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The Effect of Manual Wheelchair Design on Mobility: A Study with Non-Users and Experienced Wheelchair Users

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• Sara Raquel Martins Barili 19 ,
• Frode Eika Sandnes 20 ,
• Luis Carlos Paschoarelli 19 ,
• Galdenoro Botura Junior Botura 19 &
• Fausto Orsi Medola 19  

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The use of inappropriate wheelchairs is believed to limit mobility and reduce the freedom and quality of living for the user. This study therefore set out to investigate the influences of wheelchair design on the performance in a wheelchair agility test. Ten participants performed an agility test involving operating three manual wheelchairs with different designs as fast as possible. The wheelchair designs (independent variable) included a lightweight rigid frame, foldable frame and hospital model. The wheelchairs order was randomized for the agility tests. The time to complete an agility test (dependent variable) was measured with a chronometer. The results show that the use of the rigid frame wheelchair yielded the fastest performance during the agility tests, while the hospital model resulted in longer task-completion times. The findings support the view that active users should be provided with lightweight wheelchairs, as heavy hospital wheelchairs limit mobility.

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World Health Organization. Health statistics and information systems: Global Health Estimates (GHE) (2011). http://www.who.int/mediacentre/news/releases/2011/disabilities_20110609/en/

Gauthier, C., Grangeon, M., Ananos, L., Brosseau, R., Gagnon, D.H.: Quantifying cardiorespiratory responses resulting from speed and slope increments during motorized treadmill propulsion among manual wheelchair users. Ann. Phys. Rehabil. Med. 60 (5), 281–288 (2017)

Article   Google Scholar  

Qi, L., Ferguson-Pell, M., Salimi, Z., Haennel, R., Ramadi, A.: Wheelchair users’ perceived exertion during typical mobility activities. Spinal Cord 53 (9), 687–691 (2015)

Paulson, T.A., Bishop, N.C., Eston, R.G., Goosey-Tolfrey, V.L.: Differentiated perceived exertion and self-regulated wheelchair exercise. Arch. Phys. Med. Rehabil. 94 (11), 2269–2276 (2013)

Bertolaccini, G.S., Filho, I.F.P.C., Christofoletti, G., Paschoarelli, L.C., Medola, F.O.: The influence of axle position and the use of accessories on the activity of upper limb muscles during manual wheelchair propulsion. Int. J. Occup. Saf. Ergon. 24 (2), 311–315 (2018)

Louis, N., Gorce, P.: Surface electromyography activity of upper limb muscle during wheelchair propulsion: influence of wheelchair configuration. Clin. Biomech. (Briston, Avon) 25 (9), 879–885 (2010)

Bertolaccini, G.S., Sandnes, F.E., Paschoarelli, L.C., Medola, F.O.: A descriptive study on the influence of wheelchair design and movement trajectory on the upper limbs’ joint angles. In: Rebelo, F., Soares, M. (eds.) Advances in Ergonomics in Design. (AHFE 2017). Advances in Intelligent Systems and Computing, vol. 288, pp. 645–651. Springer, Cham, Amsterdam (2018)

Google Scholar  

Gorce, P., Louis, N.: Wheelchair propulsion kinematics in beginners and expert users: influence of wheelchair settings. Clin. Biomech. (Bristol, Avon) 27 , 7–15 (2012)

Medola, F.O., Paschoarelli, L.C., Silva, D.C., Elui, V.M.C., Fortulan, C.A.: Pressure on hands during manual wheelchair propulsion: a comparative study with two types of handrim. In: European Seating Symposium, pp. 63–65 (2011)

Medola, F.O., Elui, V.M.C., Santana, C.S.: La selección de la silla de ruedas y la satisfacción de indivíduos con lesion medular. Rev Iberoam de Fisioterapia y Kinesiología 13 (1), 17–21 (2010)

Medola, F.O., Elui, V.M.C., Santana, C.S., Fortulan, C.A.: Aspects of manual wheelchair configuration affecting mobility: a review. J. Phys. Ther. Sci. 26 (2), 313–318 (2014)

Kwarciak, A.M., Yarossi, M., Ramanujam, A., Dyson-Hudson, T.A., Sisto, S.A.: Evaluation of wheelchair tire rolling resistance using dynamometer-based coast-down tests. J. Rehabil. Res. Dev. 46 (7), 931–938 (2009)

Sprigle, S., Huang, M.: Impact of mass and weight distribution on manual wheelchair propulsion torque. Assist. Technol. 27 (4), 226–235 (2015)

Caspall, J.J., Seligsohn, E., Dao, P.V., Sprigle, S.: Changes in inertia and effect on turning effort across different wheelchair configurations. J. Rehabil. Res. Dev. 50 (10), 1353–1362 (2013)

Lin, J.T., Huang, M., Sprigle, S.: Evaluation of wheelchair resistive forces during straight and turning trajectories across different wheelchair configurations using free-wheeling coast-down test. J. Rehabil. Res. Dev. 52 (7), 763–774 (2015)

Medola, F.O., Dao, P.V., Caspall, J.J., Sprigle, S.: Partitioning kinetic energy during freewheeling wheelchair maneuvers. IEEE Trans. Neural Syst. Rehabil. Eng. 22 (2), 326–333 (2014)

Belasco Jr., D., Silva, A.C.: Consistência dos resultados do teste de corrida em ziguezague de Barrow (modificado) em jogadores de basquetebol em cadeira de rodas. International Congress of Motor Rehabilitation, Águas de Lindóia (1998)

JASP Team.: JASP (Version 0.9) Computer software (2018)

Wobbrock, J.O., Findlater, L., Gergle, D., Higgins, J.J.: The aligned rank transform for nonparametric factorial analyses using only anova procedures. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems 2011, pp. 143–146. ACM, Vancouver (2011)

Oliveira, N., Blochlinger, S., Ehrenberg, N., Defosse, T., Forrest, G., Dyson-Hudson, T., Barrance, P.: Kinematics and pushrim kinetics in adolescents propelling high-strength lightweight and ultra-lightweight manual wheelchairs. Disabil. Rehabil. Assist. Technol. 14 (3), 209–216 (2019)

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Acknowledgments

The authors would like to thank FAPESP (Process No. 16/05026-6) and the Norwegian Agency for International Cooperation and Quality Enhancement in Higher Education–DIKU (Project No. UTF-2016-long-term/10053) for the financial support.

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Sara Raquel Martins Barili, Luis Carlos Paschoarelli, Galdenoro Botura Junior Botura & Fausto Orsi Medola

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Correspondence to Sara Raquel Martins Barili .

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Juraj Dobrila University of Pula, Pula, Croatia

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Barili, S.R.M., Sandnes, F.E., Paschoarelli, L.C., Botura, G.B.J., Medola, F.O. (2021). The Effect of Manual Wheelchair Design on Mobility: A Study with Non-Users and Experienced Wheelchair Users. In: Karwowski, W., Ahram, T., Etinger, D., Tanković, N., Taiar, R. (eds) Human Systems Engineering and Design III. IHSED 2020. Advances in Intelligent Systems and Computing, vol 1269. Springer, Cham. https://doi.org/10.1007/978-3-030-58282-1_57

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Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study

• Emma Williams   ORCID: orcid.org/0000-0003-3262-3512 1 ,
• Elizabeth Hurwitz 1 ,
• Immaculate Obaga 2 ,
• Brenda Onguti 2 ,
• Adovich Rivera 3 ,
• Tyrone Reden L. Sy 3 ,
• R. Lee Kirby 4 ,
• Jamie Noon 5 ,
• Deepti Tanuku 1 ,
• Anthony Gichangi 2 &
• Eva Bazant 1  

BMC International Health and Human Rights volume  17 , Article number:  22 ( 2017 ) Cite this article

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The United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study’s purpose was to describe wheelchair users’ experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines.

Local researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework.

Wheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.

Conclusions

Interventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma.

Trial registration

Not applicable since this was a descriptive study.

Peer Review reports

The United Nations has affirmed the right for persons with disabilities to have access to affordable mobility devices, social inclusion, and community participation [ 1 ]. Disability is strongly associated with poverty, and most people in less-resourced settings who need wheelchairs are unable to buy their own wheelchairs [ 2 ]. Approximately 15% of the world’s population have some type of disability, and 1% of the population globally need wheelchairs for increased mobility, although precise estimates for less-resourced settings are unavailable [ 2 ]. More than 300,000 wheelchairs are donated annually to low and middle income countries by international donors and charitable organizations; this includes an estimated 900 per year in Kenya and 4000 per year in the Philippines [ 3 ]. Often this process is outside the formal health care system [ 4 ].

When a wheelchair is provided to a person, other services are needed to improve the chance that the wheelchair will enable improved quality of life and social functioning. In 2008, the World Health Organization (WHO) published guidelines on the provision of manual wheelchairs in less-resourced settings, as well as training packages for service providers [ 5 ]. These guidelines included eight steps for service delivery, as presented in Table 1 .

A few studies have explored to what extent wheelchair service guidelines are implemented in low and middle-income countries [ 6 ]. One longitudinal study from Indonesia found that adults and children who received wheelchair services according to WHO guidelines had improved outcomes compared to wait listed controls [ 7 ]. One cross-sectional survey in Bangladesh of wheelchair users and -individuals with hearing impairment found some aspects of services (being asked about their needs, being measured and receiving training) were associated with some outcomes, including wheelchair satisfaction, participation and quality of life [ 8 ]. A review of wheelchair service provision in Afghanistan, India, Kosovo and Zimbabwe found that the needs and service distribution models vary by setting [ 4 ]. A study from India assessed 167 recipients of wheelchairs from charitable organizations and found that only 18% were still using the wheelchairs that they were given [ 9 ]. In a study in Beijing, China, of wheelchair users and persons with other disabilities, survey-based needs assessment related to rehabilitation and a quantitative assessment of barriers to rehabilitation services [ 10 ].

Fewer studies have employed qualitative methods to capture wheelchair users’ experiences in their own words and specifically examine how wheelchair recipients experience wheelchair provision and related services. In a small mixed methods study from Zimbabwe using two focus group discussions and two case studies [ 11 ] found that while wheelchair users appreciated receiving wheelchairs, they often faced challenges related to poor fit, lack of training in proper maneuvering of the wheelchair, and frequent needs to repair tires and other parts.

Thus, descriptive data is largely absent regarding how wheelchair services have been implemented in low and middle income countries and the extent to which wheelchair users perceive these services to be responsive to their needs [ 12 ]. The purpose of this qualitative study was to describe the services that urban and peri-urban wheelchair users received in Kenya and the Philippines and the perceived value of receiving a wheelchair with services or receiving a wheelchair without accompanying services.

Study setting

The study team selected Kenya and the Philippines as the study sites in collaboration with the donor, expert advisors, and organizations that provide wheelchairs in Africa and Asia. in order to (a) include one country each from Asia and Africa that are broadly representative of other countries in East Africa and the Asia Pacific, (b) include countries with large volume of wheelchair provision both with and without accompanying services, (c) obtain lists of wheelchair recipients. The study sites were further limited to urban and peri-urban areas, because in rural areas it would have been difficult to recruit sufficient numbers of wheelchair users within the time and budget restrictions.

Data collection took place in and around Nairobi from December 2014 through May 2015 and in the greater Manila area from February to May 2015. Participants in Kenya were mainly recruited from 3 urban and peri-urban counties near the capital city - Nairobi, Machakos and Kiambu - which account for 15% of the Kenyan population according to the 2009 Kenya population and housing census report [ 13 ]. (One participant was from Nakuru and two were from Mombasa.) The 2008 Kenya National Survey for persons with disability reported an overall disability rate of 4.6%, of which 1.6% of the Kenyan population has some physical impairment [ 10 ]. Although Kenya’s Persons with Disability Act of 2003 provides a legislative framework for access to services and inclusion of persons with disabilities in all facets of life, a 2014 status report on the implementation of the rights of persons with disabilities pointed out many challenges to persons with disabilities, including discrimination and stigma, and physical inaccessibility of buildings and transportation services [ 11 ].

As the capital region of the Philippines, the Metro Manila area is a highly urbanized district with a population of almost 12 million. An estimated 1.6% of the population are people living with disabilities, according to 2010 census data [ 14 ]. In the Philippines, laws exist to protect the rights of persons with disabilities - such as employment and educational equality - and provide discounts to some basic goods and services [ 15 ]. The social health insurance program does not cover wheelchair provision and services; however, some government social welfare offices offer free wheelchairs that have been donated by charitable organizations.

Ethical issues

The study was approved by the research ethics boards of Johns Hopkins University Bloomberg School of Public Health in Baltimore, Maryland, United States (#5839), the Kenya Medical Research Institute in Nairobi, Kenya (Non-SSC Determination #457) and the University of Philippines Manila (#2014-351-01).

All study participants provided informed consent; oral in Kenya and written in Philippines, based on local institutional review board preferences.

Study design

The qualitative study sample was a subset of participants in a survey of 852 wheelchair users in Kenya and the Philippines conducted between December 2014 and May 2015. The survey methods and quantitative results have been published elsewhere [ 13 , 15 ]. The rationale for employing qualitative data collection was to describe wheelchair service provision in wheelchair users’ own voices and to place this in the context of wheelchair users’ lives.

Participants, recruitment and screening

In Kenya, the study team recruited potential participants from lists provided by (a) 10 wheelchair-providing organizations, such as faith-based organizations, nongovernmental organizations, community-based organizations, and government hospitals; (b) 11 disabled persons’ organizations; and (c) snowball sampling (referral from other study participants). Surveyors and field supervisors prescreened participants by phone and scheduled appointments at wheelchair users’ homes or other accessible locations. In the Philippines, the team recruited from lists provided by (a) five local government units (LGUs) within metropolitan Manila, which provide free wheelchairs to residents; (b) a charitable organization that provides free wheelchairs through LGUs, civic organizations and other organizations; (c) a nongovernmental organization where wheelchair users live and work; and (d) snowball sampling. Potential participants were screened over the phone, if possible, or contacted by visiting their homes.

Inclusion and exclusion criteria

Participants were at least 18 years old and basic manual wheelchairs users, meaning that they required no postural support to remain in a seated position. Eligible respondents received their current wheelchairs at least six months and less than five years prior to data collection. In the Philippines only, in response to challenges in recruiting a large enough sample, toward the end of data collection, users who had received their wheelchair 10 years earlier were included to increase the participation of users of rugged wheelchairs, which might last longer and be delivered in conjunction with services. Study enrollment was preceded by screening to determine if potential participants had ever received wheelchair services; details are provided elsewhere [ 13 , 15 ]. All qualitative interview participants had first completed the survey. One participant in Kenya completed the survey but refused to complete the in-depth interview. No interview participants refused in the Philippines.

Qualitative interviews

A team of two experienced interviewers in Kenya and seven in the Philippines completed 24 in-depth interviews in each country, purposively selected to include even distribution based on sex, receipt of any services with their most recent wheelchair, age (a binary categorization of younger or older than 45 years) and geographical area . We stratified the sample this way to include diverse opinions. Because we had no reliable information about the age distribution or life expectancy of wheelchair users, age 45 was somewhat arbitrarily chosen as a cut-off for older users.

The interview guide included open-ended questions about experiences with wheelchairs, wheelchair services and contextual factors and was translated into Swahili and Filipino. (Additional file 1 ). Interviews took place in participants’ homes. Interviewers sought a location with auditory privacy, and no one else was present for the interview, except for one participant in the Philippines who was caring for his child during the interview. Interviewers used digital voice recorders during the interviews. Interviewers transcribed the audio files and then translation into English was done by the interviewers in Kenya and the Center for the Filipino Language at the University of the Philippines in Manila; in the Philippines, field interviewers checked the completed English translations against the Filipino transcriptions to identify translation errors.

Data analysis and interpretation

A qualitative content analysis approach was employed [ 16 ]. Data from the two countries were analyzed separately. Members of the research team coded the transcripts with Atlas-ti software, using a code list created based on WHO guidelines for service delivery. Coders added emergent codes based on multiple-person coding of a subset of transcripts, and more codes were added as the process continued. Strategies to improve consistency across coders included developing standard code definitions, double-coding a subset of transcripts, and holding regular discussions among coders. In addition to the coding, the first author also read the transcripts in their entirety several times. Using the computer-assisted Noticing-Collecting-Thinking approach of Friese [ 17 ], analysts queried the data to generate reports based on codes and respondent characteristics and identified patterns in the data. The first author wrote memos to synthesize the findings. The qualitative team was in frequent communication to discuss the findings. For this manuscript, participants were given a unique identifier starting with K for Kenya or P for Philippines and ending with a two-digit number that was different from the identifier used by the study team. This code is provided to enable to readers to understand whether the the participants were quoted more than once.

Data for steps 1-2 (referral and appointment, and assessment) and for steps 3-4 (prescription, and funding and ordering) were combined because in these settings they occurred simultaneously. Similarly, data. Findings related to step 5 are not presented because wheelchair users were rarely present during the product preparation stage. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.

In August 2015, representatives of the research team and stakeholders met for two days in each country to disseminate study findings; meeting attendees included more than 100 representatives of government agencies, nongovernmental organizations, disabled persons organizations, local universities, wheelchair manufacturers, and wheelchair professionals, and their responses to the findings were taken into account for this article and served as a form of member checking.

Overview of respondents

In Kenya, 9 of qualitative interview participants were less than 35 years old, the most common reason for using a wheelchair was spinal cord injury (11), and 18 said they used their wheelchair for at least eight hours per day (Table 2 ). In the Philippines, four participants were less than 35 years old, had needed wheelchair was complications of polio (9), and 10 used their wheelchair for at least eight hours per day. Twelve participants in the Philippines and eight in Kenya were currently married or cohabiting. Most respondents had at least a secondary education. They were evenly split between men and women.

Other characteristics were elicited from the interviews rather than the survey data. Study participants ranged from those with robust physical health and strength to those with complex morbidities, and their duration of wheelchair use varied from a few years to several decades. Some participants were able to use crutches or braces to walk, or even walk independently for short distances, while others were unable to walk independently and used no mobility devices other than wheelchairs. The sample included those had attended schools for children with disabilities and thus had always had a peer group that included wheelchair users, as well as people who had little contact with other wheelchair users and felt isolated by their mobility impairment. Only two in-depth interview participants in Kenya and three in the Philippines had received their first wheelchair during the past five years. Participants had used up to 12 wheelchairs in Kenya and four wheelchairs in Philippines during their lifetimes, with an average of about 5 in Kenya and 2.5 in the Philippines, but some respondents were uncertain about the total number of wheelchairs that they had owned.

Findings below are presented according to the service steps outlined in Table 1 .

Steps 1-2: Referral, appointment, and assessment

Because of the sampling approach, most participants had received their wheelchairs for free from either local government officials (in the Philippines only) or charitable organizations, and referral occurred through a combination of luck and social networks. Generally, wheelchairs were described as being readily available. One Kenyan man said:

I don’t ask for anyone to bring me a wheelchair. . . . I have not stayed with a wheelchair for a long time. . . . I just stay for some time and after about two years somebody comes or an organization comes. For, like an example, some people come here in school and say that we have brought you some wheelchairs, and we need you to use them. So I move to the next one. [K22]

Less commonly, healthcare workers referred respondents through the health care system, such as during a hospital stay. Others described buying their new or used wheelchairs either in a market or shop or directly from other wheelchair users. Those who received wheelchairs from charitable organizations sometimes described being measured or otherwise assessed prior to being presented with wheelchairs, as well as being asked to submit some identifying information; photographs, especially in Kenya, were required from potential recipients. In other cases, recipients were assessed at the same time the wheelchairs were given or they were assigned wheelchairs without any assessments being done. Occasionally, well-meaning individuals gifted participants with wheelchairs, as surprise gestures.

Generally, participants could not describe the steps taken to prepare the wheelchairs for their use, since they received wheelchairs that had already been assembled.

Steps 3-4: Prescription or selection, funding and ordering

Although some participants described an active prescription and selection process, many said that few choices in type of wheelchair were available in their community or few choices were presented to them. Some of those who received their wheelchairs through donation said they did not expect to receive a choice in wheelchairs or provide input in selection, since they were free, particularly for newer wheelchair users. However, some described negotiating with wheelchair providers to try to get a different wheelchair. In the Philippines, some described miscommunication or misunderstanding regarding the types of wheelchairs they were expecting to receive and the ones that they received. One man from the Philippines said that he was expecting to receive a wheelchair built for rugged outdoor settings (called a Roughrider) but he said:

What arrived was a medical wheelchair. Of course that was given, what, you'll still complain?Ah, it was already here. And it's big! So, they arrived all at the same time, many arrived. I overheard [the doctor who distributed the wheelchairs] saying that there's one more that's quite small. I said, "Doc, maybe it's possible for me to replace it with anything." [She said] "No. You're better there! Because it's big. You're big." [P14]

He went on to say that he still felt the wheelchair was too big and that he had added a piece of plywood to the seat and made other modifications to try to make the chair more comfortable.

Some respondents described how the wheelchairs had been unsuitable, but they only realized this later after having a chance to use other wheelchairs. With experience, users described more actively selecting wheelchairs to suit their needs. Experienced users desired choice in wheelchair selection, and an opportunity to try prospective wheelchairs, more than they wanted recommendations from service providers. However, they recommended that new wheelchair users be given counseling and training in wheelchair selection.

Because the sampling strategy primarily recruited people who had received their wheelchairs from charitable organizations or through a government program for those who could not afford to buy wheelchairs (in the Philippines only), most participants had received free wheelchairs. Users who paid for all or part of their wheelchair were often more engaged in the selection process and expressed more satisfaction with the wheelchairs, compared to users whose wheelchairs had been given to them.

Step 5: Product preparation

Little data was available about product preparation since participants generally received fully assembled wheelchairs. Some participants described modifying the footrests, armrests or cushions on their own wheelchairs. Some added pockets or bags for carrying their necessities. Changing the cushion was one of the most common modifications described, to improve comfort, to reduce the risk of pressure sores, and to adjust wheelchairs that were too large or too low to the ground. In the Philippines, some participants lived near a wheelchair manufacturing facility and could ask employees to help make major modifications to their wheelchairs with welding. One participant in the Philippines designed his own wheelchair and had it manufactured, and another improvised a wooden chair with wheels attached, because his previous wheelchair tipped over too easily. In Kenya, users often had multiple wheelchairs for showering and indoor and outdoor use.

Step 6: Fitting

Fitting was described as a range of experiences, from none at all to both the measurement of the body and adjustment of the wheelchair. Many participants, particularly those with longer experiences using wheelchairs or those who had used wheelchairs as children, had past experience receiving wheelchairs that fit poorly. As with selection, some recipients who received donated wheelchairs were not in a position to request fitting. One Kenyan man said:

They think a wheelchair is a wheelchair. No, a wheelchair is supposed to fit you, but how do you get to the one fitting you if it is a donation? You know you want to save every cent when you are in this condition ‘coz there are other expenses definitely. [K5]

Often participants were unaware of the value of fitting when they received their first wheelchairs and developed preferences over time by wearing out and replacing wheelchairs. A student from the Philippines, who had paraplegia resulting from a spinal cord injury and lived in a dormitory with other persons with disabilities, described two different experiences with fitting. First, he received a hospital-type wheelchair that was too large and caused “bed sores,” so he started using crutches instead. When the crutches became frustrating, he bought a used wheelchair from a fellow wheelchair user, after briefly sitting in the wheelchair and being advised by other wheelchairs users that it seemed like a good fit for him.

Step 7: User training

Generally, study participants had received little formal training in how to maneuver their wheelchairs or solve problems related to wheelchair use, such as adapting to public bathrooms. Exceptions were those who stayed in a hospital for a long time and received physical therapy, or those who received some other kind of institutional care, such as in a residential school for children with disabilities. Instead, most described teaching themselves to use the wheelchair through practice, which one Kenyan man called “by feel, learning through experience, the hard way.” [K3] They might learn a few skills through brief training that was offered along with each new wheelchair. One Kenyan man received written booklets that helped him understand how to better maneuver his wheelchair. Some participants thought that new wheelchair recipients could benefit from training but that they themselves had figured out what they needed to know. Yet, even these experienced users had problems with some types of wheelchairs.

Frequently people spoke about light wheelchairs that tipped easily or rolled too quickly. Interviewers were not qualified to assess whether participants could have wheeled independently if given more suitable wheelchairs, skills training or both. Some environmental barriers could be overcome with training. For example, one Kenyan woman said:

When a person is being given the chair, they need to be trained. We have the first timers, those who do not know anything. It is like taking a child to school and giving him a book and you do not give him a pen. What will he write? At times, you may find some [wheelchair users] stuck on the road simply because they are not aware of what to do, but if they were trained they would have known what to do. [K20]

Participants added that organizations should provide training to family members and that training should be provided on wheelchair maintenance. A Filipino woman said only her most recently acquired wheelchair had been provided with training related to maintenance:

Before, I didn’t even have an idea that you can use cooking oil for cleaning the wheelchair and that you should only wipe to clean it and not wash it. That’s the reason why my second wheelchair got rusty. . . I washed and even soaped it. Then, when I got this wheelchair and the instructional book, I learned the proper maintenance, but it was too late [for the previous wheelchair]. [P7]

However, many participants described receiving a basic toolkit along with the wheelchairs, and some received training in what one Kenyan man called “first aid” for the wheelchair. Maintenance needs also depended on the users’ health, with some reporting performing basic maintenance, while limited hand mobility or other factors made this impossible for others.

Step 8: Follow-up, maintenance, and repairs

Participants rarely described receiving follow-up services from health care providers or organizations that provided wheelchairs, but they often participated in organizations that supported wheelchair users. Many respondents had difficulty finding a person capable of repairing their wheelchairs, particularly in Kenya, and paying for repairs could be challenging. Sometimes replacement parts were difficult to obtain. Some chairs seemed poorly made and non-functional. Tires were a source of frustration, and users expressed preference for either inflatable or solid rubber tires. Like the receipt of wheelchairs, access to repairs was haphazard. For example, one Filipino man said that the proprietor of a local welding and vulcanizing shop “took pity” and repaired wheelchairs only for the cost of supplies.

On the other hand, for one Kenyan woman, lack of spare parts and maintenance, coupled with wear and tear resulting from wheelchairs not being suited to the environment, resulted in a cycle of obtaining new wheelchairs:

In that area, we didn’t have people specialized in repairing those wheelchairs, and there were no spare parts. And the environment was full of thorns and that wheelchair had a tube, and it used to get punctures all the time. And so in the process the rim would be damaged, and once it’s damaged and they continue pushing you using that same wheelchair. So what used to happen was the wires would cut, then the tire comes out and the tire falls off. So it was such a challenge I nearly gave up and just decided to stay home. [K10]

Other contextual factors

Participants described other services and needs not fitting easily within the WHO service-delivery steps – physical access issues, the need for multiple wheelchairs, the challenges of stigma and the value of peer support.

Physical environment as a barrier

The physical environment was often a barrier to wheelchair use. After visiting South Africa, one Kenyan woman contrasted her neighborhood, where public transportation was inaccessible to wheelchair users, with buses in South Africa which are equipped to be wheelchair accessible. Participants talked about needing to request strangers’ help to gain access to public buildings, or carry them upstairs because light rail train stations were inaccessible. In Kenya, participants felt obligated to pay these strangers at times. In both countries, a few participants had modified motorbikes acquired on their own that aided their independent mobility and social and work participation.

Multiple chairs for improved access

Study participants frequently had multiple wheelchairs to fulfill different functions and overcome barriers to access. For example, they might have wheelchairs for indoor and outdoor use, or an older wheelchair that they used while showering to prevent a newer wheelchair from rusting. In Kenya, some study participants described needing to keep wheelchairs at their rural homes, because it would not be feasible to transport their wheelchairs with them from the city to a rural area. Sometimes multiple wheelchairs were required because of limitations in wheelchair functionality. For example, study participants might be reluctant to use a wheelchair that was too heavy for them to propel easily alone or one that tipped over easily, but they might keep it in case it was needed. One man from Kenya said, “This one you can see the wheels wear out, and maybe at that time I don’t have money to replace them or have them fixed, so I will use another one before I get money to fix the other one.” [K2] In the Philippines, a few study participants described building skateboard-like devices to move about more easily inside their homes. In addition, some participants had acquired wheelchairs for specific activities, like racing or basketball.

Although the interview guide did not specifically ask about stigma, participants mentioned stigma, particularly those who started using wheelchairs as adults. These users reported that people stared at them in public. For example, a Kenyan woman said, “ I hated going outside because you would find people staring at you and some offering you money like you are a beggar without knowing whether you need it or not or even talking to [you].” [K15] One woman from the Philippines with mobility recently limited by stroke cried during the interview and expressed worry about being a burden on her family. She said, “I’m a bother also. I feel ashamed also. Somehow, they must also be getting tired of me. I also seem to be feeling pity for myself. It’s difficult to be like this. More so … it’s better that I died than be like this. I can no longer do everything. It’s like they’re already annoyed with me. Of course, at the very least I’m a bother.” [P13] However, a man from the Philippines said he experience less stigma after moving from a rural province to the Manila metro area. He said, “Definitely it changed a lot. I tell you, even if we go out, even if I go to [place name] mall, no one notices us. It seems like we’re normal. Unlike in my province that people are like that especially at the mall, at the cinema [staring] like that.” [P24].

Value of peer support

In the absence of follow-up services and formal training in wheelchair skills or maintenance, a key strategy for learning new skills was interacting with other wheelchair users. Peer support from other wheelchair users emerged as an important source of companionship, emotional support, and skill acquisition related to wheelchair use, as well as employment or income generation; this occurred through formal groups for some, and informally for others. A woman from Kenya said, “ The other thing is just the everyday maintenance things, like oiling. I didn’t use to know about that until my wheelchairs joints had rust until they get stuck, because when you wash water goes in. I didn’t know about that until someone asked me, ‘Do you ever oil your wheelchair?’ And I went like, ‘Oh. Am I supposed to?’ This was somebody who was also using a wheelchair and knew that it was important. I do not know where they learnt that from. ” [K12].

This influence was particularly strong in the Philippines since some participants had lived and worked with persons with disabilities. One man from the Philippines said that before moving to Manila and living with other wheelchair users:

“ I had no idea about the correct specifications of a wheelchair. All I care is that I’m using one. And then when I got here, I learned the right specifications of a good wheelchair that I can use. It’s also because of the people I met here. They would advise me, ‘[Name] that’s too wide, have it customized at Metal Craft.’ … Until it came to the point that I became an expert on how I want my wheelchair to be. ” [P21].

Summary of findings

This study described the experiences of a group of peri-urban and urban wheelchair users in Kenya and the Philippines, to understand how their experiences receiving wheelchair services compared with WHO guidelines. This study aimed to sort people into binary categories of those who had received wheelchairs with services and those who received wheelchairs without services. However, we found that services exist on a wide continuum. Exposure to services may take place over decades and exert a cumulative influence. Personal experience, acquired over years of wheelchair use, also seemed to be an important influence outside receipt of services from others. Another important influence was services received from those outside the formal rehabilitation field, such as peers. Repair services were generally provided by welding and bicycle repair shops. Across diverse backgrounds and medical conditions, most participants described a similar pattern in which their first wheelchairs were unsatisfactory. Later, through exposure to different wheelchairs and perseverance, they learned to seek out wheelchairs that met their needs. This was consistent with the quantitative survey component of this study that found that specific elements of service delivery were associated with improved functioning in both countries [ 17 ].

Study strengths and limitations

Understanding users’ perspectives is an essential aspect of the provision of wheelchairs or any other technology. However, wheelchair provision has tended to rely more on anecdote than research data [ 4 ]. This study addresses this crucial gap in the disability research literature.

A limitation of this study is that it asked participants to remember past events, which could lead to recall bias. Also, only one in-depth interview was conducted per respondent, whereas multiple interviews could have improved rapport and led to more detailed responses. Lastly, our sample included only basic wheelchair users, excluding certain types of wheelchairs commonly distributed and some wheelchairs or tricycles specific for longer distance travel. This study only included adults, yet children are an important sector of the wheelchair market, and research into their complex needs and those of their caregivers is scant. More broadly, this study only described wheelchair users’ perception of what services helped their functioning, and the results could yielded more insights into other aspects of wheelchair services and distribution if we had. We did not interview other key informants such as health care providers or wheelchair service providers.

Findings in context of the published literature

These findings reinforce and expand upon some findings from similar studies. Environmental access, particularly access to public transportation, was a challenge described by other studies [ 12 , 16 ]. Others have recognized the need for wheelchairs to be adapted to rugged terrains [ 4 , 9 ] and that currently available wheelchairs often lead to challenges with repair and maintenance [ 4 , 7 ]. Just as Papadimitriou described the process of “becoming en-wheeled”; participants in this study also described a process of trying to find a wheelchair that became an extension of their bodies [ 18 ]. Although the interview guide had minimal emphasis on wheelchair users’ interactions with the public, this subject arose frequently. Like Cahill, we found that wheelchair users experienced stigma at times, and that this was a source of distress, yet they also experienced gestures of kindness and assistance and words of encouragement from strangers [ 19 ].

Previous studies in Bangladesh and Indonesia have found that training on how to maneuver wheelchairs was associated with improved outcomes [ 7 , 8 ]; this is consistent with the survey data from this study which found that training was associated with higher functioning on activities of daily life in the Kenya sample [ 13 , 15 ]. Wheelchair skills training has also been shown to be beneficial in North America and Europe [ 20 , 21 – 23 ]. Informal peer-to-peer instruction in wheelchair use occurred frequently and was perceived to be beneficial. In Canada, Best et al. conducted a pilot study of a formal peer role in training in wheelchair skills and found that the training led to improvements in self-efficacy, wheelchair skills capacity and performance [ 19 ]. More broadly, increased social capital has often been linked to improved health outcomes [ 22 ]. Improving peer networks could also enable service providers to do outreach to this community more effectively, as their networks could be used to share information and resources. The lack of health professionals available to provide wheelchair services in low- and middle-income countries may be another argument for a peer role in training [ 23 ]. In the study settings, self-taught people often are informally teaching other people, leading to a risk of suboptimal practices being shared. Formal peer training models may be a more effective approach; the nonprofit organization Motivation has developed one such training model. Ideally, peers working with trained health-care professionals may provide the most effective model of care.

Borg found that cost was a primary barrier to use of assistive devices [ 8 ]. Although most wheelchairs were distributed for free in our study sites, these data suggest that wheelchair users often had to accept unsuitable wheelchairs because they were unable to pay for better quality wheelchairs. However, many only identified them as unsuitable in retrospect, especially when receiving their first wheelchair. In India, Mukherjee found that more than half of donated wheelchairs were discarded and that poorly fitted wheelchairs resulted in pain and injuries [ 9 ]. In this study, participants rarely reported discarding wheelchairs, if they were functional, at least until they could obtain a suitable replacement. As in the Mukherjee study, receipt of poorly fitted wheelchairs and injuries related to wheelchair use were commonly described. In Zimbabwe, Visagie et al. observed that adult recipients of donated wheelchair were dissatisfied with their chairs even if they found that the wheelchairs helped them perform daily activities [ 11 ]. Similarly, survey data from this study also found that having the fit assessed while the user propelled the wheelchair was associated with higher performance of activities of daily living, compared with those who did not receive this service [ 13 , 15 ].

Previous research has suggested that a shortage of wheelchairs leads many to go without wheelchairs. One three-country study found that, prior to receiving their current wheelchairs, 90% of recipients had spent most time sitting in chairs or lying in beds [ 24 ]. By including participants who had received their current wheelchair six months to five years ago, we expected to sample many participants who had spent extended periods of time in need of wheelchairs but were unable to obtain them. In fact, this scenario was rarely described. Many respondents had multiple wheelchairs that they used for different purposes, such as moving around within the house or outside the house. This discrepancy may be because all of our respondents lived in major urban centers in countries that benefit from international donors’ contributions and this enabled them to have better access to wheelchairs and accompanying services. It is also possible that disadvantaged populations existed within these settings and that our sampling strategies did not reach them.

Recommendations for future research and programs

Although this study has in many ways focused on the challenges of wheelchair provision in these settings, participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for and, despite challenges, they were grateful to have some means of mobility. This study highlights some key information for the research community and needs for future research, among an underserved population where systematic descriptions of available services have been scarce. Future qualitative studies should seek to include caregivers and service providers in addition to wheelchair users, as their perspectives are essential to the success of wheelchair service programs. Recruitment was challenging because wheelchair service organizations have limited capacity for recordkeeping, particularly in Kenya. Creating a registry of wheelchair users and updating that registry consistently could facilitate both research and follow-up services. Respondents suggested that disabled persons organizations or other organizations create a searchable network or database of service providers, repair shops, and other resources; this information could also identify underserved areas and then try to increase services in those areas.

Implications for provision of mobility devices and other types of technology

These findings have implications not just for mobility devices but for other new technologies that are introduced into less resourced settings. Whenever a product is introduced to a new market, it is essential to understand the user population. Obtaining users’ perspectives is critical to ensuring adequate access. The approach used in this study may also be applicable to other new technologies, since the concerns they face are the same for any innovation that has failed to achieve scale. Although the service steps have been outlined, and donors are available to provide wheelchairs questions remain about who will provide the services, how to train or license providers, and where they will work. It will also be important to consider to what extent technology could play a part in expanding service reach, whether task sharing and whether a need exists to increase demand. Current service provision models should be examined to identify who can access the services, who is currently left out, and how inclusion can be increased. Future studies may include a review of product safety standards, the range of available products and what models, incentives, and training are needed to support the maintenance and repair of the product. Further work can be done to fully understand the challenges posed by the physical environment and the potential policy implications.

This qualitative study allowed wheelchair users to describe their experiences in their own words and to contribute their views on what services would be valuable for themselves and other wheelchair users. Given the limited resources in low and middle income countries, it will be crucial to establish efficient models for service delivery. In addition to providing wheelchairs and services to individual wheelchair users and their families, intervention must also be directed toward environmental factors, such as barriers in the physical environment and perceived social stigma, and toward fostering peer support.

United Nations. Convention on the rights of persons with disabilities [internet]. Geneva: United Nations; 2007. Available from: https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html .

World Health Organization. The World Bank. World report on disability. Geneva: World Health Organization; 2011.

Google Scholar  

Accelovate. Phase one desk review: research study of wheelchair and wheelchair services provision in low-resource settings. Baltimore, MD: Jhpiego; 2013.

Jefferds AN, Beyene NM, Upadhyay N, Shoker P, Pearlman JL, Cooper RA, et al. Current state of mobility technology provision in less-resourced countries. Phys Med Rehabil Clin N Am. 2010;21:221–42.

Article   PubMed   Google Scholar  

World Health Organization. Wheelchair service training package [internet]. Geneva: World Health Organization; 2008. Available from: http://apps.who.int/iris/bitstream/10665/78236/1/9789241503471_reference_manual_eng.pdf?ua=1

Borg J, Lindström A, Larsson S. Assistive technology in developing countries: national and international responsibilities to implement the convention on the rights of persons with disabilities. Lancet Lond Engl. 2009;374:1863–5.

Article   Google Scholar  

Toro ML, Eke C, Pearlman J. The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Serv Res. 2016;16:26.

Article   PubMed   PubMed Central   Google Scholar  

Borg J, Östergren P-O. Users’ perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers. Disabil. Rehabil. Assist. Technol. 2015;10:301–8.

Mukherjee G, Samanta A. Wheelchair charity: a useless benevolence in community-based rehabilitation. Disabil Rehabil. 2005;27:591–6.

Zongjie Y, Hong D, Zhongxin X, Hui X. A research study into the requirements of disabled residents for rehabilitation services in Beijing. Disabil Rehabil. 2007;29:825–33.

Visagie S, Mlambo T, van der Veen J, Nhunzvi C, Tigere D, Scheffler E. Is any wheelchair better than no wheelchair? A Zimbabwean perspective. Afr J Disabil. 2015;4:10.

Smith EM, Sakakibara BM, Miller WC. A review of factors influencing participation in social and community activities for wheelchair users. Disabil Rehabil Assist Technol. 2014:1–14.

Bazant, Eva, Hurwitz, Elizabeth, Onguti, Brenda, Williams, Emma, Noon, Jamie, Xavier, Cheryl, et al. Wheelchair Services and Use Outcomes: A Cross-sectional Survey in Kenya and the Philippines. Afr. J. Disabil. 2017. In press.

Philippines Statistics Authority. Persons with Disability in the Philippines (Results from 2010 Census) [Internet]. Philippines Statistics Authority; 2013. Available from: https://psa.gov.ph/content/persons-disability-philippines-results-2010-census

Accelovate. Wheelchair use and Services in Kenya and Philippines: a cross-sectional study. Accelovate final report. Baltimore, MD: Jhpiego; 2015.

Dhungana B. The lives of disabled women in Nepal: vulnerability without support. Disabil. Soc. 2007;21:133–46.

Friese S. Qualitative data analysis with Atlas.Ti. Second. London: Sage; 2014.

Papadimitriou C. Becoming en-wheeled: the situated accomplishment of re-embodiment as a wheelchair user after spinal cord injury. Disabil Soc. 2008;23:691–704.

Cahill S. Reconsidering the stigma of physical disability: wheelchair use and public Kindess. Sociol Q. 1995;36:681.

Best KL, Kirby RL, Smith C, MacLeod DA. Wheelchair skills training for community-based manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil. 2005;86:2316–23.

Kirby RL, Mitchell D, Sabharwal S, McCranie M, Nelson AL. Manual wheelchair skills training for community-dwelling veterans with spinal cord injury: a randomized controlled trial. PLoS One. 2016;11:e0168330.

Routhier F, Kirby RL, Demers L, Depa M, Thompson K. Efficacy and retention of the French-Canadian version of the wheelchair skills training program for manual wheelchair users: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93:940–8.

Worobey LA, Kirby RL, Heinemann AW, Krobot EA, Dyson-Hudson TA, Cowan RE, et al. Effectiveness of group wheelchair skills training for people with spinal cord injury: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97:1777–84. e3

Shore S, Juillerat S. The impact of a low cost wheelchair on the quality of life of the disabled in the developing world. Med Sci Monit Int Med J Exp Clin Res. 2012;18:CR533–42.

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Acknowledgements

Thank you to Shannon Egan for coding assistance and Cheryl Xavier for helping to plan and implement the study in the Philippines. The authors also would like to acknowledge the many wheelchair service providers and study participants who contributed to this study and the study teams at Jhpiego Kenya and Institute of Health Policy and Development Studies in the Philippines. The full acknowledgements can be found in the final study report. ( http://reprolineplus.org/system/files/resources/wheelchair-study-report-2015Dec.pdf ).

This work was supported by the United States Agency for International Development under Grant AID-OAA-A-11-00050.

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The datasets generated and analyzed during the current study are not publicly available out of concern that individuals who participated could be accidentally identifiable, given the highly personal nature of some information that was shared. Data are available from the corresponding author on reasonable and well-justified request.

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DT, EB, EH, EW, RLK and JN designed the study, with EB serving as principal investigator. IO, BO and AG helped to implement the study in Kenya; AR and AS helped to implement the study in the Philippines. IO, BO, AR, and AS conducted some of the qualitative interviews. EB, EH, EW, BO and IO coded the transcripts. All authors contributed to the data analysis and interpretation and edited and approved several drafts of the manuscript, including the final version.

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Williams, E., Hurwitz, E., Obaga, I. et al. Perspectives of basic wheelchair users on improving their access to wheelchair services in Kenya and Philippines: a qualitative study. BMC Int Health Hum Rights 17 , 22 (2017). https://doi.org/10.1186/s12914-017-0130-6

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Received : 16 September 2016

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Exploring Powered Wheelchair Users and Their Caregivers’ Perspectives on Potential Intelligent Power Wheelchair Use: A Qualitative Study

Dahlia kairy.

1 School of Rehabilitation, Université de Montréal, C.P. 6128 Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada; E-Mails: [email protected] (P.W.R.); [email protected] (E.P.); [email protected] (L.D.)

2 Center for Interdisciplinary Research in Rehabilitation (CRIR)—IRGLM Site, 6300 Avenue Darlington, Montréal, QC H3S 2J4, Canada; E-Mail: [email protected]

Paula W. Rushton

3 Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 Chemin Queen Mary, Montréal, QC H3W 1W4, Canada; E-Mail: ac.nortoediv@enotsp

Philippe Archambault

4 School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, QC H3G 1Y5, Canada; E-Mail: [email protected]

5 Center for Interdisciplinary Research in Rehabilitation (CRIR)—JRH Site, 3205 Place Alton-Goldbloom, Laval, QC H7V 1R2, Canada; E-Mail: [email protected]

Evelina Pituch

Caryne torkia, anas el fathi.

6 Polytechnique Montréal, C.P. 6079 Succursale Centre-Ville, Montréal, QC H3C 3A7, Canada; E-Mails: [email protected] (A.E.F.); [email protected] (R.G.)

Paula Stone

François routhier.

7 Department of Rehabilitation, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6, Canada; E-Mail: [email protected]

8 Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de Réadaptation en Déficience Physique de Québec (IRDPQ), 525 Boulevard Hamel, Québec, QC G1M 2S8, Canada

Robert Forget

Louise demers, joelle pineau.

9 School of Computer Science, McGill University, 3480 University Street, Montréal, QC H3A 0E9, Canada; E-Mail: ac.lligcm.sc@uaenipj

Richard Gourdeau

Power wheelchairs (PWCs) can have a positive impact on user well-being, self-esteem, pain, activity and participation. Newly developed intelligent power wheelchairs (IPWs), allowing autonomous or collaboratively-controlled navigation, could enhance mobility of individuals not able to use, or having difficulty using, standard PWCs. The objective of this study was to explore the perspectives of PWC users (PWUs) and their caregivers regarding if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs. A qualitative exploratory study using individual interviews was conducted with PWUs (n = 12) and caregivers (n = 4). A semi-structured interview guide and video were used to facilitate informed discussion regarding IPWs. Thematic analysis revealed three main themes: (1) “challenging situations that may be overcome by an IPW” described how the IPW features of obstacle avoidance, path following, and target following could alleviate PWUs’ identified mobility difficulties; (2) “cautious optimism concerning IPW use revealed participants” addresses concerns regarding using an IPW as well as technological suggestions; (3) “defining the potential IPW user” revealed characteristics of PWUs that would benefit from IPW use. Findings indicate how IPW use may help overcome PWC difficulties and confirm the importance of user input in the ongoing development of IPWs.

1. Introduction

Recent estimates from the World Health Organization indicate that some 65 million people worldwide need a wheelchair [ 1 ]. Statistics Canada reported in 2000–2001 that 264,000 people used wheelchairs as a primary means of mobility [ 2 ] and the United States Census conducted in 2010 reported that there were 3.6 million wheelchair users over the age of 15 [ 3 ]. In 2002 in the United States, there were 2.7 million non-institutionalized users of wheeled mobility devices, approximately 30% of which used powered wheelchairs (PWCs) or scooters [ 4 ]. Similar data has been reported for Europe [ 5 , 6 ]. Furthermore, power mobility device use will likely continue to increase given the growing prevalence of disability worldwide due to changing demographics such as an ageing population and an increase in chronic health conditions [ 7 ]. It is therefore essential to ensure that mobility devices, in particular powered mobility devices, best meet wheelchair users’ needs in order to facilitate participation and enhance quality of life.

The benefits of power mobility, including improved self-esteem [ 8 ], decreased pain [ 9 ], and increased activity levels and social participation [ 10 , 11 , 12 , 13 ] are well documented. PWC use also has its challenges. For example, power wheelchair users (PWUs) report being afraid to navigate in crowded spaces with their device [ 14 ]. In addition, clinicians who prescribe wheelchairs report that some clients cannot use PWCs safely because of visual, motor and cognitive deficits [ 15 , 16 , 17 ]. Smart or intelligent power wheelchairs (IPW) that provide navigation assistance have hence been proposed for PWUs who either cannot use, or have difficulty using, existing power mobility devices. These types of IPWs are not yet commercially available for use outside the lab and are still in the development phase. However, a review of studies looking at IPWs that provide navigation assistance to the PWU reports that these new mobility devices could benefit people with severe motor, sensory or cognitive limitations, allowing them to carry out their everyday activities [ 17 ]. Including users in the design process of new health technologies is increasingly recognized as essential in order to understand and consider users’ needs [ 18 ]. Including the user in the design process provides information regarding the needs, experience and ideas of future users, and has been found to lead to greater functionality, usability and quality of the devices that are developed [ 19 ]. User input at the prototype stage is essential so that design changes can be made prior to the manufacturing stage [ 20 ].

The objective of this study was to explore the perspectives of PWUs and their caregivers regarding IPW to better understand if and how IPWs could impact on current challenges faced by PWUs, as well as inform current development of IPWs.

2.1. Study Design

A qualitative exploratory study was used, with semi-structured individual interviews conducted with PWUs’ and their caregivers’, in order to obtain their perspectives regarding IPW use.

2.2. Participants

Using a convenience sample, 12 PWUs and four caregivers were recruited for this study from the wheelchair and seating departments of two rehabilitation centers in Montreal. PWUs were included if they: (1) had been using a PWC in the community for at least one year, (2) were 18 years of age or older, (3) were able to express themselves in French or English, and (4) had any musculoskeletal or neurological diagnosis resulting in a long-term severe mobility limitation. PWUs were excluded if: (1) they had a communication difficulty and/or a hearing or vision deficit significantly limiting their ability to participate in the interviews, and (2) if they presented emotional or psychiatric problems or cognitive disabilities that could limit their participation in the study, as discussed with the participant’s referring therapist.

Caregivers were recruited if: (1) they were informal caregivers or long term companions of a PWU and (2) they provided assistance to or accompanied a PWU in activities that involved the PWC, such that they could provide meaningful insight into current PWC use and possible IPW use. Caregivers did not have to be caregivers to the PWU participants in this study.

2.3. Data Collection and Analysis

Individual interviews were conducted with PWUs and caregivers. Prior to the interviews, socio-demographic and PWC use information was collected using a sociodemographic form to document self-reported personal data (e.g., age, sex, diagnosis) and wheelchair data (e.g., duration of power wheelchair use, method of power wheelchair control, etc. ) for PWUs. A different form was used to collect sociodemographic data from the caregiver (e.g age, sex, relationship to the PWU, extent of help provided with the PWC, etc. ). A semi-structured interview guide with open-ended questions and probes was developed by the research team. This guide was modified as the interviews progressed in order to capture data about emerging themes. Participants were asked about past and current PWC use, including positive aspects (e.g., benefits, activities performed) and challenging aspects (e.g., barriers encountered, safety concerns, accidents). PWUs were also asked to describe any unmet mobility needs. All participants were then shown a four-minute video illustrating the functionalities of an IPW to facilitate informed discussion about the IPW and its relevance to them. This video illustrated the main features of a prototype IPW that our research team is developing (see section 2.5), used within the environment of a major shopping center in downtown Montreal (Quebec, Canada). After the video, participants were asked questions about their perception of the IPW (e.g., use, safety, confidence and relevance), as well as more specific questions about the relevance of the IPW features (e.g., path following, obstacle avoidance, target following). Caregivers were asked questions regarding PWC and IPWs with respect to both their role as a caregiver and what they perceived to be the impact on the PWU. The interviews were conducted in the PWU’s home by an occupational therapist with extensive knowledge of and experience with power mobility and the wheelchair community. Prior to meeting the participants (PWU and caregivers), she was aware of the PWU’s primary diagnosis and how long they had been using a PWC. When possible, separate interviews were conducted for the PWU and their caregiver. Interviews, conducted in English or French (depending on the participants’ preference), were audio recorded and transcribed verbatim in the language of origin.

Data collection and preliminary analysis were conducted concurrently. Each interview was initially analyzed for general impressions by four team members (Dahlia Kairy, Paula W. Rushton, Evelina Pituch and Paula Stone) and initial codes were generated collaboratively [ 21 ]. Once each interview was analyzed individually, a more in-depth analysis of the codes across interviews was conducted and overarching themes were identified by the first two authors (Dahlia Kairy and Paula W. Rushton) using NVivo 8 software (QSR International, Doncaster, Victoria, Australia). Any differences in opinions regarding codes were resolved through discussion among team members involved in the data analysis process.

The study was approved by the Research Ethics Committee of the institutions managing the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) and informed consent was obtained from all participants prior to the interview.

2.4. Description of IPW Prototype Used for Video

Since 2006, our multidisciplinary team has been developing a prototype IPW with semi-autonomous navigation functions, using robotic and artificial intelligence technologies (see Figure 1 ). The robot and computer interface, built onto a commercially-available PWC, can be controlled by speech recognition, a joystick or a tactile display (see Figure 2 ). Using laser and sonar sensors mounted on the chair, the IPW has several unique functions: (1) it can follow a planned path (path following); (2) it avoids static and dynamic obstacles (obstacle avoidance); (3) it negotiates through doorways and in between obstacles (path following/obstacle avoidance combination); (4) it can follow a given object such as a wall or a person or a group of people (target following). The IPW user has the choice to control the IPW as a regular PWC or to allow the “intelligent” functions to guide the chair [ 22 ]. The video used during the interviews illustrated the use of the IPW by a PWU in a mall setting, highlighting the intelligent functions of the chair.

Intelligent power wheelchair prototype.

Tactile interface illustrating intelligent power wheelchair path finding function.

3.1. Participants and Interviews

Participant demographics are presented in Table 1 . With regard to PWUs, there were twice as many men as women with ages ranging from 22–88 years. The primary diagnoses were neurological in nature and participants had used PWCs for at least 3 years. Three of the four caregivers lived with the PWU. Half of the PWUs did not need any assistance to navigate with their PWC, while five out of 12 needed help with transfers. All caregivers assisted the PWU in their activities, although the amount of help provided by the caregiver with respect to the PWC ranged from rarely to several times a week.

Participant characteristics.

Interviews lasted on average 40 min (range 24–66 min) with the PWUs and 43 min (range 31–66 min) with the caregivers. One interview was conducted with a PWU who had severe dysarthria as a result of cerebral palsy. However, since the caregiver assisted the PWU in expressing his thoughts he was included in the study and interviewed with the caregiver.

3.2. Findings

When considering current PWC use and potential IPW use, 3 main themes emerged from the participants’ perspectives: (1) challenging situations that may be overcome by an IPW; (2) cautious optimism concerning the IPW; (3) defining the IPW user. These are presented in the following sections with verbatim quotes to illustrate the themes where appropriate. When needed, selected quotes have been translated from French to English by bilingual members of the research team for the purpose of presenting the results.

3.2.1. Challenging Situations that may be Overcome by an IPW

PWUs described the “autonomy”, “independence”, and “freedom” that their PWC afforded them. The meaning of their PWC was expressed by PWUs in a variety of ways, including “The chair is my legs!” (59 years old, female, primary diagnosis of rheumatoid arthritis, 11 years as a PWU) and “I go everywhere with it!” (81 years old, male, primary diagnosis of fibromyalgia, 6 years as a PWU). However, PWUs and caregivers also recounted challenging situations that occurred with the PWC, as presented in Table 2 . These are most commonly related to the built environment (e.g., inaccessible buildings, narrow entrances, small elevators, narrow store aisles, spaces made narrow by displays and temporary set ups), outdoor environment (e.g., poor visibility of the PWC user on the street, sidewalks in poor conditions, snow and rain, long distances), and crowded places (e.g., stadiums, festivals, malls). Some of the challenges are related to the physical impairments of the PWC user. For example, a common difficulty expressed by participants was backing up in the PWC such as when exiting a narrow elevator, in particular for participants with limited head mobility or control.

Difficulties reported with PWC and IPW features that could address these.

For many of the challenging situations, PWUs and caregivers described strategies that had been developed to overcome the challenges, namely avoiding difficult situations, finding alternative activities or locations to perform the activities, or relying on the caregiver or other people in the area for assistance. Some strategies compromised the safety of the PWU, such as using reserved bus or bicycle lanes instead of sidewalks. Participants described a range of accidents and incidents that occurred as a result of their identified challenging situations, ranging from scraping their knuckles or banging doorframes to getting hit by cars or buses when not seen at crosswalks or in bus lanes.

After viewing the IPW video, participants discussed how the various IPW features would alleviate many of the challenging situations they had identified when using their current PWC ( Table 2 ). Situations they described suggest context in which IPW use could be beneficial. Obstacle avoidance was identified as a feature that would minimize a number of difficulties frequently encountered in the physical environment, as highlighted by this participant’s statement, “…the fact that it can really calculate and see the distance and able to get through (doorways), it helps a lot for somebody who has difficulty in controlling the chair in narrow places.” (33 years old, male, primary diagnosis of muscular dystrophy, 11 years as a PWU). This feature was also perceived as useful to exit crowded or narrow elevators while backing up. Similarly, PWUs and caregivers described obstacle avoidance as a feature that would facilitate negotiating crowded spaces. For example, “avoiding pedestrians would be super in the ( hockey arena )” (66 years old, male, primary diagnosis of cerebral palsy, 29 years as a PWU). Similarly, a PWU stated “Excellent. Excellent all these things (the IPW features), I find it interesting…because if a person (in front of the chair) stops suddenly, we’re not stuck with a problem. The chair will stop” (61 years old, male, primary diagnosis of spinal cord injury, 39 years as a PWU). The path following function of the IPW was described as providing additional autonomy to the PWU when going to a new place or travelling long distances.

Lastly, target following was reported as being useful when power mobility navigation is limited by fatigue or visual impairments. For example, one caregiver described that he takes over driving the PWC when the PWU’s ability to drive using the joystick is hindered by fatigue.

3.2.2. Cautious Optimism Concerning the IPW

While participants were very enthusiastic when they saw what an IPW could do, as evidenced by their verbal expressions such as “Amazing!”, “Genius!”, and “Wow!”, they nevertheless expressed concerns on both a personal level, regarding their abilities and ways in which they would experience the IPW, as well as on a technological level.

PWUs commented that they wanted to continue to do the tasks that they perceived themselves as currently physically able to carry out, and caregivers corroborated this finding. Participants did not want the IPW to replace the abilities of the PWU. For example, one PWU stated: “So if I have this feature, of it driving itself, I’d become, hum, really, hum I’d rely on it too much more than I need to…So it could make me lazy and not enhance my mobility” (22 years old, male, primary diagnosis of muscular dystrophy, 10 years as a PWU).

In most cases, participants perceived only some of the IPW features as relevant to them. For example, several participants were skeptical about trusting the IPW more than their instinct or their abilities, or felt they needed to be convinced about the IPW’s reliability with respect to its ability to avoid moving obstacles. For instance, one participant said, “Well for me, I…I would have difficulty trusting more a machine’s reflexes than my own abilities to control the chair. Because I have very good control of the chair. And, I think, pressing on a touch screen, waiting for it to react, that it sends a command, for me, in my head, it is faster to take my control and do what I need to do now…” (25 years old, female, rheumatoid arthritis, 10 years as a PWU). However, other participants had the opposite perspective, as described by this participant, “I wouldn’t be as quick to respond to emergency…obstacles if there’s, say, someone appears at the corner and I’m about to turn right. It could happen where I’m not quick enough to press the emergency button or to let go of the joystick, so I think it’s a plus, because this would respond I think faster than…if you’re driving by yourself” (22 years old, male, primary diagnosis of muscular dystrophy, 10 years as a PWU).

“Following a planned path” was viewed by half the participants as being useful. Those that did not find it useful expressed that this was a task that everyone has to do, for example in a shopping mall, and that this was a task they could and wanted to continue to do by themselves.

In addition to perceived benefits of the IPW, some participants expressed concerns with some of the technical characteristics of the chair. Participants were concerned that sensors, which are used for navigation and obstacle avoidance, would increase the overall width of the chair making it more difficult or impossible to navigate in narrow spaces or go through narrow doorways, as expressed by a PWU when talking about where the sensors on the IPW, “Exactly. If we, we increase the width of the wheelchair, we just ruined many situations” (61 years old, male, primary diagnosis of spinal cord injury, 39 years PWU experience). Participants also had concerns about using the IPW for outdoor activities. They were concerned with the speed of the chair, either that it was too slow to allow them to participate in the activities in which they would like to participate, or that it may not slow down enough in the event of going over a pothole for example. They wondered whether it would be able to detect holes, edges of sidewalks, cracks in sidewalks, or other low obstacles such as cans or glass on the floor. One participant expressed the following hesitations: “Hum… that, I don’t know if I’m fully comfortable with it, (…) because sometimes like it could be something on the floor that I think it may not detect, so… let’s say, you are going towards a wall, there’s like a can on the floor.” (22 years old, male, primary diagnosis: muscular dystrophy, 10 years as a PWU). Participants also questioned how the chair would identify certain features of outdoor environments, such as red traffic lights while in intelligent mode, expressing that this would be a significant safety concern. Participants also voiced reservations with the target following feature when the target was a group. Specifically, participants wondered what happens if the group disperses, “And at some point, you don’t know anymore who you are with”. Finally, several participants questioned whether the path following ability of the IPW would work, for example, if a store would move locations, or if entering a new place where the map has not been previously loaded.

Knowing that the IPW was still being refined, participants provided technical suggestions during the interviews. Examples of such suggestions include having an auditory signal when approaching an obstacle as a warning signal and being able to detect problems with the IPW, “… failsafe mechanism could’ve built into… hum, to warn you if hum… there is any… technical problem with it.” (65 years old, male, primary diagnosis of multiple sclerosis, 6 years as a PWU). One participant questioned how the chair would know which feature to use. He suggested that for example if the IPW is set to follow a person, it should also be able to also avoid a moving obstacle. Finally, some participants suggested that they would like to be able to choose the features they would want on their IPW if they had concerns with some features or did not consider them to be useful to them.

3.2.3. Defining the IPW User

When discussing the relevance of the different features of the IPW, all of the participants found that at least two of the features would be helpful in their activities. More specifically, most participants described situations where obstacle avoidance and path following would be useful. With the presence of fatigue, path following and target following were seen as important. Use of these features would reduce the physical and cognitive demand involved in navigating the PWC, thereby increasing independence for the PWUs and decreasing caregiver burden for those caregivers who often take over driving the PWC in these situations. The husband of a PWU participant with multiple sclerosis described several situations in which he currently helps his wife and felt confident he would not have to do so with an IPW, “For example, I, I imagine that I would not have to sometimes move the WC to make more room, she sometimes parks it at a certain distance…” and “… I would not always have to accompany her, hum…., when she goes out if she wants to go out…to a shopping mall.” (Caregiver, 57 years old).

PWU and caregivers identified characteristics of people who would likely benefit from the IPW, including poor upper extremity motor control, decreased orientation, poor reaction times, decreased vision, and fatigue. They also suggested that the IPW becomes more relevant as people age, increased cognitive and visual impairments. For example, one PWU stated “…for orientation, that is, that is interesting, when I was talking about cognitive difficulties… and that you want to go out alone…because often when you have cognitive difficulties you will be accompanied by someone to go and do things. But here, (the person) could be alone. And for elderly people, exactly, the fact that they can follow a person or hum….it avoids maybe making a wrong move, because when you are with someone, you tend to be close to them….and you make a wrong move the other person trips on your WC….so it would be more reassuring pour elderly people or also for people who have problems with motor abilities” (45 years old, female, primary diagnosis of multiple sclerosis, 3 years as a PWU).

Overall, the IPW would be advantageous for those individuals with decreased autonomy related to their power wheelchair use.

Some participants emphasized how the IPW features would become more useful as their condition progressed. For example, two participants with multiple sclerosis, could see the benefit of the IPW should their condition deteriorate, in particular with respect to loosing upper extremity control or having increased fatigue, as indicated by a PWU talking about using the IPW to avoid obstacles instead of manually controlling his current PWC, “A priori, it would not be now, in the sense that now I still have good use…but absolutely, it would be something that would need to be considered yes yes, absolutely.” (44 years old, male, primary diagnosis of multiple sclerosis, 7 years as a PWU). Conversely, another participant, with a very slow progressive spinal muscular atrophy, did not feel that his condition was likely to deteriorate to the point of losing motor control in the hands and hence did not feel he would need to use the IPW.

When questioned about their intent to use the IPW if it were available today, half of the PWUs expressed that they would use it, and three of the four caregivers expressed that the PWU for which they provide care would likely use it. Some even expressed that they would feel safer (or in some cases people around them would be safer) if they were driving an IPW rather than their current PWC. Those that did not feel that they would use it today explained that they found it less relevant for them because of their current capabilities, although they could identify other PWUs who would benefit from it.

4. Discussion

In this article, we have described the perceptions of PWUs and caregivers regarding IPW use. The results of this study indicate that PWUs and their caregivers encounter challenging situations with their current PWC that may be overcome by the IPW. In fact, the IPW may not only eliminate the need for certain compensatory strategies (e.g., avoiding crowded venues), it may also reduce safety hazards associated with other strategies (e.g., driving the power wheelchair in bike and bus lanes). However, while there are clear benefits to the use of the IPW, participants also raised important questions and concerns from both a personal and technological perspective. Through the user-centered approach implemented in this study, the results provide important information for the further development of IPWs. Impact that IPWs may have on difficulties encountered by PWUs and recommendations for future design are discussed in the following section.

4.1. Impact of IPWs on Current Challenges Faced by PWUs

To date, most studies in the field of IPWs have focused on developing and testing the intelligent features of the IPWs. For example, Nguyen et al. [ 23 ] reported on the use of an IPW with a brain-computer interface or a head movement controller with eight able-bodied individuals and two people with tetraplegia. They analyzed path navigation and reported decreased time to complete an obstacle course with the brain-computer interface coupled with the intelligent PWC. How et al. [ 24 ] assessed the usability, efficacy and safety of an add-on for a PWC to assist with navigation and obstacle avoidance in two cognitively impaired individuals. They reported that the WC avoided collisions and was able to navigate as intended, while decreasing the perceived demands of the tasks by the users. They also reported user satisfaction, which tended to be greater with the add-on than without. Montesano et al. [ 25 ] evaluated the use of an IPW designed for children with cognitive and motor impairments. They tested driving performance of the IPW with four children with cerebral palsy and observed user interest and enthusiasm during the tasks. There is no doubt that studies examining IPW capabilities are essential. However, along side these studies, there is a paucity of studies reporting user perceptions regarding IPWs.

In our study, we interviewed PWUs’ and caregivers’ regarding IPW use. First we obtained a portrait of the challenges participants face with their current PWC, including accidents or near-misses that occurred indoors and outdoors, such as when backing up, navigating in crowded places, and avoiding low lying obstacles and holes. Similar challenging situations were reported by Wang et al [ 26 ], who interviewed mobility device users over the age of 65, caregivers and therapists about a collision avoidance technology for a PWC. In their study, the authors exclusively addressed the obstacle avoidance function as this was the main intelligent of the IPW they had developed, and it was found to be perceived as less useful for avoiding dynamic obstacles. Participants in our study expressed that the all the IPW features, including obstacle avoidance, path following and target following could help overcome some of the challenges reported. The differences with regards to obstacle avoidance may in part be due to the methods used for soliciting feedback. In our study we used a 4-min video illustrating each of the intelligent features in a mall setting, including avoiding dynamic obstacles such as people, where as Wang et al. [ 26 ] provided a verbal description of the collision avoidance technology. Hence, the participants’ perception may in part be influenced by their understanding of the IPWs abilities and limitations.

Some participants acknowledged that if the PW were available now they would not choose to use the IPW. Participants reported similar reasons to those reported by Wang et al. [ 26 ], namely feeling that they may have better driving abilities than an automated wheelchair, not wanting to rely on the IPW to do what they feel they can do themselves, or lacking confidence in the IPWs abilities. In addition, some participants in our study were concerned that the speed of the IPW may be too slow for their activities. This was also reported in the two small studies which documented IPW perceptions of elderly residents of long term care facilities [ 27 , 28 ]. Taken together, these findings underscore the importance of understanding and taking into account the needs of eventual IPW drivers.

It should be noted that these types of studies provide a snapshot at one point in time, of an innovative technology that is not yet commercially available. Hence, over time, users’ perspectives may evolve as newer technologies, such as technologies using GPS capabilities and collision avoidance, become more routinely used in society in general, which may in turn change how these technologies are perceived by potential IPW users.

4.2. Design Recommendations for the IPW Using a User-centered Approach

As suggested by user-centered approaches for design, our research team has continued to integrate the PWU’s perspective at pivotal points in the development of the IPW. For example, at a more preliminary stage of development, user input led to the inclusion of a tactile control panel to reduce difficulties encountered by the PWU with a vocal interface [ 29 ], and IPW use was assessed using an earlier prototype in a controlled setting [ 22 ]. The current study provides insight, from the PWU and caregiver’s perspective, which can then be used to further inform development of the current and future IPWs. Participants provided information about challenging situations encountered with their current PWC, both indoors and outdoors, some of which could potentially be overcome with an IPW ( Table 2 ). Additional described challenges, as well as voiced questions, concerns, and feedback have provided our research team with design ideas for the continued development of the IPW. Future refinements of IPW prototypes should take participants’ concerns and feedback for improvement, such as the one listed in Table 3 , into account.

Design recommendation examples for IPWs based on participants’ feedback.

When designing assistive technologies for people with disability, a significant challenge is designing a technology in a group that presents a range of abilities [ 20 ]. Indeed, in this study, while participants found at least two of the functions of the IPW relevant for their use, several participants considered that at least one of the functions would not be of use to them. Knowing that some but not all the IPW features are appropriate for everyone, refinement of the prototype could therefore allow users to select the options appropriate for them, as suggested by some participants.

Participants in this study had a number of questions about the way in which the IPW would function, in particular with respect to the path-finding and following a group functions. This emphasizes the need for adequate training and education of future IPW users when the IPW is ready to be used by PWUs in a real setting, in order to address and alleviate concerns they may have which may limit their use of the IPW.

4.3. Study Limitations and Future Directions

This study has several limitations. First, the participants provided feedback on the IPW based on a video rather than personal experience in a real-life context. Hence, we do not know if and how their perspectives regarding the IPW would have been different had they actually experienced the IPW. Nevertheless, our results suggest that the video was effective in facilitating participants’ recall of personal situations similar to those depicted in the video. Further, the video also allowed participants to recall problematic situations they had encountered which had not been raised prior to viewing the video as well as situations not depicted in the video, such as outdoor and other community-based activities. Hence, the use of the video did not limit the scope of activities recalled by our participants. Therefore, in our opinion, the video is a useful tool to document perceptions regarding IPWs at this point in time, when actual independent use in real environments is not yet possible.

Another limitation of this study is that only the perspectives of current PWUs were elicited. Future studies could include individuals who are not currently using a PWC, both those who have been denied use (e.g., secondary to safety concerns), as well as those who are planning to obtain a PWC. Perspectives of clinicians will also be important to explore in terms of understanding for whom an IPW would or would not be prescribed. In addition, only four caregivers were recruited in this study. For this study, we were looking to include caregivers who assist their close ones for mobility tasks, in order to document their perspectives on the use of an IPW and the impact it might have on the PWU or themselves. However, despite recruiting efforts in two large wheelchair and seating departments as well as through the PWUs, few people met this criteria. Future studies could include the perspective of more formal caregivers who may be more involved in assisting PWUs in mobility tasks. For this study, we did not conduct member checking with participants after the interviews.

A convenience sample of PWU and caregivers was used for this study, which may limit generalizability of the results to the larger PWU population. Nevertheless, the participants in our study do reflect the age range and diversity of health conditions of non-institutionalized individuals who use power mobility devices, as reported by the National Institute on Disability and Rehabilitation Research reporting on United States census data from 1994 [ 30 ]. In addition, our sample did not include participants with cognitive deficits. Although some of the current IPWs being developed are aimed at this patient population, the IPW developed by our team is in fact not designed for PWU with cognitive impairments.

In qualitative research, one aspect of internal validity is the credibility of the data collected [ 31 , 32 ]. It is important to consider the interviewer’s perspective and its possible impact on the data collected. In this study, the interviewer's extensive knowledge of and experience with power wheelchairs and the wheelchair community may be seen as a limitation in that the participants may have responded to the interview questions positively in order to please this occupational therapist who has contributed to their community in many ways. However, it was also this knowledge and experience that enabled the study interviewer to quickly and easily develop rapport with the participants, understand their described experiences and situations, and effectively probe in order to acquire our rich data.

Findings from this study cannot be generalized to other settings which may have different geographical and contextual realities. Participants in this study lived in Montreal, Quebec, Canada, a city with a northern climate with harsh winters often leading to poor road conditions, a factor which was raised numerous times during the interviews. In addition, wheelchairs are prescribed and reimbursed within a public health care system. Participants in this study did not address the issue of cost as a barrier to using the IPW, and this may in part be due to the fact that once a wheelchair is prescribed and approved its cost is covered by a provincial Medicare program. This type of prescribing and funding system may not be the case in other geographical locations

Interestingly, our results suggest that the IPW, when used in a social context, could have potential for change in social participation. For example, participants described how driving in an IPW could change the way in which they experience activities such as going to the mall with their spouse. Further analyses are currently underway to better understand how IPWs could impact social participation. In addition, future studies should include the development of appropriate measurement tools and methodologies that will be used to assess actual IPW use in a variety of natural settings. For example, our team is currently validating an existing measure of wheelchair navigation, the WheelChair Skills Test 4.1 for use with an IPW in a shopping center environment.

5. Conclusions

Including the key stakeholders’ perspective in the design and development process of the IPW is essential. It allows early detection of potential challenges and obstacles. Using an iterative process as proposed here, the stakeholders’ input can be integrated into the IPW during the development phase. Future studies exploring the prescribers’ perspective, as well as evaluating actual use with PWUs and other potential IPW users will be essential to continue to develop an IPW that best meets the users’ needs, and thus increasing community participation.

Acknowledgments

We thank the CRIR-Living Lab Vivant team and Cominar Reit, who have supported our project from inception and graciously opened the doors of Alexis Nihon shopping mall to our researchers. Without their partnership, this project would not have been possible. This project was funded by the RQRV, the CRIR-PSI fund, NSERC and FQRNT (Regroupement stratégique INTER). As well, Evelina Pituch received summer student grants from IRGLM CRIR-PSI and RQRV. We thank the participants in this study for time and feedback. In addition, we thank Alejandro Hernandez for his assistance in the manuscript preparation.

Author Contributions

Dahlia Kairy and Paula W. Rushton contributed to all stages of the research study, as well as manuscript preparation and revisions. Robert Forget, Louise Demers and François Routhier contributed to all stages of the research process as well as manuscript revisions. Philippe Archambault and Caryne Torkia contributed to the study design, interview guide preparation and manuscript revisions. Evelina Pituch and Paula Stone contributed to all stages of the research study and contributed to manuscript revisions. Anas El Fathi, Joelle Pineau and Richard Gourdeau were responsible for the technological development of the IPW, including the video of the IPW. They participated in manuscript revisions and collaborated on identifying design recommendations.

Conflicts of Interest

The authors declare no conflict of interest.

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I Thought Using A Wheelchair Would Hem Me In. Actually, It Set Me Free

By Lottie Mills

As a girl, Lottie Mills’s cerebral palsy diagnosis meant the prospect of becoming a “wheelchair user” was never far from her mind – and something she did everything she could to avoid. More than a decade on, embracing her wheelchair has irrevocably changed her life for the better, taking her everywhere from Cambridge University, where she read English Literature at Newnham College, to the decks of a tall ship that carried her 800 miles across the Atlantic. Having been named the BBC Young Writer of the Year in 2020, she releases her first short story collection, Monstrum , this week, a compilation of modern fairytales themed around otherness that’s already won praise from the likes of AS Byatt. Here, in a personal essay for Vogue, she writes about how she changed her perspective on wheelchairs – and her own future in the process.

Monstrum by Lottie Mills is out now.

On 8 December 2010, when I was nine years old, my surgeon suggested – not for the first time – that it was time to consider the idea of a wheelchair.

I can just about remember the airlessness of that room, the word wheelchair echoing around the clinic, an unwelcome visitor. I can remember the way my parents tensed defensively in their chairs, inching forward as if to prepare for a fight. I can remember, most of all, the wild, furious defiance which rose up in me instinctively – an overwhelming determination to prove the naysayers wrong. It had been the defining emotion of my childhood. The ensuing discussion, in the appointment notes, was described as “upsetting” .

Now, as a proud wheelchair user of more than a decade, it is difficult for me to fully comprehend just how negative my feelings about this prospect once were. My medical records paint a picture of a child fixated on “independent mobility”, one who saw the use of a wheelchair as the worst kind of failure. My parents clearly recognised the intensity of my drive – they, for their part, were concerned about the “psychological impact” wheelchair use might have on me. All of us feared, too, that a wheelchair would steal away my hard-won mobility. Like so many, we had absorbed that ugly term “wheelchair-bound”, seeing wheelchair use as a permanent – and horribly restrictive – state. Why subject me to that, if I could walk?

By Emma Spedding

By Chioma Nnadi

By Tracy Achonwa

Much of my resistance came from my minimal, but nonetheless off-putting, experiences of wheelchair use up to that point. A few years prior, I had been provided with a wheelchair, a clunky medical model. With its high back, heavy frame, and solid tyres, it was nearly impossible for me to push myself. The only thing I liked about the chair was its shiny purple frame, and this was poor consolation for the utter frustration it often caused.

In 2012, everything changed. A charity grant opened up a new and thrilling possibility: a custom wheelchair, lightweight and completely tailored to my needs. Even then, I felt some reluctance. I remember my sister and I passing notes across the backseats of the car as my parents discussed the matter of the chair. I silently scribbled my doubts. She, keen to encourage me, began to draw up plans for the most exciting wheelchair she could imagine: super-fast, colourful, with smiley-face spoke guards. I had no idea how accurate her vision would ultimately turn out to be.

We arrived for my first consultation at Draft Wheelchairs , their small showroom an Aladdin’s cave, unlike anything I had seen before. They had everything: not just the high-end, lightweight day-chairs I was there to try, but racing chairs, basketball chairs, rugby chairs. There was an off-road chair with camouflage upholstery and tyres twice as thick as my arm, and other contraptions I didn’t even recognise.

The staff there were fantastic: fun, sporty types. Many were wheelchair users themselves, skilled racers or wheelchair rugby players. They ribbed me for my garish choice of colour scheme (an electric-blue frame, orange spokes and red front wheels) and indulged me as I played around on every kind of wheelchair imaginable. I had thought that a wheelchair would close up my world, would limit me. But in that showroom, I saw a dozen thrilling futures unfolding all at once.

The moment I finally sat in my own wheelchair for the first time was extraordinary. I was astonished by its lightness, by how keenly attuned it was to even the slightest twitch of movement. It is difficult to explain the unimaginable freedom I felt – suddenly able to move with a half-thought, able to glide across a room in seconds.

It was fortunate, too, that the arrival of the wheelchair coincided with the London Paralympics that year. There had never been a cooler time to be a wheelchair user, and I revelled in it all – watching and rewatching the punchy Channel 4 ads of our “superhuman” Paralympic team, gleefully high-fiving volunteers as I raced through the Paralympic Park, my new chair adorned with Union Jack spoke guards. I was seeing, in real time, the glorious empowerment of mobility aids, the exciting possibility of embracing my Disabled identity in this new, visible way.

That wheelchair – and its adult-sized successor – have taken me to National and International Para-Swimming meets around the country, and on an 800-mile Atlantic voyage on the world’s only wheelchair-accessible tall ship. They have enabled European holidays and visits to Kenya, South Africa, Dubai and India – indeed, on one memorable occasion, the disassembled chair was thrown, wheel by wheel, onto an already-moving Indian train. It has taken me through a degree at the University of Cambridge, into a career as an author and an independent life I once feared would be impossible.

My early worries about being “bound” to the chair also proved unfounded. Roughly one-third of wheelchair users in the UK are ambulatory, and, like them, I can walk a little, and frequently do, despite the incredulous looks this often garners from passersby. I will pull myself out of my chair to take a few steps, or to navigate some other impassable terrain.

This ability, in our inaccessible world, is an undeniable privilege. But it is also only possible because I have the wheelchair to get me there in the first place: conserving my energy, protecting me from pain and injury. Without it, my world would be small.

Clearly, my attitude to wheelchairs has transformed since that early, “upsetting” discussion. I – and my family – are now near-evangelical about the wonders of the wheelchair, and the immeasurable ways it has enriched my life. But I still recognise that little girl in the clinic, her never-ending battle for “independent mobility”. It’s one I am still fighting to this day. I just didn’t realise, then, that my “independent mobility” was right in front of me.

I thought that the wheelchair represented a failure – but I had it backwards. Without the wheelchair, I would have been forced to fail, day after day. With it, I have experienced only victories: joy, adventure, and liberation beyond my wildest imaginings.

Monstrum by Lottie Mills is published by Oneworld on 16 May in hardback.

By Chloe Schama , Taylor Antrim , Marley Marius , Lisa Wong Macabasco , Chloe Malle and Daniel Rodgers

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How Does Society Treat the Disabled People | Essay on Disability

Disability essay: introduction, disability in modern society, how does society treat the disabled person, disability essay: conclusion, works cited.

Disability is a mental or physical condition that restricts a person’s activities, senses or movements. Modern societies have recognized the problems faced by these individuals and passed laws that ease their interactions.

Some people, therefore, believe that life for the disabled has become quite bearable. These changes are not sufficient to eliminate the hurdles associated with their conditions.

The life of a person with a disability today is just as difficult as it was in the past because of the stigma in social relations as well as economic, mobility and motivational issues associated with such a condition.

A person with a disability would live a hard life today owing to the emotional issues associated with the condition. His or her identity would revolve around his or her disability rather than anything else that the person can do.

It does not matter whether the individuals is handsome or talented, like Tom Cruise. At the end of the day, he will always be a disabled man. This attitude obscures one’s accomplishments and may even discourage some people from accomplishing anything.

Other able-bodied individuals would always categorize such a person as a second-class citizen. It would take a lot of will power and resolve to get past these labels and merely lives one’s life. Opponents of this argument would claim that some great inventors of modern society are disabled.

A case in point was Dr. Stephen Hawkings, whose mathematical inventions led to several breakthroughs in the field of cosmology (Larsen 87). While such accomplishments exist, they do not represent the majority.

Persons like Hawkings have to work harder because they have their handicaps to cope with alongside their other scientific work. A disabled scientist is more diligent than a normal one because he has two forms of hurdles to tackle.

It is not common to find such immense willpower in the general population. Therefore, disability leads to a tough life owing to its emotional demands on its subjects.

How the Society Can Be Helpful to the Disabled People

Modern life has created several technologies designed to simplify movement. For instance, modern cities have stairs, trains, cars, doors and elevators to achieve this. However, these technologies are not easy to use for disabled people.

Many of them find that they cannot climb stairs, drive cars or even access trains without help from someone else. Therefore, while the rest of the world is enjoying the benefits of technology, a disabled person would still have to overcome these challenges in order to move from place to place.

Some opponents of this assertion would claim that the life of a disabled person today is unproblematic because a lot of devices have been developed to facilitate movement and other interactions. For instance, a person with amputated legs can buy artificial limbs or use a wheelchair.

However, some of the best assistive technologies for the disabled are quite expensive, and average citizens cannot afford them.

Many of them would have to contend with difficult -to-use devices like wheelchairs, which may not always fit into certain spaces. They would also have to exert themselves in order to use those regular devices.

Social relations are a serious challenge for disabled people today. A number of them live isolated lives or only interact with persons who have the same condition. Social stigma is still rife today even though progress has been made.

Friends would simply be unwilling to dedicate much of their free time to help this disabled person move. Additionally, finding a life partner or marrying someone would also be a laborious process because of the physical and psychological implications.

If one’s handicap is physical, and affects their kinetics, then they would not engage in sexual activity.

Alternatively, psychical deformities may be off putting as many individuals find them sexually unattractive. These social stigmas can impede a disabled person’s ability to enjoy normal relationships with others.

Economic hurdles are also another cause of unfulfilled lives amongst the disabled. Some jobs do not require an investment in one’s image, so these would be tenable for the disabled. However, a number of positions take into account one’s physical image.

These include television anchoring, sports, politics, and even sales jobs. The practical demands of these jobs, such as sales and sports, would not allow a disabled person to engage in them meaningfully.

Alternatively, the positions may also place too much emphasis on physical appearance to the point of making disabled persons unsuitable for them. While the latter might seem like discrimination, it is a given fact that the world is increasingly becoming superficial.

Companies only want to focus on what sells, so they have little time to be proactive or fair. In essence, these attitudes close the door t many opportunities for the disabled as they pigeonhole them into passive professions.

Modern societies have not eradicated the obstacles that persons with disabilities face. This is evident in their attitudinal inclinations as most of them reduce a disabled person’s identity to their inability rather than their accomplishments.

Difficulties in mobility and use of technology among the disabled also testify to their hardships. Social stigma concerning their physical attractiveness and demands in friendships also limit their social relationships.

Finally, their economic prospects are neutralized by their mobility challenges as well as their physical image. All these hurdles indicate that disability causes its victims to live painstaking lives.

Larsen, Kristine. Stephen Hawking: A biography . Westport, Connecticut: Greenwood Publishing, 2007. Print.

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IvyPanda . 2019. "How Does Society Treat the Disabled People | Essay on Disability." July 4, 2019. https://ivypanda.com/essays/disability-in-modern-society/.

1. IvyPanda . "How Does Society Treat the Disabled People | Essay on Disability." July 4, 2019. https://ivypanda.com/essays/disability-in-modern-society/.

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IvyPanda . "How Does Society Treat the Disabled People | Essay on Disability." July 4, 2019. https://ivypanda.com/essays/disability-in-modern-society/.

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• Published: 11 March 2024

An autonomous wheelchair with health monitoring system based on Internet of Thing

• Lei Hou 1 , 2   na1 ,
• Jawwad Latif 1   na1 ,
• Pouyan Mehryar 1 ,
• Stephen Withers 3 ,
• Angelos Plastropoulos 3 ,
• Linlin Shen 4 &
• Zulfiqur Ali 1  

Scientific Reports volume  14 , Article number:  5878 ( 2024 ) Cite this article

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Assistive powered wheelchairs will bring patients and elderly the ability of remain mobile without the direct intervention from caregivers. Vital signs from users can be collected and analyzed remotely to allow better disease prevention and proactive management of health and chronic conditions. This research proposes an autonomous wheelchair prototype system integrated with biophysical sensors based on Internet of Thing (IoT). A powered wheelchair system was developed with three biophysical sensors to collect, transmit and analysis users’ four vital signs to provide real-time feedback to users and clinicians. A user interface software embedded with the cloud artificial intelligence (AI) algorithms was developed for the data visualization and analysis. An improved data compression algorithm Minimalist, Adaptive and Streaming R-bit (O-MAS-R) was proposed to achieve a higher compression ratio with minimum 7.1%, maximum 45.25% compared with MAS algorithm during the data transmission. At the same time, the prototype wheelchair, accompanied with a smart-chair app, assimilates data from the onboard sensors and characteristics features within the surroundings in real-time to achieve the functions including obstruct laser scanning, autonomous localization, and point-to-point route planning and moving within a predefined area. In conclusion, the wheelchair prototype uses AI algorithms and navigation technology to help patients and elderly maintain their independent mobility and monitor their healthcare information in real-time.

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Introduction.

An electric-powered wheelchair (EPW) is an assistive technology solution for people with motor disabilities, which gives them independent mobility. An estimated 65 million people worldwide need a wheelchair 1 , and the number of people who are in need of a wheelchair is estimated to increase over 22% in the next decade 2 . There is a high level of demand for wheelchair services for the elderly that is difficult to meet.

The research on EPW started around the 1980s. The prototype wheelchair allowed a person to maneuver within an office building 3 . Since then, many EPWs have been developed and commercialized, such as TinMan 4 , NavChair 5 , Maid 6 , and SPAM 7 to provide users indoor mobility. However, the traditional type of EPW was controlled by a joystick and was difficult to maneuver by patients with complicated disabilities and mobility impairment due to cerebral palsy, cognitive impairment, and fatigue 8 . For example, patients with Parkinson’s disease often lack the cognitive and physical skills to maneuver the EPW due to perceptual impairments. A study of 65 clinicians reported that between 10 and 40% of their patients could not be equipped with EPW due to sensory disabilities, impaired mobility, or cognitive deficits. These impairments made it difficult to operate a wheelchair safely with the current control functions 9 . Consequently, those individuals who cannot maneuver an EPW independently and safely must be seated in a manual wheelchair and pushed by a caregiver. To solve these problems, academics improved the design of the EPW in three main areas: the assistive technology mechanics, physical interface, and power shared control between the user and the wheelchair 10 , 11 .

Currently, most autonomous wheelchairs are modified by existing commercially available EPW, with additional facilities to improve maneuverability, locomotion, localization, navigation, and control interface 12 . The smart autonomous wheelchairs have been trialled in hospitals and airports.

In 2016, two prototype autonomous wheelchairs developed by the Singapore-MIT Alliance for Research and Technology Centre were tested in a hospital of Singapore to navigate the hospital’s hallways 13 . The prototype wheelchair created a path map using data from three Lidar sensors. The location of the wheelchair on the map is determined using a localization algorithm. In 2017, an autonomous wheelchair embedded with LIDAR sensors was proposed by Harkishan 14 . This wheelchair can navigate to predefined locations in an unstructured environment. Another model WHILL autonomous wheelchair was developed in 2017 by Panasonic and Whill 13 . This type of wheelchair was premiered at Haneda Airport in Tokyo with further trials in Amsterdam’s Schiphol airport, Abu Dhabi airport and north American airports since 2018 15 . However, these prototypes can only take passengers to predefined locations within the airport or hospital. The maximum luggage carrying capacity of four kilograms cannot fulfill the baggage requirements for most passengers. In addition to autonomous driving, assistive biophysical sensors can be integrated into the wheelchair to check passengers’ vital signs before use.

A robot operating system was used in an autonomous wheelchair for individuals who have difficulty in controlling movements by Grewal 16 . He employed only 2D laser scanners to design a mapping system that enabled the wheelchair to move autonomously. The same approach was used by Wang 17 , but the sensor offered large degree measurements in a narrow space. On the other hand, Surmann utilized a rotatory mechanism and a 2D LiDAR scanner to create a 3D environment map for anti-collision system. Nonetheless, the solution may be insufficient to ensure the safety of the wheelchair user 18 . Furthermore, a wheelchair system developed by Andre can transport inpatients autonomously to their departments by integrating with the hospital information system 19 . However, using this system for private transportation may be challenging, as it requires specific location and path information for departments in the hospital.

Electrically powered wheelchairs should not only provide mobility for advanced stages of disability but also integrate with assistive technology to offer better clinical care. Chronic diseases, such as arthritis, asthma and coronary heart disease, are becoming more prevalent among the elderly and place a high demand for healthcare services 20 . A wheelchair health monitoring system with routine tests can be a cost-effective way for clinicians and caregivers to manage chronic conditions in their patients 21 . The remote monitoring system can improve the management of chronic condition transparency and quality of care for patients while reducing the burden on healthcare facilities, emergency situations, and re-admissions. For example, a biomedical sensing system was integrated into a prototype wheelchair to record users’ pulse rate, respiratory rate and motion states 22 . However, the signal communication and autonomous system were limited by Wi-Fi signals and not viable for outdoor scenarios. Based on that prototype, a home healthcare system for wheelchair users was proposed to connect more sensors in a prototype wheelchair. Similar work was proposed to develop an Intelligent Robotic Wheelchair (iRW) 23 that integrates telehealth systems to collect vital signs of users in real time. However, there is no effective analysis of these healthcare signals which can be used for remote diagnosis by doctors.

One of the significant limitations for the autonomous telehealth wheelchair is the battery life. The operating of biophysical sensors embedded in the wheelchair is limited by various resources, such as power supply, memory storage and processing capabilities 24 , 25 . Continuous monitoring sensors produce a large amount of data and consume significant storage memory and transmission power. According to a survey 26 , nearly 80% of the power is consumed during the transmission of data in each sensor node. Therefore, it is essential to develop a lower power design to make the battery last longer. Data compression in sensor nodes before the data transmission provides an adequate method to reduce the size of data. The performance of various data compression algorithms is evaluated based on dataset types.

Lempel–Ziv–Welch (S-LZW) data compression algorithm uses structured data to reduce substantial energy consumption 27 . However, S-LZW is a dictionary-based algorithm that occupies memory for calculation, so it is not suitable for sensors with restricted RAM 25 . Another compression algorithm of Run Length Encoding (RLE) works by removing duplicate data values. Based on RLE, K-RLE was developed to achieve a better compression ratio 28 . Meanwhile, because it concentrates on computing floating-point data, the Minimalist Adaptive and Streaming (MAS) method was recommended as resource efficient 29 . Among them, MAS and S-LZW algorithms have been widely applied in real-time sensing applications, such as monitoring wind speed, rainfall, temperature, humidity, soil moisture, pressure, and battery level 24 , 30 . The reduction of power consumption during data transmission of the MAS algorithm is between 53.55 and 55.95%, while that of the S-LZW is between 23.41 and 33.97%. To further improve the data compression ratio during transmission, the Minimalist, Adaptive and Streaming R-bit (O-MAS-R) algorithm was proposed.

In this paper we propose an intelligent autonomous wheelchair (iChair) integrated with telemedicine sensors based on IoT, and the architecture of the wheelchair system is shown in Fig.  1 . Various sensors including wireless location, position accelerometer, seat cushion sensors, and biophysical sensors are embedded in the wheelchair to collect users’ physiological and behavioral data in real time. At the same time, an improved data compression algorithm Minimalist, Adaptive and Streaming R-bit (O-MAS-R), is also proposed to achieve a higher compression ratio during the data transmission. To visualize and analyze the data, a user interface was developed to provide telediagnosis, advice and alert to users and caregivers using artificial intelligence algorithms.

The architecture of the smart wheelchair system. A portable wheelchair is equipped with sensors, cameras, and screens. The data acquisition system processes, compresses and uploads the measurements from biophysical sensors. A MATLAB graphic user interface allows users and doctors access and diagnose the health information in real-time 31 .

Wheelchair monitoring interface

The handrail of the wheelchair system included three biophysical sensors: pulse oxygen (SpO 2 ), blood pressure, and temperature sensors to collect and transmit four kinds of vital signs from users (blood oxygen levels, pulse rate, blood pressure and temperature) 31 , as depicted in Fig.  2 .

The prototype of the smart wheelchair consists of a controller box, laser sensors, power system, screens, and biophysical sensors 31 .

On the wheelchair as shown in Fig.  2 , there are two monitoring interfaces to provide feedback to users: the large screen interface and the handrail screen as depicted in Fig.  2 . The screen installed on the handrail of the wheelchair and the remote GUI are for data classification, visualization, and analysis.

The information includes data initialization, measurement, upload status to the cloud, and transmission completion. The duration for each process results in a 40-s cycle, with each set lasting 10 s. The display shows a countdown for each phase, and the timing allows the data from all three biophysical sensors to finish transmitting.

The GUI, developed in MATLAB and shown in Fig.  3 allows users to download, inspect, and analyze the cloud-stored data once it finishes uploading. In the user interface, access to users’ healthcare data requires a unique Patient Identity number (PID) assigned to each user before experiments. The warning system uses three colors to flag conditions: red, yellow, and blue. The red indicates that the gathered data is above the upper threshold, the yellow shows the data is below the lower threshold, and the blue indicates the measured data is within the thresholds.

The iChair monitoring interface. The GUI comprises four main sections: patient information, last update, vital signs, and inspection. It allows users and doctors to download and analyze cloud-stored data as well as inspect the data being recorded in real-time.

Figure  3 shows the iChair monitoring interface comprising four main sections: patient information, last update, vital signs, and inspection. The last update section shows the most recent collecting date and time from the user, and the users’ vital signs appear in the vital signs section. In the inspection section, users can see an aggregated display of their specific vital sign’s information in the past.

Data compression algorithm

Both MAS and O-MAS-R compression algorithms were applied to five ECG datasets, twelve EMG datasets, and three accelerometer datasets to evaluate the approaches effectiveness. Figure  4 depicts the compression ratio performance.

The compression ratio results of MAS and O-MAS-R algorithms are shown in ( a – c ), in each figure, x-axis shows the group number, and y-axis is the compression ratio. The average ratio increase of the O-MAS-R algorithm over MAS is shown in ( d ). The compression ratio of ( a ) five ECG datasets, ( b ) twelve EMG datasets and ( c ) three accelerometer datasets are demonstrated.

In Fig.  4 a, the compression results of MAS and O-MAS-R algorithms applied to five ECG datasets are demonstrated. The data in ECG datasets is assigned integer type with two bytes per sample. Each ECG dataset comprises 3,600 samples that occupy 7,200 bytes of memory. Among the simulation results, the group three of O-MAS-R algorithm shows the greatest compression ratio of 20.54%, while the MAS algorithm is 12.47%. For each group, the O-MAS-R method achieves compression ratios of 19.86%, 19.13%, 20.54%, 18.78%, and 18.26% respectively. Meanwhile, the MAS algorithm demonstrates compression ratios of 11.9%, 11.57%, 12.47%, 12.32% and 12.28% respectively.

In Fig.  4 b, EMG data of twelve muscle activities during treadmill walking have been compressed by the MAS and O-MAS-R algorithms. The EMG values are float type that contains 4 bytes per sample. Each EMG dataset comprises 15,000 samples that occupy 60,000 bytes of memory. The RF activity shows the highest O-MAS-R compression ratio of 39.85%, while the MAS is 31.26%. For each group, the O-MAS-R algorithm achieves compression ratios of 39.85%, 35.44%, 34.74%, 39.5%, 35.58%, 36.4%, 33.21%, 36.01%, 39.33%, 35.71%, 35.86% and 37.87% respectively. Meanwhile, the MAS algorithm demonstrates compression ratios of 31.26%, 26.41%, 26.07%, 30.8%, 27.07%, 27.62%, 25.95%, 28.53%, 31.18%, 28.27%, 28.41% and 28.95% respectively.

In Fig.  4 c, the compression algorithms have been applied to three accelerometer datasets. The data type in the dataset is float type and contains 4 bytes per sample. Each Accelerometer dataset has 15,000 samples that take 60,000 bytes of memory. For each group, the O-MAS-R algorithm achieves compression ratios of 84%, 83.83%, and 83.76% respectively. Meanwhile, the MAS algorithm demonstrates compression ratios of 38.83%, 38.28%, and 38.77% respectively.

For all the datasets, O-MAS-R compression algorithm demonstrates a better performance. The average increase of O-MAS-R over MAS is shown in Fig.  4 d. The accelerometer datasets of O-MAS-R algorithm shows the greatest increase of 45.25% over the MAS algorithm. The average increases of compression ratios for ECG, EMG, and Acc datasets are 7.21%, 8.26%, and 45.25%, respectively.

According to the Spyder platform's profiler tool, the encoding function of the MAS and O-MAS-R algorithms in compressing ECG dataset values took 20.28 µs and 25.69 µs, respectively. However, the repetition of data, on the other hand, resulted in fewer calls to the encoding function in the O-MAS-R algorithm, which decreased the overall run time of the O-MAS-R algorithm. The total run time for the MAS and O-MAS-R algorithms applied in ECG dataset were 79.37 ms and 73.04 ms, respectively. Similarly, the encoding function of the MAS and O-MAS-R algorithms in compressing Accelerometer dataset values took 18.90us and 19.25 µs, respectively. However, due to high frequency of repetitions of data in accelerometer dataset, the total run time for O-MAS-R encoding algorithm is significantly reduced from 283.53 to 71.67 ms 25 .

MATLAB graphic user interface (GUI)

This paper discusses the smart wheelchair prototype and the three integrated biophysical sensors used to collect four vital health indicators from users. It also discusses the MATLAB GUI software designed to synchronize and download the patients’ healthcare data for diagnosis and analysis.

The preliminary experiments, five participants were involved in the clinical trials, and healthcare data was collected for 5–10 mins for each user. Figure  5 a–d demonstrates the results.

Four types of vital signs from five participants were monitored: ( a ) finger temperature, ( b ) pulse rate, ( c ) blood oxygen levels, and ( d ) blood pressure. Each column represents a single measurement, and the group of columns represents the results from a single participant. The gap between each column is the time spent uploading the measurements.

Figure  5 a documents the five participants whose finger temperatures were measured and recorded. The x-axis is the measurement time, and the y-axis is the measured temperature in Celsius (°C). Before taking the measurements, participants were advised to place their forefinger on their wrist for a minute to equalize the temperature. An upper threshold of 37 °C was set as it was considered as the average normal body temperature. Among the participants, users four and five had a slightly higher temperature than normal, and thus the column automatically turned red following the three-color system.

As seen in Fig.  5 b, the five participants’ pulse rate were recorded with the upper threshold set to 120 bpm. The results revealed one participant had a higher average pulse rate than the other participants. Figure  5 c depicts the blood oxygen saturation level (SpO 2 ) for each participant. The lower limit of SpO 2 was set at 90%, as any number below that represents hypoxemia, and poses a variety of complications 32 . Therefore, the level of SpO 2 is a highly useful approach for measuring health conditions 32 . Figure  5 d shows the participants’ systolic and diastolic blood pressures in the top and bottom rows, respectively. The upper threshold for systolic blood pressure is 120 mmHg, while the upper threshold for diastolic blood pressure is 80 mmHg. The results indicate that participant three had unreasonably high systolic blood pressure on certain tests, and participant five had high systolic blood pressure and diastolic blood pressure. The three-color system automatically marked the column for high blood pressure data in red.

iChair autonomous driving

The autonomous driving experiments were conducted in the factory testing area 33 . We described the smart wheelchair safety and obstacle detection system in our previously published papers 31 . Based on that system, the wheelchair was improved to travel autonomously from point to point inside a lager and obstacle completed area. An Android-based smartphone app iChair was developed to control and tracks the entire driving progress depicted in Fig.  6 .

The smart wheelchair autonomous driving and control. ( a ) An engineer sits in the wheelchair and controls it using the iChair app. ( b ) The navigation panel with the iChair app control information, while ( c ) depicts the mapping information of the enclosed area.

There are three main sections in the iChair app: bio-medical, navigation and mapping. The biomedical section displays the collected bio-sensory data, the navigation section links the wheelchair to the app and controls its movement, and the mapping section displays the wheelchair's real-time location.

In Fig.  6 a, an engineer sits in the wheelchair and controls it using the iChair app. To perform autonomous driving well, the iChair must be in a pre-scanned, enclosed environment, achieved by recording the surrounding information into the map using the data from LIDAR sensors. As shown in Fig.  6 c, the app remembers its scanned path of the office, the start and stop coordinates, and the blue dots provides the position of the wheelchair. The red and grey dots, in addition to the lines, are the LIDAR sensors reflecting signals that represent the barriers along the path. Once the scanned map saves, the iChair will link with the app to perform the autonomous driving as shown in Fig.  6 b. As a result, the user can enter the start and stop coordinates from the Android app or directly through the ROS network as separate position names. By clicking different positions in the app panel, the wheelchair will drive to the location autonomously.

During the reliability tests, the iChair navigated to various predetermined locations using automated driving scripts. It successfully operated for five hours until the battery ran out of power. Wooden boards were used to modify the configuration of the path during the mobility tests to determine the maximum capacity of the system to maneuver. The results show that the iChair could pass through a minimal gap of 0.85 m and can operate in at least 1.2 m wide corridors. The maximum speed that the wheelchair could move in an unmapped area while accounting for unknown obstacles was 0.2 m/s.

Patients who cannot safely and independently operate an Electric Powered Wheelchair (EPW) must be seated in a manual wheelchair and pushed by a caregiver. An autonomous telemedicine wheelchair is one solution to overcoming the cognitive and physical challenges and improve independence for those users 34 . It not only takes people to their desired location but also assesses their physical location, status conditions and vital bio-signs in real-time. This data will help them manage and prevent chronic diseases in the long term.

The paper proposes a smart wheelchair equipped with three biophysical sensors and a novel Internet of Thing (IoT) compression algorithm that monitors and assesses users' physiological and behavioral data in real-time. The iChair design should prioritize simplicity in control to minimize usage barriers, especially for patients who require assistance. They may initially struggle with or forget to use some of the features. To address the issue, the wheelchair controls should be similar to EPWs on the market, facilitating their usage habits. The central screen can serve as a user-friendly dashboard, displaying the patient's current status, providing prompts for necessary measurements, and offering easy navigation to desired locations. It serves as an interface for users to interact with the iChair smoothly. Due to the wheelchair being integrated with advanced components, algorithms, and sensors, if it is deployed in the market on a large scale, maintenance may require specific technical skills. To mitigate this issue, the system should support remote monitoring and diagnostic tools for spotting issues early. It also provides detailed documents with best practices and maintenance guidelines. Lastly, regular training for maintenance staff can be conducted to ensure they can handle any problems effectively.

The smart wheelchair can further develop as a proprietary medical device for autonomous health monitoring and navigation. For example, it will offer those affected by Parkinson’s disease the ability to proactively manage their chronic condition, and help them avoid fainting, which are considered the most common diagnosis for patients attending emergency departments. It will also help maintain their mobility. The artificial intelligence algorithms incorporated into the wheelchair will analyze sensor data and provide feedback in real-time to the user and clinicians on any potential risks to the patient, such as the experience of a sharp and unexpected drop in blood pressure, causing dizziness and an increased risk of fainting. With the assistant of the smart wheelchiar, the ratio of carers to patients can be increased from 1:2.5 to 1:4 or 1:5 for completely disabled people, allowing the cost of carers to be reduced by up to CNY 15–18 k per year. The wheelchair system is estimated to be priced at CNY 8000 (~ £920), and the retrofitted system is priced at CNY 3000 (~ £345). In the UK market, the cost of the systems will be £2500 and £500, respectively.

During the trials, the system could only process up to three sensors simultaneously, because of the microcontroller’s restrictions in supporting concurrent sensor readings from one group of sensors (analog, UART, Bluetooth) to one interface (TFT, Bluetooth, Wi-Fi) 35 . The constraint may limit the system's coverage of health conditions, especially when managing chronic diseases that involve monitoring multiple health indicators. These problems could be optimized by implementing intelligent algorithms that prioritize and cycle through different sets of sensors over time, ensuring continuous monitoring of key health parameters relevant to chronic conditions. Additionally, adapting the system to support sensor modularity and sensor fusion technologies would enable the integration of more sensors. The detecting sensors integrated into the microcontroller could expand to eighteen different functions, including features such as snore monitoring, temperature readings, glucometer readings, ECGs, EMGs, breath monitoring, SpO 2 , blood pressure, airflow, body position, emergency alarms, and room thermometer, providing a more comprehensive view of the patient's health status.

Health monitoring sensors, such as heart rate, blood pressure and temperature sensors, need to be strategically placed for accurate readings while considering user comfort. Integrating sensors without interfering with wheelchair controls is critical. Thus, for the convenience of our wheelchair design, the temperature sensor was placed on the handrail to detect users’ fingers, palm and wrist temperature. However, we acknowledge that environmental factors influencing temperature in these areas may cause variations in sensor readings. Further improvements involve implementing adaptive calibration algorithms that dynamically adjust temperature readings based on environmental conditions. Additionally, to extend the functionality of the wheelchair, certain sensors can be integrated as conformable and wearable patches on the body and be easily removable modular elements. The integration of multiple sensors, including non-contact sensors on the screen, could be applied to offer a comprehensive approach.

However, the effectiveness of the O-MAS-R compression algorithm may be specific to the types of data used in the study. The performance might vary when applied to different types of datasets beyond the scope of the initial experiments. Additionally, the study demonstrated positive results under controlled conditions, but real-world scenarios can be more complex. Factors such as signal interference, hardware malfunctions, or variations in environmental conditions could affect the actual performance of the proposed model.

Further research can focus on optimizing the compression algorithm for diverse sensor data types, ensuring it maintains efficiency across a wide range of physiological parameters. Extensive validation studies can be conducted in diverse healthcare settings, such as different patient demographics, environmental conditions, and healthcare practices. Moreover, the algorithm can be further integrated with advanced healthcare AI models for automated monitoring and forecasting of users' physiological conditions and diseases.

To explore the EPW with other sensors for more functionalities, previous work by Shen et.al., 36 extend  the scope of the work. This extension includes a face-recognition screen with a camera on the left handrail of the wheelchair. This innovative approach aims to evaluate users' long-term cardiovascular conditions based on facial information, utilizing a CHD evaluation algorithm published by Shen 36 . First, sixty-eight face feature points and ears from patients’ face images were collected. Based on their coordinates, six regions of interests (ROI) were extracted: left canthus, right canthus, left crowsfeet, right crowsfeet, nose bridge and forehead 36 . Then, a gray-level co-occurrence matrix algorithm was applied to the ROIs to extract and analyze their texture features. Lastly, the random forest and decision tree classification methods were applied to predict the risk of CHD.

In the paper, 1528 facial images were captured from 309 subjects, comprising 226 males and 83 females 36 . Among them, 195 patients have coronary heart disease. Each patient had at least three face images collected: front, left, and right faces. By adopting features into the models, the random forest algorithm had a maximum accuracy of 72.73% in identifying patients with CHD, while the decision tree model had a maximum accuracy of 70.45%. The results demonstrated that facial images can be an effective method of detecting patients with CHD, with an accuracy rate of above 70%. The algorithm will be embedded into the wheelchair's screen to monitor the user’s coronary health condition over time.

In the paper, we demonstrated that the proposed use of the O-MAS-R compression algorithm maintained a greater compression ratio than the MAS algorithm at a 53% reduction in data transmission power consumption 24 . As the compression ratio is directly proportional to data transmission power usage, implementing the O-MAS-R algorithm in wireless sensor network sensor nodes will result in even lower data transmission power consumption 25 . This approach uses the least amount of memory to store and transmit data by reducing consecutively repeated data values. This functionality is particularly useful in dealing with healthcare data. However, the effectiveness of the O-MAS-R compression algorithm may be specific to the types of data used in the study. The performance might vary when applied to different types of datasets beyond the scope of the initial experiments. Additionally, the study demonstrated positive results under controlled conditions, but real-world scenarios can be more complex. Factors such as signal interference, hardware malfunctions, or variations in environmental conditions could affect the actual performance of the proposed model.

This paper documents and evaluates the obstacle avoidance, human–machine interaction, and point-to-point autonomous driving of the smart wheelchair. Currently, the intelligent wheelchair can only drive autonomously in a pre-scanned enclosed area because the only way to calculate the optimal route between any two locations requires the system to store localized data from the laser sensors. However, once scanned, the stored maps and routes can be shared with other wheelchairs for collaborative driving.

For wheelchair users with limited mobility, safety is the top priority. Unmapped areas may have construction zones, temporary obstacles, changes in road conditions, lacking lane markings and road signs, which can cause severe dangers to the wheelchair's autonomous driving. Therefore, the autonomous driving function will be deactivated in unmapped areas. Users have to rely on the manual control of the wheelchair to ensure safety. Additionally, to ensure safety for wheelchair users, we conduct thorough testing to validate the system's performance under different conditions, ensuring robustness and safety. We implement redundant sensor systems, the obstacle avoidance system, to ensure the vehicle can rely on multiple sources of information, mitigating the risk of sensor failures and avoiding collisions. A software filter that used LIDAR sensor data successfully hid the user’s legs from the scan data to minimize blind spots. Increasing the use of obstacle detection over a wider range reduced the remaining blind spots discovered around the four corners of the wheelchair.

The smart autonomous wheelchair will assist disabled and elderly patients by allowing them to pick locations on their phones and drive independently and autonomously. It will reduce their dependency on caregivers and family members while also eliciting feelings of self-reliance. Therefore, the wheelchair has potential uses in nursing homes, hospitals, communities, airports, and shopping malls. In hospitals and nursing homes, the wheelchair will work in conjunction with the other infrastructure, such as elevators, ward doors, and automated doors to complete easy point-to-point and ward-to-ward mobility. The telemedicine diagnosis from the wheelchair will complete the initial evaluation of vital sign measurements at the hospital’s entrance and then continually monitor those patients.

In this paper we proposed a smart autonomous wheelchair (iChair) that integrates with telemedicine sensors based on IoT. The wheelchair, controlled by a mobile app, achieved point-to-point autonomous driving within a predefined area with and without obstructions. Various sensors, including wireless location, position accelerometer, seat cushion sensors, and biophysical sensors embedded in the wheelchair, collected users’ physiological and behavioral data in real-time. This comprehensive data was extracted, transformed, and uploaded to a cloud platform for storage. An improved data compression algorithm, Minimalist, Adaptive and Streaming R-bit (O-MAS-R) will likely achieve a higher compression ratio during the data transmission. Performance of MAS and O-MAS-R was evaluated in healthcare applications such as ECG, EMG, and accelerometer datasets. The designed user interface allowed users and their caretakers or doctors to see and analyze the data using the artificial intelligence algorithm to receive telediagnosis, advice and alerts. The interface also allowed users to track and diagnose long-term health issues with similar algorithms and makes it easier for medical professionals to diagnose probable health conditions in the patients.

System architecture

The robotic wheelchair system was designed based on the research of our previously published papers 31 .

The wheelchair prototype modified and improved upon the Titan-LTE powered wheelchair 37 and integrated with the DMC60C digital motor controllers 38 to allow wheelchair manipulation both manually and autonomously. The new components include DC motor controllers, a Jetson Nano developer kit, an Inertial Measurement Unit (IMU), a joystick module, two light detection and ranging sensors (LIDAR), and a 3D printed shield were incorporated into the wheelchair and allowed users to operate the wheelchair via a mobile app. These integrated components communicated with each other by a central Controller Area Network (CAN). The joystick module was a custom-made unit that used a potentiometer joystick with access to the CAN enabled microcontroller.

The Jetson module included Wi-Fi capability, which allowed the entire wheelchair system to be linked to a wireless Android application. The software that enabled mobility assistance and autonomous driving was written in C++. The sensors connected to the Jetson Nano development kit used Robot Operating System middleware (ROS). It implemented a navigation stack and custom configurations for obstacle avoidance. The stack consisted of specially developed modules, including a localization module and a mapping module. The packages for reading the joystick, movement aid, and motor control were developed while the autonomous movement was powered by an open-source navigation. The Timed Elastic-Band (TEB) route planner 30 enabled path planning optimization to ensure smooth and safe mobility in the iChair system. It also included two laser sensors 31 mounted on the front of the wheelchair to help ensure obstruct avoidance.

The microcontroller used by the data acquisition unit was an Arduino component 39 , while the biophysical sensors were MySignals packages 35 . Consequently, we designed a converter microcontroller to resolve the incompatibility between the Arduino and MySignals system. The ThingSpeak 40 cloud platform was used to allow users to view, download and analyze the stored data. We also developed a new MATLAB graphic user interface (GUI) to help users and doctors access and diagnose health information in real-time.

Data communication and compression

We introduced the proposed Minimalist, Adaptive and Streaming R-bit (O-MAS-R) data compression algorithm in our previously published papers 25 , 31 . The improvements made to the MAS algorithm allowed for a decrease in the sequential repeating of data values, which lead to a higher compression ratio. Equation ( 1 ) represents the floating data format of the O-MAS-R data compression algorithm.

where nnn is the length of the input data in binary format, eee represents the position of the decimal point for the input data from left to right. Additionally, ns shows whether the input value is positive or negative, and the proposed R-bit represents the consecutive repetition of input digits.

The algorithm calculates up to seven input digits. The repetition input value from the subsequent input data sets the R digit to 1. When there is no repetition, R is 0. The number of R-bits increases as the number of consecutive repetitions of input data increases. The decoding process outputs the same value until it reads 0. Similarly, Eq. ( 2 ) represents the O-MAS-R encoding format for the integer value.

To distinguish between integer and floating-point data, the first three digits 000 indicated the input data is integer and eee bit is removed. The repetition digit R-bit indicates if the following data is the same as the current value.

The following describes the detailed encoding and decoding process of data. When the sensor nodes send out data, the algorithm determines if the value is an integer or float number. When the value is a float number, the data value compresses using the float encoding format described in Eq. ( 1 ). In contrast, when the value is an integer, the integer encoding format [Eq. ( 2 )] compresses the data. Following data encoding, an R-bit will append to the end of the format dependent on the repetition of the next data value. If the value is the same as the present value, the R-bit is 1. If not, the R-bit value is 0. For the data decoding progress, the software reads the first data value and examines the R-bit to determine whether the upcoming value is the same as the current value. If the R-bit is 1, the upcoming value is treated as the same as the current one. The method keeps reading R-bit until it equals 0.

Both the MAS and O-MAS-R were implemented across three healthcare datasets: electrocardiography (ECG), surface electromyography (sEMG), and accelerometer-based events (Acc) to assess the efficacy of the data compression methods. Scripts for data compression algorithms were simulated in Spyder (Python 3.7). The compression ratio was determined by dividing the dataset’s compressed size by its original size, as indicated in Eq. ( 3 ). The higher the compression ratio, the better the data compression algorithm would perform.

Five ECG datasets 41 , twelve EMG datasets 42 , and three accelerometer datasets 43 were obtained from the MIT-BIH Arrhythmia Database 44 , with a sampling frequency of 360 samples per second and an 11-bit resolution. Additionally, sEMG datasets were recorded at 1.5 kHz, corresponding to 12 lower limb muscles in a healthy subject during treadmill walking. These muscles include rectus gemoris (RF), vastus lateralis (VL), gracilis (GR), biceps femoris long head (BFLH), tensor fasciae latae (TFL), Vastus medialis (VM), Tibialis Anterior (TA), Soleus (SOL), Gluteus Medius (GMD), gastrocnemius lateralis (GL), gastrocnemius medialis (GM) and semitendinosus (SEM) 44 . Lastly, datasets from three-axis accelerometers were selected and evaluated at a frequency of 120 Hz.

Ethical approval

This study was approved by the Innovative Technology and Science Ltd on 2020.06. We affirm that all experiments were conducted in compliance with the experimental guidelines and regulations established by the Innovative Technology and Science Ltd.

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Labbé, D., Ben Mortenson, W., Rushton, P. W., Demers, L. & Miller, W. C. Mobility and participation among ageing powered wheelchair users: Using a lifecourse approach. Ageing Soc. https://doi.org/10.1017/S0144686X18001228 (2020).

Article   Google Scholar  

Kaye, H. S., Kang, T. & LaPlante, M. P. Mobility device use in the United States. Disabil. Stat. Rep. 14 , 1–10 (2000).

Google Scholar  

Madarasz, R. L., Heiny, L. C., Cromp, R. F. & Mazur, N. M. The design of an autonomous vehicle for the disabled. IEEE J. Robot. Autom. https://doi.org/10.1109/JRA.1986.1087052 (1986).

Miller, D. P. & Slack, M. G. Design and testing of a low-cost robotic wheelchair prototype. Auton. Robots https://doi.org/10.1007/BF00735440 (1995).

Levine, S. P. et al. The navchair assistive wheelchair navigation system. IEEE Trans. Rehabil. Eng. https://doi.org/10.1109/86.808948 (1999).

Article   PubMed   Google Scholar  

Prassler, E., Scholz, J. & Fiorini, P. A robotic wheelchair for crowded public environments. IEEE Robot. Autom. Mag. https://doi.org/10.1109/100.924358 (2001).

Simpson, R. et al. A prototype power assist wheelchair that provides for obstacle detection and avoidance for those with visual impairments. J. Neuroeng. Rehabil. https://doi.org/10.1186/1743-0003-2-30 (2005).

Article   PubMed   PubMed Central   Google Scholar  

Simpson, R. C., LoPresti, E. F. & Cooper, R. A. How many people would benefit from a smart wheelchair?. J. Rehabil. Res. Dev. https://doi.org/10.1682/JRRD.2007.01.0015 (2008).

Fehr, L., Langbein, W. E. & Skaar, S. B. Adequacy of power wheelchair control interfaces for persons with severe disabilities: A clinical survey. J. Rehabil. Res. Dev. 37 , 3 (2000).

Simpson, R. C. Smart wheelchairs: A literature review. J. Rehabil. Res. Dev. https://doi.org/10.1682/JRRD.2004.08.0101 (2005).

Tomari, M. R. M., Kobayashi, Y. & Kuno, Y. Development of smart wheelchair system for a user with severe motor impairment. Procedia Eng. https://doi.org/10.1016/j.proeng.2012.07.209 (2012).

Prassler, E., Scholz, J. & Fiorini, P. A robotic wheelchair for crowded public environments. IEEE Robot. Autom. Mag. 8 (1), 38–45. https://doi.org/10.1109/100.924358 (2001).

Scudellari, M. Self-driving wheelchairs debut in hospitals and airports [news]. IEEE Spectr. https://doi.org/10.1109/mspec.2017.8048827 (2017).

Grewal, H., Matthews, A., Tea, R. & George, K. LIDAR-based autonomous wheelchair. in SAS 2017 IEEE Sensors Applications Symposium, Proceedings . https://doi.org/10.1109/SAS.2017.7894082 (2017).

Fisher, R. WHILL Has Brought Autonomous Wheelchairs to Airports in North America . (2019). https://globalshakers.com/whill-has-brought-autonomous-wheelchairs-to-airports-in-north-america/ . Accessed 28 Sept 2023.

Grewal, H., Matthews, A., Tea, R. & George, K. LIDAR-based autonomous wheelchair. in Proceedings of the 2017 IEEE Sensors Applications Symposium (SAS) (2017).

Wang, Y., Ramezani, M. & Fallon, M. Actively mapping industrial structures with information gain-based planning on a quadruped robot. in Proceedings of the 2020 IEEE International Conference on Robotics and Automation (ICRA) , 8609–8615 (2020).

Surmann, H., Nüchter, A. & Hertzberg, J. An autonomous mobile robot with a 3D laser range finder for 3D exploration and digitalization of indoor environments. Robot. Autonom. Syst. 45 , 181–198. https://doi.org/10.1016/j.robot.2003.09.004 (2003).

Baltazar, A. R., Petry, M. R., Silva, M. F. & Moreira, A. P. Autonomous wheelchair for patient’s transportation on healthcare institutions. SN Appl. Sci. 3 , 354 (2021).

Schmidt, H. Chronic Disease Prevention and Health Promotion 137–176 (Springer, 2016).

Glasziou, P., Irwig, L. & Mant, D. Monitoring in chronic disease: A rational approach. Br. Med. J. 330 , 7492. https://doi.org/10.1136/bmj.330.7492.644 (2005).

Postolache, O., Girao, P. S., Mendes, J. & Postolache, G. Unobstrusive heart rate and respiratory rate monitor embedded on a wheelchair. in 2009 IEEE International Workshop on Medical Measurements and Applications, MeMeA 2009 , 83–88. https://doi.org/10.1109/MEMEA.2009.5167960 (2009)

Hsu, P. E., Hsu, Y. L., Chang, K. W. & Geiser, C. Mobility assistance design of the intelligent robotic wheelchair. Int. J. Adv. Robot. Syst. https://doi.org/10.5772/54819 (2012).

Abuda, C. F. P., Caya, M. V. S., Cruz, F. R. G. & Uy, F. A. A. Compression of wireless sensor node data for transmission based on minimalist, adaptive, and streaming compression algorithm. in 2018 IEEE 10th International Conference on Humanoid, Nanotechnology, Information Technology, Communication and Control, Environment and Management, HNICEM 2018 . https://doi.org/10.1109/HNICEM.2018.8666320 (2019).

Latif, J., Mehryar, P., Hou, L. & Ali, Z. An efficient data compression algorithm for real-time monitoring applications in healthcare. in 2020 5th International Conference on Computer and Communication Systems, ICCCS 2020 . https://doi.org/10.1109/ICCCS49078.2020.9118600 (2020).

Kimura, N. & Latifi, S. A survey on data compression in wireless sensor networks. Int. Conf. Inf. Technol. Cod. Comput. ITCC 2 , 8–13. https://doi.org/10.1109/itcc.2005.43 (2005).

Sadler, C. M. & Martonosi, M. Data compression algorithms for energy-constrained devices in delay tolerant networks. in SenSys’06: Proceedings of the Fourth International Conference on Embedded Networked Sensor Systems , 265–278. https://doi.org/10.1145/1182807.1182834 (2006).

Capo-Chichi, E. P., Guyennet, H. & Friedt, J. M. K-RLE: A new data compression algorithm for wireless sensor network. in Proceedings—2009 3rd International Conference on Sensor Technologies and Applications, SENSORCOMM 2009 , 502–507. https://doi.org/10.1109/SENSORCOMM.2009.84 (2009).

El Assi, M., Ghaddar, A., Tawbi, S. & Fadi, G. Resource-efficient floating-point data compression using MAS in WSN. Int. J. Ad hoc Sens. Ubiquit. Comput. 4 (5), 13–28. https://doi.org/10.5121/ijasuc.2013.4502 (2013).

Monjardin, C. E. F., Uy, F. A. A., Tan, F. J. & Cruz, F. R. G. Automated real-time monitoring system (ARMS) of hydrological parameters for Ambuklao, Binga and San Roque dams cascade in Luzon Island, Philippines. in 2017 IEEE Conference on Technologies for Sustainability, SusTech 2017 , vol. 2018, 1–7. https://doi.org/10.1109/SusTech.2017.8333532 (2018).

Hou, L. et al . IoT Based Smart Wheelchair for Elderly Healthcare Monitoring . https://doi.org/10.1109/icccs52626.2021.9449273 (2021).

Hersh, M. Overcoming barriers and increasing independence: Service robots for elderly and disabled people. Int. J. Adv. Robot. Syst. https://doi.org/10.5772/59230 (2015).

InnoTecUK. AI (Artificial Intelligence) Based Healthcare System for Elderly People. (2019). https://projects.innotecuk.com/key-projects/ichair/ . Accessed 08 Dec 2023.

Sarkar, M., Niranjan, N. & Banyal, P. K. Mechanisms of hypoxemia. Lung India https://doi.org/10.4103/0970-2113.197116 (2017).

MySignals—eHealth and Medical IoT Development Platform. http://www.my-signals.com/ . Accessed 22 Aug 2023.

Lin, S. et al . Face analysis for coronary heart disease diagnosis. in Proceedings 2019 12th International Congress on Image and Signal Processing, BioMedical Engineering and Informatics, CISP-BMEI 2019 . https://doi.org/10.1109/CISP-BMEI48845.2019.8966020 (2019).

Titan LTE. https://drivedevilbiss.co.uk/products/titan-lte . Accessed 22 Aug 2023.

Digilent. DMC60C Digital Motor Controller for FIRST Robotics . (2019). https://www.digikey.co.uk/en/product-highlight/d/digilent/dmc60c-digital-motor-controller . Accessed 29 Sept 2023.

Arduino Sensor Kit—Base. https://store.arduino.cc/sensor-kit-base?_gl=1*1hnfgac*_ga*MzQxNzY1MjczLjE2Mjk2NDI1MDI.*_ga_NEXN8H46L5*MTYyOTY0MjUwMS4xLjEuMTYyOTY0MjUzMi4w . Accessed 22 Aug 2021.

IoT Analytics—ThingSpeak Internet of Things. https://thingspeak.com/ . Accessed 22 Aug 2023.

Goldberger, A. L. et al. PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation 101 (23), e215–e220 (2000).

Article   CAS   PubMed   Google Scholar  

Hunter, I. et al. EMG activity during positive-pressure treadmill running. J. Electromyogr. Kinesiol. 24 (3), 348–352 (2014).

Amin, M. R., Wickramasuriya, D. S. & Faghih, R. T. A wearable exam stress dataset for predicting grades using physiological signals. in 2022 IEEE Healthcare Innovations and Point of Care Technologies (HI-POCT), IEEE (2022).

MIT-BIH Arrhythmia Database v1.0.0. https://physionet.org/content/mitdb/1.0.0/ . Accessed 22 Aug 2023.

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This work was supported in part by the UK Research and Innovation under Grant 104312, as well as the Horizon Europe EC SusFE project under grant agreement No. 101070477, and in part by the Science and Technology Project of Guangdong Province, China under Grant 2018A050501014.

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These authors contributed equally: Lei Hou and Jawwad Latif.

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Healthcare Innovation Centre, School of Health & Life Sciences, Teesside University, Middlesbrough, TS1 BX, UK

Lei Hou, Jawwad Latif, Pouyan Mehryar & Zulfiqur Ali

Zhejiang Lab, Research Center for Frontier Fundamental Studies, Hangzhou, 311121, China

Innovative Technology and Science Ltd, Hildersham Road, Cambridge, CB21 6DR, UK

Stephen Withers & Angelos Plastropoulos

College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, 518060, China

Linlin Shen

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Z.A. and L.L.S. conceived and supervised the project. L.H. performed the experiments. A.P. and J.L. performed the algorithm. P.M. designed the sensing experiments. All authors analyzed the data. L.H., and S.W. wrote the manuscript. All authors discussed the results and commented on the paper. The authors affirm that human research participants provided informed consent for publication of the images.

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Hou, L., Latif, J., Mehryar, P. et al. An autonomous wheelchair with health monitoring system based on Internet of Thing. Sci Rep 14 , 5878 (2024). https://doi.org/10.1038/s41598-024-56357-y

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Unleashing Independence: The Benefits and Drawbacks of Power Wheelchairs

For individuals with limited mobility, power wheelchairs offer a life-changing opportunity to regain their independence. These state-of-the-art devices provide a newfound freedom to explore, engage, and participate in daily activities.

But while power wheelchairs can be a game-changer, it’s essential to understand both the benefits and drawbacks they bring.

This article embarks on a journey to unravel the complexities of power wheelchairs, shedding light on the profound advantages they offer while also delving into the potential drawbacks that shape the decisions of users and their caregivers.

Table of Contents

Benefits of Using Power Wheelchairs

Power wheelchairs offer a range of benefits that significantly enhance the quality of life for individuals with mobility limitations . Here are some of the primary advantages:

1. Enhanced Mobility and Independence

Power wheelchairs are designed with motorized propulsion systems, allowing users to move around effortlessly. Unlike traditional manual wheelchairs that require physical strength and stamina, power wheelchairs allow individuals to conserve their energy while maximizing their mobility.

This newfound freedom enables users to navigate their surroundings independently, promoting a sense of self-reliance and empowerment.

2. Versatility in Terrain Navigation

One of the most significant advantages of power wheelchairs is their ability to maneuver different terrains. These devices are equipped with advanced control systems, large wheels, and sturdy frames, enabling smooth navigation across various surfaces. Whether it’s tight indoor spaces, uneven outdoor paths , or rough terrains, power wheelchairs offer unparalleled convenience and adaptability.

3. Improved Posture and Comfort

Power wheelchairs are designed with ergonomic considerations to provide optimal comfort and support. They typically feature adjustable seating positions and cushioning to accommodate individual needs. By promoting proper posture and reducing the risk of developing pressure sores, power wheelchairs contribute to improved overall health and well-being.

4. Access to a Wide Range of Activities

With the increased mobility and independence offered by power wheelchairs, individuals can actively participate in various activities and engage with their communities. Whether it’s socializing with friends, pursuing hobbies, or accessing public spaces, power wheelchairs enable individuals to break barriers and enjoy a fulfilling life.

5. Customization and Adaptability

Power wheelchairs come in a variety of models and configurations, allowing users to customize their devices based on their specific needs and preferences. From adjustable seating positions to specialized controls, power wheelchairs can be tailored to accommodate different body types, physical limitations, and personal preferences.

This customization ensures optimal comfort and usability, promoting a seamless user experience.

While power wheelchairs offer numerous benefits, it’s important to acknowledge the drawbacks associated with these devices as well. Understanding the potential challenges can help individuals make informed decisions and effectively mitigate any drawbacks they may face.

Drawbacks of Using Power Wheelchairs

Power wheelchairs, like any other assistive device, have certain drawbacks that users should be aware of. Here are some of the common drawbacks:

1. Bulky and Heavy

Power wheelchairs tend to be larger and heavier than manual wheelchairs. While this is necessary to accommodate the motorized components and provide stability, it can make transportation and storage challenging. Maneuvering through narrow doorways, fitting into vehicles, or accessing certain spaces can be more difficult due to the size and weight of power wheelchairs.

2. Cost and Maintenance Expenses

Power wheelchairs can be expensive, often costing significantly more than manual wheelchairs. The advanced technology, specialized components, and customization options contribute to the higher price tag.

Additionally, ongoing maintenance and repair costs should be considered. Regular servicing, battery replacements, and repairs can add up over time, making power wheelchairs a more significant investment compared to their manual counterparts.

3. Limited Battery Life

Power wheelchairs rely on batteries for their operation. While modern batteries have improved significantly, they still have limitations. Depending on the model and usage, power wheelchairs may have limited battery life, requiring regular recharging or carrying spare batteries.

This limitation can potentially impact users’ ability to engage in extended activities without access to power outlets.

4. Learning Curve and Adaptation

Transitioning from a manual wheelchair to a power wheelchair may require a learning curve and time for adaptation. Operating the controls, understanding the various features, and adjusting to the different dynamics of a power wheelchair can take some practice.

Individuals should be prepared to invest time and effort into becoming familiar with their power wheelchair to maximize its benefits.

5. Accessibility Limitations

While power wheelchairs excel in navigating different terrains, there may still be accessibility limitations in certain environments. Uneven surfaces, stairs, or lack of appropriate ramps can pose challenges for power wheelchair users. It’s essential to assess the accessibility of the intended environments to ensure the power wheelchair can be used effectively and safely.

Now that we have explored the benefits and drawbacks of power wheelchairs, let’s delve into the factors to consider when choosing a power wheelchair to maximize its advantages and mitigate potential drawbacks.

Factors to Consider when Choosing a Power Wheelchair

Choosing the right power wheelchair is crucial to ensuring optimal comfort, usability, and functionality. Here are some essential factors to consider when selecting a power wheelchair:

1. Mobility Needs and Usage Patterns

Understanding your mobility needs and usage patterns is the first step in choosing the right power wheelchair. Consider the environments you will be navigating, the distances you will be traveling, and the activities you want to engage in.

This will help determine the necessary features, such as terrain adaptability, battery life, and seating configurations, to ensure the power wheelchair meets your specific requirements.

2. Physical Considerations

Take into account your physical capabilities and limitations when selecting a power wheelchair. Factors such as body size, weight capacity, and any specific medical or postural needs should be considered.

Ensure the power wheelchair provides adequate support, adjustability, and customization options to accommodate your physical requirements comfortably.

3. Maneuverability and Control

Evaluate the maneuverability and control features of different power wheelchair models. Consider the turning radius, ease of operation, and control options based on your dexterity and preferences.

Test out different models to determine which one offers the most intuitive and comfortable control system for you.

4. Seating and Comfort

Comfort is crucial when selecting a power wheelchair. Evaluate the seating options, cushioning, and adjustability to ensure optimal comfort and support. Look for features such as reclining backrests, adjustable leg rests, and pressure-relieving cushions to prevent discomfort and promote good posture.

5. Portability and Transportability

Consider the portability and transportability of the power wheelchair, especially if you frequently travel or need to transport the device. Look for models that offer folding capabilities, detachable components, or lightweight construction to facilitate transportation and storage.

By carefully considering these factors, you can narrow down your options and find a power wheelchair that suits your specific needs and preferences. Once you have chosen the right power wheelchair, it’s essential to be aware of the key features to look for to maximize its benefits.

Features to Look for In a Power Wheelchair

When looking at a wheelchair for sale , certain features can enhance its functionality and usability. Here are some key features to look for:

1. Terrain Adaptability

Choose a power wheelchair that can navigate various terrains effectively. Look for models with large wheels, robust suspension systems, and anti-tip mechanisms to ensure stability and safety on uneven surfaces.

2. Battery Life and Charging Options

Consider the battery life of the power wheelchair and the charging options available. Look for models with long-lasting batteries or the ability to easily swap out batteries for extended usage. Additionally, ensure the power wheelchair can be conveniently charged using standard power outlets or portable charging solutions.

3. Customizable Seating and Positioning

Opt for a power wheelchair that offers customizable seating and positioning options. Look for adjustable seat heights, backrest angles, and leg rest configurations to ensure optimal comfort and support. This customization can prevent postural issues and enhance overall comfort during prolonged use.

4. Intuitive Control System

Choose a power wheelchair with an intuitive and user-friendly control system. Look for models with easy-to-use joystick controls, programmable settings, and clear display panels. This ease of use will enhance your overall experience and make operating the power wheelchair more intuitive.

5. Safety Features

Ensure the power wheelchair is equipped with essential safety features. Look for models with anti-tip devices, seat belts, and reliable braking systems. These features will provide added security and peace of mind while using the power wheelchair.

By prioritizing these features, you can select a power wheelchair that aligns with your specific needs and requirements. However, it’s important to note that owning a power wheelchair requires regular maintenance and occasional repairs to ensure its longevity and optimal performance.

Tips for Maintaining and Repairing Power Wheelchairs

Proper maintenance and timely repairs are essential to keep power wheelchairs operating smoothly. Here are some tips to help you maintain and repair your power wheelchair:

1. Regular Cleaning and Inspection

Clean your power wheelchair regularly to remove dirt, dust, and debris that can affect its performance. Inspect the wheels, tires, batteries, and control systems for any signs of wear or damage. Promptly address any issues to prevent further damage or potential breakdowns.

2. Battery Care

Follow the manufacturer’s guidelines for battery care and charging. Ensure the batteries are charged regularly and avoid overcharging or discharging them excessively. If you notice a significant decrease in battery life, consider replacing them to maintain optimal performance.

3. Tire Maintenance

Inspect the tires regularly and ensure they are properly inflated. Check for signs of wear, punctures, or damage. Replace worn-out or damaged tires promptly to ensure safe and efficient operation.

4. Lubrication and Adjustment

Periodically lubricate the moving parts of the power wheelchair, such as the wheels and hinges, to prevent friction and ensure smooth operation. Additionally, adjust the seating position, footrests, and armrests as needed to maintain optimal comfort and support.

5. Professional Servicing

Schedule regular professional servicing and maintenance for your power wheelchair. This will help identify any underlying issues, perform necessary repairs, and ensure the device is in optimal condition. Professional servicing can extend the lifespan of your power wheelchair and prevent potential breakdowns.

By following these maintenance tips and promptly addressing any repairs or issues, you can extend the lifespan of your power wheelchair and minimize potential disruptions to your mobility.

Finally, it’s crucial to consider the cost implications associated with power wheelchairs, as they can be a significant investment.

Cost Considerations for Power Wheelchairs

Power wheelchairs often come with a higher price tag compared to manual wheelchairs. The cost can vary based on factors such as brand, model, features, customization options, and additional accessories. When budgeting for a power wheelchair, consider the following cost considerations:

1. Device Cost

The initial cost of the power wheelchair encompasses the base model and its standard features. More advanced models with additional functionalities and customization options may come at a higher price. Consider your budget and prioritize the features that align with your specific needs to make an informed decision.

2. Insurance Coverage

Check your health insurance coverage to determine if power wheelchairs are eligible for reimbursement. Some insurance plans may provide partial or full coverage for power wheelchairs, depending on the individual’s medical condition and mobility needs. Contact your insurance provider to understand the coverage options available to you.

3. Maintenance and Repair Expenses

Factor in the ongoing maintenance and repair costs associated with power wheelchairs. Regular servicing, battery replacements, and occasional repairs should be considered when budgeting for a power wheelchair. Additionally, inquire about warranty options and extended coverage plans that can help mitigate potential repair expenses.

4. Accessories and Modifications

Consider any additional accessories or modifications you may need for your power wheelchair. Features such as specialized seating systems, enhanced control options, or additional storage solutions may come at an extra cost. Evaluate the necessity of these accessories based on your specific requirements and budget accordingly.

5. Long-Term Value

While power wheelchairs require a significant upfront investment, it’s essential to consider their long-term value. The enhanced mobility, independence, and improved quality of life they provide can outweigh the initial cost. Evaluate the long-term benefits and the potential impact on your overall well-being when determining the value and affordability of a power wheelchair.

By considering these cost factors and exploring reimbursement options, you can make an informed decision that aligns with your budget and ensures you receive the maximum benefit from your power wheelchair. With the right power wheelchair, individuals can unleash their independence, break barriers, and embrace a life of enhanced mobility and empowerment.

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Virginia O'Gallagher

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Smart Wheelchair with Voice Control for Physically Challenged People

A wheel chair is a mechanically operated device that allows the user to move about independently. This minimizes the user's personal effort and force required to move the wheelchair wheels. Furthermore, it allows visually or physically handicapped people to go from one location to another. Voice commands and button controls can be used to operate wheelchairs. In recent years, there has been a lot of interest in smart wheelchairs. These gadgets are very handy while traveling from one location to another. The devices can also be utilized in nursing homes where the elderly have difficulties moving about. For individuals who have lost their mobility, the gadgets are a godsend. Different types of smart wheelchairs have been created in the past, but new generations of wheelchairs are being developed and utilized that incorporate the use of artificial intelligence and therefore leave the user with a little to tamper with. The project also intends to develop a comparable wheel chair that has some intelligence and so assists the user in his or her mobility.

A Novel IOT Based Smart Wheelchair Design for Cerebral Palsy Patients

Several patients face Cerebral Palsy. Such debilitating diseases impede motor control and make it difficult for them to operate traditional electric wheelchairs. Existing models of smart wheelchairs accommodate these issues to a certain extent but fail to deliver a solution for patients to use the wheelchairs completely autonomously. This paper proposes a novel model for a cost-effective smart wheelchair that takes simple gestures as input for movement, along with several quality-of-life and assistive modules such as vitals monitoring and voice memo support for patients suffering from memory loss, along with obstacle detection to ensure complete safety of the patient regardless of the terrain. The paper discusses the various modules present in the wheelchair, elaborates upon the algorithm used for input detection and calculation, and finally, the implementation of each module. Lastly, the paper enlists comparisons between existing smart wheelchair models and the proposed model and lists out its strengths, weaknesses and states its findings from the proposed system's results.

Indoor Path Finding and Simulation for Smart Wheelchairs

Further improvement of customized vibration generator for machine–human feedbacks with the help of resonant networks.

Modern industrial, household and other equipment include sophisticated power mechanisms and complicated control solutions and require tighter human–machine–human interaction, forming the structures known as cyber–physical–human systems. Their significant parts are human–machine command links and machine–human feedbacks. Such systems are found in medicine, for example, in orthopedics, where they are important for operation and functional abilities of orthopedic devices—smart wheelchairs, verticalizers, prosthesis, rehabilitation units, etc. The mentioned feedbacks may be implemented based on the haptic perceptions that require vibration actuators. In orthopedics, such actuators can also be used for diagnostic purposes. This research brings forward the idea of the use of resonant operation of the driver of vibration actuator. The corresponding driver has been built and experimentally tested. It has been found that (1) the point of maximal current is actually defined by the resonant frequency, (2) change of the capacitance allows shifting of the point of maximal current output and (3) damping factors make the above-described effect less obvious. Further development of the proposed idea requires a comprehensive comparison of four-quadrant and two-quadrant schemes in this application and development of a real-time programmable capacitor pack consisting of several binary weighted capacitors and a commutating circuit, which is installable to these schemes.

The Improved Security System in Smart Wheelchairs for Detecting Stair Descent using Image Analysis

Assistive robot for mobility enhancement of impaired students for barrier-free education: a proof of concept.

AbstractSmart wheelchairs are in the category of assistive robots, which interact physically and/or non-physically with people with physical disabilities to extend their autonomy. Smart wheelchairs are assistive robots that enhance mobility, and can be especially useful for improving access to university premises. This paper proposes a smart wheelchair that can be integrated with an academic management system to enable students who have serious leg problems and cannot walk on their own to reach any academic building or room on a university campus autonomously. The proposed smart wheelchair receives information from the academic management system about the spaces on campus, the lesson schedule, the office hours of lecturers, and so on. Students can select the desired task from the user interface. The smart wheelchair can then guide the student autonomously to the desired point of interest, while planning the best barrier-free route inside the campus/building and, simultaneously, avoiding fixed and moving obstacles. The assistive robot has localization and navigation capabilities, which allow students to move about campus freely and autonomously, and benefit from a barrier-free education.

AI-based smart and intelligent wheelchair

The differently abled and/or old-aged people require assistance for their movement. Generally, such assistant providing tool is wheelchair. Normal wheelchairs are manually operated and heavy to move adding burden to the suffered. Hence, automated wheelchairs that are equipped with sensors and a data processing unit constitute a special class of wheeled mobile robots, termed as “smart wheelchairs” in general. In the existing system, the wheelchair movement that is controlled by joystick uses buttons to start and stop the wheel. This is difficult for the differently abled to press the required button with precision. Although there are smart wheelchairs with gesture control, it lacks accuracy in the calculation of the location. The proposed system uses artificial intelligence for its working and proves to be a unique combination of wheelchair and health monitoring system. The wheelchair can be accessed both in manual and automatic modes. In the manual mode, the wheel is controlled using joystick whereas in the automated mode, MPU6050 sensor and accelerometer is used to control the direction by gesture. SPO2 sensor attached to the wheelchair is used to collect the health parameters. Thus, enabling the self-dependency of the person. Further, deep learning analysis of the data from the sensors and the wheelchair usage pattern is compared with the dataset to determine the stress level. The signal from the sensors is monitored and the vitals data is updated in the ThingSpeak website via Bluetooth module serving as a digital health chart.

A Path Tracking Control Algorithm for Smart Wheelchairs

Decentralized motion control for omnidirectional wheelchair tracking error elimination using pd-fuzzy-p and ga-pid controllers.

The last decade observed a significant research effort directed towards maneuverability and safety of mobile robots such as smart wheelchairs. The conventional electric wheelchair can be equipped with motorized omnidirectional wheels and several sensors serving as inputs for the controller to achieve smooth, safe, and reliable maneuverability. This work uses the decentralized algorithm to control the motion of omnidirectional wheelchairs. In the body frame of the omnidirectional wheeled wheelchair there are three separated independent components of motion including rotational motion, horizontal motion, and vertical motion, which can be controlled separately. So, each component can have its different sub-controller with a minimum tracking error. The present work aims to enhance the mobility of wheelchair users by utilizing an application to control the motion of their attained/unattained smart wheelchairs, especially in narrow places and at hard detours such as 90˚ corners and U-turns, which improves the quality of life of disabled users by facilitating their wheelchairs’ maneuverability. Two approaches of artificial intelligent-based controllers (PD-Fuzzy-P and GA-PID controllers) are designed to optimally enhance the maneuverability of the system. MATLAB software is used to simulate the system and calculate the Mean Error (ME) and Mean Square Error (MSE) for various scenarios in both approaches, the results showed that the PD-Fuzzy-P controller has a faster convergence in trajectory tracking than the GA-PID controller. Therefore, the proposed system can find its application in many areas including transporting locomotor-based disabled individuals and geriatric people as well as automated guided vehicles.

Wheelchair Neuro Fuzzy Control and Tracking System Based on Voice Recognition

Autonomous wheelchairs are important tools to enhance the mobility of people with disabilities. Advances in computer and wireless communication technologies have contributed to the provision of smart wheelchairs to suit the needs of the disabled person. This research paper presents the design and implementation of a voice controlled electric wheelchair. This design is based on voice recognition algorithms to classify the required commands to drive the wheelchair. An adaptive neuro-fuzzy controller has been used to generate the required real-time control signals for actuating motors of the wheelchair. This controller depends on real data received from obstacle avoidance sensors and a voice recognition classifier. The wheelchair is considered as a node in a wireless sensor network in order to track the position of the wheelchair and for supervisory control. The simulated and running experiments demonstrate that, by combining the concepts of soft-computing and mechatronics, the implemented wheelchair has become more sophisticated and gives people more mobility.

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