Accessible Autonomous Transportation and Services: Design Considerations From the Perspective of Consumers and Providers.

OBJECTIVE: To understand the priorities and preferences of people with disabilities (PwDs) and older adults regarding accessible autonomous vehicles (AVs) to address existing transportation barriers. DESIGN: Two national surveys, Voice of the Consumer and Voice of the Provider, were conducted to gather feedback from accessible AV consumers and providers, respectively, in the United States. SETTING: This U.S.-based study focused on PwDs and older adults who may face transportation challenges and those who provide or design AV solutions. PARTICIPANTS: The 922 consumers and 45 providers in the surveys encompassed a diverse range of disability types, caregiver roles, and age groups (N = 967). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The main outcomes were consumer usage needs and provider preferences for features in accessible autonomous transportation. Patterns in usage needs and feature preferences through 2-step clustering algorithm were applied subsequent to the descriptive analysis of participant demographics and their responses. RESULTS: Participants strongly preferred AV features enhancing personal transportation, especially for rural medical appointments. Most sought comprehensive AV automated features. Wheelchair users emphasized accessible entrances, particularly for lower-income brackets ($25,000-$49,000). Provider priorities closely aligned with consumer preferences, reinforcing content validity. CONCLUSIONS: The study highlights the importance of prioritizing wheelchair accessibility in AVs and improving access to medical appointments, especially in rural and low-income communities. Implications include developing inclusive AV services for PwDs and underserved populations. The research establishes a foundation for a more equitable and accessible transportation landscape through AV technology integration.

Teeth outside the mouth: The evolution and development of shark denticles.

Vertebrate skin appendages are incredibly diverse. This diversity, which includes structures such as scales, feathers, and hair, likely evolved from a shared anatomical placode, suggesting broad conservation of the early development of these organs. Some of the earliest known skin appendages are dentine and enamel-rich tooth-like structures, collectively known as odontodes. These appendages evolved over 450 million years ago. Elasmobranchs (sharks, skates, and rays) have retained these ancient skin appendages in the form of both dermal denticles (scales) and oral teeth. Despite our knowledge of denticle function in adult sharks, our understanding of their development and morphogenesis is less advanced. Even though denticles in sharks appear structurally similar to oral teeth, there has been limited data directly comparing the molecular development of these distinct elements. Here, we chart the development of denticles in the embryonic small-spotted catshark (Scyliorhinus canicula) and characterize the expression of conserved genes known to mediate dental development. We find that shark denticle development shares a vast gene expression signature with developing teeth. However, denticles have restricted regenerative potential, as they lack a sox2+ stem cell niche associated with the maintenance of a dental lamina, an essential requirement for continuous tooth replacement. We compare developing denticles to other skin appendages, including both sensory skin appendages and avian feathers. This reveals that denticles are not only tooth-like in structure, but that they also share an ancient developmental gene set that is likely common to all epidermal appendages.

Evaluation of Power Wheelchair Dynamic Suspensions for Tip Prevention in Non-ADA Compliant Surfaces.

OBJECTIVE: To evaluate the driving performance and usability of a mobility enhancement robot (MEBot) wheelchair with 2 innovative dynamic suspensions compared with commercial electric powered wheelchair (EPW) suspensions on non-American with Disabilities Act (ADA) compliant surfaces. The 2 dynamic suspensions used pneumatic actuators (PA) and electro-hydraulic with springs in series electrohydraulic and spring in series (EHAS). DESIGN: Within-subjects cross-sectional study. Driving performance and usability were evaluated using quantitative measures and standardized tools, respectively. SETTING: Laboratory settings that simulated common EPW outdoor driving tasks. PARTICIPANTS: 10 EPW users (5 women, 5 men) with an average age of 53.9±11.5 years and 21.2±16.3 years of EPW driving experience (N=10). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): Seat angle peaks (stability), number of completed trials (effectiveness), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST), and systemic usability scale (SUS). RESULTS: MEBot with dynamic suspensions demonstrated significantly better stability (all P<.001) than EPW passive suspensions on non-ADA-compliant surfaces by reducing seat angle changes (safety). Also, MEBot with EHAS suspension significantly completed more trials over potholes compared with MEBot with PA suspension (P<.001) and EPW suspensions (P<.001). MEBot with EHAS had significantly better scores in terms of ease of adjustment (P=.016), durability (P=.031), and usability (P=.032) compared with MEBot with PA suspension on all surfaces. Physical assistance was required to navigate over potholes using MEBot with PA suspension and EPW suspensions. Also, participants reported similar responses regarding ease of use and satisfaction toward MEBot with EHAS suspension and EPW suspensions. CONCLUSIONS: MEBot with dynamic suspensions improve safety and stability when navigating non-ADA-compliant surfaces compared with commercial EPW passive suspensions. Findings indicate MEBot readiness for further evaluation in real-world environments.

Changes to physical activity behavior during the COVID-19 pandemic and their associated factors: a cross sectional survey of Mexican women.

BACKGROUND: On March 24, 2020, the Mexican Government established social distancing measures to address the outbreak of the COVID-19 pandemic. The resulting home confinement affected daily lifestyle habits such as eating, sleeping, and physical activity (PA). The objectives of this study were to determine changes in PA behaviors among Mexican women due to the COVID-19 pandemic and to assess potential factors associated with these changes. METHODS: This was a cross-sectional study based on an anonymous online questionnaire developed by the Task Force on Physical Activity for Persons with Disabilities (PAPD) within the International Society of Physical and Rehabilitation Medicine (ISPRM). Descriptive, quantitative statistics were used for data analysis. A Chi-squared (χ²) test was used to explore associations between dependent and independent variables. RESULTS: A total of 1882 surveys were completed. Among the respondents, 53.3% declared that their PA was reduced during the pandemic, 26.6% reported similar PA behavior, and 20.1% declared that their PA had increased during the pandemic. Lower PA behavior during the pandemic was associated with lower education levels, stricter pandemic constraints, obesity, and lower self-perceived functioning levels. A statistically significant association between poorer self-perceived mental health and decreased PA behaviors was also found. Respondents who were younger, self-perceived as unimpaired, not overweight, and whose income was not impacted by COVID-19 were associated with higher levels of reported physical and mental health. CONCLUSIONS: The study results identify disparities experienced in PA behavior during the COVID-19 pandemic among Mexican women and highlights the need for social support for PA participation.

Participatory Action Design and Engineering of Powered Personal Transfer System for Wheelchair Users: Initial Design and Assessment.

Caregivers that assist with wheelchair transfers are susceptible to back pain and occupational injuries. The study describes a prototype of the powered personal transfer system (PPTS) consisting of a novel powered hospital bed and a customized Medicare Group 2 electric powered wheelchair (EPW) working together to provide a no-lift solution for transfers. The study follows a participatory action design and engineering (PADE) process and describes the design, kinematics, and control system of the PPTS and end-users' perception to provide qualitative guidance and feedback about the PPTS. Thirty-six participants (wheelchair users (n = 18) and caregivers (n = 18)) included in the focus groups reported an overall positive impression of the system. Caregivers reported that the PPTS would reduce the risk of injuries and make transfers easier. Feedback revealed limitations and unmet needs of mobility device users, including a lack of power seat functions in the Group-2 wheelchair, a need for no-caregiver assistance/capability for independent transfers, and a need for a more ergonomic touchscreen. These limitations may be mitigated with design modifications in future prototypes. The PPTS is a promising robotic transfer system that may aid in the higher independence of powered wheelchair users and provide a safer solution for transfers.

Test-Retest Reliability of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA): A Cohort Study.

IMPORTANCE: Currently, no self-report instruments exist for assessing satisfaction with performing instrumental activities of daily living and occupations for people with disabilities using internet-connected assistive devices like accessible smartphones, tablets, laptops, and apps. OBJECTIVE: To assess the test-retest reliability and internal consistency of the Electronic Instrumental activities of daily living Satisfaction Assessment (EISA) self-report outcome tool. DESIGN: Repeated-measures cohort study with a time frame of 7 to 21 days. SETTING: Multicity online recruitment at assistive technology clinics, nongovernmental organizations, advocacy and peer support groups for people with disabilities, and higher education institutions. PARTICIPANTS: Eighty-four participants with disabilities, age 18 yr or older, with a mean age of 43.3 yr (range = 19-75 yr), and 57% female. INTERVENTION: Not applicable. OUTCOMES AND MEASURES: The a priori study hypotheses were that the EISA test-retest reliability scores would be above the minimum acceptable level (Rs > .80) and that internal consistency would be good (Cronbach's α = .70-.90). RESULTS: On the basis of the study data, the EISA, Version 1.0, demonstrated good test-retest reliability (Rs = .81) and excellent internal consistency (Cronbach's α = .88). CONCLUSIONS AND RELEVANCE: The results of the test-retest reliability and internal consistency analyses provide good support for the EISA to be used in clinical settings. What This Article Adds: This article documents the reliability and internal consistency of, to our knowledge, the first-ever self-report instrument for assessing satisfaction with performance of everyday occupations for people with disabilities using internet-connected assistive devices such as smartphones, tablets, laptops, and apps.

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries. METHODS: A secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey. RESULTS: Among the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic. CONCLUSION: In Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.

Development and regeneration of the crushing dentition in skates (Rajidae).

Sharks and rays (elasmobranchs) have the remarkable capacity to continuously regenerate their teeth. The polyphyodont system is considered the ancestral condition of the gnathostome dentition. Despite this shared regenerative ability, sharks and rays exhibit dramatic interspecific variation in their tooth morphology. Ray (batoidea) teeth typically constitute crushing pads of flattened teeth, whereas shark teeth are pointed, multi-cuspid units. Although recent research has addressed the molecular development of the shark dentition, little is known about that of the ray. Furthermore, how dental diversity within the elasmobranch lineage is achieved remains unknown. Here, we examine dental development and regeneration in two Batoid species: the thornback skate (Raja clavata) and the little skate (Leucoraja erinacea). Using in situ hybridization and immunohistochemistry, we examine the expression of a core gnathostome dental gene set during early development of the skate dentition and compare it to development in the shark. Elasmobranch tooth development is highly conserved, with sox2 likely playing an important role in the initiation and regeneration of teeth. Alterations to conserved genes expressed in an enamel knot-like signalling centre may explain the morphological diversity of elasmobranch teeth, thereby enabling sharks and rays to occupy diverse dietary and ecological niches.

Automated Curb Recognition and Negotiation for Robotic Wheelchairs.

Common electric powered wheelchairs cannot safely negotiate architectural barriers (i.e., curbs) which could injure the user and damage the wheelchair. Robotic wheelchairs have been developed to address this issue; however, proper alignment performed by the user is needed prior to negotiating curbs. Users with physical and/or sensory impairments may find it challenging to negotiate such barriers. Hence, a Curb Recognition and Negotiation (CRN) system was developed to increase user's speed and safety when negotiating a curb. This article describes the CRN system which combines an existing curb negotiation application of a mobility enhancement robot (MEBot) and a plane extraction algorithm called Polylidar3D to recognize curb characteristics and automatically approach and negotiate curbs. The accuracy and reliability of the CRN system were evaluated to detect an engineered curb with known height and 15 starting positions in controlled conditions. The CRN system successfully recognized curbs at 14 out of 15 starting positions and correctly determined the height and distance for the MEBot to travel towards the curb. While the MEBot curb alignment was 1.5 ± 4.4°, the curb ascending was executed safely. The findings provide support for the implementation of a robotic wheelchair to increase speed and reduce human error when negotiating curbs and improve accessibility.

Usability Evaluation of a Novel Robotic Power Wheelchair for Indoor and Outdoor Navigation.

OBJECTIVE: To compare the Mobility Enhancement roBotic (MEBot) wheelchair's capabilities with commercial electric-powered wheelchairs (EPWs) by performing a systematic usability evaluation. DESIGN: Usability in effectiveness, efficacy, and satisfaction was evaluated using quantitative measures. A semistructured interview was employed to gather feedback about the users' interaction with MEBot. SETTING: Laboratory testing of EPW driving performance with 2 devices in a controlled setting simulating common EPW driving tasks. PARTICIPANTS: A convenience sample of expert EPW users (N=12; 9 men, 3 women) with an average age of 54.7±10.9 years and 16.3± 8.1 years of EPW driving experience. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Powered mobility clinical driving assessment (PMCDA), Satisfaction Questionnaire, National Aeronautics and Space Administration's Task Load Index. RESULTS: Participants were able to perform significantly higher number of tasks (P=.004), with significantly higher scores in both the adequacy-efficacy (P=.005) and the safety (P=.005) domains of the PMCDA while using MEBot over curbs and cross-slopes. However, participants reported significantly higher mental demand (P=.005) while using MEBot to navigate curbs and cross-slopes due to MEBot's complexity to perform its mobility applications which increased user's cognitive demands. CONCLUSIONS: Overall, this usability evaluation demonstrated that MEBot is a promising EPW device to use indoors and outdoors with architectural barriers such as curbs and cross-slopes. Current design limitations were highlighted with recommendations for further improvement.

Sox2+ progenitors in sharks link taste development with the evolution of regenerative teeth from denticles.

Teeth and denticles belong to a specialized class of mineralizing epithelial appendages called odontodes. Although homology of oral teeth in jawed vertebrates is well supported, the evolutionary origin of teeth and their relationship with other odontode types is less clear. We compared the cellular and molecular mechanisms directing development of teeth and skin denticles in sharks, where both odontode types are retained. We show that teeth and denticles are deeply homologous developmental modules with equivalent underlying odontode gene regulatory networks (GRNs). Notably, the expression of the epithelial progenitor and stem cell marker sex-determining region Y-related box 2 (sox2) was tooth-specific and this correlates with notable differences in odontode regenerative ability. Whereas shark teeth retain the ancestral gnathostome character of continuous successional regeneration, new denticles arise only asynchronously with growth or after wounding. Sox2+ putative stem cells associated with the shark dental lamina (DL) emerge from a field of epithelial progenitors shared with anteriormost taste buds, before establishing within slow-cycling cell niches at the (i) superficial taste/tooth junction (T/TJ), and (ii) deep successional lamina (SL) where tooth regeneration initiates. Furthermore, during regeneration, cells from the superficial T/TJ migrate into the SL and contribute to new teeth, demonstrating persistent contribution of taste-associated progenitors to tooth regeneration in vivo. This data suggests a trajectory for tooth evolution involving cooption of the odontode GRN from nonregenerating denticles by sox2+ progenitors native to the oral taste epithelium, facilitating the evolution of a novel regenerative module of odontodes in the mouth of early jawed vertebrates: the teeth.

Reflections on recovery, rehabilitation and reintegration of injured service members and veterans from a bio-psychosocial-spiritual perspective

Medical interventions regarding trauma resuscitation have increased survivorship to levels not previously attained. Multiple examples from recent conflicts illustrate the potential return to high-level function of severely injured service members following medical and rehabilitative interventions. This review addresses the goals of rehabilitation, distills hard-won lessons of the last decade of military trauma and rehabilitation, and recommends the use of a bio-psychosocial-spiritual approach to care that can be applied at all tiers of the health care system. Questions on enabling participation in meaningful life activities include the following: Why do some patients do well and others do not? What elements contribute to positive outcomes? What factors relate to suboptimal results? Lessons learned revolve around the importance of considering the physical, psychosocial and spiritual aspects of a person's well-being; empowering patients by fostering self-efficacy; and helping patients find meaning in life events and set high-level goals. A bio-psychosocial-spiritual model from the rehabilitation medicine literature ­ the Canadian Model of Occupational Performance and Engagement ­ is proposed as a guide to the provision of person-centred care and the maximization of a person's functioning posttrauma.

Les interventions médicales de réanimation en traumatologie ont porté les taux de survie à des niveaux encore inégalé. Plusieurs exemples tirés de conflits récents illustrent le retour potentiel à un degré fonctionnel élevé après des interventions médicales et de réadaptation chez des membres des forces armées grièvement blessés. La présente revue expose les objectifs de la réadaptation, résume les dures leçons tirées de la dernière décennie en traumatologie et réadaptation dans le monde militaire et recommande l'utilisation d'une approche de soins bio- et psychosociospirituelle qui peut être appliquée à tous les échelons du système de soins de santé. Les questions concernant la capacité d'un retour à des activités signifiantes incluent : Pourquoi les patients n'obtiennent-ils pas tous les mêmes résultats? Quels éléments contribuent à des résultats positifs? Quels facteurs sont en lien avec des résultats optimaux? Les leçons apprises font ressortir l'importance de tenir compte des dimensions physique, psychosociale et spirituelle des personnes pour assurer leur bien-être, de les rendre autonomes en favorisant une plus grande auto-efficacité et de les aider à trouver du sens dans les événements de la vie et à se fixer des objectifs ambitieux. Un modèle bio- et psychosociospirituel tiré de la littérature en médecine de réadaptation ­ le Modèle canadien de rendement occupationnel et de participation ­ est proposé comme guide pour la prestation de soins centrés sur la personne et la maximisation de son fonctionnement après un traumatisme.

An ancient dental gene set governs development and continuous regeneration of teeth in sharks.

The evolution of oral teeth is considered a major contributor to the overall success of jawed vertebrates. This is especially apparent in cartilaginous fishes including sharks and rays, which develop elaborate arrays of highly specialized teeth, organized in rows and retain the capacity for life-long regeneration. Perpetual regeneration of oral teeth has been either lost or highly reduced in many other lineages including important developmental model species, so cartilaginous fishes are uniquely suited for deep comparative analyses of tooth development and regeneration. Additionally, sharks and rays can offer crucial insights into the characters of the dentition in the ancestor of all jawed vertebrates. Despite this, tooth development and regeneration in chondrichthyans is poorly understood and remains virtually uncharacterized from a developmental genetic standpoint. Using the emerging chondrichthyan model, the catshark (Scyliorhinus spp.), we characterized the expression of genes homologous to those known to be expressed during stages of early dental competence, tooth initiation, morphogenesis, and regeneration in bony vertebrates. We have found that expression patterns of several genes from Hh, Wnt/ß-catenin, Bmp and Fgf signalling pathways indicate deep conservation over ~450 million years of tooth development and regeneration. We describe how these genes participate in the initial emergence of the shark dentition and how they are redeployed during regeneration of successive tooth generations. We suggest that at the dawn of the vertebrate lineage, teeth (i) were most likely continuously regenerative structures, and (ii) utilised a core set of genes from members of key developmental signalling pathways that were instrumental in creating a dental legacy redeployed throughout vertebrate evolution. These data lay the foundation for further experimental investigations utilizing the unique regenerative capacity of chondrichthyan models to answer evolutionary, developmental, and regenerative biological questions that are impossible to explore in classical models.

A novel tool for naturalistic assessment of behavioural dysregulation after traumatic brain injury: A pilot study.

OBJECTIVE: This study aimed to develop a novel tool for measuring behavioural dysregulation in adults with traumatic brain injury (TBI) using objective data sources and real-world application and provide preliminary evidence for its psychometric properties. RESEARCH DESIGN: Fourteen adults with TBI receiving services at a local brain injury rehabilitation programme completed multiple assessments of behaviour and followed by a series of challenging problem-solving tasks while being video recorded. Trained clinicians completed post-hoc behavioural assessments using the behavioural dysregulation ratings scale, and behavioural event data were then extracted for comparison with self-report measures. RESULTS: Subject matter experts in neurorehabilitation were in 100% agreement that preliminarily, the new tool measured the construct of behavioural dysregulation. Construct validity was established through strong convergence with 'like' measures and weak correlation with 'unlike' measures. Substantial inter-rater reliability was established between two trained clinician raters. CONCLUSIONS: This study provides preliminary evidence supporting the use of a new precision measurement tool of behaviour in post-acute TBI that has the capability to be deployed naturalistically where deficits truly manifest. Future large-scaled confirmatory psychometric trials are warranted to further establish the utility of this new tool in rehabilitation research.

Estimation of Energy Expenditure for Wheelchair Users Using a Physical Activity Monitoring System.

OBJECTIVE: To develop and evaluate energy expenditure (EE) estimation models for a physical activity monitoring system (PAMS) in manual wheelchair users with spinal cord injury (SCI). DESIGN: Cross-sectional study. SETTING: University-based laboratory environment, a semistructured environment at the National Veterans Wheelchair Games, and the participants' home environments. PARTICIPANTS: Volunteer sample of manual wheelchair users with SCI (N=45). INTERVENTION: Participants were asked to perform 10 physical activities (PAs) of various intensities from a list. The PAMS consists of a gyroscope-based wheel rotation monitor (G-WRM) and an accelerometer device worn on the upper arm or on the wrist. Criterion EE using a portable metabolic cart and raw sensor data from PAMS were collected during each of these activities. MAIN OUTCOME MEASURES: Estimated EE using custom models for manual wheelchair users based on either the G-WRM and arm accelerometer (PAMS-Arm) or the G-WRM and wrist accelerometer (PAMS-Wrist). RESULTS: EE estimation performance for the PAMS-Arm (average error ± SD: -9.82%±37.03%) and PAMS-Wrist (-5.65%±32.61%) on the validation dataset indicated that both PAMS-Arm and PAMS-Wrist were able to estimate EE for a range of PAs with <10% error. Moderate to high intraclass correlation coefficients (ICCs) indicated that the EE estimated by PAMS-Arm (ICC3,1=.82, P<.05) and PAMS-Wrist (ICC3,1=.89, P<.05) are consistent with the criterion EE. CONCLUSIONS: Availability of PA monitors can assist wheelchair users to track PA levels, leading toward a healthier lifestyle. The new models we developed can estimate PA levels in manual wheelchair users with SCI in laboratory and community settings.

Type and Frequency of Reported Wheelchair Repairs and Related Adverse Consequences Among People With Spinal Cord Injury.

OBJECTIVE: To investigate the frequency and types of wheelchair repairs and associated adverse consequences. DESIGN: Convenience cross-sectional sample survey. SETTING: Nine Spinal Cord Injury Model Systems Centers. PARTICIPANTS: People with spinal cord injury who use a wheelchair >40h/wk (N=591). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Number of repairs needed and resulting adverse consequences, number and types of repairs completed, and location where main repair was completed in the previous 6 months. RESULTS: There were 591 participants responded to the survey, 63.8% (377/591) of them needed ≥1 repair; of these, 27.6% (104/377) experienced ≥1 adverse consequence, including 18.2% (69/377) individuals who were stranded. Of those who needed repairs, 6.9% did not have them completed (26/377). Repairs completed on the wheels and casters were the most frequent repair to manual wheelchairs, whereas repairs to the electrical and power and control systems were the most frequent type of repair on power wheelchairs. Forty percent (79/201) of manual wheelchair users reported completing repairs at home themselves compared with 14% (21/150) of power wheelchair users. Twelve percent of the variance in the odds of facing an adverse consequence because of a wheelchair breakdown can be described as a function of occupation, funding source, and type of wheelchair. CONCLUSIONS: Wheelchair repairs are highly prevalent. There are differences in types of repairs and who completes the repairs based on the type of wheelchair. Wheelchair breakdowns result in adverse consequences for users, and there is a deficit between repairs needed and those completed, highlighting the need for interventions that address these problems.

Interrater Reliability of the Power Mobility Road Test in the Virtual Reality-Based Simulator-2.

OBJECTIVE: To assess interrater reliability of the Power Mobility Road Test (PMRT) when administered through the Virtual Reality-based SIMulator-version 2 (VRSIM-2). DESIGN: Within-subjects repeated-measures design. SETTING: Participants interacted with VRSIM-2 through 2 display options (desktop monitor vs immersive virtual reality screens) using 2 control interfaces (roller system vs conventional movement-sensing joystick), providing 4 different driving scenarios (driving conditions 1-4). Participants performed 3 virtual driving sessions for each of the 2 display screens and 1 session through a real-world driving course (driving condition 5). The virtual PMRT was conducted in a simulated indoor office space, and an equivalent course was charted in an open space for the real-world assessment. After every change in driving condition, participants completed a self-reported workload assessment questionnaire, the Task Load Index, developed by the National Aeronautics and Space Administration. PARTICIPANTS: A convenience sample of electric-powered wheelchair (EPW) athletes (N=21) recruited at the 31st National Veterans Wheelchair Games. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Total composite PMRT score. RESULTS: The PMRT had high interrater reliability (intraclass correlation coefficient [ICC]>.75) between the 2 raters in all 5 driving conditions. Post hoc analyses revealed that the reliability analyses had >80% power to detect high ICCs in driving conditions 1 and 4. CONCLUSIONS: The PMRT has high interrater reliability in conditions 1 and 4 and could be used to assess EPW driving performance virtually in VRSIM-2. However, further psychometric assessment is necessary to assess the feasibility of administering the PMRT using the different interfaces of VRSIM-2.

Stability and Workload of the Virtual Reality-Based Simulator-2.

OBJECTIVE: To assess the stability of clinicians' and users' rating of electric-powered wheelchair (EPW) driving while using 4 different human-machine interfaces (HMIs) within the Virtual Reality-based SIMulator-version 2 (VRSIM-2) and in the real world (accounting for a total of 5 unique driving conditions). DESIGN: Within-subjects repeated-measures design. SETTING: Simulation-based assessment in a research laboratory. PARTICIPANTS: A convenience sample of EPW athletes (N=21) recruited at the 31st National Veterans Wheelchair Games. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite PMRT scores from the Power Mobility Road Test (PMRT); Raw Task Load Index; and the 6 subscale scores from the Task Load Index developed by the National Aeronautics and Space Administration (NASA-TLX). RESULTS: There was moderate stability (intraclass correlation coefficient between .50 and .75) in the total composite PMRT scores (P<.001) and the users' self-reported performance scores (P<.001) among the 5 driving conditions. There was a significant difference in the workload among the 5 different driving conditions as reflected by the Raw Task Load Index (P=.009). Subanalyses revealed this difference was due to the difference in the mental demand (P=.007) and frustration (P=.007) subscales. Post hoc analyses revealed that these differences in the NASA-TLX subscale scores were due to the differences between real-world and virtual driving scores, particularly attributable to the conditions (1 and 3) that lacked the rollers as a part of the simulation. CONCLUSIONS: Further design improvements in the simulator to increase immersion experienced by the EPW user, along with a standardized training program for clinicians to deliver PMRT in VRSIM-2, could improve the stability between the different HMIs and real-world driving.

Immediate Biomechanical Implications of Transfer Component Skills Training on Independent Wheelchair Transfers.

OBJECTIVE: To evaluate the immediate effects of transfer training based on the Transfer Assessment Instrument (TAI) on the upper limb biomechanics during transfers. DESIGN: Pre-post intervention. SETTING: Biomechanics laboratory. PARTICIPANTS: Full-time manual wheelchair users (N=24) performed 5 transfers to a level height bench, while their natural transfer skills were scored using the TAI, and their biomechanical data were recorded. INTERVENTION: Participants with 2 or more component skill deficits were invited to return to receive personalized transfer training. MAIN OUTCOME MEASURES: TAI part 1 summary scores and biomechanical variables calculated at the shoulder, elbow, and wrist joints were compared before and immediately after transfer training. RESULTS: Sixteen of the 24 manual wheelchair users met the criteria for training, and 11 manual wheelchair users came back for the revisit. Their TAI part 1 summary scores improved from 6.31±.98 to 9.92±.25. They had significantly smaller elbow range of motion, shoulder resultant moment, and rates of rise of elbow and wrist resultant forces on their trailing side during transfers after training (P<.05). On the leading side, shoulder maximum internal rotation and elevation angles, and shoulder resultant moments and rates of rise of shoulder resultant force and moment decreased after training (P<.04). CONCLUSIONS: The TAI-based training showed short-term beneficial biomechanical effects on wheelchair users' upper limbs, such as better shoulder positioning and lower joint loadings. If the skills are practiced longer-term, they may help protect the upper limbs from developing pain and injuries.

Data logger device applicability for wheelchair tennis court movement.

Assessment of movement logging devices is required to ensure suitability for the determination of court-movement variables during competitive sports performance and allow for practical recommendations to be made. Hence, the purpose was to examine wheelchair tennis speed profiles to assess data logger device applicability for court-movement quantification, with match play stratified by rank (HIGH, LOW), sex (male, female) and format (singles, doubles). Thirty-one wheelchair tennis players were monitored during competitive match play. Mixed sampling was employed (male = 23, female = 8). Friedman's test with Wilcoxon signed-rank post hoc testing revealed a higher percentage of time below 2.5 m · s(-1) [<2.5 vs. ≥2.5 m · s(-1): 89.4 (5.0) vs. 1.2 (3.5)%, Z = -4.860, P < 0.0005, r = 0.87] with the remaining time [9.0 (4.9%)] spent stationary. LOW-ranked players were stationary for longer than HIGH-ranked counterparts [12.6 (8.7) vs. 8.2 (5.1)%, U = 30.000, P = 0.011, r = 0.46] with more time at low propulsion speeds (<1.0 m · s(-1)). HIGH-ranked and doubles players spent more time in higher speed zones than respective counterparts. Females spent more time in the 1.0-1.49 m · s(-1) zone (U = 48.000, P = 0.047, r = 0.36). Regardless of rank, sex or format, propulsion speeds during wheelchair tennis match play are consistent with data logger accuracy. Hence, data logging is appropriate for court-movement quantification.