Hobson, Ph.D. is Associate Professor Emeritus and Co-Director of the Rehabilitation Engineering Research Center (RERC) on Wheelchair Transportation Safety at the University of Pittsburgh, Department of Rehabilitation Science and Technology. From 1992 to 2001, he served as managing director of the RERC on Wheeled Mobility (RERCWM) at the University of Pittsburgh.
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
A variation in the number of AT devices used has been observed among people with different conditions within the aging population. Acceptance of AT among older adults is also largely determined by societal views.
PARTICIPATORY ACTION DESIGN
Assistive technology is getting "smarter". The availability and ubiquity of computing power will change the face of AT. All product features are then compared to available benchmarks, ensuring that the designed features are in line with industry standards.
POLICY, HUMAN, ACTIVITY, ASSISTANCE, TECHNOLOGY, AND ENVIRONMENT (PHAATE)
Of course, the person must be at the heart of the model and the entire process related to technology development and service delivery.
TRENDS IN AT SERVICE DELIVERY
NECESSARY EXPANSION OF AT CLINICAL SERVICE WORLDWIDE
TELEREHABILITATION
For example, 3D models of the home environment that include mobility simulations to make accessibility determinations can optimize technology selection and home modifications. The use of this modeling technology in conjunction with advances in telecommunications and the Internet allows remote use of such access analysis systems via asynchronous or interactive communication links with a central source.
RESEARCH AND DEVELOPMENT FUNDING
Support is also possible for the decision-making process regarding appropriate AT selection and environmental adaptations for specific people in certain environments and for accessibility analysis of public spaces in relation to population norms. When making award decisions, the curators take into account both the scientific assessments and the relevance of the work for people with spinal cord injury or dysfunction.
THE REHABILITATION ENGINEERING AND ASSISTIVE TECHNOLOGY SOCIETY OF NORTH
RESNA's structure can be viewed from various perspectives, and the organization looks different depending on the angle perspective. From another perspective, it is an organization that promotes advances in public policy, research, and clinical practice related to AT and rehabilitation engineering.
THE FUTURE OF REHABILITATION ENGINEERING
Most of the federal agencies that support research and development of assistive and rehabilitative technology did not exist at the time. There are several models of wheelchairs available and the concept of adapting a wheelchair to the needs of an individual with special needs is an accepted practice.
STUDY QUESTIONS Describe the PHAATE model
Cummings D., Prosthetics in the Developing World: A Review of the Literature, Prosthetics and Orthotics International, Vol. Staats T.B., The Rehabilitation of the Amputee in the Developing World: A Review of the Literature, Prosthetics and Orthotics International, Vol.
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
To give the reader a broad understanding of the field, service delivery models and the role of CRE in each model will be discussed. Rehabilitation engineering is defined as (1) the application of engineering principles, technical expertise, and design methodology to the development and delivery of assistive technology to help a person with a disability achieve his or her goals; (2) a total approach to rehabilitation that combines medicine, engineering, and related sciences to improve the quality of life of persons with disabilities;. 3) application of engineering concepts and techniques to understand, define and solve problems related to improving the quality of life for people with chronic disabilities; and (4) the branch of biomedical engineering concerned with the application of science and technology to improve the quality of life of individuals with disabilities.
SERVICE DELIVERY MODELS
T ECHNOLOGY S ERVICE D ELIVERY C ENTER
In this case, the CRE will work with the SLP and PT to meet the specific needs of the consumer. As a teacher, CRE must be informed about current and future practices and current and future equipment.
S TATE -A GENCY -B ASED P ROGRAM
The CRE may assume the role of the ATS depending on the availability of suppliers to provide equipment in a particular service area. The role of the CRE in a manufacturing firm is typically not included in service delivery models.
T ECHNOLOGY S ERVICE D ELIVERY C ENTER IN
This will increase the feedback gained during field testing and the future success of AT. However, this must be weighed against the individual's ability to receive services in any other way.
TOOLS
Medium-tech tools, similar to low-tech tools, are commercially available and are not specific to the field of rehabilitation engineering. High-tech tools are commercially available, but may require the CRE to assemble components from other fields, may require a computer to run, and may be specific to the field of rehabilitation engineering.
THE REHABILITATION ENGINEER IN THE CLINICAL SETTING
For the CRE to be an effective member of the service delivery process and increase the likelihood of long-term success, the CRE must have exceptional communication skills, both written and verbal. The CRE must be able to communicate in layman's terms, in clinical terms and in technical terms, depending on the audience.
THE CLINICAL REHABILITATION ENGINEER VS
INCORPORATING ENGINEERING INTO THE AT SERVICE DELIVERY PROCESS
PRINCIPLES OF SERVICE DELIVERY
This is very similar to other engineering disciplines, where the goal is to design a better method for accomplishing a particular task, rather than simply "fixing" a problem. The fifth and final principle focuses on CRE's ability to collect and interpret data.
SERVICE DELIVERY PROCESS
I NITIAL E VALUATION
This will lead CRE to the next component of the service delivery process, the synthesis process. Finally, CRE will be involved in training the individual and any other stakeholders in the correct use of the equipment.
REIMBURSEMENT
CREDENTIALING
The RET tests for technical knowledge and the application of technical knowledge to the analysis, design, delivery and training in the use of AT. Unfortunately, there is no professional technical (PE) exam for rehabilitation engineering, and this credential is not intended for clinical services in the US.
EVIDENCE-BASED PRACTICE
Technology Provider (ATP) or concurrently taking the exams can take the RET exam. In the US, engineers can become licensed professional engineers in the state in which they live and practice.
SUMMARY
Commentary on Warren's cost-effectiveness and efficiency in the delivery of assistive technology services, Assist Technol, vol. Selwyn D., Rehabilitation engineering: new hope for the permanently disabled, J Am Soc Psychosom Dent Med, vol.
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
BACKGROUND
With improved health care services and the beginning of the Americans with Disabilities Act (ADA), the last few decades show a growing percentage of elderly individuals and those who have disabilities. Enabling integration of people with disabilities and the elderly into our society requires the development of "adaptable" or "accessible" products in the market.
ORPHAN TECHNOLOGY
UNIVERSAL DESIGN
O RIGIN OF U NIVERSAL D ESIGN
- Principle One: Equitable Use
- Principle Two: Flexibility in Use
- Principle Three: Simple and Intuitive Use
- Principle Four: Perceptible Information
- Principle Five: Tolerance for Error
- Principle Six: Low Physical Effort
- Principle Seven: Size and Space for Approach and Use
- Societal Benefits
- Personal Benefits
- Benefits to Industry
Using the design is easy to understand, regardless of the user's experience, knowledge, language skills or current level of concentration. One of the goals of rehabilitation engineering is its contribution to "participation" in society.
T HE U NIVERSAL D ESIGN M ATRIX
Product group 1: There are many personal product choices made by an individual user within consumer and durable goods. Product group 2: This product group consists of durable goods and public goods for use by the individual user and family.
A PPLYING U NIVERSAL D ESIGN
And to develop successful products for a wide range of users, we must be able to put ourselves in the shoes of different end users to meet their needs. To “design with a universal approach” it is important to be able to conceptualize broadly and think about the potential limitations your user population may have.
DESIGN AND HUMAN ABILITIES
P ERSONA
Another useful tool that puts you in the shoes of the user is "persona" - the creation of an imaginary "family" of potential users. Finally, there is Brian, Cheryl's uncle, who has poor eyesight and uses a guide dog for navigation.
USE OF A DESIGN PROCESS
She has memory loss and recently suffered a stroke that affected the right side of her body, reducing the function of her right hand, hand and leg. Poor vision or no vision. Deafness or no hearing. Loss of smell, taste or senses.
STANDARDS RELATED TO UNIVERSAL DESIGN
List the functional and cognitive limitations of the people affected by the problem. Describe stakeholder needs. JIS Z8071 contains guidelines for the elderly and persons with disabilities on information and communication equipment, software and services.
EXAMPLES OF UNIVERSALLY DESIGNED PRODUCTS
L IVING
The technology of a rehabilitation or assistive device (a special toilet seat for the disabled) was integrated into a regular product, resulting in a universally designed product that is easy to use by everyone. An adjustable toilet seat for use by people with disabilities was integrated into a regular toilet seat.
P ACKAGING
When individuals in wheelchairs use public transportation, there are a number of features they use to keep them safe during transportation. When a wheelchair user enters the bus, a special section is reserved in the bus (wheelchair docking station) where the person in a wheelchair can leave their wheelchair during transport.
SUMMARY
First, many public buses have elevators or kneeling technology that allows people in wheelchairs and the elderly to enter the bus easily. A new technology that makes traveling on public buses safer, easier and more independent is the so-called "reversed passenger station". This station consists of an empty space where wheelchair passengers can independently maneuver their wheelchairs to minimize wheelchair movement during travel.
STUDY QUESTIONS 1. What is universal design?
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
THE SUPPLY-PUSH PROCESS
THE DEMAND-PULL PROCESS
INTELLECTUAL PROPERTY
S MALL B USINESS L OANS OR G RANTS
Grants do not have to be repaid as long as the specified terms of the agreement are met. Most small businesses need a line of credit to cover expenses not allowed under grants.
PRIVATE FUNDING .1 C HARITABLE A SSISTANCE
F OUNDATION F UNDING
V ENTURE C APITAL
Venture capitalists require a more formal process that includes a detailed business plan, market analysis, description of IP protection and information on company principles. It is very competitive to get venture capital funding, but if one manages it, the help provided in the form of financing and business management can be of tremendous help in making the company successful.
PAYMENT MODEL
MANUFACTURING
Since there are companies around the world that specialize in manufacturing components and assemblies for other companies (sometimes referred to as virtual manufacturing); it has become increasingly easy to outsource most, if not all, manufacturing processes. Due to the widespread use of computer-aided design (CAD) programs and computer-aided manufacturing (CAM), it is no longer necessary for the design engineer and manufacturing engineer to be located in close proximity.
DISTRIBUTION MODELS
A careful study of the market, payment mechanisms and business resources is needed to optimize distribution channels. Of course, the approach can vary from product to product and over time for the company.
A TECHNOLOGY-TRANSFER FRAMEWORK
SUMMARY
STUDY QUESTIONS
Understand the history of assistive technology (AT) standards. Know the current status of various AT standards. Have insight into the technical contributions to AT standards. Have some knowledge of future needs for AT standards.
INTRODUCTION
H ISTORICAL O VERVIEW OF U.S. I NVOLVEMENT IN
Most wheelchair products now manufactured and marketed in the United States meet most of the requirements of RESNA and/or ISO standards. Although encouraging, it may prove problematic given the limitations and use of test data (Raflo, 2002).
ORGANIZATION OF NATIONAL AND INTERNATIONAL INDUSTRY STANDARDS
T HE U SER -R ESPONSIVE D EVELOPMENT M ODEL
- Impact Benefits for Users, Clinicians, Industry, and Healthcare-Funding Agencies
In the over 25-year history of developing wheelchair standards, only about 50 volunteers have carried most of the workload. This helps improve the precision of the standards' language and helps clarify the product literature.
THE ROLE AND CONTRIBUTION OF
In the United States, there is an ANSI requirement that there must be multidisciplinary distribution in which; researchers, doctors, users and manufacturers as voting members of a committee. But even if someone is not immediately recognized as a voting member, participation in meetings is always welcome and remote electronic contributions are appreciated.
HIDDEN RATIONALE FOR PARTICIPATION IN INDUSTRY STANDARDS DEVELOPMENT
T HE D IRECT R EWARDS TO I NDUSTRY
Most industry professionals have little background training in research methodology or the clinical application of their products. It is extremely valuable to be partners in a working group of top-level clinicians and research engineers who openly share information directly relevant to the safety and usability testing of their products.
FUTURE OPPORTUNITIES
R ESOLVING B ARRIERS TO C LINICAL AND U SER A PPLICATION
The first barrier is the lack of support to participate in the development of the standards themselves. The standards are also highly technical and require technical knowledge to be able to use them.
SUMMARY
STUDY QUESTIONS
Development of AT standards in the United States has been supported by many organizations and agencies since its inception in the early 1980s. ANSI/RESNA Part 19 — Wheelchairs for Use in Motor Vehicles, a consortium of national school transportation entities, secured the funding to begin this work in the United States.
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
SEATING AND COMMON PATHOLOGIES
SEATING ASSESSMENT
It is important to note that a person may sit in a particular position due to preference, limitations or the design of the seating system. Hip flexion limitations will affect the seat-back angle configuration of the seating system.
INTERVENTIONS: SEATING SYSTEMS
- B ACK S UPPORTS
- A RM S UPPORTS
- F OOT AND L EG S UPPORTS
- H EAD S UPPORTS
Foot and leg supports can be classified according to the angle at which they place the knee and the location of the feet. However, removable or removable footrests are essential for people who stand to move out of a wheelchair or who propel a manual wheelchair with their feet.
STANDING SYSTEMS
It is critical to carefully assess a person's posture and range of motion before considering a standing device, as certain people with range of motion limitations and postural deformities may not be able to stand upright. A candidate for a standing wheelchair should be carefully assessed by a physician or other qualified practitioner before standing, as there are also concerns about orthostatic hypotension in cases where people have not stood for extended periods of time.
SEAT ELEVATION SYSTEMS
SUMMARY
STUDY QUESTIONS Name and describe the following
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
PRESSURE ULCERS .1 E TIOLOGY
PRESSURE ULCER STAGING SYSTEM .1 R ISK A SSESSMENT
They found a difference by anatomical site in the amount of interface pressure that was transferred to the interstitial fluid. Therefore, the interpretation of the skin interface pressure measurement must take into account the properties of the underlying tissues.
SUPPORT-SURFACE CLASSIFICATION .1 E LASTIC F OAM
F LUID -F ILLED P RODUCTS
Most fluid-filled products allow a high degree of immersion, allowing the body to sink into the surface as the surface conforms to bony projections. However, the insulating effects of rubber and plastic used in some liquid-filled products have been shown to increase relative humidity due to perspiration.
A IR -F LUIDIZED B EDS
Low air loss describes a support surface characteristic in which air moves through the pores of the covering material. For example, what are the ideal properties of the support surface (geometry of the surface [size/shape of cells and space between cells], material, depth, composition and shape of the supporting structure).
SUMMARY
Alternating pressure describes a support surface feature in which the pressure distribution is periodically changed. Houle's conclusion (1969) that a dynamic device that shifts pressure alternately from one area to another "would be the choice to provide adequate protection against the development of ischemic ulcers" has been supported by many others over the years.
STUDY QUESTIONS
The results of these investigations reflect the limitation of using interface pressure as a sole indicator of the threshold for pressure ulcer formation. Wheelchair cushion effect on skin temperature, heat flux and relative humidity.Arch Phys Med Rehabil.
LEARNING OBJECTIVES OF THIS CHAPTER Upon completion of this chapter, the reader will be able to
INTRODUCTION
OVERVIEW
MANUAL WHEELCHAIRS .1 B RIEF H ISTORY
In addition to strength and durability, the choice of materials greatly affects the total weight of the wheelchair. Moving the axle position up relative to the seat will actually lower the seat height of the chair.
WHEELCHAIR PROPULSION
To prevent the danger of tipping backwards, anti-tip pieces can be added to the back of the chair so that users can have the advantage of reaching more of the push edge without the risk of tipping over unexpectedly. Lowering the seat height improves stability, but being too low can cause poor drive patterns due to abducted arms.
ELECTRIC POWER WHEELCHAIRS .1 B RIEF H ISTORY
B ASIC S TRUCTURAL C OMPONENTS
To accommodate these additional features, the EPW was redesigned as a two-component power-based style. The seat component simply attaches to the power base, and so can be swapped out for whatever seat style best meets the user's needs.
P OWER AND D RIVE S YSTEMS
Depending on the user's need for pressure control and the condition of their musculoskeletal system, any combination of the aforementioned movements may be prescribed. Tilting the seat is one of the most common functions because it allows to shift the pressure distribution from the buttocks to the back; this can help prevent dangerous pressure ulcers common to wheelchair users with sensory loss.
C ONTROL S YSTEM
The most common input device for speed and direction control of the EPW is the proportional control joystick. Thus, a user with limited sensorimotor function or spasticity can control a wheelchair using a single switch to select the desired direction when highlighted.
POWER-ASSISTED WHEELCHAIRS
PAS C ONTROL A LGORITHM
When optimal arm engagement/disengagement occurs, the PAS push ring torque should be similar in shape to that of an experienced manual wheelchair user, but lower in amplitude. The time just before tr release is defined as when the thrust ring torque begins to decrease toward the dead zone torque threshold.
MULTIFUNCTIONAL WHEELCHAIRS
When a user leans forward or backward, or an assistant leans on the device and the center of gravity shifts, the device rotates the wheelset, causing the device to climb down or up one flight of stairs. The operating system requires the device to pause for a few seconds at each step before allowing a new cluster operation.
WHEELCHAIR STANDARDS
F ATIGUE -S TRENGTH T ESTS
- Example
When considering the initial cost of the wheelchair, some cost effectiveness can be established. The wheelchair completed three rounds of testing on the double drum and curb drop machines.
S TATIC AND D YNAMIC S TABILITY
Moving the seat forward moves the CG system of the wheelchair user forward, which increases rear stability and decreases front stability. Adding a load near the front of the wheelchair increases stability at the back while decreasing stability at the front.
M ANUAL W HEELCHAIR P ERFORMANCE
1993) developed computational models to understand the effect of wheelchair user position, and Kirby et al. 1996) studied the addition of loads to different parts of the wheelchair on the static stability of the wheelchair-user system. Figure 8.9 shows a simple geometric model of the wheelchair user system to illustrate how changing the CG of the system (which occurs when the seat is moved relative to the rear wheels) affects stability.
SUMMARY
Three-wheel scooters are reported to be less stable than power and manual wheelchairs in lateral steering. In the future, modular designs may be developed that allow configuration of wheeled mobility systems (eg, wheelbase, track width, and steering interface) for user and activity.
STUDY QUESTIONS
Fass MV, Cooper RA, Fitzgerald SG, Schmeler M, Boninger ML, Algood SD, Ammer WA, Rentschler AJ, Duncan J. Evaluating the safety and durability of low-cost non-programmable electric wheelchairs. Arch Phys Med Rehabil.
CLINICAL CONSIDERATIONS OF FES .1 N EURO M USCULAR S TIMULATION (NMS) OF.1 NEUROMUSCULARSTIMULATION(NMS)OF
NMS TO M ODIFY P ATTERNS OF M OVEMENT
1954: Artificial pacemaker used in humans 1957: Hearing prosthesis first implanted in a human 1960: First pacemaker to be fully implanted 1961: Restoration of lost function in paralyzed leg muscles.
F OOT D ROP AND W RIST D ROP
It is relatively simple to stimulate the contraction of one muscle group and coordinate this movement with the voluntary movements of the surrounding muscles.
FES FOR SCI
ELECTRODES
E LECTRODE –E LECTROLYTE I NTERFACE
Living tissue is rich in ions and acts as the electrolyte at the interface with the electrode. Near the anode, the concentration of positive ions hyperpolarizes the cell membrane, making it less sensitive to depolarization.
E LECTRICAL C URRENTS
The resting membrane potential of muscle fibers and nerve axons near the electrodes is affected by the concentration of charge at each electrode site. The current flow is bidirectional with the leading phase of the pulse above the baseline and the trailing phase below the baseline.
T ISSUE I MPEDANCE
To maximize treatment, the clinician must determine the size of the area to be stimulated. Epimysial electrodes are attached to the surface of the target muscle, while intramuscular electrodes are embedded within the muscle fibers.
CLINICAL APPLICATION OF FES .1 FES FOR F OOT D ROP.1 FESFORFOOTDROP
FES FOR W ALKING
The push-button commands (which require only a single light finger touch of the button) serve to select a program menu in the Parastep's microcomputer. As the user walks, the sensors send information to the gait detector, which uses preset information in the software to determine the patient's gait cycle and activate muscle groups that are part of the gait cascade.
FES FOR U PPER E XTREMITY F UNCTION
Stimulating electrodes are used to generate flexion and extension of the fingers and thumb. Opening and closing of the hand is controlled using an external position sensor that is placed on the shoulder of the patient's opposite arm.
FES FOR E XERCISE
The control strategy can be varied to suit the user's different shoulder movement abilities. Typically, the forward/retract movement of the shoulder is used as a proportional signal for opening and closing the hand.
SPINAL CORD STIMULATION .1 O VERVIEW.1 OVERVIEW
If the bike is to be converted for use by a person with tetraplegia, more restraints must be added to stabilize the upper body. Some serious concerns must be included during the design process of an FES cycling system.