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Purpose: This study aimed to evaluate the clinical applicability of a customised power wheelchair joystick using rapid prototyping with 3D modeling and printing technology within a rehabilitation centre for patients with cervical spinal cord injury. Materials and Methods: Two male participants with tetraplegia following cervical-level spinal cord injury who had difficulty operating a powered wheelchair were recruited. The procedure of the joystick-making and training service consists of four steps: (1) driving evaluation; (2) digital fabrication; (3) functional test; and (4) driving training. K-QUEST 2.0 (Korean-Quebec User Evaluation of Satisfaction version 2.0) was used to measure the usability of the off-the-shelf and customised joystick. Results: During the application process, several redesign stages were required to obtain the final customised joystick. After participants attended a 30-min driving training five times per week for 8 weeks, the usability of the customised joystick was higher than that of the off-the-shelf one. Conclusion: Providing the customised joystick-making and training service can be used in hospitalised rehabilitation centre before the hospital discharge of patients and returns to their everyday lives. IMPLICATIONS FOR REHABILITATION: 3D printing technology in rehabilitation clinics can provide new benefits, including cost-effectiveness, customisation of assistive devices, higher productivity, and enhanced collaboration with clients. More specifically, the entire intervention process, from medical evaluation, designing and manufacturing the devices, and training the client, can be performed efficiently and quickly by rehabilitation practitioners who best understand the client's characteristics. This study aimed to confirm the clinical applicability of a quick and efficient service for a customised power wheelchair joystick using 3D modelling and printing technology in rehabilitation centres for patients with cervical spinal cord injury. This study is expected to provide clinical support for connecting potential users and practitioners with technological advancements. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the review was to explore current factors affecting the use of a powered wheelchair for an adult person a with a disability. Materials and Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. Information about the characteristics of the studies (type, setting) and perceived barriers and facilitators to powered wheelchair use were extracted using a data extraction sheet. Data synthesis was achieved using narrative synthesis. The quality of the included studies was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (SQAC) and the CASP checklist (Critical Appraisal Skills Programme), Centre for Evidence-Based Medicine, SIGN (Scottish Intercollegiate Guidelines Network). Results: Fifteen studies qualified for inclusion in the review. The narrative synthesis produced a conceptual map of reported factors affecting the usability of a powered wheelchair. Conclusions: This review demonstrates that powered wheelchair use is a multifaceted and multidisciplinary phenomenon that is dependent on numerous interconnected factors including individual adjustment, stakeholder cooperation, societal attitudes, functional performance, and environmental features. Based on the review findings, there are several applied learning outcomes and practical applications to the powered wheelchair prescription and provision. IMPLICATIONS FOR REHABILITATION: The rejection, misuse or damage of a powered wheelchair can result in condition deterioration and loss of independence for the user. Adult powered wheelchair prescription, maintenance, and use is a multi-faceted process spanning social, individual, environmental, technical and functional, and organisational factors. Individuals in this stakeholder network should aim to account for these interdisciplinary factors when engaging with people who use powered wheelchairs. [ABSTRACT FROM AUTHOR]

To evaluate children's characteristics and impact of a powered wheelchair lending program including comparisons of diagnostic sub-groups, and validation of a predictive model of powered mobility proficiency. This retrospective study included 172 children who participated in the ALYN powered mobility lending program from 3/2009-7/2022. Demographics and functional levels were measured via questionnaires; driving proficiency was evaluated when the wheelchair was returned, and parents and children were interviewed following their participation in the program. Two diagnostic groups were identified: cerebral palsy (CP) (n = 136, median = 9.75 yrs) and other neuromuscular diseases (NMD) (n = 30, median = 5.83 yrs). They differed significantly in the age they commenced PM training, the male/female ratio, walking ability and access mode. Fifty-seven percent of the participants with CP achieved powered mobility proficiency, a rate that was significantly lower than the 73% proficiency found for the NMD group. Four significant predictors were identified: communication, manual wheelchair operation, access mode and go-stop upon request. They predicted proficiency in approximately 80% of cases. Overall feedback from the parents and children indicated that their personal and family's quality of life improved as a result of their child's ability to use a powered wheelchair. A lending program provides children with opportunities to improve mobility skills in an appropriate powered wheelchair. Children who can communicate verbally, propel a manual wheelchair, use a joystick and go-stop upon request are significantly more likely to become proficient drivers; however, many who were unable to complete these tasks also improved and even became proficient drivers. Children who are able to engage in verbal communication, propel a manual wheelchair for short distances, use a joystick and go-stop upon request are significantly likely to become a proficient powered wheelchair drivers. Children with cerebral palsy who have greater physical challenges (e.g., cannot walk at all or propel a manual wheelchair) can reach powered mobility proficiency following practice with a powered wheelchair borrowed from a lending program, although at a lower rate than those with other neuromuscular diseases; additional training strategies should be developed to increase the percent success for children with cerebral palsy. A multivariate logistic regression was able to correctly predict whether a child will become proficient driver in 80% of case. Training with a powered wheelchair from the lending program enabled parents to observe their children's independent mobility in their home environment; they reported improvement in the family's quality of life. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONThe increasing prevalence of mobility impairments underscores the urgent need for accessible and affordable mobility aids. To overcome the mobility limitations of people with disabilities, there is an increasing need for the development of lightweight and portable powered wheelchairs that can be easily loaded. This study aimed to perform an early health technology assessment and a formative usability evaluation on a modular (detachable) powered wheelchair. It aimed to gauge device satisfaction among users, pinpoint areas for improvement, and detect any unforeseen errors to inform future development. Engaging 16 participants, including powered wheelchair users, healthcare professionals, and caregivers, the research evaluated the wheelchair’s functionality in various scenarios, emphasizing safety, effectiveness, and convenience. Statistical analyses of task performance and satisfaction surveys highlighted that, while powered wheelchair users successfully completed tasks focusing on driving and power control, healthcare professionals and caregivers encountered difficulties with the wheelchair’s assembly and disassembly. Despite general positivity, the surveys indicated mixed satisfaction levels regarding safety, validity, and convenience, with specific issues related to frame durability, seat comfort, and control mechanisms. These findings suggest that refining the wheelchair’s design and addressing user concerns could significantly enhance satisfaction and mobility services. Future efforts will include a thorough review of an advanced prototype and further satisfaction assessments.We believe that our study makes a significant contribution to the literature by addressing a critical gap in the understanding of user-centric design and usability testing for powered wheelchairs.By emphasizing the importance of early assessments and incorporating user feedback into the development process, our research offers practical insights for creating more accessible and user-friendly mobility solutions.This contribution is particularly relevant in the context of advancing assistive technology and improving the quality of life for individuals with disabilities.We believe that our study makes a significant contribution to the literature by addressing a critical gap in the understanding of user-centric design and usability testing for powered wheelchairs.By emphasizing the importance of early assessments and incorporating user feedback into the development process, our research offers practical insights for creating more accessible and user-friendly mobility solutions.This contribution is particularly relevant in the context of advancing assistive technology and improving the quality of life for individuals with disabilities. [ABSTRACT FROM AUTHOR]

The current technological revolution driven by advances in machine learning has motivated a wide range of applications aiming to improve our quality of life. Representative of such applications are autonomous and semiautonomous Powered Wheelchairs (PWs), where the focus is on providing a degree of autonomy to the wheelchair user as a matter of guidance and interaction with the environment. Based on these perspectives, the focus of the current research has been on the design of lightweight systems that provide the necessary accuracy in the navigation system while enabling an embedded implementation. This motivated us to develop a real-time measurement methodology that relies on a monocular RGB camera to detect the caregiver's feet based on a deep learning method, followed by the distance measurement of the caregiver from the PW. An important contribution of this article is the metrological characterization of the proposed methodology in comparison with measurements made with dedicated depth cameras. Our results show that despite shifting from 3D imaging to 2D imaging, we can still obtain comparable metrological performances in distance estimation as compared with Light Detection and Ranging (LiDAR) or even improved compared with stereo cameras. In particular, we obtained comparable instrument classes with LiDAR and stereo cameras, with measurement uncertainties within a magnitude of 10 cm. This is further complemented by the significant reduction in data volume and object detection complexity, thus facilitating its deployment, primarily due to the reduced complexity of initial calibration, positioning, and deployment compared with three-dimensional segmentation algorithms. [ABSTRACT FROM AUTHOR]

To develop a tool to assess the progression of powered mobility skills for children and determine its psychometric properties. A three-phase, the mixed-method design included: I) conceptualisation based on international specialists' input through a focus group or interview to generate initial items; II) tool development using a two-round Delphi survey and III) evaluation of psychometric properties from eight video recordings of children. The Progression of Paediatric Powered Mobility (3PM) was validated via Intraclass correlation coefficients (ICC) calculated from conventionally powered mobility assessments: the Powered Mobility Program, the Assessment of Learning Powered Mobility tool, and the Powered Mobility Proficiency test. Content derived from 20 clinical experts led to the development of the first version consisting of 19 demographic and 61 driving skill items. Following two Delphi rounds, the final tool included 14 demographic and 41 driving skill items. Internal consistency was excellent (Cronbach alpha = 0.96) as was the inter-rater reliability (ICC = 0.96, 95% confidence interval = 0.95–0.96). Pearson correlation coefficients between the 3PM and other PM assessments demonstrated good convergent validity. The 3PM, created through international collaboration with experts in PM, has excellent psychometric values as a valid measure that can be used reliably to assess children's powered mobility skills. The 3PM reflects the three stages of powered mobility development: exploratory, operational, and functional stages. Input from clinical experts in PM mobility contributed to the identification of the key driving skills important to include in the 3PM. A reliable and valid tool can facilitate assessment and tailored intervention in paediatric powered mobility. [ABSTRACT FROM AUTHOR]

Background Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self.Aim The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users.Material and methods Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis.Findings The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant’s sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed.Conclusions and significance Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare.

Mobility experience has a positive impact on activity, participation, socialisation, language and cognition, but children with cerebral palsy (CP), Gross Motor Function Classification System (GMFCS) level V require assistive devices or assistance in all environments. Supported standing devices afford upright, weight-bearing positions to promote muscle, bone, joint and overall health. Supported stepping devices afford stepping and upright independent mobility, positively impacting self-esteem and participation, while power mobility is the only possibility for effective, independent community mobility. These devices and opportunities should be introduced at the age when children who are typically developing are pulling to stand, moving and exploring their environment. A detailed case description including lived experience and device use data is presented for female twins with dystonic tetraplegic CP born at 25 weeks gestational age and functioning at GMFCS level V. The feasibility of using power mobility, standing and stepping devices in home and community settings within the first two years is illustrated. The twins transitioned from spending 24 h in lying positions or being held in arms to spending more than 2 h daily in upright positions and having opportunities to move independently. Positioning and mobility devices can help to address all the F-words for child development: functioning, family, fitness, fun, friends and future.

The dynamic model of mobile wheelchair technology requires developing and implementing an intelligent control system to improve protection, increasing performance efficiency, and creating precise maneuvering in indoor and outdoor spaces. This work aims to design a robust tracking control algorithm based on a reference model for operating the kinematic model of powered wheelchairs under the variation of system parameters and unknown disturbance signals. The control algorithm was implemented using the pole placement method in combination with the sliding mode control (PP-SMC) approach. The design also adopted a neural network approach to eliminate system uncertainties from perturbations. The designed method utilized the sinewave signal as an essential input signal to the reference model. The stability of a closed-loop control system was achieved by adopting the Goa reaching law. The performance of the proposed tracking control system was evaluated in three scenarios under different conditions. These included assessing the tracking under normal operation conditions, considering the tracking performance by changing the dynamic system's parameters and evaluating the control system in the presence of uncertainties and external disturbances. The findings demonstrated that the proposed control method efficiently tracked the reference signal within a small error based on mean absolute error (MAE) measurements, where the range of MAE was between 0.08 and 0.12 in the presence of uncertainties or perturbations.

Mobility experience has a positive impact on activity, participation, socialisation, language and cognition, but children with cerebral palsy (CP), Gross Motor Function Classification System (GMFCS) level V require assistive devices or assistance in all environments. Supported standing devices afford upright, weight-bearing positions to promote muscle, bone, joint and overall health. Supported stepping devices afford stepping and upright independent mobility, positively impacting self-esteem and participation, while power mobility is the only possibility for effective, independent community mobility. These devices and opportunities should be introduced at the age when children who are typically developing are pulling to stand, moving and exploring their environment. A detailed case description including lived experience and device use data is presented for female twins with dystonic tetraplegic CP born at 25 weeks gestational age and functioning at GMFCS level V. The feasibility of using power mobility, standing and stepping devices in home and community settings within the first two years is illustrated. The twins transitioned from spending 24 h in lying positions or being held in arms to spending more than 2 h daily in upright positions and having opportunities to move independently. Positioning and mobility devices can help to address all the F-words for child development: functioning, family, fitness, fun, friends and future. [ABSTRACT FROM AUTHOR]

Background: Young and adult users of electric wheelchairs (EWs) describe how EWs have personal, functional, emotional, and symbolic values and are considered by some to be part of the self. Aim: The aim of this study was to increase our understanding of how occupational identity is constructed in the daily practices of EW users. Material and methods: Context-based, in-depth oral stories and filmed sequences of daily practice enactments of persons who have used an EW since childhood were the basis for the narrative analysis. Findings: The findings elucidate how the informants enact and tell about their identity-development in response to daily and relational practices, and its relevance to the informant's sense of self, belonging, competence, life-prospects, conduct, and awareness of shifting values, and this was likewise demonstrated in different appearances and roles related to social recognition. A model illustrating the findings is proposed. Conclusions and significance: Contextual values and exploring experiences, such as possibilities to develop competences and roles, along with encountering social recognition, but also hindering regulations and adversities, influence the development of occupational identities. Findings in this study can contribute to increased understanding, conscious political decisions, as well as a more person-centred approach within healthcare. [ABSTRACT FROM AUTHOR]

The dynamic model of mobile wheelchair technology requires developing and implementing an intelligent control system to improve protection, increasing performance efficiency, and creating precise maneuvering in indoor and outdoor spaces. This work aims to design a robust tracking control algorithm based on a reference model for operating the kinematic model of powered wheelchairs under the variation of system parameters and unknown disturbance signals. The control algorithm was implemented using the pole placement method in combination with the sliding mode control (PP-SMC) approach. The design also adopted a neural network approach to eliminate system uncertainties from perturbations. The designed method utilized the sinewave signal as an essential input signal to the reference model. The stability of a closed-loop control system was achieved by adopting the Goa reaching law. The performance of the proposed tracking control system was evaluated in three scenarios under different conditions. These included assessing the tracking under normal operation conditions, considering the tracking performance by changing the dynamic system's parameters and evaluating the control system in the presence of uncertainties and external disturbances. The findings demonstrated that the proposed control method efficiently tracked the reference signal within a small error based on mean absolute error (MAE) measurements, where the range of MAE was between 0.08 and 0.12 in the presence of uncertainties or perturbations. [ABSTRACT FROM AUTHOR]

Abstract Background Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care. Methods Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9–12 months post incident to review and record the outcome for each PMD user. Results No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income. Conclusion This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care.

BackgroundPowered wheelchairs are an essential technology to support mobility, yet their use is associated with a high level of sedentarism that can have negative health effects for their users. People with Duchenne muscular dystrophy (DMD) start using a powered wheelchair in their early teens due to the loss of strength in their legs and arms. There is evidence that low-intensity exercise can help preserve the functional abilities of people with DMD, but options for exercise when sitting in a powered wheelchair are limited.MethodsIn this paper, we present the design and the feasibility study of a new version of the MOVit device that allows powered-wheelchair users to exercise while driving the chair. Instead of using a joystick to drive the wheelchair, users move their arms through a cyclical motion using two powered, mobile arm supports that provide controller inputs to the chair. The feasibility study was carried out with a group of five individuals with DMD and five unimpaired individuals. Participants performed a series of driving tasks in a wheelchair simulator and on a real driving course with a standard joystick and with the MOVit 2.0 device.ResultsWe found that driving speed and accuracy were significantly lowered for both groups when driving with MOVit compared to the joystick, but the decreases were small (speed was 0.26 m/s less and maximum path error was 0.1 m greater). Driving with MOVit produced a significant increase in heart rate (7.5 bpm) compared to the joystick condition. Individuals with DMD reported a high level of satisfaction with their performance and comfort in using MOVit.ConclusionsThese results show for the first time that individuals with DMD can easily transition to driving a powered wheelchair using cyclical arm motions, achieving a reasonable driving performance with a short period of training. Driving in this way elicits cardiopulmonary exercise at an intensity found previously to produce health-related benefits in DMD.

Background: Powered wheelchairs and motorised mobility scooters, collectively called powered mobility devices (PMD), are highly valued by older Australians, including those living in residential care, to facilitate personal and community mobility. The number of PMDs in residential aged care is expected to grow proportionally with that of the wider community, however, there is very little literature on supporting residents to use PMDs safely. Prior to developing such supports, it is important to understand the frequency and nature of any incidents experienced by residents whilst using a PMD. The aim of this study was to determine the number and characteristics of PMD use related incidents occurring in a group of residential aged care facilities in a single year in one state in Australia including incident type, severity, assessment, or training received and outcomes on follow-up for PMD users living in residential aged care. Methods: Analysis of secondary data, including documentation of PMD incidents and injuries for one aged care provider group over 12 months retrospectively. Follow-up data were gathered 9–12 months post incident to review and record the outcome for each PMD user. Results: No fatalities were recorded as a direct result of PMD use and 55 incidents, including collisions, tips, and falls, were attributed to 30 residents. Examination of demographics and incident characteristics found that 67% of residents who had incurred incidents were male, 67% were over 80 years of age, 97% had multiple diagnoses and 53% had not received training to use a PMD. Results from this study were extrapolated to project that 4,453 PMD use related incidents occur every year within Australian residential aged care facilities, with the potential for outcomes such as extended recovery, fatality, litigation, or loss of income. Conclusion: This is the first time that detailed incident data on PMD use in residential aged care has been reviewed in an Australian context. Illuminating both the benefits and the potential risks of PMD use emphasizes the need to develop and improve support structures to promote safe PMD use in residential aged care. [ABSTRACT FROM AUTHOR]

The current technological revolution driven by advances in machine learning has motivated a wide range of applications aiming to improve our quality of life. Representative of such applications are autonomous and semiautonomous Powered Wheelchairs (PWs), where the focus is on providing a degree of autonomy to the wheelchair user as a matter of guidance and interaction with the environment. Based on these perspectives, the focus of the current research has been on the design of lightweight systems that provide the necessary accuracy in the navigation system while enabling an embedded implementation. This motivated us to develop a real-time measurement methodology that relies on a monocular RGB camera to detect the caregiver’s feet based on a deep learning method, followed by the distance measurement of the caregiver from the PW. An important contribution of this article is the metrological characterization of the proposed methodology in comparison with measurements made with dedicated depth cameras. Our results show that despite shifting from 3D imaging to 2D imaging, we can still obtain comparable metrological performances in distance estimation as compared with Light Detection and Ranging (LiDAR) or even improved compared with stereo cameras. In particular, we obtained comparable instrument classes with LiDAR and stereo cameras, with measurement uncertainties within a magnitude of 10 cm. This is further complemented by the significant reduction in data volume and object detection complexity, thus facilitating its deployment, primarily due to the reduced complexity of initial calibration, positioning, and deployment compared with three-dimensional segmentation algorithms.

This paper presents a haptic-based assistance system(AS) for powerwheelchair users designed using the model-based shared control approach. The idea is to combine robust control with a high-level driving supervisor in order to successfully share control authority between thewheelchair user and the assistance system. This shared control strategy is composed of two parts, namely an operational part and a tactical part. Through the haptic joystick interface, this assistance system aims to reduce user's effort when manipulating the joystick, guide the user to avoid any potential collisions, and maintain the active participation of the user in driving the wheelchair. In the operational part, an optimal Takagi-Sugeno fuzzy control approach is proposed to deal with the time-varying user's intention represented by his desired longitudinal and angular position errors and velocities and hand torques. The control design is formulated as an LMI optimization problemwhich can be easily solved with numerical solvers. Two unknown input observers for Takagi-Sugeno fuzzy model have been designed to estimate the user's intention in order to generate an assistance torque via a haptic force feedback joystick. The control supervisor in the tactical part, aims to provide a decision-making signal which allows for the conflict management based on the user hand torque estimation. A specific algorithm has been developed to solve the conflict between the user's desired actions and the suggestions fromthe assistance system to ensure the user remains the final decision-maker. Experimental results show the effectiveness and the validity of the proposed assistance system. [ABSTRACT FROM AUTHOR]

Background: Intelligent powered wheelchairs remain a popular research topic that can improve users' quality of life. Although our multidisciplinary research team has put a lot of effort into adding features based on end-users needs and impairments since 2006, there are still open issues regarding the usability and functionalities of an intelligent powered wheelchair (IPW). Methods: For this reason, this research presents an experience with our IPW followed by a study in two parts: a quantitative one based on the System Usability Scale (SUS) questionnaire and a qualitative one through open questions regarding IPW functionalities with novice users, e.g., IPW non-users. These users never used an IPW before, but are users and aware of the impacts of the technology used in our IPW, being undergraduate to postdoctoral students and staff (faculty, lecturers, research engineers) at the Faculty of Engineering of Université de Sherbrooke. Results: The qualitative analyses identified different behaviours among the novice users. The quantitative analysis via SUS questionnaire done with novice users reports an "okay" rating (equivalent with a C grade or 68 SUS Score) for our IPW's usability. Moreover, advantages and disadvantages opinions were gathered on the IPW as well as comments which can be used to improve the system. Conclusions: The results reported in these studies show that the system, e.g., IPW, was judged to be sufficiently usable and robust by novice users, with and without experience with the software used in developing the IPW. [ABSTRACT FROM AUTHOR]

Powered wheelchair use promotes participation in individuals with limited mobility, however training is required for safe and effective use. There is limited evidence on the task demands of powered wheelchair use to inform an evidence-based skills training programme. To conduct a systematic exploration of the task demands of indoor powered wheelchair use to identify frequently used skills, abilities, and knowledge. We used a two-phased think aloud process to conduct a task analysis of powered wheelchair use with experienced powered wheelchair users (n = 5) and expert clinicians (n = 5). Participants completed seven indoor driving tasks while speaking aloud (concurrent think aloud) and subsequently engaged in a structured qualitative interview to discuss skills, abilities, and knowledge used across each of the seven tasks (retrospective think aloud). We used directed content analysis to map the skills and abilities to the ICF framework and conventional content analysis to develop thematic areas of knowledge used while operating a powered wheelchair. One-hundred and ten (110) distinct skills and abilities were identified and mapped to the ICF; 80 in the Body Structures and Functions domain, and 30 in the Activities and Participation domain. Approximately 50% of skills and abilities were mental functions. Four thematic knowledge domains were identified: knowledge of self, environment, wheelchair, and task. Powered wheelchair use is complex and requires a variety of skills and abilities from all areas of human functioning, in addition to a wide range of knowledge. Training programmes should address a range of areas of skill development. Powered wheelchair use is a complex skill; training should develop skills from all. Domains of the ICF, including mental and physical functions. A range of knowledge is used while operating a powered wheelchair; training programs. Should include the development and application of necessary knowledge. Clinicians may consider a range of factors when assessing suitability for powered. Wheelchair user, however should acknowledge that while the range of skills idenotified. May be useful, they may not be critical for success in powered wheelchair use. [ABSTRACT FROM AUTHOR]

Young infants, children, and persons of any age who have cognitive limitations can be thought of as tyro learners, who are beginners in learning. For tyro learners, the self-produced mobility afforded by a powered mobility device offers opportunities, to explore tool-use learning and interact with the surrounding environment, thereby potentially enhancing development and learning, providing a foundation for future goal-directed, tool-use activities. The Assessment of Learning Powered mobility use tool, version 2.0 (ALP), developed with tyro learners, is a process-based implementation package, focused on assessing and progressing an individual's understanding of how to use a powered mobility device. Although the ALP tool can be used with any powered mobility learner, research suggests that this process-based approach may be, especially, beneficial for tyro learners, who are in the early phases of learning how to operate a powered mobility device. This article aims to (1) explain tool-use learning in powered mobility intervention; (2) distinguish between the characteristics of process-based and task-based implementation packages; (3) provide an in-depth description of using the ALP tool in providing powered mobility intervention; and (4) highlight the benefits of using the ALP tool, with a focus on tyro learners. [ABSTRACT FROM AUTHOR]

A large number of people in the world need to use a wheelchair because of different disabilities. Driving a wheelchair requires complex physical and cognitive abilities which need to be trained. Virtual training helps users acquire driving skills in a safe environment. The aim of this paper is to describe and technically validate simulation models for both manual (MW) and powered wheelchairs (PW) based on immersive virtual reality CAVE (VR). As VR system, the Gait Real-time Analysis Interactive Lab (GRAIL) was used, a CAVE equipped with a motion platform with two degrees of freedom and an optoelectronic motion capture system. A real wheelchair was positioned onto the motion platform with rear wheels free to turn in MW modality, and a commercial joystick was installed on an armrest to simulate the PW modality. Passive markers were used to track the wheel rotation, the joystick and the user hand motion. Custom D-flow applications were developed to manage virtual scene response to user actions. Overground tests, based on single wheel rotation, were performed to verify the simulation model reliability. Quantitative results demonstrated that the MW simulator kinematics was consistent with a real wheelchair overground in the absence of wheel slip and inertia (median error for MW 0.40 °, no systematic bias p = 0.943, high correlation rho > 0.999, p < 0.01). The proposed solution is flexible and adaptable to different wheelchairs, joysticks and optoelectronic systems. The main limitation is the absence of force feedback. Nevertheless, it is a reliable prototype that can be used to validate new virtual scenarios as well as for wheelchair training. The next steps include the system validation with real end users and assessment of the simulator effectiveness as a training tool. [ABSTRACT FROM AUTHOR]

Abstract Background Powered wheelchairs are an essential technology to support mobility, yet their use is associated with a high level of sedentarism that can have negative health effects for their users. People with Duchenne muscular dystrophy (DMD) start using a powered wheelchair in their early teens due to the loss of strength in their legs and arms. There is evidence that low-intensity exercise can help preserve the functional abilities of people with DMD, but options for exercise when sitting in a powered wheelchair are limited. Methods In this paper, we present the design and the feasibility study of a new version of the MOVit device that allows powered-wheelchair users to exercise while driving the chair. Instead of using a joystick to drive the wheelchair, users move their arms through a cyclical motion using two powered, mobile arm supports that provide controller inputs to the chair. The feasibility study was carried out with a group of five individuals with DMD and five unimpaired individuals. Participants performed a series of driving tasks in a wheelchair simulator and on a real driving course with a standard joystick and with the MOVit 2.0 device. Results We found that driving speed and accuracy were significantly lowered for both groups when driving with MOVit compared to the joystick, but the decreases were small (speed was 0.26 m/s less and maximum path error was 0.1 m greater). Driving with MOVit produced a significant increase in heart rate (7.5 bpm) compared to the joystick condition. Individuals with DMD reported a high level of satisfaction with their performance and comfort in using MOVit. Conclusions These results show for the first time that individuals with DMD can easily transition to driving a powered wheelchair using cyclical arm motions, achieving a reasonable driving performance with a short period of training. Driving in this way elicits cardiopulmonary exercise at an intensity found previously to produce health-related benefits in DMD.

Abstract This paper proposes a stair-climbing gait for a four-wheeled vehicle. The idea and methodology of climbing stairs are described, and the results of experiments are shown. Crawler-type vehicles and vehicles with special, complicated mechanisms are commonly used for climbing continuous steps (stairs). In contrast, in this paper, a four-wheeled vehicle with additional degrees of freedom, whose mechanism is not as complicated, is discussed. A gait algorithm based on a pace gait is proposed, and its performance is evaluated.

Background: Intelligent powered wheelchairs remain a popular research topic that can improve users’ quality of life. Although our multidisciplinary research team has put a lot of effort into adding features based on end-users needs and impairments since 2006, there are still open issues regarding the usability and functionalities of an intelligent powered wheelchair (IPW). Methods: For this reason, this research presents an experience with our IPW followed by a study in two parts: a quantitative one based on the System Usability Scale (SUS) questionnaire and a qualitative one through open questions regarding IPW functionalities with novice users, e.g., IPW non-users. These users never used an IPW before, but are users and aware of the impacts of the technology used in our IPW, being undergraduate to postdoctoral students and staff (faculty, lecturers, research engineers) at the Faculty of Engineering of Université de Sherbrooke. Results: The qualitative analyses identified different behaviours among the novice users. The quantitative analysis via SUS questionnaire done with novice users reports an “okay” rating (equivalent with a C grade or 68 SUS Score) for our IPW’s usability. Moreover, advantages and disadvantages opinions were gathered on the IPW as well as comments which can be used to improve the system. Conclusions: The results reported in these studies show that the system, e.g., IPW, was judged to be sufficiently usable and robust by novice users, with and without experience with the software used in developing the IPW.

Abstract Background Powered wheelchair (PW) driving is a complex activity and requires the acquisition of several skills. Given the risks involved with PW use, safe and effective training methods are needed. Virtual reality training allows users to practice difficult tasks in a safe environment. An additional benefit is that augmented feedback can be provided to optimize learning. The purpose of this study was to investigate whether providing augmented feedback during powered wheelchair simulator training results in superior performance, and whether skills learned in a virtual environment transfer to real PW driving. Methods Forty healthy young adults were randomly allocated to two groups: one received augmented feedback during simulator training while the control group received no augmented feedback. PW driving performance was assessed at baseline in both the real and virtual environment (RE and VE), after training in VE and two days later in VE and RE (retention and transfer tests). Results Both groups showed significantly better task completion time and number of collisions in the VE after training and these results were maintained two days later. The transfer test indicated better performance in the RE compared to baseline for both groups. Because time and collisions interact, a post-hoc 2D Kolmogonov-Smirnov test was used to investigate the differences in the speed-accuracy distributions for each group; a significant difference was found for the group receiving augmented feedback, before and after training, whereas the difference was not significant for the control group. There were no differences at the retention test, suggesting that augmented feedback was most effective during and immediately after training. Conclusions PW simulator training is effective in improving task completion time and number of collisions. A small effect of augmented feedback was seen when looking at differences in the speed-accuracy distributions, highlighting the importance of accounting for the speed-accuracy tradeoff for PW driving.

Power wheelchairs (PW) with head/foot steering systems are used as an alternative to joysticks in children with severe dyskinetic cerebral palsy (DCP). Mobility training programs are unstandardized to date, and insight on dystonia, choreoathetosis, and mobility performance may lead to greater independent mobility. To map the presence and severity of dystonia and choreoathetosis during PW mobility in DCP and their relation with mobility performance. Ten participants with DCP performed four PW mobility tasks using a head/foot steering system. Dystonia and choreoathetosis in the neck and arm regions were evaluated using the Dyskinesia Impairment Mobility Scale (DIMS). PW mobility performance was assessed using time-on-task and the number of errors during performance. The Wilcoxon-signed rank test and the Spearman's correlation coefficients were used to explore differences and correlations. Median levels of dystonia (83.6%) were significantly higher (p < 0.01) than median levels of choreoathetosis (34.4%). Positive significant correlations were found between the Arm Proximal DIMS and the PW mobility experience (r s= -0.92, p < 0.001), and between the Arm Distal DIMS and the number of errors (r s = 0.66, p = 0.039) during mobility performance. Dystonia is more present and severe during PW mobility than choreoathetosis. The hypertonic hallmark of dystonia may mask the hyperkinetic hallmark of choreoathetosis, resulting in lower median levels. Results may suggest that with an increase in driving experience, children with DCP adopt deliberate strategies to minimize the negative impact of arm overflow movements on mobility performance, however, future research with bigger sample size and additional outcome measures is strongly encouraged. • First study to map dystonia and choreoathetosis patterns during PW powered mobility. • Dystonia and choreoathetosis are both present, with dystonia levels dominating. • Mobility performance is positively related to the distal arm overflow movements. • Mobility experience is negatively related to the proximal arm overflow movements. • Powered mobility training should initially focus on the control of the head or feet. [ABSTRACT FROM AUTHOR]

Aim: Poorer physical and mental health often accompany loss of walking in Duchenne muscular dystrophy. This study assessed the impacts of powered wheelchair standing device (PWSD) use on muscle and joint pain, joint angles when standing and mental health in adolescents with Duchenne muscular dystrophy. Methods: Fourteen adolescents and parents participated in a stepped wedge design study over 12 months. During a baseline and intervention period, adolescents described pain and mental health, and parents reported their child's mental health. Video data were collected to measure hip, knee and ankle joint angles in the preferred standing position. Results: Compared with baseline and adjusting for covariates, standing wheelchair use was associated with no change in muscle or joint pain or videoed joint angles in standing. Child‐reported Strengths and Difficulties total scores decreased (coefficient −3.1, 95% confidence interval −4.6, −1.5); and parent‐reported Personal Adjustment and Role Skills Scale total scores increased (coefficient 7.9, 95% confidence interval 3.3–12.5). Conclusions: PWSD use was associated with maintenance of musculoskeletal status and advantages to mental health. Long‐term observations are necessary to improve understanding of how to support wellbeing in adolescents with Duchenne muscular dystrophy. [ABSTRACT FROM AUTHOR]

This paper proposes a stair-climbing gait for a four-wheeled vehicle. The idea and methodology of climbing stairs are described, and the results of experiments are shown. Crawler-type vehicles and vehicles with special, complicated mechanisms are commonly used for climbing continuous steps (stairs). In contrast, in this paper, a four-wheeled vehicle with additional degrees of freedom, whose mechanism is not as complicated, is discussed. A gait algorithm based on a pace gait is proposed, and its performance is evaluated. [ABSTRACT FROM AUTHOR]

Recline and tilt functions are the most desirable features for relieving seating pressure to decrease the risk of pressure ulcers. This study presents a new recline mechanism for a powered wheelchair for users sitting for a long duration. We analyzed the effect of a developed two-slide mechanism. In this study, body slip distance and buttock pressure were measured during wheelchair reclining and repositioning using a three-dimensional motion analysis and a pressure measurement system in 10 healthy subjects. Non-slide, one-slide, and two-slide versions were compared. During reclining, the total slip distance along the backrest with two slides was 40.6 mm, which was 77% and 44% smaller than non-slide and one-slide backrests, respectively. The slip variation of the non-slide was 38 mm at the beginning of recline in the initial seated position, and the slip distance tended to decrease as the recline angle increased. However, in the two-slide backrest, the average slip distance per 10° interval was only 5.1 ± 1.1 mm. In addition, we observed a similar slip in repositioning as in reclining, and the slip distance along the seat also decreased most in the two-slide backrest. The buttock pressure gradually decreased from 100° to 150° and then increased again from 160°, but the two-slide backrest showed a tendency to decrease at larger angles of recline and decreased by 59% of the maximum pressure. This study confirms that the two-slide system reduces body slip and buttock pressure, and it is expected that risk factors caused by the long-term use of a wheelchair can be minimized. [ABSTRACT FROM AUTHOR]

Powered wheelchair users can experience negative health effects from reduced physical activity. If a user could exercise by driving the chair, it might improve fitness. This paper presents the development of MOVit, an exercise-enabling, wheelchair driving interface. The design goal of MOVit was that users cyclically move their arms to drive the chair, thereby providing a light level of exercise while driving. MOVit supports this arm movement with custom mobile arm supports that also serve as the sensors that provide controller inputs. Here, we first quantified how increasing the frequency and amplitude of arm movement increase oxygen consumption and heart rate. Then, we evaluated two novel control methods for driving by moving the arm supports. Participants without impairment (${N}= {24}$) were randomized to one of the two methods, or conventional joystick control, and performed driving tests over two days on a simulator and test course. Our results indicate that driving speed and accuracy were significantly lowered with the exercise-enabling methods compared to joystick control (ANOVA, ${p} < {0.05}$), but the decreases were small (speed was ~0.1 m/s less and course tracking error ~1 cm greater). These results show, for the first time, the feasibility of exercising while driving a powered wheelchair. [ABSTRACT FROM AUTHOR]

Highlights • The standing wheelchair provided the adolescent with choice of when and where to stand. • The standing wheelchair allowed frequent position change without physical transfer. • Autonomous participation in physical, social and educational activities was considered important. Abstract Duchenne muscular dystrophy is a common neuromuscular disorder involving progressive muscle weakness. A powered wheelchair standing device provides capacity to stand despite increasing muscle weakness. This study used qualitative methods to explore how adolescents with Duchenne muscular dystrophy used a powered wheelchair standing device in their daily lives. Semi-structured interviews were conducted with 12 adolescents, 11 parents and 11 teachers. Qualitative thematic analysis using a grounded theory framework was conducted to identify emerging domains. "Capacity to be able" was the central theme that emerged across the dataset: the introduction of the powered wheelchair standing device at a time when motor skills were declining enabled the adolescent to maintain and sometimes extend his independence. There were four underlying themes including (1) Independence, (2) Health, (3) Comfort, and (4) Community belonging and involvement. Each theme was illustrated in data collected from adolescents, parents and teachers. The device appeared to mitigate some of the challenges of progressive muscle weakness by providing the option for the individual with Duchenne muscular dystrophy to choose when and where to stand for participation in a range of activities, beyond what would be possible with existing therapeutic regimes involving standing frames. [ABSTRACT FROM AUTHOR]

In recent years, studies increasingly employed data loggers to record the objective behaviors of powered wheelchair users. Of the data logging work reported in the literature, the technologies used offer marked differences in characteristics. In order to identify and describe the extent of published research activity that relies on data logger technologies for powered wheelchairs, we performed a scoping review of the scientific and grey literature. This scoping review, complementary to a previous one related to manual wheelchairs, is part of a process aiming to help further the development and increase the functionality of data loggers with wheelchairs. Five databases were searched: Medline, Compendex, CINAHL, EMBASE, Google Scholar. Sixty papers were retained for analysis. The most frequently used technologies were all installed on the wheelchair: 19.0% were accelerometers, 14.6% were pressure sensors or switches, 13.9% were odometers, 10.9% were global positioning systems, 9.5% were tilt sensors, and 7.3% were force-sensing technologies. The most reported outcomes were pressure-relief activities (17.3%), distance traveled (9.3%), mobility events (8.9%), acceleration (8.5%), and sitting time (6.9%). Future research may be needed to assess the usefulness of different outcomes and to develop methods more appropriate to optimize the practicality of wheelchair data loggers. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this research is to identify stakeholder views with regard to the development of effective powered wheelchair assistive technologies more suited to the user and carer needs, whilst also meeting the requirements for other stakeholders, such that developers can be better guided towards producing solutions which have a better chance of getting to the market place and hence to the end user. Method: A questionnaire was designed to collect the views of all stakeholders and circulated to a statistically representative number of them. The question rating data were then checked for correlation between groups, and within groups, to establish validity. Results: The 74 stakeholders across the eight classes who responded had a good correlation between each other, with a cross class "Pearson's correlation" ranging between 0.7 and 0.95, and the "Fleiss's Kappa reliability of agreement" within each class ranging between 0.07 and 0.36. Conclusions: This research has identified that all stakeholders should be involved in the development of the technology and that some may benefit in 'role-reversal' to help understand user problems and stakeholder concerns more clearly. Cost was a significant barrier to the uptake of appropriate technology, and training of users and carers was a major issue. Furthermore, development should not increase user isolation and the impact on the user must be monitored for 'quality of life'. Technical support and training should be given to the user and their carers, and equipment must be adaptive to meet the changing needs of the user. Improved acceptance and use of technology by the user and their carers. Reduced rejection of appropriate provision. Improved mobility and interaction with others. Improved quality of life for users and carers. [ABSTRACT FROM AUTHOR]

This document is an editorial titled "Model-based methods for human-machine cooperative and shared control systems" published in the journal Frontiers in Control Engineering. The editorial discusses the importance of human-machine cooperation and shared control in various scientific communities. It reviews state-of-the-art methods and recent approaches for modeling and designing human-machine cooperative systems, highlighting different interaction scenarios and models. The editorial also includes two articles related to highly automated driving, focusing on shared control approaches and driver assistance systems. Additionally, it mentions other articles related to cooperative human-machine system design for mobile nursing robots, power wheelchairs, and tele-operated underwater vehicles. The editorial concludes by emphasizing the need for continued research in this field and its potential applications in other domains. [Extracted from the article]

Purpose: To determine improvements in goal satisfaction following individualized mobility-related powered wheelchair skills training and whether changes in satisfaction are maintained 3 months post-training. Materials and methods: Seventeen powered wheelchair users, from two centres, who were randomized to the training intervention from a larger multicentre study, were included in this secondary analysis. The intervention consisted of five 30-min individualized Wheelchair Skills Training Program sessions. Participants rated their current satisfaction with each of their goals from 0 to 10 (10 being the highest) prior to training, immediately after the intervention, and approximately 3 months following the intervention. Themes relating to the participants’ goals were also explored. Results: Goal satisfaction scores improved statistically (p < .001) from baseline (4.7 ± 1.9) to immediately following training (8.0 ± 1.0) and were maintained 3 months (8.3 ± 1.2) following the intervention. Participants’ goal satisfaction scores were not significantly correlated with goal attainment scores recorded by the trainer (r = 0.387, n = 17, p = .125). The majority of goals set fell into the broader “manoeuvring” category. Conclusion: Goal satisfaction following the Wheelchair Skills Training Program improved years after initially learning how to operate a powered wheelchair. The five training sessions were effective in improving goal satisfaction. The quantification of goal satisfaction appears to be a sensitive outcome for powered wheelchair users undergoing mobility-related training. Implications for rehabilitation: Goal satisfaction improved following the Wheelchair Skills Training Program. Even with years of powered wheelchair experience, the majority of goals set fell into the broader “manoeuvring” category. An individual’s goal satisfaction may not correlate with whether they have attained their goal as determined by a trainer. [ABSTRACT FROM AUTHOR]

Background   This article deals with powered wheelchair (PW) simulators. In any application of simulation (learning, medical prescription, experimentation of new features, etc.) it is necessary to define driving performance criteria. The aim of this work is to validate a new performance index for PW driving analysis. Methods   The validation was carried out in two stages. First, we modelled the human-machine system consisting of the pilot and the PW with the OPCM model (Optimal Preview Control Model) and we deduced the importance of the preview time T p or its equivalent, the preview distance D p . Experiments on a panel of 15 healthy subjects were carried out on the 3D simulator ViEW (Virtual Electrical Wheelchair) associated with an eye-tracker system and allowed to validate this modelling. In the second stage, the healthy panel was separated into two skill-level groups (accustomed/novice). Results   The experimental results showed that the parameter D p is representative of the driving quality: accustomed drivers get greater values of D p than the novice users during the driving. To illustrate this assertion, we conclude by a case study conducted on five subjects with motor disabilities. Conclusion   This work showed that D p allows to differentiate accustomed users from the novice ones using a test on healthy subjects. A second test on subjects with disabilities showed that this indicator can be used for analysing their abilities to drive the PW. [ABSTRACT FROM AUTHOR]