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App For The Seating Devices Prescription Process

Adriana N. Klein1, Roseli de Deus Lopes1,2

1 Department of Electronic Systems Engineering - Polytechnic School at University of São Paulo

2Interdisciplinary Center in Interactive Technologies from University of São Paulo

INTRODUCTION

Figure 1 shows the screen of the app where the rehabilitator has 6 options of seat models to prescribe to the patient. The designs of the seats are blue, yellow and black, square in shape and each model has a different nomenclature.
Figure 1. e.g. Seat models  
According to World Health Organization (WHO) there are in the world 70 million people who need to use wheelchairs for locomotion1,2. Recent studies indicate that wheelchairs are not always appropriate for their users3 and in developing countries less than 5% of those who need a wheelchair have access to a suitably adjusted model1,4. Seating prescription makes the individualized wheelchair more suitable for posture, comfort and functionality5. In Brazil the process of evaluation of Seating is carried out by rehabilitation professionals and the prescription is directed to technicians of specialized manufactory, generating a wheelchair "customized" as final product.

Figure 2 shows the screen of the app where the rehabilitator must choose which model and height of the designs of the backrests will be prescribed to the patient. The background of the screen is white and the six types of backrest are blue, each model has a different description
Figure 2.e.g Backrest models
The fail of systematization in this process favors communication failures of what was prescribed by the rehabilitation professional, which may lead to errors of interpretation by the technician and in the final product delivered to the user.

The purpose of this study was to investigate the processes involved in the prescription of Seating in Brazil and to propose an architecture for electronic platform to support the prescription of Seating.

METHODS

Design

This was a investigative, exploratory and descriptive study. We have collected information from fourteen Brazilian rehabilitation centers (public and private) that carry out the seating prescription procedure for elaboration of an electronic system or app for seating prescription. The study was approved by the Research Ethics Board of the Faculty of Medicine, University of São Paulo. Informed written consent was obtained from all participants.

Participants

Were interviewed fourteen rehabilitation professionals (physiotherapists, occupational therapists and physiatrists) to collect data on the main nomenclatures used to prescribe seating devices. The inclusion criteria were: have experience in Seating prescriptions for at least 2 years. In the test of the first prototype participated another six rehabilitation professionals who analyzed the electronic system and suggested new changes.

Equipment

Figure 3 shows the screen of the app where the rehabilitator must choose between the 8 models of head restraints and the inclusion of an anti-gravitational strip. The background of the screen is white and the headrest models are blue.
Figure 3.e.g. Head restraints
The quali-quantitative data extracted from the interviews were organized into tables in excel®. The answers were categorized and counted for elaboration of a framework. Programming was done with Android Studio® and the Java® software and XML® language. The internal database software was sqLite® and the external back4app®. The images were made using Adobe Flash CS6 and Adobe Photoshop CC and Wacon's Intous Tablet.

Procedure

Figure 4 shows the screen of the app where the rehabilitator must choose which seat belt model will be prescribed. The screen has white background and 4 drawings of the human body (trunk, upper limbs and head) with the 4 options of belt that can be prescribed in blue color.
Figure 4.e.g. Safety System (belts)
The semi-structured questionnaire of 34 questions was elaborated by the author of this study, and the interviews were carried out in an interval of 2 months.

The data found in the answers of the professionals were categorized into eight items: types of seat(cushion), types of backrest, types of trunk supports, types of head restraints, types of upper limb supports, lower limb supports, safety system and accessories (tables and brackets). In each category the most cited nomenclature was extracted.

A framework for the construction of the first prototype was developed. It was presented to six other rehabilitation professionals who were not part of the first stage, the results were analyzed and the suggestions were considered in the elaboration of the second prototype, which will be tested soon.

Analysis

The integration of qualitative and quantitative analysis was used to extract as much detail as possible from the nomenclature used by the rehabilitation professionals in the seating prescription in Brazil. The analysis data, although not statistically valid, indicated a great variation in the nomenclature of the devices and little systematization in the seating prescription process.

The data analysis of the evaluation of the first prototype was only qualitative.

RESULTS

The results demonstrated the variety of nomenclature used by professionals (Table 1) The most equivalent terms were selected for the elaboration of the electronic system framework, called EasySeating. The suggestions of the analysis of the first prototype were considered for the elaboration of the second prototype that will be validated soon. The second prototype has eight windows for choosing the devices. Each prescription generates an image with text and metrics, the final product appears complete with the features that the user needs. The figure 1 exemplifies the options of the seat model, figure 2 the models of the Backrest, figure 3 the models of head restraints and figure 4 the models of Safety System (belts).

Table 1. Types of Seating Devises
Seating Devices

Analysis quantitative
1.Types of seat 16 differents types
2.Types of backrest 12 differents types
3.Types of trunk supports 10 differents types
4.Types of head restraints 12 differents types
5.Types of upper limb supports 10 differents types
6.Types of lower limb supports 9 differents types
7.Safety System (belts) 9 differents types
8.Accessories 8 differents types

DISCUSSION

The initial results of this research confirmed the existence of a lack of systematization in the process of seating prescriptions in Brazil, such as several names to rank the same device, which corroborates with WHO data on the difficulties wheelchair service in less resourced countries6.

The professionals interviewed reported difficulties in communicating with the technicians who make the seating, and the constant dissatisfaction in the final product delivered to the wheelchair user.

Some studies have already demonstrated the efficacy of telerehabilitation for Seating prescription in developed countries, with the use of the electronic system Remote Wheelchair Selection Advisor (RWSA) that works as support in the decision of rehabilitators, suppliers and patients7.

The EasySeating also has the potential to favor greater systematization and assertiveness for seating prescription in Brazil.

CONCLUSIONS

This study contemplates the use of technology to favor the prescriptive seating process, but also proposes a tool for investigation of seating interventions, due to the possibility of documenting in a more systematized way the clinical needs of the wheelchair user and to monitor their effects and benefits remotely and collaboratively.

REFERENCES

[1] World Health Organization. Guidelines on the provision of manual wheelchairs in less resourced settings. Genebra, 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/index.html, acessado em 15 de dezembro de 2017).

[2] Frost S, Mines K, Noon J, Scheffler E, Stoeckle RJ. Wheelchair service training package: basic level. Malta: World Health Organization; 2012.

[3] Gowran RJ, Mccabe M, Murphy N, Mcgarry A, Murray E.Wheelchair and seating service provision: Exploring users’ perspectives. Irish Journal of Occupational Therapy.2012. 39(2), 3–14

[4] Dolan MJ, Henderson GI. Patient and equipment profile for wheelchair seating clinic provision. Disabil Rehabil Assist Technol. 2014;9(2):136-43.

[5] Khasnabis C, MINES K. Wheelchair service training package: intermediate level. Malta: World Health Organization; 2013.

[6] Toro ML; Eke C; Pearlman J. The impact of the World Health Organization 8-steps in wheelchair servisse provision in wheelchair users in a less resourced setting: a cohort study in Indonesia. BMC Health Services Research.2016.16:26. DOI 10.1186/s12913-016-1268-y

[7] Kim  K-Y; Kim YS; Schemeler M.R .Remote decision support for wheeled mobility and seating devices. Expert Systems with Applications.2012. (v.39)7345-7354.