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To understand the priorities and preferences of people with disabilities (PwDs) and older adults regarding accessible autonomous vehicles (AVs) to address existing transportation barriers. Two national surveys, Voice of the Consumer and Voice of the Provider, were conducted to gather feedback from accessible AV consumers and providers, respectively, in the United States. This U.S.-based study focused on PwDs and older adults who may face transportation challenges and those who provide or design AV solutions. The 922 consumers and 45 providers in the surveys encompassed a diverse range of disability types, caregiver roles, and age groups (N = 967). Not applicable. The main outcomes were consumer usage needs and provider preferences for features in accessible autonomous transportation. Patterns in usage needs and feature preferences through 2-step clustering algorithm were applied subsequent to the descriptive analysis of participant demographics and their responses. 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. 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. [ABSTRACT FROM AUTHOR]

• Electric powered wheelchair (EPW) users are prone to tips on non-ADA-compliant surfaces. • MEBot was developed with 2 dynamic suspensions for tip prevention on these surfaces. • MEBot dynamic suspensions improved stability compared with EPW on a driving course. • MEBot with EHAS suspension was rated as comfortable and easy to use as common EPWs. • Quantitative and standardized metrics were used to compare robotic EPW performance. 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). Within-subjects cross-sectional study. Driving performance and usability were evaluated using quantitative measures and standardized tools, respectively. Laboratory settings that simulated common EPW outdoor driving tasks. 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). Not applicable. Seat angle peaks (stability), number of completed trials (effectiveness), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and systemic usability scale (SUS). 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. 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. [ABSTRACT FROM AUTHOR]

• Participatory action engineering has transformed assistive device design. • Assistive technologies empower people with disabilities. • Despite improvements there is still much to be done. • Low income countries lag high income countries in technical and social changes. • There are exciting emerging technologies and systems. Over the past four decades, there have been breakthroughs in communication, mobility and tools to manipulate objects. Probably the most important transformation has been the growing inclusion of people with disabilities into the prioritization, conceptualization, and design of new assistive devices. Advances in technology, demands from people with disabilities, and changes in cultural perceptions have made noteworthy changes in the technologies that have improved lives, and affected transformations that benefit both individuals and society. People with disabilities lives have been improved but there is still much to be done. Unfortunately, people with disabilities in low income countries have lagged people in higher income countries in benefitting from technical and social changes. Assistive devices have benefitted from the availability of powerful, portable computing power, from small low-power sensors, from new materials, from rapid prototyping and flexible manufacturing. There are exciting emerging technologies that show promise for future advances. [ABSTRACT FROM AUTHOR]

Abstract 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. Graphical abstract Highlights • Power wheelchair (electric-powered wheelchair [EPW]) users are prone to tips and falls when driving outdoor terrains. • Mobility Enhancement roBotic (MEBot) was designed to improve navigational skills of EPW users in common terrains. • Active EPW users compared MEBot capabilities to their own EPWs in a driving course. • Results demonstrated MEBot's efficiency and efficacy to drive in all terrains. • EPW users recommended semiautonomous applications and an intuitive interface. [ABSTRACT FROM AUTHOR]

Objective To investigate the frequency and types of wheelchair repairs and associated adverse consequences. Design Convenience cross-sectional sample survey. Setting Nine Spinal Cord Injury Model Systems Centers. Participants People with spinal cord injury who use a wheelchair >40h/wk (N=591). Interventions Not applicable. Main Outcome Measures Number of repairs needed and resulting adverse consequences, number and types of repairs completed, and location where main repair was completed in the previous 6 months. Results There were 591 participants responded to the survey, 63.8% (377/591) of them needed ≥1 repair; of these, 27.6% (104/377) experienced ≥1 adverse consequence, including 18.2% (69/377) individuals who were stranded. Of those who needed repairs, 6.9% did not have them completed (26/377). Repairs completed on the wheels and casters were the most frequent repair to manual wheelchairs, whereas repairs to the electrical and power and control systems were the most frequent type of repair on power wheelchairs. Forty percent (79/201) of manual wheelchair users reported completing repairs at home themselves compared with 14% (21/150) of power wheelchair users. Twelve percent of the variance in the odds of facing an adverse consequence because of a wheelchair breakdown can be described as a function of occupation, funding source, and type of wheelchair. Conclusions Wheelchair repairs are highly prevalent. There are differences in types of repairs and who completes the repairs based on the type of wheelchair. Wheelchair breakdowns result in adverse consequences for users, and there is a deficit between repairs needed and those completed, highlighting the need for interventions that address these problems. [ABSTRACT FROM AUTHOR]

Objective To evaluate the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on the upper limb biomechanics during transfers. Design Pre-post intervention. Setting Biomechanics laboratory. Participants Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded. Intervention Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training. Main Outcome Measures TAI part 1 summary scores and biomechanical variables calculated at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training. Results Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training ( P <.05). On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training ( P <.04). Conclusions The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users' upper limbs, such as better shoulder positioning and lower joint loadings. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries. [ABSTRACT FROM AUTHOR]

Objective To develop and evaluate energy expenditure (EE) estimation models for a physical activity monitoring system (PAMS) in manual wheelchair users with spinal cord injury (SCI). Design Cross-sectional study. Setting University-based laboratory environment, a semistructured environment at the National Veterans Wheelchair Games, and the participants' home environments. Participants Volunteer sample of manual wheelchair users with SCI (N=45). Intervention Participants were asked to perform 10 physical activities (PAs) of various intensities from a list. The PAMS consists of a gyroscope-based wheel rotation monitor (G-WRM) and an accelerometer device worn on the upper arm or on the wrist. Criterion EE using a portable metabolic cart and raw sensor data from PAMS were collected during each of these activities. Main Outcome Measures Estimated EE using custom models for manual wheelchair users based on either the G-WRM and arm accelerometer (PAMS-Arm) or the G-WRM and wrist accelerometer (PAMS-Wrist). Results EE estimation performance for the PAMS-Arm (average error ± SD: -9.82%±37.03%) and PAMS-Wrist (-5.65%±32.61%) on the validation dataset indicated that both PAMS-Arm and PAMS-Wrist were able to estimate EE for a range of PAs with <10% error. Moderate to high intraclass correlation coefficients (ICCs) indicated that the EE estimated by PAMS-Arm (ICC3,1=.82, P<.05) and PAMS-Wrist (ICC3,1=.89, P<.05) are consistent with the criterion EE. Conclusions Availability of PA monitors can assist wheelchair users to track PA levels, leading toward a healthier lifestyle. The new models we developed can estimate PA levels in manual wheelchair users with SCI in laboratory and community settings. [ABSTRACT FROM AUTHOR]

Objective To assess the stability of clinicians' and users' rating of electric-powered wheelchair (EPW) driving while using 4 different human-machine interfaces (HMIs) within the Virtual Reality-based SIMulator-version 2 (VRSIM-2) and in the real world (accounting for a total of 5 unique driving conditions). Design Within-subjects repeated-measures design. Setting Simulation-based assessment in a research laboratory. Participants A convenience sample of EPW athletes (N=21) recruited at the 31st National Veterans Wheelchair Games. Interventions Not applicable. Main Outcome Measures Composite PMRT scores from the Power Mobility Road Test (PMRT); Raw Task Load Index; and the 6 subscale scores from the Task Load Index developed by the National Aeronautics and Space Administration (NASA-TLX). Results There was moderate stability (intraclass correlation coefficient between .50 and .75) in the total composite PMRT scores (P<.001) and the users' self-reported performance scores (P<.001) among the 5 driving conditions. There was a significant difference in the workload among the 5 different driving conditions as reflected by the Raw Task Load Index (P=.009). Subanalyses revealed this difference was due to the difference in the mental demand (P=.007) and frustration (P=.007) subscales. Post hoc analyses revealed that these differences in the NASA-TLX subscale scores were due to the differences between real-world and virtual driving scores, particularly attributable to the conditions (1 and 3) that lacked the rollers as a part of the simulation. Conclusions Further design improvements in the simulator to increase immersion experienced by the EPW user, along with a standardized training program for clinicians to deliver PMRT in VRSIM-2, could improve the stability between the different HMIs and real-world driving. [ABSTRACT FROM AUTHOR]

Objective To assess interrater reliability of the Power Mobility Road Test (PMRT) when administered through the Virtual Reality-based SIMulator-version 2 (VRSIM-2). Design Within-subjects repeated-measures design. Setting Participants interacted with VRSIM-2 through 2 display options (desktop monitor vs immersive virtual reality screens) using 2 control interfaces (roller system vs conventional movement-sensing joystick), providing 4 different driving scenarios (driving conditions 1-4). Participants performed 3 virtual driving sessions for each of the 2 display screens and 1 session through a real-world driving course (driving condition 5). The virtual PMRT was conducted in a simulated indoor office space, and an equivalent course was charted in an open space for the real-world assessment. After every change in driving condition, participants completed a self-reported workload assessment questionnaire, the Task Load Index, developed by the National Aeronautics and Space Administration. Participants A convenience sample of electric-powered wheelchair (EPW) athletes (N=21) recruited at the 31st National Veterans Wheelchair Games. Interventions Not applicable. Main Outcome Measures Total composite PMRT score. Results The PMRT had high interrater reliability (intraclass correlation coefficient [ICC]>.75) between the 2 raters in all 5 driving conditions. Post hoc analyses revealed that the reliability analyses had >80% power to detect high ICCs in driving conditions 1 and 4. Conclusions The PMRT has high interrater reliability in conditions 1 and 4 and could be used to assess EPW driving performance virtually in VRSIM-2. However, further psychometric assessment is necessary to assess the feasibility of administering the PMRT using the different interfaces of VRSIM-2. [ABSTRACT FROM AUTHOR]

Abstract: Hiremath SV, Ding D, Farringdon J, Cooper RA. Predicting energy expenditure of manual wheelchair users with spinal cord injury using a multisensor-based activity monitor. Objective: To develop and evaluate new energy expenditure (EE) prediction models for manual wheelchair users (MWUs) with spinal cord injury (SCI) based on a commercially available multisensor-based activity monitor. Design: Cross-sectional. Setting: Laboratory. Participants: Volunteer sample of MWUs with SCI (N=45). Intervention: Subjects were asked to perform 4 activities including resting, wheelchair propulsion, arm-ergometer exercise, and deskwork. Criterion EE using a metabolic cart and raw sensor data from a multisensor activity monitor was collected during each of these activities. Main Outcome Measures: Two new EE prediction models including a general model and an activity-specific model were developed using enhanced all-possible regressions on 36 MWUs and tested on the remaining 9 MWUs. Results: The activity-specific and general EE prediction models estimated the EE significantly better than the manufacturer''s model. The average EE estimation error using the manufacturer''s model and the new general and activity-specific models for all activities combined was –55.31% (overestimation), 2.30% (underestimation), and 4.85%, respectively. The average EE estimation error using the manufacturer''s model, the new general model, and activity-specific models for various activities varied from –19.10% to –89.85%, –18.13% to 25.13%, and –4.31% to 9.93%, respectively. Conclusions: The predictors for the new models were based on accelerometer and demographic variables, indicating that movement and subject parameters were necessary in estimating the EE. The results indicate that the multisensor activity monitor with new prediction models can be used to estimate EE in MWUs with SCI during wheelchair-related activities mentioned in this study. [Copyright &y& Elsevier]

Abstract: Mahajan H, Spaeth DM, Dicianno BE, Collins DM, Boninger ML, Cooper RA. Comparison of virtual wheelchair driving performance of people with traumatic brain injury using an isometric and a conventional joystick. Objective: To compare wheelchair driving performance in a driving simulator using a conventional joystick and an isometric joystick. Design: Randomized, cohort study. Setting: A research facility based in a hospital or in an independent living center. Participants: Participants (N=20; 12 men, 8 women; mean age ± SD, 30.62±10.91y) who were at least 1 year post-TBI. Interventions: Driving performance using an isometric joystick compared with a conventional movement joystick. Main Outcome Measures: Average trial completion time, and trajectory-specific measures measured orthogonal to the center of driving tasks: root mean squared error, movement offset, movement error, and number of significant changes in heading. Results: After statistically controlling for driving speed, participants were able to complete the driving tasks faster with an isometric joystick than while using a conventional movement joystick. Compared with the conventional joystick, an isometric joystick used for driving forward demonstrated fewer driving errors. During reverse driving the conventional joystick performed better. Conclusions: The customizable isometric joystick seems to be a promising interface for driving a powered wheelchair for individuals with TBI. [Copyright &y& Elsevier]

Abstract: Riggins MS, Kankipati P, Oyster ML, Cooper RA, Boninger ML. The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury. Objective: To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. Design: Retrospective case study of National SCI Database data. Setting: SCI Model Systems (SCIMS) sites (N=18). Participants: Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. Interventions: Not applicable. Main Outcome Measures: Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. Results: Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). Conclusions: Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation. [Copyright &y& Elsevier]

Abstract: A smart home is a residence equipped with technology that observes the residents and provides proactive services. Most recently, it has been introduced as a potential solution to support independent living of people with disabilities and older adults, as well as to relieve the workload from family caregivers and health providers. One of the key supporting features of a smart home is its ability to monitor the activities of daily living and safety of residents, and in detecting changes in their daily routines. With the availability of inexpensive low-power sensors, radios, and embedded processors, current smart homes are typically equipped with a large amount of networked sensors which collaboratively process and make deductions from the acquired data on the state of the home as well as the activities and behaviors of its residents. This article reviews sensor technology used in smart homes with a focus on direct environment sensing and infrastructure mediated sensing. The article also points out the strengths and limitations of different sensor technologies, as well as discusses challenges and opportunities from clinical, technical, and ethical perspectives. It is recommended that sensor technologies for smart homes address actual needs of all stake holders including end users, their family members and caregivers, and their doctors and therapists. More evidence on the appropriateness, usefulness, and cost benefits analysis of sensor technologies for smart homes is necessary before these sensors should be widely deployed into real-world residential settings and successfully integrated into everyday life and health care services. [Copyright &y& Elsevier]

Abstract: Koontz AM, Brindle ED, Kankipati P, Feathers D, Cooper RA. Design features that affect the maneuverability of wheelchairs and scooters. Objective: To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. Design: Case series. Setting: University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. Participants: The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). Intervention: A mock environment was constructed to create passageways to form an L-turn, 360°-turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. Main Outcome Measure: Minimum passageway widths for the 4 maneuverability tasks. Results: Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360°-turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. Conclusions: Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas. [Copyright &y& Elsevier]

Abstract: McClure LA, Boninger ML, Oyster ML, Williams S, Houlihan B, Lieberman JA, Cooper RA. Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury. Objectives: To investigate the frequency of repairs that occurred in a 6-month period and the consequences of breakdowns on wheelchair users living with spinal cord injuries (SCIs), and to determine whether certain wheelchair and subject characteristics are associated with an increased number of repairs and adverse consequences. Design: Convenience sample survey. Setting: Sixteen Model Spinal Cord Injury Systems Centers that are part of the national database funded through the Department of Education, National Institute on Disability and Rehabilitation Research. Participants: People with SCI who use a wheelchair for more than 40h/wk (N=2213). Intervention: Not applicable. Main Outcome Measures: The frequency of wheelchair repairs and occurrence of adverse consequences caused by a wheelchair breakdown in a 6-month period. Results: Within a 6-month period, 44.8% of full-time wheelchair users completed a repair, and 8.7% had an adverse consequence occur. People who use power wheelchairs required significantly more repairs (P<.001), and adverse consequences occurred more frequently (P<.001) compared with manual wheelchair users. The presence of power seat functions, and a person''s occupational status or sex did not influence the number of repairs or adverse consequences. Conclusions: Frequent repairs and breakdown can negatively impact a person''s life by decreasing community participation and threatening health and safety. Mandatory compliance with the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America standards, changes in insurance reimbursement policy, and patient and clinician education are necessary to reduce the number of repairs and adverse consequences that occur. [Copyright &y& Elsevier]

Abstract: Koontz AM, Roche BM, Collinger JL, Cooper RA, Boninger ML. Manual wheelchair propulsion patterns on natural surfaces during start-up propulsion. Objectives: To classify propulsion patterns over surfaces encountered in the natural environment during start-up and compare selected biomechanical variables between pattern types. Design: Case series. Setting: National Veterans Wheelchair Games, Minneapolis, MN, 2005. Participants: Manual wheelchair users (N=29). Intervention: Subjects pushed their wheelchairs from a resting position over high-pile carpet, over linoleum, and up a ramp with a 5° incline while propulsion kinematics and kinetics were recorded with a motion capture system and an instrumented wheel. Main Outcome Measures: Three raters classified the first 3 strokes as 1 of 4 types on each surface: arc, semicircular (SC), single looping over propulsion (SL), and double looping over propulsion (DL). The Fisher exact test was used to assess pattern changes between strokes and surface type. A multiple analysis of variance test was used to compare peak and average resultant force and moment about the hub, average wheel velocity, stroke frequency, contact angle, and distance traveled between stroke patterns. Results: SL was the most common pattern used during start-up propulsion (44.9%), followed by arc (35.9%), DL (14.1%), and SC (5.1%). Subjects who dropped their hands below the rim during recovery achieved faster velocities and covered greater distances (.016≤P≤.075) during start-up on linoleum and carpet and applied more force during start-up on the ramp compared with those who used an arc pattern (P=.066). Conclusions: Classifying propulsion patterns is a difficult task that should use multiple raters. In addition, propulsion patterns change during start-up, with an arc pattern most prevalent initially. The biomechanical findings in this study agree with current clinical guidelines that recommend training users to drop the hand below the pushrim during recovery. [Copyright &y& Elsevier]

Abstract: Globally, the number of people older than 65 years is anticipated to double between 1997 and 2025, while at the same time the number of people with disabilities is growing at a similar rate, which makes technical advances and social policies critical to attain, prolong, and preserve quality of life. Recent advancements in technology, including computation, robotics, machine learning, communication, and miniaturization of sensors have been used primarily in manufacturing, military, space exploration, and entertainment. However, few efforts have been made to utilize these technologies to enhance the quality of life of people with disabilities. This article offers a perspective of future development in seven emerging areas: translation of research into clinical practice, pervasive assistive technology, cognitive assistive technologies, rehabilitation monitoring and coaching technologies, robotic assisted therapy, and personal mobility and manipulation technology. [Copyright &y& Elsevier]

Abstract: Karmarkar A, Cooper RA, Liu H, Connor S, Puhlman J. Evaluation of pushrim-activated power-assisted wheelchairs using ANSI/RESNA standards. Objective: To determine and compare performance of pushrim-activated power-assisted wheelchairs (PAPAW) (iGLIDE, e-motion, Xtender) on national standards. Design: Engineering performance and safety evaluation. Setting: A Veteran Affairs and university-based research center. Specimens: Nine PAPAWs. Interventions: Not applicable. Main Outcome Measures: Static, dynamic stability, brake effectiveness, maximum speed, acceleration, retardation, energy consumption, static, impact, and fatigue strength. Results: There was no significant difference among the 3 models in forward stability. The iGLIDE was the most stable, whereas the e-motion was the least stable model in the rearward stability tests. All PAPAWs performed equally on the slopes of 3° and 6° in the forward and rearward directions. Braking distance was the highest for e-motion (5.64±0.28m) and the lowest (1.13±0.03m) for the iGLIDE in forward direction. The average equivalent cycles of all PAPAWs were 318,292±112,776.6 cycles (n=8) on the fatigue tests. All PAPAWs passed the impact and static strength tests. Conclusions: The standards of the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America could act as quality assurance tool for wheelchairs. The standards for wheelchairs were first approved in 1990; after 17 years, exceeding the minimum values in the standards would be a reasonable expectation. [Copyright &y& Elsevier]

Abstract: Spaeth DM, Mahajan H, Karmarkar A, Collins D, Cooper RA, Boninger ML. Development of a wheelchair virtual driving environment: trials with subjects with traumatic brain injury. Objective: To develop and test a wheelchair virtual driving environment that can provide quantifiable measures of driving ability, offer driver training, and measure the performance of alternative controls. Design: A virtual driving environment was developed. The wheelchair icon is displayed in a 2-dimensional, bird''s eye view and has realistic steering and inertial properties. Eight subjects were recruited to test the virtual driving environment. They were clinically evaluated for range of motion, muscle strength, and visual field function. Driving capacity was assessed by a brief trial with an actual wheelchair. During virtual trials, subjects were seated in a stationary wheelchair; a standard motion sensing joystick (MSJ) was compared with an experimental isometric joystick by using a repeated-measures design. Setting: Subjects made 2 laboratory visits. The first visit included clinical evaluation, tuning the isometric joystick, familiarization with virtual driving environment, and 4 driving tasks. The second visit included 40 trials with each joystick. Participants: Subjects (n=8; 7 men, 1 woman) with a mean age of 22.65±2y and traumatic brain injury, both ambulatory and nonambulatory, were recruited. Interventions: The MSJ used factory settings. A tuning program customized the isometric joystick transfer functions during visit 1. During the second visit, subjects performed 40 trials with each joystick. Main Outcome Measure: The root mean square error (RMSE) was defined as the average deviation from track centerline (in meters) and speed (in m/s). Results: Data analysis from the first 8 subjects showed no statistically significant differences between joysticks. RMSE averaged .12 to .21m; speed averaged .75m/s. For all tasks and joysticks, driving in reverse resulted in a higher RMSE and more virtual collisions than forward driving. RMSE rates were greater in left and right turns than straight and docking tasks. Conclusions: Testing with instrumented real wheelchairs can validate the virtual driving environment and assess whether virtual driving skills transfer to actual driving. [Copyright &y& Elsevier]

Abstract: Collinger JL, Boninger ML, Koontz AM, Price R, Sisto SA, Tolerico ML, Cooper RA. Shoulder biomechanics during the push phase of wheelchair propulsion: a multisite study of persons with paraplegia. Objectives: To present a descriptive analysis and comparison of shoulder kinetics and kinematics during wheelchair propulsion at multiple speeds (self-selected and steady-state target speeds) for a large group of manual wheelchair users with paraplegia while also investigating the effect of pain and subject demographics on propulsion. Design: Case series. Setting: Three biomechanics laboratories at research institutions. Participants: Volunteer sample of 61 persons with paraplegia who use a manual wheelchair for mobility. Intervention: Subjects propelled their own wheelchairs on a dynamometer at 3 speeds (self-selected, 0.9m/s, 1.8m/s) while kinetic and kinematic data were recorded. Main Outcome Measures: Differences in demographics between sites, correlations between subject characteristics, comparison of demographics and biomechanics between persons with and without pain, linear regression using subject characteristics to predict shoulder biomechanics, comparison of biomechanics between speed conditions. Results: Significant increases in shoulder joint loading with increased propulsion velocity were observed. Resultant force increased from 54.4±13.5N during the 0.9m/s trial to 75.7±20.7N at 1.8m/s (P<.001). Body weight was the primary demographic variable that affected shoulder forces, whereas pain did not affect biomechanics. Peak shoulder joint loading occurs when the arm is extended and internally rotated, which may leave the shoulder at risk for injury. Conclusions: Body-weight maintenance, as well as other interventions designed to reduce the force required to propel a wheelchair, should be implemented to reduce the prevalence of shoulder pain and injury among manual wheelchair users. [Copyright &y& Elsevier]

Abstract: Kim J, Brienza DM, Lynch RD, Cooper RA, Boninger ML. Effectiveness evaluation of a remote accessibility assessment system for wheelchair users using virtualized reality. Objective: To determine the value of the Remote Accessibility Assessment System (RAAS), a 3-dimensional (3D) image reconstruction technology designed to analyze accessibility of the target built environment in a virtualized reality, in assessing a built environment’s accessibility by calculating the congruence level between the RAAS and conventional in-person method. Design: Repeated-measures (within-subject) design. Setting: A university research laboratory. Participants: Three homes for people who use wheeled mobility devices. Intervention: Home physical environment was divided into several potential problem areas such as entrance, hallway, bathroom, and living room. Each area was identified by several tasks that might be performed in it. All possible tasks in each area within each home were evaluated using 2 methods: RAAS and the conventional in-person assessment. The evaluations were performed by a different home modification specialist for each method. Main Outcome Measures: Conventional in-person assessments were cross-tabulated with assessments from RAAS, with which there are 4 possible assessment combinations. A true positive (checked–checked) occurs when the RAAS method checks the target task as problematic and it is also checked as problematic by the conventional in-person method. True negative (not checked–not checked), false positive (not checked–checked), and false negative (checked–not checked) were also identified as the same way. Results: The proportion of overall agreement was high at 94.1% and the overall sensitivity and specificity was 95.6% and 90.3%, respectively. A significant κ coefficient of .857 and the 95% confidence interval of the odds ratio of 104.062 to 404.921 were calculated and a high level of overall agreement rate was shown. A high P value (.868) of the McNemar test implied that there was no marginal homogeneity, that is, no tendency to identify the task incorrectly in the positive or negative direction. Conclusions: This system proved that virtualized reality and 3D reconstruction technology may provide an effective means to investigate the architectural features of a built environment without an expert visiting the site. This system could become an efficient tool for the service provider and can provide expert service to underserved clients that would otherwise be unavailable. [Copyright &y& Elsevier]

Abstract: Cowan RE, Boninger ML, Sawatzky BJ, Mazoyer BD, Cooper RA. Preliminary outcomes of the SmartWheel Users’ Group database: a proposed framework for clinicians to objectively evaluate manual wheelchair propulsion. Objectives: To describe a standard clinical protocol for the objective assessment of manual wheelchair propulsion; to establish preliminary values for temporal and kinetic parameters derived from the protocol; and to develop graphical references and a proposed application process for use by clinicians. Design: Case series. Setting: Six research institutions that collect kinetic wheelchair propulsion data and contribute that data to an international data pool. Participants: Subjects with spinal cord injury (N=128). Interventions: Subjects propelled a wheelchair from a stationary position to a self-selected velocity across a hard tile surface, a low pile carpet, and up an Americans with Disabilities Act−compliant ramp. Unilateral kinetic data were obtained from subjects using a force and moment sensing pushrim. Main Outcome Measures: Differences in self-selected velocity, peak resultant force, push frequency, and stroke length across all surfaces, relationship between (1) weight-normalized peak resultant force and self-selected velocity and (2) push frequency and self-selected velocity. Results: Graphical references were generated for potential clinical use based on the relation between body weight−normalized peak resultant force, push frequency, and velocity. Self-selected velocity decreased (ramp < carpet < tile), peak resultant forces increased (ramp > carpet > tile), and push frequency and stroke length remained unchanged when compared across the different surfaces. Weight-normalized peak resultant force was a significant predictor of velocity on tile and ramp. Push frequency was a significant predictor of velocity on tile, carpet, and ramp. Conclusions: We present preliminary data generated from a clinically practical manual wheelchair propulsion evaluation protocol and we describe a proposed method for clinicians to objectively evaluate manual wheelchair propulsion. [Copyright &y& Elsevier]

Abstract: Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity. Executive summary. The general objective of the “Rehabilitation Medicine Summit: Building Research Capacity” was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were researchers; research culture, environment, and infrastructure; funding; partnerships; and metrics. Participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. Small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called for to pursue the agendas outlined in this report. [Copyright &y& Elsevier]

Abstract: Pearlman JL, Cooper RA, Karnawat J, Cooper R, Boninger ML. Evaluation of the safety and durability of low-cost nonprogrammable electric powered wheelchairs. Objective: To evaluate whether a selection of low-cost, nonprogrammable electric-powered wheelchairs (EPWs) meets the American National Standards Institute (ANSI)/Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Wheelchair Standards requirements. Design: Objective comparison tests of various aspects of power wheelchair design and performance of 4 EPW types. Specimens: Three of each of the following EPWs: Pride Mobility Jet 10 (Pride), Invacare Pronto M50 (Invacare), Electric Mobility Rascal 250PC (Electric Mobility), and the Golden Technologies Alanté GP-201-F (Golden). Setting: Rehabilitation engineering research center. Interventions: Not applicable. Main Outcome Measures: Static tipping angle; dynamic tipping score; braking distance; energy consumption; climatic conditioning; power and control systems integrity and safety; and static, impact, and fatigue life (equivalent cycles). Results: Static tipping angle and dynamic tipping score were significantly different across manufacturers for each tipping direction (range, 6.6°−35.6°). Braking distances were significantly different across manufacturers (range, 7.4−117.3cm). Significant differences among groups were found with analysis of variance (ANOVA). Energy consumption results show that all EPWs can travel over 17km before the battery is expected to be exhausted under idealized conditions (range, 18.2−32.0km). Significant differences among groups were found with ANOVA. All EPWs passed the climatic conditioning tests. Several adverse responses were found during the power and control systems testing, including motors smoking during the stalling condition (Electric Mobility), charger safety issues (Electric Mobility, Invacare), and controller failures (Golden). All EPWs passed static and impact testing; 9 of 12 failed fatigue testing (3 Invacare, 3 Golden, 1 Electric Mobility, 2 Pride). Equivalent cycles did not differ statistically across manufacturers (range, 9759−824,628 cycles). Conclusions: Large variability in the results, especially with respect to static tipping, power and control system failures, and fatigue life suggest design improvements must be made to make these low-cost, nonprogrammable EPWs safe and reliable for the consumer. Based on our results, these EPWs do not, in general, meet the ANSI/RESNA Wheelchair Standards requirements. [Copyright &y& Elsevier]

There are limited interface options for electric powered wheelchairs, which results in the inability of some individuals to drive independently. In addition, the development of new interface technologies will necessitate the development of alternative training methods. This study compares a conventional position sensing joystick to a novel isometric joystick during a driving task in a virtual environment and a real environment. The results revealed that there were few differences in task completion time and root-mean-square error (RMSE) between the two types of joysticks. There were significant correlations between the RMSE in the virtual environment and the real environment for both types of joysticks. The data indicate that performance in the virtual environment was representative of driving ability in the real environment, and the isometric joystick performed comparably to the position sensing joystick. [Copyright &y& Elsevier]

• Electric Powered Wheelchair (EPW) users are at risk of tips and falls when driving in outdoor environments. • MEBot increases the stability and safety of the user by adjusting its seat to ground changes. • MEBot was compared to the participant's own EPW in controlled outdoor tasks. • MEBot maintained its seat leveled compared to commercial EPWs in uneven terrains. • Participants reported no difference in satisfaction and task load demand between EPWs. Tips and falls are the most prominent causes of wheelchair accidents that occur when driving on uneven terrains and less accessible environments. The Mobility Enhancement Robotic Wheelchair (MEBot) was designed to improve the stability of Electric Powered Wheelchairs (EPW) when driving over these environments. MEBot offers six independently height-adjustable wheels to control attitude of its seat over uneven and angled terrains. Its attitude control application uses an inertial measurement unit to detect seat angles changes to adjust each wheel-height accordingly. MEBot was compared to commercial EPWs in terms of EPW performance (seat angle changes and response time) and participant perception (satisfaction and task-load demand) towards each device. Ten participants drove their own EPW and MEBot for five trials each through driving tasks that replicated outdoor environments. Results showed less change in the pitch angle when driving up and down a 10° slope using MEBot (5.6 ± 1.6°, 6.6 ± 0.5°) compared to the participants' own EPW (14.6 ± 2.6°, 12.1 ± 2.6°). However, MEBot required 7.8 ± 3.0 s to self-adjust to the minimum angle when driving over the tasks. Participants reported no difference in satisfaction and task load demand between EPWs due to similarities in comfort and ease-of-use. Improving the speed and efficiency of MEBot's attitude control application will be addressed in future work based upon participants' feedback. [ABSTRACT FROM AUTHOR]

• A sensorized air cell-based seat cushion was developed for PU prevention. • Real-time seating pressure was mapped using sensorized air cells. • Closed-loop control algorithm was used for interface pressure modulation. • Testing verified automated pressure offloading and redistribution. A sensorized air cell-based seat cushion system was developed to address the issues of loading magnitude and duration at a sitting interface to aid in reducing risk of sitting acquired pressure ulcers. This system is capable of pressure mapping, redistribution, and offloading which were verified using an anthropomorphic model and a human subject. The system is comprised of an air cell array cushion, a pneumatic control unit, and a graphical user interface. ISO load deflection testing confirmed that the cushion's loading response is comparable to commercial air cell-based seat cushions. Testing demonstrated that the internal pressure of the air cells are indicative of interface pressure and can be used as input to pressure modulating algorithms. Uniform pressure distribution was achieved through automated pressure redistribution algorithm implementation where the immersion of a subject into the seat cushion increased and interface pressure decreased. High pressure point identification and automatic offloading were performed in which newly created high pressure points were addressed using subsequent redistribution. Pressure mapping enabled offloading and redistribution can objectively manage the effects of loading magnitude and duration at the sitting interface. [ABSTRACT FROM AUTHOR]

Spinal deformities are common in people who require the use of a wheelchair for mobility as a result of spinal cord injuries and other disabilities. Sitting positions vary between individuals with disabilities who use wheelchairs and individuals without disabilities. In individuals with spinal cord injury, spinal deformities can result in the development of back contours that deviate from the shape of standard rigid back support shells. The purpose of this study was to distinguish and classify various back contours of wheelchair users by utilizing digital anatomic scanning technology in order to inform the future development of back supports that would enhance postural support for those with spinal deformities. The three dimensional (3D) locations of bony landmarks were digitized when participants were in position, using a mechanical wand linked to the FastScan tm system commonly used to measure surface contours. Raw FastScan tm data were transformed according to bony landmarks. A total of 129 individuals participated in this study. A wide range of back contours were identified and categorized. Although participant characteristics (e.g., gender, diagnosis) were similar amongst the contour groups; no one characteristic explained the contours. Participants who were seated in a forward lean position had a higher amount of pelvic obliquity compared to those seated in an upright position; however, participants’ back contour was not correlated with pelvic obliquity. In conclusion, an array of different back shapes were classified in our cohort through 3D laser scanning technology. The methods and technology applied in this study could be replicated in future studies to categorize ranges of back shapes in larger populations of people with spinal cord injuries. Preliminary evidence indicates that customized postural support may be warranted to optimize positioning and posture when a standard rigid shell does not align with contours of a person's back. To optimize positioning, a range of contoured rigid backrests as well as height and angle adjustability are likely needed. [ABSTRACT FROM AUTHOR]

The aim of the smartphone virtual seating coach (SVSC) was to provide a personalized reminder/warning system to encourage powered wheelchair users to use their powered seating functions (PSFs) as clinically recommended. This study evaluated the usability of the SVSC system by gathering feedback from five powered wheelchair users and five rehabilitation professionals through questionnaires and interviews. The results indicated that clear and understandable instructions to adjust the PSFs are the most important requirement for SVSC application. The instructions must be intuitive, could benefit from animations or indications of PSFs control buttons so powered wheelchair users can adjust their PSFs immediately and appropriately. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Availability of physical activity monitors for wheelchair users can potentially assist these individuals to track regular physical activity (PA), which in turn could lead to a healthier and more active lifestyle. Therefore, the aim of this study was to develop and validate algorithms for a physical activity monitoring system (PAMS) to detect wheelchair based activities. The PAMS consists of a gyroscope based wheel rotation monitor (G-WRM) and an accelerometer device (wocket) worn on the upper arm or on the wrist. A total of 45 persons with spinal cord injury took part in the study, which was performed in a structured university-based laboratory environment, a semi-structured environment at the National Veterans Wheelchair Games, and in the participants’ home environments. Participants performed at least ten PAs, other than resting, taken from a list of PAs. The classification performance for the best classifiers on the testing dataset for PAMS-Arm (G-WRM and wocket on upper arm) and PAMS-Wrist (G-WRM and wocket on wrist) was 89.26% and 88.47%, respectively. The outcomes of this study indicate that multi-modal information from the PAMS can help detect various types of wheelchair-based activities in structured laboratory, semi-structured organizational, and unstructured home environments. [ABSTRACT FROM AUTHOR]

Abstract: The Personal Mobility and Manipulation Appliance (PerMMA) is a recently developed personal assistance robot created to provide people with severe physical disabilities enhanced assistance in both mobility and manipulation. PerMMA aims to improve functional independence when a personal care attendant is not available on site. PerMMA integrates both a smart powered wheelchair and two dexterous robotic arms to assist its users in completing essential mobility and manipulation tasks during basic and instrumental activities of daily living (ADL). Two user interfaces were developed: a local control interface and a remote operator controller. This paper reports on the evaluation of PerMMA with end users completing basic ADL tasks. Participants with both lower and upper extremity impairments (N =15) were recruited to operate PerMMA and complete up to five ADL tasks in a single session of no more than two hours (to avoid fatigue or frustration of the participants). The performance of PerMMA was evaluated by participants completing ADL tasks with two different control modes: local mode and cooperative control. The users’ task completion performance and answers on pre/post-evaluation questionnaires demonstrated not only the ease in learning and usefulness of PerMMA, but also their attitudes toward assistance from advanced technology like PerMMA. As a part of the iterative development process, results of this work will serve as supporting evidence to identify design criteria and other areas for improvement of PerMMA. [Copyright &y& Elsevier]

Abstract: Background: The objective of this study was to investigate differences in shoulder, elbow and hand kinetics while performing three different SPTs that varied in terms of hand and trunk positioning. Methods: Fourteen unimpaired individuals (8 male and 6 female) performed three variations of sitting pivot transfers in a random order from a wheelchair to a level tub bench. Two transfers involved a forward flexed trunk (head–hips technique) and the third with the trunk remaining upright. The two transfers involving a head hips technique were performed with two different leading hand initial positions. Motion analysis equipment recorded upper body movements and force sensors recorded hand reaction forces. Shoulder and elbow joint and hand kinetics were computed for the lift phase of the transfer. Findings: Transferring using either of the head hips techniques compared to the trunk upright style of transferring resulted in reduced superior forces at the shoulder (P <0.002), elbow (P <0.004) and hand (P <0.013). There was a significant increase in the medial forces in the leading elbow (P =0.049) for both head hip transfers and the trailing hand for the head hip technique with the arm further away from the body (P <0.028). The head hip techniques resulted in higher shoulder external rotation, flexion and extension moments compared to the trunk upright technique (P <0.021). Interpretation: Varying the hand placement and trunk positioning during transfers changes the load distribution across all upper limb joints. The results of this study may be useful for determining a technique that helps preserve upper limb function overtime. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to evaluate the effects of three different control methods on driving speed variation and wheel slip of an electric-powered wheelchair (EPW). A kinematic model as well as 3D dynamic model was developed to control the velocity and traction of the wheelchair. A smart wheelchair platform was designed and built with a computerized controller and encoders to record wheel speeds and to detect the slip. A model based, a proportional-integral-derivative (PID) and an open-loop controller were applied with the EPW driving on four different surfaces at three specified speeds. The speed errors, variation, rise time, settling time and slip coefficient were calculated and compared for a speed step-response input. Experimental results showed that model based control performed best on all surfaces across the speeds. [Copyright &y& Elsevier]

• Robotic wheelchairs (RWs) offer advanced mobility applications to overcome environmental barriers • Over the past 30 years, little consideration was given to user feedback and standardized metrics for RW design and evaluation • A novel robotic wheelchair taxonomy and readiness model was proposed to evaluate a mini-review of RWs • The majority demonstrated indoor navigation with obstacle avoidance and proof-of-concept readiness • RW designs focused on technological adaptations and did not address broad user needs 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. [ABSTRACT FROM AUTHOR]

Abstract: Background: Manual wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during wheelchair propulsion and shoulder pathology. Methods: Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their wheelchairs at two speeds (0.9 and 1.8m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan. Findings: Subjects who experienced higher posterior force (Odds Ratio (OR)=1.29, P =0.03), lateral force (OR=1.35, P =0.047), or extension moment (OR=1.35, P =0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR=4.35, P =0.045) or abduction moments (OR=1.58, P =0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR=1.05, P =0.09) and internal rotation moments (OR=1.61 P =0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam. Interpretation: Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a wheelchair in order to preserve upper limb integrity. Potential interventions include changes to wheelchair setup, propulsion training, or alternative means of mobility. [Copyright &y& Elsevier]

• Rehabilitation Engineering appears to be a male-dominated profession similar to other engineering disciplines. • There are disparities in the number of rehabilitation engineers and measures of scientific productivity between different regions of the world. • Despite people identifying as rehabilitation engineers in every WHO region, the most cited and impactful were working in the Region of Americas and the European Region. • There appears to be benefits for rehabilitation engineers who have multiple collaborations and who work in doctoral degree-granting institutions. • Seven areas of research identified as consumer priorities were not captured by the most cited rehabilitation engineers. 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. • Rehabilitation Engineering appears to be a male-dominated profession similar to other engineering disciplines. • There are disparities in the number of rehabilitation engineers and measures of scientific productivity between different regions of the world. • Despite people identifying as rehabilitation engineers in every region, the most cited were identified as working in the World Health Organization Region of Americas and the European Region. • There appears to be benefits for rehabilitation engineers who have multiple collaborations and who work in doctoral degree-granting institutions. • Seven areas of research identified as consumer priorities were not captured by the most cited rehabilitation engineers these include: 1) Transportation and automobile driving 2) Recreation/Leisure 3) Autonomous vehicles/wheelchairs 4) Smart home/IoT 5) Computer/mobile applications and telecommunications 6) Patient transfer devices 7) Power sources. These priorities are opportunities for growth and innovation. [ABSTRACT FROM AUTHOR]

• Scientific evidence (n = 35) includes research studies, reviews, reports, and policy proposals. • Literature on older adults is most prevalent. • Grey literature (n = 37) spans a variety of sources and focuses on a variety of disability types. • Accessible and usable AV design should include the entire travel journey and all vehicle features. • Solutions must be tailored to the needs of those with different disabilities and impairments. • Guidance on accessible and usable AV design and planning for infrastructure changes are needed. • Research gaps and implications for policy and knowledge translation are outlined. 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. [ABSTRACT FROM AUTHOR]