Poster AA3 - Assessing Community Mobility and Participation of Wheelchair Users with Wearables: Feasibility Study

Introduction: Wheelchair users make up a substantial proportion of the world, with 3.3 million living in the United States. Wheelchair use can negatively impact community mobility (the ability to move independently) and participation (interaction with peers outside the home). The well-being, physical and mental health, and quality of life of manual wheelchair users (MWU) is directly impacted by community mobility and participation (CMP). There is a need for a detailed means of measuring the real-world day-to-day CMP of MWUs as current in-clinic measurement methods only represent a moment in time and lack a holistic view of the MWU’s condition. Remote measurement is an alternative to in-clinic testing and can be done via self-surveys, activity journals, and questionnaires. The Life Space Assessment (LSA), which inquires as to the activity level of the individual, and the Wheelchair Use Confidence Scale (WheelCon), which is used to assess confidence when using the wheelchair, are examples of questionnaires for MWUs. However, such methods lack precision and reliability due to bias and recall ability. Accelerometers, heart rate monitors, and GPS devices have shown promise in giving objective, precise real-world data, but they are unable to measure the engagement and interactions of individuals. In this paper, we present a feasibility study for remote measurement of real-world CMP utilizing GPS, heart rate, questionnaires, and an activity journal. This method accounts for the weaknesses of existing methods and allows for precise measurement of mobility while providing the necessary social and societal context to fully understand a patient’s CMP.

Materials and

Methods: The study was approved by the University of Wisconsin-Milwaukee International Review Board (protocol #24.059). The participant, a 39-year-old man with a T-8 complete spinal cord injury, met with the research team in the University of Wisconsin-Milwaukee Advanced Mobility Biomechanics Lab where he signed a written informed consent form. He was given a GPS wristwatch, instructions on its use, and the activity journal. The wristwatch used to measure GPS location and heart rate was a commercially available Garmin Forerunner 735XT watch (Garmin Ltd, Olathe, Kansas, US). The paper activity journal included questions on the interactions, locations and barriers encountered. The participant was instructed to use the wristwatch’s recording function as soon as he left home and keep it active until back at home at which point he was to fill out the activity journal. At the end of the week, the participant returned the wristwatch and activity journal, and filled out the LSA and WheelCon (short form). Data processing was done with MATLAB software R2023b (MathWorks Inc., Natick, MA). Velocity of the participant was calculated from the distance between measured GPS locations and the time interval, providing a continuous velocity profile. A threshold of 9 m/s was applied to differentiate between self-propelled wheeling and driving. The mapped geolocation from the GPS data was compared with the activity journal to verify and contextualize destinations and activities. The recorded mean heart rate was calculated for each recorded trip and used to further assess physical activity.

Results, Conclusions, and Discussions: The wristwatch collected GPS data over five days due to an uncharged battery on the last day. Moreover, it did not collect heart rate data for the first two days, therefore three days of heart rate data is presented. Data from the activity journal are presented for a total of six days. The results from the GPS and heart rate data (Table 1) show that the participant maintained a high level of community mobility throughout the week, see Fig. 1, Fig. 2, and Fig. 3. The activity journal entries by the participant support the GPS and heart rate results for community mobility through its confirmation of the number of locations visited and expands upon it by providing details for the participant’s community participation. The journal details where the participant went and what activities they participated in, it also gives insight into the participant’s social circle (Table 2). The LSA and WheelCon questionnaires support the results of both the journal and GPS and heart rate data, indicating that the participant had a high confidence in almost every area of their own mobility and social engagement. On the WheelCon, the participant indicated that the only scenario they were not as confident maneuvering in was through a combination of snow and a curb-cut. Furthermore, they indicated that they were not confident advocating for their needs at work/school nor in their ability to present themself as they want to be seen when impressing others. For the LSA, the participant indicated that they had been active in their home, beyond their home, in their neighborhood, their city, and within the state. GPS measurements lack the subjective context necessary to fully understand the day-to-day activities of MWUs, whereas questionnaires and activity journals lack the precision and accuracy required for accurate tracking of CMP. Our combined approach provides more qualitative and quantitative information than GPS, activity journals, or questionnaires on their own. The integration of the three methods gives a holistic understanding of the CMP of the participant, strengthening the ability of rehabilitation specialists to support and improve the CMP and quality of life of their patients.

Acknowledgements (Optional):