Glenis Donaldson

Increases in wheelchair use and perceptions of disablement

Between 1986 and 1995, there appeared to be a 100% increase in the number of wheelchair users in England and Wales. This article reports some of the findings of a study designed to explore the social implications of this increase. Specifically, it examines the various explanations for the increases and concludes that whilst demographic changes or research methodologies are not responsible, the more likely causes are changing prescription practice, medical advances and changing attitudes to disablement. The article then explores the latter explanation by examining perceptions of wheelchair use, contrasting clinical and user views gained from in‐depth interviews. It also reports findings from part of a large‐scale postal survey of wheelchair users, which examined their attitudes toward different models of disability. It concludes that the responses of a large majority of wheelchair users of all ages are better explained by the social model of disability than any other.

A blended user centred design study for wearable haptic gait rehabilitation following hemiparetic stroke

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or out-door settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use.

Older People and Dissatisfaction with Wheelchair Services

Britain has experienced an unprecedented increase in wheelchair use during the past two decades. The authors take a social model approach to disability and report on their study in the north-west of England into the social implications of this increase. Qualitative interviews and a large-scale social survey reveal the circumstances of users and their experiences. Building on their descriptive statistics, the authors use latent class analysis to identify from amongst their respondents the characteristics of dissatisfied users of UK National Health Service wheelchair provision: they were more likely to be older, frailer females; and to be living in residential and nursing care homes. Prescribing practices and policy guidelines are analysed to consider how a hierarchy of need is operating to determine wheelchair allocation.

Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

Classifying stroke survivors based on their walking abilities is an important part of the gait rehabilitation process. It can act as powerful indicator of function and prognosis in both the early days after a stroke and long after a survivor receives rehabilitation. This classification often relies solely on walking speed; a quick and easy measure, with only a stopwatch needed. However, walking speed may not be the most accurate way of judging individual’s walking ability. Advances in technology mean we are now in a position where ubiquitous and wearable technologies can be used to elicit much richer measures to characterise gait. In this paper we present a case study from one of our studies, where within a homogenous group of stroke survivors (based on walking speed classification) important differences in individual results and the way they responded to rhythmic haptic cueing were identified during the piloting of a novel gait rehabilitation technique.

Walk to the Beat: A Case Report of the Use of a Novel Haptic Device to Improve Walking after Stroke

Background: Stroke affects 15 million people worldwide every year and leaves two-thirds of survivors with signifi cant mobility defi cits including reduced walking speed, increased unevenness of step length and asymmetry. Haptic cues, which utilise sensory stimulation and so are unaffected by visual or auditory interference could discreetly improve the gait of people after stroke. Therefore, the objective of this single mixed methods case study was to evaluate the use of a novel haptic device in a single participant after stroke. Context and purpose: After initial familiarisation, gait symmetry, walking speed and cadence of a 69 year old male stroke survivor were recorded using a Qualisys Motion Capture system whilst he walked on a ten metre walkway, fi rstly without and then with a haptic device on each leg, which provided a metronomic rhythmical vibratory cue. The participant then provided a user evaluation of the devices using a semi structured interview. Results: The haptic device was evaluated positively by the participant although he noted it needed to be refi ned to increase its wear-ability and acceptability for everyday use. Whilst gait speed and cadence remained unaltered, there was a 14% improvement in temporal gait symmetry when wearing the haptic device, suggesting it improved this aspect of gait. Conclusion: Whilst limited by its design, the fi ndings of this single case study indicate that the haptic device could be a novel technology-based therapeutic adjunct to improve gait symmetry after stroke. It also provides key understanding of user needs which can be used to guide the development of a new prototype device for stroke survivors. Brief summary: Many stroke survivors have residual mobility problems. Haptic cueing may improve walking by providing a tactile cue that the participant follows to improve symmetry. This single case study suggests that gait symmetry could be improved by haptic cueing and indicates factors affecting the wear ability of such a device.