Technologies That Enable Mobility

Chapter objectives
• Identity the activity, human, and contextual influences on the use of wheeled mobility
• Describe the assessment of the client for a mobility system
• Describe the two primary structures of wheelchairs
• Identify the major characteristics of manual wheelchairs
• Describe the classifications of power mobility systems and their characteristics
• Understand the influence of the relationship between the center of gravity of the user and
the center of gravity of the wheelchair on the performance of the wheelchair
• Describe the key elements of implementation and training for the use of wheeled mobility
devices
• Identify standardized assessments that are specific to use of wheeled mobility devices
 Introduction
• Mobility is essential for an individual's quality of life and functioning in self-care, work or
school, and play or leisure activities.

• Limitations to functional mobility can be addressed through the use of assistive

technologies (ATs).

• Low-tech aids like canes, walkers, or crutches can augment the activity of ambulation.

• Wheeled mobility systems, such as manual and power wheelchairs, can replace the
activity of ambulation.

• Utilizing manual and power wheelchair systems can increase independence in mobility
and contribute to positive self-image, social interaction, and health maintenance.

• The chapter focuses on the delivery process of manual and power wheelchair
systems, including initial need identification, goal setting, assessment,
recommendation, implementation, and training.
 Activity components
• Personal mobility refers to the ability to move oneself within and between locations, distinct
from transportation.

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

mobility as an activity that encompasses moving within different locations, including
buildings, floors, and the community.

• The ICF also addresses transportation as part of mobility but excludes the use of mobility
devices.

• Lack of access to mobility devices can limit participation in society.

• Wheelchair skills are crucial for competent mobility and can be assessed using measures
like the Wheelchair Skills Test.
Wheelchair parts
 Activity components cont.
• Wheelchair assessment considers both occupations requiring seated support and
those necessitating mobility.

• Frequency of wheelchair use varies among individuals, from full-time to part-time or

specific situations.

• Independence in wheelchair skills and the need for assistance are important factors
in understanding mobility.

• Competent wheelchair users typically require assistance only in exceptional

circumstances.

• Understanding mobility includes knowledge of how wheelchairs are used and the
individual's proficiency in wheelchair skills.
 Human component

• The increase in individuals using mobility systems is attributed to

three trends:

– The growing proportion of older adults,

– Rising rates of obesity, and

– Accessibility legislation.
 Disorders Resulting in Mobility
Impairments
• Mobility impairments can result from various disorders, including neurological, musculoskeletal, and
cognitive conditions.

• Neurological disorders that may cause mobility impairments such as stroke.

• Orthopedic and rheumatological conditions such as arthritis, and scoliosis can also lead to mobility
impairments.

• Chronic conditions like diabetes, cardiorespiratory conditions, and obesity may require the use of
mobility devices due to fatigue or energy expenditure restrictions.

• Cognitive disorders such as Alzheimer's disease and cognitive impairment should be considered
when addressing mobility, as they can affect an individual's ability to learn and make judgments.

• The degree of mobility limitation can vary, ranging from individuals with no impairment to those with
severe limitations who are dependent on manual or powered mobility devices.

• Marginal ambulators can move independently but may benefit from part-time use of a mobility device
for certain situations.
• Manual wheelchair users may self-propel using different methods, while those unable to propel a
manual wheelchair may benefit from a power mobility device.
 Mobility Issues Across the Lifespan
• Powered mobility for young children is supported by recent literature, as it has physical, cognitive, and
social benefits.

• Providing mobility opportunities for children should happen at an appropriate developmental time,
focusing on movement within the environment and functional tasks.

• Comfort, safety, increased function, and security are important considerations for seating and mobility in
older adults in long-term care facilities.

• Mobility devices for older adults should be easy for attendants to use, and safety and security are
important for both the user and the caregiver.

• Obesity is a major health problem globally, and it can cause mobility impairments.
• Wheelchairs designed for bariatric clients, who are significantly overweight, have become a recent
development.

• Obesity is associated with diabetes, which further restricts mobility due to weight, low physical endurance,
cardiorespiratory complications, and other diabetes-related issues.

• Bariatric wheelchairs have higher weight limits to accommodate heavier individuals, ranging from 600
pounds to 1000 pounds (approx. 270-450 kg)
 CONTEXT COMPONENTS
Physical context:

• Indoor and outdoor use influence the type of mobility device recommended.
• Considerations include door width, floor surfaces, bathroom layout, and access to
structures like ramps or stairs.
• Outdoor surfaces, terrain, and obstacles impact tire choice and maneuverability.
• Climate affects device durability and performance.

Social context:

• Peers, family, and others influence the choice and use of mobility devices.
• Pressure or misconceptions may arise regarding manual vs. power wheelchairs.
• Accommodation by schools, workplaces, and community environments should be
considered.
Cultural context:

• Cultural values of inclusivity impact wheelchair use and recommendations.

• Availability, access, and fit of technology in the user's environment are important.
• Principles relevant to the provision of these devices:
– (1) the device is acceptable to the users and others in the environment,
– (2) users are able to access these devices,
– (3) the device is adaptable to the needs of the user and the context in which it will be used,
– (4) devices are affordable,
– (5) available, and
– (6) the device is of high quality

Institutional context:

• Regulations and policies influence mobility device recommendations.

• Funding criteria, eligibility, and performance requirements need to be considered.
• Institutional policies may affect wheelchair use and maintenance.
• Considering these contextual factors helps clinicians make appropriate mobility device
recommendations that align with the client's needs, environment, and societal factors.
 Assistive Technology
Characteristics of manual and power mobility systems:
• Modern mobility systems are flexible and adaptable to various functional tasks.
• Adaptations may include height adjustment, tilt, recline, axle position adjustment, and
combinations of these features.

Broad categories of wheeled mobility systems:

• Dependent mobility systems: Propelled by an attendant and include strollers, transport chairs,
and manual chairs pushed by an attendant.
• Independent manual mobility systems: Users can propel the wheelchair manually with two
smaller front wheels and two larger drive wheels at the back.
• Independent power mobility systems: Power wheelchairs driven by the user, suitable for those
who have difficulty propelling a manual wheelchair.

Commercial options:
• There are numerous commercial options available within each category to meet individual user
needs.
• Manufacturers listed in Table 11.1 offer personal mobility systems.

Wheelchair structures:
• Supporting structure: Provides stability and support for the user.
• Propelling structure: Enables independent or assisted propulsion of the wheelchair.
Supporting Structure:
- The supporting structure of the wheelchair includes the frame, attachments, specialized
seating, and positioning.
- Accessories like armrests and footrests are part of the supporting structure and can be
customized for the user.
- Some supporting structures are adjustable and offer features like tilt or standing support.

Frame Types:
- Frames can be folding or rigid.
- Common frame styles include box, cantilever, and T or I frames.
- Box frames provide a strong and durable base, while lighter-weight designs use cantilever
structures.
- T or I frames have a bar attached to the center of the cantilever and form a T or I shape
under the seat.
- The choice between rigid and folding frames depends on factors such as the user's needs,
functional ability, and method of transfer.
Position of the Axle:
- The position of the axle of the rear wheel relative to the user's center of gravity affects
wheelchair stability and maneuverability.

- When the center of gravity is forward of the drive wheels, the chair is more stable but less
maneuverable.

- Moving the center of gravity closer to or slightly behind the drive wheel axis increases
maneuverability but decreases stability.

Wheelchair Frame Materials:

- Wheelchair frames are made from various materials such as steel, aluminum,
steel/aluminum alloy, titanium, and carbon fiber composites.

- Different materials have varying weight, strength, cost, vibration conductivity, component
attachment methods, and forming techniques.
Folding vs Rigid Manual Wheelchairs
 Wheelchair Classifications
Standard Wheelchairs:
• - Folding steel chairs with limited adjustment.
• - Fixed axle of the rear wheel.
• - Limited choice of seat width and depth.
• - Heaviest of the manual wheelchairs.
• - Not suitable for long-term use due to high energy requirements.

Lightweight Wheelchairs:
• - Usually made with steel/aluminum alloy frames.
• - Weigh less than standard wheelchairs.
• - More flexibility in seat width and back height adjustment.
• - Lower seat-to-floor height for foot propulsion.

Ultra-Lightweight Wheelchairs:
• - Substantially lighter than standard wheelchairs.
• - Retain folding frames and offer lower seat-to-floor height.
• - Adjustable axle of the rear wheel.
• - Considered most appropriate for primary means of mobility.
Rigid Sport Ultra-Lightweight Wheelchairs:
• - Rigid frames usually made of titanium or carbon fiber composites.
• - Quick-release rear wheels and foldable back for transfer and storage.
• - Adjustable axle of the rear wheel.
• - Growing trend in the wheelchair industry.

Tilt and Recline Frames:

- Provide the ability to change seating position.
- Tilt rotates the seating position around a fixed axis.
- Recline changes the seat-to-back angle, offering greater than 90 degrees.
- Benefits include pressure relief, improved circulation, postural control, and respiratory
function.
- Shear forces and considerations for individual needs and limitations should be taken into
account.
Seat-to-Floor Height:
- Important for accessing tables, counters, and the floor for foot propulsion.
- Height should allow knees to fit under tables or desks.
- Lower seat-to-floor height allows walking feet on the floor while propelling the chair.

Integration with Assistive Technology:

- Tilt and recline options should be integrated with other assistive technologies.
- Consideration for head array controls, ventilators, and transportation methods.
 Standing Frames and Standing
Wheelchair
• Standing frames and standing wheelchairs provide the option of placing an individual in a
standing position, offering physiological and psychological benefits.

• Standing frames include prone standers, supine standers, upright standers, and mobile
standers. They provide support and weight-bearing on different parts of the body.
– Prone standers are the most common type and tilt forward to use gravity to assist in
maintaining an upright position. They often have a lap tray for support and activities.
– Supine standers support the posterior surfaces of the body and are useful for individuals
with poor head control.
– Upright standers allow for complete weight-bearing on the lower extremities.
 Upright
standers

Prone standers Supine standers

• Standing wheelchairs have functional and social benefits. They simplify tasks of daily
living and allow individuals to be at the same level as others, improving psychological
well-being.

• Standing wheelchairs come in manual-driven and power-driven configurations, with

different mechanisms for raising the person to the standing position. 3 types:
– Manual driven with a manual lifting mechanism,
– Manual driven with a power lifting mechanism, and
– Power driven with a power lifting mechanism.

• Stability in the upright position is a concern with standing wheelchairs, and some models
are not mobile while in the standing position.

• Frames with variable seat height, such as elevating seats on power wheelchairs, offer
advantages for different activities and environmental accommodations.

• Frames that accommodate growth are important for pediatric wheelchairs and can be
adjusted directly or through the use of replacement kits.
 Accessories for Wheelchair
• Accessories for wheelchairs include armrests, legrests, footplates, wheel locks, anti-tip devices,
push handles, and upholstery options.

– Armrests can be fixed, flip-back, or removable, with different lengths and adjustable
heights. They provide support and facilitate transfers.

– Legrests and footplates support the legs and feet, with options for angle adjustment and
swing-away features for easier transfers. (90-degree or 70-degree hangers)

– Wheel locks prevent wheel movement during transfers and other stationary activities, and
their design should be selected based on user preferences and needs.

– Anti-tip devices enhance stability and prevent tipping backward, particularly when the drive
wheels are located forward on the chair.

– Push handles assist caregivers in maneuvering the wheelchair and come in different
shapes and materials for improved grip.

– Upholstery options vary depending on the intended use of the wheelchair, with seating
systems being more common for regular, long-term use.
 Propelling Structure: Manual
Tires:
• Three main types: solid, semipneumatic, and pneumatic.
• Solid tires require less maintenance but are less versatile.
• Pneumatic tires are useful over varied terrain but require maintenance and can be punctured.
• Tire pressure maintenance is important for energy efficiency and preventing flats.
• Tread depth affects performance on different surfaces.

https://www.youtube.com/watch?v=A5a7duLYfdg

Wheels:
• Rear wheels can be composite or spoke.
• Composite wheels are more economical and require less maintenance but may provide a less
comfortable ride.
• Spoke wheels transmit less vibration and are lighter but require more maintenance.
• High-performance wheels are available for active users.
• Wheel size ranges from 18 to 26 inches.
• Adjustable wheel position affects maneuverability and stability.
• Camber and alignment impact chair responsiveness and rolling resistance.
Casters:
• - Front wheels are called casters.
• - Caster size affects ride quality and responsiveness.
• - Excess weight on casters can make propulsion difficult and affect stability.
• - Shimmy and caster float are maintenance issues that can affect performance.

Hand Rims:
• - Hand rims are the interface between the user and the wheel.
• - Made from materials like titanium, aluminum, and stainless steel.
• - Ergonomic designs provide a natural fit with the user's palm.
• - For users with one functional arm, a linkage connects the hand rims to allow forward
movement and turning.
 Propelling Structure: Power
• - The propelling structure of power wheelchairs consists of a wheeled mobility base, power
drive to the wheels, control interface, electronic controller, and power accessories.
• - Power wheelchairs can be classified as rear-wheel drive, mid-wheel drive, or front-wheel
drive based on the location of the drive wheels.
• - Rear-wheel drive chairs have the drive wheels located in the rear, while front-wheel drive
chairs have them in the front.
• - The location of the drive wheels affects the wheelchair's performance on inclines, rough
terrain, and when turning corners.
• - Control interfaces for power wheelchairs include proportional control with a continuous
joystick and nonproportional control with a discrete joystick or switches.
• - Proportional control allows for 360-degree directionality and speed control based on joystick
displacement, while nonproportional control offers limited movement in one direction at a time.
• - Common methods of control include a four-direction continuous joystick, touch pad control,
sip-and-puff switches, and head control systems.
• - Joysticks can have different handle variations, such as a U-shaped cuff or extended
joystick, to accommodate different grasping abilities.
• - Touch pad control involves moving a finger on a touch pad to determine the direction and
speed of the wheelchair.
• - Sip-and-puff switches use air pressure from the mouth to control the wheelchair's
movement.
• - Head control systems use electronic switches in a head array, allowing users to control
the wheelchair's movement by tilting or moving their head.
• - Scanning is an option for clients who can only use a single switch, where lights
representing different directions are scanned and activated by pressing the switch.
• - Single-switch scanning can be time-consuming and demanding, and it may require
additional steering switches for correcting the wheelchair's direction of travel.
Power Wheelchair Controllers:
• - Controllers connect the control interface to the drive system in power wheelchairs.
• - Proportional drive systems use joystick deflection to determine the voltage supplied to
the motor, allowing for gradual acceleration.
• - Momentary control activates the motors only while the switch is pressed, while latched
control keeps the motors on after a single press and turns them off with another press.
• - Controllers are programmable, allowing for adjustments such as forward and reverse
speed, turning speed, and sensitivity to accommodate tremors.
• - Short throw adjustment is a feature that alters the range of motion required to operate a
control interface, useful for users with limited range.
• - Computer-based controllers allow for the storage and recall of parameter setups for
different situations or clients.
• - Controllers can operate different functions or external devices with the same control
interface, allowing for versatility.
Batteries:
• - Gel batteries are commonly used in power wheelchairs and do not require maintenance
like regular discharge or memory conditioning.
• - Battery capacity is measured in ampere-hours and can range from 30 to 90 Ah at 12
volts.
• - Battery life and performance are influenced by motor type, environmental conditions,
and maintenance.
• - Proper battery chargers specific to the battery type must be used.

Ventilators:
• - Ventilators used for respiratory support must be considered in terms of placement and
movement in power wheelchairs.
• - Ventilators can be mounted low on the chair base or on an articulating frame attached to
the back uprights.
• - Fixed mounts maintain the ventilator's orientation congruent with the wheelchair seat,
while articulating mounts accommodate tilt and recline functions.
• - Ventilator placement should keep it out of the way of chair batteries and ensure proper
orientation.
 Specialized Bases for Manual
•
Wheelchairs
- Dependent mobility bases for manual wheelchairs are designed for users who require
assistance from caregivers. They have unique structural and propelling characteristics.
• - Stroller bases, similar to those used for young children, are lightweight and easily
maneuverable. They may lack sitting support and often have a reclined position.
• - Transport wheelchairs are designed for occasional use and short-term situations. They
are lightweight, durable, and not intended for long-term seating and positioning.
• - Manual wheelchairs for older clients should consider age-related disabilities and visual
changes. The setup should optimize stability, mobility balance, and access to drive wheels
and hand rims.
• - Some chairs for older clients have rocking and tilt features, which can provide a
calming effect for agitated individuals.
• - Wheelchairs for bariatric clients are designed to accommodate higher weight
capacities. They may have adjustable seat depth and width, as well as options for tilt.
• - Fitting a wheelchair for a bariatric client requires consideration of soft tissue distribution
and accumulation, and adjustments may be needed for proper support and comfort.
 Specialized Bases for Power
Wheelchairs
• - Scooters are a popular choice in the power wheelchair market, especially for individuals who
conserve energy and need mobility assistance outside the home.
• - Scooters come in three- or four-wheel versions with front-wheel drive or rear-wheel drive.
Front-wheel drive scooters are more maneuverable and perform better in small spaces, while
rear-wheel drive scooters offer better traction and power for handling inclines and rough
terrains.
• - Scooters are steered using a tiller-type control, and acceleration is achieved by grasping a
lever or pressing with the thumb. They have adjustable tiller height and angle, as well as
proportional or switched control for adjusting the speed.
• - The seat of a scooter is typically a bucket type with limited options for customization. It can
swivel to the side for transfers and accessing table surfaces.
• - Scooters are lighter, can be disassembled for transportation, and are more cost-effective
compared to other power wheelchairs. However, they have limited control flexibility, provide
inadequate postural support, and require sufficient trunk and upper extremity control.
• - Power-assist mechanisms, such as push rim-activated wheels, are designed to assist individuals
with shoulder pain who have difficulty propelling a manual wheelchair but prefer not to use a power
wheelchair. These wheels have a motor in the hub that provides assistance when the user applies
force to the hand rims, particularly when going uphill. The motors engage and help propel the
wheelchair, and assistance is provided for both forward and backward motion.
• - Magicwheels™ is a product that offers geared technology for manual wheelchairs. It provides a
selection of two gears, with the second gear offering a 2:1 mechanical advantage. Users can easily
change gears by adjusting the housing on the wheel's hub. Magicwheels™ are particularly useful on
inclines as they assist with propulsion uphill and provide braking when descending.
• - Studies have shown that Magicwheels™ can help reduce shoulder pain and improve uphill travel
endurance. They require sustained muscle effort but offer benefits in terms of reduced muscle and
shoulder flexion effort when ascending ramps.
• - Further research is needed to investigate the effects of Magicwheels™ on propulsive efforts in
wheelchair users ascending ramps.
 SMART WHEELCHAIRS
• - Smart wheelchairs are designed to incorporate smart technology, such as sensors and
computers, to provide additional options for individuals who have difficulty controlling a
wheelchair through traditional means.
• - These wheelchairs can be either standard power wheelchairs with added sensors and a
computer or mobile robot bases with a seat attached.
• - Smart wheelchairs typically offer collision avoidance and navigation functions. Sensors
detect obstacles in the wheelchair's path and can slow down or stop the chair or provide
warnings to the user. The sensors can also guide the wheelchair along programmed paths or
through features like doorways.
• - Shared control systems are available, where control is divided between the user and the
onboard computer, allowing users to retain some control. Autonomous control systems involve
the onboard computer assuming full control of the wheelchair.
• - Various types of sensors, including infrared, sonar, laser range finders, and computer
vision, can be used to guide the wheelchair.
 ASSESSMENT FOR WHEELED
MOBILITY
The assessment for wheeled mobility involves considering various factors, including human
factors and the context of the individual. Some key points to consider are:

1. Human Factors:
• - Living situation, accommodation type, and whether the client is alone or with others.
• - Diagnosis and the duration of the impairment (acute, long-term, stable, or progressive).
• - Existing technology and age of the client.
• - Changes in motor function, fatigue, loss of ability to control the wheelchair, or cognitive
decline.

- Physical Evaluation:
• - Measurements of weight, leg length, thigh length, back height, and hip breadth.
• - Changes in weight or posture indicating the need for adjustments in the wheelchair and
seating system.

- Mobility Goals:
• - Determine the activities the individual wishes to engage in while using the mobility device.
• - Assess the level of assistance required and the interface with other technologies.
- Physical and Sensory Skills:
• - Evaluate range of motion, motor control, strength, vision, and perception.
• - Determine the optimal control site and interface for propelling the wheelchair.
• - Consider visual-perceptual changes resulting from stroke or other conditions.

- Wheelchair Skills Evaluation:

• - The Wheelchair Skills Test (WST) is a standardized measure of various wheelchair skills.
• - Assess the individual's ability to perform basic and advanced wheelchair skills.
• - The WST has a developed training program available at www.wheelchairskillsprogram.ca.

- Power Mobility Considerations:

• - Power mobility may be suitable for individuals with severe mobility limitations.
• - Control interfaces enable individuals with limited movements to operate powered wheelchairs.
• - Perceptual, cognitive, and behavioral impairments may affect the use of power wheelchairs.

It's important to conduct a comprehensive assessment that combines the considerations for wheeled
mobility with the assessment of seating components to ensure an appropriate match for the client's needs
and skills.
 Physical Context:
• - Clinician should visit the client's home and other relevant environments to assess limitations for
wheelchair use.
• - Questions about transportation should be included to ensure compatibility between the
wheelchair and the mode of transportation.

Social Context:
• - Identify caregivers and assess their ability to support wheelchair use, including transfers,
propelling the wheelchair, lifting and moving it, securing it in a vehicle, and providing routine care
and maintenance.
• - Educate caregivers, especially if multiple caregivers are involved.
• - Consider the influence of others in the environment, such as employers and school personnel,
regarding their knowledge and attitudes towards wheelchair accommodation.

Institutional Context:
• - Familiarize oneself with policies, legislation, and regulations related to funding, access, and
wheelchair use.
• - Understand institutional elements that may impact wheelchair acquisition and use before making
recommendations and providing supporting documentation for funding.
IMPLEMENTATION AND TRAINING FOR
MANUAL AND POWERED MOBILITY
• - Implementation and training are crucial for the successful use of assistive devices,
including mobility systems.
• A fitting appointment should be held with the client and caregiver to make any
necessary adjustments to the wheelchair and ensure it meets the original objectives
outlined during the assessment.
• - During the fitting process, important features of the chair should be demonstrated to
the user and caregiver, and instructions for maintenance should be provided.
• - Wheelchairs often have adjustable components that may require modifications by the
provider to fit the chair to the user's needs.
• - Adjustments such as axle position, wheel camber, wheel alignment, seat angle, back
height and angle, and leg rests should be made carefully to ensure user comfort, safety,
and performance.
• - Users are responsible for keeping the wheelchair clean, tires properly inflated, brakes
adjusted, and conducting regular inspections.
• - Power wheelchair users should conduct regular battery maintenance and ensure proper
charging.
• - Wheelchair users should monitor or have regularly monitored items such as tire
condition, brake function, and overall wheelchair condition.
• - The user manual for the wheelchair will provide guidance on scheduled periodic
inspection and maintenance.

• Proper implementation, fitting, and ongoing maintenance are essential for maximizing
the performance and satisfaction of individuals using manual and powered mobility
systems.
 Developing Mobility Skills for Manual
and Power Systems
• - Training in mobility skills can occur before or after the delivery of the final wheelchair to the
client.
• - A trial period may be necessary to determine the most suitable wheelchair and the client's
ability to operate it.
• - Training during the trial period helps assess if the person can develop the skills to use the
wheelchair effectively and safely.
• - Setting specific, measurable objectives for training is important for both manual and power
mobility skills.
• - Basic manual mobility skills include maneuvering indoors, navigating tight spaces, and
traversing different surfaces.
• - Advanced manual mobility skills involve negotiating rough terrain, ramps, curbs, and
performing wheelies.
• -
• The Wheelchair Skills Program (www.wheelchairskillsprogram.ca) offers a well-researched
training program for wheelchair users, covering basic and advanced skills for both manual
and power mobility.
• - Power mobility training for young children focuses on enabling the experience of
movement rather than teaching specific skills.
• - The three phases of power wheelchair use by children are exploration, use of wheelchair
functions, and use of the wheelchair for functional activities.
• - Current practice guidelines recommend offering power mobility opportunities to children
as soon as they show an interest in movement.
• - Play and allowing the child to move freely in a safe environment facilitate exploration and
learning of power mobility skills.
• - As the child becomes more confident, they gain direct control over the wheelchair and
develop subskills that enable them to complete daily activities while moving independently.
 OUTCOME EVALUATION
• - There are several instruments available to evaluate the outcome of wheeled mobility
intervention, including the Assistive Technology Outcomes Profile-Mobility, the Functional
Mobility Assessment, the Functioning Everyday in a Wheelchair Instrument, and the Wheelchair
Outcome Measure.
• - The Nordic Outcome Measure and the Wheelchair Use Confidence Measure are newer
instruments that are still undergoing research and development.
• - The Participation and Activity Measurement System (PAMS) is a system that uses sensors
and a GPS system attached to the user's wheelchair to collect objective data about their
activities and context of wheelchair use.
• - Research has been conducted to evaluate different aspects of wheelchair use, such as
propulsion techniques, wheelchair setup, and wheelchair training programs.
• - In children with cerebral palsy, the use of manual and/or power wheelchairs increases with age
and severity of the condition. Wheelchair use indoors and outdoors varies, with some children
being pushed by an attendant and others using manual or power wheelchairs independently.
• -
• Power mobility devices can benefit children with disabilities who are unable to walk, are likely to
lose the ability to walk, or for whom walking is inefficient.
• - Studies have shown some evidence for beneficial outcomes related to mobility device use in
children, including improved social and play skills, better independent and functional mobility,
enhanced communication, decreased need for caregiver assistance, lower caregiver stress, and
greater parental satisfaction.
• - Studies with adults who use wheelchairs have focused on the influence of mobility device use
on participation. Research has been conducted with older adults, stroke survivors, individuals
with multiple sclerosis, and individuals with spinal cord injury.
• - The findings from these studies converge on key themes related to the benefits of mobility
device use in terms of enhancing participation and improving various aspects of function and
quality of life.
• - The review provided in the text is not exhaustive, but it highlights the importance of mobility
device use in facilitating participation and improving outcomes for individuals with mobility
impairments.