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A survey and observational study was conducted with 29 people who remain seated in their wheelchair when driving (21) or riding as a front-row passenger (8) in their personal vehicle. Each subject was observed and surveyed in their own personal vehicle that has been modified for use by occupants seated in wheelchairs. Our survey obtained responses on issues related to occupant restraint (seat belt) system usage, wheelchair securement device usage, and perception of personal safety while riding in a vehicle. Usability and accessibility issues related to seat belt and automated (docking) wheelchair securement technology were revealed, suggesting that wheelchair-seated occupants travel with a higher risk of serious injury in vehicle crashes than front-row occupants seated in original equipment manufacturer (OEM) vehicle seats and using OEM seat belts. Study results also indicate the need for improved torso support for many wheelchair-seated drivers to maintain a posture that allows for effective vehicle control. Study results demonstrate the need for innovative passive restraint technologies that provide postural support during normal vehicle operation and improved occupant restraint during crash conditions for people who drive while seated in their wheelchairs.

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An overview of the current status of wheelchair transportation safety in fixed route and demand-responsive, non-rail, public transportation vehicles within the US is presented. A description of each mode of transportation is provided, followed by a discussion of the primary issues affecting safety, accessibility, and usability. Technologies such as lifts, ramps, securement systems, and occupant restraint systems, along with regulations and voluntary industry standards have been implemented with the intent of improving safety and accessibility for individuals who travel while seated in their wheeled mobility device (e.g., wheelchair or scooter). However, across both fixed route and demand-responsive transit systems a myriad of factors such as nonuse and misuse of safety systems, oversized wheeled mobility devices, vehicle space constraints, and inadequate vehicle operator training may place wheeled mobility device (WhMD) users at risk of injury even under non-impact driving conditions. Since WhMD-related incidents also often occur during the boarding and alighting process, the frequency of these events, along with factors associated with these events are described for each transit mode. Recommendations for improving WhMD transportation are discussed given the current state of

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Ease of use, comfort, security, and independent use of three types of wheelchair securement systems were evaluated in a large accessible transit vehicle by 20 wheelchair and scooter users. The securement systems included a 4-point tie-down system, a prototype autodocking system, and a prototype rear-facing wheelchair passenger (RF-WP) system. Study participants took a 15-minute city ride and completed a survey. Participants responded positively to the autodocking and RF-WP systems that were quicker and easier to use and allowed more independent use than the 4-point tie-down system (p < 0.001). There was concern regarding the RF-WP system that rear-facing travel made it more difficult to see upcoming stops and was less comfortable than a forward-facing ride and that the system may damage wheelchair wheels during use. The majority of participants preferred using an autodocking system because it allowed secure and independent forward-facing travel. Participants found it undesirable, however, that a wheelchair-mounted docking adaptor was needed to use the autodocking system. Study results indicate a need for improved securement systems for forward-facing use that do not require a wheelchair adaptation and can be easily and independently used by wheelchair and scooter users.

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Motor vehicles are a technology that has been embedded in the built environment since the early 1900s. Personal transportation is important for the quality of life of individuals who have disabilities because it gives a feeling of freedom and enables individuals who have mobility impairments to participate in the community. This article describes the evaluation of individuals and their cognitive, sensory, and physical abilities that are important for (safe) driving. A case is made for independent mobility for individuals who have disabilities and elderly individuals by first giving an overview of the functional, cognitive, and sensory abilities that are critical for driving. Second, the types of vehicle modifications and state-of-the-art controls that are available and on the horizon are described and the way in which these technologies are selected to meet driver needs is explained. Requirements for driver safety systems for drivers who remain in their wheelchairs are then discussed. Finally, emerging and innovative driving enhancement systems, such as obstacle avoidance and navigation, are discussed, as are their benefits in helping drivers who have disabilities and elderly drivers to experience safe and independent driving.

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The Rehabilitation Engineering Research Center on Wheelchair Transportation Safety held a state-of-the-science workshop on wheelchair transportation. The workshop had three purposes: reviewing and documenting the status of wheelchair transportation safety, identifying deficiencies, and formulating, discussing, and prioritizing recommendations for future action. The final goal was to disseminate the workshop outcomes for utilization in formatting future research priorities. A nominal group technique was used to facilitate focused open discussion by knowledgeable persons, resulting in the identification and ranking of existing deficiencies according to priority. Participants then formulated potential short-term solutions and speculated what wheelchair transportation safety should be in the future. This document presents four white papers, prepared prior to the workshop and modified according to participant feedback, and summarizes the outcomes of the workshop. The results identify and prioritize recommendations for future action.

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In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users' clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches.

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A survey among 127 wheelchair users was conducted to characterize wheelchair occupant restraint usage patterns, restraint deficiencies, user characteristics, and essential wheelchair occupant restraint design parameters for when individuals travel in motor vehicles while seated in their wheelchairs. Survey respondents value independent travel and seem generally interested in the use of an occupant restraint system that is attached to the wheelchair frame and that can be used independently by the wheelchair user without caregiver or vehicle driver assistance. Results of the survey further indicate that despite the relatively high percentage of respondents who are attempting to travel safely (78.8%), almost half of these wheelchair users have experienced injury or compromised wheelchair balance while traveling in motor vehicles.

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The Americans with Disabilities Act requires that transit providers accommodate passengers who use "common wheelchairs" when traveling in a motor vehicle. Wheelchair tiedown and occupant restraint systems are commonly used to secure wheelchairs and restrain occupants in fixed-route and demand route transit vehicles. Throughout the 17 years since the Americans with Disabilities Act has been in effect, transit providers have complained about the usability of wheelchair tiedown and occupant restraint systems, and improper securement has been linked to injuries among wheelchair users during "nonimpact incidents." This research study explored the use of wheelchair tiedown and occupant restraint systems in actual practice and the potential risks of misuse to wheelchair-seated individuals. The qualitative research conducted in this study revealed that improper wheelchair securement (i.e. using less than four tiedown straps) can be fairly common practice in fixed-route transit. In addition, preliminary computer simulations show that improper wheelchair securement in emergency driving conditions may place wheelchair occupants at a greater risk of injury. It should be noted, however, that this is a pilot study and has its limitations. For example, qualitative data were gathered from one metropolitan area transit provider across a limited range of vehicle and wheelchair types. Additionally, the computer simulation model used in this study was originally validated for impact situations.

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The main purpose of this study was to demonstrate that an auto-docking device (ADD) could be produced that would meet the requirements for the universal interface contained in the evolving International Standard Organization (ISO10542-3) standard and also meet Americans with Disabilities Act (ADA) regulations within the United States. A secondary purpose was to produce a practical design that directly addressed the most pressing securement deficiencies being experienced by transit users and providers that had promise of transfer to commercial availability. ADD development has demonstrated that a standards-compatible ADD can be produced that meets the rigorous crash test requirements of ISO10542-3. Follow-up in-vehicle testing indicated the need for design refinement in order to prevent movement of an occupied manual wheelchair in excess of the 2-in. maximum requirement stipulated in the 1990 ADA. A user focus group provided feedback on the utility of the overall universal auto-docking concept, as well as guidance for improvement to control interfaces that would be located in the wheelchair and driver stations. The partnership with Kinedyne Inc., a manufacturer of securement devices, provided the industry-based focus that resulted in the cost containment and marketing expertise necessary to make the ADD a viable commercial product.

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This study investigates the usability of wheelchair occupant restraint systems (WORS) that are used for crash protection of individuals seated in wheelchairs during motor vehicle transit. Ten independent adults with significant functional limitations who use wheelchairs for primary mobility were observed and interviewed while performing reach and manipulation tasks associated with WORS usage. Participants' opinions on ease of use and comfort-related factors were obtained for four occupant restraint scenarios. The study results show evidence of user problems with common WORS designs for use by wheelchair-seated individuals with significant functional limitations. Results from this pilot study suggest redesign of latch plates and buckles used in WORS to enable wheelchair-seated individuals with functional limitations to don and buckle belt restraints more easily and independently. Additionally, this study provides guidance to occupant-restraint manufacturers and wheelchair designers regarding belt-restraint usability. Improved WORS usability will complement other efforts to increase frequency of safety belt usage and lead to improved occupant safety.

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A method was developed to assess the reach capability of people seated in wheelchairs for purposes of establishing design and placement requirements for safety belts used by vehicle occupants who are seated in wheelchairs. The method uses simple technology and is intended to be readily implemented in the field. Participants use a marker to draw their acceptable reach zone on a vertical surface placed adjacent to the wheelchair. A pilot study with 10 wheelchair users showed that the method generates easily interpreted data quickly. Even with a small number of participants, the results from the pilot study provide useful information for designers of restraint systems for wheelchair-seated vehicle occupants.

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Many wheelchair users are required or choose to use their wheelchairs as a motor vehicle seat during transport. It is therefore key that the wheelchair components be designed to tolerate crash-level loading conditions. Casters are particularly prone to failure under crash loading conditions. Our study evaluated wheelchair caster loading during 20g/48 kph frontal sled impact testing using an 85-kg surrogate wheelchair base (SWCB) with casters positioned on a load-measuring platform. A Hybrid III 50th percentile male test dummy was seated in the SWCB, which simulated a power wheelchair and was secured using four-point tiedowns. Various rear securement point heights and wheelchair seating systems were used to study their effect on caster loading. Caster normal loading was found to vary from 769 to 7,209 N depending on rear securement location and integrity of the seating system. Dynamic sled impact test results showed that normal loading of the front wheelchair casters was influenced by wheelchair seating system integrity and rear wheelchair securement height. Shear loading varied from 781 to 1,589 N and did not appear to be dependent on seat integrity or rear securement height. The load/time histories measured during dynamic impact testing can be used to guide the development of transit-safe caster design.

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Individuals using wheeled mobility devices (WMDs) often use them as motor vehicle seats during transportation. Wheelchair occupant restraint systems (WORSs), consisting of upper torso and pelvic restraints, are usually mounted to the structure of transit vehicles to secure individuals within their wheelchair seats. This preliminary study attempts to evaluate the use and satisfaction of currently installed vehicle-mounted WORSs for individuals using WMD as seats in motor vehicles. A survey was conducted among 33 adults who use their WMD to travel in motor vehicles. Results from the survey showed that upper torso and pelvic restraints installed in private vehicles are quick, comfortable, and easy to use. However, WORS installed in mass transit and paratransit are often uncomfortable to wear, difficult to reach, and time-consuming to use. This preliminary study documents the growing need for developing alternative WORS that are safe, comfortable, and that allow independent usage for wheelchair occupants while traveling in a motor vehicle.

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