City Government's Adoption of Housing Adaptation Policy Innovation for Older Adults: Evidence From China.

OBJECTIVES: Utilizing policy innovation and diffusion theory, this study aims to explain why city governments adopt housing adaptation policies that primarily benefit older people based on the case of China. METHODS: The data are drawn from an event history data set of a housing adaptation policy for older people collected from 283 Chinese cities from 2010 to 2018. Piecewise constant exponential models are utilized. RESULTS: The results indicate that cities facing greater internal pressure and a higher political status are more likely to adopt a housing adaptation policy for older people. Policy adoption by neighboring cities could further facilitate this process. DISCUSSION: Policy innovation and diffusion theory provide a useful framework for this study. That is, the Chinese city government's adoption of housing adaptation policy for older adults is initially driven by local needs and then accelerated by interactions among neighboring governments.

Climate driven spatiotemporal variations in seabird bycatch hotspots and implications for seabird bycatch mitigation.

Bycatch in fisheries is a major threat to many seabird species. Understanding and predicting spatiotemporal changes in seabird bycatch from fisheries might be the key to mitigation. Inter-annual spatiotemporal patterns are evident in seabird bycatch of the U.S. Atlantic pelagic longline fishery monitored by the National Marine Fisheries Service Pelagic Observer Program (POP) since 1992. A newly developed fast computing Bayesian approximation method provided the opportunity to use POP data to understand spatiotemporal patterns, including temporal changes in location of seabird bycatch hotspots. A Bayesian model was developed to capture the inherent spatiotemporal structure in seabird bycatch and reduce the bias caused by physical barriers such as coastlines. The model was applied to the logbook data to estimate seabird bycatch for each longline set, and the mid-Atlantic bight and northeast coast were the fishing areas with the highest fleet bycatch estimate. Inter-annual changes in predicted bycatch hotspots were correlated with Gulf Stream meanders, suggesting that predictable patterns in Gulf Stream meanders could enable advanced planning of fishing fleet schedules and areas of operation. The greater the Gulf Stream North Wall index, the more northerly the seabird bycatch hotspot two years later. A simulation study suggested that switching fishing fleets from the hindcasted actual bycatch hotspot to neighboring areas and/or different periods could be an efficient strategy to decrease seabird bycatch while largely maintaining fishers' benefit.

Effects of skin moisturizer on the skin barrier dysfunction model: An evaluation of the heel via tape-stripping in healthy, young adults.

BACKGROUND: This study seeks to establish the skin barrier dysfunction model at the heel via tape-stripping (TS) by evaluating the skin moisturizing effects. MATERIALS AND METHODS: Nineteen young, female participated in the study. A sequence of TS was performed at the heel and trans-epidermal water loss (TEWL), stratum corneum (SC) hydration, and surface pH were measured. Following TS, the subjects were divided into three groups: moisturizer, emollient, and overcoat. These agents were applied daily at night, and the skin parameters were measured the next morning for a week. RESULTS: The TEWL value of TS immediately and 5 min after TS were significantly higher than what was obtained before TS, while the SC hydration after TS was significantly lower than what was obtained before TS. However, there were no significant differences in the skin parameters among the three agents on day 7 after application, with the two-way ANOVA showing no interaction among the agents and number of days. CONCLUSION: The skin barrier dysfunction model at the heel was established by TS in healthy, young adults. However, the physiological function of the skin at the heel did not change drastically and showed no differences even after continuous application for 7 days.

Reliability and agreement of skin barrier measurements in a geriatric care setting.

BACKGROUND: The non-invasive skin barrier measurements transepidermal water loss, stratum corneum hydration and the skin surface pH are widely used in clinical skin research. Relative and absolute measurement errors of these measurements are unknown in geriatric care settings. MATERIAL AND METHODS: Transepidermal water loss, stratum corneum hydration, skin surface pH and temperature were measured on the volar forearm and lower leg twice by trained raters within a cross-sectional study in ten nursing homes. Intrarater reliability was calculated using the ICC (1,1). Intrarater agreement was analyzed using Bland Altman Plots with limits of agreement. RESULTS: Two hundred twenty-three residents were included and mean age was 84.2 years. The highest ICC was found for transepidermal water loss and skin surface temperature of the leg with 0.95 (95% CI 0.93 to 0.96). The ICC of the stratum corneum was 0.91 (95% CI 0.88 to 0.93) for both investigated skin areas. The measurement of the pH at the lower leg had the lowest ICC with 0.73 (95% CI 0.66 to 0.78). Highest limits of agreement of approximately 8 a.u. were calculated for stratum corneum hydration and lowest limits of agreement of approximately 1 °C were calculated for skin surface pH. CONCLUSION: Relative measurement errors of transepidermal water loss and stratum corneum hydration were very low indicating that single measurements provide reliable estimates in this population and setting. However, the absolute measurement errors were high for both of these parameters. To increase reliability of skin surface pH we recommend at least two repeated measurements.

Development of modified dental chair to accomodate both wheelchair bound patients and general population.

Background: Dental chairs are a vital tool in modern dentistry. Their design has paved the way for increasing improvement in dental treatment. Since the 1900's, the dental chair design has continuously evolved and transformed from manually operated mechanisms to recently automated mechanism, in spite of advancements a common obstacle faced by these wheelchair bound populations in using present dental chair is transfer. Wheelchair users need to be transferred from the wheelchair to other places many times a day. In most of the cases the wheelchair user does not possess the capability of transferring to a dental chair independently. Therefore assistance is needed either from dental clinic staff or from family and friends. This transfer of patients from wheelchair not just requires manpower but also creates unnecessary anxiety among the wheel chair bound patients.Solution: Thus a modified dental chair was constructed which would accommodate the wheelchair bound patients to the dental chair without any transfer. This study highlights the mechanism of action of the modified dental chair.Implication for rehabilitationImprove access among wheelchair bound patients to dental care servicesDecreases anxiety among the disadvantaged population in clinical set up.

Effectiveness of the International Symbol of Access and inclusivity of other disability groups.

BACKGROUND: The International Symbol of Access (ISA) is recognized world-wide for designating and identifying areas which are wheelchair accessible, however its meaning has evolved to include both restricted use and universal accessibility. OBJECTIVE: This study seeks to investigate the effectiveness of the ISA in representing individuals of all impairment types. METHODS: A mixed-method survey was disseminated in the U.S. and internationally to persons without self-identified impairment and individuals of various impairment group types, including mobility, vision, hearing, and cognitive impairments, using convenience sampling (n = 981). Quantitative data was analyzed using ranking patterns and regression analysis. Qualitative data was analyzed using thematic analysis and triangulation. RESULTS: Participants with self-identified mobility impairments rated the ISA more favorably than other disability groups (p = 0.002). In addition, there is a significant correlation between age and effectiveness of the ISA, with participants rating the symbol more favorably as age increases. Common themes included association of the ISA with a mobility impairment, implications for restricted use or reserved space, and physical accessibility. CONCLUSIONS: The ISA is not effective in representing individuals with non-mobility impairments and its ambiguous nature leads to confusion for both persons with and without impairment.

Evaluating the effectiveness of platform screen doors for preventing metro suicides in China.

BACKGROUND: Metro suicide can cause tremendous effects on the general public. Platform screen doors (PSDs) have been identified as one of the most effective methods of suicide prevention at metro stations. However, there are few studies focusing on their effectiveness in preventing suicides. In particular, the effect of types of PSDs, including full-height and half-height PSDs, has rarely been assessed and compared. METHODS: Based on the suicide data provided by the Shanghai metro operator, the effectiveness of installing different types of PSDs for preventing metro suicides was investigated using a Poisson regression model. Ten-year monthly panel data for 94 metro stations from 2008 to 2017 were used in this study. RESULTS: The number of metro suicides declined by 90.9% after the PSDs were installed at metro stations. In addition, different types of PSDs had different effects on decreasing the number of suicides, and a higher half-height PSD was more effective in preventing suicides. Specifically, full-height PSDs could eliminate metro suicides by completely preventing passengers from entering the track area, while half-height PSDs that were 1.5 m and 1.2 m high could decrease the number of suicides by 79.2% and 60.2%, respectively. Moreover, there was no significant indication that the installation of PSDs at metro stations displaced suicides to railway stations without PSDs (p = 0.706). LIMITATION: The potential economic benefits of different types of PSDs were not considered in our study. In addition, we did not examine whether suicide attempters would try to take their own lives by using other methods of suicide. CONCLUSION: The installation of PSDs, especially full-height PSDs, could be very effective in preventing suicides at metro stations. Although half-height PSDs are less effective than full-height PSDs, increasing the height of half-height PSDs could be an effective way of enhancing their effectiveness in reducing the number of suicides.

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.

Bricks and Morals-Hospital Buildings, Do No Harm.

The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field's inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.

Wheelchair accessibility of mosques in Riyadh.

BACKGROUND: Engagement in religious and spiritual activities and expression are important to many people. Praying in a mosque is a major component of basic worship for Muslims. Riyadh has a population of more than six million people and more than 17 thousand mosques. OBJECTIVE: The purpose of this study was to explore wheelchair accessibility of mosques in Riyadh from the perspective of wheelchair users and their caregivers. METHODS: A survey was conducted to explore the opinions of wheelchair users and their caregivers regarding wheelchair accessibility of frequently used mosques. RESULTS: Forty-eight wheelchair users and 12 caregivers participated in the study. The main reason for being confined to a wheelchair was a motor vehicle accident (77%). The majority of the participants (84%) indicated that they needed assistance to propel their wheelchairs. Overall, 86% of wheelchair users and 84% of caregivers expressed dissatisfaction with the mosques' accessibility for wheelchair users. CONCLUSION: Mosques were found not to be accessible for wheelchair users. The current situation forces wheelchair users to pray in isolation in their houses, preventing them from participating in an important part of their faith. Though acts mandating the accessibility of public places for wheelchair users have been promulgated in the Kingdom of Saudi Arabia (KSA), the acts are not implemented in ways which can contribute to a meaningful, tolerable and independent life for wheelchair users.

Perceptions of appropriateness of accommodations for university students: Does disability type matter?

PURPOSE: The purpose of this experiment was to examine the impact of disability type and accommodation type on participants' perceptions of the appropriateness of accommodations on university campuses. RESEARCH METHOD: Participants were 223 university students who evaluated the written symptom descriptions of 8 hypothetical university students with disabilities to determine whether a series of 8 different accommodations would be appropriate for them. RESULTS: Perceptions of accommodation appropriateness were impacted by both the type of disability and the type of accommodation under consideration. The results indicated that accommodations for psychiatric disabilities and invisible physical disabilities were less likely to be viewed as appropriate regardless of how well they addressed the symptoms of the disability. CONCLUSIONS: Students with psychiatric and invisible physical disabilities may be especially vulnerable to negative peer perceptions if they receive accommodations. These attitudinal barriers make it harder for students with disabilities to integrate into the college social environment. Students with disabilities who do not feel welcome are less likely to self-advocate to acquire the accommodations that they need and are therefore less likely to succeed in their course work. Our results highlight the importance of programs that encourage the integration of students with disabilities and decrease the stigma of disability on campus. (PsycINFO Database Record

Prospective Associations of Local Destinations and Routes With Middle-to-Older Aged Adults' Walking.

Background and Objectives: To examine prospective associations of perceived attributes of local destinations and routes with middle-to-older aged adults' 4-year changes in walking for transport (WT) and walking for recreation (WR). Research Design and Methods: Data were collected from adults aged 50-64 years old, living in Adelaide, Australia. Participants (N = 454) reported weekly frequency of WT and WR at baseline (2003-2004) and follow-up (2007-2008). Attributes of local destinations and routes were based on self-reported measures at baseline and included: proximity to utilitarian and recreational destinations, the number of such destinations within 10 and 11-20 min walk from home, street connectivity, and walking paths. Generalized additive mixed models were used to examine the associations of perceived destination and route attributes with changes in frequency of WT and WR. Results: Higher levels of perceived proximity to utilitarian destinations, reporting a larger number of utilitarian destinations within 10 min walk from home and higher street connectivity were associated with more positive changes in frequency of WT. Higher levels of perceived proximity to recreational destinations and better walking paths were associated with more positive changes in frequency of WR. No curvilinear relationships were observed and baseline frequency of walking did not moderate the associations. Discussion and Implications: Proximity of utilitarian and recreational destinations, well-connected streets, and better walking paths can be supportive of long-term participation in walking among middle-to-older aged adults. Environmental and policy initiatives focusing on such destination and route attributes have the potential to support residents' aging in place.

A novel method for designing and optimizing the layout of facilities in bathroom for the elderly in home-based rehabilitation.

PURPOSE: The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. METHODOLOGY: A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. FINDINGS: The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.

Perceived effects of home renovation on independence of physically disabled Koreans living at home.

PURPOSE: This study aims to identify the potential effects of home renovation on independence promotion of physically disabled Koreans living at home. METHOD: The method of the study is a survey with a questionnaire; subjects are physically disabled people living at home in rural and urban areas in Korea. The Functional Independence Measure was used to measure changes in subjects' levels of independence. RESULTS: It was expected that if homes were renovated according to individual needs, disabled people's independence level would be increased by one or more level compared to their current daily independence level in their existing homes. In particular, independence levels concerning bathing and locomotion, which are low in existing conditions, were expected to increase significantly with renovation. Such effects on independence level were conspicuous for disabled people in rural area. CONCLUSION: The results prove the positive effects of home renovations of disabled people's independence, thus providing meaningful academic evidence on home renovations for disabled people. Implication for rehabilitation Korea had a culture where support measures to aid the life independence of disabled persons relied heavily on human services, leading to a lack of diversity in support measures. By closing the gap between the resident's disability and the inadequacy in their prevailing environment, house remodeling can be a crucial intervention for improving the independence of disabled persons in their daily lives. Depending on the nature of their disabilities and their residential arrangements, disabled persons have diverse needs regarding home remodeling. Implementing home remodeling in such a manner that suits the resident's needs is crucial to boosting their independence. Because of this, remodeling personnel must interact with residents prior to the renovation while also strengthening their expertise.

Use of two test methods to ensure accurate surface firmness and stability measurements for accessibility.

PURPOSE: The firmness and stability of indoor and outdoor surfacing are critical to the accessibility and safety of all environments for people with mobility impairments and/or who use mobility devices. ASTM F1951 laboratory test procedures include pass/fail criteria for determining playground surface accessibility by comparing the work to propel up a 1:14 (7.1%) grade ramp to that of the test surface in a wheelchair. A portable instrumented surface indenter (ISI) was developed to validate that accessibility results obtained in the laboratory are maintained in the field where the surface is installed and used. METHODS: Accessibility measurements have been made on indoor and outdoor surfaces tested in the laboratory using both the ASTM F1951 and the ISI over 13 years. Correlations between these two methods were calculated. RESULTS: A strong correlation has been demonstrated for the sum of the ISI firmness and stability results compared to the sum of the ASTM F1951 straight propulsion and turning results (R2=0.9006). CONCLUSIONS: The portable ISI can be used to verify that the firmness and stability of an installed surface in the field correlates to the accessibility results of the surface tested in the laboratory concurrently according to ASTM F1951 and the ISI. Implications for Rehabilitation The Instrumented Surface Indenter (ISI) allows for surfaces in all environments to be tested for firmness and stability, which is critical for wheelchair user safety, especially during rehabilitation when learning to use a wheelchair. The ISI allows for surfaces in all environments to be tested for firmness and stability, which increases access to all indoor and outdoor surfaces, thereby improving the quality of life for people who have mobility impairments and/or use mobility devices, such as canes, crutches, walkers, and wheelchairs. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for children with mobility impairments, facilitating developmentally critical peer-play opportunities for children who use mobility devices. Using the ISI to test the firmness and stability of installed playground surfaces increases access to playgrounds for people with mobility impairments, allowing adults who use a mobility device to supervise and play with children in their lives.

Modifying homes for persons with physical disabilities in Thailand.

PROBLEM: Thailand passed the Persons with Disabilities Empowerment Act in 2007. The Act, which is in compliance with the United Nations Convention on the Rights of Persons with Disabilities, ensures that registered persons with disabilities are entitled to home environment modifications' benefits up to a maximum of 20 000 baht (670 United States dollars); however, the Act's enforcement is still weak in Thailand. APPROACH: In 2013, researchers developed a home modification programme, consisting of a multidisciplinary team of medical and nonmedical practitioners and volunteers, to modify homes for persons with disabilities. The programme recruited participants with physical disabilities and assessed their functioning difficulties. Participants' homes were modified to address identified functioning difficulties. LOCAL SETTING: The project was implemented in four provinces in collaboration with staff from 27 district hospitals located in north-eastern Thailand. RELEVANT CHANGES: After the home modifications, all 43 recruited participants reported reduced difficulties in all areas, except for participants with severe degrees of difficulties, such as those reporting being unable to walk and unable to get up from the floor. The participants' quality of life had also improved. The average EQ-5D-5L score, measuring quality of life, increased by 0.203 - from 0.346 at baseline to 0.549 after the modifications. LESSONS LEARNT: Home modifications in low-resourced settings are technically and financially feasible and can lead to reducing functioning difficulties and improving the quality of life of persons with disabilities. Implementation requires government subsidies to finance home modifications and the availability of technical guidelines and training on home modifications for implementing agents.

Workplace accommodations for employees with disabilities: A multilevel model of employer decision-making.

PURPOSE: Existing research suggests that the decision to grant or deny workplace accommodations for people with disabilities is influenced by a range of legal and nonlegal factors. However, less is known about how these factors operate at the within-person level. Thus, we proposed and tested a multilevel model of the accommodation decision-making process, which we applied to better understand why people with psychological disabilities often experience greater challenges in obtaining accommodations. METHOD: A sample of 159 Australian adults, composed mostly of managers and HR professionals, read 12 vignettes involving requests for accommodations from existing employees. The requests differed in whether they were for psychological or physical disabilities. For each vignette, participants rated their empathy with the employee, the legitimacy of the employee's disability, the necessity for productivity, the perceived cost, and the reasonableness, and indicated whether they would grant the accommodation. RESULTS: Multilevel modeling indicated that greater empathy, legitimacy, and necessity, and lower perceived cost predicted perceptions of greater reasonableness and greater granting. Accommodation requests from employees with psychological disabilities were seen as less reasonable and were less likely to be granted; much of this effect seemed to be driven by perceptions that such accommodations were less necessary for productivity. Ratings on accommodations were influenced both by general between-person tendencies and within-person appraisals of particular scenarios. CONCLUSIONS: The study points to a need for organizations to more clearly establish guidelines for how decision-makers should fairly evaluate accommodation requests for employees with psychological disabilities and disability more broadly. (PsycINFO Database Record

Exploring the Objective and Perceived Environmental Attributes of Older Adults' Neighborhood Walking Routes: A Mixed Methods Analysis.

Walking is a central form of physical activity among older adults that is associated with the physical environment at various scales. This mixed-methods study employs a concurrent nested design to explore objective and perceived environmental characteristics of older adults' local walking routes. This was achieved by integrating quantitative Geographic Information System (GIS) data with qualitative data obtained using the Stanford Discovery Tool (DT). Fifty-nine community-dwelling middle-aged and older adults (14 men and 45 women aged 50+) were recruited in a snowball approach through community centers in the city of Haifa (Israel). Four neighborhood environment themes were identified: pedestrian infrastructure, access to destinations, aesthetics, and environmental quality. Both geometrical traits (i.e., distance, slope) and urban features (i.e., land-uses, greenery) of the route may impact the experience of walking. The findings thus highlight the importance of micro-scale environmental elements in shaping environmental perceptions, which may consequently influence the choice of being active.

Perceived and objective entrance-related environmental barriers and daily out-of-home mobility in community-dwelling older people.

PURPOSE: We studied whether entrance-related environmental barriers, perceived and objectively recorded, were associated with moving out-of-home daily in older people with and without limitations in lower extremity performance. METHODS: Cross-sectional analyses of the "Life-space mobility in old age" cohort including 848 community-dwelling 75-90-year-old of central Finland. Participants reported their frequency of moving out-of-home (daily vs. 0-6 times/week) and perceived entrance-related environmental barriers (yes/no). Lower extremity performance was assessed (Short Physical Performance Battery) and categorized as poorer (score 0-9) or good (score 10-12). Environmental barriers at entrances and in exterior surroundings were objectively registered (Housing Enabler screening tool) and divided into tertiles. Logistic regression analyses were adjusted for age, sex, number of chronic diseases, cognitive function, month of assessment, type of neighborhood, and years lived in the current home. RESULTS: At home entrances a median of 6 and in the exterior surroundings 5 environmental barriers were objectively recorded, and 20% of the participants perceived entrance-related barriers. The odds for moving out-of-home less than daily increased when participants perceived entrance-related barrier(s) or when they lived in homes with higher numbers of objectively recorded environmental barriers at entrances. Participants with limitations in lower extremity performance were more susceptible to these environmental barriers. Objectively recorded environmental barriers in the exterior surroundings did not compromise out-of-home mobility. CONCLUSION: Entrance-related environmental barriers may hinder community-dwelling older people to move out-of-home daily especially when their functional capacity is compromised. Potentially, reducing entrance-related barriers may help to prevent confinement to the home.

Evaluating the Functionality and Usability of Two Novel Wheelchair Anti-Rollback Devices for Ramp Ascent in Manual Wheelchair Users With Spinal Cord Injury.

BACKGROUND: Difficulty ascending ramps and inclines with a manual wheelchair adversely affects the everyday mobility and overall quality of life of manual wheelchair users. Currently, various anti-rollback devices are available to assist manual wheelchair users to ascend ramps and inclines. However, these devices have 2 main shortcomings: restriction to backward motion limiting recovery from an overturning wheelchair, which is a safety concern; and difficulty in engaging/disengaging the device while on the ramp. OBJECTIVE: To evaluate the functionality and usability of 2 novel wheelchair anti-rollback devices developed to address these shortcomings (prototypes "Wheel" and "Brake"). DESIGN: Cross-sectional. SETTING: Rehabilitation research facility. PARTICIPANTS: Twelve adult participants with chronic spinal cord injury. METHODS: Participants completed training and tested with both the wheelchair anti-rollback devices on a 7.3-m-long ramp. MAIN OUTCOME MEASUREMENTS: Number of stops, perceived physical exertion, pain, and ease of use of these devices as participants maneuvered their wheelchairs up a 7.3-m ramp were assessed. Participants also evaluated their satisfaction with the usability of both the devices using the Quebec User Evaluation of Satisfaction With Assistive Technology (QUEST 2.0). RESULTS: Both prototypes evaluated overcame the limitations of the existing anti-rollback devices. Nonparametric statistical tests showed that participants rated both prototypes similarly for the overall functional and usability aspects. However, the participants' satisfactory rating were higher for the prototype "Brake" than for the prototype "Wheel" based on a functional aspect (ie, engaging/disengaging easiness), and higher for Wheel than for Brake, based on a usability aspect (prototype size). CONCLUSIONS: The qualitative and quantitative outcomes of this investigation, based on the usability and functional evaluations, provided useful information for the improvement in the design of both anti-rollback devices, which may allow manual wheelchair users to manage ramp ascent more safely and easily. Further evaluations with a different SCI population is recommended. LEVEL OF EVIDENCE: IV.