Wheeled Mobility Research Articles

Development and Implementation of a Wheelchair Outcomes Registry

ObjectiveTo describe the development of a patient registry related to wheeled mobility and seating (WMS) device interventions to accumulate large datasets for clinical quality assurance and research purposes. DesignAccepted guidelines for registry development were applied and anchored around the Functional Mobility Assessment (FMA) questionnaire and a uniform dataset (UDS). SettingThe FMA and UDS were developed under a corporate research agreement between clinical researchers and commercial providers. The questionnaires are administered in rehabilitation clinics to patients at the time of assessment for new device interventions (baseline) and readministered by telephone or other remote strategies periodically thereafter (follow-up). ParticipantsThe FMA and UDS can be administered to any patient with a mobility impairment in need of a WMS device. InterventionsWMS interventions include manual wheelchairs, power wheelchairs, scooters, seating, and other accessories. Main Outcome MeasuresThe FMA is a validated 10-item patient-centered outcome measure that investigates satisfaction in performing common mobility-related activities of daily living. The UDS includes variables related to age, diagnosis, and type of device used, as well as health, participation, and environmental factors. ResultsCurrently there are over 1500 complete FMA and UDS cases at baseline and more than 600 follow-up datasets from 45 providers nationwide. Feedback indicates use of the FMA and UDS does not add burden to the clinical routine. ConclusionsA registry in the field of WMS has been developed and shown to be feasible in a clinical setting. This has created an opportunity to collect large datasets to increase sample sizes for future analyses to more scientifically evaluate what types of WMS devices work best for what types of patients under varying circumstances to promote health and participation.

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.

Wheelchair Skills Training for Functional Activity in Adults with Cervical Spinal Cord Injury.

Wheelchair skills training can improve independent wheeled mobility for daily living activities as well as functional and social participation of adults with cervical spinal cord injury (C-SCI). The objective of this study was to examine the effectiveness of wheelchair skills training in improving both wheelchair skills and upper arm skilled performance in adults with C-SCI. In a randomized controlled study, 24 adults with tetraplegia were randomized and allocated to training group (n=13) or control group (n=11). The training group attended wheelchair skills training sessions, whereas the control group attended conventional exercise sessions. All interventions lasted 8 weeks, with a frequency of 3 days per week. All individuals were tested with the Wheelchair Skills Test (WST) and the Van Lieshout Test (VLT). The test was repeated at pre- and post-training (after 4 weeks and 8 weeks). For WST, univariate analysis demonstrated significant main effects in between-group, within-group, and group-by-time interaction (p<0.05). VLT showed no significant effect in between-group comparison (p>0.05), whereas within-group comparison of test times and group-by-time interaction showed significant main effects (p<0.05). Thus, wheelchair skills training is more beneficial for adults with C-SCI than conventional exercise.

A Randomized Clinical Trial of Wheeled Mobility for Pressure Injury Prevention and Better Function.

To evaluate the effectiveness of wheelchair assessment and configuration on pressure injury incidence, mobility, and functioning in a wheelchair. Randomized controlled trial with participants individually randomized into intervention and control groups. Nursing home. Nursing home residents aged 60 and older who used wheelchairs and were at risk for pressure injuries (N=258). Treatment and evaluation, individually configured wheelchair and skin protection cushion; control and evaluation, facility-provided wheelchair and skin protection cushion. Pressure injury incidence, Nursing Home Life Space Diameter score, Functioning Every Day in a Wheelchair-Capacity (FEW-C) score, and Wheelchair Skills Test (WST) score. No differences in pressure injuries (p=.77) were found. Pelvic rotation (odds ratio (OR)=0.15, 95% confidence interval (CI)=0.03-0.70, p=.02) and Day 14 WST skill score (OR=0.74, 95% CI=0.60-0.91, p=.004) were significant predictors of pressure injuries. Significant differences were observed between groups in change in FEW-C independence scores between before randomization and endpoint (p=.03) and before randomization and 14 days (p=.04). Participants with individually configured wheelchairs improved more in the safe and effective use of their wheelchairs than residents with facility-provided wheelchairs. The outcomes indicated that nursing home residents functioned safely at a higher level in their wheelchairs if their devices were individually configured using a comprehensive wheelchair and seating assessment process. There was no difference in the incidence of pressure injuries between the two groups. NCT01275313.

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.

Evaluating Mobility in Advanced Dementia: A Scoping Review and Feasibility Analysis.

Mobility decline is a symptom of advanced dementia that affects function, safety, caregiving, and quality of life. Monitoring mobility status is essential for initiating timely and targeted interventions aimed at preventing excess disability in people with dementia (PWD). The physical, cognitive, and behavioral symptoms of dementia however, present unique challenges for mobility assessment. The goals of this review were to (a) identify and describe measures of mobility used for PWD and (b) assess measures' feasibility for use in people with advanced dementia; a group whose degree of cognitive impairment results in severe functional deficits. Electronic searches of Medline, Embase, CINAHL, and PsychInfo databases were conducted using keywords related to dementia, mobility, measurement, and validation. Descriptive characteristics were extracted and measures coded for mobility components. Tools were also evaluated for feasibility of use in advanced dementia and those deemed feasible, screened for psychometric strength. Thirty-eight measures were included and 68% of these tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%), and wheeled mobility (3%). 36% of studies included people with advanced dementia. Only 18% of tools received high scores for feasibility. Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most measures are not feasible for people with advanced dementia, and the psychometric evaluation of these measures is limited. Further research is needed to develop a comprehensive, dementia-specific, mobility assessment tool.

A Timed Seated-Mobility Measure for Older Adults Using Manual Wheelchairs

Aims: To assess reliability and validity of a two-minute wheeled mobility test (2MWMT) for older adults using manual wheelchairs living in long-term care communities. Methods: The distance wheeled on two days was compared. Three functional measures were completed on Day 1: Nursing Home Life Space Diameter (NHLSD), Physiotherapy Functional Mobility Profile (PFMP), and Nursing Home Physical Performance Test (NHPPT). Results: The 2MWMT showed excellent 1-week test-retest (ICC2,2 = 0.92, CI = 0.83 − 0.96), intra-rater (ICC1,1 = 0.99, CI = 0.98 − 1.0), and inter-rater (ICC2,1 = 0.97, CI = 0.94 − 0.99) reliability. The 2MWMT was moderately correlated with the NHLSD (r = 0.55, p < 0.01) and NHPPT (r = 0.45, p = 0.02), but poorly related to the PFMP (r = 0.12, p > 0.05). Conclusions: One 2MWMT measure is needed to provide a short, reliable test of seated mobility in older adults using manual wheelchairs.

An optional passive/active transformable wheel-legged mobility concept for search and rescue robots

A novel transformable wheel-legged robot, namely Land Devil Ray (LDR), is proposed for search and rescue mission in complex terrains. Inspired from spatial folding mechanism and metamorphic mechanism, a multi-four-bar linkage transformable wheel-legged locomotion mechanism is proposed for LDR, which can transform from circle-wheeled mobility to wheel-legged mobility, or vice versa, for adaptability of different terrains. Aimed to minimize the robot actuators, the wheel-legged transformation is designed to be triggered passively when contacting the obstacles, or be actively driven without extra actuator by active triggering mechanism. The parameters of wheel-legged structure are optimized as well for an optimal transformation success rate and better obstacle-negotiation capability. A prototype of LDR robot is conducted, and its experiment results show that the proposed robot integrates the advantages of both wheeled and legged mobility, and has excellent performance in maneuverability, stability, maximum obstacle-negotiation height and mode switch process, such as transformation ratio as 1.88, transformation success rate as 100%, and ability to over obstacles 2.8 times as tall as its wheel radius. Lessons learned from the proposed robotic mobility and its results have general applicability to search / rescue robots, and other types of mobile robots as well.

Adaptation of the adult Functional Mobility Assessment (FMA) into a FMA-Family Centred (FMA-FC) paediatric version.

The aims of this study were to adapt an adult wheeled mobility outcome measure, the Functional Mobility Assessment, for use with children (FMA-Family Centred) and establish the new measure's content validity, test-retest reliability, and internal consistency. Although several tools exist to measure a child's ability to operate and move a wheeled mobility device, none focus on the ability of the wheeled mobility device to support children and their families as they perform daily activities. After adapting the FMA items with examples relevant to children aged 3-21, parent/caregiver and therapist stakeholder groups recommended adaptations relevant for families with children who cannot respond for themselves. Six of the initial FMA items were retained with child-appropriate examples, and 4 new items were developed. The content validity of the FMA-Family Centred was strongly supported, and internal consistency and test-retest reliability met accepted psychometric standards.

End user evaluation of a Kneeling Wheelchair with “on the fly” adjustable seating functions

A “kneeling” ultralight wheelchair prototype has been developed that allows users to adjust seat position “on the fly” for different activities throughout the day. The wheelchair includes independent adjustment functions for rear seat height, front seat height (“kneeling”) and backrest angle. Aim: This work aimed to gather feedback about the wheelchair’s functionality and performance through end user evaluation trials. Methods: Eight manual wheelchair users evaluated the prototype Kneeling Wheelchair for a range of activities. User perspectives on parameters such as usability, comfort, stability and effectiveness were obtained through both open-ended and Likert-scale rating questions. Results: Results indicate several potential benefits of the adjustment functions of the Kneeling Wheelchair. Rear seat height adjustment may facilitate a number of activities of daily living, as well as provide benefits for comfort and social interactions. Back rest adjustment may increase comfort and stability on slopes. Front seat height adjustment may be beneficial for transfers and conducting sustained low-to-the-ground activities. While benefits of this adjustment function were described by many participants, some struggled with usability of the kneeling mechanism and rated this function less favourably than the other two. Conclusion: The findings of this study will inform future iterations of the Kneeling Wheelchair design and may spur future developments in wheeled mobility. In the long-term, it is anticipated that novel wheelchair solutions, such as the one described in this paper, may support improved health, quality of life and community participation for people with mobility impairments.Implications for rehabilitationWheelchairs that allow users to easily adjust seat and backrest position “on the fly” to better suit different tasks throughout the day may provide benefits such as facilitating activities of daily living.A front seat height adjustment feature on a new wheelchair prototype may be beneficial for transfers and conducting sustained low-to-the ground activities.End user evaluations can provide valuable insight to direct future design modifications and innovation.

Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

ObjectivesTo investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI). DesignProspective observational study using the SCIRehab database. SettingSix IPR facilities. ParticipantsPatients with new SCI (N=1376) receiving initial rehabilitation. InterventionsPatients were divided into groups consisting of those who did and did not receive GT. Patients were further subdivided based on their primary mode of mobility as measured by the FIM. Main Outcome MeasuresPain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART). ResultsNearly 58% of all patients received GT, including 33.3% of patients who were primarily using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year and received GT, compared with those who used a wheelchair and did not receive GT in IPR. Older age was also a significant predictor of worse participation as measured by the CHART. ConclusionsA significant percentage of individuals who are not likely to become functional ambulators are spending portions of their IPR stays performing GT, which is associated with less time allotted for other functional interventions. GT in IPR was also associated with participation deficits at 1 year for those who used a wheelchair, implying the potential consequences of opportunity costs, pain, and psychological difficulties of receiving unsuccessful GT. Clinicians should consider these data when deciding to implement GT during initial IPR.

Wheelchair tiedown and occupant restraint practices in paratransit vehicles.

The purpose of this study was to characterize wheelchair tiedown and occupant restraint system (WTORS) usage in paratransit vehicles based on observations of wheelchair and scooter (wheeled mobility devices, collectively, “WhMD”) passenger trips. A retrospective review of on-board video monitoring recordings of WhMD trips was conducted. Four hundred seventy-five video recordings were collected for review and analysis. The use of all four tiedowns to secure the WhMD was observed more frequently for power WhMDs (82%) and manual WhMDs (80%) compared to scooters (39%), and this difference was significant (p< 0.01). Nonuse or misuse of the occupant restraint system occurred during 88% of WhMD trips, and was most frequently due to vehicle operator neglect in applying the shoulder belt. Despite the absence of incidents or injuries in this study, misuse and nonuse of WTORS potentially place WhMD seated passengers at higher risk of injury during transit. These findings support the need for improved vehicle operator training and passenger education on the proper use of WTORS and development of WTORS with improved usability and/or alternative technologies that can be automated or used independently.

Modelling optimisation of vehicle velocity for wheeled construction vehicles traversing in off-road terrain

This paper presents the results of an investigation into the effect of terrain conditions on vehicle velocity at each given vehicle speed selection in wet clay and sand terrain beds. Wheeled vehicles face mobility challenges when traversing in deformable terrain resulting in reduced velocity. This experimental modelling-based investigation was carried out using a modified and instrumented wheeled mobility scooter named MOBILITY SF-3713. This vehicle was run on non-deformable pavement in order to obtain reference results. It was then run on wet sand and clay terrain test beds under controlled laboratory conditions. Results from this experiment indicated that terrain type, applied load and tyre inflation pressure all have significant effects on velocity, influenced by tyre rutting in deformable terrain. The results suggest that reliable prediction of this relationship can assist earth moving and deformable haulage road engineers in making economic operational decisions that affect the velocity of wheeled plant.

Modelling optimisation of vehicle velocity for wheeled construction vehicles traversing in off-road terrain

This paper presents the results of an investigation into the effect of terrain conditions on vehicle velocity at each given vehicle speed selection in wet clay and sand terrain beds. Wheeled vehicles face mobility challenges when traversing in deformable terrain resulting in reduced velocity. This experimental modelling-based investigation was carried out using a modified and instrumented wheeled mobility scooter named MOBILITY SF-3713. This vehicle was run on non-deformable pavement in order to obtain reference results. It was then run on wet sand and clay terrain test beds under controlled laboratory conditions. Results from this experiment indicated that terrain type, applied load and tyre inflation pressure all have significant effects on velocity, influenced by tyre rutting in deformable terrain. The results suggest that reliable prediction of this relationship can assist earth moving and deformable haulage road engineers in making economic operational decisions that affect the velocity of wheeled plant.

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.

Effect of wheelchair design on wheeled mobility and propulsion efficiency in less-resourced settings.

BackgroundWheelchair research includes both qualitative and quantitative approaches, primarily focuses on functionality and skill performance and is often limited to short testing periods. This is the first study to use the combination of a performance test (i.e. wheelchair propulsion test) and a multiple-day mobility assessment to evaluate wheelchair designs in rural areas of a developing country.ObjectivesTest the feasibility of using wheel-mounted accelerometers to document bouts of wheeled mobility data in rural settings and use these data to compare how patients respond to different wheelchair designs.MethodsA quasi-experimental, pre- and post-test design was used to test the differences between locally manufactured wheelchairs (push rim and tricycle) and an imported intervention product (dual-lever propulsion wheelchair). A one-way repeated measures analysis of variance was used to interpret propulsion and wheeled mobility data.ResultsThere were no statistical differences in bouts of mobility between the locally manufactured and intervention product, which was explained by high amounts of variability within the data. With regard to the propulsion test, push rim users were significantly more efficient when using the intervention product compared with tricycle users.ConclusionUse of wheel-mounted accelerometers as a means to test user mobility proved to be a feasible methodology in rural settings. Variability in wheeled mobility data could be decreased with longer acclimatisation periods. The data suggest that push rim users experience an easier transition to a dual-lever propulsion system.

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

Exercise interventions for cerebral palsy.

Exercise interventions for cerebral palsy.

Labor, delivery, and anesthesia experiences of women with physical disability.

Although many women with physical disabilities report poor quality reproductive health care, little research has addressed labor, delivery, and anesthesia experiences of these women. This study was conducted to explore these experiences in women with significant mobility disabilities. A qualitative descriptive study was conducted with 22 women from the United States who had delivered newborns within the prior 10years. All had significant mobility disabilities. Two-hour, in-depth telephone interviews were conducted using a semistructured, open-ended interview protocol, which addressed many topics, including labor, delivery, and anesthesia experiences. We recruited most participants through social networks, interviewing women from 17 states. Conventional content analysis, facilitated by NVivo software, was used to identify major themes. The mean age of women was 34.8±5.3years. Most women were white, college educated, and used wheeled mobility aids. Four key themes emerged from participants' narratives of laboring and giving birth with a disability. These included women's preferences for type of delivery, clinicians and some women expected no labor pain, fears prompting active advocacy, and positive experiences. As participants discussed their experiences with anesthesia, four additional themes were identified: importance of consultation with the anesthesia team, decisions about epidural/spinal vs general anesthesia, failed epidural with repeated efforts, and fear of injury related to anesthesia. The responses of women in this study suggest that there is need to make intrapartum care better for women with physical disabilities and to improve their experiences with labor, birth, and obstetric anesthesia care.