R.L. Grubbs, MA, M.Ed.

ABSTRACT

Mobility device users are using public (paratransit and fixed route) and social services transportation options in greater numbers than ever before, but they continue to experience a variety of environmental barriers that must be removed to improve transportation outcomes. A survey was administrated to 118 mobility device users in a national sample who rode public and social services transportation to identify important environmental barriers to use, comfort, safety and satisfaction. Preliminary results indicated that service denials continue to occur based on a misunderstanding and misapplication of the common wheelchair definition, current wheelchair tie-downs and occupant restraint systems (WTORS) caused problems with mobility devices and the personal accessories and equipment being carried on board and WTORS are difficult to use largely due to poor operator training and attitudes. There was broad-based support for the ANSI/RESNA WC-19 Standard. Results will encourage advocates to address policy and regulatory issues, transportation designers to plan for the next generation of wheeled mobility devices and transportation managers to better target their operator and customer support training to improve customer satisfaction.

KEYWORDS:

ICF, mobility device, wheelchair transportation, wheelchair securement, common wheelchair definition

BACKGROUND

The International Classification of Functioning, Disability and Health (ICF) provides a framework for identifying the dynamic interactions between people, environments and activities and participation. This framework is useful for identifying environmental barriers and facilitators and their impact on activity and participation [(1), (2)]. Mobility implies the dynamic interaction of people and their devices in activities they find important (3). Applying this framework requires a shift in research emphasis from a traditional focus on problems caused by the wheelchair to a broad focus on contexts of use by intended users [(4), (5), (6)].  Approximately seven million Americans use some type of mobility device (7). While the prevalence of wheelchair use has doubled in the last decade and is growing rapidly, users still experience barriers to activity and participation [(8), (9)].  Trends indicate that there has been a dramatic increase in travel by passengers with disabilities in recent years (10). Yet, sixteen years after the passage of Americans with Disabilities Act of 1990, mobility device users still encounter significant barriers to use, comfort, safety and satisfaction when using public and social services transportation systems. Research efforts must focus on identifying environmental barriers and evaluating solutions that improve transportation outcomes for mobility devices users.

METHOD

A survey was developed to engage a cross-section of mobility device users of public and private transportation to: 1) discover barriers to use, boarding and securement, 2) identify contextual/environmental factors not incorporated in current designs of systems and 3) identify training and needs. A draft version of the survey was sent out for review and comment to key informants/ stakeholders in the disability/advocacy community to ensure validity and build commitment to distribution of the survey and interest in using the resulting report.  The final survey was composed of 28 multiple-choice, check-all-that-apply, or open-ended questions that allowed for additional comments from respondents. The survey yielded both quantitative and qualitative data to questions addressing environmental barriers (such as service denials, lack of assistance, physical barriers, social attitudes and user satisfaction) regarding the use of mobility devices on public and social services transportation.

The final version of the survey was converted using accessible HTML forms and was placed on an internet server for Project ACTION. An announcement was sent out to key informants and stakeholders in disability/advocacy community, to disability oriented list serves and linked to disability oriented bulletin boards.  The announcement was sent directly to members of the CATEA Consumer Network Registry (CCN)—a national registry of people with disabilities who have agreed to participate in research.  Advocates and stakeholders were asked to post the link on their organization’s websites and send the announcement to their networks asking mobility device users of public transit to respond to the survey. The web survey link was active for 30 days and advocates, stakeholders and registry members were sent at least two reminders about the survey.

Survey respondents (n=118) represented a national purposive sample of mobility device users of public and private transportation services.  Demographic data is summarized in Table 1. Almost all respondents (92.4%) were mobility device users, 5.9% were family members and 1.7% provided personal assistance to mobility devices users. About 1/3 of respondents used more than one mobility device, 30.7% used a manual wheelchair (MWhc) and 30.7% used a power wheelchair (PWhc), 11.3% used a scooter (Scr), 23.8% used a cane, crutches or walker (CCW) and 3.5% used lower extremity prosthesis. With the exception of scooter users, the sample represented experienced users who were diverse with regards to gender and age. The sample was almost evenly split between females and males. With respect to age, the sample most likely under represented elders (65+) and older adults with disabilities. A web-based survey available online may have encouraged responses from younger persons with disabilities. 

RESULTS AND DISCUSSION

Service denials were a problem for 17.4% of respondents. Based on a review of qualitative comments, it appears that most of the denials were questionable.  For example, several respondents reported being denied service due to the width of their device. A respondent reported denial of service because the wheelchair space on the vehicle didn’t fit a four wheeled scooter.  A transit provider told a scooter user that the service didn’t transport scooters. A respondent was denied service because s/he had too many packages.  40.7% of respondents reported that there was “not enough space to turn the wheelchair around.” There appears to be a misunderstanding and misapplication of the ‘common wheelchair’ definition found in the Americans with Disabilities Act of 1990. Wheeled mobility devices are changing. Out dated design and models are giving way to more choice in modern technology. Given these exclusionary practices and the expanding focus on improving transportation outcomes, the ‘common wheelchair’ notion needs to be revised to reflect current mobility devices and contexts of use.   

Respondents were asked about personal items, accessories and equipment that they bring along on transit trips. 79.7% carried a backpack, 50.8% carried grocery or shopping bags, 40.7% carried a laptop computer or a briefcase and 28.8% carried luggage (including a purse). Environmental factors and context of use information must be considered in the design of transportation systems. This evidence seems to support the idea that exclusive focus on changing the ‘wheelchair’ in the transit system is misguided. For more than 25% of respondents, current wheelchair tie-downs and occupant restraint systems (WTORS) caused problems with their device and/or with the personal accessories and equipment being carried.  For the purpose of transportation system design, anthropometric measures of mobility device users should incorporate measures not only of the person and the device, but appropriate elements of the context of use, specifically what users are carrying during typical rides.

Only 45% of respondents reported using WTORS on every ride. Some respondents never used WTORS (14%).  Driver/operator error was the most reported reason for non-use of WTORS. Respondents reported that drivers/operators didn’t know how to secure the mobility device or that the operator didn’t offer or seemed unwilling to take the time to use WTORS. Almost half of respondents (49.6%) used WTORS with difficulty. 45% of respondents reported that their device either tipped over or shifted dangerously during rides. While this finding illustrates the grave safety risks experienced by mobility device users, it is an understandable finding based on nonuse and misuse of WTORS.  Probably the most surprising finding from this survey was the overwhelming support of respondents for the ANSI/RESNA WC-19 Standard. The standard was described as a ‘transit option’ consisting of permanent brackets or loops for the attachment of vehicle tie-down equipment. 75.9% of respondents indicated they would obtain this feature with the purchase of a new wheeled mobility device.

39.4% of respondents reported that the attitudes of drivers/operators toward transporting mobility device users varied greatly. This was perhaps the most disturbing survey finding.  Training of operators appears to vary greatly in effectiveness, when it is provided. Not only do drivers/operators need effective service delivery skills, they also need to understand why it is essential to improve transportation outcomes for mobility device users. It appears that operators/drivers would benefit from Competency Based training designed to train attitudes and knowledge as well as skills.  Transit providers should seek out and use knowledgeable mobility device users who can provide and evaluate this training.

Since this study is ongoing, further data analysis will be needed to identify which mobility device users are encountering the most difficulty with which environmental barriers. Once this is determined, efforts can be made to improve outcomes for mobility device users of transportation systems.

CONCLUSION

Survey results have policy, technical and economic implications. This survey has documented significant barriers experienced by mobility device users of public and social services transportation systems. Denials of service, boarding and maneuvering problems, securement and occupant restraint problems and training needs have been discussed. Findings discussed above can provide direction to those engaged in advocacy efforts and regulatory and policy development. For example, results indicate that the ADA’s common wheelchair definition standard is out of step with the evolution of mobility devices and needs to be revised. Designers of transportation safety systems can use the finding related to misuse and non-use of WTORS and can begin to collect and analyze anthropometric measures of mobility device users that incorporate measures of the person, the mobility device and appropriate elements of the context of use, specifically what users are carrying during typical rides. Transportation managers can use the finding discussed above to add training in attitudes to knowledge and skill training for operators and customer service personnel. Wheelchair manufacturers should note the overwhelming acceptance of recently developed securement standards that included attachment points on mobility devices, known as WC-19/Transit Option and make this option available.  Finally, wheeled mobility device users should have these attachment points (WC-19) installed on their devices. Experienced device users should offer to assist in the training of operators and customer service personnel to bring in real-world context to training.

REFERENCES

1. World Health Organization.  International classification of functioning, disability and health standards. Resolution WHA 54.21, (May2001). 
2. Gater, D.R. (2006). Interactions between the environment and wheeled users. U.S. Department of Education, ICDR, Wheeled Mobility and Accessible Transportation, Washington, D.C. 2006.
3. Gray, D.B., Hollingsworth, H.H., & Morgan, K.A. (2006). 29th Annual RESNA Conference Proceedings, RESNA, 1700 N. Moore Street, Suite 1540, Arlington, VA 22209.
4. Armstrong, C.M., & Buning, M.E. (2004).  Real world wheelchair transportation safety: A study of wheelchair user attitudes, knowledge and behavior when riding fixed-route transportation.  The proceedings of the Annual RESNA Conference, Orlando, FL, RESNA Press.
5. Foreman, C. & Harding, J. (2002). The challenges of wheelchair securement: Searching for solutions. Tampa, FL: The Center for Urban Transportation Research: 1-8. 
6. van Roosmalen, L; Bertocci, G.E., Hobson, D.A., & Karg, P. (2002). Preliminary evaluation of wheelchair restraint systems usage in motor vehicles. Journal of Rehabilitation Research and Development, Vol 39-1. 
7. Kaye, H., Kang, T., & LaPlante, M. (2000). Mobility device use in the United States. Disability Statistics Report, (14). Washington, D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
8. Kaye, H., Kang, T., & LaPlante, M. (2002). Wheelchair use in the United States. Disability Statistics Abstract, (23). Washington, D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
9. Russell, J.N., Hendershot, G.E., LeClere, F., Howie, J., & Adler, M. (2000). Trends and differential use of assistive technology devices: United States, 1994. Advance Data, No. 292, National Center for Health Statistics, Centers for Disease Control, Public Health Services, U.S. Department of Health and Human Services, Hyattsville, MD.
10. Cross, D.J. (2006). Securing wheelchairs: Recent developments, future challenges. U.S. Department of Education, ICDR, Wheeled Mobility and Accessible Transportation, Washington, D.C. 2006.

ACKNOWLEDGEMENTS

This project was funded through Project ACTION by the Federal Transit Administration and administrated through Easter Seals. The participation and support of the Rehabilitation Engineering Research Center on Wheeled Mobility in Everyday Life at the Center for Assistive Technology & Environmental Access, Georgia Institute of Technology, Atlanta, GA, is acknowledged.  

AUTHOR CONTACT INFORMATION

R.L. Grubbs, MA., M.Ed.
Research Scientist
Center for Assistive Technology & Environmental Access (CATEA)
Georgia Institute of Technology
490 Tenth Street, NW
Atlanta, GA 30332
Voice: 404-522-2363 or 404-385-0475
Email: rl.grubbs@coa.gatech.edu

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