Driving performance in a power wheelchair simulator

Evaluation of power wheelchair driving performance in simulator compared to driving in real-life situations: the SIMADAPT (simulator ADAPT) project-a pilot study

OBJECTIVE

The objective of this study was to evaluate users' driving performances with a Power Wheelchair (PWC) driving simulator in comparison to the same driving task in real conditions with a standard power wheelchair.

METHODS

Three driving circuits of progressive difficulty levels (C1, C2, C3) that were elaborated to assess the driving performances with PWC in indoor situations, were used in this study. These circuits have been modeled in a 3D Virtual Environment to replicate the three driving task scenarios in Virtual Reality (VR). Users were asked to complete the three circuits with respect to two testing conditions during three successive sessions, i.e. in VR and on a real circuit (R). During each session, users completed the two conditions. Driving performances were evaluated using the number of collisions and time to complete the circuit. In addition, driving ability by Wheelchair Skill Test (WST) and mental load were assessed in both conditions. Cybersickness, user satisfaction and sense of presence were measured in VR. The conditions R and VR were randomized.

RESULTS

Thirty-one participants with neurological disorders and expert wheelchair drivers were included in the study. The driving performances between VR and R conditions were statistically different for the C3 circuit but were not statistically different for the two easiest circuits C1 and C2. The results of the WST was not statistically different in C1, C2 and C3. The mental load was higher in VR than in R condition. The general sense of presence was reported as acceptable (mean value of 4.6 out of 6) for all the participants, and the cybersickness was reported as acceptable (SSQ mean value of 4.25 on the three circuits in VR condition).

CONCLUSION

Driving performances were statistically different in the most complicated circuit C3 with an increased number of collisions in VR, but were not statistically different for the two easiest circuits C1 and C2 in R and VR conditions. In addition, there were no significant adverse effects such as cybersickness. The results show the value of the simulator for driving training applications. Still, the mental load was higher in VR than in R condition, thus mitigating the potential for use with people with cognitive disorders. Further studies should be conducted to assess the quality of skill transfer for novice drivers from the simulator to the real world. Trial registration Ethical approval n∘ 2019-A001306-51 from Comité de Protection des Personnes Sud Mediterranée IV. Trial registered the 19/11/2019 on ClinicalTrials.gov in ID: NCT04171973.

Pediatric powered mobility training: powered wheelchair versus simulator-based practice

METHOD

Participants included 30 children and adolescents (23 males, 13 females) with cerebral palsy and other neuromuscular diseases, aged 6-18. Data were collected and compared at baseline and after 12 weeks of home-based practice via a powered wheelchair or a simulator. Powered mobility ability was determined by the Powered Mobility Program (PMP), the Israel Ministry of Health's Powered Mobility Proficiency Test (PM-PT) and the Assessment of Learning Powered Mobility (ALP).

RESULTS

All participants practiced for the required amount of time and both groups reported a similar user experience. Both groups achieved significant improvement following the practice period as assessed by the PMP and PM-PT assessments, with no significant differences between them. A significant improvement was found in the ALP assessment outcomes for the powered wheelchair group only.

CONCLUSIONS

This is the first study, to our knowledge, that compares two different wheelchair training methods. Simulator-based practice is an effective training option for powered mobility for children with physical disabilities aged 6-18 years old, demonstrating that it is possible to provide driving skill practice opportunities safe, controlled environments.

Skills assessment metrics of electric powered wheelchair driving in a virtual environment: a survey

The purpose of this review is to present studies on the parameters for assessing the skills of users of electric wheelchair driving simulators in a virtual environment. In addition, this study also aims to identify the most widely used and validated parameters for the quantification of electric wheelchair driving ability in a virtual environment and to suggest challenges for future research. To carry out this research, the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. Literature searches in English, French, and Portuguese were conducted up to December 2020 in the PubMed, SciELO, Science Direct, World Wide Science, and Scopus databases. The keywords used were electric wheelchair, simulator, performance indicators, performance skills, driving skills, training platform, virtual environment, and virtual reality. We excluded studies involving "real" wheelchairs without a simulator in a virtual environment. We have selected a total of 42 items. In these studies, we identified 32 parameters (3 qualitative and 29 quantitative) that are used as parameters for the evaluation of the ability to control a powered wheelchair in a virtual environment. Although the amount of research in this area has increased significantly in recent years, additional studies are still needed to provide a more accurate and objective assessment of skills among the target population. A challenge for future work is the increasing application of artificial intelligence techniques and the exploration of biomedical data measurements, which may be a promising alternative to improve the quantification of user competencies.

Simulation System of Electric-Powered Wheelchairs for Training Purposes

For some people with severe physical disabilities, the main assistive device to improve their independence and to enhance overall well-being is an electric-powered wheelchair (EPW). However, there is a necessity to offer users EPW training. In this work, the Simcadrom is introduced, which is a virtual reality simulator for EPW driving learning purposes, testing of driving skills and performance, and testing of input interfaces. This simulator uses a joystick as the main input interface, and a virtual reality head-mounted display. However, it can also be used with an eye-tracker device as an alternative input interface and a projector to display the virtual environment (VE). Sense of presence, and user experience questionnaires were implemented to evaluate this version of the Simcadrom in addition to some statistical tests for performance parameters like: total elapsed time, path following error, and total number of commands. A test protocol was proposed and, considering the overall results, the system proved to simulate, very realistically, the usability, kinematics, and dynamics of a real EPW in a VE. Most subjects were able to improve their EPW driving performance in the training session. Furthermore, all skills learned are feasible to be transferred to a real EPW.

ViEW: A wheelchair simulator for driving analysis

The powered wheelchair (PW) has become an essential mobility assistive technology for people with motor disabilities. A critical step involved in maximizing the end-user experience is evaluating individual functional abilities. Using powered wheelchair simulation for driving analysis offers flexibility for safely evaluating the individual's driving performance in a variable environment and situations ranging in difficulty. Additionally, it makes it possible to measure numerous variables involved in the driving process. The main objectives of this pilot study were to assess PW users' outdoor driving abilities to study how the simulator can improve outdoor driving task performance, and to define new objective criteria for evaluating the overall driving process. The study presented involved a group of 12 children and young adults diagnosed with cerebral palsy. Simulations were conducted using ViEW (Virtual Electrical Wheelchair), a 3D wheelchair simulator designed in our laboratory. A customized virtual environment was designed to immerse the user in a life-like driving experience. We used the data collected on the simulator to define driving skills indicators. The acquired skills during simulations were transferable to on-road wheelchair driving. The participants' performance indicators produced positive results. Computed performance indicators can be a valuable decision-making tool for occupational therapists.

Comparing children's driving abilities in physical and virtual environments

PURPOSE

To compare children's driving abilities in a physical and virtual environment and to validate the McGill Immersive Wheelchair Simulator (MiWe-C) for the use of children with disabilities.

MATERIALS AND METHODS

Participants included 30 children (17 males, 13 females; mean age 14 y 1 mo, [SD 3 y 6 mo]; range: 5-18 y) with cerebral palsy, neuromuscular disease and spinal cord injury. All children were proficient drivers with more than 3 months' experience, who had their own powered wheelchairs. Participants drove a 15-minute physical route and high-fidelity simulation of that route in a counterbalanced order. Performance of the two routes was compared using the 32 item Powered Mobility Programme (PMP). Differences between the driving modes were analyzed with the non-parametric Wilcoxon signed-rank test. Significance was set at α = 0.05.

RESULTS

The scores for the total PMP score as rated during both simulator wheelchair driving and during physical driving were very high (M = 4.90, SD = 0.20; M = 4.96, SD = 0.12, respectively) with no significant difference between them (z= -1.69, p = .09). Five out of the 32 PMP tasks showed significant differences between driving modes (narrow corridors, crowded corridors, doorway, sidewalks), with higher scores for the physical driving mode.

CONCLUSIONS

Having a validated powered mobility simulator for children provides a viable option for an additional practice mode. The MiWe-C simulator is affordable and a user-friendly simulator that can be used anywhere including at home and in school. Children can be independent when practicing even if they are not yet proficient drivers since continual adult assistance is not needed.Implications for rehabilitationHaving a validated powered mobility simulator for children provides a viable option for an additional practice mode.The MiWe-C is now validated to be used with children 5-18 years with physical disabilities.The MiWe-C is one of the few options for children to practice outside of a research environment.

A scoping review of powered wheelchair driving tasks and performance-based outcomes

Introduction: Wheelchairs and scooters promote participation and have positive effects on quality of life. However, powered wheelchairs (PW) use can be challenging and can pose safety concerns. Adequate PW assessment and training is important. There is a wide variety of tasks and PW driving assessment measures used for training and assessing PW driving ability in the literature and little consensus as to which tasks and outcomes are the most relevant. A scoping review of the literature was performed in order to characterize this extensive variety of tasks and performance-based outcomes used for training and assessing PW skills.Methods: A search of the literature was conducted in January 2017. Four databases were searched: CINAHL, Embase, PsycInfo and Medline. Articles were included if they contained at least one PW driving task.Results: 827 articles were screened and 48 articles were retained. PW driving tasks from each article were identified and categorized in terms of the environment in which they were performed: Driving in a controlled environment, ecological driving tasks, 2D virtual environment (VE) tasks, 3D VE tasks. The assessment measures formed a separate category. Subjective and objective performance-based outcomes related to PW driving were also identified and grouped into outcomes assessing speed and outcomes assessing accuracy.Conclusion: This scoping review provides an overview of tasks and performance outcomes used in the literature when training and assessing PW skills. The results of this review could guide future research when choosing appropriate tasks and performance outcomes for PW driving ability.Implications for rehabilitationThere is wide variety of tasks and performance-based outcomes for PW driving.Results showed that available assessment measures are not commonly used in research and that tasks used often lacked consistency across studies.New methods to measure the interaction of speed and accuracy are needed.The contents of this review could be used by researchers as a starting point when designing a PW task and selecting appropriate performance-based outcomes.

Augmented feedback for powered wheelchair training in a virtual environment

BACKGROUND

Powered wheelchair (PW) driving is a complex activity and requires the acquisition of several skills. Given the risks involved with PW use, safe and effective training methods are needed. Virtual reality training allows users to practice difficult tasks in a safe environment. An additional benefit is that augmented feedback can be provided to optimize learning. The purpose of this study was to investigate whether providing augmented feedback during powered wheelchair simulator training results in superior performance, and whether skills learned in a virtual environment transfer to real PW driving.

METHODS

Forty healthy young adults were randomly allocated to two groups: one received augmented feedback during simulator training while the control group received no augmented feedback. PW driving performance was assessed at baseline in both the real and virtual environment (RE and VE), after training in VE and two days later in VE and RE (retention and transfer tests).

RESULTS

Both groups showed significantly better task completion time and number of collisions in the VE after training and these results were maintained two days later. The transfer test indicated better performance in the RE compared to baseline for both groups. Because time and collisions interact, a post-hoc 2D Kolmogonov-Smirnov test was used to investigate the differences in the speed-accuracy distributions for each group; a significant difference was found for the group receiving augmented feedback, before and after training, whereas the difference was not significant for the control group. There were no differences at the retention test, suggesting that augmented feedback was most effective during and immediately after training.

CONCLUSIONS

PW simulator training is effective in improving task completion time and number of collisions. A small effect of augmented feedback was seen when looking at differences in the speed-accuracy distributions, highlighting the importance of accounting for the speed-accuracy tradeoff for PW driving.

Virtual reality-based wheelchair simulators: A scoping review

Sense of presence (SoP) has recently emerged as one of the key elements promoting the effectiveness of virtual reality-based training programs. In the context of wheelchair simulators (WSs), the effectiveness of the simulation has been sought using different perception and interaction devices, providing the end-users with different levels of SoP. We performed a scoping review searching scientific and grey literature databases with the aim of assessing the extent of published research dealing with SoP and effectiveness of WSs. Sixty-two articles, describing 29 WSs, were included in the review. In spite of promising results, the high heterogeneity of the employed technological solutions, of the training programs and of their outcomes precluded drawing definitive conclusions about the optimal solution for the enhancement of SoP and thus of WSs' effectiveness. Future research should focus on controlled trials in order to help researchers in assessing the most suitable technologies and methodologies for the application of WSs in clinical practice.

Intelligent Control Wheelchair Using a New Visual Joystick

A new control system of a hand gesture-controlled wheelchair (EWC) is proposed. This smart control device is suitable for a large number of patients who cannot manipulate a standard joystick wheelchair. The movement control system uses a camera fixed on the wheelchair. The patient's hand movements are recognized using a visual recognition algorithm and artificial intelligence software; the derived corresponding signals are thus used to control the EWC in real time. One of the main features of this control technique is that it allows the patient to drive the wheelchair with a variable speed similar to that of a standard joystick. The designed device "hand gesture-controlled wheelchair" is performed at low cost and has been tested on real patients and exhibits good results. Before testing the proposed control device, we have created a three-dimensional environment simulator to test its performances with extreme security. These tests were performed on real patients with diverse hand pathologies in Mohamed Kassab National Institute of Orthopedics, Physical and Functional Rehabilitation Hospital of Tunis, and the validity of this intelligent control system had been proved.

Design and Evaluation of the Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair for Pediatric Powered Mobility Training

BACKGROUND

Children with severe disabilities are sometimes unable to access powered mobility training. Thus, we developed the Kinect-Wheelchair Interface Controlled (KWIC) smart wheelchair trainer that converts a manual wheelchair into a powered wheelchair. The KWIC Trainer uses computer vision to create a virtual tether with adaptive shared-control between the wheelchair and a therapist during training. It also includes a mixed-reality video game system.

METHODS

We performed a year-long usability study of the KWIC Trainer at a local clinic, soliciting qualitative and quantitative feedback on the device after extended use.

RESULTS

Eight therapists used the KWIC Trainer for over 50 hours with 8 different children. Two of the children obtained their own powered wheelchair as a result of the training. The therapists indicated the device allowed them to provide mobility training for more children than would have been possible with a demo wheelchair, and they found use of the device to be as safe as or safer than conventional training. They viewed the shared control algorithm as counter-productive because it made it difficult for the child to discern when he or she was controlling the chair. They were enthusiastic about the video game integration for increasing motivation and engagement during training. They emphasized the need for additional access methods for controlling the device.

CONCLUSION

The therapists confirmed that the KWIC Trainer is a useful tool for increasing access to powered mobility training and for engaging children during training sessions. However, some improvements would enhance its applicability for routine clinical use.

Virtual community centre for power wheelchair training: Experience of children and clinicians

PURPOSE

To: 1) characterize the overall experience in using the McGill immersive wheelchair - community centre (miWe-CC) simulator; and 2) investigate the experience of presence (i.e., sense of being in the virtual rather than in the real, physical environment) while driving a PW in the miWe-CC.

METHOD

A qualitative research design with structured interviews was used. Fifteen clinicians and 11 children were interviewed after driving a power wheelchair (PW) in the miWe-CC simulator. Data were analyzed using the conventional and directed content analysis approaches.

RESULTS

Overall, participants enjoyed using the simulator and experienced a sense of presence in the virtual space. They felt a sense of being in the virtual environment, involved and focused on driving the virtual PW rather than on the surroundings of the actual room where they were. Participants reported several similarities between the virtual community centre layout and activities of the miWe-CC and the day-to-day reality of paediatric PW users.

CONCLUSION

The simulator replicated participants' expectations of real-life PW use and promises to have an effect on improving the driving skills of new PW users. Implications for rehabilitation Among young users, the McGill immersive wheelchair (miWe) simulator provides an experience of presence within the virtual environment. This experience of presence is generated by a sense of being in the virtual scene, a sense of being involved, engaged, and focused on interacting within the virtual environment, and by the perception that the virtual environment is consistent with the real world. The miWe is a relevant and accessible approach, complementary to real world power wheelchair training for young users.

Design of an immersive simulator for assisted power wheelchair driving

Driving a power wheelchair is a difficult and complex visual-cognitive task. As a result, some people with visual and/or cognitive disabilities cannot access the benefits of a power wheelchair because their impairments prevent them from driving safely. In order to improve their access to mobility, we have previously designed a semi-autonomous assistive wheelchair system which progressively corrects the trajectory as the user manually drives the wheelchair and smoothly avoids obstacles. Developing and testing such systems for wheelchair driving assistance requires a significant amount of material resources and clinician time. With Virtual Reality technology, prototypes can be developed and tested in a risk-free and highly flexible Virtual Environment before equipping and testing a physical prototype. Additionally, users can "virtually" test and train more easily during the development process. In this paper, we introduce a power wheelchair driving simulator allowing the user to navigate with a standard wheelchair in an immersive 3D Virtual Environment. The simulation framework is designed to be flexible so that we can use different control inputs. In order to validate the framework, we first performed tests on the simulator with able-bodied participants during which the user's Quality of Experience (QoE) was assessed through a set of questionnaires. Results show that the simulator is a promising tool for future works as it generates a good sense of presence and requires rather low cognitive effort from users.

Immersion factors affecting perception and behaviour in a virtual reality power wheelchair simulator

Virtual Reality based driving simulators are increasingly used to train and assess users' abilities to operate vehicles in a controlled and safe way. For the development of those simulators it is important to identify and evaluate design factors affecting perception, behaviour, and driving performance. In an exemplary power wheelchair simulator setting we identified the three immersion factors display type (head-mounted display v monitor), ability to freely change the field of view (FOV), and the visualisation of the user's avatar as potentially affecting perception and behaviour. In a study with 72 participants we found all three factors affected the participants' sense of presence in the virtual environment. In particular the display type significantly affected both perceptual and behavioural measures whereas FOV only affected behavioural measures. Our findings could guide future Virtual Reality simulator designers to evoke targeted user behaviours and perceptions.

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.

Powered wheelchair simulator development: implementing combined navigation-reaching tasks with a 3D hand motion controller

Background

Powered wheelchair (PW) training involving combined navigation and reaching is often limited or unfeasible. Virtual reality (VR) simulators offer a feasible alternative for rehabilitation training either at home or in a clinical setting. This study evaluated a low-cost magnetic-based hand motion controller as an interface for reaching tasks within the McGill Immersive Wheelchair (miWe) simulator.

Methods

Twelve experienced PW users performed three navigation-reaching tasks in the real world (RW) and in VR: working at a desk, using an elevator, and opening a door. The sense of presence in VR was assessed using the iGroup Presence Questionnaire (IPQ). We determined concordance of task performance in VR with that in the RW. A video task analysis was performed to analyse task behaviours.

Results

Compared to previous miWe data, IPQ scores were greater in the involvement domain (p < 0.05). Task analysis showed most of navigation and reaching behaviours as having moderate to excellent (K > 0.4, Cohen’s Kappa) agreement between the two environments, but greater (p < 0.05) risk of collisions and reaching errors in VR. VR performance demonstrated longer (p < 0.05) task times and more discreet movements for the elevator and desk tasks but not the door task.

Conclusions

Task performance showed poorer kinematic performance in VR than RW but similar strategies. Therefore, the reaching component represents a promising addition to the miWe training simulator, though some limitations must be addressed in future development.

A body machine interface based on inertial sensors

Spinal cord injury (SCI) survivors generally retain residual motor and sensory functions, which provide them with the means to control assistive devices. A body-machine interface (BoMI) establishes a mapping from these residual body movements to control commands for an external device. In this study, we designed a BoMI to smooth the way for operating computers, powered wheelchairs and other assistive technologies after cervical spinal cord injuries. The interface design included a comprehensive training paradigm with a range of diverse functional activities to enhance motor learning and retention. Two groups of SCI survivors and healthy control subjects participated in the study. The results indicate the effectiveness of the developed system as an alternative pathway for individuals with motor disabilities to control assistive devices while engaging in functional motor activity.

Upper Body-Based Power Wheelchair Control Interface for Individuals With Tetraplegia

Many power wheelchair control interfaces are not sufficient for individuals with severely limited upper limb mobility. The majority of controllers that do not rely on coordinated arm and hand movements provide users a limited vocabulary of commands and often do not take advantage of the user's residual motion. We developed a body-machine interface (BMI) that leverages the flexibility and customizability of redundant control by using high dimensional changes in shoulder kinematics to generate proportional control commands for a power wheelchair. In this study, three individuals with cervical spinal cord injuries were able to control a power wheelchair safely and accurately using only small shoulder movements. With the BMI, participants were able to achieve their desired trajectories and, after five sessions driving, were able to achieve smoothness that was similar to the smoothness with their current joystick. All participants were twice as slow using the BMI however improved with practice. Importantly, users were able to generalize training controlling a computer to driving a power wheelchair, and employed similar strategies when controlling both devices. Overall, this work suggests that the BMI can be an effective wheelchair control interface for individuals with high-level spinal cord injuries who have limited arm and hand control.

Cursor control by Kalman filter with a non-invasive body-machine interface

OBJECTIVE

We describe a novel human-machine interface for the control of a two-dimensional (2D) computer cursor using four inertial measurement units (IMUs) placed on the user's upper-body.

APPROACH

A calibration paradigm where human subjects follow a cursor with their body as if they were controlling it with their shoulders generates a map between shoulder motions and cursor kinematics. This map is used in a Kalman filter to estimate the desired cursor coordinates from upper-body motions. We compared cursor control performance in a centre-out reaching task performed by subjects using different amounts of information from the IMUs to control the 2D cursor.

MAIN RESULTS

Our results indicate that taking advantage of the redundancy of the signals from the IMUs improved overall performance. Our work also demonstrates the potential of non-invasive IMU-based body-machine interface systems as an alternative or complement to brain-machine interfaces for accomplishing cursor control in 2D space.

SIGNIFICANCE

The present study may serve as a platform for people with high-tetraplegia to control assistive devices such as powered wheelchairs using a joystick.

Power wheelchair driving challenges in the community: a users' perspective

PURPOSE

There is limited information on the difficulties individuals experience in manoeuvring their power wheelchairs during daily activities. The aim of this study was to describe the nature and context of power wheelchair driving challenges from the perspective of the user.

METHODS

A qualitative design using semi-structured interviews with power wheelchair users. Qualitative content analysis was used to identify themes.

RESULTS

Twelve experienced power wheelchair users were interviewed. Findings revealed that power wheelchair driving difficulties were related to the accomplishment of activities of daily living, and the influence of environmental context. Four key themes emerged: (1) difficulties accessing and using public buildings-facilities, (2) outdoor mobility, (3) problems in performing specific wheelchair mobility tasks/manoeuvres and (4) barriers and circumstances that are temporary, unforeseen or specific to a particular context.

CONCLUSION

This qualitative study furthers our understanding of the driving difficulties powered wheelchair (PW) users experience during daily activities. This knowledge will assist clinicians and researchers in two areas: in choosing assessment measures that are ecologically valid for power wheelchair users; and, in identifying and refining the content of training programs specific to the use of power wheelchairs.

IMPLICATIONS FOR REHABILITATION

A better understanding of the everyday challenges individuals experience in driving their power wheelchair will assist clinicians and researchers in: Choosing assessment measures and identifying training programs for this population. Refining the content of power wheelchair training programs.

Assessment of wheelchair driving performance in a virtual reality-based simulator

OBJECTIVE

To develop a virtual reality (VR)-based simulator that can assist clinicians in performing standardized wheelchair driving assessments.

DESIGN

A completely within-subjects repeated measures design.

METHODS

Participants drove their wheelchairs along a virtual driving circuit modeled after the Power Mobility Road Test (PMRT) and in a hallway with decreasing width. The virtual simulator was displayed on computer screen and VR screens and participants interacted with it using a set of instrumented rollers and a wheelchair joystick. Driving performances of participants were estimated and compared using quantitative metrics from the simulator. Qualitative ratings from two experienced clinicians were used to estimate intra- and inter-rater reliability.

RESULTS

Ten regular wheelchair users (seven men, three women; mean age ± SD, 39.5 ± 15.39 years) participated. The virtual PMRT scores from the two clinicians show high inter-rater reliability (78-90%) and high intra-rater reliability (71-90%) for all test conditions. More research is required to explore user preferences and effectiveness of the two control methods (rollers and mathematical model) and the display screens.

CONCLUSIONS

The virtual driving simulator seems to be a promising tool for wheelchair driving assessment that clinicians can use to supplement their real-world evaluations.