september 26, 2012 iwt workshop technical support number: 330-720-1749

IWT Workshop Technical Support Number: 330-720-1749

September 26, 2012

Independent Wheelchair Transfer IWT Workshop ‘All Group’ Meeting – Morning Session


Welcome IWT Participants!!!


University of Pittsburgh/Human Engineering Research Laboratories◦ Alicia Koontz◦ Rory Cooper◦ Theresa Crytzer◦ Genevieve Jerome – Technical Support

Call her at 330-720-1749 if you need help at any time during the meeting

Who we are…


U. S. Access Board:◦ Peggy Greenwell: Project Officer◦ Karen Braitmayer, Board member◦ David Capozzi: Executive Director◦ Marsha Mazz: Director of the Office of Technical

and Information Services◦ Rex Pace: Technical Assistance Coordinator

National Institute of Rehabilitation Research and Development (NIDRR)◦ Kenneth Wood: Project Officer

Project sponsors


33+ Clinicians (therapists, nurses, physiatrists), Architects, Engineers, Designers, Educators, Researchers, Accessibility Consultants

~28 unique affiliations in the US, Canada, Sweden and Finland

Who you are…


Roll CallIWT Workgroup Participants


To share with you what learned from the first phase of the project

To provide a forum for the exchange of ideas and information related to independent transfers

To help us determine what are important future directions for research in this area

Why are we doing this workshop?


We will be recording all audio and visual from the workshop for transcription and archive purposes

Closed captioning pod will be running throughout the meeting◦ Enlarge text function

Please keep your phone muted when you are not speaking; some hold and mute phones services play music…please disconnect and call back in when ready

Housekeeping


If you have a question in the all group sessions please use the ‘Raise Hand’ feature◦ Followup dialog can use the audio connection ---

please state your name before you speak

The chat pod should be used for minor comments that you don’t want to vocalize or use it to convey general information

Use of a web cam is encouraged during small group discussions

Housekeeping


9:15-9:45 AM◦ Investigating the Impact of Setup on Independent

Transfers: Overview of the Research Project Results

9:45-10:15 AM◦ Question/Answer Discussion about the Research

Project Results 10:15-10:30 AM

◦ Break 10:30 AM-12:30 PM

◦ Small Group Breakout Meetings to facilitate exchange of information on selected topics

AGENDA


12:30-2:00 PM◦ Working Lunch Break

Each Small Group leader to prepare a presentation summarizing the key points discussed in their breakout meeting.

2:00 PM◦ Reconvene as Large Group

2:00-2:45 PM◦ Group 1 Presentation/All Group Discussion


3:30-3:45 PM◦ Break


4:30-4:45 PM◦ Brief Overview of Next Steps

AGENDA


Any Questions?


Overview of the Research Project Results

Investigating the Impact of Setup on Independent Transfers: Overview of the Research Project Results

Alicia Koontz, Rory CooperMario Toro Hernandez


Transfers are essential for independence with activities of daily living and community participation

Accessibility standards contain provisions addressing elements designed for transfer◦ See Support Document on the IWT Website◦ Recently revised standards contain double the

elements where transfer is expected Very little research on environmental

barriers to transfers

Introduction


Phase I ◦ An Expert Review of the Scientific Literature on

Independent Transfers Published in Disability and Rehabilitation Assistive

Technology, May 18, 2011 [Epub ahead of print]. Phase II

◦ Design a study to identify issues concerning the transfer process Accepted for publication in International Journal of

Human Factors and Ergonomics◦

Purpose


Searched multiple scientific databases with 43 keywords ◦ 41 related articles.

Sought expert opinion (n=13) on the relevance and strength of the evidence concerning set up and transfer performance. ◦ Vertical transfer distance◦ Transferring across gap◦ Number of transfers to go from the initial location to final

surface◦ Use of transfer assistive device◦ Positioning of the mobility device◦ Others…◦

Phase I: Methods


All the studies identified involved small groups of subjects

All of them included either subjects with SCI or unimpaired subjects except for one study

Consensus among studies that transferring to a higher surface implies greater exertion of the upper limb◦ None of the studies specifically investigated the

range of heights feasibly attainable by subjects

Phase I: Results


A small number of studies directly related to the influence of transfer setup on performing independent transfers and thus pointed to a critical need for more studies in this area

No evidence concerning how high, how far away and how much space is needed next to the target surface for it to be accessible to a majority of wheeled mobility device users who independently transfer

Phase I: Conclusions

Phase IIImpact of Setup on the Performance of Independent Transfers

Criteria◦ Flexibility in the side of

approach◦ Constrained foot

placement◦ Unconstrained mobility

device positioning◦ Optional front grab bar of

variable height◦ Optional obstacle to

transfer◦ Height and gap

adjustability◦ Portable

Phase II: Transfer Station


Fixed height lateral grab bar

Optional fixed height side guard (obstacle)

Optional variable height front grab bar


Adjustable height protocol

Adjustable gap protocol

Phase II Methods: Five Protocols

DimensionsSeat: 18 x18 inBackrest: 18 x18 in Height: 10 to 29 inOverall length: 57 inFoot compartment: 14.6 x 22.4 in

Transfer ProtocolsSide guard protocol: Physical obstacle with varied height or gap

Front grab bar protocol: Frontal grab with varied height with/without obstacle

Adjustable height/gap protocol: Varied height of downhill and uphill transfers with a gap


Inclusion Criteria◦ 18+ years of age◦ Independent with transfers (with or without a

transfer board)◦ Own and use of a mobility device for at least 1

year◦ Free from active pressure sore or history that

could be exacerbated◦ No upper limb pain/injury that would inhibit ability

to transfer

Phase II: Participants


Two national veterans events, vocational school (HGA Johnstown, PA), US Access Board meeting, VA Heinz, and HERL

Asked to perform a transfer to/from the station ◦ Use sound judgment and do only transfers they

felt safe and comfortable doing Spotted during the process No adverse events occurred

Test Sites and Instructions


Primary: Maximum attainable limit for each setup parameter

For both transfers (to/from station) recorded:

Measures

Device x, y position Perceived level of exertionDevice orientation Safe/unsafeUse of transfer board Footrest/armrest removedLeading hand placement Method of transferTrailing hand placement Preferred direction of transfer

Measures Recorded device positioning (x, y, α)

Gap

Y = Length

X=width

WMD

α

Transfer station (back)

(front)

(back)


Results: Participants (N=120)

Gender: 96 male, 24 female

Age: 48 ± 15, range 18-85 years

Height: 67 ± 6”

Weight: 171 ± 48 lb

Duration of wheelchair use: 15 ± 12, range 1-59 years

Wheelchair seat + cushion height: 21.6 ± 1.4” median = 22 and range: 17-25”

No. of transfers: 27 ± 9; range 2-48

Results: ParticipantsOTHER*:Spina bifida:6MS+SCI:3Osteogenesis

Imperfecta:2Post-polio:2MD:2TBI+SCI:2Rheumatoid arthritis:2TBI:2Double

amputee+stroke:1TBI+Amputee:1SCI+Amputee:1Adams-Oliver:1Osteoporosis:1Stroke:1Ambulatory

Dysfunction:1Reflex sympathetic

dystrophy:1Spinal stenosis:1Epidemiral cyst:1ALS:1Respiratory issues:1 Sacroidosis: 1Knee replacement:1Hip injury:1

45%

9%8%

8%

5%

25%

Type of DisabilitySpinal cord injury ranging from C3-L4

Cerebral Palsy

Multiple Sclerosis

Lower extremity amputation

Spina bifida

Other*


Number of subjects that attempted each protocol


92% of the sample could transfer at a height of 22”

Results: Adjustable Height


95% were able to do a transfer with a gap of 3” 81% were able to transfer with a gap of 9”

Results: Adjustable gap


42% unable to perform a level transfer with obstacle Of the 60 subjects who were able, 98% could transfer to

height of 22”

Results: Side guard


Results: Adjustable Height/Gap 86% could transfer at a 22” height surface with a gap of 3”


Results: Front grab bar


Mobility device dimensions of the users: ◦ Average length: 37.0 ± 6.0” and width 26.5 ±

2.4”

Results: Space needed

Protocol Length (ADA 48”)

Width (ADA 30”)

Angle(degrees)

Adjustable Height 40.7±10.7” 38.3±11.6” 34±38

Adjustable Gap 39.6±12.2” 39.9±15.7” 34±38

Adjustable Height/Gap

40.5±11.3” 39.8±13.8” 29±31

Side guard 44.9±18.1” 38.7±15.2” 37±35

Front grab bar 47.9±14.1” 36.1±13” 40±32

Our subjects positioned their device at an angle of around 30 to 45°on average. When an obstacle was introduced many users repositioned their chairs at 90°

Results: Space needed

http://www.access-board.gov/recreation/guides/pdfs/amuse.pdf

Current ride standard specifies seat height between 14 - 24” with no specification on gap distance◦ 43% of the subjects could

transfer at 14” (no gap)◦ 85% at a 24” height (no

gap) Note: 1002.4.3 specifies

gap distance up to 3” for rides with space for a wheelchair

Discussion: Height

Current guidelines exclude up to 57% of wheeled mobility device users.

Current element standard:◦ 17”-19” height

Study results suggest element height fall within a range of ◦ 21” – 23” to include 90%

Discussion: Absolute Heights

Heights Attainable (%)

17” – 69%

18” – 75%

19” – 88%

20” – 89%

21” – 91%

22” – 92%

23” – 90%

24” – 85%

Study results suggest 2” transfer step heights are achievable by at least 86%◦ Current guidelines permit heights

up to 8”

Discussion: Step Heights

Step Heights Attainable (%)

-6” – 57%

-5” – 64%

-4” – 69%

-3” – 78%

-2” – 86%

-1” – 96%

0” - 96%

+1 - 94%

+2 - 89%

+3 - 76%

+4 - 63%

+5 - 51%

+6 – 43%


Study results suggest front-mounted horizontal grab bar height should be between 30”-33” (76.2-83.8cm)◦ Current provisions require a 33”-36” horizontal

bar height for water closets, bathtubs, and showers.

Study results suggest more clear space may be needed◦ Some elements only require 30” x 48” space

while others require a turning space of 60” X 60”.

Discussion: Bars and Clear Space


Device characteristics ◦ powered seat functions, pressure relieving

cushions, variety of wheel sizes Demographics

◦ E.g. aging and obesity trends Technology enabling for greater community

participation

Discussion: Reasons for Changes


Adults only Few scooter users Did not assess overhead grips Did not employ a full-factorial design Fatigue Setup limited to those who could perform

lateral transfers

Limitations


Handhelds location/positioning and space requirements

Multi-step transfers Mining the data to address other trends or

more specific needs There are likely issues uncovered pertaining

to specific elements or aspects of transfer THIS IS WHERE YOU COME IN !

Future work


Discussion About the Research Project Results

Questions and Comments

ACKNOWLEDGEMENTS:Funding for this study was provided by the Department of Education (NIDRR), United States Access Board grant H133E070024 and Project #84.133E.

This material is the result of work supported with resources and the use of facilities at the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System.

The contents do not represent the views of the Department of Veterans Affairs or the United States Government.


Group 1: Identifying areas where current accessibility standards for transfers need updating: ◦ Rory Cooper (host)◦ URL: http://pitt.adobeconnect.com/r1kr71k4wrt/◦ Phone number: 877-262-2695 or 719-867-7633◦ Passcode: 609010

Group 2: Identifying what additional research is needed concerning transfer setup Theresa Crytzer (host) URL: http://pitt.adobeconnect.com/r219knmy3b0/ Phone number: 877-262-2695 or 719-867-7633 Passcode: 270504

Group 3: Identifying other issues related to transfers that need further examination Alicia Koontz (host) URL: http://pitt.adobeconnect.com/r6mlj0fwcbd/ Phone number: 877-262-2695 or 719-867-7633 Passcode: 853147

Connection Info for Breakouts: 10:30 AM -12:30 PM

http://pitt.adobeconnect.com/r1kr71k4wrt/

http://pitt.adobeconnect.com/r219knmy3b0/

http://pitt.adobeconnect.com/r6mlj0fwcbd/


Additional Slides


Number of subjects (in each protocol) who could transfer at ADAAG heightsProtocol 14” high 17” high 19” high 24” high

Height 43%(50/116) 69%(80/116) 90%(104/116) 85%(99/116)

Height/Gap (3”

gap)

30%(35/116) 58%(67/116) 76%(90/116) 72%(84/116)

Side guard 27%(31/113) 40%(45/113) 43%(49/113) 47%(53/113)

Grab bar without

side guard

44%(54/115) 71%(82/115) 91%(105/115) 88%(101/115)

Grab bar with side

guard

29%(33/115) 48%(55/115) 57%(66/115) 54%(62/115)


Results: Lateral grab bar useProtocol % Subjects

(subjects/total protocol specific)

% of transfers used mean ± standard deviation(range)

Adjustable Height 22%(25/111) 32±25%(5-100%)

Adjustable Gap 11%(12/108) 61±32% (16-100%)

Adjustable Height/Gap

44%(48/109) 58±32% (13-100%)

Side guard 64%(42/66) 56±34(8-100%)

Front grab bar 25%(28/111) 37±20% (8-100%)

Space (cm) Percentile Minimum Maximum

5 50 95

Adjustable Gap

(n=108)

Length 63.6 96.5 136.3 57.3 167.9Width*,†,‡ 57.9 102.6 151.1 50.8 167.6

Angle 0 30 90 0 90

Adjustable height

(n=111)

Length 60.5 92.0 155.7 54.6 167.6Width 61.0 119.6 153.4 57.2 175.5Angle 0 30 90 0 105

Side guard (n=66)

Length 58.2 85.6 162.3 53.3 167.6Width* 72.9 110.0 158.2 55.9 170.4Angle 0 30 90 0 90

Front grab bar

(n=107)

Length 55.9 89.4 144.0 39.6 177.3Width† 71.1 112.8 165.1 61.0 185.4Angle 0 30 90 0 90

Front grab bar with

side guard (n=75)

Length 53.3 83.3 137.2 50.8 164.1Width‡ 71.1 115.3 181.1 68.6 185.4

Angle 1.4 26 53.5 0 55

Percentiles for the space parameter for all the protocols. The number of subjects who were capable of completing each protocol is shown in parentheses. Symbols denote the significant differences found in between the protocols (*,†,‡ p < 0.002)

september 26, 2012 iwt workshop technical support number: 330-720-1749

Documents

office of technical

research project results9

general information

exchange of information

group sessions

independent transfersto

chat pod

information servicesrex