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The Current State of Wheelchair Training and Assessment (Part 2)

04/26/2018

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.

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.

Two VA therapists standing in front of a Veteran that's using a power wheelchair.
A veteran testing navigation device using a power wheelchair.

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

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 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.
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The 5 Things You Need to Know About Smart Wheelchairs! (Part 1)

04/17/2018

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 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!

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.

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Image depicting the different symbols of holidays and accessibility

10 Accessible Holiday Gift Ideas for People Who Use Wheelchairs

11/29/2017

The temperatures are falling, and Christmas music is being played on repeat. This can only mean one thing-the holiday season is upon us, and with it, the pressure to find the perfect gift is building. Everyone is in pursuit of the perfect gift for their family members and friends-something that is fun, useful and shows how much they care. Easier said than done! Below is a list of accessible gifts, perfect for people who use wheelchairs or other mobility devices.

Give the gift of cozy ears, and hands free mobile device control. Voice controlled bluetooth technology, built-in speaker and microphone all in a fashionable and warm hat. Various designs available on Amazon.com and the pictured hat is available at Robot Shop.

The Braze Sentina is a blind spot sensor system that can turn any wheelchair into a ‘smart’ wheelchair (cars have sensors, why can’t wheelchairs?!).

Benefits of Braze’s Blind Spot Sensors

These add-on devices are the first in the world that easily attach to any wheelchair and offer visual, audio, and vibrational feedback to wheelchair users regarding location and proximity of obstacles. They provide the freedom of improved maneuverability, increased spatial awareness, and increased safety.

These products have been available for purchase mainly by institutions, but anyone in Canada or the U.S. can now get the Braze Sentina. Contact us to find out more about this innovation solution for people who use wheelchairs!

Chairmelotte designs wheelchair couture, specifically designed to be comfortable and fashionable. Check out the Evening Collection and find the perfect outfit to work on New Year’s Eve! Available at Chair melotte. (Pictured: Dress Sophia, €248.00; Coat Roger, €565.00)

Having cold hands is never fun, but driving a wheelchair with cold hands is worse. This device protects hands from the cold, and allows the user to still have the control and visibility they need. It also protects the control panel from snow! A less bulky alternative could be tight fitting gloves. If you are feeling crafty, a similar design could be made with crochet or knitting skills. Available at Active Mobility Centre.

Homemade gifts are a great option, and truly show that you care. It also makes the gift customizable, and lets you show off your skills! This design for a water bottle holder is a quick, easy and practical gift. Available at Sew Can Do.

For those feeling less crafty, Etsy has some different designs for bottle holders, and sidebags, with a variety of different designs.

No holiday is complete without adding to one’s cozy sock collection, and for people with limited lower body mobility, cozy socks are essential to keeping feet warm. Canada’s Indigo sells many designs of reading socks, that keep feet and legs warm.

Sock Alternatives: Slippers or Leg Warmers

For people who may find it difficult to get long socks on, check out these slippers from Egli Farm, or a leg warmer designed for wheelchair users!

This speaker provides hands-free control of smart appliances. It can also control the lights, and heating in your house- all handsfree! Plus, the google assistant can book appointments, set alarms, Google things for you and play music! This is the perfect device for someone who has limited upper body mobility, giving them hands-free control of the house! Available at the Google Store.

Hands-free technology doesn’t have to be left behind when your friend/family member leaves their Google home system at home! The Tecla Shield connects with smart devices, providing hands-free control anywhere you go! Check it out at Adaptive Switch Laboratories (ASL).

As the days get shorter, a flashlight becomes more and more handy- no one can navigate in the dark! Pair this flashlight up with the Braze Sentina (gift #2) for the ultimate safe driving gift! This flashlight available on Amazon is designed to attach to mobility devices. Flashlight available on Amazon.

Don’t let a curb stand in the way of your plans! The world is slowly becoming more accessible, and apps like Accessnow can be used to find accessible hang outs. Unfortunately accessibility still has a long way to go. Bringing a ramp can help reduce the barriers faced during your adventures! Available at Wheelchair Friendly Solutions.

Looking for more Accessible Gift Ideas?

Thank you for reading about all of these gift ideas. Looking for more? Check out our birthday gift ideas here! Have any other suggestions? Please comment below! Have a very happy holiday!

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Photo of the chessboard and the player moving a white chess piece

Life is a journey, not a destination

06/20/2016

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.

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Two People in a Meeting sitting at a office table in front of their laptops

Graham’s Trip to Discovery

06/03/2016

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.

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Nighttime skyline of the City of Toronto with its reflection in the water

Wheeling Around the GTA – Our new series

05/20/2016

“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!

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