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Image with four people wearing masks

Face Masks & Disabilities

08/23/2020

All advice in this blog should not replace medical advice. Be sure to follow updates from the WHO and CDC/Health Canada for the most updated advice on COVID-19 management. 

As the COVID-19 pandemic evolves, the ability to go to stores, restaurants and other public places has been a welcome relief to many after months of isolation. Here in Ontario Canada, the opening of businesses has come with the requirement of all customers to wear a face mask or covering while inside the business (unless seated and eating). These laws are designed to keep everyone safe, while allowing a return to the lives that we have all been missing. 

The Accessibility Challenges Of Using Face Masks

But, how do people with disabilities fit into these laws? The use of face masks may be a challenge for many people. According to the Americans with Disabilities Act (ADA), the people who may be limited in their ability to use a face mask includes: 

  • Someone who has low fine motor skills or spasticity in their upper body may find putting on or taking a mask off difficult
  • Someone who relies on lip reading for communication may find it difficult to understand others while they are wearing a mask.
  • Someone who uses a mouth-control for their wheelchair such as a sip-and-puff alternative joystick control would not be able to wear a mask while operating their chair. 
  • Someone who has speech impairment may not be understood while wearing a mask.
  • Someone with autism may experience sensory overload when having a mask covering their face
  • Someone with PTSD or claustrophobia may experience severe fear when wearing a mask
  • Someone with COPD or other breathing difficulty

For all of these reasons and many more, people with disabilities may not be able to wear face masks in public. There is a requirement by the ADA to modify the rules around mask wearing to accommodate people with a disability. Some suggestions include: 

  • Allowing prompt curbside pickup from a safe social distance, using both telephone and internet orders
  • Allowing loose-fitting face coverings when entering buildings, including face shields
  • Allowing people to wait in vehicles for appointments, and calling them in when ready
  • Providing phone or video appointments as an option

Overcoming Accessibility Challenges of Face Mask Wearing

All of these options are useful, however many of them do not reduce the isolation, or help return life to normal. People with disabilities have been greatly impacted by social isolation, and enabling a return to normal everyday life should be a priority. Some ideas for helping people with disabilities overcome the challenges of wearing masks include: 

  • Face masks with transparent windows have been made by accessibility-focused groups  such as the Como Foundation to help those who are hard of hearing access masks that enable communication through lip-reading
  • Face Shields are another more loose-fitting option. Although the CDC does not currently recommend using face shields in place of a mask, they recommend that a mask that wraps around the face, and descends past the chin may be used when a mask is not a viable option. 
  • Help educate others about the importance of wearing a mask. If you are unable to wear a mask, help others protect you by encouraging proper mask wearing and hand cleaning & surface sanitizing. 

We would love to hear your ideas for staying healthy and returning to activities of daily living in the face of COVID-19. Leave a comment below! 

Resources

COVID-19: Considerations for Wearing Masks. (2020, August 7). Retrieved August 08, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html Williamson, P. R., Morder, M. J., & Whaley, B. A. (2020) The ADA and Face Mask Policies [Fact sheet]. Retrieved from https://www.adasoutheast.org/ada/publications/legal/ada-and-face-mask-policies.php

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Braze Mobility image with symbols from mechanical cogs, joystick, power, lighting, and addition.

Things to Consider When Ordering a Power Wheelchair

07/23/2020

If you have recently been prescribed a power wheelchair, there are quite a few things to consider. There are many different options when ordering a power wheelchair and ensuring that you are provided with a chair that is right for you is important. The following blog post offers some ideas about options that you have when choosing a wheelchair. Speak to your Occupational or Physical Therapist and your wheelchair vendor if you have any questions regarding your wheelchair order. The following post contains some ideas of things to consider, but is not meant to be an exhaustive list of all options available.

Location of the drive wheels

The optimal location for the drive wheels on your chair will depend on a few things. Often, once someone gets used to a certain location of drive wheels, any other location might feel weird. Each type of chair has different pros and cons, so there is no one best location. The Queensland Spinal Cord Injuries Service provides a full comparison of the wheelchair drive trains.

Rear Wheel Drive

Pros of Rear Wheel Drive

These chairs usually have the highest top speeds, and are very stable navigating rugged terrain.

Cons of Rear Wheel Drive

The turning radius is higher in rear-wheel drive chairs, making navigation in tight spaces more difficult. Additionally, the concentration of mass at the back of the chair makes tipping on uphills more likely.

Front Wheel Drive

Pros of Front of Wheel Drive

You will be able to turn your front end very quickly, making rounding tight corners easier! These chairs are also very stable, because they distribute the overall mass of the chair the most evenly. Additionally, you will be able to get close to workspaces or tables easily.

Cons of Front Wheel Drive

Going uphill these chairs have a higher chance of losing traction, as if the mass is concentrated on the rear of the chair the front wheels will have less ability to grip. When turning corners in a front wheel drive chair it may be difficult to maintain awareness of the rear of the chair. This could result in hitting more things with the back of the chair if you aren’t careful! At top speeds, these chairs have also been known to be difficult to maintain control.

Mid Wheel Drive

Pros of Mid Wheel Drive

These chairs are the most maneuverable of any chairs! You do not require any extra space to turn than that which you already have. They are also the most stable on a slope, because the mass is centered in the middle! Often, people find mid wheel drive chairs the easiest to drive.

Cons of Mid Wheel Drive

They can get stuck in uneven terrain if the front and rear castors suspend the middle wheels.

Joystick Control Options

You can operate your chair using a few different methods depending on your abilities and preferences.

The Most Common Control Types

  • The most common control used is a hand-held joystick controller. These are controlled by using your hand to move the control arm in the direction you wish to go. Operation of these requires motor control of your hand and arm.
  • Chin control uses a chin instead of a hand to control the joystick. The controller will be mounted near your face, and you will use your chin to move the control arm.
  • A head array is a control that you can trigger with your head. Pushing your head towards the sensors on either side will turn the chair, and pushing your head backwards will make it move forwards. To reverse, a switch is activated and then you can push your head back on the head array.
  • Sip and puff users control their wheelchairs via air blown into or sucked out of a straw-like controller. For example a hard puff may mean forwards, and a hard sip backwards. Soft sip and soft puff may correlate to a left or right turn. This control method requires practice to drive smoothly, as the output is not intuitive.
  • Touchpads do not require much force, but do require steady control of the hand and arm. Sliding your hand along a controller panel will move the chair in that direction.
Lighting Options

Lights can be added to wheelchairs when ordering, however this option is typically quite expensive and often not covered by public insurance. Lights are important to ensure safety when driving, especially in traffic. This blog post discusses the importance of visibility in a wheelchair to prevent injury.

Affordable, DIY Solutions For Wheelchair Lights

If you do not want to spend hundreds of dollars on lights from the wheelchair manufacturer, many people create DIY solutions, including attaching battery powered lights to the chair. If you aren’t able to create a solution yourself, organisations like the Tetra Society may be able to help you make a custom light solution.

Power tilt, lift and elevation

Many power wheelchairs are able to tilt, recline, and seat elevate electronically. These features can be especially useful for people who are unable to adjust themselves in their seats. Being able to tilt back is an easy way for care attendants to help someone adjust back in their seat. Being able to recline is important if you are going to spend a lot of time in your chair as it will allow you to stretch your back out. Elevation will allow you to rise up to eye level with people who are standing, and is useful to reach high cabinets, and to reach counters at cashiers, coffee shops, etc. These features may be funded depending on the need for them. Without funding, electric tilt, recline and elevate can cost thousands of dollars. Speak to your therapist about whether or not these features are right for you.

Options for Power Wheelchair Add-Ons

There are many different things that you can buy as odd-ons upon ordering a power wheelchair. Our Mobility Blog discusses add-ons, including those that increase safety, rear visibility, or have cool features. One feature that you can add on that fits into all three of these categories is the Braze Sentina, which is a blind spot sensor system designed for use with wheelchairs.

Bringing Your Wheelchair Home

When you first bring your wheelchair home, you may find it difficult to know what the footprint of the chair is, and as a result there is a high chance that you will bump some walls and doorways in your home. This can be avoided using various visual aids, such as blind spot sensors to monitor the environment behind your wheelchair. Braze Mobility Inc. makes blind spot sensors that can be added to any wheelchair, and provide the user with 180 degrees of rear view blind spot coverage.

I hope this blog post has given you an idea of some of the options available to you in ordering a power wheelchair. Your OT and/or PT and wheelchair vendor are there to answer all of your questions and support you in your selection. Make sure that you advocate for yourself, and know your options in order to ensure that the chair you get is right for you. Please comment below if there are any other features you think should be included!

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Image with symbols depicting different disasters and in the middle the accessibility symbol

Preparing for Emergencies When Using a Wheelchair: Healthcare

05/24/2020

As the world faces the COVID-19 crisis, it is time to evaluate what is emergency preparedness for wheelchair users and the disability community in particular. The focus of this article is the development of the health care accessibility standard for people with disabilities. This advice is written by Terri-Lynn Langdon who is a resident of Ontario, Canada and uses a wheelchair. The opinions expressed are Terri-Lynns, and should not replace medical advice. 

Emergency Preparedness for Wheelchair Users

The healthcare concerns of the wheelchair-using community demands attention every-day in order to continue to make healthcare services and options increasingly accessible to all of us, and no time for this is more crucial than during the COVID-19 crisis. Here are 5 things to consider when advocating for yourself in the healthcare system to ensure you are ready for whatever the happens.

  1. If you do not have a family doctor, reach out to your local health care network and inform them of your situation, and ask to be advised on next steps. In Ontario, contact Health Care Connect.
  2. If there are non-essential medical needs during this time, speak to your healthcare provider about accessing your appointment remotely through tele-health or delaying it until after COVID-19 concerns are controlled.
  3. For essential care needs try to access a familiar clinic and use the same service as often as possible to help ensure continuity of healthcare and communications related to your healthcare visits. Make sure you let your healthcare team know what you need in order to make your healthcare experiences as accessible as possible, this includes transportation to medical appointments.
  4. In a medical emergency, you cannot control which hospital or medical team you receive care from. For this reason, keep a summary of your medical conditions, emergency contacts and medications in your wallet.
  5. Make sure that your medications are up to date and that you have access to them. Call your local pharmacy and see whether they will deliver your medications. Call ahead to pre-book delivery to ensure you are able to receive your medications on time. 

Thank you for joining us! Come back next week for the second part of the Emergency Preparedness for People Who Use Wheelchairs series. 

References

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Image with the accessibility symbol and the words Accessible Design

All About Accessible Design

02/04/2020

When I joined Braze Mobility, I found all discussion of the design process fascinating, and the iterations undertaken by the design team are a great study in accessible design. The following blog series will discuss Universal Design and Accessible Design, and will profile some great design concepts that inspire and help.

There is no such thing as disability, only poor design*. Of course, some people have a harder time navigating the built environment than others, and there are people who have physical and cognitive abilities that change the way in which they interact with the world.

But, when a person is unable to go into a restaurant because someone built stairs instead of a ramp, is it their disability holding them back, or the short-sightedness of the architect who failed to realize not everyone gets around using two legs? Likewise, if someone who is on the Autism spectrum has difficulty visiting a shopping mall at during the holiday times, the poor overstimulating design is to blame for their inability to interact with the environment.

Accessibility for Ontarians with Disabilities Act (AODA)

The world is beginning to become more accessible. Governments are producing legislation that forces businesses to ensure their premises are as accessible as possible, such as the Accessibility for Ontarians with Disabilities Act (AODA). Ensuring that spaces and products are able to be used specifically by people with disabilities is important. People regardless of ability and mobility should have the same opportunities to succeed and interact with their environment, no question. Ensuring that a business is accessible also benefits the business itself. By being inaccessible, not only are you losing the business of the person who can’t get into the store, but also everyone who is with them. Accessible design benefits everyone.

The “Curb Cut” Effect

But, design for people with disabilities has an added benefit- spaces and products designed to be used by people with disabilities also tend to be easier to use for people without disabilities as well. Take the example of the curb cut, for instance. If you haven’t heard the story of the Rolling Quads at Berkeley in the 1970’s, there is a great 99% invisible podcast that outlines the story.

The positive impact of curb cuts benefits everyone, not just those with disabilities. Whether a person using a wheelchair, a parent pushing a stroller, an elderly person wheeling their groceries or just someone crossing the road who doesn’t want to take a step up, curb cuts help make travelling on sidewalks easier. Studies have shown that 90% of people will alter their course to use a curb cut instead of stepping up onto a curb, regardless of physical ability.

This phenomenon is known as the “curb cut effect”, and is a widespread aspect of design.

So, how can we design things to be universally accessible, and therefore a better design for everyone? Follow the Mobility blog series to follow our accessible design process! Braze Mobility would love to hear from you if you have any thoughts about accessible design.

*This statement is intended to demonstrate the necessity of considering all abilities in design, and how good design can enable all people to interact with their environment. It is not intended to minimize the impact a disability has on someone’s life.

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What Are Autonomous Wheelchairs?

01/15/2020

As self-driving cars begin to enter the market, it becomes increasingly likely that self-driving wheelchairs will be developed. The implications of this are incredible, and will certainly change the way people roll! This blog series will look at where we are now on the journey towards fully autonomous wheelchairs, as well as some of the pros and cons of self-driving chairs. While I am not an expert on robotics (I’ll leave that to our CEO Pooja), I hope that these insights will help you understand what autonomous technology is and can do!

Self-Driving Vehicles: What Are They?

Self-driving vehicles (or autonomous vehicles) are trickling their way into the market slowly, with Google’s Waymo leading the way. The adapted cruise control to maintain distance between 2 vehicles, the lane monitoring software to alert drivers when they are crossing over the line in a road are all already implemented in cars. These technologies make cars safer and easier to drive and are generally considered to be good advances in safety technology. However, trouble arises when you take the human completely out of the equation.

Complete reliance on a computer’s ability to make life-or-death decisions properly raises concerns, and the ethics of programming a computer to make those decisions poses issues. Despite this, self-driving cars have been on the streets for a fair while, logging over 1.9 million miles, and feeding the AI with data about traffic navigation. This process will take years and millions of dollars to reach the point where you could own a car without a steering wheel or brake pedal.

How Do Self-Driving Vehicles Work?

The basic model is that the computer is teaching itself how to drive. By using artificial intelligence (a computer that can teach itself), and inputting millions of hours of driving data into the framework, the computer essentially learns to identify situations. When a car encounters, say a person on the side of the road, it will compare this to the millions of other humans that have been encountered in the past and compute the risk of collision. This will include identifying the probability that the person will step out in front of the car, the speed at which the person is moving, the degree of turning which must occur to avoid the person, the amount of brake that must be applied to avoid hitting them, etc.

The car will also need to calculate whether steering around the person will put the driver or other cars at risk, and if so will require a pre-programmed decision-making process to decide whether to swerve, brake or neither. Of course, it is all infinitely more complicated than this, and there are many other factors being considered. 

But, we aren’t talking about automobiles, we are talking about wheelchairs, which will likely be more difficult to program to drive safely.

Challenges of Autonomous Wheelchairs (That Are Not Like Self-Driving Cars)

Cars operate in fairly controlled environments. On roads, cars and pedestrians observe clear traffic rules (even if they aren’t always followed well- I’m looking at you Toronto drivers!), and although there is some level of unpredictability this is limited.

Wheelchairs, on the other hand should be able to travel anywhere someone could walk, meaning the situations that the wheelchair will encounter are pretty much as diverse, unpredictable and lawless as walking through Union Station during rush hour. Additionally, it is likely that self-driving cars will be able to communicate with each other, creating network effects, and helping cars to avoid colliding with each other. People who drive wheelchairs often face challenges with people not getting out of their way, or even walking right into their chair. Communicating with humans is a difficult challenge for autonomous wheelchairs, as warnings would need to be inclusive of people with low vision and/or hearing. 

Another challenge will be inputting the desired destination for the wheelchair. While cars can be programmed to travel to a specific address, the input for a wheelchair destination is much more complex due to the large diversity of places a wheelchair can travel.

Using Autonomous Wheelchair Technology In Real Life

Take, for example someone at a stadium needs to use the washroom. One possibility is that the person will click a button on their chair that says “bathroom”. The chair will then need to have either a blueprint map of the building, or cameras that can monitor the environment in search of the accessible washroom sign. Using this information, the chair has located the closest washroom!

Specific Variables For Autonomous Wheelchairs To Consider

Now, the computer will decide the optimal path towards that washroom. This will require the computer to know the location of all stairways to avoid, and all ramps and elevators (assuming chairs are unable to climb staircases at this point). The path is set, and the chair begins on its way! Dodging people and alerting them to move out of the way, the chair approaches the bathroom. When it approaches, the chair deploys a signal to the door to open, or a mechanical hand to push to automatic door opener. The chair registers that the door is open and is able to move into the washroom!

Once in the bathroom, the chair must be able to choose between the available stalls to locate the accessible one, and the person using the wheelchair may want to back into a specific bathroom stall at a certain angle to make transferring easier. While the wheelchair driver or a human attendant may be able to use their past experience about the easiest transfer method, and therefore best location to park in, a computer may have difficulty accounting for all variables.

Assuming this chair has learned from its driver, it successfully docks, and the process must be repeated to return the person to their place in the stadium. The complexity of this decision-making process is high, and potential for mistakes is high as well! A wheelchair colliding with a person is dangerous.

Challenges With Creating Autonomous Wheelchairs

A bathroom is an easy target, but what if the driver is hoping to travel to a more specific environment (ie the coffee table to the right of the doorway separating the kitchen and living room)? Considering input method must be adaptable for people who have a difficult time speaking or typing the challenge increases. All of these challenges will be faced by developers looking to create self-driving technology for wheelchairs.  

While Google Maps and other automobile tracking software has been perfecting available maps of streets and traffic, there are no such maps making blueprints of buildings-this means that autonomous vehicle technology must either find ways of interpreting the environment at a human level of understanding (ie- reading signs, sensing walls and obstacles etc), or every building that self-driving wheelchairs are in must be carefully mapped and categorized.

The Future Of Self-Driving Technology (Including Wheelchairs)

All autonomous technology is a challenge. It will be years before self-driving cars begin to emerge on the market. As you can see, self-driving wheelchairs pose even greater of a challenge for software developers and thus will likely take even longer to emerge onto the market.

The benefit that self-driving wheelchairs will inevitably bring to the population who uses them is incredible. Working towards an autonomous future for wheelchair controls is certainly a good thing- but the challenges are real as well. Braze Mobility‘s next post will look at the ethical implications of self driving chairs: the good and the bad

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The Ethical Implication of Autonomous Wheelchairs with two symbols one on the right is of the Scale of Justice and one on the right is the accessibility symbol with a compass in wheel of the chair

The Ethical Implications of Autonomous Wheelchairs

12/10/2018

We talked about what autonomous wheelchairs are, and some of the barriers that will need to be overcome before fully autonomous wheelchairs enter the marketplace in our last blog post. We will now examine some of the ethical limitations of autonomous wheelchairs, as well as the benefits that they will bring to people who use wheelchairs and their caregivers.

Last summer, I went to visit the camp for kids and young adults with physical disabilities that I used to work at. While there, I was heading back with a group to their cabin after a campfire- it was very dark, and the path was unlit. One of the campers that I have known for many years asked if I could navigate his chair through the darkness until we got to an area that was better lit up.

We got chatting, and he told me that he very rarely asks others for help with navigating his wheelchair- unless he feels that there could be danger to himself or others he will maintain control. He said that having grown up all of his life with CP, his power wheelchair is one of the few things that he has total physical control over, and giving up control is almost unthinkable.

This made me stop and think about the future of power mobility, and how it will affect the relationship between a person and their wheelchair.

The Benefits Of Automated Mobility

There are many potential benefits to autonomous power mobility. Power wheelchair accidents are common and can be deadly, especially among the older population. In Canada, falls among elderly people resulted in over 7,000 deaths between 2000-2002 (Public Health Agency of Canada, 2005).

In institutions with many elderly people, having an power wheelchair can be seen as a danger to the other residents, and some facilities ban the use of power mobility altogether. Autonomous wheelchairs have the opportunity to prevent accidents, by sensing their environment completely and predicting the safest path, removing or reducing the probability of driver error causing an accident.

Autonomous wheelchairs also have the ability to provide access to independent mobility for people who otherwise need to rely on attendant care to mobilize. Having the ability to move throughout the environment is important for mental health and well-being. For people who do not have access to 24-hour one-on-one care, relying on attendants for mobility could be frustrating. Autonomous wheelchairs would provide independence for the person using the chair, and would reduce the burden on caregivers. Take for example meal times. Often, with limited numbers of staff, getting all residents into place at tables can take up to an hour. With the use of autonomous chairs, that process could be streamlined and staff would be able to focus on getting everyone their food!

Autonomous Wheelchairs Encourage Independent Mobility

Despite these potential positives, the most important factor to consider is the impact for the people who would use the autonomous wheelchairs, including feelings of autonomy and independence. Autonomous chairs must be designed in such a way that people are able to feel that they fully control the chair, and not that the chair is moving them of its own volition. This presents and interesting design challenge for technology developers (spoiler alert- our next blog series will look at accessible & inclusive design!)

An alternative to fully autonomous chairs is giving the driver the information that they need to safely operate their power wheelchair, while maintaining their full control over the chair. This can be done through the use of visual aids for wheelchairs, including blind spot sensors to alert drivers to obstacles in their environment- check out the Braze Sentina for more information!

Reference

Public Health Agency of Canada. Report on seniors’ falls in Canada. 2005. http://www.phac-aspc.gc.ca/seniors-aines/alt-formats/pdf/publications/pro/injury-blessure/seniors_falls/seniors-falls_e.pdf.

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TTC Bus with the Braze Mobility branding on it

TTC vs. The World: Subway Transit Accessibility

08/23/2018

I recently saw an article on the transit accessibility around the world, which was fascinating. It is good to see that transit commissions around the world are working towards a more accessible future (albeit slowly). The Toronto Transit Commission was left off of the list, so I decided to investigate. Being much newer than Paris and much less extensive than NYC, Toronto has a clear advantage in the ease of transforming their transit system to being 100% accessible. The following blog series will focus on the accessibility of the Toronto Transit Commission (TTC), where we are now, and how far we have to go to reach full accessibility.

Transit Accessibility in Toronto

The TTC has been making strides towards a fully accessible subway system, a goal which Accessibility for Ontarians with Disabilities Act (AODA) requires is met by 2025. They boast on their website that over 50% of stations are accessible. In addition, all subway cars are accessible, and able to be both wheeled onto and off of as well as with designated spots for wheelchairs to park on the trains.

So far, the accessible map of the TTC subway system looks like this:

Map of all accessible TTC subway stations

Many stops are accessible, which means they have elevator access, accessible fare gates, automatic sliding doors and are hubs for accessible busses and Wheel-Trans. These stations also include highly visible signage. All subway cars have accessible access, and each car has at least one designated wheelchair space.

Challenges with Toronto’s Transit Accessibility

  • Elevators often malfunction or break, rendering “accessible” stations inaccessible.
  • Crowded trains may be difficult to navigate towards the designated accessible seating areas.
  • Seats with blue covers are specifically for people with disabilities, and able-bodied people are required by law to vacate the seat if someone with a disability requires it. If the train is full, or if the people in the seat do not cooperate it is difficult to enforce this law.

How the TTC is Working Towards Solutions

  • The TTC provides up-to-date status updates on elevator and escalator function. As per the TTC website, before you begin your subway trip call the TTC 24-hour Information Line at 416 393-4636 (INFO) and press 5 to confirm whether or not the elevators or escalators you plan to use on your trip are operating or scheduled for maintenance. Elevator information is also available at 416 539-5438 (LIFT) or on our Elevators and Escalators page.”
  • Posters alerting people that they must vacate seats for people with disabilities are now on most TTC subway trains.
  • Wheel-Trans vehicles are available to transport people who use wheelchairs to areas serviced by inaccessible stations.

What you can do to Make Transit Easier via Subway

  • Use a blind spot sensor system, such as the Braze Sentina to help navigate safely towards to accessible seating in crowded trains or used to navigate off of a city bus).
  • Ensure that you enter the subway car straight, not allowing front wheels to turn and get stuck in the gap.
  • Advocate for yourself, and alert people to the laws requiring them to vacate seats if required
  • Plan ahead, and ensure elevators are running along the stops you need.

Thank you for reading this post. If you have ridden the TTC or other transit system subway and want to share your story, please contact us at info@brazemobility.com, or leave a comment below!

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Braze Mobility with the three symbols depicting a pylon, accessibility, and not crashing

The Prevalence of Wheelchair Collisions

05/28/2018

Recently, I took a power wheelchair for a test drive through downtown Toronto, Ontario. Within a two hour period, I had hit at least 2 doorways, and narrowly missed the ankles of more than one person with my footrests (thankfully being Canadian they jumped out of the way of my rampaging chair with a cheerful “sorry”), avoiding any wheelchair collisions while power wheelchair driving.

This experience made it very clear the challenges associated with driving a power wheelchair-especially in a tight space. The following blog series will focus on the danger associated with operating power mobility devices, and how we can reduce that danger and improve access to power wheelchairs.

It is important to understand the risks associated with power wheelchair use in order to find ways to minimize risks while maximizing the independence of users. It is, however, difficult to measure the prevalence of collisions incurred by power wheelchair users. Statistics are difficult to obtain, as there is no central reporting centre for power wheelchair accidents. There are some research studies that have been done to evaluate the incidence of collisions for power wheelchair users.

Statistics of Wheelchair Collisions for Power Mobility Devices

Many of these studies are focused on the use of power mobility devices in an institutional setting. Here is a brief summary of the results of some of these studies:

  • Frank et al. (2000) found that within 4 months of receiving a power mobility device, 13%  (15 out of 113) of people surveyed reported at least one accident, including tipping from chairs and falls during transfers.
  • Mortenson et al. (2005) report that The Vancouver Coastal Health (VCH) residential facility which has 82 residents using power wheelchairs, reported 16 incidents of property damage in one year from power wheelchair use. This is a conservative estimate, as the author notes that only serious accidents were reported. There were likely far more minor incidents that were not reported.
  • Reed, Yochum and Schloss (1993) reported that 30% of long-term care residents surveyed felt that other drivers within the facility drove unsafely.

Challenges with Power Wheelchair Driving and Drivers

Clearly, within an institutional setting, many power wheelchair users have difficulty safely navigating their environment. In such institutions, there is a very high density of power wheelchair users, along with narrow corridors and many obstructions in hallways which present challenges to drivers. One major factor identified as contributing to decreased safety in high density areas is a lack of conformity between drivers.

Mortenson et al. (2005) write that a lack of driving rules for wheelchair drivers in an institution can result in animosity between and towards power wheelchair drivers. For example, not designating a regulated side of the hallway to drive on increases the likelihood of collision and creates an atmosphere of blame and animosity towards power wheelchair drivers (Mortenson et al., 2005).

Challenges Of Wheelchair Navigation for Power Wheelchairs

Measuring statistics only in institutions provides an incomplete view of the magnitude of the prevalence of collisions among power mobility device users. Many wheelchair users that live in the community also suffer accidents, and when navigating through traffic the consequences can be catastrophic. Mortenson et al. (2005) found that six out of ten interviewed power wheelchair drivers report that driving in the community is more difficult than diving in an institution.

Survey of Power Wheelchair Useability

A survey of wheelchair users by Arthanat et al. (2009) found that the usability of power wheelchairs in the community is low. About 40-50% of those surveyed reporting that usability was moderate to very low in the community. The difficulty in navigating in the community with a power wheelchair has been observed by multiple surveys.

  • Navigating a wheelchair in traffic is a large hazard of navigating within the community. LaBan & Nabity (2010) found that sixty fatal accidents occurred between a motorized vehicle and a wheelchair in one year. Of these accidents, 94% involved a power wheelchair.
  • Chen et al. (2011) surveyed 95 active community wheelchair users about the number of collisions experienced. 52 (54.7%) of wheelchair users reported experiencing at least one collision, and 16 (16.8%) reported experiencing 2 or more collisions within a three year period.
  • A report from Edwards and McClusky (2010) of Australian power mobility device users found that one-fifth of respondents (21%) reported having an accident in the previous year when using their device. The most commonly reported accidents were caused by running into doors and walls, the device tipping over, being hit by a car or knocking into/over objects such as shop displays.
  • Arthanat et al. (2009) found that 52.8% of wheelchair users surveyed had experienced at least one accident (collision or fall) that resulted in injury.

Clearly, the issue of accidents in power wheelchair driving is prevalent. It is important to start a conversation regarding the risks and rewards of power wheelchair use! If you have experienced a collision in your power wheelchair, or know someone who has, leave a comment!

Want to learn more about what Smart Wheelchairs can do to prevent wheelchair collisions? Download our FREE E-Book on Smart Wheelchair Technology!

References

  • Arthanat, S., Nochajski, S. M., Lenker, J. A., Bauer, S. M., & Wu, Y. W. B. (2009). Measuring usability of assistive technology from a multicontextual perspective: the case of power wheelchairs. The American Journal of Occupational Therapy, 63(6), 751.
  • Chen, W. Y., Jang, Y., Wang, J. D., Huang, W. N., Chang, C. C., Mao, H. F., & Wang, Y. H. (2011). Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users. Archives of physical medicine and rehabilitation, 92(6), 892-898.
  • Edwards, K., & McCluskey, A. (2010). A survey of adult power wheelchair and scooter users. Disability and Rehabilitation: Assistive Technology, 5(6), 411-419.
  • Frank AO, Ward J, Orwell NJ, McCullagh C, Belcher M. Introduction of a new NHS electric powered indoor/outdoor chair (EPIOC) service: benefits, risks and implications for prescribers. Clinical Rehabilitation. 2000;14:665–673. [PubMed]
  • Mortenson, W. B., Miller, W. C., Boily, J., Steele, B., Odell, L., Crawford, E. M., & Desharnais, G. (2005). Perceptions of power mobility use and safety within residential facilities. Canadian Journal of Occupational Therapy, 72(3), 142-152.
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Image with the words Pros & Cons and three symbols and words depicting Rear View Cameras, Mirrors and Sensor Systems

Visual Aids for People Who Use Wheelchairs

05/21/2018

Most people who operate any sort of motorized vehicle have aids to help them see what is going on around them. Mirrors, cameras and sensors are commonly used to help people when driving cars. So, what about people who drive wheelchairs? There are various visual aids for wheelchair users, which provide information about what is going on in blind spots. This blog will discuss the pros and cons of these solutions.

Photo of Pooja kneeling beside a power wheelchair with the Braze Mobility Sentina sensors installed
Braze Mobility’s CEO, Pooja Viswanathan, posing with the early model of the Braze system, the world’s first blind spot sensors for wheelchairs.

Backup Cameras for Wheelchair Users

Backup cameras are popular visual aids for wheelchair users to get information about what is behind them. Cameras designed for attachment to trailer hitches and license plates can be adapted for wheelchair users and attached to the back of a chair. These devices typically relay video information to the driver on a smartphone or tablet. This requires the wheelchair user to mount their phone/ tablet in an easily visible location.

Pros of Backup Cameras

  • Cameras are useful when driving outside or in large spaces, especially when operating a wheelchair safely on roads or in busy traffic areas.
  • They are good at allowing the user to track objects such as cars or pedestrians moving through their field of view.
  • These systems are fairly low cost, and take advantage of technology the user already owns by using a tablet/smartphone to relay information.
  • Many aftermarket backup camera products are magnetic, making installation on a wheelchair easy.

Cons of Backup Cameras

  • For drivers with low vision, video is ineffective at relaying information.
  • It also may be distracting to monitor a video screen when driving.
  • A tablet/smartphone large enough to clearly view will block the driver’s forward facing vision, creating another blindspot for the driver.
  • Navigating indoors using a camera may be difficult, due to difficulty differentiating between objects and walls on the screen.
  • Adequate lighting is required to make video feedback worthwhile.
  • If using a smartphone for video relay, the driver is unable to use their smartphone for other tasks while driving, such as DJing that perfect playlist!
  • Mounts for these cameras aren’t designed for wheelchairs, and may be difficult to mount.

Rear-View Mirrors

Rear-view mirrors are low-tech visual aids for wheelchair users that provides the user with instantaneous feedback regarding their environment.

Pros of Rear-View Mirrors

Cons of Rear-View Mirrors

  • In order for the mirror to be effective, it must be positioned in a very specific way, which may be an inconvenient position for the driver.
  • Mirrors are also bulky to catch a large enough frame of view, which will create an additional blindspot for drivers.
  • Mirrors don’t provide exact location information about objects. “Objects in mirror are closer than they appear” may be okay when on the roads, but inside a house it is important to know exactly how close you are to an object/wall.
  • Adequate lighting is required to make feedback useful from a mirror.
  • Mirrors have a small range of vision, so drivers will still have blind spots they can’t monitor.

Sensor Systems

GIF of Braze Sentina blind spot sensors providing visual, audio, and vibrational feedback when detecting an object.
Braze Mobility’s blind spot sensors provide multi-modal feedback using lights, vibrations, and sound.

Sensor systems are new to the market, and provide wheelchair users with information about objects in their environment. Sensors detect objects and obstacles, and that information is fed back to the user through different modalities. For example, Braze Mobility offers blind spot sensor systems that provide up to 180 degrees of rear-view blind spot coverage, and customizable 45 degrees of coverage. This information can be relayed through vibration, visual or audio feedback.

Pros of Sensor Systems

  • Customisable coverage makes it possible to monitor multiple blind spots at once. This means that people with decreased peripheral vision can easily monitor both side and rear view blind spots.
  • Coverage area of sensors is much higher than mirrors and video.
  • People with vision impairments are able to interpret feedback easily using either vibration or audio feedback.
  • The device was designed to not block vision in any way.
  • The device was designed for wheelchair use, and can be easily installed on any wheelchair.
  • The device is powered via a USB power bank, and therefore can easily be charged. One charge can last all day, due to the very low power requirements of the device.
  • Ultrasonic sensors do not rely on proper lighting to provide the user with feedback.
  • Feedback from the device splits the rear view vision into three distinct areas. This makes navigating in tight spaces and through doorways easier.
Close up photo of Braze's Sentina blind spot sensors attached to the rear of a wheelchair.

Cons of Sensor Systems

  • Feedback does not provide information about what is in your blind spot, but just that there is something there.
  • The cost of an ultrasonic sensor system designed for wheelchair use is higher than the cost of a mirror, or rear view camera designed for a car.

Self-Driving Wheelchairs

Self driving cars are beginning to drive themselves into the market, and wheelchairs might not be too far behind! Currently, self driving chairs are not available commercially, however they are being used in research studies. 

Pros of Self-Driving Wheelchairs

  • Self driving chairs will reduce barriers to accessing power mobility devices. People with low vision, decreased cognition or other reason for being denied access to power mobility may be able to operate a self-driving chair.
  • Self-driving chairs will likely be safer than regular power mobility devices, due to a lack of blind spots.

Cons of Self-Driving Wheelchairs

  • These chairs will likely be extremely expensive.
  • Depending on the level of control of the driver versus the chair, self driving wheelchairs may decrease the autonomy of the driver.

Do you have experience with any of these feedback methods? We’d love to hear about your experience and your opinion! Comment below to start the conversation!

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Braze Mobility with the two puzzle pieces with the words Challenges in the left puzzle piece and Solutions in the right puzzle piece

The Challenges and Solutions in Wheelchair Training and Assessment (Part 3)

05/10/2018

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.

Diagram that summarizes the three kinds of smart wheelchair systems, according to Viswanathan et al., 2017.
Summary of three kinds of smart wheelchair technology systems (Viswanathan et al., 2017).

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.

GIF demonstrating Braze's blind spot sensors detecting objects and providing visual feedback.
Braze’s blind spot sensors detecting objects and providing visual feedback.

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 $1850 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

A download now image for the Update on Smart Wheelchair Technology free eBook from Braze Mobility
  • 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.
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