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DIPLOMA PROJECT Redefining Mobility Appropriate wheelchair for physically challenged children Sponsor : T. I. Cycles of India, Chennai, Tamil Nadu

Volume : 1/1 student : AMRAPALI SATPUDKE Programme : Post-Graduate Diploma Programme in Design

guide : MR.SHASHANK MEHTA

2011 InDusTRIAL DEsIGn FACuLTY (PRODUCT DESIGN)

National Institute of Design Ahmedabad


The Evaluation Jury recommends AMRAPALI SATPUDKE for the

Diploma of the National Institute of Design IN INDUSTRIAL DESIGN (PRODUCT DESIGN)

herewith, for the project titled "Redefining mobility : appropriate wheelchair for physically challenged children� on fulfilling the further requirements by*

Chairman Members :

*Subsequent remarks regarding fulfilling the requirements :

Registrar (Academics)


R e d e f i n i n g

M o b i l i t y

Appropriate wheelchair for physically challenged children Diploma documentation by Amrapali Satpudke Product Design Post-graduate diploma programme in design Guide: Mr. Shashank Mehta Sponsor : T. I. Cycles of India, Chennai, Tamil Nadu NATIONAL INSTITUTE OF DESIGN, AHMEDABAD, 2010


redefining mobility appropriate wheelchair for physically challenged children

http://www.boston.com/bigpicture/


I am the child I am the child who cannot walk. The world seems to pass me by. You see the longing in my eyes to get out of this chair, to run and play like other children. There is much you take for granted. I want the toys on the shelf, I need to go to the bathroom, oh I’ve dropped my fork again. I am dependent on you in these ways. My gift to you is to make you more aware of your great fortune, your healthy back and legs, your ability to do for yourself. Sometimes people appear not to notice me; I always notice them. I feel not so much envy as desire, desire to stand upright, to put one foot in front of the other, to be independent. I give you awareness. I am the child who cannot walk. I am the disabled child. I am your teacher. If you allow me, I will teach you what is really important in life. I will give you and teach you unconditional love. I gift you with my innocent trust, my dependency upon you. I teach you about how precious this life is and about not taking things for granted. I teach you about forgetting your own needs and desires and dreams. I teach you giving. Most of all I teach you hope and faith. I am the disabled child. (Author Unknown)

(Art: Zal Pinter, http://www.disabilityworld.org)


CONTENTS

ACKNOWLEDGEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 PROLOGUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 THE INSTITUTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 SYNOPSIS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1

COMPANY PROFILE

17

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Manufacturing process. . . . . . . . . . . . . . . . . . . . . . . . . . 23 2

PROJECT BRIEF

21

Phase 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Initial research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Initial design brief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Phase 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Final design brief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3

UNDERSTANDING DISABILITY

31

What is disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Disability data in India and world over. . . . . . . . . . . . . . . . . . . . 33 Need for children’s wheelchair . . . . . . . . . . . . . . . . . . . . . . . 33

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CONTENTS

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RESEARCH AND ANALYSIS

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History of wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Types of wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Anatomy of wheelchair . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Component analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Product audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 12

ERGONOMICS

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13

USER STUDY

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Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Redefined brief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Ideation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

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CONTENTS

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EVOLUTION

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3D model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Graphics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Prototype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Initial study models . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Final prototype . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Detailing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 15

VISUALIZATION

31

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CONCLUSION

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BIBLIOGRAPHY

31

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PHOTO CREDITS

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APPENDICES

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Production drawings . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Costing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

I would like to thank my guide, Mr Shashank Mehta, Faculty, Industrial Design for his encouragement, support and feedbacks throughout the project. I would like to thank Mr Vasant Dewaji, Vice President, Product Development TI Cycles of India for giving me the opportunity to work on this project and having faith in me and for guiding me through the entire endeavour. I would also like to extend my gratitude and thanks to my new found friends in Chennai and all my friends at NID for their constant support and suggestions during the project. I wish to thank my family for their patience, support and understanding.

I am thankful to

and suggestions during the project. I wish to thank my family for their patience, support and understanding.

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At National Institute Of Design Mr Shashank Mehta for guiding my diploma project Mr Prabir Mukhopadhyay for his guidance in ergonomics At TI Cycles of India Mr Vasant Dewaji for giving me the opportunity to work with the company, his support and guidance Mr Shanmugam For his support and guidance Raghunathan Prabhu for being there for all the Raja, Murugayen for Madhuri, Vinodhini, Veeresh, for being wonderful company and Friends Annie, Shilpa,

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PROLOGUE A diploma project at NID is the culmination of a professional education program in design. The project can be an industry sponsored project where the student formulates one’s own design brief or work with a client defined brief. It aims at sensitizing a design student to the needs of the users and the industry and on a broader context catering to the needs of the society as a whole. It serves as an opportunity to put the acquired skills to test as the student prepares to embark upon a professional career. It gives the student industry exposure and firsthand experience of the design process followed in the particular industry along with self learning. With guidance from the institute and the various experts in the industry one can relate theory to practice, classroom to industry and take in the lessons industry has to offer. The diploma project helps the student realize one’s own interest, strengths and potential which helps in preparing to enter the professional world of design.

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THE INSTITUTE Fifty years ago the National institute of Design was born in Ahmedabad, India. Its backbone was a manifesto for design education, ‘The India Report’ developed and presented in April 1958 by Charles and Ray Eames. The NID campus officially opened in 1961. National Institute of Design (NID), Ahmedabad, is acclaimed world wide as one of the foremost multi- disciplinary institutions in the field of design education and research. NID has been a pioneer in industrial design education after Bauhaus and Ulm in Germany and is known for its pursuit of design excellence to make ‘Designed in India, Made for the World’ a reality.

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The motto of the institute has always been ‘Learning by doing’ or ‘Hand on minds on’ approach to lead the design scenario. The founding mission of NID still endures, and the original writings of Charles and Ray Eames are still referenced as a program for future teaching. Product Design at NID is concerned primarily with the relationship between products and user and system in which it subsists. The Product Design program inculcates a user-centered and process driven approach. Responsibility and concern towards the social, physical and ecological environment is emphasized in the process of developing innovative ideas.

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SYNOPSIS Everybody has their own bicycle story to tell, bicycle is something everybody associates with their childhood memories. Although there are some children who are deprived of simple pleasures in life such as riding a bicycle due to physical challenges. When I approached T. I. Cycles of India for my diploma project I wanted to utilize of this opportunity to design a cycle for these children not only for therapeutic purposes but also to bring the simple joy of riding a bicycle in their life along with a sense of freedom. The initial research, user study revealed that there is indeed a need for such an aid which would fulfil the therapeutic needs as well as bring joy to the mundane routine of exercising that the children have to undergo daily to increase muscle tone and balance. Upon considering the pro’s and con’s of the project and my desire to work in the area of special needs it was decided best to work in the field of mobility for physically challenged children. Mobility has many facets and means something different to everyone: physical mobility, social independence, a flexible lifestyle. This also applies to persons who are dependent on assistive devices such as wheelchair or other mobility aids. They are entitled to expect mobility aids that are not only practical and functional, but also in harmony with their lifestyle. To cross boundaries, develop independence; conquer the outdoors with daily new experiences, explore and have fun. A wheelchair is more than an assistive device for many people with disabilities; it is the means by which they can exercise their human rights and achieve inclusion and equal participation. A wheelchair provides mobility, ensures better health and quality of life, and assists people with disabilities to live full and active lives in their communities. Although for a lay person the word ‘wheelchair’ brings up the image of a boxy, shiny steel frame with black vinyl upholstery.

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In Indian scenario where most of the wheelchairs used are manufactured by NGO’s or are distributed by international NGO’s little attention is paid to the child anthropometry and comfort. If a child needed a wheelchair, little attention is paid to the fact that he or she is growing; the solution was simply to order a larger chair and let the child “grow into” it. A wheelchair must meet the user’s individual needs and environmental conditions, provide postural support, and be safe and durable. The wheelchair must be available and affordable and be maintainable and sustainable in the country of use. This is not always easy, because wheelchair users are a diverse group with different requirements and environmental and socioeconomic conditions. To study the diverse group of users a user survey was carried out in various parts of the country. The problem areas were identified after studying the users, parents and caretakers along with the manufacturing and distribution of the wheelchair. Considering the socioeconomic structure of the users the scope was narrowed down to manual wheelchairs with a possibility to be converted to into a motorized wheelchair. A wheelchair is defined as appropriate when it: • Meets the user’s needs and environmental conditions; • Provides proper fit and postural support; • Is safe and durable • Is available in the country • Can be obtained and maintained and services sustained in the country at an affordable cost.

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The objective of the project was to design a wheelchair for physically challenged children that are undergoing physical growth and would require a flexible solution to accommodate their growing body along with their changing personality. The project required to sensitize one to the world of these children, their parents and caretakers. Study the indigenous solutions that are used in various parts of the country. And to study the product in its entirety from manufacture to distribution and the various agencies involved to figure out the gap between need and supply. The discrepancies between the user requirement and the available options in the market. Factors considered in wheelchair design: • Users health, Safety • Ergonomics • Environment : home, school, playground (indoors, outdoors) • Manoeuvrability • Other functional features: ability to aid transfer, portability • Seating system • Components • Wheelchair stability • Postural support • Growth • Strength, durability • Gender issues • Manufacturing • Cost effective • Material, finishes, upholstery, colour • Adaptations required if any

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COMPANY PROFILE

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COMPANY OVERVIEW Tube Investment of India TI cycles of India, one of the leading bicycle manufacturers in India, is a part of $3.2 billion Murugappa group. The company started in 1949, has been at the forefront of innovation and is a pioneer in the market of cycles. TI cycles are the makers of countries most famous brands like Hercules, BSA and Phillips cycles. Hercules, the flagship brand of TI cycles portfolio, this first launched brand is still as young as ever, signifying strength and passion. BSA another flagship brand of TI cycles, BSA standing for The vision : “To be the Birmingham Small Arms signifies the joy of most preferred brand cycling, fun and excitement go hand in hand with BSA. Recently, the company has entered in fitness, recreation the growing fitness equipment segment in and personal mobility order to cater to the contemporary consumer solutions�. needs. With a network of 2500 plus dealers and backed by a strategic outsourcing policy, the company has a nationwide presence. It has 3 fully functioning plants across India at Chennai, Nasik and Noida and 7 regional offices situated across the country. Certified with ISO 9001, OSHAS 18001 and ISO 14001, TI Cycles is one of the most quality and customer centric organizations in the country. A pioneer in the market, TI Cycles has constantly come up with new trends in line with evolving consumer needs.

http://oldbike.wordpress.com

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The Murugappa Group Headquartered in Chennai, the Rs. 13,617crores (USD 3.03 billion as on March 31, 2010) Murugappa Group is one of India’s leading business conglomerates. Market leaders in diverse areas of business including Engineering, Abrasives, Finance, General Insurance, Cycles, Sugar, Farm Inputs, Fertilizers, Plantations, Bio-products and Nutraceuticals, its 29 companies have manufacturing facilities spread across 13 states in India. The organization fosters an environment of professionalism and has a workforce of over 32,000 employees. BSA and Hercules are two of the leading brands of bicycles from TI Cycles in the Indian market. Recently, the company has entered the growing fitness equipment segment in order to cater to the contemporary consumer needs. With a network of around 1500 direct dealers and more than 10000 indirect dealers TI Cycles has a nation wide presence. A pioneer in the market, TI Cycles has constantly come up with new trends in line with evolving consumer needs. With the changing RETAIL environment, TI Cycles has introduced ‘BSA GO’ stores, which have revolutionised the bicycle outlet in India. A one-stop premium shop for all bicycling and fitness requirements, BSA GO has a customer friendly ambience which serves as a model for other bicycle outlets in the country. TI Cycles is an exporter to many regions across the globe- Europe, South East Asia and Africa; being some of them.

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Milestones 2009 I TI retail consolidates further to 425 outlets across the country in a variety of formats. 2008 I BSA Motors was launched, unveiling the largest range of electric scooters in the country. With over 70 dealers, the company became No.1 in South India in just a few months. 2008 I While consolidating the retail business, TI introduces Hercules Express, BSA Workouts and Track & Trail. The retail footprint increases to 200 Hercules BSA Zone and 44 BSA GO outlets. 2007 I BSA Zone, the 2nd retail format is launched and by the year-end grows to 80 outlets. 2006 I TI Launches its first flagship store, BSA GO in Ahmedabad. 1998 I Hercules Top Gear takes Indian bicycles to the next level of technology. 1994 I BSA Ladybird brings smiles to many Indian girls. 1993 I Rough and tough BSA Rockshox takes on Indian roads. 1992 I Riding over mountains turns smooth with Hercules MTB. 1991 I Street cat prowls the Indian Streets. 1983 I The new BSA Champ sets children free. 1980 I BSA SLR is launched and soon becomes the largest selling in its class. 20 I

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1974 I TI Cycles celebrates 25 years of pioneering existence across various fields. 1960 I The one-millionth cycle hits the streets. 1956 I Tube Products of India established for producing tubes for bicycles. 1951 I Hercules bicycles rolls out on to Indian streets. 1949 I Murrugappa Group founded TI Cycles, with Tube Investments, UK. 1951 I Hercules bicycles rolls out on to Indian streets. 1949 I Murrugappa Group founded TI Cycles, with Tube Investments, UK.

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MANUFACTURING PROCESS

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Building of frame Raw material The raw material (MS cold rolled tubes) procured are stacked in the storage yard. Every part of the frame requires a different process to build based on the design of frame and finally all the parts of the frame are assembled together. The initial process carried

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out based on the design is as follows: Ovaling As per design wherever required, the cross section of the tube is made oval from a circular section.

Bending Tube bending method pushes a die against the tube by a mechanical force, forcing the tube to conform to the contours of the die. Lacking internal support in the tube the bending process creates some cross section ovality. The thinner the wall, the more deformation of the tube is seen. Dimpling This is a process of stretching an indentation. Planishing produces a smooth surface finish by rolling in a planishing mill.

Mitering process Two pieces of tubes are joined together such that each piece is cut at an angle in order to closely fit the receiving angle of the other piece, the two pieces have experienced mitering.

Hollow mitering Tubes are placed in the mitering jigs and machined to specific geometry.

Mitered ends

Tack welding Once the various parts of the tube are ready, they are all assembled on the frame jig and tack (spot) welded together.

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Tracking After the frame is tack welded, it is placed on the surface table to inspect the alignment, as the frame parts could have been misaligned.

Reaming It is the process which slightly enlarges the pre-existing holes to a tightly tolerance diameter. A reamer is similar to a mill bit in that it has several cutting edges arranged around a central shift. Seam welding A welding sequence is created and the welds are completed keeping the frame intact. Seam welding is carried out which is a resistance welding that produces a weld at the faying surfaces of overlapped parts along a length of a joint. Complete frame The seam welding produces the finished frame which is now sent in for the rest of the process of finishing required.

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Treatment of frame Once the frames reach the inhouse factory following processes follow: De greasing De greasing is the process of removal of grease and oil deposits on the surface of the frame with a detergent or alkali before pickling or passivation. Pickling Pickling is the removal of any high temperature scale and any adjacent chromium layer of metal from the surface of steel by chemical means.

Phosphating rinsing

Ready for painting

Downloaded form vehicles & checked

Loading for phosphating

Passivation Passivation is the treatment of the surface of steel, often with acid solutions to remove any dust and grease and promote the formation of a passive film on the freshly cleaned surface. Common passivation treatment includes nitric acid solutions. Electrostatic painting This principal is the same as opposite charges getting attracted. The component to be painted is negatively charged. The paint is precharged and fed and atomized in the nozzle. The components on the conveyer are fed into the painting rig. The nozzle is placed on a removing head in a cylindrical cabin. The components then revolve inside the cabin on the conveyer belt, exposing maximum surface area to the atomized and charged droplet of paint. The surface takes a uniform coat of paint, except in places where there is a junction where two or more members meet. This touch up work is then done manually. Although this process is more efficient than spray painting, it is only 60 % efficient and 40% paint gets wasted. Hence powder coating which is 90 % efficient is being thought of to replace the process.

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Loading

Degreasing

Raw water counter flow rinse

Pickling

Raw water counter flow rinse

DM water counter flow rinse

Phosphating

Preconditioner

Raw water counter flow rinse

Degreasing-2

Passivation

Air blowing

Ovendrying

Unloading

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Packaging Once the painting is done the graphics are applied and the bicycles are semi-assembled. Finally all the parts are packed in their scratch-proof individual packaging and all the parts of a bicycle are further packed in a bigger carton either in sets of two or four. The packaged cartons are then sent to the dealers outlets. The number of carton co-ordinates with the demand. The parts in the carton are semiassembled. Once these reach the dealers point, bicycles at their point of sales are assembled fully in front of the consumer.

Finished frames

Frame number punched Scratch proof packing in progress

Kitting in progress

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Supply chain system

Production/ cost/ standards Specialization and expertise Transportation Vendor management

Manufacturing units to Distribution Planning for a month Average per day

Packaging Transportation to dealers Costing Knock down kit

Design and development

Inventory warehouse

Resourcing

Marketing

Sales

Brand management Buyer behaviour Policies Competitiors Communication media

Segments Interchangeability Specials Customization Standards Standardization Stock

Range Age group Pricing

Components

Frames Steering Wheel Drive train Saddle Breaks Accessories

Inhouse Outsourced to external vendor

Cutting Welding Phosphating Printing Packaging Graphics Feedback

Customer care Dispatching

Dealers

Sub-dealers

Customer/ User

Shops Display Availability Margin Competition

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PROJECT BRIEF I

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Design

PHASE I

Initial design brief To develop an adaptive bicycle/ tricycle for children with special needs for therapeutic purpose.

The benefits of cycling for the disabled are just the same as for the able bodied. Its fun, gives independence, mobility and promotes physical and mental wellbeing. However for many disabled people, these benefits can have a special significance. Opportunities for exercise may be limited and there are recognized problems of weight gain, muscle wastage and poor blood circulation associated with prolonged wheelchair use or a sedentary lifestyle.

Adaptive equipment are often associated with a mysterious territory of crutches, wheelchairs, inability and dependance. Adaptive devices are believed to be complex, cumbersome, expensive and used only by people with disabilities. In fact able bodied people use adaptive devices in their everyday life. The goal of adaptive devices is to bridge the gap between “able bodied” and the “physically challenged”. Context Children with disabilities often miss out on social and physical activities that most of take for granted like, riding a bike. Stationary cycle is often used as a therapeutic aid for children with physical challenges. With the use of adaptive tricycle or bicycle children who have difficulty in walking can have an opportunity to ride a bike with their peers and family members. Not only is riding a bike a fun activity for all the children, it can offer significant health benefits for children with disabilities. Physical activities Increase in gross motor control while strengthening and maintaining range of motion through extremities. Cycling just like walking stimulates the muscles and facilitate the hip, knee and ankle to extend. Exercise Increase in aerobic capacity, balance, endurance and postural control. Health Increase in ventilation, respiration and improved muscle tone. Social skills Creates a leisure activity to experience the fun of riding along with increased social interaction, aim to build self esteem and sense of freedom on a bike os opposed to the feeling of being trapped in a wheelchair. Reaching their milestones with respect to growth such as sitting, standing and walking.

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Initial research

Mobility and fitness aids for children with special needs

The initial research involved studying the various disabilities and conditions in which cycling is used as a therapeutic aid. Children with disabilities such as: Low muscle tone Children with balance problems Decreased strength and motor control Cerebral palsy Spina bifida Autistic spectrum disorder Multiple sclerosis Downs syndrome Lissencephaly Hydrocephalus Rehabilitation for accident victims

Gait trainers Gait training refers to helping a patient relearn to walk safely and efficiently. Gait training is usually done by rehabilitation specialists who evaluate the abnormalities in the person’s gait and employ such treatments as strengthening and balance training to improve stability and body perception as these pertain to the patient’s environment. Gait trainer

Current scenario Stationary bicycles or exercycles are used to give therapy to the children on regular basis as a part of physiotherapy in enclosed environments. Which is more of a forced activity than something the children enjoy doing. Also the exercycles used are the ones that are made for adults hence children have difficulty adjusting to them. Children with special needs can find a sense of independence and freedom with mild to moderate physical involvement with the help of this bike built for therapeutic progression of special needs children.

www.allegromedical.com

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Adaptive tricycle Adaptive tricycle Adaptive tricycles provide therapeutic, reciprocal exercise with all the fun of riding. Adaptive tricycles may give a child the freedom to move and engage in age appropriate play activities with peers. It can also be used as a fun form of exercise.

Therapeutic bike • For therapy • Mobility www.rifton.com • Fitness (control weight gain due to stationary life style and avoid developing conditions such as arthritis) • Improve endurance • Help offset age related changes that lead to fatigue • Reduce tremors in patients with Parkinson • Strengthen core muscle stability • Improve balance and exercises reciprocal leg movements • Improve visual and tactile stimulation • Improve full body sensory awareness • Improve attention and assist in focusing on cognitive task • Encourage team work and verbal communication • Provides leisure, family, community outdoor activity and improve social skills • Tendency of feeling trapped in a chair vs freedom on bike • Postural control • Build self esteem and sense of independence.

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Therapeutic pusher pumper

Therapeutic tricycle

www.news.bbc.co.uk

Paediatric tricycle

http://www.amtrykestore.org/

www.everykidmobility.com

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The bicycle frame forms the skeleton of the bicycle which holds all the other components together such as the saddle, crank set, handlebar, wheels and other accessories. It is a major part of the bicycle anatomy whose geometry determines the performance of the bike. Bicycle components Frame Fork (fork tips, fork crown, steerer tube) Top tube, head tube, down tube, seat tube, bottom bracket, chain stays, seat stays, dropouts Steering

handle bar stem, handle bar, break lever, grip

Wheel

hub, spokes, rim, tires (tire bead, inner tube, valve)

Drive train crank arm, chain wheel, chain, pedal (pedal body, pedal axel) Saddle

Seat post, saddle clamp, saddle rails, saddle cover

Rear break

Break cable, cable-guide tube, braking surface, break pad, break arm

BICYCLE BASICS

bikeith-blog.blogspot.com

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Bicycle components Bike controls Gear shift lever Handle bar

Frame Down tube Seat tube Seat stay Chain stay

Saddle Saddle cover Saddle rail Seat post Saddle clamp

Rear break Braking arm Cable guide tube Brake pad Brake surface

Rear Hub Rear dropout Hub Quick release

Cassette Cassette body Cog Locking

Break lever Grip Steering Handle bar Spacer Top cup and bearing Stem cap Head tube Top tube Steer tube Bottom cup & bearing

Front wheel Hub Spoke Rim

Fork crown Fork blade

Tires Tire bead Inner tube Tire Valve

Bottom bracket

Rear derailleur Jockey pulley Derailleur Barrel adjuster

Drive train RHcrank arm Chain ring Front derailleur Chain

Pedal Pedal body Foot retention mechanism Pedal axle

http://www.khurramweb.com/

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Framing material Steel has been used to build the frame for a long time. While steel is still used, frames are also made from aluminium alloys, titanium, carbon fibre and bamboo. Various properties of the material help decide whether it is appropriate in the construction of the bicycle frame. Density the measure of light or heavy the material per unit volume. Stiffness affects the ride comfort and power transmission efficiency. Yield strength determines how much force is needed to permanently deform the material. Elongation determines how much deformity the material allows before cracking. Fatigue and endurance limit determines the durability of the frame when subjected to cyclical stress from pedaling or ride bumps. Steel Steel is stiff, strong, durable, easy to repair and more workable. Steel is relatively inexpensive but more dense than many other materials structurally. Aluminium alloy Aluminium alloys have low density and is light weight hence react badly to repetitive loading, can suddenly fail through fatigue - the tube will crack then fracture. Also in contrast to some steel and titanium alloys, which have a fatigue endurance limit, aluminium has no such limit. However, alloying, good mechanical design and good construction practices help to extend the fatigue life of aluminium bicycle frames to acceptable lengths. In order to raise aluminium’s stiffness, the tubing diameter is increased beyond that of steel and thus known as oversized tubing. The greater diameter generally results in a frame that is significantly stiffer than steel.

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Titanium Titanium is the most expensive metal with enviable properties such as high strength to weight ratio and excellent corrosion resistance. Reasonable stiffness (half that of steel) so it is required to use it in larger diameters. It weighs half that of steel and about 25% more than aluminium. Titanium is not as tough as steel is, so cracks in it tend to propagate faster, leading to earlier failure and is hard to repair. Carbon fibre Carbon fibre a composite nonmetallic material used for bicycle frames. Although expensive, it is light weight, corrosion resistant, strong and can be formed in almost any desired shape. It loses its strength when it gets chipped, kinked or weathered and is difficult to repair. Combination of different materials Frames are constructed out of tubes of different materials to provide desired stiffness, compliance or damping in different areas better than can be accomplished with a single material. The combination of material usually used are carbon fibre and a metal either steel, aluminium or titanium. Bamboo frame Bamboo is well-known as a premier sustainable material, fast-growing bamboo is stronger than steel, light weight, with a wonderfully natural radiance.

www.biomega.com

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Frame construction Top tube Seat stays Head tube Seat tube

Fork crown Front Fork

Chain stay

Fork tips

Bottom bracket

Dropouts

TIG welding Also known as gas tungsten arc welding (GTAW), is an arc welding process that uses a non- consumable tungsten electrode to produce the weld. The weld area is protected from atmospheric contamination by a shielding gas (usually an inert gas such as argon). Among arc welding process, GTAW ranks the highest in terms of the quality of weld produced and is expensive. It is fast, strong and versatile. Any tube configuration can be TIG welded. MIG welding Also known as gas metal arc welding (GMAW) or metal active gas (MAG) welding. It is semi-automatic or automatic arc welding process in which a continuous and consumable wire electrode and a shielding gas are fed through a welding gun. A constant voltage, direct current power source is most commonly used with GMAW, but constant current systems, as well as alternating current, can be used. Two most prevalent quality problems in MIG are dross and porosity. If not controlled, they can lead to weaker, less ductile welds.

Welding A common method for steel, aluminium and titanium bikes in which argon gas is used to fuse similar materials into a single frame. Welded frames offer a great combination of light weight, strength and affordable. TIG welded connector

www.rlcanon.sw.utexas.edu

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Brazing with lug

Brazing without lug

MIG welded steel

www.jz88.com

www.redkiteprayer.com

www. bgcycles.com

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Brazing Metal tubes (usually steel) are adjoined by melted brass solder with or without the aid of lugs. It is very expensive and time consuming process, usually used for custom frames.

Carbon fiber bottom bracket lug

Brazing with lugs Lugged frame construction is a method of building frames using steel tubing and sockets, called lugs, is primarily an assembling method. Tubes are either brazed or soldered into metal lugs. The lug greatly increases the strength of the joint by distributing the molten filler metal over a larger surface area via capillary action. Traditional stamped lugs (pressed lugs) are formed by pressing sheet steel over a mandrel, bending them to shape, and then welding the seams. Lugs used today on higher performance bicycles are investment cast (lost wax process). Allows customizing of joints, the process is time consuming and expensive. Useful only for regular tube shapes, so it’s becoming uncommon. Conventionally found in steel, aluminium, and carbon fibre bikes. Bonded (glued) Tubes are glued into cast aluminium lugs. Generally produces a somewhat flexible frame. The material’s properties are unaltered by heat and repairs are difficult.

Monocoque construction

Monocoque NASA often designs rockets using the monocoque method, because it places almost all of the stress on the outer shell. Bikes constructed this way are usually made of carbon fibre, sometimes with aluminium. They are light and offer the biker control over the ride. This method differs from most others in that no major joints are glued. Instead, a single piece of material is moulded into the frame. Monocoque bikes are generally best for long, flat rides. Carbon tubes bonded to titanium lugs

www. bgcycles.com

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forums.roadbikereview.com

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Components HANDLE BAR Bicycle handlebar refers to the steering mechanism for bicycles; the equivalent of a steering wheel. Besides steering, handlebars also often support a portion of the rider’s weight, depending on their riding position, and provide a convenient mounting place for brake levers, shift levers, cyclocomputers, bells, etc. There are three basic types of handle bars : flat, dropped and high riser

Straight / Flat handle www.bikerumour.com

Straight / Flat handle bar These handle bars are frequently used on MTB ‘s where there is a need to have full control over the steering mechanism. Slight movement of the handle bar should send immediate reaction to the front wheel. Dropped handle bar Most of the racing bikes adopt a dropped handle bar for increasing control over the front wheel and to get the body of the rider over the handle bar. This reduces wind drag. They are not ergonomic for long distance travelling as they can result in back injury.

Dropped handle bar www.roadbike198.com

High riser handle bar These handle bars are used in comfort ride cycles, where the handle come over the seat position resulting in a comfortable body posture of the rider. The comfort feeling is compromised by low control over the steering mechanism. But in touring bike comfort is a prime objective and hence control over steering can be compromised.

High riser handle

www.bikerumour.com

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SADDLE A bicycle saddle, often called a seat is one of three contact points on an upright bicycle, the others being the pedals and the handlebars. The crucial element of bicycle performance and comfort is a saddle. It also enables the maximum energy transfer from the riders legs to the pedals. Types of seat

Race It’s ideal for people who ride for fitness and training wearing cycling clothing and maintaining a high rpm and fairly rapid pace. For longer rides and sometimes ride aggressively on/off the road. Lightweight (sometimes have titanium or hollow seat rails); minimal padding, narrow shape, pretty stiff top. Mountain bike For riding off road on challenging terrain. For those who move around on the seat, for example sliding way off the back of the seat to safely descend a steep slope or perching on the saddle nose to keep the front wheel down on a cliff like climbs. Fairly narrow shape; often reinforced with Kevlar (Fibre material) on the areas that touchdown when rider crash; medium padding to soften blows; lightweight; shaped rear section to ease moving rearwards; downward sloped nose for moving forward further. Wide cushion For an upright position on a bike where the handlebars are as high or higher than the seat, which puts a lot of weight on the seat. When the rider does not wear cycling clothing & do not pedal very fast. Wide throughout but especially on the back; lots of padding; sometimes springs are built into the underside of the seat; heaviest of all seat types.

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Gel To the riders to whom seats irritate sit bones, suffer from occasional numbness if you ride long. Great cushion through the use of gel, a shock absorbing material that also moulds to your shape for a custom fit; medium weight (not light); often slightly wider throughout; flexible top; may feature bumps to support the sit bones. Suspension For long rides and hard on/off road. For the ones who don’t want the additional weight and prefer the racy looks of the lightweight seats. Suspension is built into the underside of the seat in various ways, often by adding elastomers (rubber bumpers) between the seat rails. Cut-away To reduce the bothersome by the saddle nose that digs into rider’s groin and genitals causing pain and suffering even on short rides. Material is removed from the saddle top to eliminate pressure points; some have actual cutouts (holes) in the top; various models. Looks streamlined and high tech. All leather For a traditionalist who likes natural bike products and wants a classy looking bicycle. For long distance riding at a good pace. Material is removed from the saddle top to eliminate pressure points; some have actual cutouts (holes) in the top; various models. Looks streamlined and high tech.

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SEAT POST Seat post attaches the saddle to the bicycle. It also allows the rider to adjust the height of the cycle. The seat post consists of a pillar and a clamp. Sometimes they are integrated into one unit, in which case they are referred to as a one piece seat post. The two part seat post consists of a tube with a clamp attached around its upper end. The clamp simultaneously holds the rail of the seat in position and fastens the seat to the top of the seat post. The clamp is usually made of steel and has serrations that allow the saddle to be tilted up or down. The pillar is also usually made of steel or aluminium. A one piece is more rigid than a two part seat post because of the way the clamp is integrated into the upper end of the post.

Saddle

Basic functions Adjusting the tilt of the seat If, for example the nose of the saddle is tilted down, the cyclist’s body weight is thrown forward, creating extra strain on the arms and shoulder. On the other hand, if the nose is tilted up, the cyclist may feel discomfort in the genital area. As a general rule, the seat should be set parallel to the top tube of the bicycle. Seat height Proper height of the saddle is very important. If the saddle is very low, riding becomes very difficult. If it’s too high, adequate leverage needed on the cranks for efficient use of energy is not obtained.

Rails

Clamp assembly Clamp bolt

Seat post

Seat position The correct fore- and-aft seat position allows maximum leverage from the muscles. Too far forward and the leverage is sacrificed; too far back, and it triggers back pain www.technical-illustrations.co.uk

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PEDALS The pedals transfer human muscle power to the drive train of the bicycle. A bicycle pedal provides the connection between the cyclist’s foot or shoe and the crank arm allowing the leg to be used to turn the crank. The pedals are attached to a crank arm driving a ring gear that transmitted power to the driven wheel my means of a chain. The left -hand pedal has a left hand thread, to prevent it from becoming loose from an effect called precession (a change in the direction of the axis of a rotating object). Although the pedal turns clockwise in its bearing relative to the crank arm, the force from the rider’s foot presses the bearing against the crank arm thread at a point which rolls around clockwise, thus slowly pulling the outside of the bearing anti clockwise because of friction. Platform pedals In initial years of cycle development, platform pedals referred to pedals with a large flat top area and flat bottom. The pedals were designed with a larger topside for better leverage and a smaller underside for less potential contact with the track. Today, platform pedals refer to any flat pedal(typically for mountain biking and BMX) without a cage.

The clip is generally made of metal or high impact plastic. The strap is generally made of leather or nylon. A notable difference between track, road and touring cages is width. Track being a narrow and squarish width, roads being a little wider with a rounded cage, and touring being the widest to allow comfort during longer rides. Clip less pedals Clip less pedals require a special cycling shoe with a cleat fitted to the sole, which locks into a mechanism in the pedal holding the shoe firmly to the pedal. Clip less refers to the lack of an external toe clip, but not to be confused with platform pedals without toe clips. In these pedals , the cyclist can release the foot from the pedal by twisting the heel outward. Cycling shoes have inflexible soles to maximise power transfer and efficiency they may be specific to road or mountain biking, or usable for both.

Cages and toe clips Cages called toe clips were added to help keep the foot in place. Then toe straps were added to both further secure the foot to the pedal and to allow the cyclist to apply power on the upstroke by pulling against the pedal. Cleat fitting

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WHEELS, RIMS AND TYRES Wheels A bicycle wheel in a pair is often called a wheel set. A wheel consists of a rim connected to the hub by spokes. At the end of each wheel spoke is a nut, called a nipple. Bicycle wheels connect to the frame and fork via dropouts. Wheel design Comfort and durability Lighter is quicker, stiffer riding and more fragile Heavier is slower, softer riding and more durable Wheels selection Generally, heavier wheels are better to able to cope with bumps, potholes and rough surfaces, and lighter wheels are faster but harsher riding. Wheels for racing on smoothly surfaced roads are lighter, slimmer than wheels for touring with heavy loads on gravel tracks. Stout (fat) tires, wide rims, and thick spokes go with touring bikes and mountain bikes. Light tires, narrow rims, and slender spokes go with sport and racing bikes.

condition is not so effective with steel rim. Rims can either have a single-wall or double-wall cross section. Single-wall rims are usually less expensive and weaker or heavier; double-wall rims tend to be stronger and more expensive. Double-wall rims may have a deep profile either to reduce aerodynamic drag or for additional strength or rigidity, especially for wheels with fewer spokes. Tread Inner tube Rim Nipples Spokes Hub

Rims The rim is an extrusion that is butted into itself to form a circle. Most rims are made of aluminium alloy, while some very high-end rims are made of carbon fibre, and some old or very low-end rims are made of steel. Rims designed for use with rim brakes provide a smooth parallel braking surface, while rims meant for use with disc brakes or hub brakes sometimes lack this surface. Steel is heavier than the alloy and takes more time to get into motion. Most of the calliper brakes work by pressing two blocks against the sides of the rim. In dry condition it works well with alloy rims. But, in wet www.technical-illustrations.co.uk

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TYRES A tire or tyre is a device covering the circumference of a wheel. It is an essential part of most ground vehicles and is used to dampen the oscillations caused by irregularities in the road surface, to protect the wheel from wear and tear as well as to provide a high-friction bond between the car and the road to improve accelerations and handling. Types of tyres Wire-on / Clincher (HP-high pressure) on HP rims Have open casing, where the two edges of the casing nestle within the lips of a U shaped rim. The casing edges are reinforced with the beads (The “bead” is the edge of the tyre) of wire or Kevlar, so that retain shape and stay inside the rim when the inner tube is inflated. Easy to handle when need to change the tyre or tube to mend the puncture Sprints have tubular tyres on sprint rims The casing edges are sewn together, completely surrounding the inner tube. A sprint rim is slightly concave, smooth top with no lips and the tyre is held in place with glue or shellac and lighter than the HP, preferable for racing. The whole tyre has to be changed when required to replace the tyre during puncture.

Tyre selection • Wide tyres More comfortable ride, better traction on loose surfaces such as gravel and wet conditions, and are the most durable. • Narrow tyre Stiffer ride, less traction, and are vulnerable to punctures. Use of properly surfaced roads or competitions. • Mountain and roadsters 26 or 24 in. wheels, stronger because of their small diameter and generally more robust construction. Use for hard-off road bashing, and for traction in sand and mud.

Tread Sub - tread

Casing

Beads Cross section of a tyre

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HUBS Every wheel has a hub at the centre, small as they are the hubs are extremely critical part of the wheel system. They hold the wheels in the frame and allow them to spin. The largest part of the hub is the shell. The shell is the part to which the spokes are attached, and it encases the working parts - that is the axle and the bearings. The part of the shell that holds the heads of the spokes is called the flange. Hubs are often described by the type of flange they have. Inside the shell of the hub are two bearing races, one at each end. The bearings roll on the surface of the surface of the races and are held in place by the cones. The cone fits on the axle and is held in place by a series of washer and locknut.

Axle Spacer Lock nut Lock washer Flange Hub shell Cam lever Adjusting nut Spring Quick release skewer

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www.technical-illustrations.co.uk

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BRAKES Bicycle brake systems are used to slow down, or brake a bicycle. Bicycle brakes are a dynamic part of bike performance. After the development of the “safety bicycle” which was roughly the bicycle we would recognize today, with two wheels of equal size, initially with solid rubber tyres. These were generally equipped with a front spoon break and no rear break, but it was not very powerful and almost useless in wet weather. With the introduction of the pneumatic tyres also came the next advance in bicycle braking around the 1890’s the invention of the rim brake. This is the type of brake most commonly used in bicycles of today. Coaster Brakes Also known as a back pedal brake or foot brake, is an offshoot of the drum brake integrated into hubs with an internal freewheel. Freewheeling functions as with other system, but, when back pedaled, the brake engages after a fraction of a revolution. It can frequently be found in both single speed and geared hubs.

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Disc Brakes Disc brakes consist of a metal disc attached to the wheel hub that rotates with the wheel. Callipers are attached to the frame or fork along with pads that squeeze together on the disc. Most suitable for and used mostly in mountain bikes ridden off road. They are also used on hybrid bicycles, tandem cycles, and some road bicycle. There are two general categories of disc brakes, mechanical and hydraulic. Performance is equally good in all conditions including water and mud and less finger effort. They are usually heavier and more expensive than rim brakes.

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In rim brakes, the braking force is applied by the rider squeezing a lever mounted on the handlebar; this causes friction pads (usually made of leather or rubber and mounted in metal “shoes”) to contact the rim of the rotating wheel, thus slowing it and the bicycle. The following are among the many sub-types of rim brakes. Side pull calliper brakes These are widely used on the most inexpensive bikes. They consist of two curved arms that cross at a pivot above the wheel and hold the brake pads on opposite sides of the rim. These brakes are simple and effective for narrow tires. Centre pull calliper brakes These were developed to fill the price niche between the cheaper and the more expensive ones. Tension on the cable is evenly distributed to the two arms, preventing the brake from talking a “set” to one side or the other. V-brakes (linear or direct pull) Arms extend straight up, the outer housing is attached to one arm and inner housing to the other, similar to the cable attachment for side pull brakes. They are more powerful & easier to adjust than cantilever brakes, & have the additional advantage of functioning well with the suspension systems found on many mountain bikes.

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Dual pivot calliper brakes These are used on most modern racing bikes. The cable housing is attached like that of a side-pull brake. Centering of side-pull brakes was simplified with the mass market adoption of dual pivot side-pulls and these brakes also offer a higher mechanical advantage. One arm pivots at the center, like a side pull; and the other pivots at the side, like a centre pull. U brakes These have the pivots for the arms mounted to the frame or fork on each side above the rim. The arms cross over similarly to side pull or centre pull brakes, and BMX bikes. Its main advantage was that it did not protrude sideways from the frame like the early cantilevers. This advantage was reduced by V brakes.

Rod brakes These use a series of rods and pivots to pull the friction pads upwards onto the inner surface of the wheel rim. They are reliable and durable and can be repaired and adjusted with simple hand tools.

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Basic geometry of bicycle

TOP OF HEAD TUBE

TOP OF SEAT LUG TOP TUBE LENGTH TOP TUBE

BOTTOM OF HEAD TUBE

ALLEN KEY BOLT TUBE SEAT STAY

CL BRAKE BOLT HOLE

BRAKE BRIDGE

HEAD TUBE ENG TH SEA T TU BE

FRONT BRAKE REACH FENDER CLEARANCE .

WHEEL CLEARANCE

FRONT WHEEL AXLE

REAR BRAKE REACH FENDER CLEARANCE REAR WHEEL AXLE

.

FORK BLADE CURVATURE

UNDERSIDE OF CROWN DOWN TUBE

SEA T TU

WHEEL CLEARANCE

CL BRAKE BOLT HOLE AND BRIDGE

BE L

TOP TUBE HEIGHT

WHEEL CLEARANCE CRANK AXIS

FORK RAKE

TOE CLIP ARC

H

NGT

E TAY L AINS

TOE CLIP CLEARANCE

CH

.

RAKE LINE

BOTTOM BRACKET HEIGHT

.

.

BASELINE

CL HORIZONTAL WHEEL AXIS

DROP CL CRANK AXIS

.

FORK LENGTH

WHEELBASE HEAD TUBE ANGLE

SEAT TUBE ANGLE

TRAIL (or positive caster)

Ultimate bicycle book- Richard Ballantine, Richard Grant

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Top tube length Measured along the centre of the tube between the head tube centre line and the seat tube centre line. This dimension is relative to the length of the torso and the arms. Seat tube angle The angle formed between the seat tube and the ground. The typical range is between 68 ° - 75 ° A steeper seat tube angle offers a stiffer ride while a laid back tube allows for more frame flex resulting in reduced road shock. Seat tube length The distance from the centre of the crank axis to the top of the seat lug. This measurement is always taken on the centre line of the tube. Chain stay length This dimension is defined as the distance from the crank axis to the intersection of the seat and chain stay centre lines. Shorter chain stays give a stiffer ride and more energy efficient. Longer stays have more flex and better shock absorption. Wheelbase Wheelbase is the horizontal distance between the centres (or the ground contact points) of the front and rear wheels. Wheelbase has a major influence on the longitudinal stability of a bike, along with the height of the centre of gravity characteristics. A short wheelbase offers a stiff, energy efficient ride since very little work is lost in frame flex. A longer wheelbase on the other hand has greater resiliency offering better control, reduced road shock and rider fatigue.

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Head tube angle As with the seat tube, this angle is measured between the head tube and the ground. Typically this angle falls in the 68 °- 75 ° range as with the seat tube. This dimension is directly related to the fork rake (the perpendicular distance from head tube centre to the centre of the front wheel axle). Top tube height This is the perpendicular distance from the ground to the top of the top tube. This should always be at least 1/2” less than the distance from the cyclist crotch to the ground. This 1/2” space should exist while the cyclist has both feet flat on the ground and is wearing the same shoes used to ride. Fork rake The fork rake is perpendicular measurement of the distance from the centre line of the centre of the axle. Every head tube angle has only one rake that will provide neutral steering, no rise or fall as the fork is turned. Bottom bracket height The distance from the ground to the centre line of the bottom bracket. This height ranges from 9.5” for touring and up to 12” for cyclocross, criterium and track bikes. This is also one of the primary dim. having a direct bearing on the top tube height. Fork length The convenient way to measure fork length is along a straight line from the front axle to the centre of the brake hole. Another way to measure is along the centre line of the fork blade. This method will give different results base on fork curvature. This method of measurement gives a more accurate representation of handling characteristics. Fork length is determined by the type of crown that is used, wheel clearance and more importantly head tube angle and rake.

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PROJECT BRIEF II

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Design brief

Design

Phase II

Designing a mobility device for physically handicapped children, not only by keeping in mind the comfort factor and providing adaptations for optimal support if required but also with the larger context of the environment in which it will be used (play, home, school, transportation). Easily maneuverable, narrow, individually adaptable, multiple fitting options to restore mobility and to mobilize residual activities, easy to stow, flexible design to be extension of his or her personality are some of the properties which can contribute to motivate the users to drive themselves and finally lead a better quality of life.

To design an assistive device not to call attention to the technology, but to enhance the abilities and the impression of the user. Redefining what a wheelchair can and should be.

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Scope of the project Designing a mobility device for physically handicapped children, not only by keeping in mind the comfort factor and providing adaptations for optimal support if required but also with the larger context of the environment in which it will be used (play, home, school, transportation). Easily maneuverable, narrow, individually adaptable, multiple fitting options to restore mobility and to mobilize residual activities, easy to stow, flexible design to be extension of his or her personality are some of the properties which can contribute to motivate the users to drive themselves and finally lead a better quality of life. Design process The step by step approach followed while designing: • Need identification or problem identification for redesigning • Analysis of existing and parallel products and collection of relevant information on products of similar nature. Literature review on the subject. • Identification of the needs of the user, to know exactly what is wanted and to set up objectives of the product development and determine what is required to be incorporated into the product. • A research methodology is set on what could be done to fulfill the objectives, including incorporation of detailed user’s survey. • Planned research, elimination of probable shortcomings, elimination and arrival at feature specifications. • Creative design with alternates. • Final design and prototype development. • Verification of its feasibility through feedback from probable user’s and experts in the field. • Refinement of design • Final product design and prototype.

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Methodology Bicycles have evolved from wheelchairs and have a lot of shared components. Since the companies primary product is bicycle, the methodology adopted was to study the bicycle anatomy and the manufacturing process to have a better understanding of how an organized set-up works. Also primary user study and market survey was carried out to understand the product in entirety. The initial project proposal (Adaptive tricycle/bicycle for children with special needs) was prepared after visiting Vidyasagar (formerly Spastics society of India), Chennai. The interaction with the children, parents, social workers and physiotherapists gave an insight into the world of children with physical handicap. The therapy methods, equipments used for therapy and mobility were studied by observation and interaction with the children themselves. Also knowing the company’s expertise in bicycle design and manufacturing it provided all the technical know-how required for project- Adaptive tricycle/bicycle for children with special needs. After the finalization of the design brief (Appropriate wheelchair for physically challenged children) user study and market survey was conducted with an objective of understanding the user, their needs and usage patterns of wheelchairs and various mobility aids used in various parts of the country. As major cities are highly populated so to find a broad pattern of usage among various levels in society, a user study was conducted in five major cities of India. The user survey helped in understanding various indigenous methods of mobility used in the various parts of the country along with manufacturing and the distribution.

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Research methodology Field research Observation Participative Non participative First hand data collection Interviews Questionnaires Secondary data collection Literature review Standards and norms Internet research Audit Product Service Infrastructure Existing system model study Study of existing products services, organizations etc. related to physically challenged Data interpretation and analysis Inferences Systems model Re-define brief

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Methodology Stage I (Primary research) •Understanding the existing product range/ company portfolio, various segments/ focus groups. • Initial market study of the existing products and understanding consumer needs. • Literature study and various competitive brands. • Brainstorming and deriving a project brief based on the study for redesign of existing segment or developing new concept altogether.

The pan India user and market survey was conducted to get a better understanding of the product with a system point of view. How is the product is placed in the current scenario and what measures can be adopted towards the improvement. Places visited

The users

Stage II (Secondary research and analysis) • Market study of various regions of India to understand the consumer needs. • Analysis • To understand the need and possibilities within the selected domain, the context and the user concerns. • To understand client aspirations and reach to a redefined brief for the product need assessment. • To redefine the brief with respect to the research analysis to determine the scope of work. Stage III (Ideation and detailing) Ideation and concept generation • Ideation and concept explorations according to the design criteria. • Creating 2D/3D models and scaled mock ups based on the concepts and short listing on one particular concept for development. Detailing • Concept realization and refinement. • Detailing the selected concept based on material and manufacturing constraints. • Detailed graphics, branding and product identity. • Evaluate the concepts based on the design criteria (include costing etc)

People met

Medical practitioners Physiotherapist, Child psychologist Jaipur

Teachers Social workers

Ahmedabad

Nurses, caretakers Parents

Mumbai

NGO’s Manufacturers Bangalore Chennai

Retailers Suppliers

Stage IV (Prototyping) • Prototyping for concept validation and field testing. Stage V (Documentation)

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UNDERSTANDING DISABILITY

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Disability If one has to look up for the meaning of the word disability in the dictionary one comes across the following results: “Disabled modif. handicapped, incapacitated, crippled, physically challenged, impaired, injured, maimed, hamstrung, wounded, mangled, lame, mutilated, silenced, run-down, worn-out, useless, wrecked, stalled, bedridden, weakened, helpless; confined to one’s bed, confined to one’s home, confined to a hospital, confined to a nursing home, etc.; impotent, castrated, halting, limping, hobbling, palsied, superannuated, paralysed, paraplegic, quadriplegic, brain damaged, senile, decrepit, on one’s back*, laid up*, done for*, done in*, cracked up*, banged up*, broken down*, out of action*, counted out*; also see hurt, useless 1, weakened. ANTONYMS able-bodied, healthy*, strong.” - Websters, New World Thesaurus ; 2010

JoshuaSatpudke Rice, http://www.disabilityworld.org) 52(Art: I Amrapali I Product Design I NID 2010

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Disability The word disability often brings up images of people who are unable to “do things on their own.” The word “disability” has a negative connotation associated with it. One would dread the moment when a child with physical challenges were to come across this entry considering the negative impact it might create on their impressionable mind. However disabilities are common and very much World health organization a part of our everyday lives be it physical recognizes disability as or otherwise. We move in and out of ” A complex interaction between dependent and independent states features of a persons body and throughout our lives. As infants we are features of the environment and totally dependent on elders to satisfy society in which he or she lives.” our needs. As adults some of us may be relatively independent while some of us may face accidents and injuries that render us temporarily or permanently unable to function without assistance. As we age, we may become dependent due to illnesses related to ageing. These times of dependence are times of disability, hence we need to look at the word “disabled” differently. Disability is broadly understood in continuum as: Disease/Accident

Impairment

Disability

Handicap

WHO‐ICIDH, Geneva, 1980

With a right attitude and well thought out adaptive plan adversity can be turned into opportunity for growth. Prescribing an appropriate adaptive device along with a rehabilitation plan for a child with a disability can enable the child growth , foster independence, help cultivate skills that contribute to society and allow main streaming (integrating students with disabilities into regular classrooms).

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Main streaming provides an opportunity to introduce children to the concepts of ability, disability, separation and inclusion. While exploring these terms, we can empower children with an understanding that, depending on how we define each of the above- mentioned terms, each of us can be considered disabled in a manner or another. Society can become aware that people can choose between terminology that separates and alienates or includes and supports. Children are not their disabilities A child’s chance for success cannot be presumed by his physical diagnosis. Assessments by rehabilitation physician, occupational therapists and care givers, can tell us what a child is capable of doing. These assessments can facilitate the development of a team to work with common goal of rehabilitation. Just like our likes and dislikes shape our choices, a child’s ideas about how the assistive technology/ device fits into his life will affect whether he chooses to accept the technology/ device or not. Selecting an assistive technology/ device Selecting the appropriate assistive Assistive devices/ technology technology/ device is very crucial as a Products or technology that wrong choice can be more harmful to enable people with disabilities a child’s well-being than not providing to participate in activities of any. To make an informed decision one daily life, helping to ensure needs to understand the childs current equal opportunities. and potential future needs including the child’s prognosis along with the ease and cost of maintaining the device and the product life cycle. Thus in order to develop a plan an assistive technology or device four aspects need to be considered: users desired outcomes, preferences, abilities and the environment in which the device will be used.

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Facts and figures

National scenario

Disability rate (Movement) Per 100,000 population

According to the census data released by the Registrar- General of India, there are 2.19 crore disabled people in the country. This is about 2.13% of the total population. Of this 1.03% is ‘visually’ impaired, 0.16% ‘speech’ impaired, 0.12% ‘hearing’ impaired, 0.59% ‘movement’ impaired and 0.22% ‘mentally’ disabled.

Mentally 10% Visual 48%

Movement 28%

Hearing 6% Speech 8%

Disability by movement 400 and below 401 - 500 501 - 600 601 - 700 701 and above Census of India 2001

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Census of India 2001

Disability in movement constitutes 27.9% of the total disabled population and a big percentage of the movement restricted people are paraplegics (Paraplegia is a condition in which the lower part of a person’s body is paralysed and cannot will fully function. It is usually the result of spinal cord injury or a congenital condition). The total number of people in India with movement disabilities is 6.1 million, a higher percentage of disabled women are in the visually impaired and hearing impaired categories. In the case of male however a higher percentage has been reported in the ‘movement’ and ‘mental’ categories. The census also indicates the geographical distribution of the disabled state-wise across India. Regions where the population of disabled people is larger than the average include the states of Kerala, Madhya Pradesh, Himachal Pradesh. Haryana, Rajasthan and Chattisgarh.

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Disability data comparison between Census 2001 And NSSO 2002 According to the Census 2001, there are 2.19 crore people with disabilities in India who constitute 2.13 per cent of the total population. This includes persons with visual, hearing, speech, locomotor and mental disabilities. Although there are certain discrepancies between the figures of the 2001 Census and the National sample survey carried out in 2002. 75% of persons with disabilities live in rural areas, 49 per cent of disabled population is literate and only 34 per cent are employed. The earlier emphasis on medical rehabilitation has now been replaced by an emphasis on social rehabilitation. Mentally 10%

Visual 14%

Movement 51%

Speech 10%

Hearing 15%

National sample survey organiztion NSSO 2002

Till the 2001 Census, there was no accurate figure for the number of disabled people in the country. Coverage of disabled people was included in the Census only after repeated appeals and a massive campaign. Till the latest census the Government of India, based on a 1991 survey, put the figure of the number of disabled at 1.9 per cent of the Indian population. The recent Census report points to a disability percentage of 2.13per cent, which means the number of people with disabilities is 2.19 crore. According to the United Nations Development Fund (UNDP), however, the percentage of people with disabilities in developing countries stands at 10%, and Asia-Pacific average is 5%-6%. If which is true then the real figure for people with disabilities in India should be around 70 million. Government figures put the number of those with disabilities in employment at a meagre 1% while according to an independent study Indians spend Rs 72,000 crore per annum in caring for disabled family members of which the government bears only a fraction of the cost.

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Global scenario About 10% of the global population, i.e. about 650 million people, have disabilities. Studies indicate that, of these, some 10% require a wheelchair. It is thus estimated that about 1% of a total population or 10% of a disabled population need wheelchairs, i.e. about 65 million people worldwide. In 2003, it was estimated that 20 million of those requiring a wheelchair for mobility did not have one. There are indications that only a minority of those in need of wheelchairs have access to them, and of these very few have access to an appropriate wheelchair. Although infectious diseases such as polio are largely under control in high income countries, in some low-income countries, these diseases cause almost half of the disabilities (UN statistics division,1990). Road traffic accidents, war injuries and poor birthing conditions are also major causes of mobility disabilities (WHO, 2008). Post conflict areas such as Angola, Afghanistan, Sri Lanka and Cambodia often have very high numbers of land mine survivors with amputations of lower limbs. However, high numbers of disabilities are caused by preventable diseases such as polio, attributed to the interruption of vaccination programs and cerebral palsy, caused by lack of primary maternity health care facilities. 50%

Census 2001

40% 30%

NSSO 2002 (http://www.disabilityindia.com/html/facts.html)

Census 2001 v/s NSSO 2002 20% 10% 0%

Hearing Speech Mentally Movement Visual • UN: 600 m people globally suffer disabilities. • There are an estimated 60 m or 6 crore people with disabilities in India and it directly impacts the lives of about 600m Indians. • India has more disabled people than total population of UK, Canada or Australia.

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Causes of disability (affecting mobility) Brittle bones (Osteogenesis Imperfecta) It is the tendency to fractures in children and young adults. It is inherited, and it is estimated that about seven in every 100.000 births are affected. The cause of the defect is a fault in the protein structure of the bones. Most babies with the disorder will show signs of fracture at birth and will continue to occur throughout infancy and in the early years of life. Cerebral Palsy Spastic children (50% of all cerebral palsy) have abnormal & increased muscle tension, which makes movement difficult according to the particular muscles affected. Ataxic Cerebral Palsy It is due to the damage to the nerves which descend from the equilibrium centres of the brain. The child therefore has great difficulty in balancing. Many cerebral palsied children will seem ataxic at times, because of their poor muscle control will make them appear to move in jerky and uncontrolled manner. But in true ataxia, the child lacks balance in a variety of situations. He may not be able to judge distances, will fall and trip easily and will need good deal of help in adjusting to his environment. Athetoid Cerebral Palsy It is characterised by constant wriggling & writhing movements which the child cannot control. Child is usually floppy & lacking in movement in the 1st year of life. Many children with athetoid cerebral palsy are of normal or high intelligence. They can develop well intellectually if physical solutions are found for their often profound communication problems (many athetoids are additionally deaf or partially hearing). Even though there is no cure, there is treatment. Physiotherapy is essential, to prevent from the child’s condition getting worse & at times surgical & correcting procedures can be given to enable the child to move and sit more normally.

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Paraplegia and Tetraplegia/ Quadriplegia Paraplegia is usually caused by spinal injury. If the spinal cord is injured below the neck, messages of movement and feeling from the brain cannot be transmitted to the limbs. The person is therefore paralysed to a greater or lesser degree. Tetraplegia is much more serious, since the damage to the spinal cord is higher up at the neck level and all the four limbs and possibly the lungs will be affected. Friedreich’s Ataxia It is a hereditary disease of central nervous system, starts in childhood or adolescence. In early stages child will show slight unsteadiness in walking followed by increasing awkwardness & clumsiness of hands & difficulties in manipulation which becomes progressive over years. Vision & hearing is unaffected, but speech can become indistinct and slurred. There is no treatment, but physiotherapy can play a useful (if limited) part in maintaining mobility & helping with adjustments to everyday life. Haemophilia It is relatively rare condition (one in every 25,000), it is a disorder of the normal clotting mechanism of blood, genetically transmitted through both sexes but commonly affecting only men. Children affected by haemophilia will never need a wheelchair however severely affected suffer haemorrhages into muscles & joints which are acutely painful, potentially crippling. Knees, elbows,& ankle joints are commonly affected, in many cases child will have to rest in bed with the limb immobilised. Mental Handicap The majority of mentally handicapped children are in no way physically handicapped. But those who are multiply handicapped will usually be brain damaged during or shortly after birth. Most of these children will not become independently mobile, and their use of a wheelchair will be dependent upon an assistant to push. Powered wheelchair require a degree of skill to operate them successfully, although some children will manage to use them to a limited extent.

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Paraplegia and Tetraplegia/ Quadriplegia Usually caused by spinal injury. If the spinal cord is injured below the neck, messages of movement and feeling from the brain cannot be transmitted to the limbs. The person is therefore paralysed to a greater or lesser degree. Tetraplegia is much more serious, since the damage to the spinal cord is higher up at the neck level and all the four limbs and possibly the lungs will be affected. Muscular Dystrophy It is a neuromuscular disease caused due to disorder of central nervous system involving one or many parts of the motor units. Muscular weakness is the major cause of the disability. It is a degenerative condition but it is essential to keep the child mobile & active. The progress of the disease is fairly predictable. By the time the child is 8 or 9, he will be showing marked curvature of spine & will probably use the ‘toe’ walk. Between 8 and 11, he may have to start using a wheelchair. Hands are usually affected after the legs, but gradual loss of movement will be experienced. Between the ages of 16 and 25, deterioration may also affect the muscles of the face, hands and respiration, and the adolescent is exposed to infections and strain on heart. In the final stages, the child will require 24 hours attention. Multiple Sclerosis It affects older adolescents and adults: it is a disease of the central nervous system, which affects the nerve fibres. Poliomyelitis Polio is regarded as one of the few success stories amongst the major handicapping conditions affecting the central nervous system. Development of vaccine in 1960 has ensured that the children (in theory at least) can now be totally protected. Better hygiene and sanitation in western countries have eliminated most potential breeding grounds for the virus. However, with air travel and increased world mobility, it is still possible to be exposed to infection, reluctance to take vaccination

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programme due to possible brain damage will increase the likelihood of cases re-emerging. The majority of current polio victims suffering from a handicapping degree of paralysis are adolescents and young adults. It is not a progressive condition and the major practical problem lies in the adjustment to a severe degree of disability. Rheumatoid Arthritis (Stills disease) It affects children & adults, earliest onset can be as early as 2 or 3 years resulting in serious damage & handicap. The basis of arthritis is chronic inflammation of the synovial membrane (joint lining) producing destructive changes in the joint itself. Symptoms are pain, swelling, stiffness and tenderness, affected joint becoming difficult to move. About 1/3rd affected children will be severely disabled & have a major mobility problem. Orthopaedic surgery, physiotherapy, various splints & walking devices may help. Spina Bifida It is a malformation of the neural tube, which forms the part of the spinal cord. Paralysis will vary according to the site of the defect. If this is high, there will be considerable paralysis, loss of sensation and incontinence and the child will be, in effect, a paraplegic. Physiotherapy is important to avoid scoliosis (distortion and humping) of the back and to encourage the child, where possible to use callipers or propel a chariot or wheelchair. Surgery may be involved to correct leg or back deformities. Amelia of dysmelia Abnormality resulting in the absence or shortening of a limb. As congenital defects of this kind are comparatively rare, it is unlikely that a good service for the artificial limb or appliances needed can be obtained outside a specialist centre. Wheelchair children with limb deficiencies will normally be affected in the lower limbs and may be able to crawl or move themselves around shuffling movement. Many of the severely affected children will have to use a wheelchair for part of the time, particularly outdoors. Accidents followed by loss of limb/ amputation

The wheelchair child - Philippa Russel

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Need for wheelchairs Design for special needs is often neglected owing to the pressing need to cater to increasing demand of design and re-design for the able-bodied. A physical aid plays a crucial role in the lives of the disabled. And for those whose lower limbs are incapacitated, the wheel chair is a convenient mobility aid to help them actively participate in the daily activities without much assistance and realise their potential. When one comes across a wheelchair bound person the immediate reaction is that of sympathy and pity. So the wheelchair bound person not only has to deal with the difficulties of depending on mobility aid to fulfil their daily activities but also bear the hurt caused due to the constant stares and sympathy directed towards them. And if the wheelchair bound person happens to be a child one cannot imagine the plight of a child subjected to such hurt and pity. When it comes to other mobility devices used by children such as bicycles people exhibit a sense of awe and cycling is often considered a major milestone in the growth chart. Although there is a lot more a wheelchair can do for a wheelchair bound child provided it fits him/her perfectly and fulfil his/ her need to be independent along with providing a sense of identity and reflect the users personality. At a growing age of 7-12 years a child has to change at least 2-3 wheelchairs as the child has outgrown the old wheelchair, which can be a financial setback to the family and often result in getting the child an adult wheelchair hoping he/she would grow in to it or worse still use the same wheelchair bearing severe discomfort. It is often difficult to find a paediatric wheelchair that is made in according to Indian standards and can be serviced here. The wheelchairs manufactured by NGO’s and other such institutions pay very less attention to comfort and ergonomics as they target more on quantity and quality. There are not many players in this arena of wheelchair manufacture as result of which wheelchairs are often imported from abroad.

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Wheelchairs currently being used in India are as of today mostly manufactured by agencies like ALIMCO (Artificial limbs manufacturing corporation of India in the government channel and smaller industries at the local level privately (e.g. VISSCO in Mumbai, SAGE in Delhi etc) Quantity in nos. in year 2005-06 Tricycles 81,794 Wheelchairs 34,754 Since last few years the import duties on mobility devices have been abolished hence there has been an influx of cheaper Chinese made wheelchairs mainly in the retail open channel, these come at an average selling price of Rs 2800 - Rs 3500. However they lack the ability to customize and at times poor after sales support plague this sector. In the period of April 2006 to December 2006 a total of 7,810 wheelchairs were imported into India. If one has to purchase a wheelchair especially specialized wheelchairs such as a paediatric wheelchair, which if not readily available there is a waiting period of few weeks after the placement of order and arrive in the next shipping. Wheelchair charity The manually-operated wheelchairs donated to users are often unused and many are sold only few are used regularly and some are used occasionally most of which turn out to be attendant propelled. Rejection of the wheelchairs can be attributed to lack of habitat adaptability , pain, fatigue, discomfort, frequent damage, upper limb issues, and inability to drive. Also the cardiorespiratory response is higher in occasional users than regular users, as wheelchairs used for locomotive tasks are high in energy demand contributing to physiological strain. The problem lies in the fact that patients themselves are rarely consulted while designing wheelchairs and there is a ‘one size fits all’ approach that simply does not work in practice, for example, standard wheelchairs used in many Indian hospitals are not adjustable and cannot be adapted to suit the needs of individual patients.

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REHABILITATION

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Rehabilitation Rehabilitation is a process aimed at enabling patients to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides people with disabilities the tools they need to attain independence and self-determination. Most of the estimated 650 million people living with disabilities around the world lack access to appropriate medical care and rehabilitation services, especially those living in low- and middle-income countries. As a result, people with disabilities experience greater challenges in attaining and maintaining maximum independence and health. Lack of services creates a barrier to full inclusion and participation in all aspects of life. Physical medicine and rehabilitation (PM&R) Emotional rehabilitation Community-based rehabilitation (CBR) Paediatric rehabilitation

Habilitation team Child’s family Service personnel Physician Nurse Educator Psychologist Social worker Physical therapist

Selective and specialized involvement

The child and his family

GOALS

Occupational therapist Speech pathologist Audiologist Dentist Recreation worker

Optimal health Physical Mental Knowledge Skills Understanding Independence

Nutritionist Volunteers

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Physical medicine and rehabilitation (PM&R)

Emotional rehabilitation

Physical rehabilitation is a recovery and restoration process recommended for those who have suffered an injury that led to amputation or other conditions that may impair mobility, it can also benefit those who have endured a life-altering event that poses physical challenges such as cancer and burns patients. Emphasis is placed on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement & activities modification, adaptive equipment and assistive device, orthotics (braces), prosthesis, and experiential training approaches.

It emphasizes on the emotional aspect of rehabilitation the process is interwoven with a patient’s physical rehabilitation. The impact of trauma and subsequent rehabilitation involves for patients the resolution of these stages: shock, denial, depressive reaction, reaction against independence, and adaptation. In the situations of this nature, the rehab process involves counselling with a qualified therapist as well as physical retraining. The patient may engage in therapy on a one-on-one basis with the therapist, or be part of a group therapy that allows him or her to interact with other people facing similar challenges.

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Community-based rehabilitation (CBR)

Paediatric rehabilitation

Community-based rehabilitation (CBR) focuses on enhancing the quality of life for people with disabilities and their families, meeting basic needs and ensuring inclusion and participation. CBR was initiated in the mid-1980s but has evolved to become a multi-sectoral strategy that empowers persons with disabilities to access and benefit from education, employment, health and social services. CBR is implemented through the combined efforts of people with disabilities, their families, organizations and communities, relevant government and non-government health, education, vocational, social and other services.

Paediatric rehabilitation is a form of rehabilitation which focuses specifically on the needs of children. It can involve a team of care providers including audiologists, speech pathologists for children with speech or language defects, occupational therapy to help children learn to perform tasks like writing, training in the use of prosthetics, and developmental evaluations to determine why children are developing slowly and what can be done to help them, physical therapists and psychologists, among others.

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Children with disabilities represent a unique population within paediatric. The division of paediatric rehabilitation, focuses on maximizing the function and enhancing the lives of children with a wide range of conditions such as cerebral palsy, spina bifida, stroke, brain injury, genetic abnormalities and other developmental disabilities.

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ASSISTIVE DEVICES

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Assistive devices for Mobility Assistive devices and technologies are items that enable people with disabilities to participate in activities of daily living, helping ensure equal opportunities. It levels the playing field between disabled and the ablebodied counterparts. Many of these devices can be inexpensive, easy to use and can seamlessly interface with one’s environment, blurring the lines between disabled and able-bodied. These includes standing/walking aids, transfer aids, stair lifts, walkers, scooters, wheelchairs , adapted bikes, trikes, car seats/bed, stretchers, patient chairs, ramps, recliners, strollers, patient and wheelchair lifts, wheelchair loaders/carriers, wheelchair restraint systems, etc.

Walking stick, crutches

Adult walking frame

Manual wheelchair

Wheelchair lift

Mobility scooter

Some common mobility aids include: Ambulatory Aids (adapted for walking aids) Includes canes and accessories, crutches, walkers and accessories, etc. Canes and Walkers The types of cane and walking aids can vary as much as the individuality of the person being served. Factors to be considered- vision, hearing, other sensory, cognitive and motor issues before deciding on a functional walking aid with the most potential benefit. Through trial and sometimes error, that the child’s needs are best met. Wheelchairs, strollers and scooters Wheelchairs and scooters are individually adjusted to ensure proper fit, sitting alignment, and functional movement. It is the role of the occupational and physical therapist to adjust wheelchairs and recommend supports. Sensory and cognitive function are taken into consideration when determining if a motorize chair is an appropriate option. Scooter Boards Scooter boards, for appropriate age, are a functional mobility aid that can be used in either a prone or sitting position.

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Motorized scooter

Modified scooter

Motorized wheelchair

Modified car

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Adapted Mobility Devices Many times the most efficient and inexpensive mobility solution is “homemade.� What can provide the best support while allowing the user to participate in his world to the fullest extent possible, are ideas to be considered while thinking about mobility solutions.

Crutches Kids walking frame by: Don Caston

Scooter board

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Standing frame

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Ground mobility device Purpose A ground mobility device/ chariot provides an alternative way for a disabled person to move inside and close to home. As the seat is close to the ground it eliminates the need to change the environment to a wheelchair height. This design will help the person to: • Move from one place to another independently; • Perform activities at ground height (e.g., eating with the family, sweeping, school work, child care, cooking, washing dishes); • Carry items (e.g., water bucket, children). Who can use this device? For people with old or new injuries to their legs (e.g., polio, amputations, spinal cord injuries); People with long or short term difficulties, children, adults, women - men or the aged with good upper body strength. It can be used in communities where activities are performed on or close to the ground, indoors - outdoors, urban or rural areas; at home, school, or at work.

Other features a. Push handles b. Seat belt c. Back cushion, extra back or side support d. Seat cushion e. Leg extension f. Larger or smaller seating area g. Motorised version weaving and one castor wheel. Options for pushing • Hands on wheels; • Hands on rim; • Hands on pegs. •Design with jute or plastic weaving and one castor wheel.

Manual ground mobility device

http://hcdg.org/ground_mobility.htm

Motorised ground mobility device

http://www.callidai.com

http://hcdg.org/ground_mobility.htm

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WHEELCHAIR

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Wheelchair The wheelchair is one of the most commonly used assistive devices by people for whom walking is difficult or impossible, due to illness or disability for enhancing personal mobility, which is a precondition for enjoying human rights and living in dignity and assists people with disabilities to become more productive members of the community. Wheelchairs can be roughly categorized into manual and motorized or powered. Wheelchair designs vary to enable users to safely and effectively use their wheelchair in the environment in which they live and work.

Appropriate wheelchair A wheelchair is appropriate when, • It meets the user’s needs and environmental conditions • Provides proper fit and postural support • Is safe and durable • Is available in the country • Can be obtained and maintained and services sustained in the country at the most economical and affordable price.

Types of Wheelchair Manual Powered

Self-propelled Rigid frame Attendant propelled Folding frame Indoor Quick release wheels Temporary use Outdoor Detachable wheels Long term use All terrain Postural support Other wheelchair variants

Standing wheelchair Mobility scooter Bariatric wheelchair Paediatric wheelchair Knee scooter

Sports wheelchairs Power chair football/ power, soccer Transfer, stretcher or mechanical chairs Beach wheelchairs

Transfer wheelchairs Transfer, stretcher or mechanical chairs

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Wheelchair components

Push handle bracket tube Swing away padded armrest Backrest

Aluminum hand rim Spokes Rear wheel hub Release axel

Seat cushion Seat sling Frame Cross brace

Aluminum wheel rim Pneumatic tire Brakes Castor housing cover Caster plate

Calf strap

Swing-away footrest

Caster tire Caster wheel Caster housing Self-propelled, foldable, manual wheelchair

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History of wheelchairs The chair and the wheel are two of mankind’s oldest inventions .The first image that is documented of furniture on wheels was found on a Greek vase in 530 B.C. The picture was of a child’s bed on a set of four wheels, giving the image of attaching wheels to furniture.

Image on Greek vase of wheeled childs bed

After which evidence was found of a chariot on spoke wheels in China in 1300 B.C, but in 525 A.D, an engraving of a representation of a wheelchair was discovered, this is the earliest impression found of a wheel chair to date. 525 A.D. engraving of one of the earliest representation of a wheeled chair

Wheel chairs were originally referred to as ‘invalids chairs’ and in 1554 one of the first wheel chairs was made by Jehan Lhermite for Phillip II of Spain. It was constructed of iron, leather and wood, and featured footrests. An artist sketched the king sitting in this wheelchair in 1595. King Phillip II (1595) of Spain on his rolling chair with foot rest

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Later on in 1655 a disabled British watchmaker called Stephen Farfler built himself a three-wheeled chair to help himself get about on. Unlike earlier wheelchairs, which had to be pushed by another person, this one was made to be moved by the occupant. It was boxy, with two back wheels and one front wheel. The rider turned Paraplegic watchmaker, Stephen Farfler two levers, one on each side of the (1655) built his own chair at 22 yrs of age front wheel, to move the chair. In 1881 the ‘push rim’ was invented which meant no more dirty hands for wheelchair users, a smaller circular steel tube was attached to the wheel. They could use the push rim to move the wheels and not get covered in mud. A smaller circular steel tube was attached to the rear wheel. This circular tube, made turning the wheel easier, because the user could grab the tube instead of directly grabbing the wheel. Push rims became “Bath” chair standard and provided a better means of spinning the wheel. In 1783, John Dawson invented the Bath chair, so named because it was used to transport disabled bathers to and from the spas in Bath, England. It was made in a number of styles, some open and others enclosed. The occupant steered it with a handle, but the Bath chair had to be pushed by an attendant.

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Comfort for the disabled person became more of an issue, so in 18th century a convertible chair with reclining back and adjustable foot rests was made. Through the 19th century, wheelchairs were mostly made of wood, with wicker backs and seats. The wheels were made increasingly larger, however, and riders began to push themselves by turning the wheels. From wheel chairs came the invention of powered chairs and mobility scooters, which takes the basic concept of the wheelchair but instead of it being self propelling the chair is moved forward by electricity and power. The first motorized wheelchair was invented in 1916, but as they are expensive manual wheel chairs were still the more popular choice. The powered chairs were also very heavy and so were hard to move about. Until the 1930’s, the wheelchair was a rather cumbersome device. They were bulky and while a lightweight wicker wheelchair had been built, even this could not be easily transported; making travelling very difficult for many wheelchair users. In 1933 Harry Jennings invented a lightweight steel powered wheelchair. He invented this because his friend was caught in a mining accident that broke his back and he had to use a heavy and non-foldable wheelchair as that was all that was available.

18t century seating

Jennings was a mechanical engineer and after hearing his friend complain so much about the wheel chair set to work on inventing a lightweight and folding wheelchair. After he had invented the chair the two friends saw the potential in the business and set up the mass-manufacturer international company Ernest and Jennings. About twenty years after the invention of the E & J wheelchair, the first electric wheelchair was built. This chair utilized the First folding metal wheelchair E & J frame, outfitting it with an electric motor. A simple hand control was mounted on the handle bar of the chair. New control methods were also created at this time, including those that relied on head movements to control the chair. As the popularity of this first electric wheelchair began to unfold, many companies began selling converter kits that allowed an existing E & J wheelchair to be made electric. Today, there are many electric and manual wheelchairs to choose from. Many off road and alternative wheelchairs are available. These chairs have changed a good deal since the early Greek wheeled vehicle, but many of these early wheelchairs helped to mold the wheelchair of today.

Made from Indian reed light weight wheelchair Large wheels either front or back 58 lbs. with pushrims 50 lbs. without pushrims

images: wheelchairnet

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Wheelchair journey in time 4000 B.C.

Man’s two earliest inventions: Chair and Wheel

Eastern Mediterranean basin

1300 B.C.

Spoked wheels on chariots it is the oldest evidence of wheeled chairs

China

530 B.C

First record of combining wheels to furniture Image on Greek vase of wheeled child’s bed

Greece

525 A.D

engraving of one of the earliest representation of a wheeled chair

China

3rd century

Wheel barrow: Used for moving the sick or disabled to the “Fountain of Youth”

China

1553

Greek and Roman physicians prescribed a “gestation” or transportation for the sick or disabled

Europe

Get people out into fresh air and help work with whatever they could do in the fields. Carried on a sedan or push on a chair with wheels

1595

King Phillip II of Spain Had his own rolling chair with foot rests

1655

Self propelled chair-Paraplegic watchmaker, Stephen Farfler built his own chair at 22 yrs of age.

Spain

1783 Bath Chair- Bath, England Invented by John Dawson, “Wheel-chair maker” 1783 Dominated the market of 19th century Two large wheels, one small wheel 18th century Comfort for the disabled person became more of an issue Convertible chair (reclining back and adjustable foot rests)

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Wheelchair design today

i-real Toyota

ibot DEKA i-unit Toyota

Speedy Electra

HELLO Honda Electric mobility Loop MIO Suzuki Motor

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Types of wheelchairs Manual wheelchairs Manual wheelchairs are those that require human power to move them. Many manual wheelchairs can be folded for storage or placement into a vehicle. Manual wheelchairs can be self-propelled and attendant propelled. Which can be further categorized into rigid or folding according to the structure of the frame. Powered/ motorized wheelchair A motorized wheelchair, power chair, electric wheelchair or electricpowered wheelchair (EPW) is a wheelchair that is propelled by means of an electric motor rather than manual power. Motorized wheelchairs are useful for those unable to propel a manual wheelchair or who may need to use a wheelchair for distances or over terrain which would be fatiguing in a manual wheelchair. They may also be used not just by people with ‘traditional’ mobility impairments, but also by people with cardiovascular and fatigue based conditions. An electric-powered wheelchair  is a wheelchair that is moved via the means of an  electric motor and navigational controls rather than manual power.

Self-propelled, non-foldable, wheelchair www.canadiandesignresource.ca

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Power Wheelchair with controller www.rehabwa.com.

Folding wheelchairs Folding mechanism is available in both manual and powered wheelchair. Manual wheelchairs are easy to fold where as, in case of powered wheelchair the battery needs to be removed requires assistance and training. Advantages of a Folding Wheelchair • Folds for car transport • Can be folded and stowed without removing any parts • Its flexibility keeps all four wheels on the ground on rough surfaces • Has swing-away leg rests, where rigid frames have fixed front ends • Stores in out of the way places in small homes Disadvantages of a Folding Wheelchair • Has adjustable and removable parts that could break or be lost • Maybe too flimsy for certain sports • Seat angle is usually not adjustable • Harder to push than rigid models

www.shermanoaksmedical.com

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Detachable wheelchair All the components of the wheelchair are detachable for ease of transport and storage.

Wheelchair for short term use Wheelchair used to transfer physically handicapped or older people from one place to another is called temporary wheelchair. These are mostly attendant propelled . These are used in airports, hospitals, malls and various public places.

www.cnwheelchair.com

www.callidai.com

Outdoor wheelchair An outdoor or all terrain wheelchair can enhance your quality of life by enabling you to participate in a bevy of outdoor activities. This off-road style of mobility chair is designed to handle rugged and uneven surfaces that a standard wheel chair could not navigate.

www.scootermobility.com

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Wheelchair for long term use This wheelchair is for prolonged use. These can be both self propelled or attendant propelled. It is more comfortable and has additional features which the temporary wheelchair lacks as it is for prolonged use.

www.callidai.com

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Postural support wheelchair This is a specialized wheelchair used to provide postural support for users who cannot maintain the posture due to neurological or spinal injury.

www.danmedica.com

Beach wheelchair Beach wheelchair would come under recreational category. This wheelchair allow users to enter the water and provide a better mobility in the sand. In many countries in Europe where the Accessible Tourism is well set, many beaches are wheelchair accessible and provide this kind of wheelchairs to clients free of charge.

Sports wheelchair Disabled athletes use streamlined sport wheelchairs for  disabled sports that require speed and agility, such as basketball, rugby, tennis and racing. Each wheelchair sport tends to use specific types of wheelchairs, and these no longer look like their everyday cousins. They are usually non-folding (in order to increase rigidity), with a pronounced angle called ‘camber’ for the wheels (which provides stability during a sharp turn) and made of composite, lightweight materials. Sport wheelchairs are not generally for everyday use, and are often a ‘second’ chair specifically for sport use, although some users prefer the sport options for everyday.

Racing wheelchair

www.2.bp.blogspot.com

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Soccer wheelchair

Tennis wheelchairs

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Wheelchair Variants Standing wheelchair Wheelchairs with built in standing features allow the patient to obtain a standing position without transferring from the wheelchair. Such wheelchairs incorporate a mechanical or electromechanical system manipulated with levers or controls that move the seat from horizontal to a vertical or anteriorly sloping position while maintaining verticality of the leg rests and backrest, thus extending the hips and knee joints. A full vertical standing position is achieved directly from sitting, or through gradual angle changes from a laying position, or a combination of either of these positions. Most wheelchair standers allow for full or partial extension of the hip and knee joints, and full upright or partially tilted positions. Benefits of standing include: • Improved functional reach to enable participation in ADLs (Activities of Daily Living) • Enhanced independence and productivity • Vital organ capacity is greatly improved • Reduced occurrence of urinary tract infections • Bone mineral density loss reduced or eliminated • Improved circulation; reduced swelling in extremities • Reduced abnormal muscle tone and spasticity • Occurrence of pressure sores reduced • Diminished occurrence of skeletal deformities • Enhanced physiological well being • Additional benefits of standing wheelchairs include: reduced fatigue, ability for some male patients to use public urinals, a reduction in the need for attendant care, reduced transfers and reduced home modifications.

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Mobility scooter A  mobility scooter  (see full article) is a motorized assist device similar to an EPW, but with a steering ‘tiller’ or bar instead of the joystick, and fewer medical support options. Mobility scooters are available without a prescription in some markets, and range from large, powerful models to lightweight folding ones intended for travel.

Standing wheelchair

Mobility scooter

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Bariatric wheelchair A bariatric wheelchair is one designed to support larger weights; most standard chairs are designed to support no more than 250 lbs. on average. Paediatric wheelchair Paediatric wheelchairs are another available subset of wheelchairs used by children. Hemi wheelchairs have lower seats which are designed for easy foot propulsion. The decreased seat height also allows them to be used by children and shorter individuals.

Shower and commode chair Toilet aids such as shower and commode chair are convenient and hygienic solution for wheelchair users. They are available in both varieties such as self propelled and assistant propelled, folding and non-folding. It can be used as a commode or over the toilet. The swing away, padded arms make it ideal where side transfer is required.

Knee scooter A  knee scooter  is a related device which may be substituted for a wheelchair when an injury has occurred to only one leg, below the knee. The patient rests the injured leg on the scooter, grasps the handlebars, and pushes with the uninjured leg.

Bariatric wheelchair

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Pediatric wheelchair

Knee scooter

Shower and commode chair

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Transfer Wheelchair Transfer, stretcher, or mechanical chairs Stretcher (or transfer) chairs are mobile chairs that can be adjusted to lay flat like a stretcher to help in the lateral (or supine) transfer of a patient from a bed to the chair. Once transferred, the stretcher can be adjusted to allow the patient to assume a sitting position. Transfer chairs often use sliding sheets or inflatable sliding mats with air bearings to facilitate the movement of the patient from the bed to the chair. The patient in bed is rolled onto the transfer sheet or mat, and the sheet slides between the bed and the chair (configured as a flat stretcher), carrying the patient with it. 

Transfer chair

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Stretcher wheelchair

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WHEELCHAIR ACCESSORIES

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Seat cushion

Foam cushions

Chair and cushion are a team, each influencing the other. The proper combination of chair and cushion will enable one to sit in a neutral and stable posture and to operate the chair safely. Cushions come in various depths and sizes which need to be accommodated by the size of the wheelchair frame. The four basic types of cushions: foam, gel, air flotation, and urethane honeycomb, as well as designs and systems for more specialized needs. Functions of seat cushion The kind of cushion to choose depends on a variety of factors, including how much time is spent in the chair, how much one move around in the chair, and how stable the body posture is.

Foam comes in a range of densities and with varying degrees of “memory,” holding its shape as you sit, contributing to stability. The new foams can adapt to any shape, and still provide even support, spreading pressure across the sitting surface. Different foams are often used in combination, layered for their various properties of softness, even support, and memory. Foam is relatively inexpensive, and it is easy to cut. Foam wears out faster than other materials and loses its shape. It needs to be replaced when its time is up as old foam that is compressed can allow pressure points to form that can lead to a sore. It can be used as a backup for air flotation cushion as gel & air flotation cushions can leak.

To prevent pressure sores: When we sit, only 1/3rd of the body’s surface is supporting all of its weight, blood flow is restricted. In the presence of muscle atrophy which is experienced in spinal cord injuries - circulation is limited further by the loss of muscle which once served as a natural cushion. An additional risk of sitting is shear force, as we tend to slide forward in the cushion, causing stress across the surface of the skin. Resulting pressure sores (decubitus ulcers) can be very serious, leading to hospitalization, surgery, and though rare even death. The right cushion is a primary tool for maintaining the health of skin. Provide postural stability: The right cushion helps to support the spine. For asymmetry in the body, one needs to be supported in a way that will not increase any spinal deformity. For manual chair users, greater stability in chair can help push the wheels with more confidence and strength. The wrong seating system leads to poor posture, which leads to physical problems, which leads to becoming more sedentary, which leads to a negative emotional and personal experience.

Gel cushions

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Gel cushion designs attempt, in effect, to replace the consistency and support of atrophied muscle tissue. Highly engineered gel fluids are placed in pouches and usually attached to a foam base, so that the cushion conforms to the pressures placed on it. As a result, gel cushions provide excellent pressure distribution and are very comfortable. Many gel products also offer supplemental inserts to stabilize legs. When knees tend to fall together (adduction) or apart (abduction), such an accessory can help keep legs straight which also aids overall posture. Gel cushions are much heavier than other types and are also not able to absorb impact.

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Another drawback to gel cushions is the possibility of them “bottomingout” as the gel is pushed aside by body weight. It can be prevented by kneading the gel cushion once a day, keeping the fluids loose and spread evenly. The gel portion is divided into several sections so that all of the gel cannot push to the sides. There is also chance of the gel leaking. While cushions arrive with patching kits, patches are ineffective when the breach is at a seam, which is often the case. A leak might be very minor, or it could be extremely messy. Urethane honeycomb cushions Thermoplastic urethane honeycomb cushions are the most recent development. Because there are many individual cells-like a beehivethese cushions are able to distribute weight evenly, but there is no risk of leaking gel or of an air bladder being punctured. The many open spaces in the beehive structure of the cushion allow air to travel more effectively. This design helps to protect against skin breakdown because your skin is kept cooler and moisture is prevented from collecting. Urethane honeycomb cushions are very light, absorb shock, and a low profile cushion can provide significant support. These cushions are washable hence can be used for people with incontinence. Types of Urethane honeycomb cushions • Multiple layers of varying stiffness to allow your sit bones to sink into the cushion while deeper layers provide overall support and weight distribution. • Contoured to provide adduction and abduction, plus a rear dish for pelvic positioning.

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Air or dry flotation cushions It supports the body entirely on air. It is designed with a group of small, interconnected rubber balloons arranged in rows. Pressure is balanced by air shifting out to surrounding balloons, spreading pressure evenly against the skin. The whole system is closed so air flotation cushions can’t bottom out the way gel cushions can. If you have a pressure sore, you can tie off individual balloons to reduce contact under that area, allowing to spend more time sitting as the sore heals. It comes in many different sizes and shapes, is made of heavy duty rubber, and although different from the balloon design it is uniquely formed to minimize pressure at the bony protrusions on which we sit. Air cushions can be less stable for those who move around a lot in their chair, but recent designs offer either low profile or quadrant options that minimize this problem. The balloons used in air cushions can be punctured, of course, and leaks do occur, although a fairly heavy duty rubber is used. But patching them is easier than with the gel design. The hard part is submerging the cushion under water to find the leak (look for escaping air bubbles). The biggest drawback to air cushions is that they require more maintenance. It is necessary to check the pressure frequently, especially if you have pressure sores.

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Alternating pressure An air pump is used to create alternating pressure, for those with more severe disabilities who are unable to perform their own weight shifts to relieve pressure. Sitting for extensive periods of time without pressure relief causes the muscle and fatty tissues to separate, putting the delicate skin layer in closer contact with the bone, increasing pressure on the skin. Lack of air circulation increases the temperature between body & the cushion. Moisture collects & is trapped against the skin increasing risk of a sore. Alternating pressure solution seating system that pumps air into and out of alternating portions of the cushion. The product is contoured for pelvic stability, with a pre-ischial cross-bar design that prevents forward slipping-and therefore shear-on the cushion. Special vent holes serve to allow the flow of air and moisture. In a five-minute cycle, compartments are inflated and deflated to shift support alternately between the ischial (sit) bones and the hips. Both areas get regular periods of complete pressure relief. It promotes blood flow and may also heal a pressure sore while you sit. This cushion system can be plugged into some power chair batteries or charged in a cigarette lighter in the car. Alternating pressure products are of course heavier-given their use of batteries and air pumps-and, like air flotation cushions, prone to puncture. Positioning systems Advanced needs such as significant spinal curvatures or asymmetries in the body require more complex kinds of trunk support. Such as a support system which customizes seat and back cushions to ones exact shape. First, a special chair takes an imprint of the body’s shape. A therapist views a computer image of the shape and can customize the contours of the cushion. From the imprint and the therapist’s specifications, a foam cushion that gives an optimal support is manufactured. Since the cushion is formed to your shape, you will only be comfortable in it when you sit in the right relationship to the customized contours. http://www.disabled-world.com/assistivedevices/mobility/wheelchairs/accessories/ cushions-wheelchair.php#ixzz1CysQEDO6

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Spoke guard Spoke guard or spoke protector are lightweight discs that cover the back wheels of wheelchairs to reduce injuries, by preventing fingers from accidently going into the spokes of the wheelchairs. It also adds playfulness and personality to the wheelchair. The spoke guards are made of fabric or other lightweight sturdy material like acrylic, connected by band or snap-on.

Spoke guard

Wheelchair gloves Wheelchair users hands are exposed to constant friction and heat generated by overuse, are numbed and desensitised in cold and wet weather. Active and athletic wheelchair owners are particularly vulnerable to overuse injuries. At least 18% of all wheelchair users experience blisters, abrasions, and lacerations and develop thick, rough calluses. Properly designed wheelchair gloves can provide: • Protection against skin damage caused by friction. • Protection against injury caused by vibrations and repeated impact • Improved stopping and manoeuvrability • Comfort in cold or wet weather

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Harness / Securing straps Supports and harnesses are available which provide support and encourage a child to sit in a firm, stable position and some also provided with alarm for fall monitor and safety. Waistcoat, bib and butterfly harnesses are more supportive and comfortable than shoulder and chest straps for children with poor trunk control. Wheelchair bag This detachable wheelchair bag can be used by children and adults to carry books and other items. It is provided with straps to hang to the assistant handles. Bottle holder Provided for children who need to carry out activities from the wheelchair. Detachable bottle holder can hold bottles or cup to carry along and prevent spillage. They come in various colours and forms to match the wheelchair.

Harness/ strap

Wheelchair lap tray Provided for children who need to carry out activities from the wheelchair to increase independence. They are available in standard sizes or can be customized, including half and full size, flip to allow easy transfer and detachable. They come in variety of materials such as polycarbonate and with magnetic boards and protective edging to prevent spilling of objects. They can also be custom made from inexpensive materials like plywood and fixed by means of velcro to the frame.

Lap tray

Reflectors Wheelchair reflectors are attached to the spokes for outdoor use to increase visibility at night. Wheelchair bag

Spoke reflectors

Bottle holder

Wheelchair canopy It can be attached to wheelchairs or scooters to protect from the sun and rain. Ideal for outdoors for getting to and from work, daily errands, waiting at the bus stop. It can be of solid fabric or mesh material for ventilation. It can also comes with additional drapes slip over and are easily removable. Wheelchair canopy

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Comparative product audit Product audit was carried out on 4 wheelchair models that are available in the Indian market taking into consideration all the components, accessories and features. In order to get a better understanding of what are the functions and features available and to assess which ones to be adopted.

Institutional model

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VISSCO (P.C. No.0912C)

W Line (G-980LA-35)Pediatric Model

Invacare Tracer EX2

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USER TESTIMONIALS

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Name Nishadh Bhai Age 37 yrs Gender Male Occupation Runs his own telephone booth and currently undergoing computer training at Blind Peoples Association (BPA), Ahmedabad. Physical Abilities Improper medications given by medical practitioners for fever while he was two months old has rendered him immobile and use his left hand along with loss of 60% mobility of his right arm. Physical Aids used He has never used a wheelchair as a child. He uses a wheelchair provided by BPA which weighs around 9-10 kg and is difficult to manoeuvre given his level of disability. Also he requires assistance to get into a wheelchair and move around. He feels totally dependent on others while using a wheelchair. He suffers from back pain due to immobility and sedentary lifestyle. He can manage stretches to exercise his body in sitting position.

Feedback and Suggestions He suggests a jack system like in case of an automobile to be provided to the wheelchair to eliminate assistance required while mounting a wheelchair, also wheelchairs to be motorized and seat belts should be provided for child users.

Bike customized used by him for commuting to work and back. Side wheel cover modified to provide footrest, seat and backrest modified

He works for almost 15 hours in the telephone booth. He uses a Scooty streak to commute to his work place, modified and altered as per his needs by Vinay auto, Raipur. The scooty is modified as per his requirements he needs assistance to get on the bike due to his physical condition. He finds it most convenient to ride in his vehicle, feels more independent and comfortable so much so that he would like to replace the wheelchair he uses in his classroom at BPA.

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He wheelchair given to him in Blind peoples association is a standard wheelchair manufactured there itself. He faces several problems while using it in the training centre such as adjusting to existing furniture, constant assistance requires to go around as the wheelchair has a push rim on the right hand alone and he cannot use his right hand with complete strength. The wheelchair is not designed for multiple disabilities and is worn out due to over use. The anti-tip device has no wheels and creates an obstruction while moving around.

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i Difficult to adjust to the worktable while on a wheelchair ii Back rest is not adjustable hence does not offer any comfort

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Name Sonal Age 26 yrs Gender Female Occupation Student Coming from Rajkot she has never studied in a special school except now that she is taking computer training in Blind Peoples Association (BPA), Ahmedebad. Is an active member of disability advocacy group (DAG). She is very assertive about her needs, once she was unable to access a place in Rajkot in her wheelchair she promptly asked for a ramp to be built for her and others like her. Her story After losing her ability to walk to polio when she was 2 years old she was given callipers to use but she prefers to use a wheelchair instead. Till the age of 2-10 years she used one wheelchair and has changed 3 wheelchairs since then. Her old wheelchairs still find a space in the storage of her house as her father is reluctant to give them away in scrap as they are still his daughters legs which have served her once. Was initially very scared to use a wheelchair but soon found it very helpful to move around with minimal efforts. She found that some of her friends were ashamed to use a wheelchair she encouraged them to use one and has been a positive role model for her friends. She can confidently climb 3-4 steps on her wheelchair. Also uses public transport.

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Mobility aids used Wheelchair at home and BPA, callipers at times. At BPA hostel wheelchairs cannot be used as the building is not designed for wheelchair use. Alternative mobility device used in the hostel is a 4 wheeled wooden plank called ‘patla’ but she has never used one. About her wheelchair The wheelchair she uses currently is gifted by one of her friend from USA. The chair was tested for her height by her friend and send to India. It does not have the usual clinical look and has red and black colours which she likes. And it is compact and can enter narrow spaces. The fibre moulded spokes are difficult to find replacement for or repaired in India. The footrest are slightly slanting due to which her feet slide from the footrest and don’t support her feet. She is also conscious of the fact that as the wheelchair is large in size can hurt others if not handled carefully. Wheelchair used in BPA Her feet do not reach the foot rest. Metal cross bars for folding are on the front hence hurt the thighs. Hand brakes are heavy to use. Width is too much to access narrow spaces. Clothes often get stuck in the spokes as there is no barrier between the seating and the wheel. Feedback and Suggestions • Would prefer to have the wheelchair folding along both so that it is convenient to be carried outdoors. • Footrest should be flat and not slanting. • Width should be adjustable as some spaces like toilets are difficult to access.

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Hand brakes too tight to operate and often do not work

Missing handrest Metal cross bars touch the leg causing discomfort

Feet would not touch the foot rest resulting in discomfort

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Name Kathan Amrish Patel Age 18 yrs Gender Male Occupation Student He is learning telephone operators course at Blind Peoples Association (BPA), Ahmedebad. His mother drops him off at BPA from home which is at Shahibaug in the family owned car. His story He finished secondary education in St. Xavier’s school, Anand with a first class. He likes playing computer games, reading books and Gujarati poems. He has been using wheelchairs since he 8-9 years old. Before that his father used to carry him from one place to another. At school he could not use wheelchair as the school building was not wheelchair friendly. At home he uses revolving chair. Uses a folding wheelchair for going outdoors which is gifted by his aunt from USA. It is a manual wheelchair by Invacare, USA. His parents avoid going to places which are not accessible by wheelchair. He does not use public transport. Earlier he found it very tiring to ride a wheelchair. He has removed the footrest a result of which his feet touch the ground. At home he crawls to access the toilet as the house is not designed for wheelchair users. In future he hopes to make his new house wheelchair friendly. Mobility aids used This is his second wheelchair (Invacare Tracer Ex2) and at home he uses revolving chair as it is easy to manoeuvre in a small house. Feedback and Suggestions Soft cushioning should be provided for the seating to avoid discomfort due to sitting for long duration and sweating. Wheelchair parts should be easily available.

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His wheelchair i Invacare Tracer Ex2 Folding, vinyl seating and backrest, light weight fibre hand rim. As the footrest is not comfortable for him he has removed the footrest ii Easy to operate hand breaks iii Tipping lever for assistant to tip wheelchair backwards

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i Maximum width of the wheelchair when folded. ii The seat, is made from vinyl and uses a sling design. Vinyl fabric makes it very easy to clean. iii The metal skirt is installed on either side between the armrests to protect the users clothes from dirt, moisture, and debris that can be kicked up by the wheels. And also prevent the users clothes from getting caught in the wheelchair. iv Crossbars are located under the seat and allow the wheelchair to be easily folded for storage and transportation. There is no locks to keep the wheelchair from folding, but instead the weight of the user prevents the wheelchair from being folded.

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i, ii For convenient transfer from classroom bench to the wheelchair he sits on the last row with his wheelchair next to him for easy access and transfer. iii Footrest is removed as a result of which his feet drag on the floor iv Open ends of various parts are concealed with adhesive tapes to prevent injury

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Name Age Gender

Seema Maprolkar 23 yrs Female

Seema is mentally challenged, has trouble walking and she has trouble communicating. She is learning ceramics in the ceramics department of NSEOH. She makes clay beads and strings them to make a necklace. Here she also exercises the small muscles of the hand and fingers, practicing eye-hand coordination and fine motor development and dexterity of movements. She is not only exercising her fine motor movements, she is also being creative, imaginative and practicing social skills. This improves her selfconfidence and self esteem.

Now that her mother has taken up multiple jobs she is often late to pick her up and she is left stranded on her own at the gates of NSEOH. I waited till her mother arrived to pick her up as I took her down to the entrance of the gate where she often waits for her mother. Being a girl who is unable to communicate properly it bothers one about her safety.

Her mother works as a domestic help during the day. She drops Seema in the morning at the centre and goes about her work and returns in the evening to take her back home. She cannot propel the wheelchair on her own as she does not have much upper body strength. And as she is mentally challenged she needs constant assistance. She has to take help from colleagues in NSEOH while in the institute. She is assisted by her colleagues for going to toilet. At times she is left stranded if nobody is available for assistance. She is uses a standard wheelchair at home as well at NSEOH where she is undergoing training in the ceramic department. It is because of the wheelchair that she is able to get out of the confined environments of her house and learn something and make a livelihood.

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Name Mangala Sonawane Age 25 yrs Gender Female Her story She is undergoing training at NASEOH, Mumbai learning to stitch and making candles. She stays at Chembur which is few minutes away from NASEOH.

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Mobility aids used Uses tricycle to commute from home to NASEOH and uses wheelchair while in the institute from 9:00 am to 5:30 pm. Although she owns a wheelchair at home she does not use it due to space constraint and not venturing outdoors much except for the training. Suggestions Wheelchairs should he light weight so that children should be able to propel on their own without assistance. The hand rim should have good grip. Wheelchair should be able to manoeuvre small level differences such as the difference between the floor level and the elevator floor

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i Wheelchair made in metal frame and painted over, with a rexine upholstery. The paint applied makes the wheelchair operations very difficult as it prevents free movement of the parts at the joinery. ii The breaks are very difficult to apply again due to the excessive application of paint along the joints and is not ergonomic and safe to operate. iii Seat belts provided iv The assistant handle bar provided with grip.

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Name Age Gender

Abdul Badshah 35 yrs Male

His story He came to Mumbai from Andhra Pradesh, he does welding work for manufacturing tricycles and wheelchairs at NSEOH. He stays in beggars home which is close to the NSEOH workshop. He is picked up by the bus from the home to the workshop. Mobility aids used Uses wheelchair while in the institute. He mostly uses the wheelchair to move around in the institute and while working. He also uses crutches as mobility aid. He has used tricycle in the past for 9-10 years. He is not very confident of using the wheelchair on slopes and ramps as he started using it 2 months ago and feels that he does not have sufficient training to use one. He finds the wheelchair too high while performing operations such as cutting and welding. He needs assistance to use wheelchair as he is not familiar with it and thinks that he requires at least 1-2 months to get used to the wheelchair.

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Name Age Gender

Yogesh Panchal 27 yrs Male

His story He had an accident while riding a bike three years back. He was unable to walk without mobility aids and started using a wheelchair since past 11/2 - 2 years. He works in National Society for equal opportunities for handicapped (NASEOH), Chembur. He comes from Bhandup which is not very far from NASEOH he uses autorickshaw to commute from home to office. He needs assistance to fold his wheelchair and put it inside the rickshaw. Mobility aids used He uses a 26” wheelchair purchased from Bombay surgicals for Rs.4000. He uses his wheelchair at both home and office. He prefers his wheelchair to the regular office chair as it is very tedious to transfer from the wheelchair to the office chair every time that he has to move around in the office. Apart from wheelchair he uses callipers as a mobility aid. About his wheelchair He uses a 26” wheelchair purchased from Bombay surgicals for Rs.4000. He uses the wheelchair for 8-10 hours in a day. He does exercises like attempting to stand up while on the wheelchair for relief from constantly sitting in one position for a long duration. He has reduced the width of his wheelchair to 23” by tying ropes to the seating. The backrest provided on the wheelchair is not comfortable as result of which he has a back pain. A pillow is used as a backrest occasionally. He uses pillow for seating to add comfort and raise the seat height. He finds lower benches difficult to access. He puts all his weight on the hand rest while getting up and sitting down as a result of which the hand rest has cracked and had to be removed.

Feedback and Suggestions • Width should be limited to 23”-24” to enable accessibility in narrow spaces. • Light weight to handle with ease. • Seating should be adjustable for different heights. • Wheels should be detachable to increase portability. • Wheelchair should be able to climb 1-2 steps. • Footrest adjustability should be provided. • Fabric and material if used of good quality can make a huge difference for the user. • Metal parts should be rust proof. • Conventional spokes should be replaced with fibre spokes. • Seat belts should be provided for safety. • Tubeless tyres should be used as they don’t require much maintenance and width is also reduced as a result. Preferences Prefers black colour as light colours are difficult to maintain. Although he uses the wheelchair indoors only but is confident of handling it outdoors as well where the surface is flat and firm.

Tying the wheelchair with ropes to reduce the width to accomodate in narrow spaces

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Name Age Gender

Jayamani 28 yrs Female

Her story She had a spinal cord injury after a fall. She works and stays in the Little Hearts school Chennai, which is an integrated school for mentally, physically challenged and regular children. She does the office work with the help of a motorized wheelchair. About her wheelchair She has been using a wheelchair since past 4 years and has changed 2 wheelchairs since. The wheelchair she is using currently is a motorized wheelchair donated by Callidai Motors, and she has been using it since one year. The wheelchair has been modified so that she can carry out her office work in the wheelchair itself. A flip over detachable side board provided creates discomfort as the cutout provided is too small and not designed as per her requirements. Also it obstructs the access to the wheels rim. Although the wheelchair is provided with angle adjustable footrest she is unable to access it and hence never used. She needs assistance to get into the wheelchair and to get out of it. But she is able to move around the wheelchair on her own and do her daily duties.

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Name Age Gender

Rajiv Rajan 36 yrs Male

His story Born as a single child Rajiv did not attend school till the age of 14, as access to special education was difficult since his father was working in the Ordinance Factory in a rural area. As a child with cerebral palsy, he was initiated into formal education at Vidya Sagar (formerly: Spastics society of Chennai). This opened up a new world to him. He completed his schooling within a span of less than nine years. He is a commerce graduate from Loyola College and did his post graduation in Human Rights, from the Indian Institute of Human Rights, New Delhi. His determination to fight for the rights of the disabled arose from his personal experiences. His achievements did not stop with overcoming his own disabilities but inspired him to fight for the rights of people with disability, especially in rural areas. He strongly feels that disability is a human rights issue. As a coordinator of the self advocacy group at Vidya Sagar, he fights for the rights of the disabled. Hallmarks of his achievements includes making Chennai central railway station accessible for people with disability, coordinating and creating awareness among the higher authorities of MRTS and Metropolitan transport corporation (MTC) on the lack of accessibility to the disabled. His knowledge, fluency in various languages and inborn ability of communicating with people have made it easy for him to interact with parents of disabled children to make them understand the problems of

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their child in a better way. As a leader of the advocacy group, his approach has been proactive and participative towards problems and issues, thus making his team members feel comfortable to work with him. He is also General Secretary of Ektha, a forum of people with neurological impairment which works towards bringing them into main stream of life. His has avid interest in nature, travel, quiz programs and chess. Mobility aids used He uses 3 wheelchairs, as he needs one as a back up in case the other is not working or sent for repairs. The wheelchairs are donated by Vidya Sagar. Out of 3 wheelchair one is motorized and others are folding as he is a frequent traveller and needs a wheelchair that can fit into any mode of transport. He feels that using a wheelchair has helped him to maintain a correct posture. He did not use a wheelchair till the age of 18, since then he has used about 7-8 wheelchairs. Being a left hand user he cant use both his hands to propel hence he has to use his legs to propel the wheelchair. Excessive use of legs for propelling gives leg pain and also as he uses the wheelchair for 10-14 hours in a day he experiences back pain as well. He has removed the hand rim for the wheelchair as he does not use his hands to propel the wheelchair. He finds that he has adapted to his wheelchair over the period of time. He travels by air quite frequently. He has experienced that the wheelchair is given at the very end in the baggage claim. And have to show luggage coupon to prove that the wheelchair belongs to him. And are left stranded at times if they don’t have the luggage coupon to verify.

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Manual wheelchair used by Rajiv that has been modified as per his requirement Motorized wheelchair

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Name Age Gender

Deepak P.S. 25 yrs Male

He is currently in 2nd year MA at Loyola college. He stays in hostel at Vidya Sagar He commutes mostly by auto rickshaw to his college. Uses public transport such as trains and often travels by air. Mobility aids used: He owns both manual and motorized wheelchairs. Since 12 years he has been using a manual wheelchair and started using a motorized one from past 4 ½ to 5 months. He uses wheelchair for approximately 3-5 hours daily.

Likes and dislikes He watches mostly sports on television. He follows cricket, tennis and racing. Being a sports fan he is all for sports merchandise and promotional stickers like the one used by sportsmen. He would like to have something on his wheelchair that would catch peoples attention and make them look at his wheelchair in awe.

The motorized wheelchair is used in and around the hostel where as the manual one is used in college as well as for using the toilet. The manual wheelchair has problems with the air tubes and the foot rest. The foot rest angle is not adjustable, as he needs his feet to be slanting inwards in order to maintain neutral position. Seat needs adequate cushioning to prevent seat sores. Back rest should provide comfort as well as help to maintain better posture. The motorized wheelchair although it is folding it is quite heavy and the wiring is difficult to handle for a layman. He finds that the motorized wheelchair has given him freedom to explore places he wants to and finds it convenient to use. The motorized wheelchair is very delicate and is not meant for Indian roads.

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Name Age Gender

Unmul 25 yrs Female

She is currently pursuing law in Loyola college and a resident in the hostel at Vidya Sagar, Chennai. She commutes mostly by auto rickshaw to college. Uses public transport such as trains, buses and often travels by air. She travels frequently to Bangalore on her own. She needs the help of porter for assistance. Had a bad experience once during her journey as drunk porter tried to propel her wheelchair without her consent and was helped by passersby when raised an alarm. Mobility aids used Started using the motorized wheelchair a year back and finds that it gives her freedom to go places and she even compares the experience to walking as the interaction to people is very different and spontaneous. The motorized wheelchair is very delicate to use and its difficult to find replacement for the various parts. She has removed the footrest as her feet would not touch the footrest and also the study board as it obstructs free movement. The seat upholstery is of vinyl and is already tearing off at the joinery screws. She finds motorized wheelchair useful when she falls sick and is not able to propel on her own. As a frequent traveller by air she finds that people are not sensitive enough and often handle the wheelchair very roughly.

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Name Age Gender

Vishnu Kaushik 9 yrs Male

He suffers from progressive muscular dystrophy with very low muscle tone. He uses a assistant propelled manual wheelchair, which has contoured seating to support and maintain his posture also neck support to hold his head in position. He is totally dependant on assistance. He uses ankle foot orthosis to keep his feet in normal position. He has been using this wheelchair for a long time now and has outgrown the wheelchair and needs to get a bigger wheelchair. Also as he has started attending classes actively it needs to be assessed by experts whether the wheelchair is suitable for him to use for long hours. His feet would not reach the footrest although the wheelchair has provision for adjustable footrest. As his mother was not aware about the adjustments and is not able to do it without the guidance of the technician or a physiotherapist. Since he is able to convey his requirements it is possible to make those changes as per his needs.

Since his condition is of progressive nature it was decided instead of investing in new wheelchair some adjustments will be done to the current seating to accommodate his growing needs.

Assistant hand breaks Adjustable headrest Colourful upholstery Seat belts Internal seat contours built with foam to give postural support

Seat moulded from density polyethylene seat Height adjustable foot plate

His wheelchair He uses a wheelchair specially meant for postural support, it is a German make paediatric wheelchair meant for children with spasticity. Motorized wheelchair with feather touch controls and multiple adjustments for lifting legs and back would be helpful to him.

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i Adjusting metal plate provided to adjust the seat angle according to comfort of the user. ii Internal seat contours built with foam to give postural support and stability to control the spastic movement, unlike other wheelchair the upholstery is colourful. Instead of giving individual footrest there is a continuous foot plate provided whose height can be adjusted for children who can stand on the footrest when required. iii Adjusting mechanism underneath the seat for height and angle adjustments iv Headrest to keep the head in neutral position, the height of the headrest can be adjusted as per requirement. v As it is a assistant propelled manual wheelchair it is provided with assistant hand breaks on the right hand side

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Name Age Gender

Chandrika 5 yrs Female

She suffers diplegia a from of cerebral palsy (CP) which primarily affects the legs. Most children with CP also have some problem with their arms but with Diplegia they are less involved and less severe. Most children with diplegia have spasticity, and have difficulty with balance and coordination. Delayed muscle growth and spasticity cause their leg muscles to be short, and as a result the range of motion can decrease as a child grows and the joints become stiff. She uses 18� wheelchair (by Alimco, manual, standard model). She needs assistance to propel, sit and get off the wheelchair. She has difficulty in walking due to muscle tightness and is undergoing physiotherapy in Spastics society. Although she can walk short distances with knees in bended position, which is contraindicated for long run.

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Name Age Gender

Mrityunjay 14 yrs Male

He suffers from cerebral palsy. Earlier he used a manual wheelchair with spokes and he still prefers the old wheelchair as it was sturdy and good for rough use. He is currently using a wheelchair donated by IBM since few months. The new wheelchair is a standard manual wheelchair manufactured by VISSCO. He complains that the new wheelchair is not sturdy enough and spokes once broken cannot be fixed and need to be replaced and replacement is difficult to find.

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Name Age Gender

Prajwal 16 yrs Male

i His name painted on the backrest for identification of the wheelchair amongst the others when parked.

Prajwal studies in Spastics society, Bangalore in 10th standard. He suffers from Muscular dystrophy. He uses a manual self propelled wheelchair of Italian make which is of standard size. He needs supporting seat belts to keep his posture. The wheelchair he is using currently does not have seat belts. He requested for seat belts with velcro bands for adjustment as it is easy for him to use. For temporary use he was provided with ropes to hold him in position which he promptly refused as he did not want to ruin the look of his wheelchair. As the supporting belts are made by private vendors and not the institute itself it would take some time to attend to the request. Or else all the other request to fix the wheelchair are attended to in the institute itself inhouse.

ii Stickers of various religious places stuck to the clothes guard to personalize as well as a blessing on the wheelchair.

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iii Folding sling made in rexine with handles to held fold the wheelchair.

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Users quotes

Why persons with physical challenges are left out most of the time from the FUN part of life? “I was hesitating to use wheelchair because of the clinical look and negative image it gives to the observer.” “As a girl I have inhibitions, shame and fear to use a wheelchair.” “My wheelchair should be such that people will look at it in awe…” “Accessories to go with the look of the wheelchair…” “Just as people have legs wheelchairs are our legs and should not be treated any differently…” “Most of the adaptations made initially for specific pupils have been assimilated by teachers that are found in the class rooms.” “To believe that a disabled pupil cannot participate in a regular class room is common sense, opinions have to be changed.” A teacher. “Integration is “being together” while inclusion is “being a part of”. “It is difficult for the teacher to make adaptations; there isn’t enough class room time to do everything.” A teacher.

“I want my wheelchairs to stand out among the rest of the wheelchairs. I like to show my personality through them, as do most other wheelchair users.” We want opportunity, not pity!

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OBSERVATIONS AND INFERENCES

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Chassis i Folding along both axis or removable wheels can provide more flexibility in terms of portability and packaging ease.

Folding along both axis

ii Light weight design, push rim should be lighter and provide better grip. iii Fibre parts are difficult to replace due to non- availability. iv Sturdy yet adjustable hand rest to provide of ease transfer. v Flexibility of use as per change in size, instead of one size fits all approach. i Quick release mag

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Paediatric chair preferred by young adult as it is light and fits his body type Person of smaller stature given an adult wheelchair to use

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Footrest Height and angle adjustability, anti-slip footrest to ensure comfort, calf support not provided. Seat i Seating is high to access hence assistance is required for some with limited mobility of upper limbs.

ii Seat width to be adjustable to access narrow spaces. Backrest Back rest does not provide adequate support and cannot be adjusted as required and most often leads to back pain. Brakes Adjustable brake’s position , allowing to fine-tune the action with easier lock, more grip on tires. Brakes are not accessible to the assistant.

Ergonomically designed grip for brakes

Slouched back due to inadequate back support Lack of space for personal items

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In absence of foot strap, calf guard ropes are used to keep legs in position

Small castor wheels makes it difficult to manoeuvre levels Covers are kept intact for long as it makes it easy to clean Secured with chain lock

No place to rest or support the crutches

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Swivel chairs often used instead of wheelchairs

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Foot rest removed as feet cannot be accommodated

Parts of chair used to make the back rest and the seat.

Hand rest, spokes missing due to over use

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Provision For Storage • Very often the assistant handle bar is used to hold the school bags which can lead to wear and tear of the hand grip, and also a bag, backpack or any weight hanging behind the wheelchair will move the centre of gravity backwards and make the wheelchair more likely to tip backwards. • Also at times the school bag is kept on the lap of the person using the wheelchair. • The spoke guards serves as a canvas to personalize the wheelchair by putting stickers and artwork.

• Assistant handle as an anchor for holding the backpack • Personalizing the wheelchair with stickers and art work

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Accessories • The wheelchair does not adjust to existing furniture such as school bench or office desk and work table is provided only with motorized wheelchairs. • Improvisations are done as per the requirement to provide working surface according to individual need and the environment in which it is going to be used. • Provision for seat belts, concealing various sharp components, durable material.

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Customized lap tray for children who need to carry out activities from the wheelchair to increase independence.

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Adjustability • Seat height should be adjustable so as to fit under the table or work desk in schools and at home. The armrest should not cause hindrance to fit the chair under the table. • Additional horizontal assistant handle bar is provided for assistant driven wheelchairs for pushing efficiency on a ramp and lifting the wheelchair. Push rim Smaller wheelchairs meant for toddlers provided without push rim are provided with hand gloves for protection but would not be suitable for outdoor use where the usage is rough.

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Upholstery Adequate cushioning, soft and firm to prevent pressure sores. Upholstery with more modern, stylish look, while retaining essential qualities like long-term stretch resistance and hygienic, wipe-clean maintenance. Colours Colours chosen so far give a very clinical look to the wheelchair, darker colours chosen primarily to give it a clean look. In order to make the wheelchair stand out from the crowd stickers, monograms and painted graphics are often used. Others • Should be able to cover small level differences. • Manual wheelchairs can be used for small durations as it can lead to fatigue especially in sickness • Motorized wheelchairs when introduced at right age can bring about a great change in lifestyle and also the interaction with people is very spontaneous and different. • Tubeless tires to reduce maintenance and effective width. • Hand gloves can be provided to increase better efficiency, pushing efficiency and safety.

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Task analysis Ingress • The wheelchair is pushed towards self in position. • Once the wheelchair is in position to sit the hand brakes are applied to prevent the wheelchair from moving. • Holding the wheelchair seat tube as pivot point with one hand and the bed with the other the buttocks are raised and transferred to the wheelchair. • The wheelchair breaks are released and push rims are pushed to move. Egress • Pushing the wheelchair towards the bed or chair in position. • Putting the hand brakes on to prevent the wheelchair from moving. • Holding on to the seat tube with one hand & resting the other hand on the bed or chair. • Using the hand holding on the bed or chair as the pivot point the buttocks are lowered and rested on the bed or chair. • The hand brakes are released and the wheelchair is kept away from the bed.

Transfer 1: Hips with arms extended

Transfer 2: Head-hips with arm close

Transfer 3: Trunk upright with arm extended

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Transfer from bed to wheelchair and back

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Task analysis: Transfer from wheelchair to toilet seat

Diagonal transfer

Diagonal Approach (For narrow bathrooms, 3 to 4 feet in width size) 1. Position manual wheelchair diagonally about 6 inches away from toilet. Swing the footrest out of your way. Lock the brake. 2. Remove armrest. Place one hand on wheelchair seat and other on toilet seat. Redistribute weight on hands as you move across. Grab bar handle if necessary and sit on the edge of the toilet. 3. Move wheelchair out of the way and change position (some people fold chair or pivot it 90 degrees to the toilet) 4. Position yourself on toilet and release the brake. For public bathrooms, paper is applied on the seat first, since the toilet seat is used as a brace to make the wheelchair toilet transfer.

Side transfer

Side Approach (For handicapped bathrooms about 5 feet in width size) 1. Position wheelchair to the side of the toilet. Remove the armrest and apply the brakes. 2. Use the same weight transfer technique on the hands to sit on toilet seat. 3. Grab bar handle to adjust your seated position on toilet. To make your toilet transfer a lot easier, toilet transfer benches or handicap transfer boards are used that hooks onto your wheelchair and creates a bridge connecting the toilet seat to your wheelchair. There are other transfer boards that simply provide for a sliding board between two points. Another alternative to help wheelchair toilet transfer is to obtain some grab bars.

Toilet transfer board www.handicappedequipment.org

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Wheelie In vehicle acrobatics, a wheelie is a vehicle manoeuvre in which the front wheel or wheels come off the ground due to extreme torque being applied to the rear wheel or wheels. Wheelies are usually associated with bicycles, wheelchairs and motorcycles. Wheelies are a very necessary skill to learn in order to jump up and down curbs, and to rest against a wall or turn in a very tight space and doing a pressure relief. It is initially practiced with the anti-tip tubes down once the user can touch these to the ground one can start practicing with a spotter (fig. right) until one gains enough confidence. A few principles that one needs to understand before beginning: • The front of the chair is raised by pushing backwards on the back of the chair. It is the back of the chair that does the lifting, not some tremendous burst of speed. • As you lift the front end of your chair, it begins to feel weightless. This is because it is close to its balancing point. It is simply a matter of changing your centre of gravity by pushing your chair forward while your body is going backwards.

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http://www.dinf.ne.jp/doc/

Practicing wheelie with a spotter or assistant

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CHILD DEVELOPMENT

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Child development Each child is different, yet they show consistent similarities as they grow and develop. We can predict when, how and why children do the things they do based on the cognitive, physical, social, emotional and language dimensions of each developmental stage. Although the physical development of a physically handicapped child needs to be studied separately from that of a child without physical handicap, the normal developmental stages will not vary much and provide an insight into their physical and cognitive development. Stages of Growth & Development: a. Embryonic stage 1st 12 weeks of pregnancy during which the fertilized ovum differentiates into an organism b. Fetal stage 12-40 weeks of pregnancy characterized by rapid growth & development c. Perinatal stage Start of labor to end of 1st 24 hours after birth d. Postnatal stage 1. Neonatal period: 1st month of life 2. Infancy: 1-12 months 3. Preschool child (toddler) 1-4 years 4. School child 5-12 yr 5. Adolescence 12-20 yr Period of passage from childhood to adulthood

Growth and developmental changes Childhood is a dynamic process of moving through a number of stages of growth with its own characteristics and risk factors that affect physical development and well being. Which is more or less common to all children whether physically challenged or not. Children’s developmental pattern such as onset of puberty have design implications. For example, children getting taller will require a higher seats. Those who are wider (heavier) require deeper and wider seat pans. The rate of growth varies during childhood. Growth is rapid during the first few years of life and then slows until the adolescent growth spurt when it increases again. The timing of the growth spurt varies between individuals and is different in boys and girls. In general this growth spurt occurs between the age of 9 and 14 years for girls and between 11 and 16 years for boys, although there is evidence that the adolescent growth spurt is starting earlier in todays youth. Muscle strength and endurance increases as children age from early childhood to approximately 14 years. Between the ages of 7 and 12 years, muscle strength nearly doubles. In general, a muscle’s strength reflects its cross-sectional area or size. Some strength gains during childhood are a result of typical muscle growth in size. Designing for children of different ages Children are typically described by their age groups. While designing for children their is often differentiation between preschool and school-age children. However childhood is a time of continual and rapid change in physical and psychological abilities. While buying products for children for example, clothing is often labelled by the year-of-age of the child it is expected to fit; yet, it rarely fits children of that age. The large variation in size among children of the same age as well as their rapid growth, make designing for children challenging. www.google.com

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Infancy to toddler hood (Birth to 2 years) Cognitive development Young children think and reason very differently from older children and adults. Children of this age group explore the world through their senses and motor skills. They smell, look at, touch, taste and listen as they explore new objects. These interactions though purely accidental become purposeful and goal oriented as they learn about their world. Between the ages of 18 and 24 months, children develop symbolic thinking, which allows them to engage in pretend play, one thing or object can represent another and children begin to act out different roles such as mother, father, baby, teacher, doctor etc. They also begin to develop a sense of object permanence at this age. For example, 6-month old children do not become upset when caregivers remove toys as at this age, children do not remember objects they cannot see. By the time they reach 18 to 24 months, these children will remember and search for hidden toys and object permanence is fully achieved.

Social and emotional development Humans are instinctively social beings. They need to feel emotionally secure in order to develop healthy relationships. The need for emotional and physical security remains, even as children begin to explore their world. As children in this age group continue to struggle between their contradictory needs to be independent and feel secure, they alternatively explore and return to their trusted parents or caregivers for physical comfort. Toddlers learn that they have the power to control some of their world by resisting it. As they attempt to express their will and learn their limitations, they may say “no,” scream, or have temper tantrums. Children resort to such “negative” behaviours because their language skills are too primitive to easily communicate their needs, desires and fears.

Physical development Over their first 2 years, children’s gross motor skills develop as they learn to roll over, sit up, crawl, stand, walk, run and climb. Fine motor skills also progress rapidly. Children move from being unable to intentionally pick up objects, to picking up objects with a swipe of the hand and finally to using their fingers and thumb in a pincer grasp to manipulate small objects.

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Early childhood (2 to 7 years) Cognitive development At this age, children learn representational skills and become more proficient in many areas, including language. Children in this age group have difficulty imagining other’s viewpoints. They are not selfish, but simply incapable of seeing the world through someone else’s eyes. They cannot understand the consequences of their own actions. Physical development Children between the ages of 2 and 7 like to practice their developing motor skills. Their equilibrium, gross and fine motor skills improve, and they become proficient at activities such as hopping on one foot, pumping a swing and skipping. Refinement of fine motor skills occurs simultaneously as children demonstrate independent self-care skills as they button, snap and zip the zippers on their clothes, as well as begin to hold a pencil, write and draw.

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Social and emotional development Two year old want to be independent, yet feel safe and secure. They are very possessive and have difficulty sharing with friends. However, children become progressively more independent by the time they reach 3, 4 and 5 years of age. They are better at communicating, sharing and taking turns. They enjoy dramatic play, move from parallel play to interactive play and tend to develop close relationships with one or two “best friends” For the first time, children begin to exhibit more interest in other children than in adults. As children enter formal schooling, social acceptance from someone other than their parents or family takes priority. Language development Three and four year old children often know between 900-1600 words. By the time they are 6, they may be able to speak 2600 words. They answer simple questions, have conversations and tell stories toward the end of early childhood. Children between the age of 2 and 7 have fun learning language by playing word games using rhymes, songs and chants.

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Middle childhood (7 to 14 years) Cognitive development Around 5th to 7th year, children enter concrete operations stage of development. At this stage, children begin to understand others viewpoints. They also understand concrete, hands-on problems, and start to apply basic logic. However they are still unable to think or perform in an abstract manner. They still have problems considering all of the logical, possible outcomes of their actions. For many children, the ability to use foresight and understand the consequences of their actions before engaging in them does not consistently appear until they reach 11 to 14 years of age (continuing into their early twenties). Physical development In middle childhood, children’s fine or small and gross or large motor skills are well on their way of full development. They can usually tie their shoelaces, print their name, and balance on their bike. During this stage of development, children enjoy organized sports. The ability to judge distances, eye-hand coordination, strength and endurance all improve in adolescence, allowing children to begin to master the skills needed to play more adult-oriented sports.

Social and emotional development In these middle years, children value acceptance by friends (normally of the same sex) more than their own independence or obeying parental wishes and guidelines. They become more daring or adventurous. Rules and rituals are important during middle childhood, as they give children a sense of comfort and stability. Unlike younger children who engage in pretend play, children between the ages of 7 and 14 prefer real tasks and real activities, depending on the temperament or personality of the child. They spend much of their day interacting and socializing with peers; these may include indoor games such as video games as well as outdoor play such as sports and bike riding. Friendships offer security and intimacy. Through friendships, children develop a sense of trust and attachment to others or their own age and usually, of their own gender. Language development Communication skills move beyond direct verbal and nonverbal interaction, as middle school children continue to prove their reading and writing skills. Their play includes secret codes, word meanings, and made-up languages. Through these activities, they learn more about language and bond with their friends.

www.google.com

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CHILD ANTHROPOMETRY

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Child anthropometry Anthropometry is the scientific measurement of sizes and shapes of the human body. Children’s anthropometric dimensions vary considerably within age groups and designing for children requires adjusting the product dimensions to fit these ranges. Anthropometry plays an important role in human factors considerations for safe product design. Designing for children of different ages: Children are typically described by their age groups. For instance, when designing for children, we often differentiate between preschool and school-age children. However childhood is a time of continual change in physical and psychological abilities. The rate of growth varies during childhood. Growth is rapid during the first few years of the life and then slows until the adolescent growth spurt when it increases again. The timing of growth spurt varies between individuals and is different in boys and girls. In general growth spurt occurs between the age of 9 and 14 years for girls and between 11 and 16 years for boys, although there is evidence that the adolescent growth spurt is starting earlier in today’s youth. As a result there is standard deviation (SD) of anthropometric data for adolescents. Anthropometric differences between the sexes appear slowly after birth and increases with age. After approximately aged 13, the anthropometric differences between the sexes become more pronounced; for example, dimensions such as shoulder breadth in boys and hip breadth in girls increase and begin to resemble adult proportions.

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Anthropometric dimensions for children age 07-13 Sitting height (crown to rump) in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 63.8 58.9 64.3 67.6 65.7 60.7 65.8 70.4 68.5 63.5 68.2 73.3 70.6 65.7 70.3 76.1 73.3 68.2 73.2 78.3 75.4 69.5 75.3 81.9 80.8 75.3 80.4 86.2

Sitting mid shoulder height in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 40.4 36.5 40.2 44.2 41.8 37.5 42.0 45.3 44.0 40.2 43.9 48.2 45.6 41.4 45.6 49.9 47.7 43.7 47.5 52.0 49.5 44.6 49.6 53.4 53.6 49.1 53.6 57.1

Sitting height (crown to rump) in cm’s males

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Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 37.7 34.6 37.8 41.3 39.6 35.8 39.6 43.6 42.5 38.5 42.2 46.7 44.1 40.2 43.8 49.0 47.1 41.8 46.8 52.1 48.7 43.8 48.9 53.9 52.0 46.8 52.7 55.9

Mean 5% 50% 95% 65.2 60.8 65.0 69.8 67.1 61.8 66.9 71.9 69.1 64.4 68.9 73.7 70.7 64.4 70.8 75.9 73.5 69.4 73.3 77.9 75.4 70.1 75.1 81.7 76.8 71.5 76.9 82.4

Sitting mid shoulder height in cm’s males Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 41.6 38.2 41.3 45.9 42.8 39.0 42.8 47.3 44.3 40.8 43.9 48.4 45.7 41.4 45.3 49.7 47.8 43.9 47.8 51.4 49.4 45.1 49.2 54.6 50.2 45.6 50.7 53.5

Buttock to knee (rump to knee) in cm’s males

Buttock to knee (rump to knee) in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 37.8 33.4 37.6 41.3 39.6 35.3 39.5 44.2 41.5 37.8 41.4 46.2 43.5 39.3 43.4 47.7 46.4 42.5 46.3 50.8 48.5 44.3 48.5 53.0 50.0 44.9 49.2 56.0

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Knee height (knee to sole) in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 36.0 32.4 36.3 38.8 37.8 34.5 37.8 41.2 40.8 36.5 40.8 45.4 41.9 38.7 41.7 45.9 44.4 39.5 44.0 49.5 45.7 41.1 45.6 50.5 49.0 45.4 49.1 52.3

Knee height (knee to sole) in cm’s males

Mean 5% 50% 95% 24.6 22.2 24.6 26.6 25.6 23.4 25.5 27.9 27.3 25.2 27.1 29.7 28.1 26.0 28.0 30.4 29.8 27.8 29.5 32.7 30.8 27.8 30.6 33.3 33.2 29.6 33.4 35.2

Lower arm length in cm’s females

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Mean 5% 50% 95% 31.2 28.8 31.2 33.6 32.4 29.3 32.3 35.1 34.4 31.2 34.3 38.3 35.4 32.6 35.2 38.2 37.5 33.9 37.3 42.1 39.0 35.2 39.0 42.9 41.5 37.6 41.5 45.0

Mean 5% 50% 95% 36.5 33.3 36.4 39.7 38.3 34.2 38.2 41.8 40.2 36.7 40.4 43.5 42.2 37.8 42.0 45.8 44.6 40.9 44.6 47.9 46.8 42.2 46.5 51.2 47.5 42.1 47.4 55.5

Shoulder to elbow length in cm’s males

Shoulder to elbow length in cm’s females Age (Yrs) 07 08 09 10 11 12 13

Age (Yrs) 07 08 09 10 11 12 13

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 24.9 22.9 24.7 27.2 26.1 23.2 26.1 28.5 27.2 24.7 27.2 29.6 28.3 25.6 28.3 31.2 29.9 27.7 29.8 31.9 31.2 28.4 30.9 34.1 31.8 28.4 31.4 35.5

Lower arm length in cm’s males

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 32.0 29.2 31.7 34.6 33.3 29.9 33.2 36.4 34.5 31.9 34.6 37.7 36.0 32.7 35.8 39.2 38.0 35.2 37.8 41.0 39.4 35.8 39.1 43.2 40.1 35.7 39.6 44.0

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Foot length in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 17.9 16.1 17.9 19.5 18.6 16.8 18.7 20.2 19.8 18.0 19.7 21.5 20.1 18.4 20.0 21.9 21.0 19.2 20.9 23.2 21.7 19.8 21.5 23.3 22.5 20.3 22.5 24.0

Foot length in cm’s males

Mean 5% 50% 95% 6.6 5.9 6.5 7.4 6.8 6.0 6.7 7.6 7.1 6.2 7.1 7.9 7.3 6.3 7.3 8.1 7.6 6.7 7.6 8.5 8.0 7.1 7.9 8.8 8.3 7.4 8.1 9.2

Age (Yrs) 07 08 09 10 11 12 13

Inside grip diameter in cm’s females

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Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 3.58 3.18 3.48 3.93 3.77 3.32 3.66 4.14 4.00 3.50 3.87 4.49 4.06 3.54 3.95 4.65 4.34 3.68 4.25 4.91 4.51 3.75 4.48 4.97 4.87 4.24 4.82 5.35

Mean 5% 50% 95% 18.3 16.6 18.2 20.0 19.0 17.1 19.0 20.8 19.7 17.9 19.7 21.5 20.4 18.3 20.2 22.5 21.5 19.7 21.4 23.4 22.2 19.9 22.0 24.5 22.6 20.6 22.4 25.4

Foot breadth in cm’s males

Foot breadth in cm’s females Age (Yrs) 07 08 09 10 11 12 13

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 6.9 6.2 6.8 7.6 7.0 6.2 6.9 7.9 7.2 6.3 7.2 8.1 7.4 6.5 7.4 8.2 7.9 6.8 7.8 8.9 8.0 6.9 8.0 8.8 8.4 7.4 8.3 9.4

Inside grip diameter in cm’s males

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 3.65 3.20 3.54 4.00 3.81 3.24 3.69 4.27 3.93 3.40 3.79 4.42 4.12 3.54 4.04 4.61 4.32 3.75 4.22 4.82 4.42 3.82 4.29 5.05 4.54 3.83 4.42 5.17

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Outside grip diameter in cm’s females Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 6.4 5.6 6.4 7.2 6.7 5.9 6.6 7.3 7.0 6.2 6.9 7.8 7.2 6.3 7.1 8.0 7.6 6.5 7.5 8.6 7.7 6.5 7.8 8.5 8.2 7.4 8.1 9.2

Outside grip diameter in cm’s males Age (Yrs) 07 08 09 10 11 12 13

Max shoulder breadth in cm’s males

Max shoulder breadth in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 28.4 25.5 28.4 30.8 29.3 26.4 29.0 32.5 30.9 28.0 30.5 35.3 31.9 28.6 31.6 35.9 33.7 28.8 33.4 38.4 34.9 30.4 34.6 39.7 37.4 33.5 36.8 41.8

Lower torso breadth in cm’s females

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Mean 5% 50% 95% 20.6 18.5 20.4 22.7 21.4 19.1 21.1 24.3 22.8 20.1 22.5 26.1 23.6 21.0 23.4 26.4 25.1 21.7 25.1 28.8 26.3 23.2 26.4 30.4 28.7 25.0 28.5 31.5

Mean 5% 50% 95% 6.6 5.8 6.5 7.4 6.9 5.9 6.8 7.7 7.1 6.2 7.0 7.8 7.3 6.5 7.2 8.0 7.6 6.7 7.5 8.6 8.0 7.1 7.8 8.8 8.0 7.0 7.8 9.1

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 29.2 27.1 28.9 31.9 30.3 27.2 30.3 33.3 31.2 27.6 31.2 34.6 32.1 28.8 32.0 35.0 34.0 29.8 33.9 37.6 35.5 32.0 35.3 38.7 35.8 32.7 35.7 41.7

Lower torso breadth in cm’s males

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 20.7 18.3 20.5 22.9 21.3 18.6 21.0 24.2 22.1 19.8 21.9 24.6 22.8 20.4 22.8 25.1 24.5 21.7 24.4 28.0 25.5 23.5 25.1 28.5 26.2 23.8 25.5 30.9

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Seated CG - % sitting height in cm’s females

Age (Yrs) 07 08 09 10 11 12 13

Sitting height (crown to rump) in cm’s males

Mean 5% 50% 95% 33.3 29.6 33.0 36.6 32.2 28.7 31.8 36.4 30.7 27.6 30.8 32.8 30.2 26.5 30.4 33.9 29.5 26.9 29.5 32.4 29.4 27.3 29.1 32.0 29.2 27.4 29.0 31.6

Age (Yrs) 07 08 09 10 11 12 13

Mean 5% 50% 95% 33.1 28.7 33.2 36.6 32.3 28.9 31.8 35.9 32.1 28.2 32.0 34.5 31.1 27.6 31.0 34.1 30.0 26.2 29.7 32.9 30.1 27.1 30.0 33.6 29.7 26.1 29.8 32.3

Anthropometric dimensions for adults

Lower position height

Grip inside diameter

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Parameters

5th

25th

50th 75th 95th

Lower position height

Male Female

659 619

729 719

779 769

839 819

939 889

Grip inside diameter Maximum

Male Female

42 40

46 42

49 46

51 49

56 52

Hand breadth without Thumb

Male Female

42 40

46 42

49 46

51 49

56 52

Hand breadth without thumb

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Body Measurements

6 years

8 years

10 years

Ref: The Measure of Man and Woman-Human Factors in Design and data compared with “Measurement of Indian Kids� - Report by IDC,

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Measuring the user for Wheelchair Body measurement is necessary to ensure that the wheelchair fits properly. A wheelchair that is too large can affect access to the wheels and brakes, as well as the posture and ability to reach the footrests. A wheelchair that is too small can put constant pressure on the skin and tissues, which can lead to skin breakdown. The thickness of a cushion, which can be a separate purchase, can affect the measurements. The measurements are taken by letting the user sit comfortably in an upright chair and resting the feet flat on the floor. Measuring for a Wheelchair (measuring, in inches)

User assesment

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Seat width is calculated by measuring from one side to the other, the widest points across your hips and thighs as you sit in a normal position, knees slightly apart and adding 1 inch to this measurement to allowing for comfort. Seat depth is calculated by measuring, from the rear of the buttocks to the back of the knee and subtracting 1 inch from this measurement for the final seat depth and subtracting 1 more inch if feet are used to push or manoeuvre the wheelchair. Back height is calculated by extending the your arms out forwards and measuring the distance from the bottom of the buttocks to the underside of the extended arm. This measurement is used as the back height if one is unable to use upper body, but 3 inches is subtracted from this measurement if the user has good shoulder and arm strength. If the user has great upper body strength and is able to actively push the wheelchair, 4 inches is subtracted from the back height. Armrest height is calculated by bending one arm at the elbow while keeping the forearm parallel to the floor and measuring, the distance from the bent elbow to the bottom side of the buttocks. 1 inch is added to this measurement. Footrest height is calculated by measuring, from the bottom of the heel to the underside of the thigh. 1 inch is added to this measurement.

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Adjusting the Measurements for a Wheelchair Cushion Step 1 Adding the total thickness of both side cushions to the seat width measurement. Step 2 Adding the thickness of the back cushion to the seat depth measurement. Step 3 Adding ½ the thickness of the seat cushion to the back height measurement if the user has good shoulder and arm strength or if one has great upper body strength and is able to actively push the wheelchair. Step 4 Adding ½ the thickness of the seat cushion to the armrest height measurement. Step 5 Subtracting the thickness of the compressed cushion from the footrest height.

Other considerations • Both sides of the body should be measured, since some people may have significant differences between their left side and their right side. Use these measurements of the shorter side to determine the wheelchair size. • Some wheelchairs have adjustable features which are helpful if one happens to purchase a new wheelchair cushion that is thicker or thinner than the one currently used. One can also purchase a custom seat cushion that can be adjusted. • The wheelchair seat width is only the width of the seat, not the actual wheelchair. This should be taken into consideration when determining if the wheelchair will fit through your doorways. http://wheelchair.ca http://www.ehow.com

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WHEELCHAIR DESIGN

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Wheelchair design Although basic ergonomic principles have permeated most modern seating in the mainstream of western society, they have yet to reach all corners of the wheelchair industry. Most wheelchairs available in low- income countries are still based on the basic cross-folding format, an outdated 1930’s design that, because of its ease of manufacture, transport and storage has hung on perniciously, causing postural deformities and pressure ulcers. In richer countries, these wheelchairs are now acceptable only for short-term use, usually within hospitals and would not be considered for people who need postural support. However, these wheelchairs are still being distributed widely in lowincome countries under the philosophy that “something is better than nothing.� Unfortunately these products were not designed for everyday, outdoor use and do not survive long in the reality of low-income countries. The low production cost and convenience of folding for transportation would be positive factors if donor organizations provided supportive, pressure relieving cushions, adjustable backrests and increased local service capacity, which seldom happens.

Centre of gravity of upright seated person

As per the mainstream ergonomic practice the seating methodology should be based on achieving a neutral or as close to neutral posture as possible.

Primary function of the backrest is to provide support to the lumbar region. Provision should be made for the protrusion of the buttock area

Neutral pelvic posture, side, back view

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Seating Pressure and discomfort Pressure distribution has a clear relationship with discomfort during sitting. A higher pressure resulted in more discomfort. On earth, human bodies are under the influence of gravitational forces. Which means that the body is pulled downward due to its weight. Pressure on the bottom and under the feet carries most of this weight. To change these pressures it is possible to move the pelvis in three directions: yaw, roll and pitch. Movement is experienced when the discomfort rises above a certain threshold. The position of the pelvis influences pressure distribution under the buttock and a pressure also influences the position of the pelvis. (Comfort and design- principles and good practice- Peter Vink) Just like child with cerebral palsy will have individual needs and might require great deal of support just to sit up, a person with spinal cord injury will need to sit on pressure- relieving cushion to stop hard surfaces from creating pressure ulcers. These different and complex requirements mean that ergonomic seated posture means different things to different people.

• Common pressure • Common pressure sensitive areas (back view) sensitive areas (side view) Common pressure spots experienced in case of folding wheelchair with fabric leather sling seating

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Pressure sores form when there is constant pressure on certain parts of the body. Long periods of unrelieved pressure cause or worsen pressure sores and slow healing once a sore has formed. Taking pressure off the sore is the first step toward healing. Pressure sores usually form on parts of the body over bony prominences (such as hips and heels) that bear weight when you sit or lie down for a long time. One can relieve or reduce pressure by: • Using special surfaces to support your body. • Putting your body in certain positions. • Changing positions often.

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Camber angle Camber angle is the angle made by the wheels of a vehicle in relation to the road surface; the angle between the vertical axis of wheels and the vertical axis of the vehicle when viewed from the front or rear. If the top of the wheel is farther out than the bottom (that is, away from the axle), it is called positive camber; if the bottom of the wheel is farther out than the top, it is called negative camber. Wheel camber is applied to the rear wheels of a wheelchair. It can be described as an angling that brings the top of the wheels closer to each other. Athletes who wish to improve wheelchair-handling characteristics and stability first introduced camber into wheelchairs. The amount of camber introduced into the wheels is measured in degrees. In general the camber angle for an daily use wheelchair is 2 to 4 degrees and for a racing wheelchair between 4 and 12 degrees. Some wheelchairs have methods of adjusting the camber, while others do not. Camber adjustment is most often accomplished by inserting a different camber bar that alters the angle or by adjusting the axle plate for increased camber. Wheelchairs with fixed camber do not allow for altering the angle. In these cases the camber angle may be specified when the wheelchair is ordered (except in the case of low end wheelchairs).

Advantages

Disadvantages

•The wider footprint adds lateral stability to the wheelchair. •Redirects forces to soften the ride. •Places the push rims in a more ergonomic position for pushing. It is more natural to push down and outward. •Protects the hands when pushing in tight areas since the bottom of the wheels will make contact first with walls and door frames. •Less strain on shoulders since the plane of the wheel is closer to that of the shoulder. •Makes turning quicker. •Gives the wheelchair a sportier look.

•Wheelchair will be wider. •May add cost to the chair. •Excessive camber may cause the wheels to rub against the armrest side panels or against the user. •Diminished traction and uneven tire wear on a conventional tire. Conventional tread placement is centred on the tire. A cambered tire rides on the inside edges of the tire. Some manufacturers make tires with offset treads to compensate for cambering.

As camber is increased, the width of the wheelchair across the bottom increases. This adds lateral stability to the system by increasing the wheelchairs footprint. If to much camber is added there may be a problem getting through doorways. The amount of camber required for daily use is not commonly the same as that which is required for sports.

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Seat position and biomechanics Neutral or relaxed posture It is when the joints are not bent and the spine is aligned and not twisted. Working in neutral postures is preferable to working to reduce strain and injury. The effects of different chair positions on the strain and pressure distribution on the backrest, seat surface and foot rests can contribute to risk factors for occurrence of pressure sores--pressure, temperature and humidity. The pressure-distribution findings suggest that in the postures studied SCI (spinal cord injury) subjects have maximum pressures that are higher than able subjects in all postures, ranging from 6% to 46% depending on the posture. Maximum pressures can be reduced by postural changes: backrest recline to 120 degrees, -12%; and, full body tilt, -11%.

The effect of axle position on biomechanics. The position of the seat relative to the rear wheels is generally adjusted to modify the rearward stability of the wheelchair. Recent studies have shown that seat position also has an effect on propulsion biomechanics and suggest that seat position can be optimized. shows biomechanical changes associated with movement of the axle (F = resultant force). The large black arrows indicate the direction of movement of the axle relative to the shoulder and the information in the box indicates how this affects propulsion biomechanics. For example moving the axle further forward relative to the shoulder is associated with a decreased frequency of propulsion. • The more forward position of the rear wheel improves push rim biomechanics, shoulder joint forces, push frequency and stroke angle. • Manual wheelchairs with adjustable axle position appear to improve wheelchair propulsion and reduce the risk of upper extremity injury.

Neutral body posture

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Wheelchair functional performance

Table 1 Aim: To increase stability in all directions:

Functional performance is how a wheelchair performs for different users in different environments. It is determined by its unique design features. There are many compromises to consider when designing or selecting for different uses. Following are the key features of a wheelchair that affect the main categories of performance, how to evaluate them and also outlined are the negotiation that need to be considered when choosing different design features.

Advantages Disadvantages By lowering the seat and thus the centre of gravity of the user • It may be easier for ingress and • Being lower may make it harder to reach objects above. egress from the floor • The posture may be less • It may be easier for the user to comfortable and may increase reach objects on the floor. the pressure on the user’s seat (a • The seat (and the user’s knees) cause of pressure sores). will be more likely to fit under desks and tables. • The user’s pushing position may be worse and access to the hand • Users will be more able to use their feet to assist with rims more difficult. propulsion (if they are able).

Stability Wheelchair stability determines how safe the wheelchair is, and how well the user can carry out activities in the wheelchair. Wheelchair tipping causes many injuries for users. • Static stability relates to the stability of the wheelchair when it is not moving. This determines whether the wheelchair will tip over (where some wheels lose contact with the ground) when the user, for example, leans over to pick something up off of the ground or transfers into or out of his or her wheelchair. • Dynamic stability relates to the stability of the wheelchair when moving. This determines whether the user can ride over bumps or sloped surfaces without tipping. The design features used to increase wheelchair stability have secondary effects on other functional performance characteristics. For example, moving the front castor wheel forward increases stability but reduces the manoeuvrability of the wheelchair in confined spaces. These relationships are described below: General stability is affected by the position of the combined centre of gravity of the user and the wheelchair relative to its wheelbase. A way of increasing general stability and its associated advantages and disadvantages are:

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Apart from seat height, stability in each direction is affected by several design factors, such as: Rearward stability (resistance to tipping backwards) is affected by the rear axle position in relation to the user’s centre of gravity. Ways of increasing rearward stability and their associated advantages and disadvantages are: Table 2 Aim: To increase rearward stability: Advantages Disadvantages By using anti-tip devices to prevent a wheelchair tipping over backwards • Anti-tip devices can be useful for • Most anti-tip designs restrict the some users who are unstable or wheelchair’s ability to travel over are learning to perform “wheelies” uneven surfaces (such as kerbs or (whereby the user raises the front dips). castor wheels and balances on the rear drive wheels). Note: A bag, backpack or any weight hanging behind the wheelchair will move the centre of gravity back and make the wheelchair more likely to tip backwards.

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Table 2 Aim: To increase rearward stability:

Table 3 Aim: To increase forward stability:

Advantages Disadvantages By moving the rear wheel further behind the user’s centre of gravity • Some people, such as some • Increased tendency to turn double above-knee amputees, downhill on side slope. require increased rearward • Poorer access to the hand rim stability because their centre of and a shortened push-stroke, gravity is further behind. making it difficult to push the wheelchair and harder on upper extremities. • It will be more difficult to perform a “wheelie” to negotiate obstacles. • Wheelchair is harder to manoeuvre in confined spaces.

Advantages Disadvantages By moving the front castor wheel forward of the user’s centre of gravity • The wheelchair will resist tipping • Overall wheelchair length is forward when the castors are longer, making it harder to manoeuvre in confined spaces. stopped suddenly by an object they cannot roll over. • Less weight on the front wheels will reduce the rolling resistance of the front wheels, allowing the wheelchair to roll more easily. By using larger front castor wheels • Front castor size significantly • Larger front castor wheels need affects dynamic stability; with more room to swivel; the larger front wheels the wheelchair wheelchair design will need to will be able to roll over larger be much longer or wider to allow obstacles without being stopped room for the user’s feet. and tipped forward.

Forward stability is affected by the size and position of the front castor wheel in relation to the user’s centre of gravity. Ways of increasing forward stability and their associated advantages and disadvantages:

Note: If the footrests are ahead of the front wheels, a weight placed on the footrests (a heavy child, for example) can tip the wheelchair forwards.

Sideways stability is affected by wheelchair width. The further out to the side of the wheelchair the front and rear wheels touch the ground, the more the chair will resist tipping over sideways. Ways of increasing sideways stability and their associated advantages and disadvantages

Anti-tip device

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Table 4 Aim: To increase sideways stability: Advantages Disadvantages By increasing the width of the wheelchair • Provides more stability. • A wide wheelchair is more • Comfortable seating. difficult to get through narrow • Better for overweight people. doorways. • Not efficient for pushing and hard on upper extremities as the user has to reach out to push the hand rims. • Difficult to push for children. By adding camber to the wheels • Camber brings the wheels • A wide wheelchair is more closer to the user and more in difficult to get through narrow line with the user’s forward push doorways. stroke, thus making it easier • Camber increases the width of to push. This can be especially the wheelchair when it is folded. helpful for women, who usually have narrower shoulders but

wider hips than men. • Traction is better when traversing slopes.

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Wheelchair without camber (left) and with camber (right) Users with advanced mobility skills and with good trunk control can partially compensate for some of the wheelchair’s instability if they can balance on the rear wheels (perform a “wheelie”) and if they can shift their weight forwards, backwards or to the side to prevent tipping. Manoeuvrability Manoeuvrability has been divided into two categories: manoeuvrability around obstacles and manoeuvrability over obstacles. Manoeuvrability around obstacles determines the user’s ability to manoeuvre in an environment with confined spaces, such as a toilet with a narrow door and very limited space. • Moving through narrow passageways. The narrowest space through which a wheelchair can pass is determined by its width, measured from the outermost point on each side. The ability to move through narrow passageways can be improved by making the wheelchair narrower. See Table 2.6 for related design solutions and effects. • Pulling up close to surfaces and objects. How close users can get to surfaces and objects they cannot roll under, such as toilets, low tables, counter tops, centre-post tables and bathtubs, is determined by how far the wheelchair extends both forwards and to the side of the seat. A user can get closer to surfaces and objects if the wheelchair is shorter in height

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• Rolling under surfaces: The user’s ability to pull up to a table is determined by the height of the user’s knees (the length of the user’s lower leg plus the minimum safe height of the footrest above the ground). Some types of fixed armrest also prevent users from pulling up to tables and counters. • Turning around in confined spaces: The smallest area in which a wheelchair can turn around is determined by its maximum diagonal measurement

• Manoeuvrability over obstacles determines the user’s ability to negotiate obstacles such as soft ground or raised obstacles. When negotiating obstacles, the user is at risk of tipping backwards or forwards and falling out of the chair (a common cause of injury); thus it is also important to consider stability when evaluating a wheelchair’s ability to manoeuvre over obstacles (see Tables 2 and 3). • Manoeuvring over soft ground, such as mud, sand, grass, gravel and snow, depends on the area of contact that the wheels have with the ground and the amount of weight on the wheel. Ways of improving manoeuvrability over soft ground and their associated advantages and disadvantages are shown in Table 5.

Table 5 Aim: to improve the ability to turn round in confined areas Advantages Disadvantages weight. A shorter narrower • ReducedBy making the wheelchair•shorter andand narrower • Easier to handle and transport. wheelchair will be less stable. Wheelchairs can only be as narrow as the user’s width plus the wheels. See Tables 3, 6 and 8 for related effects. By moving the rear wheel forward in relation to the user • Reduced rearward stability. • Improved access to hand rims. With a longer push stroke, both forwards and backwards, the user is able to use fewer strokes to turn in confined spaces. • With more of the user’s weight See Tables 6 for related effects. Providing wheelchair with easily removable footrests • Increased ability to pull up close • Removable parts can be lost or broken. to surfaces and objects.

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Table 6 Aim: to improve manoeuvrability over soft ground Advantages Disadvantages By increasing the width, diameter and softness of the castor wheel to increase the contact area, • A wide wheel with a raised point • Increasing the contact area of the castor wheel with the ground on the centre of its tread can combine low rolling resistance on can make it more difficult to turn, hard surfaces with good flotation especially in tight, slow turns. over soft ground. • Less weight on the front wheels will reduce the rolling resistance of the front wheels, allowing the wheelchair to roll more easily. By increasing the width, diameter and softness of the rear wheel to increase the contact area, • Larger-diameter rear wheels can • Wider and softer rear wheels can make it more difficult to turn, make it easier to roll over rough especially in tight, slow turns. terrain. • In many less-resourced settings, • Larger-diameter rear wheels make the wheelchair more 28” bicycle tyres are widely available; 26” tyres are somewhat difficult to transport. less common, and 24” tyres are more difficult to find. By moving the front castor wheels forward to reduce the weight on the smaller castor wheels • More of the user’s weight on • Overall wheelchair length is the rear wheels will provide more longer, making it harder to traction on the rear wheels to manoeuvre in confined spaces. drive through soft ground. See also Table 3 for related effects

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Advantages Disadvantages By moving the rear wheels forward in relation to the user to reduce the weight on the front castor wheels • Reduced rearward stability. • More of the user’s weight on the rear wheels will provide more traction to the rear wheels to drive through soft ground. • Reduced tendency to turn downhill on side slope, which requires less energy from the user to correct for downhill turning. • User has better access to the hand rim and a longer push stroke, making it easier to push the wheelchair and better for the upper extremities. • Easier to perform “wheelies” to negotiate obstacles. • Wheelchair is easier to manoeuvre in confined spaces. By using rear wheels with knobs, such as those on mountain bike tyres, to increase traction on soft ground & keep wheels from slipping • Spikes or knobs on tyres cause additional flexing of the tyre and thus higher rolling resistance. • Mud will collect more on tyres with knobs than on smoother tyres. Substituting larger castor &/or rear wheels on a wheelchair not designed to take them can change important functional performance features, including seat angle, castor barrel angle and seat height (user’s centre of gravity).

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Manoeuvring over raised obstacles, such as bumps, kerbs or rocks, depends on many factors. The size of the castor wheel, the distance of the castor wheel from the user’s centre of gravity and the springiness of the castor wheel all have a significant effect. Castor flutter is also a result of hitting bumps at speed. Ways of improving manoeuvrability over raised obstacles and their associated advantages and disadvantages are shown in Table 8. Table 7 Aim: to improve manoeuvrability over raised obstacles Advantages Disadvantages By increasing the distance between the front castor wheels and the user’s centre of gravity user’s centre of gravity See Table 3 for related effects. By increasing the diameter of the castor wheel See Table 6 for related effects. By increasing the diameter of the rear wheel See Table 6 for related effects. By increasing the amount of deflection/springiness of the castor wheel • A softer wheel can make it more difficult to turn, especially in tight, slow turns. • A pneumatic castor wheel can be difficult to repair or replace. Note: Although users with advanced mobility skills can compensate for a wheelchair’s lack of manoeuvrability over objects by moving their body posture to balance the wheelchair, unseen obstacles can put the user’s safety at risk.

Pushing efficiency is related to the amount of energy required for the user to push the wheelchair over a given distance. Lighter wheelchairs are normally easier to push, but there are many factors and wheelchair features that affect how difficult or easy it is to push one’s wheelchair. Ways of improving the pushing efficiency and their associated advantages and disadvantages are shown in Table 7.

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Table 8 Aim: to improve pushing efficiency Advantages Disadvantages By moving the rear wheels forward in relation to the user See Table 5 for related effects. By optimizing seat width and putting the push rims in line with See Table 6 for related effects. By increasing the diameter of the rear wheel • User will not have to reach out for hand rims. By putting camber in the rear wheels • Brings the top of the hand rims closer to the body & more in line with the user’s natural push stroke. See also Table 3 for related effects. With an aligned wheelchair; it is in good condition and working order Note: A wheelchair with a broken or misaligned component (e.g. untrue wheels, distorted frame, broken bearings causing friction, unparallel wheels or poorly inflated pneumatic tyres) resists the user’s forward motion, thereby wasting For use on smooth ground, use harder tyres • Harder tyres (which deform less) • Harder/solid tyres provide little shock absorption. have lower rolling resistance on smooth ground than softer tyres, • Solid tyres are difficult to repair or replace (unless a supply of all other factors being equal. • Solid tyres can never fail the user replacement parts is available). by being punctured. For use on imperfect surfaces, use larger-diameter wheels that have lower rolling resistance than smaller wheels of similar construction

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Table 9. Aim: to improve pushing efficiency Advantages Disadvantages For use on imperfect surfaces (such as outdoors), use tyres that return energy and “spring back” • Spikes or knobs, such as those • Tyres that return energy have lower rolling resistance than those on mountain bike tyres, cause additional flexing of the tyre and that dissipate energy (i.e. they deform but return to shape slowly, thus higher rolling resistance. such as solid foam tyres or inserts). • Pneumatic bicycle tyres can be punctured. • Pneumatic bicycle tyres are relatively easy to repair with the right facilities. Other functional performance characteristics Ability to transfer into and out of the wheelchair depends on the type of transferral that is easiest for the user and whether the wheelchair’s structure impedes transfer. Ways of making transfer easier and their associated advantages and disadvantages are shown in Table 2.10. Table 10. Aim: to make transferral easier Advantages Disadvantages By having removable or folding armrests • There is more room for the • Components can get lost. user to be in an easy position for • Mounting locations can bend or transferring sideways into or out damage, making them difficult to of the wheelchair. put on and take off. • Locking mechanism can fail creating a accident when an assistant tries to lift the wheelchair & user holding the armrests.

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Advantages Disadvantages By having fixed armrests that do not extend to the front of the seat • Greater comfort. • Creates obstacles to easy • It helps to transfer upwards into transferral. a taller vehicle. • Ability to raise the body and take the weight from pressuresensitive areas during prolonged sitting. By having detachable armrests • Easy to transfer. • Armrests can be easily lost or damaged. Note: For users who transfer by pivoting their bottom about their knees (side transfer), there must be sufficient space at the end of the seat surface to be able to move their body past the armrest. By having removable footrests • Removable footrests can allow a • Removable components can get user to pull up closer to surfaces to lost. which the user wishes to transfer. • Locking mechanisms can fail, • For standing transfers, removable creating a dangerous situation or flip-up footrests are needed to when an assistant tries to lift the get out of the way of the user’s wheelchair and user up stairs feet. while holding the footrests. See also Table 2.6 for related effects. By having, for standing transfers, a seat with little to no backward tilt (reclined seat angle) • Dependent on user’s abilities in • Insufficient backward tilt of the transferring. seat (seat angle) can lead to poor posture, pressure sores without full sensation in their buttocks.

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Table 10. Aim: to make transferral easier Advantages Disadvantages By having, for standing transfers, a seat with little to no backward tilt (reclined seat angle) • Note: Too much tilt will cause high localized pressure on the buttocks. • Less backward tilt shifts the user’s centre of gravity forward, which makes the wheelchair less stable in the forward direction. • During an impact, if the wheelchair does not tip forward, the seat angle and surface material (of seat and seat cushion) will affect whether or not the user slides out of the seat. Note: Transferring in and out of a three-wheeled wheelchair requires a different technique to avoid the central frame tube at the front. In a three wheeled wheelchair, users can get closer to objects by approaching them at an angle. Transporting the wheelchair For long-distance travel, for example, bus, taxi or train, it is important to take an account of design and size of the wheelchair & the materials used in its construction. Weight is a crucial factor in transporting a wheelchair, & is determined by the types of component (wheels/frames) used & by the construction materials (e.g. steel, steel/ aluminium alloy or other metal). Reducing weight has a direct effect on durability and cost. Design & size are equally important, foldable & smaller wheelchairs being easier to carry. Ways of making it easier to transport a wheelchair and their associated advantages and disadvantages are shown in Table 11.

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Table 11. Aim: to make it easier to transport the wheelchair Advantages Disadvantages By reducing the weight of the wheelchair • Greater convenient for the user • Reduced durability. and family members/ caregivers. • Greater mobility and productivity. By using folding mechanisms built into the frame (i.e. cross-folding frame, folding backrest) • Makes the wheelchair easier to • Makes the wheelchair carry and transport. comparatively heavier. By having components (i.e. wheels, footrests, armrests) removable to help reduce the overall weight and size for lifting, transport and storage • Reduced weight and volume. • Removable parts can get lost, • Makes the wheelchair easier to bent or broken. carry and transport. • Standard push-button quickrelease axles are not available everywhere and are expensive compared to fixed axles. • Standard push-button quickrelease axles have a shorter life where conditions of use are rough, whereby sand, dust and moisture can cause the locking mechanism to seize. This can allow the axle to slip out of the axle socket and the wheel to fall off the wheelchair.

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Table 11. Aim: to make it easier to transport the wheelchair Advantages Disadvantages Other factors • Wheel camber increases the folded width of the wheelchair. • More stable wheelchairs with long frames are more difficult to transport. • Spiked or knobbly “mountain bike” style tyres tend to collect more mud and soil than smooth tyres, which may reduce cooperation from taxi drivers and bus passengers. Reliability: A wheelchair’s reliability is determined by its durability and the length of its useful life. In the case of failure, the frequency and difficulty of repair also determines the reliability of a particular model of wheelchair. Ways of improving the reliability of a wheelchair include: • Better materials and technologies at an affordable cost; • Fewer removable parts; • Non-folding design where folding is not a necessity; • Use of materials that can be repaired or replaced locally; • Regular servicing, repair and maintenance; and • Knowledge by the user of the product and its use, care and maintenance. Reference: Guidelines on the provision of Manual wheelchairs in less resourced settings

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SYTSTEM OVERVIEW

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Project Scope

Selecting appropriate wheelchair

Urban Rural Semi- urban

Environment Physical Social Cultural

Various impairments Lifestyles Socioeconomic status

Barriers Psychological Physical Financial

Light weight Indoor Outdoor Stackable Semi-outdoor Small size

Storage, portability Performance requirements Policies and planning Training and education Maintenance Local production Resources Manufacturers Training Suppliers Users Retailers Transportation Family Caretakers Workmen

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Wheelchair Assistive device

Design for Comfort Usability Safety Ergonomics Manufacturing ease Features Value addition Sustainability

Suppliers Manufacturers Transportation Servicing personnel

Stakeholders Manufacturers Suppliers Evaluators Technicians Engineers Designers

Structure Mechanism

Ease of Assembly Availibility of components

Supply Design and assembly Hospitals Modularity Public health centres Combining multiple parts Disabled peoples org. Reduction Retailers Reduce Fasteners Govt. body Snap-fit assembly NGO Private sectors (corporate) Professional groups Individuals

Users Children Adult Adolescent Boys Girls Men Women

Indirect users Parents Assistants Nurses, helpers Medical professionals

Environment Home School Institution office Playground Public places Nature of use

Personal Public Hospitals Malls,multiplexes Airports Railway stations Bus stations Historical places Restaurants

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Policy and planning for wheelchair provision Wheelchair provision policy should be developed in consultation with other stakeholders, aiming at effective measures to ensure personal mobility with the greatest possible independence for people with disabilities such as: • Facilitating personal mobility in the manner at the time of their choice and at affordable cost. • Access to wheelchair, also making them available at an affordable cost. • Providing training in mobility skills to people with disabilities and to rehabilitation personnel. • Encourage the entities that produce the wheelchairs and other mobility aids within the country. Standards for wheelchair products, service delivery and training are adopted, promoted and enforced. • Measures are taken to ensure that wheelchair provision is equitable and accessible to all, including women and children, the poorest and those in remote areas. • Wheelchair services are developed as an integral part of health care structures and in coordination with associated services, such as rehabilitation, prosthetic, orthotic and community-based rehabilitation. services. • Sustainable funding policies for wheelchair provision are developed. • Wheelchair user groups and disabled peoples’ organizations are involved at every stage from planning to implementation. According to United Nations Standard Rules and the Convention, it is the primarily responsibility countries to make wheelchairs available at an affordable cost. Ensuring the availability of wheelchair services within a country does not necessarily mean the direct provision of services by the government. Government can work closely with NGO’s and international NGO’s, development agencies, user groups and the private sector to develop national policies and a provision system. In developing the policy one needs to ensure that wheelchair services are cohesive and closely linked with national health and rehabilitation strategies.

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Wheelchair provision and government ministries Wheelchair provision impacts on a number of government ministries and authorities. Ministries of health are generally responsible for health care and rehabilitation services, and therefore have a primary responsibility for wheelchair provision. In some countries, however, other ministries take a leading role. In India, wheelchair services are provided by the Ministry of Social Justice and Empowerment. Other ministries can also play a role, as the needs of users include economic and social issues that may be addressed by the ministry of social welfare or similar. Ministries responsible for employment and education have a role in ensuring the rights of wheelchair users. Thus, unless the responsible ministries or authorities ensure that wheelchair users have access to buildings and public transport, they will not be able to participate in educational, economic and social activities. Manufacturers and suppliers The suppliers deliver wheelchairs to service providers, either through sales or donation. The role of manufacturers and suppliers of wheelchairs is to develop, produce or supply wheelchairs that meet the needs of users in different contexts such as: • Manufacturing or supplying products that are appropriate for the use to which they will be put; • Ensuring their products meet or exceed relevant wheelchair standards; • Providing wheelchairs through wheelchair services that offer, as a minimum, assessment, fitting, user training and follow-up; and • Ensuring that wheelchairs can be repaired locally. Irrespective of the service model used to provide wheelchairs, it is recommended that suppliers exercise their responsibility by ensuring that: • The service provider has the capacity to provide the supplied wheelchairs in a reasonable and responsible manner; and • The supply is based on an assessment of the situation country or region and considers the impact on local manufacturers and service providers.

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Wheelchair services Wheelchair services provide the essential link between the users and the manufacturers and suppliers of wheelchairs. Service providers include: • Government wheelchair services • Nongovernmental organizations that provide such services • The private sector • Hospitals and public health centres. The main role of a wheelchair service is to assist users to choose the most appropriate wheelchair, to ensure that it is adjusted or modified to suit their individual needs, to train users, and to provide follow-up and maintenance services. Professional groups Rehabilitation is a question of teamwork. Professionals such as therapists, health/nursing personnel, orthotist/prosthetist, physiatrist and others can play a major role in providing quality services, training personnel as well as users, enhancing the quality of life of the users, and sharing and documenting best practices. A team comprising all groups of rehabilitation personnel can ultimately benefit the user and has in particular proven useful in the development of the new profession or discipline of wheelchair provision. More professional groups need to be involved in wheelchair provision in less-re sourced settings. A good example of such involvement is the International Society for Prosthetics and Orthotics (ISPO), which has supported the development of structured professional training for wheelchair technologists. International nongovernmental organizations International nongovernmental organizations are often involved in facilitating wheelchair provision where there is little or no national service delivery. The policies and practices of these organizations should promote coordinated wheelchair provision that is equally accessible to all.

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Disabled people’s organizations Disabled people’s organizations have a crucial role to play in the planning, initiation and ongoing support of wheelchair service delivery. As organizations, they are able to advocate more effectively than individuals for users’ needs. To be effective, disabled people’s organizations need knowledge and experience with appropriate products and services. Such organizations played an important role in preparing the Convention on the Rights of Persons with Disabilities and will continue to be involved in its implementation in the future. Users families and caregivers Users and their groups are at the centre of developing and implementing wheelchair provision. They can help ensure that wheelchair services meet their needs effectively. Some users permanently rely on members of their family to assist with day-to-day activities of living, while others may be more independent. Where a family member or caregiver is responsible for assisting a user on a daily basis, such as a parent of a child with cerebral palsy, he or she should also be involved in all the roles listed above for users. Family groups for parents, siblings and other relatives of children with disabilities are encouraged to undertake the activities listed.

Reference: Guidelines on the provision of Manual wheelchairs in less resourced settings

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Wheelchair Services

• Government wheelchair services • Hospitals and public health • Non-governmental organizations (NGO) • Professional groups • International NGO’s

• • • • • •

Physiotherapist Rehabilitation physician Health/ nursing personnel Orthopaedic Orthotics and prosthetics Physiatrist

ROLES • Guide and support activities for wheelchair services • Advance practice and standards for wheelchair service delivery • Placement of wheelchair professionals • Promote education and training of wheelchair professionals

• Private sector • Disabled peoples organizations (DPO) ROLES • Define user needs and barriers to equal participation • Raise awareness regarding appropriate wheelchair and financing • Consulting policy makers & policy implementers in development of wheelchair services • Identify people who need wheelchair & provide linkage with wheelchair services • Monitoring and evaluating wheelchair services • Advocating against inappropriate wheelchair and services • Support users by providing peer support and training

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ROLES • Meet needs where local provisions fail • Support state to fulfill wheelchair requirements • Assist national authorities develop wheelchair services • Delivery system within the country • Long term strategy approved and supported by Govt. authority • Help DPO access wheelchair and develop partnerships • Provide linkage between stakeholders: Users Service provider Government bodies • Provide training and expertise • Build both technical & organizational aspect of wheelchair service & delivery • Establish services and projects including Govt, NGO’s, DPO

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Policy, Planning and Implementation

• Ministry of health

Disabled peoples organization

• Social welfare services

Governmental organizations

• Ministry of social justice and empowerment

Work in tandem with

Non-governmental organizations

• • • •

Identification Communication Awareness Inclusion

• Education ministry

Public health centres (PHC’s)

Inclusivity

• Public welfare department

Hospitals

Men,women, children Poor Remote areas

• World health organization National policies National health Economic and social issues Financial and other benefits Healthcare plans Provision system Associated services Structure Financing provision Raising awareness Access to wheelchair Affordable ISO standards Products Services Delivery Planning Implementation

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Public sector Funding Training Laws, promotion and enforcement Rehabilitation strategies Encouraging production of mobility aids Community based rehabilitation

Private sector Professional groups Government wheelchair services

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[

• • • • • • • •

Assessment Fitting User training Production Supply Follow up Optimum use of local resources Customizing should be possible Role

Team work

Providing linkages Local manufacturer Local supplier Local service provider

Manufactures Suppliers

Local National International • Ease of purchase • Reasonable • On time delivery (without waiting period)

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Design and engineering

User

• Service model • Service & delivery system

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[

Work as a team

• • • • • • • • • • • • • • •

Meet the users needs Adjust and modify as per needs Develop referral networks Provide follow-ups Develop and find sustainable funding sources Assist to choose Maintenance services Feedback Manufacturing ease Meet various needs in different contexts Locally available parts Serviced locally Ease of purchase Customizing should be possible Available on demand

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Design and Delivery process

Basic requirement of a wheelchair

DESIGN PRODUCTION SUPPLY

USER INPUTS

WHEELCHAIR DESIGN SELECTION PROCESS NEEDS ASSESSMENTS USER TECHNOLOGY ESTABLISH CRITERIA FOR DESIGN DESIGN - SELECT WHEELCHAIR PRODUCT TESTING (Performance, strength, durability)

USER INPUTS

USER TRIALS PRODUCTION/ PROVISION OF WHEELCHAIR LONG TERM FOLLOW-UP WITH USERS SERVICING

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SERVICE DELIVERY

Parents may often feel inadequate & incompetent in the face of the special needs of their child & confused by choices which seem to face them when considering wheelchairs & other aids, they can help themselves & their child by having some idea of what they are looking for in a chair. The energetic paraplegic boy with strong arm muscles may look for a lightweight & tough wheelchair, with high manoeuvrability, in order to enjoy sports & to achieve a high degree of personal independence. A very young child may need wheelchair with a tray & is easy to push. If a child is going to use powered or self-propelled chair independently outside the house, it is important to see that the breaking system is both strong & accessible. For a severely handicapped child (in particular one with cerebral palsy where all four limbs may be severely affected) an assistant propelled chair may be required which can tip to alter the sitting position, can offer special foot supports to compensate for spasms & perhaps alternative sets of road and indoor wheels so that the chair is usable both indoor & outdoors. Some families may be heavily dependent on car or public transport hence a lightweight folding model may be essential. Also, the accessories available for particular models will vary. The school child may need removable armrest in order to sit normally at a desk or table. As wheelchair will vary between providing an occasional outing and offering the sole means of independent mobility & since houses & flats have very different space & storage- facilities. Any choice made should be based on a balanced professional & personal decision.

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Usability factors

Seating and angle

Tracing in darkness Slippage and traction on floor surface

Light weight

Crossing thresholds and obstacles Level difference

Transportability

Manoeuvring through doors and obstacles

Vision and muscular response

Turning radius

Spillage and stains

Storage

Center of gravity

Eating

Ingress

Bumping into household objects like furniture etc

Egress

Panic alarm and calling people

Safety of fingers / limbs Parking

Bath and toilet Adjustable

Writing

Breaking and inertia

Changing clothes

Taking a nap / reading / watching TV

Body sores and blood circulation

Accessories Sweating and heat

Maintenance

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Clothing and hindrance caused due to clothing / accessories

Bumping into people

Weight and compactness

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Cleaning wheelchair

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Materials FRAME

TIRES

FOOT REST

PUSH RIM

Aluminium Steel alloy Carbon fibre Aircraft Aluminium Chrome-moly steel Titanium Other composite materials

Pneumatic Solid Gel filled Urethane Urethane - High Profile Pneumatic - Flat-Free

Aluminium Composite Fibre moulded Transparent lexan or carbon

Aluminium Chrome plated Plastic coated Fibre Plain Serrated Texture painted Titanium Vulcan wheel

SPOKE GUARD Acrylic Fabric ABS Alloy

Materials

ALT. FOR SPOKES

FINISHES

Bicycle spokes Fibre spokes/ Mag wheels Carbon fibre spokes Coloured spokes Kevlar strings Spoke less

Paint- Matte Paint- Glossy Textured Cushioned

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HUB Aluminium Steel Alloy Carbon fibre

BREAKS Front independent drum Brakes and rear cantilever Brake C/W parking brake

CUSHIONS Leather Vinyl Gel filled Sling seat Air filled Electric ripple Inflatable- air, water Foam

ARMREST Steel Lexan Carbon fibre Composite

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Existing product study Three existing wheelchairs were studied in detail to get a better understanding of the product in terms of component study, mechanism, usability, materials etc. Standard wheelchair for adults Worldmade Dedicated Tricycle Paediatric wheelchair

Wheelchair terminology

Standard wheelchair

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Details: standard wheelchair

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The Worldmade Dedicated Tricycle It is a hand powered tricycle. Built on the platform of the WM3 wheelchair it provides some postural support to the user. It has a height adjustable footrest, pedals and backrest so that the user can have an optimal riding position and maximum comfort. It has a basic cushion, sculpted backrest and comes with a built in rear carrier. Overview • It consists of a tubular mild steel frame, with standard bicycle components so that it is easy to maintain and repair. • It has a single 20” pneumatic wheel at the front, parking brakes and running brake and in line pedal cranks for propelling by hand. It helps the user to travel greater distances with less effort. Also gives postural support and adjustable footrest. • One boxed flat-pack tricycle kit can be adjusted to suit most riders. • The tricycle is individually assembled & fitted to each user by trained staff. • The Worldmade packaging is designed for easy disassembly for recycling or reuse.

Backrest fixing detail

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Footrest

Front caster wheel detail

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Performance specifications Armrests: Removable aluminium arm supports to facilitate pressure relief lifts, transfers and sitting in a rested position. The armrests also protect both the user and the sides of the cushion from mud. Backrest: Posture supportive solid backrest - lateral support, angular/ height adjustment and adjustable lumbo-sacral pad. Polyurethane foam padding inside water resistant / fire retardant nylon upholstery. Box details: Plain brown five ply cardboard with black printed graphics. The packaging is not waterproof. Outside dimensions - 1325 x 195 x 550 (L x W x H) Brakes: V brake Push rims: Standard WM3 push rims. Seat: Varnished 12mm plywood seat base (with simplified cushion). Chain: A standard bicycle chain is supplied. Chain tension is adjustable. Tyres: Pneumatic - medium tread. Chain guard: It is fitted as standard to protect the user from the chain. Gears: The clip-on attachment comes with simple single speed freewheel gear to suit most users. Cushion: Simplified 70mm thick polyurethane foam padding inside a water resistant / fire retardant nylon cover. Life cycle: The product is designed to provide at least 5 years of service, during normal use and providing it is appropriately maintained. Each user is supplied with an Allen key for home maintenance. Wheels: 26” x 1 3/8” diameter rear wheels, with 40 spoke aluminium rims. Robust 40 spoke hub with two 6202 2RS bearings and diameter 12mm axles. 20” x 1.75” front wheel with 28 hole steel rim.

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Finish: Frame components are enamel painted in black colour. Standard bicycle components have various finishes Transport / storage: Rear wheels & armrests are removable. For infrequent transportation the backrest and the drive can be removed with tools. Weight: Net weight of the tricycle is 24kg. Gross boxed weight is 29kg (in two separate boxes). Product user group • The tricycle can be used by people with a range of mobility disabilities. It is most suited to people who have sensation. In general it is not recommended for people with a spinal cord injury. • The tricycle is suitable for users whose body measurements fall within the following ranges: a. Hip width: up to 470 mm b. Buttock to back of knee: 430 - 540 mm c. Back of knee height from bottom of feet: 310 – 430 mm d. Backrest to centre of fist on outstretched arm 680-750mm normal range but can vary outside this range Environment • The tricycle is designed for use over rough ground and most environments where a standard single speed bicycle would reasonably be expected to travel. • The tricycle can also be used successfully in urban and semi-urban areas which often have similar road conditions and obstacles to rural areas. • Tricycle is stable & rides easily over rough ground as it has a long wheelbase, 20” front wheel and cambered rear wheels. Users may still require assistance over extremely rough ground, high curbs or steep inclines. • Although the tricycle is primarily for outdoor use it can be used indoors. Users may experience some limitations in confined spaces due to its long wheelbase. http://www.motivation.org.uk

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Tricycle chassis

Complete tricycle

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Tricycle drive

http://www.motivation.org.uk

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Paediatric wheelchair The paediatric wheelchair meant for children in their middle childhood (approx. 7-12 years) depending on their body type and anthropometric dimensions. A lightweight, self propelled wheelchair for children featuring a multi- coloured folding, aluminium frame. The chair has a folding backrest, lift up armrests that fold behind the chair and fixed adjustable height footrests. Available in one size only. Frame: Aluminium folding multi- coloured frame with single cross member and push handles

Armrests: Lift up desk style arms. Fold behind backrest. Plastic side guards Brakes: Pull on to lock, lever style with knob grip Front Castors: 150mm diameter narrow profile solid rubber Backrest: Folding with rear pocket

Upholstery: Slung; foam padded with quilted cover on seat and back attached with hook and loop. Footplates: Height adjustable lift up plastic footplates. The fitting on the main hanger can also be adjusted in height. Calf strap

Seat tube connection

Rear Wheels: 560mm diameter fixed wheels, with steel rims and spokes and pneumatic tyres

Frame and castor wheel detail

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Paediatric wheelchair

Cross bar and frame connection detail

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Specification

Standard

Load Capacity (Supplier stated) Seat Depth Seat Width Weight (kg) Seat height Handle height Width

100 kg 410 mm 350 mm 13 kg 480 mm 890 mm 510 mm

Back rest folding mechanism

Foot rest details

Front and side elevation

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Rear wheel hub fixed to the frame

Assistant handle bar

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Responsibility

Children

Parents Siblings Spouse Relatives

Hopes Expectations

Education, social interaction

Family

Person with disabilities Inaccessibility

Prejudice Discrimination, Isolation, segregation Role

Society

Neighbour Doctors Teachers Therapist, specialists Social workers Care takers, nurses

Personal Medical

Self Issues

Social

Financial

Self pity To be pitied on To be looked after

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Transportation Mobility, aids Infrastructure

Medical expenses Mental Special education Brave Limited employment Depressed Courageous Bitter Inspiring Aggressive

Mental model

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Mobility aids, Physiotherapy Counselling

Need help/charity Empathy, special services, special schools, welfare schemes

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USER PERCEPTION

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Children’s perception

Satisfied

IO SC

US MIN D

SU

BC

Special/ N different O Influence Follow role Parental/ models Social/ What others Cultural think Never say die My world spirit and your Guilt world Expectation Denial for the world OverInferior, expectation incompetent

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Fear

Independence Unique

Curious

Creative

Inhibition

Mobility

Winner Sporting

IO

NS

dreams/ ideals

Dignity

Change

Confidence

Speed

Control Aesthetics

Opportunities

Self worth

Safety

Simplicity

Attention

Excel

Motivate

Freedom

T

Self reliance

Equality

Athletic

RA

Comfort

Leadership

Adevnture

Seeking Unhappy support / acceptance/ Fun Positive love Courageous

Dependent

PI

NS

E MOT

AS

IO

The people met for the user survey were the most amazing people with an attitude one wouldn’t believe. One comes out humbled by the courageous and optimistic outlook on life shared by these children and their parents. And above all it should be understood that wheelchair bound children are children first and disabled second. These are their hopes, fears, emotions and aspirations. The attributes are drawn from these to represent the expectations of the users form the product. The attributes form an inspiration for the form, function and feel to the product.

Noticed Clean

Fantasy Adapt

Fearless Helpless Aggressive Joy Different Enthusiasm Discriminated Happy Depressed Courageous Innocence Special Surrender Cheerful Pride Calm/ composed Attitude Energetic Ignored Hope

Playful

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Children’s self image The children’s concept of themselves include their thoughts and feelings about their physical and psychological self-images. Like other concepts the child will acquire, the self-concept is an outgrowth of experiences. In this case, the experience come from the relationship with the immediate environment, their behaviour, how they think people perceive them and how they perceive themselves. The children’s self portraits and drawings describe their personalities and reveal their fun loving and joyful nature. They are grouped according to their personality traits and habits such as Day dreamers Curious as a cat Strong Chatterbox, who love to talk, naughty Happy, cheerful Mischievous or pranksters

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Play is a way of life for all children. A disabled child is a child first disabled second. They show the similar traits as any other children. Whether it is dreaming about their favourite food or sports personality or holidays or life in general the kids come across as very cheerful in their thoughts and expression. The kids are curious as a cat, they like to ask questions to fulfil their curiosity. They like to talk and hence the nickname chatterbox is stuck to some of them. They like to talk to impress people, get somebodies attention and also argue at times. The mischievous lot likes to get in trouble to get attention and are full of pranks. Their act of mischief is a natural attempt to learn. They like to ride cycle and play with friends. The group that is considered strong likes to eat, fight and want to be a superhero. Also they are an assertive lot knowing what they want and consider them their own boss. The most of them perceive as happy and love to smile and spread the happiness around them. Some of them are happy to be with their siblings, singing, reading and above all smiling. All in all the children see everything not just in colour but in full spectrum of the rainbow.

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Mood board

Mood board

Although the parents play an important role in the selection of the wheelchair, the products designed for children have to finally appeal to them and also reflect their attitude. To understand their likes, dislikes and what they hope, aspire for one has to study them carefully and closely. Emotional needs often overpower their physical needs hence it is important that the product engages the user emotionally as well as performs well. In the absence of this emotional connect there is a possibility that the product might not appeal to the user.

l

To get an insight into the children’s world observations, one on one interactions with the children in their environment such as, classrooms, therapy room, playground was an essential part of the project. In order to develop the visual direction for the product a mood board was created based on the observations and interactions with the children.

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b

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simplicity

light

independent

adaptable

fun balance sporty cheerful

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minimal

playful

aspiration

comfort

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Young children react best to toys and products with bright colours rather than pastels. They need direct impact on their senses. Which is evident when you visit their therapy room which is dominated by toys and equipments in bright colours. The colour scheme is for the entire range. The colours chosen for the final prototype is selected considering both the genders so that it appeals both. White is used as a base colour to give a clean and light look and highlights the secondary colour. The colour white stands for simplicity, purity, lightness, fantasy and innocence. The colour orange is fun, jovial, playful, warm and generates enthusiasm and creativity.

Therapy room

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Colour board

Colour palette

pantone 7451C

pantone 2757C

pantone 7459C

pantone 376C

pantone 7404C

pantone 166C

pantone 485C

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pantone 675C


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The material board further helps in determining the look, touch and feel of the product, its components and finishes to be achieved. The frame work has to be able to achieve the lightness and strength at the same time. The components closest in contact with the body have to provide the comfort, the components exposed to constant wear and tear have to be sturdy to withstand the constant abuse they are subjected to. The touch spots should be soft to touch but not fragile at the same time. All in all the product should have look and feel that the user is looking for and more.

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Material board

Material board

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A handicapped child is a child first and handicapped second. Play is a way of life for all children. It is easy to starve a handicapped child of an active stimulation and affection assuming that he is just happy to be there sitting by himself. Handicapped child has the same needs as the normal child, though they may need help in active selection of the toys. Creative play is essential part of the development for all children. For children play is something they do in their free time but for children with physical handicap play is also a means of therapy and is often included in their classroom activities. The product graphics and brand name should reflect this playful nature of the kids, bring some fun factor and help bridge the gap between other children and physically handicapped children.

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Branding, graphics

Branding and graphics

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aspiration

mobility glide

excel freedom

rider cruise

pride aspire

drive chase

quest

swing

whiz spin

marvel

swift

zeal zoom

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revival

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Graphics Since wheelchair is a personal mobility product the focus of the graphics was mainly on the mobility aspect and the aspiration of the children who are going to use the wheelchair. The brand name was selected out of options that were categorized the two main attributes that relate to the product: mobility and aspiration. The brand name “Spin� was selected as it is associated with mobility and also fulfils an aspiration value for the child using the wheelchair similar to that of a car or a personal mobility vehicle.

Branding graphics for wheelchair on the foot rest and spoke guard

Branding graphics for wheelchair on the calf rest and caster wheel arm

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CONCEPTUALIZATION

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Frame Metal was adopted as the framing material for the structural frame for its strength, rigidity and manufacturing ease. The primary product of the company is bicycles which uses steel, aluminium and metal alloy tubes for the structural framing material, the product and its components were studied in detail so as to get a better understanding and making use of the existing resources. As bicycle parts are easy to find, replace and service, wheelchair borrows a lot form bicycle and vice a versa.

It is very important to reduce the effective width of the wheelchair so that it is easy to manoeuvre in narrow spaces, is easy to transport and is light weight. The oval aluminium or alloy sections will help increasing the rigidity and also reducing the width to a little extent.

The circular sections are commonly used for building the frame for both wheelchairs and bicycles instead of which flow moulded oval section can be introduced to provide strength and rigidity as well as to reduce the width of the frame.

Options for frame section

Flow moulded oval aluminium tubing Used in the racing bike industry. Ensures all lightweight parts are stronger, fit without play and do not turn under load. Extremely rigid and ultralight weight also helps reducing the effective width of the wheelchair.

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Folding axis Exploring the folding mechanism in all the three axis. Considering the pros and cons of each and building concepts based on the same.

Option-1

Option-2

a. Folding along Y-axis

b. Fully reclining back rest

a. Folding along the Y-axis is used most frequently in wheelchairs and products such as pram etc as it considerably reduces the footprint, is convenient to transport and is light weight. The seating cannot be rigid but of fabric sling in order to ease folding. Which further has to be accessorized with seating cushion to make it comfortable and ergonomic. Cross-frame has to be introduced to facilitate folding. b. Folding along Y, Z-axis makes the wheelchair even more compact for transportation purpose. But then the factors such as adjustable reclining angle cannot be provided.

Option-3

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c. Folding along Z-axis

c. Folding along Z-axis can be used in case of rigid frame and seating, the footprint is not much reduced vertically.

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Based on, the requirements, folding mechanism and the wheelchair design principles thumb nail sketches were done to get a general idea of the components, form and mechanisms which will further form the basis for design of frame for the wheelchair chassis.

Thumbnail sketches for the frame design for the wheelchair

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Telescopic sections instead of folding cross bars to adjust the seat width according to the size of the child. The telescopic section needs to be adjusted as per the growth of the child slots will be provided considering the growth rate. The folding mechanism is along Y-axis which can be used in case of rigid frame and seating, the footprint is not much reduced vertically.

Option-4

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Folding along Y-axis and telescopic sections for seat adjustment

Changing the folding axis of the cross bar from vertical to horizontal

Option-5

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Option-6

Minimalistic frame was considered in order to reduce the weight and cross bar folding mechanism along the X-axis was used to make it easy to transfer. A metal plate connected to the hub connects the main framing members and also the cross bars. Although the reduction in weight is achieved the frame is rather weak in the absence of the horizontal member that connects the backrest and the member that connects the footrest. This results in loss of rigidity and would require rigorous user testing in order to check whether it will withstand the weight and rough handling.

Further working on the minimalistic frame in order to make it more rigid and sturdy the seat tube is separated from the lower framing member and is connected to the rear wheel hub.

Option-7

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Frame with cross bars attached to the rear wheel hub. Also showing the different options of attaching the cross bar to the hub. The arm rest is low raise to make getting in and out of the wheelchair easy.

Option-8

The cross bar mechanism for folding the wheelchair are attached to a horizontal member that connects to the rear wheel hub. To add rigidity to the frame the rear wheel hub can be connected with a horizontal member, in which case the wheelchair cannot be folded.

Option-9

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By extending the framing member to attach a tippler wheel also gives a detachable platform which can be used to place the battery pack in case the wheelchair needs to be converted to a battery operated one. The attachment can be optional and easily detachable in case it needs to be converted into a manual wheelchair. The wheelchair can come with the battery pack and attachments or one can decide to upgrade it at later stage.

Option-10

The backrest is detached from the main frame to make the backrest adjustable. The wheelchair footprint is reduced by bringing the footrest closer to the frame. The battery pack is detachable and can be optional.

Option-11

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Cross bars are fixed to the rear wheel hub via a hub arm. Removable extended platform can be attached to the hub for battery attachment which also serves as a tipping end for the wheelchair.

Option-12

Free flowing form following the natural body contours of the human body in sitting position was is used to get the frame structure. The cross bars are connected to the rear wheel hub via a hub arm and the tipping member is welded to the chassis directly.

Option-13

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Adjustable arm rest cum clothes guard is proposed so that it is easier to get in and out of the wheelchair for the user as well as gives comfort while sitting. The rear wheel is connected directly to the frame.

Option-14

The rear wheel is connected directly to the frame and the cross bars. Since the rear wheel is moved to the front the centre of gravity of the user is shifted backwards can create imbalance for person with a loss of limbs. Also the push rim is moved towards the front can be difficult to operate.

Option-15

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Assistant handle bar

Option-16

Flip arm rest

The rear wheel is attached to the back rest member of the frame and the cross bars are connected to a fixed member which forms a platform for battery pack or storage and also has anti tip rear caster wheels. The flip arm rest helps the user in getting in and out of the wheelchair.

Rear wheel connected directly rear side of the chassis so that the push rim is accessible. Fibre or capstan push rim for better grip, the low profile arm rest along with clothes guard and height adjustable foot rest is provided. The tipping edge is provided to help wheel the chair along the slopes easily. Spoke guard for protection for the user.

Option-17

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The back rest frame is bent to connect to the cross bar and the frame holding the battery pack platform is connected to the rear wheel hub. The battery pack platform has its own dedicated caster wheels can prevent tipping of the chair rearwards.

Option-18

Similar version as in case of option-18 with slight variation in the frame holding the battery pack.

Option-19

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Form variation in the frame is tried so that the frame can be directly connected to the rear wheel hub and the caster wheel fork directly connected to the frame.

Option-20

Working on the previous frame it was observed that the user weight is concentrated on the rear side which causes the wheelchair to tip backwards. To prevent the chair from tipping backwards a rear antitip wheel is added. This helps in balancing the chair considerably but the wheelchair movements are not as smooth due to additional wheels on rear and it is difficult to manoeuvre small risers and curbs.

Option-21

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The horizontal framing member connects the back rest tube and the member that connects the foot rest to make the frame more rigid. The rear wheel is connected to the frame at the back rest tube such that it is easy to access the push rim. Cushioning is provided to the front part of the frame to help hold the frame while getting on the wheelchair from ground. Instead of tubular section the cross bars are flat metal sections.

Option-22

An additional curved member in the frame is introduced that forms the arm rest tube and also holds the foot rest in place. Since the curved member is fixed it creates an obstruction to get in and out of the wheelchair sideways. Also it adds to the weight of the chair.

Option-23

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Adding two stiffening members on the frame on either sides to give rigidity to the frame. The disadvantage of this would be the increase in weight due to addition of the extra members.

Option-24

Frame with the similar geometry as the option-24 but without the stiffening members.

Option-25

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Climbing wheelchair The wheelchair is not meant for climbing but to manoeuvre small obstacles and steps that might come in the way such as curbs, 2-3 plinth risers. The front wheel is made of three caster wheel assembly with the diameter of 150mm which is the height of a standard staircase riser.

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Battery assisted wheelchair Although a child is able to propel the wheelchair on his own there are times when he is unwell or tired and have to depend on an attendant to propel the wheelchair, and if there is no attendant to propel the wheelchair the child might feel stranded. To overcome this a battery assisted wheelchair that can transform into a manual wheelchair by just removing the external battery attachment is an option. The battery is one of the major limiting factors in power wheelchair performance. Manufacturers have to design much of the wheelchair around the battery package because of the package’s immense weight and volume. The powered wheelchair versions can be heavy and non-foldable on account of the weight and volume of the battery which makes it very difficult for transportation. Although in some of the powered versions the frame can be folded after removing the battery pack, but due to the complexity of the circuits it has to be done by a trained person. Given a powered wheelchair the child who is otherwise able to propel the wheelchair on his own may not be willing or able to exercise his upper body strength. But given an optional battery pack that can be used when necessary can be of help.

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Charger circuit

Chargeable battery Gear box and break assembly

Controller circuit

DC motor

Rear wheels

Front casters Schematic layout : Conventional powered wheelchair

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Battery assisted wheelchair Although a child is able to propel the wheelchair on his own there are times when he is unwell or tired and have to depend on an attendant to propel the wheelchair, and if there is no attendant to propel the wheelchair the child might feel stranded. To overcome this a battery assisted wheelchair that can transform into a manual wheelchair by just removing the external battery attachment is an option. The battery assisted bicycle that is manufactured in the company was studied to get an idea of the components, working, performance and costing. Considering this battery assisted solution an option was created for the wheelchair. In the following option the lead acid battery can be externally attached on a platform that can be detached when not required. The battery is not as heavy as the normal powered wheelchair. The circuits are easy to install and the battery can be removed easily.

Controller

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Battery

Controller

Hub motor Battery pack

Motor

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Design intent The children from infancy to toddler hood (0-2 years) usually are carried by their parents or are carried in a pram or a buggy, in their early childhood (2-7 years) a buggy or an attendant propelled chair is used depending on the weight, size and physical ability of the child as the child may be too young to propel on his own and needs adult supervision. During middle childhood (7-14 years) the child is old enough to propel on his own without adult supervision (depending on the physical and mental abilities). The child goes through significant physical growth in his pre-teens and early teens and to accommodate this physical growth he needs to change multiple wheelchairs. This can be a financial burden on the family. Also if the child is completely dependent on a wheelchair he needs a spare wheelchair in case the other one needs a repair to keep him mobile. To accommodate this growing need of the user the wheelchair has to adapt as per their physical growth. The idea of expendable wheelchair came across as one of the user testimonials revealed how the user ties his wheelchair to reduce the width and manoeuvre in narrow spaces of his home.

Wheelchair seat and backrest tied to reduce the width

Growing child needs to change multiple wheelchairs to accommodate the growing needs

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Working mechanism The cross bar mechanism helps in folding and unfolding the wheelchair, it also holds the wheelchair in open position by means of the locking plate. The cross bar folding mechanism was explored by making a paper mock-up to increase the seat width of the wheelchair. The locking plate can be adjusted to get varying seat widths for expansion as per the growth in the children from age 7 years to 12 years, giving a possibility to expand up to as close to an adult size (400mm). As the seat width of the wheelchair is increased, the wheel has to be lowered to adjust the leg height. Additional slots are provided at regular intervals on the frame to adjust the wheel.

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315mm

Slots on the frame to adjust the wheel

340mm

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Camber angle Varying seat widths that can be obtained by adjusting the cross bar folding mechanism along with 3 ° camber angle for easy manoeuvrability. Since the children’s wheelchair width is lesser than that of an adult it is possible to give a nominal camber angle without compromising on accessibility into narrow spaces for : • Easy manoeuvrability • Side ways stability, rigidity • Ease reach to the hand rim The maximum width of the wheelchair without a camber being 456mm and with 3°camber it is 500 mm. Maximum overall width of the wheelchair without camber obtained after adjusting the maximum seat width is 532mm and with 3°camber is 590mm. Allowing to pass through narrow toilet door of 750 mm width.

Maximum seat width

3° camber angle

750mm minimum door width (toilet)

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Seating system Ergonomic seating The seating methodology involves in achieving neutral or close to neutral posture as possible. It involves two streams: correction and accommodation. Just as a child with cerebral palsy will have individual needs and might require a great deal of support just to sit up (children with cerebral palsy require much more complex postural support which will vary according to individual), a person with spinal cord injury will need to sit on a pressure relieving cushion to stop hard surfaces from creating pressure ulcers. These different and complex requirements mean that ergonomic seated posture means different things to different people.

Option 3: Horizontal adjustable straps with velcro to provide a base for seat and backrest cushion attached with a loop directly to seat tube.

Option 1

The factors in designing of supportive seating for people with disabilities are, flexibility, strength, cost, durability, appropriateness, efficient contact surfaces, good understanding of wheelchair ergonomics in order to promote self-mobility and independence. Environmental and climatic conditions also play a major role in selection of materials and finishes for the seating system. Neutral pelvic posture

Back view

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Option 2 Option 1: Horizontal adjustable straps with velcro to provide a base for seat and backrest cushion Option 2: Diagonal adjustable straps with velcro and sling to provide a base for seat and backrest cushion

Side view

Straps integrated in seating to help fold the wheelchair

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Seating system The seating system comprises of : Adjustable straps for backrest and seat rest The straps will hold the cushion in place and help adjust the width of the wheelchair. Integrated seat cushion, back cushion Seat cushion will help keep the user in position, maintain posture and provide firmness and stability.

Seat and backrest cushion design

Option 4: Horizontal adjustable straps with velcro are joined to fabric or leather loop to be inserted into the backrest frame (for backrest cushion)and seat frame (for seat cushion) The straps are provided with polymer buckles to adjust the width. Over this will the seat and backrest cushion are placed and held in position with the help of velcro

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Seat cushion

Seat cushion internal structure

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Design intent Heat and moisture dissipation are critical to minimise skin integrity issues and pressure sores (heat and moisture are known risk factors for skin breakdown). The seating comprises of lightweight cushion with foam base, inserts and fabric cover providing structure and support. Seat and backrest cushion The cushion cover is made of 3DX spacer fabric that allows heat and moisture to flow easily through the material, without blocking ventilation even when compressed. To increase airflow through the cushion highly porous foam inserts with punched base are used. The inserts can be changed as per the change in width of the wheelchair. Both are made from continuous fabric and are integrated. Pressure distribution Some seat wells tend to slope too quickly, placing tension on the tissue between the bony prominences of the pelvis and those of the hips and thighs. They may also slope too gradually, failing to reduce weight on the (at risk) bony prominences of the pelvis. In the cushion the pelvic loading area is optimally shaped and sized to evenly distribute pressure under the pelvis, without placing excessive strain on the tissue between the pelvis, hips and thighs. Ischial cut-outs ( under the bony prominences of the pelvis – ischial tuberosities) and scooped reticulated foam inserts also help reduce reaction forces that are caused by foam compression. Custom carrying handle helps to place and remove. Postural stability The pre-contoured angle of the cushion wall matches the angle of the pelvic bone structure, resulting in both lateral and forward / rearward stability due to a more evenly distributed load. The firmness layering of the foam base provides optimal comfort without sacrificing stability. The soft EVA foam provides comfort and the firm Oletex foam offers positioning and support.

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Other details

Cross bar fixing options

Cross bars fixing detail Option 1 To reduce the effective weight of the wheelchair flat metal sections can be used instead of tubular ones. By directly welding the flat sections to the main frame joinery can be reduced. Option 2 Alternatively the cross bars can be joined to the main frame by using a concentric tubular section as shown in the figure.

Option 1

Spoke guard fixing detail Spoke guard can be of various materials and depending on the material (Fabric, acrylic, ABS, alloy) the fixing will vary. Fabric spoke guard can be tied to the members that hold the push rim by means of fabric strings and to the wheel hub. For fixing the half round spoke guard in the form of a sheet (eg. acrylic, ABS, alloy )the sheet is punctured with holes corresponding to the screws that hold L-angle and the push rim to the metal rim of the rear wheel. The spoke guard is then attached between the push rim and the wheel. Refer figure for detail.

Option 2

Spoke guard fixing detail

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Push rim detail Option 1 At times there is a possibility of push rim getting damaged or broken due to rough handling or accident. Instead of making the push rim a separate component it can be integrated with the rear wheel itself. The added advantage of which is that there is no gap between the push rim and the wheel thus eliminating the chances of fingers getting stuck in between the gap of the push rim and the wheel. Disadvantage It would be difficult to find replacement or repair in case of damage. Option 1

Option 2 In order to give a better grip capstan hand rims can be used instead of smooth metal ones. The fibre rims will eliminate the cold metallic touch. Disadvantage In case of damage it would be difficult to repair or find replacement. Option 2

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Mock-up Based on the foldable option for battery assisted wheelchair a mock-up was made in wire frame for study purpose. A detachable platform with extra caster wheels is fixed to the chassis on which the battery pack can be mounted. The powered option can be included or added later on in stages. The external platform can be attached externally in case there is a requirement to carry oxygen cylinder. Observations In the minimalistic frame it was observed that in the absence of the horizontal stiffening member the chassis becomes weak and the folding action is not smooth. Also the wheelchair becomes eccentric as when the person sits on it the weight is not evenly distributed on all the wheels. The chair becomes heavy on the rear side. Which will not be suitable if the child has a loss of lower limbs.

Mock-up -2 (revised with horizontal stiffening member)

Horizontal stiffening member

Detachable platform Rear caster wheels Mock-up -1(without horizontal stiffening member)

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Adjustable backrest In order to have a reclining backrest for more comfort and flexibility the backrest is made adjustable from 5 ° - 20 °. An adjustable backrest can provide sufficient support for many people to achieve neutral pelvic posture. To achieve this the backrest is detached from the main frame and is in turn attached by means of a bracket which helps to keep in place and also to adjust the reclining angle of the backrest. Reclining angles can be adjusted and backrest held in position by means of a locking pin provided with key ring and string to hold the two pins together don’t get lost. This entire process can be done without much assistance by the user himself. The locking pin mechanism is similar to the one used in some treadmills to change the angle of the floor. To understand the mechanism the treadmill working was studied. The form of the bracket was designed by putting the slots for adjusting different reclining angles and optimizing shape, it is inspired form the form of a boomerang. The similar form language is followed in designing the caster wheel bracket. Since the backrest is detachable it helps in further reducing the effective size of the wheelchair after folding for transportation and packaging.

Form iterations for the bracket

Locking pin Angle adjusting mechanism in treadmill

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Final form for caster wheel fork and back rest adjustable bracket

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Wheelchair with reclining backrest

Adjustable backrest, Bracket

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Bracket when fixed on frame

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Packaging The backrest folding option not only helps in giving comfort by being able to change the reclining backrest angle it also helps in reducing the volume of the wheelchair for ease of packaging and transport. As the wheelchairs are distributed in assembled form to the dealers it is helpful in reducing the footprint of the wheelchair for packaging. Also it is helpful for individual transportation of the wheelchair in cars or public transport.

Packaging foot print in case of fixed backrest

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Packaging foot print in case of folding detachable backrest

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Arm rest The arm rest is one of the most crucial part as it decides whether the wheelchair is easy to access in terms of ingress and egress, access to the push rim and also how well does the wheelchair adjusts to the existing furniture. It is often the component most subjected to wear and tear due to the body weight it supports while getting in and out of the wheelchair and doing pressure release exercises. High rise armrest often create an obstruction for ingress and egress and at times to operate the push rim with ease. Also if the armrest is high it is difficult to adjust the wheelchair to existing furniture. While accessing the push rim often the hand comes in contact with the wheel.

Wear and tear of the arm rest over the years

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Fender is the part of an automobile, motorcycle or other vehicle body that frames a wheel well (the fender underside). Its primary purpose is to prevent sand, mud, rocks, liquids, and other road spray from being thrown into the air by the rotating tire. The bicycle fender guards the cyclist from the wheel and splashing water during the rain. Also in women’s bicycle the rear fender extends to form a clothes guard for safety of the women rider. This property of the bicycle fender was applied to the armrest of the wheelchair and the form was designed in such a way that it is functional, comfortable and reduces the number of components thus reducing weight.

Bicycle and segway fender

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Design intent The armrest was kept low raise to make the ingress and egress more comfortable and the push rim accessible. The extended inner side of the armrest functions as a clothes guard by providing a barrier between the body of the user and the wheel. The side in contact with the user is cushioned for comfort. In order to make it more sturdy and strong to withstand the daily wear and tear the material proposed is lexan or carbon fibre. After trying out various iterations in form trials were carried out on actual wheelchair to the scale by making paper prototype and testing it on self.

Integrated arm rest and spoke guard

Integrated arm rest and clothes guard

Collapsible arm rest

Low profile arm rest in comparison with detachable high raise arm rest using a sketch and paper prototype

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Form iterations for armrest

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Arm rest 3D visualization 3d visualization of the arm rest in relation with the wheelchair carried out to study the fixing and the overall form, functionality and how the material blend with each other.

Form iterations

Final form: Low profile arm rest

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3d visualization

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Assistant handle bar Although the primary user of the wheelchair is the child who suffers from physical handicap, the wheelchair has to be designed taking into consideration the secondary users as well who are the care takers, helpers or parents who at times help propel the wheelchair when the child is tired, sick or unable to propel on his own. And also to lift the wheelchair in case of emergency which would involve carrying the child along with the wheelchair. The assistant handle bar in a wheelchair is often perpendicular to the surface of the seat. Thus holding and pushing the wheelchair puts the wrist in a awkward angle resulting in discomfort. Also while going downhill on the ramp there is a possibility of hand slipping off from the handle bar if child using the wheelchair is heavy or the slope is steep.

Assistant handle bars and handle bar grips concept board

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Design intent While designing for the secondary user two basic factors considered were - safety and comfort. The handle bar has to be horizontal in order to get keep the hands in the most neutral position. Most of the parallel products such as airport trolley, shopping cart, baby pram, bicycle and push scooter handle bars were studied. It was observed that the horizontal push bar gives the better efficiency both on flat and sloping surfaces. But by giving the horizontal handle bar the folding mechanism of the wheelchair is compromised in order to avoid that the handle bar is made to rotate and fold just in case of the push scooter. So that you can have the handle bar in two different positions- horizontal and vertical to use and folded as well. For safety purpose the handle bar can be provided with independent hand breaks that can be operated by the assistant.

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Mechanism The assistant handle bar can be rotated from the horizontal axis to downward vertical axis to help folding of the wheelchair. The mechanism used to rotate and fold the handle bar is the similar to the one used in case of the push scooter. The independent section with the grip is held together with the help of a push plug which when pushed and released lets the grip section free from the main vertical and the string holds the grip section attached to the main frame.

Push plug Grip bar Internal detail

Slot to hold Grip bar

Push scooter handle bar details

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Grip bar

Horizontal and vertical positions of the handle bar

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Foot rest Wheelchairs have largely converged in their resemblance to modern bicycles, especially the mountain bike (MTB). They already share major components such as spoked wheels, brakes and handlebar grips, and a construction from tubular alloy, but in the choice of finishes, colours, and graphics, further opportunities are taken to adopt the same design language. In order to lend the reassuring familiarity of a mainstream product, and set up positive association with mobility, fitness, and ability. Some of the products with similar components such as exercise equipments were studied to get a better understanding of the form, function and materials.

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Design intent It was observed that most children who use the wheelchair used it without shoes at home just as one would not wear shoes in an Indian household. Children going to school would wear shoes and socks. As some of the children’s feet are too weak to hold any kind of footwear they mostly didn’t wear any. The footrest contain an orthotic, moulded foot bed and built-in arch support for comfort and avoid foot injury. The insoles are lined with nubs to provide traction, stimulate circulation, and displace accumulated moisture. Material: foam resin, slip resistant, anti-bacterial and no marking.

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Foot bed with built in arch Toe guard Strap to hold feet in position

Calf strap

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Safety device The children who use self-propelled wheelchair often feel vulnerable due to their dependence on the wheelchair for their mobility and parents often worry about their safety, but are forced to allow them to be on their own to make them self-reliant and independent. The incident revealed by one of the motorized wheelchair user where she needs the help of porter for assistance while travelling had an awful experience during one of her journey as a drunken porter tried to propel the wheelchair without her consent and was helped by passersby when raised an alarm. Most of the times wheelchair user is not able to see who is behind the wheelchair, be it for ensuring safety or for communicating with the attendant or helper propelling the wheelchair. There is a lack of an alarm system in a manual wheelchair as opposed to motorized wheelchair. And given the multiple disabilities that some of the wheelchair users suffer from there is a need for an alarm system that is functional and simple to use to fill that gap.

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Design intent Automobiles and bicycles are fitted with rear-view mirror to enable the rider to see a vehicle approaching from the rear. Based on this concept a safety device with a mirror and an alarm system was designed to enable the wheelchair user to have a rear view for safety and also to help communicate with the attendant or helper without having to turn around every time. The mirror is fitted in the end part of the seat tube of the frame. It can be rotated for better view by means of push clip mechanism.

Bicycle rear-view mirrors

Mirror attachment detail

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Grab bar When the child needs to be ambulated at times the child has to be lifted along with the wheelchair. During this process two people are required to hold the wheelchair one holds the attendant handle bar and the other holds the grab bar in the front of the wheelchair. At times the grab bar is not provided in this case the framing member is held. The member on which the safety device is fixed can be extended using the similar mechanism as in the case of the attendant handle bar to increase the seat length. Same member also serves as a grab bar to help lift the wheelchair during ambulation.

Slots to extend the grab bar and the wheelchair length Grab bar

Grab bar attachment to the main frame

Grab bar

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Grab bar detail

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Wheelchair brakes Various parallel products that use brakes such as prams, bicycle, push scooter were studied along with wheelchair brakes to get a better understanding of the brakes used in the product its usability, user concerns and their relevance in the given product. Bicycle brakes are used in push scooter and wheelchair attendant handle bar. The brakes used in the pram are of foot operated toggle clamp as it is attendant propelled. Push scooter has both hand brake and foot operated brake. To increase the usability of the wheelchair by both attendant as well as the child using the wheelchair both attendant operated rear brakes and hand brakes operated by the user sitting on the wheelchair are required. The attendant operated brakes can be the kind that are used in the bicycle or additionally they can be provided with anti- roll back brakes that

wheelchair brakes

Push scooter rear breaks

Brakes used in a pram

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Anti-roll- back brakes for wheelchair

Push scooter front and rear brakes

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Attendant hand brakes When the child needs to be ambulated at times the child has to be lifted along with the wheelchair. During this process two people are required to hold the wheelchair one holds the attendant handle bar and the other holds the grab bar in the front of the wheelchair. At times the grab bar is not provided in this case the framing member is held. The member on which the safety device is fixed can be extended using the similar mechanism as in the case of the attendant handle bar to increase the seat length. Same member also serves as a grab bar to help lift the wheelchair during ambulation.

Slots to extend the grab bar and the wheelchair length Grab bar

Grab bar attachment to the main frame

Grab bar

Grab bar detail

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Wheelchair brakes Various parallel products such as prams, bicycle, push scooter were studied along with wheelchair brakes to get a better understanding of the brakes used in the product its usability, user concerns and their relevance in the given product.

wheelchair brakes

Push scooter rear breaks

Brakes used in a pram

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Push scooter front and rear brakes

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Caster wheel The caster wheels are aligned to the rear wheels by means of a curved caster wheel arm to give stability and balance without increasing the width of the wheelchair. The size of the caster wheel is 6”- 1-1/4” so that it is possible to manoeuvre small obstacles such as curbs, single tread which is approximately 6” or 150mm high. The caster wheel fork follows the similar geometrical language as the bracket connecting the backrest and the chassis. It is provided with 3 slots to adjust the height and tilt of the wheelchair. Caster wheel components: • Smooth, gray solid pneumatic tire with three spokes, to absorbs shock and vibrations associated with rough surfaces. • 5/16 Bearing, • 1-3/16” aluminium anodized hubs help to avoid scratching.

Final form for caster wheel fork and back rest adjustable bracket

Chassis

Caster wheel arm

Caster wheel fork Solid pneumatic tires Aluminium & composite rims

Caster wheel assembly

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Slots to adjust the wheelchair height, tilt

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Design intent In order to push the wheelchair uphill on the ramp the attendant has to tilt the chair at an angle so that it rests on its rear wheels and is easy to manoeuvre. But it is quite difficult to tilt the wheelchair rearwards by only putting weight on the assistant handle bar. To help this operation the lower member of the chassis is extended and provided with a rubberised cap so that with the help of the foot the attendant can tilt the wheelchair at an angle and wheel it along the slopes.

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Play Play is a way of life for all children. It is easy to starve a handicapped child of active stimulation and affection by accidently assuming that he is just happy to be there sitting by himself. Handicapped child has the same needs as the normal child, though they may need help in active selection of the toys. creative play is essential part of development for all children. Spoke guard decal In order to bring the joy of play and remove the fear of wheelchair from the child using it and the children around him. The spoke guard graphics are designed in the form of a maze. The spoke guard is made of translucent white board on which the children can write with the help of a white board marker with magnet to hold it on the spoke guard surface when done. In the second option the spoke guard can have the graphical map of the city or town that the child lives in to make it playful as well as informative.

Spoke guard graphics

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Prototype trial I

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Prototype trial II

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CONCLUSION The design of wheelchair I got a chance to work on my weaknesses and discover my strengths. The project also gave me the confidence to think differently, without worrying about the final outcome as every thing can be resolved and refined provided the ideas are in place.

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I want to reach sky… I want to reach sky… It seems so close meeting its lover ocean Yet so far for me to reach… With different hues so same as my moods Can’t it bend for me? Sure can, if I say so … I Want to meet sky… Mingle with rest of the stars Some sparkle, some don’t Hide some, reveal some Reckless of their identity Consuming my entity… I Want to touch sky… Is it velvety like a star studded saree? Caress of a mother…? Warmness of a dear one…? Melancholy of a heart…? Softness of a compassionate hand…? I Want to feel sky… With so much music inside it Wish to explore it With bare hands And love that is so rare now-a-days like a rainbow occasional I want to be sky… to come down and caress who wish to reach me from wheelchairs, walkers… helpless…despondent for the seen and heard sky for a caress and a real care !! Sai Padma http//lotusbeats.wordpress.com redefining mobility

(Art: Jason Bell, http://www.disabilityworld.org)

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REFERENCES

GUIDELINES ON THE PROVISION OF MANUAL WHEELCHAIRS IN LESS RESOURCED SETTINGS William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon (World Health Organization 2008)

NOTHING ABOUT US WITHOUT US Developing Innovative Technologies For by and with disabled persons

ERGONOMICS FOR CHILDREN 13 Designing Products And Places For Toddlers To Teens Edited by Rani Lueder and Valerie Berg Rice

DISABLED VILLAGE CHILDREN A guide for community health workers, rehabilitation workers, and families

WHEELCHAIRS IN INDIA ‘ABLING’ THE DISABLED i ² Knowledge Services

INDIAN ANTHROPOMETRIC DIMENSIONS - FOR ERGONOMIC DESIGN PRACTICE Dr. Debkumar Chakrabarti

DESIGN MEETS DISABILITY 13 Graham Pullin

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ULTIMATE BICYCLE BOOK Richard Ballantine, Richard Grant

ERGONOMICS IN DESIGN, Fall 2008

Global Ergonomic

DESIGN DATA FOR WHEELCHAIR CHILDREN Brian C Goldsmith

YOUNG CHILDREN WITH SPECIAL NEEDS Nancy H Fallen with E. McGovern

DOWN TO EARTH Magazine issue: February 1-15, 2010

THE WHEELCHAIR CHILD Philippa Russell

THE HANDICAPPED CHILD Grace E. Woods

ACCESSIBLE ENVIRONMENTS: Toward Universal Design Ronald L. Mace, Graeme J. Hardie, Jaine P. Place

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THANKS I am thankful to everybody who directly on indirectly have contributed to this project and have been great help. Blind People’s Association Director H.M.Panchal Ahmedabad PRO Shelly Bapna Engineer Sunil Parmar Zakir Bhai Ashok Bhai,Nishad Bhai, Sonal, Kathan, Sahil, Mahaveer Viklang Sahayata Samiti Ext. consultant A.K.Garg

Jaipur Madan Sharma Naveen Kumar, Niranjan Kumar, Roadermal, Ishwar Sharma, Dhanu Kumar Gupta, Rakesh Kumar Choudhary, Nainaram, Rajendra kumar, Chaupal Singh Rathore, Mohanlal, Sunil Kumar, Neeraj Kumar Fellowship for Physically Handicapped Generel Manager, Works R.B.Pawar Mumbai Pramila Yogesh Panchal, Mangala Sonawane, Abdul Badshah, Seema Maprolkar, Child Psychiatrist, Dr.Ratna Bilwani Ahmedabad (MD, Psychiatry) Little Hearts (Integrated School), Residential And Special School For The Mentally Challenged Manager, Administration V.N.Prabhakaran M.D.Ayyapan VidyaSagar (Formerly: Spastics Society, Chennai) Co-ordinator HRD Shirin Mammen Jayamani, Senthil, Rajiv Rajan, Unmul, Deepak, Vishnu Kaushik, Chandrika, Joseph, Mrityunjay, Prajwal, Namrata Sukriti Social Foundation, Chennai Manager, Programs M.S.Srinivasan Suresh, Pachayamal, Balachandran, National Society For Equal Opprtunities For Handicapped

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THANKS Callidai Motor Works Director Bhargav Sundaram Raju Spastics Society, Therapist Maxine Bangalore Shrivalli Deivanai Dr. Usha Ravindran Retailers Welcome Surgicals Co. Suveer Gulati Pikays Medico South India Surgicals Ltd Liberty Surgical Co. Ideal Surgical Co.

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Doc redefining mobility