Effects of Upper Extremity Immobilization and Use of a Spinner Knob on Vehicle Steering.

BACKGROUND: A person's ability to safely drive while immobilized is not well defined. Steering ability with a spinner knob during immobilization is unknown. The goal of this study is to further clarify the effect of immobilization on steering reaction time and accuracy with and without a steering wheel spinner knob. METHODS: Twenty participants were enrolled in this crossover trial using a driving simulator with an automatic transmission. Five conditions were tested in a counterbalanced order. Steering reaction time and accuracy (number of errors on a dynamic steering task at 2 difficulty levels) were measured. Participants were allowed to steer with the immobilized extremity. RESULTS: No significant differences in reaction time were observed between any conditions. Both immobilized conditions and difficulty level of the steering task led to diminished accuracy compared with controls, resulting in significantly more errors. The use of a spinner knob significantly improved the accuracy for the condition with the sugar-tong splint during the easier steering task, but this improvement was not observed in the harder steering task. There were no differences between conditions based on gender or observed use of the immobilized arm. CONCLUSIONS: Immobilization had a negative effect on steering accuracy for both the wrist splint and the sugar-tong splint condition, which may negatively impact driving ability of immobilized patients. Immobilization, regardless of spinner knob use, did not significantly impact steering reaction time. The steering wheel spinner knob did not consistently improve accuracy, and further study is needed to determine its utility.

The Design, Prototyping, and Formative Evaluation of an Assistive Robotic Table (ART) for Stroke Patients.

OBJECTIVE: This article presents the results of an exploratory study in which 14 healthcare subject matter experts (H-SMEs) in addition to four research and design subject matter experts (RD-SMEs) at a regional rehabilitation hospital engaged in a series of complementary, participatory activities in order to design an assistive robotic table (ART). BACKGROUND: As designers, human factor experts, and healthcare professionals continue to work to integrate assistive human-robot technologies in healthcare, it is imperative to understand how the technology affects patient care from clinicians' perspectives. METHOD: Fourteen clinical H-SMEs rated a subset of conceptual ART design ideas; participated in the iterative design process of ART; and evaluated a final cardboard prototype, the rehabilitation hospital's current over-the-bed table (OBT), an ART built with true materials, and two therapy surface prototypes. Four RD-SMEs conducted a heuristic evaluation on the ART built with true materials. Data were analyzed by frequency and content analysis. RESULTS: The results include a design and prototype for the next generation ART and a pneumatically controlled therapy surface, a broadened list of specifications for the future design and implementation of assistive robotic furniture, and final observations. CONCLUSION: When compared to the rehabilitation hospital's current OBT, the developed ART in this study was successful. Designing novel features is dependent upon ensuring patient safety. The inclusion of clinicians in the participatory iterative design and evaluation process and the use of personas provided a broadened list of specifications for the successful implementation of assistive robotic furniture.

An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital.

OBJECTIVE: This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table. BACKGROUND: This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand. METHODS: The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities. RESULTS: Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand. CONCLUSIONS: Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized.

The reliability of a VISION COACH task as a measure of psychomotor skills.

The VISION COACH™ interactive light board is designed to test and enhance participants' psychomotor skills. The primary goal of this study was to examine the test-retest reliability of the Full Field 120 VISION COACH task. One hundred eleven male and 131 female adult participants completed six trials where they responded to 120 randomly distributed lights displayed on the VISION COACH interactive light board. The mean time required for a participant to complete a trial was 101 seconds. Intraclass correlation coefficients, ranging from 0.962 to 0.987 suggest the VISION COACH Full Field 120 task was a reliable task. Cohen's d's of adjacent pairs of trials suggest learning effects did not negatively affect reliability after the third trial.

Understanding the needs of hand control users, driver rehabilitation specialists, and dealers/installers.

Understanding unique perspectives from key stakeholder groups involved in the hand control (HC) industry, including driver rehabilitation specialists (DRSs) who train users how to use their HCs, dealers/installers, and users, may become increasingly important in the United States due to increases in elderly, diabetic, and wounded warrior amputee driving populations. In this exploratory study, phone interviews were conducted with 20 DRSs, 20 dealers/installers, and 20 users regarding their perspectives about HC training, maintenance and operation, and design improvements. Results revealed common views and differences in perspectives about whether HC users should receive training and for how long, when and how often users should receive maintenance on their HCs, and what DRSs, dealers/installers, and users would like to see in the future.

Evaluation of four steering wheels to determine driver hand placement in a static environment.

While much research exists on occupant packaging both proprietary and in the literature, more detailed research regarding user preferences for subjective ratings of steering wheel designs is sparse in published literature. This study aimed to explore the driver interactions with production steering wheels in four vehicles by using anthropometric data, driver hand placement, and driver grip design preferences for Generation-Y and Baby Boomers. In this study, participants selected their preferred grip diameter, responded to a series of questions about the steering wheel grip as they sat in four vehicles, and rank ordered their preferred grip design. Thirty-two male participants (16 Baby Boomers between ages 47 and 65 and 16 Generation-Y between ages 18 and 29) participated in the study. Drivers demonstrated different gripping behavior between vehicles and between groups. Recommendations for future work in steering wheel grip design and naturalistic driver hand positioning are discussed.

Examination of How and Why Over-the-Bed Tables Are Used: Use Cases and Needs from Healthcare Providers.

OBJECTIVE: This article presents the results of an exploratory study in which 14 clinical and staff subject matter experts (SMEs) at a regional rehabilitation hospital were interviewed in order to understand how and why over-the-bed tables are used. BACKGROUND: It is important to understand how and why a device or environment is used when designing it, and not just what features and functions are preferred. This knowledge is valuable both for contextualizing user feature and function preferences and for characterizing and prioritizing design challenges and opportunities. METHODS: Fourteen hospital clinical and support staff subject-matter experts participated in semi-structured interviews with scenario enactments in a medium-fidelity, full-scale mock-up of a typical patient room. During these interviews, they interacted with two personas played by actors and were asked to enact an example of a normal visit, from entering the room through treatment/service and then exiting. Data were analyzed via methodological triangulation including frequency analysis, content analysis, and affinity diagramming. RESULTS: The results include a use-case analysis with illustrative sketches, a list of needs statements, and final observations. CONCLUSIONS: Successfully using the over-the-bed table is dependent upon proper positioning, especially in bed during meals. There are fewer problems associated with over-the-bed table use while seated in a chair than when in the bed. The over-the-bed table is a key component in acute care, inpatient therapies. Clinicians are generally open to "smart" furniture in the patient room but question its cost-effectiveness, robustness, and flexibility. KEYWORDS: Evidence-based design, human factors, patient-centered care, quality care, technology.

Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation.

OBJECTIVE: This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more useful, usable, and actively assistive over-the-bed table. BACKGROUND: Manganelli et al. (2014) generated a list of 74 needs for use in developing an actively assistive over-the-bed table. This present study assesses the value and importance of those needs. METHODS: Fourteen healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process. A mixed methods qualitative approach used methodological triangulation to confirm the value of the findings and ratings to establish importance. Open and closed card sorts and a Delphi study were used. Data analysis methods included frequency analysis, content analysis, and a modified Kano analysis. RESULTS: A table demonstrating the needs that are of high importance to both groups of subject matter experts and classification of the design challenges each represents was produced. Through this process, the list of 74 needs was refined to the 37 most important need statements for both groups. CONCLUSIONS: Designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients.

Examination of overbed tables: healthcare provider and user preferences.

OBJECTIVE: This exploratory study examined the preferences of healthcare providers and patients with respect to overbed table features and functions, as well as how the devices tend to be used. BACKGROUND: In order to improve the design of overbed tables, it is important to understand which features and functions of existing models are valued by healthcare providers and patients. METHODS: A sample of overbed table models was presented to volunteers, who were asked to choose which models' implementation of specific features and functions they preferred. Structured interviews incorporating both forced choice and free response questions were administered to the volunteers-healthcare providers and patients at a rehabilitation hospital. RESULTS: While the overbed tabletop and extendable tray are heavily used, all other features of the overbed table models are rarely used. Usability of the models exhibits the potential for improvement. Healthcare providers' and patients' feature preferences differ and occasionally conflict. CONCLUSIONS: Existing overbed tables are valued primarily for the top surface. Other features and functions of the overbed table present opportunities for refinement of design, durability, and usability. There are strong patterns of agreement and disagreement in the preferences of healthcare providers and patients with respect to overbed table design, use, features, and functionality. There is potential to improve overbed table designs from both the perspectives of the staff and the patient. KEYWORDS: Evidence-based design, hospital, human factors, patient-centered care, quality care, technology.

Group differences in preferences for a novel nightstand.

OBJECTIVE: Multiple user groups (patients and employees at a rehabilitation facility, community-dwelling seniors, and university students) participated in a study that examined their preferences for the features and functions of three novel nightstand prototypes. BACKGROUND: It is valuable to get input from different user groups in order to improve furniture usefulness and usability, especially furniture prevalent in clinical settings where users of all age groups are found. METHODS: Feedback was obtained from different user groups in both clinical (rehabilitation facility) and nonclinical (university) settings. This was done using structured interviews to ask participants about multiple features of the novel nightstand designs. RESULTS: There were several features that all groups preferred. There were also some distinctly opposing opinions between groups. In general, the patient group showed the most similarities to the other groups. CONCLUSION: This research explores differences and similarities in preferences for nightstand design across a variety of user groups. It yields ideas for improving the nightstand design to be useful for a wider group of people.

Pedestrians' estimates of their own visibility: a simple and effective computer-based technique.

INTRODUCTION: Research has shown that both pedestrians and drivers drastically overestimate pedestrians' nighttime visibility (NHSTSA, 2008a, 2008b; Owens & Sivak, 1996) and fail to appreciate the safety benefits of proven conspicuity aids. One solution is educational intervention (Tyrrell, Patton, & Brooks, 2004); however, the on-road assessment of its effectiveness is expensive and time consuming. METHOD: Experiment One introduces a computer-based alternative to the field-based approach, successfully replicating the previous study's trends among 94 students who either receive or do not receive an educational lecture. Experiment Two utilizes the simulation's portability to determine if professional roadway workers have a more accurate understanding of pedestrian conspicuity than students. RESULTS: RESULTS among 88 workers show they do not significantly appreciate the advantages of effective retroflective material configurations or vehicle headlamp settings, for example, any better than non-lectured students in Experiment One. IMPACT: The study's results demonstrate the need for education among all pedestrians and the benefits of efficient testing methods.

Certified driver rehabilitation specialists' preferred situations for driving simulator scenarios.

The use of driving simulators is increasing in clinical settings that provide driving evaluation and rehabilitation. To identify the driving simulator scenarios desired by certified driving rehabilitation specialists (CDRSs), we developed a questionnaire consisting of 22 driving scenario situations. A total of 164 CDRSs rated each situation in terms of its importance for inclusion in simulator-based driving. The four situations they identified as most critical were turning left across oncoming traffic, navigating four-way intersections with traffic lights or signs, driving in multiple lanes with traffic on both sides, and reacting to unexpected events that require emergency braking or aggressive maneuvers to prevent an accident. We conducted exploratory and confirmatory factor analyses to group the 22 driving scenario situations. The model with the best fit included 11 situations forming three factors: (1) Intersections, (2) Roadway and Traffic Conditions, and (3) Environmental Conditions. Future studies should include these factors in driving simulator scenarios and evaluate their clinical efficacy in driving evaluation and rehabilitation.

Seniors' and physicians' attitudes toward using driving simulators in clinical settings.

ABSTRACT Interactive driving simulators may offer a safe and controlled environment for occupational therapists to treat clients with conditions that affect their ability to drive safely. The use of simulators has been mostly limited to research settings. To make appropriate use of this technology, identifying and understanding the needs of clients and medical personnel that simulators can fulfill is important. The current investigation seeks to identify the attitudes of potential clients and physicians regarding the use of driving simulators. Using survey and interview methodology, clients' and physicians' needs in regard to driving and community mobility are investigated in the context of identifying potential applications for simulator technology. In addition, general needs and attitudes about driving in the context of medical practice were identified. Attitudes toward the use of simulators were generally positive, and the desire for a greater ability to understand and treat clients in the context of driving appears strong.

Developing a driving simulator based functional object detection task.

The purpose of this study was to validate a driving simulator-based tool for assessing functional visual scanning while driving (Goodenough, 2010) by replicating a previous study and assessing whether the results of the task are moderated by strategic decisions regarding task prioritization. Participants completed a functional object detection task that includes a peripheral target detection task and a central braking response task. Results indicated that the simulator task can identify differences in older and younger participants' abilities to functionally scan the driving environment and these differences appear unaffected by prioritizing either the scanning or braking task. Implications are discussed.

Toward a "smart" nightstand prototype: an examination of nightstand table contents and preferences.

OBJECTIVE: Two studies were conducted to obtain an understanding of the types of items seniors keep in their nightstands and to understand how users feel about the possibility of "smart" furniture. BACKGROUND: To enable aging in place and universal design, it is vital to understand the needs of a broad range of aging individuals, especially since there is little research on nightstand usage and design. METHODS: Study 1 allowed for the development of a structured inventory of nightstand use today in assisted living and rehabilitation facilities. Study 1 led to Study 2, demonstrating the need to conceptualize new ideas for smart nightstands. Feedback was obtained from intergenerational participants who could discuss their needs and preferences for a smart nightstand. RESULTS: In Study 1, more than 150 items were recorded and categorized into 25 different groups. The authors found that participants utilized the top portion of their nightstand as opposed to the lower sections; most items were found on top of the nightstand or in the top drawer. In Study 2, the authors found that the vast majority of participants are willing to consider the use of a smart nightstand. Participants discussed key functions and design preferences, which included carefully designed storage, the ability to move the nightstand up and down, contemporary design, and interaction through voice activation. CONCLUSION: Existing nightstands do not meet the needs of current users. This research provides greater understanding of the existing limitations associated with nightstands. Study 2 confirmed that user-centered design and the use of technology can be used to enhance daily living. Smart furniture may play a role in promoting the health and independence of diverse user groups.

Speed choice and driving performance in simulated foggy conditions.

Driving in fog is a potentially dangerous activity that has been investigated in a number of different ways; however, most have focused on identifying the underlying perceptual changes that result in an inability to perceive speed of vehicle motion. Although the previous research has identified the perceptual changes associated with driving in fog and shows that people are highly likely to perceive their speed to be higher than it actually is, these research studies have not investigated driving behavior when drivers are allowed to maintain speed as they feel appropriate and make use of the vehicle's speedometer. In addition, much of the existing research focuses on speed perception and presents a limited view of other driving performance metrics in terms of lane keeping and event detection. The current study addresses these issues utilizing a driving simulator-based method where fog is simulated as a distance dependent contrast reduction while having participants drive at speeds they feel are appropriate. A number of different instructions and speed feedback mechanisms were tested in order to determine how drivers react when driving in varying levels of fog. Results also include lane keeping measures in order to assess whether drivers are willing to drive at speeds where their lane keeping performance is degraded due to the reduced visibility. Results indicate that, in general, drivers do not tend to slow down significantly until visibility distance is drastically reduced by fog; however, lane keeping ability is maintained throughout most of the range of visibility distances. Lane keeping ability was reduced only when fog results in visibility distances <30 m. Overall, the current study shows that drivers are willing and able to maintain vehicular control at high speed when driving in fog; however, it is important to note that drivers chose to drive at speeds where they would be incapable of stopping to avoid obstacles in the roadway even if they were to identify and react to the obstacle immediately at the border of visibility distance. This research suggests that safety benefits may be gained by convincing drivers to slow down more than they would on their own when driving in fog or enhancing a vehicle's ability to identify and react to hazards that are not visible to the driver. In order to further understand the effects of driving in fog, future naturalistic driving research should focus on identifying and mitigating risky behaviors associated with driving in foggy conditions.

Physician knowledge, assessment, and reporting of older driver fitness.

ABSTRACT Physicians have the potential to serve as an important portal for information gathering, assessment, counseling, and reporting older driver fitness, as almost all older adults require medical care and have a primary care physician. However, there are few studies that have evaluated physician knowledge about, attitudes toward, and performance of older driver fitness assessment. Two pilot studies were conducted to assess physician knowledge and attitudes and aid understanding of physician knowledge of legal reporting requirements regarding older driver medical fitness. Results suggest that although physicians believe that patients should be evaluated for safe driving, many physicians do not routinely assess fitness to drive and few feel qualified to do so. It also appears that physicians may not be adequately knowledgeable about laws about reporting unsafe drivers. Thus, occupational therapy practitioners have an opportunity to educate about driving as a complex instrumental activity of daily living.

Simulator sickness during driving simulation studies.

While driving simulators are a valuable tool for assessing multiple dimensions of driving performance under relatively safe conditions, researchers and practitioners must be prepared for participants that suffer from simulator sickness. This paper describes multiple theories of motion sickness and presents a method for assessing and reacting to simulator sickness symptoms. Results showed that this method identified individuals who were unable to complete a driving simulator study due to simulator sickness with greater than 90% accuracy and that older participants had a greater likelihood of simulator sickness than younger participants. Possible explanations for increased symptoms experienced by older participants are discussed as well as implications for research ethics and simulator sickness prevention.

Validation of the IOF quality of life questionnaire for patients with wrist fracture.

INTRODUCTION: Wrist fracture causes pain and decreased physical, social and emotional function. The International Osteoporosis Foundation has developed a specific questionnaire to assess quality of life in patients with wrist fracture. This questionnaire, including 12 questions, was validated in a multicentre study and compared with an osteoporosis-specific questionnaire (Qualeffo-41) and a generic questionnaire (EQ-5D). METHODS: The study included 105 patients with a recent wrist fracture and 74 sex- and age-matched control subjects. The questionnaire was administered as soon as possible after the fracture, at 6 weeks, 3 months, 6 months and 1 year after the fracture. Test-retest reproducibility, internal consistency and sensitivity to change were assessed. RESULTS AND DISCUSSION: The results showed adequate repeatability and internal consistency of the International Osteoporosis Foundation (IOF) wrist fracture questionnaire. The discriminatory capacity between patients and control subjects was very high, with significant odds ratios for each question and domain. The IOF-wrist fracture questionnaire domain scores showed significant improvement after 3 and 6 months and some improvement from 6 months up to 1 year. The sensitivity to change was much higher for the IOF-wrist fracture total score than for Qualeffo-41 and EQ-5D. CONCLUSION: In conclusion, the IOF-wrist fracture questionnaire appears to be a reliable and responsive quality of life questionnaire.