Independent Wheelchair Transfers in the Built Environment: How Transfer Setup Impacts Performance

Very little is known about how the built environment impacts the performance of an individual’s independent wheelchair transfer (the task of moving oneself from one surface to another). To gain a better understanding of this the U.S. Access Board and the National Institute on Disability and Rehabilitation Research (NIDRR) has sponsored a multi-year research project on independent transfers.

My role in this project consists of two parts: 1. Conducting an international workgroup of experts with various backgrounds in independent wheelchair transfers to facilitate an exchange of ideas and information related to independent transfers and to develop future research directions (Completed). 2. Use the results from the workgroup to help design a data collection tool to be used to gain a better understanding of how the built environment impacts the performance of an individual’s independent wheelchair transfer.This study will provide data that the Board and designers/engineers can use to modify equipment and/or environments (e.g. buildings, recreational facilities and playgrounds) for the purposes of enhancing the transfer process. A secondary goal is to study the relationship between physical function (e.g. strength, balance control, and transfer skill) and ability to perform different types of transfers. The workgroup phase has been completed. The data collection tool has been fabricated and is ready to be used to test subjects as soon as the study has IRB approval.

The custom-built modular, transfer station will be used to investigate the impact handhelds, back rests, and seat widths have on transfer performance. The station consists of a height adjustable scissor lift with two height adjustable platforms that are secured on top. An adjustable height slide can be attached to the two platforms. Grab bars of varying heights and barricades can be attached to the platforms to define the transfer seat width. The platforms are cushioned to protect their skin during transferring activities. To protect against falls, subjects will be under direct supervision throughout the study. At least one study personnel will stand next to the subject to prevent a fall from occurring. Wheeled device position (e.g. angular orientation and linear distances from the target) will be recorded. The subjects will be asked to transfer from their own wheelchair to the platform. Hand placement, method of transfer, and use of a transfer board will be noted.

Their perceived level of exertion will be recorded using the OMNI Scale15. An investigator using the Transfer Assessment Instrument (TAI) will assess their transfer skill ability. Each subject will be asked by an investigator to perform four test protocols in random order. Each protocol tests a specific environmental factor. Subjects will be encouraged to notify study investigators if they feel uncomfortable performing any of the transfer scenarios we setup. They will not do a transfer that study investigators would consider to be unsafe. After each transfer in each protocol, their perceived level of exertion, changes made to device positioning (if any), use of a board, and surface(s) used for hand placement during the transfer process will be recorded. The TAI will be repeated after the initial setup protocol and protocols A, B, and C. Subjects will not perform more than 50 transfers.