Wheelchair ramp navigation in snow and ice-grit conditions

Development of the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course

Introduction

Manual wheelchairs (MWC) users have limited mobility during winter months as they encounter many environmental barriers that restrict their community participation. This paper outlines the creation and standardization of an outdoor environment designed to simulate the real-life conditions and obstacles experienced by MWC users in winter.

Methods and results

This study consisted of four phases. In Phase 1, researchers used a qualitative ethnographic approach to document the specific challenges and adaptive strategies used by MWC users in winter conditions. In Phase 2, key informants with expertise in MWC winter mobility were invited to co-design the Standardized Navigation Of Winter Mobility & Accessibility Network (SNOWMAN) course. Participants reviewed draft design solutions and offered their input and suggestions to expand upon the initial design. A second co-design workshop included additional key informants, including service providers, policymakers, and professionals with expertise in landscape architecture and engineering, to validate the design solution. The workshops resulted in a detailed illustration of the SNOWMAN course, including five sections: platforms with side slopes, a miniature ice rink, curbs and curb cuts, a path with uneven winter surfaces, and modular ramps at various slopes. Phases 3 and 4 marked the conclusion of the study and involved fabrication of the SNOWMAN course and establishment of a standardized protocol for course setup and maintenance.

Discussion

The project aimed to offer several additional potential benefits, supported by the various stakeholders across the study phases, that extend beyond creation of a controlled and safe environment for wheelchair users to develop their winter mobility skills. Practicing wheelchair skills in this area may assist wheelchair users in gaining confidence which may ultimately translate to increased participation in the community.

The Symmetry of the Muscle Tension Signal in the Upper Limbs When Propelling a Wheelchair and Innovative Control Systems for Propulsion System Gear Ratio or Propulsion Torque: A Pilot Study

Innovative wheelchair designs require new means of controlling the drive units or the propulsion transmission systems. The article proposes a signal to control the gear ratio or the amount of additional propulsion torque coming from an electric motor. The innovative control signal in this application is the signal generated by the maximum voluntary contraction (MVC) of the muscles of the upper limbs, transformed by the central processing unit (CPU) into muscle activity (MA) when using a wheelchair. The paper includes research on eight muscles of the upper limbs that are active when propelling a wheelchair. Asymmetry in the value for MVC was found between the left and right limbs, while the belly of the long radial extensor muscle of the wrist was determined to be the muscle with the least asymmetry for the users under study. This pilot research demonstrates that the difference in mean MVCmax values between the left and the right limbs can range from 20% to 49%, depending on the muscle being tested. The finding that some muscle groups demonstrate less difference in MVC values suggests that it is possible to design systems for regulating the gear ratio or additional propelling force based on the MVC signal from the muscle of one limb, as described in the patent application from 2022, no. P.440187.

Quantifying Mobility Scooter Performance in Winter Environments

OBJECTIVES

To quantify mobility scooter performance when traversing snow, ice, and concrete in cold temperatures and to explore possible performance improvements with scooter winter tires.

DESIGN

Cross-sectional.

SETTING

Hospital-based research institute.

PARTICIPANTS

Two drivers (50 and 100 kg) tested 8 scooter models (N=8). Two mobility scooters were used for winter tire testing.

INTERVENTIONS

Scooters were tested on 3 different conditions in a random sequence (concrete, 2.5-cm depth snow, bare ice). Ramp ascent and descent, as well as right-angle cornering up to a maximum of 10° slopes on winter conditions, were observed. Winter tire testing used the same slopes with 2 scooters on bare and melting ice surfaces.

MAIN OUTCOME MEASURES

Maximum achievable angle (MAA) and tire traction loss for ramp ascent and descent performance. The ability to steer around a corner on the ramp.

RESULTS

All scooters underperformed in winter conditions, specifically when traversing snow- and ice-covered slopes (χ² [2, N=8]=13.87-15.55, P<.001) and corners (χ² [2, N=8]=12.25, P<.01). Half of the scooters we tested were unable to climb a 1:12 grade (4.8°) snow-covered slope without losing traction. All but 1 failed to ascend an ice-covered 1:12 grade (4.8°) slope. Performance was even more unsatisfactory for the forward downslopes on both snow and ice. Winter tires enhanced the MAA, permitting 1:12 (4.8°) slope ascent on ice.

CONCLUSIONS

Mobility scooters need to be designed with winter months in mind. Our findings showed that Americans with Disabilities Act-compliant built environments, such as curb ramps that conform to a 1:12 (4.8°) slope, become treacherous or impassible to mobility scooter users when covered in ice or snow. Scooter manufacturers should consider providing winter tires as optional accessories in regions that experience ice and snow accumulation. Additional testing/standards need to be established to evaluate winter mobility scooter performance further.

Design of an mHealth application for winter mobility for mobility device users

BACKGROUND

There is limited evidence on the strategies, resources, and tools shown to improve winter mobility and community participation.

OBJECTIVE

This paper describes a multifaceted approach taken to develop an mHealth application that provides information, resources, and strategies to facilitate winter mobility for mobility device users, service providers, community organisations, and researchers.

METHODS

The study was conducted in three phases: (1) A scoping review of peer-reviewed and grey literature was completed to identify literature that reported on tools, strategies, resources, and recommendations used to promote winter mobility; (2) Online asynchronous focus groups were conducted to identify the type of content that mobility device users wanted to include in the web-based application; and (3) A prototype mHealth application was developed based on the findings from the previous phases. Using a rapid prototyping process that included stakeholder review through an online survey, four cycles of application design and development were undertaken.

RESULTS

The scoping review identified 23 peer-reviewed studies and limited grey literature on winter mobility strategies, resources and recommendations. Twenty-four participants from across Canada engaged in one of five focus groups. Focus group analysis led to the development of the content categories for the mHealth application. The initial prototype application developed was reviewed by; 27 mobility device users, 16 health care providers, and seven consumer organisation representatives identified areas of strength and further refinement in regard to application design.

CONCLUSIONS

The approach used in this study provided a method to develop an application based on the ideas, needs, and interests of a variety of stakeholders. Once fully developed, the application has the potential to fill the gaps related to the lack of a unified collection of winter mobility strategies and resources, and open the dialogue on methods to improve winter participation among mobility device users.IMPLICATIONS FOR REHABILITATIONDespite winter conditions being a common challenge among mobility device users, there is an absence of an organised approach towards helping individuals manage their winter mobility needs.As the development and usage of mHealth applications continues to increase, it is valuable to use methods of designing applications based on the ideas, needs, and interests of a variety of stakeholders.Development of a framework for collating information on winter mobility strategies and resources is the first step towards launching an mHealth application.

Evaluation of the Biomechanical Parameters of Human-Wheelchair Systems during Ramp Climbing with the Use of a Manual Wheelchair with Anti-Rollback Devices

Purpose: The main purpose of the research conducted was the analysis of kinematic and biomechanical parameters measured during manual wheelchair ramp-climbing with the use of the anti-rollback system and the comparison of the values tested with the manual wheelchair climbing the same ramp but without any modifications. The paper presents a quantitative assessment relating to the qualitative research of the anti-rollback system performed by another research team. Method and materials: The article presents the measurement results of the wheelchair motion kinematics and the activity of four upper limb muscles for eight subjects climbing a 4.58° ramp. Each subject propelled the wheelchair both with and without the anti-rollback system. The kinematic parameters were measured by means of two incremental encoders with the resolution of 500 impulses per single revolution of the measurement wheel. Whereas, the muscle activity was measured by means of surface electromyography with the use of Noraxon Mini DTS apparatus equipped with four measurement channels. Results: The surface electromyography measurement indicated an increase in the muscle activity for all four muscles, during the use of the anti-rollback system. The increase was: 18.56% for deltoid muscle anterior, 12.37% for deltoid muscle posteriori, 13.0% for triceps brachii, and 15.44% for extensor carpi radialis longus. As far as the kinematics analysis is concerned, a decrease in the measured kinematic parameters was observed in most participants. The medium velocity of the propelling cycle decreased by 26%. The ratio of the generated power and the loss power in a single propelling cycle λ had decreased by 18%. The least decrease was recorded for the measurement of mechanical energy E and the propelling cycle duration time. For the total mechanical energy, the decrease level was 3%, and for the propelling cycle duration it was 1%. The research carried out did not demonstrate any impact of the anti-rollback system use on the push phase share in the entire propelling cycle.

Ramps remain a barrier to safe wheelchair user transit bus ingress/egress

Background: Wheelchair users (WCUs) often rely on ramps for access to transit buses. Previous studies indicate WCUs have difficulty using ramps for bus ingress/egress and many transportation-related incidents occur on ramps. However, experiences of WCU ramp usage during ingress/egress have not been fully described.Methods: Cross-sectional, internet-based survey of WCUs who ride transit buses was conducted. The participants were queried on frequency of bus usage, difficulty and incidents involving ramps, and factors contributing to difficulty and incidents. Wheelchair characteristics, primary condition, and whether participants received travel training were also captured. Chi-square was used to describe relationships between wheelchair type and frequency of difficulties and incidents, and odd ratios were used to determine likelihood of the incidents.Results: The majority (55.7%) of 384 participants reported using public transportation ≥ 1 per week. Seventy-eight percent of WCUs had ≥ 1 ramp incident over the past 3 years, with an increased likelihood of incidents occurring during ingress (OR = 1.53; CI 1.21-1.86). Of those who had an incident, 22% were injured or had damage to their wheelchair. Over 60% of those who had an incident identified steep ramp slope as being the contributing factor. Steep ramp slope, exterior ramp thresholds and wet surfaces were the most common contributing factors to difficulty using ramps.Conclusion: This is the first large-scale US study enabling WCUs to describe their experiences using transit bus ramps. Despite ADA guidelines, steep ramps remain the primary factor contributing to incidents and difficulty when using ramps to access transit buses.Implications for rehabilitationThe discrepancy between ADA maximum allowable ramp slopes for the built environment and transit buses may require an increased level of effort that is a barrier to transportation accessibility for some wheelchair users.Wheelchair users who access transit buses should be made aware of, and trained, to navigate ramp configurations found in the environment.We suggest rehabilitation therapists provide skills training specific to navigating transit bus ramp slopes that may be steeper and narrower than building ramps.

Winter Mobility and Community Participation Among People Who Use Mobility Devices: A Scoping Review

OBJECTIVE

To identify the knowledge, products, and strategies for individuals with mobility-related disabilities used to address challenging winter conditions.

DATA SOURCES

AgeLine, OVID, Scopus, and CIHAHL were searched for studies that met the inclusion criteria, from inception to April 2018. Sources for gray literature, or information outside commercial publishing, included ProQUEST, government websites, and manufacturers, vendors, and consumer organization websites.

SOURCE SELECTION

Population of people with limited or reduced mobility or mobility device users involved in winter-related environmental conditions; aim was to increase activity, participation, or safety.

DATA EXTRACTION

Two reviewers independently applied the inclusion criteria to select eligible sources. Two reviewers independently extracted the data from each source.

DATA SYNTHESIS

Twenty-three published peer-reviewed papers were located. Study populations were predominantly those who used wheelchairs (mixed wheelchair type, n=7; power, n=4; manual, n=2), canes (n=3), or specialized winter footwear (n=2). The primary focus of these papers was determined to be tool or device (n=10), recommendations (n=9), strategy (n=2), or resource (n=2). Civic policy documents were variable in citizen responsibility for snow clearing. Limited winter-related supports were identified on consumer organization websites. Although some winter-specific products exist, very few studies have examined the effectiveness of any of these products.

CONCLUSIONS

Despite the common experience of challenging winter conditions, a paucity of winter-specific research and innovation relevant for individuals who use mobility devices exists. Researchers, consumers, and industry need to partner to develop novel tools, strategies, resources, and evidence-based recommendations.

Mapping review of accessible pedestrian infrastructures for individuals with physical disabilities

BACKGROUND

Due to the ageing population and higher prevalence of individuals living with physical disabilities, there is a critical need for inclusive practices when designing accessible pedestrian infrastructures for ensuring social participation and equal opportunities.

PURPOSE

Summarize the physical characteristics of current pedestrian infrastructure design for individuals with physical disabilities (IPD - motor, visual and hearing) found in the scientific literature and assess its quality.

MATERIALS AND METHODS

A mapping review of the existing literature on pedestrian infrastructures specifically built for individuals with physical disabilities identifying measurable physical characteristics for their design was done using online databases (Urban Studies Abstracts, Geobase, PubMed, and Cairn and secondary research). Information about accessibility (physical characteristics) of existing pedestrian infrastructures was extracted. The quality of the evidence was assessed using the Guidelines for critical review form - Quantitative studies and Qualitative studies version 2.0 (SAGE Publications, Inc., Thousand Oaks, CA).

RESULTS

Of the 1131 articles identified, forty-one articles examined access to bus stops, curb ramps, lighting, pedestrian crossings, ramps, shared spaces, sidewalks and steps. Six articles reported on more than one physical disability. Quality scores were generally low (quantitative: 2-11/15 and qualitative: 1-22/23). Recommended design features differed for the same infrastructure.

CONCLUSIONS

While there were a fair number of articles (n = 41) documenting accessible design features of pedestrian infrastructures, the quality of the evidence was low. The review identified knowledge gaps. Although specific design solutions exist, they have not yet been tested among individuals with various or multiple types of physical disabilities to ensure access to pedestrian infrastructures by all. Implications for Rehabilitation Pedestrian infrastructures still pose problems to mobility, limiting social participation and quality of life outcomes for individuals with physical disabilities (motor, visual and hearing). The results of this mapping review show that few articles are concerned with the accessibility of pedestrian infrastructures for more than one type physical disability, which might lead to recommendations that are inadequate for individuals with differing disabilities, few recommendations have been compared, most studies have been performed in environments not representative of northern countries and their quality score was generally low. Health professionals and State Parties have a complementary expertise that should be put to use in the determination and implementation of best design solutions to ensure the respect of the needs of individuals with physical disabilities. This review can thus help them have an idea of what has already been done to identify what needs to be achieved to fill the gap of knowledge required to insure access for individuals with motor, visual as well as hearing disabilities. Rehabilitation profesionals should take part in the assessment of the proposed solutions as well as the development of new designs to fill knowledge gaps.

The experiences of participating in winter among youths with a physical disability compared with their typically developing peers

BACKGROUND

Having a physical disability and using a wheelchair can create difficulties in navigating the physical and built environment, especially during winter when snow and ice become problematic. Little is known about the experiences of winter among youth who use an assistive mobility device. This study aimed to understand how youth with a physical disability experience winter, compared with typically developing peers.

METHODS

A purposive sample of 25 youths (13 with a physical disability; 12 typically developing) completed a 2-week weather journal and photographs in two Canadian cities during winter. These data were used to guide semi-structured interviews with participants.

RESULTS

Youths with disabilities experienced many similar challenges in winter, such as health and safety concerns and accessibility issues, compared with typically developing youth - but to a greater extent. Youths with disabilities reported more challenges going outdoors during winter and negative psychosocial impacts, including loneliness and increased dependence, compared with peers without a disability. They also, however, described developing several adaptive strategies to cope with these challenges.

CONCLUSIONS

There is a strong need to remove physical and environmental barriers to facilitate the participation and inclusion of youth with disabilities in winter.

Exploring Winter Community Participation Among Wheelchair Users: An Online Focus Group

The aim of this qualitative study was to gain an understanding of what people who use wheeled mobility devices (WMDs; e.g., manual and power wheelchairs, and scooters) identify as environmental barriers to community participation in cold weather climates, and to explore recommendations to overcome environmental barriers to community participation. Researchers conducted an online asynchronous focus group that spanned seven days, with eight individuals who use WMDs. Each day, participants were asked to respond to a moderator-provided question, and to engage with one another around the topic area. The researchers analyzed the verbatim data using an inductive content-analysis approach. Four categories emerged from the data: (1) winter barriers to community participation; (2) life resumes in spring and summer; (3) change requires awareness, education, and advocacy; and (4) winter participation is a right. Participants confirmed that it is a collective responsibility to ensure that WMD users are able to participate in the community throughout the seasons.