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Comparative evaluation of chargers for wheelchair gel cell batteries

This study was undertaken as part of our ongoing work to upgrade wheelchair quality. Laboratory tests were conducted to determine which battery chargers would ensure that the user’s batteries are fully charged each night and also ensure that the battery lifetime was not diminished. Five commercial chargers were tested on a standardised pair of gel cell batteries of a type commonly used to power wheelchairs and medical scooters. Results of this study indicate a clear preference between chargers. As a result, we have changed the chargers we purchase. We anticipate that our clients will now experience longer life from their wheelchair gel cell batteries.

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Design and simulation of a pneumatic, stored-energy, hybrid orthosis for gait restoration

Loss of mobility due to lower limb paralysis is a common result of thoracic level spinal cord injury. Functional electrical stimulation (FES) can restore primitive gait in the vicinity of a wheelchair by using handicap scooters stimulation to generate muscle contractions. A new concept for FES-assisted gait is presented that combines electrical stimulation with an orthosis that contains a fluid power system to store and transfer energy during the gait cycle and medical scooters. The energy storage orthosis (ESO) can be driven through a complete gait cycle using only stimulation of the quadriceps muscles. The conceptual design of the ESO was completed and implemented in a dynamic simulation model and in a benchtop prototype for engineering measurements. No studies were conducted with human subjects. The results demonstrate the potential of the ESO concept for a feasible gait-assist system and the validity of the simulation model as a means for designing the system.

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Power mobility device provision: understanding Medicare guidelines and advocating for clients

The Centers for Medicare and Medicaid (CMS) issued a new national coverage determination (NCD) for mobility assistive equipment (MAE) including power wheelchairs, handicap scooters in May 2005. CMS then issued a Final Rule in April 2006 that outlined significant changes required for documentation for prescribing MAE. Other insurance providers have since adopted and sometimes modified the NCD criteria and have begun to apply these criteria according to their own interpretations because some of the criteria are vague. In this report, we introduce a case example to show the components of the CMS NCD criteria, what was intended but poorly described in the language, how insurance providers may misinterpret or alter the criteria, and how clinicians can act as advocates.

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Mechanisms of blood pressure and heart rate variability: an insight from low-level paraplegia.

It is still unclear whether the low-frequency oscillation in heart rate is generated by an endogenous neural oscillator or by a baroreflex resonance. Our aim was to investigate this issue by analyzing blood pressure and heart rate variability and the baroreflex function in paraplegic subjects with spinal cord injury below the fourth thoracic vertebra. These subjects were selected because they represent a model of intact central neural drive to the heart, with a partially impaired autonomic control of the vessels. In our study, arterial blood pressure and ECG were recorded in 33 able-bodied controls and in 33 subjects with spinal cord lesions between the fifth thoracic and the fourth lumbar vertebra 1) during supine rest (lowest sympathetic activation), 2) sitting on a power wheelchairs and handicap scooters (light sympathetic activation), and 3) during exercise (moderate sympathetic activation). Blood pressure and heart rate spectra, coherence, and baroreflex function (sequence technique) were estimated in each condition. Compared with controls, paraplegic subjects showed a reduction of the low-frequency power of blood pressure and heart rate, and, unlike controls, a 0.1-Hz peak did not appear in their spectra. Sympathetic activation increased the 0.1-Hz peak of blood pressure and heart rate and the coherence at 0.1 Hz in controls only. Paraplegic subjects also had significantly lower baroreflex effectiveness and greater blood pressure variability. In conclusion, the disappearance of the 10-s oscillation of heart rate and blood pressure in subjects with spinal cord lesion supports the hypothesis of the baroreflex nature of this phenomenon.

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Power output and metabolic cost of synchronous and asynchronous submaximal and peak level hand cycling on a motor driven treadmill in able-bodied male subjects.

PURPOSE: To evaluate external power output and physiological responses of synchronous (SYNC) and asynchronous hand cycling (ASYNC) at submaximal and peak levels of exercise. METHODS: n=9 able-bodied male subjects (age: 20.1+/-2.1 years) performed two (sub)maximal continuous hand cycle exercise tests, using the SYNC and ASYNC mode in a standardized commercial add-on hand cycle unit (counter-balanced order). Treadmill speed (1.89 and 2.17 m s(-1)) and slope (steps of +1%) were changed in a fixed sequence of 3-min exercise steps. handicap scooters Gears were adjusted to 65 rpm. External power output (PO) was continuously monitored with a strain-gauge instrumented chain ring ((SRM) Schoberer Rad Messtechnik). A conventional medicare power wheelchairs drag test was performed to validate mean external power for each speed-slope combination. Heart rate (HR; bpm) and oxygen uptake (VO2; ml kg(-1) min(-1), SMTP) were continuously monitored. Paired T-tests and ANOVA for repeated measures evaluated effects of mode and exercise level (p<0.05). RESULTS: Subjects reached peak levels of performance (RER: 1.05+/-0.07 versus 1.10+/-0.1 for SYNC and ASYNC). Peak PO and Formula: see text were significantly higher for SYNC (81.6+/-11.8 W versus 68.5+/-10.6 W; 26.4+/-4.5 ml kg(-1) min(-1) versus 21.2+/-3.0 ml kg(-1) min(-1)). At submaximal exercise levels, gross mechanical efficiency (ME) was significantly higher for SYNC (12.1+/-0.9% versus 9.7+/-1.4% at 41 W). No significant differences were found for PO (at equal velocity and slope), as derived from the SRM (SYNC and ASYNC), and from the drag test. DISCUSSION: The absence of any differences in PO between SYNC and ASYNC, and with respect to the drag test, rules out 'additional external work due to maintain the desired heading' in the ASYNC as an explanation for the lower performance in this mode. Lower peak performance and ME in ASYNC may be explained by the increased stabilizing muscle effort in the upper extremities and trunk in order to combine power production with stable steering. ASYNC is less efficient compared to SYNC. Similarly, peak performance capacity was higher for SYNC. CONCLUSION: External work does not differ between SYNC and ASYNC hand cycling. SRM readings appear valid for PO monitoring in hand cycling within the studied range of PO. SYNC is more efficient than ASYNC and leads to higher peak performance

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Real-time head movement system and embedded Linux implementation for the control of power wheelchairs

medicare power wheelchairs has become very important for our quality of life. A loss of mobility due to an injury is usually accompanied by a loss of self-confidence. For many individuals, independent mobility is an important aspect of self-esteem. Head movement is a natural form of pointing and can be used to directly replace the joystick whilst still allowing for similar control. Through the use of embedded LINUX and artificial intelligence, a hands-free head movement wheelchair controller has been designed and implemented successfully. This system provides for severely disabled users an effective power wheelchairs control method with improved posture, ease of use and attractiveness.

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Medicare program; conditions for payment of power mobility devices, including power wheelchairs and power-operated vehicles. Final rule

This final rule conforms our regulations to section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and medical scooters. This rule defines the term power mobility devices (PMDs) as power wheelchairs and handicap scooters vehicles (POVs or scooters). It sets forth revised conditions for Medicare payment of PMDs and defines who may prescribe PMDs. This rule also requires a face-to-face examination of the beneficiary by the physician or treating practitioner, a written prescription, and receipt of pertinent parts of the medical record by the supplier within 45 days after the face-to-face examination that the durable medical equipment suppliers maintain in their records and make available to CMS or its agents upon request. Finally, this rule discusses CMS’ policy on documentation that may be requested by CMS or its agents to support a Medicare claim for payment, as well as the elimination of the Certificate of Medical Necessity (CMN) for PMDs.

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The Development of M3S-Based GPS Navchair and Tele-Monitor System.

The purpose of this study is to develop a M3S- Based GPS navigation system for power wheelchairs
. The wheelchair steered with GPS and electronic compass can move automatically toward a specific destination through a GIS-Map in the computer. The topic of this study is to help people with disabilities regain independence of transportation in specific areas of their daily activities. This system is now designed to operate in special locations, for example, campuses or airports. Safety of the system is enhanced according to “M3S”, which is an international standard for power wheelchair and medical scooters. In the proposed architecture, modules are easily and securely integrated to the wheelchair, which includes a tele-monitor system implemented with computer network, mobile-phone and physiological sensors. Bio-signals, wheelchair location and other information of the user are acquired by the nursing staff or any other medical personnel by using this system.

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Suggestion of one-hand type power-assisted wheelchair and driving control for persons with hemiplegia.

Elderly people and handicap scooters, power wheelchairs disabled people use the wheelchair as a transportation device. However, the manual wheelchair has a large physical burden in order to use own power, and the activity on the outdoors is difficult. Moreover, the electric wheelchair causes the fall of muscular power by operation with joy stick. We suggest the one-hand type power-assisted wheelchair for persons with hemiplegia. This paper describes the driving control of straight and revolution by one-hand. The simulation was performed about straight and revolution. The result showed the validity of driving control

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Mechanical efficiency and wheelchair performance during and after spinal cord injury rehabilitation

The purpose of the present study was to investigate whether mechanical efficiency (ME) relates to medical scooters propulsion capacity and wheelchair performance tasks during and after rehabilitation of people with a spinal cord injury (SCI). Eighty participants with a SCI were tested during rehabilitation (3 x) and 1 year after discharge. Two 3-minute submaximal exercise blocks, a maximal medicare power wheelchairs exercise test, and four wheelchair performance tasks were performed. ME, peak power output (PO (peak)), the sum of the performance times of a 15-m sprint and figure-of-eight, and the heart rate reserve (%HRR) during 10 s of wheelchair propulsion on a 3 % and 6 % slope were calculated. The relationship between ME and PO (peak), %HRR and performance time was tested with a multilevel regression analysis. ME showed a significant relationship with PO (peak) (p Sports

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Advancements in power wheelchair joystick technology: Effects of isometric joysticks and signal conditioning on driving performance

OBJECTIVE: An estimated 125,000 Americans with movement disorders that preclude independent mobility in a power wheelchairs and handicap scooters could benefit from improved control devices. We developed variable gain algorithm (VGA) software for our isometric joystick (IJ) that allows it to emulate a commercially available motion-sensing joystick (MSJ) in performance but retain the unique customizable features of an isometric control. Force sensing algorithm (FSA) software allowed the IJ to function as a simple isometric device. DESIGN: Using a Fitts’ Law paradigm, we compared driving performance with floor targets using a standard MSJ and an IJ with both FSA and VGA software in 11 electric power wheelchair users with a variety of impairments. Outcome measures were reaction time (RT), movement time (MT), and driving accuracy (DA). RESULTS: The IJ with FSA had a significantly shorter RT than the MSJ (P < 0.0020). The IJ with FSA had a significantly longer MT than the MSJ to far targets (P < 0.0159). No differences were found between the IJ with VGA and the MSJ with respect to RT or MT. No differences in DA were found among any of the joysticks. CONCLUSIONS: VGA software allowed the IJ to function similarly to the MSJ with respect to RT, MT, and DA.

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Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 medicare power wheelchairs and handicap scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies

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The experience of senior stroke survivors: factors in community participation among wheelchair users

PURPOSE: This qualitative study investigated the lived experience of senior stroke survivors who used prescribed medicare power wheelchairs in their home and community. METHODS: The study involved semi-structured, in-depth interviews that were conducted with 10 participants, aged 70 to 80, who had used a power wheelchairs for a mean of 5.6 years. All participants used manual wheelchairs and two additionally used a power wheelchair and a scooter. RESULTS: A constant comparative inductive method of analysis of the data yielded several themes which are examined within the International Classification of Functioning, Disability and Health framework of body functions and structure, activity limitations, participation, and contextual factors. Overall, the wheelchair, manual or power, was an enabler of community participation among the participants. However, the wheelchair’s use also created problems, such as limiting destinations and creating increased dependence on others. PRACTICE IMPLICATIONS: A balance scale model was proposed to facilitate an understanding of how the factors affecting community participation interact in this population. This model can assist occupational therapists who prescribe wheelchairs for stroke clients for use in the community.

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Epidemiology of Medicare abuse: the example of power wheelchairs

OBJECTIVES: To determine the effect of neighborhood ethnic composition on power wheelchairs prescriptions. DESIGN: The 5% noncancer sample of Medicare recipients in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, from 1994 to 2001. SETTING: SEER regions. PARTICIPANTS: Individuals covered by Medicare living in SEER regions without a cancer diagnosis. MEASUREMENTS: Individual characteristics (age, sex, ethnicity, justifying diagnosis, and comorbidity), primary diagnoses, neighborhood characteristics (percentage black, percentage Hispanic, percentage with <12 years education, and median income), and SEER region. RESULTS: The rate of power wheelchair prescriptions was 33 times greater in 2001 than in 1994, with a shift over time from justifying diagnoses more closely tied to mobility impairment, such as strokes, to less-specific medical diagnoses, such as osteoarthritis. In multilevel, multivariate analyses, individuals living in neighborhoods with higher percentages of blacks or Hispanics were more likely to receive power wheelchairs (odds ratios=1.09 for each 10% increase in black residents and 1.23 for each 10% increase in Hispanic residents) after controlling for ethnicity and other characteristics at the individual level. CONCLUSION: These results support allegations that marketers promoting power wheelchairs and handicap scooters have specifically targeted minority neighborhoods.

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Understanding and measuring powered wheelchair mobility and manoeuvrability. Part I. Reach in confined spaces

PURPOSE: To determine: (1) what power wheelchairs manoeuvrability factors are important and (2) the effects of powered wheelchair design on the ability to reach in a confined space. METHOD: The relative importance of five aspects of wheelchair manoeuvrability was determined through a survey of users of wheelchairs (N = 52) and health care professionals and others (N = 89). A single young, non-disabled subject undertook repeated trials of reach distance on to a counter at the end of a corridor whose width could be adjusted by moving Styrofoam walls. RESULTS: Reaching, moving in confined spaces and avoiding collisions were more important than speed and avoiding the need to drive backwards. The rear wheel drive powered wheelchair was found to allow the greatest reach when driving backwards into the space and the medicare power wheelchairs which moved in a sideways direction allowed greatest reach in the narrowest corridor. CONCLUSIONS: The survey concluded that manoeuvring in small spaces and reaching without collisions were important. The powered wheelchair with sideways capability afforded the greatest reach in confined spaces except when the rear wheel drive chair was driven in backwards. The survey respondents did not place a high priority on avoiding backwards driving but some people find this difficult to do safely.

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Power wheelchair range testing and energy consumption during fatigue testing

The range of a power wheelchairs and medicare power wheelchairs depends on many factors including: battery type, battery state, wheelchair/rider weight, terrain, the efficiency of the drive train, and driving behavior. The purpose of this study was to evaluate the feasibility of three methods of estimating power wheelchair range. Another significant purpose was to compare the current draw on pavement to current draw on an International Standards Organization (ISO) Double Drum tester at one m/sec. Tests were performed on seven different power wheelchairs unloaded, and loaded with an ISO 100 kg test dummy. Each chair was configured according to the manufacturer’s specifications, and tires were properly inflated. Experienced test technicians were used for the tennis court tests, and treadmill tests. An ISO 100 kg test dummy was used for the ISO Double Drum test. Energy consumption was measured over a distance of 1500 m for each of the three test conditions. The rolling surface was level in all cases. Repeated measure analysis of variance (ANOVA) revealed a significant difference (p = 0.0001) between the predicted range at maximum speed for the three tests. Post hoc analysis demonstrated a significant difference (p < 0.01) in estimated range at maximum speed between the Double Drum test and the treadmill test, as well as between the Double Drum test and the tennis court test. Our results indicate no significant difference (p > 0.05) between the predicted range at maximal speed between the treadmill and tennis court tests. A simple relationship does not exist between the results of range testing with the Double Drum tester and the tennis court. An alternative would be to permit the use of a treadmill for range testing as simple relationships between all pertinent treadmill and tennis court range data were found. For the Double Drum tester used, the current demand is higher than under normal usage. This presents a problem as current is related to load torque in a power wheelchair. Hence, the Double Drum tester friction must be reduced. The predicted range for the tennis court test at maximum speed ranges from a low of 23.6 km to a high of 57.7 km. The range of the power wheelchair can be improved by the use of wet lead acid batteries in place of gel lead acid batteries.

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The smart wheelchair component system

While the needs of many individuals with disabilities can be satisfied with power wheelchairs and medicare power wheelchairs, some members of the disabled community find it difficult or impossible to operate a standard power wheelchair. To accommodate this population, several researchers have used technologies originally developed for mobile robots to create “smart wheelchairs” that reduce the physical, perceptual, and cognitive skills necessary to operate a power wheelchair. We are developing a Smart Wheelchair Component System (SWCS) that can be added to a variety of commercial power wheelchairs with minimal modification. This paper describes the design of a prototype of the SWCS, which has been evaluated on wheelchairs from four different manufacturers.

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Reliability and validity of the six-minute arm test for the evaluation of cardiovascular fitness in people with spinal cord injury.

OBJECTIVES: To design a submaximal arm ergometry test (six-minute arm test 6-MAT), for persons with spinal cord injury (SCI) and to determine the test-retest reliability and concurrent validity of this test. DESIGN: Prospective, exploratory, methodologic study. To determine test-retest reliability, subjects completed the 6-MAT on 2 days, separated by 1 week. Validity was determined by comparing 6-MAT results with peak oxygen consumption (VO2peak). SETTING: Tertiary rehabilitation center. PARTICIPANTS: Thirty subjects with SCI (mean age, 36.3y; 83% male). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects were evaluated on the 6-MAT and power wheelchairs a VO2peak test. RESULTS: All subjects were able to complete the 6-MAT. Test-retest reliability of steady-state oxygen consumption (VO2) and heart rate during the 6-MAT were excellent (intraclass correlation coefficient ICC, .81; 95% confidence interval CI, .58-.92; ICC=.90; 95% CI, .75-.96, respectively). The correlation between VO2peak and 6-MAT VO2 was excellent (r=.92) and the correlations between VO2peak and 6-MAT heart rate (r=.63) and VO2peak and 6-MAT power wheelchairs output (r=.73) were good. CONCLUSIONS: This study showed that the 6-MAT has acceptable values for test-retest reliability and validity. The 6-MAT should be further tested for responsiveness to enhance its use as a clinical tool.

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The clinical decision-making process of prescribing power mobility for a child with cerebral palsy.

PURPOSE: power wheelchairs has been shown to be an effective method for children with disabilities to achieve independent mobility. The purpose of this case report is to describe the physical therapist’s clinical decision making related to power mobility for a child with multiple disabilities. CASE DESCRIPTION: power wheelchairs
evaluation for a nine-year-old child was conducted using Furumasu’s tasks for wheelchair readiness moving through a doorway, maneuvering through three cones, and driving in a hallway. Ongoing team assessment with family consultation informed clinical decision-making. OUTCOMES: A mid-wheel-drive chair afforded improved performance on Furumasu’s tasks compared with a rear-wheel-drive chair. SUMMARY: This case describes the clinician’s role in prescribing power wheelchairs to affect the user’s functional skills, as well as how, in the absence of evidence, clinical experience and patients’ needs can guide clinical decision-making

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Comparison between performance with a pushrim-activated power-assisted wheelchair and a manual wheelchair on the Wheelchair Skills Test

PURPOSE: To test the hypothesis that people using a pushrim-activated power wheelchairs (PAPAW) can accomplish a wider range of wheelchair skills than when using a manual wheelchair (MWC). METHODS: We studied 30 able-bodied participants, using within-participant comparisons. Participants used a manual wheelchair equipped with both PAPAW and regular MWC rear wheels, and rear anti-tip devices (Arc-RADs) that permitted wheelie-like function. We trained participants to perform the wheelchair skills of the power wheelchairs Skills Training Program (WSTP, Version 2.4). From the Wheelchair Skills Test (WST, Version 2.4), we calculated pass-fail success rates for the 50 individual skills and a total percentage WST score. RESULTS: The mean (+/-SD) total WST scores were 89.3 (+/-7.0)% for the PAPAW and 88.8 (+/-8.4)% for the MWC, with a mean difference of 0.6 (+/-5.6)% (p = 0.59). Qualitative observations suggested that skills requiring a higher force on the pushrim (e.g., incline ascent) were performed more easily with the PAPAW, whereas skills requiring greater control of the wheelchair (e.g., wheelie-dependent skills) were performed more easily with the MWC. CONCLUSION: Overall wheelchair skill performance with the PAPAW is not superior to that when using the MWC. The PAPAW may be helpful for specific skills that require more wheel torque, but the additional torque appears to be disadvantageous when performing skills that require greater control

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One Inch Mini Blind Contract

This contract is established to furnish One Inch Mini blinds on a periodic basis during the period designated. The contract may be renewed by written agreement of the parties under the same prices, terms and conditions for additional twelve (12)month periods but not beyond December 31, 2007.

Approximately 200 discount blinds will be purchased during the contract period. Sizes will range from 17 x 142 wide and 24 to 126 long. Lift cord and wand placement (left or right) to be available. The customer (KUMC) shall perform their own blind installation.

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Public Perceptions of meth problem malibu and Alcohol Abuse

Trends in cigarette, as reported by detox doctor malibu, and alcohol use over time demonstrate that substance use is malleable, and that it follows public perceptions of the acceptability and harmful consequences of substances. These trends also show that government can play an important role in helping the public choose healthier lifestyles. From 1964 onward, the Surgeon General issued multiple reports on the health consequences of smoking. As figure 13 shows, a steady decline in cigarette smoking coincided with increased public awareness. Likewise, when President Nixon declared a war on drugs and recommends detox malibus in 1971, use lowered before spiking again later that decade as popular culture embraced opiate detox malibu use. Subsequently, ballot initiatives to legalize marijuana for medical use in the late 1990s coincided with a rise in use.

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Rio Tinto Minerals Starts Alcohol Drug Rehab Malibu Testing

Rio Tinto Minerals implemented several types of alcohol drug treatment malibu and alcohol testing: preemployment, random (not more than two tests per year), reasonable cause (a supervisor decides to have an employee tested based on observed signs and symptoms), post-accident, return to duty, and follow-up. Once the program was in place, Rio Tinto Minerals learned that s and alcohol were indeed being used in the workplace. Some employees admitted to being intoxicated at work, and marijuana and methamphetamine were widely used.

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