Outcomes of wheelchair systems intervention with residents of long-term care facilities

Cognitive status is associated with performance of manual wheelchair skills in hospitalized older adults

PURPOSE

To examine the relationship between manual wheelchair skills and cognitive function in hospitalized older adults.

METHODS

The observational study included older adults who used a manual wheelchair following hip/knee surgery. Participants underwent a series of tests to evaluate manual wheelchair skills and cognitive performance. Four items appearing on the Wheelchair Skills Test: brake handling (locking/unlocking), a 10-metre forward roll, a 2-metre backward roll and rotating in place, were used to evaluate manual wheelchair skills. Cognitive function was evaluated by the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), the Clock Drawing Test, and the Loewenstein Occupational Therapy Cognitive Assessment. The relationship between wheelchair skills and cognitive scores was assessed by a series of univariate linear regression analyses.

RESULTS

Fifty older adults, aged 65-85, participated in the study. The MoCA-7 (orientation) explained 19.3% of the variance related to the turn in place wheelchair skill, 18.8% of the variance related to the two-metre backwards roll and 31.9% of the variance related to the 10-metre forward roll. The addition of gender (to the MoCA-7) increased the explained variance related to the 10-metre forward roll and turn in place skills to 38.5% and 28.5%, respectively. As for the brakes handling skill test, gender explained 18.3% of the variance. The addition of the CDT (to gender) increased the explained variance for the brakes handling skill to 31.4%.

CONCLUSIONS

Because cognitive impairments negatively affect the performance of wheelchair skills, rehabilitation therapists may need to adjust wheelchair mobility training methods for cognitively impaired older adults.Implication for rehabilitationGiven the prevalence of older adults with cognitive impairments who use manual wheelchairs, it is critical to better understand the relationship between cognition and wheelchair skills.Poor results reported on the cognitive tests, specifically, visual attention and orientation, were found to be associated with poor performance of four manual wheelchair skills.Rehabilitation therapists should consider the cognitive status of older adults when teaching manual wheelchair skills, specifically in new users. Future studies should examine whether a customized preparation program, enhancing visuospatial orientation, can benefit manual wheelchair control in older adults.

Available Assistive Technology Outcome Measures: Systematic Review

BACKGROUND

The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments.

OBJECTIVE

This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice.

METHODS

We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023.

RESULTS

We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles.

CONCLUSIONS

Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.

Analysis of Whole-Body Vibration Using Electric Powered Wheelchairs on Surface Transitions

Wheelchair users are exposed to whole-body vibration (WBV) when driving on sidewalks and in urban environments; however, there is limited literature on WBV exposure to power wheelchair users when driving during daily activities. Further, surface transitions (i.e., curb-ramps) provide wheelchair accessibility from street intersections to sidewalks; but these require a threshold for water drainage. This threshold may induce high WBV (i.e., root-mean-square and vibration-daily-value accelerations) when accessibility guidelines are not met. This study analyzed the WBV effects on power wheelchairs with passive suspension when driving over surfaces with different thresholds. Additionally, this study introduced a novel power wheelchair with active suspension to reduce WBV levels on surface transitions. Three trials were performed with a commercial power wheelchair with passive suspension, a novel power wheelchair with active suspension, and the novel power wheelchair without active suspension driving on surfaces with five different thresholds. Results show no WBV difference among EPWs across all surfaces. However, the vibration-dose-value increased with higher surface thresholds when using the passive suspension while the active suspension remained constant. Overall, the power wheelchair with active suspension offered similar WBV effects as the passive suspension. While significant vibration-dose-value differences were observed between surface thresholds, all EPWs maintained WBV values below the ISO 2631-1 health caution zone.

Development of a New Negative Obstacle Sensor for Augmented Electric Wheelchair

Due to pathologies or age-related problems, in some disabled people, motor impairment is associated with cognitive and/or visual impairments. This combination of limitations unfortunately leads to an inability to move around independently. Indeed, their situation does not allow them to use a conventional electric wheelchair, for safety reasons, and for the moment there is no other technological solution providing safe movement capacity. This lack of access to an autonomous travel solution has the consequence of weakening the intellectual, personal, social, cultural and moral development, as well as the life expectancy, of the people concerned. In this context, our team is working on the development of an optoelectronic system that secures the displacement of electric wheelchairs. This is a large project that requires the development of several functionalities such as: the anti-collision of the wheelchair with its environment, the prevention of falls from the wheelchair on uneven levels, and the adaptation of the system mechanically and electronically to the majority of commercially available electric wheelchair models, among others. In this article, we introduce our solution for detecting dangerous height differences, also called “negative obstacles”, through the creation of a dedicated sensor. This sensor works by optical triangulation and can embed several laser beams in order to extend its detection zone. It has the particularity of being robust in direct sunlight and rain and has a sufficiently high measurement rate to be suitable for the displacement of electric wheelchairs. We develop an adapted algorithm, and point out compromises, in particular between the orientation of the laser beams and the maximal speed of the wheelchair.

Wheelchair Seated Posture and Health Outcomes of Older Veterans in Community Living Centers

PURPOSE

Nursing home residents sit in wheelchairs (WCs) for extended periods, often with slumped posture. They often experience pneumonia, pressure ulcers, and pain. This study described WC seated posture with its selected predictors and outcomes in the nursing home environment, throughout the daytime hours of 1 day.

DESIGN AND METHODS

This observational study (n = 45) in two Veterans Administration Community Living Centers introduced a new measure of WC fit and described WC seated posture of older Veterans, with selected predictors and outcomes.

FINDINGS

Wheelchair seated posture was predicted by cognitive status, WC fit, WC skills, and duration of sitting, but not by level of sitting ability. Poor posture measured by the Seated Posture Scale was associated with pain. Highest interface pressures measurable were seen in peak pressure index (PPI = 200 mm Hg), indicating risk of pressure injury. Veterans often denied discomfort, possibly lowering overall pain scores, while reporting severe pain in specific body parts.

CONCLUSIONS

Wheelchair seated posture was predicted by cognitive status, WC fit, WC skills, and duration of sitting. Poor posture was associated with pain, and poor posture was an outcome of poor WC fit. Poor WC fit in this study supported earlier findings in non-Veterans Administration nursing homes.

Changes in residents' seating needs and perception of stakeholders since implementation of a provincial wheelchair program

BACKGROUND

People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes.

OBJECTIVES

To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme.

METHODS

A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically.

FINDINGS

SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents' needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme).

CONCLUSION

This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. Implications for rehabilitationThese findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme.Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs.Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents' needs.Recommend future research on the use of tilt in space wheelchairs for residents' in long-term care.

The Voice of the Consumer: A Survey of Veterans and Other Users of Assistive Technology

Introduction

A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development.

Materials and Methods

This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions.

Results

A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments.

Conclusion

This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.

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

OBJECTIVES

To evaluate the effectiveness of wheelchair assessment and configuration on pressure injury incidence, mobility, and functioning in a wheelchair.

DESIGN

Randomized controlled trial with participants individually randomized into intervention and control groups.

SETTING

Nursing home.

PARTICIPANTS

Nursing home residents aged 60 and older who used wheelchairs and were at risk for pressure injuries (N=258).

INTERVENTION

Treatment and evaluation, individually configured wheelchair and skin protection cushion; control and evaluation, facility-provided wheelchair and skin protection cushion.

MEASUREMENTS

Pressure injury incidence, Nursing Home Life Space Diameter score, Functioning Every Day in a Wheelchair-Capacity (FEW-C) score, and Wheelchair Skills Test (WST) score.

RESULTS

No differences in pressure injuries (p=.77) were found. Pelvic rotation (odds ratio (OR)=0.15, 95% confidence interval (CI)=0.03-0.70, p=.02) and Day 14 WST skill score (OR=0.74, 95% CI=0.60-0.91, p=.004) were significant predictors of pressure injuries. Significant differences were observed between groups in change in FEW-C independence scores between before randomization and endpoint (p=.03) and before randomization and 14 days (p=.04).

CONCLUSION

Participants with individually configured wheelchairs improved more in the safe and effective use of their wheelchairs than residents with facility-provided wheelchairs. The outcomes indicated that nursing home residents functioned safely at a higher level in their wheelchairs if their devices were individually configured using a comprehensive wheelchair and seating assessment process. There was no difference in the incidence of pressure injuries between the two groups.

TRIAL REGISTRATION

NCT01275313.

The future of the provision process for mobility assistive technology: a survey of providers

PURPOSE

The purpose of this study was to evaluate the opinions of providers of mobility assistive technologies to help inform a research agenda and set priorities.

MATERIALS AND METHODS

This survey study was anonymous and gathered opinions of individuals who participate in the process to provide wheelchairs and other assistive technologies to clients. Participants were asked to rank the importance of developing various technologies and rank items against each other in terms of order of importance. Participants were also asked to respond to several open-ended questions or statements.

RESULTS

A total of 161 providers from 35 states within the USA consented to participation and completed the survey.

CONCLUSIONS

This survey revealed themes of advanced wheelchair design, assistive robotics and intelligent systems, human machine interfaces and smart device applications. It also outlined priorities for researchers to provide continuing education to clients and providers. These themes will be used to develop research and development priorities. Implications for Rehabilitation • Research in advanced wheelchair design is needed to facilitate travel and environmental access with wheelchairs and to develop alternative power sources for wheelchairs.• New assistive robotics and intelligent systems are needed to help wheelchairs overcome obstacles or self-adjust, assist wheelchair navigation in the community, assist caregivers and transfers, and aid ambulation.• Innovations in human machine interfaces may help advance the control of mobility devices and robots with the brain, eye movements, facial gesture recognition or other systems.• Development of new smart devices is needed for better control of the environment, monitoring activity and promoting healthy behaviours.

Consumer Feedback to Steer the Future of Assistive Technology Research and Development: A Pilot Study

Objective: The overall objective of this project was to identify consumers' opinions of their needs and wants related to assistive technology (AT) in a systematic and quantitative manner via a questionnaire that can be used to validate existing and establish new research priorities. Methods: This pilot study describes questionnaire development, online implementation, and revisions considered to the questionnaire in preparation for conducting a nationwide survey. Data from a sample (N = 112) are presented. The pilot study was critical to refine the questions and ensure that meaningful information was being collected. Results: It was identified that revisions were warranted to provide more structure and allow for consumers to prioritize AT research efforts. Conclusion: The questionnaire results, although positively in favor of many of the technologies presented, are inconclusive to identify generalizable research priorities, thus expansion to a nationwide population is warranted.

Shared control strategies for human-machine interface in an intelligent wheelchair

In this paper, we introduce a shared control mechanism for an intelligent wheelchair designed to support people with mobility impairments, who also have visual, upper limb, or cognitive impairment. The method is designed to allow users to be involved in the movement as much as possible, while still providing the assistance needed to achieve the goal safely. The data collected through URG-04LX and user interface are analyzed to determine whether the desired action is safe to perform. The system then decides to provide assistance or to allow the user input to control the wheelchair. The experiment results indicate that the method performs effectively with high satisfaction.

Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users

Elderly and aging manual wheelchair (MWC) users have increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review paper addresses important issues for preserving function and mobility for elderly and aging individuals who use a MWC by presenting the current available evidence and recommendations. These include recommendations for maximizing function, by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area.

Yaw rate and linear velocity stabilized manual wheelchair

We present the development of a prototype novel low-power, inexpensive stability control system for manual wheelchairs. Manual wheelchairs, while providing the ability to maneuver in relatively small indoor spaces, have a high center of gravity making them prone to tipping. Additionally, they can easily slide on sloped surfaces and can even spin and tip when attempting to turn or brake too quickly. When used on ramps and in outdoor environments where the surface is rarely perfectly flat (slopes greater than 1∶20 (5%) are common), wheelchair users can easily encounter potentially dangerous situations. The design and evaluation of an accident prevention system for independent manual wheelchair users that increases independence by enabling mobility with greater confidence and safety is described. The system does not limit a wheelchair user's ability to manually brake, rather, if the system detects that the wheelchair is out of control, braking force will be added by the system to either one or both wheels. The prototype utilized inexpensive bicycle technologies for the wheel brake and electrical power generator assemblies. Custom servos were designed along with custom electronics and firmware in the prototype to evaluate performance. The goal of the project was to derive specifications for a control and actuation system that utilizes inexpensive bicycle components in this cost-sensitive application. The design is detailed and the final specifications provided.

The advancement of an obstacle avoidance Bayesian neural network for an intelligent wheelchair

In this paper, an advanced obstacle avoidance system is developed for an intelligent wheelchair designed to support people with mobility impairments who also have visual, upper limb, or cognitive impairment. To avoid obstacles, immediate environment information is continuously updated with range data sampled by an on-board laser range finder URG-04LX. Then, the data is transformed to find the relevant information to the navigating process before being presented to a trained obstacle avoidance neural network which is optimized under the supervision of a Bayesian framework to find its structure and weight values. The experiment results showed that this method allows the wheelchair to avoid collisions while simultaneously navigating through an unknown environment in real-time. More importantly, this new approach significantly enhances the performance of the system to pass narrow openings such as door passing.

Association between mobility, participation, and wheelchair-related factors in long-term care residents who use wheelchairs as their primary means of mobility

OBJECTIVES

To explore how wheelchair-related factors, mobility, and participation are associated in a sample of long-term care residents who use wheelchairs as their primary means of mobility.

DESIGN

Cross-sectional survey.

SETTING

Eleven residential care facilities in the lower mainland of British Columbia, Canada.

PARTICIPANTS

One hundred forty-six self-responding residents and 118 proxy respondents: mean age 84 (range 60-103). Most were female (69%), and a small proportion (9%) drove a power wheelchair.

MEASUREMENTS

The Nursing Home Life Space Diameter Assessment was used to measure resident mobility, and the Late Life Function and Disability Instrument: Disability Component was used to measure participation frequency in daily activities.

RESULTS

Path analysis indicated that wheelchair-related factors were associated with participation frequency directly and indirectly through their relationship with mobility. The final model explained 46% of the variance in resident mobility and 53% of the variance in resident participation frequency. Wheelchair skills, which include the ability to transfer in and out of and propel a wheelchair, were important predictors of life-space mobility and frequency of participation, and life space mobility was a significant predictor of frequency of participation. Depression was associated with poorer wheelchair skills and mobility and less-frequent participation. Counterintuitively, perceived environmental barriers were positively associated with frequency of participation.

CONCLUSION

The findings suggest that, by addressing wheelchair-related factors, resident's mobility and participation may be improved, but the efficacy of this approach needs to be confirmed experimentally.

Grey spaces: the wheeled fields of residential care

Many individuals living in residential care use a wheelchair as their primary means of mobility. Although studies have documented challenges encountered by residents in these facilities, few have addressed the role that wheelchairs, as potential enablers and barriers to mobility and participation, play in their lives. To better understand residents' experiences, an ethnographic study was conducted drawing on Bourdieu's theoretical constructs of capital, field, and habitus. Participant observations were conducted at two facilities, and residents, family members and staff took part in in-depth individual interviews. Our analysis revealed three themes. Ready to roll detailed how residents used wheelchairs as a source of comfort and means for expanding their social space, while staff could use them as a means to move and control some residents. Squeaky wheels described how residents solicited assistance from staff and family amid having to wait to perform activities of daily living. In, out and about revealed diversity in the places residents went, spaces they shared and the social activities in which they engaged inside and outside their residential facilities. The study findings emphasise how wheelchairs constitute capital that governs many fields of practice for residents and staff and suggest how practice and policy might be adjusted.

Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents

BACKGROUND

Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care.

OBJECTIVE

To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors.

METHODS

Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy.

RESULTS

The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found.

CONCLUSION

Prevalence of need for seating assessment in long-term care is high overall but it varies considerably between facilities. Increasing access to occupational therapy services appears to mediate this need.

Predictors of mobility among wheelchair using residents in long-term care

OBJECTIVE

To identify predictors of mobility among long-term care residents who use wheelchairs as their main means of mobility. Based on the Matching Person to Technology Model, we hypothesized that wheelchair-related, personal, and environmental factors would be independent predictors of mobility.

DESIGN

Cross-sectional study.

SETTING

Eleven long-term residential care facilities in the lower mainland of British Columbia, Canada.

PARTICIPANTS

Residents (N=268): self-responding residents (n=149) and residents who required proxy respondents (n=119).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Mobility was measured using the Nursing Home Life-Space Diameter. Standardized measures of personal, wheelchair-related, and environmental factors were administered and sociodemographic data were collected as independent variables.

RESULTS

Independent mobility decreased as the distance from the resident's room increased: 63% of participants were independently mobile on their units, 40% were independently mobile off their units within the facilities, and 20% were independently mobile outdoors. For the total sample, the significant predictors of mobility, in descending order of importance, were: wheelchair skills (including the capacity to engage brakes and maneuver), functional independence in activities of daily living, having 4 or more visits per week from friends or family, and use of a power wheelchair. This regression model accounted for 48% of variance in mobility scores.

CONCLUSIONS

Limited independent mobility is a common problem among facility residents. Residents may benefit from interventions such as wheelchair skills training or provision of powered mobility, but the effectiveness of these interventions needs to be evaluated.

Demographic profile of older adults using wheeled mobility devices

The purpose of this study was to determine whether the use of wheeled mobility devices differed with respect to age, gender, residential setting, and health-related factors among older adults. A total of 723 adults ageing 60 and older are representing three cohorts, from nursing homes, the Center for Assistive Technology, and the wheelchair registry from the Human Engineering Research Laboratories. Wheeled mobility devices were classified into three main groups: manual wheelchairs, power wheelchairs, and scooters. Our results found factors including age, gender, diagnosis, and living settings to be associated with differences in use of manual versus powered mobility devices. Differences in use were also noted for subtypes of manual (depot, standard, and customized) and powered (scooter, standard, and customized) mobility devices, on demographic, living arrangements, and health-related factors. Consideration of demographic, health-related, and environmental factors during the prescription process may help clinicians identify the most appropriate mobility device for the user.

Perceived impacts of a first wheelchair on social participation

PURPOSE

To document perceived impacts in users' daily activities and social roles (social participation) following the acquisition of a first manual or powered wheelchair.

METHODS

A qualitative design with a phenomenological approach was used. Semi-structured interviews were conducted. An interview guide was developed based on the 12 social participation categories in the Disability Creation Process (DCP) conceptual model as themes underlying the questions: 'What has changed in your daily life since you got your new wheelchair?' and 'What has not changed in your daily life that you thought you would do differently with your new wheelchair?'

RESULTS AND DISCUSSION

The average age of the ten participants was 64.3 years (±16.3) and 90% had received a manual wheelchair. Four main themes emerged from the detailed analysis: changes in daily activities, expectations not met, impacts on social roles and emotional changes. The participants considered the changes in daily activities to be generally positive. Expectations not met mainly related to outdoor mobility. The participants had not anticipated the impacts on social roles and emotional changes, which demonstrate the complexity of human occupation.

CONCLUSION

Getting a wheelchair is a major and complex event in a person's life.

Prevalence and Predictors of Need for Seating Intervention and Mobility for Persons in Long-Term Care

A descriptive cross-sectional study was conducted to (a) determine the prevalence of need for wheel-chair seating intervention in two long-term care facilities in Vancouver, BC, (b) determine the extent of the residents' independent mobility within these facilities, and (c) explore the relationship between proper wheel-chair seating and positioning and independent mobility. The study population comprised 99 wheel-chair-using older adults. Four trained raters assessed need for seating intervention, using the Seating Identification Tool, and quantified extent and frequency of wheel-chair mobility, using the Nursing Home Life-Space Diameter. Results indicated that (a) there was a low need (overall 22%) for wheel-chair seating intervention in the two facilities, (b) half of the residents were independently mobile in their own rooms and on their units, but independent mobility decreased when greater distances needed to be travelled, and (c) the need for wheel-chair seating intervention was the only significant predictor of extent of independent mobility. These findings suggest that, where there are dedicated staff and equipment resources, the need for wheel-chair seating intervention can be minimized and independent mobility for long-term care residents maximized.

Participation in community-based activities of daily living: comparison of a pushrim-activated, power-assisted wheelchair and a power wheelchair

PURPOSE

The purpose of this study was to evaluate pushrim-activated, power-assisted wheelchair (PPW) performance among dual-users in their natural environment to determine whether the PPW would serve as a satisfactory alternative to a power wheelchair for community-based activities.

METHODS

A concurrent mixed methods research design using a cross-over trial was used. The outcome measures used were number of hours reported using the different wheelchairs, Quebec User Evaluation of Satisfaction with assistive Technology (QUEST), Functioning Everyday with a Wheelchair (FEW), Psychosocial Impact of Assistive Devices Scale (PIADS) and Canadian Occupational Performance Measure (COPM).

RESULTS

The number of hours spent participating in self-identified activities was not significantly different. Only the Self-Esteem subscale of the PIADS identified a statistically significant difference between the PPW and power wheelchair conditions (p = 0.016). A clinically important difference for Performance and Satisfaction was suggested by the COPM, in favour of the power wheelchair.

CONCLUSIONS

Additional knowledge was gained about the benefits of PPW technology. Participants were able to continue participating independently in their self-identified community activities using the PPW, and identified comparable ratings of satisfaction and performance with the PPW and the power wheelchair. For some individuals requiring power mobility, the PPW may provide an alternative to the power wheelchair.

Wheelchair-Bound Residents in Nursing Facilities: The Basics

More than 70% of nursing home residents spend at least part of their day in wheelchairs. Ideally, each resident would be fitted for his or her own wheelchair. A well-fitted chair can improve mobility, safety, and comfort. Wheelchairs that are ill fitting, however, can cause or exacerbate medical problems. These include posture-related complications like poor breathing or dysphagia, falls, pressure sores, and several other conditions. Pharmacists who are involved with quality improvement activities can make wheelchair use and selection a priority, improving care for wheelchair-bound residents.

Personal mobility and manipulation using robotics, artificial intelligence and advanced control

Recent advancements of technologies, including computation, robotics, machine learning, communication, and miniaturization technologies, bring us closer to futuristic visions of compassionate intelligent devices. The missing element is a basic understanding of how to relate human functions (physiological, physical, and cognitive) to the design of intelligent devices and systems that aid and interact with people. Our stakeholder and clinician consultants identified a number of mobility barriers that have been intransigent to traditional approaches. The most important physical obstacles are stairs, steps, curbs, doorways (doors), rough/uneven surfaces, weather hazards (snow, ice), crowded/cluttered spaces, and confined spaces. Focus group participants suggested a number of ways to make interaction simpler, including natural language interfaces such as the ability to say "I want a drink", a library of high level commands (open a door, park the wheelchair, ...), and a touchscreen interface with images so the user could point and use other gestures.