Kids Standing Up: Promoting Independent Mobility in Children with Neuromuscular Conditions with a Standing Wheelchair

PROJECT SUMMARY Optimal Mobility proposes the development of a pediatric manual mobile standing wheelchair (PedMMSWC) that can be maneuvered in both seated and standing positions. This first-of-its kind device will enable children with neuromuscular conditions to transition between sitting and standing independently and participate in activities in whatever position they desire without caregiver assistance. It will also incorporate standing naturally into their days, promoting positive psychosocial and health benefits. This project builds on the work of members of the project team who developed a manual mobile sit-to-stand wheelchair for veterans. Using feedback from early pilot studies in this device, the team developed a pediatric computer-aided design model and presented it to key stakeholders via focus groups; this feedback will guide device redesign and prototyping efforts included as part of this proposal. We propose a multi-stage design and testing cycle to establish the technical and commercial feasibility of our PedMMSWC. Aim 1 is to engineer functional device prototypes based on stakeholder feedback. An iterative process, which includes designing and prototyping critical subsystems of the PedMMSWC, will result in two full device prototypes which will undergo safety testing by the study team to ensure they are appropriate for trialing in the target pediatric population. In Aim 2, we will recruit children and adolescents with spina bifida (ages 8-18) to perform in-lab usability tests with the PedMMSWC and commercially available comparators. Participants will be assessed in their own wheelchair and the PedMMSWC in seated and standing positions with tasks from the Wheelchair Skills Test Version 5.4. In addition, they will complete a 100-meter roll test to obtain feedback about ease of wheeling both devices. Finally, pressure mapping and three-dimensional motion analysis will be used to quantify the extent that sit-to-stand transitions in the PedMMSWC and a commonly prescribed stander (EasyStand) alters participant alignment; this measure will be used as a proxy for skin shearing to understand the potential risk of pressure injury during regular sit-to-stand transitions. In Aim 3, a subset of this group of individuals will complete a course in the PedMMSWC and their daily wheelchair that is designed to simulate home, school, and community environments. In each environment, participants will engage in a series of prescribed activities and unstructured, free-play time. Following completion of this course, the child and their caregiver will be interviewed to obtain their impressions of the device, its usefulness, and how they believe it might be improved. The result of this project will be a fully realized prototype and preliminary usability testing results for the PedMMSWC. Optimal Mobility is committed to pursuing swift commercialization of the proposed product, understanding that following study completion, comprehensive device testing will be needed to ensure compliance with all RESNA wheelchair testing standards. Ultimately, we believe that this device fills a critical gap in the pediatric assistive device landscape and will positively impact how children who use wheelchairs navigate, participate, and explore their environments.