Search Results (91)

Background/Objectives: Spinal cord injuries (SCIs) are among the most debilitating conditions and are a leading cause of disability in young people. This study aimed to analyze the causes of SCIs, assess injury severity using the AIS scale, and evaluate complications during rehabilitation in a hospital setting. Methods: The study involved 176 individuals with SCI, including 142 with a traumatic SCI (TSCI) and 34 with a non-traumatic SCI (NTSCI), rehabilitated at various times post-injury. The data on injury causes, paresis type, complications, wheelchair use, gender, age, and treatment methods were collected. The injury severity was assessed using the AIS. Results: A significant gender difference was found between the TSCI and NTSCI groups (85.2% male vs. 61.8% male). TSCI individuals were also younger. The causes of TSCI were traffic accidents, falls from height, and diving, while the causes for NTSCI included spinal ischemia, tumors, degenerative disc disease, and inflammation. TSCI individuals had more AIS A lesions (52.8% vs. 26.5%) and more cervical injuries (53.5% vs. 14.7%), whereas NTSCI individuals had more AIS C lesions (38.2% vs. 18.3%) and thoracic damage (58.8% vs. 35.2%). TSCI patients were more often treated surgically (95.7% vs. 61.8%) and used wheelchairs (88% vs. 55.9%). No significant differences were found in terms of complications between the groups, though TSCI individuals underwent more chronic rehabilitation. Conclusions: Our research shows that there are significant differences between TSCI and NTSCI both in terms of the level of damage and the severity of damage to neural structures (AIS scales), and thus significant differences in the patients’ functioning in later life for both groups of individuals. Full article

An accurate assessment of sidewalk conditions is critical for ensuring compliance with the Americans with Disabilities Act (ADA), particularly to safeguard mobility for wheelchair users. This paper presents a novel 3D reconstruction framework based on neural radiance field (NeRF), which utilize a monocular video input from consumer-grade cameras to generate high-fidelity 3D models of sidewalk environments. The framework enables automatic extraction of ADA-relevant geometric features, including the running slope, the cross slope, and vertical displacements, facilitating an efficient and scalable compliance assessment process. A comparative study is conducted across three surveying methods—manual measurements, LiDAR scanning, and the proposed NeRF-based approach—evaluated on four sidewalks and one curb ramp. Each method was assessed based on accuracy, cost, time, level of automation, and scalability. The NeRF-based approach achieved high agreement with LiDAR-derived ground truth, delivering an F1 score of 96.52%, a precision of 96.74%, and a recall of 96.34% for ADA compliance classification. These results underscore the potential of NeRF to serve as a cost-effective, automated alternative to traditional and LiDAR-based methods, with sufficient precision for widespread deployment in municipal sidewalk audits. Full article

Manual wheelchair users are at high risk of upper limb overuse injuries due to repetitive propulsion mechanics. To address this, we developed a novel detachable push–pull dual-propulsion device that enables both forward and backward propulsion, aiming to reduce shoulder strain and promote balanced muscle engagement. This study presents a protocol to evaluate the device’s biomechanical impact and ergonomic effects, focusing on objective, quantitative analysis using a repeated-measures within-subject design. Thirty participants with spinal cord injury will perform standardized propulsion trials under two conditions: push and pull. Motion capture and surface electromyography (EMG) will assess upper limb kinematics and muscle activation. Each propulsion mode will be repeated over a 10-m track, and maximum voluntary contraction (MVC) data will be collected for EMG normalization. The protocol aims to provide objective evidence on the propulsion efficiency, muscle distribution, and ergonomic safety of the device. Findings will inform future assistive technology development and rehabilitation guidelines for manual wheelchair users. Full article

The accessibility of nature trails for people with motor disabilities and impairments stands as a significant challenge for inclusive tourism. In the present study, we would like to present a review of research, approaches, and solutions to enable people with motor impairments to enjoy nature trails independently or with assistance. The study is conducted from the perspective of public bodies that aim to reduce the accessibility barriers for People with Disabilities (PwDs) by adapting and improving the conditions of the trails and by providing clear and comprehensive information about the difficulties that hikers may encounter on a trail while using a specific aid. The paper initially presents the wide variety of aids for outdoor mobility, including both those to be used independently (i.e., self-propelled wheelchairs that can be equipped with additional small wheels, off-road wheels and/or auxiliary drives) and those that require assistance (e.g., single-wheeled wheelchairs). Then, we shift focus onto the difficulty classification of trails for PwDs, analysing papers and guidelines that tried to define objective evaluation criteria such as the slope, the trail surface, and the length of the sloping sections. Starting from these studies, the paper proposes a synthesis of the different classifications that consider, for the first time, all the aids available on the market, thus filling the gaps of the single studies. In the last sections, we present some national and international guidelines with tailored and practical solutions to improve the accessibility of nature trails and some studies about the inclusive planning that directly involves PwDs, as well as on the need for a better training of tourism service providers. The present work aims to stimulate a debate on the barriers and opportunities related to the accessibility of hiking trails, contributing to making nature a truly accessible experience for all. Full article

Objectives: Wheelchair seat sagging is hypothesized to increase pressure and shear forces, potentially leading to pressure injuries. The objective of this study was to assess the impact of correcting wheelchair seat sagging on ischial pressure, shear force, and posture in a population of healthy adults. Methods: A total of twenty-two participants who met the study requirements were included in the study. Participants were evaluated under two conditions: with seat base correction (With Correction) and without it (No Correction). Correction was achieved using insert panels. Ischial pressure was measured using a pressure-mapping system (CONFORMat), shear force with a specialized sensor (iShear), and posture with accelerometers (TSND151). The primary analysis compared peak pressure index (PPI), shear force, slide, and postural changes between conditions. The subgroup analysis was conducted as an exploratory approach to assess potential variation among participants with elevated shear forces. Results: There was no statistically significant difference in ischial pressure between the No Correction and With Correction conditions (p = 0.37). However, shear force and slide were significantly reduced when seat sagging was corrected (p < 0.05). Accelerometer data showed no significant difference in postural changes between conditions (p ≥ 0.05), although the With Correction condition displayed a slight trend toward greater positional variability over time. Conclusions: These findings indicate that correcting seat sagging can reduce shear force and slide, potentially lowering the risk of pressure injuries. However, because this study targeted healthy adults, further research involving older or at-risk populations is necessary. Addressing seat sagging could be an important component of comprehensive pressure injury prevention strategies. Full article

This study evaluates the safety aspects of a prototype electric vehicle designed to enable wheelchair users to independently perform simple farm tasks in rural settings, like sample collection and crop monitoring. The vehicle, built at CREA, features four in-wheel electric motors, a pneumatic suspension system, and a secure wheelchair anchoring system. Tests at the CREA experimental farm assessed the vehicle’s whole-body vibrations on different surfaces (asphalt, headland, dirt road) using two tyre models and multiple speeds. A triaxial accelerometer on the wheelchair seat measured vibrations, which were analysed in accordance with ISO standards. Frequency analysis revealed significant vibrations in the 2–40 Hz range, with the Z-axis consistently showing the highest accelerations, which increased with the speed. Tyre A generally induced higher vibrations than Tyre B, likely due to the tread design. At high speeds, the effective accelerations exceeded safety thresholds on asphalt and headland. Statistical analysis confirmed speed as the dominant factor, with the surface type also playing a key role—headland generated the highest vibrations, followed by dirt road and asphalt. The results of these first tests highlighted the high potential of the vehicle to improve the agricultural mobility of disabled people, granting safety conditions and low vibration levels on all terrains at speeds up to 10 km h⁻¹. At higher speeds, however, the vibration levels may exceed the exposure limits, depending on the irregularities of the terrain and the tyre model. Overcoming these limitations is achievable through the optimization of the suspensions and tyres and will be the subject of the next step of this study. This technology could also support wheelchair users in construction, natural parks, and urban mobility. Full article

With the aging population and rising demand for assistive devices, electric wheelchairs have garnered significant attention. However, existing stair-climbing wheelchairs often suffer from complex structural complexity and limited flexibility. Spoke-wheel mechanisms, known for their simple structure and strong obstacle-crossing capabilities, hold promise but experience oscillation on flat terrain. This paper proposes an improved spoke-wheel mechanism (Flexwheel), which integrates springs into the spokes. These springs compress to varying lengths under gravitational force during ground contact, while sliding grooves and pre-compression constraints regulate spoke length, ensuring a stable height. A novel selection method for the optimal spring constant is developed based on mass, spoke length, and the number of spokes. This mathematical framework is applicable to stable, smooth ground motion under varying friction conditions between the upper and lower spokes. A wheelchair prototype equipped with four Flexwheels, a self-balancing mechanism, and multi-sensor fusion technology is designed. The simulation results indicate that Flexwheel reduces the range in body height from 10.75 mm (traditional spoke wheels) to 3.39 mm on flat terrain, a 68.47% improvement. During stair climbing, Flexwheel significantly reduces body oscillation compared to traditional spoke or circular wheels. Physical experiments validate that Flexwheel exhibits a 6.28 mm height fluctuation vs. traditional spokes wheels’ 12.13 mm, a 48.28% improvement, demonstrating its effectiveness in enhancing wheelchair stability and adaptability. Full article

A novel electromyography (EMG)-based wheelchair interface was developed that uses contractions from the temporalis muscle to control a wheelchair. To aid in the training process for users of this interface, a serious training game, Limbitless Journey, was developed to support patients. Amyotrophic Lateral Sclerosis (ALS) is a condition that causes progressive motor function loss, and while many people with ALS use wheelchairs as mobility devices, a traditional joystick-based wheelchair interface may become inaccessible as the condition progresses. Limbitless Journey simulates the wheelchair interface by utilizing the same temporalis muscle contractions for control of in-game movements, but in a low-stress learning environment. A usability study was conducted to evaluate the serious-game-based training platform. A major outcome of this study was qualitative data gathered through a concurrent think-aloud methodology. Three cohorts of five participants participated in the study. Audio recordings of participants using Limbitless Journey were transcribed, and a sentiment analysis was performed to evaluate user perspectives. The goal of the study was twofold: first, to perform a think-aloud usability study on the game; second, to determine whether accessible controls could be as effective as manual controls. The user comments were coded into the following categories: game environment, user interface interactions, and controller usability. The game environment category had the most positive comments, while the most negative comments were primarily related to usability challenges with the flexion-based controller. Interactions with the user interface were the main topic of feedback for improvement in future game versions. This game will be utilized in subsequent trials conducted at the facility to test its efficacy as a novel training system for the ALS population. The feedback collected will be implemented in future versions of the game to improve the training process. Full article

Background: Manual wheelchairs (MWCs) are critical assistive devices for individuals with spinal cord injury (SCI) and other mobility impairments. However, inconsistencies exist in evaluating usability across different manual wheelchair designs. Usability evaluation methods are essential to ensure optimal design and function. Methods: A systematic review following PRISMA guidelines was conducted. Databases searched included PubMed, ScienceDirect, and DBpia. A comprehensive search was completed up to April 2024. Keywords combined concepts such as “spinal cord injury”, “manual wheelchair”, and “usability evaluation” using Boolean operators (AND, OR) and truncation strategies. Results: From 2134 initial records, 30 studies met the inclusion criteria. Studies included individuals with SCI as the primary population, but also incorporated able-bodied participants when necessary to simulate conditions not feasible for SCI users. Evaluation methods included objective assessments (e.g., kinematics, kinetics, electromyography) and subjective measures (e.g., System Usability Scale, user interviews). Conclusions: This review highlights methodological trends in MWC usability testing and identifies key metrics to guide future research and design improvements. While the primary focus was on individuals with SCI, studies involving healthy participants were included where ethically or practically justified. Full article

Measuring the propulsion performance of sport wheelchairs in ecological conditions remains complex due to variations inherent in real-world practice. This study aims to develop a validation protocol for an instrumented wheel designed to measure propulsion power under ecological conditions. The wheel’s precision was compared to that of the Lode Esseda roller ergometer, the gold standard for measuring the force exerted on both the left and right hands. Tests were conducted at three speeds (1, 2, and 3 m/s) on a multisport wheelchair. Results show a strong correlation between the two systems, confirmed by a repeated measures ANOVA test (p > 0.05) and a root mean square error (RMSE < 5%). Bland–Altman plots reveal good agreement despite discrepancies observed at high speeds, potentially due to mechanical limits. The proposed protocol validates the instrumented wheel and highlights the importance of multi-speed evaluation to ensure valid measurements in ecological conditions. Full article

Introduction: The COVID-19 pandemic challenged people with spinal cord injury (SCI) regarding a variety of mental and physical issues. New challenges may arise as the effects of the pandemic continue. The objective of this descriptive qualitative study was to explore the social participation of Canadians with SCI during the second wave of COVID-19. Methods: Participants with SCI from two Canadian provinces (Quebec and British Columbia) were interviewed. Results: Eighteen participants completed interviews. The facilitators of social participation remain similar since the first wave of COVID-19, such as the use of technology, help received by relatives, and the use of delivery services to obtain groceries and other essentials. Obstacles to mobility due to winter conditions and lack of considerations related to COVID-19 public health measures specific to wheelchair users were also discussed by participants. Conclusions: People with SCI perceived participation restrictions, little changes in life habits, and uncertainty about the future during the second wave of COVID-19. The unique living conditions of people with SCI, ability to adapt life habits, and the lived experiences of people with SCI may have contributed to an overall resilience during the pandemic. Adaptive families, social contacts, and technology made a difference during the pandemic. Full article

Background: Temporal lobe epilepsy is the most common pharmaco-resistant type of epilepsy. The chance of obtaining seizure freedom after resective surgery in pharmaco-resistant mesial temporal lobe patients (mTLE) is significantly higher compared to pharmaceutical treatment (at least 50–60% compared to less than 15%). However, some factors (e.g., craniotomy) may prevent epilepsy patients undergoing surgery. A recent advancement in epilepsy surgery, i.e., magnetic resonance guided laser interstitial thermal therapy (MRgLITT), has become an attractive alternative for performance of selective amygdala-hippo-campectomy, especially because of its minimal invasiveness. Among other medial temporal lobe structures, the hippocampus is particularly important for successful processing of vestibular inputs. Nevertheless, it is still unclear whether mTLE patients who underwent MRgLITT perform worse on vestibular-dependent tests, including balancing, spatial orientation and rotational memory. Methods: Nine patients (Age 40.1 ± 14.5; 2 females) underwent vestibular-dependent assessments before and after MRgLITT using the following test battery: (I) clinical balancing test (CBT), (II) triangle completion test (TCT) and (III) rotational memory test (RM). Results: We found significant improvement from pre- to post-surgery in the vestibular-dependent spatial orientation test, namely in the wheelchair condition of the triangle completion test. Additionally, the obtained effect sizes were medium to large in favor of post-surgery assessment for the majority of conditions in the three tests applied in this study, indicating that the assessment of a larger number of patients could also, potentially, lead to significant results in these cases. Conclusions: This plausibility study is the first to assess vestibular-dependent balancing, spatial orientation and rotational memory functions before and after MRgLITT in mTLE patients. Even with a small sample of nine patients, significant changes and medium to high effect sizes in favor of surgery were observed. Nevertheless, prospective studies with larger sample sizes are necessary for appropriate estimation of MRgLITT effectiveness in these functional domains. Full article

In wheelchair basketball, classes are based on competition observations. Since 2021, out-of-competition testing has been implemented; however, research remains limited. This study aimed to determine whether the quantified volume of action (VOA) can be an indicator for classification and examined the influence of a competitive wheelchair on VOA evaluation. This cross-sectional study included 47 wheelchair basketball players (21 able-bodied, 26 with physical impairments: class 1, n = 8; class 2, n = 5; class 3, n = 4; class 4, n = 9). Tests were performed in a wheelchair (wheelchair condition) and on a trainer bed (bed condition). Participants held a ball and rotated their trunks in various planes. Movements were recorded using four cameras, and position coordinates were extracted using the three-dimensional DLT method. Classes and sitting conditions were compared across five groups: classes 1, 2, 3, 4, and able-bodied. Comparisons between classes revealed significant differences in all planes, including wheelchair and bed conditions (p < 0.05). The VOA expanded in the wheelchair condition compared to the bed condition across multiple classes and planes (p < 0.05). Measuring the VOA outside the competition while sitting on a bed may effectively classify players by eliminating equipment influence. Full article

Canada’s heritage sites, while fewer in number compared to Europe, face significant challenges in accessibility due to strict preservation laws. Many were built before social inclusion became a priority, making them difficult to navigate for individuals with disabilities. For example, cobbled streets with uneven surfaces or significant level differences create obstacles for wheelchair users and others with mobility challenges. This qualitative action research aimed to develop guidelines for shared street designs and innovative solutions that balance heritage preservation with inclusive accessibility. The study involved go along interviews with 21 participants with disabilities in Quebec City’s Petit-Champlain and Place-Royale areas, as well as the Old-Seminary. Insights from these interviews informed a co-design methodology involving three sessions with participants with disabilities, family caregivers, and experts in accessibility and heritage. The co-design sessions generated practical solutions such as lift platforms, accessible signage, and guided handrails, addressing both outdoor and indoor accessibility barriers. For indoor spaces, solutions included integrating acoustic panels and foldable seating, while outdoor recommendations emphasized autonomous access solutions like non-slip coatings and accessible elevators for winter conditions. It was concluded that achieving a balance between preservation and accessibility requires collaboration among architects, designers, heritage experts, and individuals with disabilities. This research highlights the importance of co-design as a method to ensure heritage sites remain culturally significant and universally accessible. Full article

The mobility and independence of people with disabilities could be significantly improved by wheelchairs. Wheelchair adoption is a complex process that is influenced by various factors, including personal demands, social dynamics, and technological advancements. To effectively promote wheelchair adoption and enhance the quality of life for people with mobility issues, it is crucial to understand the adoption of wheelchairs from a holistic perspective. A model comprising six hypotheses was developed based on the UTUAT-2 (Unified Theory of Acceptance and Use of Technology) framework with modifications. The data was analyzed from 330 individuals living with a disability using SPSS and Smart PLS. The study revealed that performance expectancy, effort expectancy, habit, social influence, and perceived infrastructure individually influence the intention to use wheelchairs. The results further revealed that price value and facilitating conditions were not significant predictors of intention to use a wheelchair. The results also showed that aesthetic design moderates the effect of effort expectancy, habit, social influence, price value, and perceived infrastructure on behavioral intention. Through a multidimensional lens, the paper offers practical recommendations to improve the adoption of wheelchairs for people with mobility impairments. Full article