Assistive Technology

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ISSN: 1040-0435 (Print) 1949-3614 (Online) Journal homepage: http://www.tandfonline.com/loi/uaty20

Design and Evaluation of the Kinect-Wheelchair

Interface Controlled (KWIC) Smart Wheelchair for
Pediatric Powered Mobility Training

Daniel K. Zondervan PhD, Riccardo Secoli PhD, Aurelia Mclaughlin Darling,

John Farris PhD, Jan Furumasu BSPT & David J. Reinkensmeyer PhD

To cite this article: Daniel K. Zondervan PhD, Riccardo Secoli PhD, Aurelia Mclaughlin
Darling, John Farris PhD, Jan Furumasu BSPT & David J. Reinkensmeyer PhD (2015) Design
and Evaluation of the Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair
for Pediatric Powered Mobility Training, Assistive Technology, 27:3, 183-192, DOI:
10.1080/10400435.2015.1012607

To link to this article: http://dx.doi.org/10.1080/10400435.2015.1012607

View supplementary material Accepted author version posted online: 26

May 2015.

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 Assistive Technology® (2015) 27, 183–192
Copyright © 2015 RESNA
ISSN: 1040-0435 print / 1949-3614 online
DOI: 10.1080/10400435.2015.1012607

Design and Evaluation of the Kinect-Wheelchair Interface

Controlled (KWIC) Smart Wheelchair for Pediatric Powered
Mobility Training

DANIEL K. ZONDERVAN, PhD1∗ , RICCARDO SECOLI, PhD1, AURELIA MCLAUGHLIN DARLING1, JOHN FARRIS, PhD2,
JAN FURUMASU, BSPT3, and DAVID J. REINKENSMEYER, PhD1,4,5
1
Department of Mechanical and Aerospace Engineering, University of California at Irvine, Irvine, CA, USA
Downloaded by [University of Nebraska, Lincoln] at 07:57 03 November 2015

2
Department of Product Design & Manufacturing Engineering, Grand Valley State University, Grand Rapids, MI, USA
3
Rehabilitation Engineering Research Center on Technology for Children With Orthopedic Disabilities, Rancho Los Amigos National
Rehabilitation Center, Downey, CA, USA
4
Department of Biomedical Engineering, University of California at Irvine, Irvine, California, USA
5
Department of Anatomy and Neurobiology, University of California at Irvine, Irvine, California, USA

Received 02 September 2014; revised 02 December 2014; accepted 22 January 2015.

Background: Children with severe disabilities are sometimes unable to access powered mobility training. Thus, we developed the
Kinect-Wheelchair Interface Controlled (KWIC) smart wheelchair trainer that converts a manual wheelchair into a powered wheelchair.
The KWIC Trainer uses computer vision to create a virtual tether with adaptive shared-control between the wheelchair and a therapist dur-
ing training. It also includes a mixed-reality video game system. Methods: We performed a year-long usability study of the KWIC Trainer
at a local clinic, soliciting qualitative and quantitative feedback on the device after extended use. Results: Eight therapists used the KWIC
Trainer for over 50 hours with 8 different children. Two of the children obtained their own powered wheelchair as a result of the training.
The therapists indicated the device allowed them to provide mobility training for more children than would have been possible with a demo
wheelchair, and they found use of the device to be as safe as or safer than conventional training. They viewed the shared control algorithm
as counter-productive because it made it difficult for the child to discern when he or she was controlling the chair. They were enthusiastic
about the video game integration for increasing motivation and engagement during training. They emphasized the need for additional access
methods for controlling the device. Conclusion: The therapists confirmed that the KWIC Trainer is a useful tool for increasing access to
powered mobility training and for engaging children during training sessions. However, some improvements would enhance its applicability
for routine clinical use.
Keywords: powered mobility training, shared control, virtual reality, cerebral palsy, smart wheelchair

Introduction skills requires caregivers to request a demo powered wheelchair

Independent mobility is a critical component in the devel-
opment of a child’s cognitive, emotional, and social well-
being (Bertenthal, Campos, & Barrett, 1984; Galloway, Ryu, &
Agrawal, 2008; Guerette, Furumasu, & Tefft, 2013; Kermoian,
1997; Tefft, Guerette, & Furumasu, 2011). It provides opportu-
nities for children to explore their surroundings, interact with
others, and learn self-sufficiency. However, for severely disabled
children, independent mobility is often impossible without the
aid of a powered wheelchair (Guerette, Tefft, & Furumasu, 2005),
and the skills needed to operate a powered wheelchair can be
difficult to master. The conventional approach to training these
∗ researchers have developed smart wheelchairs that use an array
Address correspondence to: Daniel Zondervan, PhD, Department
of Mechanical and Aerospace Engineering, UC Irvine, 2402 Calit2
Building, Irvine, CA 92697. Email: dkzondervan@gmail.com
from a supplier, attempt to fit the chair to a trainee, and then
use it to perform guided training. During a typical training
session, a caregiver walks alongside a child using the demo pow-
ered wheelchair, and places her hand over the child’s hand on
the joystick to manually guide them as they drive about. This
approach is both time and labor intensive, requiring one- on-one
staff time, so children who do not learn how to operate a pow-
ered wheelchair quickly are often excluded from future training
and are prevented from achieving independent mobility. Further,
many children have specific postural and seating needs, and have
difficulty using a demo chair that has not been specifically fit for
them (Guerette et al., 2005).
In order to simplify the task of driving a powered wheelchair
and thus reduce the time required for learning how to drive,
of sensors and artificial intelligence to automate or simplify
many driving tasks. These devices are able to help a user avoid
 184
obstacles (Simpson & Levine, 2002), control the wheelchair
by simply gazing in the direction he/she wants to move
(Matsumototi, Inot, & Ogasawarat, 2001), or accomplish specific
tasks like driving through a doorway (Carlson & Demiris, 2012;
Hoyer, Borgolte, & Jochheim, 1999). These devices use a variety
of sensors, such as sonar in the NavChair (Levine et al., 1999),
laser range finders in the SENARIO system (Katevas et al.,
1997), infrared sensors, or a combination of all of these, which
is used in the Bremen Chair (Lankenau & Rofer, 2001). Most
smart wheelchairs also have physical bump sensors for collision
detection (Simpson, 2005).
Limitations to clinical acceptance of smart wheelchairs
include cost, complexity, and safety concerns. Further, smart
wheelchairs typically do not encourage skill development for
driving a conventional powered wheelchair, because they instead
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seek to automate driving tasks. An exception to this are smart
wheelchairs that use novel collaborative or shared control algo-
rithms to allow a user to participate in control of the device,
and only intervene for safety purposes, such as avoiding colli-
sions or reducing speed (Carlson & Demiris, 2012; Goil, Derry,
& Argall, 2013; Soh & Demiris, 2012). These systems are
unique in that they allow the user to make bounded steering
errors and explore the cause-effect relationship of the joystick
in a controlled environment, which could promote learning and
eventual independent mobility without the aid of the smart
wheelchair.
Indeed, the use of a smart wheelchair as a training and assess-
ment tool, rather than solely as a mobility aid, has become
increasingly prevalent in recent years. An advantage of this
approach is that it could allow the equipment cost and oper-
ating complexity of the smart wheelchair to be managed by
a clinic rather than by the client, since the clinic could use a
single device to train multiple individuals. The Communication
Aids for Language and Learning (CALL) Center (Nisbet, Craig,
Odor, & Aitken, 1996) and the GoBot (Wright-Ott, 1997) were
early adopters of this approach, both using smart wheelchairs
to provide additional safety and assistance for children as they
practiced driving a powered wheelchair. A more recent study
in Australia also showed three out of four children with cere-
bral palsy (CP) were able to gain independence in multiple
driving skills after undergoing training with a smart wheelchair
(McGarry, Moir, & Girdler, 2012). In our lab, we previously
developed a robotic wheelchair training system that used a com-
bination of line tracking and haptic feedback to provide an
automated driver’s training program, which was motivated by
a prior study that found haptic guidance can improve the learn-
ing of a steering task (Marchal Crespo & Reinkensmeyer, 2008).
We found that training with this system significantly improved
the steering ability of children without a disability compared to
training without haptic guidance, and improved the driving abil-
ity of a child with cerebral palsy (Marchal-Crespo, Furumasu,
& Reinkensmeyer, 2010). Similar results were also found with
another novel system that used haptic feedback to train toddlers
to drive mobile robots (Chen & Agrawal, 2013; Chen, Ragonesi,
Galloway, & Agrawal, 2011). To increase motivation to train with
our system, we then developed a floor-projected video game sys-
tem that children interacted with while moving about with the
Zondervan et al.
device (Secoli, Zondervan, & Reinkensmeyer, 2012). We also
incorporated a platform-based system developed at Grand Valley
State University that converts a manual wheelchair to a powered
wheelchair (Ripmaster, Farris, Kenyon, Pung, & Peck, 2013),
allowing users to remain in their own custom seating system
during training.
While children and caregivers found this system to be highly
engaging in pilot testing, it required a darkened room and a
large amount of floor space to use, making it impractical for
use in most clinics. Further, the haptic joystick we used was
large and heavy, and it was difficult to properly position it for
the children that used the device during pilot testing. Therefore,
we created a revised version of the system, called the Kinect-
Wheelchair Interface Controlled (KWIC) Trainer (Figure 1) that
uses a standard (i.e. non-haptic) joystick and operates in two
main modes designed to be more appropriate for clinical use.
The first mode is a stationary video gaming mode, where the
user plays video games shown on a screen mounted on a wall
or table. With this approach, users no longer drive through the
virtual environments as in the floor projected system previously
developed, but they are able to rotate the chair in place and trans-
late a small amount to control the games, learning causality with
the joystick and turning skills in an engaging, semi-automated,
and safe training environment. Rather than attempt to simu-
late powered mobility, as other studies have done (Archambault,
Tremblay, Cachecho, Routhier, & Boissy, 2012), this approach
seeks to motivate massed practice of specific joystick skills
though an engaging medium while maintaining some of the
physical and vestibular responses associated with those joystick
movements.
The second mode is an overground driver’s training mode.
Here, we used a Microsoft KinectTM sensor and a basic shared
control algorithm to allow a caregiver to stand in front of the
trainee and use natural gestures to provide assistance to the child
during training, as well as to create a virtual tether between the
caregiver and the wheelchair to increase the safety of the device
(Zondervan & Reinkensmeyer, 2012). Our goal with this mode
was to allow full-movement driving practice while avoiding sev-
eral potential limitations of traditional hand-over-hand guidance.
Specifically, we designed this mode to put the training therapist
in front of the child, at a safer and more natural focus point,
and to allow him/her to signal to the child the intended driving
direction in a more natural way simply by moving and/or call-
ing to the child. The shared control algorithm allows the child to
practice independent driving skills safely, without the immediate
presence of a therapist over the child’s shoulder, since it allows
some errors to be made while automatically preventing the child
from steering the wheelchair too far away from the caregiver and
into potentially hazardous situations. We believed this approach
would create a system that allows the caregiver and the smart
wheelchair to work together to teach wheelchair driving skills in
an engaging, intuitive, and safe manner.
Next, we first describe the design and operating principles of
the KWIC Trainer. We then present the results from a year-long
usability study in which we donated the device to a local clinic
and collected feedback after they had used the device extensively
in their routine practice.
 Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair Trainer 185

Fig. 1. Training modes of the KWIC Smart Wheelchair trainer. Left: video game mode. The user plays video games shown on a monitor
(left) in front of the chair by rotating the chair left and right. The second screen in the picture (right) is the on-board control laptop, which
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also displays the game and control parameters that a caregiver can adjust. Right: Overground Mode: The Kinect depth camera tracks the
trainer, allowing the trainer to assist in driving remotely. The chair automatically stops if it loses tracking of the trainer, creating a safe,
engaging environment for the child to practice driving a powered wheelchair without the trainer having to walk next to him with his hand
over the joystick.

Fig. 2. The platform design of the KWIC Trainer. Left: The Trainer without a manual wheelchair mounted. The Kinect (A) and compass
(B) are mounted on a vertical boom. The USB joystick can be positioned using the mount on the left (C). The laptop (D) and emergency
stop switch (E) rest on a shelf in the back. Right: A close up view of a manual wheelchair on the KWIC Trainer. The wheels of the manual
wheelchair rest on steel tubing and are held in place by straps (F). The powered wheels are positioned behind the manual wheelchair.

Methods driven by two DC motors controlled by a commercial motor con-

troller (Rnet System—PG Drives Technology) connected to the
Device Design and Operating Principle on-board laptop through a National Instruments USB-6009 mul-
tifunction data acquisition unit. The laptop sits on a raised shelf
The KWIC Trainer is a sensorized version of a powered
on the back of the platform, and the electronics are housed below
wheelchair platform designed at Grand Valley State University
in a covered encasement (see Figure 1, left). A three-joint, height-
that converts any standard manual wheelchair into a powered
adjustable arm allows the position and orientation of the USB
wheelchair (Ripmaster et al., 2013). The platform component
joystick to be placed in the most comfortable location possible
includes a rectangular steel frame that rests about 3 cm above
for each user. The onboard laptop also provides auditory cues
the floor, with two small ramps at the front to allow the rear
to the caregiver to inform him or her of the operational state of
wheels of a manual wheelchair to be rolled up and onto the
device. A video of a child using the KWIC Trainer can be found
platform. Once a manual wheelchair has been placed onto the
at http://youtu.be/a3DqCfwmrtg.
platform, the rear wheels are locked and strapped to the frame
For the stationary video gaming mode, we modified the floor-
using two adjustable straps (Figure 2). To this, we added a USB
projected video game training system to display the games on an
joystick (Apem HFX-11S00-U), a digital compass (VectorNav
LED display screen mounted on a wall or table, making it more
VN-100), a depth sensor (Microsoft KinectTM ), and an on-board
practical for use in a clinic. The games are hosted on the on-board
laptop with custom control software. The robotic platform is
 186 Zondervan et al.

Fig. 3. Screen shots of the three video games developed for the KWIC Trainer. The games were designed to require increasing control
complexity, from left to right. Left: A balloon bursting game with left/right controls only. Middle: A Space Invaders clone with left/right
controls and a bullet that shoots when the joystick is pressed forward. Right: A racing game with 2D proportional control such as would be
experienced while driving a normal powered wheelchair. For this game, the chair rotates left/right during turns, but does not move forward
and back when accelerating/decelerating the race car with the joystick.
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Fig. 4. Gesture commands for the KWIC Trainer. The gesture on the left makes the KWIC Trainer drive forward, the gesture in the center
makes the KWIC Trainer reverse, and the gesture on the right halts the device.

laptop, then projected to the remote display using a wireless
HDMI transmitter (Brite-View). In this mode, the input from the
joystick simultaneously controls the rotation of KWIC Trainer
and serves as an input to three custom video games designed to
be appropriate for children with CP (Figure 3); translation of the
KWIC Trainer is disabled in this mode. This allows the user to
explore the cause and effect properties of the joystick while play-
ing engaging games. The rotation of the KWIC Trainer can be
disabled if desired, allowing the user to practice using the joy-
stick to control the video games only without moving the device
in order to simplify the task and increase safety. If rotation is
enabled, the caregiver can set a maximum allowable rotational
angle that the device can move through, as sensed by the digi-
tal compass, to further ensure safety and prevent the child from
rotating the KWIC Trainer away from the video game screen.
Furthermore, the position of the KWIC Trainer can be adjusted
at any point during training by using the keyboard of the on-board
laptop.
In the overground training mode, the Kinect sensor is used
to track the position of a therapist in front of the device, allow-
ing the therapist to provide training simply by walking about
and calling to the child. The child is given full control of for-
ward and backward movement of the wheelchair, but the therapist
is able to override this input using gesture commands: opening
both hands with palms upward signals the chair to drive toward
the trainer, raising one hand with palm outward reverses the
chair, and raising both hands with palms outward stops the chair
(Figure 4). To control chair rotation, The KWIC Trainer uses
a shared control algorithm that uses a weighted average of the
joystick input from the child and the left-right position of the
therapist as sensed by the depth sensor according to the equation:
u = αJ + (1 − α) K (1)
where u is the left/right output to the KWIC Trainer motors, J is
the joystick position, K is the Euclidean distance of the therapist
away from a reference line extending straight out from the center
of the chair, and α is a variable between zero and one that deter-
mines the level of shared control. Adjusting the level of shared
control changes the maximum rotational error a child is able to
make since the value of K in (1) increases as the child steers
the KWIC Trainer further away from the therapist. For added
safety, the KWIC Trainer automatically stops the movement of
the wheelchair and emits auditory warning beeps if it does not
detect a therapist in front of the device, or if the therapist is too
close to the front of the device (within 1 meter). The ranges of
J, K, and u are all [−1000, 1000]. The control parameter, u, is a
 Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair Trainer
unit-less number that is linearly proportional to the physical rota-
tional velocity of the chair. The maximum rotational speed (and
thus the scaling constant between u and the physical speed) is
controlled by a commercial joystick controller (Omni+) on the
back of the KWIC Trainer, which can be easily adjusted within
commercial limits by the supervising therapist during training.
We also developed an adaptive shared control algorithm that
adjusts the amount of control the child has of the wheelchair’s
rotation based on their driving performance (i.e. it increases the
level of control if the child is driving well, and reduces it if the
child is driving poorly). The algorithm is defined by the following
formula, which updates α at 30 Hz:
αn+1 = αn + .01, for (K − ) < J < (K + );
(2)
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αn+1 = αn −β otherwise
where  denotes a tolerance range of “good” joystick positions
offset from the position of the therapist (i.e. it accounts for the
fact that the child could use a curved path to reach the therapist)
and β is a constant (defined experimentally, typically greater than
0.01) that controls the rate of adaptation for returning control to
the caregiver if the child is driving poorly (i.e. if the joystick is
pointed away from the therapist). The upper and lower limits of
α may be adjusted, but are constrained between zero and one.
During training with the adaptive control algorithm, auditory
cues are used to inform the therapist about a change of the param-
eter α within three levels (0%-33%, 34%-66%, 67%-100%). This
information provides a real-time evaluation of the driving skill of
the child during the session. It is also possible to turn off the
adaptive control and virtual tether algorithms completely, which
allows a therapist to provide traditional hand-over-hand therapy
with the device if desired.
Finally, for additional safety, the KWIC Trainer incorporates a
large emergency stop button on the back, a watchdog timer circuit
that cuts power to the motors in the event of a laptop crash, a
remote RF emergency stop switch with a 10 meter range, and a
circuit breaker in series with the main power line of the device,
mounted on the side of the device within easy reach.
Usability Study
In order to assess the usability of the KWIC Trainer in clinical
practice, we loaned the device to a local California Children’s
Services Medical Therapy Unit (MTU). The Irvine-based MTU
provides physical, occupational, and speech therapy services to
children in the Orange County area who are affected by cerebral
palsy, spina bifida, traumatic brain injury, muscular dystrophy,
juvenile rheumatoid arthritis, or other disabling conditions.
We provided a one hour training session to the therapists at
the MTU on the use of the device. They then used the device as
they saw fit to aid them in delivering their normal wheelchair
driver’s training programs (i.e. we did not constrain the ther-
apists to a specific training protocol). After a year of use, we
conducted qualitative and quantitative surveys of the therapists’
opinions of the device. The surveys were approved by the UC
Irvine Institutional Review Board.
The qualitative survey was aimed at assessing the strengths
and weaknesses of the device, as well as best practices for how
187
it could be used in a clinic. The questions used in the survey are
included in the Appendix 1. We conducted the survey with every
therapist who used the KWIC Trainer for at least one training
session, as well as with an administrative therapist who oversaw
the training of multiple individuals with the device, for a total of
eight respondents.
The quantitative survey compared several important qualities
of the KWIC Trainer to a typical demo powered wheelchair.
We developed this survey from the device portion of the
QUEST 2.0 survey, which is an established method for evalu-
ating assistive technologies (Demers, Monette, Lapierre, Arnold,
& Wolfson, 2002). In this survey, the participants were asked to
rank their satisfaction with eight different qualities of the device
on a scale from one to five, where five means they are very sat-
isfied with that quality, and one means they are not satisfied at
all. The eight qualities assessed by the survey were: the physical
dimensions, overall weight, ease in adjusting, safety, durability,
ease of use, comfort, and effectiveness of the device. Participants
were also asked to note their top three most important quali-
ties from this list. The inclusion criterion for participating in the
quantitative survey was that the therapist must have performed
extended training with the KWIC Trainer, defined as complet-
ing more than one training session with a single child. This was
done so that the limited data set would represent the assessment
of experienced users of the device, rather than first impressions.
Due to a small sample size (n = 4), the results from this quantita-
tive survey were not analyzed for statistical significance, but the
responses from each participant are presented in full.
Results
During the year-long usability study, 8 different therapists used
the KWIC Trainer for a total of over 50 hours of use with eight
different children. One child had a disability due to an aneurysm,
one had spinal muscular atrophy, and the others had cerebral
palsy. No adverse events occurred during the study. After train-
ing with the chair, two children were able to obtain their own
powered wheelchair. The participating therapists were all able to
use the device in both modes after the one hour training session
provided. A typical training session with a child involved loading
the child’s manual wheelchair onto the KWIC Trainer, assessing
his/her initial skill level using conventional methods (e.g. hand-
over-hand training), and then providing individualized training
using the modality deemed most appropriate by each individual
therapist. For example, the therapists reported using the video
game mode to introduce the basic concepts of joystick control
(e.g. cause and effect) or to assess a child’s visual-spatial aware-
ness. The therapists reported using the overground mode to train
children who had higher initial skill levels or to train children
who were more motivated by personal praise and attention than
by the video games. Therapists often used a combination of both
modes in a single session, depending on the specific needs and
motivations of the child they were training, though the amount of
time spent in each mode was not measured directly. Initial set-up
at the beginning of a training session took about 5–10 minutes,
and switching between modes during the training session took
less than 5 minutes.
Based on the responses of the eight therapists who completed
the qualitative survey, the primary advantages of the device were:
 188
the ability to use a child’s own seating system, rather than trying
to fit them in a demo chair; the use of video games to motivate
training; the ability to select which degrees of freedom a child
could control so that turning could be taught independently from
forward/backward movements; and the ability to introduce the
basic cause and effect relationship between the joystick and the
powered wheelchair in a safe, motivating, and highly constrained
environment. When asked if these features improved their abil-
ity to do their job, the therapists responded positively, citing the
ability to use the device to assess and train children for powered
mobility who otherwise would have been excluded from train-
ing with a demo powered wheelchair due to time constraints in
adjusting seating and safety concerns.
The primary disadvantages of the KWIC Trainer that were
stated were: it was difficult and time intensive to initially set
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up and turn on the device before a training session; the system
only included a single access method (the USB joystick) that
could not be customized; it was heavy and bulky, making it dif-
ficult to maneuver; and it had low ground clearance making it
difficult to use in the real-world environment. When asked what
improvements they considered to be most important, the survey
participants unanimously named the lack of other access meth-
ods. Their primary reason cited was that many children require
the use of specially designed joysticks handles, switches, head
arrays, or sip-puff systems to operate a powered wheelchair, and
these children were unable to benefit from the KWIC Trainer in
its current form.
The four therapists who used the chair more intensively com-
pleted the quantitative survey for both the KWIC Trainer and a
typical demo wheelchair. Each of these therapists used the device
with only one child, and they completed at least two training
sessions. The results of this survey are reported in Table 1.
Three of the four therapists rated the KWIC Trainer as easier
to adjust than the demo chair. When asked about the mechanics of
the platform seating system, all the survey participants said they
were very comfortable with the setup, and found it secure and
easy to use. Only one respondent encountered a wheelchair that
would not fit on the platform. This was due to a stroller handle
on the back of the manual wheelchair that interfered with the
computer stand on the back of the KWIC Trainer.
Three of the four therapists also rated the KWIC Trainer as
safer than a conventional demo wheelchair. The one therapist that
did not said the video game mode was safer, but the Kinect mode
felt less safe. The other four participants who only responded
Table 1. Results from the quantitative survey. Each row contains the responses of one of the four quantitative survey participants. The
numbers in column one refer to the total number of sessions each therapist used the device. In each of the other columns, the numbers on
the left correspond to the respondent’s level of satisfaction with the KWIC Trainer, while the numbers on the right correspond to the level
of satisfaction with a conventional demo powered wheelchair. The bolded values show the top three qualities marked by each of the four
participants.
Times Ease in
Used Dimensions Weight adjusting Safety
18 2/3 2/3 2/2 4/5
2 3/2 4/3 4/3 5/3
30 4/3 4/4 4/3 5/3
6 3/4 3/4 5/3 4/3
Total 12 / 12 13 / 14 15 / 11 18 / 14
Zondervan et al.
to the qualitative survey said that they considered the KWIC
Trainer to be as safe as or safer than using a demo chair. Based
on responses from all eight participants, this was primarily due to
the inclusion of several emergency stop switches, especially the
remote RF emergency stop switch, though some also cited the
virtual tether that prevented the children from driving away from
the therapists during overground training. Some also commented
that the ability to use the child’s own seating system rather than a
demo chair also improved the system’s safety since the children’s
own wheelchairs included custom straps and constraints to hold
them in a good posture during training.
The KWIC Trainer had the same average rating as a demo
chair for ease of use. While the therapists liked the ability to
stand in front of a child during overground training as a means
of increasing the child’s sense of independence without decreas-
ing safety, they found the use of the shared control algorithm in
this mode to be counter-productive. This is because it made it
difficult for a child using the system to discern when they were
controlling the movement of the chair versus when the KWIC
Trainer’s tracking system was overriding their input, thus limit-
ing their ability to learn the cause-effect relationship between the
joystick and the wheelchair. They also commented that the device
took too long to set up.
Finally, all four therapists rated the KWIC Trainer as effective
as or more effective than a demo chair. Based on their comments,
this was due to the engaging nature of the training, the ability
to train rotation and translation independently, and the ability to
properly position a child during training using their own seating
system. Again, they commented that the overall effectiveness was
limited by a lack of other access methods.
Discussion
The KWIC Trainer successfully provided a powered mobility
training platform that therapists were able to incorporate into
their ongoing clinical practice over a one-year period. Two chil-
dren obtained their own powered wheelchair after training with
the device. Overall, the therapists responded positively to the
technology, considering it to be more effective than using a demo
wheelchair, but they had several critiques of the design that need
to be addressed in future models. While previous studies have
shown that smart wheelchairs can be used to effectively provide
powered mobility training (e.g. (Marchal-Crespo et al., 2010;
Ease of
Durability use Comfort Effectiveness
5/5 3/4 5/3 3/2
3/3 3/2 5/2 4/3
5/2 4/4 5/3 4/3
4/4 4/4 4/5 4/4
17 / 14 14 / 14 19 / 13 15 / 12
 Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair Trainer
McGarry et al., 2012; Nisbet et al., 1996; Wright-Ott, 1997; Xi,
Ragonesi, Galloway, & Agrawal, 2011)), to our knowledge this
is the first long-term usability study of a smart platform trainer
that uses a child’s own seating system, incorporates video games,
and provides adaptive shared control based on a therapists body
position. The results of this study support the platform approach
and suggest that the use of video games as a motivating tool
rather than as a simulation tool is beneficial and can be used
to effectively train powered mobility skills, which supports the
conclusions made in (Snider, Majnemer, & Darsaklis, 2010).
We next discuss the feedback on the two operating modes of
the device in detail, then the observed limitations of the KWIC
Trainer and future steps needed to improve the device. We con-
clude by outlining several broader lessons learned through this
usability study that can inform the design of smart wheelchairs
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for powered mobility training.
Responses to the Operating Modes of the KWIC Trainer
While the therapists were initially enthusiastic about the track-
ing capabilities of the KWIC Trainer in the overground training
mode, they found these features difficult to use in practice.
Specifically, they thought that the lack of clarity as to who was in
control of the device during training with the shared control algo-
rithm outweighed its positive qualities. Their preferred method
of training in this mode was to turn off the shared control algo-
rithm so that the child had full control of the wheelchair (i.e.
setting α to 1 in (1) above), and then to use the tracking capa-
bilities as a safety mechanism to allow the caregiver to stand
in front of the child during training. However, this safety fea-
ture is also provided by the remote emergency stop switch that
the therapist can hold in her hand. Even with this feature avail-
able, therapists still elected to occasionally provide traditional
hand-over-hand training with the device, since it allowed them
to physically demonstrate correct patterns of movement during
driving.
In contrast, the therapists universally lauded the video game
mode of the KWIC Trainer. The key reason they liked it was the
motivating nature of the games. They mentioned that the children
would come to their appointments excited to do their mobility
training since it was a chance to improve their score in the games.
The therapists also said they would occasionally use the promise
of the video games as a reward to encourage the children to focus
during another training task. This mode also had the advantage of
being highly constrained, since the forward/backward movement
of the KWIC Trainer was disabled during game play. This abil-
ity to selectively train first rotation using the video game mode,
and then translation using the overground mode allowed the ther-
apists to grade the difficulty of the driving task, which allowed
them to tailor the training process to the specific needs of each
child. They could also use the video game mode to familiarize the
children with the physical motion of the wheelchair while they
were engaged in the interactive games in order to get them past
the startle response sometimes associated with initial accelera-
tion of the chair. For those children who had very limited initial
control, movement of the wheelchair could be turned off com-
pletely, and they could practice manipulating the joystick using
the movement of their avatar on the screen as visual feedback.
189
For this study, we did not measure the amount of time the thera-
pists spent in each available mode during training, but this would
be a valuable addition in future studies.
The therapists also universally appreciated the ability of the
KWIC Trainer to convert a manual wheelchair into a powered
wheelchair, since it allowed them to provide traditional powered
mobility training without the use of a demo chair. The therapists
considered this to be an important feature because it increased
the availability of powered mobility training to a larger number of
the children. Indeed, several therapists noted that the availability
of the KWIC Trainer allowed them to assess and train several
children for powered mobility who otherwise would have been
excluded from training. This feature also made the system safer
and more comfortable, since every child could remain in their
own customized seating system.
Limitations of the Study and the Device and Future Directions
for Research
A more rigorous test of this technology would be a random-
ized controlled trial that compares changes in driving ability
after matched doses of conventional powered mobility training.
Further quantitative analysis could also shed light on how the
children transferred skills learned during training in the video
game mode to real driving, or assess how driving performance
changed after training in each mode independently. However,
such studies will require a large number of subjects because
of the high level of physical and cognitive variability in the
target population. Thus, as a first step toward this goal, we
elected to conduct a usability study that targeted the therapists
who provide mobility training. Even if a new technology can
improve outcomes of training, it will not gain clinical accep-
tance if the therapists being asked to use the device have issues
or concerns with its implementation. Further, when carried out
appropriately, qualitative outcome measures provide important
and meaningful information for assessing assistive technologies
(Hoenig, Giacobbi, & Levy, 2007). The results provided here
were solicited from skilled therapists who spent over 50 hours
using the KWIC Trainer in normal practice.
The primary limitation of the KWIC Trainer was the lack
of access methods. In its current form, the system can only be
controlled by a single USB joystick. During traditional powered
mobility training, therapists have a wide variety of off-the-shelf
input systems to use, which are designed to integrate seamlessly
with most demo powered wheelchairs. Future iterations of the
KWIC Trainer should be modified to allow any of these input sys-
tems (e.g. switches, head arrays, sip-puff systems, etc.) to be used
to control the device. It is important that the KWIC trainer work
with commercially available input systems since it is helpful if
the children are trained with the input system they will eventually
use on their own powered wheelchair.
The second major limitation of the device was the overall
complexity of the system. Specifically, the use of a laptop that
required booting and then starting the correct program, along
with a wheelchair controller module that had to be turned on and
set to the right mode, increased the setup time required before
training. Some usability issues are to be expected from a pro-
totype device, but it is clear that future iterations of the KWIC
Trainer must reduce the number of steps required to begin using
 190 Zondervan et al.

the device. This is because a long setup time cuts into valuable Informing the Design of Smart Wheelchairs for Mobility
training time for the children, which is already limited during a Training
typical session.
While the usability study presented here was focused on the
Although the shared control capabilities of the device were not
evaluation of the KWIC Trainer, the feedback provided by
widely accepted in their current form, the algorithm could per-
the therapists is valuable for the development of other smart
haps be improved through further analysis. For example, future
wheelchairs for powered mobility training. First, it is clear that
studies could quantify how often the KWIC Trainer was halted
the development of shared or collaborative control algorithms
due to the therapist going out of view of the Kinect sensor, or
must be approached carefully, since the ultimate goal is indepen-
how the shared control parameter α evolved over time in a typi-
dent control, yet the users are only given partial control during
cal session. Design changes, such as allowing the adaptation rate
training. The shared control algorithm used here did not per-
of α to be more easily controlled by a therapist, implementing a
form well since it obfuscated the cause and effect relationship
new algorithm that adjusts α in larger, discrete steps so that the
between the joystick and the movement of the chair, disrupt-
child has time to adapt to and understand the level of control they
ing the motor learning process. While the KWIC Trainer did
have over the device, or returning to a joystick with haptic feed-
provide auditory cues that reflected the percentage of control
back so that the cause-effect relationship between the joystick
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the child had of the chair, these were regarded as insufficient

and the movement of the chair would be maintained even if the
to allow the child to understand the differences in the way the
KWIC Trainer was overriding the user’s input, could enhance the
KWIC Trainer responded to the same inputs at different times.
performance of the shared control algorithm.
This is in line with other studies that have emphasized the impor-
Finally, we found that during the video game mode, the KWIC
tance of preventing this potential occluding effect by using clear
Trainer slowly crept forward towards the game screen as a result
and consistent cues to inform the user of exactly how their
of wheel slippage or velocity differences during the back and
input is affecting the device (O’Malley, Gupta, Gen, & Li, 2006;
forth rotation of the device. We recently modified the system
Winstein, Pohl, & Lewthwaite, 1994). For example, if a smart
to use the Kinect depth sensor to measure the distance of the
wheelchair were to use proximity sensors to halt the wheelchair
KWIC Trainer from the video game screen, and then use this
in the event that it comes too close to another object, an audi-
measurement in a proportional feedback controller to automat-
tory or visual cue should be provided to the driver so that they
ically maintain the device at an appropriate distance from the
are aware that the wheelchair is ignoring their input until the haz-
screen as it rotates (Figure 5). This feedback control approach
ard has been removed. Further studies, such as those mentioned
also causes the KWIC Trainer to move forward a controlled
above, should seek to understand how best to implement shared
amount in response to a forward joystick input during video
control algorithms in order to improve motor learning during
gaming, and then to move back to its original position over
training.
time. Thus, the user experiences the vestibular and spatiotempo-
Second, with appropriate contextual cues, it is advantageous
ral feedback associated with forward acceleration, similar to the
for smart wheelchairs to be able to grade the complexity
“washout filter” technique used in motion simulators such as air-
of the driving task. For example, the children who used the
craft simulators to convey realistic motion sense (Grant & Reid,
KWIC Trainer were able to understand that the wheelchair only
1997).
responded to left/right input from the joystick during video game

Fig. 5. Changes in the distance between the KWIC Trainer and the screen displaying the video game during six simulated, three-minute
training sessions in the video game mode both with and without the depth sensor-based proportional feedback controller. The red line
shows the average of six runs with the controller in place, while the blue line shows the average of six runs without the controller. Shaded
areas denote ±1 standard deviation. The KWIC Trainer was continuously rotated clockwise and counter-clockwise in a sinusoidal fashion
throughout the duration of each three minute trial. When the controller was active, the distance between the KWIC Trainer and the screen
did not change over time, confirming that the forward creep was eliminated by the feedback controller.
 Kinect-Wheelchair Interface Controlled (KWIC) Smart Wheelchair Trainer
play. This allowed them to focus specifically on these two move-
ments, thus practicing and learning one part of the more complex
full driving task. Training at the appropriate challenge level and
breaking down a complex task during training have both been
shown to improve motor learning in general (Fontana, Mazzado,
Furtado, & Gallagher, 2009; Guadagnoli & Lee, 2004; Klein,
Spencer, & Reinkensmeyer, 2012) and powered mobility skills
in particular (Nilsson & Durkin, 2014).
Third, the motivating nature of the KWIC Trainer’s video
game mode enabled the therapists that used the device to keep the
trainees engaged during the training process, even across multi-
ple sessions. This is in line with numerous other studies that have
found motivational benefits of virtual reality augmented training
(Cooper et al., 2005; Harris & Reid, 2005; Reid, 2004). While
video games may not be appropriate for every training context,
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smart wheelchairs should strive to create motivating, engaging,
and immersive training experiences as much as possible.
Finally, perhaps the biggest contributor to the success of the
KWIC Trainer was its ability to convert a child’s own manual
wheelchair into a powered wheelchair. The therapists responded
very positively to this capability since it allowed them to quickly
place almost any child into the device in order to assess their
driving ability and provide initial mobility training. Indeed, the
biggest critique of the device was the lack of this same level
of universality for the input system. When approaching powered
mobility, every potential trainee will have a unique set of skills
and impairments. Thus, in order to increase access to training,
a training device should be extremely flexible and adjustable,
integrating with the user’s own custom assistive technologies
wherever possible.
By developing powered mobility training systems that allow
for flexible training regimens, incorporate safety cutoffs, uti-
lize motivating factors such as video games, and increase access
to training, device designers can empower therapists to provide
high quality training to a larger number of individuals than are
currently benefitting from it.
Acknowledgments
Supported by grant H133G090111 from the National Institute on
Disability and Rehabilitation Research. A special thank you to
Madhavi Yarlagadda and her team at the Irvine Medical Therapy
Unit for their willingness to collaborate on this project.
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Appendix 1. Targeted Questionnaire
1. How often did you use the device, and in which mode did you
most often use the device?
1a. If you did not use the device often, why not?
2. What need, if any, do you think this device meets?
3. What were things that you liked about each mode? Why?
3a. Did these things improve your ability to do your job?
3b. Did you use these features often?
4. What were things that you did not like about each mode? Why?
4a. Did these things make it more difficult for you to do your job?
4b. Did these features cause issues often?
5. What was your experience with the mechanical interface of the
Trainer? Was it easy to mount and secure a manual chair? Did
every chair fit?
6. What was your experience with the joystick? Was it easy to
place in a desired location? Any improvements that could be
made to the input device?
7. Do you have any safety concerns regarding the device?
7a. How likely do you think it is that an adverse event could occur
with the device?
7b. Is this device more safe, less safe, or as safe as the Traditional
Method?
8. How could this device be improved?
8a. Would you consider these improvements to be essential?
8b. Would these improvements make you more likely to use the
device?
8c. Would that improvement make the device more effective?
Why?
9. Would you use/continue to use the device if it was available?
Why or why not?
10. Any additional comments?