Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury

Challenges with mobility devices for female Veterans with spinal cord injuries

CONTEXT

The growing number of females entering the armed forces has led to an increase in the number of female Veterans with spinal cord injury and diseases (SCI/D) requiring mobility devices. Limited research exists that explores whether mobility devices meet their needs in terms of comfort, fit and design.

OBJECTIVE

To characterize respondents with SCI/D who use mobility devices and determine if these devices are meeting their daily needs.

DESIGN

Online survey.

SETTINGS

Veterans Health Administration.

PARTICIPANTS

Female Veterans with SCI/D who received mobility devices in the past five years.Interventions: Participants completed an online survey regarding their challenges in obtaining and using mobility devices for their daily needs.

RESULTS

101 women with SCI/D participated in a nation-wide online survey. Respondents were mainly in their 50s and 59% were not currently employed due to their disability. Most used manual (35%) or power wheelchairs (34%). Many female Veterans felt their devices were not made with female users in mind and some felt they did not meet their needs. Opportunities to improve the assessment, follow-up, maintenance and repair processes were identified.

CONCLUSIONS

Given that some female Veterans with SCI/D felt their devices did not meet all their needs, it is important for researchers to engage women in user-centered design of mobility devices and for providers to be mindful of Veterans' daily needs within all steps of the provision process in order for mobility devices to support overall function and usability.

SWADAPT2: benefits of a collision avoidance assistance for powered wheelchair users in driving difficulty

PURPOSE

In France, tens of thousands of people use a wheelchair. Driving powered wheelchairs (PWCs) present risks for users and their families. The risk of collision in PWC driver increases with severity of disability and may reduce their independence to drive. The European ADAPT project has developed a robotic assistance add-on for PWCs to prevent collisions and improve their driving performance.

MATERIALS AND METHODS

The aim of the SWADAPT2 study is to assess the benefit of this robotic assistance add-on arranged on a Standard Quickie Salsa M2 PWC in a population of PWC drivers with neurological disorders and driving difficulties. Eighteen (18) participants tested the system on three circuits of increasing difficulty, with and without the robotic assistance add-on.

RESULTS

The benefit of the robotic assistance add-on was important especially on the more difficult circuits without impacting cognitive load or driving speed. The number of collisions was significantly reduced when using robotic assistance add-on from 2.16 to 0.36 on circuit 2 (p = 0.009) and from 7.3 to 1.33 on circuit 3 (p = 0.0009). Task load demand was not increased with the assistance.

CONCLUSION

Finally, this system seems to be indicated to assist and improve driving safety for PWC drivers in driving difficulty. Evaluation was performed in controlled environments; therefore, further evaluation in real-world scenarios is needed to reach technology readiness.

Effects of the WHO 8-step wheelchair-service-delivery process on wheelchair users in El Salvador: a cohort study

PURPOSE

To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease.

METHODS

This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up.

RESULTS

Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs.

CONCLUSIONS

Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components.

Wheeled repair alliance: Rolling out wheelchair repair and maintenance in community bicycle shops

The increasing population of wheelchair users in the United States highlights the importance of access to reliable and affordable wheelchair maintenance and repair. Having a well-maintained mobility device is essential to living a safe, healthy, and social life as a wheelchair user. Unfortunately, access to these services is limited. This study aims to address this need by developing and evaluating a workshop program designed to teach basic wheelchair maintenance skills to bike shop employees, allied health professionals, and wheelchair users themselves. The workshops covered key wheelchair maintenance tasks. Pre and post workshop surveys assessed participants' confidence in basic maintenance and repair skills and overall satisfaction with the workshop. Workshop participants reported increased confidence in all maintenance skills following the workshops and bike shop employees expressed increased confidence in their ability to work with and provide resources for wheelchair users. This study highlights that community-based workshops may help to enhance confidence in wheelchair maintenance skills, potentially aiding in bridging the gap in affordable and accessible repair services. The Wheeled Repair Alliance has the potential to empower wheelchair users and improve their quality of life. Further research should consider increasing the precision of measurements and assessing long-term outcomes related to wheelchair maintenance and repair.

Power wheelchair usage and repair are associated: a retrospective analysis

Purpose: This study evaluates the effect of power wheelchair telemonitoring and battery charging training on user charging behavior and repair measures and assesses the relationship between wheelchair usage and repair measures to support technician-led servicing.Methods: This is a retrospective analysis of two matched cohorts with a total of n=237 users from the NHS service dataset. In the training cohort, a wheelchair usage telemonitoring device monitored the battery usage of n=119 power wheelchair users for 12 months. Users whose battery charging behavior was not optimal were instructed on appropriate charging practices. Wheelchair usage parameters of wheelchair drive and power time every month were used to predict repairs and associated costs.Results: Fifty-four out of 119 users in the training cohort did not charge batteries regularly and were instructed on appropriate charging. Twenty-six of them changed their behavior and charged their batteries every night. This cohort experienced reduced battery repairs by 18%, wheelchair repairs by 11%, and repair costs by £3,092 compared to a matched standard care cohort (n=118). User age and drive time were associated with repair measures. Drive time predicted time-to-failure for wheelchair parts and classified failure risk with the area under the receiver operating characteristic curve as 0.71 (95% CI 0.61 to 0.82; p<.001). Conclusions: By leveraging the significant relationships between wheelchair usage and repairs, wheelchair users at risk of part failures can be identified, and technician-led servicing tools for proactive interventions can be developed. Wheelchair battery health telemonitoring and instructing users on appropriate battery charging reduced repairs and associated costs.

Using the lens of assistive technology to develop a technology translation readiness assessment tool (TTRAT)™ to evaluate market readiness

PURPOSE

Assistive Technologies encompass a wide array of products, services, healthcare standards, and the systems that support them. Product/market fit is necessary for a technology to be transferred successfully. Current tools lack variables that are key to technology transfer, and current trainings do not have a validated tool to assess the effectiveness of a training, increasing innovators' readiness for technology transfer. The goal was to develop a tool to evaluate the readiness of a technology by incorporating other models and focusing beyond just commercialization.

MATERIALS AND METHODS

The development involved five stages: 1. Review of current tools used in technology transfer in academic, government, and industry settings; 2. Development of the draft version of the tool with internal review; 3. Alpha version review and refinement, 4. Content validation of the tool's beta version; 5. Assessment of the readiness tool for reliability and preparedness for wide-use dissemination.

RESULTS

The tool was revised and validated to 6 subscales and 25 items. The assistive technology subscale was removed from the final version to eliminate repetitive questions and taking into consideration that the tool could be used across technologies.

CONCLUSIONS

We developed a flexible assessment tool that looked beyond just commercial success and considered the problem being solved, implications on or input from stakeholders, and sustainability of a technology. The resulting product, the Technology Translation Readiness Assessment Tool (TTRAT)TM, has the potential to be used to evaluate a broad range of technologies and assess the success of training programs.IMPLICATIONS FOR REHABILIATIONQuality of life can be substantially impacted when an assistive technology does not meet the needs of an end-user. Thus, effective Assistive Technology Tech Transfer (ATTT) is needed.The use of the TTRAT may help to inform NIDILRR and other funding agencies that invest in rehabilitation technology development on the overall readiness of a technology, but also the impact of the funding on technology readiness.The TTRAT may help to educate novice rehabilitation technology innovators on appropriate considerations for not only technology readiness, but also general translation best practices like assembling a diverse team with appropriate skillsets, understanding of the market and its size, and sustainability strategies.

Barriers and facilitators to technology transfer of NIDILRR grantees

PURPOSE

The objectives of this mixed-methods study were to gather survey and interview data about the barriers and facilitators from grantees funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and to extract themes that could inform program changes that would increase technology translation (TT) success in assistive technology (AT).

MATERIALS AND METHODS

We developed a TT Barriers and Facilitators survey consisting of Likert scale and multiple-choice questions about barriers and facilitators to TT. With survey respondents who were willing, we conducting a semi-structured interview and asked pointed questions to expand upon survey response rankings and perceived barriers and facilitators. The questions were framed to explore the grantee's personal experience with ATTT and what helped and hindered their individualised processes.

RESULTS

Across survey and interview respondents, the three most common themes when exploring the barriers and facilitators of TT were funding, incentives, and collaboration.

CONCLUSIONS

Results indicate that there is a need for increased collaboration and access to additional resources such as funding for pilot grants, support to assess technology marketability, help to navigate regulatory and legal aspects, and assistance in establishing goals to help grantees successfully transfer assistive technologies to consumers. IMPLICATIONS FOR REHABILITATIONA large amount of research and development into assistive technology does not lead to tech transfer which means that these technologies are not getting to the people that need them.Educating tech transfer offices at universities about how to transfer AT would improve outcomes greatly.Creating a community of practice where grantees can find academic or industry partners would also increase the likelihood of tech transfer.Some tools to catalyse these improvements are: mentoring, access to consultants, podcasts, and online training.

A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services

PURPOSE

It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States.

MATERIALS AND METHODS

A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection.

RESULTS

A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with.

CONCLUSIONS

Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Implications for rehabilitationHighlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers.In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs.There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs.

Mapping wheelchair functions and their associated functional elements for stair climbing accessibility: a systematic review

PURPOSE

Wheelchair (WC) design elements are subjected to the accessibility and assistive needs of a person with locomotor disability. In order to pursue a holistic design for a stairclimbing WC, there is a need for literature review on WC functions reported for both stair climbing and plane surface movement.

METHODS

A total of 112 Research articles are reviewed for the purpose of extracting the relationship between WC design elements and the functions associated with them. Stairclimbing technologies are reviewed for their technological assessment in terms of functional elements associated with stairclimbing. Cross-functional mapping between functional elements and their dominant function is performed. Heat map for primary user needs and associated design elements is generated from cross mapping.

CONCLUSIONS

A design gap for user's functional needs is indicated from the review of literature on prototypes and products of WC. The literature in stairclimbing technology is primarily focussed on stair climbing capability and not on the other functional needs, such as safety, ride comfort, seat comfort, manoeuvrability, etc.Implications for rehabilitationFor attaining the goal of an effective rehabilitation, it is important to design and develop an assistive technology that can provide maximum accessibility and functioning for a person with disability. In case of locomotor disability, wheelchair (WC) is the most empowering tool that can assist people in both accessibility and activities of daily living. This review of literature was conducted to draw out the functions fulfilled by a WC, such as safety, comfort, propulsion for its users and the associated WC elements like seat, wheels, backrest, etc., that are required to fulfil those functions.WC being the most important technological intervention in the life of a person who cannot walk should be designed with the highest level of empathy. Therefore, each and every aspect of the user's physical and emotional needs should be catered up to the limits of engineering design. The research on stair climbing technologies has also grown exponentially, fuelled by technological growth in engineering mechanisms, ambient awareness sensors, actuators, etc. The review attempts to envelop such technologies and consolidate them on the basis of their capabilities and efficacies.The virtue of stair climbing has been realized through some novel and innovative mechanisms reviewed in this article that can be integrated with the research in field of functional elements required to carry out primary functions of a disabled person, such as safety, comfort, intuitiveness, etc. This review can help in coupling both of them in a more rational way where a designer who is designing the technology is more empathetic towards the design for accessibility. It can also help user in becoming more confident towards adapting a new assistive technology.

Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study

PURPOSE

The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would be the strongest predictor of cycle time.

MATERIALS AND METHODS

Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted.

RESULTS

The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro [p < .001], Great Lakes [p = .016], and Northeast area [p < .001]), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and "other" (p = .028)) were associated with lower cycle time.

CONCLUSIONS

Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities.Implications for rehabilitationThe national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source.Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times.Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times.As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.

A descriptive analysis of wheelchair repair registry data

Wheeled mobility and seating (WMS) devices allow users to achieve greater mobility independence. Previous studies determined that 53% of wheelchair users required one or more repairs over a 6-month period; however, there are a limited number of studies that have evaluated types of repairs. The purpose of this study was to describe the types of manual wheelchair, power wheelchair, and scooter repairs within the Wheelchair Repair Registry (WRR) and examine the association between WMS devices and the frequency of repairs. A dataset of 4,645 devices distributed in the United States was collected from equipment suppliers who performed and logged community-based wheelchair repair services. The results demonstrated common repairs found across devices were within the wheels/tires/forks and batteries/cables categories. Device type was the most significant predictor of variance in the number of repairs. Customizable manual wheelchairs, tilt-in-space, Groups 2 & 3 power wheelchairs, and scooters were associated with higher number of repairs compared to non-customizable manual wheelchairs, pediatric, heavy-duty manual wheelchairs, and Group 4 power wheelchairs. The higher failure rate found in specific devices may be associated with a population of more active users, environment/conditions where equipment is used, time spent in equipment, additional features on device, or lower durability.

A Goal-Directed Program for Wheelchair Use for Children and Young People with Cerebral Palsy in Uganda: An Explorative Intervention Study

In this exploratory study, we investigate whether goal-directed intervention for wheelchairs can increase the activities of daily living for children and young people with cerebral palsy (CP) when implemented in rural Uganda. Thirty-two children and young people with CP (aged 3–18 years) participated in a home-visit intervention program, which included donating wheelchairs and setting individual goals. Goal achievement, frequency of wheelchair use, condition of wheelchairs, and caregivers’ perspectives were collected by interviews at 6–10 month after the start of intervention and the after three years. Our result show that most wheelchairs were in good condition and frequently used after 6–10 month with 83% goal achievement (132/158 goals; mean 4.3 (range 0–7). The caregivers reported several advantages (e.g., the child being happier) and few disadvantages (e.g., poor design and durability). At the three-year follow-up, only eleven wheelchairs were still used by 23 available participants (seven deceased and two moved). The children achieved 60% of their goals (32/53 goals mean 2.9; range 1–5). This demonstrates that the goal-directed intervention program for wheelchairs can be successfully implemented in a low-income setting with a high rate of goal achievement and frequent wheelchair use, facilitating participation. However, maintenance services are crucial to obtain sustainable results.

Estimating power wheelchair battery lifespan based on real-world data

PURPOSE

The purpose of this study was to: (1) estimate battery lifespan in power wheelchairs (PWCs) as measured by the length of time until battery replacement occurs and (2) identify factors associated with variability in battery lifespan after device distribution.

MATERIALS AND METHODS

PWCs distributed between 1 January 2016 and 31 December 2018 were retrieved from the Wheelchair Repair Registry (WRR) and included into this retrospective cohort study. Factors associated with battery lifespan were examined with the stratified Cox proportional hazard model.

RESULTS

A data set of 1268 PWCs from four different manufacturers was analysed. Five hundred and ten PWCs (40.2%) had one battery replacement with median battery lifespan of 22.3 months. The overall cumulative incidences of battery replacement were 14.5%, 56.2% and 88.2% at the end of the first, second and third year after device distribution, respectively. Among PWC manufacturers, manufacturer C (hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.35-5.12; p = 0.004) and manufacturer D (HR, 3.02; 95% CI, 1.51-6.01; p = 0.002) were associated with shorter battery lifespan. PWCs operated in warmer states (65-75 °F annual temperature averages) were associated with longer battery lifespan.

CONCLUSIONS

Results showed that the median battery lifespan was 22 months. PWC manufacturer and operating climate temperature were associated with variability in battery lifespan. This research has implications to better inform users, providers, manufacturers and payers to be more aware of battery lifespan across PWC types and manufactures to anticipate replacement timelines and avoid adverse situations associated with battery failures. Implications for rehabilitationThere are differences in battery lifespan across different power wheelchair (PWC) manufactures.Power wheelchair batteries last longer in warmer operating climates.Future attention needs to be sought towards the types of batteries manufacturers are using for PWC group classifications.These types of studies could be useful to justify reasonable timelines and the costs associated with battery replacements.

Factors Influencing Incidence of Wheelchair Repairs and Consequences Among Individuals with Spinal Cord Injury

OBJECTIVE

To investigate the frequency and consequences of wheelchair repairs, looking at the relationship to usage, components, out-of-pocket costs, number of days affecting the user, and factors associated with the need for repairs or consequences.

DESIGN

Survey, cross-sectional.

SETTING

Nine spinal cord injury (SCI) Model Systems centers.

PARTICIPANTS

Wheelchair users with SCI (N=533).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Cost and incidence of wheelchair repairs and consequences and wheelchair usage within the past 6 months.

RESULTS

A total of 310 participants (56%) reported repairs, 127 (42%) of whom experienced at least 1 adverse consequence lasting a median of 5 days (interquartile range [IQR], 2-17.3 days). Repair rates were highest for the seating system, electronics, and tires. Participants were most often stranded at home or forced to use a backup chair. Median out-of-pocket costs were $150 (IQR, $50-$620). Active users, based on type of mobility and terrain, experienced more repairs and consequences than less active users. Repairs were more common among those who were Black (odds ratio [OR], 2.42) or power wheelchair (PWC) users (OR, 1.84), whereas consequences were more common among those who were Black (OR, 2.27), PWC (OR, 2.08) or power assist users (OR, 2.76), and those who had public insurance (OR, 1.70).

CONCLUSIONS

Wheelchair repairs continue to affect more than 50% of wheelchair users with significant financial and personal cost. High repair rates limited participation inside and outside of the home. Consequences lasted longer than 2 weeks for many and may be minimized by a working backup chair. Disparities exist based on participant and wheelchair factors; repairs and adverse consequences appear to hit those most vulnerable with the least financial resources. Costs may be a barrier to repair completion for some individuals. This ongoing problem of high repair rates and their associated effects requires action such as higher standards, access to quicker service, and better training of users on wheelchair maintenance and repair.

Community-based wheelchair caster failures call for improvements in quality and increased frequency of preventative maintenance

STUDY DESIGN

Secondary data analysis of wheelchair failures and service repair logs from a network of wheelchair suppliers.

OBJECTIVE

To determine the frequency of wheelchair caster failures and service repairs across wheelchair manufacturers and models and investigate the relationships between them.

SETTING

Wheelchair caster failures and service repairs occurred in the community.

METHODS

Reported caster failure types were classified based on the risk they pose for user injuries and wheelchair damage. Caster failures experienced by users of tilt-in-space and ultralightweight manual wheelchair models and Group 2, 3 and 4 power wheelchair models between January 2017 and October 2019 were analyzed using Chi-Square tests for independence. Correlational analysis of failures and service repairs was performed.

RESULTS

A total of 6470 failures and 151 service repairs reported across four manufacturers and five models were analyzed. Failure types were significantly associated with manufacturers and models, respectively. Users of tilt-in-space wheelchairs, who require greater seating support, experienced twice the proportion of high-risk caster failures than the ultralightweight manual wheelchair users. Similarly, Group 3 and 4 power wheelchair users, who have complex rehabilitation needs, experienced 15-36% more high-risk failures than Group 2 users. Service repairs negatively correlated with high-risk manual wheelchair caster failures.

CONCLUSIONS

Wheelchair users who have greater seating and complex rehabilitation needs are at a higher risk for sustaining injuries and secondary health complications due to frequent caster failures. The study findings call for significant reforms in product quality and preventative maintenance practices that can reduce wheelchair failures and user consequences.

Rolling resistance of casters increases significantly after two years of simulated use

Introduction

Manual wheelchair propulsion is associated with upper limb pain and injury, and clinical guidelines recommend minimizing propulsive force to lower health risks. One of the strategies to reduce propulsive force is by minimizing rolling resistance (RR). Product testing studies suggest that RR of casters is affected by wear and tear which could have implications on the health risk of wheelchair users. The study will investigate the relationship between caster RR and environmental exposure using standard testing protocols.

Methods

RR of ten casters representing a range of diameters for different models of wheelchairs were measured before and after environmental exposure that includes corrosion, shock and abrasion simulating two years of community use.

Results

Four casters exhibited failures during durability testing, one catastrophically. Increases to RR after corrosion, shock and abrasion exposure were statistically significant using mixed-effects modeling, and four casters had increased RR greater than 20%.

Conclusions

Many of the casters evaluated exhibited increased RR forces and failure after environmental exposure. Improved caster design and use of corrosion resistant materials may reduce these failures. In addition, modification of the provision process could include replacement casters to reduce failures and avoid breakdowns that leave manual wheelchair users stranded or injured.

Factors associated with injury severity among users of powered mobility devices

Objective

To examine the features of powered mobility device-related injuries and identify the predictors of injury severity in such settings.

Methods

Emergency Department-based Injury In-depth Surveillance data from 2011 to 2018 were used in this retrospective study. Participants were assigned to the mild/moderate and severe groups based on their excess mortality ratio–adjusted injury severity score and their general injury-related factors and injury outcome-related factors were compared.

Results

Of 407 patients, 298 (79.2%) were assigned to the mild/moderate group and 109 (26.8%) to the severe group. The severe group included a higher percentage of patients aged 70 years or older (43.0% vs. 59.6%, P=0.003), injuries incurred in the daytime (72.6% vs. 82.4%, P=0.044), injuries from traffic accidents and falls (P=0.042), head injuries (38.6% vs. 80.7%, P<0.001), torso injuries (16.8% vs. 32.1%, P=0.001), overall hospital admission (28.5% vs. 82.6%, P<0.001), intensive care unit admission (1.7% vs. 37.6%, P<0.001), death after admission (1.4% vs. 10.3%, P=0.034), and total mortality (0.7% vs. 9.2%, P<0.001). The odds ratios (ORs) for injury severity were as follows: age 70 years or older (OR, 2.124; 95% confidence interval [CI], 1.239–3.642), head injury (OR, 10.441; 95% CI, 5.465–19.950), and torso injury (OR, 4.858; 95% CI, 2.495–9.458).

Conclusion

The proportions of patients aged 70 years or older, head and torso injuries, injuries from traffic accidents and falls, and injuries in the daytime were higher in the severe group. Our results highlight the need for measures to address these factors to lower the incidence of severe injuries.

Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVE

To assess the effectiveness of group wheelchair maintenance training and investigate participant characteristics associated with responsiveness to training.

DESIGN

Randomized controlled trial with an immediate group and a waitlist control group (WLCG) who received the intervention after a 6-month delay.

SETTING

Four Spinal Cord Injury Model Systems Centers.

PARTICIPANTS

Manual (MWC; n=80) and power wheelchair (PWC; n=67) users with spinal cord injury (N=147).

INTERVENTIONS

Two 90-minute structured wheelchair maintenance training program classes with 12-20 people per class and separate classes for MWC and PWC users. Each class included in-person hands-on demonstrations and practice of wheelchair maintenance.

MAIN OUTCOME MEASURES

Separate analysis was completed for MWC and PWC users using the Wheelchair Maintenance Training Questionnaire (WMT-Q) capacity (ability to complete), performance (frequency of completion) and knowledge at baseline, 1 month, 6 months, 6 months pretraining (WLCG only), and 1 year (immediate only).

RESULTS

After the intervention, participants in both the immediate and WLCG improved in maintenance capacity (MWC and PWC, P<.001) and performance (MWC and PWC, P<.001) with training. Only PWC users improved knowledge of wheelchair maintenance (P<.001). For both WLCGs (MWC and PWC), there was no difference between the 6-month pretraining time point and baseline. MWC users who responded to training had lower WMT-Q scores for all domains, whereas this was only the case for knowledge for PWC users.

CONCLUSIONS

Group wheelchair skills training is effective at improving capacity to complete maintenance and performance of maintenance activities for MWC and PWC users, even in a cohort of experienced wheelchair users. For MWC users, improvements were tied to lower WMT-Q scores at baseline, whereas PWC users improved in capacity and performance independent of baseline score. Delivering this training in a structured group format has a lower cost, which might improve adoption into clinical practice.

A review of adaptive sport opportunities for power wheelchair users

PURPOSE

To identify adaptive sports opportunities for individuals who use powered wheelchairs for their primary means of mobility, and to determine barriers and facilitators for new sporting opportunities.

MATERIALS AND METHODS

A structured literature review of the peer-reviewed scientific literature and analysis of major adaptive sport competitions information. Pubmed and Scopus were searched for the phrases "Power wheelchair sports" and "complex disability sport" to identify articles discussing competitive sport opportunities for power wheelchair users. Also, the websites and instructional materials were searched to identify what sports exist for power wheelchair users in the Paralympics, the National Veteran Wheelchair Games, the Invictus Games and the Warrior Games.

RESULTS

Eleven articles were found from Pubmed and Scopus which met the criteria, most of which were focused on power soccer. The search for sport opportunities from the four major competitions found few events where someone using a power wheelchair could participate, most of which involve a stationary chair during competition (e.g., archery, billiards).

CONCLUSIONS

This literature review identified few programs for sports for people who use power wheelchairs. Many challenges such as lack of appropriate technology, lack of programs, and challenging classification categories all interact to contribute to this problem. Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for these athletes to benefit more from sport and recreation.Implications for rehabilitationAthletes with complex disabilities and high support needs are not provided with the same opportunities as other athletes.Challenges such as insufficient technology, lack of programs, and challenging classification categories all interact to contribute to the lack of opportunities.Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for athletes with complex disabilities and high support needs to benefit more from sport and recreation.

Design of an adjustable wheelchair for table tennis participation

PURPOSE

Physical activity and recreation are very important for people with disabilities and provide benefits for self-esteem, social relationships, employment, rehabilitation, and education. Para Table Tennis is an adaptive sport where participants compete in table tennis while sitting in a wheelchair. However, athletes generally use their everyday wheelchair instead of a device specifically designed for the sport. The specific support, movements, and posture needed to participate in table tennis at the highest level are different than general day-to-day mobility and a device could be optimized for the sport. This research describes the development of a wheelchair specifically designed for para table tennis.

MATERIALS AND METHODS

The design followed a participatory action design approach which identified the specific needs for a wheelchair to be used during para table tennis.

RESULTS

Three design needs were identified which included 1) locking the casters in the forward direction, 2) ability to raise the seat height as high as possible while allowing the user's knees to fit under the table, and 3) adjustable seat angle which will allow some users to have anterior tilt to get their trunk even higher while other users could have posterior tilt for stability. A new chair meeting these needs was designed and prototyped.

CONCLUSIONS

Para table tennis has some specific requirements related to movements and posture which were improved by a new wheelchair design specific for the sport.IMPLICATIONS FOR REHABILITATIONMany adaptive sports are improved with sport specific technology.A model client was used to develop a wheelchair specifically for adaptive table tennis.The height and angle of the seat of the new wheelchair can be adjusted for optimal stability and reach.The casters of the new wheelchair can be locked to allow only forward and backward motion.

Development of a Wheelchair Repair Registry

OBJECTIVE

To describe the development of a wheelchair repair registry from large datasets to attain an understanding of wheelchair failures and service repairs.

DESIGN

Guidelines for registry development were applied and anchored around Labor-Tracker, a web-based information management system for wheelchair suppliers to manage and track wheelchair repairs. The registry was designed using online analytical processing, allowing for rapid data queries from multiple dimensions that enable complex data analysis and discovery.

SETTING

The Wheelchair Repair Registry (WRR) was developed through an industry and academic collaboration whereby repair data were collected in the field, entered into the Labor-Tracker system, deidentified, and then transferred to the registry and made available for analyses.

PARTICIPANTS

Wheelchair supplier service technicians reported data from repair services provided to individuals who use power wheelchairs, manual wheelchairs, and scooters.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Wheelchair failure and repair data, including variables related to scheduling, equipment information (eg, manufacturer, model, serial number, purchase date), labor, parts, and reasons for repairs.

RESULTS

The WRR was developed to analyze wheelchair repairs and failures from the Labor-Tracker system. Currently, the registry has more than 60,000 repairs conducted on more than 5000 wheelchair devices from 25 manufacturers. The devices include 60% power wheelchairs, 35% manual wheelchairs, and 5% scooters.

CONCLUSIONS

The WWR creates opportunities to apply large-data analytical methodologies that will serve to inform quality standards, practice, equipment selection, preventative maintenance routines, product design, and policy.

Neuroergonomic Assessment of Wheelchair Control Using Mobile fNIRS

For over two centuries, the wheelchair has been one of the most common assistive devices for individuals with locomotor impairments without many modifications. Wheelchair control is a complex motor task that increases both the physical and cognitive workload. New wheelchair interfaces, including Power Assisted devices, can further augment users by reducing the required physical effort, however little is known on the mental effort implications. In this study, we adopted a neuroergonomic approach utilizing mobile and wireless functional near infrared spectroscopy (fNIRS) based brain monitoring of physically active participants. 48 volunteers (30 novice and 18 experienced) self-propelled on a wheelchair with and without a PowerAssist interface in both simple and complex realistic environments. Results indicated that as expected, the complex more difficult environment led to lower task performance complemented by higher prefrontal cortex activity compared to the simple environment. The use of the PowerAssist feature had significantly lower brain activation compared to traditional manual control only for novices. Expertise led to a lower brain activation pattern within the middle frontal gyrus, complemented by performance metrics that involve lower cognitive workload. Results here confirm the potential of the Neuroergonomic approach and that direct neural activity measures can complement and enhance task performance metrics. We conclude that the cognitive workload benefits of PowerAssist are more directed to new users and difficult settings. The approach demonstrated here can be utilized in future studies to enable greater personalization and understanding of mobility interfaces within real-world dynamic environments.

Comparing the performance of ultralight folding manual wheelchairs using standardized tests

Objective: To evaluate ultralight folding manual wheelchairs (UFMWs) in order to produce comparative data on their strength, durability, stability and cost-benefit, and to determine progress of wheelchairs by comparing these results to results of past studies.Design: Engineering testing using American National Standards Institute (ANSI) and Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) standards.Setting: Laboratory testing of UFMW stability, and static, impact and fatigue strength performance with three devices using ANSI/RESNA standardized tests.Participants: The three wheelchair models were the TiLite Aero X (Permobil, Lebanon, TN), Sunrise Medical Quickie 2 (Fresno, CA) and Ki Mobility Catalyst 5 (Stevens Point, WI).Interventions: ANSI/RESNA standardized tests.Main outcome measures: Mass and critical measurements, static stability, static strength, impact strength, fatigue strength and cost analysis.Results: The ultralight folding wheelchairs continued to outperform their lightweight and rigid framed counterparts. According to these data, the quality of ultralight wheelchairs has not declined over the past 10 years. The Ki Catalyst did not pass strength and durability testing, while the TiLite Aero X and Sunrise Medical Quickie 2 surpassed these tests.Conclusions: This result exemplifies the need for ongoing research to identify whether wheelchairs satisfy ANSI/RESNA testing requirements and highlights the importance of creating a resource data set. This is particularly important when numerous other wheelchairs fail to meet minimum ANSI/RESNA requirements.Implications for RehabilitationFolding frame wheelchairs offer benefits such as transportability and convenience that may benefit certain wheelchair users, assuming their durability is sufficient and they provide similar benefits vs. other wheelchair construction.Previous studies have shown that folding wheelchairs perform meet the minimum requirements of standardized testing, and it is important to see if durability has increased, decreased or remained the same over the years. Other wheelchair types have remained stagnant with respect to durability and are less likely to meet the minimum durability requirements.Durable devices will improve a wheelchair user's quality of life by reducing downtime while waiting for repairs, and also reduce the likelihood of injury due to component failure.

Development of Wheeled Mobility indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Background: Wheeled mobility is critical for individuals with Spinal Cord Injury or Disease (SCI/D) related paralysis. The World Health Organization (WHO) developed guidelines highlighting eight steps in wheelchair service delivery: (1) referral and appointment; (2) assessment; (3) prescription; (4) funding and ordering; (5) product preparation; (6) fitting; (7) user training; and, (8) follow-up maintenance/repairs. This article describes the processes used to develop structure, process and outcome indicators that reflect the WHO guidelines within the Domain of Wheeled Mobility rehabilitation for Canadians. Methods: Wheeled mobility experts within the SCI-High Project Team used the WHO guideline to inform the Construct refinement and development of a Driver diagram. Following seven meetings, the Driver diagram and review of outcome measures and literature synthesis regarding wheelchair service delivery informed indicator selection and group consensus. Results: The structure indicator examines the proportion of SCI/D service providers within a rehabilitation program who have specialized wheelchair training to ensure prescription, preparation, fitting, and maintenance quality. The process indicator evaluates the average number of hours of wheelchair service delivery provided per patient during rehabilitation. The intermediary outcome indicator (rehabilitation discharge), is a target capacity score on the Wheelchair Skills Test Questionnaire (WST-Q). The final outcome indicators (at 18 months post rehabilitation admission) are the Life Space Assessment (LSA) and the Wheelchair Use Confidence Scale (WheelCon) short form mean scores. Conclusion: Routine implementation of the selected Wheeled Mobility structure, process and outcome indicators should measurably advance care within the Wheeled Mobility Domain for Canadians living with SCI/D by 2020.

Development and efficacy of an online wheelchair maintenance training program for wheelchair personnel

OBJECTIVES

To develop an online version of the wheelchair maintenance training program (WMTP) and compare learning outcomes from the in-person and online programs using the wheelchair maintenance training questionnaire (WMT-Q), administered before and after the intervention.

DESIGN

Iterative development of an online version of the WMTP and implementation.

SETTING

Online.

PARTICIPANTS

26 graduate and undergraduate students.

INTERVENTION

Web-based training. These results are compared with those from another study of the in-person WMTP with 10 participants.

MAIN OUTCOME MEASURES

Feedback survey and WMT-Q.

RESULTS

The training program was well-received and valued by all 26 participants. A significant increase in all scores after the online training program was found, based on pre-/post-intervention scores. In manual wheelchair open-ended questions, knowledge increased from 16% to 21%, p < .05; in power wheelchair open-ended questions, from 9% to 31%, p < .05; in multiple-choice questions related to knowledge, from 27% to 59%, p < .05; confidence increased from 8% to 80%, p < .05; and capacity from 12% to 88%, p < .05. There was no statistical difference in WMT-Q scores between individuals who participated in the in-person and online programs.

CONCLUSION

This study indicates that there was a similar-increased knowledge for participants, indicating that web-based training may be a viable approach for delivering maintenance training.

Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs' performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.Implications for rehabilitationCarbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these modelsCarbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, howeverIncreased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their communityThe low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment.

Wheelchair Breakdowns Are Associated With Pain, Pressure Injuries, Rehospitalization, and Self-Perceived Health in Full-Time Wheelchair Users With Spinal Cord Injury

OBJECTIVES

To evaluate the relation between wheelchair breakdowns, their immediate consequences, and secondary health complications after spinal cord injury. "Immediate consequences" occur when part of a wheelchair breaks and leaves an individual stranded or injured, or causes him or her to miss medical appointments, work, or school.

DESIGN

Survey, cross-sectional.

SETTING

Spinal Cord Injury Model Systems Centers.

PARTICIPANTS

Full-time wheelchair users (N=771) with SCI from 9 Spinal Cord Injury Model Systems Centers, with data collected between 2011 and 2016.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Incidence of self-reported wheelchair breakdowns within the past 6 months that did or did not result in immediate consequences (ie, injury, being stranded, missing a medical appointment, or an inability to attend school/work); self-perceived health status scale; pain severity numerical rating scale; rehospitalizations; and self-reported pressure injury development within the past 12 months.

RESULTS

A total of 610 participants with complete data sets were included in the analyses. When compared to those who reported no breakdowns, participants who reported 1 or more immediate consequences had worse secondary complications: higher self-perceived health status and pain scores (partial -η²=.009-.012, P<.05), and higher odds of rehospitalization (odds ratio: 1.86, P<.05) and pressure injury development (odds ratio: 1.73, P<.05). Secondary health complications were not different in those who reported no immediate consequences compared to those who reported no breakdown.

CONCLUSIONS

Wheelchair breakdowns that resulted in injury, being stranded, missing medical appointments, and/or an inability to attend work/school appear to have far-reaching impacts on health and secondary injury. Preventing wheelchair breakdowns, through either better maintenance or manufacturing, may be a means of decreasing secondary disability.

A novel mobile-cloud system for capturing and analyzing wheelchair maneuvering data: A pilot study

The purpose of this pilot study was to provide a new approach for capturing and analyzing wheelchair maneuvering data, which are critical for evaluating wheelchair users' activity levels. We proposed a mobile-cloud (MC) system, which incorporated the emerging mobile and cloud computing technologies. The MC system employed smartphone sensors to collect wheelchair maneuvering data and transmit them to the cloud for storage and analysis. A k-nearest neighbor (KNN) machine-learning algorithm was developed to mitigate the impact of sensor noise and recognize wheelchair maneuvering patterns. We conducted 30 trials in an indoor setting, where each trial contained 10 bouts (i.e., periods of continuous wheelchair movement). We also verified our approach in a different building. Different from existing approaches that require sensors to be attached to wheelchairs' wheels, we placed the smartphone into a smartphone holder attached to the wheelchair. Experimental results illustrate that our approach correctly identified all 300 bouts. Compared to existing approaches, our approach was easier to use while achieving similar accuracy in analyzing the accumulated movement time and maximum period of continuous movement (p > 0.8). Overall, the MC system provided a feasible way to ease the data collection process and generated accurate analysis results for evaluating activity levels.

Satisfaction with assistive technology device in relation to the service delivery process-A systematic review

The service delivery process (SDP) of assistive technology devices (ATDs) is attracting interest, as the provision of ATDs is critical for the independence and participation in society of individuals with disabilities. The purpose of the current study was to investigate what impact the SDP has on satisfaction with ATDs in individuals with disabilities in relation to everyday activities. A systematic literature review was conducted, which resulted in 53 articles included. The results showed that there are factors in almost all the different steps of the SDP that affect the satisfaction with of the devices, which can lead to underutilization and abandonment of ATDs. Only a few studies have been conducted with a design robust enough to generalize the results; therefore, more research is needed. Therefore, the conclusion is the SDP as a whole contributes to the satisfaction with and usability of ATDs in individuals with disability in relation to achieving the desired goals of participation in everyday activities, for the articles included must be deemed as moderate. A client-centred approach in the process is advocated, and was found to be an important factor for an effective SDP and satisfied users.

Development and evaluation of a wheelchair service provision training of trainers programme

Background

In many countries, availability of basic training and continued professional development programmes in wheelchair services is limited. Therefore, many health professionals lack access to formal training opportunities and new approaches to improve wheelchair service provision. To address this need, the World Health Organization (WHO) developed the WHO Wheelchair Service Training of Trainers Programme (WSTPt), aiming to increase the number of trainers who are well prepared to deliver the WHO Wheelchair Service Training Packages. Despite these efforts, there was no recognised method to prepare trainers to facilitate these training programmes in a standardised manner.

Objectives

To understand if the WSTPt is an effective mechanism to train aspiring wheelchair service provision trainers.

Method

An action research study was conducted using a mixed-methods approach to data collection and analysis to integrate feedback from questionnaires and focus groups from three WHO WSTPt pilots.

Results

Trainees were satisfied with the WHO WSTPt and the iterative process appears to have helped to improve each subsequent pilot and the final training package.

Conclusion

The WHO WSTPt is an effective mechanism to train wheelchair service provision trainers. This programme has potential to increase the number of trainees and may increase the number of qualified service providers.

Data Logger Technologies for Powered Wheelchairs: A Scoping Review

In recent years, studies increasingly employed data loggers to record the objective behaviors of powered wheelchair users. Of the data logging work reported in the literature, the technologies used offer marked differences in characteristics. In order to identify and describe the extent of published research activity that relies on data logger technologies for powered wheelchairs, we performed a scoping review of the scientific and grey literature. This scoping review, complementary to a previous one related to manual wheelchairs, is part of a process aiming to help further the development and increase the functionality of data loggers with wheelchairs. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, Google Scholar. Sixty papers were retained for analysis. The most frequently used technologies were all installed on the wheelchair: 19.0% were accelerometers, 14.6% were pressure sensors or switches, 13.9% were odometers, 10.9% were global positioning systems, 9.5% were tilt sensors, and 7.3% were force-sensing technologies. The most reported outcomes were pressure-relief activities (17.3%), distance traveled (9.3%), mobility events (8.9%), acceleration (8.5%), and sitting time (6.9%). Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to optimize the practicality of wheelchair data loggers.

A longitudinal study assessing the maintenance condition of cadres of four types of wheelchairs provided in low-resource areas

Wheelchair breakdowns increase the risk of injury and limit the mobility of wheelchair users. In the endeavour to meet the enormous global need for wheelchairs, manufacturers of wheelchairs for low-resource settings face a cost-benefit tension between affordability and durability. Field studies are needed to provide feedback on durability. Four manufacturers provided cadres of wheelchairs to the organization providing rehabilitation to students at a boarding school for children with disabilities in a low-resource area. The Wheelchair Components Questionnaire for Condition was used to evaluate wheelchair maintenance condition at several time intervals after fitting. Because the maintenance regime was not identical for the four wheelchair types, wheelchair types were not compared. Analysis of variance indicated differences in condition across time and between wheelchair components. Tukey's simultaneous comparison of means indicated that across the entire group, brakes, seats, casters and foot rests received lower ratings than frame. Preliminary data after each iteration of this study were provided to manufactures and resulted in responsive design changes. Implications for Rehabilitation Longitudinal studies with the Wheelchair Components Questionnaire for Condition (WCQc) have enabled manufacturers to make responsive design improvements. Additional studies could be done with other wheelchair types to result in responsive positive design changes for those wheelchairs as well. The WCQc can be used in studies on wheelchair condition even when records of repair history are not reliably available, a situation which is not uncommon in low-resource areas. Data sets collected at an individual clinic uses the WCQc could focus attention on wheelchair components needing regular repair. With that data in mind, the maintenance regime could be modified to respond and in so doing improve wheelchair condition and reduce loss of mobility or risk of injury. Organizations involved in funding wheelchairs for a particular location could use data from longitudinal studies done with the WCQc at that location to inform purchasing decisions.

Development of a wheelchair maintenance training programme and questionnaire for clinicians and wheelchair users

Purpose of state: The aims of this study were to develop a Wheelchair Maintenance Training Programme (WMTP) as a tool for clinicians to teach wheelchair users (and caregivers when applicable) in a group setting to perform basic maintenance at home in the USA and to develop a Wheelchair Maintenance Training Questionnaire (WMT-Q) to evaluate wheelchair maintenance knowledge in clinicians, manual and power wheelchair users.

METHODS

The WMTP and WMT-Q were developed through an iterative process.

RESULTS

A convenience sample of clinicians (n = 17), manual wheelchair (n ∞ 5), power wheelchair users (n = 4) and caregivers (n = 4) provided feedback on the training programme. A convenience sample of clinicians (n = 38), manual wheelchair (n = 25), and power wheelchair users (n = 30) answered the WMT-Q throughout different phases of development. The subscores of the WMT-Q achieved a reliability that ranged between ICC(3,1) = 0.48 to ICC(3,1) = 0.89. The WMTP and WMT-Q were implemented with 15 clinicians who received in-person training in the USA using the materials developed and showed a significant increase in all except one of the WMT-Q subscores after the WMTP (p < 0.007).

CONCLUSION

The WMTP will continue to be revised as it is further implemented. The WMT-Q is an acceptable instrument to measure pre- and post-training maintenance knowledge. Implications for Rehabilitation The Wheelchair Maintenance Training Program can be used to educate rehabilitation clinicians and technicians to improve wheelchair service and delivery to end users. This training complements the World Health Organization basic wheelchair service curriculum, which only includes training of the clinicians, but does not include detailed information to train wheelchair users and caregivers. This training program offers a time efficient method for providing education to end users in a group setting that may mitigate adverse consequences resulting from wheelchair breakdown. This training program has significant potential for impact among wheelchair users in areas where access to repair services is limited.

Prevalence of Wheelchair and Scooter Use Among Community-Dwelling Canadians

BACKGROUND

Mobility impairments are the third leading cause of disability for community-dwelling Canadians. Wheelchairs and scooters help compensate for these challenges. There are limited data within the last decade estimating the prevalence of wheelchair and scooter use in Canada.

OBJECTIVE

The aims of this study were: (1) to estimate the prevalence of wheelchair and scooter use in Canada and (2) to explore relevant demographic characteristics of wheelchair and scooter users.

DESIGN

This study was a secondary analysis of a cross-sectional national survey.

METHODS

The Canadian Survey on Disability (2012) collected data on wheelchair and scooter use from community-dwelling individuals aged 15 years and over with a self-identified activity limitation on the National Household Survey. Prevalence estimates were calculated as weighted frequencies, with cross-tabulations to determine the number of wheelchair and scooter users in Canada, by province, and demographic characteristics (ie, age, sex) and bootstrapping to estimate the variance of all point estimates.

RESULTS

There were approximately 288,800 community-dwelling wheelchair and scooter users aged 15 years and over, representing 1.0% of the Canadian population. The sample included 197,560 manual wheelchair users, 42,360 powered wheelchair users, and 108,550 scooter users. Wheelchair and scooter users were predominantly women, with a mean age of 65 years. Approximately 50,620 individuals used a combination of 2 different types of devices.

LIMITATIONS

The results are representative of individuals living in the community in Canada and exclude individuals in residential or group-based settings; estimates do not represent the true population prevalence.

CONCLUSION

This analysis is the first in more than 10 years to provide a prevalence estimate and description of wheelchair and scooter users in Canada. Since 2004, there has been an increase in the proportion of the population who use wheelchairs and scooters, likely related to an aging Canadian population. These new prevalence data have potential to inform policy, research, and clinical practice.

Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal Cord Injury

OBJECTIVE

To investigate the frequency and types of wheelchair repairs and associated adverse consequences.

DESIGN

Convenience cross-sectional sample survey.

SETTING

Nine Spinal Cord Injury Model Systems Centers.

PARTICIPANTS

People with spinal cord injury who use a wheelchair >40h/wk (N=591).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Number of repairs needed and resulting adverse consequences, number and types of repairs completed, and location where main repair was completed in the previous 6 months.

RESULTS

There were 591 participants responded to the survey, 63.8% (377/591) of them needed ≥1 repair; of these, 27.6% (104/377) experienced ≥1 adverse consequence, including 18.2% (69/377) individuals who were stranded. Of those who needed repairs, 6.9% did not have them completed (26/377). Repairs completed on the wheels and casters were the most frequent repair to manual wheelchairs, whereas repairs to the electrical and power and control systems were the most frequent type of repair on power wheelchairs. Forty percent (79/201) of manual wheelchair users reported completing repairs at home themselves compared with 14% (21/150) of power wheelchair users. Twelve percent of the variance in the odds of facing an adverse consequence because of a wheelchair breakdown can be described as a function of occupation, funding source, and type of wheelchair.

CONCLUSIONS

Wheelchair repairs are highly prevalent. There are differences in types of repairs and who completes the repairs based on the type of wheelchair. Wheelchair breakdowns result in adverse consequences for users, and there is a deficit between repairs needed and those completed, highlighting the need for interventions that address these problems.

Development of a contextually appropriate, reliable and valid basic Wheelchair Service Provision Test

PURPOSE

Currently, there is no internationally accepted way to measure the competency of wheelchair service professionals. The International Society of Wheelchair Professionals aims to develop a Wheelchair Service Provision - Basic Test as a preliminary step towards establishing a certification process.

METHOD

A team of wheelchair service provision experts developed test questions and conducted alpha and beta testing in order to validate them. Low-performing test items were eliminated. A pilot test was then conducted, which focused on developing a pass score, determining language barriers and validating the test as a measure of competency.

RESULTS

90 participants completed one of three versions of the Wheelchair Service Provision - Basic Test. A pass score of 70% was established and 135 questions were accepted for the final test. Analysis of variance indicated there was a difference in scores based on language (p = 0.001), but not based on experience level. This result motivated translation in to the United Nations' official languages.

CONCLUSIONS

The results indicate that the Wheelchair Service Provision - Basic Test is a valid method for measuring basic competency of wheelchair professionals. Additionally, researchers recommend a skills assessment to help to ensure only qualified wheelchair professionals receive the certificate. Implications for Rehabilitation Identify key steps in contextually appropriate test development. Describe the components of a contextually appropriate, reliable, and valid test for basic wheelchair service provision. Identify methods used for contextually appropriate test validation.

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia

Background

For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization’s service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls.

Methods

This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only.

Results

167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a “wheelie”. The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019).

Conclusions

Wheelchair provision according to World Health Organization’s 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.

Effectiveness of a Wheelchair Skills Training Program for Powered Wheelchair Users: A Randomized Controlled Trial

OBJECTIVES

To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation.

DESIGN

Randomized controlled trial.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Powered wheelchair users (N=116).

INTERVENTION

Five 30-minute WSTP training sessions.

MAIN OUTCOME MEASURES

Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA).

RESULTS

There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3.

CONCLUSIONS

Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Development and feasibility of an automated call monitoring intervention for older wheelchair users: the MOvIT project

Background

Recent advances in wheeled mobility technology are multiplying opportunities for community integration and improved quality of life. The mobility needs of older wheelchair users are particularly complex due to a constellation of chronic conditions and comorbidities that may compromise optimal use of the device. The purpose of the Mobility Outcomes via Information Technologies (MOvIT) project is to examine the feasibility of automated calls for the systematic monitoring for adverse outcomes associated with wheelchair use.

Methods

A two-phase mixed methods approach was used. Phase I involved user-centered development and face validation of a monitoring questionnaire with end-users (seven wheelchair users and five healthcare providers). Phase II tested the feasibility of monitoring outcomes using automated calls to administer the MOvIT questionnaire 1 and 3 months after wheelchair delivery with a prospective cohort of older adults (50–84 years of age). When problems were identified, the computer monitoring system notified a clinical coordinator who followed up with respondents requiring interventions. Feasibility data were extracted from the web database and from individual interviews covering perceived ease of use, usefulness and intention to use the MOvIT questionnaire in the future.

Results

The MOvIT monitoring questionnaire developed in phase I tracks nine potential wheelchair-related adverse outcomes considered important for end-users: 1) non-use of wheelchair, 2) pain, 3) skin condition, 4) positioning, 5) wheelchair incidents, 6) psychosocial issues, 7) restricted wheelchair participation, 8) limited wheelchair skills and knowledge, and 9) technical problems. In phase II, 92 individuals who received a wheelchair were eligible, 71 out of 92 accepted (77 %) and 65 out of 71 (92 %) completed the 3-month follow-up. In the sample of 65 participants, a wheelchair-related adverse outcome was confirmed by a rehabilitation professional for 58.5 %, and at least one recommendation was given to 66.2 % during the 3-month monitoring period. A majority of participants found the intervention useful (82.8 %) and said they intended to use the MOvIT monitoring questionnaire in the future (81.5 %). Participants made suggestions to make the calls more adaptive to various ability profiles.

Conclusions

Automated calls tailored for individuals with mobility limitations and associated comorbidities are a promising approach to reach clients who need post-rehabilitation support.

Capturing and analyzing wheelchair maneuvering patterns with mobile cloud computing

Power wheelchairs have been widely used to provide independent mobility to people with disabilities. Despite great advancements in power wheelchair technology, research shows that wheelchair related accidents occur frequently. To ensure safe maneuverability, capturing wheelchair maneuvering patterns is fundamental to enable other research, such as safe robotic assistance for wheelchair users. In this study, we propose to record, store, and analyze wheelchair maneuvering data by means of mobile cloud computing. Specifically, the accelerometer and gyroscope sensors in smart phones are used to record wheelchair maneuvering data in real-time. Then, the recorded data are periodically transmitted to the cloud for storage and analysis. The analyzed results are then made available to various types of users, such as mobile phone users, traditional desktop users, etc. The combination of mobile computing and cloud computing leverages the advantages of both techniques and extends the smart phone's capabilities of computing and data storage via the Internet. We performed a case study to implement the mobile cloud computing framework using Android smart phones and Google App Engine, a popular cloud computing platform. Experimental results demonstrated the feasibility of the proposed mobile cloud computing framework.

Automatic Detection and Classification of Unsafe Events During Power Wheelchair Use

Using a powered wheelchair (PW) is a complex task requiring advanced perceptual and motor control skills. Unfortunately, PW incidents and accidents are not uncommon and their consequences can be serious. The objective of this paper is to develop technological tools that can be used to characterize a wheelchair user’s driving behavior under various settings. In the experiments conducted, PWs are outfitted with a datalogging platform that records, in real-time, the 3-D acceleration of the PW. Data collection was conducted over 35 different activities, designed to capture a spectrum of PW driving events performed at different speeds (collisions with fixed or moving objects, rolling on incline plane, and rolling across multiple types obstacles). The data was processed using time-series analysis and data mining techniques, to automatically detect and identify the different events. We compared the classification accuracy using four different types of time-series features: 1) time-delay embeddings; 2) time-domain characterization; 3) frequency-domain features; and 4) wavelet transforms. In the analysis, we compared the classification accuracy obtained when distinguishing between safe and unsafe events during each of the 35 different activities. For the purposes of this study, unsafe events were defined as activities containing collisions against objects at different speed, and the remainder were defined as safe events. We were able to accurately detect 98% of unsafe events, with a low (12%) false positive rate, using only five examples of each activity. This proof-of-concept study shows that the proposed approach has the potential of capturing, based on limited input from embedded sensors, contextual information on PW use, and of automatically characterizing a user’s PW driving behavior.

Evaluation of lightweight wheelchairs using ANSI/RESNA testing standards

Lightweight wheelchairs are characterized by their low cost and limited range of adjustment. Our study evaluated three different folding lightweight wheelchair models using the American National Standards Institute/Rehabilitation Engineering Society of North America (ANSI/RESNA) standards to see whether quality had improved since the previous data were reported. On the basis of reports of increasing breakdown rates in the community, we hypothesized that the quality of these wheelchairs had declined. Seven of the nine wheelchairs tested failed to pass the multidrum test durability requirements. An average of 194,502 +/- 172,668 equivalent cycles was completed, which is similar to the previous test results and far below the 400,000 minimum required to pass the ANSI/RESNA requirements. This was also significantly worse than the test results for aluminum ultralight folding wheelchairs. Overall, our results uncovered some disturbing issues with these wheelchairs and suggest that manufacturers should put more effort into this category to improve quality. To improve the durability of lightweight wheelchairs, we suggested that stronger regulations be developed that require wheelchairs to be tested by independent and certified test laboratories. We also proposed a wheelchair rating system based on the National Highway Transportation Safety Administration vehicle crash ratings to assist clinicians and end users when comparing the durability of different wheelchairs.

Evaluation of scooters using ANSI/RESNA standards

To date, only one research study has evaluated how scooters respond to static and dynamic stability. However, no other studies have evaluated how scooters respond to adverse conditions and how they perform in all standard tests. A selection of 12 three-wheeled scooters was tested according to American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/ RESNA) wheelchair standards. Scooter models included the Victory, Gogo, Golden Companion (GC) I, and GC II. Victory and GC II were the most stable scooters. The Gogo scooters were the least dynamically stable. Five scooters (3 Gogo, 1 GC I, 1 GC II) failed the environmental condition tests. All GC I and II scooters failed parts of the power and control system tests. All scooters passed static and impact tests; however, all Gogo scooters and one GC II scooter had structural or motor failure during durability tests. The scooter models' survival life ranged from 62,512 to 1,178,230 cycles out of the 400,000 needed to pass the test. Tiller failures (typically tiller tube snapping) occurred with an average of 1,483 N force applied to the tiller structure. Our results indicate that these commercially available devices may not meet ANSI/RESNA standards. In addition, the tiller test should be conducted with scooters to further ensure their safety and durability and should use a test dummy with weight capacity according to the mobility device capacity.

Use, performance and features of mobile shower commodes: perspectives of adults with spinal cord injury and expert clinicians

PURPOSE

The purpose of this article is to explore the use of Mobile Shower Commodes (MSCs) by adults with Spinal Cord Injury (SCI) and to understand how adults with SCI and expert clinicians identify and select MSC designs and features.

METHOD

Semi-structured interviews were conducted with seven adults with SCI and eight expert clinical prescribers using semi-structured guides. Transcripts were analysed thematically using the Policy, Human, Activity, Assistance and Technology, and Environment (PHAATE) model as the underpinning theoretical framework.

RESULTS

Analysis of the interview transcripts revealed 3 themes and 12 sub-themes. The main themes were: (1) Activities, routines and interacting factors, (2) Features for functioning and (3) Getting it right. Substantial links existed between and across the themes and subthemes.

CONCLUSIONS

The use of MSCs by adults with SCI is complex. MSC performance varies across activities, and during interactions between the user, the MSC, other assistive technologies, assistance and physical environments. Future studies should explore service delivery processes and develop validated clinical assessment instruments and outcome measures for MSC provision. Implications for Rehabilitation Mobile shower commode use is complex, involving nine distinct activities and three types of routines. Mobile shower commodes used by Australian adults with SCI are individualised to users and include customisations and custom-made components. Trialling individualised mobile shower commodes prior to funding is problematic and not reflected in assistive service delivery models. Validated clinical instruments for assessing and selecting mobile shower commode features are needed.