Assistive Technologies Research: Mobility or Spinal Cord Injuries

Accessible microscopy workstation for students and scientists with mobility impairments.

Duerstock BS.  Department of Basic Medical Sciences, Center for Paralysis Research, Purdue University, West Lafayette, Indiana, USA.  Assist Technol. 2006 Spring;18(1):34-45.

An integrated accessible microscopy workstation was designed and developed to allow persons with mobility impairments to control all aspects of light microscopy with minimal human assistance. This system, named AccessScope, is capable of performing brightfield and fluorescence microscopy, image analysis, and tissue morphometry requisite for undergraduate science courses to graduate-level research. An accessible microscope is necessary for students and scientists with mobility impairments to be able to use a microscope independently to better understand microscopical imaging concepts and cell biology. This knowledge is not always apparent by simply viewing a catalog of histological images. The ability to operate a microscope independently eliminates the need to hire an assistant or rely on a classmate and permits one to take practical laboratory examinations by oneself. Independent microscope handling is also crucial for graduate students and scientists with disabilities to perform scientific research. By making a personal computer as the user interface for controlling AccessScope functions, different upper limb mobility impairments could be accommodated by using various computer input devices and assistive technology software. Participants with a range of upper limb mobility impairments evaluated the prototype microscopy workstation. They were able to control all microscopy functions including loading different slides without assistance.

Assessing the influence of wheelchair technology on perception of participation in spinal cord injury.

Chaves ES, Boninger ML, Cooper R, Fitzgerald SG, Gray DB, Cooper RA.

Department of Rehabilitation Science and Technology, University of Pittsburgh, PA, USA.  Arch Phys Med Rehabil. 2004 Nov;85(11):1854-8.

OBJECTIVE: To investigate factors related to the wheelchair, impairment, and environment that affect perception of participation of persons with spinal cord injury (SCI) in activities performed in 3 settings: in the home, in the community, and during transportation.

DESIGN: Cross-sectional study.

SETTING: Research centers and a specialized assistive technology (AT) clinic in Pittsburgh (Pitt). Research centers and community-based rehabilitation technology suppliers in Saint Louis (SL).

PARTICIPANTS: Seventy wheelchair users with SCI. INTERVENTIONS: Subjects from Pitt and SL completed a written survey of AT usage in daily activities.

MAIN OUTCOME MEASURES: Subjects were asked 5 questions within each setting (home, community, transportation) related to their perceived reason for functional limitations.

RESULTS: The wheelchair was the most commonly cited factor limiting participation, followed by physical impairment and physical environment. Twenty-one percent of subjects with paraplegia reported pain as a limiting factor for their transportation use, significantly more (P=.047) than subjects with tetraplegia (3%). A trend (P=.099) was seen toward a higher percentage of subjects with tetraplegia (tetraplegia, 7%; paraplegia, 3%) reporting lack of equipment as a limiting factor for use of transportation. Differences were also seen across sites.

CONCLUSIONS: The wheelchair was the most commonly cited limiting factor, followed by physical impairment and physical environment. The wheelchair is the most important mobility device used by persons with SCI and the one that users most associate with barriers.

Bioengineering and spinal cord injury: a perspective on the state of the science.

Cooper RA.  Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.  J Spinal Cord Med. 2004;27(4):351-64.

There is little doubt that as technologic advances become available, people with spinal cord injuries (SCIs) are living healthier, more productive, and longer lives. Federally and privately funded research, foreign competition, and globalization appear to be factors that will drive bioengineering advances within the assistive technology (AT) industry. The seeds of bioengineering research are likely to contribute to improvements in universal design and the mainstreaming of products. The aims of AT have changed tremendously in the past 50 years. Most of the federal agencies supporting assistive and rehabilitative technology research and development did not exist 50 years ago. Indeed, the leading AT companies all were established within the past 50 years. Bioengineering has the potential to be to the 21st century what electronic engineering was to the 20th century. Advances in power electronics, telecommunications, controls, sensors, and instrumentation have really only just begun to be applied for devices to assist people with SCI. Advancing technology for people with SCI represents a significant career and business opportunity for engineers who want to serve the public good in a meaningful and tangible way.

Computer and internet use by persons after traumatic spinal cord injury.

Goodman N, Jette AM, Houlihan B, Williams S.  Department of Public Health, Boston University, Boston, MA 02118, USA.  Arch Phys Med Rehabil. 2008 Aug;89(8):1492-8.

OBJECTIVE: To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI. DESIGN: A multicenter cohort study.

SETTING: Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems. PARTICIPANTS: Patients with traumatic SCI (N=2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury.

INTERVENTIONS: Not applicable.

RESULTS: Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P<.001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P<.001). Internet use increased with education level (P<.001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate’s degree did.

CONCLUSIONS: While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups.

Powered mobility for middle-aged and older adults: systematic review of outcomes and appraisal of published evidence.

Auger C, Demers L, Gélinas I, Jutai J, Fuhrer MJ, DeRuyter F.  School of Rehabilitation, Université de Montréal, Montréal, Canada.  Am J Phys Med Rehabil.2008  Aug;87(8):666-80.

OBJECTIVE: To identify the outcomes of power mobility devices for middle-aged and older adult users, and to critically appraise the research evidence.

DESIGN: Systematic review of primary source studies involving adults aged 50 and over using power mobility devices (1996-2007). Articles were (i) mapped to the Taxonomy of Assistive Technology Device Outcomes, which describes categories of impact of assistive devices from the vantages of effectiveness, social significance, and subjective well-being; and (ii) appraised using the Grading of Recommendations, Assessment, Development, and Evaluation criteria.

RESULTS: This review retained 19 studies and identified 52 different categories of impacts of power mobility devices spanning the three vantages of the taxonomy. The coverage of outcome dimensions was not as extensive for adults age 50 and over as it was for mixed-age groups. Most of the research designs were assigned very low evidence grades. Three studies were low to moderate in quality of evidence, among which one was a randomized trial.

CONCLUSIONS: A vast array of potential impacts of powered mobility devices have been described in the last decade. The level of quality of this evidence is improving, but most of these studies were not designed to verify causal relationships, and this is largely responsible for the absence of unequivocal evidence for directly attributing benefits to devices themselves and for quantifying relationships between power mobility device intervention and outcome. To raise the level of evidence about power mobility device interventions in older adults, studies are needed that use prospective designs, better-defined user groups, and well-grounded conceptual frameworks for measuring interventions and outcomes.

Powered tilt/recline systems: why and how are they used?

Lacoste M, Weiss-Lambrou R, Allard M, Dansereau J.  Natural Sciences and Engineering Research Council of Canada (NSERC), Industrial Research Chair on Wheelchair Seating Aids, Ecole Polytechnique de Montréal, Montréal Quebec, Canada.  Assist Technol. 2003 Summer;15(1):58-68.

Prolonged static sitting can lead to discomfort, pain, pressure sores, spinal curvatures, and loss of functional independence. In order to counteract these harmful effects, adjustable tilt and/or recline systems are often prescribed. Considering the current context of assistive technology service delivery and budget cuts, it is essential to have a better knowledge of the use of these technical aids and user’s satisfaction with them. The purpose of this study was to characterize the use of powered tilt and recline systems. A questionnaire was developed for this purpose, and 40 subjects were interviewed at home. They were asked to identify, from a list of 25 objectives, the reasons for which they used their repositioning system and to rank these reasons in order of importance. For each objective, they were also asked to identify the frequency and range of use as well as their satisfaction level with their system. Results revealed that 97.5% of the subjects were using their powered tilt and recline system everyday, and their satisfaction was high. The main objectives for using this type of assistive technology were to increase comfort and to promote rest. Although mainly descriptive, results are of clinical relevance and can be helpful when selecting wheelchairs.


Technological advances in powered wheelchairs.

Edlich RF, Nelson KP, Foley ML, Buschbacher RM, Long WB, Ma EK.  University of Virginia Health System, Charlottesville, Virginia, USA.  J Long Term Eff Med Implants. 2004;14(2):107-30.

During the last 40 years, there have been revolutionary advances in power wheelchairs. These unique wheelchair systems, designed for the physically immobile patient, have become extremely diversified, allowing the user to achieve different positions, including tilt, recline, and, more recently, passive standing. Because of this wide diversity of powered wheelchair products, there is a growing realization of the need for certification of wheeled mobility suppliers. Legislation in Tennessee (Consumer Protection Act for Wheeled Mobility) passed in 2003 will ensure that wheeled mobility suppliers must have Assistive Technology Supplier certification and maintain their continuing education credits when fitting individuals in wheelchairs for long-term use. Fifteen other legislative efforts are currently underway in general assemblies throughout the US. Manufacturers, dealers, hospitals, and legislators are working toward the ultimate goal of passing federal legislation delineating the certification process of wheeled mobility suppliers. The most recent advance in the design of powered wheelchairs is the development of passive standing positions. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced orthostatic circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and enhanced functional status in general. In February 2003, Permobil, Inc., introduced the powered Permobil Chairman 2K Stander wheelchair, which can tilt, recline, and stand. Other companies are now manufacturing powered wheelchairs that can achieve a passive standing position. These wheelchairs include the Chief SR Powerchair, VERTRAN, and LifeStand Compact. Another new addition to the wheelchair industry is the iBOT, which can elevate the user to reach cupboards and climb stairs but has no passive standing capabilities. In addition, the physically immobile patient must be seated on an ERGODYNAMIC Seating System 2000, which is inflated by the alternating pressure compressor 8080. This seating system has a deep center seam between the two ischial-support chambers, which provides a recess for the coccyx. The pre-ischial crossbar compartment inflates during each cycle to prevent the pelvis from slipping forward. It is essential that the physician of the immobile patient order two ERGODYNAMIC Seating Systems 2000 because the patient must have an additional seating system in the case one leaks. Moreover, two compressors are necessary because each compressor must be serviced after 2500 hours of use. For the protection of the consumer, these pressure relief systems must be supplied and serviced by a Certified Rehabilitation Technology Supplier such as Wheelchair Works Inc. Despite the indisputable scientific evidence of the medical benefits of passive standing for the immobile user, few individuals have access to these revolutionary wheelchairs. Consequently, it is mandatory that the medical community, headed by specialists in physical and occupational therapy as well as rehabilitation medicine, CRTS, and manufacturers collaborate in a national education campaign to convince Medicare/Medicaid and all commercial insurance companies to approve immediately these assisted technologies. This program is essential so that the physically immobilized patient can achieve the undisputed physical benefits of passive standing.

Tracking mobility-related assistive technology in an outcomes study.

Demers L, Fuhrer MJ, Jutai JW, Scherer MJ, Pervieux I, DeRuyter F.  School of Rehabilitation, University of Montreal, Box 6128, succursale Centre-Ville, Montreal, Quebec, Canada.  Assist Technol. 2008 Summer;20(2):73-83.

The objective of this follow-up study was to describe changes in the mobility-related assistive technology devices (ATDs) that are used from shortly after discharge from a hospital setting until 5-6 months later. One hundred and thirty-nine participants who had one or more mobility ATDs (canes, crutches, walkers, and wheelchairs) that had been recommended during hospitalization were interviewed an average of 5.5 weeks after discharge and an average of 23.2 weeks later. Information about mobility ATD usage was obtained by questionnaire during face-to-face interviews. The SF-36 was used to assess perceived health status, both physical and mental, as an additional outcome. Results show that at follow-up, only 23.3% of participants were using the ATD provided at baseline as their primary aid. Seven distinct groups of participants were noted based on individual experience with ATD use from the time of discharge to follow-up. Those groups varied according to continued versus discontinued use of an ATD, single versus multiple ATD use across time, and primary versus secondary importance attributed to the ATD. The groups also differed in terms of their differential association with rehabilitation diagnosis, age, as well as physical and mental perceived health status. The findings have implications for designing ATD outcome studies and for interpreting the relationship of ATD outcomes to other variables. The information about changes in mobility-related ATDs can also help rehabilitation specialists at the point of device referral target their patients for interventions that will either increase their adherence to device prescriptions or support nondevice strategies for managing disabilities.


Trends and issues in wheelchair technologies.

Cooper RA, Cooper R, Boninger ML.  Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.  Assist Technol. 2008 Summer;20(2):61-72.

There is an overwhelming need for wheelchairs and the research and development required to make them safer, more effective, and widely available. The following areas are of particular importance: practitioner credentials, accreditation, device evaluation, device user training, patient education, clinical prescribing criteria, national contracts, and access to new technology. There are over 170 U.S. wheelchair manufacturers with a total reported income of $1.33 billion. However, of these companies, only five had sales in excess of $100 million. Wheelchairs account for about 1% of Medicare spending. Use of assistive technology is an increasingly common way of adapting to a disability. The emergence of advanced mobility devices shows promise for the contribution of engineering to the amelioration of mobility impairments for millions of people who have disabilities or who are elderly. Some of the trends in wheelchairs are going to require new service delivery mechanisms, changes to public policy, and certainly greater coordination between consumers, policy makers, manufacturers, researchers, and service providers.

Virtual reality and computer-enhanced training applied to wheeled mobility: an overview of work in Pittsburgh.

Cooper RA, Ding D, Simpson R, Fitzgerald SG, Spaeth DM, Guo S, Koontz AM, Cooper R, Kim J, Boninger ML.

Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.  Assist Technol. 2005 Fall;17(2):159-70.

Some aspects of assistive technology can be enhanced by the application of virtual reality. Although virtual simulation offers a range of new possibilities, learning to navigate in a virtual environment is not equivalent to learning to navigate in the real world. Therefore, virtual reality simulation is advocated as a useful preparation for assessment and training within the physical environment. We are engaged in several efforts to develop virtual environments and devices for mobility skills assessment and training, exercise training, and environment assessment. Virtual reality offers wheelchair users a training tool in different risk-free environments without any indoor (e.g., walls, furniture, and stairs) and outdoor (e.g., curb cuts, uneven terrain, and street traffic) physical constraints. Virtual reality technology will probably become more common in the field of assistive technology, especially given the rapid expansion of gaming technology and the continued exponential growth of computing power.

The wheelchair procurement process: perspectives of clients and prescribers.

Mortenson WB, Miller WC.  Vancouver Coastal Health, Vancouver, BC, Canada.  Can J Occup Ther. 2008 Jun;75(3):167-75.

BACKGROUND: Increasing choices in assistive technology have made the process of procuring a wheelchair more complex and challenging.

PURPOSE: To explore the intricacies of the procurement process from the perspectives of clients and therapists.

METHODS: Thirty-four participants were interviewed, including 13 wheelchair prescribers, 14 wheelchair users, and 7 wheelchair associates (family members and caregivers).

FINDINGS: Analysis revealed five main themes. “Who decides?” described varying degrees of client involvement in the procurement process. “Expert knowledge” reflected the expert knowledge that all parties possessed. “Form versus function” captured the primary and, at times, conflicting outcomes that participants wanted to achieve. “Fitting in” depicted the environmental factors that affected wheelchair procurement. “(Re)solutions” illustrated strategies that participants felt improved the process. IMPLICATIONS: This study reveals clients’ experiences with wheelchair procurement, identifies potential issues therapists may encounter, and suggests possible remedies they might consider when prescribing wheelchairs within a client-centred framework.