The natural-fit handrim: factors related to improvement in symptoms and function in wheelchair users

Usability of mechanical assistive technologies for performing activities involving the upper extremities in individuals with impairments: a systematic review

PURPOSE

To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper extremity impairments, and to synthesize the strengths and limitations of these devices.

METHOD

Three independent reviewers conducted systematic searches of articles published between 2003 and 2023 in Compendex, Inspec, Embase, PubMed/Medline, IEEE Xplore, and Web of Science, as well as manual searches on the RESNA website for conference papers over the same period. The methodological quality of articles was appraised using the QualSyst tool.

RESULTS

From the 34 retained studies, 28 mechanical devices were identified and classified into two categories: (1) mobile arm supports (MASs) designed to perform multiple activities, and (2) devices used to assist with a specific activity of daily living (ADL). Overall, MASs helped users to perform manual activities in elevation and/or against gravity. Specific ADL devices allowed users to perform unique activities requiring fine motor skills such as opening a medicine container. Some of these devices have advantages like portability, adaptability, low cost, and ease of use. Limitations most often reported included interference or mobility restraints.

CONCLUSION

This review synthesizes the impacts of mechanical devices on the three domains of the International Classification of Functioning, Disability and Health (ICF) for individuals with upper extremity impairments. Impacts regarding function and performance in activities were more often measured than participation. Future studies should include outcomes related to participation, as taking this aspect into account might favor successful continued use of assistive devices.

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

PURPOSE

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

METHODS

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

CONCLUSIONS

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

Evaluation of two wheelchair hand rim models: contact pressure distribution in straight line and curve trajectories

Manual wheelchairs are essential for people with disabilities or limited mobility. However, manual propulsion causes biomechanical loads, including contact pressures on the palms of the hands. The hand rim design has received little attention over time, remaining almost unchanged since its creation. This study investigated how two different designs of such devices - one standard and another with a contoured design - influence the contact pressure on the surface of the hands. The procedures included a figure-of-eight shape propulsion task on a regular floor, using both models on a wheelchair. A pressure-mapping system coupled with a pair of fabric gloves recorded the data. The results show that the contoured hand rim provides lower pressure in most of the analysed regions. Considering that manual propulsion is performed during a considerable part of the day as a routine activity, improving the hand rim interface may benefit the user's comfort and safety during wheelchair use. Practitioner summary: The design of the hand rim used in wheelchair propulsion influences the contact pressure on the hands. Conventional round tube rims tend to concentrate high levels of pressure on the distal phalanges and metacarpal regions. A contoured design generally provides better stability and promotes the distribution of pressure. Abbreviations: AT: assistive technology; kPa: kilopascal.

Training wheelchair navigation in immersive virtual environments for patients with spinal cord injury - end-user input to design an effective system

PURPOSE

A user-centred design was used to develop and test the feasibility of an immersive 3D virtual reality wheelchair training tool for people with spinal cord injury (SCI).

METHOD

A Wheelchair Training System was designed and modelled using the Oculus Rift headset and a Dynamic Control wheelchair joystick. The system was tested by clinicians and expert wheelchair users with SCI. Data from focus groups and individual interviews were analysed using a general inductive approach to thematic analysis.

RESULTS

Four themes emerged: Realistic System, which described the advantages of a realistic virtual environment; a Wheelchair Training System, which described participants' thoughts on the wheelchair training applications; Overcoming Resistance to Technology, the obstacles to introducing technology within the clinical setting; and Working outside the Rehabilitation Bubble which described the protective hospital environment.

CONCLUSIONS

The Oculus Rift Wheelchair Training System has the potential to provide a virtual rehabilitation setting which could allow wheelchair users to learn valuable community wheelchair use in a safe environment. Nausea appears to be a side effect of the system, which will need to be resolved before this can be a viable clinical tool. Implications for Rehabilitation Immersive virtual reality shows promising benefit for wheelchair training in a rehabilitation setting. Early engagement with consumers can improve product development.

Aspects of manual wheelchair configuration affecting mobility: a review

Many aspects relating to equipment configuration affect users' actions in a manual wheelchair, determining the overall mobility performance. Since the equipment components and configuration determine both stability and mobility efficiency, configuring the wheelchair with the most appropriate set-up for individual users' needs is a difficult task. Several studies have shown the importance of seat/backrest assembly and the relative position of the rear wheels to the user in terms of the kinetics and kinematics of manual propulsion. More recently, new studies have brought to light evidence on the inertial properties of different wheelchair configurations. Further new studies have highlighted the handrim as a key component of wheelchair assembly, since it is the interface through which the user drives the chair. In light of the new evidence on wheelchair mechanics and propulsion kinetics and kinematics, this article presents a review of the most important aspects of wheelchair configuration that affect the users' actions and mobility.

A new design for an old concept of wheelchair pushrim

PURPOSE

Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user's perception of the quality of the device.

METHOD

Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol.

RESULTS

The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance.

CONCLUSIONS

The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user. [Box: see text].