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Archive for the Community category
Reliability and validity of the power-mobility community driving assessment
by Admin on August 17th, 2009
Reliability and validity of the power-mobility community driving assessment
The Power-Mobility Community Driving Assessment (PCDA) is a performance-based measure designed to assess driving performance of individuals using power wheelchairs or handicap scooters in community environments. This article reports the results of pilot testing and an evaluation of the assessment’s reliability and validity. Pilot testing was conducted with a random selection of Canadian occupational therapists working in the area of mobility. Although the response rate was very low, feedback confirmed the utility of the measure and contributed to one substantive scoring revision. Reliability and validity testing was conducted with a sample of 34 drivers. Internal consistency results were positive. Interrater reliability was fair to high but limited by the lack of variability in the scores. Construct validity hypotheses were tested on the relationships between PCDA scores and vision, perception, cognition, and environmental accessibility. Results indicated no relationships between the PCDA and perceptual and cognitive function and only a weak trend for a relationship with environmental accessibility. Concurrent validity was established: PCDA scores were positively associated with the judgments of therapists familiar with the driving performance of participants. In summary, the PCDA has moderate to good reliability, and content and concurrent validity results were found. More research is needed, particularly on the underlying constructs of successful driving performance. At this point, rehabilitation professionals and their clients are urged to use this assessment to establish driving performance rather than relying on assessments of perception, cognition, or environmental accessibility to predetermine whether someone will receive power mobility. Clinicians may find this a useful tool to identify where clients are able to drive safely in community settings, to identify specific learning needs, and, through those, to promote independent living for drivers of power-mobility devices.
Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury
by Admin on August 9th, 2009
Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury
OBJECTIVES: To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample. DESIGN: Convenience sample survey. SETTING: Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education. PARTICIPANTS: A total of 412 people with SCI who use wheelchairs over 40 hours a week. INTERVENTION: Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source. MAIN OUTCOME MEASURES: Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls). RESULTS: Ninety-seven percent of manual wheelchair users and 54% of power wheelchairs users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs and handicap scooters. CONCLUSIONS: The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs.
Real-time head movement system and embedded Linux implementation for the control of power wheelchairs
by Admin on August 1st, 2009
Real-time head movement system and embedded Linux implementation for the control of power wheelchairs
medicare power wheelchairs has become very important for our quality of life. A loss of mobility due to an injury is usually accompanied by a loss of self-confidence. For many individuals, independent mobility is an important aspect of self-esteem. Head movement is a natural form of pointing and can be used to directly replace the joystick whilst still allowing for similar control. Through the use of embedded LINUX and artificial intelligence, a hands-free head movement wheelchair controller has been designed and implemented successfully. This system provides for severely disabled users an effective power wheelchairs control method with improved posture, ease of use and attractiveness.
Power wheelchair range testing and energy consumption during fatigue testing
by Admin on July 23rd, 2009
Power wheelchair range testing and energy consumption during fatigue testing
The range of a power wheelchairs and medicare power wheelchairs depends on many factors including: battery type, battery state, wheelchair/rider weight, terrain, the efficiency of the drive train, and driving behavior. The purpose of this study was to evaluate the feasibility of three methods of estimating power wheelchair range. Another significant purpose was to compare the current draw on pavement to current draw on an International Standards Organization (ISO) Double Drum tester at one m/sec. Tests were performed on seven different power wheelchairs unloaded, and loaded with an ISO 100 kg test dummy. Each chair was configured according to the manufacturer’s specifications, and tires were properly inflated. Experienced test technicians were used for the tennis court tests, and treadmill tests. An ISO 100 kg test dummy was used for the ISO Double Drum test. Energy consumption was measured over a distance of 1500 m for each of the three test conditions. The rolling surface was level in all cases. Repeated measure analysis of variance (ANOVA) revealed a significant difference (p = 0.0001) between the predicted range at maximum speed for the three tests. Post hoc analysis demonstrated a significant difference (p < 0.01) in estimated range at maximum speed between the Double Drum test and the treadmill test, as well as between the Double Drum test and the tennis court test. Our results indicate no significant difference (p > 0.05) between the predicted range at maximal speed between the treadmill and tennis court tests. A simple relationship does not exist between the results of range testing with the Double Drum tester and the tennis court. An alternative would be to permit the use of a treadmill for range testing as simple relationships between all pertinent treadmill and tennis court range data were found. For the Double Drum tester used, the current demand is higher than under normal usage. This presents a problem as current is related to load torque in a power wheelchair. Hence, the Double Drum tester friction must be reduced. The predicted range for the tennis court test at maximum speed ranges from a low of 23.6 km to a high of 57.7 km. The range of the power wheelchair can be improved by the use of wet lead acid batteries in place of gel lead acid batteries.
The smart wheelchair component system
by Admin on July 12th, 2009
The smart wheelchair component system
While the needs of many individuals with disabilities can be satisfied with power wheelchairs and medicare power wheelchairs, some members of the disabled community find it difficult or impossible to operate a standard power wheelchair. To accommodate this population, several researchers have used technologies originally developed for mobile robots to create “smart wheelchairs” that reduce the physical, perceptual, and cognitive skills necessary to operate a power wheelchair. We are developing a Smart Wheelchair Component System (SWCS) that can be added to a variety of commercial power wheelchairs with minimal modification. This paper describes the design of a prototype of the SWCS, which has been evaluated on wheelchairs from four different manufacturers.
Consumer participation in identifying research and development priorities for power wheelchair input devices and controllers
by Admin on July 5th, 2009
Consumer participation in identifying research and development priorities for power wheelchair input devices and controllers
A focus group comprised of persons who use power wheelchairs, handicap scooters and professionals working in the field were asked to participate in a brainstorming session to determine priorities for the development and application of power mobility input devices and control concepts. The group consensus was that durability and reliability are the most important criteria. Essentially, the expectation is that a power wheelchair must work everyday in the way a person needs it and wants it. At the same time, there is a desire to enhance and advance the features of input devices and control systems. Many would say these changes constitute designing “smarter” power wheelchairs, such as systems that can independently detect obstacles and can provide users with more feedback. This paper presents the rationale behind forming this focus group and details of the results of a brainstorming session where ideas were generated and prioritized. The five most important issues as determined by the group are discussed in depth.
Characterization of power wheelchair use in the home and community
by Admin on June 28th, 2009
Characterization of power wheelchair use in the home and community
OBJECTIVE: To characterize the use of power wheelchairs and handicap scooters to determine if multiple measures of mobility and occupancy jointly provide a more comprehensive picture of wheelchair usage and daily activity in full-time power wheelchair users than daily distance alone. DESIGN: Prospective observational study. SETTING: Subjects’ everyday mobility was measured in their homes and communities for 2 weeks, and prompted recall interviews were conducted by phone. PARTICIPANTS: A convenience sample (N=25) of nonambulatory, full-time power wheelchair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wheelchair usage was logged electronically, and geolocation and interview data were used to isolate chair use to (1) in the home, (2) not in the home indoors, or (3) outdoors. Distance wheeled, time spent wheeling, number of bouts, time spent in the wheelchair, and the percentage of time in the wheelchair spent wheeling were measured to describe wheelchair use. RESULTS: The median wheelchair user spent 10.6 hours (range, 5.0-16.6h) in his/her wheelchair daily and wheeled 1.085 km (range, 0.238-10.585 km) over 58 minutes (range, 16-173 min) and 110 bouts (range, 36-282 bouts). Wheelchair use varied across subjects, within subjects from day to day, and between environments. Mobility bouts outdoors were longer and faster than those wheeled indoors. In a regression analysis, distance wheeled explained only 33% of the variation in the number of bouts and 75% in the time spent wheeling. CONCLUSIONS: Power wheelchair use varies widely both within and between users. Measuring distance, time, and number of bouts provides a clearer picture of mobility patterns than measuring distance alone, whereas occupancy helps to measure wheelchair function in daily activities.
Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration
by Admin on June 20th, 2009
Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration
During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 power wheelchairs and medical scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies.
Testing of gel-electrolyte batteries for wheelchairs
by Admin on June 13th, 2009
Testing of gel-electrolyte batteries for wheelchairs
A simple test rig was developed to measure the capacity of the lead-acid gel-electrolyte batteries used to power wheelchairs and medical scooters. Results of 166 tests revealed a wide scatter of battery life with different users and also showed that, in many cases, the two batteries used in a wheelchair became unequal in charge capacity after some time in use. It is recommended that pairs of batteries should be charged in series to overcome this problem.
Perceptions of power mobility use and safety within residential facilities
by Admin on June 7th, 2009
Perceptions of power mobility use and safety within residential facilities
BACKGROUND: power wheelchairs and medical scooters enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE: As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use. METHOD: In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS: A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS: Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.
Wheelchairs, walkers, and canes: what does Medicare pay for, and who benefits
by Admin on June 1st, 2009
Wheelchairs, walkers, and canes: what does Medicare pay for, and who benefits
Medicare’s role in the distribution of mobility-related assistive technology has not been well documented, yet rapid growth and regional variation in spending, and concerns over “in-the-home” coverage criteria, highlight the need for facts. Using the 2001 Medicare Current Beneficiary Survey, we find that 6.2 percent percent of beneficiaries obtained mobility assistive technology under the Medicare durable medical equipment (DME) benefit. These beneficiaries were disproportionately poor, disabled, and users of both acute and postacute services. Average per item spending ranged from $52 for canes to $6,208 for power wheelchairs and handicap scooters. Among beneficiaries who acquired such technology through the DME benefit, these devices comprised just 2 percent of overall Medicare spending.
Comparative evaluation of chargers for wheelchair gel cell batteries
by Admin on May 23rd, 2009
Comparative evaluation of chargers for wheelchair gel cell batteries
This study was undertaken as part of our ongoing work to upgrade wheelchair quality. Laboratory tests were conducted to determine which battery chargers would ensure that the user’s batteries are fully charged each night and also ensure that the battery lifetime was not diminished. Five commercial chargers were tested on a standardised pair of gel cell batteries of a type commonly used to power wheelchairs and medical scooters. Results of this study indicate a clear preference between chargers. As a result, we have changed the chargers we purchase. We anticipate that our clients will now experience longer life from their wheelchair gel cell batteries.
Integrated control and related technology of assistive devices
by Admin on May 16th, 2009
Integrated control and related technology of assistive devices
Assistive devices are now available that allow persons with severe physical disabilities to complete tasks independently. When the user has severe physical limitations, it may be advantageous to have an integrated control system where a single control interface (e.g., joystick, head switches, voice recognition system, keypad) is used to operate two or more assistive devices (e.g., power wheelchairs, augmentative communication devices, handicap scooters, computers, environmental control units, and other devices that are controlled electronically). The advantages of integrated control are that persons with limited motor control can access several devices with one access site without assistance, and the user does not need to learn a different operating mechanism for each device. The purpose of this review is to convey the depth and breadth of the research that has been conducted on integrated control systems, as well as to provide some insights into future directions. We reviewed research works pertaining to communication and environmental control, computer access, and wheelchair guidance systems. Information gathered in this study will help people become fully aware of the status of contemporary integrated control technology in order to increase the quality of life of people who use electronic assistive devices.
Medicare program; conditions for payment of power mobility devices, including power wheelchairs and power-operated vehicles. Final rule
by Admin on May 8th, 2009
Medicare program; conditions for payment of power mobility devices, including power wheelchairs and power-operated vehicles. Final rule
This final rule conforms our regulations to section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This rule defines the term power mobility devices (PMDs) as power wheelchairs and medical scooters power operated vehicles (POVs or scooters). It sets forth revised conditions for Medicare payment of PMDs and defines who may prescribe PMDs. This rule also requires a face-to-face examination of the beneficiary by the physician or treating practitioner, a written prescription, and receipt of pertinent parts of the medical record by the supplier within 45 days after the face-to-face examination that the durable medical equipment suppliers maintain in their records and make available to CMS or its agents upon request. Finally, this rule discusses CMS’ policy on documentation that may be requested by CMS or its agents to support a Medicare claim for payment, as well as the elimination of the Certificate of Medical Necessity (CMN) for PMDs.