Quantitative Exploratory Evaluation of the Frequency, Causes and Consequences of Rehabilitation Wheelchair Breakdowns delivered at a Paediatric Clinic in Mexico

Maria Luisa Toro, Yasmin Garcia, Alejandra Manoela Ojeda, David J Dausey, Jon Pearlman

Abstract


Purpose: The United Nations Convention on the Rights of Persons with Disabilities recognises assistive technology such as wheelchairs (WCs) as a tool for social inclusion for this population. In less resourced settings, organisations lack information about effective models of WC service provision.  The goal of this study was to investigate the lifespan of WCs and whether they provided reliable mobility, at one clinic in Mexico.

Methods: Caregivers of children, who had requested replacements for their WCs from a clinic in Mexico, were interviewed in Spanish. Among others, the questions pertained to repairs/modifications, adverse events and WC usage characteristics. The owners exchanged their WCs for new ones at the clinic, and the maintenance status of each returned WC was evaluated using the WC Assessment Checklist (WAC).

Results: Twenty-three donated WCs, used by children aged 3 to 14 years for an average of 19 months, were evaluated.  Brakes (n=18), seat and back-sling upholstery (n=11 and 7 respectively), and armrests (n=14) were the components that failed most frequently. A total of 26 adverse events due to WC failure were reported. Adverse events were significantly associated with poor WAC scores (rs=-0.544, p=0.007).

Conclusions: Poor WC reliability, associated with adverse events which could undermine social engagement, indicates the need for a stronger WC and for regular maintenance. For instance, brake failures which were most often associated with adjustment issues, could have been resolved with maintenance, while seat and back-sling upholstery and armrest failures suggest that the WC may not be appropriate for the environment.  Future work should investigate the robustness of these WCs using standardised methods (ISO 7176), as well as the impact of maintenance interventions on WC reliability.

doi: 10.5463/dcid.v23i3.167


Keywords


people with disabilities; mobility; less resourced settings; donated wheelchairs; wheelchair maintenance

Full Text:

PDF

References


Arledge S, Armstrong W, Babinec M, Dicianno BE, Digiovine C, Dyson-Hudson T, Pederson J, Piriano J, Plummer T, Rosen L, Schmeler M, Shea M, Stogner J (2011). RESNA Wheelchair Service Provision Guide. http://www.resna.org/dotAsset/22485.pdf [Accessed on 2 December 2012]

Batavia M, Batavia AI, Friedman R (2001). Changing chair: anticipating problem in prescribing wheelchairs. Disability and Rehabilitation; 23: 387-393.

Boninger M, Stripling T (2007). Preserving upper-limb function in spinal cord injury. Archives of Physical Medicine and Rehabilitation; 88: 817.

Borg J, Khasnabis C (2008). Guidelines on the provision of manual wheelchairs in less resourced settings. Geneva: World Health Organization.

Borg J, Lindstrom A, Larsson S (2009). Assistive technology in developing countries: national and international responsibilities to implement the Convention on the Rights of Persons with Disabilities. The Lancet; 374: 1863-1865.

Borg J, Lindstrom A, Larsson S (2011a). Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities. Prosthetics and Orthotics International; 35: 20-29.

Borg J, Ostergren PO, Larsson S, Rahman AA, Bari N, Khan AN (2011b). Assistive technology use is associated with reduced capability poverty: a cross-sectional study in Bangladesh. Disability and Rehabilitation: Assistive Technology; 1-10.

Chen WY, Jang Y, Wang JD, Huang WN, Chang CC, Mao HF, Wang YH (2011). Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users. Archives of Physical Medicine and Rehabilitation; 92: 892-898.

Cooper R, Wolf E, Fitzgerald S, Kellerher A, Ammer W (2004). Evaluation of selected sidewalk pavement surfaces for vibration experience by users of manual and powered wheelchairs. Journal of Spinal Cord Medicine; 27: 468-475.

Cooper RA (1998). Wheelchair selection and configuration. Demos Medical Publishers.

Fitzgerald S, Collins D, Cooper R, Tolerico M, Kelleher A, Hunt P, Martin S, Impink B, Cooper R (2005). Issues in the maintenance and repairs of wheelchairs: A pilot study. Journal of Rehabilitation Research and Development; 42: 853-862.

Francois I, Lambert M, Salort C, Slypen V, Bertrand F, Tonglet R (1998). Causes of locomotor disability and need for orthopaedic devices in a heavily mined Taliban-controlled province of Afghanistan: Issues and challenges for public health managers. Tropiacl Medicine & International Health; 3: 391-396.

Gaal R, Rebholtz N, Hotchkiss R, Pfaelzer P (1997). Wheelchair rider injuries: cause and consequences for wheelchair design and selection. Journal of Rehabilitation Research and Development; 34: 58-71.

Ham R, Aldersea P, Porter D (1998). Wheelchair users and postural seating a clinical approach. London, Churchill Livingstone.

Hansen R, Tresse S, Gunnarsson R (2004). Fewer accidents and better maintenance with active wheelchair check-ups: a randomized controlled clinical trial. Clinical Rehabilitation; 8: 631-639.

Hotchkiss R (1987). Putting the tools in the hands that can use them: Wheelchairs in the Third World. RESNA 10th Annual Conference. San Jose, CA.

Howitt J (2006). Donated wheelchairs in low-income countries - issues and alternative methods for improving wheelchair provision. The 4th Institution of Engineering and Technology Seminar on Appropriate Healthcare Technologies for Developing Countries. IEEE Explore.

Johnson K, Dudgeon B, Kuehn C, Walker W (2007). Assistive technology use among adolescents and young adults with spina bifida. American Journal of Public Health; 97: 330-336.

Kamarkar A (2009). Prescription, outcomes, and risk assessment of wheelchairs for aging population. PhD, University of Pittsburgh.

Kim J, Mulholland S (1999). Seating/wheelchair technology in the developing world: need for a closer look. Technology and Disability; 11: 21-27.

Langton A, Ramseur H (2001). Enhancing employment outcomes through job accommodation and assistive technology resources and services. Journal of Vocational Rehabilitation; 16: 27-37.

May-Teerink T (1999). A survey of rehabilitative services and people coping with physical disabilities in Uganda, East Africa. International Journal of Rehabilitation Research; 22: 311-316.

Mcclure L, Boninger M, Oyster M, Williams S, Houlihan B, Lieberman J, Cooper R (2009). Wheelchair repairs, breakdown, and adverse consequences for people with traumatic spinal cord injury. Archives of Physical Medicine and Rehabilitation; 90: 2034-2038.

Mukherjee G, Samanta A (2005). Wheelchair charity: a useless benevolence in community-based rehabilitation. Disability and Rehabilitation; 27: 591-596.

Parette HP, Peterson-Karlan GR (2007). Facilitating student achievement with assistive technology. Education and Training in developmental Disabilities; 42: 387-97.

Pearlman J, Cooper R, Krizack M, Lindsley A, Wu Y, Reisinger K, Armstrong W, Casanova H, Chhabra H, Noon J (2008). Lower-Limb Protheses and wheelchairs in low income countries: An overview. IEEE-EMBS Magazine; 27: 12-22.

Pearlman J, Cooper R, Zipfel E, Cooper R, Mccartney M (2006). Towards the development of an effective technology transfer model of wheelchairs to developing countries. Disability and Rehabilitation: Assistive Technology; 1: 103-110.

Phillips B, Zhao H (1993). Predictors of assistive technology abandonment. Assistive Technology; 5: 36-45.

Saleeby PW (2006). Application of a capability approach to disability and the International Classification of Functioning, Disability and Health (ICF) in social work practice. Journal of Social Work in Disability and Rehabilitation; 6: 217-232.

Sheldon S, Jacobs NA (2006). Report of a consensus conference on wheelchairs for developing countries. Bengaluru, India: WHO, ISPO, and USAID.

Shore S (2008). Use of an economical wheelchair in India and Peru: Impact on health and function. Medical Science Monitor; 14: 71-79.

Tan AHG, Ang WT (2008). Towards an inclusive society in Asia: The invisible helping hand. Disability and Rehabilitation: Assistive Technology; 3: 366-380.

Tomlinson M, Swartz L, Officer A, Chang KY, Rudan I, Saxena S (2009). Research priorities for health of people with disabilities: An expert opinion exercise. The Lancet; 374: 1857-1862.

United Nations (2006). Convention on the rights of persons with disabilities and optional protocol. New York, NY: United Nations.

World Health Organisation (2002). International classification of functioning, disability and health (ICF). Geneva: World Health Organization.

World Health Organisation (2010). Assistive devices/technologies. Geneva: World Health Organization.

World Health Organisation (2011). World report on disability. Geneva: World Health Organization.

World Health Organisation, USAID (2011). Joint position paper on the provision of mobility devices in less resourced settings. Geneva: World Health Organization.

Worobey L, Oyster M, Nemunaitis G, Cooper R, Boninger ML (2012). Increases in wheelchair breakdowns, repairs, and adverse consequences for people with traumatic spinal cord injury. American Journal of Physical Medicine and Rehabilitation; 91.




DOI: https://doi.org/10.5463/dcid.v23i3.167



Copyright (c) 2015 Maria Luisa Toro, Yasmin Garcia, Alejandra Manoela Ojeda, David J Dausey, Jon Pearlman

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Supported by:

netherlandsleprosyrelief_logo_rgb_-_new_logo_2014_120                   

© Disability, CBR & Inclusive Development