Search

Objective. To investigate the relationship between the durability of wheelchairs according to American National Standard for Wheechairs/ Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/RESNA) Wheelchair Standards and wheelchair type as well as year of test. Design. A retrospective study design with a sample of 246 wheelchairs that were tested in accordance with the ANSI/RESNA standards from 1992 to 2008 including four types of wheelchairs: manual wheelchair (MWC), electrical powered wheelchair (EPW), scooters and pushrim-activated power-assisted wheelchair (PAPAW). Unconditional binary logic regression analysis was chosen to evaluate the relationship between test results and test year as well as wheelchair type. Setting. Rehabilitation Engineering Research Center. Main Outcome Measures:Wheelchair durability test result (fatigue test: pass or fail) Results. There was no significant correlation between the year when tested and equivalent cycles. A significant relation was found between test results and wheelchair type (Wald score=10.845, degree of freedom=3, p=0.013) with scooters having a significantly higher pass ratio than MWC (OR=15.629, 95% CI=2.026-120.579). EPW also had significantly higher pass ratio than MWC (OR=1.953, 95% CI=1.049-3.636). No significant difference on pass ratio was found between PAPAW and MWC. Conclusions. No significant improvements in wheelchair test results during the time frame from 1992 to 2008 were discovered. Wheelchair standard tests should be conducted to assure minimum quality of the wheelchairs and for improving the design of wheelchairs. Although the ANSI/RESNA wheelchair durability test procedures have remained consistent, it does not appear that the introduction of new materials, designs and the availability of test data have improved wheelchair fatigue life. © 2010 Informa UK Ltd.

To date, no published data exists on distances and speeds traveled by rugby or basketball players during game play. The purpose of this study was to provide quantitative information of selected characteristics of wheelchair basketball and rugby game play. A miniaturized data logger was used to collect the distance traveled, average velocity, activity time, and number of starts and stops during basketball and rugby games. Participants were recruited prior to wheelchair basketball and rugby tournaments during the 2007 and 2008 National Veterans Wheelchair Games. Inclusion criteria were age 18 years or older and been participating in wheelchair basketball or rugby. The wheelchair rugby athletes on average traveled 2364.78±956.35 meters at 1.33±0.25 m/sec with 242.61±80.31 stops and starts in 29.98±11.79min of play per game. The wheelchair basketball athletes on average traveled 2679.52±1103.66m at 1.48±0.13 m/sec with 239.78±60.61 stops and starts in 30.28±9.59min of play per game. Previous research has not reported basketball or rugby game play variables such as these, making this data set unique. The information could be used by players and coaches to create training protocols to better prepare for game conditions. © 2009 ISPO.

Purpose. Older adults commonly use wheelchairs for mobility impairments regardless of their living situations. However, limited outcomes data are available to determine quality of the wheelchairs that older Americans are receiving, as well as their satisfaction with wheelchair service delivery programs. The purpose of this article was to analyze satisfaction data collected from three cohorts of older individuals living at nursing homes and in community settings. Ninety participants were residents in VA (n=60). Methods. One hundred thirty two older adults completed the standardized Quebec User Evaluation of Satisfaction with Assistive Technology. Ninety participants were residents in VA (n=30) or private nursing homes (n=30), and 42 were community dwelling participants. Those enrolled were either independent manual or power wheelchairs users. Results. The community dwelling group reported significantly higher levels of satisfaction with their manual wheelchairs and service delivery when compared with the private nursing home participants (4.3 versus 2.9, p=0.002). The satisfaction was also higher for VA nursing homes than private (3.9 versus 2.9, p=0.004). No significant differences were reported for satisfaction levels regarding powered wheelchairs use between three groups. Conclusion. Level of satisfaction should be incorporated as an outcomes measure for evaluating wheelchair prescriptions and service delivery programs. This study also supports the establishment of a re-evaluation process of wheelchair fit as the users' age, to aide in provision of the best quality wheelchairs and service delivery programs. © 2009 Informa UK Ltd All rights reserved.

We determined the demographic, health, functional, and satisfaction factors related to lower-limb prosthesis or wheelchair use among veterans with lower-limb amputation. Forty-two veterans were recruited from the 20th National Disabled Veterans Winter Sports Clinic and the 26th National Veterans Wheelchair Games. Participants were at least 18 years of age, had a lower-limb amputation, and were either prosthesis or wheelchair users. Level of amputation was the most significant health-related characteristic determining the veterans' use of a prosthesis versus a wheelchair (p = 0.02). Veterans who had a higher level of amputation and used a prosthesis reported significantly greater difficulty navigating a ramp (p = 0.03), getting in and out of cars and buses (p = 0.03), carrying 10 lb of groceries (p = 0.02), and participating in sports and leisure activities (p = 0.03). The parameter "satisfaction related to prosthesis" did not determine selection of mobility device type. The interaction of demographics, health-related characteristics, and mobility device characteristics affects functional performance and influences the use of prostheses, wheelchairs, or both in persons with lower-limb amputation. Long-term outcome assessments may help determine factors associated with either transition from one device to another or combined use of the devices over time.

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.

Background. The objective of this study was to examine how surface electrical stimulation of trunk musculature influences the kinematic, kinetic, and metabolic characteristics, as well as shoulder muscle activity, during wheelchair propulsion. Methods. Eleven participants with spinal cord injury propelled their own wheelchairs on a dynamometer at a speed of 1.3 m/s for three 5-minute trials. During a propulsion trial, 1 of 3 stimulation levels (HIGH, LOW, and OFF) was randomly applied to the participantĝ€™s abdominal and back muscle groups with a surface functional electrical stimulation device. Propulsion kinetics, trunk kinematics, metabolic responses, and surface electromyographic (EMG) activity of 6 shoulder muscles were collected synchronously. Kinetic, kinematic, and EMG variables were recorded during 3 time intervals (30 seconds each) within a 5-minute trial. Metabolic variables were recorded through the entire 5-minute trial. Results. Participants with HIGH stimulation increased their gross mechanical efficiency (P =.05) during wheelchair propulsion. No differences were found in shoulder EMG activity, energy expenditure, and trunk motion between stimulation levels. Conclusion. Functional electrical stimulation on the trunk musculature has potential advantages in helping manual wheelchair users with spinal cord injury improve propulsion efficiency without placing additional demands on shoulder musculature.

Purpose. This paper describes the design, manufacture and evaluation of a custom hand-cycle with a Delta-style frame and fork steering. The state of hand-cycle design and future design directions are also examined. Method. The design of the custom hand-cycle was based on these criteria: Light weight, aerodynamics, climbing ability, ergonomic fit and the user's specific needs. We designed and built a custom hand-cycle for one expert user, therefore, the user's personal needs were key design drivers. The hand-cycle was evaluated by the user over three years of use. Results. During three years of evaluation and over 8000 km of use there were two frame failures: i A crack propagated around one of the tubes connecting the mainframe tube to the headset tube; and ii a crack propagated around the circumference of the curved part of the main frame tube directly behind the seat. The first failure was repaired and after the second, the device was retired. The evaluation of this design serves as a basis for a new set of design criteria. Conclusions. Large amounts of frame flexion can indicate eventual plastic deformation and failure. Future hand-cycle designs should see the use of more advanced materials, finite element analysis software, and continued incorporation of bicycle technology and design innovation. © 2009 Informa UK Ltd All rights reserved.

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.

Purpose. The purpose of this study was to determine the characteristics of individuals who participa e in the National Veterans Wheelchair Games (NVWG) and the Winter Sports Clinic (WSC) for veterans with disabilities. In addition, it was of interest to determine how these events had impacted their lives. Method. Participants were recruited atthe 20th Winter Sports Clinic, held in Snowmass Colorado and the 26th National Veterans Wheelchair Games held in Anchorage, Alaska. Data of interest included demographic, sport participation information, community integration, self-esteem, and quality of life. A secondary data analysis was completed to determine how comparable individuals who attended the NVWG/WSC were to individuals who did not participate in these events. Results. The 132 participants were a mean age of 47.4 + 13.4 and lived with a disability for an average of 13.4 + 12.1. Participants felt that the NVWG/WSC increased their knowledge of sports equipment (92%), learning sports (89%), mobility skills (84%), and acceptance of disability (84%). The majority of participants stated that the NVWG/WSC improved their life. Of those who participated at the NVWG/WSC, they tended to be more mobile, but have increased physical and cognitive limitations as measured by the CHART when compared to the non-attendees. Conclusions. Recommending veterans participate in events such as the NVWG and WSC can provide psychosocial benefits to veterans with disabilities.

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. © 2009 American Congress of Rehabilitation M

People with disabilities such as multiple sclerosis and Parkinson's disease have difficulty operating conventional movement-sensing joysticks (MSJs) because of varying levels of tremor. We developed an isometric joystick (IJ) that has performed as well as a conventional MSJ when used by persons with upper-limb impairments in real and virtual wheelchair driving tasks. The Weighted-Frequency Fourier Linear Combiner (WFLC) filter has been used to cancel tremor effectively in microsurgery. In this study, we compared an MSJ, IJ, and IJ with the WFLC filter in individuals performing a virtual driving task. Although the WFLC filter did not improve driving performance in this study, the IJ without a filter yielded better results than the conventional MSJ and thus may be a potential alternative to the MSJ in minimizing the effects of tremor.

This study's main objective was to determine if upper-limb (UL) muscular demand was reduced when individuals with a spinal cord injury (SCI) performed a sitting pivot transfer (SPT) in the preferred direction compared with that in a nonpreferred direction. Fourteen individuals (mean +/-standard deviation age 47.0 +/- 8.3 yr, height 1.80 +/- 0.08 m, and weight 75.3 +/- 11.3 kg) with SCI levels ranging from the sixth cervical to first sacral vertebra levels volunteered to participate in this study during the 2008 National Disabled Veterans Winter Sports Clinic. Surface electromyography (EMG) was used to record activity of the biceps, triceps, deltoid, pectoralis major, trapezius, and latissimus dorsi bilaterally during SPTs. These transfers were performed in each of the preferred and nonpreferred directions from the individuals' wheelchairs to a padded tub bench of even height. To quantify electromyographic muscular utilization ratio (MUREMG), we normalized EMG data recorded during the transfer tasks to values obtained during static maximum voluntary contraction and then multiplied this ratio by 100 to obtain a percentage MUREMG(%MUREMG). The overall peak %MUREMG and the area under the %MUREMG curve were selected as primary outcome measures. Similar peak %MUREMGs were found between the preferred and nonpreferred transfer directions for all muscles from which data were recorded (p = 0.053 to 0.961). The peak %MUREMGs were also found to be similar between the leading and trailing ULs during the transfers in all muscles from which data were recorded (p = 0.125 to 0.838), except for the anterior deltoid, which was found to be solicited the most in the trailing UL (p = 0.008). Comparable areas under the %MUREMG curves were calculated between the preferred and nonpreferred transfer directions for all muscles (p = 0.289 to 0.678) and between the leading and trailing ULs (p = 0.104 to 0.946). These results indicate that direction preference expressed by individuals with SCI w

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 tes

Electric powered wheelchair (EPW) controllers have not seen substantial improvement since the introduction of the microprocessor. There are no features that warn the driver of danger or help keep the EPW under control in adverse conditions such as slipping or tipping. With an estimated 300,000 EPWs in use in the United States and the population of older adults increasing rapidly, the need for safer control systems for EPWs is a priority. This paper presents in detail the electronic, mechanical, and software design used in developing a smart controller for EPWs. A single board computer provides the computational power and storage space needed to execute normal operations, complex safety algorithms, and extensive data logging. An array of sensors connects to the computer, providing feedback on velocity, inertia, caster angle, and obstacle range. A rugged aluminum enclosure protects the electronics and provides connectors for all the sensors. A real-time operating system is used as the basis for programming. The software architecture uses a 3 level hierarchical structure that organizes tasks based on periodicity, priority, and computational load. The goal of this project is to demonstrate what can be done with an EPW to enhance the mobility, participation, and safety of its occupant.

Comfortable propulsion and support, light weight, and small dimensions are important features that help preserve upper-limb integrity of manual wheelchair users and improve accessibility. The titanium wheelchair is a product developed in response to these goals, but none of the test results of titanium wheelchairs had been disclosed before this study was performed. We hypothesized that these titanium wheelchairs would be in compliance with American National Standards Institute (ANSI)/Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) standards. We tested 12 ultralight titanium rigid-frame wheelchairs (4 models) using ANSI/RESNA testing procedures and compared the test results with previously tested ultralight and lightweight aluminum wheelchairs. All wheelchairs passed the forward braking effectiveness test, but eight wheelchairs tipped backward before inclining to 7° in the rearward braking effectiveness test. All wheelchairs passed the impact strength tests, but six wheelchairs failed in the static strength tests. Three wheelchairs successfully completed the fatigue tests, but the remaining wheelchairs failed prematurely. This group of titanium wheelchairs had less equivalent cycles and value than the ultralight aluminum wheelchairs that were tested in a previous study. The failure modes revealed important design issues of each model. Our results suggest that manufacturers may need to perform more careful analyses before commercializing new products.

Automated terrain classification for electric powered wheelchairs (EPWs) has two primary motivations. First, certain terrains (e.g., sand and gravel) make wheelchair mobility more difficult. To alleviate this problem the wheelchair control system can be manually tuned for maximum speeds and/or accelerations to help adapt to various terrains. Terrain classification can then be used to automate the switch from one control mode to another. Second, terrain classification can help yield a better understanding of the surfaces traversed by various groups of wheelchair users. This can provide the data needed to develop wheelchairs geared to specific groups of users. This paper presents an algorithm for vibration-based terrain classification on EPWs. This algorithm has been shown to be highly accurate in offline analysis of experimental data. Future work will stress online implementation and algorithm improvements.

Independent mobility is important, but some wheelchair users find operating existing manual or powered wheelchairs difficult or impossible. Challenges to safe, independent wheelchair use can result from various overlapping physical, perceptual, or cognitive symptoms of diagnoses such as spinal cord injury, cerebrovascular accident, multiple sclerosis, amyotrophic lateral sclerosis, and cerebral palsy. Persons with different symptom combinations can benefit from different types of assistance from a smart wheelchair and different wheelchair form factors. The sizes of these user populations have been estimated based on published estimates of the number of individuals with each of several diseases who (1) also need a wheeled mobility device and (2) have specific symptoms that could interfere with mobility device use.

A group of 158 service members who sustained major limb amputations during the global war on terrorism were surveyed on their satisfaction with the quality of care received from the Walter Reed Army Medical Center (WRAMC) Amputee Clinic from the time of their injury to their inpatient discharge. Of these participants, 96% were male, 77% were Caucasian, 89% were enlisted personnel, and 68% had sustained lower-limb amputations. WRAMC inpatient therapy, peer visitors, overall medical care, and pain management received particularly high satisfaction ratings. Age, race, rank, and level and side of amputation had little effect on overall satisfaction ratings. Significant differences, however, were found by location of injury (Iraq vs Afghanistan, Cuba, and Africa) regarding satisfaction with care received while in Europe and with the education process at WRAMC. Study findings strongly support the rehabilitation-based, integrative care approach designed by the U.S. military to care for service members with amputations.

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 m

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.

The Guido is a robotic walker that provides navigation and obstacle-avoidance assistance. Engineering tests have found that the device performs adequately and presents no hazard to the user. The performance of the Guido was compared with a low-tech mobility aid, the Assistive Mobility Device (AMD) developed at the Atlanta Department of Veterans Affairs Medical Center, in trials involving older adults with visual impairments. The purpose of this study was to determine whether the Guido could increase the safety and mobility of elderly visually impaired individuals in supervised care facilities. Subjects traversed an obstacle course with the Guido and the AMD. Completion time, obstacle/wall contacts, and reorientations were compared for both devices. No significant differences were found between the devices for any of the tests. The Guido did not perform better than the AMD during the trials. Revisions to the device as well as a change in subject requirements and testing protocol may produce different results.

This study examined the usage of powered seating functions, including tilt-in-space, backrest recline, and seat elevation, among a group of wheelchair users during their typical daily activities. Twelve individuals who used a power wheelchair with seating functions participated in the study. They drove their own wheelchair and used the seating functions as needed in their community environment for about 2 weeks while the seating function usage was recorded with a portable device. We found that subjects occupied their wheelchair for 11.8 +/- 3.4 hours a day (all data shown as mean +/- standard deviation). While occupying their wheelchairs, they accessed tilt-in-space, backrest recline, and seat elevation 19 +/- 14 times a day for 64.1% +/- 36.8%, 12 +/- 8 times for 76.0% +/- 29.8%, and 4 +/- 4 times for 22.5% +/- 34.9%, respectively. Subjects chose to stay in tilted and reclined positions in their wheelchair for 39.3% +/- 36.5% of their time each day. They spent little time in a fully upright position. Subjects changed their seating positions every 53.6 +/- 47.0 minutes. Time spent in positions of different seating pressures varied among subjects. The information collected could enhance clinical practice of wheelchair provision, resulting in better compliance with clinical instructions and appropriate use of seating functions among wheelchair users.

Objectives: This preliminary study was to evaluate the impact of pushrim-activated power-assist wheelchairs (PAPAWs) on mobility, community participation, satisfaction, and psychosocial impact among individuals with tetraplegia. Design: Frfteen manual wheelchair users with tetraplegia completed a 4-wk protocol including a 2-wk trial where they used their personal wheelchairs for mobility and a 2-wk trial where they were provided with a PAPAW and could choose either wheelchair for mobility. The mobility levels with both wheelchairs were recorded by a datalogger. Participants completed dairy questionnaires regarding community participation and their satisfaction with the wheelchair used. The Psychosocial Impact of Assistive Devices Scale was used to compare the psychosocial impact of PAPAWs with their personal wheelchairs. Results: Participants chose to use PAPAWs and their personal wheelchairs at a similar frequency in the PAPAW trial. The distances traveled with both wheelchairs were not statistically different (P = 0.09). Participants traveled significantly faster with PAPAWs (P = 0.03). PAPAWs did not result in significantly greater community participation, satisfaction, and psychosocial impacts than the personal wheelchairs. Conclusions: PAPAWs could be a viable mobility option for individuals with tetraplegia, which can provide independent mobility especially for outdoor activities. A user's preference, life style, physical conditions, transportation issues, and environmental factors should be considered in prescribing such a device. Copyright © 2008 by Lippincott Williams & Wilkins.

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. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Objective: The purpose of this study was to investigate mobility-related wheelchair activity of children in their community setting. Design: Mobility-related wheelchair activity data from 18 community-dwelling children (9 manual and 9 electric powered) were collected using custom-designed data logging devices. The children were between 8 and 17 yrs of age and independently used a wheelchair as their primary means of mobility. A data logging device was installed on their wheelchair for 7 days. However, because the device was attached and removed at different times of the day, the first and last days of the study period were not analyzed. Therefore, a total of 5 days of data were used to investigate wheelchair activity. Results: Overall, the children who used manual wheelchairs traveled on an average of 1602.31 m/day (SD, 976.78) at a speed of 0.67 m/sec (SD, 0.1 2), and the children who used electric-powered wheelchairs drove 1752.42 m/day (SD, 835.14) at a speed of 0.75 m/sec (SD, 0.35). It was also calculated that the average daily number of starts/stops per thousand meters the manual and electric-powered wheelchair users completed were 166.77 (SD, 64.32) and 112.53 (SD, 62.27), respectively. A comparison of mobility-related wheelchair activity revealed a significant (P = 0.008) difference in the average daily distance traveled between genders, with the boys traveling further than the girls. Conclusions: The mobility data obtained from the children wheelchair users suggest that one possible factor of variability among wheelchair activity is between genders. The data collected provide us with direction for future research in this area. Copyright © 2008 by Lippincott Williams & Wilkins.

There is an overwhelming need for wheelchairs and the research and development required to make them safer, more effective, and widely available. The following areas are of particular importance: practitioner credentials, accreditation, device evaluation, device user training, patient education, clinical prescribing criteria, national contracts, and access to new technology. There are over 170 U.S. wheelchair manufacturers with a total reported income of $1.33 billion. However, of these companies, only five had sales in excess of $100 million. Wheelchairs account for about 1% of Medicare spending. Use of assistive technology is an increasingly common way of adapting to a disability. The emergence of advanced mobility devices shows promise for the contribution of engineering to the amelioration of mobility impairments for millions of people who have disabilities or who are elderly. Some of the trends in wheelchairs are going to require new service delivery mechanisms, changes to public policy, and certainly greater coordination between consumers, policy makers, manufacturers, researchers, and service providers. © 2008 Taylor and Francis Group, LLC.

Manual wheelchair users are subjected to wholebody vibrations (WBV) on a regular basis as they traverse obstacles and uneven surfaces. One way users could protect themselves from secondary injuries related to WBV is by using a suspension manual wheelchair. This study investigated the ability of suspension manual wheelchairs to reduce seat accelerations during curb descents of various heights (5, 10, and 15 cm). Sixteen manual wheelchairs (four suspension, four folding, four rigid, and four rigid titanium) were tested. Suspension wheelchairs transmitted significantly lower peak seat accelerations than folding wheelchairs during the 5 cm curb descents (p = 0.048) and significantly lower frequencyweighted peak seat accelerations during the 5 and 10 cm curb descents (p = 0.03 for both heights). However, when the suspension wheelchair Quickie XTR (Sunrise Medical; Carlsbad, California) was removed from the analysis, the suspension wheelchairs were not significantly different from the nonsuspension wheelchairs. When weight was considered, the suspension wheelchairs had significantly lower peak seat accelerations than the lighter rigid wheelchairs during 5 cm curb descents (p = 0.047). While suspension manual wheelchairs offer some reduction in WBV during curb descents, their limitations should be considered when a wheelchair is selected for everyday use.

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 evaluatio

Acute mountain sickness (AMS) is a frequent complication for military personnel, veterans, athletes, and travelers at high altitudes. Symptoms may occur in individuals with less cerebrospinal fluid volume and less ability to accommodate increased brain volume. No studies on AMS exist in individuals with neurological impairments. We studied 64 subjects, including active and sedentary controls and those with tetraplegia, paraplegia, multiple sclerosis, and traumatic brain injury at the 2007 National Veterans Winter Sports Clinic in Snowmass, Colorado. Subjects completed three Lake Louise Score surveys to quantify symptoms. We found a higher than expected occurrence of AMS overall (51.6%) but no differences among groups, and few participants sought treatment. Fatigue and weakness were common symptoms. High subject activity levels may explain these findings. More research is warranted on larger sample sizes and on preventative medications and treatments for AMS, especially since many military personnel with neurological impairments are returning to full active service.

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. © 2008 American Congress of Rehabilitation Medicine and the American Academy of Ph

This paper provides an overview of the development of a wheelchair users registry and subsequently describes a population of individuals who use wheelchairs. The characteristics of Americans who permanently use wheelchairs and scooters are currently unknown. As the result of developing a Registry of individuals who use wheeled mobility devices for systematic recruitment for research studies, this study provides a description of a nationwide sample of over 1000 individuals who used wheelchairs or scooters for their daily mobility. The Registry is predominantly Caucasian (83%), 63% male, with a mean age of 50 years. Some 54% used manual wheelchairs for an average of 16 years. When quality of wheelchairs was compared, results indicated those in more customizable manual wheelchairs were significantly more likely to be younger. Males were significantly more likely to receive more customizable, heavy duty power wheelchairs than females. The Wheelchair Users Registry provides an organized and systematic way to maintain contact with previous research participants. Expected to grow in size, the Registry may enable an even more diverse pool of subjects interested in participating in research studies. © 2007 Informa UK Ltd All rights reserved.

Although engaging in an active lifestyle is beneficial for maintaining quality of life, a majority of wheelchair users are inactive. This study investigated the mobility characteristics and activity levels of manual wheelchair users in the residential setting and at the National Veterans Wheelchair Games (NVWG). Demographic factors that may have influenced activity in the home environment were also identified. Fifty-two manual wheelchair users completed a brief survey, and their activity was monitored with a custom data logger over a period of 13 or 20 days. We found that they traveled a mean +/- standard deviation of 2,457.0 +/- 1,195.7 m/d at a speed of 0.79 +/- 0.19 m/s for 8.3 +/- 3.3 h/d while using their primary wheelchair in the home environment. No significant differences in mobility characteristics or activity levels were found for level of spinal cord injury or disability. We also found that subjects traveled significantly farther and faster and were active for more hours during an average day at the NVWG than in the home environment (p < 0.001). We found that manual wheelchair users who were employed covered more distance, accumulated more minutes, and traveled a greater average maximum distance between consecutive stops than those who were unemployed. Results from this study provide a better understanding of the activity levels achieved by manual wheelchair users and insight into factors that may influence this activity.

A multisite collaborative study is being conducted on the association between propulsion biomechanics and upper-limb injuries. This substudy compared subject characteristics and pushrim kinetics across three sites and identified early on in the main study any differences that could affect interpretation of the findings or data pooling. A total of 42 manual wheelchair users with paraplegia (14 from each site) performed 0.9 m/s and 1.8 m/s steady state propulsion trials and an acceleration-brake-coastdown trial on a wheelchair dynamometer while propulsion forces and moment about the hub were measured with a Smart-Wheel. Significant differences between two sites were found in peak and average resultant force (p < 0.05), peak and average moment at the slower steady state speed (p < 0.005), and peak and average torque at the faster steady state speed (p = 0.06). Subjects at the site with significantly lower forces and torques had a slower deceleration rate during coastdown compared with the subjects at the other two sites (p < 0.001). These results imply that rolling resistance is lower at one of the sites and likely due to differences in dynamometer properties. A mechanical method was used to site-normalize the data and enable data pooling for future analyses.

To help manage pressure ulcers and adjust posture, powered wheelchairs can be equipped with seat tilt and backrest recline features. Clinicians usually prescribe these features for wheelchair users who are vulnerable to pressure sores or have difficulty changing postures, but little data has been collected to determine whether or not, and to what extent, these features are used. this study examined how wheelchair users use power wheelchair seat features such as seat tilt, backrest recline, and seat elevation, during typical daily activities. A Seat Feature Data Logger (SFDL) was attached to 11 subject's wheelchairs for 10-14 days to gather data regarding daily usage of these features. The results showed that while subjects did not always use large angles of tilt and recline as many clinicians recommend, these features were used frequently and their use resulted in lower peak pressures. The information collected by the SFDL allows for a novel and quantitative description of the effectiveness and use of power seat features, and can also be used as a clinical compliance tool. © 2007 IEEE.

This study describe an experiment measuring the moment of inertia of an electric powered wheelchair (EPW) using a torsional pendulum method. Inertia of the wheelchair is an important factor for control, which is a key issue in wheelchair driving. The experimental test platform consisted of a bottom circular wood plate, an upper metal plate, and four ropes. Materials with known moments of inertia such as the metal disk and cylinder were used to test the accuracy of the system. The EPW used in the experiment was Invacare G3 Torque SP Storm Series. The measured result of the moment inertia of the wheelchair was 5.2280 kg.m(2) and the errors of the system are less than 10% even when the object is only 25lbs. The results are consistent when compared with other approximate methods. In addition, the experimental method could be used to measure the moment of inertia of manual wheelchairs and other irregular objects.

Purpose. The most common methods of delivering assistive technology in developing countries are charitable donation and workshops. This describes a new approach to solving the problem, a collaboration undertaken by a US-based lab and a manufacturer in India to produce quality wheelchairs. One goal is to publicize the design free of charge to manufacturers and interested parties world-wide. The process, a demonstration of a new technology transfer method, and the product, an adult manual wheelchair, are described. Method. An iterative process occurred over four years to design and produce the wheelchair. This consisted of prototypes, small production runs, ANSI/RESNA testing, hardness and tensile testing and informal user testing. Results. The design is a manual folding cross-brace design with several points of adjustability. Final pre-production prototypes experienced fastener failures during durability testing. Higher grade bolts were specified. Trial-run production has begun. An ANSI/RESNA wheelchair test lab was constructed in India. Subsequent projects include power and pediatric tilt-in-space wheelchairs. Conclusions. The approach seems promising as a method to improve the quality of assistive technology available in India and begin to meet the vast need in India. Pitfalls encountered throughout the collaboration are described in this paper along with solutions to remedy these problems for future projects.

Purpose. The purpose of this research was to determine the clinical usefulness of the Tool for Assessing Wheelchair disComfort (TAWC) by examining floor and ceiling effects and responsiveness when used with two groups of wheelchair users -one known to have experienced real changes in discomfort levels and the other with unchanged levels. Method. In a retrospective analysis of data from two previous studies, change scores were compared across two groups of subjects -one stable group (NON-CHANGERS) and one experiencing a seating intervention (CHANGERS) intended to decreased seating discomfort. Results. No significant floor or ceiling effects were found. The average General Discomfort Score (GDS) change among the NON-CHANGERS was 2.0 (with a possible score range of 13 -91) and average Discomfort Intensity Score (DIS) change was 1.8 (with a possible score range of 8 -99) for the same group. Conversely, average GDS change among the CHANGERS was 8.7 and the average DIS change was 7.7. Additionally, both scores demonstrated a moderate effect size (d) for two tested treatments (GDS = 0.53 and 0.50, DIS = 0.31 and 0.33) and the standardized response means were 0.78 and 0.77 for the GDS and 0.80 and 1.2 for the DIS. Conclusions. All analyses indicate good responsiveness of the TAWC, supporting its use clinically and in future research. © 2007 Informa UK Ltd All rights reserved.

Wheelchair users rely on their wheelchairs for mobility for extended periods of time every day. According to the International Standards Organization 2631-1 standard on human vibration, individuals in a seated position when exposed to whole-body vibrations (WBV) are at risk of injury. This study evaluated vibration exposure during manual and power wheelchair driving over nine sidewalk surfaces and differences in vibration exposure over 3 years. Ten nondisabled subjects were asked to drive a manual wheelchair at 1 m/s and a power wheelchair at 1 m/s and 2 m/s over nine sidewalk surfaces while WBV were measured at the seat and footrest of the wheelchair. At 1 m/s, significant differences existed between surfaces and years at both the seat and the footrest for the manual and power wheelchair users. At 2 m/s, significant differences existed between surfaces and years at the seat and the footrest for power wheelchair users. Our results show that both manual and power wheelchair users may be at risk for secondary injuries from WBV when traveling over certain surfaces.

Purpose. The objective of this study was to explore the applicability of the Wheelchair Skills Program (WSP) to the Indian context. Method. During a two-week period, we visited two clinical institutions and one manufacturing facility, in New Delhi, Jaipur and Kanpur, respectively. We met with local clinicians, held workshops and training sessions, and made qualitative observations. Results. The community obstacles observed in India were similar in nature to those in North America. However, obstacles appeared to be more prevalent and, in some cases, more extreme. Of the wheeled mobility devices that we observed in the community, arm-crank-propelled tricycles were most commonly seen. Of the hand-rim-propelled wheelchairs we observed, most were heavy and non-adjustable ('depot style'). Ground-level carts were also seen. We also encountered people who needed wheelchairs but did not have them. Conclusions. The WSP requires further development and implementation in India will address present challenges. However, this preliminary evaluation suggests that WSP training has potential to help the mobility and participation of wheelchair users in India.

Recent advancements of technologies, including computation, robotics, machine learning, communication, and miniaturization technologies, bring us closer to futuristic visions of compassionate intelligent devices. The missing element is a basic understanding of how to relate human functions (physiological, physical, and cognitive) to the design of intelligent devices and systems that aid and interact with people. Our stakeholder and clinician consultants identified a number of mobility barriers that have been intransigent to traditional approaches. The most important physical obstacles are stairs, steps, curbs, doorways (doors), rough/uneven surfaces, weather hazards (snow, ice), crowded/cluttered spaces, and confined spaces. Focus group participants suggested a number of ways to make interaction simpler, including natural language interfaces such as the ability to say "I want a drink", a library of high level commands (open a door, park the wheelchair, ...), and a touchscreen interface with images so the user could point and use other gestures. © 2007 IEEE.

OBJECTIVE: The objective of this study was to examine the effectiveness of a new user-adjustable wheelchair seating system designed to relieve discomfort for long-duration wheelchair users. DESIGN: This objective was carried out using the newly developed Tool for Assessing Wheelchair disComfort (TAWC) as the primary outcome measure. Two wheelchair users each tested two different designs and feedback from the wheelchair users regarding the first design was used to guide development of the second design. A single-subject research methodology was used, allowing long-duration (up to 2 wks per test) evaluation of the wheelchair seating systems and comparison of subject discomfort levels with those experienced during a baseline period using their own wheelchairs. The experimental wheelchair seating systems employed existing automotive seating with embedded pneumatic bladders that allowed adjustment of the seat and back-support characteristics. The test wheelchair also had tilt, recline, and elevating leg rests. RESULTS: The two subjects completed limited periods of testing with the first design, both finding poor results with either stable or increased levels of discomfort. Subject feedback was used to redesign the wheelchair seat. After redesign, both subjects tested the second design and found it substantially more comfortable. CONCLUSIONS: The selected research methodology was a very positive method for a progressive wheelchair seating design and the second design provided improved comfort for both users when compared with that experienced using their own wheelchairs and the first test wheelchair. Future research of this type of user-controlled technology is recommended. © 2007 Lippincott Williams & Wilkins, Inc.

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies.

Innovations to control interfaces for electric powered wheelchairs (EPWs) could benefit 220 000 current users and over 125 000 individuals who desire mobility but cannot use a conventional motion sensing joystick (MSJ). We developed a digital isometric joystick (IJ) with sophisticated signal processing and two control functions. In a prior study, subjects' driving accuracy with our IJ was comparable to using an MSJ. However, we observed subjects using excessive force on the IJ possibly because its rigid post provides no positional feedback. Thus, this paper examines the time-series data recorded in the previous study to characterize subjects' force control strategies since weakness is a concern. Eleven EPW users with upper limb impairments drove an EPW using an IJ with two different control functions and an MSJ in a Fitts' law paradigm. Subjects relied upon positional feedback from the MSJ and used appropriate force. In contrast, subjects using the IJ with either control function applied significantly higher force than necessary (p< 0.0001 and p=0.0058). Using higher average force was correlated with quicker trial times but not associated with accuracy. Lack of positional feedback may result in use of excess isometric force. Modifying control functions, adjusting gain, or providing additional training or feedback might address this problem. © 2007 IEEE.

Nanotechnology is a scientific movement that has the potential to transform the diagnosis and treatment of disease in the 21st century. The area of investigation is defined by the study, design, manipulation, manufacture, and control of materials or devices by physical or chemical means at resolutions on the order of one billionth of a meter. The potential for a wide range of clinical applications makes a basic understanding of nanotechnology important to physiatrists. This review presents an introduction to nanotechnology and discusses key developments in tissue engineering, drug delivery, imaging, diagnostics, surface texturing, and biointerfaces that could impact the practice of physiatry in the future. © 2007 Lippincott Williams & Wilkins, Inc.

Wheelchair-related physical restraints, lap belts, and other alternatives are intended to provide safe and adequate seating and mobility for individuals using wheelchairs. Physical restraints and lap belts are also helpful for positioning people in their wheelchairs to reduce the risk of injury during wheelchair tips and falls. However, when used improperly or in ways other than intended, injury or even death can result. Although widely prescribed, little evidence is available to direct professionals on the appropriate use of these restraints and lap belts and for whom these restraints are indicated. The purpose of this study was to conduct a review of available literature from 1966–2006 to identify the risks and benefits associated with lap belts while seated in wheelchairs. Twenty-five studies that met the inclusion criteria were reviewed. Nine studies reported the frequency of asphyxial deaths caused by physical restraints, nine studies reported the long-term complication and indirect adverse effects of physical restraints and lap-belt use, and seven studies reported the benefits of physical restraints and lap belts with individuals using wheelchairs. Despite the weak evidence, the results suggest a considerable number of deaths from asphyxia caused by the use of physical restraints occurred each year in the U.S. The majority of the deaths occurred in nursing homes, followed by hospitals, and then the home of the person. Most deaths occurred while persons were restrained in wheelchairs or beds. Based on that, caution needs to be exercised when using restraints or positioning belts. In addition, other seating and environment alternatives should be explored prior to using restraints or positioning belts, such as power wheelchair seating options. Positioning belts may reduce risk of falls from wheelchairs and should be given careful consideration, but caution should be exercised if the individual cannot open the latch independently. Also, the duration of use of the

Purpose. Appropriate wheelchairs for basic mobility needs are still not commonly available in low-income countries, although several organizations are working toward this goal. After basic mobility is secured it is important to provide more diverse assistive technology to allow people with disabilities to more completely participate in society and live healthy lives. Our goal was to design an affordable sports wheelchair that would allow individuals in low-income countries to participate in basketball. Methods. Design requirements established forthe sports wheelchair included: removable anti-tippers, adjustable tension backrest, 24″ wheels, adjustable seat dump, variable camber, 4″ casters, fore-aft axle position, removable bumpers, height adjustable footrest, four wheels, single anti-tipper (pivot), cost less than $125 without wheels, 16″ seat width and backrest height, and nylon upholstery. The wheelchair was designed using 3D modeling, standard materials, and standard tools. Discussion. An affordable wheelchair, versatile enough to be used for a variety of sports and even everyday use, was designed and prototyped successfully. Documentation for the design including step-by-step directions, engineering drawings, and photographs are available at the Human Engineering Research Laboratories website (http://www.herlpitt.org/ intw.htm). Future work on the prototype should include design refinement including adaptations for other sports, and standards testing.

Individuals with multiple sclerosis (MS) report decreased satisfaction with their mobility devices compared with individuals with spinal cord injuries (SCIs). This study (1) investigated the demographic differences between veterans with MS (V-MS) and veterans with SCI (V-SCI) who were issued a wheelchair by the Veterans Health Administration (VHA) and (2) described differences in mobility device prescription. We merged two VHA databases to obtain demographic and wheelchair information for all V-MS and V-SCI in 2000 and 2001. Descriptive information for issued wheelchairs was available for 2,154 V-MS and V-SCI. We found that V-MS were significantly less likely to receive higher quality wheelchairs (manual or power) compared with V-SCI (p < 0.001). The disparity in VHA wheelchair prescription between these two groups indicates a need for further research regarding the assistive device prescription process in these populations.

Purpose. Training of appropriate wheelchair propulsion methods may be beneficial to the individual who uses a wheelchair by reducing the incidence of pain and improving one's quality of life. This paper discusses the development and initial testing of a training device that was developed to aid in wheelchair propulsion techniques: GAMEWheels System. Methods. Two separate models of GAMEWheels have been developed: a GAMEWheels Clinical and a GAMEWheels Trainer. Details of the development process and the refinement have been included in this manuscript. To verify and compare the practicality and functionality of the two GAMEWheels systems, several focus groups were conducted: first to determine whether the systems could be set-up with informational materials and second to determine if the systems could be taught to novice users. Results. Results from the focus group indicate that the overall impressions of the systems were that they were fun to play. Suggestions were raised to improve the design, which have been incorporated into further refinement of the GAMEWheels systems. Conclusions. This paper provides an overview of the development of a wheelchair-training device. Valuable information was gained to improve the design of the GAMEWheels systems. © 2006 Informa UK Ltd All rights reserved.