Clinical Evaluation of Pneumatic Technology for Powered Mobility Devices

超过240，000名残疾退伍军人使用手动和电动轮椅等移动设备， 摩托车，这个数字还在继续增长。移动设备已被描述为最有利的 临床医生可以为残疾人提供的技术。适当的移动设备改善功能， 独立、家庭和社区融合;活动和参与;舒适;生活质量。然而， 电池供电的移动设备（BPMD）具有许多缺点。尽管技术进步，电池 仍然对人类和环境有害，重（这限制了可运输性）， 潮湿或高湿度的环境。电力系统的维修和电池的更换经常 needed.这些都是昂贵的，并导致被困，错过医疗预约，错过工作或学校， 受伤，疼痛增加，自我感觉健康降低，皮肤破裂，住院率升高， 社区参与。我们的VA轮椅和相关康复中心进行的调查 工程部（WARE）将替代电源确定为退伍军人和供应商的首要研究重点。 压缩空气是一种电源，与电池相比具有许多优点，包括对两者都安全 人类和环境，重量更轻，防水性，以及缺乏任何电气元件， 可以减少维修的频率。两种新型的电动移动设备（PPMD），一种踏板车， 和轮椅，开发和测试的可行性与107用户。这些设备更轻， 对于普通用户来说，每次充电的行驶里程足够长。没有遇到安全或维修问题， 11周的实地测试充气罐也比给普通电池充电快得多。有了试点资金， 然后，我们制造了两辆新的踏板车和两辆新的动力轮椅，它们的行驶距离更长。我们还开发 一个便携式备用水箱系统，使我们能够在社区中轻松地重新填充或更换水箱。 本研究的目的是临床评估PPMD对长期生活在 护理设施，并从关键利益攸关方获得关于使用的设计和可行性的反馈， PPMD长期护理。选择长期护理是因为它是技术的理想环境， 防水的（例如，与恶劣天气相容，易于清洁，并能防止失禁， 需要较少的维护和保养。在第一阶段（技术），我们将建造8个 踏板车、8辆电动轮椅、2个充气站，配有流量开关，可测量充气量 20个数据记录器将测量电池充电时间，20个数据记录器将监测活动 程度.第2阶段（临床评价）将包括两个目标。首先，我们将招收50名退伍军人进入交叉 在试验中，他们使用提供给他们的BPMD，该BPMD与他们自己的BPMD具有相同的品牌和型号， PPMD对应物随机排列，每种6个月。我们将比较电池供电和电池供电- 电动踏板车和轮椅在功能性移动性、满意度、心理社会影响、 "充电时间"、保养和维修。我们假设退伍军人将有更高的流动性， 满意度和心理社会影响时，使用PPMD相比，当使用BPMD。我们也 假设PPMD将更快地“充电”，并且比BPMD具有更少的维护和维修问题。 第二，我们将对临床评价中的40名参与者进行定性访谈， 参与PPMD和BPMD使用的54个关键利益相关者（例如，家庭成员/护理人员、临床医生和 技术支持人员）。我们将评估患者、设施、VA医疗保健系统以及可能 成为使用PPMD的障碍或促进因素，并确定可能进一步改进设计的可修改因素。 拟议研究的结果将为在VA内采用该技术铺平道路。 这种采用可能对退伍军人的生活产生直接和积极的影响。这项研究有可能 国家对VA内轮椅提供过程和服务的影响。

Over 240,000 Veterans with disabilities use mobility devices such as manual and power wheelchairs and scooters, and this number continues to grow. Mobility devices have been described as the most enabling technology a clinician can provide to a person with a disability. Appropriate mobility devices improve function, independence, home and community integration; activity and participation; comfort; and quality of life. Yet, battery-powered mobility devices (BPMDs) have many drawbacks. Despite advances in technology, batteries are still hazardous to humans and the environment, heavy (which limits transportability), and incompatible with wet or highly humid environments. Repairs to electrical systems and replacement of batteries are frequently needed. These are costly and result in being stranded, missing medical appointments, missing work or school, injury, increased pain, lower self-perceived health, skin breakdown, higher hospitalization rates, and reduced community participation. Surveys conducted by our VA Center on Wheelchairs and Associated Rehabilitation Engineering (WARE) identified alternative power sources as a top research priority of Veterans and providers. Compressed air is a power source that has many advantages over batteries, including safety to both humans and the environment, lighter weight, waterproof nature, and lack of any electrical components which can reduce the frequency of repairs. Two novel pneumatically-powered mobility devices (PPMDs), a scooter and wheelchair, were developed and tested for feasibility with 107 users. The devices were lighter and had sufficient driving range per charge for the average user. There were no safety or repair issues encountered in the 11-week field test. Filling air tanks was also much faster than charging a typical battery. With pilot funds, we then built two new scooters and two new power wheelchairs with longer driving ranges. We also developed a portable backup tank system that allows us to refill or replace the tanks easily in the community. The purpose of this study is to clinically evaluate the impact of PPMDs on Veterans living in long-term care facilities, and to obtain feedback from key stakeholders regarding the design and feasibility of use of PPMDs in long-term care. Long-term care was chosen because it is an ideal setting for technology that is water-proof (e.g., compatible with inclement weather, ease of cleaning, and resistant to incontinence and requires less maintenance and upkeep. In Phase 1 (Technical), we will build 8 pneumatically-powered scooters, 8 pneumatically-powered wheelchairs, 2 air filling stations with flow switches that measure air filling time, 20 dataloggers that will measure battery charging time, and 20 dataloggers that will monitor activity levels. Phase 2 (clinical evaluation) will comprise two aims. First, we will enroll 50 Veterans into a cross-over trial in which they use a BPMD provided to them that is the same make and model as their own BPMD, and its PPMD counterpart in random order, each for 6 months. We will compare pneumatically-powered and battery- powered scooters and wheelchairs with respect to functional mobility, satisfaction, psychosocial impact, “charging time,” maintenance and repairs. We hypothesize that Veterans will have higher levels of mobility, satisfaction, and psychosocial impact when using PPMDs compared to when using BPMDs. We also hypothesize that PPMDs will be faster to “charge” and have fewer maintenance and repair issues than BPMDs. Second, we will conduct qualitative interviews of the 40 participants in the clinical evaluation and an additional 54 key stakeholders involved in PPMD and BPMD use (e.g., family members/caregivers, clinicians, and technical support personnel). We will assess patient, facility, VA healthcare system, and other factors that may be barriers or facilitators to use of PPMDs and identify modifiable factors that may further improve the design. Results of the proposed study will pave the way for potential adoption of this technology within the VA. Such adoption could have a direct and positive impact on Veterans' lives. This research has the potential for national impact on the wheelchair provision process and services within the VA.