Wheelchairs Updated 9/17/2018 Please let participants know that their resource manual contains information on wheelchairs and a list of wheelchair resources.

Acknowledgement Miriam Manary The University of Michigan Transportation Research Institute (UMTRI) Please credit the University of Michigan Transportation and Research Institute/Rehabilitation Engineering Research Center on Wheelchair Transportation Safety and thank Miriam Manary for her assistance in providing the most updated information for this presentation. Provide participants with a copy of the Ride Safe brochure developed by UMTRI. You can download it at www.travelsafer.org. This PPT presentation is only a brief overview of issues and recommendations related to transporting children in wheelchairs. 4/24/2019

Background In general, not designed for transportation purposes If possible, transfer occupant to appropriate restraint A wheelchair is a mobility device that allows individuals who cannot walk and/or who have difficulty walking or maneuvering through their environment become more independent. If possible it is recommended to transfer a wheelchair occupant to an appropriate child restraint that meets their positioning needs. We recently saw a child who was 35 pounds who was transported in a family van using their wheelchair. It was recommended that the child be transported in an appropriate child restraint vs. the wheelchair. 4/24/2019

Background In some cases, children are transported in wheelchairs Transfer issues No CSS fits Independent mobility There are a number of reasons why some children are transported in wheelchairs. It may be difficult to transfer some children from their wheelchairs to child restraints due to size or positioning challenges. Some children exceed the size parameters of child restraints or have complex positioning requirements that are better met by their customized wheelchairs. Wheelchair transport is an option to be more independent in their daily activities. Children can be transported in their wheelchair in a bus, in a family vehicle, Medicaid transportation, cabs, or public transportation. The standards you will be learning about today are voluntary and apply to all vehicles that children are transported in. Source: Google 4/24/2019

Occupant Protection in Wheelchairs Secure the wheelchair independent of the rider Secure/protect the rider Face rider forward Upper and lower torso (lap) restraint belts required Lap belt angles between 45-75 degrees to vertical If possible use tie downs, restraint belts and wheelchairs that meet current standards Although lap belt angles can be between 30-75 degrees to vertical, it is ideal to have the angles placed in the 45-75 degree range. (source UMTRI) Source: UMTRI 4/24/2019

Voluntary Standards WC18-Compliant WC19-Compliant WC 20-Compliant Wheelchair Tie-Down and Occupant Restraint Systems (WTORS) WC19-Compliant Wheelchairs (frames and seating) used as seats in motor vehicles WC 20-Compliant Seating systems There is no government regulation to address the safety needs of using a wheelchair as a transportation device. In response to lack of legislation/standards the Society of Automotive Engineers and Rehabilitation and Engineering Assistive Technology Society of North America (RESNA) began efforts in the 1980’s to develop safety standards. RESNA is the premier professional organization dedicated to promoting the health and well-being of people with disabilities through increasing access to technology solutions. http://www.resna.org/ SAE International is a global body of scientists, engineers, and practitioners that advances self-propelled vehicle and system knowledge in a neutral forum for the benefit of society. http://www.sae.org 4/24/2019

WC18-Compliant Tests strength of WTORS and ability to restrain forward motion of wheelchair and rider Pass 30 mph dynamic test 4-point tie down Source: UMTRI 4/24/2019

WC18-Compliant WTORS must: Provide both upper and lower torso restraint to protect the rider It is now part of the new standard to have crashworthy lap belts that can interface with shoulder belt for proper fit. This is an important improvement to the voluntary standard in an effort to ensure that the lap/shoulder portion of the belt is properly fitting over the child. According to Larry Schneider, “We’ve learned that the seatbelt accommodation is much more important. In the real world, we’ve seen wheelchair passengers severely injured because of the lack of use or proper positioning of belts, even in minor crashes.” Source: UMTRI 4/24/2019

WC19-Compliant Wheelchair (frame + seating) designed by manufacturer as a seat in a motor vehicle Strong crashworthy frame Absence of sharp edges Better occupant seat belt fit Frontal crash-testing measures the following: 1)dynamic strength of WC, securement points and belt restraints 2) seat and seatback support for occupant 3) retention of wheelchair components and batteries Many durable medical equipment vendors, physicians and rehabilitation therapists are not yet aware of the advantages of using WC-19 chairs. It is important for physicians and therapists to educate their patients about transit chairs. If appropriate, physicians should write prescriptions for transit chairs and along with therapists, write letters of medical necessity to facilitate use of transit chairs. Source: Convaid 4/24/2019

WC19-Compliant Have clearly marked securement points on the frame for tie down attachment Must be able to hook using one hand in 10 seconds or less Must be able to hook using one hand in 10 seconds or less is a new “design requirement” 4/24/2019

WC19-Compliant Some manufacturers may provide option of a crash- tested lap belt Lap belt will be labeled it complies with WC19 and will allow connecting to a vehicle mounted shoulder belt 4/24/2019

WC20-Compliant Crash test of WC seating system on “surrogate” frame (20 g frontal impact) WC20 seating system must be used with WC19 wheelchair Several manufacturers have met new standard The photo is an example of a WC-20 compliant seating system manufactured by Therafin on a WC-19 compliant wheelchair frame. “WC20 is a standard that covers specialized seating that is not made by the same company that produces the wheelchair frame.  As you know, many people need specialized wheelchair seating to meet their needs but they also want to use their complete wheelchair as a seat in a motor vehicle.  Often, they will buy seating from one manufacturer and a frame from another to create a complete wheelchair.   Before WC20, seating manufacturers had to test multiple combinations of their seating with commercial frames to see if the combinations were crashworthy.  Now that we have WC20, after market seating can be tested independent of a particular wheelchair frame.  We use a surrogate frame that delivers worst case loads for the crash test, so that the seating manufacturer can be confident that when the seating system is paired with a commercial frame that has been tested to WC19, they can create a system that will work as a seat in a motor vehicle.” e-mail response clarifying WC-20 from Miriam Manary to Judith Talty and Janell Yonkman,11-21-2013.   Source: Therafin 4/24/2019

Logo Introduced December 2012 Used for WTORS, wheelchairs and seating systems that comply with latest version of WC-18, WC-19 and WC- 20 A logo, introduced in December 2012, is on products that comply with the latest version of WC18, WC19 and WC20 standards to help consumers identify transit-safe equipment. The hook symbol is still be on wheelchairs, so that the actual securement point location can be easily identified.     4/24/2019

Securing the Wheelchair to the Vehicle Always position wheelchair and rider facing forward Secure wheelchair to vehicle using an appropriate tie-down system 4/24/2019

Securing the Wheelchair to the Vehicle 4-point tie-down: Most common, affordable and effective Universal tie-down that works with wide range of wheelchairs Commonly used in public and school transportation Requires someone to attach straps for person seated in wheelchair There are different types of tie-down systems but discussion here is limited to the 4-point tie-down system because is the most common type. Illustration of WC-19 wheelchair secured to vehicle with four tie-downs, adapted from Ride Safer brochure. 4/24/2019

Securing the Wheelchair to the Vehicle Never attach tie downs to moveable parts Always tighten and remove all slack from straps 4/24/2019

Securing a WC19-Compliant Wheelchair Attach tie-down straps to designated securement points Tighten straps and remove all slack The hook symbol identifies the location on which to attach the tie-down. 4/24/2019

Securing a Non-WC19 Wheelchair Attach tie-down straps to welded junctions of wheelchair frame or to structural areas where frame is fastened with hardened steel bolts Choose securement points as high as possible but below seat surface Should be as close to the seat surface as possible to provide greater stability. Illustration from UMTRI of hardened steel bolts indicated by six raised lines or bumps on head of bolt 4/24/2019

Securing the Wheelchair Rider Use crash-tested lap and shoulder belts Lap belt low on hips and angled between 45 and 75 degrees to the horizontal when viewed from side Source: UMTRI 4/24/2019

Securing the Wheelchair Rider Shoulder belt across collarbone and center of chest Some wheelchairs may have integrated crashworthy lap belt that anchors to wheelchair and has connector hardware to attach to vehicle mounted shoulder belt 4/24/2019

Dynaform posture support Source: AEL Postural Supports Postural support belts attached to wheelchair are NOT strong enough to withstand crash forces The photos are examples of postural support systems, which should not be used for restraint. Dynaform posture support Source: AEL Postural pelvic belt 4/24/2019

Helpful Hints Remove trays and secure them Properly positioned headrest helps protect neck in a rear impact Soft cervical collar if needed Secure equipment 4/24/2019

Helpful Hints Read and follow manufacturer’s instructions Best to ride with wheelchair backrest positioned at an angle of 30 degrees or less to the vertical Check WTORS equipment regularly Wheelchair maintenance regularly If WTORS or wheelchair have been in crash check with manufacturer about replacement if necessary 4/24/2019

Misuse Exercise 4/24/2019

Wheelchair Misuse Child is nine years old and forty seven pounds with cerebral palsy. Child has no 3 point seat belt and back packs on back of wheelchair. The wheelchair is tied down at 4 points. Only using postural support system 4/24/2019

Wheelchair Misuse Four and a half year old, thirty five pound female with cerebral palsy. Child is side facing in the family van and only a lap belt is securing the bottom part of the wheelchair. Child is over the 30 degree tilt recommendation and has a back pack on the back of the wheelchair. Child only has a positioning harness and pelvic belt. Child transferred by O.T. to forward facing CSS with higher weight harness. 4/24/2019

Wheelchair Misuse Seventeen year old female with cerebral palsy who is transported in her wheelchair with a lap-tray. The child weighs 60 pounds and is four foot three inches. Armrests up. Equipment hanging on chair. 4/24/2019