Exploring powered wheelchair users and their caregivers' perspectives on potential intelligent power wheelchair use: a qualitative study

3D-printed design iteration of a low-tech positive obstacle pushing/gliding wheelchair accessory

PURPOSE

Steering a wheelchair while navigating through manual doors or against obstacles is challenging for some users. Previously, a low-cost, low-tech accessory made using off-the-shelf components, conventional manufacturing, and 3D-printed fasteners demonstrated the proof-of-concept for uncrossable positive obstacle pushing or gliding. Current work presents the fabrication and testing of an entirely 3D-printed prototype of the accessory.

METHODS

The accessory was 3D-printed using ABS (10% fill density) in sections. A finite element stress analysis simulation was performed for the entire accessory. Prototype tests were done with the accessory installed on an unoccupied powered wheelchair against a door and an obstacle with ∼25 N and ∼50 N resistance forces, respectively.

RESULTS

The maximum stresses in none of the crucial components exceeded the break strength of ABS. Test results demonstrate the ability and mechanical robustness of the fully 3D-printed accessory to push open manual doors, allowing easy navigation through doors, and to push or glide against obstacles. The current prototype improves over the previous prototype in terms of manufacturability, weight, design, and safety.

CONCLUSIONS

To the best of our knowledge, this is the first demonstration of an entirely 3D-printed wheelchair accessory that pushes or glides against uncrossable positive obstacles. Future studies would involve end-user satisfaction assessment and functionality evaluation in different scenarios under clinical supervision. The pushing or gliding ability of the accessory could be beneficial to wheelchair users with neuromuscular disorders or paraplegia.

Blind spot sensor systems for power wheelchairs: obstacle detection accuracy, cognitive task load, and perceived usefulness among older adults

PURPOSE

Blind spot sensor systems can improve power wheelchair (PWC) safety. This research (1) compared accuracy of obstacle detection in the rear of a wheelchair with and without a sensor system, and (2) explored cognitive task load and perceived usability, safety, confidence and awareness in a laboratory setting, and (3) PWC users' perceptions in real-world settings.

MATERIALS AND METHODS

A mixed-method design was used. PWC users were provided with the sensor system. In laboratory accuracy of obstacle detection with and without a sensor system, cognitive task load and perceived usability, safety, confidence and awareness were evaluated. Participants then used the sensor system at home for two-months before completing semi-structured interviews. Statistical and thematic analyses were conducted.

RESULTS

Among 11 PWC users (age = 67.5 ± 7.5y), obstacles were detected more accurately with sensor system than without (p < 0.001). Using the sensor system required lower cognitive task loads (p = 0.005). The system was perceived by most users as easy to use (9/11) and its capabilities meeting their requirements (8/11). Most users did not perceive safety (9/11), confidence (9/11) or increased awareness (10/11) in the laboratory. Three themes emerged in the follow-ups: perceived usefulness, barriers to use, and recommendations. Four participants reported continued use after 2 months, reporting perceived increased awareness, convenience, and independence using the system. Those who discontinued use reported perceived lack of usefulness and technical issues. Recommendations included types of users who can benefit and sensor improvements.

CONCLUSIONS

Sensor systems may improve obstacle detection accuracy while reducing cognitive task load. However, larger scale implementation should consider recommendations for PWC service provision.IMPLICATIONS FOR REHABILITATIONBlind spot sensors systems increased speed and accuracy of obstacle detection when using a power wheelchair.Technical and hardware issues encountered by PWC users highlight the need for training and support services.Technical support was out of scope for the current research project and will be explored in future research given the critical role it might play in the usability and adoption of assistive technologies.PWC users perceived there to be practical uses for blind spot sensor systems.

Filling the Gap between Research and Market: Portable Architecture for an Intelligent Autonomous Wheelchair

Under the umbrella of assistive technologies research, a lot of different platforms have appeared since the 1980s, trying to improve the independence of people with severe mobility problems. Those works followed the same path coming from the field of robotics trying to reach users' needs. Nevertheless, those approaches rarely arrived on the market, due to their specificity and price. This paper presents a new prototype of an intelligent wheelchair (IW) that tries to fill the gap between research labs and market. In order to achieve such a goal, the proposed solution balances the criteria of performance and cost by using low-cost hardware and open software standards in mobile robots combined together within a modular architecture, which can be easily adapted to different profiles of a wide range of potential users. The basic building block consists of a mechanical chassis with two electric motors and a low-level electronic control system; driven by a joystick, this platform behaves similar to a standard electrical wheelchair. However, the underlying structure of the system includes several independent but connected nodes that form a distributed and scalable architecture that allows its adaptability, by adding new modules, to tackle autonomous navigation. The communication among the system nodes is based on the controller area network (CAN) specification, an extended standard in industrial fields that have a wide range of low-cost devices and tools. The system was tested and evaluated in indoor environments and by final users in order to ensure its usability, robustness, and reliability; it also demonstrated its functionality when navigating through buildings, corridors, and offices. The portability of the solution proposed is also shown by presenting the results on two different platforms: one for kids and another one for adults, based on different commercial mechanical platforms.

Usability Evaluation of the SmartWheeler through Qualitative and Quantitative Studies

Background: Intelligent powered wheelchairs remain a popular research topic that can improve users’ quality of life. Although our multidisciplinary research team has put a lot of effort into adding features based on end-users needs and impairments since 2006, there are still open issues regarding the usability and functionalities of an intelligent powered wheelchair (IPW). Methods: For this reason, this research presents an experience with our IPW followed by a study in two parts: a quantitative one based on the System Usability Scale (SUS) questionnaire and a qualitative one through open questions regarding IPW functionalities with novice users, e.g., IPW non-users. These users never used an IPW before, but are users and aware of the impacts of the technology used in our IPW, being undergraduate to postdoctoral students and staff (faculty, lecturers, research engineers) at the Faculty of Engineering of Université de Sherbrooke. Results: The qualitative analyses identified different behaviours among the novice users. The quantitative analysis via SUS questionnaire done with novice users reports an “okay” rating (equivalent with a C grade or 68 SUS Score) for our IPW’s usability. Moreover, advantages and disadvantages opinions were gathered on the IPW as well as comments which can be used to improve the system. Conclusions: The results reported in these studies show that the system, e.g., IPW, was judged to be sufficiently usable and robust by novice users, with and without experience with the software used in developing the IPW.

The Interface Usage Skills Test: An Open Source Tool for Quantitative Evaluation in Real Time for Clinicians and Researchers

Assistive machines endow people with limited mobility the opportunity to live more independently. However, operating these machines poses risks to the safety of the human operator as well as the surrounding environment. Thus, proper user training is an essential step towards independent control and use of functionally assistive machines. The human operator can use a variety of control interfaces to issue control signals to the device, depending on the residual mobility and level of injury of the human operator. Proficiency in operating the interface of choice precedes the skill in operating the assistive machine. In this systems paper, we present an open source tool for automatically and objectively quantifying user skill in operating various interface devices.

International research priorities on the role of cognition in power mobility device use: In pursuit of informed clinical practices and knowledge translation

Cognition is an important factor affecting power mobility device (PMD) use. However, a gap in knowledge on the role of cognition in PMD use limits evidence of best practices for screening, assessment, and training. The overall goal of this research activity was to identify strategic research priorities to delineate the next steps in research. Following the Collaborative Prioritized Planning Process (CP3), a 1.5-day meeting was held with an interdisciplinary and international team of assistive technology users, clinicians, service providers, and researchers with expertise in PMD use and cognition. Our four-stage process included: knowledge synthesis; identification and prioritization of challenges; identification, consolidation, and prioritization of solutions; and action planning. Five of 14 challenges for research on cognition and PMD use were prioritized, and five solutions (of the 100 generated) perceived to be the most impactful were selected as the focus for the remainder of the meeting. The resulting prioritized solutions included, improving knowledge translation of existing and new evidence, profiling and addressing individualized needs, creating and evaluating training tools, development of practice guidelines, and validating and developing evaluation tools or toolkit. Preliminary action planning facilitated discussion of potential future projects, initiated new research collaborations and partnerships, and provided a foundation to build a program of research for investigating the role of cognition in PMD use.

Patient and Parent Experiences with Group Telerehabilitation for Child Survivors of Acute Lymphoblastic Leukemia

BACKGROUND

Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. ALL and its treatment cause altered bone-mineral homeostasis, which can contribute to musculoskeletal late adverse effects (LAEs). With the increasing number of childhood cancer survivors, LAEs are reported often, and are aggravated by inactive lifestyles. A telerehabilitation program is proposed to strengthen the muscle-bone complex and prevent future impairment.

OBJECTIVE

This study aimed to explore and better understand patient and parent experience of a telerehabilitation program after completion of ALL treatment.

METHODS

ALL survivors (n = 12), 75% girls, 7.9 to 14.7 years old, within six months to five years of treatment, were recruited to participate in the proposed study, along with a parent. The 16-week group program included 40 potential home-based physical activities, with monthly progression, supervised by a kinesiologist, through an online telerehabilitation platform. Patients could be included in the study if they joined during the first month of intervention of their group (minimum 12 weeks of intervention). A semi-structured post-intervention interview was conducted with the patients and their parent during the final assessment, along with a review of the kinesiologist's clinical notes, to obtain a portrait of the participants' experience with the telerehabilitation program. Overarching themes were identified by one author and confirmed by two senior authors before extracting the various aspects of each theme.

RESULTS

Of the 12 patients recruited, three were excluded from the analysis because they did not complete the minimum 12 weeks of intervention (one = relapse, one = failure to meet technical requirements, and one = abandoned due to parent's disinterest). The nine patients who completed the program (six girls; 10.93 ± 2.83 years) had a mean adherence of 89%. The overarching themes identified were the program modalities (group approach with patient-parent paired training, supervised by a kinesiologist), the telerehabilitation system, the participants' perception of the benefits, and recommendations and suggestions from the families. Both patients and parents expressed very high satisfaction with the program and perceived benefits.

CONCLUSION

Participants appreciated the program and reported they would all recommend it to other families in similar situations. The telerehabilitation method of service delivery was perceived by some as decisive in choosing to participate, while the supervision and intra- and inter-family interactions were the motivating factors that were key to program adherence.

DEVELOPMENT OF THE USABILITY SCALE FOR POWER WHEELCHAIRS AND ITS APPLICATION IN POWER WHEELCHAIRS USERS IN KOREA

More of power wheelchair users’ needs have to be met in the making of power wheelchairs. However, there has been no usability scale for the power wheelchair that is specifically focusing on the users’ needs. The purpose of this study was to test and validate a usability scale for power wheelchairs (USPW). The USPW has been developed through interviews with power wheelchair and consultations with a panel of experts. The USPW consists of four evaluation categories (safety, operation, efficiency, and satisfaction). In order to validate it, its usability and the Quebec User Evaluation of Satisfaction Assistive Technology (QUEST) were also administered to 50 power wheelchair users. The USPW was extracted 12 items from safety, 7 from operation, 5 from efficiency, and 14 from satisfaction, with a total of 38 items. The content validity met the criteria. The total internal consistency (Cronbach’s [Formula: see text]) of the USPW was 0.75. Users of power wheelchair demanded that the safety of moving on the slopes, the satisfaction of storage space for power wheelchairs, and the repair service process would be improved. The correlation between the USPW and the QUEST was significant ([Formula: see text]). The USPW may be very useful to evaluate overall usability of power wheelchair including its safety, operability, efficiency, and satisfaction. The developed usability scale (USPW) may help wheelchair makers become aware of the problems of present power wheelchairs and the users’ needs, allowing them to make better ones.

Development and Evaluation of MOVit: An Exercise-Enabling Interface for Driving a Powered Wheelchair

Powered wheelchair users can experience negative health effects from reduced physical activity. If a user could exercise by driving the chair, it might improve fitness. This paper presents the development of MOVit, an exercise-enabling, wheelchair driving interface. The design goal of MOVit was that users cyclically move their arms to drive the chair, thereby providing a light level of exercise while driving. MOVit supports this arm movement with custom mobile arm supports that also serve as the sensors that provide controller inputs. Here, we first quantified how increasing the frequency and amplitude of arm movement increase oxygen consumption and heart rate. Then, we evaluated two novel control methods for driving by moving the arm supports. Participants without impairment ( N = 24 ) were randomized to one of the two methods, or conventional joystick control, and performed driving tests over two days on a simulator and test course. Our results indicate that driving speed and accuracy were significantly lowered with the exercise-enabling methods compared to joystick control (ANOVA, ), but the decreases were small (speed was ~0.1 m/s less and course tracking error ~1 cm greater). These results show, for the first time, the feasibility of exercising while driving a powered wheelchair.

Ultrasonic Tethering to Enable Side-by-Side Following for Powered Wheelchairs

In social situations, people who use a powered wheelchair must divide their attention between navigating the chair and conversing with people. These conversations could lead to increased mental stress when navigating and distraction from maneuvering the chair. As a solution that maintains a good conversation distance between the wheelchair and the accompanying person (Social Following), a wheelchair control system was developed to provide automated side-by-side following by wirelessly connecting the wheelchair to the person. Two ultrasonic range sensors and three piezoelectric ultrasonic transducers were used to identify the accompanying person and determine their position and heading. Identification involved an ultrasonic beacon worn on the person’s side, at hip level, and receivers on the wheelchair. A drive control algorithm maintained a constant conversation distance along the person’s trajectory. A plug-and-play prototype was developed and connected to a Permobil F5 Corpus wheelchair with a modified Eightfold Technologies SmartChair Remote. Results demonstrated that the system can navigate a wheelchair based on the accompanying person’s trajectory, which is advantageous for users who require hands-free wheelchair control during social activities.

Low-cost low-tech obstacle pushing/gliding wheelchair accessory

Purpose: Some wheelchair users continue to struggle in maneuvering a wheelchair and navigating through manual doors. Several smart wheelchairs and robotic manipulators were developed to minimize such challenges facing disabled people. Disappointingly, a majority of these high-tech solutions are restricted to laboratories and are not extensively available as commercial products. Previously, a low-tech wheelchair accessory (arc-shaped with many wheels) for pushing doors was modelled and simulated. This work demonstrates the fabrication and testing of the first-generation prototype of the accessory.Materials and methods: The accessory has side portions with a straight arrangement of wheels and a front portion with a straight-arc-straight arrangement of wheels. The accessory was fabricated using conventional manufacturing, off-the-shelf components, and 3D printed ABS fasteners. Stress analysis simulations were done for the fasteners that attach the front accessory to the wheelchair frame. The proof-of-concept of the prototype installed onto a powered wheelchair was tested with a door and an obstacle, each with ∼50 N resistance force.Results: Prototype tests demonstrate the ability of the accessory along with the mechanical robustness of the 3D printed fasteners to push open doors allowing easy navigation through doors and to push/glide against obstacles. The accessory is foldable and detachable.Conclusion: The low-cost of the accessory makes it affordable to many users intending to improve their quality of life. The current study provides an engineering perspective of the accessory, and a clinical perspective is crucial. Other potential applications of the wheelchair accessory include use with scooters, walkers and stretchers.Implications for rehabilitationLow-cost, low-tech accessory is foldable and detachable.Accessory is effective for pushing doors and pushing/gliding against obstacles.Protective nature of the front accessory could prove highly beneficial to some wheelchair users.

Longitudinal Outcomes Among Family Caregivers of Power Mobility Users

OBJECTIVE

To examine the change over 1 year in the burden, wheelchair skills, social support, social participation, and mental health of family caregivers providing assistance to older adult powered wheelchair users.

DESIGN

Longitudinal study.

SETTING

Community.

PARTICIPANTS

Participants (N=35) included family caregivers (mean age ± SD=63.7±10.2y) who provided at least 2 hours of general care per week for a powered wheelchair user.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The Power Mobility Caregiver Assistive Technology Outcome Measure (frequency of care and subjective burden), the Wheelchair Skills Test Questionnaire for caregivers (wheelchair skills), the Interpersonal Support Evaluation List-6 (social support), the Late-Life Function and Disability Instrument (social participation), the Hospital Anxiety and Depression Scale (mental health). Measures were taken at baseline, 1, 3, 6, and 12 months. Descriptive statistics were calculated, and a linear mixed model was used to assess changes over time in the outcomes.

RESULTS

The results showed that the caregivers helped on average with 3 powered wheelchair-related activities and 10 other caregiving activities. They also experienced moderate subjective burden and social participation and were within the normal range for depression and anxiety. Moreover, those outcomes remained stable over the 1-year study period. However, the wheelchair skills scores showed significant changes over time, as the scores improved during the first 6 months of the study.

CONCLUSION

Given that previous research indicated that subjective burden tends to decline over time among caregivers, the findings of stability in this study may reflect increasing needs among this population of caregivers, who may benefit from additional support and interventions. This would need further consideration.

Extent to Which Caregivers Enhance the Wheelchair Skills Capacity and Confidence of Power Wheelchair Users: A Cross-Sectional Study

OBJECTIVE

To test the hypothesis that caregivers enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and to describe the nature of that assistance.

DESIGN

Multicenter cross-sectional study.

SETTING

Rehabilitation centers and communities.

PARTICIPANTS

Participants (N=152) included caregivers (n=76) and wheelchair users (n=76).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Version 4.3 of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q). For each of the 30 individual skills, we recorded data about the wheelchair user alone and in combination (blended) with the caregiver.

RESULTS

The mean total WST capacity scores ± SD for the wheelchair users alone and blended were 78.1%±9.3% and 92.4%±6.1%, respectively, with a mean difference of 14.3%±8.7% (P<.0001). The mean WST-Q capacity scores ± SD were 77.0%±10.6% and 93.2%±6.4%, respectively, with a mean difference of 16.3%±9.8% (P<.0001). The mean WST-Q confidence scores ± SD were 75.5%±12.7% and 92.8%±6.8%, respectively, with a mean difference of 17.5%±11.7% (P<.0001). The mean differences corresponded to relative improvements of 18.3%, 21.0%, and 22.9%, respectively. The nature and benefits of the caregivers' assistance could be summarized in 7 themes (eg, caregiver provides verbal support [cueing, coaching, reporting about the environment]).

CONCLUSIONS

Caregivers significantly enhance the wheelchair skills capacity and confidence of the power wheelchair users to whom they provide assistance, and they do so in a variety of ways. These findings have significance for wheelchair skills assessment and training.

The effectiveness of various robotic technologies in assisting older adults

There is concern about the expanding size of the ageing population and burgeoning care costs for older adults. Robotic technology could assist older adults. In this study, the effectiveness of the robotic technologies is evaluated. A systematic literature review was undertaken of peer-reviewed literature. An initial set of 8533 studies was evaluated for relevance; these were reduced to a final subset of 58 studies finally subjected to analysis. This study categorised the problems encountered by older adults, identified robot types deployed to overcome them and derived a subjective effectiveness score. The most used and most effective robots were companion robots followed by telepresence robots. The findings imply positive effects of robotic technologies in helping elderly people's problems. Although robotic technologies could bring some innovation into aged care, more research is needed to design and develop robots to be of assistance and support elderly in having an independent lifestyle.

Modeling and Simulation of Two Wheelchair Accessories for Pushing Doors

Independent mobility is vital to individuals of all ages, and wheelchairs have proven to be great personal mobility devices. The tasks of opening and navigating through a door are trivial for healthy people, while the same tasks could be difficult for some wheelchair users. A wide range of intelligent wheelchair controllers and systems, robotic arms, or manipulator attachments integrated with wheelchairs have been developed for various applications, including manipulating door knobs. Unfortunately, the intelligent wheelchairs and robotic attachments are not widely available as commercial products. Therefore, the current manuscript presents the modeling and simulation of a novel but simple technology in the form of a passive wheelchair accessory (straight, arm-like with a single wheel, and arc-shaped with multiple wheels) for pushing doors open from a wheelchair. From the simulations using different wheel shapes and sizes, it was found that the arc-shaped accessory could push open the doors faster and with almost half the required force as compared to the arm-like accessory. Also, smaller spherical wheels were found to be best in terms of reaction forces on the wheels. Prototypes based on the arc-shaped accessory design will be manufactured and evaluated for pushing doors open and dodging or gliding other obstacles.

The order and priority of research and design method application within an assistive technology new product development process: a summative content analysis of 20 case studies

Summative content analysis was used to define methods and heuristics from each case study. The review process was in two parts: (1) A literature review to identify conventional research methods and (2) a summative content analysis of published case studies, based on the identified methods and heuristics to suggest an order and priority of where and when were used. Over 200 research and design methods and design heuristics were identified. From the review of the 20 case studies 42 were identified as being applied. The majority of methods and heuristics were applied in phase two, market choice. There appeared a disparity between the limited numbers of methods frequently used, under 10 within the 20 case studies, when hundreds were available. Implications for Rehabilitation The communication highlights a number of issues that have implication for those involved in assistive technology new product development: •The study defined over 200 well-established research and design methods and design heuristics that are available for use by those who specify and design assistive technology products, which provide a comprehensive reference list for practitioners in the field; •The review within the study suggests only a limited number of research and design methods are regularly used by industrial design focused assistive technology new product developers; and, •Debate is required within the practitioners working in this field to reflect on how a wider range of potentially more effective methods and heuristics may be incorporated into daily working practice.

Creating an inclusive mall environment with the PRECEDE-PROCEED model: a living lab case study

PURPOSE

Although public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The Rehabilitation Living Lab in the Mall is a unique, interdisciplinary, and multi-sectoral research project with an aim to transform a shopping complex in Montreal, Canada, into an inclusive environment optimizing the participation and social inclusion of all people.

METHODS

The PRECEDE-PROCEDE Model (PPM), a community-oriented and participatory planning model, was applied as a framework. The PPM is comprised of nine steps divided between planning, implementation, and evaluation.

RESULTS

The PPM is well suited as a framework for the development of an inclusive mall. Its ecological approach considers the environment, as well as the social and individual factors relating to mall users' needs and expectations. Transforming a mall to be more inclusive is a complex process involving many stakeholders. The PPM allows the synthesis of several sources of information, as well as the identification and prioritization of key issues to address. The PPM also helps to frame and drive the implementation and evaluate the components of the project.

CONCLUSION

This knowledge can help others interested in using the PPM to create similar enabling and inclusive environments world-wide. Implication for rehabilitation While public environments provide opportunities for participation and social inclusion, they are not always inclusive spaces and may not accommodate the wide diversity of people. The PRECEDE PROCEDE Model (PPM) is well suited as a framework for the development, implementation, and evaluation of an inclusive mall. Environmental barriers can negatively impact the rehabilitation process by impeding the restoration and augmentation of function. Removing barriers to social participation and independent living by improving inclusivity in the mall and other environments positively impacts the lives of people with disabilities.