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Background: CLASSIC-MS evaluated the long-term efficacy of cladribine tablets in patients with relapsing multiple sclerosis. Objective: Report long-term mobility and disability beyond treatment courses received in CLARITY/CLARITY Extension. Methods: This analysis represents CLASSIC-MS patients who participated in CLARITY with/without participation in CLARITY Extension, and received ⩾1 course of cladribine tablets or placebo (N = 435). Primary objective includes evaluation of long-term mobility (no wheelchair use in the 3 months prior to first visit in CLASSIC-MS and not bedridden at any time since last parent study dose (LPSD), i.e. Expanded Disability Status Scale (EDSS) score <7). Secondary objective includes long-term disability status (no use of an ambulatory device (EDSS < 6) at any time since LPSD). Results: At CLASSIC-MS baseline, mean ± standard deviation EDSS score was 3.9 ± 2.1 and the median time since LPSD was 10.9 (range = 9.3–14.9) years. Cladribine tablets–exposed population: 90.6% (N = 394), including 160 patients who received a cumulative dose of 3.5 mg/kg over 2 years. Patients not using a wheelchair and not bedridden: exposed, 90.0%; unexposed, 77.8%. Patients with no use of an ambulatory device: exposed, 81.2%; unexposed, 75.6%. Conclusion: With a median 10.9 years' follow-up after CLARITY/CLARITY Extension, findings suggest the sustained long-term mobility and disability benefits of cladribine tablets. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medical child abuse (MCA), previously referred to as Munchausen by proxy, can present as chronic pain. We report the presentation of five children seeking treatment for chronic pain who we identified as victims of MCA. The index case had essentially not eaten for the 6 years of her life due to alleged allergies to all foods, developed severe pain, used a wheelchair for ambulation beyond a few blocks, and was alleged to have dysautonomia requiring oxygen monitoring at night. Other cases posed as arthritis that resulted in foot amputation and total body pain, fibromyalgia with alleged mutation negative Stickler syndrome who had symptoms only in her mother's presence, severe incapacitating intermittent pains along with abdominal pain that resulted in appendectomy, cholecystectomy, and pancreatectomy, and alleged disabling hypermobile Ehlers-Danlos in a non-hypermobile child for which the mother sought a power wheelchair. The unusual pattern to the pain, the presence of multiple additional, atypical symptoms and diagnoses, and a generally well appearing child are characteristic. The perpetrator is typically over-invested in the symptoms, derives tangible and intangible secondary gain from the child's alleged illnesses, and is able to present the child in such a fashion to enlist the physician to aid in perpetuating the abuse. These children are highly over-medicalized and suffer significant morbidity. Multiple barriers exist to identifying and reporting these children to Child Protective Services, which need to be recognized and overcome in order to protect these vulnerable children. [ABSTRACT FROM AUTHOR]

Introduction: The aim was to explore occupational participation and quality of life (QoL) for power mobility device users with chronic disease. Methods: Arksey and O'Malley's framework for scoping reviews was used. Six data bases were searched using keywords: wheelchair, scooter, QoL and participation. Data were extracted with coding and thematic analysis performed. Results: Forty-one articles met the inclusion criteria. An overarching theme of enhanced QoL was identified with subthemes of (i) independence, (ii) enabling participation in instrumental activities of daily living, (iii) enhanced social participation and leisure, (iv) environmental barriers to occupational participation, (vi) power mobility device (PMD) performance concerns impacting occupational participation and (vii) overcoming risk of harm through PMD training. Conclusion: The scoping review identified a heterogeneity of study designs and outcome measures, which makes comparison between studies difficult. For people with chronic diseases, PMDs improve independence in occupational participation, particularly in IADL, social participation and leisure. Unfortunately, improved QoL was often inferred, without the use of an outcome measure. Areas which impacted occupational participation for PMD users were environmental barriers and a lack of PMD training. Further research is needed to understand the impact of a PMD on QoL and occupational participation for those with chronic disease. [ABSTRACT FROM AUTHOR]

Introduction: This pre-post study explored the effect of children's 6 months' experience in one of four early power mobility devices. Method: Satisfaction with parent-selected goal achievement was measured using the wheelchair outcome measure for young people and compared with the assessment of learning powered mobility use, as well as device expectation fulfilment ratings. Results: Forty-six children with mobility limitations, aged 13–68 months (mean 40.40; SD 15.60) participated. The most common condition was cerebral palsy (n = 33; 71.74%). The Wilcoxon signed rank test measured the positive change in goal achievement (z = 4.90; P <0.001; r = 0.51). Fair to good statistically significant Spearman's correlations were observed between power mobility skill and goal achievement, as well as parent and therapist device expectation scores (r s = 0.48, 0.46 and 0.66, respectively; P <0.001). Parent and therapist ratings did not differ significantly. No statistically significant associations were found between goal achievement and child (age, diagnosis, abilities) or environmental factors (device, access method, loan length). Conclusion: Children at all phases of power mobility skill, using various devices and access methods, can demonstrate activity and participation change following power mobility experience. This study adds validity evidence supporting the use of the wheelchair outcome measure for young people with young children by parent-proxy rating. [ABSTRACT FROM AUTHOR]

The control schemes of a wheelchair having two wheels with movable payload utilizing the concept of a double-link inverted pendulum have been investigated in this article. The proposed wheelchair has been simulated using SimWise 4D software considering the most efficient parameters. These parameters are extracted using the spiral dynamic algorithm while being controlled with interval type-2 fuzzy logic controller (IT2FLC). The robustness and stability of the implemented controller are assessed under different situations including standing upright, forward motion and application of varying directions and magnitudes of outer disturbances to movable (up and down) system payload. It is shown that the two-wheeled wheelchair adopted by the newly introduced controller has achieved a 94% drop in torque for both Link1 and Link2 and more than 98% fall in distance travelled in comparison with fuzzy logic control type-1 (FLCT1) controller employed in an earlier design. The present study has further considered the increased nonlinearity and complexity of the additional moving payload. From the outcome of this study, it is obvious that the proposed IT2FLC-spiral dynamic algorithm demonstrates better performance than FLCT1 to manage the uncertainties and nonlinearities in case of a movable payload two-wheel wheelchair system. [ABSTRACT FROM AUTHOR]

Powered wheelchair standing devices (PWSDs) allow supported standing for activity; however, little is known about their use. To understand factors affecting use of supported standing for participation among boys with Duchenne muscular dystrophy (DMD) and characteristics of successful users, we gathered data over 7 days from boys who had used PWSDs for 24 months, using a smartphone application. We used descriptive statistics to identify factors that affected their participation. Physical/social engagement and independence were motivators for standing in PWSDs. Enablers included positive attitudinal/social environments. Barriers included pain during supported standing and lack of physical environment accessibility. The characteristics of successful users were identified. Supported standing via PWSDs has potential to improve participation for boys with DMD. The disease stage, individual personal factors and environmental supports impact on use. Therapists should carefully consider and manage factors that impact on uptake and sustainability of use. [ABSTRACT FROM AUTHOR]

3D object recognition has been a cutting-edge research topic since the popularization of depth cameras. These cameras enhance the perception of the environment and so are particularly suitable for autonomous robot navigation applications. Advanced deep learning approaches for 3D object recognition are based on complex algorithms and demand powerful hardware resources. However, autonomous robots and powered wheelchairs have limited resources, which affects the implementation of these algorithms for real-time performance. We propose to use instead a 3D voxel-based extension of the 2D histogram of oriented gradients (3DVHOG) as a handcrafted object descriptor for 3D object recognition in combination with a pose normalization method for rotational invariance and a supervised object classifier. The experimental goal is to reduce the overall complexity and the system hardware requirements, and thus enable a feasible real-time hardware implementation. This article compares the 3DVHOG object recognition rates with those of other 3D recognition approaches, using the ModelNet10 object data set as a reference. We analyze the recognition accuracy for 3DVHOG using a variety of voxel grid selections, different numbers of neurons (Nh) in the single hidden layer feedforward neural network, and feature dimensionality reduction using principal component analysis. The experimental results show that the 3DVHOG descriptor achieves a recognition accuracy of 84.91% with a total processing time of 21.4 ms. Despite the lower recognition accuracy, this is close to the current state-of-the-art approaches for deep learning while enabling real-time performance. [ABSTRACT FROM AUTHOR]

The emergence of the ultralightweight wheelchair has transformed the lives of millions of disabled people. It has radically changed the principles and practices of wheelchair design, manufacture, and prescription and redefined wheelchair users and wheelchair use. Designed and built largely by wheelchair users themselves, it was driven initially by a desire to improve sport performance and later by a wish for improved access to the community and built environment. In this paper, we draw on oral histories and documentary sources to reconstruct its sociotechnical history. We employ the analytical concept of "boundary object" to illuminate how the wheelchair as a technological artifact is implicated in relations of social change and show the role of wheelchair users in the development and emergence of the ultralightweight wheelchair. We highlight the tensions and negotiations within this history and the push and pull between different social groups. The emergence of the ultralightweight wheelchair helped to reconfigure ideas about wheelchairs and their users and allowed wheelchairs to gain a foothold within broader social and technological infrastructures. What makes this account powerful is that this is a success story for a group who have historically been excluded from design processes. [ABSTRACT FROM AUTHOR]

Purpose To report functional mobility in patients with diplegic cerebral palsy (CP) at long-term follow-up after singleevent multilevel surgery (SEMLS). The secondary aim was to assess the relationship between functional mobility and quality of life (QoL) in patients previously treated with SEMLS. Methods A total of 61 patients with diplegic CP, mean age at surgery 11 years, eight months (sd 2 years, 5 months), were included. A mean of eight years (sd 3 years, 10 months) after SEMLS, patients were contacted and asked to complete the Functional Mobility Scale (FMS) questionnaire over the telephone and given a weblink to complete an online version of the CP QOL Teen. FMS was recorded for all patients and CP QOL Teen for 23 patients (38%). Results Of patients graded Gross Motor Function Classification System (GMFCS) I and II preoperatively, at long-term follow-up the proportion walking independently at home, school/work and in the community was 71% (20/28), 57% (16/28) and 57% (16/28), respectively. Of patients graded GMFCS III preoperatively, at long-term follow-up 82% (27/33) and 76% (25/33) were walking either independently or with an assistive device at home and school/work, respectively, while over community distances 61% (20/33) required a wheelchair. The only significant association between QoL and functional mobility was better 'feelings about function' in patients with better home FMS scores (r = 0.55; 95% confi- dence interval 0.15 to 0.79; p = 0.01). Conclusion The majority of children maintained their preoperative level of functional mobility at long-term follow-up after SEMLS. [ABSTRACT FROM AUTHOR]

Independent mobility in typically developing infants and young children has been linked to growth in many areas of child development and changes in family behavior and interaction. Research suggests similar benefits in young children with motor disability who use powered mobility. The purpose of this study was to gain an understanding of how families experienced their child's development, growth, and abilities after using a power wheelchair for 1 year with the intent to generate a preliminary model to capture the process and relationships among these experiences. Eight families participated in interviews, and using grounded theory methodology the research team investigated their experiences. Results informed the development of the preliminary model that framed three key themes: (a) child competence, (b) parenting experience, and (c) the influence of power wheelchair use along with the key category It will help in the long run that titled and anchored the model. This model provides a possible view into how the use of powered mobility may influence development by supporting both child competence and the parenting experience. [ABSTRACT FROM AUTHOR]

Background.: Powered-wheelchair use improves participation for people with mobility limitations; however, many individuals do not receive powered-wheelchair skills training that meets their learning needs. Purpose.: The aim of this work is to evaluate the feasibility of a powered-wheelchair training program for older adults with cognitive impairment, using errorless learning strategies facilitated by shared control technology. Method.: A feasibility 2 × 2 factorial randomized controlled trial will recruit 32 older adults in residential care with mild to moderate cognitive impairment who are new powered-wheelchair use. The intervention consists of six or 12 training sessions, facilitated by shared control technology, using errorless learning techniques. Control participants will receive six or 12 training sessions using trial-and-error methods. Feasibility and clinical outcomes data (primary outcome: powered-wheelchair skills) will be collected. Implications.: Errorless learning facilitated by shared control technology may be an alternative to meet the powered-wheelchair learning needs of older adults with cognitive impairments. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify the interactions between impairment-related and work-related factors associated with recommendations for specific assistive technology devices (ATDs) for persons with mobility limitations who used workplace accommodation (WA) services. A retrospective and secondary data analysis was conducted on 132 WA service users with mobility limitations in Taipei City from 2008 to 2012 using chi-square automatic interaction detector (CHAID). The CHAID analyses revealed interactions between impairment-related factors (difficulty walking and upper extremity pain) and work-related factors (frequent moving around outdoors), which were significantly associated with the recommendation of powered wheelchairs (p < .05). Interactions between the impairment-related factor (difficulty walking) and the work-related factor (frequent sitting for long periods of time) were associated with the recommendation of ergonomic chairs (p < .001) for persons with mobility limitations. By identifying the interactions between impairment-related and work-related factors in recommending workplace ATDs for persons with mobility limitations, this study provides evidence-based ATDs recommendations for persons with mobility limitations. [ABSTRACT FROM AUTHOR]

Nonetheless, continued development of lighter, easier fitting and more comfortable equipment, coupled with continued outcome research and regulatory approval (already available for some systems in the USA) suggest a bright future for powered exoskeleton rehabilitation in persons with MS. Rehabilitation has been recognized as the best, and perhaps only way to restore function in persons with MS.[1] Recently, the application of robotic exoskeletons in MS rehabilitation has garnered much attention, as this approach is associated with a host of advantages relative to manual rehabilitation. [Extracted from the article]

Statement of context: Powered mobility has reported benefits as a learning tool for individuals limited in independent mobility. The majority of literature focuses on early years populations and there remains a need to address powered mobility for adults with profound and multiple learning disabilities. This article explores the experience of switch-operated powered mobility training for one young adult with profound and multiple learning disabilities. Critical reflection on practice: Powered mobility provided a motivating medium through which previously unseen skills, such as upper limb use, were demonstrated. Use of switches, rather than typically used joysticks, allowed successful participation. Implication for practice: Providing the right equipment, environment and appropriate challenge for an individual can facilitate unexpected achievement. [ABSTRACT FROM AUTHOR]

Background. The Nordic Mobility Related Outcome Evaluation of Assistive Device Intervention (NOMO 1.0) instrument evaluates the effectiveness of mobility devices in assessing mobility-related participation, captured by three scales (Need for Assistance, Frequency, and Ease/Difficulty) and one index (Participation Repertoire). Purpose. This study aimed to investigate a range of psychometric properties of the NOMO 1.0 in a sample of adult powered mobility device (PMD) users. Method. Data collected from PMD users (N = 248) in Denmark, Finland, and Norway as part of a larger study were analyzed using state-of-the-art statistical methods. Findings. The acceptability and applicability of the NOMO 1.0 items were generally within recommended values. Some floor/ceiling effects were found and the reliability was acceptable for only the Frequency scale. The factor analysis identified one component for the Need for Assistance scale and six components of the Frequency scale. Implications. The NOMO 1.0 should be used for research purposes and not for clinical practice. Better reliability should be established for the Need for Assistance and Ease/Difficulty scales prior to further psychometric testing to establish the validity of the NOMO 1.0. [ABSTRACT FROM AUTHOR]

The article examines powered mobility for people with profound cognitive disabilities leads to developing occupational performance. It mentions about providing children who have profound cognitive disabilities with opportunities to practice using a joystick-operated powered wheelchair. It also mentions about the Assessment of Learning Powered mobility use (ALP) that includes the ALP-instrument with eight phases.

Introduction Northern Ireland wheelchair guidelines state that wheelchair users who wish to drive their National Health Service provided powered wheelchairs outdoors must complete an electrically powered indoor/outdoor chair test. Within the same guidelines, children in Northern Ireland under the age of 10 years are not permitted to complete this assessment. Research was completed to evaluate how children under 10 years would perform in electrically powered indoor/outdoor chair training and testing under adult supervision. Method A case-study design was utilised with three children aged 7–9 years to evaluate if: (a) these children can complete electrically powered indoor/outdoor chair training/testing safely with adult supervision; (b) the length of time using an electric powered indoor chair correlates with performance on electrically powered indoor chair training/testing; (c) the current Northern Ireland guidelines on age restriction should be re-evaluated so that each child is assessed on an individual basis rather than age. Findings Paediatric powered wheelchair users aged seven to nine years can become competent electrically powered indoor/outdoor chair users with adequate training and adult supervision. Length of time (years) driving an electrically powered indoor chair may not correlate with improved electrically powered indoor/outdoor chair performance. Conclusion Regional Northern Ireland criteria relating to electrically powered indoor/outdoor chair provision for children should be revised in order to consider an individual needs assessment, rather than imposing an age restriction. [ABSTRACT FROM AUTHOR]

This paper focuses on how to provide mobility to people with motor impairments with the integration of robotics and wearable computing systems. The burden of learning to control powered mobility devices should not fall entirely on the people with disabilities. Instead, the system should be able to learn the user's movements. This requires learning the degrees of freedom of user movement, and mapping these degrees of freedom onto electric-powered wheelchair (EPW) controls. Such mapping cannot be static because in some cases users will eventually improve with practice. Our goal in this paper is to present a hands-free interface (HFI) that can be customized to the varying needs of EPW users with appropriate mapping between the users' degrees of freedom and EPW controls. EPW users with different impairment types must learn how to operate a wheelchair with their residual body motions. EPW interfaces are often customized to fit their needs. An HFI utilizes the signals generated by the user's voluntary shoulder and elbow movements and translates them into an EPW control scheme. We examine the correlation of kinematics that occur during moderately paced repetitive elbow and shoulder movements for a range of motion. The output of upper-limb movements (shoulder and elbows) was tested on six participants, and compared with an output of a precision position tracking (PPT) optical system for validation. We find strong correlations between the HFI signal counts and PPT optical system during different upper-limb movements (ranged from r = 0.86 to 0.94). We also tested the HFI performance in driving the EPW in a virtual reality environment on a spinal-cord-injured (SCI) patient. The results showed that the HFI was able to adapt and translate the residual mobility of the SCI patient into efficient control commands within a week's training. The results are encouraging for the development of more efficient HFIs, especially for wheelchair users. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Rolling knee scooters and standard crutches are commonly used following foot and ankle surgery for patients who are required to keep weight off the extremity. In all non-weight bearing situations, muscle atrophy, lack of stability, and decreased blood flow increasing the risk of clots. Postoperative falls within 30 days after surgery have been shown to significantly increase morbidity and correlate directly with age. While it is known that falls following procedures are a definitive concern and should be guarded against, there is a deficiency in reporting with regards to the use of knee scooters and the commonality of falls in the postoperative period while using them in comparison to more traditional means of ambulatory aid like crutches. Methods: From June 2021 to February 2022, 120 patients were prospectively enrolled after foot and ankle procedures at a single institution that required a non-weight bearing period of at least 2-weeks. Patients completed surveys at each post-operative visit until they were weight-bearing asking them to report ambulatory aid device utilized, level of satisfaction, time using the device, number of falls, and complications. Patient demographics, including sex, age, BMI, smoking history, co-morbidities were retrospectively collected and analyzed using descriptive statistics (means, standard deviations, ranges). The relative incidence of a fall occurring was calculated among the entire cohort, with each separate fall counting individually. A regression analysis was performed to identify any patient factors associated with the occurrence of falls. T-tests will be performed to compare the relative chance of a postoperative fall or device-related complication between patients using rolling scooters and those using crutches and assess for significance (p<.05). Results: 106 patients (59 female and 47 male) either used a rolling knee scooter or crutches. For 65 ankle procedures and 41 forefoot procedures, the average age was 51.6 +- 16.0, BMI was 28.6 +- 5.59. Regression analysis of all falls found that only age (p=0.058) was slightly, but not significantly associated with a greater fall risk. Demographic factors such as sex, BMI, procedure type (forefoot vs. hindfoot), and previous experience with the device were not associated with a greater fall risk (p>0.05). Patients were more likely to have used crutches for a previous injury compared to knee scooters (p=.006). Knee scooters were used significantly more often and had higher patient satisfaction compared to crutches (p=0.043, p=0.03). Patients using crutches reported a total of 22 falls compared to 14 total falls knee scooters (p=0.188). Overall, patients would rather use knee scooters than crutches for future foot and ankle surgeries (p=0.001). Conclusion: Both standard crutches and rolling knee scooters are safe and effective methods of non-weight bearing ambulatory aid after foot and ankle procedures. Older patients may be associated with a greater risk of falling regardless of ambulatory aid device utilized. Although there were no significant differences in number of falls between patients who used crutches vs. scooters, patients were significantly more satisfied with rolling knee scooters and more likely to use them in the future. [ABSTRACT FROM AUTHOR]

The article focuses on a study which reviews the power mobility use for infants, children and adolescents with mobility limitations. Topics include American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) criteria, outcome assessment (health care) and child rehabilitation. It also talks about motor impairment or a movement disorder in adolescents related to a neurological, musculoskeletal or neuromuscular condition.

The article discusses a study conducted to determine the advantages and disadvantages of switching from a hand-rim wheelchair to a push rim-activated power-assisted wheelchair by looking at the inferences for its use. The research showed reduced pressure on the arm and cardiovascular system while using the power-assisted forward motion. In conclusion, it states that this wheelchair can be beneficial for people who have suffered from an arm injury or cardiopulmonary reserves.

Objective: The extent to which individual differences in fine motor abilities affect indoor safety and efficiency of human-wheelchair systems was examined. Background: To reduce the currently large number of indoor wheelchair accidents, assistance systems with a high level of automation were developed. It was proposed to adapt the wheelchair’s level of automation to the user’s ability to steer the device to avoid drawbacks of highly automated wheelchairs. The state of the art, however, lacks an empirical identification of those abilities. Method: A study with 23 participants is described. The participants drove through various sections of a course with a powered wheelchair. Repeatedly measured criteria were safety (numbers of collisions) and efficiency (times required for reaching goals). As covariates, the participants’ fine motor abilities were assessed. Results: A random coefficient modeling approach was conducted to analyze the data, which were available on two levels as course sections were nested within participants. The participants’ aiming, precision, and arm– hand speed contributed significantly to both criteria: Participants with lower fine motor abilities had more collisions and required more time for reaching goals. Conclusion: Adapting the wheelchair’s level of automation to these fine motor abilities can improve indoor safety and efficiency. In addition, the results highlight the need to further examine the impact of individual differences on the design of automation features for powered wheelchairs as well as other applications of automation. Application: The results facilitate the improvement of current wheelchair technology. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify a timeline for mapping the different types of wheelchair used by people with motor neurone disease (MND) from diagnosis to death. It also reviewed the use of the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) and the site of disease onset as predictors of wheelchair need and how this could influence commissioning and service delivery. Method: Retrospective data were collected from a clinical database to map when different types of wheelchair were provided to 62 people with MND from diagnosis to death. ALSFRS and site of disease onset were identified when each wheelchair was issued. Findings: The average number of months between diagnosis and the provision of different wheelchairs and death are mapped on a timeline. Higher ALSFRS scores indicate that wheelchairs that are less supportive are required and lower scores indicate that more supportive and complex wheelchairs are required. People with bulbar-onset disease need each type of wheelchair more rapidly than people with limb-onset disease. Conclusion: The timeline could be used by wheelchair services to map the likely intervention and resources required for their MND population. The use of ALSFRS scores and the site of onset of disease on referrals into wheelchair services can further help to predict the likely course of need. [ABSTRACT FROM AUTHOR]

Truncated domes on curb ramps benefit travelers with visual impairments. However, concerns associated with the safety and negotiability of such detectable warnings for other travelers have resulted in much controversy. The findings of the study presented here indicate that detectable warnings did not adversely affect the negotiability of ramps by the 21 participants who ambulated by wheelchairs. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Demand for National Health Service (NHS)-funded electrically powered indoor/outdoor wheelchairs (EPIOCs) persistently outstrips supply. The provision criteria require recipients to be able to benefit 'through easier/increased mobility, leading to improved quality of life' (NHS Guidelines 1996, p3). Recipients' views on the latter remain largely unknown, however, generating the impetus for this study. A convenience sample of 20 patients from one NHS wheelchair service participated. Their perceived occupational performance and satisfaction were rated before and 4-12 weeks after EPIOC provision, using the Canadian Occupational Performance Measure. Six participants also gave post-provision interviews, exploring their perceived quality of life over this period. Interpretative phenomenological analysis was used to investigate the resulting data. Statistically significant improvements occurred in participants' occupational performance and satisfaction scores post-EPIOC provision (p<0.001). At interview, four data categories emerged. Two linked changes in participants' functional abilities and psychological health to EPIOC provision. The remaining two, relating to perceived environmental constraints and separation from society by disability, were unaffected by EPIOC provision. These findings show that EPIOC provision can improve perceived occupational performance and quality of life, in keeping with the above criteria. The implications for occupational therapy practice and research are outlined. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this article is to examine the demographic, health, and social characteristics of mobility device users in long-term care settings. Methods: Data were used from a recently institutionalized sample of older adults from the Canadian Study of Health and Aging. Multinomial logistic regression was used to examine the factors associated with the use of different mobility devices (cane, walker, or wheelchair). Results: Over 70% used mobility aids (over 50% used a wheelchair). Mobility limitations were strongly associated with the use of mobility devices. However, among those with mobility limitations, educational resources reduced the odds of wheelchair use. Conclusions: Consistent with findings from the community setting, need factors are strongly associated with the use of mobility aids in institutions. However, socioeconomic resources may provide older adults with alternate ways to manage mobility limitations in institutional settings. [ABSTRACT FROM AUTHOR]

Objective: To determine problems associated with electric-powered indoor/outdoor wheelchairs (EPIOCs) and the benefits perceived by their users. Design: Hospital-based cohort study of all patients referred over a 19-month period. Setting: Regional Wheelchair Service for North West London serving nine district wheelchair services. Subjects: Of the 174 subjects referred, 10 withdrew their application or were found to be unsuitable at screening, 164 were assessed and 124 were prescribed chairs. One hundred and thirteen subjects were interviewed by telephone four months after provision of the chair. Main measures: Demographic and diagnostic data; current chair usage; self-reported accidents and component faults were compared with those recorded in the unit records; new activities embarked on since delivery; and benefits reported for main carers. Results: Seventeen ‘mishaps’ were reported by 15 users including tipping from chairs (6) and falls during transfers (3). Three probably reflected mechanical failure. Component failure was found in 39% of EPIOCs, mostly affecting control boxes (22), frames (10) and footrests (10). New activities were undertaken by 56 (50%) users, usually shopping and visits to friends/family. Eighty-five per cent of users felt that the chairs made life easier for their informal carers through increased independence, reducing transfers and reduced need for ‘pushing’. Conclusions: The component failures and self-reported accidents (some potentially dangerous) have implications for the NHS, manufacturers, prescribers and users. EPIOCs enhance the independence of severely physically disabled individuals in the community and assist carers by lessening dependence and enhancing social interaction. This study demonstrated the need for follow-up of EPIOC users and chairs. [ABSTRACT FROM AUTHOR]

This chapter explores the relation between subjectivities, materialities (including technological arrangements) and bodily competencies. Starting from the assumption that all material and bodily arrangements are specific, it considers some of those specificities, and the 'passages' through which these specific arrangements are fitted together for a particular person, Liv, who is physically disabled. It explores the character of some of Liv's 'passages' -- some are 'good', some 'bad', some public, and some discrediting -- and the ways in which they are shaped to produce personal and biographical continuity and relative autonomy for her -- an autonomy and capacity discretionary decision making which she highly values. The paper thus uses some of the tools developed in the actor-network approach, but also in feminism, to interpret the material and corporeal relations involved in the formation of contemporary subjectivities. [ABSTRACT FROM AUTHOR]

Wheeled power mobility can fulfil an intrinsic desire to be mobile, to explore one's environment and to be active and participate in occupations regardless of age. This opinion piece briefly presents the potential of power mobility for children with physical impairments, the recent evidence base, an exploration of the readiness and training of children in the use of power mobility, and current United Kingdom prescription practice. This mode of intervention should no longer be considered as the final option but, rather, as a tool to prevent passivity and dependence and to enable children to optimise their participation in childhood occupations. [ABSTRACT FROM AUTHOR]

In this article, we present an obstacle avoidance controller implemented in a field programmable gate array for an electric wheelchair. It is based on a traditional approach with ultrasonic sensors and fuzzy logic. Various tests were conducted to characterize the prototype and to evaluate the controller performance. The results showed that the system is able to acquire data from sensors and make decisions 46.16 times per second. The sensors’ coverage extends 3 m to the front, rear, left, and right sides of the wheelchair; moreover, the sensors detect 0.95-cm diameter objects at 40 cm. The power consumption was evaluated, and it was found that the hardware architecture reduces the battery life by only 0.87%. Furthermore, the controller helped to navigate in confined areas, avoiding obstacles with cautious movements and decreasing the likelihood of collision. The proposed methodology uses data from eight sonars distributed around the wheelchair to make navigation decisions, besides the hardware-based architecture guarantees real-time control and on-time response. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the article "Neuropsychological predictors of powered wheelchair use: A prospective follow-up study" by B. Cullen, B. O'Neill, and J. Evans in issue 22 (2008).