The Smart Wheelchairs in Assessment and Training (SWAT) State of the Field workshop was an initiative to gather various stakeholders in power wheelchair training and assessment and create a comprehensive review of the current state of the discipline. The participants involved a balance of both clinical and technical experts on wheelchair training and assessment and the outcomes of the workshop are published in an AGEWELL report. The 3-part Braze Mobility SWAT Blog Series will discuss some key outcomes of this workshop.

According to the SWAT report, the main challenges faced by practitioners in wheelchair training and assessment and those being assessed and trained for wheelchair use are:

1. High cost of equipment and funding constraints
2. Lack of available resources to train and supervise users safely
3. Limitations in commercially available technology to accommodate client needs

What Solutions Have Been Proposed to Combat These Challenges?

1. Lack of Available Resources to Train and Supervise Users on Safe Use

In order to gain the maximum impact from the limited resources available, therapists can use technologies such as Smart Wheelchairs. Smart Wheelchairs have many different benefits that will help to increase the efficiency of training and assessment sessions.

The first is that these devices can monitor users at all times, not just when in the clinic. This provides therapists with a more holistic view of their clients’ driving habits, and can help them to identify problems that occur in settings outside of the clinic environment or assessment hours.

For example, smart wheelchair technology could be used to detect if clients experience more collisions after a certain time due to fatigue or side effects of medication. This data can also be used to determine skills requiring additional training sessions, and target therapy sessions accurately towards the needs of the user. This could in turn reduces the required one-on-one evaluation time.

Smart wheelchairs can also provide the user with feedback about their driving, and hazards in their environment. This allows for training to occur outside of the clinic, maintaining client safety without requiring one-on-one therapist supervision. These benefits could reduce the time constraints on therapists, as well as increase the amount of training the user is able to obtain from each session.

2. Limitations in Commercially Available Technology to Accommodate Client Needs

Translating research into clinical practice was found by the report to be critical to ensuring progress in adaptive technology. In adapting research into commercially available products, usercentered design must be used to develop the technologies through engaging end users in the design process. The SWAT report identifies that potential technological solutions to accessibility challenges mostly involve solutions that engineers already have the technological know-how to create, and therefore progress is within reach. There is currently a commercially available option to provide a wheelchair user with feedback outside of the clinic.

The Braze Sentina Plus provides users with 180 degrees of blind spot detection, with the possibility of adding up to three Echo heads for 45 degrees of customizable coverage. The Sentina can provide visual, auditory or vibration feedback to the user, alerting them of objects in their environment and helping them to navigate tight spaces independently. This product was developed using the outcomes of the SWAT report along with extensive user feedback, and can be used with almost any wheelchair. To learn more, click here!

3. High Cost of Equipment and Funding Constraints

In order for smart wheelchairs to be economically viable, there must be access to funding for those who would benefit from the device. The SWAT report found that the additional cost in development and production of a smart wheelchair is justified by the benefit provided to the user, as access to powered mobility devices for safe and independent mobility is a human right. Low-cost solutions are another possible solution, such as the Braze Hydra which is available for $770 USD! For more information on funding challenges and solutions, stay tuned to the Braze blog, as our next series will tackle available funding in Canada!

Read More About Smart Wheelchair Technology

• Download our FREE E-Book on Smart Wheelchair Technology!
• Read Part 1: The 5 things you should know about Smart Wheelchair technology!
• Read Part 2: The Current State of Wheelchair Training and Assessment

References

1. Viswanathan, P., Wang, R., Sutcliffe, A., Kenyon, L., Foley, G., Miller, W., Bell, J., Kirby, L., Simpson, R., Mihailidis, A., Adams, M., Archambault, P., Black, R., Blain, J., Bresler, M., Cotarla, S., Demiris, Y., Giesbrecht, E., Gardner, P., Gryfe, P., Hall, K., Mandel, C., McGilton, K., Michaud, F., Mitchell, I., Mortenson, B., Nilsson, L., Pineau, J., Smith, E., Zambalde, E., Zondervan, D., Routhier, F. & Carlson, T. (2018). “Smart Wheelchair in Assessment and Training (SWAT): State of the Field” AGEWELL.

The Smart Wheelchairs in Assessment and Training (SWAT) State of the Field workshop was an initiative to gather various stakeholders in power wheelchair training and assessment and create a comprehensive review of the current state of the discipline. The participants involved a balance of both clinical and technical experts on wheelchair training and assessment and the outcomes of the workshop are published in an AGEWELL report. The 3-part Braze Mobility SWAT Blog Series will discuss some key outcomes of this workshop.

As discussed in the previous blog post, power wheelchairs provide diverse benefits to their users. However, they also pose a risk to both the user and those around them if not properly paired with the user’s abilities. It is therefore important for therapists to thoroughly assess the abilities of their client, and train them on the safe use of a power wheelchair (PWC).

What Do Therapists Measure in a PWC Assessment?

Assessments will include an interview with the user to determine their mobility goals and needs. Following this, the assessment will typically include several trials of PWCs, in order to assess various PWC skills. In addition, an evaluation of physical, cognitive and perceptual functional status of the user will be performed. Additional relevant information includes the client’s support network, main method of transportation, age, personality, and details about the environment the PWC will be used.

All of this information is used to determine which PWC, if any, is the most appropriate for the client. In addition, this information can be used by clinicians to determine appropriate modifications or technologies that can help the user to succeed in operating a PWC safely.

For example, for users who have difficulty with backing up or navigating in tight spaces, the Braze Sentina is a new technology that attaches to any wheelchair and provides auditory, visual and/or vibration feedback to the user about hazards in the environment. Find out more about Braze mobility products!

What are the Challenges in PWC Assessment?

In the SWAT workshop, it was determined that there is an overall lack of well-established tools to guide therapists in training and assessment that demonstrate both scientific rigour and clinical utility. In a recent survey of power wheelchair training and assessment professionals, most reported using non-standardized mobility skills assessments.

Given the diverse and unique needs of clients, standardization of assessments may be ineffective, and unjustly limit access to PWCs. However, the push for evidence based practices encourages the integration of standardized, evidence-based PWC assessments.

What are the Assessment Tools Currently Used in PWC Assessments?

1. Power-mobility Indoor driving assessment (PIDA) and Power Mobility Community Driving Assessment (PCDA)

The Power-mobility Indoor driving assessment (PIDA) (Dawson, Kaiserman, Chan, & Gleason, 2006) and Power Mobility Community Driving Assessment (PCDA) (Letts, Dawson, & Kaiserman, 1998) are clinically useful, and provide therapists with a guideline to assess skills both within the community and indoors. These checklists draw attention to certain areas of power wheelchair use, and are intended to act as an indication of areas requiring further training, device modification, or environmental interventions.

2. The Wheelchair Skills Program

The Wheelchair Skills Program (Dalhousie University, 2007) includes the Wheelchair Skills Test (WST), a questionnaire (WST-Q) and the Wheelchair Skills Training Program (WSTP). The program can be used to both assess and train users, and have undergone several tests to ensure reliability, validity and clinical utility

3. Driving to Learn

The Driving to Learn (Nilsson, Eklund, Nyberg, & Thulesius, 2011). approach uses a training PWC and tool to understand the incremental learning process, and appropriate strategies to facilitate a user’s continued learning. This tool is designed for individuals with profound cognitive disabilities. It has demonstrated very good inter-rater reliability, and is a reliable tool for clinical use.

4. The Pediatric Powered Wheelchair Screening Test (PPWST)

The Pediatric Powered Wheelchair Screening Test (PPWST; Furumasu, Guerette, Tefft, 2004) tool is designed to help therapists assess a child’s readiness to drive a PWC. Only cognitive skills are evaluated using this tool.

6. The Obstacle Course Assessment of Wheelchair User Performance

The The Obstacle Course Assessment of Wheelchair User Performance (Routhier, Vincent, Desrosiers, Nadeau, & Guerette, 2004) tool is used to assess the more difficult wheelchair skills . Both the content and construct validity has been established, however clinical usefulness is less clear.

7. The Power Mobility Skills Test

The Power Mobility Skills Test (Rico, 2014) provides standardization and consistency in assessment of individuals for PWC use. It has been used extensively in California, where it is now mandatory in evaluation of PWC readiness. More research is needed to establish the clinical utility, reliability and validity outside of the California Children’s Services agencies.

Read More About Wheelchair Technology

• Download our FREE E-Book on Smart Wheelchair Technology!
• Read Part 1: The 5 things you should know about Smart Wheelchair technology!
• Read Part 3: Challenges and Solutions in Wheelchair Training and Assessment.

References

1. Dalhousie University. Wheelchair Skills Program (WSP), Version 4.1 2007. Available from: www.wheelchairskillsprogram.ca. Last accessed 23 July 2014.
2. Dawson, D., Kaiserman-Goldenstein, E., Chan, R., & Gleason, J. (2006). Power-Mobility Indoor driving assessment manual.
3. Letts, L., Dawson, D., & Kaiserman-Goldenstein, E. (1998). Development of the power-mobility community driving assessment. Canadian Journal of Rehabilitation, 11, 123-129.
4. Nilsson, L., Eklund, M., & Nyberg, P. (2011). Driving to Learn in a powered wheelchair: Interrater reliability of a tool for assessment of joystick-use. Australian occupational therapy journal, 58(6), 447-454.
5. Rico, L. (2014, May 29). Powered Mobility Devices (PMD). Retrieved July 22, 2014, from http://www.dhcs.ca.gov/services/ccs/Documents/ccsnl090514.pdf
6. Viswanathan, P., Wang, R., Sutcliffe, A., Kenyon, L., Foley, G., Miller, W., Bell, J., Kirby, L., Simpson, R., Mihailidis, A., Adams, M., Archambault, P., Black, R., Blain, J., Bresler, M., Cotarla, S., Demiris, Y., Giesbrecht, E., Gardner, P., Gryfe, P., Hall, K., Mandel, C., McGilton, K., Michaud, F., Mitchell, I., Mortenson, B., Nilsson, L., Pineau, J., Smith, E., Zambalde, E., Zondervan, D., Routhier, F. & Carlson, T. (2018). “Smart Wheelchair in Assessment and Training (SWAT): State of the Field” AGEWELL.
7. Routhier, F., Vincent, C., Desrosiers, J., Nadeau, S., & Guerette, C. (2004). Development of an obstacle course assessment of wheelchair user performance (OCAWUP): a content validity study. Technology and Disability, 16(1), 19-31.

The Smart Wheelchairs in Assessment and Training (SWAT) State of the Field workshop was an initiative to gather various stakeholders in power wheelchair training and assessment and create a comprehensive review of the current state of the discipline. The participants involved a balance of both clinical and technical experts on wheelchair training and assessment and the outcomes of the workshop are published in an AGEWELL report. The next 3 blogs will discuss some key outcomes of this workshop.

The top 5 things you should know about smart wheelchair technology!

1. What is a “Smart Wheelchair”?

A smart wheelchair is a power wheelchair (PWC) that collects information on driver behavior and interaction with their environment. This is done through the use of sensors and/or cameras positioned to provide feedback on a driver’s ability to control the device and navigate their environment safely. The information can be relayed directly to the user to modify behavior, such as through an auditory, sensory or visual feedback system. The data can also be tracked and used to provide therapists with valuable insight on the user’s driving habits. This can be used to assess the safety of the user and those around them, as well as areas to focus on during future training sessions and ways to modify the environment.

2. Why is This Important?

Access to PWC technology can increase a clients independence, improve their ability to navigate their environment and is considered to be a human right by advocacy groups such as UsersFirst. Access to mobility devices is closely tied to an increase in confidence level, self-efficacy and self-reported desire to use technology. Mobility devices can also reduce the social stigma related to disability, by increasing independence of a person with mobility impairment. Through the use of information collected by smart wheelchairs, therapists are able to more thoroughly assess a client’s ability to safely operate a PWC, and could increase access for users who might otherwise be denied access due to safety concerns.

3. What Can Smart Wheelchairs Do for Therapists?

A smart wheelchair can supplement a clinician’s decision making. Although there is no substitute for clinician experience and judgment, smart wheelchair feedback can provide valuable insights into how a client interacts with their PWC on a daily basis. They can provide insight into a client’s potential to learn, and whether training sessions will increase their ability to operate a PWC independently. They also provide insight into specific areas to focus on during future training sessions. They can create objective measures of performance (such as number of collisions experienced) and provide ongoing monitoring of clients, even when training sessions end.

4. What are the Main Barriers Preventing Client Access to PWC Technology?

The primary concern of most therapists in prescribing a PWC is the safety of both the client, and the people the client interacts with. Exclusion from PWC use is more likely to occur in users who show symptoms of inattention, delayed reaction time, poor judgment and decreased visuospatial awareness. For clients who require extensive training to safely use PWC technology, a limitation in the amount of training available due to therapist time constraints acts as a barrier to access. In addition, the high cost of PWC equipment, along with funding constraints can limit client access. There is additionally a limitation in commercially available technology to accommodate client needs for smart wheelchair technology.

5. What Smart Wheelchair Technology is Commercially Available?

Braze Mobility develops devices that can turn any wheelchair into a smart wheelchair. The Braze Sentina and Hydra are blind spot sensors that can be easily installed on any wheelchair, and provide auditory, visual and/or vibration feedback increasing the user’s spatial awareness and ability to maneuver tight spaces.  Braze CEO and co-organizer of the SWAT initiative Dr. Pooja Viswanathan developed these devices using the outcomes of the SWAT report to guide user-focused design. To learn more, click here!

Learn More About Smart Wheelchair Technology!

• Download our FREE E-Book on Smart Wheelchair Technology!
• Read Part 2 of this article: The Current State of Wheelchair Training and Assessment
• Read Part 3 of this article: Challenges and Solutions in Wheelchair Training and Assessment

Reference

Viswanathan, P., Wang, R., Sutcliffe, A., Kenyon, L., Foley, G., Miller, W., Bell, J., Kirby, L., Simpson, R., Mihailidis, A., Adams, M., Archambault, P., Black, R., Blain, J., Bresler, M., Cotarla, S., Demiris, Y., Giesbrecht, E., Gardner, P., Gryfe, P., Hall, K., Mandel, C., McGilton, K., Michaud, F., Mitchell, I., Mortenson, B., Nilsson, L., Pineau, J., Smith, E., Zambalde, E., Zondervan, D., Routhier, F. & Carlson, T. (2018). “Smart Wheelchair in Assessment and Training (SWAT): State of the Field” AGEWELL.

The Braze team discovered a whole new meaning to the saying “Life is a journey, not a destination” on an outing to demo our anti-collision technology. For the trip back, decided to take the TTC to avoid the expense of taking a wheelchair cab (more on that later). What was supposed to take 36 minutes (according to Google maps) turned into a transit nightmare that dragged on for more than two hours!!

It started out as a fine day, but as rain started falling we quickly shed our coats to protect our chair’s exposed electronics. Things went downhill from there…

As the four of us got to the closest subway station, we looked around for a second entrance that did not involve going up a flight of stairs. We had some hope of finding one across the street, since an overhead tunnel seemed to lead to a parking structure with an elevator. False hope! As opposed to what we were told, this station wasn’t – and had never been – accessible.

We immediately turned to our phones to find alternative routes. This turned out to be tricky, since Google maps kept telling us to take the subway where we were, since it didn’t consider our accessibility predicament.  Thankfully, a kind policeman realized we were struggling and told us which buses to take to reach an accessible TTC subway station.

When the first bus came, Pooja had the honour of driving the chair into the bus and parking into the spot reserved for wheelchairs, not without bumping into different parts of the bus. Unfamiliar as we were with the anchoring system, we didn’t figure out right away how to pull the retractable hooks out (especially since the first one we tried turned out to be broken). The sign with paragraph upon paragraph of instructions (see picture below) was of no help at all! The worst part was that the driver pulled away from the curb without even checking that the chair was anchored down – it wasn’t. Getting off the bus was just as eventful as getting on since the space immediately in front of the platform was blocked by a mailbox.

Two buses and a good 45 minutes later, we arrived at the subway station only to find out that the only elevator was broken down. This time, a genuinely apologetic TTC employee offered us an alternate route to another accessible station and even called ahead to check that those elevators were working.

We finally reached an accessible station after taking three different buses – Pooja’s skills at getting on/off the bus had already improved! At this station, we noticed a few more accessibility gaps, like the lack of signage near the elevator, which led us to the wrong side of the platform, as if we hadn’t wasted enough time already.

A full 2 hours and 15 minutes after our departure, four times Google’s estimated trip duration, we finally arrived back at the office with our patience tested and a banged up prototype. It became apparent, even before the end of the trip, that this experience was about much more than just making it back to the office. It became one small piece of my journey to be more aware of the accessibility challenges that powered wheelchair drivers and their caregivers can face every single day, even if I wasn’t the one sitting in the wheelchair.

The morning of the Accessibility Innovation Showcase, I was tasked with transporting our demo wheelchair from UofT’s Rehabilitation Sciences Building, at 500 University Avenue, to the Metro Toronto Convention Center. The plan of action was straightforward but daunting, made worse by my inexperience at operating a motorized wheelchair (I’d never driven one before!). After leaving the lab and doing some practice driving in the hallway to boost my confidence, I was off!

Immediately upon entering the elevator, I realized how difficult it was to reach the buttons. I knew that if I drove into trouble anywhere on my trip, I could stand up and try to sort out my problem, but I resolved at this point to make the entire journey without cheating. After some negotiating, I was able to reach the buttons and head to ground level. The ramp at the back of the building was easily navigated, even while covered in scaffolding, and I set off up the street. The first major concession I had to make on my trip was driving all the way to Queen’s Park Station (an extra 450m) because St. Patrick Station is not accessible. After arriving at Queen’s Park, I purchased my token and headed down to the platform.

I especially liked the TTC elevators for having both front and back doors so I could drive straight through instead of trying to turn around or back out (something I am really bad at). Once on the platform, I waited for the train, slightly anxious that I wouldn’t be lined up with a door in time to board, but was able to catch the first train that came through. I parked as close as I could to the priority seating, although the passengers sitting in the fold-up seats did not seem interested in moving for me. I darted off the train at Union and made my way to the elevators. Exiting Union Station proved to be the most difficult part of the trip. Due to ongoing construction, some routes are closed and others inaccessible, so I asked for directions several times. I was able to navigate into the Skywalk without assistance, save for one set of doors with no power opener (opened for me by a GO passenger). The trip down to the hall of the MTCC for the showcase went smoothly, save for a minor mishap backing out of an elevator.

Overall, I was impressed by how easy the trip was. The only thing that took a significant amount of extra time was driving to a further subway station. I also developed a new appreciation for the importance of good elevator design. Ironically, driving in elevators were some of the most stressful parts of the trip.

This trip made me realize that applying the “accessible” label, and including the bare minimum of accessibility features isn’t good enough; the features really need to be user friendly. Elevators that are too small, gaps between trains and platforms, and accessible stations scattered far apart are all examples of areas that could be improved upon given interest and investment.

“Know thy user” is a mantra well-known to anyone in the field of product development. As a founder of a new start-up that develops accessible technologies for independent mobility, and as someone who has never experienced a mobility impairment except for the occasional and minor knee injuries, I realised that I needed to better understand the accessibility challenges of my users before I attempted to come up with solutions. I figured a good way to do this was to experience first-hand what it is like to drive around the Greater Toronto Area in a wheelchair.

In our blog series called “Wheeling around the GTA”, my team members and I share our various trips within the GTA – the good, the bad, and the ugly. As all of my team members would agree, we noticed several issues (some related to the environment, and others related to mindsets and attitudes) that we perhaps would never have recognized if it wasn’t for our (brief) lived experiences in wheeling around.

We hope that this blog brings some of these issues to the forefront for those who are unaware of them, in addition to providing a public platform where others can share their own accessibility challenges, or those of their loved ones. If you have a story to share, please contact us and write for our blog!