ACCESIBILIDAD

ACCESIBILIDAD – DISCAPACIDAD – SILLA DE RUEDAS – ESPACIOS PÚBLICOS BIBLIOGRAFÍA SOLICITADA POR MAURICIO MATINEZ. Email: [email protected] REALIZADA POR ROSSANA ZÚÑIGA, Referencia Electrónica, Biblioteca Central Facultad de Medicina Universidad de Chile. Email: [email protected] Santiago, 08 de julio 2014 FUENTE MEDLINE/PUBMED 1. Hum Factors. 2013 Jun;55(3):567-80. The impact of transfer setup on the performance of independent wheelchair transfers. Toro ML1, Koontz AM, Cooper RA. Author information: 1Human Engineering Research Laboratories, VA Pittsburgh Health Care System, 6425 Penn Ave., Suite 400 (151R-B), Pittsburgh, PA 15206, USA. Abstract OBJECTIVE: The aim of this study was to determine how selected environmental factors affect transfers and to compare our results to the Americans with Disabilities Act Accessibility Guidelines (ADAAG). BACKGROUND: Few data are available to support standards development related to transfers in the built environment. METHOD: Participants were 120 wheeled mobility device (WMD) users who transferred to and from a modular transfer station that consisted of a height-adjustable platform with a lateral grab bar, optional obstacle to the transfer, and an optional height-adjustable front grab bar. Maximum and minimum vertical heights of the transfer surface, maximum gap distance between the WMD and transfer surface, grab bar use, and WMD space needs were recorded. RESULTS: The 95th percentile lowest and highest heights attained were similar to the median WMD seat-to-floor height (56 cm).We found that 42% (47/113) could not perform a transfer with the obstacle present. Participants transferred higher when the front grab bar was added to the setup (p = .005) and higher and lower with the front grab bar than without it when the obstacle was present in the setup (p = .003 and p = .005, respectively). We found that 95% of participants performed a transfer across an 8.9-cm gap. ADAAG recommendations fall short for the height and clear-space needs of the 50th-percentile WMD users. CONCLUSION: Revisions concerning transfer heights, gaps, clear spaces, and grab bar heights are necessary to make transfers more accessible to WMD users. APPLICATION: The data will be used to revise the guidelines related to transfers and to enable designers and engineers to create an environment that is more accessible. PMID: 23829031 [PubMed - indexed for MEDLINE] Related citations 2. Gerontologist. 2013 Apr;53(2):268-79. doi: 10.1093/geront/gns119. Epub 2012 Sep 25. Outdoor built environment barriers and facilitators to activity among midlife and older adults with mobility disabilities. Rosenberg DE1, Huang DL, Simonovich SD, Belza B. Author information: 1Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA. [email protected] Abstract PURPOSE: To gain better understanding of how the built environment impacts neighborhood-based physical activity among midlife and older adults with mobility disabilities. DESIGN AND METHODS: We conducted in-depth interviews with 35 adults over age 50, which used an assistive device and lived in King County, Washington, U.S. In addition, participants wore global positioning systems (GPS) devices for 3 days prior to the interview. The GPS maps were used as prompts during the interviews. Open coding of the 35 interviews using latent content analysis resulted in key themes and subthemes that achieved consensus between coders. Two investigators independently coded the text of each interview. RESULTS: Participants were on average of 67 years of age (range: 50-86) and predominantly used canes (57%), walkers (57%), or wheelchairs (46%). Key themes pertained to curb ramp availability and condition, sidewalk availability and condition, hills, aesthetics, lighting, ramp availability, weather, presence and features of crosswalks, availability of resting places and shelter on streets, paved or smooth walking paths, safety, and traffic on roads. IMPLICATIONS: A variety of built environment barriers and facilitators to neighborhood-based activity exist for midlife and older adults with mobility disabilities. Preparing our neighborhood environments for an aging population that uses assistive devices will be important to foster independence and health. PMCID: PMC3605937 Free PMC Article PMID: 23010096 [PubMed - indexed for MEDLINE] Related citations 3. Ann Intern Med. 2013 Mar 19;158(6):441-6. doi: 10.7326/0003-4819-158-6-201303190-00003. Access to subspecialty care for patients with mobility impairment: a survey. Lagu T1, Hannon NS, Rothberg MB, Wells AS, Green KL, Windom MO, Dempsey KR, Pekow PS, Avrunin JS, Chen A, Lindenauer PK. Author information: 1Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts 01199, USA. [email protected] Comment in • Ups and downs of improving physical examination access for patients and physicians. [Ann Intern Med. 2013] Summary for patients in • Ann Intern Med. 2013 Mar 19;158(6):I-17. Abstract BACKGROUND: Adults who use wheelchairs have difficulty accessing physicians and receive less preventive care than their able-bodied counterparts. OBJECTIVE: To learn about the accessibility of medical and surgical subspecialist practices for patients with mobility impairment. DESIGN: A telephone survey was used to try to make an appointment for a fictional patient who was obese and hemiparetic, used a wheelchair, and could not self-transfer from chair to examination table. SETTING: 256 endocrinology, gynecology, orthopedic surgery, rheumatology, urology, ophthalmology, otolaryngology, and psychiatry practices in 4 U.S. cities. PATIENTS: None. MEASUREMENTS: Accessibility of the practice, reasons for lack of accessibility, and planned method of transfer of the patient to an examination table. RESULTS: Of 256 practices, 56 (22%) reported that they could not accommodate the patient, 9 (4%) reported that the building was inaccessible, 47 (18%) reported inability to transfer a patient from a wheelchair to an examination table, and 22 (9%) reported use of height-adjustable tables or a lift for transfer. Gynecology was the subspecialty with the highest rate of inaccessible practices (44%). LIMITATION: Small numbers of practices in 8 subspecialties in 4 cities and use of a fictional patient with obesity and hemiparesis limit generalizability. CONCLUSION: Many subspecialists could not accommodate a patient with mobility impairment because they could not transfer the patient to an examination table. Better awareness among providers about the requirements of the Americans with Disabilities Act and the standards of care for patients in wheelchairs is needed. PRIMARY FUNDING SOURCE: None. PMID: 23552258 [PubMed - indexed for MEDLINE] Related citations 4. Assist Technol. 2013 Winter;25(4):230-9. Pedestrian pathway characteristics and their implications on wheelchair users. Pearlman J, Cooper R, Duvall J, Livingston R. Abstract Individuals who use wheelchairs (WCs) frequently navigate over pathways with obstacles (e.g., bumps or curb descents) or terrain that is extremely rough. Surface characteristics such as roughness can have an effect on comfort and variables associated with bodily injury. Understanding these relationships can be helpful to ensure safe and comfortable access to all public and private pathways. This article reviews existing research related to the topics of surface roughness effects on WC user's bodies, surface roughness measurement techniques, and design guidelines and exposure limits that attempt to ensure pathways are safe and passable. These findings are discussed along with opportunities to improve them. Using a broad literature search, it was found that several measurement and analysis techniques exist to characterize surface roughness related to automobile roadways, but they have not been systematically applied to WC use over pedestrian pathways. The roughness measurement approach that appears most relevant and adaptable for sidewalks are rolling profilers. Commercially available devices could be recalibrated or adapted to measure pedestrian pathways. IRI and ride-quality analysis techniques appear most relevant and could also be adapted. Any analysis technique that uses profiles of surfaces should focus on frequencies and wavelengths that are most applicable to WC riders. PMID: 24620706 [PubMed - indexed for MEDLINE] Related citations 5. Reumatol Clin. 2013 Jan-Feb;9(1):24-30. doi: 10.1016/j.reuma.2012.05.010. Epub 2012 Jul 31. Usage problems and social barriers faced by persons with a wheelchair and other aids. Qualitative study from the ergonomics perspective in persons disabled by rheumatoid arthritis and other conditions. [Article in English, Spanish] Herrera-Saray P1, Peláez-Ballestas I, Ramos-Lira L, Sánchez-Monroy D, Burgos-Vargas R. Author information: 1Universidad Católica de Pereira UCP, Risaralda, Colombia. Abstract OBJECTIVE: The objective of this study was to identify the usage and accessibility problems faced by the disabled (whether in pain or not) users of assistive devices (conventional wheelchairs), identify physical barriers that limit their mobility, and recognize the socio-cultural practices excluding them from the design process of such devices. Another main purpose of this paper is to improve the ergonomic criteria that influence the design and manufacture of assistive devices. MATERIALS AND METHOD: Study population: 15 patients with any of the following diagnoses: ankylosing spondylitis, rheumatoid arthritis, or amputees using wheelchairs in Mexico and Colombia. Design: Qualitative study. Thematic analysis with a theoretical industrial design approach to employing usability testing for ergonomic analysis. RESULTS: We identified 6 issues associated with usability problems from the patient's standpoint: barriers for use of wheelchairs (usability and acceptability), creative adaptations, potential use of technical devices, independence, body perception and assistive devices, and architectural barriers. The ergonomic and usability requirements and the resulting level of independence vary across wheelchair users with chronic pain and those whose disability does not involve pain. The latter are more independent in their movements and decisions. CONCLUSIONS: User input is essential in the design of assistive devices. The proposal of "design from and for the user" must rely on both engineering and medical perspective on the ergonomy as well as the user interpretation of the environment and the experience of the disease. Thus we can arrive at a "user-centered design". Copyright © 2012 Elsevier España, S.L. All rights reserved. Free Article PMID: 22854174 [PubMed - indexed for MEDLINE] Related citations 6. Assist Technol. 2012 Summer;24(2):87-101. Wheeled mobility device transportation safety in fixed route and demand-responsive public transit vehicles within the United States. Frost KL1, van Roosmalen L, Bertocci G, Cross DJ. Author information: 1J.B. Speed School of Engineering, Mechanical Engineering Department, University of Louisville, Louisville, KY 40202, USA. USA. [email protected] Abstract An overview of the current status of wheelchair transportation safety in fixed route and demand-responsive, non-rail, public transportation vehicles within the US is presented. A description of each mode of transportation is provided, followed by a discussion of the primary issues affecting safety, accessibility, and usability. Technologies such as lifts, ramps, securement systems, and occupant restraint systems, along with regulations and voluntary industry standards have been implemented with the intent of improving safety and accessibility for individuals who travel while seated in their wheeled mobility device (e.g., wheelchair or scooter). However, across both fixed route and demand-responsive transit systems a myriad of factors such as nonuse and misuse of safety systems, oversized wheeled mobility devices, vehicle space constraints, and inadequate vehicle operator training may place wheeled mobility device (WhMD) users at risk of injury even under non-impact driving conditions. Since WhMD-related incidents also often occur during the boarding and alighting process, the frequency of these events, along with factors associated with these events are described for each transit mode. Recommendations for improving WhMD transportation are discussed given the current state of PMID: 22876731 [PubMed - indexed for MEDLINE] Related citations 7. Spinal Cord. 2012 Mar;50(3):232-7. doi: 10.1038/sc.2011.119. Epub 2011 Oct 25. Follow-up study of spinal cord injured patients after discharge from inpatient rehabilitation in Nepal in 2007. Scovil CY1, Ranabhat MK, Craighead IB, Wee J. Author information: 1Green Pastures Hospital and Rehabilitation Centre, Pokhara, Nepal. [email protected] Abstract STUDY DESIGN: Observational cohort study. OBJECTIVES: To evaluate ongoing health and community reintegration of patients with spinal cord injury (SCI) after discharge from inpatient rehabilitation in Nepal. SETTING: Nepal. METHODS: This study follows a cohort of 37 patients with SCI in Nepal, 1-2 years after discharge from inpatient rehabilitation in 2007. Participants were visited at home and data were obtained through semi-structured interviews that evaluated health, independence in daily living (Modified Barthel Index), community participation (Participation Scale) and barriers due to socioeconomic issues, housing, accessibility, and availability and use of mobility aids. RESULTS: One-quarter of the cohort had died (35% of wheelchair users). Secondary health concerns, such as pressure ulcers and urinary tract infections, were common in the 24 patients interviewed, and eight had been rehospitalized to treat them. Inappropriate wheelchairs, inadequate housing and rugged terrain restricted accessibility. 80% of wheelchair users could not enter their homes independently and 74% of those who were using mobility aids could not access the community independently because of the physical terrain. Of all those who were interviewed, half had no accessible toilet, access to a water source or road access to their home. Community participation was a challenge for most using mobility devices, and less than half earned any income. CONCLUSION: This study identifies important areas of focus for rehabilitation centres in less-resourced contexts like Nepal to help with reintegration after discharge: vocational training during or after rehabilitation; accessible housing; wheelchairs appropriate to the terrain and the need for strong community-based rehabilitation. PMID: 22025245 [PubMed - indexed for MEDLINE] Related citations 8. Disabil Rehabil. 2012;34(14):1232-43. doi: 10.3109/09638288.2011.641665. Epub 2011 Dec 29. Participation-based environment accessibility assessment tool (P-BEAAT) in the Zambian context. Banda-Chalwe M1, Nitz JC, de Jonge D. Author information: 1Division of Physiotherapy, Brisbane, Australia. [email protected] Abstract PURPOSE: The purpose of this study was to describe the preliminary development and validation of a potential measure for assessing the accessibility of the built environment in Zambia. It was designed to identify environmental features that present barriers to participation for people with mobility limitations (PWML) using mobility devices such as wheelchairs or crutches. METHOD: The Participation-Based Environment Accessibility Assessment Tool (P-BEAAT) was developed through focus group discussions and personal interviews with 88 PWML from five provinces of Zambia regarding the accessibility of their built environment. The content validity of the P-BEAAT checklist was accomplished through three phases of development with data gathered from 11 focus groups and nine personal interviews. RESULTS: Participants described accessibility barriers which affect their participation in daily life. This information generated the P-BEAAT with 66 items describing eight environmental features with potential for identifying environmental barriers. The P-BEAAT has shown good homogeneity with Cronbach's α score of 0.91. CONCLUSION: The P-BEAAT was constructed grounded in the reality of people's experiences in Zambia for use in assessing environmental features important in the participation of daily life of PWML pertinent to developing countries. Further clinimetric testing of the properties of the P-BEAAT to establish reliability should be conducted next. PMID: 22204415 [PubMed - indexed for MEDLINE] Related citations 9. Work. 2012;41 Suppl 1:4754-61. doi: 10.3233/WOR-2012-0762-4754. Chemical toilet for persons with disabilities: proposal for an urban furniture affordable. Tavares AS1, Montenegro GN. Author information: 1Federal University of Campina Grande. Address: Rua da Cruz, 18 - 1° andar - MB Jesus, BO 55008-280, Caruaru, Pernambuco, Brazil. [email protected] Abstract Street furniture is an important element to the social and democratic life in the cities. In this case, public restrooms must be available to practically all kinds of citizens that inhabit the city. However disabled people have many difficulties in using the existing models, particularly public chemical toilets. Through a design project, a new proposition for a public chemical toilet addressed to wheelchair users was conceived. In this way, the main aspect of this work refers to the actual participation of the disabled expressing their opinion through interviews and usability analysis as well as the observation on technical recommendations for accessibility. PMID: 22317453 [PubMed - indexed for MEDLINE] Related citations 10. Can J Occup Ther. 2011 Apr;78(2):127-36. Experiences with using a pushrim-activated power-assisted wheelchair for community-based occupations: a qualitative exploration. Giesbrecht EM1, Ripat JD, Cooper JE, Quanbury AO. Author information: 1Department of Occupational Therapy, University of Manitoba, 771 McDermot Avenue, Room R214, Winnipeg, MB, Canada R3E OT6. [email protected] Abstract BACKGROUND: Occupational therapists strive to engage individuals in occupation and enhance community access through wheelchair prescription. Previous research with pushrim-activated, power-assisted wheelchairs identifies a reduction in the physical demands of manual wheelchair propulsion but limited evidence exists regarding user evaluation in context. PURPOSE: This study explored the experience of using a power-assisted wheelchair in the community. METHODS: Eight individuals who used both a power and manual device participated in focus groups after trialing a power-assist wheelchair for three weeks. Data were analyzed using a qualitative description approach. FINDINGS: Three themes emerged from our analysis: relative advantages and disadvantages; environmental factors that affect accessibility; and evaluation of mobility device. IMPLICATIONS: Participants perceived the power-assist as improving performance and accessibility compared with the manual wheelchair, increasing the potential scope of occupations and environments, but not replacing their power mobility device. Sufficient time for adjustment of both user and device was important. PMID: 21560917 [PubMed - indexed for MEDLINE] Related citations 11. Disabil Rehabil Assist Technol. 2011;6(5):432-9. doi: 10.3109/17483107.2010.549898. Design of built environments to accommodate mobility scooter users: part II. King EC1, Dutta T, Gorski SM, Holliday PJ, Fernie GR. Author information: 1Toronto Rehabilitation Institute, Ontario, Canada. [email protected] Abstract PURPOSE.Accessibility standards for wheeled mobility devices currently use a 1.5 m turning circle, designed to accommodate manual wheelchairs. Scooters are less manoeuvrable than wheelchairs, so allowing a full turning circle would require too much space. Instead, we propose using a rectangle that provides space for a three-point turn. Here, we determine the area requirements of this approach. METHOD. For rectangular 'rooms' of varying aspect ratios, we measured the minimum dimensions in which two four-wheeled scooters (the Celebrity-X and Fortress-1700), which combine good outdoor performance with reasonable indoor manoeuvrability, could enter the space, perform a three-point turn and exit. Moveable Styrofoam walls defined each 'room', and a doorway was located either near the corner of the space or in the middle of one wall. 'Room' size was decreased until our expert driver could no longer perform the manoeuvre. RESULTS. Compared to the area required for a turning circle, 42-54% savings were achieved. Relative to existing requirements, 53-95% more space is required to accommodate the Celebrity-X; 173-223% increases are necessary for the Fortress-1700. CONCLUSIONS. When accommodating four-wheeled scooters, our proposed three-point turn definition would require more space than the current standards, but considerably less than if a full turning circle were used. PMID: 21657823 [PubMed - indexed for MEDLINE] Related citations 12. Arch Phys Med Rehabil. 2010 Oct;91(10):1516-23. doi: 10.1016/j.apmr.2010.07.215. Wheelchair ramp navigation in snow and ice-grit conditions. Lemaire ED1, O'Neill PA, Desrosiers MM, Robertson DG. Author information: 1Ottawa Hospital Rehabilitation Centre, ON, Canada. [email protected] Abstract OBJECTIVE: To explore manual wheelchair propulsion strategies for ramp ascent and descent in snow and snow-ice-grit conditions. DESIGN: Cross-sectional study. SETTING: Climatic Engineering and Testing Chamber (Ottawa, Canada). PARTICIPANTS: Manual wheelchair users (N=11) who typically self-propel their wheelchair in winter. INTERVENTIONS: Ramp ascent and descent at 3 grades (1:10, 1:12, 1:16) and 2 winter conditions (packed snow, packed snow with a freezing rain cover, and traction grit). MAIN OUTCOMES MEASURES: Type of ascent and descent strategy, success rate, number and severity of obstructions, average speed, and perceived ramp navigation rating. A questionnaire regarding the subject's past experiences with wheelchair propulsion in winter. RESULTS: Snow accumulation on ramps at 1:10 grade will render the ramp inaccessible for many wheelchair users who do not have external assistance. For snow conditions, the transition area from the level group to the first 2m of ramp incline were the most difficult to traverse for both ascent and descent. All subjects were able to ascend and descend the ramp for the ice-grit condition. Two-railing propulsion is a preferred strategy for ice-grit ramp navigation because of enhanced trajectory control and reducing the potential for wheel-slip problems. Backwards ramp ascent was a successful strategy for ascent in soft-snow conditions. CONCLUSIONS: The 1:16 grade is preferred for winter ramp navigation. Backwards ramp ascent for snow conditions should be considered for people with sufficient shoulder and trunk range of motion. Two handrails are recommended for exterior ramps for both propulsion and wheelchair extraction from ruts and other snow-related obstacles. For ice ramp navigation, the amount of grit required and the effective time (ie, time to when grit becomes embedded in snow-ice, becoming much less effective) should be addressed in further research. Front wheels typically available with manual wheelchairs are not appropriate for soft-snow conditions. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved. PMID: 20875508 [PubMed - indexed for MEDLINE] Related citations 13. Arch Phys Med Rehabil. 2010 May;91(5):759-64. doi: 10.1016/j.apmr.2010.01.009. Design features that affect the maneuverability of wheelchairs and scooters. Koontz AM1, Brindle ED, Kankipati P, Feathers D, Cooper RA. Author information: 1Human Engineering Research Laboratories, Veterans Affairs Pittsburgh HealthCare System, University of Pittsburgh, Pittsburgh, PA 15206, USA. [email protected] Abstract OBJECTIVE: To determine the minimum space required for wheeled mobility device users to perform 4 maneuverability tasks and to investigate the impact of selected design attributes on space. DESIGN: Case series. SETTING: University laboratory, Veterans Affairs research facility, vocational training center, and a national wheelchair sport event. PARTICIPANTS: The sample of convenience included manual wheelchair (MWC; n=109), power wheelchair (PWC; n=100), and scooter users (n=14). INTERVENTION: A mock environment was constructed to create passageways to form an L-turn, 360 degrees -turn in place, and a U-turn with and without a barrier. Passageway openings were increased in 5-cm increments until the user could successfully perform each task without hitting the walls. Structural dimensions of the device and user were collected using an electromechanical probe. Mobility devices were grouped into categories based on design features and compared using 1-way analysis of variance and post hoc pairwise Bonferroni-corrected tests. MAIN OUTCOME MEASURE: Minimum passageway widths for the 4 maneuverability tasks. RESULTS: Ultralight MWCs with rear axles posterior to the shoulder had the shortest lengths and required the least amount of space compared with all other types of MWCs (P<.05). Mid-wheel-drive PWCs required the least space for the 360 degrees -turn in place compared with front-wheel-drive and rear-wheel-drive PWCs (P<.01) but performed equally as well as front-wheel-drive models on all other turning tasks. PWCs with seat functions required more space to perform the tasks. CONCLUSIONS: Between 10% and 100% of users would not be able to maneuver in spaces that meet current Accessibility Guidelines for Buildings and Facilities specifications. This study provides data that can be used to support wheelchair prescription and home modifications and to update standards to improve the accessibility of public areas. PMID: 20434614 [PubMed - indexed for MEDLINE] Related citations 14. Assist Technol. 2010 Spring;22(1):51-67. doi: 10.1080/10400430903520280. Anthropometry and standards for wheeled mobility: an international comparison. Steinfeld E1, Maisel J, Feathers D, D'Souza C. Author information: 1Center for Inclusive Design and Environmental Analysis, School of Architecture and Planning, State University of New York at Buffalo, New York 14214-3087, USA. [email protected] Abstract Space requirements for accommodating wheeled mobility devices and their users in the built environment are key components of standards for accessible design. These requirements typically include dimensions for clear floor areas, maneuvering clearances, seat and knee clearance heights, as well as some reference dimensions on wheeled mobility device sizes. Recent research from four countries was reviewed and compared with their prevailing accessibility standards to identify needs for improving standards. Findings from ongoing anthropometry research on wheeled mobility in the U.S. were used for evaluating the adequacy of existing U.S. accessibility standards. Preliminary analysis suggests that the U.S. standards, which are based on research conducted in the 1970s, need to be updated to address advances in wheeled mobility technology and changes in user demographics. The analysis highlights the importance of integrating research with standards development, organizing international collaborations, and developing international standards. PMID: 20402047 [PubMed - indexed for MEDLINE] Related citations 15. Assist Technol. 2010 Spring;22(1):46-50. doi: 10.1080/10400430903520264. Impact of the A18.1 ASME Standard on platform lifts and stairway chairlifts on accessibility and usability. Balmer DC. Author information: DC Balmer & Associates Ltd., Brampton, Ontario, Canada. [email protected] Abstract ABSTRACT This article summarizes the effect of the ASME A18.1 Standard concerning accessibility and usability of Platform Lifts and their remaining technological challenges. While elevators are currently the most effective means of vertical transportation related to speed, capacity, rise and usability, their major drawbacks for accessibility are cost and space. Platform lifts and stairway chairlifts remain the "devices of choice" for small elevation changes in existing buildings. ADAAG limits them to very specific circumstances in new construction. The ASME A18.1 Standard addresses the safety requirements of inclined stairway chairlifts (which are not ADA compliant) and inclined and vertical platform lifts (which are ADA Compliant). Chairlifts do not provide access for wheeled mobility devices. Restricting access by means of keys is eliminated, inclined platform lift designs that do not interfere with stairway traffic, promoting new ideas for the design of vertical lifts, increasing the allowable vertical travel of a lift and strengthening lift ramps to improve their safety. Despite design advances inherent in the A18.1, significant platform lift usability issues continue to exist. Increased sizes and weights of powered mobility devices indicate that the permitted lift platform area be modified and that permitted weight capacities be codified as minimums instead of maximums. PMID: 20402046 [PubMed - indexed for MEDLINE] Related citations 16. J Emerg Med. 2010 Feb;38(2):150-4. doi: 10.1016/j.jemermed.2007.07.067. Epub 2008 Feb 20. A case report of a severe musculoskeletal injury in a wheelchair user caused by an incorrect wheelchair ramp design. Edlich RF1, Kelley AR, Morton K, Gellman RE, Berkey R, Greene JA, Hill L, Mears R, Long WB 3rd. Author information: 1Distinguished Professor Plastic Surgery, University of Virginia Health System, USA. Abstract The Americans with Disabilities Act (ADA) gives all Americans with disabilities a chance to achieve the same quality of life that individuals without disabilities enjoy. In this case report, we will be discussing the consequences of having inaccessible ramps to persons with disabilities that can result in severe musculoskeletal injuries in a wheelchair user. While going down an inaccessible ramp in the garage of a hospital, a wheelchair tipped over, causing a fracture to the user's right femur. The injured patient was taken to the Emergency Department, where the diagnosis of a fracture of the right femur was made. The fracture then had to be repaired with an intramedullary rod under general anesthesia in the hospital. It was discovered that the ramps in the hospital garage did not comply with the guidelines of the ADA. The wheelchair ramps had a ramp run with a rise > 6 inches (150 mm) and a horizontal projection > 72 inches (1830 mm). This led to the redesign and construction of safe ramps for individuals using wheelchairs as well as for pedestrians using canes, within 1 month after the patient's injury, making it safe for wheelchair users as well as pedestrians using the parking facilities. The ADA specifies guidelines for safe ramps for patients with disabilities. It is important to ensure that hospital ramps comply with these guidelines. Copyright (c) 2010 Elsevier Inc. All rights reserved. PMID: 18281174 [PubMed - indexed for MEDLINE] Related citations