Low Cost Magnetic Field Control for Disabled People.

Our research presents a cost-effective navigation system for electric wheelchairs that utilizes the tongue as a human-machine interface (HMI) for disabled individuals. The user controls the movement of the wheelchair by wearing a small neodymium magnet on their tongue, which is held in place by a suction pad. The system uses low-cost electronics and sensors, including two electronic compasses, to detect the position of the magnet in the mouth. One compass estimates the magnet's position while the other is used as a reference to compensate for static magnetic fields. A microcontroller processes the data using a computational algorithm that takes the mathematical formulations of the magnetic fields as input in real time. The system has been tested using real data to control an electric wheelchair, and it has been shown that a trained user can effectively use tongue movements as an interface for the wheelchair or a computer.

Natural history of Charcot-Marie-Tooth disease type 2A: a large international multicentre study.

Mitofusin-2 (MFN2) is one of two ubiquitously expressed homologous proteins in eukaryote cells, playing a critical role in mitochondrial fusion. Mutations in MFN2 (most commonly autosomal dominant) cause Charcot-Marie-Tooth disease type 2A (CMT2A), the commonest axonal form of CMT, with significant allelic heterogeneity. Previous, moderately-sized, cross sectional genotype-phenotype studies of CMT2A have described the phenotypic spectrum of the disease, but longitudinal natural history studies are lacking. In this large multicentre prospective cohort study of 196 patients with dominant and autosomal recessive CMT2A, we present an in-depth genotype-phenotype study of the baseline characteristics of patients with CMT2A and longitudinal data (1-2 years) to describe the natural history. A childhood onset of autosomal dominant CMT2A is the most predictive marker of significant disease severity and is independent of the disease duration. When compared to adult onset autosomal dominant CMT2A, it is associated with significantly higher rates of use of ankle-foot orthoses, full-time use of wheelchair, dexterity difficulties and also has significantly higher CMT Examination Score (CMTESv2) and CMT Neuropathy Score (CMTNSv2) at initial assessment. Analysis of longitudinal data using the CMTESv2 and its Rasch-weighted counterpart, CMTESv2-R, show that over 1 year, the CMTESv2 increases significantly in autosomal dominant CMT2A (mean change 0.84 ± 2.42; two-tailed paired t-test P = 0.039). Furthermore, over 2 years both the CMTESv2 (mean change 0.97 ± 1.77; two-tailed paired t-test P = 0.003) and the CMTESv2-R (mean change 1.21 ± 2.52; two-tailed paired t-test P = 0.009) increase significantly with respective standardized response means of 0.55 and 0.48. In the paediatric CMT2A population (autosomal dominant and autosomal recessive CMT2A grouped together), the CMT Pediatric Scale increases significantly both over 1 year (mean change 2.24 ± 3.09; two-tailed paired t-test P = 0.009) and over 2 years (mean change 4.00 ± 3.79; two-tailed paired t-test P = 0.031) with respective standardized response means of 0.72 and 1.06. This cross-sectional and longitudinal study of the largest CMT2A cohort reported to date provides guidance for variant interpretation, informs prognosis and also provides natural history data that will guide clinical trial design.

Evaluation of interface pressure and temperature management in five wheelchair seat cushions and their effects on user satisfaction.

BACKGROUND: Factors such as the manufacturing materials, shape or even the mechanical and thermal response of sitting Pressure Redistribution Support Surfaces (PRSS) can be potential contributors to pressure ulcers. However, few studies have compared a number of characteristics of the most frequently used devices. OBJECTIVE: To compare three potential contributors to pressure ulcers in five commercial PRSS: pressure redistribution, temperature and perceived comfort. METHOD: Study with a cross-over randomized design in healthy volunteer participants. Data was collected in a temperature and relative humidity controlled environment. To assess thermal response, the temperature (Flir-E60) of the region of interest was captured before and after use of each PRSS for further analysis. The region of interest was the gluteal zone. To assess the pressure redistribution a pressure mat (XSensor®) was used between the 5 cushion and each study participant using a standardized method. Finally, a subjective perception questionnaire recorded comfort, adaptability and thermal sensation parameters. Data analysis levels of significance were set at 0.05. RESULTS: A total of 22 participants completed the assessments. There were no statistically significant differences in baseline temperatures between PRSS (>0.05). Pressure redistribution analysis showed significant differences between all PRSS in all variables evaluated except in the maximum and peak pressure index al sacrum. The subjective assessment suggested no major user-perceived differences between PRSS. CONCLUSION: Seat cushions made of open cell polyurethane foam blocks of variable hardness and the horseshoe cushion (also open cell polyurethane foam) seem to provide a more effective pressure relief characteristic than those injected with polyurethane foam and gel in most of the studied pressure variables. However, the cushions provide similar thermal response and perceived comfort.

Influence of Training Models at 3,900-m Altitude on the Physiological Response and Performance of a Professional Wheelchair Athlete: A Case Study.

Sanz-Quinto, S, López-Grueso, R, Brizuela, G, Flatt, AA, and Moya-Ramón, M. Influence of training models at 3,900-m altitude on the physiological response and performance of a professional wheelchair athlete: A case study. J Strength Cond Res 33(6): 1715-1723, 2019-This case study compared the effects of two training camps using flexible planning (FP) vs. inflexible planning (IP) at 3,860-m altitude on physiological and performance responses of an elite marathon wheelchair athlete with Charcot-Marie-Tooth disease (CMT). During IP, the athlete completed preplanned training sessions. During FP, training was adjusted based on vagally mediated heart rate variability (HRV) with specific sessions being performed when a reference HRV value was attained. The camp phases were baseline in normoxia (BN), baseline in hypoxia (BH), specific training weeks 1-4 (W1, W2, W3, W4), and Post-camp (Post). Outcome measures included the root mean square of successive R-R interval differences (rMSSD), resting heart rate (HRrest), oxygen saturation (SO2), diastolic blood pressure and systolic blood pressure, power output and a 3,000-m test. A greater impairment of normalized rMSSD (BN) was shown in IP during BH (57.30 ± 2.38% vs. 72.94 ± 11.59%, p = 0.004), W2 (63.99 ± 10.32% vs. 81.65 ± 8.87%, p = 0.005), and W4 (46.11 ± 8.61% vs. 59.35 ± 6.81%, p = 0.008). At Post, only in FP was rMSSD restored (104.47 ± 35.80%). Relative changes were shown in power output (+3 W in IP vs. +6 W in FP) and 3,000-m test (-7s in IP vs. -16s in FP). This case study demonstrated that FP resulted in less suppression and faster restoration of rMSSD and more positive changes in performance than IP in an elite wheelchair marathoner with CMT.

Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies.

Adaptive sports refers to organized sporting activities that are practiced by individuals with disabilities and are worthwhile to maintain physical and psychological health. As adaptive sports participation continues to rise, health care providers must have an enhanced understanding of injury and illness patterns specific to the adaptive athlete. Early recognition and prevention are important to ensure safe and successful participation in sport. The present review aims to provide a framework for diagnosis and prevention of common conditions specific to the wheelchair athlete. In particular, autonomic dysreflexia, impaired thermoregulation, urinary tract infection, and pressure injuries, as well as shoulder pain, upper-extremity entrapment neuropathies, and osteoporotic fractures will be discussed.

Mindfulness training attenuates the increase in salivary cortisol concentration associated with competition in highly trained wheelchair-basketball players.

This study determined the effect of 8 wk of mindfulness training (MT) on salivary cortisol (sCort) and rate of salivary Immunoglobulin-A (sIgA) secretion in wheelchair-basketball players during a competition period. The mindful group completed 8 weeks of MT in addition to training and competition. sCort and rate of sIgA secretion were measured at baseline, at 2-week intervals, the end and 2 weeks following the intervention. A significant time and group interaction was observed for sCort (F = 3.297, P = 0.040, ES = 0.191); sCort increased in the control group from MT-BL to MT-2wk (P = 0.001) and remained significantly elevated at MT-4wk (P = 0.013) and MT-6wk (P = 0.002). sCort decreased from MT-6wk to MT-8wk (P < 0.001) and concentrations were not different at MT-8wk and Post-2wk to MT-BL (P > 0.05). Mindful group sCort increased from MT-BL to MT-2wk (P = 0.042) but decreased to concentrations no different to MT-BL for the rest of the intervention period (P > 0.05). There were no group differences in rate of sIgA secretion during the intervention (P = 0.810). It was concluded that 8 weeks of MT attenuated the increase in sCort associated with the competition period.

Monitoring Heart Rate Variability Before and After a Marathon in an Elite Wheelchair Athlete: A Case Study.

The purpose of this study was to analyze heart rate variability (HRV) oscillations before and after a marathon which involved trans-meridian air travel and substantial time zone differences in a professional wheelchair athlete with Charcot-Marie-Tooth (CMT) disease. The natural logarithm of the root mean square difference between adjacent normal R-R intervals (Ln rMSSD) was measured daily on the days before, including and following the race. Relative to baseline, small (-3.8 - -4.6%) reductions in LnRMSSD were observed following relocation and on race-day, indicating only minor effects of travel on cardiac-autonomic activity. On the morning following the marathon, a 23.1% reduction in Ln rMSSD was observed, which returned to baseline by 48 h. The race time set by the athlete was the world-leading time in his class. This case study showed that Ln rMSSD responses to marathon in an elite wheelchair athlete with CMT was similar to those previously reported among unrestricted endurance athletes.

Access to Dental Services for People Using a Wheelchair.

OBJECTIVES: We investigated the perspectives of people using a wheelchair and their difficulties in accessing dental services. METHODS: Our participatory research was on the basis of a partnership between people using a wheelchair, dental professionals, and academic researchers. Partners were involved in a committee that provided advice at all stages of the project. Our team adopted a qualitative descriptive design. Between October 2011 and October 2012 we conducted semistructured individual interviews with 13 adults who lived in Montreal, Québec, Canada, and used a wheelchair full time. We audio-recorded and transcribed verbatim interviews, and we interpreted data using an inductive thematic analysis. RESULTS: Oral health is of heightened importance to this group of people, who tend to use their mouth as a "third hand." We identified successive challenges in accessing dental services: finding a dentist and being accepted, organizing transportation, entering the building and circulating inside, interacting with the dental staff, transferring and overcoming discomfort on the dental chair, and paying for the treatments. CONCLUSIONS: Governments, dental professional bodies, dental schools, and researchers should work with groups representing wheelchair users to improve access to dental services.

Measurement of Load Redistribution Properties of Wheelchair Cushions Using a Compliant Cushion Loading Indenter.

The aim of this project was to develop and validate a compliant cushion loading indenter (CCLI) capable of evaluating wheelchair cushion performance by measuring internal pressures and deflection. The design of the CCLI consists of 3 subsystems: 1) an internal substructure with medial and lateral protuberances to mimic the load-bearing ischial tuberosities and trochanters, 2) an elastomeric shell to mimic soft tissue and 3) instrumentation to measure internal pressures at both protuberances and deflection of the elastomer at 7 locations. It is parametrically designed so can be scaled larger or smaller to represent different body sizes. To assess the repeatability and sensitivity of measurements, the model was loaded onto two wheelchair cushions, 3″ flat foam and Jay3, using two loads, 44kgf and 53kgf, representing the average upper body mass of 70kg and 83kg persons, respectively. The results showed a high precision of pressure and deflection measurement across two different cushions and loads. Under both loads, pressure measurements exhibited a standard error of < 1 mm and <3 mmHg. The standard deviations of deflection values were less than 2.5 mm (0.1 in.). The pressures and absolute deflection differed significantly across load and cushion type indicating sensitivity to change.

[Design and evaluation of preventive seats for pressure ulcers associated with spinal injuries]. / Diseno y evaluación de asientos preventivos de úlceras por presión para lesionados medulares.

INTRODUCTION: Pressure ulcers are a dominant health problem for people who, for various reasons, must spend most of their time in a seated position. The spinal cord injury patients are the most affected for this situation. One strategy to prevent pressure ulcers is throughthe use of special seats. In the Instituto Nacional de Rehabilitación, contoured special seats have been developed according to anatomical measure of spinal cord injured patients. OBJECTIVE: To find one or more combinations of test materials that reduced pressure below 60 mmHg, in the ischial area, in order to help to prevent pressure ulcers. MATERIAL AND METHODS: The special seats were fabricated using thermoplastic materials and polyurethane foams, following prosthetic fitting technique; and were tests in healthy volunteers. RESULTS: The results were compared with a vinyl seat, because most of wheelchairs have it. All different test combinations were superior to vinyl seat, specially the two polyurethane foam- polypropylene combinations. A group of nine patients with spinal cord injury were recruited to test the designed seats, for a three month period. DISCUSSION: The results showed that pressure values are lower in the special seats than in the vinyl seats. No complications or pressure ulcers were found during follow up.

Stability of ischial pressure with 3D thermoplastic elastomer cushion and the characteristics of four types of cushions in pressure redistribution.

Wheelchair cushions are recommended to be used with wheelchair and can protect the buttocks from pain and injury by relieving interface pressure for wheelchair users. However, further investigations are required for proper use in response to the development of new types of wheelchair cushions. The objective of this study was to evaluate physical characteristics of wheelchair cushions by comparing pressure redistributing effects of four types of cushions. The participants were 16 healthy adults who consented to participate in this study. A pressure mapping system (CONFORMat, Nitta Corp.) was used for the measurements. Pressure at ischium was measured immediately after the stabilization of the sitting posture and 10 minutes after. The pressure at ischium significantly decreased with any wheelchair cushions (P < 0.01). A significant negative correlation between body mass index and pressure at ischium was observed without a wheelchair cushion (r = - 0.70), however, the correlation disappeared upon use of a wheelchair cushion. The pressure at ischium increased over time with cushions of urethane, air, and urethane-air hybrid while that with the 3D thermoplastic elastomer cushion did not, and the change in the pressure was statistically less than that in other cushions (P < 0.01). Use of wheelchair cushions was effective in redistribution of the pressure at ischium, and the overtime change in the pressure depends on the type of used cushions.

Reliability of the revised wheelchair rugby trunk impairment classification system.

STUDY DESIGN: Observational, cross-sectional. OBJECTIVES: A new classification system for trunk impairment in wheelchair rugby was introduced in 2010. It consists of 10 tests, arranged in an algorithm, to assign four different trunk scores (0, 0.5, 1.0 or 1.5) to athletes. The purpose of this study was to assess the inter-rater reliability of this classification system. SETTING: National competition for wheelchair rugby and wheelchair basketball in the Netherlands and Belgium. METHODS: Three experienced wheelchair rugby classifiers independently assigned trunk scores to wheelchair rugby and wheelchair basketball athletes in two sessions. After each session, test descriptions were adjusted. The inter-rater reliability was evaluated by determining the agreement and Fleiss Kappa. RESULTS: In the first session, all classifiers agreed on the trunk score in 13 out of 16 athletes; the overall Kappa was 0.76 (P<0.001). The Kappa per trunk score ranged from 0.29 to 1. Four test descriptions were adjusted after the first session. In the second session, there was an agreement in trunk score between the classifiers in 15 out of 21 athletes. The overall Kappa was 0.75 (P<0.0001), and the Kappa per trunk scores ranged from 0.58 to 0.92. After the second session, two test descriptions were improved. CONCLUSION: The revised classification system for trunk impairment in wheelchair rugby showed a adequate inter-rater reliability for the allocation of trunk scores.

Testing for boosting at the Paralympic games: policies, results and future directions.

BACKGROUND: 'Boosting' is defined as the intentional induction of autonomic dysreflexia (AD) by athletes with a spinal cord injury (SCI) at or above the level of T6 for the purpose of improving sports performance. Boosting has been shown to confer up to a 9.7% improvement in race time. Additionally, to compete in a hazardous dysreflexic state, whether intentional or unintentional, would present an extreme health risk to the athlete. For these reasons, the International Paralympic Committee strictly bans the practice of boosting, and has developed a protocol to test for its presence. METHODS: Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test. RESULTS: A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98-178) and 82 mm Hg (range 44-112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD. DISCUSSION: Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing protocol and the development of further educational initiatives.

Experimental study of the influence of using polyurethane cushion to reduce vibration received by a wheelchair user.

PURPOSE: The aim of this experimental study was to compare the ability of polyurethane cushions of three arbitrary selected thicknesses to minimize vibrations transmitted from the wheelchair to its user. METHODS: Measurements were made during passive motion on five different surfaces often found in public spaces. Two tests were carried out during the measurements. In the first test, the sensor was located directly on the surface of the wheelchair seat. In the second test, a polyurethane cushion was placed on the seat, on which the measuring sensor was then placed. RESULTS: The study showed that regardless of the surface on which the wheelchair user moves, the threshold defined in the ISO standard for frequencies in the range of 4-40 Hz was exceeded. However, thanks to the use of polyurethane cushions, vibration damping was visible for frequencies ranging from 10 to 40 Hz. The impact of the user's weight on the magnitude of the perceived vibrations was also observed. CONCLUSIONS: Studies show that wheelchair users are exposed to whole body vibration that can negatively affect their health. Cushions made of polyurethane seem to be a promising solution to reduce whole body vibration in the frequency range that is burdensome and harmful to human health.

Determining frictional properties of pants and cushion cover materials using human soft tissue and a rigid sled and how they affect seated shear forces.

Shear forces on the buttocks while seated are directly linked to friction, yet the frictional properties at the seat interface are unknown. Shear forces are one of the factors related to increase risk of pressure injury formation. The goals of this study included determining coefficients of friction between three cushion covers and two clothing fabrics using a mechanical system as well as human participants and to evaluate the impact of the cushion covers on shear loading on the buttocks while seated. A chair with separate seat pan tilt and back recline movements was built and instrumented with reflective markers and a load cell. A motion capture system and load cell were used to determine the angles of seat pan tilt at which the sled and participants started sliding, as well as shear forces at three recline angles for three cushion covers (vinyl, one-layer nylon, and two-layer nylon). Results showed the vinyl and two-layer nylon cushion covers respectively had the largest and smallest coefficients of friction for both pants materials. The coefficients of friction calculated with the human participants and rigid sled were within 10% of each other, demonstrating similar results. Further, increasing back recline increased shear load on the buttocks, while the two-layer nylon cover reduced shear forces seen on the buttocks. This work furthers the understanding of shear loading on the buttocks, will aid in the protocols for reducing pressure injuries, and suggests that coefficients of friction found using rigid bodies may be applied to deformable bodies.

Patient acceptability of a wheel chair recliner developed to perform dental procedures at wheelchair itself: A cross-sectional study.

Aim: Transfer from a wheelchair and discomfort in dental chair are two important barriers for access to dental care among wheelchair-bound patients. The authors have devised an automated wheelchair recliner that helps to mimic the dental chair functioning at wheelchair itself. The aim of this study was to analyze the performance and acceptability of wheelchair recliner among wheelchair-bound patients. Settings and Design: Tertiary care settings, cross-sectional design. Materials and Methods: A total of 100 wheelchair-bound adult patients (aged >21 years) were evaluated for acceptability of the recliner. The patients were assessed using eight-item covering patient comfort/acceptability related to positioning, reclining, repositioning, fear of falls, joy, discomfort, perception regarding dentist's discomfort, and use in future on a scale of 0-4 with 0 indicating least satisfying and four indicating most satisfying experience. Overall, patient experience was graded as poor, fair, good, very good, and excellent. The Chi-square test was used to compare the results. Statistical Analysis Used: IBM Stats package 21.0 was used. Mean ± standard deviation, Numbers/percentages and Chi-square test were used to compare results. The confidence level of the study was 95%. Results: The age of patients ranged from 22 to 83 years (mean age 52.26 ± 18.58 years). Majority were males (58%) and had temporary (60%) disability. On a 4-point scale, the mean scores of patients ranged from 2.47 ± 1.23 (positioning) to 3.40 ± 0.74 (intent to use in future). Overall experience was rated as good to very good by 77% of patients. No significant association of age, sex, or type of disability was seen with overall patient experience. Conclusion: The acceptability rates were good to very good among wheelchair-bound patients and were unaffected by their age, sex, and type of disability.

A Patient with a History of Right-Sided Stroke and Hemiplegia, in a Wheelchair, Presents with a Complaint of Upper Left Tooth Pain.

Patients with a history of stroke often present with numerous neurologic deficits and varying degrees of disability. Ambulation problems requiring the use of a wheelchair can make accessing and receiving dental care difficult for these patients. Side effects from medications can compromise their oral health and complicate care. Possible dexterity limitations decrease their ability to maintain their oral health. Innovative care plans and adaptations may be needed to accommodate the needs of these patients but care generally can be provided safely and effectively in the outpatient dental setting.

Mucosal immune responses during court training in elite tetraplegic athletes.

STUDY DESIGN: Experimental study. OBJECTIVES: To examine salivary secretory immunoglobulin A (sIgA) responses and α-amylase activity during court training in highly trained tetraplegic athletes. SETTING: Loughborough, UK. METHODS: Seven highly trained wheelchair rugby athletes with tetraplegia performed two separate wheelchair rugby court training sessions, lasting 23 and 41.5 min, respectively, with either an aerobic or an interval focus. Timed, unstimulated saliva samples were obtained pre, post and 30 min post exercise and analysed for sIgA and α-amylase. Furthermore, blood lactate concentration and rating of perceived exertion (RPE) immediately after training were measured. RESULTS: sIgA secretion rate and α-amylase were unaffected by exercise during both sessions. However, the increases of sIgA concentration (30 min post exercise: +67 ± 29%) during the aerobic session were accompanied by decreases in saliva flow rate (-35 ± 22%). Athletes' physiological responses to exercise document the highly strenuous nature of the sessions, with blood lactate concentrations reaching 8.1 ± 1.0 and 8.7 ± 1.6 mmol l(-1) and RPE reaching 18(17,18) and 16(15,17) for the aerobic and the interval session, respectively. CONCLUSION: Acute bouts of highly strenuous exercise do not have negative impacts on the mucosal immune response in tetraplegic athletes, nor do they influence the production of α-amylase, a marker of sympathetic nervous activity. This contrasts responses previously observed in able-bodied athletes. The disruption of the sympathetic nervous system may prevent the downregulation of sIgA secretion rate following intense exercise, which is a response previously observed in able-bodied athletes.

Investigating the effects of varying the angle of application and increasing the ignition source flow rate during ISO ignitability testing on foam and vinyl.

To investigate how, and to what extent, the following factors influence burn damage: (1) the angle of application of the ignition source to the sample surface, and (2) the flow rate for the ignition source, when assessing samples in accordance with ISO 8191-2:1988. Varying the ignition source flow rate and the angle of application of the ignition source to the sample undergoing testing, which are both variations on the existing procedure outlined in the Standard ISO 8191-2:1988. Burn damage as measured by the depth (if applicable) and greatest horizontal and vertical dimensions. Increasing the ignition source gas flow rate (from 45 ml/min to 240 ml/min) increased the measured burn damage for both foam and vinyl samples. The increased damage factor was at least two-fold (and up to five-fold). Changing the angle of application of the ignition source (45 degrees compared to 0 degrees) did not significantly affect the measured burn damage for either sample. These findings indicate that the direction of application of a match-flame equivalent ignition source has no significant affect on the resulting burn damage, but that increasing the ignition source flow rate increases the burn damage for both foam and vinyl samples.

Validating a change of technique proposed in draft ISO7176-16 ignitability testing on wheelchair materials.

To investigate whether (1) the changes to the angle of application of the ignition source to the sample surface, and (2) more precise failure criteria, would result in similar outcomes (in terms of pass/fail criteria) when assessing samples in accordance with ISO CD 7176-16:2010. Time before smouldering/fire/smoke had ceased following withdrawal of the flame as well as area of burn damage were recorded. Changing the angle of application of the ignition source (45 degrees compared to 0 degrees) did not appreciably affect the ongoing smouldering/smoking of samples, but did result in increased measured burn damage for most samples. Thin structures showed more variable outcomes especially in the vertical orientation. The direction of application of a match-flame equivalent ignition source has only a moderate affect on the resulting burn damage, and that pass/fail results from the proposed revision would be consistent with the existing ISO7176-16 with the exception of the proposed burn damage criterion. It is suggested that the burn damage area be moderately increased in the draft standard to maintain consistency under the existing standard. Some benefits were identified in fixing thin coverings to underlying materials, and little value in any cleaning or laundering pre-test.