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

Wheelchair-mounted robotic arms: a survey of occupational therapists' practices and perspectives

PURPOSE

Despite the benefits of wheelchair-mounted robotic arms (WMRAs), occupational therapists are not yet widely involved in the recommendation or implementation of these assistive devices. The purpose of this study was to investigate and compare the current practices and perspectives of occupational therapists who had and had not recommended a WMRA on the recommendation, training, and implementation of WMRAs.

METHODS

This was a descriptive cross-sectional study. An online survey was sent to Canadian, European, and American occupational therapists who had or had not worked with WMRAs. Respondents were asked close-ended questions about their experience, role, barriers, motivations, and future needs regarding WMRAs. We compared results between respondents who had and had not recommended WMRAs using descriptive statistics.

RESULTS

Ninety-three North American and European occupational therapists completed the survey. Of those, 29 (31.2%) had recommended a WMRA, mostly the JACO robotic arm (n = 26, 89.7%) in rehabilitation centres (n = 18, 62.1%). Their perspectives on their role and barriers related to WMRAs were similar to those who had never recommended a WMRA. All respondents recognised the relevance of occupational therapists' contribution, and most reported interest in WMRAs (n = 76, 81.7%). However, many barriers emerged, mainly related to limited funding (n = 49, 76.6%), lack of training and knowledge (n = 38, 59.4%), and resource constraints (n = 37, 54.4%). Future needs identified matched these barriers.

CONCLUSION

This survey provides novel insight into occupational therapists' perspectives on WMRAs. It highlights that health professionals need to have easier access to funding, formal training, and resources to support their involvement with WMRAs.Implications for rehabilitationMost occupational therapists are interested in working with WMRAs, considering the potential of these devices to support individuals with upper extremity impairments in their daily activities. They also recognise their unique contribution to the assessment, recommendation, and implementation process among multidisciplinary teams.WMRA recommendation is relevant in various clinical settings and with a wide range of client populations. Nevertheless, it appears that occupational therapists working with adults, in rehabilitation centres or specialised clinics, may have more opportunities to get involved in this process and to attend formal training on this technology, as compared to other settings.Many barriers remain, impeding occupational therapists' role in the recommendation and implementation of WMRAs. Addressing these barriers may increase the number of devices that are successfully adopted and utilised by individuals with upper extremity impairments. In particular, future research and health policies should focus on access to sufficient funding, formal training, and resources for occupational therapists relative to their role in recommending and implementing WMRAs.

Practices and views of wheelchair service providers regarding wheelchair-skills training for clients and their caregivers: a global online survey

PURPOSE

To determine the extent to which wheelchair service providers conduct wheelchair-skills training, the nature of training, and the providers' perceptions on training.

MATERIALS AND METHODS

Anonymous global online survey consisting of 29 questions administered via the REDCap electronic data-capture tool to English-speaking wheelchair service providers.

RESULTS

We received 309 responses from wheelchair service providers in 35 countries. Of the respondents who responded to the question "…do you typically provide wheelchair-skills training…?" 227 (81.6%) reported "yes, always" or "yes, usually" for clients and 213 (81.9%) for caregivers. The median duration of training sessions for clients and caregivers was 45 and 30 min; the median number of sessions was 2 for both. Regarding the importance of training, 251 (94.4%) answered "very important" for clients and 201 (78.5%) for caregivers. For clients and caregivers, 182 (68.4%) and 191 (74.3%) of respondents considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified.

CONCLUSIONS

Most wheelchair service providers report that they provide wheelchair-skills training for clients and their caregivers, most consider such training to be important and most consider themselves adequately prepared for the training role. However, the amount of training is generally minimal. Further efforts are needed to address the identified barriers to training.IMPLICATIONS FOR REHABILITATIONMost wheelchair-service providers report that they provide wheelchair-skills training.Most consider such training to be important.Most consider themselves adequately prepared.However, the extent of training is generally minimal.These findings have implications for clinicians, educators, and policymakers.

Comparison of trunk mechanics and spatiotemporal outcomes in caregivers using a robotic assisted transfer device and a mobile floor lift

OBJECTIVE

The purpose of this study was to compare trunk mechanics, distance covered, and average instantaneous velocity and acceleration recorded with caregivers performing transfer tasks using a research mannequin with both a prototype robotic assisted transfer device (RATD) and a mobile floor lift.

DESIGN

Cross-Sectional.

SETTING

Biomechanics Lab and Human Engineering Research Laboratories.

PARTICIPANTS

Caregivers (N = 21).

INTERVENTION

Robotic Assisted Transfer Device.

OUTCOME MEASURES

Range of flexion-extension, lateral bend, and axial rotation; distance covered; average instantaneous velocity and acceleration.

RESULTS

Caregivers performing transfers using the RATD as compared to when using the moble floor lift reported significantly smaller range of trunk flexion-extension, lateral bending, and axial rotation, and reported lower pelvic based distance covered and slower average instantaneous velocity and acceleration (P < 0.001).

CONCLUSION

The design and usability of a RATD indicates design driven mobility advantages over clinical standard mobile floor lifts due to its ability to expand the workspace while further reducing risk factors for low back pain. While the concept is promising, further testing is required to address limitations and confirm the concept for clinical applications.

Lauren M, Cooper R, Bendixen R, Koontz AM, Cooper RA. Clinical and Ergonomic Comparison Between a Robotic Assisted Transfer Device and a Mobile Floor Lift During Caregiver-Assisted Wheelchair Transfers

BACKGROUND

The robotic assisted transfer device was developed as an updated lift technology to reduce adjustments in posture while increasing capabilities offered by transfer devices. The purpose of this study was to compare the trunk biomechanics of a robotic assisted transfer device and a mechanical floor lift in the transfer of a care recipient by a caregiver during essential transfer tasks.

METHODS

Investigators enrolled 28 caregiver/care recipient dyads to complete 36 transferring tasks. Surface electromyography for the back muscles and motion data for trunk range of motion were collected for selected surfaces, phase, and direction tasks using a robotic assisted transfer device and a mechanical floor lift.

RESULTS

Robotic assisted transfer device transfers required significantly smaller range of trunk flexion (P < 0.001), lateral bend (P < 0.001), and axial rotation (P = 0.01), in addition to smaller distance covered (P < 0.001), average instantaneous velocity (P = 0.01), and acceleration (P < 0.001) compared with a mobile floor lift. The robotic assisted transfer device transfers required significantly smaller peak erector spinae (left: P = 0.001; right: P < 0.001) and latissimus dorsi (right: P < 0.001) and integrated erector spinae left (P = 0.001) and latissimus dorsi right (P = 0.01) electromyography signals compared with the floor lift.

CONCLUSIONS

The robotic assisted transfer device provides additional benefits to mobile floor lifts which, coupled with statistically lower flexion, extension, and rotation, may make them an appealing alternative intervention.

Air-powered shopping carts in grocery stores: a pilot study

PURPOSE

Motorized shopping carts found at grocery and retail stores provide mobility for those who have difficulty walking through the store or pushing a regular cart. The purpose of this study was to understand the usage of motorized carts in grocery stores and pilot test an air-powered cart to determine its feasibility as a replacement for electric-powered carts as well as identify areas for improvement and preferred users.

METHODS

Users were asked to complete an online survey that assessed their shopping characteristics and experience using the motorized cart. K-Means clustering determined user demographics who chose to use the air-powered carts versus the electric-powered carts. Open-ended comments for improvements were also collected.

RESULTS

A total of 65 participants were provided informed consent, 60 participants met inclusion criteria and completed the survey. A majority of the air-powered (N = 29, 91%) and electric-powered (N = 11, 73%) cart users had a positive experience. Clustering found age and type of mobility device owned were significant whether participants chose the air-powered or electric-powered carts. Most suggested improvements for the air-powered carts were better braking, higher speed and a bigger basket while a longer battery life was most suggested for electric-powered carts.

CONCLUSIONS

Motorized shopping carts are used by a wide variety of individuals. Individuals aged 54 or younger and do not own a mobility device chose to use air-powered more than electric-powered carts. The functional capabilities of the air-powered carts demonstrated their potential to serve as practical replacements for electric-powered carts found in grocery and retail stores.Implications for rehabilitationThe availability and reliability of motorized shopping carts at retail stores are integral for individuals with physical impairments to complete their shopping needs.The development of novel assistive devices such as air-powered carts provides improved experiences and quality of life.Integrating end-user feedback during the design of assistive technologies is paramount for meeting actual needs.

Retrospective Chart Review Examining Differences and Timelines in Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department

OBJECTIVE

This study compares recommended wheeled mobility equipment to delivered equipment, excluding custom seats and backs, considering demographic factors such as sex, age, and funding source, as well as the timeline of the procurement process.

DESIGN

Retrospective chart review.

SETTING

Dedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers.

SAMPLE

Wheelchair recommendations (n = 546) made between January 1, 2017 and December 31, 2017.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURE(S)

Recommended and delivered wheelchair equipment type and length of time between recommendation and delivery.

RESULTS

Differences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (p = ≤.001). Delivered manual wheelchairs were 7% more likely to be different than recommended for each year decrease in age (p = ≤.001), although the model lacked sufficient predictive accuracy for clinical application. Average length of time from equipment recommendation to delivery was about 6 months (M = 176 days). Standard and complex power mobility devices were associated with longer timelines (Mdn = 137, 173 days respectively; p = .001); although, only complex power mobility device timelines were significantly associated with public funding sources (p = .02).

CONCLUSIONS

Wheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be further studied. Health care professionals should consistently follow-up on delivered equipment to ensure expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication post-recommendation may improve patient outcomes.

TECHNOLOGY TRANSFER ASSISTANCE PROJECT BRINGS VA HEALTH CARE IDEAS TO LIFE

Clinicians and staff of the Department of Veterans Affairs Health Care System (VA), who provide services to veterans, have invented many devices and methods for improving veterans' lives. However, translating those inventions to the market has been a challenge due to limited collaboration between the clinical inventors and the scientists, researchers, and engineers who can produce the prototypes necessary for licensing the technology. The VA Technology Transfer Program office and the Human Engineering Research Laboratories, a research laboratory with experience with developing prototypes and licensing technology, jointly developed a program called the Technology Transfer Assistance Project (TTAP) to bridge the gap between clinical inventors and prototypes ready for licensing. This paper describes TTAP and provides examples of the first inventions that were developed or enhanced through TTAP.

A consumer assessment of women who use wheelchairs

LAY SUMMARY

Female Veterans and female athletes with disabilities express concerns with mobility devices that are male-centric and do not address their unique needs. It is important that the needs of women are given the same attention as those of men. The following study asked groups of women who use wheelchairs or scooters, including Veterans and athletes, about their experiences. Twenty-four women, recruited from two sporting events for Veterans with disabilities, were asked to fill out a survey and participate in a focus group where they would discuss their views on mobility aids and related services. There were four major themes women often mentioned when they talked about using their mobility aids: usability (how they like using it), service delivery (how they get help with it), well-being (how they feel), and design (how it looks and works). Participants were concerned about the ability to adjust their device to their needs, how people obtained a device, and how they felt about using the device. Female wheelchair and scooter users recommended several changes to mobility aids that would improve the devices and improve the lives of women who use them.

The voice of the consumer: A survey of consumer priorities to inform knowledge translation among Veterans who use mobility assistive technology

LAY SUMMARY

Mobility assistive technology (AT) can improve the lives of people with disabilities by helping them get around in their communities. Today, over 23.9 million Americans use a wheelchair or assistive device, and over 85,000 wheelchairs, scooters, or other mobility devices are provided to Veterans each year. In order to find out how people learn about AT to improve efforts to disseminate information about AT, a survey of people who use mobility AT was conducted. The majority of people who completed the survey were Veterans (82%). It was determined that these people most often learned about AT through other users and/or from Veterans and the Internet, and that some people wish to receive information in other ways. Researchers can use these findings to better reach the people who could benefit from the new mobility AT they are creating.

Usability and task load comparison between a robotic assisted transfer device and a mechanical floor lift during caregiver assisted transfers on a care recipient

INTRODUCTION

The RATD represents a novel methodology to reduce strain, manoeuvring, and cognitive load a caregiver experiences when conducting transfers on a mannequin. However, caregivers who used this new technology report suggested adjustments regarding the robot's human machine interface and shape as to improve transfer efficiency and comfort for care recipients. The purpose of this study was to test a redesigned RATD and compare its ergonomics during a transfer to those of a mechanical floor lift.

METHODS

This was cross sectional protocol. As opposed to prior research which used a mannequin, caregivers in this study (N = 28) partnered with, and transferred, a mobility device user (N = 28) at three unique surfaces. Information about task demand and usability was collected from surveys after use of each device at each surface.

RESULTS

Results indicated reduced physical demand (p = .004) and discomfort frequency (p = .01) in caregivers conducting the transfers with the RATD compared to the mechanical floor lift. Care recipients reported no significant differences between both transfer devices. Critiques with the interface, the harness and sling, and the robot's rigidity indicated more work is needed before introducing this technology to a larger market. Conclusions: The RATD represents a promising new intervention for transferring and handling care recipients who use wheelchairs. However, while caregivers report reduced physical demand and discomfort, more work is required to advance the ease of the human machine interface, the amount of space allowed for the robot to operate, and the ability of the care recipient to operate the technology independently.IMPLICATIONS FOR REHABILITATIONCaregivers report significant physical and mental stress while transferring clients in and out of a wheelchair.Clinical standard transfer equipment is limited in the space which it can be used.Robots, particularly those portable and powered, have the ability to not only make the transfer experience safer, but also expand the applications this equipment can provide.

Comparing the performance of ultralight folding manual wheelchairs using standardized tests

Objective: To evaluate ultralight folding manual wheelchairs (UFMWs) in order to produce comparative data on their strength, durability, stability and cost-benefit, and to determine progress of wheelchairs by comparing these results to results of past studies.Design: Engineering testing using American National Standards Institute (ANSI) and Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) standards.Setting: Laboratory testing of UFMW stability, and static, impact and fatigue strength performance with three devices using ANSI/RESNA standardized tests.Participants: The three wheelchair models were the TiLite Aero X (Permobil, Lebanon, TN), Sunrise Medical Quickie 2 (Fresno, CA) and Ki Mobility Catalyst 5 (Stevens Point, WI).Interventions: ANSI/RESNA standardized tests.Main outcome measures: Mass and critical measurements, static stability, static strength, impact strength, fatigue strength and cost analysis.Results: The ultralight folding wheelchairs continued to outperform their lightweight and rigid framed counterparts. According to these data, the quality of ultralight wheelchairs has not declined over the past 10 years. The Ki Catalyst did not pass strength and durability testing, while the TiLite Aero X and Sunrise Medical Quickie 2 surpassed these tests.Conclusions: This result exemplifies the need for ongoing research to identify whether wheelchairs satisfy ANSI/RESNA testing requirements and highlights the importance of creating a resource data set. This is particularly important when numerous other wheelchairs fail to meet minimum ANSI/RESNA requirements.Implications for RehabilitationFolding frame wheelchairs offer benefits such as transportability and convenience that may benefit certain wheelchair users, assuming their durability is sufficient and they provide similar benefits vs. other wheelchair construction.Previous studies have shown that folding wheelchairs perform meet the minimum requirements of standardized testing, and it is important to see if durability has increased, decreased or remained the same over the years. Other wheelchair types have remained stagnant with respect to durability and are less likely to meet the minimum durability requirements.Durable devices will improve a wheelchair user's quality of life by reducing downtime while waiting for repairs, and also reduce the likelihood of injury due to component failure.

Practices and views of occupational therapists in Nova Scotia regarding wheelchair-skills training for clients and their caregivers: an online survey

Purpose: To determine the extent to which Occupational Therapists (OTs) in Nova Scotia (NS) conduct wheelchair skills training, the nature of training and the OTs' perceptions on training.Materials and methods: Anonymous online survey.Results: We received 110 responses from OTs living in NS and involved in direct patient care, 96 (93%) of whom reported helping clients obtain manual wheelchairs. Of the OTs who responded to the question "…do you typically provide wheelchair-skills training…?", 40 (43.5%) answered "Yes, usually" for clients and 40 (46.0%) for caregivers. The median duration of training sessions for clients and caregivers was 30 and 20 min; the median number of sessions was 2 and 1. Regarding the importance of training, 65 (73.9%) OTs answered "Very important" and 22 (25%) "Somewhat important" for clients and 55 (64.0%) answered "Very important" and 29 (33.7%) "Somewhat important" for caregivers. About one-third of OTs considered themselves adequately prepared for the trainer role. A variety of barriers and facilitators to training were identified. Trainers were significantly more likely than non-trainers to consider wheelchair skills training as important (p = .0003 for clients and p = .0039 for caregivers) and to consider themselves adequately prepared for the trainer role (p = .002 for clients and .003 for caregivers).Conclusions: Only a minority of NS OTs usually provide wheelchair-skills training for clients or their caregivers and the training provided is minimal, despite a majority who consider such training to be important. Only about one-third of OTs feel prepared for the training role.Implications for rehabilitationOnly a minority of Occupational Therapists (OTs) in Nova Scotia, Canada usually provide wheelchair-skills training for clients or their caregivers.The training that is provided is minimal.A majority of OTs consider such training to be important.Only about one-third of OTs feel prepared for the training role.

Person transfer assist systems: a literature review

OBJECTIVE

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness.

METHOD

Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included.

RESULTS

29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices.

CONCLUSION

Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person.IMPLICATIONS FOR REHABILITATIONCeiling mounted lifts are preferred over floor-based lifts due to lower injury rates.Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies.Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries.

A Heuristic Approach to Overcome Architectural Barriers Using a Robotic Wheelchair

The Mobility Enhancement roBotic (MEBot) wheelchair was developed to improve the safety and accessibility of wheelchair users when facing architectural barriers. MEBot uses pneumatic actuators attached to its frame and six wheels to provide curb ascending/descending for heights up to 20.3 cm. To improve MEBot's application, this study used a heuristic approach with power wheelchair users to evaluate and improve the MEBot application at different curb heights. Wheelchair users were trained on MEBot's features to operate its curb ascending/descending application. Three trials were carried out with wheelchair users ascending and descending three curbs of different height. Quantitative variables were analyzed to improve the sequential steps to ascend/descend curbs. Additionally, the application's effectiveness and efficiency were measured by the number of completed tasks, change in seat angle, and task completion time. Results showed that participants completed each trial and applied alternative strategies to traverse different curb heights. Furthermore, results suggested the combination and/or re-arrangement of steps to reduce task completion time. MEBot demonstrated its effectiveness to ascend/descend different curb heights with a heterogeneous participant sample. Future work will incorporate participant's most efficient strategies to improve the ascending/ascending process and the efficiency of the MEBot application.

Assessment of Usability and Task Load Demand Using a Robot-Assisted Transfer Device Compared With a Hoyer Advance for Dependent Wheelchair Transfers

OBJECTIVE

Manual lifting can be burdensome for people who care for power wheelchair users. Although technologies used for dependent transfers are helpful, they have shortcomings of their own. This study compares the usability and task load demand of a novel robot-assisted transfer device to a clinical standard when performing dependent transfers.

DESIGN

A cross-sectional study was conducted to assess caregivers (N = 21) transferring a 56-kg mannequin with the Strong Arm and Hoyer Advance at three transfer locations. Feedback was gathered through qualitative surveys.

RESULTS

Usability was significant in multiple areas important for transfers. Caregiver fatigue and discomfort intensity were reduced, and the Strong Arm was preferred at the three transfer locations. Device ease and efficiency favored Strong Arm at two stations as was discomfort frequency. In addition, physical demand, frustration, and effort were significantly lower using Strong Arm compared with the Hoyer Advance.

CONCLUSIONS

Compared with the Hoyer, participants favored Strong Arm for transfer usability and task load demand. However, further Strong Arm developments are needed.

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.

Comparison of carbon fibre and aluminium materials in the construction of ultralight wheelchairs

Carbon fibre-reinforced polymers have been used in the sporting goods industry for decades, and wheelchairs have incorporated the material since the late 1980s. There is no independently collected data available on carbon fibre-reinforced polymer wheelchairs' performance on the ANSI/RESNA testing standards, however. This study evaluated three full carbon fibre wheelchair specimens to determine their performance versus similar wheelchairs. Testing determined that while the frames survived more testing cycles than any other wheelchair, the casters and rear tires failed similarly to other devices. Overall, due to the purchase cost, the cost benefit of the tested wheelchair model was similar to aluminium wheelchairs.Implications for rehabilitationCarbon fibre wheelchair construction is a viable alternative to aluminium, titanium, or steel construction, and decreasing costs will continue to improve the benefits of carbon fibre over these modelsCarbon fibre wheelchair found to be more durable than aluminium models, but are also much more expensive. The additional cost may be justified for some users that need the increased durability, howeverIncreased durability will reduce the number of repairs and warranty claims, potentially reducing the burden on a wheelchair user, and also improving their ability to travel and participate in their communityThe low weight of carbon fibre wheelchairs may increase the mobility of some users by allowing them to transfer more easily into and out of vehicles and manoeuvre throughout the environment.