Active wheelchairs and safety

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Active wheelchairs (custom made) and safe wheelchair transport, is it possible? Yes it is! But what about back support and headrest?

First of all, a video of an active wheelchair that meets the ISO 7176/19 crash test:

Crash test Wolturnus W5 fixed with 4-point system / Dahl Engineering

There are several brands of active wheelchairs that have been crashtested with a headrest.

But how? I hear you think. As an active wheelchair user do I move around with a headrest on the wheelchair, if I also want to use a wheelchair taxi? Because without that headrest, the wheelchair might not pass the crash test? Strong enough, but there is little support for head and back.

Do you do that? As a passenger in a car, when getting off, take your headrest with you, because yes you need it on the next trip? No, right? Modern car seats are equipped with headrests as standard.

What does the VVR code say about the basics of safe wheelchair transport:

“The accessibility principle of the UN Convention on Rights for People with Disabilities states that everyone has the same rights in terms of accessibility and participation in society. This includes the right to free choice of means of mobility. In addition, wheelchair occupants may expect to be offered an equal level of protection as non-wheelchair-bound passengers. The latter is called the principle of equality …”

In many guidelines, there is usually a relativity almost immediately after that second paragraph, if not here. That has quite a few implications:

Crash tests

Cars are tested head-on, head-tail, sideways and with an angle from the front with an instrumented dummy that measures the risk of head and neck injuries. Wheelchairs are crashtested only frontal, with an non instrumented dummy. So, the crash test doesn’t give you an outcome on the possibillity of neck and head injuries. It is also not known how the wheelchair behaves in non-head-on collisions. The crash test, at the current state of the art, actually serves as a relatively easy-to-test strength criterion for a serially produced wheelchair. However, custom wheelchairs can also be strong enough. Because it is single-piece manufacturing, a crash test is an impossible requirement in that case.

The Code VVR lists the injury of other passengers as a risk of transporting wheelchair users in wheelchairs who have not been tested for crashes. We shouldn’t want that, of course. How often does this risk actually occur in practice? Wheelchairs that failed in such a crash that wheelchair users or other passengers were injured or died as a result? I really would like to know that, does anyone have any examples? Will you let me know? Is the risk really that high, that the first principle of the VVR SFM code – the right to free choice of mobility aids – can be passed? See also Pièce de Résistance of the Code VVR for another more inclusive approach to safe wheelchair transport.

A wheelchair that meets the crash test is always first choice if it is to be used as a vehicle seat. If – on the basis of the requirements in the provision – no suitable wheelchair can be found, wheelchairs can also be used as a vehicle seat. If at least the manufacturer indicates this use and hook symbols are present. The manufacturer has then thought about the strength requirements and how to meet them.

Safetybelt loop

Vehicle seats have a fairly fixed configuration, so that in most cases the three-point belt automatically connects to the body in the right way. In wheelchairs this is very different, the belt loop deserves a lot of attention if it is to be correct. Well low over the hips and in the middle over the shoulder. The closure should be on the side, not in the middle of the abdomen. See also the previous comments to de rijdende rechter. The risks of wrong belt loop are indeed real. A wrong use of the seat belt has led to casualties:

“an other recent and ongoing study, in-depth investigations of crash and non-crash events involving wheelchair-seated occupants are being performed (Schneider, Klinich, Moore, & MacWilliams, 2010). In these investigations, interviews are conducted with the wheelchair occupant and/or vehicle driver (if other than the wheelchair occupant) and detailed inspections of the case vehicle, accident site, wheelchair, and occupant wheelchairdown and occupant restraint systems, are conducted when appropriate. As of 2009, in 39 crash and non-crash evens involving 42 wheelchair-seated occupants, 34 of the 42 wheelchairs were effectively secured during the crash or non-crash event. However, only 12 of these occupants were properly restrained using a crash-tested pelvic/shoulder belt restraint. Many wheelchair-seated occupants failed to use shoulder belts or wore the belt restraints loosely or improperly positioned. Wheelchair components frequently interfere with the routing of lap/shoulder belts, or individuals assume that a postural or positioning belt will provide effective restraint in crash situations. Ten of the 42 occupants died and at least others sustained serious injuries, and many of these occurred in low-to-moderate severity crash events that would not be expected to result in serious or fatal injuries to properly restrained occupants sitting in vehicle seats.”

Head and back rest

Vehicle seats have a good head and back rest. This is less obvious with a number of hand-moved wheelchairs. The requirement for at least a shoulder-high backrest is insufficient on the one hand (no headrest) and on the other hand limiting in the choice of wheelchair. Think of light active, custom wheelchairs, with a deliberate low backrest to keep the shoulders free when powering the wheelchair. When do they need a high backrest and headrest? Exactly, only if they use wheelchair taxi transport.

If you want to get closer to a regular vehicle seat as a Code VVR SFM, you can of course choose to require a headrest and back support in the taxi bus for hand-moved wheelchairs. The question is whether this solution is the best in view of all the interests, including those of wheelchair users? It remains very important that wheelchair ergonomics is taken into account in solutions of safe wheelchair transport. And that the wheelchair manufacturer indicates that the wheelchair can be used as a seat in wheelchair transport and how it can be fixed in transport indicated by hook symbols. In the case of an active wheelchair with a low backrest, the consequence is to use a vehicle-bound headrest and back support.

That’s innovation and choosing the most secure solution for everyone!

The wheel does not need to be reinvented. There are already several examples of head and back supports on the market, including this:

Or this one,

At trade fairs I also came across solutions from Dutch bus builders. The fact that these solutions have not yet been implemented in general will obviously have something to do with finance.

Conclusion

There are indeed opportunities for innovation and improving the safety of wheelchair transport. The basis is a good risk analysis and a guideline that meets both the basic principles mentioned in the VVR code. The current Code VVR SFM does not comply. If the Code VVR SFM appoints users of a tailor-made wheelchair as a residual group, this is extremely discriminatory and does not demonstrate a will to find suitable solutions. The time when you could choose all the colors Ford’s as long as they were black, is already some time behind us.

Have an open conversation with individual wheelchair users, occupational therapists, rehabilitation doctors and custom made wheelchair manufacturers. And create a guideline with inclusive solutions instead of restrictive exceptions.

References

Buning, Mary Ellen, et al. “RESNA’s Position on Wheelchairs Used as Seats in Motor Vehicles.” Assistive Technology, vol. 24, no. 2, 2012, pp. 132–41, https://doi.org/10.1080/10400435.2012.659328.
Ambulance Mobile. Safetyhead Kopfstütze Für Rollstuhlfahrer - Ambulanz Mobile. 2020, https://www.ambulanzmobile.eu/project/safetyhead-kopfstuetze-fuer-rollstuhlfahrer.
AMF Bruns. FutureSafe Head & Backrest. 7 May 2020, https://www.amfbrunsamerica.com/futuresafe.php.
Euro NCAP. Official Site of The European New Car Assessment Programme. 2020, https://www.euroncap.com/nl.

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