Gut microbiome and inflammation among athletes in wheelchair in a crossover randomized pilot trial of probiotic and prebiotic interventions.

Disorders related to gut health are a significant cause of morbidity among athletes in wheelchair. This pilot feasibility trial aims to investigate whether probiotics compared to prebiotics can improve inflammatory status and gut microbiome composition in elite athletes in wheelchair. We conducted a 12-week, randomized, cross-over controlled trial involving 14 elite Swiss athletes in wheelchair. Participants were given a multispecies-multistrain probiotic or prebiotic (oat bran) daily for 4 weeks (Clinical trials.gov NCT04659408 09/12/2020). This was followed by a 4-week washout and then crossed over. Thirty inflammatory markers were assessed using bead-based multiplex immunoassays (LegendPlex) from serum samples. The gut microbiome was characterized via 16S rRNA sequencing of stool DNA samples. Statistical analyses were conducted using linear mixed-effect models (LMM). At baseline, most athletes (10/14) exhibited low levels of inflammation which associated with higher gut microbiome alpha diversity indices compared to those with high inflammation levels. The use of probiotic had higher decrease in 25 (83%) inflammatory markers measured compared to prebiotic use. Probiotic has the potential in lowering inflammation status and improving the gut microbiome diversity. The future trial should focus on having sufficient sample sizes, population with higher inflammation status, longer intervention exposure and use of differential abundance analysis.

Handcycling with concurrent lower body low-frequency electromyostimulation significantly increases acute oxygen uptake in elite wheelchair basketball players: an acute crossover trial.

OBJECTIVE: Wheelchair basketball (WCB) demands high-intensity training due to its intermittent nature. However, acute oxygen uptake (V˙O2) in handcycling is restricted. Combining handcycling with low-frequency electromyostimulation (LF-EMS) may enhance V˙O2 in elite WBC athletes. DESIGN: Randomized crossover trail. SUBJECTS: Twelve German national team WCB players (age: 25.6 [5.6] years, height: 1.75 [0.16] m, mass: 74.0 [21.7] kg, classification: 2.92 [1.26]). METHOD: Participants underwent 2×5 min of handcycling (60 rpm, ¾ bodyweight resistance in watts) (HANDCYCLE) and 2×5 min of handcycling with concurrent LF-EMS (EMS_HANDCYCLE). LF-EMS (4Hz, 350µs, continuous stimulation) targeted gluteal, quadriceps, and calf muscles, adjusted to individual pain thresholds (buttocks: 69.5 [22.3] mA, thighs: 66.8 [20.0] mA, calves: 68.9 [31.5] mA). RESULTS: Significant mode-dependent differences between HANDCYCLE and EMS_HANDCYCLE were found in V˙O2 (17.60 [3.57] vs 19.23 [4.37] ml min-1 kg-1, p = 0.001) and oxygen pulse (16.69 [4.51] vs 18.41 [5.17] ml, p = 0.002). ΔLactate was significantly lower in HANDCYCLE (0.04 [0.28] vs 0.31 [0.26] mmol l-1). Although perceived effort did not differ (p = 0.293), discomfort was rated lower in HANDCYCLE (1.44 [1.28] vs 3.94 [2.14], p = 0.002). CONCLUSION: LF-EMS applied to the lower extremities increases oxygen demand during submaximal handcycling. Thus, longitudinal application of LF-EMS should be investigated as a potential training stimulus to improve aerobic capacity in wheelchair athletes.

The association between physical activity and neck circumference with cardiovascular disease risk in older wheelchair users.

OBJECTIVE: To examine the association between physical activity, neck circumference, and cardiovascular disease risk in older wheelchair users. DESIGN: A cross-sectional study. SUBJECTS/PATIENTS: Sixty-one Korean wheelchair users aged 50 years and older. METHODS: Physical activity was assessed using a self-administered questionnaire. Neck circumference was measured with a tape ruler. Cardiovascular disease risk was evaluated by calculating the Framingham risk score (FRS) for estimating 10-year cardiovascular disease risk, which was classified as low-moderate (19% or less) or high risk (20% or more). RESULTS: The FRS for 10-year cardiovascular disease risk was inversely related to physical activity (beta [SE] = -0.213 (0.103), p = 0.043) and positively related to neck circumference (beta [SE] = 1.331 ± 0.419, p = 0.003). Binary logistic regression showed that those with low physical activity (odds ratio [95% confidence interval] = 4.256 (1.188~15.243), p = 0.026) or a large neck circumference (odds ratio [95% confidence interval] = 3.645 (1.172~11.338), p = 0.025) had a higher risk for high cardiovascular disease risk compared with those with high physical activity or normal neck circumference. CONCLUSION: The current study findings suggest that an intervention targeting physical inactivity and upper-body obesity should be implemented to reduce cardiovascular disease risk in older wheelchair users.

Transformable Quadruped Wheelchairs Capable of Autonomous Stair Ascent and Descent.

Despite advancements in creating barrier-free environments, many buildings still have stairs, making accessibility a significant concern for wheelchair users, the majority of whom check for accessibility information before venturing out. This paper focuses on developing a transformable quadruped wheelchair to address the mobility challenges posed by stairs and steps for wheelchair users. The wheelchair, inspired by the Unitree B2 quadruped robot, combines wheels for flat surfaces and robotic legs for navigating stairs and is equipped with advanced sensors and force detectors to interact with its surroundings effectively. This research utilized reinforcement learning, specifically curriculum learning, to teach the wheelchair stair-climbing skills, with progressively increasing complexity in a simulated environment crafted in the Unity game engine. The experiments demonstrated high success rates in both stair ascent and descent, showcasing the wheelchair's potential in overcoming mobility barriers. However, the current model faces limitations in tackling various stair types, like spiral staircases, and requires further enhancements in safety and stability, particularly in the descending phase. The project illustrates a significant step towards enhancing mobility for wheelchair users, aiming to broaden their access to diverse environments. Continued improvements and testing are essential to ensure the wheelchair's adaptability and safety across different terrains and situations, underlining the ongoing commitment to technological innovation in aiding individuals with mobility impairments.

A Brain-Controlled and User-Centered Intelligent Wheelchair: A Feasibility Study.

Recently, due to physical aging, diseases, accidents, and other factors, the population with lower limb disabilities has been increasing, and there is consequently a growing demand for wheelchair products. Modern product design tends to be more intelligent and multi-functional than in the past, with the popularization of intelligent concepts. This supports the design of a new, fully functional, intelligent wheelchair that can assist people with lower limb disabilities in their day-to-day life. Based on the UCD (user-centered design) concept, this study focused on the needs of people with lower limb disabilities. Accordingly, the demand for different functions of intelligent wheelchair products was studied through a questionnaire survey, interview survey, literature review, expert consultation, etc., and the function and appearance of the intelligent wheelchair were then defined. A brain-machine interface system was developed for controlling the motion of the intelligent wheelchair, catering to the needs of disabled individuals. Furthermore, ergonomics theory was used as a guide to determine the size of the intelligent wheelchair seat, and eventually, a new intelligent wheelchair with the features of climbing stairs, posture adjustment, seat elevation, easy interaction, etc., was developed. This paper provides a reference for the design upgrade of the subsequently developed intelligent wheelchair products.

The impact of high-intensity arm crank exercise on reaction time in wheelchair fencers: gender differences and mechanical predictors.

To achieve high performance, wheelchair fencing (WF) athletes are required to exhibit good physiological and timing indicators. The main aims of this study were to assess the relationship between the results of the repeated sprint ability (RSA) test and reaction time (RT) in WF, and to evaluate changes in RT after repeated high-intensity sprints in the group of an international-level WF athletes. This experimental study involved 18 athletes (aged 34.6 ± 7.70) from the Paralympic WF team. To establish the impact of fatigue on psychomotor capacity, the participants undergo a series of tests. At the beginning of the study, first reaction time (RT1) was measured. Afterwards, the RSA test was performed using the arm crank ergometer to evaluate the participants' repeated sprint ability. Immediately after RSA, the second reaction time (RT2) was measured. Statistical analysis revealed moderate correlations between the RT2 and total work, decrease of work (DW), highest peak power, mean peak power, and highest peak power/kg, but these correlations were not statistically significant (p > 0.05). All fencers achieved a significantly shorter average RT2 (p < 0.005) after the RSA test (0.383 ± 0.035 s) than before the test (0.391 ± 0.038 s). Additionally, RT2 was significantly shorter than RT1 in the women's group (p < 0.001). Moreover, males had significantly greater values of repeated sprint ability parameters: highest work, total work, decrease of work and highest peak power (p < 0.05) than females. To conclude, repeated high-intensity arm crank exercise has a positive impact on simple postexercise cognitive tasks in WF fencers, especially in women, and leads to a decrease in RT. The RSA parameters can be predictors of changes in RT in men and women wheelchair fencers.

Towards an accurate rolling resistance: Estimating intra-cycle load distribution between front and rear wheels during wheelchair propulsion from inertial sensors.

Accurate assessment of rolling resistance is important for wheelchair propulsion analyses. However, the commonly used drag and deceleration tests are reported to underestimate rolling resistance up to 6% due to the (neglected) influence of trunk motion. The first aim of this study was to investigate the accuracy of using trunk and wheelchair kinematics to predict the intra-cyclical load distribution, more particularly front wheel loading, during hand-rim wheelchair propulsion. Secondly, the study compared the accuracy of rolling resistance determined from the predicted load distribution with the accuracy of drag test-based rolling resistance. Twenty-five able-bodied participants performed hand-rim wheelchair propulsion on a large motor-driven treadmill. During the treadmill sessions, front wheel load was assessed with load pins to determine the load distribution between the front and rear wheels. Accordingly, a machine learning model was trained to predict front wheel load from kinematic data. Based on two inertial sensors (attached to the trunk and wheelchair) and the machine learning model, front wheel load was predicted with a mean absolute error (MAE) of 3.8% (or 1.8 kg). Rolling resistance determined from the predicted load distribution (MAE: 0.9%, mean error (ME): 0.1%) was more accurate than drag test-based rolling resistance (MAE: 2.5%, ME: -1.3%).

Safety and feasibility of in-hospital autonomous transportation using a driverless mobility for patients with musculoskeletal disorders: preliminary clinical study to achieve mobility as a service in medical care.

BACKGROUND: Recent advancements in and the proliferation of autonomous mobility technology, such as intelligent wheelchairs, have made it possible to provide mobility services for patients with reduced mobility due to musculoskeletal disorders. In the present study, we conducted a preliminary clinical study to assess the safety and feasibility of in-hospital autonomous transportation using a driverless mobility (wheelchair) for patients with musculoskeletal disorders. METHODS: From January to February 2022, 51 patients with musculoskeletal disorders exhibiting gait disturbance who presented to our institution were included in the present study. Driverless mobility rides were conducted over a straight-line distance of 100 m from the orthopaedic outpatient reception to the payment counter after the outpatient consultation. We assessed the quality of life using an EQ-5D-5 L index and pain using a VAS score before riding the mobility to investigate the patient's condition. After the ride, a questionnaire survey was conducted to assess patient satisfaction on a 5-point scale. In addition, adverse events during the mobility ride were investigated. RESULTS: Overall satisfaction levels showed that 44 out of 51 (86%) patients rated the level as 3 or higher. There were no significant differences in the level of satisfaction based on the cause of disorders or EQ-5D-5 L Index. Among 19 patients who rated the level of satisfaction as 2-3, the ratio of postoperative patients and those with pain tended to be higher (p < 0.05). While 26 of 51 (51%) patients reported moments of feeling unsafe during the mobility ride, no actual adverse events, such as collisions, were observed. CONCLUSIONS: An in-hospital autonomous transportation service using a driverless mobility for patients with musculoskeletal disorders demonstrated high satisfaction levels and was safe with no severe adverse events observed. The expansion of autonomous mobility deployment is expected to achieve mobility as a service in medical care.

Optimizing wheelchair basketball lineups: A statistical approach to coaching strategies.

This study was designed to support the tactical decisions of wheelchair basketball (WB) coaches in identifying the best players to form winning lineups. Data related to a complete regular season of a top-level WB Championship were examined. By analyzing game-related statistics from the first round, two clusters were identified that accounted for approximately 35% of the total variance. Cluster 1 was composed of low-performing athletes, while Cluster 2 was composed of high-performing athletes. Based on data related to the second round of the Championship, we conducted a two-fold evaluation of the clusters identified in the first round with the team's net performance as the outcome variable. The results showed that teams where players belonging to Cluster 2 had played more time during the second round of the championship were also those with the better team performance (R-squared = 0.48, p = 0.035), while increasing the playing time for players from Classes III and IV does not necessarily improve team performance (r2 = -0.14, p = 0.59). These results of the present study suggest that a collaborative approach between coaches and data scientists would significantly advance this Paralympic sport.

The impact of Wheelchair Rugby classification lineup structure on possession outcome.

OBJECTIVES: To investigate the impact that the structure and combination of athlete classification within lineups has on possession outcome in Wheelchair Rugby (WR). DESIGN: Retrospective. METHODS: Analysis was conducted using data from all 18 WR matches from the 2020 Tokyo Paralympic Games. Pearson's chi-squared analysis was conducted to investigate the effect of lineup structures on performance and a nested generalised logistic mixed model (GLMM) was fitted to the data to investigate the association between independent variables and the outcome of possessions. Specifically, the impact of offensive and defensive lineup structures on possession outcome and whether the offensive and defensive lineup structures matching or not impact possession outcome. RESULTS: There was a significant relationship between the offensive lineup structure and possession outcome. Balanced lineups had greater turnovers than expected. Balanced lineups also had fewer tries than expected, whilst high-low lineups had fewer than expected turnovers. There were no significant associations between the defensive lineup structure and possession outcome. Furthermore, no significant associations were found between whether the structure of the offensive and defensive lineup matched (or not) and the possession outcome. CONCLUSIONS: The findings suggest that the offensive team's lineup structure plays a more prominent role in impacting possession outcome, compared to the defensive team's lineup structure. The present results provide valuable insights into WR performance for coaches, practitioners, and researchers.

How does classification score affect falls in wheelchair basketball? A video-based cross-sectional study on the Italian national team during the European Para Championships 2023.

OBJECTIVES: The aim of this study was to investigate the mechanism of falls in male elite wheelchair basketball (WB) players and to analyse the falls characteristics considering their classification score which ranges from 1.0 to 4.5 and it is related to their functional capacity and particularly to their volume of action. DESIGN: A cross-sectional video analysis was conducted using European para championships 2023official match videos. SETTING: Players of the sample team were divided into 2 groups according to their classification point: low-point players (LPP) and high-point players (HPP). Every occurred fall was systematically analysed focusing on falling related characteristics and game circumstances. PARTICIPANTS: Twelve WB players of the Italian national team. MAIN OUTCOME: Number of falls and mechanism of falls. RESULTS: The results showed a higher number of falls for HPP and highlighted a statistically significant differences between LPP and HPP for the fall direction, the playing time and the first anatomical site in contact with the floor. CONCLUSION: Results reported significant differences between LPP and HPP in terms of mechanism of fall. Further studies should focus on the development of new preventive training strategies tailored to WB players with different levels of impairments to reduce fall related injuries.

Evaluation of power wheelchair driving performance in simulator compared to driving in real-life situations: the SIMADAPT (simulator ADAPT) project-a pilot study.

OBJECTIVE: The objective of this study was to evaluate users' driving performances with a Power Wheelchair (PWC) driving simulator in comparison to the same driving task in real conditions with a standard power wheelchair. METHODS: Three driving circuits of progressive difficulty levels (C1, C2, C3) that were elaborated to assess the driving performances with PWC in indoor situations, were used in this study. These circuits have been modeled in a 3D Virtual Environment to replicate the three driving task scenarios in Virtual Reality (VR). Users were asked to complete the three circuits with respect to two testing conditions during three successive sessions, i.e. in VR and on a real circuit (R). During each session, users completed the two conditions. Driving performances were evaluated using the number of collisions and time to complete the circuit. In addition, driving ability by Wheelchair Skill Test (WST) and mental load were assessed in both conditions. Cybersickness, user satisfaction and sense of presence were measured in VR. The conditions R and VR were randomized. RESULTS: Thirty-one participants with neurological disorders and expert wheelchair drivers were included in the study. The driving performances between VR and R conditions were statistically different for the C3 circuit but were not statistically different for the two easiest circuits C1 and C2. The results of the WST was not statistically different in C1, C2 and C3. The mental load was higher in VR than in R condition. The general sense of presence was reported as acceptable (mean value of 4.6 out of 6) for all the participants, and the cybersickness was reported as acceptable (SSQ mean value of 4.25 on the three circuits in VR condition). CONCLUSION: Driving performances were statistically different in the most complicated circuit C3 with an increased number of collisions in VR, but were not statistically different for the two easiest circuits C1 and C2 in R and VR conditions. In addition, there were no significant adverse effects such as cybersickness. The results show the value of the simulator for driving training applications. Still, the mental load was higher in VR than in R condition, thus mitigating the potential for use with people with cognitive disorders. Further studies should be conducted to assess the quality of skill transfer for novice drivers from the simulator to the real world. Trial registration Ethical approval n ∘ 2019-A001306-51 from Comité de Protection des Personnes Sud Mediterranée IV. Trial registered the 19/11/2019 on ClinicalTrials.gov in ID: NCT04171973.

Characteristics and Consequences of Falls in People Who Use Wheelchairs in Long-Term Care Settings.

OBJECTIVES: The purpose of this study was to understand the characteristics and consequences of falls in individuals using wheelchairs in long-term care settings. DESIGN: Observational analysis of real-world falls in long-term care. SETTING AND PARTICIPANTS: Residents using wheelchairs from 2 long-term care facilities in British Columbia, Canada (n = 32 participants, mean age = 84.7 years, 12 women). METHODS: Two raters used the validated Falls Video Analysis Questionnaire, adapted from the original version, to assess the causal, behavioral, and environmental aspects of falls from wheelchairs. RESULTS: A total of 58 wheelchair fall videos were identified out of 300 total videos that were collected from 2007 to 2014. Wheelchair falls were most often caused by incorrect transfer or shift of body weight (70.7%). Participants most often fell backward with 89.7% striking their pelvis. Individuals using wheelchairs had limited protective response, with only 10.3% demonstrating a step response. Improper brake position contributed to 67.2% of falls. No serious fall-related injuries were reported. CONCLUSIONS AND IMPLICATIONS: The findings highlight the unique nature of falls in older adults who use wheelchairs in long-term care settings. Overall, the results of this study support clinical practice and the critical need for developing specialized fall prevention and fall detection interventions for individuals who use wheelchairs in long-term care.

Investigating the challenges of air travel in the United States: a qualitative study of the lived experiences of wheelchair users with spinal cord injury or disorder.

STUDY DESIGN: Qualitative exploratory study. OBJECTIVES: To understand the lived experiences of individuals with spinal cord injuries or disorders (SCI/D) who use wheelchairs during air travel in the United States (US), with a focus on the challenges and barriers to accessing this form of transportation. SETTING: Wheelchair users with SCI/D living in the community in the US. METHODS: Semi-structured interviews were used to collect data from six wheelchair users with SCI/D. Data were analyzed using a six-step thematic analysis. RESULTS: Experiences of wheelchair users during air travel clustered into three themes; experiences interacting with the airport, experiences interacting with the airplane, and experiences across all stages of air travel. Barriers to airport accessibility were minimal. Physical barriers to airplane accessibility and damage to wheelchairs occurred when interacting with the airplane and airline staff. Undertrained staff and a shift in responsibility to the passenger with a disability impacted all stages of the experience. CONCLUSION: Wheelchair users with SCI/D encounter challenges that can result in unsafe and inaccessible air travel within the US. Adverse consequences of air travel often impact the individual's independence and quality of life during and after the flight. Participants provided recommendations to improve the air travel experience for wheelchair users, including the ability to remain in one's wheelchair while onboard the airplane.

Development and evaluation of the ARM algorithm: A novel approach to quantify musculoskeletal disorder risk factors in manual wheelchair users in the real world.

This study aimed to develop and evaluate the ARM (arm repetitive movement) algorithm using inertial measurement unit (IMU) data to assess repetitive arm motion in manual wheelchair (MWC) users in real-world settings. The algorithm was tested on community data from four MWC users with spinal cord injury and compared with video-based analysis. Additionally, the algorithm was applied to in-home and free-living environment data from two and sixteen MWC users, respectively, to assess its utility in quantifying differences across activities of daily living and between dominant and non-dominant arms. The ARM algorithm accurately estimated active and resting times (>98%) in the community and confirmed asymmetries between dominant and non-dominant arm usage in in-home and free-living environment data. Analysis of free-living environment data revealed that the total resting bout time was significantly longer (P = 0.049) and total active bout time was significantly shorter (P = 0.011) for the non-dominant arm. Analysis of active bouts longer than 10 seconds showed higher total time (P = 0.015), average duration (P = 0.026), and number of movement cycles per bout (P = 0.020) for the dominant side. These findings support the feasibility of using the IMU-based ARM algorithm to assess repetitive arm motion and monitor shoulder disorder risk factors in MWC users during daily activities.

From theory to practice: Monitoring mechanical power output during wheelchair field and court sports using inertial measurement units.

An important performance determinant in wheelchair sports is the power exchanged between the athlete-wheelchair combination and the environment, in short, mechanical power. Inertial measurement units (IMUs) might be used to estimate the exchanged mechanical power during wheelchair sports practice. However, to validly apply IMUs for mechanical power assessment in wheelchair sports, a well-founded and unambiguous theoretical framework is required that follows the dynamics of manual wheelchair propulsion. Therefore, this research has two goals. First, to present a theoretical framework that supports the use of IMUs to estimate power output via power balance equations. Second, to demonstrate the use of the IMU-based power estimates during wheelchair propulsion based on experimental data. Mechanical power during straight-line wheelchair propulsion on a treadmill was estimated using a wheel mounted IMU and was subsequently compared to optical motion capture data serving as a reference. IMU-based power was calculated from rolling resistance (estimated from drag tests) and change in kinetic energy (estimated using wheelchair velocity and wheelchair acceleration). The results reveal no significant difference between reference power values and the proposed IMU-based power (1.8% mean difference, N.S.). As the estimated rolling resistance shows a 0.9-1.7% underestimation, over time, IMU-based power will be slightly underestimated as well. To conclude, the theoretical framework and the resulting IMU model seems to provide acceptable estimates of mechanical power during straight-line wheelchair propulsion in wheelchair (sports) practice, and it is an important first step towards feasible power estimations in all wheelchair sports situations.

Effect of a Neuromodulation Protocol Associated With Sports Training on the Precision Sports Performance of a Wheelchair Basketball Para-Athlete: A Case Study.

OBJECTIVE: To investigate whether transcranial direct-current stimulation (tDCS) optimizes the performance of a wheelchair basketball player on precision tasks. METHODS: A right-handed wheelchair basketball player (1.5 points functional class) with myelomeningocele (low lumbar level) participated in this case study. The tDCS neuromodulation protocol was applied throughout 10 interventions of 20 minutes with a current intensity of 2 mA, simultaneously with sport-specific training, 3 times a week for 4 weeks. Anodic stimulation was performed on the right cerebellar hemisphere (CB2) and cathodic stimulation in the left dorsolateral prefrontal cortex. A control participant was submitted to a sham-tDCS stimulation protocol for the same period. Functional performance was assessed before the intervention and after the 5th and 10th interventions using "pass accuracy," "free-throw shooting," and "spot shot" tests. Outcome measures were compared using percentage differences between preintervention, intermediate intervention, and postintervention values. RESULTS: There was a gradual increase in the athlete's total and average scores in all tests performed, with an overall improvement of 78% between the baseline and final assessments, while the control participant had an overall improvement of 6.5%. CONCLUSION: The tDCS protocol was effective in improving performance in precision activities in a wheelchair basketball player.

Satisfaction with social roles and activities across mobility status among persons with spinal cord injury.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). SETTING: Community setting. METHODS: Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury - Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants' mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. RESULTS: A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). CONCLUSIONS: Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.

An autonomous wheelchair with health monitoring system based on Internet of Thing.

Assistive powered wheelchairs will bring patients and elderly the ability of remain mobile without the direct intervention from caregivers. Vital signs from users can be collected and analyzed remotely to allow better disease prevention and proactive management of health and chronic conditions. This research proposes an autonomous wheelchair prototype system integrated with biophysical sensors based on Internet of Thing (IoT). A powered wheelchair system was developed with three biophysical sensors to collect, transmit and analysis users' four vital signs to provide real-time feedback to users and clinicians. A user interface software embedded with the cloud artificial intelligence (AI) algorithms was developed for the data visualization and analysis. An improved data compression algorithm Minimalist, Adaptive and Streaming R-bit (O-MAS-R) was proposed to achieve a higher compression ratio with minimum 7.1%, maximum 45.25% compared with MAS algorithm during the data transmission. At the same time, the prototype wheelchair, accompanied with a smart-chair app, assimilates data from the onboard sensors and characteristics features within the surroundings in real-time to achieve the functions including obstruct laser scanning, autonomous localization, and point-to-point route planning and moving within a predefined area. In conclusion, the wheelchair prototype uses AI algorithms and navigation technology to help patients and elderly maintain their independent mobility and monitor their healthcare information in real-time.