A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services

PURPOSE

It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States.

MATERIALS AND METHODS

A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection.

RESULTS

A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with.

CONCLUSIONS

Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Implications for rehabilitationHighlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers.In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs.There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs.

In Situ Diagnosis of Industrial Motors by Using Vision-Based Smart Sensing Technology

This study uses machine vision, feature extraction, and support vector machine (SVM) to compose a vibration monitoring system (VMS) for an in situ evaluation of the performance of industrial motors. The vision-based system respectively offers a spatial and temporal resolution of 1.4 µm and 16.6 ms after the image calibration and the benchmark of a laser displacement sensor (LDS). The embedded program of machine vision has used zero-mean normalized correlation (ZNCC) and peak finding (PF) for tracking the registered characteristics on the object surface. The calibrated VMS provides time–displacement curves related to both horizontal and vertical directions, promising remote inspections of selected points without attaching additional markers or sensors. The experimental setup of the VMS is cost-effective and uncomplicated, supporting universal combinations between the imaging system and computational devices. The procedures of the proposed scheme are (1) setting up a digital camera, (2) calibrating the imaging system, (3) retrieving the data of image streaming, (4) executing the ZNCC criteria, and providing the time–displacement results of selected points. The experiment setup of the proposed VMS is straightforward and can cooperate with surveillances in industrial environments. The embedded program upgrades the functionality of the camera system from the events monitoring to remote measurement without the additional cost of attaching sensors on motors or targets. Edge nodes equipped with the image-tracking program serve as the physical layer and upload the extracted features to a cloud server via the wireless sensor network (WSN). The VMS can provide customized services under the architecture of the cyber–physical system (CPS), and this research offers an early warning alarm of the mechanical system before unexpected downtime. Based on the smart sensing technology, the in situ diagnosis of industrial motors given from the VMS enables preventative maintenance and contributes to the precision measurement of intelligent automation.

Real-Time Evaluation of the Mechanical Performance and Residual Life of a Notching Mold using Embedded PVDF Sensors and SVM Criteria

The geometric tolerance of notching machines used in the fabrication of components for induction motor stators and rotators is less than 50 µm. The blunt edges of worn molds can cause the edge of the sheet metal to form a burr, which can seriously impede assembly and reduce the efficiency of the resulting motor. The overuse of molds without sufficient maintenance leads to wasted sheet material, whereas excessive maintenance shortens the life of the punch/die plate. Diagnosing the mechanical performance of die molds requires extensive experience and fine-grained sensor data. In this study, we embedded polyvinylidene fluoride (PVDF) films within the mechanical mold of a notching machine to obtain direct measurements of the reaction forces imposed by the punch. We also developed an automated diagnosis program based on a support vector machine (SVM) to characterize the performance of the mechanical mold. The proposed cyber-physical system (CPS) facilitated the real-time monitoring of machinery for preventative maintenance as well as the implementation of early warning alarms. The cloud server used to gather mold-related data also generated data logs for managers. The hyperplane of the CPS-PVDF was calibrated using a variety of parameters pertaining to the edge characteristics of punches. Stereo-microscopy analysis of the punched workpiece verified that the accuracy of the fault classification was 97.6%.

Diagnostic X-ray facilities as per quality control performances in Tanzania

Without appropriate quality control (QC) and preventative maintenance (PM) measures for X-ray machines in place, the benefits of reduced dose to the patient and early diagnosis will not be realized. Quality control and PM also make it possible to unify X-ray-imaging practices in the country using international image quality guidelines. The impetus for the present work resulted from the concern that with the recent increase in the numbers of X-ray machines in Tanzania, but with limited technical support to maintain and operate them, can increase radiation risk to patients and lower diagnostic accuracy. The aim of this work is to report on the current status of diagnostic X-ray machines in Tanzania in order to produce the data needed to formulate QC and PM policies and strategies. These policies and strategies are needed to ensure that patients receive the lowest possible radiation risk and maximum health benefits from X-ray examinations. Four QC tests were performed on a total of 196 X-ray units. Accurate beam alignment and collimation were tested on 80 (41%) units, the timer accuracy was tested on 120 (61%) units, and a radiation leakage test was performed on 47(24%) units. Preventative maintenance tests were performed on all 196 X-ray units. The results showed that of the units tested for QC, 59% failed the kilovoltage (kVp) test, 57% failed the timer accuracy test, 60% failed the beam alignment test, and 20% failed the radiation leakage test. Only 13% of the units passed the PM test: 53% of the units were defective, and 34% were out of order. As a result of the PM findings, the government has introduced a rehabilitation project to service X-ray units and replace nonoperational X-ray units. The new units have full support service contracts signed by their suppliers. As a result of the QC findings, X-ray maintenance retraining programs have been introduced.

Preventative maintenance and unscheduled downtime from an economic perspective

A spreadsheet-based model for economically characterizing the operation of a radiation treatment program has been used to perform a quantitative financial analysis of scheduled and unscheduled downtime. The incremental cost of downtime is broken down into three categories: remuneration of in-house or third party service technologists, decreased patient capacity, and local operating procedures for dealing with downtime. Different service arrangements and operating procedures are simulated to demonstrate the financial cost of treatment machine unavailability due to either preventative maintenance or unexpected breakdown. Depending on the service arrangement and operating policies for accommodating downtime, the combined cost of scheduled and unscheduled downtime (at 5%) can exceed 10% of the total cost of the radiation treatment program. It has also been demonstrated that the greatest cost component of downtime is decreased patient capacity, which can exceed $400,000 (CAN) when unscheduled downtime reaches 5%. The interpretation of this cost depends on the funding environment. Although the emphasis of this study has been the financial consequences of downtime, there are other factors which must be considered when developing policies and procedures for accommodating downtime such as effects on treatment, patient convenience and quality of life for staff. Even though the numerical results are strictly valid only within the context of the simulations performed, they do provide a broad framework within which medical physicists can make recommendations regarding service support and downtime.