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Automated fall detection devices for individuals who use wheelchairs to minimize the consequences of falls are lacking. This study aimed to develop and train a fall detection algorithm to differentiate falls from wheelchair mobility activities using machine learning techniques. Thirty, healthy, ambulatory, young adults simulated falls from a wheelchair and performed other wheelchair-related mobility activities in a laboratory. Neural Network classifiers were used to train the algorithm developed based on data retrieved from accelerometers mounted at the participant's wrist, chest, and head. Results indicate excellent accuracy to differentiate between falls and wheelchair mobility activities. The sensors mounted at the wrist, chest, and head presented with an accuracy of 100%, 96.9%, and 94.8%, respectively, using data from 258 falls and 220 wheelchair mobility activities. This pilot study indicates that a fall detection algorithm developed in a laboratory setting based on fall accelerometer patterns can accurately differentiate wheelchair-related falls and wheelchair mobility activities. This algorithm should be integrated into a wrist-worn devices and tested among individuals who use a wheelchair in the community. [ABSTRACT FROM AUTHOR]

A reliable fall detection device is crucial to minimize long-term consequences of falls among wheelchair users. This study examines the sensitivity of Apple Watch to detect intentional falls from a wheelchair. Twenty-five able bodied (age: 21.9 ± 2.5 years) participated in a protocol in which they intentionally fell out of a wheelchair in a laboratory setting. Each participant wore an Apple Watch Series 5 and performed 3 falls in the forward, right and left sideways, and backward directions onto a crash pad totaling 12 falls each. The Apple Watch was manually checked after each fall to determine if the device registered a fall. From 300 fall trials captured, the Apple Watch detected 14 falls showing a sensitivity of 4.7%, a false negative rate of 95.3%. Logistic regression showed that participant's height, impact force, lower limb functioning, and fall direction are parameters that may influence the ability of the Apple Watch to detect falls from a wheelchair. The Apple Watch fall detection feature presented with a very poor sensitivity to detect intentional falls from a wheelchair among able bodied young adults. Due to the high incidence and consequences of falls, a reliable fall detection device specific for wheelchair users is warranted. [ABSTRACT FROM AUTHOR]

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

Purpose: Individuals with traumatic brain injury (TBI) often experience difficulties in performing kitchen-related sequencing tasks due to cognitive deficits. The primary aim of this study is to examine the feasibility of a context-aware automatic prompting system in assisting individuals with TBI in multi-step cooking tasks. Method: Sixteen individuals with TBI participated in the study. A randomized cross-over design was used to compare the automatic prompting method with a conventional user-controlled method through a tablet device. Participant performance under each prompting method was assessed using the Performance Assessment of Self-Care Skills in terms of independence, safety, and adequacy. Subjective workload and qualitative feedback were also collected. Results: The automatic method, when compared with the user-controlled method, significantly decreased the amount of external assistance required by participants, received higher ratings in user perceived ease-of-use, and was considered less stressful for participants. However, the user-controlled method showed strengths in offering participants more flexibility in terms of controlling on the timing of prompts. Conclusions: The results provided insight into the potential benefits and user perceptions of a context-aware prompting system. The information could contribute to the future development of advanced prompting technology for people with cognitive impairments in completing sequential tasks. For people with traumatic brain injury, the context-aware prompting method showed advantages in improving user performance, receiving better ratings on ease-of-use, and decreasing stress levels, compared to the user-controlled prompting method in completing multi-step cooking tasks. Future prompting systems for people with cognitive impairments may allow users to control the pace of prompting and use sensing information as back-up assistance in critical situations. In this way, the system may help users monitor their actions and offer confirmations, especially at steps with safety concerns, thus enhancing the sense of security and reducing the stress from self-monitoring. [ABSTRACT FROM AUTHOR]

Objective To compare 2 correction algorithms and 2 joysticks (a conventional movement-sensing joystick and a custom-designed isometric joystick) in computer access tasks. Design Repeated-measures, within-subject. Setting National Veterans Wheelchair Games. Participants Fifteen participants with various diagnoses including multiple sclerosis, spinal cord injury, traumatic brain injury, Wilson disease, and Parkinson disease. Methods A computer access test scenario was used to evaluate the effects of applying proportional integral derivative (PID)–based and least means–based algorithms to suppress unintentional cursor motions by users with upper extremity spasticity. Main Outcome Measures Trial completion time, reaction time, and trajectory-based measures: movement offset, movement variability, and percentage of out-of-path motion on test tracks. Results The quantitative outcome measures showed a high correlation with clinical measures for spasticity and functional independence. On small test tracks, compared to when no correction algorithms were used, both algorithms performed equally well in suppressing unintentional cursor motions. On longer test tracks, participants navigated most accurately while using the PID algorithm. Participants moved the cursor more accurately using the isometric joystick compared to the movement-sensing joystick, with only a slight increase in the task completion times. Conclusions The joysticks and the advanced correction algorithms show promise for use in wide-ranging applications as control interfaces. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

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

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo evaluate the psychometric properties of a Fall Concerns Scale for people who use Wheelchairs and Scooters (FCS-WC/S).Developed by fall prevention experts, FCS-WC/S underwent refinement through interdisciplinary reviews and focus groups with researchers, clinicians, and individuals who use WC/S full-time. The psychometric evaluation involved adults who used WC/S for ≥1 year and had ≥1 fall in the previous 3 years, recruited between April and September 2022.The FCS-WC/S evaluates fall concerns among people with various health conditions who use WC/S full-time across 33 daily activities. One hundred and twenty-four participants responded to the baseline survey. A subgroup of 63 people repeated the FCS-WC/S a week later. The FCS-WC/S demonstrated excellent internal and good test–retest reliability (α ≥ 0.90, ICC = 0.86–0.9), as well as concurrent validity (Spearman’s rho = 0.72) with the Spinal Cord Injury Falls Concern Scale (SCI-FCS). It effectively differentiated fear of falling levels from an established measure (ORs 4.1, 25.8, 46.7). Factor and parallel analysis revealed three factors, two of which were retained for further analysis.Preliminary findings support FCS-WC/S validity and reliability for assessing fall concerns among individuals with various conditions who use WC/S. Further scale construction analysis is recommended.Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions.Measuring concerns about falling among full-time wheelchair and scooter users is crucial due to its potential negative impact on activity curtailment, which in turn may affect community participation and quality of life.Most validated tools, except for the Spinal Cord Injury-Falls Concern Scale, designed for manual wheelchair users with spinal cord injury, are primarily tailored for individuals who ambulate, highlighting the need for assessment tools specifically designed for full-time wheelchair and scooter users.Using the Spinal Cord Injury-Falls Concern Scale as a foundation, the Fall Concerns Scale for people who use Wheelchairs and Scooters was developed to measure fall concerns among full-time wheelchair and scooter users, irrespective of their specific health conditions.The Fall Concerns Scale for people who use Wheelchairs and Scooters has a good potential to offer clinicians a valid and reliable tool to systematically screen fall concerns across various health conditions, with further large-scale studies needed to validate the tool across a wider range of health conditions. [ABSTRACT FROM AUTHOR]

A survey was designed and administered in this study to assess the use of assistive technology for cognition (ATC), especially portable electronic ATC, among veterans with traumatic brain injury (TBI). The aim of the survey was to obtain information on current ATC devices and applications use, users' experience with different features of ATC, and relevant training/support for their ATC. Twenty-nine veterans with TBI participated in this study. Results showed that portable electronic ATC, especially smartphones and a variety of apps, were widely used by the participants to compensate for cognitive limitations. Portable electronic devices such as smartphones and smart pads received higher usability ratings than paper-based tools. More than 75% of participants did not go through a service delivery process for these electronic ATC. The information collected in the study provided a more updated picture of ATC use, especially portable electronic ATC use, among people with TBI. It also potentially informs the future development of ATC and supports the need for training and an appropriate acquisition process of portable electronic ATC devices. [ABSTRACT FROM AUTHOR]

In-home falls and fear of falling (FOF) are significant concerns among older adults and people with disabilities (PwD), impacting independence in daily lives. The indoor home environment (IHE) plays an important role in influencing FOF, as it is influenced by barriers and facilitators within the home. This systematic review provides an evidence-based list of IHE factors and investigates their association with FOF, especially in older adults, PwD, and wheelchair users. Examining 24 studies, we found associations between IHE factors and FOF, suggesting the importance of home modifications to live in a supportive environment to reduce FOF. Most studies were experimental and intervened for either single or multiple IHE factors, indicating reasonably strong evidence. Our findings highlight the importance of considering psychological factors when evaluating home environments to reduce FOF. The list of barriers and facilitators we provide can help healthcare professionals conduct evidence-based home assessments., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.