september 26, 2012 iwt workshop technical support number: 330-720-1749
TRANSCRIPT
IWT Workshop Technical Support Number: 330-720-1749
September 26, 2012
Independent Wheelchair Transfer IWT Workshop ‘All Group’ Meeting – Morning Session
IWT Workshop Technical Support Number: 330-720-1749
Welcome IWT Participants!!!
IWT Workshop Technical Support Number: 330-720-1749
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…
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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…
IWT Workshop Technical Support Number: 330-720-1749
Roll CallIWT Workgroup Participants
IWT Workshop Technical Support Number: 330-720-1749
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?
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
2:45-3:30 PM◦ Group 2 Presentation/All Group Discussion
3:30-3:45 PM◦ Break
3:45-4:30 PM◦ Group 3 Presentation/All Group Discussion
4:30-4:45 PM◦ Brief Overview of Next Steps
AGENDA
IWT Workshop Technical Support Number: 330-720-1749
Any Questions?
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
Fixed height lateral grab bar
Optional fixed height side guard (obstacle)
Optional variable height front grab bar
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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)
IWT Workshop Technical Support Number: 330-720-1749
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*
IWT Workshop Technical Support Number: 330-720-1749
Number of subjects that attempted each protocol
IWT Workshop Technical Support Number: 330-720-1749
92% of the sample could transfer at a height of 22”
Results: Adjustable Height
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
Results: Adjustable Height/Gap 86% could transfer at a 22” height surface with a gap of 3”
IWT Workshop Technical Support Number: 330-720-1749
Results: Front grab bar
IWT Workshop Technical Support Number: 330-720-1749
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%
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
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.
IWT Workshop Technical Support Number: 330-720-1749
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
IWT Workshop Technical Support Number: 330-720-1749
Additional Slides
IWT Workshop Technical Support Number: 330-720-1749
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)
IWT Workshop Technical Support Number: 330-720-1749
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)