Search

To catalog and study the effects of indoor home environmental factors associated with fear of falling (FOF) for 1) general population, 2) wheelchair (WC) users, and 3) persons with disability (PwD). PubMed, Web of Science, Scopus, and CINAHL until February 14th, 2023. KP and AA independently screened titles/abstracts. Articles were included if they met following criteria: original research, peer-reviewed, mentioned >= 1 indoor environmental factor, mentioned >=1 FOF outcome, English language. Fourteen of 4462 (2239 after duplicate removal) retrieved peer-reviewed articles meeting eligibility criteria were included in qualitative synthesis after discussions among KP, AA, and HM. Standardized data extraction tool developed by KP and HM was used by all the authors for information on author's name, publication year, purpose, study location, study characteristics (i.e., study design, sample size, age, target population), statistical method, list of indoor environmental factors, description and measurement of FOF. Author's KP and AA assessed Risk-of-bias (NIH tool). Overall quality of studies was moderate (2 studies = high quality, 0 = low). Preliminary results indicate at least seven studies reported positive association between various environmental modifications and FOF. One study reported no difference in FOF regarding housing type (apartment vs. house). Studies reported barriers of FOF like uneven, hard, slippery, shiny floors for PwD; cluttered environment, reach for objects, equipment failure for wheelchair users; and height of appliances, pathway obstacles, etc., across all populations surveyed. Whereas facilitators of FOF were grab bars, shower seats for PwD; grab bars, handles, and alarm in toilet, night light, white noise, etc., across all populations surveyed. Home hazards were not associated with FOF when measured using a single question, whereas associated with FOF based on Spinal Cord Injury-Fall Concerns Scale (SCI-FCS). Inappropriately installed potential facilitators (e.g., grab bars, wheelchair transfer setup) could serve as barriers that tend to increase FOF. Association of home environmental factors with FOF is sensitive to the measurement instrument of FOF. None. [ABSTRACT FROM AUTHOR]

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

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

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

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