How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Development and Evaluation of Pneumatic Powered Mobility Devices

The performance of battery-powered mobility devices (PMDs) has continually improved since their invention in the 1950s due to advances in electronics and their control systems. Yet they continue to experience increases in repairs and utilize battery technologies that require long recharge times and frequent, expensive replacement. Although advances in battery technologies are ongoing, the technology is expensive and raises safety concerns. The need for the development of alternative power sources has been voiced by consumers as well as providers of PMDs. Alternative forms of power need to be researched to further improve the performance of powered mobility devices. The purpose of this project was to develop a novel power system for powered mobility devices driven by compressed air and evaluate its performance in a real-world setting. This was accomplished by following the product development process with the addition of participatory action design to maximize the potential for meeting end user’s needs. Through the development of several iterations of mobility scooter prototypes, a pneumatic-powered system was created and optimized for efficiency. The results of the mobility scooter developments were later incorporated into the design of a powered wheelchair configuration. The two types of mobility devices were tested using ISO Wheelchair Standards to evaluate their safety, durability and maneuverability of which both devices performed comparatively to their battery-powered equivalents. Additionally, a pneumatic-powered shopping cart configuration was created to test its usage in a grocery store setting. K-Means clustering analysis was performed to evaluate whether certain demographics of individuals preferred to use the pneumatic-powered cart versus the battery-powered cart of which the results revealed individuals younger than 54 years old and those who do not own a mobility device preferred to use the pneumatic-powered shopping cart over the battery-powered shopping cart. Overall, the feasibility for pneumatic-powered mobility devices to serve as an alternative to battery-powered mobility devices is plausible. Although, further improvements as well as additional pilot tests are needed prior to commercialization

THE IMPACT OF A PUSHRIM ACTIVATED POWER ASSIST WHEELCHAIR AMONG INDIVIDUALS WITH TETRAPLEGIA

The goal of this project was to test the influence of a pushrim activated power-assisted wheelchair (PAPAW) on the functional capabilities of individuals with cervical level spinal cord injuries (tetraplegia). This repeated measures design type study was divided into two phases, which included testing in two different laboratory settings: a biomechanics laboratory and an activities of daily living laboratory. Fifteen participants included in both phases were fulltime manual wheelchair users (MWUs) with tetraplegia. The purpose of the first phase of the study was to determine the differences in metabolic demands, stroke frequency, and upper extremity joint range of motion, during PAPAW propulsion and traditional manual wheelchair propulsion. Participants propelled both their own manual wheelchairs and a PAPAW through three different resistances (slight, moderate and high), on a computer controlled wheelchair dynamometer. Variables analyzed during this phase included: mean steady state oxygen consumption, ventilation, heart rate, mean stroke frequency, maximum upper extremity joint range of motion, and propulsion speed. Results from the first phase of the study revealed a significant improvement in kinematic, speed, and metabolic variables when participants were propelling with a PAPAW. In Phase II, participants propelled both their own manual wheelchairs and a PAPAW three times over an activities of daily living course. The course was constructed to reflect certain obstacles that a manual wheelchair user might encounter in his or her daily routine. PAPAWs received higher user ratings than the participant's own manual wheelchair for 10 out of 18 obstacles. Additionally, when using a PAPAW, participants were able to complete the course in the same amount of time while maintaining a lower mean heart rate. For individuals with tetraplegia, PAPAWs have the potential to decrease metabolic demands during propulsion, while increasing or maintaining function within ADLs. Use of this device could help MWUs maintain overall physical capacity while reducing the risk for pain and injuries to the upper extremities, which are often seen among manual wheelchair users with tetraplegia. Future studies with this device should focus on the ability of MWUs with tetraplegia to perform necessary activities of daily living within their home environment and community

DEVELOPMENT AND EVALUATION OF AN ADVANCED REAL-TIME ELECTRICAL POWERED WHEELCHAIR CONTROLLER

Advances in Electric Powered Wheelchairs (EPW) have improved mobility for people with disabilities as well as older adults, and have enhanced their integration into society. Some of the issues still present in EPW lie in the difficulties when encountering different types of terrain, and access to higher or low surfaces. To this end, an advanced real-time electrical powered wheelchair controller was developed. The controller was comprised of a hardware platform with sensors measuring the speed of the driving, caster wheels and the acceleration, with a single board computer for implementing the control algorithms in real-time, a multi-layer software architecture, and modular design. A model based real-time speed and traction controller was developed and validated by simulation. The controller was then evaluated via driving over four different surfaces at three specified speeds. Experimental results showed that model based control performed best on all surfaces across the speeds compared to PID (proportional-integral-derivative) and Open Loop control. A real-time slip detection and traction control algorithm was further developed and evaluated by driving the EPW over five different surfaces at three speeds. Results showed that the performance of anti-slip control was consistent on the varying surfaces at different speeds. The controller was also tested on a front wheel drive EPW to evaluate a forwarding tipping detection and prevention algorithm. Experimental results showed that the tipping could be accurately detected as it was happening and the performance of the tipping prevention strategy was consistent on the slope across different speeds. A terrain-dependent EPW user assistance system was developed based on the controller. Driving rules for wet tile, gravel, slopes and grass were developed and validated by 10 people without physical disabilities. The controller was also adapted to the Personal Mobility and Manipulation Appliance (PerMMA) Generation II, which is an advanced power wheelchair with a flexible mobile base, allowing it to adjust the positions of each of the four casters and two driving wheels. Simulations of the PerMMA Gen II system showed that the mobile base controller was able to climb up to 8” curb and maintain passenger’s posture in a comfort position

Electric Wheelchair Navigation Simulators: why, when, how?

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U.S. Micromobility Law (Major Road Work Ahead)

Over the past decade electrically powered bicycles, stand-up scooters, skateboards, and more have burst onto the nation’s streets and sidewalks. While some have been owned by their riders, a combination of embedded technology and smartphone apps allowed well-funded start-ups to distribute these novel e-vehicles across urban public spaces, making them available for on-demand, short-term rental. This blossoming of “micromobility” has taken place within physical and legal infrastructures ill-prepared for the change. Indisputably, most of the new types of individual motorized mobility fell outside established vehicle categories. The literal terms of existing law banned their use on all public rights of way, whether road, bicycle lane, or sidewalk. This paper surveys the ad hoc, largely industry-driven, and still-distressingly-incomplete adjustment of U.S. vehicle and traffic laws to accommodate and regulate the rapid spread of electrically-powered personal mobility devices. It also reviews some of the costs of ignoring the phenomenon

Development and Validation of the Wheelchair Seating Discomfort Assessment Tool (WcS-DAT).

Wheelchair seating discomfort is an important but poorly understood negative outcome for long duration wheelchair users. A major impediment to the study of this problem is the lack of a validated tool for quantification of wheelchair seating discomfort. The goal of this dissertation research was to develop and validate an assessment tool appropriate for the quantification of wheelchair seating discomfort among long duration (more than 8 hours per day) wheelchair users. This was accomplished through the completion of three research phases, each described within the body of this dissertation. Phase I consisted of a qualitative research study involving in-depth interviews with experienced wheelchair users. Data from these interviews resulted in the development of the Wheelchair Seating Discomfort Assessment Tool (WcS-DAT), a three-part tool to allow wheelchair users to quantify their level of seating discomfort. Phase II of the research assessed the reliability and concurrent validity of this assessment tool through a test/re-test reliability study. Intra class correlation (ICC) coefficient scores ranged from 0.83 to 0.97, indicating adequate reliability of the two discomfort scores in the WcS-DAT. Internal item consistency, assessed using Cronbach's alpha, indicated that all items were consistent and not redundant, with scores ranging from 0.82 to 0.92. Pearson product-moment correlations were used to assess the concurrent validity of the WcS-DAT and all of these correlations were significant at a minimum of p less than 0.05, with many significant results at the 0.01 and 0.001 levels. These results indicated good concurrent validity of the WcS-DAT. In Phase III, the WcS-DAT was evaluated for its ability to show changes in discomfort over time and with the introduction of novel, user adjustable wheelchair seating. Both the General Discomfort Assessment score (GDA) and the Discomfort Intensity Score (DIS) were sensitive to changes in seating discomfort level and were adequate for use in detecting differences associated with changes in duration of sitting as well as those associated with use of different seating equipment. Results of this final phase indicated that the WcS-DAT is a useful tool for evaluation of wheelchair seating discomfort in a research or clinical environment

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable