Search Results (103)

The objective of this feasibility study was to demonstrate and evaluate a remotely tongue-controlled wheelchair mounted assistive robotic manipulator (ARM), for the first time with end users: three individuals with cervical spinal cord injury. For three days, they remotely tongue-controlled the wheelchair and the ARM (WMARM) to complete two activities of daily living (ADL): Driving the wheelchair and ARM to a remote setting to (1) pick up a bottle and (2) pick up a ball. The participants controlled the system using full manual control by tongue and through semi-automation. Finally, the participants answered a NASA Task Load Index (TLX) questionnaire and a semi-structured interview. Results: All participants were able to remotely control the WMARM by tongue. Semi-automation resulted in shorter task completion time, gripping time and fewer commands as compared with manual control. Semi-automation decreased the measured mental load in the NASA TLX questionnaire by an average of 57%. The participants rated high satisfaction with the system. Conclusion: It was possible for the users with tetraplegia to control the wheelchair with the ARM using their tongue to perform ADL in Wi-Fi-based remote setting. This proposed system has the potential to increase independence and social interaction of individuals with tetraplegia. Full article

Caring for children with physical disabilities can be a daunting responsibility, often placing significant financial, psychological, social and health-related strains on the primary caregivers. This qualitative study explored the experiences of caregivers caring for children with physical disabilities in the Hardap region of Namibia. Using purposive sampling, twenty caregivers were selected as participants in the study. Data was collected using semi-structured interview schedules. Following the interviews, the data were manually analysed and categorised into distinctive themes and sub-themes and summarised in the final report as verbatim quotations. Study findings reveal that caregivers are motivated and determined to provide optimum care for children with physical disabilities under their care by acquiring assistive devices for them and assisting the children with activities of daily living. However, poverty and the general shortage of assistive devices, mostly wheelchairs, provide adverse conditions that are inimical to the development of children’s functional independence in daily living tasks. The burden of carrying the children was noted to be potentially deleterious to the caregivers’ physical health. The study concluded that providing assistive equipment for the children will ease the caregivers’ burden of care while equalising socioeconomic opportunities for both children with physical disabilities and their caregivers. The study only covered a small sample size in a small geographical area of Namibia. Therefore, interpretation and generalisation of the findings need to account for the specific context in the Hardap region of Namibia. Therefore, there remains scope for conducting further research with a larger sample size and one that is more geographically representative of Namibia. Full article

Upper extremity (UE) pain and pathology are prevalent among manual wheelchair users (MWUs) due to repetitive loading demands, highlighting the need for tools to identify high-risk tasks and inform injury prevention. This study investigated the feasibility of classifying activity intensity for wheelchair-related tasks using wearable sensors and supervised machine learning. Twenty-four MWUs with chronic spinal cord injury completed a standardized mobility course and simulated activities of daily living while UE electromyography (EMG) and inertial measurement unit (IMU) data were collected. Signals segmented into 3, 5, and 10 s windows, and time- and frequency-domain features were extracted and labeled as low, moderate, or high intensity. Multiple classification algorithms were evaluated using subject-dependent and subject-independent cross-validation, and dimensionality reduction was explored to assess class separability. Subject-dependent analyses demonstrated performance above chance but below 75% accuracy, with decision tree models demonstrating superior performance, particularly when trained on data segmented into 5 s windows. IMU features outperformed EMG features, but combining signal types enhanced performance. Subject-independent analyses revealed similar overall accuracy across signal types, but decreased high-intensity classification for EMG data, indicating subject dependency. Findings support the potential of wearable sensor-based machine learning with population-specific findings for activity intensity classification in MWUs, while highlighting challenges related to inter-subject variability for injury risk prediction. Full article

Manual wheelchair users with spinal cord injury (SCI) rely heavily on upper-limb function for independent mobility, which often leads to cumulative musculoskeletal loading due to repetitive propulsion. To address limitations associated with conventional unidirectional pushrim propulsion, this study presents the design and development of a detachable bidirectional wheelchair propulsion system that enables mode-dependent push and pull inputs through a mechanically reconfigurable lever mechanism. The proposed system allows conventional forward propulsion through forward pushing, while enabling alternative propulsion patterns through lever mode switching. Depending on the selected mode, either pushing or pulling inputs can be mechanically coupled to forward or backward wheel rotation, without requiring powered actuation or permanent modification of the wheelchair structure. This design expands the range of feasible propulsion strategies by allowing a selectable relationship between propulsion input direction and wheelchair movement direction through mechanical mode switching via a purely mechanical transmission architecture. The system is designed as a modular add-on compatible with standard manual wheelchairs, incorporating a clamp-based detachable interface and a gear-driven bidirectional transmission mechanism. Design considerations emphasize mechanical simplicity, controllability, and compatibility with existing wheelchair configurations, while preserving baseline pushrim functionality. This design-focused study reports the engineering rationale, mechanical architecture, and feasibility of a detachable bidirectional propulsion concept for manual wheelchairs. By explicitly documenting the system configuration and mode-switching logic, this work aims to provide a transparent design framework that can support future experimental validation and user-centered evaluation of bidirectional propulsion strategies for manual wheelchair users with SCI. Full article

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Manual wheelchair users with spinal cord injury (SCI) often experience upper-limb strain and pain due to repetitive propulsion. A detachable dual-propulsion add-on device has been developed to mitigate this issue by offering an alternative propulsion mechanism, but its user acceptability and practical benefits must be rigorously evaluated. This study will implement a structured mixed-methods usability assessment of the new device with 30 adult wheelchair users with SCI. The evaluation will combine quantitative surveys, objective task-based performance metrics, and qualitative interviews to capture a comprehensive picture of usability. We will conduct a single-arm mixed-methods protocol using a device-specific 45-item usability questionnaire and semi-structured interviews, followed by convergent triangulation to integrate quantitative scores and qualitative themes. Participants will use the dual-propulsion device in realistic scenarios and then complete a 45-item questionnaire covering effectiveness, efficiency, safety, comfort, and psychosocial satisfaction. In addition, semi-structured interviews will explore users’ experiences, perceived benefits, challenges, and suggestions. During a standardized mobility task course (doorway navigation, ramp ascent, threshold crossing, and 50 m level propulsion), objective performance indicators—including task completion time, task success/error rate, number of lever strokes, and self-selected speed—will be recorded as secondary usability outcomes. The use of both a standardized questionnaire and in-depth interviews will ensure both broad and nuanced assessment of the device’s usability. Data from the survey will be analyzed for usability scores across multiple domains, while interview transcripts will undergo thematic analysis to enrich and validate the quantitative findings. This protocol is expected to provide robust evidence of the device’s usability, inform iterative improvements in its design, and highlight the importance of structured usability evaluations for assistive technologies. Full article

Manual wheelchair propulsion is a frequent activity among people with spinal cord injury (SCI) and is linked to upper limb loading and shoulder pain. We compared propulsion strategies at cadences of 30 and 50 bpm. Kinematics and surface electromyography (EMG) were recorded across the propulsion cycle, push/recovery phases, and events. Ranges of motion for shoulder flexion/extension, adduction/abduction, and elbow flexion/extension did not differ significantly, although ROM tended to be smaller at 50 bpm; push angle was larger at 50 bpm but not significant. Propulsion cycle duration was shorter at 50 bpm (p < 0.001). Push duration was similar, but its proportion of the cycle increased at 50 bpm (p < 0.001). Recovery duration was shorter at 50 bpm (p < 0.001), yet its cycle proportion increased (p < 0.01). EMG showed cadence-specific redistribution: higher activity at 50 bpm at preparation (anterior deltoid, pectoralis major, biceps brachii, upper trapezius; p < 0.01) and at contact (posterior deltoid; p < 0.05); higher biceps brachii at release and higher anterior deltoid at end-range extension at 30 bpm (both p < 0.05). Cadence manipulation reorganized timing and muscle demands without large ROM changes, supporting rhythm-based training and propulsion design to mitigate shoulder loading. Full article

Uphill wheelchair propulsion requires considerable upper-limb effort and often leads to rapid fatigue, limiting user mobility and independence. Therefore, mechanical solutions that enhance propulsion safety and efficiency are essential. This study aimed to evaluate the effect of an anti-rollback module on upper-limb muscle activity and user load during uphill propulsion. Eight male participants propelled a manual wheelchair under three conditions: without the module (NAR), with a flexible roller (EAR), and with a stiff roller (SAR). Electromyographic (EMG) signals were recorded from four upper-limb muscles—anterior deltoid, triceps brachii, biceps brachii, and extensor carpi radialis—along with propulsion kinematics. The analyzed parameters included the number of push cycles, cycle duration, normalized muscle activity (EMG_norm), cumulative muscle load (CML), and its rate over time (CML/s). On average, participants performed 13.4 push cycles in NAR, 14.3 in EAR, and 14.4 in SAR, with corresponding cycle durations of 1.22 s, 1.59 s, and 1.39 s. The EAR configuration reduced fluctuations in EMG amplitude and CML/s compared to NAR, indicating smoother and more stable propulsion. No significant differences in mean EMG_norm or total CML were observed (p > 0.99). The flexible anti-rollback module improved propulsion stability and control without increasing muscle effort, suggesting its potential benefits for safer and more efficient manual wheelchair use on inclines. Full article

The aim of this study was to experimentally assess the effect of increased rolling resistance, generated by the Anti-Rollback System, on the muscular load of a manual wheelchair user during downhill movement. Three descent conditions were compared: without the module (NAR), with a flexible roller (EAR), and with a rigid roller (SAR). The experiment was conducted on a 6.3 m ramp inclined at 5°, involving eight adult male participants. Muscle effort was evaluated using three indicators: normalized cumulative muscle load per second (CML/s), normalized muscle activity (EMG_norm), and the peak-to-mean ratio of the EMG signal (PMR). Statistical analysis revealed significant differences between configurations (p < 0.05). Use of the module significantly reduced muscular load compared with the reference condition: CML/s decreased by 29.41% in both EAR and SAR, while EMG_norm was reduced by 44.44% in EAR and 50.00% in SAR. PMR reached its lowest value in EAR (4.78), suggesting smoother muscle activation and lower local peak tension. The results indicate that the resistive torque generated by the frictional coupling between the wheelchair tire and the anti-rollback roller, although disadvantageous during propulsion, contributes to improved control and stability during downhill descent, highlighting the system’s dual functional potential. Full article

Manual wheelchair users (MWUs) are at high risk of developing pressure injuries (PIs) from prolonged static sitting. Clinical practice guidelines suggest periodic pressure redistribution (PR) to mitigate this risk. Prior work has demonstrated that a wheelchair seat pan instrumented with force sensors can track the change in center of pressure (CoP) as MWUs perform PR and use this measurement to infer the direction and degree of a PR. This study’s objective was to quantify the relationship between change in CoP and reduction in seat interface pressure (SIP) under the ischial tuberosities for commonly practiced PR maneuvers. A theoretical model relating SIP and change in CoP for forward leaning PR was developed. Participants performed forward, leftward, and rightward leaning PRs while seated on a pressure mat on the test wheelchair with a load cell-instrumented seat pan. Linear mixed-effects models showed that the relationship of SIP and CoP varies by participant. Across participants, the change in SIP for a given change in CoP was greater with sideways than with forward leans. The type of cushion used did not affect the relationship. These findings can be used as part of her real-time smartphone-based coaching system for PI prevention. Full article

Objectives: To quantify the effects of geared wheelchair wheels on energy expenditure during manual wheelchair propulsion in individuals with spinal cord injury (SCI). Methods: Eleven adult manual wheelchair users with SCI propelled their personal manual wheelchairs, which were equipped with a pair of geared wheels, on a passive wheelchair ergometer in low-gear and standard-gear conditions for six minutes. The energy cost of transport, distance traveled, rate of oxygen consumption (SCI MET), rate of perceived exertion, heart rate, and stroke cycle frequency were measured and compared across the gear conditions. Results: The distance traveled and SCI MET were significantly lower (p = 0.003) and cost of transport was significantly higher under the low-gear condition compared with the standard-gear condition. Gear condition exerted a moderate effect on the level of exertion; however, the decrease in the rate of perceived exertion under the low-gear condition was not statistically significant. Gear condition did not significantly affect heart rate and stroke cycle frequency. Conclusions: Geared manual wheelchair propulsion was significantly more energy-demanding, but less intense (easier) under the low-gear condition than the standard-gear condition. Using geared wheels may be beneficial for manual wheelchair users to independently accomplish strenuous propulsion tasks during typical activities of daily living, such as propulsion on carpeted floor. However, the small sample size and inclusion of only male participants limit the generalizability of these findings, and future studies with larger and more diverse cohorts are warranted. Full article

Introduction: The change in environmental and social context during the COVID-19 pandemic affected daily activities of people with spinal cord injury (SCI), their interactions within the community, and, consequently, their social participation during the first wave of the pandemic. However, there is little information about the changes in social participation as the pandemic evolved in Canada. Objective: Our aim was to explore the change in the social participation of adults with SCI after the first two years of the COVID-19 pandemic in Canada. Methods: A follow-up from a previous study exploring the social participation of adults with SCI living during the first wave was conducted eight months later (second wave). Social participation was measured using the Assessment of Life Habits (LIFE-H 4.0) and Measure of Quality of the Environment (MQE) among 18 adults with SCI. Results: Participants reported increases between both waves of COVID-19 in some life habit categories, including mobility, personal care and health, nutrition, and recreation. New environmental factors were identified as facilitators, including the increased availability of businesses in the community. Conclusion: These findings indicate that people with SCI experienced greater realization and satisfaction with certain life habits. Although most barriers and facilitators showed little or no change between the two waves, the reduction in environmental barriers and the increase in facilitators may have contributed to improved social participation as the pandemic progressed. Full article

Hospital-acquired infections (HAIs) remain a major clinical and economic burden, with pathogens such as Escherichia coli contributing to high rates of morbidity and mortality. Traditional manual disinfection methods are often insufficient, particularly in high-risk hospital environments. In this study, we investigated innovative strategies to enhance surface decontamination and reduce infection risk. First, we assessed the efficacy of the SMEG BPW1260 bedpan washer-disinfector, a thermal disinfection system for human waste containers. Our results demonstrated a reduction in Clostridium difficile and Escherichia coli contamination by >99.9% (>3 log reduction), as measured by colony-forming units (CFU) before and after treatment. Molecular techniques, including spectrophotometry, cell counting, and quantitative PCR (qPCR) for DNA quantification, confirmed reduction in bacterial contamination. Specifically, Clostridium difficile showed a reduction of approximately 89% in both optical density (OD) and cell count (cells/mL). In the case of Escherichia coli, a reduction of around 82% in OD was observed, with an even more pronounced decrease in cell count, reaching approximately 99.3%. For both bacteria, DNA quantification by qPCR was below detectable limits. Furthermore, we optimized the energy efficiency of the disinfection cycle, achieving a 45% reduction in power consumption compared to standard protocols without compromising antimicrobial efficacy. Secondly, we developed a sustainable cleaning solution based on methyl ester sulfonate surfactants derived from waste cooking oil. The detergent’s antibacterial activity was tested on contaminated surfaces and further enhanced through the incorporation of nanoassemblies composed of silver, electrostatically bound either to biomimetic magnetic nanoparticles or to conventional magnetic nanoparticles. Washing with the detergent alone effectively eliminated detectable contamination, while the addition of nanoparticles inhibited bacterial regrowth. Antimicrobial testing against E. coli revealed that the nanoparticle-enriched formulations reduced the average MIC values by approximately 50%, with MIC₅₀ values around 0.03–0.06 mg/mL and MIC₉₀ values between 0.06 and 0.12 mg/mL, indicating improved inhibitory efficacy. Finally, recognizing the infection risks associated with intra-hospital transport, we tested the SAFE-HUG Wheelchair Cover, a disposable non-woven barrier designed to reduce patient exposure to contaminated wheelchair surfaces. Use of the cover resulted in a 3.3 log reduction in surface contamination, based on viable cell counts. Optical density and bacterial DNA were undetectable in all covered samples at both 1 and 24 h, confirming the strong barrier effect. Together, these approaches—thermal no-touch disinfection, eco-friendly detergent boosted with nanoparticles, and protective transport barriers—respond to the urgent need for effective, sustainable infection control methods in healthcare settings. Our findings demonstrate the potential of these systems to counteract microbial contamination while minimizing environmental impact, offering promising solutions for the future of infection prevention in healthcare settings. Full article

Urban scene understanding for inclusive smart cities remains challenged by the scarcity of training data capturing people with mobility impairments. We propose SYNTHUA-DT, a novel methodological framework that integrates unmanned aerial vehicle (UAV) photogrammetry, 3D digital twin modeling, and high-fidelity simulation in Unreal Engine to generate annotated synthetic datasets for urban accessibility applications. This framework produces photo-realistic images with automatic pixel-perfect segmentation labels, dramatically reducing the need for manual annotation. Focusing on the detection of individuals using mobility aids (e.g., wheelchairs) in complex urban environments, SYNTHUA-DT is designed as a generalized, replicable pipeline adaptable to different cities and scenarios. The novelty lies in combining real-city digital twins with procedurally placed virtual agents, enabling diverse viewpoints and scenarios that are impractical to capture in real life. The computational efficiency and scale of this synthetic data generation offer significant advantages over conventional datasets (such as Cityscapes or KITTI), which are limited in accessibility-related content and costly to annotate. A case study using a digital twin of Curitiba, Brazil, validates the framework’s real-world applicability: 22,412 labeled images were synthesized to train and evaluate vision models for mobility aids user detection. The results demonstrate improved recognition performance and robustness, highlighting SYNTHUA-DT’s potential to advance urban accessibility by providing abundant, bias-mitigating training data. This work paves the way for inclusive computer vision systems in smart cities through a rigorously engineered synthetic data pipeline. Full article

Wheelchair-mounted assistive robotic manipulators can provide reach and grasp functions for power wheelchair users. This in-lab study evaluated a vision-guided shared control (VGS) system with twelve users completing two multi-step kitchen tasks: a drinking task and a popcorn making task. Using a mixed methods approach participants compared VGS and manual joystick control, providing performance metrics, qualitative insights, and lessons learned. Data collection included demographic questionnaires, the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and exit interviews. No significant SUS differences were found between control modes, but NASA-TLX scores revealed VGS control significantly reduced workload during the drinking task and the popcorn task. VGS control reduced operation time and improved task success but was not universally preferred. Six participants preferred VGS, five preferred manual, and one had no preference. In addition, participants expressed interest in robotic arms for daily tasks and described two main operation challenges: distinguishing wrist orientation from rotation modes and managing depth perception. They also shared perspectives on how a personal robotic arm could complement caregiver support in their home. Full article