1
|
Smith EM, Miller WC, Mitchell I, Mortenson WB, Mihailidis A. Evaluation of the feasibility of an error-minimized approach to powered wheelchair skills training using shared control. Disabil Rehabil Assist Technol 2020; 18:333-342. [PMID: 33216664 DOI: 10.1080/17483107.2020.1849434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Powered wheelchairs promote participation for people with mobility limitations. For older adults with cognitive impairment, existing training methods may not address learning needs, leading to difficulty with powered wheelchair skills. Error-minimized training, facilitated by shared control technology, may provide learning opportunities more suited to this population. OBJECTIVE The objective of this study was to evaluate the feasibility of an error-minimized approach to powered wheelchair skills training using shared control in residential care. Feasibility indicators were hypothesized a priori to be feasible for use in a definitive RCT. METHODS A 2 × 2 factorial RCT compared an error-minimized powered wheelchair skills training program (Co-pilot) to a control intervention at two doses (6 sessions vs. 12 sessions). Data were collected on the feasibility of study processes (e.g., recruitment), resources (e.g., participant time), management (e.g., technology reliability), and training outcomes (e.g., adverse events, clinical outcomes). RESULTS Twenty-five older adults with cognitive impairment participated in the study. Technical issues were encountered in 14.5% of training sessions. Participants receiving 6 sessions of training adhered better to the treatment than those receiving 12 sessions. All participants learned the skills required for PWC use with minor errors, regardless of the training method or dose. Co-pilot participants and trainers reported feelings of safety and training benefits with the use of shared control technology. CONCLUSIONS Individuals with mild to moderate cognitive impairment are able to learn the skills required to drive a powered wheelchair in as few as six training sessions. Further evaluation of the Co-pilot training program is required.IMPLICATIONS FOR REHABILITATIONShared control teleoperation technology may be used to augment learning in older adults with cognitive impairments.Evaluation of the feasibility of use of novel rehabilitation technologies is critical prior to engaging in large-scale clinical research.Individuals with cognitive impairment are able to learn the required skills for operation of a powered wheelchair.
Collapse
Affiliation(s)
- Emma M Smith
- Assisting Living and Learning (ALL) Institute, Maynooth University, Maynooth, Ireland.,GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - William C Miller
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Ian Mitchell
- Department of Computer Science, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada
| | - Alex Mihailidis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Smith EM, Rismani S, Ben Mortenson W, Mihailidis A, Miller WC. “A Chance to Try”: Exploring the Clinical Utility of Shared-Control Teleoperation for Powered Wheelchair Assessment and Training. Am J Occup Ther 2019; 73:7306205020p1-7306205020p11. [DOI: 10.5014/ajot.2019.032151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: Powered wheelchairs provide independence for people with mobility impairments; however, current training practices may not meet the needs of those with cognitive impairments. Shared-control teleoperation may have utility in a clinical setting when developing training suited to this population.
Objective: To explore the clinical utility of a shared-control teleoperation device for powered wheelchair assessment and training.
Design: In this qualitative study, we used two sequential semistructured interviews conducted a minimum of 2 wk apart. Thematic analyses were used with member checking, reflexive journaling, and triangulation of researchers to establish trustworthiness of the data.
Setting: Rehabilitation center and residential care and community settings.
Participants: Using purposive sampling, we recruited occupational therapists and physical therapists who were mostly female and who had a range of practice experience.
Results: Fifteen participants were interviewed, and two primary themes were identified: (1) “A big enabler” described how shared control provides opportunities to train people who may otherwise be denied powered mobility, and (2) “changing the learner experience” described how shared control may promote success in skill development through an alternative learning experience.
Conclusions and Relevance: Shared-control technology may have the potential to broaden the scope of therapeutic intervention by reducing risk to the driver and others in the environment and by facilitating alternative training approaches.
What This Article Adds: Technological advances that allow more control over a powered wheelchair by a clinician, known as shared control, may provide learning opportunities for people who are otherwise denied access to powered mobility. Shared control may also allow the use of new instructional techniques, increase safety in the training process, and reduce anxiety associated with learning.
Collapse
Affiliation(s)
- Emma M. Smith
- Emma M. Smith, MScOT, PhD, is Postdoctoral Researcher, Maynooth University, Maynooth, Ireland. At the time this research was conducted, she was PhD Candidate, Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and GF Strong Rehabilitation Research Lab, Rehabilitation Research Program, Vancouver Coastal Health Rese
| | - Shalaleh Rismani
- Shalaleh Rismani, MSc, is Adjunct Professor, Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - W. Ben Mortenson
- W. Ben Mortenson, PhD, is Associate Professor, Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Investigator, AGEWELL NCE Inc. and International Collaboration on Repair Discoveries and GF Strong Rehabilitation Research Lab, Rehabilitation Research Program, Vancouver Coastal Health Research I
| | - Alex Mihailidis
- Alex Mihailidis, PEng, PhD, is Scientific Director, AGEWELL NCE Inc., and Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - William C. Miller
- William C. Miller, PhD, FCAOT, is Professor, Department of Occupational Sciences and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, and Investigator, AGEWELL NCE Inc. and International Collaboration on Repair Discoveries and GF Strong Rehabilitation Research Lab, Rehabilitation Research Program, Vancouver Coastal Health Research Ins
| |
Collapse
|
3
|
Smith EM, Miller WC, Mortenson WB, Mihailidis A. Feasibility RCT protocol evaluating a powered-wheelchair training program for older adults. Can J Occup Ther 2019; 86:232-242. [DOI: 10.1177/0008417419834456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs. Purpose. The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology. Method. A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected. Implications. Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments.
Collapse
|
4
|
Park J, Chung Y. The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke. NeuroRehabilitation 2018; 43:227-235. [PMID: 30040760 DOI: 10.3233/nre-172415] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted gait training provide a big therapeutic advantage in functional mobility for postural control. OBJECTIVES The purpose of this study was investigate the effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in stroke patients. METHODS All subjects were randomly divided into three groups where twelve subjects were in the Virtual reality robot-assisted gait training group (VRGT), twelve subjects in the auditory stimulation robot-assisted gait training group (ARGT), and sixteen subjects in the control group. Subjects received virtual reality and auditory stimulation while undergoing robot-assisted gait training for 45 minutes, three times a week for 6 weeks, and all subjects had undergone general physical therapy for 30 minutes, five times a week for 6 weeks. All subjects were assessed with the Medical Research Council (MRC), Berg balance scale (BBS), timed up and go test (TUG), 10-meter walk test (10MWT), Fugl-Myer Assessment (FMA) and Modified Barthel Index (MBI) pre- and post-intervention. RESULTS Results showed that BBS, TUG, and 10MWT scores significantly improved post-intervention (p < 0.05), and the control group also had significantly improved in all areas post-treatment (p < 0.05). In addition, it has been confirmed that VRGT had significantly improved in MRC and FMA scores compared with the auditory stimulation. Also, it has significantly improved in MRC, BBS, TUG, 10MWT and FMA compared with control group (p < 0.05). CONCLUSIONS The results of this study showed improve balance and gait abilities after VRGT compared with general physical therapy and were found to be effective in enhancing the functional activity of persons with stroke.
Collapse
Affiliation(s)
- Jaeho Park
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University, Seoul, Republic of Korea
| |
Collapse
|
7
|
Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of People With Stroke to Learn Powered Wheelchair Skills: A Pilot Study. Arch Phys Med Rehabil 2010; 91:596-601. [DOI: 10.1016/j.apmr.2009.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/04/2009] [Accepted: 12/10/2009] [Indexed: 11/28/2022]
|