COMMUNITY MOBILITY AND PARTICIPATION ASSESSMENT TO TRACK REHABILITATION PROGRESS IN WHEELCHAIR USERS

Abstract

This dissertation developed and applied comprehensive tools to assess and evaluate community mobility and participation (CMP) of manual wheelchair users (MWU) by integrating advanced engineering techniques and wearable sensor technology to track rehabilitation outcomes in both clinical and real-world settings.According to the World Health Organization, wheelchair use is prevalent, with an estimated growing number of 80 million people worldwide requiring one. Despite the critical role wheelchairs play in enhancing independence and quality of life (QOL) for people with mobility impairments, their use can present significant challenges that negatively impact CMP. Community mobility is the process of physically moving throughout a community, whether by oneself, through transportation services, or vehicles. Community participation involves actively engaging in activities and events. Improved CMP significantly benefits physical and psychological health. Therefore, a better understanding of it can inform improved rehabilitation protocols and activity promotion. As MWUs navigate diverse environments, understanding what influences their CMP is crucial for optimizing rehabilitation strategies and enhancing QOL. This dissertation developed a multi-dimensional framework that combines biomechanical analysis, wearable sensor technology, and environmental monitoring to provide a detailed understanding of MWU mobility in real-world settings. The research highlights the strengths and limitations of existing methods used to assess CMP among MWUs and explores their application in the following settings: 1) A clinical setting, inertial and heart rate sensors were used during the clinical standardized six-minute push test to assess physical exertion and movement patterns. 2) In an outdoor controlled course, this dissertation investigated the effects of load carrying on MWU using inertial sensors, heart rate sensors, and GPS tracking. 3) In a community context over one week, GPS tracking and activity journaling were used to monitor CMP in a real-world setting. The outcomes from these technologies were compared with muscle strength as measured by an isokinetic dynamometer and verified against standardized questionnaires like the Wheelchair Use Confidence Scale and Life-Space Assessment to quantify the mobility and psychosocial dimensions of participation. The findings from this dissertation contribute to the development of personalized rehabilitation strategies by linking clinical measurements with real-world data. This multi-faceted approach not only advances the assessment of MWUs but also offers a framework that can be adapted to a broader population, aiming to improve rehabilitation outcomes and enhance community integration.