A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design

Disabled-by-design: effects of inaccessible urban public spaces on users of mobility assistive devices - a systematic review

PURPOSE

Despite the increase of users of Mobility Assistive Devices (MobAD), there has been a lack of accessibility in urban environments in many parts of the world. We present a systematic review of how the inaccessible design of public spaces affects quality-of-life - including aspects of health and safety, independence, and social participation - of MobAD users.

MATERIALS AND METHODS

We conducted a literature search in three databases (i.e., Scopus, Web of Science, and PubMed) and initially discovered 3980 publications. We analysed 48 peer-reviewed journal articles published in English from 2005 to 2021 and assessed their quality of evidence via the Mixed Methods Appraisal Tool.

RESULTS

Findings indicated a substantial number of inaccessible elements for MobAD users in public spaces. Pathway characteristics, boarding ramps, entrance features, confined spaces, and service surfaces were deemed to be the least accessible elements. These barriers had multifaceted effects on MobAD users' quality of life with aspects of physical health, mobility, and use of public transport being most affected.

CONCLUSIONS

Notwithstanding that the reviewed studies mostly ocused on wheelchair users residing in high-income countries, this review outlines the critical role of the design of the built environment as a factor of disablement for MobAD users. We conclude by highlighting a few recommendations for future research and practice, especially inclusive approaches and adaptive techniques to assist MobAD users with performing tasks in public spaces independently.Implications for RehabilitationUsers of Mobility Assistive Devices experience a lack of accessibility provisions in public open spaces and buildings internationally.Physical barriers in public spaces substantially diminish the health and safety, autonomy, and social participation of users of Mobility Assistive Devices.There is a definite need for the adoption of inclusive strategies and adaptive techniques in placemaking processes so that users of Mobility Assistive Devices can have equitable access to public spaces.

Manual wheelchair downhill stability: an analysis of factors affecting tip probability

Background

For people who use manual wheelchairs, tips and falls can result in serious injuries including bone fractures, concussions, and traumatic brain injury. We aimed to characterize how wheelchair configuration changes (including on-the-fly adjustments), user variables, and usage conditions affected dynamic tip probability while rolling down a slope and contacting a small block.

Methods

Rigid body dynamic models of a manual wheelchair and test dummy were created using multi-body software (Madymo, TASS International, Livonia, MI), and validated with 189 experiments. Dynamic stability was assessed for a range of seat angles (0 to 20° below horizontal), backrest angles (0 to 20°), rear axle positions (0 to 20 cm from base of backrest), ground slopes (0 to 15°), bump heights (0 to 4 cm), wheelchair speeds (0 to 20 km/hr), user masses (50 to 115 kg), and user positions (0 to 10 cm from base of backrest). The tip classifications (forward tip, backward tip, rolled over bump, or stopped by bump) were investigated using a nominal logistic regression analysis.

Results

Faster wheelchair speeds significantly increased the probability of tipping either forward or backward rather than stopping, but also increased the probability of rolling over the bump (p < 0.001). When the rear axle was positioned forward, this increased the risk of a backward tip compared to all other outcomes (p < 0.001), but also reduced the probability of being stopped by the bump (p < 0.001 compared to forward tip, p < 0.02 compared to rolling over). Reclining the backrest reduced the probability of a forward tip compared to all other outcomes (p < 0.001), and lowering the seat increased the probability of either rolling over the bump or tipping backwards rather than tipping forward (p < 0.001). In general, the wheelchair rolled over bumps < 1.5 cm, and forwards tipping was avoided by reducing the speed to 1 km/hr.

Conclusions

The probability of forward tipping, corresponding to the greatest risk of injury, was significantly reduced for decreased speeds, smaller bumps, a reclined backrest, and a lower rear seat height. For wheelchairs with dynamic seating adjustability, when travelling downhill, on-the-fly adjustments to the seat or backrest can increase the likelihood of safely rolling over a bump.

Effects of ramp slope on physiological characteristic and performance time of healthy adults propelling and pushing wheelchairs

[Purpose] This study examined the effects of ramp slope (1:12, 1:10, 1:8, and 1:6) on physiological characteristics and performance times of wheelchair users and the performance times of caregivers to determine which slope would be the best for wheelchairs, in order to propose a ramp slope that incorporates a universal design. [Subjects and Methods] Twenty-four healthy subjects were enrolled in this study. Fifteen of these subjects also volunteered to participate as caregivers. A wooden ramp with an adjustable slope was constructed. As manual wheelchair users, the participants performed propulsion of a wheelchair up the ramp at a self-selected pace. Four ramp slopes (1:12, 1:10, 1:8, and 1:6) were used, and the participants sequentially ascended them in order from the gentlest to the steepest slope. The caregivers also pushed a wheelchair up the ramp at a self-selected pace. The blood pressure and pulse of participants after the ascent, as well as the performance times of the caregivers and manual wheelchair users, were measured on each of the different ramp slopes. The measured data, pulse, blood pressure, and performance time, were analyzed using repeated ANOVA. [Results] Systolic blood pressure was significantly higher after ascending the 1:6 slope than after ascending the 1:12 and 1:8 slopes. Diastolic blood pressure was significantly higher after ascending the 1:6 slope than after ascending the 1:12 and 1:8 slopes. The participants’ pulses tended to increase significantly with an increase in slope. An assessment of the propulsion performance times revealed significant differences among the slopes. [Conclusion] Considering the results of the wheelchair users and caregivers, the 1:12 and 1:10 slopes are suitable ramp slopes for wheelchairs.