Motorized mobility scooters: the use of training/intervention and technology for improving driving skills in aging adults - a mini-review

A hybrid Machine learning and statistical modeling approach for analyzing the crash severity of mobility scooter users considering temporal instability

One of the main objectives in improving the quality of life for individuals with disabilities, especially those experiencing mobility issues such as the elderly, is to enhance their day-to-day mobility. Enabling easy mobility contributes to their independence and access to better healthcare, leading to improvements in both physical and mental well-being. Mobility Scooters have become increasingly popular in recent years as a means of facilitating mobility, yet traffic safety issues such as crash severity have not been adequately investigated in the literature. This study addresses this knowledge gap by employing a hybrid method that combines a machine learning approach using the eXtreme Gradient Boosting (XGBoost) algorithm with Shapley Additive exPlanations (SHAP) and an advanced statistical model called Random Parameters Binary Logit accounting for heterogeneity in means and variances. Analyzing the United Kingdom mobility scooter crash data from 2018 to 2022, the study examined temporal instability using a likelihood ratio test. The results revealed that there was instability over the three distinct periods of time based on the coronavirus (COVID) pandemic, namely, pre-COVID, during COVID, and post-COVID. Moreover, the results revealed that mobility scooter crashes occurring at a give-way or uncontrolled junctions has a random effect on the severity, while factors such as mobility scooter riders aged over 80, rear-end and sideswipe crashes, and crashes during winter months increase the risk of severe injuries. Conversely, mobility scooter riders involved in crashes while riding on the footway are less likely to experience severe injuries. These findings offer valuable insights for enhancing road safety measures that can be utilized to effectively reduce the crash severity of mobility scooter riders.

Developing a taxonomy of hazards and hazard mitigation strategies for Motorised mobility scooter users

The increased use of motorised mobility scooters (MMSs) presents a road safety challenge as using a MMS has risks for the user, pedestrians, and other road users. In relation to enhancing MMS driving safety, much of the training and available literature focuses on training vehicular control. Equally important is the need to investigate higher-order cognitive skills involved in driving MMSs, particularly hazard perception. Through a large questionnaire study with MMS users, we develop a taxonomy of the types of hazard MMS users encounter when crossing roads and strategies that are used to negotiate these hazards. Whilst MMS experience modulated hazard perception and strategy use, a core set of hazards and strategies were identified that have policy and practice implications for training interventions and the built environment. Exploration of the advantages and disadvantages of MMS use indicated its impact on various wellbeing outcomes as well as some potential barriers to use.

Qualitative experiences of new motorised mobility scooter users relevant to their scooter skills: a secondary analysis

OBJECTIVE

To explore the experiences of new motorised mobility scooter users from the perspectives of the assessment and training of scooter skills.

DESIGN

Descriptive secondary analysis of qualitative data.

SETTING

Community.

PARTICIPANTS

20 New users of motorised mobility scooters.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Directed qualitative analysis of up to four semi-structured interviews over the course of the first year of scooter use, to identify themes and sub-themes that could inform recommendations regarding assessment and training protocols.

RESULTS

We identified two themes. The first related to potential new content. As one example of the sub-themes, there were many excerpts that dealt with the use of skills in various combinations and permutations that were used to carry out activities during everyday life and participate in society. These excerpts suggested the importance of training skills in combination to facilitate skill transfer (or generalizability). The second theme is related to enhancements of existing content. As one example of the sub-themes, there were several excerpts that dealt with scooter security. These excerpts led to the recommendation that removing and inserting the scooter key should be added to the assessment criteria for the "turns power on and off" skill of the Wheelchair Skills Test (WST) and its questionnaire version (WST-Q).

CONCLUSIONS

The experiences of scooter users over the first year of receiving a scooter appear to be relevant to the assessment and training of scooter skills and suggest themes for further study. Clinical trial registration number: NCT02696213 IMPLICATIONS FOR REHABILITATIONThe experiences of new scooter users are highly relevant to the assessment and training of scooter skills.These experiences suggest both potential new content and enhancements of existing content to the Wheelchair Skills Program Manual.

Estimation of Steering and Throttle Angles of a Motorized Mobility Scooter with Inertial Measurement Units for Continuous Quantification of Driving Operation

With the growing demand from elderly persons for alternative mobility solutions, motorized mobility scooters (MMSs) have been gaining importance as an essential assistive technology to aid independent living in local communities. The increased use of MMSs, however, has raised safety issues during driving and magnified the necessity to evaluate and improve user driving skills. This study is intended to develop a novel quantitative monitoring method for MMS driving operation using inertial measurement units (IMUs). The proposed method used coordinate transformations around the rotational axes of the steering wheel and the throttle lever to estimate the steering and throttle operating angles based on gravitational accelerations measured by IMUs. Consequently, these operating angles can be monitored simply using an IMU attached to the throttle lever. Validation experiments with a test MMS in the stationary state confirmed the consistency of the proposed coordinate transformation with the MMS's geometrical structure. The driving test also demonstrated that the operating angles were estimated correctly on various terrains and that the effects of terrain inclination were compensated using an additional IMU attached to the scooter body. This method will be applicable to the quantitative monitoring of driving behavior and act as a complementary tool for the existing skills' evaluation methods.

Mechanism and severity of mobility scooter-related injuries

OBJECTIVE

As a result of an aging population, mobility scooter use is increasing in Western countries. Consequently, an increase in mobility scooter-related injuries (MSRIs) is observed. Yet there is a paucity of studies in the literature assessing MSRIs. The purpose of this study was to investigate mechanism, severity, and localization of injury of MSRIs in the emergency department (ED) of a Dutch level 2 trauma center over a 9-year period.

METHODS

This was a retrospective study of MSRIs in the ED of a teaching hospital in the Netherlands between January 2010 and December 2019. All patients with an MSRI were included, as long as they were the driver of the vehicle. Data were collected from electronic patient files. The primary outcomes were severity of injury, defined by the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), and mechanism and localization of injury.

RESULTS

A total of 382 patients were identified. Of these, 208 (54.3%) were female and the median age was 76 years (interquartile range [IQR] = 67.0-83.0). The median Charlson Comorbidity Index (CCI) was 5.0 (IQR = 4.0-6.0). Three (0.8%) patients had an ISS ≥ 16. The median ISS was 3.0 (IQR = 1.0-5.0). The lower extremity was the most commonly injured body region (46.5%), followed by head injury (36.3%), external injury (31.6%), and upper extremity injuries. Fractures were most commonly observed in the shoulder (10.2%), hip (8.9%), and ankle (6.3%). Most crashes were single-vehicle accidents (87.2%) and the most common mechanism of injury was rollover of mobility scooter (49.3%). Almost half of the patients (44.1%) had a fracture and the admission rate was 28.2% with a median length of stay (LOS) of 10 days. Fifty (13.1%) patients required surgery, of which 58% were hip repair surgery.

CONCLUSION

In this cohort of MSRIs, mobility scooter users had a median age of 76 years and severe comorbidity was common. Based on ISS, patients had a mild injury profile. However, the relatively high admission and surgery rates reflect the potential serious consequences of MSRIs and the obvious vulnerability of this population.

The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease.

METHODS

We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality.

RESULTS

Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = -1.66, 95% CI = -2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals' ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007).

CONCLUSIONS

The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.

Acute injuries resulting from accidents involving powered mobility devices (PMDs)-Development and outcomes of PMD-related accidents in Sweden

Objective: Powered mobility devices (PMDs) are commonly used as aids for older people and people with disabilities, subgroups of vulnarable road users (VRUs) who are rarely noted in traffic safety contexts. However, the problem of accidents involving PMD drivers has been reported in many countries where these vehicles have become increasingly popular. The aim of this study is to extract and analyze national PMD-related accident and injury data reported to the Swedish Traffic Accident Data Acquisition (STRADA) database. The results will provide valuable insight into the risks and obstacles that PMD drivers are exposed to in the traffic environment and may contribute to improving the mobility of this group in the long term. Methods: The current study is based on data from 743 accidents and 998 persons. An analysis was performed on a subset of data (N = 301) in order to investigate the development of accidents over a period of 10 years. Thereafter, each accident in the whole data set was registered as either single (N = 427) or collision (N = 315). Results: The results show that there was a 3-fold increase in the number of PMD-related accidents reported to STRADA during the period 2007-2016. With regard to single accidents, collisions, as well as fatalities, the injury statistics were dominated by males. Single accidents were more common than collisions (N = 427 and N = 316, respectively) and the level of injury sustained in each type of accident is on par. The vast majority of single accidents resulted in the PMD driver impacting the ground (87%), due to either PMD turnover (71%) or the driver falling out of the PMD (16%). The reason for many of the single accidents was a difference in ground level (34%, typically a curb). Cars, trucks, or buses were involved in 67% of collision events; these occured predominantly at junctions or intersections (70%). Abbreviated Injury Scale (AIS) 3+ injuries were dominated by hip and head injuries in both single accidents and collision events. Conclusions: The present study shows that further research on PMD accidents is required, with regard to both single accidents and collision events. To ensure that appropriate decisions are made, future work should follow up on injury trends and further improve the quality of PDM-related accident data. Improved vehicle stability and design, increased usage of safety equipment, proper training programs, effective maintenance services, and development of a supporting infrastructure would contribute to increased safety for PMD drivers.

Outdoor motivation moderates the effects of accessibility on mobility in old age

BACKGROUND

Mobility plays a major role in healthy aging and social participation. This study explored whether accessibility problems in the housing environment are negatively associated with mobility in old age and whether this association is moderated by differences in an individual's preference for spending time outside the home (outdoor motivation).

MATERIAL AND METHODS

This article reports the results of a research project on mobility in old age. The project included a survey study of 120 community-dwelling older adults between 59 and 92 years of age (mean = 71.7 years, SD = 7.3 years) living in the metropolitan region of Nuremberg, Germany. Objective assessments were conducted in the participants' housing environment to evaluate the magnitude of accessibility problems.

RESULTS

Accessibility problems were negatively associated with mobility. Interaction analyses suggested a buffering effect of outdoor motivation on this association, i.e. participants who reported a preference for spending time outside the home had a higher mobility in the face of accessibility problems as compared with those who preferred staying at home.

CONCLUSION

Outdoor motivation may have protective effects for older adults when accessibility problems challenge mobility. These findings contribute to improving the understanding of how and under what circumstances older adults stay mobile and active in everyday life. Considering interindividual differences in outdoor motivation may binterventions and public health programs that are aimed at enhancing mobility and social participation in old age.

A participatory approach to develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment tool

The electric powered wheelchair (EPW) is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST) and Power Mobility Clinical Driving Assessment (PMCDA). Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user's current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools.