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Oldfrey B, Holloway C, Walker J, McCormack S, Deere B, Kenney L, Ssekitoleko R, Ackers H, Miodownik M. Repair strategies for assistive technology in low resource settings. Disabil Rehabil Assist Technol 2024; 19:1945-1955. [PMID: 37466362 DOI: 10.1080/17483107.2023.2236142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users' lives. MATERIALS AND METHODS This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies. RESULTS Three major models of repair practice emerged from the data: "Individual or Informal Repair in the Community"; "Local Initiatives"; and "Specialist AT Workshop Repair". Additionally, the wider impact on the participants' lives of "Problems & Concerns with Repair"; "Experiences of Breakages & Frequencies of Repair" and the "Impact of Broken Devices" are explored. CONCLUSIONS The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.
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Affiliation(s)
- Ben Oldfrey
- Global Disability Innovation Hub (GDI Hub), London, UK
- Institute of Making, University College London, London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Cathy Holloway
- Global Disability Innovation Hub (GDI Hub), London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Julian Walker
- The Bartlett Development Planning Unit, University College, London, UK
| | - Steven McCormack
- Orthopaedic Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bernadette Deere
- Division of Imaging Sciences and Biomedical Engineering, Department of Medical Engineering and Physics, King's College London, London, UK
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Robert Ssekitoleko
- Biomedical Engineering, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Ackers
- School of Health and Society, University of Salford, Manchester, UK
| | - Mark Miodownik
- Institute of Making, University College London, London, UK
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Örücü Atar M, Köroğlu Ö, Çetinkaya Gezer İ, Özcan F, Şamlı F, Yılmaz B. The use of standing powered wheelchairs from the perspective of individuals with spinal cord injury. Disabil Rehabil Assist Technol 2024:1-5. [PMID: 38818536 DOI: 10.1080/17483107.2024.2359489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The aim of this study was to investigate the experiences of standing powered wheelchair (SPWC) users with spinal cord injury (SCI). MATERIALS AND METHODS This cross-sectional study included 20 participants with SCI. SPWC daily usage time (total, in sitting position and standing position) and the frequency of using the SPWC's standing feature were recorded. Participants' level of satisfaction and comfort associated with the SPWC were assessed on a five-point Likert scale. If there was a dissatisfaction reason with the SPWC, the issues related to it were recorded. Participants were asked about their positive and adverse experiences with the use of SPWC. RESULTS Mean age of the participants was 41.65 (± 9.35) years. Eighty percent were tetraplegic. Ninety percent of the participants stood for at least 30 minutes at least one day a week, and 55% stood for at least 30 minutes at least four days a week. The most commonly reported perceived benefits were improvement in activities of daily living, bowel movements, and blood pressure regulation, better perception of body image, and feeling better. The most frequently identified reasons for dissatisfaction with the SPWC were its big dimensions, heavy weight, and difficulty of use in indoor environment and on uneven surfaces. CONCLUSIONS The findings show positive perceived experiences for SPWC users with SCI in terms of physical, social, and psychological aspects. Prospective controlled studies are needed to explore the benefits of SPWC use regarding secondary complications of SCI.
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Affiliation(s)
- Merve Örücü Atar
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
| | - Özlem Köroğlu
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
| | - İrem Çetinkaya Gezer
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
| | - Fatma Özcan
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
| | - Fatma Şamlı
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
| | - Bilge Yılmaz
- Department of Physical Medicine and Rehabilitation, Gaziler Physical Medicine and Rehabilitation, Training and Research Hospital, Ankara, Turkey
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McKenney CM, McKenney EE. Wheeled repair alliance: Rolling out wheelchair repair and maintenance in community bicycle shops. Assist Technol 2024:1-6. [PMID: 38771976 DOI: 10.1080/10400435.2024.2348163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/23/2024] Open
Abstract
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.
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Affiliation(s)
- Caitlin M McKenney
- Institute on Disabilities, Temple University, Philadelphia, Pennsylvania, USA
| | - Erin E McKenney
- Psychology Department, Rowan University, Glassboro, New Jersey, USA
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Mhatre A, Loew C, Yurtsever E, Mair C. Power wheelchair usage and repair are associated: a retrospective analysis. Disabil Rehabil Assist Technol 2024:1-8. [PMID: 38754034 DOI: 10.1080/17483107.2024.2353861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
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.
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Affiliation(s)
- Anand Mhatre
- The Ohio State University, Division of Occupational Therapy, College of Medicine, Columbus, OH, USA
| | - Cassandra Loew
- The Ohio State University, Division of Occupational Therapy, College of Medicine, Columbus, OH, USA
| | - Ekim Yurtsever
- The Ohio State University College of Engineering, Columbus, OH, USA
| | - Colin Mair
- National Health Service West of Scotland Mobility and Rehabilitation Centre (WestMARC), Glasgow, UK
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Cuppett M, Schein RM, Pramana G, Dicianno BE, Schmeler MR. Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study. Disabil Rehabil Assist Technol 2023; 18:1522-1526. [PMID: 35276055 DOI: 10.1080/17483107.2022.2048099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Maxwell Cuppett
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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James AM, Pramana G, Schein RM, Mhatre A, Pearlman J, Macpherson M, Schmeler MR. A descriptive analysis of wheelchair repair registry data. Assist Technol 2023; 35:312-320. [PMID: 35200093 DOI: 10.1080/10400435.2022.2044407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 10/19/2022] Open
Abstract
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.
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Affiliation(s)
- Alexandria M James
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gede Pramana
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard M Schein
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anand Mhatre
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Mark R Schmeler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Schmeler MR, Dicianno BE. Viewpoints on the scoping review for the development of a novel coverage and service delivery policy for complex rehabilitation technology. Disabil Rehabil Assist Technol 2022; 17:872-874. [PMID: 36018331 DOI: 10.1080/17483107.2022.2113457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Mark R Schmeler
- Department of Rehabilitation Science & Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brad E Dicianno
- Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Effectiveness of Group Wheelchair Maintenance Training for People with Spinal Cord Injury: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 103:790-797. [PMID: 34174224 DOI: 10.1016/j.apmr.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
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.
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