Standardized Wheelchair Assessment Towards Practical Wheelchair Design Ruwaidy Mat Rasul, Ph.D. Faculty of Innovative Design Technology, Universiti SUltan Zainal Abidin (UniSZA), Terengganu, Malaysia
[email protected] Keywords: Wheelchair Assessment Forms, Wheelchair, Quality of life, Handicapped
Abstract The wheelchair has become a main assistive tool for a person with mobility impairment in assisting them to perform daily life activities, and thus maintaining their quality of life. Without a correct wheelchair prescription, the users will suffer in term of ability functionality, physical deformities and overall, affect the user’s quality of life. As a result, the wheelchair assessment is vital in prescribing towards persons of mobility impairments in determining the suitable types of wheelchair. Moreover, their needs and requirement needs to be included within the prescriptions in relation to their physical ability and limitations. As recommendations, a standardized assessment formats as a guideline has to be created in obtaining vital information’s in prescribing prescriptions. Furthermore, a proper guideline (pocket books) for prescribers / users/ organizations provided with information’s regarding types of impairments to co-relate with types / accessories of wheelchair in term of suitability and costs needed to be produced. Introductions The needs to perform an assessment of the level of disable and physical ability are important for persons with mobility impairment before selecting appropriate wheelchairs. [1] Moreover, wheelchair assessment also involve in taking the personal information while evaluating the level of disability [2] that the process of selecting a wheelchair is a matter of a burden, especially for a new person. On the other hand, [3] the familiarity of wheelchair-bounded person whom are already in a rehab centre may be used to the sensitive questions asked during the participation. The need to have a consultation before getting a wheelchair is crucially important because the right type of chair is a ‘liberator’, not a prison. [4] Evaluation is carried out should be done by people who really experts and knowledgeable in this field and should also fully participated by the client (PWD) to make it work. [5] Wheelchair and Users; both has a connection. But the main question is; how does it affect their quality of life? In answering this, that [6] the design of a wheelchair sometimes give 'unpleasant emotional impact’ to the user experience. Therefore, wheelchair users should be given the opportunity to choose what they should wear (use). This is because the wheelchair designs available were featuring an ergonomic towards consumer demand, usability and technology. In this case, the focus of ergonomic wheelchair masterminded by the basic design; prevention of unsafe, uncomfortable or inefficient situations including working environment and daily life activity [7]. Furthermore, each design includes equipment and task requirements of users, which is part of the ergonomic optimum principles. [7] World Health Organzations of Quality of Life [8] has come out with a universal domains and facets in the instruments for quality of life assessment which shown in Table 1. The domains listed are the most ‘cross-culturally valid’ as it is have been developed in more than 20 countries. (ibid) Even though it seems like been made up from a ‘complex mix of domain factors’, to show the validity, its still can shape up any individual’s perception of their QOL. [9]
Table 1: Three Levels of Human Function by ICF A problem in bodily function 1 Body function and structures 2 Activities
Limitation in executing activities; e.g., walking or personal care
3 Participation
Restriction in life situations; e.g., going on holidays, labour etc
The study used some of the domains that focus on identifying the existing wheelchair design that affects the physically handicapped. These domains enable us to understand the ‘level of independence, the user’s feelings and managing quality of life’. [10] The understandings are towards the quality of life of for the wheelchair users to focus on their daily activities management. As the study focuses in the usage of assistive devices for people with physical disabilities, it is the result of automobile accidents, illness or since one is born. When the need is not meeting the requirement, people with physical disabilities are isolated and give a challenge to the same opportunities as others within their own communities. A possibility for injury caused by not doing wheelchair assessment is a risk that must be faced by wheelchair users. As shown in Table 2, based on interviews done in local’s government hospitals, there must be consequences if not performing an assessment; Table 2: Consequences if not performing a wheelchair assessment Participants Consequences A Wheelchair not suitable (functions) Inconvenient B Worsen the users condition Cause more harm C Not worth of money buying any wheelchair Lost of money buying wheelchair D Users conditions is less recover E Not meeting the level of comfort
Research Methods Every methods employed in the study are clearly identified in order to gain validity towards its data. Therefore, before any methods being employed, the quality criteria has been sought which any of information driven by research collection must serve the primary users [11] which in this particular study would be the end user; wheelchair users. This is to create a ‘trustworthy’ and ‘credible’ data, which later on helps to strengthen the findings. (ibid) With that, the researcher has come out a proper approach techniques towards the wheelchair users, which shown in Plate 1. With these techniques, the researcher was able to approach the wheelchair users to get trust before they are ready to share their experiences. Although it takes more time to deliver, these techniques were only applied to the mentioned wheelchair users. To be adding with, Table 3 shows the methods employed with objective justifications.
Plate 1: Approach Techniques to Get Trustworthy and Credible Data Table 3: The Methods Employed With Objective Justifications Methods Employed Objectivity To find the challenges faces by person with mobility Survey impairment Quantitative To indicates social life situations of wheelchair users To clarify the needs and expectations of wheelchair users To identify types and models of wheelchair To explore the findings from surveys Interview Qualitative To investigates the fact and figures derives from surveys To clarify and support the initial findings Observation To identifying a problem in terms of usability Qualitative To analyzing the practicality of wheelchair design
In some ethical issues cases, there are some examples involving un-ethical activities in research including; violating non-disclosure agreements, breaking participant’s confidentiality, and misrepresenting results. Un-ethical researcher may do such things in order to get something that’s might blocking up their data. The execution of the research ethics is important since the subject being studied is people with disabilities to which the appearance and sensitivity of the subject matter has to be taken care delicately besides obtaining data that are clear and thorough. Moreover, the finalized and well plan study will ensures the overall outcomes can be achieved accordingly. Moreover, the studies should be possible to detect: The role of wheelchair users towards quality of life The wheelchair design suitability regarding wheelchair assessment done The quality of wheelchair assessment from organizations in providing services towards the needy Findings The wheelchair users faced obstacles other than their limited ability. The survey question was asked from experienced participant and participants new to using wheelchairs. This is important in making the distinction between new and existing users to assess the quality of their lives. Most wheelchair users found experienced after more than 5 years of use. Based on chart 1, years of experienced using wheelchair gives useful lessons for survival. More than 75% of participant has more than 10 years of experience which indicates that the data received in term of reliability cannot be doubt. Caused from various types of disabilities, these participants has useful
information for the purpose of finding problems and challenges faced since using the wheelchair. While 19.6% of participant is expected as a new user experiences one year or less using wheelchair as a method of mobility. Moreover, beginner and experienced participant providing very useful information regarding their methods towards improving their quality of live.
11%
19%
20%
2%
One year or less 48%
3 years 10 years
20 years More than 20 years
Chart 1: Participant experience using wheelchair
Whilst the Table 4 shown the wheelchair that may suit their daily activities performances, it's a conclusion of comparison between manual and motorized type of wheelchair that participants prefer towards manual wheelchair. This is probably because most of the participants are more likely is an active user. Table 4: The most needed wheelchairs among participant Manual type of wheelchair Non-motorized Customized Sports* Reclining* Custom lightweight* 67.4%
Motorized type of wheelchair
Not Ascertain
Battery operated
n/a
30.4%
2.2%
Total: 100% Note: * Opinion from ‘Other’
While, 30.4% prefer to be seated on a battery-operated wheelchair (motorized), 17.4% participant required custom design chairs (specialized). Those who are required these types of wheelchair probably an active user which are looking forward to modify their wheelchair as simple as it could. On the other hand, a participant who is requires a sports chair might be an athletic user or else who are normally doing an exercise to maintaining their health along with their quality of life. To do that, consumers should seek advice from the experts; consult with a doctor, occupational therapist or physiotherapist before deciding to use any type of wheelchairs. This contributed to a 23.9% usage customs design wheelchairs. Experienced users provide important information in determining the appropriate level of comfort of their wheelchair. This information is important as it can be used for evaluating the effectiveness of the wheelchair prescribed by a doctor or professionals towards them. For experienced participant, they can assess the extent of the comfort level of the chair they have been
use before. Varieties of opinion from participant about their comfort while on wheelchairs are available. On the other hand, experts in wheelchair assessment suggest that the evaluation in wheelchair assessment may divide into to two as shown in Table 5; Table 5: Two types of assessment done in local hospitals Focusing on stroke, elderly, fracture, mild Standard wheelchair prescription spinal cord injuries Permanently or temporarily use Focusing on customization Seating and positioning Mentally and physically handicapped Permanently use
In relation with, the procedures of assessment will be start off with measuring the patients physicals that is done by Occupational Therapist (OT) and doctors in various fields. The basic measurement is to ensure the sizes of wheelchair that can be fitted the user’s physicals shape. Moreover, it will considering the extra accessories that will be useful to ensure user’s comfort level while sit on it. Furthermore, as a part of assessment, the initial evaluations also need to consider the deficits performance; i.e., physicals, psychosocial impairments. (ibid) These are the roles played by occupational therapist towards persons with disabilities. Most of the time, the occupational therapists are the one responsible to conduct an assessment with the referral from doctors. Moreover, doctors as well as occupational therapist can perform an assessment whereby it depends on cases. Wheelchair assessment for paraplegic persons has been developed for the use at Pusat Latihan Perindustrian dan Pemulihan [Industrial Training and Recovery Centre] or PLPP Wheelchair Workshops based on the forms developed here. The Borang Tempahan Kerusi Roda [Wheelchair Ordering Form] and Borang Penilaian / Pengukuran [Assessment / Measurement Form] have been used to cite the client. (Refer Plate 2)
Plate 2: PLPP Original forms of Wheelchair Ordering and Assessment / Measurement Source: PLPP Bangi
Conclusion and Recommendation Thus, in order to make the forms reliable and easy to use, both of the separated forms than combined into one set known as a Borang Pengukuran Kerusi Roda [Wheelchair Measurement Form] V5. However, the Maklumat Peribadi [Applicant Particular Details] section is not to be amendment due to the important to have the applicant’s details. Hence, this section been improve with other information requirements such as; A medical summary and history (primary diagnosis), Physical Ability Status, Wheelchair Type to Suggest and Proposed Parts in Enhancing Quality of Life. Most of the client will be prescribed earlier by any hospitals/medical centre. With the supported information given, it will be easier for the wheelchair maker to fabricate a new or customs type of wheelchair. Nevertheless, the Assessment / Measurement Form being upgraded towards more user friendly and easy to be use by any person of in charge. The types of measurement have been included with a simple wheelchair assessment involves the measurement of several parts of patient’s body. The minimum measurements include within five areas; seat width, seat length, popliteal height, armrest, back rest pipe (mid-shoulder height) and hanger length. An additional measurement needed as the patients/wheelchair user required custom design regarding their physical ability which is; in between mid-shoulder height to head height and sitting height (from seat to head height) as shown in Fig. 1.
Fig. 1: Sample of minimal measurement counterpart from Wheelchair Assessment Form. A: Seat width, B: Seat length, C: Popliteal height, D: Armrest, E: Back rest pipe (mid-shoulder height), F: Hanger Length,
Furthermore, the Lakaran Kerusi Roda [Wheelchair Sketch] section has been upgraded with an illustration of wheelchair as shown in fig. 2. The illustration completed with the specification provides easier steps to fill up the forms. Thus, it will reduce the chances of error in extracting measurements from any clients. Moreover, the section also has been improved with requiring optional information such as; choices of colours or any additional accessories needed. This will enhance the usability of the wheelchair with the additional items that the user might need and require. The standardized formats in evaluating wheelchair users need to be constructed. With this idea, all the professionals will have good communications among their community towards the understanding, requirements and issues related with the assessments. Moreover, the issues related with the types of wheelchairs within current market can be disclosed. Hence, this can prevent a certain individual or company from dominating the wheelchair markets. Besides, to ensure the successfulness in standardizing the formats into reality, all the professionals have to have the consensus in realizing this matter.
Fig. 2: Wheelchair specifications replacing the Wheelchair Sketch section As suggests, the assessment needs to be done in two way communications; between the prescription prescribers and the persons with mobility handicapped. In addition, the wheelchair users needed to understand the act of not being assess will affect their performance. Thus, it will jeopardize their precious quality of life. Furthermore, the assessment is a platform where both parties disclose the suitability of any types of wheelchair accordingly with the ability, physical forms and requirements from users. In performing the assessment towards the physically handicapped, two types of separated evaluation need to be done; Physical Assessment and Wheelchair Assessment as shown in Table 6. With the categorizations of the wheelchair users, it is easier for both parties to identify the suitable types of chairs to select with. Moreover, any issues influencing the selection of a wheelchair will discuss within the assessment.
Table 6: The Physical Assessment Types of Assessments Occupational Performances
Series One Mobility
Series Two
Performance
Purpose
Target Market
To see the ability to performing any work (upper extremities) To see the ability to manoeuvre / handling a wheelchair The ability to perform daily life activities To categorizing; active or non-active user To see the ability to move Will involve thorough assessment; - functional motor - muscle strength - cognitive dysfunction - etc
Moderate types of mobility impairments
Severe physical handicapped (non active) -some may require an assistant
Table 7: The types of wheelchair to be included in the Wheelchair Assessment Types of Wheelchairs
Users Suitability (MYR)
Standard
Indoor Use To Perform ADL Needed assistance to transport
Lightweight
Indoor Use and Outdoor use To Perform ADL Recreational activities Easy to transport Some will require assistant to transport
Ultra Lightweight
Indoor Use and Outdoor use To Perform ADL Recreational activities Easy to transport Totalled self independence
Manual
Standard
Motorized Scooter
Commode
Price Range
Criterion of Wheelchair
Shower Toileting
Indoor and Outdoor use Customized chair Can be transported Speed: 6 – 8 km/h Indoor and Outdoor use Swivel chair Can be transported Speed up to 8 km/h
Indoor Use only
Wheelchair Accessories (excluded)
250.00 – 950.00
750.00 – 3,000.00
3,500.00 – 15,000.00
7,500.00 – 10,000.00
6,500.00 – 12,000.00 350.00 – 1,550.00
Seating management High range Medium Low range
Based on table 7, the types of wheelchair be selected is the commonly used by the person with mobility impairment. Generally, the wheelchair assessments are towards the new wheelchair user or for persons who is requiring a wheelchair, as causes to be using mobility equipment are various. Moreover, the user’s suitability wills be the key point towards influencing the particular person to make a selection. Furthermore, the price ranges (always need updating) will be the directed accordingly with their financial justifications. In addition, the accessories will be the extra parts for the users to include within the assessment session. With the inclusion of basic general information on the types of wheelchair, it will likely be the greatest influence towards the selection and requirements of wheelchairs. Altogether, there are various types of assessment needed towards the physically handicapped. The recommendation is more towards scope of the mobility impairment issues. With that, from the recommendations and suggestions for types of wheelchairs towards the persons can be concluded, the users as well can state from their point of view; i.e., types of wheelchair, units required and specific brand in mind. References [1] Mayal, J.K., and Desharnais, G. (1995) Positioning in a Wheelchair: A guide for Professional Caregivers of The Disabled Adult. Second Edition. SLACK Incorporated, New Jersey [2] Karp, Gary. (1998) Choosing A Wheelchair; A Guide for Optimal Independence. O’Reilly & Associates, Inc., California [3] Cooper, R.A. (1998) Wheelchair Selection and Configuration. Demos Medical Publishing, New York [4] Karp, Gary. (2009). Life on Wheels: The A to Z Guide to Living Fully with Mobility Issues, Second Edition. Demos Health, New York [5] Trefler, E., Hobson, D.A., Taylor, S.J., Monahan, L.C., and Shaw, C.G. (1993) Seating and Mobility for Persons with Physical Disabilities. Therapy Skill Builders. [6] Desmet, Pieter, and Dijkhuis, Eva. (2003). Wheelchairs can be fun: a case of emotion-driven design. Proceedings of the International Conference on Designing Pleasurable Products and Interfaces, June 23-26, 2003. Pittsburgh, Pennsylvania, USA. ACM Publishing, New York [7] Dul, Jan and Weerdmeester, Bernard. (2001) Ergonomics For Beginners: A Quick Reference Guide, Second Edition. CRC Press. [8] WHOQOL. (1997). Measuring Quality of Life. Division of Mental Health and Prevention of Substance Abuse, World Health Organization. [Informal Publication] Retrieved June 28th, 2014 from http://www.who.int/mental_health/media/68.pdf [9] Murphy, K., Cooney, A., Shea E. O., & Casey, D. (2008). Determinants Of Quality Of Life For Older People Living With A Disability In The Community. Journal of Advanced Nursing, Volume 65, Issue 3, pp. 606–615. DOI: 10.1111/j.1365-2648.2008.04929.x [10] Van Campen, C., and Iedema, J. (2007). Are Persons With Physical Disabilities Who Participate In Society Healthier And Happier? Structural Equation Modelling Of Objective Participation and Subjective Well-Being. Quality of Life Research, Volume 16, Issue 4, pp. 635645. DOI: 10.1007/s11136-006-9147-3 [11] Oppenheim, A.N. (1992). Questionnaire Design, Interviewing and Attitude Measurement. Pinter Publisher, London
