Wheeled Mobility Device Users Research Articles

Use of Remote Focus Groups to Improve Inclusive Design Practice

This study examines the use of remote focus groups to obtain wheeled mobility device user’s ideas regarding Shared Autonomous Vehicles (SAVs). Given the global increase in the aging population and disabled people, inclusive design is essential for accessible transportation. Using remote focus groups, this research collected statements from nine wheeled mobility device users about their design preferences, needs, and challenges with SAVs. Participants attended four virtual sessions featured with presentations and videos of SAVs. Discussions were video recorded in Zoom, with transcripts reviewed for accuracy. Data analysis included cleaning, coding, and assessing interrater reliability using the ICC. The findings not reported here highlighted the diverse needs and preferences of participants, emphasizing the importance of collecting information from this group early in the design process. This study shows well-planned remote focus groups can be an effective tool to gather human factors system design information from user populations that face transportation barriers.

The struggle for access – a qualitative document study of how people using wheeled mobility devices experience exclusion and discrimination

Purpose The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices. Material and methods We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016. Results The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one’s life as others do. Conclusions Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change. IMPLICATIONS FOR REHABILITATION Difficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings. Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised. People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

Usability of a navigation application for travel in Quebec City with wheeled mobility device and, further validation of the Evaluation of satisfaction with geospatial assistive technology

Purpose Knowledge of route accessibility is indispensable for “wheeled mobility device” users to travel safely and efficiently; however, current navigation technologies hardly provide adapted information for this population. Aims of the study were to collect data on the usability of a navigation application and to propose a version 1.0 of the Evaluation of satisfaction with geospatial assistive technology (ESGAT), by addressing the criterion, construct and cross-cultural validities. Method A filmed field trial and a methodological study were conducted in parallel. Thirty wheeled mobility device users were filmed planning and making a 10-minute known journey using the HERE WeGo app. The ESGAT, ÉSTGA (French version) and the Computer System Usability Questionnaire were administered. A video observation grid addressed the effectiveness and efficiency during the journey. Descriptive, correlation and multiple match analyses were performed. Results Fourteen men and 16 women averaging 45.9 years old tried out HERE WeGo; 14 were powered wheelchair users. Usability of the app was moderate (good effectiveness, moderate efficiency and quite satisfied). The criterion validity of the ÉSTGA was good (r = 0.598; p < 0.001). The construct validity was average considering the results for factor 1 (α = 0.789, acceptable), factor 2 (α = 0,586, low) and factor 3 (α = 0.409, unacceptable). The cross-cultural validity (French vs English) was moderate (r = 0.861; p < 0.001). Conclusion ESGAT and ÉSTGA 1.0 questionnaires are now available in English and French with a total mean score (11 items), an informatics subscore (mean of 5 items) and a geomatic subscore (mean of 6 items). Their validation should be pursued with new navigation applications. IMPLICATIONS FOR REHABILITATION Clinicians should ask their clients using a wheeled mobility device to test navigation applications to ensure their safety and complete the Evaluation of satisfaction with geospatial assistive technology (ESGAT 1.0), also available in French. Clinicians should inquire about satisfaction for items addressing informatics (Ease of access, Learnability, Hands-free function, Ease of use, Transportability and Appearance) and items addressing geomatic (Content, Geographic information, Effectiveness, Efficiency, Real-time navigation assistance, Aspect of security). Rehabilitation clinicians should inquire about the efficiency of the navigation app, considering avoiding or announcing potential obstacles such as: travelling on the street for a long portion of the trip and not on the sidewalk; verbal indication too soon or too late; incorrect indication; damaged, and congested sidewalk.

Wheeled Mobility Use on Accessible Fixed-Route Transit: A Field Study in Environmental Docility.

Multiple field studies provide qualitative accounts of usability barriers experienced by users of wheeled mobility devices on public transit. This study aimed to examine these usability barriers from the theoretical perspective of Environmental Docility by quantifying the relationship between functional capabilities of wheeled mobility device users and ingress–egress performance on accessible fixed-route transit vehicles in an urban setting. Twenty-eight wheeled mobility users each completed three trips on a predetermined route through the local public transit system. Ingress and egress times, user-reported usability ratings and open-ended comments were analyzed. Regression analyses indicated significant interactions between age and minimum parallel-park length on ingress and egress times. Specifically, lower functional capability reflected in older age and less maneuvering ability predicted decreased performance (longer ingress–egress times), indicating less adaptability to environmental demands and agreement with the Environmental Docility Hypothesis. Usability ratings and comments revealed difficulty with negotiating access ramps and turning maneuvers in the vehicle interior and in proximity to other passengers. Despite compliance with accessibility standards, current design of transit vehicles present substantial usability barriers for wheeled mobility users. Environmental Docility provides a theoretical basis to identifying modifiable factors related to person and environment for improving usability of public transit for people aging and/or with mobility impairments.

An exploration of the navigational behaviours of people who use wheeled mobility devices in unfamiliar pedestrian environments

PurposeThis paper explores the challenges that people who use wheeled mobility devices face navigating unfamiliar pedestrian environments. The intent is to understand their decisions during the planning and travel phases and to compare these decisions and experiences between mobility device users. MethodsFourteen mobility device users (4 manual wheelchair, 6 power wheelchair, and 4 scooter users) completed surveys that captured data about socio-economic and disability status, mobility device skills and confidence, and wayfinding abilities. As part of a wheeling interview, participants planned trips to three destinations in an unfamiliar urban setting. They wore a GoPro camera affixed to their head and carried a global positioning system device as they wheeled to each destination. During each trip, participants answered questions regarding their decisions and experiences. At the end of each route, participants rated the physical and mental demand of the trip and rated their own performance using the NASA-TLX questionnaire. They also completed wayfinding skills tests of their spatial orientation and ability to estimate distance and slope. Transcripts of the videos were coded and analyzed using interpretive description. Spatial and qualitative data were then uploaded into a geographical information system to identify patterns in decision making and experiences and compare across mobility devices. ResultsThe findings highlight the complex and dynamic challenges faced by wheeled mobility device users and the implications on their mobility. The findings emphasize the relationship between the individual, the mobility device, and the environment to shape navigational experiences. Manual wheelchair users appeared to struggle more with navigation because accessibility issues diverted their attention away from maintaining orientation and heading. ConclusionsWheeled mobility device users face challenges navigating unfamiliar environments that make reaching destinations difficult which may deter community participation. Environments that incorporate their diverse and unique requirements should be considered in urban design and research.

Accessibility facilitators and barriers affecting independent wheelchair transfers in the community

Purpose The purpose of this study is to identify facilitators and barriers to wheelchair transfers in the community and to identify specific places and surfaces in the community where increasing transfer accessibility could enable greater participation. Methods This study enrolled 112 wheeled mobility device users who completed a survey describing barriers to independent transfers. Descriptive statistics (means, standard deviations, and percentages) were used to report the survey results. Results The majority of subjects (≥50% of the sample) who were impacted by the following features found them to be helpful while transferring: presence of transfer aids, presence of grab bars, large enough transfer surface size, storage space for a wheeled mobility device (WMD), large amounts of space and clearance for legs and feet, soft surfaces, and enough space next to the transfer surface. Ninety percent (90.5%) felt their participation was limited when surfaces higher than their WMD were encountered. Participants also reported feeling limited in their participation due to lack of transfer accessibility at a variety of community destinations, including medical facilities (35.1%), modes of transportation (38.5–52.1%), pools and hot tubs (45.4%), dressing rooms (50.0%), amusement parks (49.1%), and boating areas (52.1%). Conclusion Improving accessibility for independent transfers in the community may support greater participation and lead to a better quality of life. Study findings provide insight into changes that would make the built environment more accessible and safer for wheelchair users who independently transfer. Implications for rehabilitation Transferring independently is one of the most physically demanding tasks for wheelchair users, and physical and environmental factors may affect transferability in the community. Identifying environmental facilitators and barriers to transfers may improve accessibility for wheelchair users, allowing for greater community participation, reduced risk of falls and injuries, and improvements to quality of life.

Effects of grab bars and backrests on independent wheelchair transfer performance and technique.

For individuals who rely on wheeled mobility devices for primary mobility, the ability to transfer independently greatly enhances participation in activities within and outside of the home. Nonlevel transfers are challenging and inevitable as not all surfaces in all settings can be made level with an individual's seat to floor height. The purpose of this study was to investigate the effects of two transfer aids, grab bars, and backrests, on the performance and quality of nonlevel transfers. This study employed a repeated-measures design with transfer setup as the independent variable. Sixty-eight (53 men and 15 women) wheeled mobility device users performed level and nonlevel transfers to a bare surface, a surface with grab bars present, a surface with grab bars, and a backrest present. For each condition, participants were asked to transfer as high and as low as they could go while still performing an independent and safe transfer. The transfer assessment instrument was used to evaluate the quality of their transfer technique. Participants were able to transfer an absolute height up to 2.5cm (1″) higher and lower when grab bars or grab bars and a backrest were present on the surface (p<0.042) and 2.3cm (~1″) higher relative to their wheelchair level seat high when grab bars were present on the surface (p<.001). Transfer technique significantly improved for both uphill and downhill transfers with the presence of grab bars and a backrest as shown by the transfer assessment instrument scores (p<0.046). The presence of grab bars and a backrest on transfer surfaces may help mobility device users to achieve higher and lower absolute transfer heights and facilitate better transfer technique.

Revisiting Clear Floor Area Requirements for Wheeled Mobility Device Users in Public Transportation.

Current accessibility standards in the U.S. prescribe minimum dimensions for 'clear floor area' to accommodate wheeled mobility device (WhMD) users on transportation vehicles. Prior research on the anthropometry of WhMD users (n = 500) indicates that these dimensions are too small to accommodate the size of many occupied wheeled mobility devices, especially power chairs and scooters. This paper describes a development project designed to update the evidence for these technical criteria and communicate them to the vehicle designers and accessibility standards developers in a manner that would facilitate making good decisions. An interactive web-based design tool was developed for determining the dimensions of clear floor area to achieve a user-specified level of physical accommodation based on occupied device length and width measurements taken on 500 WhMD users. The web-based design tool is now available to practitioners who seek to accommodate a wider range of WhMD users than the minimum standards required by regulations. The design tool is also intended as a visual evidence base for regulatory activity and universal design practice with higher ambitions. The advent of driverless automated vehicles will increase the importance of accessibility and usability to accommodate the diversity of riders with disabilities. Clear floor space to enable independent ingress, interior circulation and egress among WhMD users will be a foremost concern. The transportation industry, standards developers, disability advocates, mobility device manufacturers and prescribers need to understand the limitations of current accessibility standards and work to address these limitations through updated vehicle design standards and policies.

Self-reported difficulty and preferences of wheeled mobility device users for simulated low-floor bus boarding, interior circulation and disembarking

Background: Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly accommodating or challenging. The objective of this study was to determine the effects of low-floor bus interior seating configuration and passenger load on wheeled mobility device user-reported difficulty, overall acceptability and design preference.Methods: Forty-eight wheeled mobility users evaluated three interior design layouts at two levels of passenger load (high vs. low) after simulating boarding and disembarking tasks on a static full-scale low-floor bus mockup.Results: User self-reports of task difficulty, acceptability and design preference were analyzed across the different test conditions. Ramp ascent was the most difficult task for manual wheelchair users relative to other tasks. The most difficult tasks for users of power wheelchairs and scooters were related to interior circulation, including moving to the securement area, entry and positioning in the securement area and exiting the securement area. Boarding and disembarking at the rear doorway was significantly more acceptable and preferred compared to the layouts with front doorways.Conclusion: Understanding transit usability barriers, perceptions and preferences among wheeled mobility users is an important consideration for clinicians who recommend mobility-related device interventions to those who use public transportation.Implications for RehabilitationIn order to maximize community participation opportunities for wheeled mobility users, clinicians should consider potential public transit barriers during the processes of wheelchair device selection and skills training.Usability barriers experienced by wheeled mobility device users on transit vehicles differ by mobility device type and vehicle configurations.Full-scale environment simulations are an effective means of identifying usability barriers and design needs in people with mobility impairments and may provide an alternative model for determining readiness for using fixed route buses or eligibility for paratransit.

Investigation of the Feasibility of an Intervention to Manage Fall Risk in Wheeled Mobility Device Users with Multiple Sclerosis.

Falls are a common concern for wheeled mobility device users with multiple sclerosis (MS); however, no evidence-based fall prevention programs have been developed to meet the specific needs of the population. We examine the preliminary feasibility of a fall management intervention in wheeled mobility device users with MS. Study participants were exposed to an intervention program targeting risk factors for falls, including transfer skills and seated postural control. The feasibility of the program was evaluated by assessing participant perspectives, cost, recruitment rates, study adherence, participant retention, safety, and the ability to collect primary and secondary outcomes, including fall frequency, concerns about falling, transfer quality, and seated postural control. 16 wheeled mobility device users completed the program, which was found to be feasible and was positively evaluated by participants. No adverse events were experienced. After exposure to the intervention, fall frequency significantly decreased (P < .001) and transfer quality (P = .001) and seated postural control (P = .002) significantly improved. No significant differences were found regarding concerns about falling (P = .728). This study examined the feasibility of an intervention program to manage fall risk in wheeled mobility device users with MS. The program was found to be feasible, and preliminary results showed the intervention to be effective in decreasing fall frequency. Additional testing is needed to further examine the efficacy and long-term impact of the intervention.

Usability of Access Ramps and Securement Systems on Transit Buses for Wheeled Mobility Device Users

Abstract Date Presented 3/30/2017 This study evaluated six ramp conditions and three securement devices encountered by wheeled mobility device users when using transit buses. The findings will help occupational therapists anticipate potential barriers and suggest accommodation strategies to improve community mobility outcomes for clients. Primary Author and Speaker: Brittany Perez Additional Authors and Speakers: Jim Lenker Contributing Authors: Victor Paquet, Lydia Kocher, Medha Nemade

Fall Prevalence in Wheeled Mobility Device Users Living with Multiple Sclerosis

To investigate the prevalence and circumstances of falls among wheeled mobility device users living with Multiple Sclerosis (MS).

Standard Lavatories for Wheeled Mobility Device Users.

In the contemporary world, building regulations and norms need to be updated to reflect the evolution in mobility devices. This research is suggesting new proposals for norms and standards for standard lavatories by taking the evolution in new wheeled mobility devices into account.

Housing characteristics of households with wheeled mobility device users from the American Housing Survey: do people live in homes that facilitate community participation?

For people with mobility impairments, having an accessible and usable home environment is a critical factor in their ability to live independently and participate in their communities. However, the status of home accessibility in the American housing stock is largely unknown. The purpose of this study was to examine accessibility of the American housing stock using the American Housing Survey. We analyzed data from the 2011 American Housing Survey to examine the accessibility of housing units across six groups defined by home ownership and impairment status. High levels of home inaccessibility across all groups and all variables were evident. Developing accessible housing stock is critical to community development in that it can support opportunities for increased participation and employment for people with disabilities. This study provides a basis for more specific studies regarding housing access and the potential impact of housing policy changes that could increase community access for people with mobility impairments.

Ramp-Related Incidents Involving Wheeled Mobility Device Users During Transit Bus Boarding/Alighting

ObjectivesTo estimate the prevalence of wheeled mobility device (WhMD) ramp-related incidents while boarding/alighting a public transit bus and to determine whether the frequency of incidents is less when the ramp slope meets the proposed Americans with Disabilities Act (ADA) maximum allowable limit of ≤9.5°. DesignObservational study. SettingCommunity public transportation. ParticipantsWhMD users (N=414) accessing a public transit bus equipped with an instrumented ramp. InterventionsNot applicable. Main Outcome MeasuresPrevalence of boarding/alighting incidents involving WhMD users and associated ramp slopes; factors affecting incidents. ResultsA total of 4.6% (n=35) of WhMD users experienced an incident while boarding/alighting a transit bus. Significantly more incidents occurred during boarding (6.3%, n=26) than during alighting (2.2%, n=9) (P<.01), and when the ramp was deployed to street level (mean slope=11.4°) compared with sidewalk level (mean slope=4.2°) (P=.01). The odds ratio for experiencing an incident when the ramp slope exceeded the proposed ADA maximum allowable ramp slope was 5.4 (95% confidence interval, 2.4–12.2; P<.01). The odds ratio for assistance being rendered to board/alight when the ramp slope exceeded the proposed ADA maximum allowable ramp slope was 5.1 (95% confidence interval, 2.9–9.0; P<.01). ConclusionsThe findings of this study support the proposed ADA maximum allowable ramp slope of 9.5°. Ramp slopes >9.5° and ramps deployed to street level are associated with a higher frequency of incidents and provision of assistance. Transit agencies should increase awareness among bus operators of the effect kneeling and deployment location (street/sidewalk) have on the ramp slope. In addition, ramp components and the built environment may contribute to incidents. When prescribing WhMDs, skills training must include ascending/descending ramps at slopes encountered during boarding/alighting to ensure safe and independent access to public transit buses.

Public transit bus ramp slopes measured in situ

Purpose: The slopes of fixed-route bus ramps deployed for wheeled mobility device (WhMD) users during boarding and alighting were assessed. Measured slopes were compared to the proposed Americans with Disabilities Act (ADA) maximum allowable ramp slope. Methods: A ramp-embedded inclinometer measured ramp slope during WhMD user boarding and alighting on a fixed-route transit bus. The extent of bus kneeling was determined for each ramp deployment. In-vehicle video surveillance cameras captured ramp deployment level (street versus sidewalk) and WhMD type. Results: Ramp slopes ranged from −4° to 15.5° with means of 4.3° during boarding (n = 406) and 4.2° during alighting (n = 405). Ramp slope was significantly greater when deployed to street level. During boarding, the proposed ADA maximum allowable ramp slope (9.5°) was exceeded in 66.7% of instances when the ramp was deployed to street level, and in 1.9% of instances when the ramp was deployed to sidewalk level. During alighting, the proposed ADA maximum allowable slope was exceeded in 56.8% of instances when the ramp was deployed to street level and in 1.4% of instances when the ramp was deployed to sidewalk level. Conclusions: Deployment level, built environment and extent of bus kneeling can affect slope of ramps ascended/descended by WhMD users when accessing transit buses.Implications for RehabilitationSince public transportation services are critical for integration of wheeled mobility device (WhMD) users into the community and society, it is important that they, as well as their therapists, are aware of conditions that may be encountered when accessing transit buses.Knowledge of real world ramp slope conditions that may be encountered when accessing transit buses will allow therapists to better access capabilities of WhMD users in a controlled clinical setting.Real world ramp slope conditions can be recreated in a clinical setting to allow WhMD users to develop and practice necessary skills to safely navigate this environment.Knowing that extent of bus kneeling and ramp deployment level can influence ramp slope, therapists can educate WhMD users to request bus operators further kneel the bus floor and/or redeploy the ramp to a sidewalk level when appropriate, so that the least practicable slope will be presented for ingress/egress.

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.

The Impact of Transfer Setup on the Performance of Independent Wheelchair Transfers

The aim of this study was to determine how selected environmental factors affect transfers and to compare our results to the Americans with Disabilities Act Accessibility Guidelines (ADAAG). Few data are available to support standards development related to transfers in the built environment. Participants were 120 wheeled mobility device (WMD) users who transferred to and from a modular transfer station that consisted of a height-adjustable platform with a lateral grab bar, optional obstacle to the transfer, and an optional height-adjustable front grab bar. Maximum and minimum vertical heights of the transfer surface, maximum gap distance between the WMD and transfer surface, grab bar use, and WMD space needs were recorded. The 95th percentile lowest and highest heights attained were similar to the median WMD seat-to-floor height (56 cm).We found that 42% (47/113) could not perform a transfer with the obstacle present. Participants transferred higher when the front grab bar was added to the setup (p = .005) and higher and lower with the front grab bar than without it when the obstacle was present in the setup (p = .003 and p = .005, respectively). We found that 95% of participants performed a transfer across an 8.9-cm gap. ADAAG recommendations fall short for the height and clear-space needs of the 50th-percentile WMD users. Revisions concerning transfer heights, gaps, clear spaces, and grab bar heights are necessary to make transfers more accessible to WMD users. The data will be used to revise the guidelines related to transfers and to enable designers and engineers to create an environment that is more accessible.

Clearance Space Envelopes of Wheeled Mobility Device Users for Computer Workstations

Operator clearance spaces under computer workstations and other work surfaces are necessary to ensure that seated operators have adequate space for their lower extremities in order to use the working surface without any obstruction. In this paper we present operator clearances at workstations designed to accommodate occupants of manual and powered wheelchairs (n=322). Six body dimensions critical to workstation design were used in two different methods to compute the clearance envelope dimensions. When compared with clearance space requirements for able-bodied seated operators at workstations specified in the ANSI/HFES 100-2007 standards for computer workstation design, the findings showed wheeled mobility device users required greater widths, work surface heights, and clearance depths than those specified in the standard.

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.