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PURPOSE: The aim of this study was to identify factors that influence the perceived stigma of two assistive devices for visual impairment, namely the white cane and smart glasses. METHOD: Face-to-face semi-structured interviews with eight European students were conducted to probe their experiences and knowledge related to disability, assistive technology, visual impairment, as well as handheld and wearable devices. RESULTS: Close relationships with disabled people seems to have a positive influence on participants perceptions about stigma, disability, and assistive technology. Academic background seems to not have any influence. The aesthetics of assistive devices was observed as an important factor that influences the adoption or abandonment of the device. CONCLUSION: Device without negative symbolism but with modern aesthetics (smart glasses) were positively accepted by the participants than the device with traditional aesthetics and symbolisms of visual impairment (white cane). Designers should, therefore, consider aesthetics in addition to functionality in order to avoid the perceived stigma, thereby reducing the chances of device abandonment.IMPLICATIONS FOR REHABILITATIONUnderstanding the factors that influence the perceived stigma associated with assistive technology can help designers and developers to reduce assistive technology abandonment and perceived stigma.Designers need to consider both functionality and aesthetics. While functionality is crucial for the users' adaptation, aesthetics is important for the users' positive perceptions.

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Objective: To perform cross-cultural adaptation of the Wheelchair Skills Test of manual wheelchair users and their caregivers into the Brazilian Portuguese language.Methods: The study was composed of translation, synthesis of translations, back-translation, review by an expert committee and pre-test, when the test was applied in the target population. Included were translators, subject specialists and coordinators to carry out the cross-cultural adaptation process, and manual wheelchair users and their caregivers with at least six months of wheelchair experience for the pre-test.Results: Forty-three people participated in the study, 30 for the pre-test and 13 for the stages that preceded the pre-test. The mean age of manual wheelchair users was 40.2 (±10.7) years and of caregivers was 44.2 (±15.7) years. Of the 47 phrases translated in the first stage, 36 discrepancies were found and resolved. During the analysis by the committee of experts the instrument underwent 13 modifications in order to achieve the best possible equivalence between the original version and the final version and was understandable by the people evaluated. The total pre-test scores of wheelchair users and their caregivers were 66.2 (±24.6) and 88.7 (±14.2), respectively.Conclusions: This instrument was able to evaluate the abilities of wheelchair users and their caregivers in Brazil, as well as being useful for training in rehabilitation programs.Implications for rehabilitationThe need to use wheelchair (WC) properly has made clinicians and rehabilitation professionals more concerned with assessing and training users' abilities with their WC.Cross-cultural adaptation allows for the linguistic modification of the original language of the evaluation tool into a new language and enables the comparison of research results in different countries.Immediate use of the instrument for WC users and caregivers in Brazil, both for evaluation and for training, is necessary and may be a means for rehabilitation professionals to improve their evaluations, their treatments and optimize the skills that aim at independence.

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A promoção de condições para a vida independente é, possivelmente, um dos maiores desafios decorrentes do fenômeno mundial de envelhecimento populacional. Para as áreas de projeto e desenvolvimento de produtos, este contexto implica em pensar novos produtos que atendam às características, necessidades e preferências desta população. Na prática, o desafio é desenvolver produtos cujas demandas para o uso sejam diminuídas, o que resulta na facilitação do uso para uma maior diversidade de usuários. Estas demandas compreendem as habilidades ­ físicas, sensoriais e cognitivas ­ que o uso de um determinado produto exige do usuário para um desempenho satisfatório. Considerando o declínio funcional natural que decorre do processo de envelhecimento com alterações como diminuição da força muscular, flexibilidade e controle postural, assim como diminuição da acuidade visual, a pessoa idosa pode vir a ter dificuldades no uso de produtos cujas demandas sejam elevadas. Conhecer de que forma as alterações fisiológicas do processo de envelhecimento influenciam as habilidades físicas, cognitivas e sensoriais do idoso é, portanto, fundamental para o sucesso no processo de design para produtos pensados para o público idoso. Especificamente, no caso de produtos de Tecnologia Assistiva, os aspectos simbólicos são importantes, pois remetem ao significado do produto para o usuário e podem influenciar a aceitação e engajamento ao uso destes dispositivos. É, portanto, necessário que o design de produtos assistivos para o público idoso busque não somente atender as questões funcionais, mas também conceber produtos atrativos e desejáveis.(AU)

The promotion of conditions for independent living is possibly one of the biggest challenges arising from the worldwide phenomenon of population aging. In the context of product design and development, this implies thinking about new products that meet the characteristics, needs and preferences of this population. In practice, the challenge is to develop products whose usage demands are reduced, which results in facilitating use for a greater diversity of users. These demands include the skills - physical, sensory and cogni- tive - that the use of a particular product requires from the user for satisfactory performance. Considering the natural functional decline that results from the aging process with changes such as decreased muscle strength, flexibility and body balance, as well as decreased visual acuity, the elderly may have difficulties in using products whose demands for use are high. Knowing how the physiological changes of the aging process influence the physical, cognitive and sensory skills of the elderly is, therefore, fundamental to the success in the design process for products designed for the elderly. Specifically, in the case of Assistive Technology products, the symbolic aspects are important as they refer to the meaning of the product to the user and may influence the acceptance and engagement to the use of these devices. It is, therefore, necessary that the design of assistive products for the elderly seeks not only to address functional issues, but also to design attractive and desirable products.(AU)

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Aims: to evaluate how the act of holding a tennis racket influences the application of forces in the handrim during manual wheelchair propulsion at a self-selected comfortable speed and sprint. Methods: A case study was conducted with an experienced wheelchair tennis player who propelled the wheelchair in a straightforward trajectory at two different velocities (self-selected comfortable speed and sprint) in two different conditions (freehand and holding the racket). Kinetic and temporal data of the pushes were obtained with the SmartWheel system attached in substitution to the conventional rear wheel at the dominant side of the player. Results: holding the racket affects the propulsion pattern mainly when an accelerated movement is required (sprint). Compared to the propulsion at a self-selected speed, propelling the chair as fast as possible with the racket in hands resulted in lower total and tangential forces on the handrim, and decreased push time and increased push frequency. Conclusion: Such influence on both kinetic and temporal propulsion impact the mechanical efficiency of the manual wheelchair propulsion, which may, ultimately, affect the sport´s performance. Special attention should be directed to the propulsion training with the racket in maneuvers and motions that are characteristic of the wheelchair tennis match in an attempt to provide the athlete with proper technique for optimal propulsion efficiency and sports performance.(AU)

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Manual wheelchairs are essential for people with disabilities or limited mobility. However, manual propulsion causes biomechanical loads, including contact pressures on the palms of the hands. The hand rim design has received little attention over time, remaining almost unchanged since its creation. This study investigated how two different designs of such devices - one standard and another with a contoured design - influence the contact pressure on the surface of the hands. The procedures included a figure-of-eight shape propulsion task on a regular floor, using both models on a wheelchair. A pressure-mapping system coupled with a pair of fabric gloves recorded the data. The results show that the contoured hand rim provides lower pressure in most of the analysed regions. Considering that manual propulsion is performed during a considerable part of the day as a routine activity, improving the hand rim interface may benefit the user's comfort and safety during wheelchair use. Practitioner summary: The design of the hand rim used in wheelchair propulsion influences the contact pressure on the hands. Conventional round tube rims tend to concentrate high levels of pressure on the distal phalanges and metacarpal regions. A contoured design generally provides better stability and promotes the distribution of pressure. Abbreviations: AT: assistive technology; kPa: kilopascal.

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The design of products for people with disabilities requires the understanding of a wide range of factors related to users' health, functional abilities, needs, expectations and preferences. Such multifactorial perspective is often perceived as beyond the reach by the students of both graphic and product design, as it comprises knowledge from different areas such are not usually part of design curriculum as health, rehabilitation, computer science and biomedical engineering. Here, we report on strategies for developing design students' empathy and awareness for the needs and expectations of people with disabilities. By means of a combination of theoretical and practical approaches, a course on Inclusive Design was developed as part of the regular curriculum of the Bachelor Programme in Design at Sao Paulo State University (UNESP, Bauru campus, Brazil), with the collaborative participation of members of SORRI BAURU Rehabilitation Center. The final projects developed by the students were based on the demands presented by SORRI BAURU's rehabilitation team, and results reveal that the theoretical-practical approach based on interdisciplinarity was shown to provide the design students a learning experience that, ultimately, supports the quality decision-making in the design process. This paper describes the pedagogical approach, theoretical contents and practical activities developed during the Inclusive Design course. The challenges, benefits, results, and contributions of this experience from the perspective of the design education are also discussed.

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INTRODUCTION: Wheelchair configuration is an important factor influencing the ergonomics of the user-device interface and, from a biomechanical point of view, small changes in chair setup may have a positive influence on the demand on the upper limbs during manual propulsion. This study aimed to investigate the influence of the position of the rear wheels' axle and the use of accessories on the activity of upper limb muscles during manual wheelchair propulsion. METHODS: Electromyography signals of the biceps, triceps, anterior deltoids and pectoralis major were collected for 11 able-bodied subjects in a wheelchair propulsion protocol with four different wheelchair configurations (differing in axle position and the use of accessories) on a straightforward sprint and a slalom course. RESULTS: With accessories, moving the axle forward led to a decrease in the activity of all muscles in both the straightforward sprint (significant differences in triceps, anterior deltoids and biceps) and the slalom course (significant difference in anterior deltoids and biceps). However, when propelling the chair without accessories, no difference was found related to axle position. CONCLUSION: Changes in wheelchair configuration can influence the ergonomics of manual wheelchair propulsion. Reducing the biomechanical loads may benefit users' mobility, independence and social participation.

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This study reports the development of a servo-controlled power-assisted wheelchair, designed to reduce the loads on the upper limbs while maintaining the drivability of a manual chair. It is presented the concept and implementation of an assisted propulsion system, focusing on the assistance controlling and the torque transmission.

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Despite consensus regarding the interference of cognitive processes on the human balance, the impact that different sensory stimuli have on the stabilometric measures remains unclear. Here, we investigated changes in the postural balance of individuals with Alzheimer's disease (AD) and in healthy controls undergoing different proprioceptive and somesthetic pitfalls. We included 17 subjects submitted to eight sensorimotor dynamics with differences in the support bases, contact surfaces, and visual clues. The measurements used to assess participants balance were as follows: position of the body in space, range of instability, area of the support base, and velocity of postural control. From a total of 56 cross-sectional analyses, 21.42% pointed out differences between groups. Longitudinal analyses showed that tasks with proprioceptive and somesthetic pitfalls similarly impact imbalance in both groups. The current results suggest that AD subjects and healthy controls had different patterns submitted to balance, but suffered similar interference when undergoing proprioceptive and somesthetic challenges

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[Purpose] This study was aimed at investigating the influence of seat height and body posture on the activity of the superior trapezius and longissimus muscles. [Subjects and Methods] Twenty two healthy subjects were instructed to perform a total of eight different body postures, varying according three main factors: seat height (low and high seat); trunk inclination (upright and leaning forward at 45°); and the hips in abduction and adduction. Electromyography of the superior trapezius and longissimus was collected bilaterally, and the average values were obtained and compared across all the postures. [Results] The activity of the superior trapezius and longissimus significantly changes according to the seat height and trunk inclination. For both seat heights, sitting with trunk leaning forward resulted in a significant increase in the activity of both muscles. When sitting in a high seat and the trunk leaning forward, the superior trapezius activity was significantly reduced when compared to the same posture in a low seat. [Conclusion] This study contributes to the knowledge on the influence of the body posture and seat configuration on the activity of postural muscles. Reducing the biomechanical loads on the postural muscles must be targeted in order to improve users' comfort and safety.

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Many aspects relating to equipment configuration affect users' actions in a manual wheelchair, determining the overall mobility performance. Since the equipment components and configuration determine both stability and mobility efficiency, configuring the wheelchair with the most appropriate set-up for individual users' needs is a difficult task. Several studies have shown the importance of seat/backrest assembly and the relative position of the rear wheels to the user in terms of the kinetics and kinematics of manual propulsion. More recently, new studies have brought to light evidence on the inertial properties of different wheelchair configurations. Further new studies have highlighted the handrim as a key component of wheelchair assembly, since it is the interface through which the user drives the chair. In light of the new evidence on wheelchair mechanics and propulsion kinetics and kinematics, this article presents a review of the most important aspects of wheelchair configuration that affect the users' actions and mobility.

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PURPOSE: To present a new walking aid with axillary support (WAAS) for children with cerebral palsy (CP) and to investigate its impact on the lower limb muscles activation in the gait of children with CP. METHOD: Six children with spastic diparesis due to CP performed a straight line walking course in two situations: with and without using the WAAS. Each course was repeated three times for both situations, and electromyography (EMG) activity of quadriceps, hamstrings, tibialis anterior and gastrocnemius were recorded during all trials. RESULTS: The use of WAAS significantly increased the EMG activity of the quadriceps and hamstrings during stance phase and tibialis anterior during swing phase, with no significant increase in gastrocnemius activation. CONCLUSION: The use of WAAS improved the synergism of lower limbs muscles of children with CP by reducing the coactivation of antagonistic muscles, especially during the swing phase of gait. Providing a walking aid with improved trunk stability may enable children with CP to improve muscular synergism and walking ability, thus favoring independent mobility, with possible gains in social participation and quality of life. IMPLICATIONS FOR REHABILITATION: Children with cerebral palsy have problems with the development of normal gait, as a result of the reduced motor control and the impaired muscle synergism of the lower limbs. Standard walking aids do not provide proper trunk stability for this group of children. In a relatively small sample of children with cerebral palsy, a walking aid with axillary support was shown to be beneficial for the muscular synergism of the lower limbs during gait.

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PURPOSE: Report on the development of an ergonomic manual wheelchair pushrim and evaluate the user's perception of the quality of the device. METHOD: Based on anthropometric features and ergonomic concepts, a new wheelchair pushrim was designed, and a prototype was manufactured in polyurethane, using the rapid prototyping technique and serial production of parts by molding. The prototype was tested by a sample of wheelchair users, who rated the perceived quality of the device after testing both the new and conventional pushrims in a wheelchair propulsion experimental protocol. RESULTS: The new ergonomic pushrim was found to be, in general, better than the conventional round tube pushrim. Specifically, experienced wheelchair users found the new wheelchair pushrim better in terms of easy and comfortable propulsion, braking and maneuvering of the wheelchair, and appearance. CONCLUSIONS: The new wheelchair pushrim provides a proper fit for the hands due to its ergonomic design and its polyurethane composition, making wheelchair propulsion easier and more comfortable than the conventional wheelchair pushrim. Assistive technology devices should be design based on ergonomic concepts that involve less effort and offer greater comfort for the user. [Box: see text].

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INTRODUÇÃO: A lesão da medula espinhal é um trauma de impacto físico e social ao indivíduo, que acarreta profundas modificações na vida de seus portadores pela paraplegia ou tetraplegia resultante. O objetivo deste estudo foi avaliar a percepção da qualidade de vida de indivíduos com lesão da medula espinhal, antes e após um período de treinamento esportivo. MÉTODOS: Participaram do estudo 16 indivíduos paraplégicos por lesão da medula espinhal, que realizaram treinamento esportivo da modalidade basquetebol em cadeira de rodas, com duração de duas horas por dia e frequência de duas vezes por semana, por um período de um ano. Para avaliação da qualidade de vida PRÉ e PÓS o período de treinamento, foi utilizado o questionário SF-36. RESULTADOS: Houve melhora geral na qualidade de vida (p = 0,006) dos participantes quando considerados os escores de todos os domínios do questionário somados PRÉ (605,7) e PÓS (651,9) treinamento. Ainda, analisando de forma específica, foi observada melhora com significância estatística na capacidade funcional (p = 0,004), estado geral de saúde (p = 0,001) e aspectos emocionais (p = 0,02). CONCLUSÃO: O treinamento esportivo mostrou-se benéfico, promove melhora na qualidade de vida de pessoas com lesão da medula espinhal que necessitam de cadeira de rodas para mobilidade e representa novos objetivos e desafios na continuidade no processo de reabilitação.

INTRODUCTION AND OBJECTIVE: The spinal cord injury is a trauma of physical and social impact to the individual, which causes profound changes in the lives of those affected by the resultant paraplegia or quadriplegia. The aim of this study was to evaluate the perception of quality of life of individuals with spinal cord injury before and after a period of sport training. METHODS: The study included 16 people with paraplegia by spinal cord injury, who underwent sports training of basketball in wheelchairs, with a frequency of 2 times per week for a period of 1 year. To assess the quality of life before and after the training period, we used the SF-36. RESULTS: There was overall improvement in quality of life (p = 0.006) when considering the average of all areas of the questionnaire combined scores PRE (605.7) and POST (651.9) training. Additionally, the analysis of the results showed statistically significant improvement in functional capacity (p = 0.004), general health (p = 0.001) and emotional aspects (p = 0.02). CONCLUSION: The sport can promote improvement in quality of life for people who need a wheelchair for mobility, and represents new goals and challenges in continuing the process of rehabilitation.

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Os objetivos do estudo foram o de mensurar o comprimento da coluna cervical quando submetida à tração manual, e o de verificar as alterações da cervical após um período de 10 sessões consecutivas. Trata-se de estudo randomizado controlado, no qual 64 participantes foram submetidos a dois procedimentos radiológicos, antes e durante a tração. As distâncias das bordas anteriores e posteriores do corpo vertebral C2 até as do corpo vertebral de C7 foram mensuradas e comparadas. Na primeira etapa as medidas das bordas anteriores foi de 8,40 para 8,50 cm (P<0,001) e nas posteriores foi de 8,35 para 8,50 cm (P<0,001). Para a segunda etapa, os indivíduos foram aleatorizados em grupo controle (n=31) e intervenção (n=33), o qual recebeu dez sessões tração cervical. Após as sessões, as distâncias anterior e posterior do grupo intervenção aumentaram significativamente de 8,40 para 8,90 cm (P<0,001) e de 8,40 para 8,65 cm (P<0,001), respectivamente. Após as trações, todos os participantes repetiram os mesmos procedimentos radiológicos, as mensurações e as comparações das distâncias vertebrais. Quando os dois grupos foram comparados após as trações, houve diferença estatisticamente significante entre as distâncias anteriores e posteriores, de 8,20 e 8,90 cm (P=0,015) e de 8,30 e 8,65cm (P=0,030), respectivamente. Portanto, a tração aumentou o comprimento da coluna cervical. Após um período de aplicação das sessões, ocorreu aumento significativo das medidas entre as vértebras.

The objectives of the study were to measure the length of the cervical spine when submitted to manual traction and to verify changes in the cervical spine after 10 consecutive sessions. In this randomized controlled study 64 participants were submitted to two radiological procedures: one before and another during traction. The distances between the anterior and posterior vertebrae edges of C2 the C7 were measured and compared. In the first stage it was shown that measures of the anterior distance was 8.40 to 8.50 cm (P<0.001) and the posterior was 8.35 to 8.50 cm (P<0.001). For the second stage, subjects were randomized in control group (n=31) and intervention group (n=33) which received ten sessions of cervical traction. After the sessions the anterior and posterior distances of the intervention group increased significantly from 8.40 to 8.90 cm (P<0.001) and 8.40 to 8.65 cm (P<0.001) respectively. After the sessions all participants repeated the same radiological procedures, measurements and comparisons of the vertebral distance. When the groups were compared after the sessions there were statistically significant differences between the anterior and posterior distance of 8.20 and 8.90 cm (P=0.015) and 8.30 and 8.65 (P=0.030) respectively. Therefore the traction increased the length of the cervical spine and after a period of application of this intervention there was significant increase of the measures between the vertebral distances.

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OBJETIVO: Avaliar, radiograficamente, o efeito da tração manual sobre o comprimento da coluna cervical. MATERIAIS E MÉTODOS: Cinqüenta e cinco participantes de ambos os gêneros - 12 masculinos (22 por cento) e 43 femininos (78 por cento) - sem história de distúrbios cervicais contituíram a amostra deste estudo. Eles foram submetidos a dois procedimentos radiológicos, um antes e outro durante a tração manual sustentada por 120 segundos. As distâncias entre as bordas anteriores e posteriores da segunda à sétima vértebras cervicais foram mensuradas e comparadas antes e durante a tração manual. RESULTADOS: A mediana da distância anterior antes da tração foi de 8,40 cm e durante a tração aumentou para 8,50 cm (p=0,002). A mediana da distância posterior antes da tração foi de 8,35 cm e durante a tração aumentou para 8,50 cm (p<0,001). CONCLUSÃO: Os resultados demonstraram que a aplicação da tração manual promoveu aumento estatisticamente significante do comprimento da coluna cervical em indivíduos assintomáticos.

OBJECTIVE: To evaluate radiographically the effect of manual traction on the length of the cervical spine in healthy individuals. MATERIALS AND METHODS: The sample of the present study included 55 individuals - 12 men (22 percent) and 43 women (78 percent) - with no previous history of cervical disorders, submitted to two radiological procedures previously and during manual traction sustained for 120 seconds. Distances between the anterior and posterior edges from the second to the seventh cervical vertebrae were measured and compared before and during manual traction. RESULTS: The median of pre-traction anterior length was 8.40 cm, increasing to 8.50 cm during the traction (p=0.002); and the median of pre-traction posterior length was 8.35 cm, increasing to 8.50 cm during traction (p<0.001). CONCLUSION: Application of manual traction resulted in a statistically significant increase in the length the cervical spine in healthy individuals.

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