Always Looking Forward:
Impacting Accessibility Through Policy

July Innovation

From turning over to running, independent mobility is a very important step in childhood development. Among other things, it facilitates socialization and other interactions between children and their peers and environment, which build their social, cognitive, and perceptual-motor skills. They use their senses, balance, cognition, and balanced muscle tone to explore and develop the necessary muscles for efficient movement. To prevent secondary impairments and developmental delays, and to promote their independence, children without these abilities must be provided assistive technologies to bridge the gap - the younger they are, the greater the benefit. Powered wheelchairs (PWCs) have been found to be a viable solution for children from as early as one year, helping them keep up and participate with their peers.

To ensure the safety of the user and others, receiving approval for a PWC requires proving proficiency, which takes significant practice, something that's hard to do when you don't have your own.  The Israeli Ministry of Health (MOH) provides a fully-funded powered wheelchair (PWC) to children who need one that can prove driving proficiency, but the procurement process of the PWC can take 4-6 months, causing additional delays to achieving independent mobility. To speed it up, with financial support and 15 PWCs from the National Social Insurance Funds, ALYN Hospital launched a PWC lending program in 2009 for children to take them home and practice driving in their natural environments. As the only such program in Israel, the waiting list grew and the need for a broader, more accessible solution became clear.

That's when Dr. Naomi Gefen, PhD, ALYN's Deputy Director of Health Services and occupational therapist, began searching for appropriate practice alternatives. She met with Dr. Philippe Archambault, whose team at McGill University in Montreal developed the McGill Immersive Wheelchair Simulator (MiWe) for adults to build their powered mobility skills in the clinic or at home. Users use a joystick to navigate a virtual PWC and through virtual environments that mimic the real-world while perform tasks such as shopping at a supermarket, crossing the street at an intersection, opening doors, and using an elevator. The program tracks the users' timing and collisions to indicate their proficiency. Dr. Archambault agreed the development of a version of the simulator adapted to children at ALYN, the MiWe-C, by creating new suitable tasks, adding Hebrew language capabilities, and supplementing virtual environments that replicate routes used to train users around the hospital. For the first time, children with disabilities could practice driving a PWC without needing to actually have one accessible to them. Subsequent clinical testing indicated that not only was driving proficiency in the simulator a valid and reliable equivalent to driving proficiency on the same route in the real world, but also that there was no difference in children's driving proficiency between simulator training and real-world training on a PWC. These findings convinced the MOH to change their policy on PWC procurement for children; proof of driving proficiency on the MiWe-C is satisfactory enough, even if they haven't actually driven a PWC yet.

Today, Naomi is in the process of enhancing the MiWe-C's with additional functionalities to further boost the learning process. To make the experience of using the simulator as close to the real-world as possible, it's important for a child to practice in their own environments - at their home, at their school, etc. Adding an authoring tool will allow therapists to independently add virtual environments relevant to each child, as well as to add and remove elements inside the space such as people and other obstacles, to give the child the freedom to practice in both an empty and crowded settings and to emulate realistic navigation.

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