Chapter 2

Review of Related Literature and Studies

This chapter presents related literature and studies after a thorough analysis of the

researchers to different references such as journals, internet publications, books, and other

research papers. The information gathered from these resources helps the researchers make up

the synthesis of the study which is presented in the latter part of this chapter.

Overview of the global situation about disability

National patterns of disability are influenced by trends in health conditions and

environmental and other factors, such as road traffic crashes, falls, violence, humanitarian

emergencies including natural disasters and conflict, unhealthy diet and substance abuse. The

prevalence of disability is greater in lower-income countries than higher-income countries. In an

outcome document of the high-level meeting on disability and development in 2013, the United

Nations General Assembly noted that an estimated 80% of people with disability live in

developing countries and stressed the need to ensure that persons with disabilities are included in

all aspects of development, including the post-2015 development agenda.

Conditions of the Lives of Persons with Disability

The International Classification of Functioning, Disability, and Health (ICF) defines

disability as an umbrella term for impairments, activity limitations, and participation restrictions.

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Disability is the interaction between individuals with a health condition and personal and

environmental factors.

Disability is conceptualized by ICF as a multidimensional experience for the person

involved. There may be effects on organs or body parts, and there may be effects on a person's

participation in areas of life. Disabilities can affect people's lives in different ways. It can hamper

or reduce a person's ability to carry out their day to day activities. Some disabilities may be

hidden, known as an invisible disability. Consequently, these disabilities can affect one or more

of a person's vision, hearing, thinking, learning, mobility, mental health, communication and

social relationships.

Mobility impairments can impact a person in several manners. Persons with mobility

difficulties were more likely to be poorly educated, living alone, obese, and having problems

conducting daily activities. Among persons with major mobility difficulties, 30.6% reported

being frequently depressed or anxious, compared to 3.8% for persons without mobility

difficulties.

Some may take longer to get from one place to another, enter buildings, or maneuver in

small spaces. In some cases physical barriers may inhibit entry into a building or room.

Accessible transportation may also be required for these people to get to fieldwork sites.

Mobility impairments can be permanent or temporary. A broken bone or surgical procedure can

temporarily impact an individual's ability to walk independently and travel between different

locations in a timely manner. Likewise, some may be assisted with a walker for short distances,

but may need a wheelchair or scooter for longer distances. In addition, other assistive devices or

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mobility aids for physical impairment disabilities include crutches, canes, walkers and

wheelchairs.

Health and Wellness Programs for Persons with Disabilities

In the Philippines, the results of the 2010 Census of Population and Housing (CPH, 2010)

show that of the household population of 92.1 million, 1.443 million Filipinos or 1.57%, have a

disability.

The mandate of the DOH to come up with a national health program for PWD was based

on Republic Act No. 7277, “An Act Providing for the Rehabilitation and Self-Reliance of

Disabled Persons and Their Integration into the Mainstream of Society and for Other Purposes”

or otherwise known as “The Magna Carta for Disabled Persons” and the Implementing Rules and

Regulations (IRR) of RA 7277. This document stipulated that the DOH is required to: (1)

institute a national health program for PWDs, (2) establish medical rehabilitation centers in

provincial hospitals, and (3) adopt an integrated and comprehensive program to the Health

Development of PWD, which shall make essential health services available to them at affordable

cost. In response to this, the DOH issued Administrative Order No. 2006-0003, which

specifically provides the strategic framework and operational guidelines for the implementation

of Health Programs for PWDs.

In 2013, a MediumTerm Strategic Plan (2013-2017) was developed to strengthen the

existing health program for PWDs. However, in the review done for the purpose, it was noted

that in the implementation of the program in the past years, there were operational issues and

gaps identified that need to be addressed. These include among others, the need to strengthen

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multi-sectoral action to harmonize efforts of stakeholders; clarify delineation of roles and

responsibilities of concerned government agencies working for PWDs; strengthen national

capacity, both facilities and manpower, to provide rehabilitation services for PWDs from primary

to tertiary level of care; provide access to health facilities and services for PWDs; and, strengthen

registration database for PWDs.

The World Health Organization released the Global Disability Action Plan 2014-2021.

This document intends to help countries direct their efforts towards specific actions in order to

address health concerns of persons with disabilities. The Action Plan identified three major

objectives: to remove barriers and improve access to health services and programmes; (2) to

strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support

services, and community-based rehabilitation; (3) to strengthen collection of relevant and

internationally comparable data on disability and support research on disability and related

services. The action plan is based on the recommendations of the WHO and World Bank World

report on disability and aligns with the Convention on the Rights of Persons with Disabilities

(CRPD). It was developed in consultation with Member States, United Nations organizations and

national and international partners, including organizations of people with disabilities.

Considering all of the above, the Health and Wellness Program of Persons with

Disabilities currently has been configured to address all the issues discussed above, and aligned

with the thrusts and goals of Kalusugang Pangkalahatan or Universal Health Care, the Global

Disability Action Plan 2014-2021, and, the direction the program should take in the succeeding

years as articulated in the newly developed strategic plan. This plan also considers giving free

mobility devices for persons with disabilities from around the world.

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Mobility Aids

Mobility aids are devices designed to help people who have problems moving around

enjoy greater freedom and independence. The type of mobility aid required will depend on the

mobility issue or injury. The most common types of mobility aids include:

Crutches

Crutches help to transfer weight from the legs to the upper body. They can be used singly

or in pairs. Crutches help keep a person upright and may be used by those with short-term

injuries or permanent disabilities.

Cane

Canes are similar to crutches in that they support the body's weight and help transmit the

load from the legs to the upper body. However, they take less weight off the lower body than

crutches and place greater pressure on the hands and wrists. Assistive canes are useful for people

who have problems balancing and who are at risk of falling.

Walker

Walkers are made up of a metal framework with four legs that provide stability and

support to the user. Users lift the frame and place it further in front of them, they then step

forward to meet it, before repeating the process. Some walkers have wheels or glides on the base

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of the legs, which means the user can slide the walker rather than lift it. This is especially helpful

for people with limited arm strength.

Wheelchair

Wheelchairs are used by people who should not put weight on their lower limbs or who

are unable to walk. They can be more suitable than walkers for people with severe disabilities or

when travel over greater distances is required.

Wheelchair Types

Wheelchairs come in a wide variety of formats to meet the specific needs of their users.

They may include specialized seating adaptations, individualized controls, and may be specific to

particular activities, as seen with sports wheelchairs and beach wheelchairs. The most widely

recognized distinction is between powered wheelchairs, where propulsion is provided by

batteries and electric motors, and manually propelled wheelchairs, where the propulsive force is

provided either by the wheelchair user/occupant pushing the wheelchair by hand, or by an

attendant pushing from the rear.

Manual Wheelchair

Manual wheelchair is the most common type of wheelchair. It has a frame, seat, footrests

and four wheels: usually two caster wheels at the front and two large wheels at the back. The

larger wheels have push-rims that are used to maneuver the wheelchair. The chair is maneuvered

and controlled by the user himself, or another person standing at the rear and pushing the handles

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incorporated into the frame. Manual wheelchairs generally have brakes that bear on the tires of

the rear wheels, however these are solely a parking brake and in-motion braking is provided by

the user's palms bearing directly on the push-rims. As this causes friction and heat build-up,

particularly on long downslopes, many wheelchair users will choose to wear padded wheelchair

gloves.

Manual Wheelchair Types

Transport Wheelchairs

These chairs are made to be pushed by others rather than the user propelling himself.

These have a small back wheel the user can't grip. These are often provided at medical offices

and hospitals. These are foldable for easy storage when not in use. Standard transport

wheelchairs accommodate users up to 300 pounds, and heavy-duty transport chairs can

accommodate users who weigh more.

Hybrid transport wheelchairs typically feature a quick-release mechanism that allows

removal and exchange of the rear wheels from large, self-propulsion wheels to smaller transport

wheels.

Wheelchairs used in magnetic resonance imaging (MRI) suites are made from

non-magnetic materials. A popular option is PVC pipe, which not only is non-magnetic but also

has been shown to inhibit bacteria growth. Some MRI chairs are made of non-magnetic metals

and will be stamped and prominently marketed as being MRI safe.

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Standard Manual Wheelchairs

These wheelchairs have large back wheels with a push rim for the user to grip to propel

himself. These chairs are suitable for users who have control of the upper limbs. These are

usually foldable, allowing easier storage when not in use or when traveling.

Heavy-Duty and Bariatric Manual Wheelchairs

Larger users may need a heavy-duty wheelchair to accommodate their size or weight.

They have a larger and sturdier frame and can have wider seats. Models for bariatric patients can

support up to 700 pounds and sometimes recline to distribute a person's weight more easily.

Light and Ultra Lightweight Wheelchairs

There has been a move toward wheelchairs that weigh less. Ultra-lightweight wheelchairs

weigh about 25 to 30 pounds and light wheelchairs weigh under 40 pounds. They are good for

traveling with your chair, folding it to place in a vehicle.

This category has the large back wheel that the user can use to propel themselves, as well

as grips to be pushed by others. They are usually upholstered in nylon, and the lightest chairs

may not have a cushioned seat.

Sport Wheelchairs

Sport wheelchairs are rarely suited for everyday use, and are often a 'second' chair

specifically for sport use, although some users prefer the sport options for everyday use. ​These

wheelchairs can be customized to a desired activity or sport.

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Pediatric Wheelchairs

Pediatric wheelchairs for children feature a small frame with a narrow, shallow seat.

They usually have handles that can telescope to a height that's comfortable for an adult pushing

the chair to reach.

Tilt and Recliner Wheelchairs

Wheelchairs that tilt can be adjusted by a caregiver to a position that is comfortable for

the user. Recliner wheelchairs may have a taller backrest that makes them comfortable when

reclined.

Hemi Height Wheelchair

If the user can use his feet to propel himself better than his arms, a hemi height

wheelchair has a lower seat height to allow this. The chair may be made on a dual axle so it can

be raised to standard height and lowered to hemi height.

Powered wheelchairs

An electric-powered wheelchair, also known as a "powerchair" is a wheelchair which

additionally incorporates batteries and motors into the frame. It is controlled by the user by using

a joystick placed at the end of the armrest. ​Powerchairs are generally prescribed for use by users

who are unable to use a manual wheelchair.

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 Powerchairs are commonly divided by their access capabilities. An indoor-chair may

only reliably be able to cross completely flat surfaces, limiting them to household use. An

indoor-outdoor chair is less limited, but may have restricted range or ability to deal with slopes

or uneven surfaces. An outdoor chair is more capable, but will still have a very restricted ability

to deal with rough terrain. A very few specialist designs offer a true cross-country capability.

Powerchairs have access to the full range of wheelchair options, including ones which are

difficult to provide in an unpowered manual chair, but have the disadvantage of significant extra

weight.

A power-assisted wheelchair is a recent development that uses the frame and seating of a

typical rigid manual chair while replacing the standard rear wheels with wheels of similar size

which incorporate batteries and battery-powered motors in the hubs. A floating rim design senses

the pressure applied by the users push and activates the motors proportionately to provide a

power assist. This results in the convenience, and small size of a manual chair while providing

motorised assistance for rough/uneven terrain and steep slopes that would otherwise be difficult

or impossible to navigate, especially by those with limited upper-body function. As the wheels

necessarily come at a weight penalty it is often possible to exchange them with standard wheels

to match the capabilities of the wheelchair to the current activity.

Power wheelchair makes use of either wired or wireless technologies to establish a

connection from the controller and the controlled unit. This allows the user to control and

maneuver the wheelchair to go to a certain location without exerting too much force. Common

controller units can be operated by a joystick, voice control, or a body part gesture.

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Wireless Technology

According to Journal of Information Technology & Software Engineering, wireless

technology is a subject which plays a role in solving the engineering problems with the help of

wireless technology like radio communication and radar. It also includes the usage of other

techniques such as acoustic, infrared, and optical technologies. It has a wide range of

applications such as cellular networks, increase in popularity leads to sudden rise in career of

wireless and also this fetch in new wireless innovation.

"Using wireless, remote-controlled equipment can help contribute to a safer work

environment, less fatigue on the body and measurable increases in production. Therefore, it

should appeal to a diverse workforce. An obvious benefit of using a remote is that it causes less

fatigue than traditional, manual, machine operation. Moving your fingers or hand, or pushing a

button to run the equipment is much easier. If you have ever used a joystick to play a video

game, you can run a remote. Vibration and noise are also eliminated or decreased by using

remote-controlled equipment." (Mark Michaels, 2016)

When compared to traditional wired networks, wireless networks provide several

advantages such as increased mobility, installation speed and simplicity, wider reach of network,

more flexible, less maintenance cost, and increased scalability.

Review of Related Studies

Foreign Studies

The impact of physical activity on quality of life of a well-being has been thoroughly

investigated among those with mobility disorders. Many studies have reported a significant

positive association between quality of life and higher levels of physical activity in these

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individuals. Fewer studies have, however, evaluated the role of technological advances in

assistive devices design in promoting quality of life, level of participation and physical activity

in those with physically challenged and impaired individuals.

Many features in designing assistive devices affect the overall mobility efficiency and

stability. Adapting all these features to the individual needs and preferences of a wide variety of

users is a challenging task from a medical engineering perspective. Some of the assistive devices

that have been innovated are:

Torque Sensor Free Power Assisted Wheelchair

In January 2007, a power assisted wheelchair system was made as a master thesis design

by Jonas Johansson and Daniel Petersson. A power assisted wheelchair is a mobility device

which combines both human power and electric power. These types of wheelchairs are

commonly used by individuals who have used regular wheelchairs but have become weaker or

those individuals who just need additional power when going uphill. The wheelchair system

which they developed is a rebuilt electric wheelchair which does not include a torque sensor.

Instead of using torque sensors, which were commonly used by powered assisted wheelchairs,

their prototype mainly relies on rotational encoders or speed sensors that measures the velocity

or speed of the wheelchair when it starts moving. The main objective of these researchers for

conducting this study is to give a new, better and more economical way for individuals to use a

powered assisted wheelchairs because torque or force sensors are not that cost efficient.

According to Johansson and Petersson, aside from being economical, the power assisted

wheelchair that they’ve developed could help not only the user but the assistant that will push the

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mobility device since the device itself gives additional speed or power boost by the use of speed

sensors which was not possible when force sensors (connected to push rims) was used.

Gesture Control Wireless Wheelchair using ARDUINO

In March 2019, a smart, motorized, gesture controlled wireless wheelchair using

ARDUINO is designed by Manpreet Gill, Rama Sahani, and Abhinav Gupta. To control the

motion of wheelchair accelerometer sensor is fitted on the head of handicapped persons.

Depending upon gestures of the head transmitter side sends the command to the receiver side.

Based on the head gesture an accelerometer generates a command signal. According to

transmitter signal driver circuit will drive the motor fitted to the wheelchair as shown in fig 6.

The wheelchair controlled unit operates on wireless technology. Transmitter and receiver are

used in this wheelchair for removing complexity. In this paper hand gesture controlled

wheelchair is designed with arduino. Because An Arduino is an open-source electronics platform

based on easy to use hardware and software. It’s intended for anyone making interactive projects.

Hand-Gesture-Based Control Interface for a Car-Robot

Xing-Han Wu, Mu-Chun Su, and Pa-Chun Wang of National Central University in

Taiwan, lead in the development of research entitled 'A Hand-Gesture-Based Control Interface

for a Car-Robot'. It is a hand-gesture-based control interface for navigating a car-robot. A 3-axis

accelerometer is adopted to record a user’s hand trajectories. The trajectory data is transmitted

wirelessly via an RF module to a computer. The received trajectories are then classified into one

of several control commands for navigating a car-robot. The control commands are forward,

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reverse, stop, turn left and turn right. The classifier adopts the dynamic time warping (DTW)

algorithm to classify hand trajectories and control the car to the specified command.

Local Studies

Voice Recognition Wheelchair

In 2012, a group of Computer Engineers from the Mapua Institute of Technology

developed their own electric wheelchair system. This wheelchair system’s primary means of

control or command is through voice recognition. Francis Mark Luna, Aljon Darryll Jade Arias,

Santillan, Lloyd Edwinson Arellano and Jonathan Temeña constructed a prototype of a

wheelchair that has the ability to automatically stop and detect objects with the help of infrared

(IR) sensors installed at the front and back of the mobility device. It also has three pairs of LED

lights that light up when the IR sensors detect obstacles in its path, preventing users from

colliding with the blockages along their way. A pair of sensors is placed beneath the wheelchair

to give it the capability to halt its movement once the sensors detect the lack of surface

underneath, a feature that will prevent users from falling off the stairs. The wheelchair can also

be elevated to a height of eight inches at most, high enough to steer clear of sidewalk gutters.

The group’s primary objective of this mobility device’s development is to enable physically

challenged individuals with no hands to move freely using a mobility companion which is the

wheelchair.

The Development of Eye Controlled Wheelchair for Amputees

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 A different study about wheelchair technology was supervised in the year 2013, wherein

several students from De La Salle Araneta University innovated a simple manually propelled

wheelchair into an eye-controlled wheelchair. The study was awarded as the best thesis. This

wheelchair technology uses eye gesture recognition which calculates or detects certain looks and

blinks of the user’s eye. According to one of the researchers, Ms. Keeshia Cuesta, this project

was intended to replace the arms and legs control for wheelchair which cannot be done for some

individuals with severe physical injuries, and also it requires some skills to operate, the

wheelchair is easy to use and maneuver.

Ergonomic Design of an Assistive Propulsion System for Manual Wheelchairs

This study was conducted by Madylaine Delfin and Danna May Mendez in Mapua

Institute of Technology. A wheelchair is developed with the aim of alleviating the handicap

faced by those with impaired mobility. The wheelchair will seek the correct position of a patient

holding a key card inside a specified room or a control environment and navigate its way to the

said patient autonomously. The wheelchair will consist of two DC motors, a transmitter-receiver

pair, and four proximity sensors that will be operated by a central Raspberry Pi 3, possibly in

combination with an Arduino. The motors used are 24VDC 250W brushed DC motors, which

will be independently controlled based on input provided by the proximity sensors and onboard

receivers. Taken into account in performance testing were factors such as time taken to complete

operation of initiation of Zigbee reception to arrival at within 30cm of the patient, detection of

sudden changes in terrain height such as stairs, variation in sizes of the obstacles in the

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environment, motor rotation in collision detection, the effect of increasing the surface inclination

and treading material on motor performance and traction.

Synthesis of the Study

Majority of the devices for physically challenged and impaired individuals have their

own individual means of control. Wheelchairs are the most economical and comfortable in many

types of impairment aids unlike crutches and exoskeleton devices.

Wheelchairs have been popular for individuals who were unable to use crutches or canes

because of full lower body paralysis due to some kind of disease. Electronic exoskeleton is good

for any impairment but is very expensive. Many people cannot afford to buy an exoskeleton

device.

The main objective of this mobility device’s development is to enable physically

challenged individuals to move freely using a mobility companion that is flexible and

cost-effective, which is the wheelchair.

The proposed project, hand-motion controlled wheelchair, could be modified to fit for

this purpose, especially if wireless technology is to be used. If this is to be done with the

proposed system, its flexibility would greatly increase as it could still be used by individuals who

have an immense form of impairment. Also, this will make the user be more self-reliant as he or

she may not need another person's assistance in propelling a wheelchair.

These automation studies tend to help physically challenged and impaired individuals by

letting and otherwise teaching them the proper way of being more self-reliant with their personal

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mobility, which ensures that external human intervention would be lessened and otherwise no

longer needed and give them the right to feel free or feel once more that they are independent.

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