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Dynamic Wheeled Mobility
The Future of Ultralight Wheelchairs for Active Users
Jaimie Borisoff, PhD
Canada Research Chair in Rehabilitation Engineering Design
Atlantic Rehab and Education Conference 2014
Atlantica Halifax Hotel, Halifax, Nova Scotia
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Podsumowanie treści

Strona 1 - Dynamic Wheeled Mobility

Dynamic Wheeled MobilityThe Future of Ultralight Wheelchairs for Active UsersJaimie Borisoff, PhDCanada Research Chair in Rehabilitation Engineering D

Strona 2 - ACKNOWLEDGEMENT

AREC 2014DWM 101Dynamic Wheeled MobilityThe Future of Ultralight Wheelchairs for Active Users

Strona 3 - DISCLOSURES

Seat Forward With Long Wheelbase on 3 1/2" Platform

Strona 4 - DEFINITION

AREC 2014"Perform Level Transfers When Possible ""Avoid Positions of Impingement When Possible"DWM Applications: TransfersDynamic

Strona 5 - Standing

Dynamic ReconfigurationDYNAMIC REPOSITIONING TO FACILITATE TRANSFERSTRANSFER ONE SETUP

Strona 6

Dynamic ReconfigurationDYNAMIC REPOSITIONING TO FACILITATE TRANSFERSTRANSFER TWO SETUP

Strona 7 - History of

DYNAMIC REPOSITIONING TO FACILITATE TRANSFERSDynamic Wheeled MobilityDynamic Reconfiguration

Strona 8

DYNAMIC REPOSITIONING TO FACILITATE TRANSFERSDynamic Wheeled MobilityDynamic Reconfiguration

Strona 9

DYNAMIC REPOSITIONING TO FACILITATE TRANSFERSDynamic Wheeled MobilityDynamic Reconfiguration

Strona 10

DYNAMIC REPOSITIONING TO FACILITATE TRANSFERS

Strona 11 - DWM 101: Rules

AREC 2014CPGs that apply to DWM(even if they don’t know it)DWM has GREATER BENEFITS than with FIXED CONFIGURATIONS 4. Minimize the force required to

Strona 12 - DWM 101: Applications

AREC 2014Some other benefits of changing seat position? (non – CPG)• Comfort• Functional positioning (other ADL’s)• Pressure re-distribution• Joint mo

Strona 13 - DWM 101: Theory

AREC 2014DWM 101: RulesDynamic Wheeled Mobility Rule 1: DWM adjustments must be easy to use - “On the fly”. Rule 2: Add-ons must be easily installed

Strona 14

Subject 1Subject 4*Subject 3Subject 2-15

Strona 15 - Clinical Practice Guidelines

Subject 1Subject 4*Subject 3Subject 20

Strona 16

Subject 1Subject 4*Subject 3Subject 2+15

Strona 17 - Material

020406080100120140SAP mmHg DAP mmHg MAP mmHg HR bpm SV mlSEATED ELEVATED LOWEREDCARDIOVASCULAR FUNCTION

Strona 18

AREC 2014- Other Activities- ParticipationDWM Applications: ADL’sDynamic Wheeled Mobility

Strona 19 - SEMICIRCULAR ARC PATTERN

AREC 2014How do people use Elevation?

Strona 20 - Transfers to:

Dynamic Repositioning For Function ~ socialization

Strona 21 - Other ADL’s

Dynamic Repositioning For Function ~ socialization

Strona 23

Children (Pediatrics)

Strona 24 - Concessions and Trade-off’s

AREC 2014DWM 101: ApplicationsDynamic Wheeled Mobility Propulsion Inclines Soft surfaces Transfers Functional Reach Ergonomics, shoulder pain A

Strona 28

AREC 2014Different Users, Different UsesDynamic Wheeled Mobility

Strona 29 - DWM - Is It Worth the Weight?

AREC 2014“Low” setupDynamic Wheeled Mobility19 degrees Dump - 13 Elevated(6 inches down) (4 inches up)

Strona 30

AREC 2014“High” setupDynamic Wheeled Mobility7 degrees Dump - 26 Elevated(2 inches down) (8 inches up)

Strona 31 - Where is weight important?

Different users, different usesCP <48 cm>SCI <41 cm>

Strona 32

AREC 2014Daily height chart – 2 people<48 cm><41 cm>CPSCIDynamic Wheeled Mobility

Strona 33 - DWM: Concepts

AREC 2014Elevation + Function / ActivitiesFunctioning Everyday with a Wheelchair (FEW) Questionnaire MEAN score = 54(Range 47 – 60)Perceived usefulnes

Strona 35 - MODULAR DESIGNS – Lasher BT-X

AREC 2014DWM 101: TheoryDynamic Wheeled Mobility Guiding Framework: Clinical Practice Guidelines (CPGs) for Preservation of Upper Limb Function Follo

Strona 36 - DWM – Add-On Components

AREC 2014Future DWM?Dynamic Wheeled Mobility Power wheels? Sliding seat + seat height + back recline The floor! Floor to seat transfers Activitie

Strona 37

Merci!Atlantic Rehab and Education Conference 2014Atlantica Halifax Hotel, Halifax, Nova Scotia

Strona 38

2015 International Seating SymposiumHosted by the University of PittsburghNashville, TNDynamic Wheeled Mobility--The Next Chapter in the Ultralight Ev

Strona 39

AREC 2014DWM 101: TheoryDynamic Wheeled Mobility

Strona 40 -  Clip-on handcycles

Clinical Practice GuidelinesParalyzed Veterans of America (PVA) Consortium for Spinal Cord Medicine (2005)

Strona 41 -  Freewheel

Minimize the Frequency of Repetitive Upper Limb Tasks.Minimize the Forces Needed to Complete Upper Limb Tasks.Minimize Extreme or Potentially Injuriou

Strona 42

Provide Manual Wheelchair Users with SCI a High Strength, Fully Customizable, Wheelchair Made of the Lightest Possible Material.C l i n i c a l P r

Strona 43 -  Wheelblades

The Wheelchair Should be Configured so That:- The Rear Axle Is Located as Far Forward as Possible Without Compromising the Stability of the User.- the

Strona 44 - DWM – DYNAMIC RECONFIGURATION

Instruct Manual Wheelchair Users With SCI to:- Use Long, Smooth Strokes that Limit High Impacts on the Pushrim.- Use a Semicircular pushing pattern.C

Strona 45 - DWM Chair Examples

AREC 2014ACKNOWLEDGEMENTAcademy of Spinal Cord Injury Professionals2014 Educational Conference and ExpoSt. Louis, MissouriDynamic Wheeled MobilityGate

Strona 46 - Modified Icon A1

Instruct Individuals with SCI who Complete Independent Transfers to:- Perform Level Transfers When Possible.- Avoid Positions of Impingement When Poss

Strona 47

AREC 2014CPG’s and ultralights – what are missing? The role of an ultralight's configuration and setup in minimizing Frequency, Forces, & Ex

Strona 48

FORM FITFUNCTIONFOOTPRINTC O N T E X TO F U S EOverallUsability "The extent to which a product can be used by specified users to achieve specif

Strona 49 - Wheelbase Adjustability

While most conventional ultralight designs provide sufficient adjustability to be customized for an individual user, the configuration itself is inher

Strona 50

These concessions & trade-off's frequently result in a base configuration to be less than optimal for any single context of use…"My chai

Strona 51 - Dynamic Seat Height

Designing Wheelchairs for Functions Other Than Propulsion…WHY?

Strona 52 - Dynamic Recline

AREC 2014How do people use wheelchairs?TimeDistance Bouts“Bouts of Mobility”Sonenblum and Sprigle, Georgia Tech1.5 km 58 min 96Propulsion during the d

Strona 53 - E L E V A T I O N

Daily Activitieshttp://www.bbc.co.uk/news/technology-11012356 via Gary Moulton

Strona 54 - “lifting” side guards

Chairs for everyone else are “dynamic”

Strona 55

DWM - Is It Worth the Weight?For Propulsion?- Wheelchairs for sports are often significantly heavier than an athlete's everyday wheelchair- Wheel

Strona 56

AREC 2014DISCLOSURESJaimie Borisoff, PhD is the Canada Research Chair in Rehabilitation Engineering Design at the BC Institute of Technology and ICORD

Strona 57

DWM - Is It Worth the Weight?How important is 3 lbs. on 200 lbs. system?Arch Phys Med Rehabil. 2010 Aug;91(8):1248-54. doi: 10.1016/j.apmr.2010.05.011

Strona 58 - Configurations

AREC 2014Where is weight important? Lifting the chair into a car

Strona 59

AREC 2014DWM 101: Concepts & ApplicationsDynamic Wheeled Mobility

Strona 60

AREC 2014DWM: ConceptsDynamic Wheeled Mobility MODULAR DESIGNS ADD-ON COMPONENTS Products That Reduce Rolling Resistance  Mechanical Alternatives

Strona 61

DWM – Modular Designs Lasher BT-X  Icon A1

Strona 62 - Conservation of Contextual

MODULAR DESIGNS – Lasher BT-X

Strona 63

AREC 2014DWM – Add-On ComponentsDynamic Wheeled Mobility Power Add On SystemsIn contrast to PAPAWs, these add-on components do not change the base co

Strona 64

ADD-ON COMPONENTS - Power Add-On Systems SmartDrive  Rio Mobility Firefly

Strona 65

ADD-ON COMPONENTS - SmartDrive Weight – 8lb battery, 11lb motor

Strona 66

ADD-ON COMPONENTS - Mechanical Alternatives Lever Drives  Manual geared wheels

Strona 67

AREC 2014DEFINITIONDynamic Wheeled MobilityDynamic Wheeled Mobility (DWM) An alternative approach to ultralight wheelchair configuration that involves

Strona 68 - DWM Applications: Reach

 Clip-on handcyclesADD-ON COMPONENTS - Mechanical Alternatives

Strona 69

ADD-ON COMPONENTS - Reduce Rolling Resistance Freewheel

Strona 71 - That’s How!

ADD-ON COMPONENTS - Reduce Rolling Resistance Wheelblades

Strona 72 - EFFECTIVELY IMPLEMENT A CPG!!

AREC 2014DWM – DYNAMIC RECONFIGURATIONDynamic Wheeled Mobility Dynamic Repositioning For Function & ADL’sReal time adjustments which change the u

Strona 73 - FUNCTIONAL REACH

AREC 2014DWM Chair ExamplesDynamic Wheeled Mobility Modified Icon A1  Elevation by PDG

Strona 74 - DWM Applications: Propulsion

2.5" of Fore/Aft Seat Adjustability2.5" of Dynamic Wheelbase AdjustabilityModified Icon A1

Strona 75 - 7° (8:1)

2.5" of Dynamic Fore / Aft Seat AdjustabilityModified Icon A1

Strona 76 - CASE STUDY

2.5" of Fore/Aft Seat AdjustabilityModified Icon A1

Strona 77 - 17x16+0 85 Degree TiLite ZRc

Modified Icon A12.5" of Dynamic Wheelbase Adjustability

Strona 78

AREC 2014What are we NOT talking about?Tilt & Recline(conventional dynamic seating)e.g. from PDG MobilityStandinge.g. from LEVO AGPower(convention

Strona 79

A Commercially Available DWM Wheelchair

Strona 80 - Seat Slope = 14°

AREC 2014Dynamic Seat HeightDynamic Wheeled Mobility(10” or > 30) of On-The-Fly Seat Height Adjustment

Strona 81

AREC 2014Dynamic Recline30° of On-The-Fly Back Angle Adjustment

Strona 82 - Effective

K n e e H i n g eE L E V A T I O N(PDG Mobility Technologies)DWM rule: easy to use“On the fly” adjustability

Strona 83 - Analysis

Elevated seating stability“lifting” side guards

Strona 84

E L E V A T I O N(PDG Mobility Technologies)Dynamic Wheeled Mobility

Strona 86 - 95 BACK recline

AREC 2014The last bit, I promise…DWM 101: TheoryDynamic Wheeled Mobility

Strona 87 - PROPULSION – LEVEL WHEELING

The Law of Mutually Exclusive ConfigurationsDynamic Wheeled Mobility

Strona 88 - 14 SEAT slope

The Law of Mutually Exclusive ConfigurationsThere Is an Inverse Relationship Between the Optimal Configuration for Smooth Level Propulsion and Most Ot

Strona 89 - 80 BACK decline

DWM is for “Active” manual wheelchair users Dynamic Wheeled Mobility

Strona 90 - PROPULSION – DOWN HILL

The Law of Mutually Exclusive ConfigurationsOptimal Propulsion on Smooth Level Surfaces Requires The User To Sit Lower & Further Back In The Chair

Strona 91

The Law of Mutually Exclusive ConfigurationsThere Is an Inverse Relationship Between the Optimal Configuration for Smooth Level Propulsion and Most Ot

Strona 92

Conservation of Contextual AnglesDynamic Wheeled Mobility

Strona 93 - 110 BACK recline

++Conservation of Contextual Angles=Changing key angles of the ultralight, its user, or the environment will result in changes to other angles in orde

Strona 94

90°Conservation of Contextual Angles

Strona 95 - Shoulder vs Elbow Angle

10°Conservation of Contextual Angles

Strona 96

90°Conservation of Contextual Angles

Strona 97

100°Conservation of Contextual Angles

Strona 98 - HOW IT WORKS

AREC 2014"Avoid positioning the hand above the shoulder"DWM Applications: ReachDynamic Wheeled Mobility

Strona 99 - (and with less skills needed

90°"Avoid positioning the hand above the shoulder"

Strona 100

History of wheelchairs

Strona 101 - DWM Applications: Transfers

How?"Avoid positioning the hand above the shoulder"

Strona 102 - TRANSFER ONE SETUP

"Avoid positioning the hand above the shoulder"That’s How!

Strona 103 - TRANSFER TWO SETUP

A NEW WAY THAT THE ULTRALIGHT CANEFFECTIVELY IMPLEMENT A CPG!!

Strona 104

DYNAMIC REPOSITIONING FOR FUNCTIONFUNCTIONAL REACHWhat about the Ground? Reaching Down?- Reaching to grab objects- Tasks “on your lap”

Strona 105

AREC 2014"Minimize the Forces Needed to Complete Upper Limb Tasks“"Minimize Extreme or Potentially Injurious Positions“…SLOPES!DWM Applicati

Strona 106

DYNAMIC REPOSITIONING TO IMPROVE PROPULSIONSLOPESADA Standard for a for a New Construction is 4.8° (12:1).ADA Maximum for an Existing Building is 7° (

Strona 107

CASE STUDYWhy Is Steve Anxious About Going Up Minivan Ramps If His Chair Has Really Been "Optimally Configured"?Conservation of Contextual A

Strona 108 - AREC 2014

17x16+0 85 Degree TiLite ZRc

Strona 109 - • Pressure re-distribution

17x16+0 85 Degree TiLite ZRc

Strona 110 - Subject 1

17x16+0 85 Degree TiLite ZRcAn Optimal Configuration for Smooth Level Surfaces

Strona 111

The cantilevered frame: introduced over 25 years ago!

Strona 112

Back Angle = 95°Seat Slope = 14°Occupied Frame Length = 23"COM 117x16+0 85 Degree TiLite ZRcAn Optimal Configuration for Smooth Level Surfaces

Strona 113 - CARDIOVASCULAR FUNCTION

17x16+0 85 Degree TiLite ZRcThe Same Configuration on a 10° SlopeGrade = 10°

Strona 114 - DWM Applications: ADL’s

EffectiveSeat Slope = 24°Grade = 10°EffectiveBack Angle = 105°17x16+0 85 Degree TiLite ZRcConfiguration on a 10° SlopeCOM 2

Strona 115 - How do people use Elevation?

U∆ anglesUSER =H∆ anglesH I L L=∑ ∆ a n g l e sC O M B I N E D= ∑ ΔD=∆ anglesDEVIC E D U H!Analysis

Strona 116

Now how can we fix the problem?

Strona 117

We Can Change the Angles of the Seating...We Can Change The Center of Mass or Pushrim Orientation by Moving the Seat Forwardand / or

Strona 118 - Employment

Effect of Dynamic Reconfiguration14 SEAT slope (4” seat dump)95 BACK recline“Optimal” Configuration for Steve

Strona 119 - Children (Pediatrics)

Dynamic Repositioning For Function:PROPULSION – LEVEL WHEELING14 SEAT slope (4” seat dump)95 BACK reclineDynamic Wheeled Mobility

Strona 120 - Recreation

Dynamic Repositioning For Function:PROPULSION – UP HILL (10 degrees)EffectiveBack Angle = 105°EffectiveSeat Slope = 24°14 SEAT slope95 BACK declineD

Strona 121 - High reaching

Dynamic Repositioning For Function:PROPULSION – UP HILL (10 degrees)0 SEAT slope (flat seat)80 BACK declineEffectiveBack Angle = 0°EffectiveSeat Slo

Strona 122 - Self care

AREC 2014Can the ultralight wheelchair evolve beyond the lightweight static chair it is now?And why would this be a good thing?Dynamic Wheeled Mobilit

Strona 123

Dynamic Repositioning For Function:PROPULSION – DOWN HILL

Strona 124 - “Low” setup

Dynamic Repositioning For Function:PROPULSION – LEVEL WHEELINGDynamic Wheeled Mobility14 SEAT slope95 BACK recline

Strona 125 - “High” setup

Dynamic Repositioning For Function:PROPULSION – DOWN HILL (10 degrees)EffectiveSeat Slope = 4°EffectiveBack Angle = 85°14 SEAT slope95 BACK recline

Strona 126 - SCI <41 cm>

Dynamic Repositioning For Function:PROPULSION – DOWN HILL (10 degrees)18 SEAT slope (5” seat dump)110 BACK reclineEffectiveSeat Slope = 8°EffectiveB

Strona 127 - Daily height chart – 2 people

Dynamic Repositioning For Function:PROPULSION – COG changes (relative in mm)Seat BackCoGUp hill080-25Level ground10950Down hill1811021

Strona 129 - Elevation + Freewheel

2.5" of Fore/Aft Seat Adjustability2.5" of Dynamic Wheelbase AdjustabilityModified Icon A1

Strona 130 - Future DWM?

EFFECT OF DYNAMIC RECONFIGURATIONUse of a Sliding Seat On a 7° Incline

Strona 131

COMHOW IT WORKSCOM

Strona 132 - Coming Soon

Which Configurations Will Enable The User To Ascend A3 1/2" Platform With Less Upper Extremity Strain?(and with less skills needed than possessed

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