How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers.

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

Designing Hospitals Through the Lens of Universal Design. An Evaluation Tool to Enhance Inclusive Healthcare Facilities.

Various studies highlight a gap on reliable methods to measure the quality of projects and environments in terms of Universal Design (UD) and Design for All (DfA). In particular, healthcare facilities need decision support systems to improve the well-being of as many users as possible through a systematic approach. The present research proposes an evaluation tool to support designers and decision makers in the adoption of UD to develop healthcare facilities suitable for a wide range of users. Several methodologies have been adopted: an in-depth literature review on the current state of knowledge on UD evaluation, workshops and focus groups with both users and experts, and the analysis of four hospital case studies. The result was an evaluation framework built by using a Multi-criteria Analysis (MCA) methodology. The first version of the tool was applied to an American hospital and validated d in an Italian pilot case study. The research outlines a tool called Design for All A.U.D.I.T., able to evaluate Physical, Sensory-cognitive, and Social qualities based on a hierarchical framework with criteria and indicators based on UD and DfA. The framework evaluates the different areas of the hospital from outdoor to indoor spaces, allowing hospital administrators to act to improve the well-being of users according to the critical aspects of UD identified by the tool. The analysis provides a report of the facility status and design strategies to support designers for new projects or buildings renovations. The application shows that DfA A.U.D.I.T. can assess hospitals by examining both spatial qualities and DfA criteria. The tool could represent a decision support system in the national and international context, where many hospitals are not newly built. Further research will include application in different facilities and building typologies, aided by the flexible structure of the tool, which allows measurement of the environment's quality in terms of DfA and UD.

Anthropometry and standards for wheeled mobility: an international comparison.

Space requirements for accommodating wheeled mobility devices and their users in the built environment are key components of standards for accessible design. These requirements typically include dimensions for clear floor areas, maneuvering clearances, seat and knee clearance heights, as well as some reference dimensions on wheeled mobility device sizes. Recent research from four countries was reviewed and compared with their prevailing accessibility standards to identify needs for improving standards. Findings from ongoing anthropometry research on wheeled mobility in the U.S. were used for evaluating the adequacy of existing U.S. accessibility standards. Preliminary analysis suggests that the U.S. standards, which are based on research conducted in the 1970s, need to be updated to address advances in wheeled mobility technology and changes in user demographics. The analysis highlights the importance of integrating research with standards development, organizing international collaborations, and developing international standards.

Space Requirements for Wheeled Mobility Devices in Public Transportation: An Analysis of Clear Floor Space Requirements: (Investing in Accessible Transportation and Mobility ABE60).

Recent research on the anthropometry of wheeled mobility devices and their users (n=369) indicates that the current dimensions for 'clear floor area' prescribed in U.S. accessibility standards for transportation are inadequate for accommodating many users of wheeled mobility devices, especially those that use power chairs and scooters. The current report presents anthropometry data for determining the dimensions of clear floor area based on occupied device length and width to achieve a specified level of physical accommodation. The implications of the findings and the need for revising guidelines for accessible public transportation systems are discussed. It is important that the transportation industry as well as mobility device manufacturers, vendors and prescribers understand the limitations of current standards and becomes involved in the dialogue about how to address the need for improving them.

Self-reported difficulty and preferences of wheeled mobility device users for simulated low-floor bus boarding, interior circulation and disembarking.

BACKGROUND: Low ridership of public transit buses among wheeled mobility device users suggests the need to identify vehicle design conditions that are either particularly accommodating or challenging. The objective of this study was to determine the effects of low-floor bus interior seating configuration and passenger load on wheeled mobility device user-reported difficulty, overall acceptability and design preference. METHODS: Forty-eight wheeled mobility users evaluated three interior design layouts at two levels of passenger load (high vs. low) after simulating boarding and disembarking tasks on a static full-scale low-floor bus mockup. RESULTS: User self-reports of task difficulty, acceptability and design preference were analyzed across the different test conditions. Ramp ascent was the most difficult task for manual wheelchair users relative to other tasks. The most difficult tasks for users of power wheelchairs and scooters were related to interior circulation, including moving to the securement area, entry and positioning in the securement area and exiting the securement area. Boarding and disembarking at the rear doorway was significantly more acceptable and preferred compared to the layouts with front doorways. CONCLUSION: Understanding transit usability barriers, perceptions and preferences among wheeled mobility users is an important consideration for clinicians who recommend mobility-related device interventions to those who use public transportation. Implications for Rehabilitation In order to maximize community participation opportunities for wheeled mobility users, clinicians should consider potential public transit barriers during the processes of wheelchair device selection and skills training. Usability barriers experienced by wheeled mobility device users on transit vehicles differ by mobility device type and vehicle configurations. Full-scale environment simulations are an effective means of identifying usability barriers and design needs in people with mobility impairments and may provide an alternative model for determining readiness for using fixed route buses or eligibility for paratransit.

A Review of Universal Design in Professional Architectural Education: Recommendations and Guidelines.

There is a growing understanding of the widespread societal benefits of a universal design (UD). To achieve these benefits, architectural professionals must have the knowledge and skills to implement UD in practice. This paper investigates UD in the context of recent architectural education. It traces changing attitudes in the culture of architectural education, and the evolving perception of UD as an important aspect of architectural practice. Specifically, continuous professional development (CPD) can advance knowledge of UD within a human-centred design paradigm. An overview of courses and resources available to architectural professionals in a number of countries in Europe and the USA is provided. Specific recommendations and guidelines are presented that were derived from a process of engagement with Irish and international architectural professionals, architectural educators and client bodies through online survey, workshops, interviews and CPD prototypes. The research described was commissioned by the Centre for Excellence in Universal Design at the National Disability Authority, working in partnership with the Royal Institute of the Architects of Ireland (RIAI).

Effects of transit bus interior configuration on performance of wheeled mobility users during simulated boarding and disembarking.

The emergence of low-floor bus designs and related regulatory standards in the U.S. have resulted in substantial improvements in public transit accessibility. However, passengers using wheeled mobility devices still experience safety concerns and inefficiencies in boarding, disembarking, and interior circulation on low-floor buses. This study investigates effects of low-floor bus interior configuration and passenger crowding on boarding and disembarking efficiency and safety. Users of manual wheelchairs (n = 18), powered wheelchairs (n = 21) and electric scooters (n = 9) simulated boarding and disembarking in three interior layout configurations at low and high passenger crowding conditions on a full-scale laboratory mock-up of a low-floor bus. Dependent measures comprised task times and critical incidents during access ramp use, fare payment, and movement to and from the doorway and wheeled mobility securement area. Individual times for unassisted boarding ranged from 15.2 to 245.3 s and for disembarking ranged from 9.1 to 164.6 s across layout and passenger crowding conditions. Nonparametric analysis of variance showed significant differences and interactions across vehicle design conditions, passenger load and mobility device type on user performance. The configuration having electronic on-board fare payment, rear-bus entrance doorways and adjacent device securement areas demonstrated greatest efficiency and safety. High passenger load adversely impacted efficiency and frequency of critical incidents during on-board circulation across all three layouts. Findings have broader implications for improving transit system efficiency and quality of service across the spectrum of transit users.

Universal Design and Continuing Professional Development for Architects: An Irish Case Study.

The Tomar Resolution urged that all occupations working in the built environment be educated in the principles and measures of Universal Design in order to facilitate all people playing a full role in society. For Architects and Architectural Technologists, under-graduate education will continue to have a major role to play. At the same time in the Republic of Ireland, and in an ever-growing number of other jurisdictions, Continuous Professional Development (CPD) is a requirement for all Architects and Architectural Technologists and can significantly affect knowledge, skill and competence in a number of subjects including Universal Design. This paper looks at the results of a recent survey of Architects and Architectural Technologists practising in Ireland, architectural educators, and client bodies that sought to assess the following: 1. How inherent is Universal Design knowledge to current building design practice? 2. What are the current Universal Design education and training needs of Architects and Architectural Technologists practising in Ireland? 3. Which Universal Design themes and topics are of most interest to Architects and Architectural Technologists practising in Ireland? 4. To what extent does existing CPD for Architects and Architectural Technologists practising in Ireland address Universal Design topics? 5. What can motivate Architects and Architectural Technologists practising in Ireland to access Universal Design CPD? 6. What are the most effective means by which to deliver Universal Design CPD to Architects and Architectural Technologists practising in Ireland? The survey discussed in this paper is one phase of a longer study aimed at providing a research base for developing CPD in Universal Design for Architects and Architectural Technologists practising in Ireland.

Development of a new assessment of effort and assistance in standing pivot transfers with functional electrical stimulation.

BACKGROUND: Currently available clinical tools for assessing rehabilitation outcomes do not capture both the effort exerted and assistance required for persons with spinal cord injuries to perform a standing pivot transfer using functional electrical stimulation (FES). This study was undertaken to develop and apply a clinical tool to measure the ability to stand and transfer with electrical stimulation. METHODS: The Functional Performance Measure (FPM) methodology was chosen to develop a tool to measure performance. Through an iterative review of videotaped FES transfers, fundamental components of the standing pivot transfer were identified and standardized performance criteria for user effort and helper assistance were developed for every phase using the 8-point FPM scales. RESULTS: Interrater and intrarater reliability were established with a simple kappa coefficient for the effort scale and assistance scale. The final version of the tool has been applied to users of the implanted FES standing neuroprosthesis to describe the effort and assistance required for the transfer. CONCLUSION: The tool has been shown to capture the effort and assistance needed during FES-assisted standing pivot transfers throughout all phases of the transfer.

Low-floor bus design preferences of walking aid users during simulated boarding and alighting.

Low-floor buses represent a significant improvement in accessible public transit for passengers with limited mobility. However, there is still a need for research on the inclusive design of transit buses to identify specific low-floor bus design conditions that are either particularly accommodating or challenging for passengers with functional and mobility impairments. These include doorway locations, seating configuration and the large front wheel-well covers that collectively impact boarding, alighting and interior movement of passengers. Findings from a laboratory study using a static full-scale simulation of a lowfloor bus to evaluate the impact of seating configuration and crowding on interior movement and accessibility for individuals with and without walking aids are presented (n=41). Simulated bus journeys that included boarding, fare payment, seating, and alighting were performed. Results from video observations and subjective assessments showed differences in boarding and alighting performance and users' perceptions of task difficulty. The need for assistive design features (e.g. handholds, stanchions), legroom and stowage space for walking aids was evident. These results demonstrate that specific design conditions in low-floor buses can significantly impact design preference among those who use walking aids. Consideration of ergonomics and inclusive design can therefore be used to improve the design of low-floor buses.