Top

Journal of NeuroEngineering and Rehabilitation

Published in:

Open Access 01-12-2018 | Research

Manual wheelchair downhill stability: an analysis of factors affecting tip probability

Authors: Louise Thomas, Jaimie Borisoff, Carolyn J. Sparrey

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2018

Abstract

Background

For people who use manual wheelchairs, tips and falls can result in serious injuries including bone fractures, concussions, and traumatic brain injury. We aimed to characterize how wheelchair configuration changes (including on-the-fly adjustments), user variables, and usage conditions affected dynamic tip probability while rolling down a slope and contacting a small block.

Methods

Rigid body dynamic models of a manual wheelchair and test dummy were created using multi-body software (Madymo, TASS International, Livonia, MI), and validated with 189 experiments. Dynamic stability was assessed for a range of seat angles (0 to 20° below horizontal), backrest angles (0 to 20°), rear axle positions (0 to 20 cm from base of backrest), ground slopes (0 to 15°), bump heights (0 to 4 cm), wheelchair speeds (0 to 20 km/hr), user masses (50 to 115 kg), and user positions (0 to 10 cm from base of backrest). The tip classifications (forward tip, backward tip, rolled over bump, or stopped by bump) were investigated using a nominal logistic regression analysis.

Results

Faster wheelchair speeds significantly increased the probability of tipping either forward or backward rather than stopping, but also increased the probability of rolling over the bump (p < 0.001). When the rear axle was positioned forward, this increased the risk of a backward tip compared to all other outcomes (p < 0.001), but also reduced the probability of being stopped by the bump (p < 0.001 compared to forward tip, p < 0.02 compared to rolling over). Reclining the backrest reduced the probability of a forward tip compared to all other outcomes (p < 0.001), and lowering the seat increased the probability of either rolling over the bump or tipping backwards rather than tipping forward (p < 0.001). In general, the wheelchair rolled over bumps < 1.5 cm, and forwards tipping was avoided by reducing the speed to 1 km/hr.

Conclusions

The probability of forward tipping, corresponding to the greatest risk of injury, was significantly reduced for decreased speeds, smaller bumps, a reclined backrest, and a lower rear seat height. For wheelchairs with dynamic seating adjustability, when travelling downhill, on-the-fly adjustments to the seat or backrest can increase the likelihood of safely rolling over a bump.

Sapey B, Stewart J, Donaldson G. The social implications of increases in wheelchair use. Dep Appl Soc Sci Lanc Univ. 2004. https://disability-studies.leeds.ac.uk/wp-content/uploads/sites/40/library/sapey-BOBs-REPORT.pdf.

Van Drongelen A, Roszek B, Hilbers-Modderman E, Kallewaard M, Wassenaar C. Wheelchair incidents. In: RIVM repos; 2002.

Calder CJ, Kirby RL. Fatal wheelchair-related accidents in the United States. Am J Phys Med & Rehabil/Assoc Acad Physiatr. 1990;69:184–90. https://doi.org/10.1097/00002060-199008000-00003.CrossRef

Opalek JM, Graymire VL, Redd D. Wheelchair falls: 5 years of data from a level I trauma center. J Trauma Nurs : Off J Soc Trauma Nurses. 2009;16:98–102. https://doi.org/10.1097/JTN.0b013e3181ac920e.CrossRef

Chen W-Y, Jang Y, Wang J-D, Huang W-N, Chang C-C, Mao H-F, et al. Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users. Arch Phys Med Rehabil. 2011;92:892–8. https://doi.org/10.1016/j.apmr.2011.01.008.CrossRefPubMed

ISO - International Organization for Standardization. ISO 7176-1: 2014 Wheelchairs - part 1 determination of static stability. 2014.

Kirby RL, McLean AD, Eastwood BJ. Influence of caster diameter on the static and dynamic forward stability of occupied wheelchairs. Arch Phys Med Rehabil. 1992;73:73–7.CrossRef

Majaess GG, Kirby RL, Ackroyd-Stolarz SA, Charlebois PB. Influence of seat position on the static and dynamic forward and rear stability of occupied wheelchairs. Arch Phys Med Rehabil. 1993;74:977–82.PubMed

Silva MPT, Ambrosio JAC, Pereira MS. Biomechanical model with joint resistance for impact simulation. Multibody Syst Dyn. 1997;1:65–84.CrossRef

10.

Romick-Allen R, Schultz AB. Biomechanics of reactions to impending falls. J Biomech. 1987;21:591–600. https://doi.org/10.1016/0021-9290(88)90222-9. CrossRef

11.

Schiehlen W. Multibody system dynamics: roots and perspectives. Multibody Syst Dyn. 1997;1:149–88.CrossRef

12.

Erickson B, Hosseini MA, Mudhar PS, Soleimani M, Aboonabi A, Arzanpour S, et al. The dynamics of electric powered wheelchair sideways tips and falls: experimental and computational analysis of impact forces and injury. J Neuroengineering Rehabil. 2016;13:20. https://doi.org/10.1186/s12984-016-0128-7.CrossRef

13.

Kirby RL, Smith C, Parker K, MacLeod D, McAllister M. Rushton P., editors. In: Wheelchair skills training program (WSTP) manual; 2016.CrossRef

14.

Edlich RF, Kelley AR, Morton K, Gellman RE, Berkey R, Greene JA, et al. A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design. J Emerg Med. 2010;38:150–4. https://doi.org/10.1016/j.jemermed.2007.07.067.CrossRefPubMed

15.

Brubaker CE. Wheelchair prescription: an analysis of factors that affect mobility and performance. J Rehabil Res Dev. 1986;23:19–26.PubMed

16.

Mattie J, Borisoff J, Miller WC, Noureddin B. Characterizing the community use of an ultralight wheelchair with “on the fly” adjustable seating functions: a pilot study. PLoS One. 2017;12:e0173662. https://doi.org/10.1371/journal.pone.0173662.CrossRefPubMedPubMedCentral

17.

Thomas L, Borisoff J, Sparrey C. Quantifying the effects of on-the-Fly changes of seating configuration on the stability of a manual wheelchair. In: The 39th annual international conference of the IEEE engineering in medicine and biology society; 2017.

18.

ISO - International Organization for Standardization. ISO 7176-11: 2012 Wheelchairs - part 11 test dummies. 2012.

19.

Bertocci GE, Esteireiro J, Cooper RA, Young TM, Thomas C. Testing and evaluation of wheelchair caster assemblies subjected to dynamic crash loading. J Rehabil Res Dev. 1999;36:32–41.PubMed

20.

US Department of Justice. ADA Standards for Accessible Design. 2010.

21.

Kirby RL, Ackroyd-Stolarz SA, Brown MG, Kirkland SA, MacLeod DA. Wheelchair-related accidents caused by tips and falls among noninstitutionalized users of manually propelled wheelchairs in Nova Scotia. Am J Phys Med & Rehabil/Assoc Acad Physiatr. 1994;73:319–30. https://doi.org/10.1097/00002060-199409000-00004.CrossRef

22.

Gaal RP, Rebholtz N, Hotchkiss RD, Pfaelzer PF. Wheelchair rider injuries: causes and consequences for wheelchair design and selection. J Rehabil Res Dev. 1996;34:58–71.

23.

Kirby RL, Atkinson SM, MacKay EA. Static and dynamic forward stability of occupied wheelchairs: influence of elevated footrests and forward stabilizers. Arch Phys Med Rehabil. 1988;70:681–6.

24.

Medola FO, Elui VMC, Santana C d S, Fortulan CA. Aspects of manual wheelchair configuration affecting mobility: a review. J Phys Ther Sci. 2014;26:313–8.CrossRef

25.

Slowik JS, Requejo PS, Mulroy SJ, Neptune RR. The influence of speed and grade on wheelchair propulsion hand pattern. Clin Biomech. 2015;30:927–32. https://doi.org/10.1016/j.clinbiomech.2015.07.007.CrossRef

26.

Chow JW, Millikan TA, Carlton LG, Chae W, Lim Y, Morse MI. Kinematic and electromyographic analysis of wheelchair propulsion on ramps of different slopes for young men with paraplegia. Arch Phys Med Rehabil. 2009;90:271–8. https://doi.org/10.1016/j.apmr.2008.07.019.CrossRefPubMed

27.

Kirby RL, Bennett S, Smith C, Parker K, Thompson K. Wheelchair curb climbing: randomized controlled comparison of highly structured and conventional training methods. Arch Phys Med Rehabil. 2008;89:2342–8. https://doi.org/10.1016/j.apmr.2008.04.028.CrossRefPubMed

28.

MacPhee AH, Kirby RL, Coolen AL, Smith C, MacLeod DA, Dupuis DJ. Wheelchair skills training program: a randomized clinical trial of wheelchair users undergoing initial rehabilitation. Arch Phys Med Rehabil. 2004;85:41–50. https://doi.org/10.1016/S0003-9993(03)00364-2. CrossRefPubMed

29.

Kirby RL, Sampson MT, Thoren FA, MacLeod DA. Wheelchair stability: effect of body position. J Rehabil Res Dev. 1995;32:367–72.PubMed

30.

Thomas L, Borisoff J, Sparrey C. Defining the stability limits of a manual wheelchair with adjustable seat and backrest. In: Rehabilitation Engineering and Assistive Technology Society of North America Conference. New Orleans, LA; 2017.

31.

Sauret C, Vaslin P, Lavaste F, de Saint Remy N, Cid M. Effects of user’s actions on rolling resistance and wheelchair stability during handrim wheelchair propulsion in the field. Med Eng Phys. 2013;35:289–97.CrossRef

32.

Tomlinson JD. Managing maneuverability and rear stability of adjustable manual wheelchairs: an update. Phys Ther. 2000;80:904–11. https://doi.org/10.1093/ptj/80.9.904.CrossRefPubMed

33.

Guo L-Y, Zhao KD, Su F-C, An K-N. Modeling the effect of seat height and fore-aft position on wheelchair propulsion. J Biomech. 2006;39. https://doi.org/10.1016/S0021-9290(06)85019-0.CrossRef

34.

Masse LC, Lamontagne M, O’Riain MD. Biomechanical analysis of wheelchair propulsion for various seating positions. J Rehabil Res Dev. 1991;29. https://doi.org/10.1682/JRRD.1992.07.0012. CrossRef

35.

van der Woude LH, Veeger HE, Dallmeijer AJ, Janssen TW, Rozendaal LA. Biomechanics and physiology in active manual wheelchair propulsion. Med Eng & Phys. 2001;23:713–33. https://doi.org/10.1016/S1350-4533(01)00083-2.CrossRef

36.

Bertolaccini G d S, Carvalho Filho IFP, Christofoletti G, Paschoarelli LC, Medola FO. The influence of axle position and the use of accessories on the activity of upper limb muscles during manual wheelchair propulsion. Int J Occup Saf Ergon. 2018;24:311–5. https://doi.org/10.1080/10803548.2017.1294369.CrossRefPubMed

37.

Giner-Pascual M, Alcanyis-Alberola M, Millan González L, Aguilar-Rodríguez M, Querol F. Shoulder pain in cases of spinal injury: influence of the position of the wheelchair seat. Int J Rehabil Res Int Z fur Rehabil Rev Int de Rech de readaptation. 2011;34:282–9. https://doi.org/10.1097/MRR.0b013e32834a8fd9.CrossRef

38.

Medola FO, Dao PV, Caspall JJ, Sprigle S. Partitioning kinetic energy during freewheeling wheelchair maneuvers. IEEE transactions on neural systems and rehabilitation engineering. 2014;22:326–33. https://doi.org/10.1109/TNSRE.2013.2289378.CrossRefPubMed

39.

Arva J, Schmeler M, Lange M, Lipka D, Rosen L. RESNA position on the application of seat-elevating devices for wheelchair users. Assist Technol. 2009;21:69–72.CrossRef

40.

Lin J-T, Huang M, Sprigle S. Evaluation of wheelchair resistive forces during straight and turning trajectories across different wheelchair configurations using free-wheeling coast-down test. J Rehabil Res Dev. 2015;52:763–74. https://doi.org/10.1682/JRRD.2014.10.0235.CrossRefPubMed

41.

Eichberger A, Schittenhelm M. Implementations, applications and limits of Tyre models in multibody simulation. Veh Syst Dyn. 2005;43:18–29. https://doi.org/10.1080/00423110500109349.CrossRef

Title: Manual wheelchair downhill stability: an analysis of factors affecting tip probability
Authors: Louise Thomas
Jaimie Borisoff
Carolyn J. Sparrey
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of NeuroEngineering and Rehabilitation / Issue 1/2018
Electronic ISSN: 1743-0003
DOI: https://doi.org/10.1186/s12984-018-0450-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Manual wheelchair downhill stability: an analysis of factors affecting tip probability

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Adaptation and post-adaptation effects of haptic forces on locomotion in healthy young adults

A robot-based gait training therapy for pediatric population with cerebral palsy: goal setting, proposal and preliminary clinical implementation

Reliability, validity and discriminant ability of the instrumental indices provided by a novel planar robotic device for upper limb rehabilitation

Amputee perception of prosthetic ankle stiffness during locomotion

Improving internal model strength and performance of prosthetic hands using augmented feedback

Autonomous multi-joint soft exosuit with augmentation-power-based control parameter tuning reduces energy cost of loaded walking