Assessing manual wheelchair caster design for mobility in winter 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.

Evaluation of two power assist systems for manual wheelchairs for usability, performance and mobility: a pilot study

BACKGROUND

Power-assist devices for manual wheelchairs offer benefits, including increased community participation. Several power-assist devices are commercially available, but research on benefits and limitations of devices is limited.

OBJECTIVE

To compare the usability, performance, and mobility of two power-assist device systems for manual wheelchairs in indoor and outdoor environments.

METHODS

This mixed methods pilot study included 11 volunteers with limited wheelchair experience. Participants tested two different power-assist device configurations: (1) the Batec® and (2) the SmartDrive® + Freewheel®. Indoor & outdoor obstacle courses contained relevant skills from the Wheelchair Skills Test, Power Mobility Community Driving Assessment, and Power Mobility Indoor Driving Assessment. The NASA Task Load Index and System Usability Scale assessed participants' perceptions of cognitive demand and usability. A semi-structured interview was conducted to explore participants' experiences.

RESULTS

Substantial differences were found in the NASA Task Load Index, and System Usability Scale scores. Participant interviews and researcher observations revealed each device performed better on some obstacle course elements. Qualitative findings showed a general preference for using the Batec® for long trips outside and off-road terrains, primarily due to the Batec's® perceived better speed control, maximum speed, and simpler braking system. Conversely, the SmartDrive® + Freewheel® was deemed most useful indoors and in tight spaces; due to a smaller wheelchair footprint, better turning radius, and increased device portability.

CONCLUSION

Further studies are required to understand the usability, performance, and mobility of power-assist devices. Moving forward, these findings will inform end users and occupational therapists when procuring manual wheelchair power-assist devices.Implications for rehabilitationPower-assist devices (PADs) for manual wheelchairs increase the potential for community participation.Qualitative findings showed a general preference for using the Batec® for long trips outside and for off-road terrains, primarily due to the Batec's® perceived better speed control, maximum speed, and simpler braking system.The SmartDrive® + Freewheel® was deemed most useful indoors and in tight spaces; due to a smaller wheelchair footprint, better turning radius, and increased device portability.Increasing knowledge and research about PADs will support development of alternative options for manual or power wheelchairs users. PADs may allow manual wheelchair users (MWC) to delay moving to a power wheelchair (PWC), potentially reducing the perceived stigma associated with transitioning to a power wheelchair and impacting health outcomes.

Ergonomic guidelines for the design interfaces of additive modules for manual wheelchairs: sagittal plane

When designing wheelchair propulsion systems operated with the upper limb, there is a noticeable lack of ergonomic analyses informing about the areas on the wheelchair frame where hand-operated controls can be installed. With that in mind, a research goal was set to measure the areas of human hand reach within the area defined by the structural elements of a manual wheelchair. An ergonomic analysis was performed on a group of ten patients representing 50% of anthropometric dimensions. Motion capture and image analysis software based on the openCV library were used for the measurement. The conducted research resulted in the development of a map of the hands range in the lateral plane of the wheelchair, parallel to the sagittal plane. In addition, the map was divided into three zones of hand reach, taking into account various levels of comfort of hand manipulation. The total hand reach area was 1269 mm long and 731 mm high, while the most comfortable manipulation area was 352 mm long and 649 mm high. The plotted hands reach areas act as a map informing the designer where on the sagittal plane additional accessories operated by the user can be installed.

Evaluation of anti-rollback systems in manual wheelchairs: muscular activity and upper limb kinematics during propulsion

Self-propelling a wheelchair up a hill requires intense muscular effort and introduces the risk of the wheelchair rolling down. The purpose of this paper was to assess the user's muscular activity during ramp climbing. Tests were carried out on a group of 10 subjects who had to propel a wheelchair up a standardized wheelchair ramp. Basic parameters of upper limb kinematics were measured to determine the total push-rim rotation angle. This was 105.91° for a wheelchair with a stiff anti-rollback system, 99.39° for a wheelchair without an anti-rollback system and 98.18° for a wheelchair with a flexible anti-rollback system. The upper limb muscle effort was measured at 55 ± 19% for the wheelchair without an anti-rollback system, 59 ± 19% for the wheelchair with a stiff anti-rollback system and 70 ± 46% for the wheelchair with a flexible anti-rollback system. The conducted research showed an increase in muscle effort while using anti-rollback systems. In the case of push-rim rotation angle, no significant differences in the value of the rotation angle were found.

Effect of Manual Wheelchair Type on Mobility Performance, Cardiorespiratory Responses, and Perceived Exertion

This study is aimed at comparing the design and configuration of the most commonly used manual wheelchair models through cardiorespiratory responses, perceived exertion, and mobility performance using two different manual wheelchairs, during mobility tasks. A within-group 2 × 3 × 2 controlled experiment was designed with three independent and four dependent variables. The independent variables included wheelchairs, with the levels active wheelchair with a rigid frame and passive wheelchair with foldable frame; conditions with the levels straight line, slalom, and agility; and speed with levels comfortable and fast. Dependent variables included oxygen uptake (VO₂), distance travelled, speed, and perceived exertion. Results show that the active wheelchair yielded more beneficial characteristics although only the effect of wheelchair type on VO₂ efficiency (oxygen uptake per meter travelled) was statistically significant with a large effect size (F(1, 14) = 118.298, p < 0.001, η² = 0.541). The better VO₂ efficiency was achieved with the active wheelchair under all tested conditions. The effect of wheelchair type on Borg scores was also statistically significant, although with a small effect size (F(1, 14) = 10.340, p = 0.006, η² = 0.119); thus, active wheelchair use had lower Borg scores under all trials and was considered less exhausting than the passive wheelchair. In summary, use of the active wheelchair resulted in the users expending less energy per meter travelled and at the same time experiencing less fatigue. This may benefit overall wheelchair mobility and possibly reduce health complications.

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.

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.