PVA Healthcare Summit + Expo – Day 3

New technology was a big focus at this year’s Summit


Technology to help people with disabilities was around every corner at this year’s Paralyzed Veterans of America Healthcare Summit + Expo in Dallas, Texas. From a waterproof wheelchair to exoskeletons, the health care professionals in attendance got hands-on experiences and had the opportunity to speak to experts.
One breakout session, however, focused on a particular type of emerging technology — all-terrain power wheelchairs.
Kendra Betz, MSPT, ATP, spoke about the advantages and drawbacks of what she referred to as “the next frontier of what folks are doing and want to do, and they just want to get out and about and experience what we like to experience, like hiking and places we’ve never been before.”
But these new wheelchairs are designed for more than just hiking, Betz said. People can use them to hunt, fish, shoot, golf and go to the beach, as well as for vocational purposes such as farming or managing large properties. In addition, they can be advantageous in adverse weather conditions.
Betz gave an overview of a few options on the market and said they all share similar features, including more camber, knobby tires and a long base of support. They also are designed to prevent someone from tipping forward and falling out of the chair while he or she is traversing rough terrain.
For manual wheelchair users, Betz said there are add-on options such as the FreeWheel and levers that can help people navigate terrain with rocks, mud and sand. In addition, a California-based company called Whirlwind Wheelchair International is a nonprofit that builds robust, low-cost manual wheelchairs for people in developing countries who often encounter large ruts and road blocks such as tree branches in their daily outings.
Betz said there are at least 20 to 25 models of all-terrain power wheelchairs now available, including the Action Trackchair and iBOT, and she encouraged those in the audience to take test drives and learn how to maneuver them over various obstacles before attempting to train patients how to use them.
“As we’re exploring these technologies, get in them and be surprised, they probably drive differently …” Betz said.
Some states are even trying to make their parks more accessible using all-terrain mobility devices like the Action Trackchair. Betz said Stauton State Park in Colorado is in the second year of program that allows people with disabilities to rent Action Trackchairs, and the state of Kansas recently purchased eight all-terrain power wheelchairs to help develop its state accessibility programs.
Other devices that are approved by the Food and Drug Administration (FDA) are Innovation in Motion’s Extreme X8, which has an option to interface with specialty controls such as an attendant, head, chin or foot control, and the Freedom Mobility 6×6.
While providing a way for people with mobility impairments to get out and do what they want to do, Betz cautioned that these all-terrain wheelchairs do have some safety implications that need to be addressed.
“Either it’s a power wheelchair or it’s not,” Betz said. “So if a device is marketed as a power wheelchair that can go anywhere and do anything, we have standards that are required to test power wheelchairs because the FDA regulates them as Class 2 medical devices.”
Those standards clearly separate and define all-terrain vehicles and power wheelchairs, she said. Testing for durability, performance and safety are governed by the International Standards Organization, the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America, in addition to the FDA.
“If folks are building things in garage-like settings and adding power and a joystick to it and tell you to wear a helmet, it could be a go-kart,” she said. “So be careful because that wouldn’t be a medical device or a vehicle. That’s really concerning about some of these devices you see being built and marketed.”
In addition, it’s important for providers and consumers to look a company’s experience in working with people with disabilities, examine what the product description claims a device can do and compare it to independent performance tests, especially when it comes to battery range.
“When they say it goes 15 miles, we would like to confirm that it goes 15 miles, especially when we’re sending somebody out into the middle of nowhere,” she said. “I would not want my batteries to die just as I’m getting close to the incoming surf.”
When it comes to wheelchair design, Betz said several organizations are conducting studies on wheelchairs in areas with less resources.
“When we’re building chairs, evaluating chairs for less resourced settings, meaning countries that are developing or don’t have paved roads, that would apply to using these devices off-road as well,” she said. “So typically they have more rugged terrain. This is important, wheelchairs tend to fail early in locations with less resources. So if we’re going to take wheelchairs off road and over logs and over gravel and into the water and up the sand, then we could expect that they could fail sooner than we could expect for everyday use. So we just need to be thinking about what those implications are … when a chair passes the everyday standards, that’s great and they’re moving in the right direction, but it may not be enough for the performance criteria we’re looking for.”
While veterans are able to obtain only FDA-approved all-terrain power chairs through the Department of Veterans Affairs on a case by case basis, some may choose another procurement method, either going out on their own to purchase a device or going through a nonprofit. That delivery method presents a safety issue, Betz said.
“If we don’t have a clinical provider involved and there’s no clinical assessment happening, we don’t have the skill level that’s in this room involved, then we’re missing a lot of components, like how about education and training, and how about, ‘Hey, let’s wait before you stand up [using the stand-up feature on a device].'”
Other considerations for an individual’s safety are the device’s dimensions, if it can be maneuvered indoors, its weight, ability to transport it (possibly by accessible van or trailer), storage options and its intended use. For power wheelchairs specifically, the device’s ability to interface with a control other than a joystick, available powered seating systems and the person’s ability to transfer need to be evaluated.
“I learned in my exploration that these devices really can help people to get where they don’t have other options to go, and there is a value to being able to do what you want to do,” Betz said. “These can be empowering devices as long as they’re adjusted appropriately.”


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