Accessible Autonomous Transportation and Services: Design considerations from the perspective of consumers and providers

OBJECTIVE

To understand the priorities and preferences of people with disabilities (PwDs) and older adults regarding accessible Autonomous Vehicles (AVs) to address existing transportation barriers.

DESIGN

Two national surveys, "Voice of the Consumer (VoC)" and "Voice of the Provider (VoP)," were conducted to gather feedback from accessible AV consumers and providers respectively in the United States (US).

SETTING

This US based study focused on PwDs and older adults who may face transportation challenges and those who provide or design AV solutions.

PARTICIPANTS

The 922 consumers and 45 providers in the surveys encompassed a diverse range of disability types, caregiver roles, and age groups.

INTERVENTIONS

Not Applicable MAIN OUTCOME MEASURES: The main outcomes are consumer usage needs and provider preferences for features in accessible autonomous transportation. Patterns in usage needs and feature preferences through two-step clustering algorithm was applied, subsequent to the descriptive analysis of participant demographics and their responses.

RESULTS

Participants strongly preferred AV features enhancing personal transportation, especially for rural medical appointments. Most sought comprehensive AV automated features. Wheelchair users emphasized accessible entrances, particularly for lower-income brackets ($25,000 - $49,000). Provider priorities closely aligned with consumer preferences, reinforcing content validity.

CONCLUSION

The study highlights the importance of prioritizing wheelchair accessibility in AVs and improving access to medical appointments, especially in rural and low-income communities. Implications include developing inclusive AV services for PwDs and underserved populations. The research establishes a foundation for a more equitable and accessible transportation landscape through AV technology integration.

Conceptual mapping proposed to comprehend the effect of wheelchair mobility on social participation and quality of life: a systematic review

PURPOSE

To identify and synthesise the available evidence on the effect of mobility on social participation and quality of life (QoL) of wheelchairs (WC) on adults who use WC as their primary means of mobility.

MATERIALS AND METHODS

Systematic review undertaken in accordance with the Centre for Reviews and Dissemination Guidelines and registered in the PROSPERO International Prospective Register of Systematic reviews. Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, LILACS, CINAHL, PEDro, SCOPUS, Web of Science, and BVS ECOS) were searched with the following PICO eligibility criteria: (P) Population was individuals with mobility limitations that live in their community, aged 18 or older; (I) Intervention was mobility devices, such as manual and powered wheelchairs; (C) Comparators, not applied; (O) Outcome was factors that can be influenced by wheelchair use, such as: social participation, health-related quality of life and QOL. Critical appraisal of methodological quality of studies were undertaken.

RESULTS

A total of 18 studies were included. The proportion of studies evaluating the effects of mobility on participation was higher than to mobility on QoL. WC quality, device benefit (ease of repairs and maintenance), confidence using a WC and WC skills were key factors determining participation. The provision of WC according to the eight steps service proposed by the Word Health Organisation contributed to higher levels of physical health, WC satisfaction, hours using the WC and QoL enhancement.

CONCLUSION

Attention should be given to enhance WC service provision (with continuous service support) as well as professional continuing education.IMPLICATIONS FOR REHABILITATIONWheelchair technology is a key element in rehabilitation. Significant effort should be made to provide and maintain the wheelchair as a facilitator to participation. A great attention should be done to enhance wheelchair services as well as professional continuous education.Wheelchair skills are associated with participation and may be targeted in clinical intervention.

Evaluation of Electric and Air-Powered Shopping Scooters in Grocery Stores

OBJECTIVE

The purpose of this study was to further previous research and gather additional information regarding the usage of motorized shopping scooters as well as feedback for improvements to an air-powered scooter.

METHODS

Online surveys were used to assess individuals' shopping characteristics and experience using the motorized scooters and to gather feedback from store employees regarding their experience. K-Means clustering analysis was used to determine user demographics who chose to use the air-powered scooter versus the electric powered scooter while shopping.

RESULTS

A total of 127 individuals provided informed consent, 65 individuals from Site 1 and 62 individuals from Site 2. 120 participants met the inclusion criteria and completed the survey. K-Means clustering found that age, type of personal mobility device, shopping bill total, and frequency using a motorized shopping scooter to be significant factors in whether individuals chose to use an air-powered scooter or electric-powered scooter.

CONCLUSION

Motorized shopping scooters are in high demand and used by a wide variety of individuals, yet electric-powered scooters are commonly unavailable due to having dead batteries or all the devices being in use. Air-powered scooters may serve as a practical replacement for the current electric-powered scooters found in grocery and retail stores.

Evaluation of Power Wheelchair Dynamic Suspensions for Tip Prevention in Non-ADA Compliant Surfaces

OBJECTIVE

To evaluate the driving performance and usability of a mobility enhancement robot (MEBot) wheelchair with 2 innovative dynamic suspensions compared with commercial electric powered wheelchair (EPW) suspensions on non-American with Disabilities Act (ADA) compliant surfaces. The 2 dynamic suspensions used pneumatic actuators (PA) and electro-hydraulic with springs in series electrohydraulic and spring in series (EHAS).

DESIGN

Within-subjects cross-sectional study. Driving performance and usability were evaluated using quantitative measures and standardized tools, respectively.

SETTING

Laboratory settings that simulated common EPW outdoor driving tasks.

PARTICIPANTS

10 EPW users (5 women, 5 men) with an average age of 53.9±11.5 years and 21.2±16.3 years of EPW driving experience (N=10).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURE(S)

Seat angle peaks (stability), number of completed trials (effectiveness), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and systemic usability scale (SUS).

RESULTS

MEBot with dynamic suspensions demonstrated significantly better stability (all P<.001) than EPW passive suspensions on non-ADA-compliant surfaces by reducing seat angle changes (safety). Also, MEBot with EHAS suspension significantly completed more trials over potholes compared with MEBot with PA suspension (P<.001) and EPW suspensions (P<.001). MEBot with EHAS had significantly better scores in terms of ease of adjustment (P=.016), durability (P=.031), and usability (P=.032) compared with MEBot with PA suspension on all surfaces. Physical assistance was required to navigate over potholes using MEBot with PA suspension and EPW suspensions. Also, participants reported similar responses regarding ease of use and satisfaction toward MEBot with EHAS suspension and EPW suspensions.

CONCLUSIONS

MEBot with dynamic suspensions improve safety and stability when navigating non-ADA-compliant surfaces compared with commercial EPW passive suspensions. Findings indicate MEBot readiness for further evaluation in real-world environments.

Accessible autonomous transportation and services: voice of the consumer - understanding end-user priorities

PURPOSE

This study aimed to explore the requirements for accessible Autonomous Vehicles (AVs) and AV services from a consumer perspective, focusing on people with disabilities (PwDs) and older adults.

METHODS

Two national surveys were conducted, capturing current transportation trends and AV priorities. Participants (n = 922) with disabilities and older adults were included in the analysis.

RESULTS

Transportation choices exhibited significant divergence based on the underlying causes of disabilities, showcasing distinct inclinations and impediments within each category. AV services, encompassing family conveyance and package delivery, proved integral, but their specific desirability fluctuated in accordance with the nature of disabilities. Notably, medical appointments emerged as the foremost AV utilisation requirement, particularly pronounced among individuals with hearing impairments. Preferences for orchestrating AV rides and the preferred vehicle types displayed disparities linked to the various disability classifications. The employment of mobile applications, websites, and text messages were preferred mediums for arranging rides. Features such as automated route guidance and collision prevention garnered unanimous precedence among AV attributes. Key priorities, spanning wheelchair accessibility, user profiles, and seamless communication with AVs, were universally emphasised across all participant clusters. The study indicated a moderate comfort level with AV deployment, implying the potential for favourable reception within the population of PwDs and older adults.

CONCLUSION

The study highlights the significance of considering diverse needs in accessible AV development of vehicle and infrastructure and policies.

Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study

IMPORTANCE

Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps.

OBJECTIVE

To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool.

DESIGN

Repeated-measures cohort study with a time frame of 7 to 21 days.

SETTING

Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions.

PARTICIPANTS

Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female.

INTERVENTION

Not applicable.

OUTCOMES AND MEASURES

The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90).

RESULTS

On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88).

CONCLUSIONS AND RELEVANCE

The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

Current state and conceptual framework of assistive technology provision in Saudi Arabia

PURPOSE

Assistive Technology (AT) devices provide essential means of mobility, employment, communication, social engagement for older adults and people with different disabilities, if prescribed correctly to match users' needs and goals. Regardless of the setting or location, a successful AT service delivery model includes the multidisciplinary collaboration of the people with disabilities and the specialists who have knowledge and expertise in the design and application of AT. In Saudi Arabia, unfortunately, the availability of AT devices is mainly limited to basic mobility and daily living aids such as wheelchairs and seating systems, prosthetics and orthotics, communication devices, low-vision devices, and adapted transportation equipment. The aim of this perspective is to provide clinicians and healthcare professionals in Saudi Arabia with a model for the optimisation of the provision of AT devices decision making regarding AT devices for people with disabilities by adhering to a user-centered team approach throughout the service delivery process.

METHOD

The policy, human, activity, assistance, technology, and environment (PHAATE) model is used as a conceptual framework and guideline for this paper.

RESULTS AND CONCLUSION

The PHAATE components could serve as a guideline for a wide range of stakeholders in Saudi Arabia (e.g., researchers, product developers, practitioners, clinicians, third-party reimbursement entities, consumers, and educators) when developing service delivery systems.IMPLICATION FOR REHABILITATIONDespite the support and funding resources of AT devices by the Saudi government, there is still the needs to increase awareness and knowledge about AT application and services, as well as optimal service delivery models of AT devices.AT service delivery provision models such as PHAATE model may help clinicians and other medical professionals in Saudi Arabia to make informed decisions about the provision of AT device services.

Classification of wheelchair pressure relief maneuvers using changes in center of pressure and weight on the seat

BACKGROUND

Pressure injuries from prolonged sitting are a significant problem for wheelchair users incurring high costs in healthcare expenditures and reducing quality-of-life. There is a need to improve pressure relief training and adherence in a variety of settings.

OBJECTIVE

To identify effective common wheelchair pressure relief (PR) manoeuvres based on changes to users' seated centre of pressure (CoP) and seated weight.

PARTICIPANTS

20 individuals who use manual wheelchairs as their primary means of mobility.

METHODS

Participants performed 5 types of PR including seated push-ups, leftward, rightward, forward, and backward leans-while sitting in a wheelchair equipped with a custom instrumented seat pan support. Data were analysed using both clustering and decision tree approaches to identify types of PR.

RESULTS

Both clustering and decision tree approaches were able to identify and classify PR though neither could accurately distinguish between forward and backward PR.

CONCLUSION

Changes in the centre of pressure and the total weight on the wheelchair's seat can be used to automatically characterise type, amplitude and duration of pressure relief manoeuvres. Building such a classification and quality assessment scheme into an algorithm could enable a virtual coaching system to track users' pressure relief behaviour and make suggestions to improve adherence with clinical recommendations.IMPLICATIONS FOR REHABILITATIONMultiple bending beam load cells can be used to measure wheelchair users' seated centre of pressure independent of type of cushion used.Both cluster analysis and decision tree algorithms can classify commonly practiced pressure reliefs by measuring changes to the centre of pressure and total weight on the wheelchair's seat.The combination of force sensing for centre of pressure determination and either algorithm could serve as the basis for an application to coach wheelchair users to do effective pressure reliefs.

Economic evaluation of wheelchairs interventions: a systematic review

OBJECTIVE

The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations.

METHODOLOGY

This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations.

RESULTS

Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations.

CONCLUSION

Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.Implication for RehabilitationSystematic reviews of health economic evaluation studies are useful for synthesising economic evidence about health interventions and provide insight in new research development.Organisations involved in the provision of wheelchairs should apply cost-effectiveness outcome measures to help raise the standard of provision, to support evidence-based practice, and to improve resource utilisation.

Accessible autonomous transportation and services: a focus group study

PURPOSE

Existing automated vehicle transportation guidelines and regulations have minimal guidance to address the specific needs of people with disabilities. Accessibility should be at the forefront to increase autonomy and independence for people with disabilities. The purpose of this research is to better understand potential facilitators and barriers to using accessible autonomous transportation.

METHODS

Focus groups were conducted with key stakeholders derived from people with disabilities (n = 5), travel companions/caregivers (n = 5), and transportation experts or designers (n = 11).

RESULTS

The themes include describing stakeholder perceptions across all three groups by identified themes: autonomous vehicle assistive technology, autonomy vs automation, cost, infrastructure, safety & liability, design challenges, and potential impact.

CONCLUSION

Specific gaps and needs were identified regarding barriers and facilitators for transportation accessibility and evidence-based guidance. These specific gaps can help to formulate design criteria for the communication between, the interior and exterior of accessible autonomous vehicles.

Preliminary evaluation of an automated robotic transfer assist device in the home setting

PURPOSE

The purpose of this study was to examine the effects of six weeks of routine use of a novel robotic transfer device, the AgileLife Patient Transfer System, on mobility-related health outcomes, task demand, and satisfaction relative to previous transfer methods.

MATERIALS AND METHODS

Six end users and five caregivers used the system in their homes for six weeks. Participants completed several surveys examining perceived demands related to preparing and performing a transfer and mobility-related health outcomes pre and post intervention. Participants were also asked about their satisfaction with using the technology compared to previous transfer methods.

RESULTS

Both end users and caregivers reported reduction in perceived physical demand (p = 0.007) and work (p ≤ 0.038) when preparing for and performing a transfer. End users indicated that the device intervention had a positive impact, indicating some improvements to health-related quality of life as well as improved competence, adaptability, and self-esteem post-intervention. All participants were highly likely to recommend the technology to others.

CONCLUSION

The AgileLife Patient Transfer System is a promising new form of transfer technology that may improve the mobility and mobility-related health of individuals with disabilities and their caregivers in home settings.Implications for rehabilitationRobotic transfer assistance reduced physical demand and work among end users and caregivers.The robotic device had a positive impact on some quality of life outcomes after 6 weeks of use.Users were highly likely to recommend the robotic transfer device to others.

Participatory action design and engineering of a manual wheelchair virtual coach including in-home and community usage

BACKGROUND

Current clinical practice guidelines (CPG) recommend periodic pressure redistribution (PR) to alter sitting pressure and reduce the risk of developing pressure injuries (PI). Individuals who have strength and trunk stability are asked to perform PR such as wheelies, leaning laterally, and forward-leaning to minimize the duration of pressure acting on the same region of the body.

OBJECTIVE

Our long-term objective is to build upon previous research and development to create a more effective device for improving PR training and adherence to CPG among manual wheelchair users (MWU). Through this study, we employed a participatory action design and engineering (PADE) approach in developing the hardware and user interface to increase the likelihood of eventually yielding a device effective for both MWU and clinicians.

PARTICIPANTS

Focus Groups: Ten clinicians - 6 physical therapists, 3 occupational therapists, and one registered nurse, and 10 MWU with spinal cord injuries (SCI) who reported using their wheelchairs 40-80 h per week. Five-Day Assessment: Five male MWU with SCI who had been wheelchair users for 18.5 ± 16.2 years. Four-Week Investigation: The 7 participants with SCI were 5 males and 2 females, who had been wheelchair users for 24.7 ± 17.0 years.

METHODS

A PADE approach was used to improve upon a manual wheelchair virtual coaching system for people with SCI. The system comprises a seat support instrumented with force sensors, software algorithms to detect PR, and a smart phone app for user interface. The methods included three stages: multiple focus groups, a five-day evaluation phase with participants using their own wheelchairs in their homes and communities, and a 4-week assessment with improvements made based on the 5-day results by users with their own wheelchairs in their homes and communities.

RESULTS

The focus groups yielded guidance for ergonomics, user interface, charging frequency, and key dimensions and mass. The 5-day study identified mechanical, electrical, and connectivity challenges, which were resolved before the 4-week study. The 4-week trial suggested that participants performed PR less frequently than clinically recommended and provided an indication of the types of maneuvers that they performed.

CONCLUSION

A prototype manual wheelchair virtual coaching system was developed using a PADE process. The system was able to detect and record PR in home and community environments. Following improvements identified in this study, a future version will be tested with additional users to determine whether it can improve adherence to PR guidance.

Participatory Action Design and Engineering of Powered Personal Transfer System for Wheelchair Users: Initial Design and Assessment

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users' perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

Usability and Vibration Analysis of a Low-Profile Automatic Powered Wheelchair to Motor Vehicle Docking System

The QLX is a low-profile automatic powered wheelchair docking system (WDS) prototype developed to improve the securement and discomfort of wheelchair users when riding in vehicles. The study evaluates the whole-body vibration effects between the proposed QLX and another WDS (4-point tiedown system) following ISO 2631-1 standards and a systematic usability evaluation. Whole-body vibration analysis was evaluated in wheelchairs using both WDS to dock in a vehicle while riding on real-world surfaces. Also, participants rated the usability of each WDS while driving a wheelchair and while riding in a vehicle in driving tasks. Both WDSs showed similar vibration results within the vibration health-risk margins; but shock values below health-risk margins. Fifteen powered wheelchair users reported low task load demand to operate both WDS; but better performance to dock in vehicles with the QLX (p = 0.03). Also, the QLX showed better usability (p < 0.01), less discomfort (p's < 0.05), and greater security compared to the 4-point tiedown while riding in a vehicle (p's < 0.05). Study findings indicate that both WDS maintain low shock exposure for wheelchair users while riding vehicles, but a better performance overall to operate the QLX compared to the 4-point tiedown system; hence enhancing user's autonomy to dock in vehicles independently.

Comparison of trunk mechanics and spatiotemporal outcomes in caregivers using a robotic assisted transfer device and a mobile floor lift

OBJECTIVE

The purpose of this study was to compare trunk mechanics, distance covered, and average instantaneous velocity and acceleration recorded with caregivers performing transfer tasks using a research mannequin with both a prototype robotic assisted transfer device (RATD) and a mobile floor lift.

DESIGN

Cross-Sectional.

SETTING

Biomechanics Lab and Human Engineering Research Laboratories.

PARTICIPANTS

Caregivers (N = 21).

INTERVENTION

Robotic Assisted Transfer Device.

OUTCOME MEASURES

Range of flexion-extension, lateral bend, and axial rotation; distance covered; average instantaneous velocity and acceleration.

RESULTS

Caregivers performing transfers using the RATD as compared to when using the moble floor lift reported significantly smaller range of trunk flexion-extension, lateral bending, and axial rotation, and reported lower pelvic based distance covered and slower average instantaneous velocity and acceleration (P < 0.001).

CONCLUSION

The design and usability of a RATD indicates design driven mobility advantages over clinical standard mobile floor lifts due to its ability to expand the workspace while further reducing risk factors for low back pain. While the concept is promising, further testing is required to address limitations and confirm the concept for clinical applications.

Inventors with Disabilities — An Opportunity for Innovation, Inclusion, and Economic Development

In the United States, about 26% of the population reports having some form of disability. However, people with disabilities (PwD) are under-represented in science, technology, engineering, and mathematics (STEM). The representation of PwD as patented inventors is unknown, but likely under-represented, given their limited numbers in STEM and the workplace. This study set the goal of identifying PwD with patented technologies that have also been introduced into the marketplace. Using web searches and patent awards/applications, 21 influential inventors with disabilities were identified. The impact of these inventors was assessed and is briefly described. Technologies that were invented for PwD that have had mainstream success were also identified. Inventors with disabilities have made important contributions, but further study is required, as the inclusion of PwD in the inventor community is a nascent field of study that is important for expanding the innovation community.

Clinical and Ergonomic Comparison Between a Robotic Assisted Transfer Device and a Mobile Floor Lift During Caregiver-Assisted Wheelchair Transfers

BACKGROUND

The robotic assisted transfer device was developed as an updated lift technology to reduce adjustments in posture while increasing capabilities offered by transfer devices. The purpose of this study was to compare the trunk biomechanics of a robotic assisted transfer device and a mechanical floor lift in the transfer of a care recipient by a caregiver during essential transfer tasks.

METHODS

Investigators enrolled 28 caregiver/care recipient dyads to complete 36 transferring tasks. Surface electromyography for the back muscles and motion data for trunk range of motion were collected for selected surfaces, phase, and direction tasks using a robotic assisted transfer device and a mechanical floor lift.

RESULTS

Robotic assisted transfer device transfers required significantly smaller range of trunk flexion (P < 0.001), lateral bend (P < 0.001), and axial rotation (P = 0.01), in addition to smaller distance covered (P < 0.001), average instantaneous velocity (P = 0.01), and acceleration (P < 0.001) compared with a mobile floor lift. The robotic assisted transfer device transfers required significantly smaller peak erector spinae (left: P = 0.001; right: P < 0.001) and latissimus dorsi (right: P < 0.001) and integrated erector spinae left (P = 0.001) and latissimus dorsi right (P = 0.01) electromyography signals compared with the floor lift.

CONCLUSIONS

The robotic assisted transfer device provides additional benefits to mobile floor lifts which, coupled with statistically lower flexion, extension, and rotation, may make them an appealing alternative intervention.

Innovations in Telemedicine Services in Spina Bifida Clinics in the U. S. During the Covid-19 Pandemic

The COVID-19 pandemic has dramatically impacted delivery of outpatient care. Many people with spina bifida (SB) in the U.S. receive outpatient healthcare in a multidisciplinary setting. In accordance with state healthcare mandates, outpatient multidisciplinary clinic visits were deferred, postponed, or canceled, while telemedicine systems were implemented. A survey was created and distributed to all known SB clinics in the U.S. We explored the impact of the COVID-19 pandemic on the delivery of outpatient care for the SB population and the use of telemedicine in response. Novel uses of telehealth, benefits of use, suggestions for overcoming barriers, and future opportunities are identified and discussed.

Rapid Deployment of Nasopharyngeal Test Swabs Within the US Department of Veterans Affairs

The COVID-19 pandemic placed tremendous strain on people, medical supply chains, and healthcare systems. The US Department of Veterans Affairs (VA) had to take extraordinary efforts to protect the veterans that it serves. The goal of this project was to rapidly deploy safe and effective nasopharyngeal (NP) test swabs to enable expanded testing for COVID-19 with a US veteran population. This manuscript describes the technical steps to achieving this goal. VA had internal additive manufacturing resources for many of the common processes and materials. Once the process and material were selected, the design of the NP swab geometry for effectiveness, strength, and maximum throughput commenced. A NP swab with tip geometry that resembles thin, rounded, stacked disks was selected for the design after the clinical members of the team reviewed several iterations of prototypes. Following the ASTM D790 test, the NP swabs were examined using a 10-power digital microscope to check for micro-fractures and surface finish. Once the NP swabs passed the initial quality assurance process, the NP swabs required cleaning, sterilization, and packaging. Subsequently, each NP swab package was labeled for identification. Approximately 30,000 NP swabs were produced with around 18,000 of them made available for immediate deployment. The effort showed that additive manufacturing along with good professional practice by engineers and healthcare professionals could rapidly respond to a shortage of NP swabs. Internal additive manufacturing and other digital manufacturing technologies should be part of an overall strategy to increase the robustness of healthcare delivery in emergency situations.

Telerehabilitation Innovation in Response to Covid-19

The State of the Science Symposium is held multiple times per year to enhance the knowledge and skills of individuals working in the fields such as rehabilitation medicine, engineering, and public health. The Symposium has continually focused on the health and well-being of active-duty military members, reserve/guard components, veterans, and their families. With the onset of the COVID-19 pandemic and the social distancing protocols adopted to combat viral spread, the State of the Science Symposium was moved to an online platform to minimize risk. In December 2020, the symposium invited professionals to discuss necessary changes in their fields of practice in light of the pandemic protocols, and how telehealth has expanded to encompass multiple disciplines. It is concluded that the adoption of telemedicine as a standard of care wherever appropriate will benefit all parties involved, even after restrictions on gatherings and interpersonal contact are eased.

Mini-review: Robotic wheelchair taxonomy and readiness

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.

Air-powered shopping carts in grocery stores: a pilot study

PURPOSE

Motorized shopping carts found at grocery and retail stores provide mobility for those who have difficulty walking through the store or pushing a regular cart. The purpose of this study was to understand the usage of motorized carts in grocery stores and pilot test an air-powered cart to determine its feasibility as a replacement for electric-powered carts as well as identify areas for improvement and preferred users.

METHODS

Users were asked to complete an online survey that assessed their shopping characteristics and experience using the motorized cart. K-Means clustering determined user demographics who chose to use the air-powered carts versus the electric-powered carts. Open-ended comments for improvements were also collected.

RESULTS

A total of 65 participants were provided informed consent, 60 participants met inclusion criteria and completed the survey. A majority of the air-powered (N = 29, 91%) and electric-powered (N = 11, 73%) cart users had a positive experience. Clustering found age and type of mobility device owned were significant whether participants chose the air-powered or electric-powered carts. Most suggested improvements for the air-powered carts were better braking, higher speed and a bigger basket while a longer battery life was most suggested for electric-powered carts.

CONCLUSIONS

Motorized shopping carts are used by a wide variety of individuals. Individuals aged 54 or younger and do not own a mobility device chose to use air-powered more than electric-powered carts. The functional capabilities of the air-powered carts demonstrated their potential to serve as practical replacements for electric-powered carts found in grocery and retail stores.Implications for rehabilitationThe availability and reliability of motorized shopping carts at retail stores are integral for individuals with physical impairments to complete their shopping needs.The development of novel assistive devices such as air-powered carts provides improved experiences and quality of life.Integrating end-user feedback during the design of assistive technologies is paramount for meeting actual needs.

Curb Negotiation With Dynamic Human-Robotic Wheelchair Collaboration

Wheelchair users often face architectural barriers such as curbs, limiting their accessibility, mobility, and participation in their communities. The mobility enhancement robotic (MEBot) wheelchair was developed to navigate over such architectural barriers. Its application allows wheelchair users to negotiate curbs automatically while the user remains in control. The application was optimized from a manual to a semiautomated process based on wheelchair users' feedback. The optimized application was evaluated by experienced wheelchair users who navigated over curbs of different heights. Participants evaluated MEBot in terms of effectiveness, workload demand, and usability. Ten participants successfully ascended and descended curbs of different heights at an average completion time of 55.7 ± 19.5 and 30.3 ± 9.1 s, respectively. MEBot maintained stability during the process, while participants reported low levels of effort, frustration, and overall cognitive demand to operate MEBot. Furthermore, participants were satisfied with the ease of learning and using the MEBot curb negotiation application to overcome the curbs but suggested less wheel adjustment for comfort and a faster pace to overcome curbs during real-world conditions.

VA TECHNOLOGY TRANSFER PROGRAM RESPONDS TO COVID-19 PANDEMIC

The COVID-19 pandemic stressed healthcare systems all over the world. Two primary challenges that healthcare systems faced were a shortage of personal protective equipment and the need for new technologies to handle infection prevention for staff and patients. The Department of Veteran's Affairs (VA) Technology Transfer Program responded by prioritizing the development of innovations in the Technology Transfer Assistance Project which addressed the pandemic. This paper describes several innovations that addressed the needs of the VA healthcare system during the pandemic and how they were rapidly developed.

Mini-review: Rehabilitation engineering: Research priorities and trends

Rehabilitation Engineering is the use of engineering principles applied to rehabilitation, disability, and independent living. Google Scholar is a searchable resource that allows people from around the world to create profiles of their interests and collaborations, and it provides a means to search the broad scientific and technical literature. Google Scholar was used to identify the 150 most cited people who listed Rehabilitation Engineering in their profile. Research impact, characteristics, and areas of research of the most cited rehabilitation engineers were examined. Furthermore, gender and geographical differences in research metrics of the highest citied rehabilitation engineers were investigated. Consumer priorities in rehabilitation engineering were identified using a voice of consumer (VoC) survey and recent literature based on VoC studies. Gaps between research publication and activities and consumer priorities were identified to recommend seven areas of research with high demand and opportunity for growth and innovation. Implications.

Assessment of Muscle Activation of Caregivers Performing Dependent Transfers With a Novel Robotic-Assisted Transfer Device Compared With the Hoyer Advance

OBJECTIVE

The purpose of this study was to compare muscle activity in caregivers while using a novel robotic-assisted transfer device (Strong Arm) to a clinical standard of care (Hoyer Advance).

DESIGN

A quasi-experimental design was used in which 20 caregivers (33 ± 15 yrs old) performed transfers with three surfaces (toilet, bench, and shower chair) with the Strong Arm and Hoyer Advance. Transfer completion time (seconds), peak percentage surface electromyography (EMG), and integrated EMG of the bilateral erector spinae, latissimus dorsi, pectoralis major and anterior deltoid were measured.

RESULTS

Caregivers required less transfer time when transferring from wheelchair to surface using the Hoyer Advance (P = 0.011, f = 0.39). For the lower back, significantly lower peak percentage EMGs were found using Strong Arm in 50% and for the integrated EMG in 25% of the cases, with the remaining cases showing no significant differences. For the shoulder, significantly lower peak percentage EMG values were found using Strong Arm in 19% of transfers and lower integrated EMG was found in 25% of transfers when using the Hoyer Advance, with the remaining cases showing no significant differences.

CONCLUSION

Although back muscle activation during Strong Arm transfers is statistically, but not clinically, lower, additional features that couple with significantly lower muscle activation make it an alternative to the clinical standard for further research and possible clinical applicability.

Systematic review: Automated vehicles and services for people with disabilities

People with disabilities face many travel barriers. Autonomous vehicles and services may be one solution. The purpose of this project was to conduct a systematic review of the grey and scientific literature on autonomous vehicles for people with disabilities. Scientific evidence (n = 35) was limited to four observational studies with a very low level of evidence, qualitative studies, reviews, design and model reports, and policy proposals. Literature on older adults was most prevalent. Grey literature (n = 37) spanned a variety of media and sources and focuses on a variety of disability and impairment types. Results highlight opportunities and barriers to accessible and usable AVs and services, outline research gaps to set a future research agenda, and identify implications for policy and knowledge translation. People with disabilities are a diverse group, and accessible and usable design solutions will therefore need to be tailored to each group's needs, circumstances, and preferences. Future research in diverse disability groups should include more participatory action design and engineering studies and higher quality, prospective experimental studies to evaluate outcomes of accessible and usable AV technology. Studies will need to address not only all vehicle features but also the entire travel journey.

TECHNOLOGY TRANSFER ASSISTANCE PROJECT BRINGS VA HEALTH CARE IDEAS TO LIFE

Clinicians and staff of the Department of Veterans Affairs Health Care System (VA), who provide services to veterans, have invented many devices and methods for improving veterans' lives. However, translating those inventions to the market has been a challenge due to limited collaboration between the clinical inventors and the scientists, researchers, and engineers who can produce the prototypes necessary for licensing the technology. The VA Technology Transfer Program office and the Human Engineering Research Laboratories, a research laboratory with experience with developing prototypes and licensing technology, jointly developed a program called the Technology Transfer Assistance Project (TTAP) to bridge the gap between clinical inventors and prototypes ready for licensing. This paper describes TTAP and provides examples of the first inventions that were developed or enhanced through TTAP.

A consumer assessment of women who use wheelchairs

LAY SUMMARY

Female Veterans and female athletes with disabilities express concerns with mobility devices that are male-centric and do not address their unique needs. It is important that the needs of women are given the same attention as those of men. The following study asked groups of women who use wheelchairs or scooters, including Veterans and athletes, about their experiences. Twenty-four women, recruited from two sporting events for Veterans with disabilities, were asked to fill out a survey and participate in a focus group where they would discuss their views on mobility aids and related services. There were four major themes women often mentioned when they talked about using their mobility aids: usability (how they like using it), service delivery (how they get help with it), well-being (how they feel), and design (how it looks and works). Participants were concerned about the ability to adjust their device to their needs, how people obtained a device, and how they felt about using the device. Female wheelchair and scooter users recommended several changes to mobility aids that would improve the devices and improve the lives of women who use them.

A review of adaptive sport opportunities for power wheelchair users

PURPOSE

To identify adaptive sports opportunities for individuals who use powered wheelchairs for their primary means of mobility, and to determine barriers and facilitators for new sporting opportunities.

MATERIALS AND METHODS

A structured literature review of the peer-reviewed scientific literature and analysis of major adaptive sport competitions information. Pubmed and Scopus were searched for the phrases "Power wheelchair sports" and "complex disability sport" to identify articles discussing competitive sport opportunities for power wheelchair users. Also, the websites and instructional materials were searched to identify what sports exist for power wheelchair users in the Paralympics, the National Veteran Wheelchair Games, the Invictus Games and the Warrior Games.

RESULTS

Eleven articles were found from Pubmed and Scopus which met the criteria, most of which were focused on power soccer. The search for sport opportunities from the four major competitions found few events where someone using a power wheelchair could participate, most of which involve a stationary chair during competition (e.g., archery, billiards).

CONCLUSIONS

This literature review identified few programs for sports for people who use power wheelchairs. Many challenges such as lack of appropriate technology, lack of programs, and challenging classification categories all interact to contribute to this problem. Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for these athletes to benefit more from sport and recreation.Implications for rehabilitationAthletes with complex disabilities and high support needs are not provided with the same opportunities as other athletes.Challenges such as insufficient technology, lack of programs, and challenging classification categories all interact to contribute to the lack of opportunities.Opportunities exist for better and more appropriate technology to be developed and for new and innovative sports and rules to be adopted for athletes with complex disabilities and high support needs to benefit more from sport and recreation.

Design of an adjustable wheelchair for table tennis participation

PURPOSE

Physical activity and recreation are very important for people with disabilities and provide benefits for self-esteem, social relationships, employment, rehabilitation, and education. Para Table Tennis is an adaptive sport where participants compete in table tennis while sitting in a wheelchair. However, athletes generally use their everyday wheelchair instead of a device specifically designed for the sport. The specific support, movements, and posture needed to participate in table tennis at the highest level are different than general day-to-day mobility and a device could be optimized for the sport. This research describes the development of a wheelchair specifically designed for para table tennis.

MATERIALS AND METHODS

The design followed a participatory action design approach which identified the specific needs for a wheelchair to be used during para table tennis.

RESULTS

Three design needs were identified which included 1) locking the casters in the forward direction, 2) ability to raise the seat height as high as possible while allowing the user's knees to fit under the table, and 3) adjustable seat angle which will allow some users to have anterior tilt to get their trunk even higher while other users could have posterior tilt for stability. A new chair meeting these needs was designed and prototyped.

CONCLUSIONS

Para table tennis has some specific requirements related to movements and posture which were improved by a new wheelchair design specific for the sport.IMPLICATIONS FOR REHABILITATIONMany adaptive sports are improved with sport specific technology.A model client was used to develop a wheelchair specifically for adaptive table tennis.The height and angle of the seat of the new wheelchair can be adjusted for optimal stability and reach.The casters of the new wheelchair can be locked to allow only forward and backward motion.

The voice of the consumer: A survey of consumer priorities to inform knowledge translation among Veterans who use mobility assistive technology

LAY SUMMARY

Mobility assistive technology (AT) can improve the lives of people with disabilities by helping them get around in their communities. Today, over 23.9 million Americans use a wheelchair or assistive device, and over 85,000 wheelchairs, scooters, or other mobility devices are provided to Veterans each year. In order to find out how people learn about AT to improve efforts to disseminate information about AT, a survey of people who use mobility AT was conducted. The majority of people who completed the survey were Veterans (82%). It was determined that these people most often learned about AT through other users and/or from Veterans and the Internet, and that some people wish to receive information in other ways. Researchers can use these findings to better reach the people who could benefit from the new mobility AT they are creating.

Health Outcomes Used to Determine Facets of Health-related Quality of Life for Post-9/11 Veterans Using Assistive Technology for A Combat-related Mobility Impairment: A Literature Review

INTRODUCTION

Novel rehabilitation methods, including distribution and adoption of assistive technology for lower extremity impairments, are becoming crucial to ensure positive quality of life in all individuals. The quality of life of post-9/11 combat veterans is not well understood, in comparison to research on other populations. The following essay describes a review on health outcomes used to determine health-related quality of life (HR-QoL) among combat-injured service members who require mobility-related assistive technology.

MATERIALS AND METHODS

Reviews pooled data from research on PubMed, EMBASE, CINAHL, and PsycINFO published after September 11, 2001, and included service members who sustained a mobility impairment because of involvement in a post-9/11 combat operation. Basic descriptors were extracted in addition to health outcomes used, which were then categorized and summarized by six domains for HR-QoL as defined by the World Health Organization.

RESULTS

This review found health outcomes that fit in the pain and discomfort, negative emotions, mobility, social relations, access to and quality of healthcare services, and religious/spiritual/personal beliefs subdomains. The categorized results detailed their application to track and model HR-QoL health states in those with mobility impairments using mobility-based assistive technology.

CONCLUSIONS

The research on combat-induced mobility impairments indicates assistive technology improves otherwise poor health states. The results model these domains and subdomains to determine overall HR-QoL and the quality of a healthcare intervention, though additional research is needed as only one study was identified to be experimental in design.

Usability and task load comparison between a robotic assisted transfer device and a mechanical floor lift during caregiver assisted transfers on a care recipient

INTRODUCTION

The RATD represents a novel methodology to reduce strain, manoeuvring, and cognitive load a caregiver experiences when conducting transfers on a mannequin. However, caregivers who used this new technology report suggested adjustments regarding the robot's human machine interface and shape as to improve transfer efficiency and comfort for care recipients. The purpose of this study was to test a redesigned RATD and compare its ergonomics during a transfer to those of a mechanical floor lift.

METHODS

This was cross sectional protocol. As opposed to prior research which used a mannequin, caregivers in this study (N = 28) partnered with, and transferred, a mobility device user (N = 28) at three unique surfaces. Information about task demand and usability was collected from surveys after use of each device at each surface.

RESULTS

Results indicated reduced physical demand (p = .004) and discomfort frequency (p = .01) in caregivers conducting the transfers with the RATD compared to the mechanical floor lift. Care recipients reported no significant differences between both transfer devices. Critiques with the interface, the harness and sling, and the robot's rigidity indicated more work is needed before introducing this technology to a larger market. Conclusions: The RATD represents a promising new intervention for transferring and handling care recipients who use wheelchairs. However, while caregivers report reduced physical demand and discomfort, more work is required to advance the ease of the human machine interface, the amount of space allowed for the robot to operate, and the ability of the care recipient to operate the technology independently.IMPLICATIONS FOR REHABILITATIONCaregivers report significant physical and mental stress while transferring clients in and out of a wheelchair.Clinical standard transfer equipment is limited in the space which it can be used.Robots, particularly those portable and powered, have the ability to not only make the transfer experience safer, but also expand the applications this equipment can provide.

Improving wheelchair route planning through instrumentation and navigation systems

Route planning is an important tool to reach points of interest. The current technology offers options for public transportation and pedestrians on the road and sidewalks, respectively. However, for people who use electric powered wheelchairs (EPW) as their primary means of mobility, the level of accessibility and EPW battery consumption are important during route planning. This paper introduces the concept of an accessible route navigation application to reduce EPW battery consumption. The application, called eNav, uses five layers of information including OpenStreetMaps (OSM), airborne laser scanner (ALS), Point-of-Interests (POIs), public transportation, and crowdsourcing. eNav collects these layers of information to provide the shortest, most accessible, and most comfortable routes that consume the least amount of EPW battery. Additionally, the paper presents the Mobility Enhancement roBot (MEBot), a legged-wheeled power wheelchair, to drive over architectural barriers and less accessible environments. The paper proposes the use of MEBot as a sixth layer of information to inform eNav and road authorities about sidewalk/route conditions, to improve road accessibility, and to provide an energy efficient route planning for non-MEBot users.

Practice improves court mobility and self-efficacy in tennis-specific wheelchair propulsion

PURPOSE

Wheelchair tennis (WT) propulsion is uniquely characterized by the requirement for racket holding coupled with effective hand-rim contact. Thus, investigations involving strategies to enhance chair mobility skills are merited. The aim was to examine the effects of organized practice on WT match play responses and the impact of racket holding during practice.

MATERIALS AND METHODS

Following physiological profiling involving graded and peak exercise testing, 16 able-bodied (AB) participants performed bouts of WT match play interspersed with practice involving wheelchair mobility drills completed with (R) or without (NR) a tennis racket. A data logger recorded distance and speed. Self-efficacy was reported.

RESULTS AND CONCLUSIONS

Significant main effects for match revealed higher post-practice overall and forwards distances (p < 0.05), peak (p < 0.005) and average (p < 0.05) speeds and self-efficacy (SE) (p = 0.001) were attained. During practice, lower distances and speeds were achieved with R, with a lower physiological cost than NR. Practice increases court movement and SE with no associated increases in physiological cost. Changes represent enhanced court mobility. Differences between practice characteristics provide options for skill development and optimization of health outcomes.IMPLICATIONS FOR REHABILITATIONWheelchair tennis participation is likely to confer positive health effects in those with a disability or physical impairment.As chair propulsion combined with racket holding represents a complex skill challenge, novices may find the sport challenging to play.Tennis-specific mobility drills improve confidence and chair propulsion skill with likely crossover into tennis match play competence and ability.

Comparing the performance of ultralight folding manual wheelchairs using standardized tests

Objective: To evaluate ultralight folding manual wheelchairs (UFMWs) in order to produce comparative data on their strength, durability, stability and cost-benefit, and to determine progress of wheelchairs by comparing these results to results of past studies.Design: Engineering testing using American National Standards Institute (ANSI) and Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) standards.Setting: Laboratory testing of UFMW stability, and static, impact and fatigue strength performance with three devices using ANSI/RESNA standardized tests.Participants: The three wheelchair models were the TiLite Aero X (Permobil, Lebanon, TN), Sunrise Medical Quickie 2 (Fresno, CA) and Ki Mobility Catalyst 5 (Stevens Point, WI).Interventions: ANSI/RESNA standardized tests.Main outcome measures: Mass and critical measurements, static stability, static strength, impact strength, fatigue strength and cost analysis.Results: The ultralight folding wheelchairs continued to outperform their lightweight and rigid framed counterparts. According to these data, the quality of ultralight wheelchairs has not declined over the past 10 years. The Ki Catalyst did not pass strength and durability testing, while the TiLite Aero X and Sunrise Medical Quickie 2 surpassed these tests.Conclusions: This result exemplifies the need for ongoing research to identify whether wheelchairs satisfy ANSI/RESNA testing requirements and highlights the importance of creating a resource data set. This is particularly important when numerous other wheelchairs fail to meet minimum ANSI/RESNA requirements.Implications for RehabilitationFolding frame wheelchairs offer benefits such as transportability and convenience that may benefit certain wheelchair users, assuming their durability is sufficient and they provide similar benefits vs. other wheelchair construction.Previous studies have shown that folding wheelchairs perform meet the minimum requirements of standardized testing, and it is important to see if durability has increased, decreased or remained the same over the years. Other wheelchair types have remained stagnant with respect to durability and are less likely to meet the minimum durability requirements.Durable devices will improve a wheelchair user's quality of life by reducing downtime while waiting for repairs, and also reduce the likelihood of injury due to component failure.

Person transfer assist systems: a literature review

OBJECTIVE

Novel developments in the robotics field have produced systems that can support person wheelchair transfers, maximize safety and reduce caregiver burden. The purpose of this study was to identify and describe these systems, their usability (or satisfaction), the context for which they have been or can be used and how they have been evaluated to determine evidence for their effectiveness.

METHOD

Available research on Person Transfer Assist Systems (PTAS) was systematically gathered using similar standards to the PRISMA guidelines. The search terms were derived from common terms and via exploring similar review articles. Initial search terms displayed 1330 articles and by using the inclusion/exclusion criteria 96 articles were selected for abstract review. After full- text reviewing 48 articles were included.

RESULTS

29 articles concerned research in robotic transfer systems, 10 articles used both ceiling and floor-mounted lifts and 9 articles used only floor-mounted lifts as an intervention/control group. The results of this analysis identified a few usability evaluations for robotic transfer prototypes, especially ones comparing prototypes to existing marketed devices.

CONCLUSION

Robotic device research is a recent development within assistive technology. Whilst usability evaluations provided evidence that a robotic device will provide better service to the user, the sample number of subjects used are minimal in comparison to any of the intervention/control group articles. Experimental studies between PTASs are required to support technological advancements. Caregiver injury risk has been the focus for most of the comparison articles; however, few articles focus on the implications to the person.IMPLICATIONS FOR REHABILITATIONCeiling mounted lifts are preferred over floor-based lifts due to lower injury rates.Many robotic transfer systems have been developed; however, there is a paucity of quantitative and qualitative studies.Based on the results of this review, rehabilitation settings are recommended to use ceiling over floor assist systems, and it is recommended to provide training on using devices to assist with patient transfers to lower the risk of injuries.

A Heuristic Approach to Overcome Architectural Barriers Using a Robotic Wheelchair

The Mobility Enhancement roBotic (MEBot) wheelchair was developed to improve the safety and accessibility of wheelchair users when facing architectural barriers. MEBot uses pneumatic actuators attached to its frame and six wheels to provide curb ascending/descending for heights up to 20.3 cm. To improve MEBot's application, this study used a heuristic approach with power wheelchair users to evaluate and improve the MEBot application at different curb heights. Wheelchair users were trained on MEBot's features to operate its curb ascending/descending application. Three trials were carried out with wheelchair users ascending and descending three curbs of different height. Quantitative variables were analyzed to improve the sequential steps to ascend/descend curbs. Additionally, the application's effectiveness and efficiency were measured by the number of completed tasks, change in seat angle, and task completion time. Results showed that participants completed each trial and applied alternative strategies to traverse different curb heights. Furthermore, results suggested the combination and/or re-arrangement of steps to reduce task completion time. MEBot demonstrated its effectiveness to ascend/descend different curb heights with a heterogeneous participant sample. Future work will incorporate participant's most efficient strategies to improve the ascending/ascending process and the efficiency of the MEBot application.

Assessment of Usability and Task Load Demand Using a Robot-Assisted Transfer Device Compared With a Hoyer Advance for Dependent Wheelchair Transfers

OBJECTIVE

Manual lifting can be burdensome for people who care for power wheelchair users. Although technologies used for dependent transfers are helpful, they have shortcomings of their own. This study compares the usability and task load demand of a novel robot-assisted transfer device to a clinical standard when performing dependent transfers.

DESIGN

A cross-sectional study was conducted to assess caregivers (N = 21) transferring a 56-kg mannequin with the Strong Arm and Hoyer Advance at three transfer locations. Feedback was gathered through qualitative surveys.

RESULTS

Usability was significant in multiple areas important for transfers. Caregiver fatigue and discomfort intensity were reduced, and the Strong Arm was preferred at the three transfer locations. Device ease and efficiency favored Strong Arm at two stations as was discomfort frequency. In addition, physical demand, frustration, and effort were significantly lower using Strong Arm compared with the Hoyer Advance.

CONCLUSIONS

Compared with the Hoyer, participants favored Strong Arm for transfer usability and task load demand. However, further Strong Arm developments are needed.

The Voice of the Consumer: A Survey of Veterans and Other Users of Assistive Technology

Introduction

A total of 3.6 million Americans and over 250,000 veterans use wheelchairs. The need for advancements in mobility-assistive technologies is continually growing due to advances in medicine and rehabilitation that preserve and prolong the lives of people with disabilities, increases in the senior population, and increases in the number of veterans and civilians involved in conflict situations. The purpose of this study is to survey a large sample of veterans and other consumers with disabilities who use mobility-assistive technologies to identify priorities for future research and development.

Materials and Methods

This survey asked participants to provide opinions on the importance of developing various mobility-assistive technologies and to rank the importance of certain technologies. Participants were also asked to provide open-ended comments and suggestions.

Results

A total of 1,022 individuals, including 500 veterans, from 49 states within the USA and Puerto Rico completed the survey. The average age of respondents was 54.3 yr, and they represented both new and experienced users of mobility-assistive technologies. The largest diagnostic group was spinal cord injury (SCI) (N = 491, 48.0%). Several themes on critical areas of research emerged from the open-ended questions, which generated a total of 1,199 comments.

Conclusion

This survey revealed several themes for future research and development. Advanced wheelchair design, smart device applications, human-machine interfaces, and assistive robotics and intelligent systems emerged as priorities. Survey results also demonstrated the importance for researchers to understand the effects of policy and cost on translational research and to be involved in educating both consumers and providers.

Development and efficacy of an online wheelchair maintenance training program for wheelchair personnel

OBJECTIVES

To develop an online version of the wheelchair maintenance training program (WMTP) and compare learning outcomes from the in-person and online programs using the wheelchair maintenance training questionnaire (WMT-Q), administered before and after the intervention.

DESIGN

Iterative development of an online version of the WMTP and implementation.

SETTING

Online.

PARTICIPANTS

26 graduate and undergraduate students.

INTERVENTION

Web-based training. These results are compared with those from another study of the in-person WMTP with 10 participants.

MAIN OUTCOME MEASURES

Feedback survey and WMT-Q.

RESULTS

The training program was well-received and valued by all 26 participants. A significant increase in all scores after the online training program was found, based on pre-/post-intervention scores. In manual wheelchair open-ended questions, knowledge increased from 16% to 21%, p < .05; in power wheelchair open-ended questions, from 9% to 31%, p < .05; in multiple-choice questions related to knowledge, from 27% to 59%, p < .05; confidence increased from 8% to 80%, p < .05; and capacity from 12% to 88%, p < .05. There was no statistical difference in WMT-Q scores between individuals who participated in the in-person and online programs.

CONCLUSION

This study indicates that there was a similar-increased knowledge for participants, indicating that web-based training may be a viable approach for delivering maintenance training.

Accessible machining for people who use wheelchairs

Despite the Americans with Disabilities Act mandate for reasonable accommodations, wheelchair users are often placed in the role of observer and note-taker when learning machining and fabrication skills due to a lack of accessibility. The focus of this case study report is to identify and develop reasonable accommodations for wheelchair users in an academic machine shop environment to address accessibility limitations of original equipment manufacturer (OEM) machines. Individual wheelchair users working and learning within the Human Engineering Research Laboratories (HERL) were observed and interviewed about their experiences using the machine shop equipment without modifications, followed by further observations after accommodations were implemented.

Reflections on recovery, rehabilitation and reintegration of injured service members and veterans from a bio-psychosocial-spiritual perspective

Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system. Questions on enabling participation in meaningful life activities include the following: Why do some patients do well and others do not? What elements contribute to positive outcomes? What factors relate to suboptimal results? Lessons learned revolve around the importance of considering the physical, psychosocial and spiritual aspects of a person’s well-being; empowering patients by fostering self-efficacy; and helping patients find meaning in life events and set high-level goals. A bio-psychosocial-spiritual model from the rehabilitation medicine literature — the Canadian Model of Occupational Performance and Engagement — is proposed as a guide to the provision of person-centred care and the maximization of a person’s functioning posttrauma.

Usability Evaluation of a Novel Robotic Power Wheelchair for Indoor and Outdoor Navigation

OBJECTIVE

To compare the Mobility Enhancement roBotic (MEBot) wheelchair's capabilities with commercial electric-powered wheelchairs (EPWs) by performing a systematic usability evaluation.

DESIGN

Usability in effectiveness, efficacy, and satisfaction was evaluated using quantitative measures. A semistructured interview was employed to gather feedback about the users' interaction with MEBot.

SETTING

Laboratory testing of EPW driving performance with 2 devices in a controlled setting simulating common EPW driving tasks.

PARTICIPANTS

A convenience sample of expert EPW users (N=12; 9 men, 3 women) with an average age of 54.7±10.9 years and 16.3± 8.1 years of EPW driving experience.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Powered mobility clinical driving assessment (PMCDA), Satisfaction Questionnaire, National Aeronautics and Space Administration's Task Load Index.

RESULTS

Participants were able to perform significantly higher number of tasks (P=.004), with significantly higher scores in both the adequacy-efficacy (P=.005) and the safety (P=.005) domains of the PMCDA while using MEBot over curbs and cross-slopes. However, participants reported significantly higher mental demand (P=.005) while using MEBot to navigate curbs and cross-slopes due to MEBot's complexity to perform its mobility applications which increased user's cognitive demands.

CONCLUSIONS

Overall, this usability evaluation demonstrated that MEBot is a promising EPW device to use indoors and outdoors with architectural barriers such as curbs and cross-slopes. Current design limitations were highlighted with recommendations for further improvement.

The American Student Placements in Rehabilitation Engineering Program (ASPIRE)

Background: American Student Placements and Internships in Rehabilitation Engineering is founded on the principal of sparking the interest in a new generation of rehabilitation engineering scientists to transform the lives of older adults and people with disabilities. Each year a minimum of 10 students were enrolled.Methods: The internship runs for 10 weeks and activities center on developing excitement about technology and engineering and understanding the principles and processes of conducting rehabilitation engineering research. This was accomplished by student participation in 1) rehabilitation engineering research projects; 2) educational research training, and 3) professional activities with clinical and engineering faculty, staff, and graduate students. Of the 162 participants, 53% were women and 47% men. 23% of participants were from minority or underrepresented groups, and 18% identified as having a disability.Results: From post-internship follow-up efforts, 65% of program participants went on to pursue or have graduated with advanced degrees, 27% of whom are engineers from underrepresented groups. Of those students that are working post-baccalaureate, 70% are engineers working in a biomedical/technology field. In the past 3 years, 92% of students stated that the program met or exceeded their expectations, while 100% of the 2018 group felt that their expectations were met.Conclusion: The American Student Placements and Internships in Rehabilitation Engineering program has demonstrated efficacy in preparing undergraduate students for future academic work and employment.Implications for RehabilitationCreative researchers and designers will lead the way in advancing accessibility standards and engineering for people with disabilities.The ASPIRE program increases excitement for and interest in the fields of rehabilitation engineering among undergraduate students to positively influence academic and professional careers.Students enrolled in the ASPIRE program actively participated in a real multidisciplinary project supervised by professor mentors. This led students to take a problem-based approach in their professional development.The ASPIRE program stimulates rehabilitation engineering in students' mindset and promotes inclusive academic environments and communities.Rehabilitation engineering is not a mainstream discipline, but the ASPIRE program indicates that there are benefits to student education, including participatory action engineering, that need to continue gain momentum until rehabilitation engineering is a mainstream discipline or a core component of engineering education.We must move beyond a "survival of the fittest" mentality. A "survival of the fittest" model places a disproportionate burden on groups that are underrepresented in science and engineering, and thereby postpones the day on which the demographics of science and engineering are comparable to that of society as a whole.The ASPIRE program needs to be replicated at various institutions around the world.

Barriers and facilitators to students with physical disabilities' participation in academic laboratory spaces

Purpose: To provide empirical evidence on learning barriers and facilitators in instructional science and engineering laboratory settings from a national survey on students with physical disabilities (SwD-P).Methods: A nationwide self-report survey, the Full Participation Science and Engineering Accessibility (FPSEA), was disseminated online via Qualtrics. Approximately 1200 organizations and universities across the United States were contacted through purposive sampling. Descriptive statistics were primarily used for the analysis of the results.Results: Survey findings reveal that students experience a wide range of limitations to full participation in the laboratory, from entering the laboratory (25%) to being given passive roles (50%). Additionally, while 66% of respondents indicated that instructors were willing to help SwD-P participate in science and engineering (S&E) laboratories, 16.8% were not willing to do so, and 47% SwD-P felt that practices were not in place to provide accommodations. The survey also reveals a range of facilitators such as elevators, ramps, accessible course materials and peer assistance. Most respondents (74%) also indicated that peers were helpful in completing laboratory tasks.Conclusion: This survey provides empirical evidence that was previously voiced through non-empirical information in the literature. Participants cited barriers such as inappropriate accommodations and instructors' negative viewpoints, as well as gaining access to facilities even after the enactment of the Americans with Disabilities Act (ADA). These findings suggest that while ADA has lessened some barriers to SwD-P, barriers remain in using the laboratory space. The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective.Implications for RehabiliationBarriers students with disabilities encounter in science and engineering (S&E) laboratory environments remain unclear.The FPSEA survey fills the gap in finding barriers and facilitators to using S&E laboratories from the SwD-P's perspective.The FPSEA survey allows former and current SwD-P to share their experiences using a postsecondary S&E instructional laboratory.

Engineering and Technology in Wheelchair Sport

Technologies capable of projecting injury and performance metrics to athletes and coaches are being developed. Wheelchair athletes must be cognizant of their upper limb health; therefore, systems must be designed to promote efficient transfer of energy to the handrims and evaluated for simultaneous effects on the upper limbs. This article is brief review of resources that help wheelchair users increase physiologic response to exercise, develop ideas for adaptive workout routines, locate accessible facilities and outdoor areas, and develop wheelchair sports-specific skills.