Jon Pearlman

Lower-limb prostheses and wheelchairs in low-income countries [An Overview]

This review covers a range of topics related to lower-extremity prostheses (LEP) and wheelchair technology and service provision. A description on how recent advances in LEP technology for low-income countries have come about through research and field studies is presented and a discussion on the required technical advances and associated research that would increase LEP production capacity is given. The paper also discusses several approaches used for designing, manufacturing, and providing WCs to and in low-income countries; there is also a discussion on past research and highlight current efforts to build research capacity in the field. Last, the paper includes an in-depth description of the social, societal, economic, and physical constraints in India to demonstrate the difficulties in successfully applying this technology.

New design and development of a manual wheelchair for India.

Purpose. The most common methods of delivering assistive technology in developing countries are charitable donation and workshops. This describes a new approach to solving the problem, a collaboration undertaken by a US-based lab and a manufacturer in India to produce quality wheelchairs. One goal is to publicize the design free of charge to manufacturers and interested parties world-wide. The process, a demonstration of a new technology transfer method, and the product, an adult manual wheelchair, are described. Method. An iterative process occurred over four years to design and produce the wheelchair. This consisted of prototypes, small production runs, ANSI/RESNA testing, hardness and tensile testing and informal user testing. Results. The design is a manual folding cross-brace design with several points of adjustability. Final pre-production prototypes experienced fastener failures during durability testing. Higher grade bolts were specified. Trial-run production has begun. An ANSI/RESNA wheelchair test lab was constructed in India. Subsequent projects include power and pediatric tilt-in-space wheelchairs. Conclusions. The approach seems promising as a method to improve the quality of assistive technology available in India and begin to meet the vast need in India. Pitfalls encountered throughout the collaboration are described in this paper along with solutions to remedy these problems for future projects.

A sports wheelchair for low-income countries

Purpose. Appropriate wheelchairs for basic mobility needs are still not commonly available in low-income countries, although several organizations are working toward this goal. After basic mobility is secured it is important to provide more diverse assistive technology to allow people with disabilities to more completely participate in society and live healthy lives. Our goal was to design an affordable sports wheelchair that would allow individuals in low-income countries to participate in basketball. Methods. Design requirements established for the sports wheelchair included: removable anti-tippers, adjustable tension backrest, 24″ wheels, adjustable seat dump, variable camber, 4″ casters, fore-aft axle position, removable bumpers, height adjustable footrest, four wheels, single anti-tipper (pivot), cost less than

Technology to improve sports performance in wheelchair sports

125 without wheels, 16″ seat width and backrest height, and nylon upholstery. The wheelchair was designed using 3D modeling, standard materials, and standard tools. Discussion. An affordable wheelchair, versatile enough to be used for a variety of sports and even everyday use, was designed and prototyped successfully. Documentation for the design including step-by-step directions, engineering drawings, and photographs are available at the Human Engineering Research Laboratories website (http://www.herlpitt.org/intw.htm). Future work on the prototype should include design refinement including adaptations for other sports, and standards testing.

Development of a contextually appropriate, reliable and valid basic Wheelchair Service Provision Test

Sport and recreation are cornerstones of how we define ourselves as human beings and the competitive spirit is just as prominent in individuals with disabilities as it is in their able-bodied counterparts. Wheelchair sports were initially developed following WWII as a rehabilitation tool to care for the young men and women injured during the war. Today athletes with disabilities are narrowing the gap in competition between the impaired and the unimpaired through training, advancement of technology, and the competitive spirit and ingenuity of the seated athlete. This article examines a number of factors related to maximizing performance and the prevention of injury in wheelchair sport. Physical and technological considerations for various wheelchair sports will be discussed including; metabolic demands, equipment selection, configuration, advances in technology and performance measurement as well as directions for future research.

Comparison of prosthetic feet prescribed to active individuals using ISO standards

Abstract Purpose: Currently, there is no internationally accepted way to measure the competency of wheelchair service professionals. The International Society of Wheelchair Professionals aims to develop a Wheelchair Service Provision – Basic Test as a preliminary step towards establishing a certification process. Method: A team of wheelchair service provision experts developed test questions and conducted alpha and beta testing in order to validate them. Low-performing test items were eliminated. A pilot test was then conducted, which focused on developing a pass score, determining language barriers and validating the test as a measure of competency. Results: 90 participants completed one of three versions of the Wheelchair Service Provision – Basic Test. A pass score of 70% was established and 135 questions were accepted for the final test. Analysis of variance indicated there was a difference in scores based on language (p = 0.001), but not based on experience level. This result motivated translation in to the United Nations’ official languages. Conclusions: The results indicate that the Wheelchair Service Provision – Basic Test is a valid method for measuring basic competency of wheelchair professionals. Additionally, researchers recommend a skills assessment to help to ensure only qualified wheelchair professionals receive the certificate. Implications for Rehabilitation Identify key steps in contextually appropriate test development. Describe the components of a contextually appropriate, reliable, and valid test for basic wheelchair service provision. Identify methods used for contextually appropriate test validation.

Developing product quality standards for wheelchairs used in less-resourced environments

Background: Little research has been done on the robustness of prosthetic feet prescribed to military personnel, and manufacturers are not required to test their products prior to sale. This is problematic because the prosthetic feet used by active individuals are subjected to loading conditions not seen in normal gait. Objectives: To evaluate whether commercially available heavy-duty prosthetic feet intended for use by military personnel meet ISO 10328 standards. Study Design: Bench testing of heavy-duty prosthetic feet using ISO 10328 standards. Methods: Prosthetic feet from three different manufacturers were tested according to ISO 10328 standards, using a testing frame fitted with axial load and displacement transducers. Pass/fail information was recorded as well as the stiffness and creep of each foot before and after cyclic testing. Results: All feet passed the ISO 10328 standards at the highest loading level, and some significant differences were found within a given model of prosthesis when comparing stiffness and creep before and after cyclic testing. Conclusions: This study demonstrated that manufacturers of heavy-duty prosthetic feet adhere to the voluntary ISO 10328 standards. However, these standards may be insufficient because the tests simulate only idealized gait. Further development of the standards may be necessary to reproduce the circumstances that occur during extreme usage to ensure that prosthetic feet do not fail.

Design and Development of a Lightweight, Durable, Adjustable Composite Backrest Mounting

Background Premature failures of wheelchairs in less-resourced environments (LREs) may be because of shortcomings in product regulation and quality standards. The standards published by the International Organization for Standardization (ISO) specify wheelchair tests for durability, safety and performance, but their applicability to products used in the rugged conditions of LREs is unclear. Because of this, wheelchair-related guidelines published by the World Health Organization recommended developing more rigorous durability tests for wheelchairs. Objectives This study was performed to identify the additional tests needed for LREs. Methods First, a literature review of the development of ISO test standards, wheelchair standards testing studies and wheelchair evaluations in LREs was performed. Second, expert advice from members of the Standards Working Group of the International Society of Wheelchair Professionals (ISWP) was compiled and reviewed. Results A total of 35 articles were included in the literature review. Participation from LREs was not observed in the ISO standards development. As per wheelchair testing study evidence, wheelchair models delivered in LREs did not meet the minimum standards requirement. Multiple part failures and repairs were observed with reviewed field evaluation studies. ISWP experts noted that several testing factors responsible for premature failures with wheelchair parts are not included in the standards and accordingly provided advice for additional test development. Conclusion The study findings indicate the need to develop a wide range of tests, with specific tests for measuring corrosion resistance of the entire wheelchair, rolling resistance of castors and rear wheels, and durability of whole wheelchair and castor assemblies.

Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts

ABSTRACT Rigid backrest systems for wheelchairs provide a stable and comfortable base of support to help users maintain good posture while propelling and sitting static. Unfortunately, these backrest systems lack the adjustability necessary to allow users to comfortably perform some tasks, such as dressing; consequently, many users retain their sling-style backrests. We developed a lightweight, durable, adjustable composite (LWDAC) backrest mounting system to address these shortcomings and performed engineering and human subjects testing to evaluate the feasibility of the device. The LWDAC prototype passed the static engineering evaluation, as well as nearly all of the fatigue testing prior to failure of the device. Clinicians (n = 9) and users (n = 8) who evaluated the device in a focus group forum had an overall positive response. The participants agreed the backrest mounting can be operated with one hand and felt comfortable when participants were seated. Wheelchair users were interested in purchasing the backrest, and clinicians indicated they would recommend the LDWAC.

Exploration of health perceptions and assistive technology use by driving status as related to transportation independence in New Delhi, India

Introduction Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization’s Wheelchair Service Training Package—Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. Methods The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts’ opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision—Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others’ evaluation and the results of the training intervention. Results Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision—Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen’s d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. Conclusions The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.