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Manual wheelchair users (MWUs) are at high risk of developing pressure injuries (PIs) from prolonged static sitting. Clinical practice guidelines suggest periodic pressure redistribution (PR) to mitigate this risk. Prior work has demonstrated that a wheelchair seat pan instrumented with force sensors can track the change in center of pressure (CoP) as MWUs perform PR and use this measurement to infer the direction and degree of a PR. This study’s objective was to quantify the relationship between change in CoP and reduction in seat interface pressure (SIP) under the ischial tuberosities for commonly practiced PR maneuvers. A theoretical model relating SIP and change in CoP for forward leaning PR was developed. Participants performed forward, leftward, and rightward leaning PRs while seated on a pressure mat on the test wheelchair with a load cell-instrumented seat pan. Linear mixed-effects models showed that the relationship of SIP and CoP varies by participant. Across participants, the change in SIP for a given change in CoP was greater with sideways than with forward leans. The type of cushion used did not affect the relationship. These findings can be used as part of her real-time smartphone-based coaching system for PI prevention.

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users’ perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

Background: Caregivers experience high rates of occupational injuries, especially during wheelchair transfers, which often result in back pain and musculoskeletal disorders due to the physical demands of lifting and repositioning. While mechanical floor lifts, the current standard, reduce back strain, they are time-consuming and require handling techniques that subject caregivers to prolonged and repeated non-neutral trunk postures, increasing the risk of long-term back injuries. Aims: The aim was to assess the time efficiency and ergonomics of the powered personal transfer system (PPTS), a robotic transfer device designed for bed-to/from-wheelchair transfers. Methods: We evaluated transfers with the PPTS and mechanical lift with eight able-bodied participants who assisted with transfers between a bed and a wheelchair. Inertial measurement units (IMUs) were placed on participants to track their motion and assess trunk joint angles during transfers. Results: The PPTS significantly reduced the transfer time (144.31 s vs. 525.82 s, p < 0.001) and required significantly less range of motion for trunk flexion (p < 0.001), lateral bending (p = 0.008), and axial rotation (p = 0.001), all of which have been associated with back injuries. Additionally, the PPTS significantly reduced the time caregivers spent in non-neutral trunk postures, potentially lowering injury risks. Conclusions: These findings suggest that the PPTS improves transfer efficiency and caregiver safety, offering a promising alternative to the current standard of care for wheelchair-to/from-bed transfers.

Common electric powered wheelchairs cannot safely negotiate architectural barriers (i.e., curbs) which could injure the user and damage the wheelchair. Robotic wheelchairs have been developed to address this issue; however, proper alignment performed by the user is needed prior to negotiating curbs. Users with physical and/or sensory impairments may find it challenging to negotiate such barriers. Hence, a Curb Recognition and Negotiation (CRN) system was developed to increase user’s speed and safety when negotiating a curb. This article describes the CRN system which combines an existing curb negotiation application of a mobility enhancement robot (MEBot) and a plane extraction algorithm called Polylidar3D to recognize curb characteristics and automatically approach and negotiate curbs. The accuracy and reliability of the CRN system were evaluated to detect an engineered curb with known height and 15 starting positions in controlled conditions. The CRN system successfully recognized curbs at 14 out of 15 starting positions and correctly determined the height and distance for the MEBot to travel towards the curb. While the MEBot curb alignment was 1.5 ± 4.4°, the curb ascending was executed safely. The findings provide support for the implementation of a robotic wheelchair to increase speed and reduce human error when negotiating curbs and improve accessibility.

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.

Wheelchair users are exposed to whole-body vibration (WBV) when driving on sidewalks and in urban environments; however, there is limited literature on WBV exposure to power wheelchair users when driving during daily activities. Further, surface transitions (i.e., curb-ramps) provide wheelchair accessibility from street intersections to sidewalks; but these require a threshold for water drainage. This threshold may induce high WBV (i.e., root-mean-square and vibration-daily-value accelerations) when accessibility guidelines are not met. This study analyzed the WBV effects on power wheelchairs with passive suspension when driving over surfaces with different thresholds. Additionally, this study introduced a novel power wheelchair with active suspension to reduce WBV levels on surface transitions. Three trials were performed with a commercial power wheelchair with passive suspension, a novel power wheelchair with active suspension, and the novel power wheelchair without active suspension driving on surfaces with five different thresholds. Results show no WBV difference among EPWs across all surfaces. However, the vibration-dose-value increased with higher surface thresholds when using the passive suspension while the active suspension remained constant. Overall, the power wheelchair with active suspension offered similar WBV effects as the passive suspension. While significant vibration-dose-value differences were observed between surface thresholds, all EPWs maintained WBV values below the ISO 2631-1 health caution zone.

The design of the mobility enhancement robotic wheelchair (MEBot) was based on input from electric powered wheelchair (EPW) users regarding the conditions they encounter when driving in both indoor and outdoor environments that may affect their safety and result in them becoming immobilized, tipping over, or falling out of their wheelchair. Phase I involved conducting a participatory design study to understand the conditions and barriers EPW users found to be difficult to drive in/over. Phase II consisted of creating a computer-aided design (CAD) prototype EPW to provide indoor and outdoor mobility that addressed these conditions with advanced applications. Phase III involved demonstrating the advanced applications and gathering feedback from end users about the likelihood they would use the advanced applications. The CAD prototype incorporated advanced applications, including self-leveling, curb climbing, and traction control, that addressed the challenging conditions and barriers discussed with EPW users (n = 31) during the participatory design study. Feedback of the CAD design and applications in phase III from end users (n = 12) showed a majority would use self-leveling (83%), traction control (83%), and curb climbing (75%). The overall design of MEBot received positive feedback from EPW users. However, these opinions will need to be reevaluated through user trials as the design advances.

The QLX is a low-profile automatic powered wheelchair docking system (WDS) prototype developed to improve the securement and discomfort of wheelchair users when riding in vehicles. The study evaluates the whole-body vibration effects between the proposed QLX and another WDS (4-point tiedown system) following ISO 2631-1 standards and a systematic usability evaluation. Whole-body vibration analysis was evaluated in wheelchairs using both WDS to dock in a vehicle while riding on real-world surfaces. Also, participants rated the usability of each WDS while driving a wheelchair and while riding in a vehicle in driving tasks. Both WDSs showed similar vibration results within the vibration health-risk margins; but shock values below health-risk margins. Fifteen powered wheelchair users reported low task load demand to operate both WDS; but better performance to dock in vehicles with the QLX (p = 0.03). Also, the QLX showed better usability (p < 0.01), less discomfort (p’s < 0.05), and greater security compared to the 4-point tiedown while riding in a vehicle (p’s < 0.05). Study findings indicate that both WDS maintain low shock exposure for wheelchair users while riding vehicles, but a better performance overall to operate the QLX compared to the 4-point tiedown system; hence enhancing user’s autonomy to dock in vehicles independently.

Despite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements.

Purpose. The aim of this study is to describe the robotic assisted transfer device (RATD) and an initial focus group evaluation by end users. The purpose of the device is to aid in the transfers of people with disabilities to and from their electric powered wheelchair (EPW) onto other surfaces. The device can be used for both stand-pivot transfers and fully dependent transfers, where the person being transferred is in a sling and weight is fully on the robot. The RATD is fixed to an EPW to allow for its use in community settings. Method. A functional prototype of the RATD was designed and fabricated. The prototype was presented to a group of 16 end users and feedback on the device was obtained via a survey and group discussion. Results. Thirteen out of sixteen (83%) participants agreed that it was important to develop this type of technology. They also indicated that user, caregiver, and robotic controls were important features to be included in the device. Conclusions. Participants in this study suggested that they would be accepting the use of robotic technology for transfers and a majority did not feel that they would be embarrassed to use this technology.