Statement of problem
Most of the wheelchairs on the market are made of a rigid frame work and are not adaptable for the users, and the basic problem seems to be the increasing number of users. It has therefore, become increasingly important to take the concerns into consideration. At present, there does not exist a standard wheel chair designed for people who are wheel chair bound. However, looking at the previous research in order to create and redesign a wheelchair that will increase the capabilities of their users that can solve all problems that this population encounters.
Introduction
Wheelchair users face several problems relating to physical movements and there exists a socio cultural and environmental dimension to it. For most people, chair selection occurs every day. Design is important to every person who sits on the chair. Since the wheelchair often becomes the main seat, seating ergonomics should be examined to the same extent as mobility. Within the broader context of re-activation and restoration of mobility, the past decade has witnessed an evolution not only in the field of wheeled mobility, but also with respect to walking and re-activation to handicapped people. (Van der Woude, de Groot & Janssen, 2006).
Nearly 2.2 million people in the US rely on wheeled mobility devices in their daily life, and the ergonomic issues among people using WCs are unique. Seating ergonomics requires careful consideration of the interaction of the morphological and biomechanical attributes of the individual with the characteristics of the seating system. (Arthanat & Strobel, 2006). Moreover, every year in Britain about 100,000 people suffer strokes. About one third are left with permanent disability, and about 300,000 are “currently living with the effects.” (Seale, et al, 2002). Wheelchair users need to find comfort and a degree of safety with strong accessibility from the device they use.
Over the past 30 years, certain improvements in the design and function of wheelchairs and seating systems have made them better fitting and more functional. In the case of indiciduals with SCI, who lead a longer and active life comfort is a growing concerns. In particular, exposure to whole body vibrations exceeding standards, has been documented during wheelchair use. Shocks and vibrations experienced during manual wheelchair propulsion can decrease an individual’s comfort, increase the rate of fatigue, and limit activities and participation. (Requejo, et al, 2008).
Certain kinds of wheelchairs like piloting a manual wheelchair is an important necessity for the everyday life and social activities of people with physical and sometimes cognitive disabilities. It requires complex capacities and may become tiring and stressful during indoor as well as outdoor activities. The enactment of laws relating to accessibility and discrimination, all around the world, has motivated researchers to verify building standards and to improve wheelchair ergonomics. Some particular studies have stressed and pointed out that nowadays, the potential of virtual wheelchair in training and daily living activities is significant. Seating comfort is a personal sensation and quite difficult to standardize. It is apparent that there is no gold standard for the measurement of wheelchair function. (Angeliki, 2003).
The aim of this literature review, which explores various objectives views of carrying out ergonomics wheelchair user, is based on several sort of ergonomics systems designed with the effects related to their design and environment. In particular, it intends to consider some new basics of an ergonomics wheelchair characteristics according to their use, as well as centered view driven by psychological effect, position change effect, habits effects, seating function effects, environmental effect, policy effects, mechanism effects, society effects, speed, situation effect. Besides, it will dwell on the causes to figure out the need for redesigning a new wheelchair that suits the environment.
Definition of Terms
Ergonomics
Ergonomics is the science concerning with the design of systems, tools, procedures or practices used at work in order to match them to people’s physical and mental abilities. The problems of long-term wheelchair use are not only pain or discomfort, but also a risk of a physically inactive lifestyle. (Arthanat & Strobel, 2006).
Handicapped individual
A handicapped individual is any person who: (a) has a physical or mental impairment which substantially limits one or more of such person’s major life activities; (b) has a record of such impairment; or (c) is regarded as having such an impairment. However, the “definition of disability has created many counterintuitive results in employment related suits brought under the ADA by individuals with physical impairments. (Tondu & Bardou, 2009).
ADA
The Americans with Disabilities Act (ADA) gives federal civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services. (Technical definitions: What is ADA – Americans with disabilities act? ADA – Americans with disabilities act definitions, 2003)
SCI
Spinal cord injury is a damage to the spinal cord that causes loss of sensation and motor control. (Bednarczyk & Sanderson, 1995).
Four main basic of wheelchair
Manual Wheelchair
The most commonly used kind of wheelchairs are usually those propelled by the users’ hands or feet or pushed by another person. These are built in traditional chair shapes with two sets of wheels replacing the legs. One set, is located at the rear, consists of large bicycle-type wheels and the other set is of small casters of 5 or 8 inches in diameter.
Power wheel chairs
These are run on battery power of 12, 24, or 36 volts. Batteries make them heavier than manual ones. Motorized wheelchairs are controlled by a hand-operated joystick, which regulates direction and speed.
Manual sports wheelchairs
These are lightweight and designed to shift the center of gravity to achieve greater mobility and stability. Some chairs are designed for specific sports such as basketball or racing while others are for general sports use. Features associated with sports wheelchairs may include larger propelling wheels, small hand rims, more durable and efficient bearings and hubs, movable axle position and steerable casters.
Power alternatives wheelchairs
These chairs function like motorized chairs but do not look like typical wheelchairs and offer several advantages. Most of these models have three wheels and resemble golf carts or motor scooters. Some allow travel over terrain that typical wheelchairs cannot, such as shallow water sand or other soft, uneven surfaces. Smaller power alternatives permit greater mobility through narrow doors and aisles. Other models have swivel seats which allow closer approaches to desks and work surfaces. (Washington, D.C., 1984).
General view of ergonomic wheelchair effects
Position change effects
Through looking at the different studies which are relevant from wheelchair users’ perspectives, it becomes evident that several sort of effects entail for on the users. (e.g. change position effect, seating function effect, habits effect, mechanisms effects, psychologist effect, society effect and the effect of the reaction, Troop, H., Nylander, E., Gerdle, B., & Samuelsson, K. (2004)/ Dan, D., Leister, E., Cooper, R., Cooper, R., Kelleher, A., Fitzgerald, S., et al. (2008). Arthanat, S., & Strobel, W. (2006) Van der Woude, L., de Groot, S., & Janssen, T. (2006). Requejo, P., Kerdanyan, G., Minkel, J., Adkins, R., & Waters, R. (2008). Wretstrand, A. (2007). For the most part function effect was larger. The results of this study shows that a position change effects will affect the user. Besides, the changes had a significant effect on propulsion technique that are aimed to give the user relatively the best propulsion condition and position.
According to Troop, H., Nylander, E., Gerdle, B., & Samuelsson, K. (2004), the effects of wheelchair ergonomics on propulsion efficiency and estimated comfort seem to be related to several aspects, including individual balance (e.g. seating habits, postural control), and the overall work capacity of the cardio respiratory system as well as arm, shoulder, and trunk range of motion and muscle strength. However, those aspects change, depending on uncomfortable design to the space around wheelchair user. Changing the position of the rear wheels strongly affects weight distribution and seat angle of the wheelchair significantly influences propulsion ergonomics concerning push frequency and stroke angle. (Troop, et al, 2004). But if the environment design the environment around them appropriately the change position effect will be less, then the effects will be less too.
Seating functions effects
This study estimated that people who use a customized portable device consistently accessed the seating functions effects through the day and spent most of their time in tilted or reclined positions and they do not reposition themselves as frequently as recommended in the clinical practice guideline. (Dan, et al, 2008).
Habits effects
The investigations in this study pointed out an occurrence of pain, discomfort, and postural complications among people using WCs (PUWCs) is a cause for concern to their vocational participation at the ergonomic and biomechanical guidelines of WC usage. (Arthanat & Strobel, 2006). According to Arthanat, S., & Strobel, W. (2006) the increasing concern with work-related disorders such as back pain and carpal tunnel syndrome, workstation ergonomics and study of body mechanics need more attention to remove negative effects.
Function effects
The effects in this study underlying mechanisms of tissue damage, effects of both peak exertion as well as high repetitions. Next to pneumatic tires, some wheelchairs are equipped with suspension in the castors or at the rear. This may indeed be comfortable, but leads to increased energy consumption (Van der Woude, de Groot & Janssen, 2006). All wheelchairs effectively reduce the forces and accelerations but vary in their ability for shock- and vibration suppression. According to Van der Woude, L., de Groot, S., & Janssen, T. (2006), the whole-body forward momentum was absent in some cases and the bumps were applied only to rear wheels.
Reaction effects
The researchers further find that the effect of the reaction forces applied to both wheelchair and rider consequently limit mobility and community participation. However, scholars looking for psychological effects on the wheelchair user have found that some users, when they have to get in to a bus, need assistance to secure and deploy the safety equipment. This could be time-consuming and otherwise demanding for the operator, and, thus, wheelchair users might see themselves as being a burden to others.
Psychologist effect and Situation effect
Psychologist effect, (Requejo, et al, 2008). Another, study implies that only significant forward preference could be seen when the speed’ situation effect on the wheelchair user was considered factors like forward or backward movements, age, gender, a tendency of feeling dizzy, and some kind of visual impairment and motion sickness etc have significant influence to the wheelchair user during their transportations (Wretstrand, 2007). /buses Wretstrand, A. (2007).
Psychology effects
According to Pithon, T., Weiss, T., Richir, S., & Klinger, E. (2009) the difficulties related to the use of a wheelchair may reduce user’s independence and lead to greater isolation. They further note that our society still tends to be biased against people who use wheelchair, in terms of negative attitudes about their abilities in spheres including education and work.
Society effects and Policy effect
This study shows the policy effects according the FEDERAL LAW SYSTEM (FSL) that in different kinds of chairs, pose varying difficulties in sitting without special body support, and opening or locking it by bending or reaching is required which entails efforts. FSL’s invention to create or develop a wheelchair design still very poor Policy effect (Washington, D.C., 1984).
The causes which caused effects on wheelchair user
In clinical practice, it often becomes confusing to combine both mobility and seating aspects into the same wheelchair without knowing how an adjustment to optimize one aspect interferes with the other. (Tropp, et al, 2004). It is further reported that more complicated models allowing individual needs should be developed to optimize mobility and seating comfort. Also, propulsion qualities were affected by wheel position which puts a responsibility on the designer to offer appropriate design to the wheelchair user in their environment. For example, in some standard manual wheelchairs are designed for people with two active hands. If operated with only one hand, the chair tends to veer towards the patient’s inactive side with neach push of the pushrim. (Seale, et al, 2002).
The study result of Dan, D., Leister, E., Cooper, R., Cooper, R., Kelleher, A., Fitzgerald, S., et al. (2008) matches the goal of this study and supports the theses in this literature review. It is difficult to determine whether one particular strategy is better than another for sports or any other kinds of performance (Goosey-Tolfrey & Lenton, 2006). Apropos of this illustrates the shortcomings of this study. Another study by Pithon, T., Weiss, T., Richir, S., & Klinger, E. 2009 also have not found enough reference to clinical experimentation.
The enactment of the Americans with Disabilities Act (ADA) in 1990 has led to the creation of WC accessible work environments and transportation facilities. These environmental factors have consequently enabled integration of users at the community level and in turn broadened the wheeled mobility market. But there is a need to examine the ergonomic and biomechanical aspects of interacting with these technologies. (Arthanat & Strobel, 2006). When assisted technology for wheelchair mobility and the biological system do not optimally match and function, a debilitative cycle may start that can lead to an inactive lifestyle nonuse, and consequently to an increased risk for secondary complications. This stresses the important preventive role of an integrative ergonomics approach. According to Woude, L., de Groot, S., & Janssen, T. (2006), in the context of mobility, the hand rim wheelchair has become a task specific, versatile, functional device. This study has found that the available guidelines, based on common practice are limited and still lacking a sufficient evidence base given the very limited work capacity of wheelchair users in general, short-term strain of hand rim mobility results in fatigue and local discomfort of the upper extremity with the described risk of repetitive strain injuries.
On other hand, this study explains serving a wheelchair user of point of technologies term with new robotics and pointed out that the close interaction between the disabled person, the robot and the environment raises the issue of low efficiency the system is and despite some partial successful outcomes, no definitive solution has yet forth come. (Tondu & Bardou, 2009). The comments made by sales representatives tested in the study are usually based on marketing strategy, rather than validated scientific evidence. These are, in most cases biased unreliable. The effectiveness of cushions is best evaluated through clinical trials. However, clinical trials are expensive to conduct and in the case of new products, such evidence is not readily available (Rithalia, 2005). The relationship among specific postural characteristics, vibration exposure, and development of neck pain is also yet to be established. (Requejo, et al, 2008).
Requejo, P., Kerdanyan, G., Minkel, J., Adkins, R., & Waters, R. (2008) suggest that while the Boing! may provide a better ride, the spring-based suspension system is heavier than its counterparts, which makes it difficult to transport and may contribute to the increased risk of upper-limb pathology. The forward-facing position (the designated space for wheelchair-seated passengers) common in the US and Canada has both advantages and disadvantage. According to Wretstrand, A (2007), the measured ride quality is limited to perceived comfort and safety onboard mid-size buses with a designated wheelchair space for both the forward and the rearward positions, operating on fixed-route or demand-responsive services. However, the wheelchairs were equipped with seat-elevation functions using the seat elevator to reach things either at home, work, or in public; four reported using the seat elevator to reach higher levels, such as when working at different levels and sitting at a bar (Dan, D., Leister, E., Cooper, R., Cooper, R., Kelleher, A., Fitzgerald, S., et al. 2008). This study finds that a condition may be due to a greater static exercise component resulting in the sustained contraction and stabilizing of the trunk (Salvi, et al, 1998).
Factors and Keys of redesign the environment for ergonomic wheelchair users
Factors are very important to all kinds of field to investigate the core cause. This review finds a lot of factors to be fundamental knowledge to future researches. The first factor indicates Knowing how the mobility and seating aspects interact and affect each other in an environmental zone to help finding the key to a successful prescription and probably to fully understand the relationship between the user, the equipment, and the environment, including the different kinds of activities the wheelchair user engages. (Tropp, et al, 2004). The second factor illustrates that some hospitals teach for coping, in which patients correct their direction of travel by continually ‘walking’ their active foot on the ground while applying a corrective sideways push. It works, but is slow and undignified. There are also problems with turning of wheelchair user (Seale, J., Turner-Smith, A., Lesley, S., & Porter, L. 2002). According to Seale, J., Turner-Smith, A., Lesley, S., & Porter, L. (2002)One of the features which the authors believe to be unique is that this method particularly useful in confined spaces for ergonomic wheelchair for hemiplegics, so the concern here is a designer for offering a confined space for wheelchair user.
The third factor is the finding in studies related wheelchair ergonomics: Implications for vocational participation support environmental context. The context component is defined as physical, social and cultural environment at home, workplace, school and community where an individual engages in meaningful tasks in activities of work, and leisure or play in order to fulfill life roles through environmental support systems (Arthanat & Strobel, 2006). According to Arthanat, S., & Strobel, W. (2006). The context of ergonomics provides an ideal outlook to recognize the user’s biomechanics, their vocational goals and preferences, and the environmental influences to their ergonomics wheelchair. The fuorth factor expects that next to impairment (i.e. high/low lesion), technique and boundary conditions (i.e. wheelchair fit, physical environment), balanced upper body physical conditioning may influence the risk of these activities for overuse problems. (Van der Woude, et al, 2006).
The fifth factor shows the development of computer technology, human movement sciences, biology, engineering and electronics into interdisciplinary fields of biomechatronics. It has driven the design and availability of precise and fast measurement technology, for looking to redesign the environment to the wheelchair user. (Arthanat & Strobel, 2006). According to Arthanat, S., & Strobel, W. (2006). The functional evaluation of wheelchairs is often conducted in standardized lab experiments on treadmills or ergo meters with limited phase validity, especially in wheelchair sports. This opens up new avenues for performance-related research, although environmental conditions may hamper sufficient consistency of the acquired data. The seventh factor points out that function-specific and modern looking design of today takes place in different phases, initiated primarily through wheelchair sports developments (Van der Woude, et al, 2006). According to Van der Woude, L., de Groot, S., & Janssen, T. (2006) various aspects of wheelchair design and technology have a major impact on rolling resistance. Different wheel and tire characteristics have been studied in fair detail for the purpose of redesigning new wheelchair that can fit into all purposes. Depending on the conditions of use, tires and wheels can be changed or are wheelchair task specific, (e.g. tennis, basketball, wheelchair rugby, tracks wheelchairs). These are all different and highly task specific in design.
The choice of tires and castor wheels will not only depend improve rolling characteristics and conditions of use but also will enhance the riding comfort. All in all, construction and mass of the wheelchair are pivotal to performance. The natural solution could be the provision of electric wheelchairs, but the already existing health-threatening inactivity cycle will not be stopped in this way. For example, Tricycle propelled lever, and especially crank wheelchairs, prove their important role in more extreme environmental conditions in many non-western countries. (Van der Woude, et al, 2006). The eighth factor generally could achieve by redistributing the weight of the patient in one of several ways, depending on the design of the surface, and the response of the patient to the changed support environment. According to Rithalia, S. (2005) both temperature and humidity are influenced by several factors within the body and the environment; for example, length of time sitting or lying on the surface, air convection, heat radiation from lights and other sources, hormonal variations and medication. Another basic difficulty is in the interpretation of local temperature and humidity findings and it takes much experience before either method can be used with reliability. Environmental strategies. (Rithalia, 2005).
The tenth factor could be to the persons with High SCI to perform daily functions and to be comfortable they must constantly adjust and correct their posture to maintain their sitting balance, demonstrating the inseparable connection between dynamic sitting posture and function in the wheelchair. (Requejo, et al, 2008). According to Requejo, P., Kerdanyan, G., Minkel, J., Adkins, R., & Waters, R. (2008), using an evidence-based approach to achieve a greater understanding of the specific factors contributing to discomfort, fatigue, onset of secondary injury, and prevention of such injuries will improve the design and prescription of suspension systems, which will enhance wheeled mobility and increase riders’ participation. The eleventh factor estimated Demand-responsive services. Several studies of wheelchair users’ comfort and safety have been made (Wretstrand, 2007). The twelfth factor shows that little or no particular attention has been addressed to the perceived ride safety and comfort for wheelchair users on buses (Petza¨ ll & Olsson, 1995; Knutsson, 1998; Shaw, 2000; Falkmer & Gregersen, 2002). Dependent on Petza¨ ll & Olsson, 1995; Knutsson, 1998; Shaw, 2000; Falkmer & Gregersen, ( 2002), the subjects were also asked to assess how the different positions in terms of contact and overview were perceived. The supportive elements, thus to some extent, interfered and served as obstacles.
However, the ordering effect seemed to play a significant role like preferring the reverse design and rearward facing position, when asked about maneuverability to and from the designated wheelchair space. Thereby, the technical development needs to continue and the design could, anyway, be seen as a pilot attempt. It was obvious that the interest in focusing on the discrete events of discomfort or lack of safety was too low. Either the events were in fact too few, so there still remains an opening for further methodological development (Petza¨ ll & Olsson, 1995; Knutsson, 1998; Shaw, 2000; Falkmer & Gregersen, 2002). The twelfth factor cleared that to date there are no comparative studies of safety and effectiveness of deferent wheelchair. (Washington, D.C., 1984).
The thirteenth factor explained that if designer wants to simulate these daily life situations, they should consider the simulation of the human vestibular system (Pithon, et al, 2009). According to Pithon, T., Weiss, T., Richir, S., & Klinger, E. (2009), the perception of physical and perceptual capacities of the user, and an adaptation of the various parameters of the wheelchair (e.g., size, wheel position, cushions) to the user’s body dimensions and needs should be considered. Regrettably, the prescription process is often inadequate. Greatly, this review showed that it is necessary to improve mechanical system, models of wheelchair, or to add into the virtual environment a physics engine or sound feedback (Weiss, Richir & Klinger, 2009). The fourteenth factor is being able to negotiate obstacles in the environment with greater skill which may help improve efficiency. That may help improve the wheelchair user interface by improving the cast of mobility in the user’s environments (Angeliki, 2003). The fifteenth factor showed very few smart wheelchair researchers have involved people with disabilities in their evaluation activities, and when they do it, “some wheelchair users do not show any immediate improvement in navigation skills.” (Tondu & Bardou, 2009).
According to Tondu, B., & Bardou, N. (2009), “this could be because the smart wheelchair does not work very well or the wheelchair user was already proficient that little improvement was possible.”
Strategies would be positively effective
This study shakes down as much as it can to discover environmental design associated with elements of change position effect, seating function effect, habits effect, mechanisms effect, psychologist effect, society effect and the effect of reaction. To serve a new design for wheelchair user through finding various strategies could greatly help redesign useful ergonomic wheelchair. For example, first strategy is through (supporting clinical practice) in a clear and uniform way which will show that a position change will affect the user, due to supporting that will change environmental design around wheelchair users according their needs. Also, using a randomized experimental crossover ergonomic wheelchair design will perform this support (Tropp, et al, 2004).
Generally, the second strategy is expected to provide useful directions to people using wheelchairs, co-workers, (clinicians), and (technology) developers in addressing ergonomic issues with wheeled mobility. However, primary design criteria for transportation systems are geared towards safety and reliability, regardless of the usability issues of WC transportation systems (Arthanat & Strobel, 2006). In conformity with Arthanat, S., & Strobel, W. (2006) a safety standpoint, it is of prime importance that people be encouraged to utilize them. Among all these elements, WC ergonomics and user biomechanics have been intermingled and considered crucial in areas of seating, propulsion, and transportation (support environment). The third strategy optimized an optimal functioning of the human movement system in the context of mobility restoration and can be conceptualized as a continued effort of the biological system to maintain a proper balance between stress, strain and physical work capacity (Van der Woude, et al, 2006). Fourth strategy guided to evaluate different wheelchair seat cushions. This study has developed experimental methods of evaluation based upon existing knowledge of pressure ulcer etiology (Rithalia, 2005). Depending on Rithalia, S. (2005), the most common methods are along with a (new technique) known as pressure relief to save and cover wheelchair user.
The Fifth strategy may improve wheelchair mobility ”Wheelchair rear-suspension systems” in terms of comfort and (function) at higher velocity by minimizing the seat forces and head accelerations experienced by the riders, especially those with higher level spinal cord injury and diminished postural control (Requejo, et al, 2008). Other study stated a seventh strategy at Woodrow Wilson Rehabilitation Center. A strictly physiological approach to measuring wheelchair function is the assessment of cardio respiratory fitness with tools that are adapted to accommodate a wheelchair user (Producer). (Angeliki, 2003). However, eighth strategy concluded the case study on wheelchair in which a dilemma appears: either the functional way is adopted with the risk to make the robot in adapted to many human-built environment, or the structural anthropomorphic way is adopted with the risk of designing a device difficult to be controlled. (Tondu & Bardou, 2009).
* Categorization used as illustration to some sort of ergonomic wheelchair effect with causes:
Note: The concept of categorization was used as a illustration background to this study and basis on unit summary to some effective. The results indicated that while the majority effected with facing function regarding of effective issues.
Summary of literature review
According to some of the effects in this study, result of function effects or habit effects etc) for using the wheelchair, does not allow for an easy change in seat or is difficult to adjust in relation to both propulsion and seating ergonomics. A conservative estimate suggests that about 10% of those with permanent disability are hemiplegic (paralyzed on one side). As population age, that number will increase. (Seale, et al, 2002). In view of variety of wheelchair configurations on seating function usage, a revised questionnaire is needed requesting information of seating function usage and pain conditions. Further investigation is needed on the correlations between seating function usage and some researchers need to investigate the outcomes, such as seating functions can realistically deliver in the natural environment of wheelchair users. It is important to understand that although extensive research has been carried out on various aspects of wheeled mobility, information exclusive to ergonomics of wheeled mobility in the vocational context is inadequate (Arthanat & Strobel, 2006). Therefore, assessment and intervention for some of the wheelchair like WC ergonomics and others should be contingent on the characteristics and features of the WC, the user’s body structure (Arthanat & Strobel, 2006).
Wheelchairs are mobility restraints. With improving wheelchair skills with targeted intervention programs, along with making wheelchairs more user-friendly could result in more wheelchair propulsion with resultant improvements in the resident’s independence, freedom of movement and quality of life. Wheelchairs are assistive devices crucial for daily functioning. The interaction between assistive technology and the (disabled) human system is complex by definition and requires detailed research from a combined ergonomics and rehabilitation perspective (Van der Woude, et al, 2006). The use of modern technology will lead to the re-introduction of redesigned new wheelchair that can especially fit to all purposes of use. It is essential that the designer who is responsible to redesign wheelchair could inform about assessment techniques, because of limitation and how the results can be interpreted for use in the clinical environment. It is also important that health-care staff understand the way in which mechanical principles govern their effectiveness and suitability (Rithalia, 2005).
Moreover, an extension of this literature review is forcing to help understand several wheelchair weaknesses. To create a new wheelchair would be the most effective and interesting to the wheelchair users. The next logical step in the overall evaluation of the ergonomic wheelchair system would involve the evaluation of functional parameter over prolonged period of time. A study which extends over a longer period of time is critical because the effects of the test design on the daily lives of wheelchair must be determined before it can be considered (Boucher, 1986). As a result of several previous studies in this literature review, a wheelchair propulsion is performed by non-wheelchair users, so why don’t take the opinion form the wheelchair user like creating the new team including at least one wheelchair user? Thereby, this study highlighted the fact that some fields of research have still not been explored. Therefore, the purpose of this study is to investigate the effect of different researches. The results must be considered in view of the limitations inherent in the study, and future focus on the principles would be more on a designer. According to these data, relatively simple adjustments to ergonomics wheelchairs seem to raise a lot of questions for investigation and certainly necessitate further study. Besides, concentration on one sort of wheelchair, and not all of them, for the future research will be better.
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