Historical technology transfer activities and productivity of NIDLRR grantees.

This paper analyzes the technology-related outputs from The National Institute of Disability, Independent Living, and Rehabilitation Research (NIDILRR). We seek to answer the questions: What are the types and frequency of assistive technology (AT) technology transfer (ATTT) outputs from NIDILRR grants? How does NIDILRR's ATTT generation compare to other granting organizations? What types of ATTT outputs occur, how, and what is the relative productivity of the most frequently funded universities and small businesses performing with funding by NIDILRR grants? An online search was conducted for indications of ATTT from grants funded from 1983-2021 through publicly available databases, the National Rehabilitation Information Center (NARIC), and the internet. This data was then categorized across relevant output types and analyzed. NIDILRR funded 662 organizations and 951 different investigators from 1983 to 2021. The NIDILRR-funded portfolio includes 6,996 papers, 438 informational websites, 163 patents, 120 software products, and 29 hardware products. Compared to the National Institutes of Health (NIH), NIDILRR produced slightly more products per dollar. Our results highlight the substantial portfolio of technology-related outputs generated with NIDILRR funding and demonstrate how productivity measures can be calculated to guide future funding strategies.

Barriers and facilitators to technology transfer of NIDILRR grantees.

PURPOSE: The objectives of this mixed-methods study were to gather survey and interview data about the barriers and facilitators from grantees funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and to extract themes that could inform program changes that would increase technology translation (TT) success in assistive technology (AT). MATERIALS AND METHODS: We developed a TT Barriers and Facilitators survey consisting of Likert scale and multiple-choice questions about barriers and facilitators to TT. With survey respondents who were willing, we conducting a semi-structured interview and asked pointed questions to expand upon survey response rankings and perceived barriers and facilitators. The questions were framed to explore the grantee's personal experience with ATTT and what helped and hindered their individualised processes. RESULTS: Across survey and interview respondents, the three most common themes when exploring the barriers and facilitators of TT were funding, incentives, and collaboration. CONCLUSIONS: Results indicate that there is a need for increased collaboration and access to additional resources such as funding for pilot grants, support to assess technology marketability, help to navigate regulatory and legal aspects, and assistance in establishing goals to help grantees successfully transfer assistive technologies to consumers. IMPLICATIONS FOR REHABILITATIONA large amount of research and development into assistive technology does not lead to tech transfer which means that these technologies are not getting to the people that need them.Educating tech transfer offices at universities about how to transfer AT would improve outcomes greatly.Creating a community of practice where grantees can find academic or industry partners would also increase the likelihood of tech transfer.Some tools to catalyse these improvements are: mentoring, access to consultants, podcasts, and online training.

Exploratory investigation of the outcomes of wheelchair provision through two service models in Indonesia.

The World Health Organization (WHO) estimates that only 17-37% of the approximately 77 million people who need a wheelchair have access to one. Many organizations are trying to address this need through varying service delivery approaches. For instance, some adhere to WHO's recommended 8-steps service approach while others provide wheelchairs with little to no service. There is limited and sometimes conflicting evidence of the impact of the WHO's recommendations on the outcomes of wheelchair provision. To help build this evidence, we \explored outcomes of two groups of users who received their wheelchairs through two service models over time. The 8-Steps group (n = 118) received a wheelchair selected from a range of models from service providers trained using the WHO process, and the standard of care (SOC) group (n = 24) received hospital-style wheelchairs and without clinical service. Interviews were conducted at baseline and at follow-up 3 to 6 months after provision, to collect data about wheelchair usage, satisfaction, skills, maintenance and repairs, and life satisfaction. Across-group statistical comparisons were not appropriate due to significant differences between groups. In general, participants used their wheelchairs every day but reported very low mobility levels (<500 meters for the 8-steps group, and <100 meters for the SOC group.) The 8-steps group used their wheelchair for either between 1-3 hours per day, or more than 8 hours per day. The SOC used it between 1 and 3 hours per day. Overall, wheelchair usage and wheelchair skills decreased over the 3- to 6-month data collection timeline. Wheelchair breakdowns were common in both groups emphasizing the need for maintenance, occurring more frequently in the 8-Steps (28.8%) compared to the SOC group (8%), and emphasizing the need for maintenance services. No significant differences were found when comparing device satisfaction across wheelchairs types. Our results emphasize the need for routine maintenance to address frequent wheelchair breakdowns. Our results also demonstrate a large disparity in several outcome variables across groups which motivates future studies where across-group comparisons are possible.

Development, reliability, and piloting of a wheelchair caster failure inspection tool (C-FIT).

Introduction: Wheelchair casters fail frequently in the field causing multiple user consequences and wheelchair breakdowns. To inform caster design improvement, there exists no validated tools that can collect caster failures. This need motivated the development of a user-reported, caster failure inspection tool (C-FIT).Methods: To develop C-FIT, a multistep design and testing approach was used which included face validity testing, test-retest reliability testing and expert review. Reliability testing was conducted with two independent cohorts of wheelchair professionals who inspected caster failures physically and online through pictures. The tool was revised based on testing outcomes and expert feedback. For preliminary data collection and evaluating usability, C-FIT was piloted at wheelchair service centers in Scotland, Indonesia and Mexico.Results: Caster failure items reported in the literature were screened to develop the initial list of C-FIT items. Face validity testing conducted through surveys with wheelchair experts (n = 6) provided 14 items for C-FIT inclusion. The test-retest reliability was found to be high for 10 items with physical failure inspections (n = 12). For each of these items, 75% or more participants had substantial to almost perfect agreement scores (κ = 0.6-1.0). Lower reliability scores were found with online failure inspections (n = 11). C-FIT received positive usability feedback from study participants and data collectors in the field. Pilot field data (n = 31) included comprehensive details about failures useful for manufacturers, designers and researchers to improve caster designs.Conclusions: The C-FIT tool developed in this study has substantial reliability and can be used for documenting caster failures at wheelchair service centers.Implications for rehabilitationCollecting data on caster failures is an important first step to inform design improvements and caster quality testing methods.The caster failure inspection tool is a reliable tool that can be used during wheelchair repair and servicing to collect caster failures in a standardized way.The failure data can be used by wheelchair manufacturers, designers, technicians and researchers to develop reliable caster designs. Wheelchair providers can select caster designs based on context of use.

Design, testing and evaluation of angle-adjustable backrest hardware.

PURPOSE: The purpose of this study was to design and evaluate a final design prototype of angle-adjustable backrest hardware. METHODS: A traditional iterative design development protocol was undertaken and completed. Before evaluation by a focus group, testing of the prototype was performed in strict accordance with ISO standards. Focus group participants were between 18 and 80 years of age, used a manual wheelchair as their primary means of mobility, and transferred independently. Individuals with pressure sores or who required of the use of specialized or custom seating for trunk support were excluded from the study. A questionnaire was administered to elicit participants' opinions on the adjustability, function and appearance of the angle-adjustable backrest device. RESULTS: The prototype successfully met the ISO testing standards. Wheelchair users (n = 8) who evaluated the device in a focus group had an overall positive response. Things they most liked about the prototype were comfort, support (function/activities) and adjustability, while things they most disliked about the prototype were problems with string and reaching back position to adjust. CONCLUSIONS: The prototype had a positive impression from participants, however, improvements on the operation method and usability were suggested. Implications for Rehabilitation The adjustable backrest is in need of development to provide function, comfort and support for manual wheelchair users. Manual wheelchair users will benefit by using the angle adjustment as they maintain their active lifestyles. Balance control while performing pressure relief in a wheelchair would be increased.

Interactive, mobile, AGIle and novel education (IMAGINE): a conceptual framework to support students with mobility challenges in higher education.

Interactive, mobile, AGIle and novel education (IMAGINE) is a conceptual framework to help students with disabilities (SwD) participate more in the physical space and become more engaged in school. IMAGINE recommends and reminds students, and allows them to make requests of key learning resources (LRs). The goal of IMAGINE is to provide SwD with the location and time for attending a LR that is most optimal with respect to their learning style and preference, learning performance and other activities. IMAGINE will be a means through which SWD will be provided with tailored recommendations with respect to their daily activities to improve learning outcomes. A pilot was conducted with SwD who used IMAGINE's navigation and wayfinding functionality, and the subjects reported that it aligns well with their needs. Preliminary results suggest that after completing a training and using the tool, SwD reported that they are more likely to use the tool and their participation may increase as a result. In contrast to before the trial, the SwD were also able to better describe the tool's benefits and how to improve its functionality after using the tool for four weeks. Implications for Rehabilitation The IMAGINE tool may be a means through which SwD can be provided with tailored recommendations with respect to their daily activities to improve learning outcomes. PWD should be involved (as research study participants and research study team members) in the design and development of tools like IMAGINE to improve participation. IMAGINE and similar tools may not only encourage better learning outcomes, but also more physical participation in the community, and could be used across education and employment settings.

Evaluation of scooters using ANSI/RESNA standards.

To date, only one research study has evaluated how scooters respond to static and dynamic stability. However, no other studies have evaluated how scooters respond to adverse conditions and how they perform in all standard tests. A selection of 12 three-wheeled scooters was tested according to American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America (ANSI/ RESNA) wheelchair standards. Scooter models included the Victory, Gogo, Golden Companion (GC) I, and GC II. Victory and GC II were the most stable scooters. The Gogo scooters were the least dynamically stable. Five scooters (3 Gogo, 1 GC I, 1 GC II) failed the environmental condition tests. All GC I and II scooters failed parts of the power and control system tests. All scooters passed static and impact tests; however, all Gogo scooters and one GC II scooter had structural or motor failure during durability tests. The scooter models' survival life ranged from 62,512 to 1,178,230 cycles out of the 400,000 needed to pass the test. Tiller failures (typically tiller tube snapping) occurred with an average of 1,483 N force applied to the tiller structure. Our results indicate that these commercially available devices may not meet ANSI/RESNA standards. In addition, the tiller test should be conducted with scooters to further ensure their safety and durability and should use a test dummy with weight capacity according to the mobility device capacity.

Health risks of vibration exposure to wheelchair users in the community.

OBJECTIVE: The purpose of this study was to evaluate whole-body vibration (WBV) exposure to wheelchair (WC) users in their communities and to determine the effect of WC frame type (folding, rigid, and suspension) in reducing WBV transmitted to the person. DESIGN: An observational case-control study of the WBV exposure levels among WC users. PARTICIPANTS: Thirty-seven WC users, with no pressure sores, 18 years old or older and able to perform independent transfers. MAIN OUTCOME MEASURES: WC users were monitored for 2 weeks to collect WBV exposure, as well as activity levels, by using custom vibration and activity data-loggers. Vibration levels were evaluated using ISO 2631-1 methods. RESULTS: All WC users who participated in this study were continuously exposed to WBV levels at the seat that were within and above the health caution zone specified by ISO 2631-1 during their day-to-day activities (0.83 ± 0.17 m/second(2), weighted root-mean-squared acceleration, for 13.07 ± 3.85 hours duration of exposure). WCs with suspension did not attenuate vibration transmitted to WC users (V = 0.180, F(8, 56) = 0.692, P = 0.697). Conclusions WBV exposure to WC users exceeds international standards. Suspension systems need to be improved to reduce vibrations transmitted to the users.

Best practices for team-based assistive technology design courses.

Team-based design courses focused on products for people with disabilities have become relatively common, in part because of training grants such as the NSF Research to Aid Persons with Disabilities course grants. An output from these courses is an annual description of courses and projects but has yet to be complied into a "best practices guide," though it could be helpful for instructors. To meet this need, we conducted a study to generate best practices for assistive technology product development courses and how to use these courses to teach students the fundamentals of innovation. A full list of recommendations is comprised in the manuscript and include identifying a client through a reliable clinical partner; allowing for transparency between the instructors, the client, and the team(s); establishing multi-disciplinary teams; using a process-oriented vs. solution-oriented product development model; using a project management software to facilitate and archive communication and outputs; facilitating client interaction through frequent communication; seeking to develop professional role confidence to inspire students' commitment to engineering and (where applicable) rehabilitation field; publishing student designs on repositories; incorporating both formal and informal education opportunities related to design; and encouraging students to submit their designs to local or national entrepreneurship competitions.

Dynamic stiffness and transmissibility of commercially available wheelchair cushions using a laboratory test method.

Evidence suggests that wheelchair (WC) users are exposed to unhealthy levels of vibration during WC use. Health risks associated with vibration exposure include vertebral disc degeneration and back pain, which may consequently decrease the function and independence of WC users. Some evidence suggests that the cushions used in WCs may amplify vibrations, although conclusive evidence has not been presented in the literature. This study evaluated and compared the transmissibility of commercially available WC cushions with two laboratory test methods: (1) direct measurement of transmissibility while human subjects propelled a WC over a road course with different cushions and (2) characterization of cushions with a material testing system (MTS) combined with mathematical models of the apparent mass of the human body. Results showed that although dynamic characterization of WC cushions is possible with an MTS, the results did not correlate well with the transmissibility obtained in the WC road course. Significant differences were found for transmissibility among the cushions tested, with the air-based cushions having lower transmissibility than the foam- or gel-based cushions.

Current state of mobility technology provision in less-resourced countries.

This article reviews mobility technology in less-resourced countries, with reference to people with disabilities in several locations, and describes technology provision to date. It also discusses a recent collaborative study between a United States University and an Indian spinal injuries hospital of Indian wheelchair users' community participation, satisfaction, and wheelchair skills. The data suggest that individuals who received technology from the hospital's assistive technology department experienced increased community participation and improved wheelchair skills. This evidence may have already enabled the hospital to improve Indian governmental policies toward people with disabilities, and it is hoped that future research will benefit other people similarly.

Evaluation of the safety and durability of low-cost nonprogrammable electric powered wheelchairs.

OBJECTIVE: To evaluate whether a selection of low-cost, nonprogrammable electric-powered wheelchairs (EPWs) meets the American National Standards Institute (ANSI)/Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) Wheelchair Standards requirements. DESIGN: Objective comparison tests of various aspects of power wheelchair design and performance of 4 EPW types. SPECIMENS: Three of each of the following EPWs: Pride Mobility Jet 10 (Pride), Invacare Pronto M50 (Invacare), Electric Mobility Rascal 250PC (Electric Mobility), and the Golden Technologies Alanté GP-201-F (Golden). SETTING: Rehabilitation engineering research center. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Static tipping angle; dynamic tipping score; braking distance; energy consumption; climatic conditioning; power and control systems integrity and safety; and static, impact, and fatigue life (equivalent cycles). RESULTS: Static tipping angle and dynamic tipping score were significantly different across manufacturers for each tipping direction (range, 6.6 degrees-35.6 degrees). Braking distances were significantly different across manufacturers (range, 7.4-117.3 cm). Significant differences among groups were found with analysis of variance (ANOVA). Energy consumption results show that all EPWs can travel over 17 km before the battery is expected to be exhausted under idealized conditions (range, 18.2-32.0 km). Significant differences among groups were found with ANOVA. All EPWs passed the climatic conditioning tests. Several adverse responses were found during the power and control systems testing, including motors smoking during the stalling condition (Electric Mobility), charger safety issues (Electric Mobility, Invacare), and controller failures (Golden). All EPWs passed static and impact testing; 9 of 12 failed fatigue testing (3 Invacare, 3 Golden, 1 Electric Mobility, 2 Pride). Equivalent cycles did not differ statistically across manufacturers (range, 9759-824,628 cycles). CONCLUSIONS: Large variability in the results, especially with respect to static tipping, power and control system failures, and fatigue life suggest design improvements must be made to make these low-cost, nonprogrammable EPWs safe and reliable for the consumer. Based on our results, these EPWs do not, in general, meet the ANSI/RESNA Wheelchair Standards requirements.

The fundamental thumb-tip force vectors produced by the muscles of the thumb.

A rigorous description of the magnitude and direction of the 3D force vector each thumb muscle produces at the thumb-tip is necessary to understand the biomechanical consequences to pinch of a variety of paralyses and surgical procedures (such as tendon transfers). In this study, we characterized the 3D force vector each muscle produces at the thumb-tip, and investigated if these thumb-tip force vectors scaled linearly with tendon tension. In 13 cadaver specimens, we measured the output 3D thumb-tip force vector produced by each tendon acting on the thumb, plus two common tendon transfers, as a function of input tendon tension. After fixing the hand to a rigid frame, we mounted the thumb by configuring it in standardized key or opposition pinch posture and coupling the thumb-tip to a rigidly held 6 degree-of-freedom force/torque sensor. Linear actuators applied tension to the distal tendons of the four extrinsic thumb muscles, and to six Nylon cords reproducing the lines of action of (i) the four intrinsic thumb muscles and (ii) two alternative tendon transfers commonly used to restore thumb opposition following low median nerve palsy. Each computer-controlled linear actuator ramped tendon tension from zero to 1/3 of predicted maximal muscle force expected at each tendon, and back to zero, while we measured the 3D force vector at the thumb-tip. In test/re-test trials, we saw thumb-tip force vectors were quite sensitive to mounting procedure, but also sensitive to variations in the seating of joint surfaces. We found that: (i) some thumb-tip force vectors act in unexpected directions (e.g., the opponens force vector is parallel to the distal phalanx), (ii) the two tendon transfers produced patently different force vectors, and (iii) for most muscles, thumb-tip force vectors do not scale linearly with tendon tension--likely due to load-dependent viscoelastic tendon paths, joint seating and/or bone motion. Our 3D force vector data provide the first quantitative reference descriptions of the thumb-tip force vectors produced by all thumb muscles and two tendon transfers. We conclude that it may not be realistic to assume in biomechanical models that thumb-tip force vectors scale linearly with tendon tensions, and that our data suggest the thumb may act as a "floating digit" affected by load-dependent trapezium motion.