Powered mobility as an intervention for children with cerebral palsy: A systematic review ; The smart wheelchair: Is it an appropriate mobility training tool for children with cerebral palsy?

Purpose. To systematically review the effectiveness of powered mobility training interventions in improving driving skills and psychosocial outcomes in children with cerebral palsy. Method. Electronic searches of CINAHL, Medline and Meditext were conducted. Using two assessment tools, two independent reviewers assessed the quality of selected studies and level of evidence. Studies were included if a powered mobility training intervention was described, at least one participant had cerebral palsy and if the majority of participants were aged between 18 months and 18 years old. A narrative analysis was conducted. Results. Seven articles were eligible for inclusion. Intervention protocols included computer simulator training, mobility training on a powered riding toy, and a powered wheelchair. The quality of the studies ranged from strong to limited, with six out of seven studies rated as level IV evidence and one study rated as level III evidence as defined by the National Health and Medical Research Council level of evidence table. Conclusions. Although research is limited observational investigations suggest that powered mobility training programs are potentially beneficial in the development of driving skills for children with cerebral palsy and may have a positive impact on psychosocial outcomes. Methodological weaknesses of the studies were small sample sizes, absence of control groups and largely descriptive data analysis. There is a need for future, more rigorous research which addresses these weaknesses and contributes to an understanding of the utility of powered mobility both as a method of access and as a therapeutic intervention tool. Purpose: To describe the impact of a mobility training program using the Smart Wheelchair on the driving skills and psychosocial outcomes of children with cerebral palsy. Method: A multiple case study design using mixed methods was used. Four children with cerebral palsy were recruited for the study. The intervention was a Smart Wheelchair mobility training program. Data was collected using a quantitative driving skills assessment, field notes and qualitative parent interviews. Results: Three out of four children gained independence in at least three driving skills or more, whilst one child was competent with verbal prompts. Three out of four mothers reported positive changes in their child\u27s confidence, motivation and affect. Conclusions: The Smart Wheelchair has the ability to uncover learning potential and facilitate the recognition of abilities in children with cerebral palsy previously excluded from access to independent mobility. Given the significant limitation that restrictions in mobility pose to participation for children with cerebral palsy, occupational therapists must begin to understand the effectiveness of interventions such as the Smart Wheelchair. The descriptive findings of this study allow for future, more rigorous research, to be conducted on the effectiveness of the Smart Wheelchair as a mobility training tool

Train vs. play: Evaluating the effects of gamified and non-gamified wheelchair skills training using virtual reality

This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered for the study, of whom eleven undertook the gamified VR training, and eleven engaged in the non-gamified VR training. To measure the efficacy of the VR-based wheelchair skills training, we captured the heart rate (HR), number of joystick movements, completion time, and number of collisions. In addition, an adapted version of the Wheelchair Skills Training Program Questionnaire (WSTP-Q), the Igroup Presence Questionnaire (IPQ), and the Simulator Sickness Questionnaire (SSQ) questionnaires were administered after the VR training. The results showed no differences in wheelchair driving performance, the level of involvement, or the ratings of presence between the two environments. In contrast, the perceived cybersickness was statistically higher for the group of participants who trained in the non-gamified VR environment. Remarkably, heightened cybersickness symptoms aligned with increased HR, suggesting physiological connections. As such, while direct gamification effects on the efficacy of VR-based wheelchair skills training were not statistically significant, its potential to amplify user engagement and reduce cybersickness is evident

The Implementation and Validation of a Virtual Environment for Training Powered Wheelchair Manoeuvres

This work has been submitted to the IEEE for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessible.Navigating a powered wheelchair and avoiding collisions is often a daunting task for new wheelchair users. It takes time and practice to gain the coordination needed to become a competent driver and this can be even more of a challenge for someone with a disability. We present a cost-effective virtual reality (VR) application that takes advantage of consumer level VR hardware. The system can be easily deployed in an assessment centre or for home use, and does not depend on a specialized high-end virtual environment such as a Powerwall or CAVE. This paper reviews previous work that has used virtual environments technology for training tasks, particularly wheelchair simulation. We then describe the implementation of our own system and the first validation study carried out using thirty three able bodied volunteers. The study results indicate that at a significance level of 5% then there is an improvement in driving skills from the use of our VR system. We thus have the potential to develop the competency of a wheelchair user whilst avoiding the risks inherent to training in the real world. However, the occurrence of cybersickness is a particular problem in this application that will need to be addressed

Uma arquitetura de telerreabilitação baseada em realidade aumentada para apoiar o treinamento de usuários de cadeiras de rodas motorizadas

Many people worldwide have been experimenting a decrease in their mobility as a result of aging, accidents and degenerative diseases. In many cases, a Powered Wheelchair (PW) is an alternative help. Currently, in Brazil, patients can receive a PW from the Unified Health System, following prescription criteria. However, they do not have an appropriate previous training for driving the PW. Consequently, users might suffer accidents since a customized training protocol is not available. Nevertheless, due to financial and/or health limitations, many users are unable to attend a rehabilitation center. To overcome these limitations, we developed an Augmented Reality (AR) Telerehabilitation System Architecture based on the Power Mobility Road Test (PMRT), for supporting PW user’s training. In this system, the therapists can remotely customize and evaluate training tasks and the user can perform the training in safer conditions. Video stream and data transfer between each environment were made possible through UDP (User Datagram Protocol). To evaluate and present the system architecture potential, a preliminary test was conducted with 3 spinal cord injury participants. They performed 3 basic training protocols defined by a therapist. The following metrics were adopted for evaluation: number of control commands; elapsed time; number of collisions; biosignals and a questionary was used to evaluate system features by participants. Results demonstrate the specific needs of individuals using a PW, thanks to adopted (qualitative and emotional) metrics. Also, the results have shown the potential of the training system with customizable protocols to fulfill these needs. User’s evaluation demonstrates that the combination of AR techniques with PMRT adaptations, increases user’s well-being after training sessions. Furthermore, a training experience helps users to overcome their displacement problems, as well as for appointing challenges before large scale use. The proposed system architecture allows further studies on telerehabilitation of PW users.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)Muitas pessoas em todo o mundo estão vivenciando uma diminuição de sua mobili- dade como resultado de envelhecimento, acidentes e doenças degenerativas. Em muitos casos, uma cadeira de rodas motorizada (CRM) é uma ajuda alternativa. Atualmente, no Brasil, os pacientes podem receber uma CRM do Sistema Único de Saúde, seguindo os critérios de prescrição. No entanto, eles não têm um treinamento prévio apropriado para dirigir a CRM. Conseqüentemente, os usuários podem sofrer acidentes, pois um protocolo de treinamento personalizado não está disponível. Além disto, devido a limi- tações financeiras e / ou de saúde, muitos usuários não podem comparecer a um centro de reabilitação. Para superar essas limitações, desenvolvemos uma arquitetura de sistema de telereabilitação com Realidade Aumentada (RA) baseado no PMRT (Power Mobility Road Test), para apoiar o treinamento de usuários de CRM. Nesse sistema, os terapeutas podem personalizar e avaliar remotamente as tarefas de treinamento e o usuário pode realizar o treinamento em condições mais seguras. O fluxo de vídeo e a transferência de dados entre cada ambiente foram possíveis através do UDP (User Datagram Protocol). Para avaliar e apresentar o potencial da arquitetura do sistema, foi realizado um teste preliminar de três participantes com lesão medular. Eles realizaram três protocolos básicos de treinamento definidos por um terapeuta. As seguintes métricas adotadas para avaliação foram: número de comandos de controle; tempo decorrido; número de colisões e biossinais. Além disso, um questionário foi usado para avaliar os recursos do sistema. Os resultados demonstram as necessidades específicas dos indivíduos que usam uma CRM, graças às métricas adotadas (qualitativas e emocionais). Além disso, os resultados mostraram o potencial do sistema de treinamento com protocolos personalizáveis para atender a essas necessidades. A avaliação do usuário demonstra que a combinação de técnicas de RA com adaptações PMRT aumenta o bem-estar do usuário após as sessões de treinamento. Além disso, esta experiência de treinamento ajuda os usuários a superar seus problemas de deslocamento, bem como a apontar desafios antes do uso em larga escala. A arquitetura de sistema proposta, permite estudos adicionais sobre a telerreabilitação de usuários de CRM

The impact of powered mobility devices on occupational performance : a systematic review ; and, The experience of being a motorised mobility scooter user

The impact of powered mobility devices on occupational performance: A systematic review Purpose: To systematically review the impact powered mobility devices have on engagement in independent occupations for adults with acquired mobility limitations. Method: The following databases were searched electronically: CINAHL Plus, Medline, PsychInfo, OT Seeker, Joanna Briggs Institute and Physiotherapy Evidence Database. The search terms used a combination of words to encompass all terms which are used for powered mobility. Studies were included if they evaluated adults’ use of a motorised mobility device, and if individuals used a powered mobility device due to acquired mobility limitation. Results: Eleven studies were eligible for inclusion. Studies varied in methodological quality and research design. One study was a true experimental design; four studies were preexperimental, and six used non-experimental designs. Positive improvements in occupational engagement were reported in five studies and increased independence was highlighted in four of these. Environmental barriers were described as being negatively associated with powered mobility use, with reports of accidents and injury closely associated with use of device when mobilising in the community. Conclusions: Due to differences in study focus, sample characteristics, outcome measures and varying methodological quality of each research study, drawing conclusions from the results is problematic. What can be suggested from the results is that environmental barriers generate difficulties and challenges for the user, which can subsequently result in accident or injury. In contrast these negative aspects, the use of a powered mobility is shown to provide positive impacts on the individual in the areas of independence, quality of life, mobility and engagement. The experience of being a motorised mobility scooter user Purpose: This study explored the individual experiences of being a scooter user and the ways in which scooters impact the individual’s community and social engagement, daily activities and maintenance of mobility. Method: A qualitative, constructive framework utilising purposive sampling and a semi structured interview with fourteen individuals residing within aged care facilities in Perth, Western Australia was utilised. Data was analysed thematically with questions categorised under the main areas of activities, participation and environmental factors according to the International Classification of Functioning, Disability and Health framework. Results: The three main themes identified through the research were knowledge, engagement and environments. Knowledge related to a lack of concise information, trialling and training prior to purchase leading to issues with the scooter catering for users’ individual needs. Engagement consisted of two sub categories of participation and interaction. Environments were broken into two areas of discrimination from the wider population and building design and barriers related to space requirements and physical barriers in the built environment. Conclusions: The research demonstrated a strong positive impact on individual’s engagement from using a scooter, while highlighting a lack of efficient knowledge about scooters, batteries, skill ability and design along with environmental challenges of discriminatory attitudes and barriers. The research indicates the need for pre-purchase assessments and trials along with improvements in community attitudes and environments. The use of a scooter results in increases to participation, role maintenance, choice, freedom and social interaction

Promoting Physical Activity in People Who Have a Long-Standing Spinal Cord Injury

The main objective of the study described in this thesis was to examine the effectiveness of a 16-week self-management intervention –called HABITS- in changing the level of physical activity of people who have lived with a spinal cord injury for a long time. We also examined whether the self-management intervention contributed to an improvement in the level of exercise behaviour of the participants and whether it resulted in an improvement in their self-management skills. We have performed a randomized controlled trial. This study showed no diffences between the intervention (HABITS) and the control group. In addition, the study tested the validity of a newly developed device for appropriately measuring the physical activity of the participants; this was based on an activity monitor that measured their self-propelled wheelchair driving. This study showed high validity results. The main research of this thesis was based on a theoretical model of the relationship between self-management skills and physical activity. This model was based on two behavioural change theories: the transtheoretical model of behavioural change and the theory of planned behaviour. A further aspect of the study, therefore, was to investigate the relationship between self-efficacy and physical activity, testing the hypothesis that, among people with a long-standing spinal cord injury, those who have a higher level of self-efficacy level have higher activity levels. We have confirmed this hypotheses

A Capstone in Education: Current Challenges For Occupational Therapist Clinicians Transitioning To Role Of Academician

The doctoral capstone I participated in for my entry-level Doctor of Occupational Therapy program was in a focus area of education with a mentor who was a professor in a master’s program. I supported my mentor in her role as a professor of a physical dysfunction intervention course and had the opportunity to present a module to students on wheelchair seating interventions. Using experience gained during my capstone as well as information learned during the review of literature, I created a guide for OTs interested in making the transition into academia to meet the capstone project requirement