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Upper-limb fatigue is a common problem that may restrict people with multiple sclerosis (MS) from using their electric powered wheelchair effectively and for a long period of time. The objective of this research is to evaluate whether participants with MS can drive better with a variable compliance joystick (VCJ) and customizable algorithms than with a conventional wheelchair joystick. Eleven participants were randomly assigned to one of two groups. The groups used the VCJ in either compliant or noncompliant isometric mode and a standard algorithm, personally fitted algorithm, or personally fitted algorithm with fatigue adaptation running in the background in order to complete virtual wheelchair driving tasks. Participants with MS showed better driving performance metrics while using the customized algorithms than while using the standard algorithm with the VCJ. Fatigue adaptation algorithms are especially beneficial in improving overall task performance while using the VCJ in isometric mode. The VCJ, along with the personally fitted algorithms and fatigue adaptation algorithms, has the potential to be an effective input interface for wheelchairs.

The ability of people with disabilities to live in their homes and communities with maximal independence often hinges, at least in part, on their ability to transfer or be transferred by an assistant. Because of limited resources and the expense of personal care, robotic transfer assistance devices will likely be in great demand. An easy-to-use system for assisting with transfers, attachable to electrical powered wheelchairs (EPWs) and readily transportable, could have a significant positive effect on the quality of life of people with disabilities. We investigated the stability of our newly developed Strong Arm, which is attached and integrated with an EPW to assist with transfers. The stability of the system was analyzed and verified by experiments applying different loads and using different system configurations. The model predicted the distributions of the system’s center of mass very well compared with the experimental results. When real transfers were conducted with 50 and 75 kg loads and an 83.25 kg dummy, the current Strong Arm could transfer all weights safely without tip-over. Our modeling accurately predicts the stability of the system and is suitable for developing better control algorithms to enhance the safety of the device.

Lightweight wheelchairs are characterized by their low cost and limited range of adjustment. Our study evaluated three different folding lightweight wheelchair models using the American National Standards Institute/Rehabilitation Engineering Society of North America (ANSI/RESNA) standards to see whether quality had improved since the previous data were reported. On the basis of reports of increasing breakdown rates in the community, we hypothesized that the quality of these wheelchairs had declined. Seven of the nine wheelchairs tested failed to pass the multidrum test durability requirements. An average of 194,502 +/- 172,668 equivalent cycles was completed, which is similar to the previous test results and far below the 400,000 minimum required to pass the ANSI/ RESNA requirements. This was also significantly worse than the test results for aluminum ultralight folding wheelchairs. Overall, our results uncovered some disturbing issues with these wheelchairs and suggest that manufacturers should put more effort into this category to improve quality. To improve the durability of lightweight wheelchairs, we suggested that stronger regulations be developed that require wheelchairs to be tested by independent and certified test laboratories. We also proposed a wheelchair rating system based on the National Highway Transportation Safety Administration vehicle crash ratings to assist clinicians and end users when comparing the durability of different wheelchairs.

To examine the heart-rate (HR) response and court-movement variables during wheelchair tennis match play for high- (HIGH) and low- (LOW) performance-ranked players. Analysis of physiological and movement-based responses during match play offers an insight into the demands of tennis, allowing practical recommendations to be made. Fourteen male open-class players were monitored during tournament match play. A data logger was used to record distance and speed. HR was recorded during match play. Significant rank-by-result interactions revealed that HIGH winners covered more forward distance than HIGH losers (P < .05) and had higher average (P < .05) and minimum (P < .01) HRs than LOW winners. LOW losers had higher average (P < .01) and minimum (P < .001) HRs than LOW winners. Independent of result, a significant main effect for rank was identified for maximum (P < .001) and average (P < .001) speed and total (P < .001), reverse (P < .001), and forward-to-reverse (P < .001) distance, with higher values for HIGH. Independent of rank, losing players experienced higher minimum HRs (P < .05). Main effects for maximum HR and actual playing time were not significant. Average playing time was 52.0 (9.1) min. These data suggest that independent of rank, tennis players were active for sufficient time to confer health-enhancing effects. While the relative playing intensity is similar, HIGH players push faster and farther than LOW players. HIGH players are therefore more capable of responding to ball movement and the challenges of competitive match play. Adjustments to the sport may be required to encourage skill developmental in LOW players, who move at significantly lower speeds and cover less distance.

Purpose: Functional mobility is necessary to perform activities of daily living and for community participation for everyone, but especially important for persons with disabilities (PWD). Therefore, functional mobility requires reliable measurement of consumer satisfaction and functional changes. The functional mobility assessment (FMA) instrument is a self-report outcomes tool designed to measure effectiveness of wheeled mobility and seating (WMS) interventions for PWD. This study examined the test-retest reliability of the FMA, and the stability of self-reported performance items. Method: A repeated-measures cohort study was conducted at the Center for Assistive Technology, at the University of Pittsburgh Medical Center. Participants (n = 41) completed an initial FMA questionnaire, and were re-administered the questionnaire within 7-21 days of the first questionnaire completion. The study sample included 20 participants who were non-WMS users but in the process of being evaluated for a device and 21 participants who were existing WMS users. Intra-Class Correlation coefficients (ICC) were computed to determine agreement between the two scores. Results: Test-retest reliability scores for all items and participants were above the acceptable value for a clinical assessment tool (≥0.80). Responses on the FMA of Existing WMS users and non-WMS users did not differ significantly at test or retest. Conclusions: Results indicate that the FMA was a reliable and stable tool for assessing the functional performance of individuals who use or need WMS interventions. Implications for Rehabilitation The FMA is applicable to non-WMS and WMS users. The FMA fills a gap in mobility assessment tools because it is applicable to the total range of WMS devices. The FMA promotes collaboration between the consumer and the practitioner, yielding a better outcome for the consumer. © 2013 Informa UK, Ltd.

The objectives of this study were: to identify the factors that are associated with prescription of wheeled mobility devices for older adults, and to determine the effect that living setting has on the types of devices that older adults receive. Retrospective medical chart review at the Center for Assistive Technology on 337 older individuals. These individuals were aged >60 years, and each of them received a new wheeled mobility device from the center during 2007 or 2008. Data were analyzed in three tiers: tier 1 (manual versus powered mobility devices); tier 2 (motorized scooters versus power wheelchairs); and tier 3 (customized versus standard power wheelchairs). For tier 1, the factor associated with higher odds for receipt of manual wheelchairs versus powered were: cognitive limitations (OR =.03). For tier 2, diagnosis of cardio-vascular and pulmonary conditions were associated with prescription of motorized scooters (OR = 3.9). For tier 3, neurological conditions (OR = 3.1), male gender (OR =.37), institutional living (OR =.23), and lower age (OR =.96) were associated with receipt of customized power wheelchairs. This study objectively describes factors associated with prescription of wheeled mobility for older adults. This information can aid in development of guidelines and improving standards of practice for prescription of wheelchairs for older adults. © 2012 RESNA.

The Personal Mobility and Manipulation Appliance (PerMMA) is a recently developed personal assistance robot developed to provide people with disabilities and older adults enhanced assistance in both mobility and manipulation, which are two fundamental components for independently activities of daily life performing, community participation, and quality of life. Technologies to assist with mobility and manipulation are among the most important tools for clinicians, end users and caregivers; however, there are currently few systems that provide practical and coordinated assistance with mobility and manipulation tasks. The PerMMA was not only developed and evaluated to provide users and caregivers enhanced mobility and manipulation options, but also as a clinical tool as well as research platform. The development and evaluation of PerMMA are presented in the paper.

Surface characteristics of a cross slope can impact the ease with which a manual wheelchair (MWC) user propels across a surface. The purpose of this research was two-fold. Phase I of this research surveyed MWC users to identify cross slope scenarios that they reported to be more difficult to traverse compared to other common driving obstacles. Our survey results showed that, overall, cross slopes were harder to propel across than narrow and manual doors, and cross-slopes in inclement weather conditions were equal or more difficult than gravel and rough-surfaces. Cross slopes with severe angles and those with compound angles (slope with cross-slope) were the most difficult to traverse. Phase II focused on identifying the responses (e.g., avoid, explore alternative, experience a sense of insecurity, no effect) people had when viewing pictures of various cross-slopes scenarios (e.g., narrow space, compound angles, extreme weather) that wheelchair users encounter. These results showed that people reported that they would avoid or feel insecure on some cross-sloped surfaces, like the weather, that are not within our control, others, like compound angle and curb-cuts on slopes, that can be addressed in the construction of pathways or sidewalks. Copyright © 2012 RESNA.

Evidence suggests that wheelchair (WC) users are exposed to unhealthy levels of vibration during WC use. Health risks associated with vibration exposure include vertebral disc degeneration and back pain, which may consequently decrease the function and independence of WC users. Some evidence suggests that the cushions used in WCs may amplify vibrations, although conclusive evidence has not been presented in the literature. This study evaluated and compared the transmissibility of commercially available WC cushions with two laboratory test methods: (1) direct measurement of transmissibility while human subjects propelled a WC over a road course with different cushions and (2) characterization of cushions with a material testing system (MTS) combined with mathematical models of the apparent mass of the human body. Results showed that although dynamic characterization of WC cushions is possible with an MTS, the results did not correlate well with the transmissibility obtained in the WC road course. Significant differences were found for transmissibility among the cushions tested, with the air-based cushions having lower transmissibility than the foam- or gel-based cushions.

OBJECTIVE: Upper limb spasticity may impair the use of control interfaces such as joysticks for many individuals with disabilities such as cerebral palsy (CP). The aims of this study were to compare the driving performance of those with CP to that of control participants, to identify the impact of lead time on performance, and to compare two joystick designs, a standard movement sensing joystick and a novel isometric joystick. DESIGN: This study used a repeated-measures design to compare the performance of a group of participants with CP to that of participants without disabilities in a two-dimensional simulated driving task on a computer screen using the two control interfaces. The driving trials used varying "lead times," or the amount of warning time available to make movement decisions and turns. A total of 34 participants with CP and without disability were matched by age and sex into two groups. RESULTS: Participants with CP had lower driving performance in most variables of interest compared with controls. However, surprisingly, reducing lead time also reduced some performance errors, possibly because of more deliberate driving. The isometric joystick outperformed the movement sensing joystick in terms of performance errors but contributed to a prolonged reaction time. CONCLUSIONS: The isometric joystick was preferred by participants over the movement sensing joystick in this study and may be a future alternative for individuals with CP for both power mobility and computer access tasks. Copyright © 2012 by Lippincott Williams & Wilkins.

Objective: To develop and evaluate new energy expenditure (EE) prediction models for manual wheelchair users (MWUs) with spinal cord injury (SCI) based on a commercially available multisensor-based activity monitor. Design: Cross-sectional. Setting: Laboratory. Participants: Volunteer sample of MWUs with SCI (N=45). Intervention: Subjects were asked to perform 4 activities including resting, wheelchair propulsion, arm-ergometer exercise, and deskwork. Criterion EE using a metabolic cart and raw sensor data from a multisensor activity monitor was collected during each of these activities. Main Outcome Measures: Two new EE prediction models including a general model and an activity-specific model were developed using enhanced all-possible regressions on 36 MWUs and tested on the remaining 9 MWUs. Results: The activity-specific and general EE prediction models estimated the EE significantly better than the manufacturer's model. The average EE estimation error using the manufacturer's model and the new general and activity-specific models for all activities combined was -55.31% (overestimation), 2.30% (underestimation), and 4.85%, respectively. The average EE estimation error using the manufacturer's model, the new general model, and activity-specific models for various activities varied from -19.10% to -89.85%, -18.13% to 25.13%, and -4.31% to 9.93%, respectively. Conclusions: The predictors for the new models were based on accelerometer and demographic variables, indicating that movement and subject parameters were necessary in estimating the EE. The results indicate that the multisensor activity monitor with new prediction models can be used to estimate EE in MWUs with SCI during wheelchair-related activities mentioned in this study. © 2012 American Congress of Rehabilitation Medicine.

This study determined the driving characteristics of wheelchair users during power wheelchair soccer games. Data for this study were collected at the 28th and 29th National Veterans Wheelchair Games. Nineteen veterans who were 18 years or older and power wheelchair soccer players completed a brief demographic survey and provided information about their power wheelchairs. A customized data-logging device was placed on each participant's wheelchair before power soccer game participation. The data logger was removed at the end of the final game for each participant. The average distance traveled during the games was 899.5 +/- 592.5 m, and the average maximum continuous distance traveled was 256.0 +/- 209.4 m. The average wheelchair speed was 0.8 +/- 0.2 m/s, and the average duration of driving time was 17.6 +/- 8.3 min. Average proportion of time spent at a speed >1 m/s was 30.7% +/- 33.8%, between 0.5 and 1 m/s was 16.2% +/- 34.4%, and <0.5 m/s was 21.4% +/- 24.3%. The information from this descriptive study provides insight for future research in the field of adapted sports for people with high levels of impairments who use power wheelchairs for their mobility.

Purpose: This study investigates travel tendencies among people with disabilities and senior citizens in New Delhi, India to reveal relationships between the desire for transportation independence, use of assistive technology for mobility, travel frequency, and satisfaction with available modes of transportation. Method: Study volunteers received invitations to complete a one-time, three-part questionnaire. The survey included an assessment battery developed by the Quality of Life Technology Engineering Research Center, questions featured in the 2002 National Transportation Availability and Use Survey, and a variation on the PARTS/M and FABS/M questionnaires. Results: 80 study participants completed the questionnaire, and were grouped according to driving status as No Driving Experience (NDE), Ceased Driving (CD), and Continue To Drive (CTD). Participants in the NDE group were less likely to use transportation more than twice daily. However, the CD group had the lowest perceived value for available transportation options, with transportation use comparable to the CTD group and an enduring desire to continue driving. Conclusions: Study findings suggest an inner drive for transportation independence. The rise of driving culture internationally presents driver rehabilitation services with challenges due to the need for vehicle modifications and driving assessment using manual transmission automobiles, scooters, and motorcycles. © 2012 Informa UK, Ltd.

The ability to perform activities of daily living and mobility-related activities of daily living are substantial indicators of one's ability to live at home and to participate in one's community. Technologies to assist with mobility and manipulation are among the most important tools that clinicians can provide to people with disabilities to promote independence and community participation. For people with severe disabilities involving both the upper and lower extremities, there are few systems that provide practical and coordinated assistance with mobility and manipulation tasks. The personal mobility and manipulation appliance (PerMMA) was created in response to goals set forth by a team of clinicians and people with disabilities. © 2012 IEEE.

Rigid backrest systems for wheelchairs provide a stable and comfortable base of support to help users maintain good posture while propelling and sitting static. Unfortunately, these backrest systems lack the adjustability necessary to allow users to comfortably perform some tasks, such as dressing; consequently, many users retain their sling-style backrests. We developed a lightweight, durable, adjustable composite (LWDAC) backrest mounting system to address these shortcomings and performed engineering and human subjects testing to evaluate the feasibility of the device. The LWDAC prototype passed the static engineering evaluation, as well as nearly all of the fatigue testing prior to failure of the device. Clinicians (n = 9) and users (n = 8) who evaluated the device in a focus group forum had an overall positive response. The participants agreed the backrest mounting can be operated with one hand and felt comfortable when participants were seated. Wheelchair users were interested in purchasing the backrest, and clinicians indicated they would recommend the LDWAC. Copyright © 2011 RESNA.

For people with significant mobility impairments who also have both lower and upper limb disability, there are few technology solutions. The aim of this article is to describe the design and development of the Personal Mobility and Manipulation Appliance, a device that provides coordinated mobility and bimanual manipulation for people with both lower and upper limb impairment. The Personal Mobility and Manipulation Appliance is integrated from several commercial products and custom technologies, including two robotic arms mounted on a mobile robotic base. It has three primary operating modes: local user, remote user, and autonomous. It also has a cooperative control mode where two or more of the primary modes can be used simultaneously. The device was evaluated in a kitchen and was able to perform several complex tasks. Future work should focus on interface improvements and evaluations by end users. © 2011 RESNA.

Objective: Approximately 40% of Americans with disabilities cannot operate wheeled mobility devices and computers adequately because of diminished upper-limb motor control, sensory limitations, and cognitive impairments. We developed tuning software that can customize control interfaces for individuals with upper-limb impairments. This study compared the differences in each parameter among different diagnostic groups. Design: The age of the subjects ranged from 18 to 80 yrs. The participants were classified into the following groups: athetoid cerebral palsy, spastic cerebral palsy, multiple sclerosis, upper-limb spasticity, and control. We used a validated tuning software protocol to customize an isometric joystick before a virtual tracing or driving task. Tuning parameters were then compared across groups. Results: Seventy-five subjects were included. Gain, the parameter responsible for force-to-output ratios, in each directional axis (leftward gain: P = 0.018; rightward gain: P = 0.003; reverse gain: P = 0.007; forward gain: P = 0.014) was significantly different across the diagnostic groups. Post hoc analyses showed that the control group required smaller leftward gain than spastic cerebral palsy, multiple sclerosis and upper-limb spasticity groups and smaller gain in all other directions compared with spastic cerebral palsy. Conclusions: Gain may be a useful parameter in tuning by clinicians, and efforts aimed at gain customization may aid the development of commercially available tuning software packages. Copyright © 2011 by Lippincott Williams & Wilkins.

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. © 2011 American Congress of Rehabilitation Medicine.

The purpose of this study was to determine whether the use of wheeled mobility devices differed with respect to age, gender, residential setting, and health-related factors among older adults. A total of 723 adults ageing 60 and older are representing three cohorts, from nursing homes, the Center for Assistive Technology, and the wheelchair registry from the Human Engineering Research Laboratories. Wheeled mobility devices were classified into three main groups: manual wheelchairs, power wheelchairs, and scooters. Our results found factors including age, gender, diagnosis, and living settings to be associated with differences in use of manual versus powered mobility devices. Differences in use were also noted for subtypes of manual (depot, standard, and customized) and powered (scooter, standard, and customized) mobility devices, on demographic, living arrangements, and health-related factors. Consideration of demographic, health-related, and environmental factors during the prescription process may help clinicians identify the most appropriate mobility device for the user. Copyright © 2011 Amol M. Karmarkar et al.

This study describes a new custom measurement system designed to investigate the biomechanics of sitting-pivot wheelchair transfers and assesses the reliability of selected biomechanical variables. Variables assessed include horizontal and vertical reaction forces underneath both hands and three-dimensional trunk, shoulder, and elbow range of motion. We examined the reliability of these measures between 5 consecutivetransfer trials for 5 subjects with spinal cord injury and 12 nondisabled subjects while they performed a self-selected sitting pivot transfer from a wheelchair to a level bench. A majority of the biomechanical variables demonstrated moderate to excellentreliability (r > 0.6). The transfer measurement system recorded reliable and valid biomechanical data for future studies of sitting-pivot wheelchair transfers.We recommend a minimum of five transfer trials to obtain a reliable measure of transfer technique for future studies.

Background: Little research has been done on the robustness of prosthetic feet prescribed to military personnel, and manufacturers are not required to test their products prior to sale. This is problematic because the prosthetic feet used by active individuals are subjected to loading conditions not seen in normal gait. Objectives: To evaluate whether commercially available heavy-duty prosthetic feet intended for use by military personnel meet ISO 10328 standards. Study Design: Bench testing of heavy-duty prosthetic feet using ISO 10328 standards. Methods: Prosthetic feet from three different manufacturers were tested according to ISO 10328 standards, using a testing frame fitted with axial load and displacement transducers. Pass/fail information was recorded as well as the stiffness and creep of each foot before and after cyclic testing. Results: All feet passed the ISO 10328 standards at the highest loading level, and some significant differences were found within a given model of prosthesis when comparing stiffness and creep before and after cyclic testing. Conclusions: This study demonstrated that manufacturers of heavy-duty prosthetic feet adhere to the voluntary ISO 10328 standards. However, these standards may be insufficient because the tests simulate only idealized gait. Further development of the standards may be necessary to reproduce the circumstances that occur during extreme usage to ensure that prosthetic feet do not fail. © The International Society for Prosthetics and Orthotics 2011.

We sought to identify logistical and ethical challenges to performing wheelchair-related research in low- and middle-income countries and to generate a list of compensatory strategies to address these challenges. Thirteen individuals with experience in the field participated in an online Delphi study. The surveys asked participants to identify research challenges, suggest strategies to address the selected challenges, and critique each other's strategies. Participants identified challenges in the use of research techniques, compensation for participation that does not result coercion, oral and written translation materials, funding for research, collaboration with local professionals, and respect for persons. Effective international mobility research requires time, cultural sensitivity, collaboration, and careful planning. An understanding of these requirements can allow researchers to anticipate and compensate for common pitfalls of their work, thus making the research more productive and beneficial to subjects. Future research is required to verify the general effectiveness of compensatory strategies. © 2011 Copyright 2011 RESNA.

This study determined and compared wheelchairmobility patterns for older adults during an organized sporting event and within their community. In July 2008, 39 veterans participating in the 28th National Veterans Wheelchair Games (Omaha, Nebraska) completed the study. Of these, 26 were manual wheelchair and 13 were power wheelchair users. We collected wheelchair-related mobility data using wheelchair data-logging devices. Participants were significantly more active using manual wheelchairs during the games than when using their wheelchairs in their homes in terms of distance traveled (4,466.2 vs 1,367.4 m, p < 0.001) and average speed of propulsion (0.76 vs 0.64 m/s, p < 0.001). The trend was the same for power wheelchair users, with respect to distance (7,306.2 vs 3,450.5 m, p = 0.004) and average speed (0.9 vs 0.7 m/s, p = 0.002). This study demonstrates an objective method of evaluating wheelchair use in community-dwelling older adults.

Riggins MS, Kankipati P, Oyster ML, Cooper RA, Boninger ML. The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury. Objective: To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. Design: Retrospective case study of National SCI Database data. Setting: SCI Model Systems (SCIMS) sites (N=18). Participants: Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. Interventions: Not applicable. Main Outcome Measures: Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. Results: Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). Conclusions: Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation. © 2011 American Congress of Rehabilitation Medicine.

A smart home is a residence equipped with technology that observes the residents and provides proactive services. Most recently, it has been introduced as a potential solution to support independent living of people with disabilities and older adults, as well as to relieve the workload from family caregivers and health providers. One of the key supporting features of a smart home is its ability to monitor the activities of daily living and safety of residents, and in detecting changes in their daily routines. With the availability of inexpensive low-power sensors, radios, and embedded processors, current smart homes are typically equipped with a large amount of networked sensors which collaboratively process and make deductions from the acquired data on the state of the home as well as the activities and behaviors of its residents. This article reviews sensor technology used in smart homes with a focus on direct environment sensing and infrastructure mediated sensing. The article also points out the strengths and limitations of different sensor technologies, as well as discusses challenges and opportunities from clinical, technical, and ethical perspectives. It is recommended that sensor technologies for smart homes address actual needs of all stake holders including end users, their family members and caregivers, and their doctors and therapists. More evidence on the appropriateness, usefulness, and cost benefits analysis of sensor technologies for smart homes is necessary before these sensors should be widely deployed into real-world residential settings and successfully integrated into everyday life and health care services. © 2011 Elsevier Ireland Ltd. All rights reserved.

Background: The objective of this study was to investigate differences in shoulder, elbow and hand kinetics while performing three different SPTs that varied in terms of hand and trunk positioning. Methods: Fourteen unimpaired individuals (8 male and 6 female) performed three variations of sitting pivot transfers in a random order from a wheelchair to a level tub bench. Two transfers involved a forward flexed trunk (head-hips technique) and the third with the trunk remaining upright. The two transfers involving a head hips technique were performed with two different leading hand initial positions. Motion analysis equipment recorded upper body movements and force sensors recorded hand reaction forces. Shoulder and elbow joint and hand kinetics were computed for the lift phase of the transfer. Findings: Transferring using either of the head hips techniques compared to the trunk upright style of transferring resulted in reduced superior forces at the shoulder (P < 0.002), elbow (P < 0.004) and hand (P < 0.013). There was a significant increase in the medial forces in the leading elbow (P = 0.049) for both head hip transfers and the trailing hand for the head hip technique with the arm further away from the body (P < 0.028). The head hip techniques resulted in higher shoulder external rotation, flexion and extension moments compared to the trunk upright technique (P < 0.021). Interpretation: Varying the hand placement and trunk positioning during transfers changes the load distribution across all upper limb joints. The results of this study may be useful for determining a technique that helps preserve upper limb function overtime. © 2011 Elsevier Ltd.

Participation is considered the most meaningful outcome of rehabilitation. The purpose of this study was to investigate whether there were correlations between wheelchair activity recorded with a data logger and community participation as measured by the Participation Survey/Mobility. Data from 16 participants were included in this study. Data collected during a two week period using a data logging device were analyzed to determine the mobility characteristics of participants. Among manual wheelchair users, significant positive correlations were found between average speed traveled and the community participation content areas of transportation (rs =.837, p =.019) and socialization (rs =.772, p =.042). In addition, for manual wheelchair users there was a trend toward a significant correlation between average speed traveled and total community participation score (rs =.714, p =.071). Among power wheelchair users, there was a trend toward a significant negative correlation between average speed traveled and the community participation content area of leisure activity (rs = -.635, p =.066). Understanding the relationship between wheelchair speed and community participation can be useful information to enable clinicians to recommend the most appropriate mobility devices designed to enhance community participation. Copyright © 2011 RESNA.

Medical rehabilitation and assistive technology are immersed in a world transitioning to a basis in evidence-based practice. Fortunately, there is a growing body of knowledge related to manual wheelchair mobility to form a basis for clinical decision making. The results from research studies are useful for designing better wheelchairs, fitting and training people appropriately, contributing to evidence-based-medicine and guiding future research. This review describes some of the work related to manual wheelchairs that has and is being conducted within the University of Pittsburgh and the Human Engineering Research Laboratories of the United States Department of Veterans Affairs, and its application. © 2010 Informa UK, Ltd.

Brose SW, Weber DJ, Salatin BA, Grindle GG, Wang H, Vazquez JJ, Cooper RA: The role of assistive robotics in the lives of persons with disability.Robotic assistive devices are used increasingly to improve the independence and quality of life of persons with disabilities. Devices as varied as robotic feeders, smart-powered wheelchairs, independent mobile robots, and socially assistive robots are becoming more clinically relevant. There is a growing importance for the rehabilitation professional to be aware of available systems and ongoing research efforts. The aim of this article is to describe the advances in assistive robotics that are relevant to professionals serving persons with disabilities. This review breaks down relevant advances into categories of Assistive Robotic Systems, User Interfaces and Control Systems, Sensory and Feedback Systems, and User Perspectives. An understanding of the direction that assistive robotics is taking is important for the clinician and researcher alike; this review is intended to address this need. Copyright © 2010 by Lippincott Williams and Wilkins.

For many wheelchair users, performing transfers is essential for achieving independence with daily activities. However, transfers are particularly straining on the upper limbs and may contribute to the development of pain and overuse injuries at the shoulder. The purpose of this study was to determine the muscular demands of seven bilateral muscles acting at the shoulder and elbow during level and non-level transfers with and without a gap separating the wheelchair and target surface. Fourteen men with spinal cord injury transferred from their own wheelchair to a 1) level bench, 2) level bench with a 10 cm gap, 3) higher bench (+10 cm), 4) higher bench with a 10 cm gap, 5) lower bench (-10 cm), and 6) lower bench with a 10 cm gap in a random order. The maximum surface EMG reached during transfers was normalized to the subject's maximum EMG value reached during maximum static contractions for each muscle. Gaps required greater recruitment of the biceps and anterior deltoid muscles (p < 0.05). The increased muscle activation observed with gaps is likely due in part to increased combined shoulder flexion and abduction and glenohumeral joint strain on the anterior wall. As a result, individuals with SCI should be advised to position their wheelchair as close as possible to the surface they intend to transfer. © 2010 The authors and IOS Press. All rights reserved.

"Virtual Coach" refers to a coaching program or device aiming to guide users through tasks for the purpose of prompting positive behavior or assisting with learning new skills. This article reviews virtual coach interventions with the purpose of guiding rehabilitation professionals to comprehend more effectively the essential components of such interventions, the underlying technologies and their integration, and example applications. A design space of virtual coach interventions including self-monitoring, context awareness, interface modality, and coaching strategies were identified and discussed to address when, how, and what coaching messages to deliver in an automated and intelligent way. Example applications that address various health-related issues also are provided to illustrate how a virtual coach intervention is developed and evaluated. Finally, the article provides some insight into addressing key challenges and opportunities in designing and implementing virtual coach interventions. It is expected that more virtual coach interventions will be developed in the field of rehabilitation to support self-care and prevent secondary conditions in individuals with disabilities. © 2010 Elsevier Inc.

Objective: To examine the prevalence and severity of upper limb entrapment syndromes in a sample of veterans with lower limb amputations. Design: A descriptive survey, pilot study. Setting: 2008 National Disabled Veterans Winter Sports Clinic. Participants: Twenty participants with various lower limb amputations. Methods: All study participants completed a questionnaire that included symptoms of both upper limbs, medical history, time since amputation, medication history, use of assistive technology, and wheelchair characteristics. A physical examination and electrodiagnostic testing were then performed on each participant. The physical examination included an assessment of bilateral upper limb weakness or sensory abnormalities, thenar/hypothenar atrophy, deep tendon reflexes, Tinel test of the wrist and elbow, and the Phalen maneuver. All nerve conduction studies were performed by an American Board of Electrodiagnostic Medicine-certified physiatrist. Outcome Measures: Correlation between symptoms, examination findings, and electrodiagnostic findings with the participant's demographic data in the questionnaire. Results: Twenty participants (19 men and 1 woman) were enrolled in the study, with a total of 38 upper limbs evaluated. The mean age of the study population was 59 ± 13 years, with an average of 23 years since the amputation. Sixteen (80%) of 20 participants had electrodiagnostic findings consistent with median neuropathy across the wrist (26/38 affected limbs, 6 participants with unilateral and 10 with bilateral findings), and 14 (70%) of 20 participants had ulnar entrapment neuropathy across the elbow (22/38 affected limbs, 6 participants with unilateral and 8 with bilateral findings). Several participants (6 of 20, 30%) were found to have electrodiagnostic evidence of ulnar entrapment neuropathy across the wrist (10 of 38 affected limbs, 2 participants unilateral and 4 bilateral findings). Conclusion: A high number of veterans with lower limb amputations p

This article reviews mobility technology in less-resourced countries, with reference to people with disabilities in several locations, and describes technology provision to date. It also discusses a recent collaborative study between a United States University and an Indian spinal injuries hospital of Indian wheelchair users' community participation, satisfaction, and wheelchair skills. The data suggest that individuals who received technology from the hospital's assistive technology department experienced increased community participation and improved wheelchair skills. This evidence may have already enabled the hospital to improve Indian governmental policies toward people with disabilities, and it is hoped that future research will benefit other people similarly.

Technology plays a critical role in promoting well-being, activity, and participation for individuals with spinal cord injury (SCI). As technology has improved, so has the realm of possibilities open to people with SCI. School, work, travel, and leisure activities are all facilitated by technology. Advances in materials have made wheelchairs lighter, and developments in design have made wheelchairs that fit individual needs. Software has made computer interfaces adaptive and in some case intelligent, through learning the user's behavior and optimizing its structure. As participatory action design and aware systems take greater hold, transformational change is likely to take place in the technology available to people with SCI.

Today, injured service members are surviving wounds that would have been fatal in previous wars. A recent RAND report estimates that approximately 320,000 service members may have experienced a traumatic brain injury (TBI) during deployment, and it is not uncommon for a soldier to sustain multiple associated injuries such as limb loss, paralysis, sensory loss, and psychological damage. As a result, many military service members and their families face significant challenges returning to a high quality of independent life. The architectural concepts of universal design (UD) and evidence-based design (EBD) are gaining interest as an integral part of the rehabilitation process of veterans with TBI. This article examines the possibilities presented by UD and EBD in accordance with the Americans with Disabilities Act of 1990, in terms of high-end building and interior design quality, and possible technological options for individuals with disabilities. © 2010 Elsevier Inc. All rights reserved.

Recent advancements in control interface technology have made the use of end devices such as power wheelchairs easier for individuals with disabilities, especially persons with movement disorders. In this article, we discuss the current state of control interface technology and the devices available clinically for power wheelchair control. We also discuss our research on novel hardware and software approaches that are revolutionizing joystick interface technology and allowing more customizability for individual users with special needs and abilities. Finally, we discuss the future of control interfaces and what research gaps remain.

Rehabilitation goals following major combat-associated limb loss in World War II and the Vietnam war focused on treatment of the injury and a return to civilian life. The goal for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) servicemembers is to restore function to the greatest possible degree and, if they desire, return them to Active Duty, by providing them with extensive rehabilitation services and a variety of prosthetic devices. Our study determines the usefulness of these diverse types of prosthetic devices for restoring functional capability and documents prosthesis use and satisfaction. We compare servicemembers and veterans with major combat-associated unilateral lower-limb loss: 178 from the Vietnam war and 172 from OIF/OEF conflicts. Of survey participants with unilateral lower-limb loss, 84% of the Vietnam group and 94% of the OIF/OEF group currently use at least one prosthetic device. Reasons for rejection varied by type of device, but common reasons were pain, prosthesis too heavy, and poor fit. Abandonment is infrequent (11% Vietnam group, 4% OIF/OEF group). Future efforts should aim to improve prosthetic-device design, decrease pain, and improve quality of life for these veterans and servicemembers.

Returning wounded veterans and servicemembers to their highest level of function following traumatic injury is a priority of the Departments of Defense and Veterans Affairs. We surveyed 245 veterans from the Vietnam war and 226 servicemembers and veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) conflicts with at least one major traumatic lower-limb loss to determine their use of mobility assistive technology (AT) and patterns of limb abandonment. Prosthetic device use without wheelchair use is found in 50.5% of Vietnam and 42.8% of OIF/OEF groups. Prostheses and supplementary wheelchairs are used by Vietnam (32%) and OIF/OEF (53%) groups (p < 0.01). Exclusive wheelchair use is more frequent in the Vietnam group (18%) than in the OIF/OEF group (4.0%, p < 0.01). In Vietnam participants, multivariate analysis found that multiple-limb loss (adjusted odds ratio [AOR] = 14.5; 95% confidence interval [CI] 5.5-38.5), bilateral lower-limb loss (AOR = 12.7; 95% CI 6.2-26.1), and number of comorbidities (AOR = 1.3; 95% CI 1.2-1.5) are associated with increased likelihood of wheelchair use. In OIF/OEF participants, bilateral lower-limb loss (AOR = 29.8; 95% CI 11.0-80.7), multiple-limb loss (AOR = 16.3; 95% CI 3.1-85.3), cumulative trauma disorder (AOR = 2.4; 95% CI 1.2-4.9), and number of combat injuries (AOR = 1.4; 95% CI 1.2-1.7) are associated with wheelchair use. Combined use of different types of mobility ATs promotes improved rehabilitation and ability to function.

Previous studies found that select titanium ultralight rigid wheelchairs (TURWs) had fewer equivalent cycles and less value than select aluminum ultralight folding wheelchairs (AUFWs). The causes of premature failure of TURWs were not clear because the TURWs had different frame material and design than the AUFWs. We tested 12 aluminum ultralight rigid wheelchairs (AURWs) with similar frame designs and dimensions as the TURWs using the American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America and International Organization for Standardization wheelchair standards and hypothesized that the AURWs would be more durable than the TURWs. Across wheelchair models, no significant differences were found in the test results between the AURWs and TURWs, except in their overall length. Tire pressure, tube-wall thickness, and tube manufacturing were proposed to be the factors affecting wheelchair durability through comparison of the failure modes, frames, and components. The frame material did not directly affect the performance of AURWs and TURWs, but proper wheelchair manufacture and design based on mechanical properties are important.

Multiple sclerosis (MS) causes a wide variety of neurological deficits, with ambulatory impairment the most obvious cause of disability. Within 10 to 15 years of disease onset, 80% of persons with MS experience gait problems due to muscle weakness or spasticity, fatigue, and loss of balance. To facilitate mobility, persons with MS frequently use mobility assistive technology (MAT), such as canes, crutches, walkers, wheelchairs, and scooters. We systematically reviewed the published literature on MAT use among persons with MS. We used electronic reference lists such as Ovid MEDLINE and PubMed to search the literature. We located 50 articles that met the initial criteria of providing good evidence of the types of MAT devices and their benefits for individuals with MS. A limited number of articles with higher levels of evidence was found regarding benefits of MAT use specifically for persons with MS. Evidence-based literature provides the basis for the strongest method of measurable clinical performance; therefore, having a strong research study design is vital to the justification of MAT prescription and reimbursement decisions. However, a paucity of studies with higher levels of evidence-based practice exists.

Aim.Manual wheelchairs are commonly prescribed for older adults in nursing homes (NH). The extent of their utilisation being unknown may result in the prescription of standard wheelchairs. The purpose of this study was to quantify manual wheelchair use by nursing home residents. Methods.Seventy-two independent wheelchair users were recruited from four NH (two VA-affiliated and two private). A customised wheelchair data logger was attached to each participant's wheelchair for 1 month. Data were reduced and compared separately for VA- affiliated and private facilities by types of propulsion pattern (arms versus legs and the combination of arms and legs) using MANOVA. Results.Participants from the VA-affiliated facilities who used their arms were covering more distance (1451m versus 806m), with greater endurance (73m versus 60m) as compared to participants who used combination of arms and legs. However, no difference was observed between velocity of wheelchair propulsion between groups (0.48m/s versus 0.58m/s). For private facilities no notable difference was observed between the groups. Conclusion.Older adults who live in NH and use of wheelchairs represent a diverse cohort. The efficacy of using an objective assessment method to measure the extent of use of wheelchairs was demonstrated in this study. © 2010 Informa UK, Ltd.

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