Disability and Rehabilitation: Assistive Technology

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Design journey of an affordable manual standing

wheelchair

Javeed Shaikh-Mohammed, Swostik Sourav Dash, Vivek Sarda & S. Sujatha

To cite this article: Javeed Shaikh-Mohammed, Swostik Sourav Dash, Vivek Sarda & S. Sujatha
(2021): Design journey of an affordable manual standing wheelchair, Disability and Rehabilitation:
Assistive Technology, DOI: 10.1080/17483107.2021.1892839

To link to this article: https://doi.org/10.1080/17483107.2021.1892839

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DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
https://doi.org/10.1080/17483107.2021.1892839

RESEARCH ARTICLE

Design journey of an affordable manual standing wheelchair

Javeed Shaikh-Mohammed , Swostik Sourav Dash, Vivek Sarda and S. Sujatha
TTK Center for Rehabilitation Research and Device Development (R2D2), Department of Mechanical Engineering, Indian Institute of Technology
Madras, Chennai, India

ABSTRACT ARTICLE HISTORY

Purpose: Only 1 in 10 people with disabilities can access assistive devices, underlining the critical need Received 23 September 2020
for low-cost assistive products. This paper describes the design evolution of a manual user-operated Accepted 16 February 2021
standing wheelchair (SWC), translating from prototype to product.
KEYWORDS
Methods: The SWC design has been refined over 5 years through multiple iterations based on comments
Design journey; standing
from user trials. The SWC product, Arise, provides standing functionality, facile outdoor mobility, afford- wheelchair; assistive device;
ability, customisability, and is aesthetically pleasing. A one-time fitting and training ensure optimal effort spring balancing; manual;
for operation, correct posture, and comfortable user experience. The SWC accommodates users of differ- user-operated;
ent sizes and body weights (up to 110 kg) and minimises user effort with the use of a gas spring. customisability
Incorporating discrete adjustments enables customisation while retaining the advantages of mass manu-
facturing, which is necessary for ensuring affordability.
Results: The SWC has been field-tested and well received by over 100 wheelchair users, and Arise was
launched recently by the industry partner.
Conclusions: It should be noted that RESNA cautions on the use of any standing device without medical
consultation. Nevertheless, with appropriate dissemination and awareness, it is anticipated that the afford-
able SWC product, Arise, will immensely benefit the eligible users and make a difference in their quality
of life.

ä IMPLICATIONS FOR REHABILITATION

Provides standing functionality, outdoor mobility, affordability and customisability

Accommodates users of different sizes and body weights in a mass-manufacturable design

Ergonomic design reduces net user effort during sit-to-stand, stand-to-sit activity

Design iterated and refined based on feedback from over 100 user trials

Introduction users to prevent secondary health problems associated with pro-

Disability should not be a loss of independence, with assistive
technologies providing either total or partial personal autonomy.
Unfortunately, the reality is that more than one billion people in
the world need assistive technology (with 75 million people need-
ing wheelchairs) [1]. A major reason for this unmet need is the
lack of affordability in low-income countries. Only 1 in 10 people
with disabilities (PwD) have access to the assistive products they
need [1] besides limited access to therapists, signifying the critical
need for low-cost assistive products for broader outreach.
People with disabilities such as spinal cord injury (SCI), spina
bifida, multiple sclerosis, etc. may have little or no control over
their lower limbs. While they may use wheelchairs and other aids
to move, their ability to stand independently is often compro-
mised. Standing posture is essential, not only to perform certain
activities of daily living (ADLs) but also to retain wide-ranging
health benefits. Some studies have also found that standing
improves respiratory function, skin integrity and bone mineral
density [2]. Standing as therapy is essential for some wheelchair
longed sitting [3]. However, some users of conventional wheel-
chairs have limited or no control over their lower limb
musculature and require considerable effort, assistance and/or
aids to stand. Furthermore, for users who are economically disad-
vantaged or living in remote places, access to therapy or a regular
standing program is next to impossible.
According to the Rehabilitation Engineering and Assistive
Technology Society of North America (RESNA), standing wheel-
chairs (SWCs) are often medically necessary as they facilitate some
individuals to improve their overall quality of life (QoL) [3]. The
QoL changes include improved functional reach and access to
enable participation in ADLs, improved mobility in individuals
with preserved muscle strength in lower limbs, improved circula-
tion, and improved range of motion and reduced risk of contrac-
tures. The SWCs also promote bone health and vital organ
capacity, including pulmonary, bowel, and bladder functions.
Besides, the SWCs reduce abnormal muscle tone and spasticity,
and the occurrence of pressure ulcers and skeletal deformities.

CONTACT Sujatha Srinivasan sujsree@iitm.ac.in TTK Center for Rehabilitation Research and Device Development (R2D2), Professor, Department of Mechanical
Engineering, Indian Institute of Technology Madras, Chennai 600036, India
Supplementary Materials for this article can be accessed here.
ß 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
2 J. SHAIKH-MOHAMMED ET AL.
Overall, SWCs provide numerous psychosocial and QoL bene-
fits [3].
A variety of SWCs is currently available in the market for the
PwD to choose [4–8]. Nevertheless, most of the SWCs available in
the market are custom-designed for a specific user, motorised,
and expensive. The expense makes the SWCs out-of-reach of the
2.2 million wheelchair users in India [9] and millions of other
wheelchair users worldwide. Therefore, the motivation for this
work was to develop an affordable SWC that could significantly
improve the QoL for PwD.
A proof-of-concept of SWC was the outcome of a graduate
student project at the TTK Centre for Rehabilitation Research and
Device Development (R2D2) in IIT Madras (IITM), Chennai, India
[10]. Preliminary studies suggested that the concept could signifi-
cantly improve people’s QoL both therapeutically and functionally.
The GRID (Grants, Research, Industry, and Dissemination) model
was applied to translate the concept into the market through five
design iterations [11]. This paper presents the 5-year journey of
the affordable manual user-operated SWC from prototype to
product, which involved design iterations, exhaustive testing, trials
and user and clinician feedback.
Nothing about Us without Us
R2D2 recognises “Nothing about us without us” [12]. Starting
from version-1 of the SWC, co-design [13–15] and user-centred
[16] design approaches were taken through the active involve-
ment of the end-users (rural and urban) along with the designers
and rehabilitation professionals – physiatrists, physical and occu-
pational therapists. During the development of version-2 of the
SWC, the immersive empathy approach of design thinking [17–19]
was used for the empowerment of the wheelchair users. Members
from The Spinal Foundation, an India based SCI self-help group,
actively participated in the design process [20].
Assistive device lifecycle
The needs and opportunities within the assistive product lifecycle,
as well as issues concerning different stages of assistive product
deployment worldwide, were reported based on work from a
summit coordinated by the WHO Global Cooperation on Assistive
Technology (GATE) [13]. This position paper discusses the dangers
of focussing on products outside the context and rolling out
products without a plan. Furthermore, typical models of R&D may
not be effective for assistive products owing to the R&D costs
involved in a market with limited purchasing power [11]. The
model implemented for the SWC has evolved from the function-
ing of R2D2 at IIT Madras, Chennai, India. The model, termed
GRID, is based on the four pillars of Grants, Research, Industry,
and Dissemination [11].
In the case of the SWC, the Grant came from Wellcome (a UK
foundation) under the “Affordable Healthcare in India” program
[21]. The funding also covered the industry partner’s development
expenses, allowing the industry to offer an affordable product to
the end-user. The research was conducted at R2D2 in IITM, where
additional resources in the form of students, faculty expertise and
the infrastructure act as a grant-multiplier. The Industry partner
was Phoenix Medical Systems (P) Ltd., India [22], a manufacturer
and supplier of healthcare and assistive products. Dissemination
was through The Association of People with Disability (APD), India
[23], The Spinal Foundation [20], and CMC Vellore [24].
Development goals
Typically, custom-made assistive devices (using niche manufactur-
ing) are more expensive than mass-manufactured products. For
affordability, the goal was to ensure that the SWC is mass-manu-
factured and yet customisable for users of different sizes and
weights. We envisioned that a manual wheelchair with an inte-
grated hand-powered standing mechanism would be easily repair-
able and affordable to wheelchair users, enabling them to be
more functional and undertake economic activities.
The SWC would have low maintenance requirements using
only pin joints and off-the-shelf wheelchair parts. The standing
mechanism would have a non-powered assist to reduce user
effort. The linkage-based standing mechanism of the SWC would
be locked in both the sitting and standing positions. Additionally,
the standing mechanism’s links and joints would be non-obtrusive
and lie within the wheelchair space, preferably under the seat, for
ease in navigation.
As many SWC users would not have control over their lower
limbs, a vertical standing posture is not recommended. Therefore,
the SWC would provide a maximum seat inclination of 75 with
respect to the ground during standing, an angle typically used in
tilt tables for therapy. The orientation of the backrest remains
constant throughout the sit-to-stand activity, for user safety
and comfort.
Translation from prototype to product
The SWC was developed over five design iterations. The standing
mechanism remained the same across the SWC prototypes.
However, design iterations were necessary to address user needs,
safety aspects, strength considerations, and manufacturability. At
the design development stage, ANSYSTM (Ansys Inc., Canonsburg,
PA) was used to analyse stresses in the solid model of the SWC
design. Maximum forces were experienced with an empty SWC in
the upright position, as the internal forces applied by the gas
spring generate large forces at the joints. This finding was taken
into account to generate the reaction forces at all the joints, and
the individual parts were analysed to ensure the design safety.
Industrial designers were included during the design process to
provide input on human-centric design and styling.
All SWC versions from Version-2 onwards underwent mechan-
ical testing (curb drop test and double drum test) as per ISO 7176
standards. Testing fixtures, designed and developed in-house,
were used to conduct mechanical tests to meet international
safety standards. After exhaustive mechanical testing, the SWC
prototypes were used in user trials. The user trials were approved
by the institutional ethics committee (IITM-IEC protocol number
IEC/2016/01/SS/09).
The inclusion criteria for subject selection were as follows:

Age: 18þ years

Height: 122–183 cm

Weight: 40–100 kg

Currently use wheelchairs and preferably use stand-
ing devices
The exclusion criteria for subject selection were as follows:

Existing contracture

Osteoporosis

Skeletal deformities

Lack of standing tolerance
The methodology used for the user trials was as follows:

Demonstration of the SWC functioning

Explanation of benefits and risks of using SWC

Explanation of test activities and test durations
 DESIGN JOURNEY OF AN AFFORDABLE MANUAL STANDING WHEELCHAIR

Examination of the user by a consulting clinician (physiatrist,
physiotherapist or occupational therapist)

Obtaining the consent to trial participation from the
user/guardian

Training of the selected users for using SWC

Conduct of the test activities using SWC (see Table 1)

Observations by the design and clinical team

Collecting user comments about the SWC
Before any training or test activities, the SWC was adjusted for
each user to achieve proper fit. The seat depth and footrest
height adjustments were made based on the user’s thigh length
and shank lengths, respectively. Gas spring adjustment was made
based on the user weight. Training was given to the users by con-
ducting the thirteen activities (see Table 1) in an assisted-manner.
The typical duration of the testing sessions was 30 min.
Figure 1 captures the 5-year design journey of the SWC. The
colour bands indicate the features achieved with each SWC ver-
sion. In contrast, the intensities of the colour bands indicate the
extent of feature implementation within each SWC version. The
summary includes the functionalities achieved and issues identi-
fied with each SWC version. Details of each of the five versions of
the SWC are discussed in the following sections.
Table 1. The user activities conducted as a part of the SWC trials.
User activities
Transfer from chair/wheel-chair/bed to SWC
Bring the arm-rest into position or wear chest strap
Wear knee block
Sit for 2 min
Move forward
Move reverse
Turn left and right
Take the shortest radius turn
Apply brakes
Transition from sitting position to standing position
Stand for 2 min
Try to stretch your hands towards front, left and right while standing
Transition from standing position to sitting position
Figure 1. Summary of the 5-year design journey of SWC. Colour bands indicate the features achieved, and intensities of the colour bands indicate the extent of fea-
ture implementation.
3
SWC versions 0 and 1
The conceptualization of the standing mechanism was an out-
come of a student class project in 2011–2012. The initial version
(V0) of the SWC was an outcome of a graduate student project
[25,26]. The SWC V0 (see Figure 2), built using aluminium and
wood, used a compression spring for weight balancing. The initial
prototype of a manually operated SWC successfully demonstrated
the proof-of-concept of the standing mechanism.
The next version V1 of the SWC (see Figure 3) was built
entirely with aluminium. The shape of the handle that allows con-
trolled actuation of the mechanism was changed to an arc-shape.
In SWC V1 and following versions of the SWC, a gas spring
replaced the compression spring for weight balancing. The link
lengths and gas spring specifications were calculated for an aver-
age user’s weight and height.
As opposed to a compression or extension spring, the gas
spring was an ideal choice as it gives almost constant force char-
acteristics. In addition, the gas spring dampens sudden movement
when the user is required to change their gripping position, i.e.
release the handle and grip it at a different point at the end of
each stroke. The gas spring plays a critical role in assisting the
user during the sit-to-stand and stand-to-sit by reducing the max-
imum required forces. By balancing the weight, the gas spring
allows the user to safely change the holding position of the han-
dle during transitions.
In both SWC V0 and V1, the standing functionality worked sat-
isfactorily for non-disabled users. The next design objective was
to get the SWC tested by wheelchair users. However, this required
the SWC to include safety features such as appropriate knee and
trunk restraints, and incorporation of adjustability to accommo-
date users of different heights and weights.
SWC version 2
For the next version of the SWC, the design objective was to val-
idate the working of the standing mechanism with wheelchair
users. Version-2 (V2) of the SWC (refer to Figure 4) was designed
and fabricated in the second quarter of 2015. The industry partner
4 J. SHAIKH-MOHAMMED ET AL.

Figure 2. SWC V0 used by a non-disabled person in sitting (left) and standing (right) positions.

Figure 3. SWC V1 used by a non-disabled person in sitting (left) and standing (right) positions.

Phoenix Medical Systems (P) Ltd., Chennai, TN, India, undertook
the fabrication of SWC V2 and all subsequent versions of the
SWC. The SWC V2 was a fully functional wheelchair with a stand-
ing mechanism.
Most SWC users require restraints at the knees and possibly, at
the chest, depending on the level of muscle control they have to
enable them to stand. The position of the restraints, the weight
to be lifted, and other adjustments required to attain a biomech-
anically correct standing posture vary between users. Therefore,
customisability is critical in a SWC. A constrained standing posture
and forces applied, if not appropriate, could cause extreme pain
and discomfort to a SWC user.
The safety features of SWC V2 included chest support, knee
block, heel restraint and brakes. Additional features such as the
ability to adjust the footrest height, seat depth and gas spring
were included in SWC V2 to ensure that users maintained a bio-
mechanically correct posture in the standing position. The attach-
ment point of the gas spring could be varied without altering
the geometry of the standing mechanism. The ideal position of
the gas spring was determined for each SWC user. The shape
of the handle was modified to improve ergonomics, reachability,
and convenience for the user to grip and push forward (using
multiple strokes) with minimal effort for the entire range of sit-to-
stand motion.
 DESIGN JOURNEY OF AN AFFORDABLE MANUAL STANDING WHEELCHAIR 5

Table 2. Demographic data of SWC V2 users.

N ¼ 50
Gender
Male 45
Female 5
Age
18–20 4
21–30 19
31–40 12
41–50 11
51–60 3
61–63 1
Range 18-61
Mean 34.4
Medical condition
SCI-cervical 7
SCI-thoracic T1–T5 14
SCI-thoracic T6–T12 26
Polio 1
Becker muscular dystrophy (BMD) 1
Cerebral palsy (CP) 1

Figure 4. SWC V2, with indicated safety and adjustable features, used by a
wheelchair user (SCI-T4 level) in the standing position.

Figure 6. Quad-handles used by quadriplegic users (max C5) to stand during the
SWC V2 tests.

Starting from SWC V2, co-design [13–15] and user-centred [16]

Figure 5. Trial locations used for SWC V2 tests.
design approaches were followed. The details of the trial locations
for SWC V2 are shown in Figure 5, and the user demographics are
shown in Table 2. The trial users included a population from both
the genders and a wide-ranging age group. Fifty wheelchair users
tested the SWC V2. All the 50 users (100% users) were able to
perform the thirteen activities, which validated the functionality.
Most users could operate the standing functionality in SWC V2
with ease once the wheelchair dimensions and gas spring settings
were adjusted to their height and weight. Paraplegic users were
able to stand with ease. Furthermore, quadriplegic users (max C5)
were able to stand with the help of quad-handles (see Figure 6).
Although SWC V2 tests successfully validated the standing
functionality with wheelchair users, the trials revealed new design
challenges. Owing to the additional weight of the standing mech-
anism, the SWC V2 was difficult to propel as compared to a regu-
lar wheelchair. Moving on rough terrain would be an even more
significant challenge. Seven users from rural settings gave feed-
back that going outdoors is very important, and travelling out-
doors for 1–2 km was important for economic independence.
Their current wheelchair, Motivation Rough Terrain, offered better
propulsion on rough rural terrain. These seven users (14% users)
were better representatives of the socio-economic status that the
product would be targeted towards. Furthermore, validation of
the user feedback was done by comparing pushes required by a
user to cover the same outdoor distance. With the three-wheel
6 J. SHAIKH-MOHAMMED ET AL.

chassis equivalent product, 30% fewer pushes were required com- The design team tested commercial SWCs at rehabilitation
pared to the four-wheel SWC V2. trade fairs held in Japan and Germany. Also, the specification
Providing outdoor mobility would enable SWC users to under- sheets, user manuals, and product videos of different SWCs were
take economic activities and be more independent. Since the reviewed. After a benchmark study of wheelchairs that are consid-
Wellcome grant objective was to have an impact, especially in ered to offer good propulsion (Invacare Action 2NG, Vermeiren
rural settings, providing outdoor mobility for at least 1–2 km Jazz S50, Whirlwind Roughrider, Motivation Rough Terrain), a
became a necessary design criterion. The key learning from the major change was implemented in SWC V3 and subsequent ver-
user trials of SWC V2 was the need to improve propulsion, pro- sions of SWC. The major difference was using a 3-wheel chassis
vide outdoor mobility, and reduce mechanical complexity. instead of the 4-wheel chassis used in previous SWC versions. For
quick iteration, SWC V3 was built by modifying the chassis of a
Motivation Rough Terrain wheelchair [27].
SWC version 3
The SWC V3 and subsequent versions of SWC have a longer
For the next version of the SWC, the design objective was to
three-wheel chassis, making the wheelchair more stable for
overcome the design challenges identified with SWC V2. Version-3
uneven outdoor terrain. The extended base reduced the mechan-
(V3) of the SWC (see Figure 7) implemented concepts from indus-
ical complexity by obviating the need for an additional linkage,
trial design. While exploring the SWC design concepts, a minimal-
used in the four-wheel SWC designs, to contact the footrest with
istic concept was chosen over the fluidic and bold design
the ground and increase the base of support in the standing pos-
concepts (terminologies used by the industrial designers involved
ition. The three-wheel configuration enabled safe and easier out-
in the SWC development to describe the visual design). The flu-
door mobility for the SWC. Additional industrial design features
idic design looked easy on the eyes but involved form design in a
incorporated in SWC V3 included rigid backrest design for better
way that would have increased manufacturing processes and tool
support and propulsion, folding backrest for portability, fixed foot-
investment, and hence cost. The bold design would bring the rest design to reduce complexity. The footrest was height adjust-
wheelchair into attention compared to the other two options and able but fixed to the frame instead of the linkage-based moving
was not considered desirable. The minimalist design allowed man- footrest of SWC V2. Overall, SWC V3 demonstrated better outdoor
ufacturing and tooling investment costs to remain low and made mobility as well as reduced mechanical complexity.
the user more visible than the wheelchair. Using an immersive
empathy approach of design thinking [17–19], the design team
realised that outdoor mobility is vital for the economic empower-
ment of wheelchair users. The challenges foreseen for developing
countries such as India included prevalence of rough terrain, ease
in maintenance at widely available cycle repair shops, and port-
ability for ease of transportation.

Figure 8. Field visit and trial locations for SWC V3 tests.

Table 3. Demographic data of SWC V3 users.

N ¼ 15
Gender
Male 13
Female 2
Age
18–20 1
21–30 3
31–40 3
41–50 6
51–60 1
61–63 1
Range 19–63
Mean 39.4
Medical condition
SCI-cervical 1
Figure 7. SWC V3 with indicated industrial design features and three- SCI-thoracic T1–T5 4
wheel base. SCI-thoracic T6–T12 10
 DESIGN JOURNEY OF AN AFFORDABLE MANUAL STANDING WHEELCHAIR 7

Figure 9. Front view (left) and side view (right) of SWC V4 with footrest moved forward and made wider apart for correct standing posture.

Table 4. Demographic data of SWC V4 users.

N ¼ 20
Gender
Male 19
Female 1
Age
21–30 9
31–40 6
41–50 3
51–60 2
Range 22-51
Mean 34.6
Medical condition
SCI-cervical 3
SCI-thoracic T1–T5 6
SCI-thoracic T6–T12 11

Figure 10. SWC V4 with indicated industrial design elements.
The details of the field visit and trial locations for SWC V3 are
shown in Figure 8, and the user demographics are shown in
Table 3. Field visits were conducted to understand the lifestyle of
wheelchair users and their environment. Fifteen wheelchair users
from rural areas tested the SWC V3. It was observed that the users
could use the standing functionality with ease and comfortably
propel the wheelchair on rough rural terrain. The three-wheel
configuration offered better outdoor propulsion over SWC V2.
Standing was stable on the three-wheel configuration of the SWC
V3. However, the standing posture was incorrect, and redness was
observed on the knees in 11 users (73.3% users).
SWC version 4
The design objective of Version-4 (V4) of the SWC was to over-
come the issue of standing posture identified during the trials of
SWC V3. The footrest angle was modified to correct the standing
posture in SWC V4. Compared to previous SWC versions, the foot-
rest was moved forward and widened (refer to Figure 9). Other
industrial design elements incorporated in SWC V4 (refer to
Figure 10) included minimal backrest design allowing functional-
ity, adjustable lumbar cushion for better support, concentric han-
dle with wheel, ergonomic knee-block, and dip to allow easy
entry and exit. Twenty wheelchair users tested the SWC V4. The
user demographics for the SWC V4 are shown in Table 4. With
SWC V4, no redness was observed on the user’s knees. The critical
issues identified during the trial were the weight and aesthetics
of the SWC V4.
SWC version 5
Owing to R2D2’s recognition of “Nothing about us without us,”
version-5 (V5) of the SWC overcame all the drawbacks in previous
versions. Industrial design inputs to improve ergonomics, usability,
aesthetics and design principles for manufacturability and assem-
bly were incorporated in this production-ready design. The usabil-
ity enhancements (see Figure 11) incorporated in the SWC V5
included removable knee block, hybrid handle, foldable armrest
and split footrest.
Twenty-four users tested the SWC V5. The user demographics
for the SWC V5 are shown in Table 5. The SWC V5 provides
8 J. SHAIKH-MOHAMMED ET AL.
Figure 11. Usability enhancements in SWC V5 (a) removable knee block, (b) hybrid handle, (c) foldable armrest and (d) split footrest.
Table 5. Demographic data of SWC V5 users.
Gender
Male
Female
Age
18–20
21–30
31–40
41–50
51–60
61–63
Range
Mean
Medical condition
SCI-cervical
SCI-thoracic T1–T5
SCI-thoracic T6–T12
standing functionality, outdoor mobility, affordability, customis-
ability, and is aesthetically pleasing. A one-time fitting and train-
ing ensure optimal operation and comfortable user experience.
The following sections present details of these features.
Standing and safety locks. The SWC V5 has a standing angle of
75 . The standing handle has knobs in the front end, and the
handle is continuous towards the back. The knee support is of
swivel type and operable with a single hand. The flexible chest
strap is provided with a buckle lock. The heel restraint is a cush-
ioned rigid support. The arm supports are foldable for easy trans-
fer to and from the SWC. The wheel brakes are of knurled type.
The SWC includes three safety locks to avoid accidental standing.
A toggle lock auto-locks upon sitting. An additional sitting lock
allows standing only when intended to actuate. A knee support
interlock prevents a person from standing if the knee support is
not in position.
Outdoor mobility. The SWC V5 provides a three-point ground con-
tact for stability on uneven terrain. The long-wheelbase ensures
stability in the standing position and on uneven terrain and
slopes. The big front castor wheel ensures that the SWC easily
moves over stones or potholes. The cambered (3 ) back wheels
N ¼ 24 enhance the stability of the SWC on side slopes. The pneumatic
tires reduce the propulsion effort and provide suspension. The
20 seat dump angle (6 ) is intended to prevent the chance of being
4 thrown out of the SWC on uneven terrain. The ground clearance
of the SWC is 115 mm. The solid back support ensures good pos-
2
5 ture while travelling outdoors over longer distances. Overall, the
5 robust nature of this SWC makes it suitable for outdoor use. But a
9 limitation is that the long-wheelbase, which improves propulsion
2 and stability outdoors, restricts manoeuvrability in cramped
1
19-63 indoor environments.
38.4
Customisability. The seat width of the SWC V5 can be chosen
4 from four different sizes based on the user’s hip-width. The seat
6
14
depth, footrest height, and knee block width and height are
adjustable based on the user’s height. The gas spring position,
adjustable to the user’s weight, enables a smooth transition
between the sitting and standing positions. The rear wheel pos-
ition is adjustable based on the desired propulsion. The backrest
height, backrest angle, and the lumbar supports are changeable
based on user comfort. To accommodate users of different limb
lengths, the seat depth is adjustable in the range of 350–450 mm.
Moreover, the centre of gravity is adjustable by changing the
rear wheel axle’s position back and forth across a range of
75 mm. This adjustability allows the wheelchair to be set appropri-
ately for individuals with good trunk balance and control in situa-
tions where wheel rolling resistance is lower, and effort to do a
wheelie to negotiate small bumps is lower. Similarly, it allows the
wheelchair to be set appropriately for individuals with poor trunk
balance and control to reduce the chances of toppling backward
in some situations. The SWC allows a user weight up to 110 kg
and is available in four sizes. Overall, integrating discrete adjust-
ability allows the SWC to be used by a wide range of users.
Customisability is key to ensuring affordability as discrete adjust-
ments are incorporated into mass-manufactured parts.
Portability. The SWC V5 is collapsible for ease in transportation.
The procedure to collapse the SWC starts with the removal of the
standing handle, followed by folding of the armrest and backrest,

Figure 12. The commercial SWC product, Arise, in the sitting (left) and standing (right) positions.
Table 6. Demographic data of safety test users.
Gender
Male
Female
Age
18–20
21–30
31–40
41–50
51–60
Range
Mean
Medical condition
SCI-cervical
SCI-thoracic T1–T5
SCI-thoracic T6–T12
SCI-lumbar
followed by removal of the knee support and the wheels. The
folded box dimensions of the collapsed SWC V5 are [l, b,
h] ¼ [1174, 600, 530] mm, which are comparable to those of
Motivation [27] [l, b, h] ¼ [1190, 540, 472] mm. However, to ensure
the affordability of the SWC, a trade-off was made between port-
ability and manufacturing cost of incorporating portability. In the
commercial version of the SWC V5, only the backrest is remov-
able. The folded box dimensions of the SWC product are [l, b,
h] ¼ [1220, 780, 763] mm. Seat width (b) would be of different
value based on the size of the wheelchair.
Aesthetics. The aesthetics of an assistive device is as important as
its functionality. The commercial version (named Arise) of the
SWC V5 ensures that the device is aesthetically pleasing. Figure
12 contains images of the Arise SWC in the sitting (left) and
standing (right) positions.
Safety study of the commercial product, Arise, was conducted
at St. John’s Medical College Hospital, Bangalore, after approval
by their ethics committee (IEC Study Ref. No. 223/2017). Thirty
participants used the SWC for six weeks (five participants per
week) within the hospital premises under the supervision of clin-
ical staff. The user demographics for the safety study are shown
in Table 6. After a 30-min interactive training session, the partici-
pants were asked to try certain general activities to get used to
the SWC as well as some functional activities. Based on the use of
the SWC, the participants responded to a Likert-scale
DESIGN JOURNEY OF AN AFFORDABLE MANUAL STANDING WHEELCHAIR 9
questionnaire. Details of the safety study are presented elsewhere.
Figure 13 contains tiled images showing the sequence of a par-
N ¼ 30
ticipant demonstrating the sit-to-stand (a–e) and the stand-to-sit
(f–j) operations using Arise. After the completion of the safety
25
5 study, Arise was launched in November 2019 by the industry part-
ner. R2D2’s journey did not end with the commercialisation of the
2 SWC. As part of the GRID model’s fourth pillar—Dissemination
13 [11], an Arise SWC awareness video and the forms required by
3
9 medical professionals to determine the suitability, prescribe and
3 check out the fit for Arise SWC have been prepared (see
18–55 Supplementary Information).
35.2
1 Conclusion
5
18 The 5-year design journey of a manual user-operated SWC that
6 accommodates users of different widths (360–480 mm), heights
(152–183 cm) and body weights (40–110 kg) and minimises user
effort is presented. The SWC design has been refined over time
through multiple iterations using inputs from users and clinicians,
conducting surveys, and studying its mechanics to improve the
ergonomics and reduce net user effort during the activity. Overall,
the SWC is robust, simple, easy to operate and customisable.
Most importantly, the SWC is affordable for a developing coun-
try—its exfactory price in India is INR 15,000 (about USD 210, at
current exchange rates). The affordability is not only a result of
the GRID model, which covered a majority of the R&D costs, but
also an outcome of incorporating customisability in a mass-manu-
facturable design. A lesson relearned during the SWC design jour-
ney was to engage with the end-users throughout the
requirement understanding, design, and test phases. The voice of
the end-user should be the guiding force for the product design.
Understanding their needs and the environmental constraints
they operate in necessitated innovations in the design that have
resulted in a US patent [28], and other patents pending.
Over 100 wheelchair users provided feedback on the SWC after
a hands-on experience with it. While the design has been tested
by users with different medical conditions such as SCI, post-polio
paralysis, cerebral palsy, muscular dystrophy, etc., the trials
showed that users with SCI are the most likely to benefit from
this device. The SWC product, Arise, was recently launched by the
industry partner. The commercialization of the SWC by the indus-
try partner demonstrates a success story of the GRID model in
translating assistive product concepts in an affordable manner
10 J. SHAIKH-MOHAMMED ET AL.
Figure 13. A participant demonstrating the sit-to-stand (a–e) and stand-to-sit (f–j) operations using the commercial product, Arise.
into the market. An awareness video and assessment, prescription,
and fit checkout forms have been made available for potential
users on the R2D2 website [29] to inform them of the product
capabilities and processes involved in its prescription and use.
This knowledge is critical since customising and ensuring fit is
essential for providing maximum benefit to the user.
Future work includes studying the QoL outcomes from long-
term SWC usage, the influence of the standing and propulsion
biomechanics on the elbow and shoulder joints, and the muscle
performance during these activities. Also in the pipeline is the
development of a SWC version with improved manoeuvrability for
indoor use. The COVID-19 (coronavirus) pandemic continues to
cause significant challenges in everyone’s lives. Due to this unpre-
cedented global crisis, remote user assessment is currently being
explored as an alternative to the conventional face-to-face
user assessment.
Note of caution
It is noteworthy that RESNA cautions that standing may not be
appropriate for all individuals, and a user must receive a proper
assessment. RESNA also warns that clinicians should consider cardio-
vascular, orthopaedic, and positioning implications before recom-
mending any kind of standing device to a client [3]. Nonetheless,
with appropriate dissemination and awareness [29], it is anticipated
that the affordable manual SWC presented here will immensely
benefit eligible users and make a difference in their QoL.
Acknowledgements
We gratefully acknowledge the help of Christian Medical College,
Vellore, Mobility India, Bangalore, Association of People with
Disability (APD), Bangalore, St. John’s Hospital, Bangalore, and all
other organisations/centres/institutions involved in the user test-
ing. We are thankful for the inputs and contacts enabled by the
Spinal Foundation, a pan-India self-help group for users with SCI.
We are grateful to every user who has bravely tried our device
and whose feedback has helped us make it to the product stage.
Disclosure statement
The authors report no conflict of interest.
Funding
We thank Wellcome, UK [grant number 105863/Z/14/Z] for fund-
ing the project and the partnership of Phoenix Medical Systems
in the development and commercialisation of this device, and
Tata Boeing Aerospace Ltd. for their support for the dissemin-
ation videos.
ORCID
Javeed Shaikh-Mohammed http://orcid.org/0000-0001-
9079-3101
S. Sujatha http://orcid.org/0000-0003-3456-1220
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