Manual wheelchair propulsion on ramp slopes encountered when boarding public transit buses

Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review

During manual wheelchair (MWC) locomotion, the user’s upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers’ lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject’s morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.

Rehabilitation: mobility, exercise & sports; a critical position stand on current and future research perspectives

BACKGROUND

Human movement, rehabilitation, and allied sciences have embraced their ambitions within the cycle of "RehabMove" congresses over the past 30 years. This combination of disciplines and collaborations in the Netherlands has tried to provide answers to questions in the fields of rehabilitation and adapted sports, while simultaneously generating new questions and challenges. These research questions help us to further deepen our understanding of (impaired) human movement and functioning, with and without supportive technologies, and stress the importance of continued multidisciplinary (inter)national collaboration.

METHODS

This position stand provides answers that were conceived by the authors in a creative process underlining the preparation of the 6th RehabMove Congress.

RESULTS

The take-home message of the RehabMove2018 Congress is a plea for continued multidisciplinary research in the fields of rehabilitation and adapted sports. This should be aimed at more individualized notions of human functioning, practice, and training, but also of performance, improved supportive technology, and appropriate "human and technology asset management" at both individual and organization levels and over the lifespan.

CONCLUSIONS

With this, we anticipate to support the development of rehabilitation sciences and technology and to stimulate the use of rehabilitation notions in general health care. We also hope to help ensure a stronger embodiment of preventive and lifestyle medicine in rehabilitation practice. Indeed, general health care and rehabilitation practice require a healthy and active lifestyle management and research agenda in the context of primary, secondary, and tertiary prevention.IMPLICATIONS FOR REHABILITATIONContinued multidisciplinary (international) collaboration will stimulate the development of rehabilitation and human movement sciences.Notions from "human and technology asset management and ergonomics" are fundamental to rehabilitation practice and research.The rehabilitation concept will further merge into general health care and the quality there-off.

A systematic review of public transport accessibility for people using mobility devices

PURPOSE

Being able to access public transport is vital for mobility device users as this is an affordable way of maintaining community connections and participating in activities that promote quality of life. This systematic review investigated literature on public transport access for people using mobility devices, excluding transit restraint and securement literature.

MATERIALS AND METHODS

A systematic review of the peer-reviewed literature in English from 1995 to 2019, with critical appraisal and narrative synthesis.

RESULTS

Twenty-six articles were identified, including 14 studies investigating user experiences, seven examining bus formats and floor layouts, and five focusing on bus ramp incidents and optimal design. Studies were generally observational and descriptive, with 12 including analysis of video data.

CONCLUSION

This is the first systematic review of literature related to the accessibility of public transport for people using mobility devices. Topics such as ramp access have been relatively well-researched, as have the experiences of users. However, many gaps remain and there is a need for research to; address the barriers identified through user experiences, discern the best access to stations and stops, as well as floor formats for people to ingress, manoeuvre and egress from a variety of transport modes, and promote universal design principles in the transport sector. Rehabilitation professionals can use the findings of this review to advocate for, and support people using mobility devices to successfully negotiate public transport.Implications for RehabilitationAccessible public transport is vital to enable people using mobility devices to remain connected in their communities.Despite increased international awareness and adoption of accessibility features by the public transport sector to improve getting to a stop, ingress, manoeuvrability within and egress from conveyances, access for people using wheeled mobility devices cannot be assumed.When prescribing new wheeled mobility devices with clients, rehabilitation professionals and users need to consider public transport access and the suitability of different devices for this purpose.Rehabilitation professionals can undertake skills training with people using wheeled mobility devices to test out access prior to independent travel on public transport and develop strategies to overcome any barriers.