Wheeled Mobility Research Articles

Telerehabilitation and Clinical Applications: Research, Opportunities, and Challenges

Rehabilitation service providers in rural or underserved areas are often challenged in meeting the needs of their complex patients due to limited resources in their geographical area. Recruitment and retention of the rural clinical workforce are beset by the ongoing problems associated with limited continuing education opportunities, professional isolation, and the challenges inherent to coordinating rural community healthcare. People with disabilities who live in rural communities also face challenges accessing healthcare. Traveling long distances to a specialty clinic for necessary expertise is troublesome due to inadequate or unavailable transportation, disability specific limitations, and financial limitations. Distance and lack of access are just two threats to quality of care that now being addressed by the use of videoconferencing, information exchange, and other telecommunication technologies that facilitate telerehabilitation.This white paper illustrates and summarizes clinical and vocational applications of telerehabilitation. We provide definitions related to the fields of telemedicine, telehealth, and telerehabilitation, and consider the impetus for telerehabilitation. We review the telerehabilitation literature for assistive technology applications; pressure ulcer prevention; virtual reality applications; speech-language pathology applications; seating and wheeled mobility applications; vocational rehabilitation applications; and cost-effectiveness. We then discuss external telerehabilitation influencers, such as the positions of professional organizations. Finally, we summarize clinical and policy issues in a limited context appropriate to the scope of this paper.Keywords: Telerehabilitation; Telehealth; Telemedicine; Telepractice

“How did that happen?” Public responses to women with mobility disability during pregnancy

BackgroundLittle is known about current societal attitudes toward women with significant mobility disability who are visibly pregnant. ObjectiveTo use qualitative descriptive analysis methods to examine perceptions of women with significant mobility disability about how strangers reacted to their visible pregnancies. MethodsIn late 2013, we conducted 2-h telephone interviews with 22 women with significant mobility difficulties who had delivered babies within the prior 10 years. The semi-structured, open-ended interview protocol addressed wide-ranging pregnancy-related topics, including statements from strangers. Most participants were recruited through social networks, coming from 17 states nationwide. We used NVivo to sort the texts for content analysis. ResultsThe women's mean (standard deviation) age was 34.8 (5.3) years; most were white, well-educated, and higher income, although half had Medicaid during their pregnancies; and 18 used wheeled mobility aids. Eighteen women described memorable interactions with strangers relating to their pregnancies or newborn babies. Strangers' statements fell into six categories: (1) curious; (2) intrusively and persistently curious; (3) hostile, including concerns that taxpayers would end up supporting the mother and child; (4) questioning woman's competence as a potential parent; (5) oblivious, not recognizing visible pregnancy or motherhood; and (6) positive. Many women reported strangers asking how their pregnancy had happened. The women doubted that visibly pregnant women without disabilities evoke the same reactions from strangers. ConclusionsWomen with mobility disability who are visibly pregnant may perceive reactions from strangers that appear intrusive. Planning ahead for handling such encounters could reduce the stresses of these interactions.

Barriers to Wheelchair Use in the Winter

ObjectivesTo test the hypothesis that challenges to community participation posed by winter weather are greater for individuals who use scooters, manual and power wheelchairs (wheeled mobility devices [WMDs]) than for the general ambulatory population, and to determine what WMD users identify as the most salient environmental barriers to community participation during the winter. DesignCross-sectional survey organized around 5 environmental domains: technological, natural, physical, social/attitudinal, and policy. SettingUrban community in Canada. ParticipantsConvenience sample of WMD users or their proxy (N=99). InterventionsNot applicable. Main Outcome MeasuresNot applicable. ResultsForty-two percent identified reduced outing frequency in winter months, associated with increased age (χ3=6.4, P=.04), lack of access to family/friends for transportation (χ2=8.1, P=.04), and primary type of WMD used in the winter (scooter χ2=8.8, P=.003). Most reported tires/casters becoming stuck in the snow (95%) or slipping on the ice (91%), difficulty ascending inclines/ramps (92%), and cold hands while using controls or pushing rims (85%); fewer identified frozen wheelchair/scooter batteries, seat cushions/backrests, or electronics. Sidewalks/roads were reported to be problematic by 99%. Eighty percent reported needing additional help in the winter. Limited community access in winter led to a sense of loneliness/isolation, and fear/anxiety related to safety. Respondents identified policies that limited participation during winter. ConclusionsPeople who use WMDs decrease their community participation in cold weather because of multiple environmental barriers. Clinicians, researchers, and policymakers can take a multidimensional approach to mitigate these barriers in order to enhance community participation by WMD users in winter.

Taking Control: An Exploratory Study of the Use of Tilt-in-Space Wheelchairs in Residential Care

Tilt-in-space (TIS) wheelchairs are common in residential care, but little empirical evidence exists regarding how they are used by residents and staff in these settings. As part of a larger study exploring the use of wheeled mobility in these facilities, we conducted a substudy to examine how TIS wheelchairs are used in practice and to explore the experiences of the residents who use them. We conducted a series of three participant observations and interviews with 6 residents or their family members and interviewed 10 staff. Our analysis identified taking control as the main overarching theme, subsuming two subthemes: promoting comfort and mobilizing to participate. Findings suggest that power TIS wheelchairs enable user control, whereas manual TIS wheelchairs promote staff control. These findings illustrate how TIS wheelchairs may enable or inhibit occupational engagement and suggest that vigilance is necessary to prevent their use as a restraint.

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.

Seating and Wheeled Mobility for Older Adults Living in Nursing Homes

There have been a number of changes in the clinical practice of seating and wheeled mobility (SWM) for older adults in nursing homes. Twenty years ago, physical restraints were being used indiscriminately with the intent to protect the person from falling. Currently, we know that physical restraints increased the risk of falls, discomfort, functional limitations, and fatalities. Some of those restrained were in ill-fitting wheelchairs. Through specific projects, collaborative efforts, awareness, education, and improved products, clinical practice has changed. The 5-step mat assessment and common postural problems in elders remain the same. Major barriers to improved seating and wheeled mobility still exist such as insufficient funding, inadequate education of practitioners, and poor maintenance of equipment. These barriers inhibit the availability of improved seating and wheeled mobility for older adults in nursing homes. Continued attention by practitioners, policy makers, and payers is necessary to increase access.

Hindi Translation, Cross-Cultural Adaptation and Validation of the “Self-Efficacy in Wheeled Mobility” (SEWM) Scale in Wheelchair Users with Spinal Cord Injury

Hindi Translation, Cross-Cultural Adaptation and Validation of the “Self-Efficacy in Wheeled Mobility” (SEWM) Scale in Wheelchair Users with Spinal Cord Injury

Preface

Preface

Physical Environmental Barriers to Community Mobility in Older and Younger Wheelchair Users

For those who rely on wheeled mobility devices for many or all of their mobility needs, barriers in the physical environment can pose significant obstacles in everyday life. Current Americans With Disabilities Act Accessibility Guidelines standards do not address barriers at the level of specificity necessary to ensure accessibility for wheelchair use. This project developed a Web-based survey to capture differences in the level of difficulty of 50 barriers that persons who use wheelchairs routinely encounter in their communities. Results showed that among the 385 people who completed the survey, the most significant differences were between older and younger manual wheelchair users and suggest that Americans With Disabilities Act Accessibility Guidelines specifications should be revised to be more sensitive to the needs of older wheelchair users.

Effects of disability on pregnancy experiences among women with impaired mobility.

Little is known about how functional impairments might affect the pregnancies of women with mobility disability. We aimed to explore complications that arise during pregnancy that are specifically related to physical functional impairments of women with significant mobility disabilities. Qualitative descriptive analysis. Telephone interviews with women from 17 USA states. 22 women with significant mobility difficulties who had delivered babies within the prior 10years; most participants were recruited through social networks. We conducted 2-h, in-depth telephone interviews using a semi-structured, open-ended interview protocol. We used NVIVO software to sort interview transcript texts for conventional content analyses. Functional impairment-related complications during pregnancy. The women's mean (standard deviation) age was 34.8 (5.3)years. Most were white, well-educated, and higher income; eight women had spinal cord injuries, four cerebral palsy, and 10 had other conditions; 18 used wheeled mobility aids; and 14 had cesarean deliveries (eight elective). Impairment-related complications during pregnancy included: falls; urinary tract and bladder problems; wheelchair fit and stability problems that reduced mobility and compromised safety; significant shortness of breath, sometimes requiring respiratory support; increased spasticity; bowel management difficulties; and skin integrity problems (this was rare, but many women greatly increased skin monitoring during pregnancy to prevent pressure ulcers). In addition to other pregnancy-associated health risks, women with mobility disabilities appear to experience problems relating to their functional impairments. Pre-conception planning and in-depth discussions during early pregnancy could potentially assist women with mobility disabilities to anticipate and address these difficulties.

Modelling and design of an augmented reality differential drive mobility aid in an enabled environment

In this paper the authors discuss the modelling and design of an augmented reality platform for disabled wheeled mobility studies. This design consists of a virtual environment with two degrees of freedom motion platform and integrated ground contact force feedback. Differential drive mobility users continue to be in touch with reality on their own mobility aid while interacting with virtual objects. The major domain related to the differential drive mobility of the disabled members of society which coincides with the use of manual wheelchairs, electric wheelchairs and mobility scooters. In order to account for environmental and dynamic effects, the wheeled mobility user needs to map the intended trajectory into the virtual world. Motion and inertia force feedback produced on the augmented simulator give the users a haptic sensory stimulus input regarding spatial movement and ground contact forces. The main objective is to model and design an augmented reality platform with real world kinematic and dynamic properties to place a wheeled mobility user closer to real world encounters. The use of the designed augmented reality platform will be beneficial to disabled wheeled mobility users in need of occupational therapist training and evaluation.

The role of the built environment and assistive devices for outdoor mobility in later life.

Despite theoretical advances in our conceptualization of disability, the "environment" remains a largely unspecified term in disablement models. The purpose of this research is to draw upon on a unique state-of-the-art nationally representative data set with innovative measures that provide the opportunity to tease apart and specify the role of different environmental factors in the disablement process. Using multinomial logistic regression with data from the first round of the recently launched National Health and Aging Trends Study (N = 6,578 community-dwelling Americans age 65+), this paper examines the role of the built environment (e.g., stairs or ramps leading up to the home) and mobility devices on reported difficulty going outside by oneself. Almost three quarters of community-dwelling older Americans live in a residence that has stairs at the entrance. Older adults who use a walker to help them get around are adversely affected by stairs at the entrance to their home, effectively doubling the odds of reporting difficulty going outside independently. Roughly 10% of community-dwelling older Americans live in a residence with a ramp at the entryway, which reduces the odds of outdoor mobility difficulty threefold among those using wheeled mobility devices. However, ramps at the entryway are associated with a higher likelihood of reporting difficulty going outdoors among those who do not use any type of mobility device. A better understanding of the complexities of the environment in the disablement process is critical for the planning and development of age-friendly environments allowing older adults to age in place.

Patterns in Wheeled Mobility Skills Training, Equipment Evaluation, and Utilization: Findings from the SCIRehab Project

Patients with traumatic spinal cord injury (SCI) participate in manual and power wheelchair (WC) skills training during inpatient rehabilitation; wheeled mobility evaluations aim to optimize use, fit, and function of equipment following discharge. Occupational and physical therapists documented treatment sessions during inpatient rehabilitation to describe types and quantity of WC skills training and adaptive equipment (AE) provided by neurological level of injury. Most patients participated in WC skills training; variation in type and frequency exists. Propulsion/driving skills were practiced most frequently. A majority of patients participated in equipment evaluations; assessment/prescription and fitting were performed frequently; mat evaluations were done infrequently. Most patients received mobility equipment in a timely manner; they continued to use their WC and were satisfied with its fit and function at the one-year injury anniversary. High levels of respondent satisfaction with fit and function of WCs suggest clinicians are prescribing mobility devices adequately and accurately supplementing information obtained during equipment assessment and fitting sessions with information from general treatment sessions. Variation in type and frequency of WC training provided by level of SCI and in types of WC prescribed use provides a foundation for future research to relate treatment modalities with functional and participation outcomes.

Rehabilitation of People with Lower-Limb Amputations

Rehabilitation of persons with lower-limb amputation is a complex endeavor that requires the consideration of a multitude of factors. This article provides an overview of the current practice of prosthesis prescription, mobility training, and the utilization of wheeled mobility options in the clinical care for this population. Recent technological advancements have helped fit persons with lower-limb amputation with more functional, better fitting, and less activity-limiting artificial limbs and wheelchairs. This is exemplified in modern computer-controlled prosthetic components and biomechanically optimized socket-fitting methods, as well as light weight and versatile wheelchairs to supplement or replace prosthetic devices. In the research setting, technology has enabled new approaches to the kinematic and kinetic assessment of prosthetic interventions, and the development of more accurate fitting and evaluation methods. Despite the noted progress in the field, there is still a considerable gap between the functionality of a sound leg and even the most advanced prosthesis. It can be predicted that continued research efforts will be undertaken to further close this gap.

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.

Functional Outcomes Associated With Adaptive Seating Interventions in Children and Youth With Wheeled Mobility Needs

ObjectiveTo determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DesignLongitudinal case series. SettingHomes of participating parents. ParticipantsParents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. InterventionAdaptive seating system for wheeled mobility devices. Main Outcome MeasureFamily Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). ResultsAll parents completed the FIATS-AS 4 times—2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η2=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. ConclusionsAdaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

Comparative Study between Wheeled and Tracked Mobility System for Mobile Robot

Robots are widely used nowadays in industries, commercial and domestic purpose for the completion of task in shortest time interval and accurate operation. In the design of a mobile robot, the main mechanical area on focus is the locomotion mechanism. The locomotion mechanism consideration would include the mobile robot flexibility, versatility and efficiency to complete the multi tasks in different environments, indoor and outdoor. This comparative study was focused on the mobile robot mobility systems between wheeled and tracked. This paper highlights the effects on mechanical design, velocity, energy and flexibility of each mobility system. A hybrid system was suggested depending on mechanical design, energy consumption and flexibility.

Predictors of needs for families of children with cerebral palsy

Background: This study examined child, family and service characteristics that are predictors of family needs for community, financial, family support and services needs for families of children with cerebral palsy (CP). CP is a non-progressive neurological condition caused by lesions in the central nervous system resulting in limitations in motor function and associated co-morbid conditions. Children with CP often require multiple health, rehabilitation, and community services. Purpose: To identify risk and protective factors among predictors of needed resources and services (i.e. community, financial, family support) and to discuss implications for coordination of medical, rehabilitation, and community services for children with CP and their families. Methods: Secondary data analysis was conducted with a national dataset (n = 441) of mothers of children with CP. The average age of children was 10.7 years (SD = 4.5) and was distributed across the various Gross Motor Function Classification System levels. Four logistic regression models were conducted to examine predictive power of child, family and current service characteristics on needed resources and services. Results: Limited child gross motor function was a risk factor (odds ratio (OR): 1.30–1.70) while perception of family-centered services (FCS) was a protective factor (OR: 0.57–0.63) in having the needs met. Conclusion: Mothers of children with CP who are able to walk, reported strong family relationships, and perceived need-oriented and FCS expressed less needs for community, financial, family support and services’ resources needs. Implications for service providers are provided.Implications for RehabilitationOver 90% of participant mothers of children and youth with CP expressed needs for medical, rehabilitation, school-based and community-based services for their children.Mothers of children and youth with CP who have severe limitation in functional mobility or might use wheeled mobility were at higher risk for expressing family needs related to locating community resources, paying for medical expenses and finding resources that support their family functioning.Mothers of children and youth with CP who perceived family-centered, respectful and supportive, and accessible services for their children were at lower risk of expressing needs for community, financial and family support resources.

Facilitating Child Participation through Power Mobility

Wheeled power mobility can fulfil an intrinsic desire to be mobile, to explore one's environment and to be active and participate in occupations regardless of age. This opinion piece briefly presents the potential of power mobility for children with physical impairments, the recent evidence base, an exploration of the readiness and training of children in the use of power mobility, and current United Kingdom prescription practice. This mode of intervention should no longer be considered as the final option but, rather, as a tool to prevent passivity and dependence and to enable children to optimise their participation in childhood occupations.