1
|
Nuri RP, Xu X, Aldersey HM. Users' satisfaction and experiences in using assistive devices distributed by a rehabilitation centre in Bangladesh: a cross-sectional study. Disabil Rehabil Assist Technol 2024; 19:868-877. [PMID: 36215415 DOI: 10.1080/17483107.2022.2129849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aimed to understand Bangladeshi users' satisfaction with their assistive devices, including (a) device characteristics, e.g., size, weight, safety, ease of use, comfort, and effectiveness, and (b) availability of parts and repair services. We also described how frequently individuals with disabilities living in the community used assistive devices in their daily activities and how the use of assistive devices promoted individuals' wellbeing. METHOD We conducted a cross-sectional survey with assistive device users or their guardians (if under 18) in Bangladesh about their experience and satisfaction with their assistive device 6 months after receiving it. The research team developed a survey questionnaire consisting of both closed and open-ended questions. All data were collected via telephone interviews. We employed descriptive statistics to analyse quantitative data and inductive analysis for the qualitative data. RESULTS We found that out of the 376 participants, nearly 95% used assistive devices on a regular basis, and their satisfaction with the devices was high. Participants reported that assistive devices improved mobility, independence, and wellbeing of persons with disabilities. A few participants (6.4%) reported that their devices were damaged. Some participants identified concerns with their assistive devices, including (i) inappropriate size of ankle-foot orthoses, manual self-propelled wheelchairs, and prostheses, (ii) back slabs (a type of brace) being too short, and (iii) walking frames being too large. Several participants noted pain and discomfort when they used their assistive device. Additionally, some participants stated that environmental factors (e.g., muddy roads) contributed to the disrepair of their assistive devices. Finally, participants recounted that repair services were limited in rural areas of Bangladesh. CONCLUSION These findings indicate that the provision of assistive devices requires accommodating individuals' needs and ensuring appropriate environments in which to function. The results support the need for follow-up services after distributing assistive devices. Further research could explore the impact of assistive devices on the family quality of life of persons with disabilities.IMPLICATIONS FOR REHABILITATIONIt is essential for rehabilitation professionals to conduct follow-up services after distributing assistive devices among persons with disabilities.There is a need for the government of Bangladesh to revisit the Rights and Protection of Persons with Disability Act of 2013 and provide further clarity about their commitment to the provision of assistive devices and associated services (e.g., repair services) and its subsequent implementation.Policymakers in Bangladesh must be proactive to translate policy commitments into practice, as it relates to building an accessible environment for people using assistive devices. Further, government efforts are needed to educate policy implementers in all relevant ministries so that all responsible bodies are fully familiar with their national and international commitments regarding the rights of persons with disabilities.Future research could (i) include user's satisfaction with the service delivery process and (ii) measure the impact of assistive devices on family quality of life of persons with disabilities.
Collapse
Affiliation(s)
| | - Xiaolin Xu
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | | |
Collapse
|
2
|
Lettre J, Routhier F, Giesbrecht EM, Choukou MA, Miller WC, Archambault PS. Clinical stakeholders' perspective for the integration of an immersive wheelchair simulator as a clinical tool for powered wheelchair training. Assist Technol 2023; 35:497-505. [PMID: 36701417 DOI: 10.1080/10400435.2022.2161669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/27/2023] Open
Abstract
This study aimed to investigate clinical stakeholders' acceptance of an immersive wheelchair simulator as a potential powered wheelchair skills training tool. Focus groups, conducted in four rehabilitation centers, were used to obtain a rich understanding of participants' experiences and beliefs. Then, a cross-sectional survey of the simulator acceptability for clinical practice was created. Twenty-three rehabilitation therapists and clinical program directors participated in the focus groups and thirty-three responded to the survey. Participants generally expressed that use of the simulator would be complementary to training in an actual powered wheelchair, and that it could be useful for challenging situations in rehabilitation centers (e.g. anxious clients; when there is uncertainty around their potential to drive a powered wheelchair; tasks that cannot be assessed in a real-life environment). They also provided suggestions to improve the simulator (e.g. more feedback during tasks; possibility of adjusting control settings such as speed and sensitivity; possibility of adding varied control interfaces). Feedback received from key stakeholders clearly indicated that the wheelchair simulator would be complementary to training provided in a real context of use. However, some important limitations must be addressed to improve the simulator and promote its adoption by clinical programs, therapists and clients.
Collapse
Affiliation(s)
- Josiane Lettre
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - François Routhier
- Center for interdisciplinary research in rehabilitation and social integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada
| | - Edward M Giesbrecht
- Department of Occupational Therapy, University of Manitoba, Winnipeg, MB, Canada
| | | | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Program and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Center for interdisciplinary research in rehabilitation of the greater Montreal, Centre intégré de santé et de services sociaux de Laval, Laval, QC, Canada
| |
Collapse
|
3
|
Lindström M, Bäckström AC, Henje C, Stenberg G. 'When I use the electric wheelchair, I can be myself' - real-life stories about occupational identity construction. Scand J Occup Ther 2023; 30:1368-1382. [PMID: 35786150 DOI: 10.1080/11038128.2022.2093268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self. AIM The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users. MATERIAL AND METHODS Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis. FINDINGS The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed. CONCLUSIONS AND SIGNIFICANCE Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.
Collapse
Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | - Ann-Charlotte Bäckström
- Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden
| | | | - Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
4
|
Rosen L, Plummer T, Sabet A, Lange ML, Livingstone R. RESNA position on the application of power mobility devices for pediatric users. Assist Technol 2023; 35:14-22. [PMID: 29232181 DOI: 10.1080/10400435.2017.1415575] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
This paper serves as an update to the previous RESNA Position on the Application of Power Wheelchairs for Pediatric Users with more current and additional scientific literature. This document contains typical clinical applications and best evidence from the literature supporting the application of power mobility (PM) for young children and to assist practitioners in decision-making and justification. It is RESNA' s position that age, limited vision or cognition, behavioral issues, and the ability to walk or propel a manual wheelchair short distances should not, in and of themselves, be used as discriminatory factors against providing PM for children. RESNA recommends early utilization of PM for children with mobility limitations as medically necessary, to promote integration and psycho-social development, reduce passive dependency, and to enhance participation, function, and independence.
Collapse
Affiliation(s)
- Lauren Rosen
- St. Joseph's Children's Hospital, Motion Analysis Center, Tampa, Florida, USA
| | | | - Andrina Sabet
- School of Health Sciences, Cleveland Clinic Children's Hospital for Rehabilitation, Cleveland State University, Cleveland, Ohio, USA
| | | | - Roslyn Livingstone
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Ouellet B, Best KL, Wilson D, Miller WC. Exploring the Influence of a Community-Based Peer-Led Wheelchair Skills Training on Satisfaction with Participation in Children and Adolescents with Cerebral Palsy and Spina Bifida: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11908. [PMID: 36231211 PMCID: PMC9564843 DOI: 10.3390/ijerph191911908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Peer-led approaches improve satisfaction with participation, wheelchair skills and wheelchair use self-efficacy in adults, but the evidence is limited in children. This pilot study aimed to explore the influence of community-based, peer-led, group wheelchair training program (i.e., Seating To Go) on satisfaction with participation (primary outcome), wheelchair skills, and wheelchair use self-efficacy in children and adolescents with cerebral palsy and spina bifida. METHODS A single group pre-post design was used. Invitations were shared online and diffused by clinicians and advocacy and provider groups to recruit a convenience sample of eight pediatric wheelchair users. Participants completed the Seating To Go program in groups that were facilitated by adult wheelchair users. Satisfaction with participation (Wheelchair Outcome Measure-Young People), wheelchair skills (Wheelchair Skills Test), wheelchair use self-efficacy (Wheelchair Use Confidence Scale), and perceived wheelchair skills capacity (Wheelchair Skills Test Questionnaire; proxy rating: parents) were evaluated before and after the Seating To Go program. Descriptive statistics and nonparametric longitudinal data analysis were conducted to explore changes in all outcomes from baseline to post-intervention. RESULTS Pediatric wheelchair users (ranging in age from 5 to 15 years) and their parents reported statistically significant improvements in satisfaction with participation. The improvements in wheelchair skills and wheelchair confidence were also statistically significant, but not the parents' perception of their children's wheelchair skills. CONCLUSIONS A community-based peer-led approach to wheelchair skills training seems promising for improving wheelchair outcomes in pediatric wheelchair users. Further controlled studies with larger samples are warranted.
Collapse
Affiliation(s)
- Béatrice Ouellet
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Krista L. Best
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire en Santé et en Services Sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC G1M 2S8, Canada
| | - Deb Wilson
- Seating To Go—Geneva Healthcare, Hamilton 3204, New Zealand
| | - William C. Miller
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, BC V6T 2B5, Canada
- G.F. Strong Rehabilitation Centre—Rehabilitation Research Lab, Vancouver, BC V5Z 2G9, Canada
| |
Collapse
|
6
|
Sivakanthan S, Candiotti JL, Sundaram AS, Duvall JA, Sergeant JJG, Cooper R, Satpute S, Turner RL, Cooper RA. Mini-review: Robotic wheelchair taxonomy and readiness. Neurosci Lett 2022; 772:136482. [PMID: 35104618 PMCID: PMC8887066 DOI: 10.1016/j.neulet.2022.136482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/05/2023]
Abstract
Robotic wheelchair research and development is a growing sector. This article introduces a robotic wheelchair taxonomy, and a readiness model supported by a mini-review. The taxonomy is constructed by power wheelchair and, mobile robot standards, the ICF and, PHAATE models. The mini-review of 2797 articles spanning 7 databases produced 205 articles and 4 review articles that matched inclusion/exclusion criteria. The review and analysis illuminate how innovations in robotic wheelchair research progressed and have been slow to translate into the marketplace.
Collapse
Affiliation(s)
- Sivashankar Sivakanthan
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Jorge L Candiotti
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Andrea S Sundaram
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Jonathan A Duvall
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | | | - Rosemarie Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Shantanu Satpute
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Science Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Human Engineering Research Laboratories, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA.
| |
Collapse
|
7
|
Whitford M, Mitchell SJ, Marzloff GE, Zindle JK, Richmond MA, Bogie KM, Henzel MK. Wheelchair Mobility-Related Injuries Due to Inadvertent Lower Extremity Displacement on Footplates: Analysis of the FDA MAUDE Database From 2014 to 2018. J Patient Saf 2021; 17:e1785-e1792. [PMID: 32217931 DOI: 10.1097/pts.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to assess reports of wheelchair mobility-related injuries from inadvertent lower extremity displacement (ILED) on footplates, which were submitted to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database during 2014-2018, characterize injury types, and evaluate MAUDE data quality. METHODS A systematic MAUDE database review was performed. Annual reports were searched using keywords: (a) "power wheelchair" and "injury" and (b) "mechanical (also known as manual) wheelchair" and "injury." Reports related to injuries from ILED on the footplate were reviewed. RESULTS Reports of 1075 wheelchair injuries were found across the review period. Twenty nine (3%) met our inclusion criteria. The most common source of reports was "manufacturer." The wheelchair was unavailable for evaluation in 55.17% of reports. Manufacturers' submission dates (number of days that passed after they were notified) ranged from 3 to 159. Reported injuries decreased by 60% from 2014 to 2018. The end user used a power wheelchair for all but one report. The most common injuries were single fractures, multiple fractures, wounds/cuts/infections, and amputations (in order of incidence). The most common mechanism was the foot slipping off the footplate during wheelchair mobility. CONCLUSIONS We observed inherent weaknesses in the MAUDE database reporting process and a concerning level of reporting bias. Although there were limited reports of injuries related to ILED on the footplate during wheelchair mobility, the injuries reported were significant. More standardized reporting of the mechanism and impact of these injuries is needed to better inform wheelchair design, prescription, and patient/family education.
Collapse
|
8
|
Bray N, Kolehmainen N, McAnuff J, Tanner L, Tuersley L, Beyer F, Grayston A, Wilson D, Edwards RT, Noyes J, Craig D. Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis. Health Technol Assess 2021; 24:1-194. [PMID: 33078704 DOI: 10.3310/hta24500] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown. OBJECTIVE The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years. REVIEW METHODS The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources. DATA SOURCES A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index™ (SSCI; Clarivate Analytics), Conference Proceedings Citation Index - Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index - Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019. RESULTS In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or ≥ 5 years. However, strong support was found that powered mobility interventions have a positive impact on children's movement and mobility, and moderate support was found for the impact on children's participation, play and social interactions and on the safety outcome of accidents and pain. 'Fit' between the child, the equipment and the environment was found to be important, as were the outcomes related to a child's independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is 'movement for movement's sake' and the latter destination-focused mobility. Powered mobility should be focused on 'movement for movement's sake' in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends £1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure. LIMITATIONS The original research question could not be answered because there was a lack of appropriately powered published research. CONCLUSIONS Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on 'movement for movement's sake'. FUTURE WORK Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility. STUDY REGISTRATION This study is registered as PROSPERO CRD42018096449. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Nathan Bray
- School of Health Sciences, Bangor University, Bangor, UK.,Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Niina Kolehmainen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer McAnuff
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lorna Tuersley
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Aimee Grayston
- Children's Services, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Dor Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rhiannon Tudor Edwards
- School of Health Sciences, Bangor University, Bangor, UK.,Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
9
|
Sebkhi N, Bhavsar A, Sahadat MN, Baldwin J, Walling E, Biniker A, Hoefnagel M, Tonuzi G, Osborne R, Anderson D, Inan O. Evaluation of a Head-Tongue Controller for Power Wheelchair Driving By People With Quadriplegia. IEEE Trans Biomed Eng 2021; 69:1302-1309. [PMID: 34529559 DOI: 10.1109/tbme.2021.3113291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The head-tongue controller (HTC) is a multimodal alternative controller designed for people with quadriplegia to access complex control capabilities by combining tongue and head tracking to offer both discrete and proportional controls in a single controller. In this human study, 17 patients with quadriplegia and current users of alternative controllers were asked to perform four trials of either simple driving tasks or advanced maneuvers in a custom-designed course. Completion time and accuracy were compared between their personal alternative controller (PAC) and various combinations of driving modalities with the HTC. Out of 8 subjects assigned to simple driving, the best HTC trial of 3 subjects was completed faster than their PAC for the tasks of rolling forward and turning around cones, and 5 subjects in rolling backward. Across all these subjects, the average completion time of their best HTC modality is 23s for rolling forward, 15s for rolling backward, and 70s for turning around cones as compared to 19s, 17s, and 45s with their PAC. For advanced driving, the course was completed faster with the HTC by 1 out of 9 subjects, while the best HTC trials of all subjects are less than 1.3 times of their best PAC completion time with an average of 170s for the HTC and 140s for their PAC. The qualitative feedback provided by all subjects to a post-study questionnaire scored to an average of 7.5 out of 10 which shows their interests in the HTC and acknowledgement of its usefulness for this population.
Collapse
|
10
|
Geers AM, Prinsen EC, van der Pijl DJ, Bergsma A, Rietman JS, Koopman BFJM. Head support in wheelchairs (scoping review): state-of-the-art and beyond. Disabil Rehabil Assist Technol 2021:1-24. [PMID: 34000206 DOI: 10.1080/17483107.2021.1892840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many wheelchair users experience disabilities in stabilising and positioning of the head. For these users, adequate head support is required. Although several types of head supports are available, further development of these systems is needed to improve functionality and quality of life, especially for the group of severely challenged users. For this group, user needs have not been clearly established. In this article, we provide an overview of the state-of-the-art in wheelchair mounted head supports and associated scientific evidence in order to identify requirements for the next generation of head support systems. MATERIALS AND METHODS A scoping review was performed including scientific literature (PubMed/Scopus), patents (Espacenet/Google Scholar) and commercial information. Types of head support and important system characteristics for future head support systems were proposed from consultations with wheelchair users (n = 3), occupational therapists (n = 3) and an expert panel. RESULTS Forty scientific papers, 90 patents and 80 descriptions of commercial devices were included in the scoping review. The identified head support systems were categorised per head support type. Only limited scientific clinical evidence with respect to the effectiveness of existing head support systems was found. From the user and expert consultations, a need was identified for personalised head support systems that intuitively combine changes in sitting and head position with continuous optimal support of the head to accommodate severely challenged users. CONCLUSIONS This study presents the state-of-the-art in head support systems. Additionally, several important system characteristics are introduced that provide guidance for the development and improvement of head supports.Implications for rehabilitationEspecially for the group of severely challenged wheelchair users, current head support systems require further development to improve their users' quality of life.The desired system characteristics which are discussed in this review are an important step in the definition of requirements for the next generation of head supports.
Collapse
Affiliation(s)
- Anoek M Geers
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands.,Focal Meditech B.V, Tilburg, The Netherlands
| | - Erik C Prinsen
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands.,Roessingh Research and Development, Enschede, The Netherlands
| | | | - Arjen Bergsma
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Johan S Rietman
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands.,Roessingh Research and Development, Enschede, The Netherlands.,Roessingh Centre of Rehabilitation, Enschede, The Netherlands
| | - Bart F J M Koopman
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| |
Collapse
|
11
|
Frank AO. Duchenne muscular dystrophy: assistive technology and preparing for employment. BMJ 2020; 368:m758. [PMID: 32111622 DOI: 10.1136/bmj.m758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Jiménez Arberas E, Ordoñez Fernández FF, Rodríguez Menéndez S. Psychosocial impact of mobility assistive technology on people with neurological conditions. Disabil Rehabil Assist Technol 2019; 16:465-471. [PMID: 31553255 DOI: 10.1080/17483107.2019.1648571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A wide range of products are available to assist mobility, and it is, therefore, of great importance to obtain empirical information regarding the expected impact of the use of these products based on outcome measures. People affected by neurological disorders often use products to assist mobility such as wheelchairs (both manual self-propelled wheelchairs and externally propelled chairs such as electric wheelchairs), walkers, walking sticks, etc. It is important to conduct an assessment of the psychosocial impact of these products on the lives of affected people. METHODS We performed this assessment using the Psychosocial Impact of Assistive Devices Scale (PIADS) and a socio-demographic questionnaire. RESULTS The results showed greater psychosocial benefits relating to the use of electric wheelchairs in comparison with walking sticks or manual, non-self-propelled chairs. Moreover, significant differences are present in the three subscales of the PIADS in relation to variables such as age, training in the use of assistive technology (AT) and funding. CONCLUSION Therefore, we conclude that the use of AT should be promoted among this group as a way to improve their adaptability, competency and self-esteem, and to reduce limits on participation deriving from the physical and contextual barriers faced by this collective.Implications for rehabilitationAmong the assessment of different mobility AT displaying a higher score in the three subscales of the PIADS amongst people using electric wheelchairs than among those using non-self-propelled manual wheelchairs. On the other hand, we found that the walker has a significant score only in the competence subscale. Canes, for example the stick 4-p is significant in the three subscales, or the walking cane in terms of competence. Despite the fact that crutches and walking sticks obtained the lowest score in this study.Not only the assessment is necessary, but also the adjustment of AT to the person who is going to use it, as well as some training on how to use it. Only 23.8% of the participants received training in the use of their main assistive device in this study.The results seem to indicate that for elder users, the score on adaptability with the AT is lower. That may result in future lines of research in usability and improving in terms of the needs of end-users and these AT since a high percentage of people with neurological conditions are elder people.The application of specific scales such as PIADS that helps to measure the use and capacity of the AT prescribed to patients with neurological disease provides more informed clinical reasoning.
Collapse
Affiliation(s)
- Estíbaliz Jiménez Arberas
- Facultad Padre Ossó (Center attached to the University of Oviedo), Degree in Occupational Therapy, Universidad de Oviedo, Oviedo, Spain
| | - Feliciano F Ordoñez Fernández
- Facultad Padre Ossó (Center attached to the University of Oviedo), Degree in Occupational Therapy, UNIR, Oviedo, Spain
| | - Sergio Rodríguez Menéndez
- Facultad Padre Ossó (Center attached to the University of Oviedo), Degree in Occupational Therapy, Universidad de Oviedo, Oviedo, Spain
| |
Collapse
|
13
|
Pousada García T, Loureiro JP, González BG, Nieto-Rivero L. Assistive technology based on client-centered for occupational performance in neuromuscular conditions. Medicine (Baltimore) 2019; 98:e15983. [PMID: 31232929 PMCID: PMC6636953 DOI: 10.1097/md.0000000000015983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Knowledge of the patient's own perception of functioning and dependence, and of environmental factors, is of significant value. The main goals of this study are (1) to obtain a general profile of the occupational performance of persons with neuromuscular disorders (NMD) and their needs related to that performance and (2) to determine the support resources (assistive technologies [AT], adjustment, and/or caregiver) required to improve or maintain their level of independence.This cross-sectional study involved 24 persons with NMD. The functional independence measure (FIM), the checklist of a home's accessibility level, and a specific questionnaire were administered.The sample included 14 women (58.3%) and 10 men (41.7%). A mean of 61.7 (standard deviation = 17.2) was obtained for FIM motor, over 91, indicating a moderate level of dependence. The AT most frequently used was a wheelchair (70.8%). Architectural barriers were detected in the majority of users' homes (87.5%).Concise assessment of the independence needs of people with NMD, according to their occupational performance, and prescription of resources to meet those needs are required. This procedure should be implemented in healthcare programs, including care to a caregiver.
Collapse
|
14
|
Alazem H, McCormick A, Nicholls SG, Vilé E, Adler R, Tibi G. Development of a robotic walker for individuals with cerebral palsy. Disabil Rehabil Assist Technol 2019; 15:643-651. [PMID: 31012754 DOI: 10.1080/17483107.2019.1604827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This study describes the first use of a robotic walker in youth and young adults with cerebral palsy (CP) Gross Motor Function Classification (GMFCS) IV.Methods: Semi-structured interviews were conducted before and after each robotic walker trial. Interviews were recorded, then transcribed and subjected to thematic analysis.Results: Five participants (4 male, 13-22 years of age) with quadriplegia secondary to CP were recruited. Four individuals with mixed tone quadriplegia GMFCS IV were able to independently walk with the device. One individual with significant dyskinesia was unable to utilize the device. The assessment team included two physiotherapists, an occupational therapist, a physiatrist and three engineers. Major themes related to physical and social impacts were identified. Some physical advantages include the ability to walk hands-free and promotion of physical fitness. Examples of physical barriers include limited harness design and large device size. Social advantages include increased independence and peer engagement. Finally, a social disadvantage identified was limited use on uneven terrains.Discussion: Suggestions for modifications for identified challenges and disadvantages include decreasing the size of the robotic walker, more harness designs, decreasing the force required to take an initial step, adding a joy stick for user control and creating a more versatile base that can be used on different terrains such as ice or baseball fields.Conclusion: Robotics holds great hope for individuals with CP where mobility options are limited. Physical and social advantages are evident. Recommendations for future improvement and studies of use in exercise and participation are provided.IMPLICATIONS FOR REHABILITATIONAs youth and young adults with cerebral palsy age, options for mobilization can become limited with challenges in placing them in a walking device due to size and numerous other physical limitations.A robotic walker with a built-in mechanical lift is available for individuals with cerebral palsy.This study was able to gather important information and recommendations to tailor a new robotic walker prototype specifically for individuals with cerebral palsy.
Collapse
Affiliation(s)
- Hana Alazem
- Division of Development and Rehabilitation, Children's Hospital of Eastern Ontario, The Ottawa Hospital Rehabilitation Centre, University of Ottawa, Ottawa, Canada
| | - Anna McCormick
- Division of Development and Rehabilitation, Children's Hospital of Eastern Ontario, The Ottawa Hospital Rehabilitation Centre, University of Ottawa, Ottawa, Canada
| | | | - Elizabeth Vilé
- Division of Development and Rehabilitation at the Children's Hospitals of Eastern Ontario, Ottawa Children's Treatment Centre, Ottawa, Canada
| | - Roselle Adler
- Division of Development and Rehabilitation at the Children's Hospitals of Eastern Ontario, Ottawa Children's Treatment Centre, Ottawa, Canada
| | - Genevieve Tibi
- Division of Development and Rehabilitation at the Children's Hospitals of Eastern Ontario, Ottawa Children's Treatment Centre, Ottawa, Canada
| |
Collapse
|
15
|
Goodwin J, Lecouturier J, Basu A, Colver A, Crombie S, Smith J, Howel D, McColl E, Parr JR, Kolehmainen N, Roberts A, Miller K, Cadwgan J. Standing frames for children with cerebral palsy: a mixed-methods feasibility study. Health Technol Assess 2019; 22:1-232. [PMID: 30234480 DOI: 10.3310/hta22500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Standing frames are recommended as part of postural management for young people with cerebral palsy (CP) Gross Motor Function Classification System (GMFCS) level IV or V. They may have a variety of benefits, including improving bone mineral density, gastrointestinal function and social participation. The NHS needs to know if these benefits are real, given the cost implications of use and the reported negative effects (e.g. pain). The lack of evidence for the clinical effectiveness of standing frames demonstrates the need for evaluative research. OBJECTIVE(S) The aim of the study was to explore the acceptability of a future trial to determine the clinical effectiveness of standing frames. DESIGN A sequential mixed-methods design was used. The findings of each stage informed the next stage. We conducted surveys, focus groups and in-depth interviews. PARTICIPANTS Professionals who work with young people who use standing frames and parents who have a child who uses a standing frame took part in a survey of current standing frame practice (n = 551), a series of focus groups (seven focus groups, 49 participants in total) and a survey of research trial acceptability and feasibility (n = 585). Twelve young people who use a standing frame were interviewed. RESULTS Standing frames were widely used as part of postural management for young people with CP both in school and at home but more frequently in school, and particularly by young people in primary school. Achieving the prescribed use was not always possible owing to resources, environment and family factors. Participation and activity engagement were important to young people. The majority of participants believed that standing frames research is necessary. Some reported concern that stopping standing frame use for a trial would cause irreversible damage. The maximum amount of time most health professionals and parents would agree to suspend standing frame use would be 12 weeks. LIMITATIONS Owing to the nature of recruitment, we could not calculate response rates or determine non-response bias. Therefore, participants may not be representative of all standing frame users. CONCLUSIONS Although parents and professionals who engaged in the qualitative aspect of this research and stakeholders who took part in the design workshops appreciated the lack of clinical evidence, our surveys, qualitative information and PPI demonstrated that most people had strong beliefs regarding the clinical effectiveness of standing frames. However, with key stakeholder engagement and careful planning, a trial would be acceptable. FUTURE WORK We recommend a carefully planned trial that includes a pilot phase. The trial should evaluate the following question: 'does using a standing frame in school improve patient-reported outcomes of participation (primary outcome), quality of life, subjective well-being, body function and body structure (secondary outcomes) in young children (aged 4-11 years) with CP GMFCS III-V?'. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Jane Goodwin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Allan Colver
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Crombie
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Sussex, UK
| | - Johanna Smith
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Niina Kolehmainen
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Keith Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Jill Cadwgan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| |
Collapse
|
16
|
Tesfaye R, Courchesne V, Yusuf A, Savion-Lemieux T, Singh I, Shikako-Thomas K, Mirenda P, Waddell C, Smith IM, Nicholas D, Szatmari P, Bennett T, Duku E, Georgiades S, Kerns C, Vaillancourt T, Zaidman-Zait A, Zwaigenbaum L, Elsabbagh M. Assuming ability of youth with autism: Synthesis of methods capturing the first-person perspectives of children and youth with disabilities. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1882-1896. [PMID: 30915852 PMCID: PMC6779014 DOI: 10.1177/1362361319831487] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most research regarding youth with autism spectrum disorder has not focused on their first-person perspectives providing limited insight into methodologies best suited to eliciting their voices. We conducted a synthesis of methods previously used to obtain the first-person perspectives of youth with various disabilities, which may be applicable to youth with autism spectrum disorder. Two-hundred and eighty-four articles met the inclusion criteria of our scoping review. We identified six distinct primary methods (questionnaires, interviews, group discussion, narratives, diaries, and art) expressed through four communication output modalities (language, sign language and gestures, writing, and images). A group of parents who have children with autism spectrum disorder were then presented with a synthesis of results. This parent consultation was used to build on approaches identified in the literature. Parents identified barriers that may be encountered during participant engagement and provided insights on how best to conduct first-person research with youth with autism spectrum disorder. Based on our findings, we present a novel methodological framework to capture the perspectives of youth with various communication and cognitive abilities, while highlighting family, youth, and expert contributions.
Collapse
|
17
|
Pituch E, Rushton PW, Ngo M, Heales J, Poulin Arguin A. Powerful or Powerless? Children's, Parents', and Occupational Therapists' Perceptions of Powered Mobility. Phys Occup Ther Pediatr 2019; 39:276-291. [PMID: 30204532 DOI: 10.1080/01942638.2018.1496964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: In Québec, Canada, the prevalence of children using powered mobility (PM) is not reflective of evidence supporting its use and for achieving developmental milestones. The aim of this study was to explore the perceptions of four key stakeholder groups in a metropolitan area regarding daily use, barriers, facilitators, and clinical practice associated with use of PM. Methods: Using convenience sampling, semi-structured qualitative interviews were conducted with children (n = 6), parents (n = 2), rehabilitation center occupational therapists (OTs; n = 4), and special needs school-based OTs (n = 6). Drawings were used as a supplemental data collection strategy with children. Interviews were audio recorded and transcribed verbatim to conduct thematic analysis. Results: Three overarching themes were identified: (1) "A sense of liberty, except…", highlighting environmental obstacles reducing social participation; (2) "A necessity, for better or for worse," covering benefits and drawbacks of PM; and (3) "First choice versus last resort," raising clinical differences related to provision, assessment, and training. Conclusions: Stakeholders' perceptions illustrated benefits of PM, yet use is contingent on the physical, institutional, and societal environments, leading stakeholders to feel both powerful and powerless as users, parents, or clinicians.
Collapse
Affiliation(s)
- Evelina Pituch
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | - Paula W Rushton
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | - Myriame Ngo
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | - Jessica Heales
- a School of Rehabilitation, Université de Montréal , Montreal , Quebec , Canada
| | | |
Collapse
|
18
|
Labbé D, Rushton PW, Mortenson WB, Demers L, Miller WC. Longitudinal Outcomes Among Family Caregivers of Power Mobility Users. Arch Phys Med Rehabil 2018; 100:656-662. [PMID: 30914119 DOI: 10.1016/j.apmr.2018.08.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/30/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Delphine Labbé
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada.
| | - Paula W Rushton
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada; CHU St-Justine Research Center, Montréal, Québec, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada
| | - Louise Demers
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada; Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Center, Vancouver, British Columbia, Canada
| |
Collapse
|
19
|
Kenyon LK, Jones M, Livingstone R, Breaux B, Tsotsoros J, Williams KM. Power mobility for children: a survey study of American and Canadian therapists' perspectives and practices. Dev Med Child Neurol 2018; 60:1018-1025. [PMID: 29956320 DOI: 10.1111/dmcn.13960] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
Abstract
AIM To explore the views and practices of paediatric occupational therapists and physical therapists in Canada and the USA regarding the implementation of power mobility for children with mobility limitations. METHOD This descriptive study utilized a web-based survey that included questions pertaining to therapists' decisions to trial and use power mobility, agreement or disagreement with statements developed from published practice considerations regarding power mobility, and the frequency of performing tasks related to power mobility prescription and training. RESULTS Most respondents reported that child characteristics (e.g. cognition, safety awareness) were important factors in decision-making about power mobility, whereas other child characteristics (e.g. communication abilities, age) were not as important. Family resources and home accessibility were also not considered important. The average age at which respondents considered power mobility for children was 2 years 3 months. The majority of respondents agreed with statements developed from published practice considerations and most frequently performed various power mobility tasks twice a year or less. INTERPRETATION Although most respondents appeared to have positive views regarding power mobility, few appeared to actively perform power mobility tasks in their practice. Resources to support therapists in the early introduction of power mobility may be beneficial. WHAT THIS PAPER ADDS Occupational and physical therapists positively view early introduction of power mobility for children with mobility limitations. Few therapists actively provide early power mobility experiences. Power mobility training and monitoring power mobility devices are important therapist roles.
Collapse
Affiliation(s)
- Lisa K Kenyon
- Grand Valley State University, Grand Rapids, MI, USA
| | - Maria Jones
- Oklahoma City University, Oklahoma City, OK, USA
| | | | | | - Jessica Tsotsoros
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | |
Collapse
|
20
|
Kenyon LK, Mortenson WB, Miller WC. 'Power in Mobility': parent and therapist perspectives of the experiences of children learning to use powered mobility. Dev Med Child Neurol 2018; 60:1012-1017. [PMID: 29777530 DOI: 10.1111/dmcn.13906] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to gain insights, from the perspectives of both parents and pediatric therapists, into the experiences of children learning to use a power mobility device. METHOD The purposive sample included 33 participants: 14 parents of children who were learning, or had learned, to use a power mobility device and 19 pediatric occupational therapists or physical therapists. Data were gathered face-to-face via seven focus groups consisting of either parents or therapists, and eight one-on-one interviews. Data were analyzed using the constant comparative method. RESULTS Three main themes were identified: (1) 'Power in mobility' described how learning to use powered mobility changed more than just a child's locomotor abilities; (2) 'There is no recipe' revealed how learning to use powered mobility occurred along an individualized continuum of skills that often unfolded over time in a cyclical process; (3) 'Emotional journey' explored how learning to use powered mobility was an emotionally charged undertaking for all those involved. INTERPRETATION Learning to use a power mobility device is a complex process that often requires perseverance and determination on the part of the child, family, and therapist. WHAT THIS PAPER ADDS Powered mobility use impacts more than just a child's locomotor abilities. Learning to use a power mobility device is a highly individualized process. Learning to use powered mobility may be an emotionally charged process.
Collapse
Affiliation(s)
- Lisa K Kenyon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - W Ben Mortenson
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William C Miller
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
21
|
Goodwin J, Lecouturier J, Crombie S, Smith J, Basu A, Colver A, Kolehmainen N, Parr JR, Howel D, McColl E, Roberts A, Miller K, Cadwgan J. Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy. Child Care Health Dev 2018; 44:203-211. [PMID: 29168216 DOI: 10.1111/cch.12540] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Although the rationale for standing frame use and the associated challenges have been described, little attention has been given to the users' experiences. The aim of the current study was to explore young people's positive and negative experiences, and attitudes regarding standing frame use. METHODS Framework analysis informed an open exploration of young people's opinions of standing frames. Using semistructured interviews, 12 young people with cerebral palsy (6 female) were interviewed, providing the data set for transcription and thematic analysis. FINDINGS The first theme "attitudes to standing frames" describes the young people's understanding of why they use standing frames. Although standing frames can be painful, some young people believe they should be endured to improve their body structure and function. There were mixed views about the impact standing frames have socially, with some young people feeling excluded from their peers, and others feeling as though standing frames helped them "fit in." Some young people are not offered a choice about how and when they use their standing frame. The second theme "challenges of standing frame use" highlights the issues with standing frame use such as manual handling, interference from siblings, and the lack of aesthetically pleasing standing frame designs. CONCLUSIONS Young people report benefits related to choice, pain relief, and participation but can also cause pain, discomfort, and reduced independence and participation. Healthcare professionals should have open, informative conversations about potential benefits and challenges of standing frames on all aspects of the young people's lives, including participation and activity.
Collapse
Affiliation(s)
- J Goodwin
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J Lecouturier
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - S Crombie
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Brighton, UK
| | - J Smith
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Basu
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A Colver
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - N Kolehmainen
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J R Parr
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Howel
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - E McColl
- Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK
| | - A Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - K Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - J Cadwgan
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.,Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust (Kings Health Partners), London, UK
| |
Collapse
|
22
|
Preliminary Results on Reducing the Workload of Assistive Vehicle Users: A Collaborative Driving Approach. Int J Soc Robot 2018. [DOI: 10.1007/s12369-018-0465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Candiotti J, Sundaram SA, Daveler B, Gebrosky B, Grindle G, Wang H, Cooper RA. Kinematics and Stability Analysis of a Novel Power Wheelchair When Traversing Architectural Barriers. Top Spinal Cord Inj Rehabil 2018; 23:110-119. [PMID: 29339887 DOI: 10.1310/sci2302-110] [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: 11/11/2022]
Abstract
Background: Electric-powered wheelchairs (EPWs) are essential devices for people with disabilities for mobility and quality of life. However, the design of common EPWs makes it challenging for users to overcome architectural barriers, such as curbs and steep ramps. Current EPWs lack stability, which may lead to tipping the EPW causing injury to the user. An alternative Mobility Enhancement Robotic Wheelchair (MEBot), designed at the Human Engineering Research Laboratories (HERL), was designed to improve the mobility of, and accessibility for, EPW users in a wide variety of indoor and outdoor environments. Seat height and seat inclination can be adjusted using pneumatic actuators connected to MEBot's 6 wheels. Method: This article discusses the design and development of MEBot, including its kinematics, stability margin, and calculation of the center of mass location when performing its mobility applications of curb climbing/descending and attitude control. Motion capture cameras recorded the seat angle and joint motion of the 6 wheel arms during the curb climbing/descending process. The center of mass location was recorded over a force plate for different footprint configurations. Results: Results showed that the area of the footprint changed with the location of the wheels during the curb climbing/descending and attitude control applications. The location of the center of mass moved ±30 mm when the user leaned sideways, and the seat roll and pitch angle were 0° and ±4.0°, respectively, during curb climbing and descending. Conclusion: Despite the user movement and seat angle change, MEBot maintained its stability as the center of mass remained over the wheelchair footprint when performing its mobility applications.
Collapse
Affiliation(s)
- Jorge Candiotti
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - S Andrea Sundaram
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brandon Daveler
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin Gebrosky
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Garrett Grindle
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hongwu Wang
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
24
|
Sprigle S, Johnson Taylor S. Data-mining analysis of the provision of mobility devices in the United States with emphasis on complex rehab technology. Assist Technol 2018; 31:141-146. [DOI: 10.1080/10400435.2017.1402391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, Georgia, USA
| | | |
Collapse
|
25
|
Torkia C, Ryan SE, Reid D, Boissy P, Lemay M, Routhier F, Contardo R, Woodhouse J, Archambault PS. Virtual community centre for power wheelchair training: Experience of children and clinicians. Disabil Rehabil Assist Technol 2017; 14:46-55. [PMID: 29092651 DOI: 10.1080/17483107.2017.1392622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Caryne Torkia
- a School of Physical and Occupational Therapy , McGill University , Montreal , Canada
| | - Stephen E Ryan
- b Holland Bloorview Kids Rehabilitation Hospital , Bloorview Research Institute , Toronto , Ontario , Canada
| | - Denise Reid
- c Department of Occupational Therapy and Graduate Department of Rehabilitation Science , University of Toronto , Toronto , Ontario , Canada
| | - Patrick Boissy
- d Research Centre on Aging , CSS-IUGS , Sherbrooke , Quebec , Canada.,e Department of Surgery , Sherbrooke University , Sherbrooke , Quebec , Canada
| | - Martin Lemay
- f Marie Enfant Rehabilitation Centre , Montreal , Canada
| | - François Routhier
- g Centre for Interdisciplinary Research in Rehabilitation and Social Integration , Institut de réadaptation en déficience physique de Quebec , Quebec , Quebec , Canada
| | - Resi Contardo
- f Marie Enfant Rehabilitation Centre , Montreal , Canada
| | - Janet Woodhouse
- h Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Canada
| | - Phillipe S Archambault
- a School of Physical and Occupational Therapy , McGill University , Montreal , Canada.,i Centre for Interdisciplinary Research in Rehabilitation , Jewish Rehabilitation Hospital , Laval , Quebec , Canada
| |
Collapse
|
26
|
Elboim-Gabyzon M, Atun-Einy O, Khoury-assaf I. RETRACTED ARTICLE: Early Use of Power Wheelchair for Children with Duchenne Muscular Dystrophy: A Narrative Review. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2016.1194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michal Elboim-Gabyzon
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Osnat Atun-Einy
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Insaf Khoury-assaf
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
27
|
Frank AO, De Souza LH. Clinical features of children and adults with a muscular dystrophy using powered indoor/outdoor wheelchairs: disease features, comorbidities and complications of disability . Disabil Rehabil 2017; 40:1007-1013. [PMID: 28338349 DOI: 10.1080/09638288.2017.1292322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe the clinical features of electric powered indoor/outdoor wheelchair users with a muscular dystrophy, likely to influence optimal prescription; reflecting features of muscular dystrophies, conditions secondary to disability, and comorbidities impacting on equipment provision. METHODS Cross-sectional retrospective case note review of recipients of electric powered indoor/outdoor wheelchairs provided by a specialist regional wheelchair service. Data on demography, diagnostic/clinical, and wheelchair prescription were systematically extracted. RESULTS Fifty-one men and 14 women, mean age 23.7 (range 10-67, s.d. 12.95) years, were studied. Forty had Duchenne muscular dystrophy, 22 had other forms of muscular dystrophy, and three were unclassified. Twenty-seven were aged under 19. Notable clinical features included problematic pain (10), cardiomyopathy (5), and ventilatory failure (4). Features related to disability were (kypho)scoliosis (20) and edema/cellulitis (3) whilst comorbidities included back pain (5). Comparison of younger with older users revealed younger users had more features of muscular dystrophy affecting electric powered chair provision (56%) whilst older users had more comorbidity (37%). Tilt-in-space was prescribed for 81% of users, specialized seating for 55% and complex controls for 16%. CONCLUSIONS Muscular dystrophy users were prescribed electric powered indoor/outdoor chairs with many additional features reflecting the consequences of profound muscle weakness. In addition to facilitating independence and participation, electric powered indoor/outdoor chairs have major therapeutic benefits. Implications for rehabilitation Powered wheelchairs have therapeutic benefits in managing muscular dystrophy pain and weakness. The use of specialized seating needs careful consideration in supporting progressive muscle weakness and the management of scoliosis. Pain, discomfort, pressure risk, and muscle fatigue may be reduced by use of tilt-in-space.
Collapse
Affiliation(s)
- Andrew Oliver Frank
- a Stanmore Specialist Wheelchair Service, Royal National Orthopaedic Hospital Stanmore , Middlesex , UK.,b The Institute of Environment, Health and Societies, Brunel University London , Middlesex , UK
| | - Lorraine H De Souza
- b The Institute of Environment, Health and Societies, Brunel University London , Middlesex , UK
| |
Collapse
|
28
|
Frank AO, De Souza LH. Problematic clinical features of children and adults with cerebral palsy who use electric powered indoor/outdoor wheelchairs: A cross-sectional study. Assist Technol 2016; 29:68-75. [DOI: 10.1080/10400435.2016.1201873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Andrew O. Frank
- Stanmore Specialist Wheelchair Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK (since disbanded)
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| | - Lorraine H. De Souza
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, Middlesex, UK
| |
Collapse
|
29
|
Frank A. Neuromuscular conditions for physicians - what you need to know. Clin Med (Lond) 2016; 16:496. [PMID: 27697821 PMCID: PMC6297295 DOI: 10.7861/clinmedicine.16-5-496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew Frank
- Vocational Rehabilitation Association and visiting professor, Brunel University London, UK
| |
Collapse
|
30
|
McCourt E, Casey J. Electrically powered indoor/outdoor chair performance for children aged 7 to 9 years. Br J Occup Ther 2016. [DOI: 10.1177/0308022616636405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Northern Ireland wheelchair guidelines state that wheelchair users who wish to drive their National Health Service provided powered wheelchairs outdoors must complete an electrically powered indoor/outdoor chair test. Within the same guidelines, children in Northern Ireland under the age of 10 years are not permitted to complete this assessment. Research was completed to evaluate how children under 10 years would perform in electrically powered indoor/outdoor chair training and testing under adult supervision. Method A case-study design was utilised with three children aged 7–9 years to evaluate if: (a) these children can complete electrically powered indoor/outdoor chair training/testing safely with adult supervision; (b) the length of time using an electric powered indoor chair correlates with performance on electrically powered indoor chair training/testing; (c) the current Northern Ireland guidelines on age restriction should be re-evaluated so that each child is assessed on an individual basis rather than age. Findings Paediatric powered wheelchair users aged seven to nine years can become competent electrically powered indoor/outdoor chair users with adequate training and adult supervision. Length of time (years) driving an electrically powered indoor chair may not correlate with improved electrically powered indoor/outdoor chair performance. Conclusion Regional Northern Ireland criteria relating to electrically powered indoor/outdoor chair provision for children should be revised in order to consider an individual needs assessment, rather than imposing an age restriction.
Collapse
Affiliation(s)
- Eileen McCourt
- Clinical Lead Occupational Therapist (Wheelchairs), Belfast Health and Social Care Trust, Belfast, UK
| | - Jackie Casey
- Lecturer in Occupational Therapy, School of Health Sciences, Ulster University, Newtownabbey, UK
| |
Collapse
|
31
|
Archambault PS, Blackburn É, Reid D, Routhier F, Miller WC. Development and user validation of driving tasks for a power wheelchair simulator. Disabil Rehabil 2016; 39:1549-1556. [DOI: 10.1080/09638288.2016.1226423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Philippe S. Archambault
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Émilie Blackburn
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Denise Reid
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - François Routhier
- Department of Rehabilitation, Université Laval, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Center intégré de santé et de services sociaux de la Capitale-Nationale, Montreal, Quebec, Canada
| | - William C. Miller
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
32
|
De Souza LH, Frank AO. Rare diseases: matching wheelchair users with rare metabolic, neuromuscular or neurological disorders to electric powered indoor/outdoor wheelchairs (EPIOCs). Disabil Rehabil 2016; 38:1547-56. [PMID: 26714619 PMCID: PMC4926775 DOI: 10.3109/09638288.2015.1106599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe the clinical features of electric powered indoor/outdoor wheelchair (EPIOC) users with rare diseases (RD) impacting on EPIOC provision and seating. METHOD Retrospective review by a consultant in rehabilitation medicine of electronic and case note records of EPIOC recipients with RDs attending a specialist wheelchair service between June 2007 and September 2008. Data were systematically extracted, entered into a database and analysed under three themes; demographic, diagnostic/clinical (including comorbidity and associated clinical features (ACFs) of the illness/disability) and wheelchair factors. RESULTS Fifty-four (27 male) EPIOC users, mean age 37.3 (SD 18.6, range 11-70) with RDs were identified and reviewed a mean of 64 (range 0-131) months after receiving their wheelchair. Diagnoses included 27 types of RDs including Friedreich's ataxia, motor neurone disease, osteogenesis imperfecta, arthrogryposis, cerebellar syndromes and others. Nineteen users had between them 36 comorbidities and 30 users had 44 ACFs likely to influence the prescription. Tilt-in-space was provided to 34 (63%) users and specialised seating to 17 (31%). Four users had between them complex control or interfacing issues. CONCLUSIONS The complex and diverse clinical problems of those with RDs present unique challenges to the multiprofessional wheelchair team to maintain successful independent mobility and community living. Implications for Rehabilitation Powered mobility is a major therapeutic tool for those with rare diseases enhancing independence, participation, reducing pain and other clinical features. The challenge for rehabilitation professionals is reconciling the physical disabilities with the individual's need for function and participation whilst allowing for disease progression and/or growth. Powered wheelchair users with rare diseases with a (kypho) scoliosis require a wheelchair system that balances spine stability and movement to maximise residual upper limb and trunk function. The role of specialised seating needs careful consideration in supporting joint derangements and preventing complications such as pressure sores.
Collapse
Affiliation(s)
- Lorraine H. De Souza
- Centre for Research in Rehabilitation, College of Health and Life Sciences, Mary Seacole Building, Brunel University London, Uxbridge,
Middlesex,
UK
| | - Andrew O. Frank
- Centre for Research in Rehabilitation, College of Health and Life Sciences, Mary Seacole Building, Brunel University London, Uxbridge,
Middlesex,
UK
- Stanmore Specialist Wheelchair Service, Royal National Orthopaedic Hospital,
Brockley Hill,
Stanmore,
UK (Frank)
| |
Collapse
|
33
|
Bray N, Yeo ST, Noyes J, Harris N, Edwards RT. Prioritising wheelchair services for children: a pilot discrete choice experiment to understand how child wheelchair users and their parents prioritise different attributes of wheelchair services. Pilot Feasibility Stud 2016; 2:32. [PMID: 27965851 PMCID: PMC5154007 DOI: 10.1186/s40814-016-0074-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 06/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 95 million children worldwide are disabled; 10 % use a wheelchair. In the UK, an estimated 770,000 children are disabled. National Health Service Wheelchair Services are the largest provider of wheelchairs in the UK; however, recent reports have highlighted issues with these services. This study explores the use of discrete choice experiment methods to inform wheelchair service provision for disabled children based on service user preferences. The aim was to explore how disabled children and their parents prioritise different attributes of wheelchair services. The secondary aims were to compare priorities between parents and disabled children and to explore marginal rate of substitution for incremental changes in attributes. Methods Discrete choice experiments are a method of attribute-based stated preference valuation used by health economists to understand how individuals prioritise different attributes of healthcare services and treatments. We conducted the first pilot discrete choice experiment to explore how disabled children (aged 11 to 18) and their parents prioritise different attributes of hypothetical wheelchair services. Eleven disabled children (aged 11 to 18) and 30 parents of disabled children completed eight pairwise choice tasks based on five service attributes: wheelchair assessment, cost contribution, training, delivery time and frequency of review. Data were analysed using conditional logistic regression. For each pairwise choice, the participants were asked to choose which service scenario (A or B) they preferred. Results Comprehensiveness of wheelchair assessment and wheelchair delivery time significantly (P < 0.05) affected service preferences of children (β-coefficients = 1.43 [95 % bootstrapped CI = 1.42 to 2.08] and −0.92 [95 % bootstrapped CI = −1.41 to −0.84], respectively) and parents (β-coefficients = 1.53 [95 % bootstrapped CI = 1.45 to 2.16] and −1.37 [95 % bootstrapped CI = −1.99 to −1.31], respectively). Parents were willing to contribute more financially to receive preferred services, although this was non-significant. Conclusions Both samples placed the greatest importance on holistic wheelchair assessments encompassing more than health. The National Health Service should consider using discrete choice experiment methods to examine wheelchair service preferences of disabled children (aged 11 and over) and their parents on a wider scale; however, care must be taken to ensure that this method is used appropriately. Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0074-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nathan Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Neuadd Ogwen, Bangor, Gwynedd LL57 2DG UK
| | - Nigel Harris
- DesignAbility, Bath Institute of Medical Engineering, The Wolfson Centre, Royal United Hospital, Bath, BA1 3NG UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy, Normal Site, Bangor, Gwynedd LL57 2PZ UK
| |
Collapse
|
34
|
Frank A. Vocational Rehabilitation: Supporting Ill or Disabled Individuals in (to) Work: A UK Perspective. Healthcare (Basel) 2016; 4:E46. [PMID: 27438864 PMCID: PMC5041047 DOI: 10.3390/healthcare4030046] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 11/17/2022] Open
Abstract
Work is important for one's self-esteem, social standing and ability to participate in the community as well as for the material advantages it brings to individuals and their families. The evidence suggests that the benefits of employment outweigh the risks of work and are greater than the risks of long-term unemployment or sickness absence. Individuals may be born with physical or intellectual disadvantages (e.g., cerebral palsy), or they may be acquired during childhood or adult life. Some progressive conditions may present in childhood or adolescence (e.g., some muscular dystrophies) and these need to be distinguished from those presenting later in life (e.g., trauma, stroke). Vocational rehabilitation (VR) thus takes three forms: preparing those with a disability, health or mental health condition for the world of work, job retention for those in work and assisting those out of work into new work. Important components of VR consist of the attributes of the individual, the skills/knowledge of their health professionals, the knowledge and attitudes of actual or potential employers and the assistance that is provided by the state or other insurance facility. Charities are playing an increasing role.
Collapse
Affiliation(s)
- Andrew Frank
- Vocational Rehabilitation Association, 42 The Croft, High Barnet, Herts EN5 2TL, UK.
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Middlesex, UB8 3PH, UK.
| |
Collapse
|
35
|
Pousada García T, Groba González B, Nieto Rivero L, Pereira Loureiro J, Díez Villoria E, Pazos Sierra A. Exploring the Psychosocial Impact of Wheelchair and Contextual Factors on Quality of Life of People with Neuromuscular Disorders. Assist Technol 2016; 27:246-56. [PMID: 26186427 DOI: 10.1080/10400435.2015.1045996] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Neuromuscular disorders (NMDs) are a group of heterogeneous diseases that show differences in incidence, hereditary, etiology, prognosis, or functional impairments. Wheelchair use (manual or powered) is influenced by several factors, including personal and contextual factors, and comprehensive evaluation of their impact is required in order to optimize prescription and provision of wheelchairs. The authors therefore assessed the influence of wheelchair use on the quality of life (QoL) of 60 participants with NMD using the Psychosocial Impact of Assistive Devices Scale (PIADS). The Functional Independence Measure (FIM) and a specially developed questionnaire were used to obtain information about contextual factors and participants' activity profile of activities of the participants. The results showed that using a wheelchair has psychosocial benefits, with the main determinants of benefit being type of wheelchair (powered), non-ambulation ability, and independence in mobility. Ensuring a good match between user and assistive technology (AT; e.g., wheelchair), as well as the effectiveness of the particular device, will increase the likelihood that the user will adopt it and use it effectively in daily life. Clinical prescription of AT would be improved by making appropriate use of outcome measures.
Collapse
Affiliation(s)
- Thais Pousada García
- a Faculty of Health Science , University of A Coruña, As Xuvias , Coruña , Spain
| | | | - Laura Nieto Rivero
- a Faculty of Health Science , University of A Coruña, As Xuvias , Coruña , Spain
| | | | - Emiliano Díez Villoria
- b Instituto Universitario de Integración en la Comunidad (INICO) , University of Salamanca , Salamanca , Spain
| | | |
Collapse
|
36
|
Lindsay S. Child and youth experiences and perspectives of cerebral palsy: a qualitative systematic review. Child Care Health Dev 2016; 42:153-75. [PMID: 26754030 DOI: 10.1111/cch.12309] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/30/2015] [Accepted: 10/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is one of the most common causes of physical disability in childhood, and many children with CP access rehabilitation services throughout their lives. The aim of this qualitative systematic review was to synthesize the experiences and perspectives of youth living with CP to inform the development of rehabilitation and social programmes. METHODS A thematic qualitative synthesis integrating qualitative evidence was undertaken where six electronic databases (MEDLINE, Embase, Healthstar, Cumulative Index to Nursing and Allied Health Literature, Proquest and PsychInfo) were searched from 1980 to September 2014. RESULTS Thirty-three articles involving 390 youth, aged from 2 to 25 years, across six countries were included. Themes were classified according to the International Classification of Functioning Child and Youth Version framework. Youth's accounts focused on social inclusion and the physical environment (i.e. services and supports, transportation, accessibility, accommodations, safety and weather), the role of family and peers and participation (i.e. leisure and recreation, school and civic engagement). Youth described how body structure and function (i.e. pain and physical functioning, mental health, fatigue and unpredictability of body function) affected them - often disrupting their biographies. Some youth described personal factors such as independence, coping and body image that affected their ability to cope with their condition. There was much less focus on youth's experiences of mobility, activities of daily living and assistive devices. CONCLUSIONS Youth with CP experience pain, fatigue and impairments to body function, along with social exclusion, which can affect their biographies. However, youth had strategies to revise their biographies to maintain personal and social normalcy.
Collapse
Affiliation(s)
- S Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
37
|
Candiotti J, Wang H, Chung CS, Kamaraj DC, Grindle GG, Shino M, Cooper RA. Design and evaluation of a seat orientation controller during uneven terrain driving. Med Eng Phys 2016; 38:241-7. [PMID: 26774421 DOI: 10.1016/j.medengphy.2015.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 12/08/2015] [Accepted: 12/19/2015] [Indexed: 11/28/2022]
Abstract
Electric powered wheelchairs (EPWs) are essential devices for people with disabilities as aids for mobility and quality of life improvement. However, the design of currently available common EPWs is still limited and makes it challenging for the users to drive in both indoor and outdoor environments such as uneven surfaces, steep hills, or cross slopes, making EPWs susceptible to loss of stability and at risk for falls. An alternative wheel-legged robotic wheelchair, "MEBot", was designed to improve the safety and mobility of EPW users in both indoor and outdoor environments. MEBot is able to elevate its six wheels using pneumatic actuators, as well to detect changes in the seat angle using a gyroscope and accelerometer. This capability enables MEBot to provide sensing for a dynamic self-leveling seat application that can maintain the center of mass within the boundaries of the wheelchair, thereby, improving EPW safety. To verify the effectiveness of the application, MEBot was tested on a motion platform with six degrees of freedom to simulate different slopes that could be experienced by the EPW in outdoor environments. The results demonstrate the robustness of the application to maintain the wheelchair seat in a horizontal reference against changes in the ground angle.
Collapse
Affiliation(s)
- Jorge Candiotti
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Hongwu Wang
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Cheng-Shiu Chung
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Deepan C Kamaraj
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Garrett G Grindle
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States
| | - Motoki Shino
- Department of Mechanical Engineering, University of Tokyo, Japan
| | - Rory A Cooper
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, United States .
| |
Collapse
|
38
|
Livingstone R, Field D. The child and family experience of power mobility: a qualitative synthesis. Dev Med Child Neurol 2015; 57:317-27. [PMID: 25403793 DOI: 10.1111/dmcn.12633] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2014] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to critically synthesize qualitative evidence regarding the child and family experience of power mobility, and to examine how this evidence fits with current theoretical concepts. METHOD Electronic database/hand searches were undertaken in September 2012 and updated in February 2014. The searches were restricted to qualitative studies published in English before February 2014 that included at least one child under the age of 19 with a disability and described an outcome related to the use of power mobility. Inclusion criteria were set a priori. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. McMaster qualitative review forms were used for quality appraisal. RESULTS Of 259 titles, 21 met inclusion criteria. From 143 codes, 15 second-order themes were developed using constant comparison and analysis. Three overarching themes emerged: power mobility experience promotes developmental change and independent mobility; power mobility enhances social relationships and engagement in meaningful life experiences; and power mobility access and use is influenced by factors in the physical, social, and attitudinal environment. INTERPRETATION This qualitative research provides rich and rigorous evidence supporting the benefits of power mobility for children and families. Numerous factors, which warrant careful consideration, influence power mobility access and use.
Collapse
|
39
|
Daveler B, Salatin B, Grindle GG, Candiotti J, Wang H, Cooper RA. Participatory design and validation of mobility enhancement robotic wheelchair. ACTA ACUST UNITED AC 2015; 52:739-50. [DOI: 10.1682/jrrd.2014.11.0278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/20/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Brandon Daveler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; and
| | - Benjamin Salatin
- Department of Physical Medicine and Rehabilitation Assistive Technology, Hunter Holmes McGuire VA Medical Center, Richmond, VA
| | - Garrett G. Grindle
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; and
| | - Jorge Candiotti
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; and
| | - Hongwu Wang
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; and
| | - Rory A. Cooper
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; and
| |
Collapse
|
40
|
Lee J, Lim JK, Lee MJ, Jo YS, Park JS, Kim JM, Kim SK. Necessity to Develop a Tool to Evaluate Activity of Daily Living for Electric Powered Indoor/Outdoor Chair Users. Ann Rehabil Med 2015; 39:277-84. [PMID: 25932425 PMCID: PMC4414975 DOI: 10.5535/arm.2015.39.2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/11/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jiwon Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Jae Kuk Lim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Min Jun Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Yoon-Sik Jo
- Department of Neurology, Konkuk University School of Medicine, Chungju, Korea
| | - Jae Sung Park
- Department of Neurosurgery, Konkuk University School of Medicine, Chungju, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea
| | - Shin Kyoung Kim
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Chungju, Korea
| |
Collapse
|
41
|
De Souza LH, Frank AO. Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis. Disabil Rehabil 2014; 37:990-6. [PMID: 25109500 DOI: 10.3109/09638288.2014.949356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. METHOD Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. RESULTS Records of 28 men mean age 57 (range 37-78, SD 12) years and 63 women mean age 57 (range 35-81, SD 11) years with MS were reviewed a mean of 64 (range 0-131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. CONCLUSIONS Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions. IMPLICATIONS FOR REHABILITATION People with multiple sclerosis (MS), referred for an EPIOC, require a full clinical assessment to identify problematic clinical features that are potentially treatable and/or can be accommodated through specialised seating and tilt. The beneficial effects of TIS should be considered for all EPIOC users with MS and particularly for those with comorbidity Poorly controlled spasticity, when identified in people with MS, should be managed through positioning in the chair, pressure-relieving cushion and referral for medical management.
Collapse
Affiliation(s)
- Lorraine H De Souza
- Centre for Research in Rehabilitation, School of Health Science and Social Care, Brunel University , Uxbridge, Middlesex , UK and
| | | |
Collapse
|
42
|
Bray N, Noyes J, Edwards RT, Harris N. Wheelchair interventions, services and provision for disabled children: a mixed-method systematic review and conceptual framework. BMC Health Serv Res 2014; 14:309. [PMID: 25034517 PMCID: PMC4110242 DOI: 10.1186/1472-6963-14-309] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background Wheelchairs for disabled children (≤18 years) can provide health, developmental and social benefits. World Health Organisation and United Kingdom Government reports demonstrate the need for improved access to wheelchairs both locally and internationally. The use of health economics within this field is lacking. Provision of wheelchairs based on cost-effectiveness evidence is not currently possible. We conducted the first systematic review in this field to incorporate evidence of effectiveness, service user perspectives, policy intentions and cost-effectiveness in order to develop a conceptual framework to inform future research and service development. Methods We used an adapted EPPI-Centre mixed-method systematic review design with narrative summary, thematic and narrative synthesis. 11 databases were searched. Studies were appraised for quality using one of seven appropriate tools. A conceptual framework was developed from synthesised evidence. Results 22 studies and 14 policies/guidelines were included. Powered wheelchairs appear to offer benefits in reduced need for caregiver assistance; improved communicative, personal-social and cognitive development; and improved mobility function and independent movement. From 14 months of age children can learn some degree of powered wheelchair driving competence. However, effectiveness evidence was limited and low quality. Children and parents placed emphasis on improving social skill and independence. Participation in wider society and development of meaningful relationships were key desired outcomes. Policy intentions and aspirations are in line with the perspectives of children and parents, although translation of policy recommendations into practice is lacking. Conclusions There is a distinct lack of high quality effectiveness and economic evidence in this field. Social and health needs should be seen as equally important when assessing the mobility needs of disabled children. Disabled children and parents placed highest priority on independence and psychosocial outcomes of wheelchair interventions. Translation of policy and guidelines into practice is lacking and more effective implementation strategies are required to improve services and outcomes. Future research should focus on outcome measure development, developing economic evaluation tools and incorporating these into high quality studies to address known research gaps. The novel conceptual framework maps current gaps in evidence and outlines areas for development.
Collapse
Affiliation(s)
- Nathan Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Ardudwy Building, Normal Site, Bangor University, Bangor, Gwynedd LL57 2PZ, UK.
| | | | | | | |
Collapse
|
43
|
Torkia C, Reid D, Korner-Bitensky N, Kairy D, Rushton PW, Demers L, Archambault PS. Power wheelchair driving challenges in the community: a users' perspective. Disabil Rehabil Assist Technol 2014; 10:211-5. [PMID: 24640944 DOI: 10.3109/17483107.2014.898159] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
Collapse
Affiliation(s)
- Caryne Torkia
- School of Physical and Occupational Therapy, McGill University , Montreal, Quebec , Canada
| | | | | | | | | | | | | |
Collapse
|
44
|
Livingstone R, Paleg G. Practice considerations for the introduction and use of power mobility for children. Dev Med Child Neurol 2014; 56:210-21. [PMID: 23998510 DOI: 10.1111/dmcn.12245] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 11/26/2022]
Abstract
AIM The aim of the study was to support clinicians in recommending and justifying power mobility for children of different ages and abilities, and with different needs. The study comprised three distinct parts: a literature review; a Delphi consensus; and clinical practice considerations. METHOD A scoping review of eight electronic databases and manual searches carried out in February 2011 identified 15 themes or transferable messages among 27 articles meeting initial inclusion criteria and these formed the basis of a draft paper. Informal consensus at two international conference presentations refined and modified the paper to include 10 messages supported by 24 articles. The literature review was updated in May 2012 and a modified Delphi process sought to formalize the consensus process with an international panel of 16 expert clinicians and researchers using a priori criteria of 80% agreement. RESULTS Evidence from studies was classified using the American Academy of Cerebral Palsy and Developmental Medicine guidelines, with evidence from most studies being classified as either level IV or level V, apart from one study each with evidence classified as level II and level III. Expert consensus on the content and wording of nine transferable messages may raise evidence overall to level III. INTERPRETATION This paper suggests that power mobility may reasonably be considered as an effective and appropriate intervention for children lacking efficient, independent mobility from around 12 months of age including children who may never become competent drivers and children lacking independent mobility only in early childhood.
Collapse
|
45
|
Gudgeon S, Kirk S. Living with a powered wheelchair: exploring children's and young people's experiences. Disabil Rehabil Assist Technol 2013; 10:118-25. [PMID: 24354745 DOI: 10.3109/17483107.2013.870609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The study aimed to explore the lived experiences of children and young people who use an Electric Powered Indoor/Outdoor wheelchair (EPIOC). METHOD To allow for the individual lived experiences of the children to be explored, an exploratory study was designed using Interpretative Phenomenological Analysis (IPA). Nine children aged 7-16 years were recruited and their views explored through semi-structured interviews. RESULTS Children appeared to be working to achieve an adequate fit between self, the EPIOC and the environment. Where an adequate fit was achieved the child experienced positive consequences of using an EPIOC including increased participation and positive feelings. However an inadequate fit led to negative experiences including reduced participation, fear and anxiety. The changing interface between self, EPIOC and environment appeared to be important in shaping these experiences. CONCLUSIONS This study adds to understanding the ambiguous experience of being a child EPIOC user and the need for ongoing support from services especially around stages of transition. It also contributes to the development of the social model of disability from a child's perspective. Implications for Rehabilitation Children who use Electric Powered Indoor/Outdoor Chairs have both positive and negative experiences which are dependent on the fit of the child, chair and the environment. Child EPIOC users are active agents in shaping their experiences. Children who use an EPIOC maybe particularly at risk of reduced participation, especially at times when their environment changes significantly such as when leaving school or college.
Collapse
Affiliation(s)
- Sue Gudgeon
- Child Development Centre, Furness General Hospital , Cumbria , United Kingdom and
| | | |
Collapse
|
46
|
Cohen L, Greer N, Berliner E, Sprigle S. mobilityRERC State of the Science Conference: considerations for developing an evidence base for wheeled mobility and seating service delivery. Disabil Rehabil Assist Technol 2013; 8:462-71. [DOI: 10.3109/17483107.2013.823577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
47
|
Vogtle LK, Malone LA, Azuero A. Outcomes of an exercise program for pain and fatigue management in adults with cerebral palsy. Disabil Rehabil 2013; 36:818-25. [PMID: 23924251 DOI: 10.3109/09638288.2013.821181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this exploratory pilot study was to examine the effect of exercise on pain and fatigue in adults with CP. METHOD Twenty-six participants (12 ambulatory, 14 non-ambulatory; 10 males, 16 females; mean age 42.3 ± 11.2 years) enrolled in a study using a repeated measures design including baseline, intervention and follow-up phases of 12 weeks each; 20 participants completed all phases. Primary outcome measures used were the FACES pain scale, the count of body parts with pain and the PedsQL™ Multidimensional Fatigue Scale. RESULTS Significant beneficial changes were found in the pain and fatigue scales among the ambulatory participants during the intervention phase. However the beneficial changes diminished during the follow-up phase. Secondary outcomes examined included, pain interference, daily physical activity and health-related quality of life. CONCLUSION Study outcomes suggest that exercise may provide some benefit for ambulatory adults with CP. Implications for Rehabilitation Pain and fatigue are secondary conditions experienced by many adults with cerebral palsy which have a significant impact on function and quality of life. Physical activity is an intervention which has been demonstrated to decrease both pain and fatigue in other health conditions. In a relatively small sample, this study demonstrates decreased pain and fatigue after an exercise intervention in ambulatory adults with cerebral palsy.
Collapse
Affiliation(s)
- Laura K Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham , Birmingham, AL , USA
| | | | | |
Collapse
|
48
|
Recipients of electric-powered indoor/outdoor wheelchairs provided by a national health service: a cross-sectional study. Arch Phys Med Rehabil 2013; 94:2403-2409. [PMID: 23891668 DOI: 10.1016/j.apmr.2013.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/06/2013] [Accepted: 07/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the characteristics across all ages of powered wheelchair users and the assistive technology prescribed by a regional specialist wheelchair service. DESIGN Cross-sectional study. SETTING Regional wheelchair service. PARTICIPANTS Electric-powered indoor/outdoor wheelchair (EPIOC) users (N=544) with 262 boys and men (mean age ± SD, 41.7±20.7y; range, 8-82y) and 282 girls and women (mean age ± SD, 47.2±19.7y; range, 7-92y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Demographic, clinical/diagnostic details of EPIOC recipients, including pain, (kypho)scoliosis, and ventilators. Technical features, including specialized (adaptive) seating, tilt in space, and modified control systems. Factors were related to age groups: 1 (0-15y), 2 (16-24y), 3 (25-54y), 4 (55-74y), and 5 (≥75y). RESULTS Neurologic/neuromuscular conditions predominated (81%) with cerebral palsy (18.9%) and multiple sclerosis (16.4%). Conditions presenting at birth or during childhood constituted 39%. Of the participants, 99 had problematic pain, 83 had (kypho)scoliosis, and 11 used ventilators. Specialized (adaptive) seating was provided to 169 users (31%); most had cerebral palsy or muscular dystrophy. Tilt in space was used by 258 (53%) participants. Younger people were more likely to receive tilt in space than older ones. Only 92 had specialized (adaptive) seating and tilt in space (mean age ± SD, 29±17.8y; range, 8-72y). Of the participants, 52 used modified control systems. CONCLUSIONS The diversity of EPIOC users across age and diagnostic groups is shown. Their complex interrelations with these technical features of EPIOC prescriptions are explored. Younger users were more complex because of age-related changes. This study provides outcomes of the EPIOC prescription for this heterogeneous group of very severely disabled people.
Collapse
|
49
|
Wang H, Candiotti J, Shino M, Chung CS, Grindle GG, Ding D, Cooper RA. Development of an advanced mobile base for personal mobility and manipulation appliance generation II robotic wheelchair. J Spinal Cord Med 2013; 36:333-46. [PMID: 23820149 PMCID: PMC3758530 DOI: 10.1179/2045772313y.0000000094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND This paper describes the development of a mobile base for the Personal Mobility and Manipulation Appliance Generation II (PerMMA Gen II robotic wheelchair), an obstacle-climbing wheelchair able to move in structured and unstructured environments, and to climb over curbs as high as 8 inches. The mechanical, electrical, and software systems of the mobile base are presented in detail, and similar devices such as the iBOT mobility system, TopChair, and 6X6 Explorer are described. FINDINGS The mobile base of PerMMA Gen II has two operating modes: "advanced driving mode" on flat and uneven terrain, and "automatic climbing mode" during stair climbing. The different operating modes are triggered either by local and dynamic conditions or by external commands from users. A step-climbing sequence, up to 0.2 m, is under development and to be evaluated via simulation. The mathematical model of the mobile base is introduced. A feedback and a feed-forward controller have been developed to maintain the posture of the passenger when driving over uneven surfaces or slopes. The effectiveness of the controller has been evaluated by simulation using the open dynamics engine tool. CONCLUSION Future work for PerMMA Gen II mobile base is implementation of the simulation and control on a real system and evaluation of the system via further experimental tests.
Collapse
Affiliation(s)
- Hongwu Wang
- University of Pittsburgh, Pittsburgh, PA 15206, USA.
| | - Jorge Candiotti
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Motoki Shino
- Department of Mechanical Engineering, University of Tokyo, Tokyo, Japan
| | - Cheng-Shiu Chung
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrett G. Grindle
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dan Ding
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A. Cooper
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
50
|
Larin HM, Dennis CW, Stansfield S. Development of robotic mobility for infants: rationale and outcomes. Physiotherapy 2012; 98:230-7. [DOI: 10.1016/j.physio.2012.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Hélène M Larin
- Department of Physical Therapy, Ithaca College, Ithaca, NY 14850, USA.
| | | | | |
Collapse
|