelchair acceptance, sustained use and social presence.

Power wheelchair vendors: Declines in rural market activity.

BackgroundMobile exercise apps for people with paraplegia that offer accessible and customized exercise programs have the potential to promote fitness and health in this population. However, there is a lack of suitable exercise apps that do not require the support of healthcare professionals for exercise progression. The ParaGym app was designed to automatically tailor and progress the training intervention using an algorithm. This study aimed to assess the feasibility and safety of the exercise program, as well as the usability of the app to determine whether the app should be further developed.MethodsTwenty-three participants with chronic paraplegia (mean age 48 ± 13 years, 15/8 male/female) performed three app-delivered exercise sessions per week over six weeks. A mixed-methods approach was used to comprehensively assess feasibility, usability, and safety based on semi-structured interviews, exercise diaries, adherence and retention rates, the System Usability Scale (SUS), and reported adverse and severe adverse events. Interviews were analyzed using structured qualitative content analysis.ResultsInterview themes comprised satisfaction, adherence and motivation, training sessions and exercises, technical functionality, ease of use, and perceived safety. Participants expressed overall satisfaction with the app, as affirmed by the intention to continue use, an adherence rate of 70%, and a retention rate of 88%. Exercises were overall suitable and feasible, supported by easily understood videos and descriptions. Areas for improvement included frequent transitions between wheelchair and floor exercises and insufficient time to change positions during timed exercises. The mean SUS score was 84 ± 11, indicating good usability. This was confirmed during interview sessions. No adverse events occurred, and participants reported feeling safe during the training.ConclusionsThe app-delivered exercise sessions were overall feasible, and the app was easy to use. Further development is indicated and should prioritize practical considerations, such as grouping floor exercises, integrating additional safety considerations, and providing features for the user to further personalize the program. A future marketable and publicly available version for wheelchair users of all fitness levels can make a valuable contribution to low-threshold leisure opportunities.Trial RegistrationGerman Clinical Trials Register (DRKS00030370), October 25, 2022.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13102-026-01801-x.

Systematic review of outcome measures in facioscapulohumeral dystrophy (FSHD): validated, usable, and feasible tools for assessing function, performance, and strength.

Wheelchair-dependent individuals place high mechanical demand on their upper extremities, relying on their shoulders as weight-bearing joints for propulsion and transfers. Although reverse total shoulder arthroplasty (rTSA) is effective for rotator cuff-deficient shoulders, outcomes in wheelchair users remain understudied. This study evaluated short-term complication and revision rates following rTSA in wheelchair-dependent patients using a large national claims database. A retrospective cohort study was performed using PearlDiver Mariner, identifying patients who underwent primary rTSA. Wheelchair dependence was defined by International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Wheelchair users were propensity score-matched 1:5 to controls by age, sex, Charlson-Deyo Comorbidity Index, and length of stay. The primary outcomes were 2-year revision rates and 90-day all-cause readmission and emergency department (ED) visits. Secondary analyses evaluated specific post-operative complications including dislocation, periprosthetic fracture, and infection. Of 106,362 patients undergoing rTSA, 133 wheelchair users were matched to 665 controls. No significant difference was observed in 2-year revision rates (6.76% vs. 3.61%; P = .09). However, wheelchair users demonstrated higher 90-day rates of dislocation (4.51% vs. 1.65%; P = .048) and periprosthetic fracture (3.76% vs. 0.30%; P = .0019). All-cause 90-day ED utilization was also greater among wheelchair users (27.1% vs. 18.1%; P = .017). Wheelchair-dependent patients undergoing rTSA experience significantly higher early complication and ED visit rates, though 2-year revision rates appear similar. These findings highlight the unique mechanical and functional challenges faced by wheelchair users, underscoring the importance of specialized perioperative care and rehabilitation strategies in this high-demand population.

Wheelchair users’ involvement in roadway crashes: Exploring injury severity with synthetic data augmentation and Bayesian analysis

[Purpose] To investigate the users’ perceptions of powered wheelchairs (PWCs) provided by the rental service of equipment for long-termcare covered by public aid in Japan and to identify factors influencing the feasibility of their widespread use. [Participants and Methods]This qualitative study was conducted using semistructured interviews with five Japanese individuals who used PWCs rented from the rentalservice of equipment for long-term care covered by public aid to investigate their usage and perceptions of PWCs. The interview data wereorganized using the KJ method. [Results] The users chose wheelchairs of their own volition based on their values, developed attachments totheir PWCs, and used them as effective tools to lead independent lives. Participants positively evaluated the value of PWCs and acceptedtheir advantages and disadvantages. However, they felt that using PWCs in their daily lives was difficult. [Conclusion] PWCs can beefficiently distributed among wheelchair users who wish to live independently and participate in society. The specific and complex drivingmaneuvers, safety considerations for operating PWCs in real-life situations, and the low public awareness of PWCs are factors influencingtheir widespread use.

Background: This study examined the independent and combined associations of hand-grip strength (HGS) and arm muscle mass index with risk of non-alcoholic fatty liver disease (NAFLD) in individuals who use wheelchairs. Methods: Eighty-five individuals aged ≥ 30 years who use wheelchairs were enrolled as volunteers from sports welfare facilities for individuals with disabilities in “G” and “C” provinces. HGS was measured using a dynamometer, whereas the arm muscle mass index was assessed using a body composition analyzer. Risk of NAFLD was defined as a hepatic steatosis index (HSI) > 36 and Framingham steatosis index (FSI) ≥ 23. Results: The low-HGS group (HSI, odds ratio [OR] = 3.589, p = 0.013; FSI, OR = 2.710, p = 0.031) had a significantly higher NAFLD risk compared to the high-HGS group (reference, OR = 1). The low-arm-muscle-mass-index group showed a higher risk of NAFLD (HSI, OR = 2.762, p = 0.043; FSI, OR = 3.493, p = 0.007) compared to the high-arm-muscle-mass-index group (reference, OR = 1). Combining the low-HGS + low-arm-muscle-mass-index group (HSI, OR = 6.849, p = 0.006; FSI, OR = 6.957, p = 0.002) showed a significantly higher risk of NAFLD compared to the high-HGS + high-arm-muscle-mass-index group (reference, OR = 1), even after adjusting for covariates (HSI, OR = 7.352, p = 0.006; FSI, OR = 7.406, p = 0.003). Conclusions: Low HGS and low arm muscle mass index are independently associated with a higher risk of NAFLD in individuals who use wheelchairs, with low HGS plus low arm muscle mass index further increasing this risk.

Efficient manual wheelchair (MWC) propulsion is essential for long-term mobility but is associated with upper limb overuse injuries. Clinical guidelines recommend the semicircular (SC) pattern, yet novice users often adopt suboptimal techniques and receive limited feedback. This study evaluated whether visual augmented feedback delivered through the miWe virtual reality MWC simulator improves SC propulsion, contact angle, and cadence in novice users. Eight adults with no prior MWC experience participated in an ABA single-subject design with 6 experimental participants and 2 control participants. Baseline and post-test were conducted with a real MWC and SMARTWheel, while intervention sessions occurred in a gamified simulator equipped with a convolutional neural network (CNN) propulsion classifier. Results showed that experimental subjects improved SC propulsion usage, with Tau-U values ranging from 0.33 to 0.67 and 100% non-overlapping data (PND) across all experimental participants, indicating consistent improvement and retention at post-test. In contrast, control participants showed deterioration, with negative Tau-U values (−0.67 and −0.33) and 0% PND, indicating no improvement. Contact angle improved in experimental participants (Tau-U up to 0.67, PND = 100%) but not in controls (PND = 0%). Cadence showed variable changes across participants, with Tau-U values ranging from −0.67 to 0 and mixed PND results (0–100%), indicating no consistent reduction at post-test. These results support the use of automated visual feedback in virtual reality (VR)-based MWC training to promote efficient propulsion patterns aligned with clinical recommendations, with the strongest and most consistent effects observed for SC pattern adoption.

Purpose Wheelchair users represent a population with significant and often permanent mobility impairment. Despite well-established links between disability and socioeconomic deprivation, the geographic relationship between wheelchair user concentration and area-level deprivation has not previously been examined at national scale. This study aimed to identify spatial clusters of wheelchair users across Wales and characterise their association with socioeconomic deprivation across domains of the Welsh Index of Multiple Deprivation (WIMD). Methods This cross-sectional ecological study used 43,790 NHS-registered wheelchair users across all 1,917 Lower Layer Super Output Areas (LSOAs) in Wales. Local Moran’s I identified statistically significant High-High (HH) spatial clusters of wheelchair user counts. Chi-square goodness of fit tests, chi-square tests of association, and binary logistic regression quantified the association between WIMD deprivation quintile (Q1-5) and HH clustering across WIMD domain, with Benjamini-Hochberg false discovery rate correction applied throughout. Results One-hundred-and-ten HH clusters were identified, with 41% in the most deprived WIMD Overall quintile. Significant deprivation gradients were observed across six domains; Health and Employment showed the strongest associations, with Q1:Q5 wheelchair user ratios of 1.747 and 1.738 and up to 20-fold greater odds of HH cluster membership in the most deprived quintile. Housing and Access to Services showed divergent patterns, with clusters concentrated in areas of moderate rather than extreme deprivation. Conclusions Wheelchair user spatial clustering in Wales is strongly associated with socioeconomic deprivation, but the association varies by WIMD domain. These findings provide actionable spatial evidence to support equitable NHS wheelchair service commissioning aligned with true geographic need.

This research paper proposes the concept of a voice-controlled smart wheelchair that enables mobility, safety and independence for physically disabled persons. This smart wheelchair incorporates various hardware and software modules, including the Raspberry Pi Zero 2 Was the brain unit, into its framework to facilitate intelligent operation. A microphone unit is designed to recognize voice commands and process them through machine learning-based speech recognition technology to enable hands-free operation of the wheelchair. To ensure the safety of the user, a physical mushroom-type emergency stop button is integrated to instantly stop the wheelchair when pressed. The wheelchair movement components include 350 watts DC brushed motors and a strong structure to ensure smooth movement. The motor speeds can be regulated through the intelligent control unit to enable smooth and efficient movement within the indoor and outdoor environments. Location tracking in real time is provided through a GPS module, while in emergency situations, location updates are sent to caregivers using a GSM module. In addition, the text-to-speech feedback provides audio confirmation for system status and user commands, further improving usability for those users challenged by vision or physical capabilities. The power input shall be provided through a rechargeable lithium-ion battery pack with BMS and voltage regulation, allowing for continuous operation in a safe manner. Overall, the workflow that can be realized consists of system wake-up through a wake word, followed by voice command processing, safety validation, execution of motor control, GPS based location monitoring, and data logging for analysis. This assistive mobility in a smart wheelchair, as proposed, is cost effective, user-friendly, and safety-focused, showing in practice how to effectively incorporate voice control, embedded systems, and real-time communication technologies.

Advanced sensor signal analysis is increasingly important for intelligent health management in human-centered environments, where continuous perception and real-time interpretation of motion-related signals are essential for safe and adaptive assistance. In this study, we propose a vision-based sensor signal analysis framework for automated ergonomic risk assessment of wheelchair users during cabinet interaction. The proposed framework integrates YOLOv11 for human detection, MHFormer for monocular 3D pose reconstruction, and a fuzzy logic-enhanced RULA model for continuous ergonomic risk quantification from video-derived motion signals. To support model development and evaluation, we constructed a dedicated wheelchair cabinet-operation dataset comprising 30 participants, including 14 experienced wheelchair users and 16 trained simulation participants, across five representative cabinet-operation scenarios. The raw dataset contained approximately 5 h of RGB video and about 150,000 original frames. To reduce redundancy caused by highly similar consecutive frames and to mitigate overfitting risk, representative frames were sampled from the continuous video sequences, resulting in 10,000 images for annotation and model development. Based on the proposed framework, raw visual sensor signals are transformed into temporally continuous kinematic representations and ergonomic risk scores, enabling non-contact and real-time health-state interpretation in assistive living environments. The proposed method achieved an average joint-angle estimation RMSE of 7.5°, representing an approximately 60% reduction compared with a Kinect v2-based motion capture baseline (18.6°), which is widely used for low-cost ergonomic evaluation. In benchmark evaluation, the proposed method achieved 84% risk-classification accuracy with a Cohen’s kappa of 0.66, outperforming representative baseline approaches. The results further indicated that low revolving-door and low-drawer operations were associated with higher and more sustained ergonomic risk exposure than sliding-door interaction. These findings demonstrate that vision-based sensor signal analysis can provide an effective solution for intelligent health management, ergonomic monitoring, and perception-driven assessment in accessible and assistive autonomous living systems.

Purpose Social participation among wheelchair users depends heavily on mobility. While assistive navigation technologies like Google Maps have reshaped urban mobility, they often overlook the specific needs of wheelchair users. This study aimed to explore how wheelchair users interact with urban environments while using an assistive navigation technology and find gaps in route instructions, in order to determine the key information components required for adapted route instructions. Methods A mixed-methods, simultaneous quantitative-qualitative field study was conducted with nine manual wheelchair users (7 males and 2 females, aged 21 to 61 years) in Quebec City, Canada. Participants navigated a predefined route using Google Maps while wearing eye-tracking glasses. Their navigation and semi-structured interviews during navigation were recorded, and their route descriptions were finally collected. Analysis of participants’ hesitation, confusion, stops, errors, visual behaviour, and perceptions was performed. Results Findings revealed the need for more adapted instructions enriched with street-crossing and continuing-straight actions. The study emphasized the importance of alerts for accessibility and safety issues during wayfaring, and salient environmental objects to support orientation and route confirmation. Conclusion Incorporating such information into adapted route instructions allows wheelchair users to anticipate route accessibility and salient environmental objects and focus on their surroundings rather than continuously checking cellphone and routes. This can improve their navigation experience and, ultimately, their social participation and quality of life.

Purpose To translate and culturally adapt the Wheelchair Skills Test-Questionnaire (WST-Q) into Italian, and to assess its reliability, measurement error and validity in manual wheelchair users. Materials and methods The WST-Q was translated and culturally adapted using forward-backward translation, expert review, and cognitive debriefing with wheelchair users and rehabilitation professionals. Internal consistency (Cronbach’s α), test-retest reliability (Intraclass Correlation Coefficient, [ICC]), measurement error (Standard Error of Measurement [SEM] and the Smallest Real Difference [SRD]) were calculated. Validity was examined through WST-Q scores correlations (concurrent validity) and known-groups comparisons (years of use, training) (construct validity). A General Linear Model (GLM) was used to explore the effects of clinical and demographic factors, accounting for interaction terms. Results Seventy-four manual wheelchair users, with a mean age of 44.0 years (SD: 15.7), participated in the study. Cronbach’s α was 0.96–0.97 across WST-Q scores. ICCs indicated excellent test-retest reliability (0.88–0.92). SEM ranged from 4.9 to 6.9, and SRD from 13.6 to 19.3. Strong correlation among WST-Q scores was observed (p = 0.81–0.90, p < 0.001). Known-groups validity showed higher scores in participants with >2 years of wheelchair use and in those with training. GLM analysis identified significant effects of baseline pathology, wheelchair type, gender, and training, with several interaction effects, explaining 77–89% of score variance. Conclusion The Italian WST-Q demonstrated excellent reliability, acceptable measurement error, and good validity. It is suitable for assessing self-reported manual wheelchair skills in Italian rehabilitation settings, supporting standardised and evidence-based practice.

Pedestrians, especially wheelchair users, face significant navigation challenges due to inadequate infrastructure. Addressing these challenges requires pathfinding services to offer optimal routes tailored to user needs. Such routes depend on detailed infrastructure data, often absent from crowdsourced maps. This study enhances OpenStreetMap (OSM) data and presents a multi-criteria, context-aware routing approach. It integrates Dijkstra’s algorithm, a Decision Tree (DT), and Ordered Weighted Averaging (OWA) for personalized navigation. The proposed framework makes two key contributions: (1) a Large Language Model (LLM)-driven OSM enrichment pipeline and (2) a custom OWA-weighted DT algorithm that adapts routes according to user preferences. Experiments on 190 routes in Calgary show the enhanced network reduces total walking distance by 25.89 km (12.45%) and travel time by 47.78 min (9.83%) compared to the original OSM-based network. The customized pathfinding method enables preference-aware routing based on criteria such as surface quality, slope, crossing safety, and lighting. Results show improvements in safety-focused profiles, with a 2.2% increase in safety-related attributes. Accessibility-focused profiles see a 5.3% increase in surface quality. Personalized routes remain efficient, averaging only 1.8% longer than the shortest available path. In 97.4% of cases, the distance stays within a 10% margin. This supports real-time routing with low computational overhead. Limitations include dependence on attribute completeness. Future research will incorporate real-time environmental conditions, expand preference-learning mechanisms, and evaluate generalizability across a wider range of urban contexts, supporting real-time routing with minimal computational overhead. • Enhances OpenStreetMap data using a multi-source enrichment pipeline. • Combines human expertise with Large Language Models to improve OSM geospatial data quality. • Cold-start routing framework combining rule-based paths, OWA, and a DT model. • Uses explicit and implicit preferences to create context-aware pedestrian routes. • Walking speed model that adapts to infrastructure and user demographic factors. • Tailored models and enriched data yield routes that better reflect user preferences.

n Advanced Patient Support System is developed to improve patient safety and care using smart technologies. This project integrates a joystick-controlled smart wheelchair and a safety-based automated bed system. The wheelchair allows easy movement of patients with limited mobility, while the bed is designed to detect patient movement and prevent accidental falls by providing alerts. The system helps caregivers monitor patients effectively and reduces manual effort. It offers a simple, reliable, and efficient solution for hospitals and home care environments. Key idea of the Abstract: The abstract describes a healthcare support system that combines a joystick-based wheelchair for easy patient mobility and a smart bed with an ultrasonic sensor for continuous monitoring. It focuses on detecting patient movement and providing immediate alerts through buzzer and LED to prevent accidents. The system highlights safety, ease of use, and costeffectiveness, making it suitable for hospitals and home care environments.